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ANNUAL REPORT
OF THE
SURGEON GENERAL of the
-,s,- PUBLIC HEALTH SERVICE
of the UNITED STATES
FOR THE FISCAL YEAR
19 3 7
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON : 1937
For sale by the Superintendent of Documents, Washington, D. C.
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Price 60 cents (cloth)
TREASURY DEPARTMENT
Document No. 3089
Public Health Service
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LETTER OF TRANSMITTAL
.TREASURY DEPARTMENT,
OFFICE OF THE SECRETARY'
Washington, January 3, 1938.
Sm: 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
1937.
Respectfully,
H. MoRGENTHAu, Jr.,
Secretary.
The SPEAKER OF THE HousE OF REPRESENTATIVES.
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CONTENTS
Pag&
Foreword ________________________________________________________ _
Division of Domestic (Interstate) Quarantine ________________________ _
Rural health service ___________________________________________ _
Consultation service to States __________ ________________________ _
Grants-in-aid __________________________________________ _______ _
Cooperation with the States and the American Red Cross in the
Ohio-Mississippi flood disaster _____________ ___ ________________ _
Cooperation with States in preventing the spread of epidemic diseases_
Plague-suppressive measures in Western States ________ _______ _
Plague-s.~ppressive
measures, ____________________________
Island of Maui,. Territory of_
Hawau ____ ________________
Public health (sanitary) engineering _____________________________ _
Supervision of water supplies used by common carriers _________ _
Supervision of water supply systems on vessels _______________ _
Railway sanitation _____________________________________ ___ _
Shellfish sanitation __ ____ __________________________________ _
Cooperative work in sanitary engineering ________________ ____ _
Cooperation
with States and other agencies relative to stream_
sanitation _____________________________________________
Water Resources Committee ___________________________ ____ _
Cooperation with States in connection with the flood emergency __
Boy Scout Jamboree at Washington, D. C ___________________ _
Reciprocity with Canada __________________________________ _
Works Progress Administration projects __________________ _______ _
Annual Conference of the Surgeon General with State and Territorial
health officers-- - ---- -- --------- - -------------------~-------N ational Institute of Health (Division of Scientific Research) __________ _
Division of Biologics Control_ __________________________________ _
Division of Chemistry _________________________________________ _
Division of Industrial Hygiene __ :.. ____________________ ________ ___
Division of Infectious Diseases _________________________________ _
Rocky Mountain laboratory _____________________________ __ _
Malaria investigations ________________ __ ___________________ _
Epidemiological studies ____________________________________ _
Leprosy investigations ____________________________________ _
Division of Pathology _________________________________________ _
Division of Pharmacology _____________________________________ _
Cancer studies in Boston __________________________________ _
Division of Public Health Methods _____________________________ _
National health inventory _________________________________ _
Morbidity and mortality ______________________ ____________ _
Child hygiene ___ _________________ __________ - - - - - - - - - - - - - - Sanitation ________ __ _____________ ____________ ____________ _
Health facilities ________ _________________________ -----_ -- -Divi¥,~~ifn~~~~~~~==
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=== ==== =
=======================
=====_
Oxyuriasis __________
_________
______
____ __________________
Amoebiasis_ ~---- - --- - -----------------------------------Office of Cooperative Studies ____ _______________________________ _
Division 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
cf~~!i!~leorts ______________ _________________________________ _
Medical inspection of aliens ____________________________________ _
62751.
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CONTENTS
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Division of Sanitary Reports and Statistics___________________________
Morbidity and mortality reports_________________________________
Office of Public Health Education_______________________________
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________________________________
Division of Venereal Diseases_______________________________________
Conference on venereal disease control work______________________
Evaluation of serodiagnostic tests for syphilis_____________________
Cooperative clinical studies_____________________________________
Cooperative work with State health departments__________________
Cooperation with other agencies_____________________________ ____
Untreated syphilis in the Negro_________________________________
Prevalence studies_____________________________________________
Educational and informative activities _____________ -·_ ____________
Venereal disease research laboratory, Stapleton, Staten Island, N. Y __
Venereal disease clinic, Hot Springs, Ark_________________________
Tabular summaries____________________________________________
Division of Mental Hygiene_ --------------------- - ----------------Studies of the nature and treatment of drug addiction______________
Dissemination of information_ _ _ _ _ __ ______ ______________________
Studies of the abusive uses of and the medicinal and scientific needs
for narcotic drugs____________________________________________
Narcotic farms_ _ ____ ____ ____ ___ _____________ ____ _______ _____ __
Medical and psychiatric services in Federal penal and correctional institutions_______________ ____________________________________
Studies and investigations of the causes, prevalence, and means for
prevention and treatment of mental diseases____________________
Division of Personnel and Accounts__________________________________
Personnel____ _________________________________________________
Property records_______________________________________________
Accounts section_______________________________________________
Personnel statement____ ________________________________ _______
Chief Clerk's Office________________________________________________
Appendix_________ ________________________________________________
Financial statement____________________________________________
Funds made available from other sources_________________________
Miscellaneous receipts__ ________________________________________
Quarantine service-Expenditures by stations_____________________
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ANNUAL REPORT OF THE SURGEON GENERAL OF THE
PUBLIC HEALTH SERVICE
u NITED
TREASURY DEPARTMENT,
STATES PUBLIO HEALTH SERVICE,
Washington, D. 0., Nov ember 1, 1937.
Sm: In accordance with the act approved July 1, 1902, I have the
honor to submit for transmission to Congress the following report
of the transactions of the Public Health Service of the United States
for the fiscal year ended June 30, 1937. This is the sixty-sixth annual report of this Service and presents an account of its activities
for the one hundred and thirty-ninth year of its existence.
In this section of the report I shall attempt to summarize th8i
principal activities of the Public Health Service during the fiscal
year, a more detailed account of which is presented by each of thei
several administrative divisions in the body of the report. The
varied fields of activities dealt with in this report indicate the
wide range of modern public health work.
Certain outstanding developments mark the year as one of progress
and achievement. While it is difficult to single out from the many
activities of the Service the most significant developments, it is
believed that the following represent the most striking adminis-,t'
trative developments and the most hopeful advances in our attack
on diseases which appear to be most pressing and most promising as
subjects of attack:
There was a steady development and increasing momentum of
the venereal disease program.
Public health service throughout the United States has been
improved and expanded under the provisions of the Social Securityj
Act; better provision has been made for the education of public
health personnel; and State and local agencies have been brought
into closer and more helpful accord in the work of promoting
national health.
Advances in laboratory research are typified in the cultivation 0£
rickettsiae in vitro, in successful chemotherapy in a virus disease, etc.
Plans crystallized for investigating the cause, prevention, and
treatment of cancer, culminating in an appropriation by the Con-gress, after the end of the fiscal year, for the construction and maintenance of a Cancer Institute.
Maritime quarantine was modified through the application of
"radio pratique" and seldom used maritime quarantine facilities
were eliminated.
Data obtained during the National H ealth Inventory were analyzed for the preparation of valuable reports.
· Aid was given to stricken communities during the January flood.
Provision was made for psychiatric advice to Federal courts.
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COOPERATIVE PUBLIO HEALTH WORK
Cooperation with the States in the various phases of public
health administration was one of the important activities of the
Service during the fiscal year 1937. In the administration of grantsin-aid to the States under title VI of the Social Security Act, a
total of $7,765,203.33 was distributed to the States for public health
work and approximately $100,000 from the Social Security appropriation was spent in the maintenance of supervision over the utilization of these funds and for general consultant service in various
phases of public health work. Not only has there been a vast expansion in State and local health services through the use of Social
Security funds, but it is highly significant that these funds have
served to stimulate new appropriations by the State and local agencies to an extent almost equal to the amount of Federal funds dis-·
t:ributed as grants-in-aid. Moreover, the public health training program made possible by the Social Security appropriation has ' had a
profound influence in raising the qualification standards of public
health workers, so that both the volume and quality of public health
work have been markedly advanced.
Another important activity conducted in cooperation with the
States is the supervision and control of the sanitary quality of drinking water served to the public by common carriers. Highly si~nificant, also, is the emergency assistance rendered to the States affected
by the Ohio-Mississippi flood disaster. It is specially gratifying to
note that through the joint action of Federal, State, and local health
agencies the incidence of communicable disease did not exceed the
normal expectancy.
The plague-control activities in Hawaii and the States of the
Pacific coast region are considered to be of immense actual and potential importance. It is being clearly demonstrated that plague
infection in the animal population and insect hosts is gradually
traveling eastward, and that it will invade the more populous territory and become a major menace to health unless adequate preventive measures are adopted. The control measures in Hawaii are
proving highly effective.
An important contribution, also, to the improvement of health
conditions generally has been made through the supervision of sanitary projects for which labor has been supplied by the Works Progress Administration. Specially noteworthy in this connection are
the community sanitation, malaria-control drainage, and mine-sealing programs.
INVES'rIGATION OF PUBLIO HEALTH PROBLEMS
On February 1, 1937, the Division of Scientific Research was consolidated with the National Institute of Health, to be operated as a
part o:f the Institute. As a result of this amalgamation the National
Institute o:f Health now comprises divisions of biologics control,
chemistry, industrial hygiene, infectious diseases, pathology,
pharmacology, zoology, public health methods, and an office of cooperative studies. The merger is expected to reduce the administrative overhead and increase the scientific output through a single
directorship.
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BIOLOGICS CONTROL
The application of the principles of absor_ption to hemolysis by
staphylococcus exotoxin was studied. United States standard staphylococcus antitoxin and United States control staphylococcus antitoxin were supplied to commercial biological concerns, medical
schools, and individuals engaged in this phase of research.
.A unit for the measurement of the potency of Sordelli antitoxin
was established and is now ready for submission to the Permanent
Commission on Biological Standardization of the Health Organization of the League of Nations, as the provisional unit. Work was
continued on a method for testing perfringens antitoxin.
Studies of meningococci were carried forward for the purpose of
finding a more satisfactory method of evaluating therapeutic antimeningococcic sera, improving the sera, and applying drug therapy
in meningococcus infection.
Laboratory investigations give some indication that the sterilizing
efficiency of neoarsphenamine is directly affected by the virulence of
the organism.
.At the close of the fiscal year 57 biologic establishments held
licenses; of these, 46 were domestic and 11 foreign concerns. The
licenses covered 157 different preparations.
CHEMOTHERAPY AND CHEMICAL RESEARCH
Several contributions were made to the chemotherapy of infectious
diseases. Prontosil was shown to have a curative action on mice with
choriomeningitis. This a;I?pears to be the first record of successful
chemotherapy in a virus disease.
·
The chemical structure of sugars continued under study from a
fundamental aspect with a view to their application in the field of
medicine and the other biological sciences.
Studies on the ascorbic acid (vitamin C) content of plants developed the fact that unripe cowpeas contain more vitamin C than do
the ripe peas. This suggests the use of the green rather than the
ripe seeds £or food. Further evidence that riboflavin (vitamin G)
is not the pallagra-preventive factor was obtained from experiments
on dogs. .Attempts to secure concentrates of the pellagra-preventive
factor, which have been in progress for several years, were continued.
INDUSTRIAL HYGIENE
Industrial hygiene continues as a promising field for the investigation and application of preventive measures. Not only do new
processes bring with them new industrial hazards, but further reduction in occupational morbidity and mortality in old industries demands attention.
Chronic mercurialism is the subject of several reports based on
medical and engineering studies of health hazards in the fur-cutting
industry. Symptoms of chronic mercurialism developed among individuals working in atmospheric concentrations ranging from 0.6 to
7.2 mg per 10 cubic meters. The findings have been published.
Experimental investigations were made of the toxicity of various
lead compounds, blood calcium and tissue analyses being included
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in the studies. Work is in progress designed to increase the
precision of measurement of small quantities of lead in biological
materials and dust samples. A survey of 26 lead storage battery
plants was made preliminary to a study of the health hazards
involved.
A study of 543 persons employed in asbestos textile plants shows
that the maximal concentration of asbestos dust to which workers
may be exposed without contracting asbestosis is in the neighborhood of 5 million particles per cubic foot. It was determined that
control measures could reduce the concentration to less than 2.5
million particles per cubic foot.
Further studies of anthraco-silicosis emphasize the £act that the
disease is caused by the inhalation of anthracite dust and free silica
over long periods of time, usually 15 years or more.
INFECTIOUS DISEASES
The rickettsiae of both endemic and European typhus were cultivated in media, in the study devoted to the development of methods
of combating the disease. Isolation of the virus of endemic typhus
from an old-field mouse trapped in southeastern Alabama brought
out the important fact that the disease can no longer be regarded as
peculiar to cities and towns but has become a wider problem through
the invasion of rural areas.
Tularaemia was reported from 36 States and the District of Columbia, with a total of 903 cases, as compared with 780 for the
preceding year.
The hereditary transmission of relapsing £ever spirochetes from
experimentally infected female ticks has been demonstrated. The
infection passes through the egg to the resultant larval stage and
first nymphal stage; these later stages infected mouse, monkey, and
man on which they fed.
Virus neutralization tests of lymphocytic choriomeningitis demonstrated the presence of antibodies against the virus in the sera of
11 percent of 1,248 persons, many of whom gave no history of central nervous disease. Protective antibodies were present in only 1.2
percent of children as compared with 18.7 percent of adults.
Some 2,000,000 persons used the picric acid-alum spray against
poliomyelitis i;11 Tennessee, Mississippi, and Alabama. The ·results
were encouragmg.
Surveys of undulant fever were completed in North C~rolina and
Kansas and continued in central Texas.
Mycological studies were confined to the examination of various
moulds obtained from patients and grown under laboratory
conditions.
Field studies of tuberculosis in a selected county in Alabama and
one in Tennessee have resulted in data which support the view that
the rates of incidence and mortality are very much higher in the
county where living conditions are better and where the consumption
of red meats, milk, and eggs is greater. This finding points to factors
hitherto unrecognized in the prevalence of and mortality from tuberculosis. Investigations to ascertain the cause of this variation are
under way.
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Laboratory and field studies of Rocky Mountain spotted fever were
continued. Success has attended efforts to cultivate the rickettsiae
of the disease in media. Several new foci of the fever have been
found, indicating that the disease has wider distribution than here,
tofore has been reported. Sufficient preventive vaccine was prepared
at the laboratory for the vaccination of 80,000 persons.
Sylvatic plague is still found in certain localities. Persistence of
infection is indicated by the discovery of infected ground squirrels.
In southwestern Montana this has been noted for three successive
years. Observations on the viability of the Bacillus pestis at th~
National Institute of Health in Washington have demonstrated that,
under certain conditions, the microorganisms may remain alive and
virulent for 14 years. This may throw light upon its persistence in
nature.
Studies of malaria continued. One of the outstanding observa'"
tions made during the year concerned the introduction of mosquitoes
into this country from tropical airports. Two hundred and fiftytwo inspections of airplanes from South and Central American ports
were made at Miami, Fla., 13 of the airplanes carrying living mosquitoes. In addition, 59 planes carried living insects other than mosquitoes. Accordingly, attention was given to improved methods of
exterminating insects. A special type of hand-operated sprayer is
·
now being developed.
Trichinosis and oxyuriasis have been found to be more prevalent
than has heretofore been suspected. A number of progress reports
have been issued; and, in the instance of trichinosis, suggestions have
been published looking toward its control.
A method of purifying and precipitating the erythrogenic toxin
of the scar let fever streptococcus has been evolved, and the prac-ticability of the method has been tested in a group of over 10,.000
persons. About 95 percent of those treated experienced no disagreeable reactions.
HEART DISEASE
Heart disease studies were largely confined to consideration of the
rheumatic type of the disease. The question as to whether streptococci play a part in the etiology of the disease remains unanswered,
notwithstanding confirming evidence noted by some observers. It is
significant that an analysis of a series of cases in 1936 revealed about
one-fourth of them as showing evidence, either serological or bacteriological, of infection with hemolytic streptococci. The survy-streptococcus lesion of the heart valves, previously studied, can be induced
by endocrinal means without scurvy. An effort is now under way
to ascertain the incidence of cardiovascular syphilis in a large number of hospitals throughout the country.
CANCER
Cancer studies were continued at the laboratories in Washington
and in Boston. Further work was done relative to the influence
of certain diets on the growth rate of a strain of spontaneous
mammary carcinoma in m1ee, and it was found that tumor growth
is inhibited if the animals are fed on a diet deficient in the amine;
acid tryptophane. Similar studies were carried on with a diet de-
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ficient in methionine. The results of nutritional studies carried on
so :far indicate that a carefully controlled low protein diet might constitute a beneficial treatment for some cancer patients. Progress
has been made in researches on the carcinogenic properties of various
substances ~nd in the preparation of filtrates; about 150 liters of
active filtrate are on hand.
OTHER PROBLEMS OF DISEASE AND SANITATION
Studies of leprosy were continued. At the National Institute in
Washington a general review of the literature is in progress. At the
Leprosy Investigation Station in Hawaii it has been demonstrated
that laboratory animals are resistant to human leprosy. Research
carried out during the year has definitely showed that undernourished
rats are more susceptible to rat leprosy than are well-nourished rats.
The investigation of possible health hazards due to consumption
of :food plants and their products grown in areas of selenium-bearing soil were extended during the year. The results so far obtained
show that residents in such areas absorb an appreciable amount of
selenium. Detailed studies are going forward to determine whether
or not this absorption is great enough to affect health.
A study of mottled enamel of teeth disclosed the existence of about
350 endemic areas in the United States, distributed through 26
States. During the year 3,277 children were examined in Oklahoma,
Illinois, Iowa, and Virginia. The relation between fluoride concentration in the water supply and the degree of clinical severity
seems now firmly established.
Epidemiological studies have brought out the fact that poliomyelitis is the most frequent of the reportable diseases of the central nervous system. As there is scarcely any other epidemic disease
that causes more general concern, the Public Health Service has
~mphasized the importance, in re~orting cases, of distinguishing between :frank paralytic ~oliomyelitis and nonparalytic or questionable
cases and that comparison of the incidence be based only upon the
frank cases.
Various experiments were made in the alteration, improvement,
and application of histologic and technical methods. During the
year, 1,638 surgical specimens from animal autopsies were examined.
Fewer parrots and parrakeets have been submitted for determination
of psittacosis infection than in preceding years.
Studies of sewage purification, with special reference to methods
of oxidation, were continued. The results of recent work have confirmed the observation that bacteria play an active role in the activated sludge process.
Further mvestigations of milk and its relation to the public health
confirm the importance of keeping rigid official control over the
production and distribution of this article of :food. That still better
methods of production are needed is evident :from the fact that the
following outbreaks of milk-borne diseases occurred during the year:
Typhoid :fever 14, paratyphoid :fever 1, scarlet fever 12, septic sore
throat 7, others 7.
Results obtained from the National Health Inventory point to
this project as one of marked importance in the field of sanitation
and hygiene. Funds have never before been available for a survey
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of such extent. Tabulation of the data accumulated in the canvass
has proceeded to a point where analyses can be made and the information gained may be applied in a practical way to health problems.
Considerable attention was given to methods of public health administration with especial reference to the organization and operation of health departments, hospitals, and clinics. The problems
concerned involve finance, personnel, procedure, and community relationship. As data are assembled, they are analyzed and made
available to health authorities.
QUARANTINE AND IMMIGRATION ACTIVITIES
Yellow fever and plague are the principal quarantinable diseases
that may be spread by maritime or air commerce. Yellow fever, by
reason of its residual reservoir of virus in South America and Africa,
and the rapidity with which air travel between these countries and
the United States is accomplished, constitutes a considerable problem.
This danger has been offset by a systematic _program of d1sinsectization of aircraft arriving from South America, the surveillance of
passengers coming from yellow-fever districts, and the immunization of aircraft personnel. Plague as a maritime menace has apparently been reduced to a mimmum by more efficient quarantine.
treatment of vessels, particularly the elimination of rat harborages.
Favorable conditions have permitted the adoption of radio pratique, now in use at the ports of New York and Boston, whereby
eli~ible vessels are relieved of quarantine inspection upon arrival.
A system of general supervision of the smaller quarantine stations
by one larger station has been put into effect on each seacoast. This
will insure a more uniform and efficient method of handling maritime ship_ping.
Detent10n facilities at ports where there are marine hospitals have
been considerably reduced but certain of the principal stations not
so conveniently located still maintain detention facilities. The result
is a considerable economy both in expenditure for quarantine maintenance and in salaries of employees.
During the year no instance occurred of the importation of a
quarantinable disease into the United States or its dependencies.
Quarantine officers of the Public Health Service inspected 16,959
vessels, carrying 846,827 passengers and 1,230,452 seamen; 1,114 vessels were fumigated upon arrival at United States ports either because
of the occurrence of contagious disease on board or for the destruction of rats as a plague-preventive measure. Examinations for plague
infection were made of 4,867 of the rats recovered.
Because medical officers of the Public Health Service are not available at all officially designated airports of entry in the United States,
it was possible to inspect, for quarantine and immigration purposes,
only 2,499 airplanes, carrying 38,926 persons, of whom 5,841 were
aliens, of a total of 4,094 arriving airplanes, carrying 45,936 persons.
At the various United States ports of entry 976,055 alien passengers and 806,225 alien seamen were examined by medical officers,
with certification to immigration officials for some mental or physical
defect or disease being made in the cases of 18,994 passengers and
1,384 seamen. Public Health Service officers attached to American
consulates in foreign countries examined a total of 52,913 applicants
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for immigration visas, 19,190 being in the Western Hemisphere and
33,723 in the Eastern Hemisphere. One hundred and ten of those
examined in the Western Hemisphere and 830 of those examined in
the Eastern Hemisphere were found to be afflicted with one or more
of the defects or diseases which prohibit entry into the United States,
while 2,838 of those examined in the Western Hemisphere and 6,845
of those examined in the Eastern Hemisphere were certified to American consuls as being afflicted with a disease or condition which was
likely to affect their ability to earn a living. Only three 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 arrival at United States ports as being afflicted
with a condition requiring deportation.
HEALTH CONDITIONS IN 19 3 6
In the work of preventing the introduction and spread of disease
from foreign countries into the United States, it is important that the
Public Health Service keep currently informed regarding the prevalence of communicable diseases, not only in the United States but
throughout the wo_rld.
WORLD HEALTH CONDITIONS
. The figures regarding the world-wide prevalence of the quarantinable diseases must be considered a bare minimum, as the cases are
only incompletely reported in many countries. While they are based
on reports from all available sources, they must not be considered as
complete or final with regard either to the list of countries or the
figures themselves.
•
During the calendar year 1936, 255,871 cases of cholera were reported, as compared with 334,000 for 1935. India alone reported
249,777 cases or 98 percent of the .total number. But one case was
reported in the Philippine Islands.
A total of 33,000 cases of plague, with approximately 20,000 deaths,
was reported for the cale.ndar year 1936, as compared with 48,000
cases and 42,000 deaths for 1935. No occurrence of plague was reported in Australia, and the only cases reported from Europe were
a few in Malta and the Azores. Seventy-two percent of the plague
in the world was reported from India. A high incidence of plague
was also reported in Africa in Kenya Colony, Uganda, and the Union
of South Africa.
· Reports of 242,819 cases of smallpox with 56,462 deaths for 1936
were received. The usual high incidence of smallpox was recorded
for India, where 216,956 cases were reported and 54,462 deaths
occurred. The usual prevalence of smallpox was noted throughout
Africa, Southern Asia, and the Americas. Europe reported a total
of 1,329 cases with 76 deaths for 1936. A number of countries were
free from the disease. England and Wales reported only 12 cases,
with no deaths during 1936. The principal smallpox foci in Africa
during 1936 were located in Nigeria, Belgian Congo, Tanganyika,
Anglo Egyptian Sudan, and Sierra Leone.
All continents reported the prevalence of typhus fever. A total
of 27,982 cases, with 2,326 deaths, was notified in 1936, distributed
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as follows : Europe, 13,070 cases; Asia, 2,127 cases; Africa, 5,904 cases;
North and South America, 6,798 cases; and Australia, 83 cases.
In South America the occurrence of yellow fever was recorded
during 1936 in Bolivia, Brazil, and Colombia. In Africa).. cases were
reported in Dahomey, Sudan, French Guinea, Ivory lJoast, Gold
Coast, Nigeria, Sierra Leone, Senegal, and Niger Territory.
The League of Nations published reports of 230 cases and 222
deaths from yellow fever in 1936. However, 33 of the registered
deaths were from Colombia where no cases were reported. The Public Health Service recorded 229 cases and 256 deaths for the yearmore deaths than cases being reported.
HEALTH CONDITIONS IN THE UNITED STATES
The trend of the general health conditions in the United States
for 1936 was obtained from a study of rates based on data for 25
selected States and the District of Columbia, representing about 60
percent of the total population. Necessarily these rates are preliminary and may di:ffer in some instances from the final rates for the
whole country to be published by the Bureau of the Census. The
general death rate in these 25 States in 193·6 was 11.3 per 1,000 population, as compared with 10.8 in 1935, an increase of about 5 percent.
The provisional mortality statistics issued by the Bureau of the
Census show an advance in the death rate from 10.9 per 1,000 population in 1935 to 11.5 in 1936. This 1936 death rate is the highest
recorded for the death registration area during the past 7 years.
This rise occurred in practically all parts of the country.
·
The provisional infant mortality rate for 1936 was 56.9 per 1,000
live births, as compared with 55.7 for 1935. The average for the
5 years, 1932 to 1936, inclusive., was 55.6 per 1,000 live births. The
decline in the maternal mortality rate continued in 1936. In the 25
States the rate was 5.1 deaths per 1,000 live births, as compared with
5.3· for 1935.
Neither cholera nor yellow fever appeared in the United States in
1936.
Four cases of human plague, without fatalities, were reported in the
United States in 1936. Three of these cases were in California and
one was in Utah. No cases of human plague were reported from
Hawaii during the year, but a number of plague-infected rats were
found. Plague infection was found in rodents in California and
Utah, and fleas taken from rodents in California, Idaho, Montana,
Nevada, and Utah were found to be plague-infected.
Poliomyelitis incidence was unusually low throughout 1936. Fortysix States reported a total of 4,461 cases, as compared with 10,744
cases for 1935 and an annual average of 8,486 cases for the 5 years
ended in 193·5. There was approximately 1 death registered for
every 6 cases reported, or a total of 723 deaths from poliomyelitis
in 1936.
The persistence of smallpox incidence is indicated by the reports
of 46 States showing a total of 7,820 cases for 1936, as compared with
7,897 for 1935. While the number of cases was practically the same
for the 2 years, the number of deaths increased 37 percent. Fortunately the cases repoi·ted in the United States represent a mild
type of smallpox, as only 33 deaths were recorded from the disease.
However, the more virulent type may appear at any time, and a
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PUBLIC HEALTH SERVICE
10
better vaccinated population is the only means of preventing a
greater toll of human life and suffering from this cause.
Forty States reported 6,878 cases of meningococcus meningitis,
as compared with 5,613 for 1935 and with 2,314 in 1934. The mortality ratio was three cases to one death.
New low death rates were recorded during 1936 for typhoid fever,
measles, whooping cough, diphtheria, and poliomyelitis.
Diseases of the heart, cancer, pneumonia ( all forms), cerebral
hemorrhage, and nephritis were the leading eauses of death in 1935
and continued their upward trend for 1936, a slight fluctuation being
indicated only for nephritis. The cessation in the decline in the
mortality from tuberculosis as indicated by preliminary figures is
noteworthy. If later figures confirm this indicated break in the
trend of the disease, 1936 will be the first year since 1918, with the
exception of 1926, that the mortality rate from tuberculosis in the
United States has failed to decline. Preliminary reports from 34
States for the first quarter of 1937 show a slight increase in tuberculosis mortality, indicating that the check in the decline of the death
rate from this disease which was first noticed in 1936, continued into
1937.
MARINE HOSPITALS AND RELIEF STATIONS
Hospital and out-patient care was furnished to American merchant
seamen and other beneficiaries at 154 ports; 355,810 accredited persons applied for treatment and other medical service. Twelve medical and dental officers were assigned to Coast Guard ships and stations. There were 136,773 more hospital days furnished all classes
of patients during the fiscal year 1937 than in the fiscal year 1936.
A new hospital ward building was completed and occupied at
Memphis, Tenn. Plans for the new marine hospital at St. Louis were
completed and construction is to begin at an early date. Plans for
the new marine hospital at Boston are under way and '8hould be
completed within the next few months.
Merchant seamen and dependents of Coast Guardsmen continued
to avail themselves of medical-relief facilities in increasing numbers.
The Veterans' Administration was allocated 525 beds m marinei
hospitals for the use of their beneficiaries. Patients from the Civilian Conservation Corps and the Works Progress Administration
were hospitalized in considerable numbers, and the same demand for
hospital beds from these agencies is expected in 1938.
Research is under way in most of the marine hospitals, special
problems being investigated at the marine hospitals in Baltimore,
New Orleans, and Cleveland.
VENEREAL DISEASE CONTROL
The menace of the venereal diseases to the. Nation has been brought
to the attention of the public with renewed vigor during the past
year, with the result that few public health programs previously
have received such widespread support as is now being given to the
control of syphilis and gonorrhea.
The National Conference on Venereal Disease Control Work held
in Washington, December 28--30, 1936, under the auspices of the
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PUBLIC HEALTH SERVICE
11
Public Health Service, established a landmark in public health and
medical history. Almost 1,000 health officers, clinician~ nurses, and
other interested workers participated in this conference. The press
rendered inestimable service in giving the transactions of the conference wide publicity. Some of the favorable results of the impetus thus imparted are reflected in the increased facilities which
many of the States are providing for the treatment of the venereal
diseases, and in the increasing public approval and support of the
venereal disease control program.
Expert advisory assistance has been extended to an increasing
number of State health departments in the development and
organization of their control programs.
The studies of the cooperative clinical group have been continued.
Cooperative assistance has been extended to several universities in
pursuing investigations pertaining to the public health aspects of
the venereal diseases.
The Committee on Evaluation of Serodiagnostic Tests for Syphilis,
made a comparative study of the efficiency of 39 State laboratories
and submitted appropriate recommendations to the State health
officers. It is planned to make similar studies each year.
Increased facilities have been provided for investigations at the
Venereal Disease Research Laboratory, Stapleton, N. Y.
The educational features of the program have been greatly expanded. In cooperation with the American Medical Association, a
motion picture film on syphilis was produced for physicians. Facilities for training selected physicians in the public health control and
clinical management of syphilis and gonorrhea have been developed
at several of the leading syphilis clinics.
The United States Public Health Service venereal disease clinic at
Hot Springs, Ark., was an important factor in preventing the interstate spread of venereal diseases. A large number of transient infected persons, who came from nearly every State in the Union, were..
treated.
The basic principles of a venereal disease control program which
can be adapted to local conditions have been formulated and are,
available to States and other interested organizations.
MENTAL HYGIENE
The work of the Public Health Service relating to mental hygiene
increased during the year incident to carrying out its functions as
defined in law. Special studies as• to the nature and treatment of
drug addiction were continued and broadened at the United States
Public Health Service Hospital, Lexington, Ky., and cooperation
with other agencies interested in various phases of this particular
problem has been continued. Publications dealing with certain aspects of this problem have been issued from time to time for th~
use of the medical profession and the general public. Studies of the
abusive uses of narcotic drugs and the determination of the medical
and scientific requirements of the United States concerning such
drugs are in progress.
Letters patent covering the discovery of new substances derived
from opium have been lodged ex officio in the custody of the Secretary of the Treasury. This is a forward step in the evolution of a
23690-37-2
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PUBLIC HEALTH SERVICE
new type of social machinery by which agencies for the promotion of
public welfare having to do with a single medico-social problem are
brought together.
Facilities at the United States Public Health Service Hospital at
Lexington, Ky., were further developed, so that in January it was in
a position to take care of its normal capacity of 1,000 patients. A
wider use was made of the probation feature of the law during the
year and a greater number of probationers was admitted. A greater
number of sentenced patients was also received directly from courts.
During the year 1,507 patients were admitted and 1,292 discharged;
182 voluntary patients were received, and 131 left against medical
advice. Because of insufficient treatment, a large proportion of the
latter relapsed shortly after leaving the hospital. Information is
received, however, from some of these I?atients indicating that they
have been cured in spite of the short per10d of treatment.
Occupational therapy, available in the industries and various
maintenance activities of the institution, is utilized to good advantage in treatment. The number of patients receiving occupational
therapy was approximately the same as last year; namely, 85 percent.
A contract was awarded for the construction of the initial group of
buildings at the United States Narcotic Farm, Fort Worth, Tex., in
July 1936, and construction began the following month. It is anticipated that funds will be available for the completion of this institution and that it will be ready for operation by the Public Health
Service late in the calendar year 1938. Plans are being made for
:furnishing and equipping, and for the assembling of personnel.
The Public Health Service continued the work of furnishing medical and psychiatric services for the Federal penal and correctional
system in 18 medical units connected with the various institutions
under the control of the Department of Justice.
The psychiatric diagnostic service for United States District
Courts, initiated at Boston, Mass., in May 1936, was extended to 6
additional courts. Preliminary arrangements were completed and
approved for the extension of the service to 4 more courts, making
a total of 11 metropolitan centers where, when it is needed, Federal
:judges may now have the benefit of a psychiatric opinion in determinmg the mental state of a defendant.
Special studies were inaugurated in cooperation with the Mental
Hospital Survey Committee, attention being focused upon what is
being done for the newly admitted patient during the first year of
residence in hospital. The results of these investigations will be the
subject of timely special reports. · As a result of the activities of this
committee, interest has been aroused among several State health
departments in the administrative care of the mentally ill.
Special studies have also been inaugurated in cooperation with the
State and local health departments of Kentucky and the State University for the purpose of determining where, when, and under what
conditions mental disorders arise in a typical American community,
the ultimate object being to determine whether, from a sociological
and epidemiological standpoint, the settings or situations influencing
the evolution of mental disorders and the economic problems involved
group themselves into etiological categories. Another objective is to
determine whether there is a pattern approach to this problem as to
the place mental hygiene might occupy in a regularly constituted
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PUBLIC HEALTH SERVICE
13
health organization. The study area involved serves both as a source
:for the collection of basic data and as a proving ground to determine
the practical nature of administrative measures. The results of this
study will be the subject of reports from time io time for the medical
profession and the general public.
COOPERATIVE ACTIVITIES
There has been no decrease in the amount of medical and public
health assistance extended to all departments of the Federal Government and their many subsidiary agencies. This aid from the Public
Health Service has been forthcoming in many different ways. Thus,
medical officers have been detailed to American consulates in Europe,
Canada, and Cuba for the purpose of examining alien applicants for
immigration visas. Current information regarding the sanitary condition of foreign ports and vessels is also furnished by these officers.
Other medical officers have been detailed for full-time duty with such
Federal agencies as the Employees' Compensation Commission, Office
of Indian Affairs, Coast Guard, Resettlement Administration, Social
Security Board, and Department of Labor.
Physical examinations have been made of employees of the Federal
Bureau of Investigation, Coast Guard, Bureau of the Census, Department of Labor, Reserve Officers Training Corps, and of aJ;>plicants for
positions in the classified civil service. Emergency rehef has been
provided for Treasury Department employees in conveniently located
clinics.
Especially noteworthy has b~en the sanitary engineering advice
afforded the Forest Service and Bureau of Agricultural Engmeering.
Advice, research, expert testimony, and laboratory investigations have
been provided for the Federal Trade Commission.
From the illustrations given it is apparent that the work of the
Public Health Service touches many subsidiary bureaus, offices, sections, and independent establishments of the Federal Government.
Fully as important is the constant and intimate relationship with
State and cjty de:partments of health, the nature and scope of which
will be discussed m the section of the report devoted to the Division
of Domestic Quarantine ( States relations). The closer Federal,
State, and local health services are brought together, the greater will
be the help and support they can obtain from each other.
There has also been a great deal of constructive cooperation with
voluntary health organizations and universities engaged in public
health research.
RECOMMENDATIONS
Each year the public is demanding increased attention to public
health as medical science adds new knowledge for the prevention of
disease and as the possibilities of life saving are more widely recognized by the people.
·
In addition to providing medical care for merchant seamen and
others legally entitled to such care, the Public Health Service has a
responsibility both to extend the boundaries of knowledge concerning the prevention and alleviation of disease and to assist in the
better application of existing knowledge. It is a primary aim of the
Public Health Service to bring to the service of the people1 every
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PUBLIC HEALTH SERVICE
advance in preventive medicine, every measure effective in the prevention of disease and the maintenance of health.
,
The Social Security Act provides a sound basis for a national
health program. The provisions of this act should be extended to
provide further cooperation with the States in dealing more effectively with such important problems as syphilis, tuberculosis, cancer,
pneumonia, and mental diseases.
The acute infectious diseases have declined rapidly during past
years under the impact of public health effort. There has been an
increase, however, in many of the diseases of adult life, particularly
the chronic diseases. The emphasis of public health services needs to
be shifted, therefore, to the prevention and treatment of the chronic
diseases, particularly among the under privileged part of the population who are unable individually to provide themselves with needed
services. This field now appears to be the most pressing and the
most promising as the object of attack.
· Since the interest of the Federal Government in the provision of
better housing has been expressed through recently enacted legislation, prompt consideration should be given to the public health aspects
of housing in order to insure that any construction receiving Government aid meet minimum standards of health and sanitation. Here is
a promising prospect for effective interdepartmental effort. ·
The problem of adequate nutrition is of basic importance in improving the national health. Adequate dealing with thjs problem
involves not only a family income sufficient to purchase an adequate
diet but education of the people concerning the essentials of an adequate diet, plus further studies to establish accurate criteria of nutritional impafrment. Such criteria are available now only for detecting
gross deviation from the normal.
As a part of the national effort to conserve water resources, it is
important that steps be taken promptly to minimize the existing pollution of our streams with sewage and industrial wastes. A practical
procedure has been suggested by leading sanitary engineering authorities of the country and a bill carrying out their recommendations is
now before the Congress.
.
A further extension of the physical facilities of the Public Health
Service is needed, particularly the completion of the National Institute of Health and the National Cancer Research Institute at Bethesda, Md. ; a suitable dispensary in Washington, D. C. ; a new
marine hospital in Florida; rehabilitation of present hospital plants
at Fort Stanton, N. Mex., and Carville, La. ; additional beds at the
Stapleton, N. Y., Marine Hospital; and additional quarantine facilities at Miami, Fla.,_San Pedro, Calif., and Galveston, Tex.
A continuing need exists for adding to the staff of the Public
Health Service a sufficient number of competent officers to meet satisfactorily the duties which from year to year continue to increase in
importance and complexity.
THOMAS p ARRAN,
Surgeon General.
Hon. HENRY MoRGENTHAu, Jr.,
Secretary of the Treasury.
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Federal Reserve Bank of St. Louis
DIVISION OF DOMESTIC (INTERSTATE) QUARANTINE
Asst. Surg. Gen. C. E.
WALLER
in charge
u
PUBLIC HEALTH PROGRAM
NDER PROVISIONS OF THE SOCIAL
SECURITY AcT
Gratifying results from the administration of Title VI of the Social
Security Act under the regulations of the Surgeon General arc becoming apparent. Through grants-in-aid and greater cooperative efforts,
the past year has witnessed unprecedented progress toward an integrated national health program and -a strengthening of State and
local health organizations. It is now possible to e--valuate some of the
more tangible results of the stimulus given to public health work in
the various States by the health provisions of the act.
RURAL HEALTH SERVICE
The survey of rural health service for the calendar year 1936
showed that there was a net gain of 331 in the number of counties
under full-time health administration over the number reported for
the preceding year. There are now six States jn which all counties
are served by full-time county or district health units, as compared
with three so organized at the close of the calendar year 1935. The
percentage of the total rural population now enjoying this service is
estimated at 41.7. In spite of these highly encouragmg facts, there
are still 10 States which do not have any local health servjce corresponding to the generally accepted standards implied by this term.
CONSULTATION SERVICE TO ST.ATES
With the expansion of health service in the States and local communities which has been stimulated by the Social Security Act, there
has been a corresponding demand for a wider range of consultant
service in the several technical fields of public health administration.
It has, therefore, become necessary for the Domestic Quarantine
Division to provide these facilities. The following is a list of consultant services which are being maintained in the Washington office
either as new services or extension of previously existing services:
1. Public Health Engineering.
2. Public Health Nursing.
3. Public Health Education.
4. Industrial Hygiene.
5. Milk Sanitation.
6. Malaria Control.
7. Nutrition (new service).
8. Dental Hygiene ( new service).
9. Laboratory Methods (new service).
10. Accounting ( new service).
15
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PUBLIC HEALTH SERVICE
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In order to facilitate contact with the States in the interest of
prompt response to all their calls, five regional offices have been
established with headquarters at New York, vVashington, Chicago,
New Orleans, and San Francisco. Each regional office is under the
direction of a medical officer of the Service, who has associated with
him a public health nurse and a sanitary engineer, all of whom render
advisory and consultant service to the States jn response to their
specific requests.
GRANTS-IN -AID
As will be seen :from the summary of payments, all 48 States, the
Territories of Hawaii and Alaska, and the District of Columbia par6cipated in the use of funds made available under the provisions of
Title VI of the Social Security Act during the fiscal year 1937.
For the 5-month period, February 1 to June 30, 1936, the amount
of $3,333,000 was appropriated for distribution to the States in accordance with the provisions of Title VI of the Social Security Act,
and there was actually paid to the States :from this appropriation
$2,451,140.79, leaving a balance of $881,859.21 to be carried forward
and added to the appropriation for the fiscal year 1937. Since the
full amount authorized, $8,000,000, was appropriated for 1937, the
total amount to be allotted to the States was $8,881,859.21.
The payments made to the States from this fund for the fiscal year
1937 amounted to $7,765,203.33, as follows:
Alabama ___________
Alaska _____________
Arizona ____________
Arkansas ___________
California __________
Colorado ___________
Connecticut ________
Delaware ___________
District
of Columbia _______________
Florida _____________
i:~!ff_-_----~========
Idaho ______________
Illinois _____________
Indiana ____________
Iowa _______________
Kansas _____________
$243, 7,52, 00
23,591.96
57,074.00
159,249.50
215,820. 66
88,065.66
98,040.00
31,024.00
51,943.00
129,630.00
262,913.00
53,688.00
62,859.00
397,209.79
110, 572.4()
108,437.25
87,169, 00
Kentucky __________
Louisiana __________
Maine ______________
Maryland __________
Massachusetts _____
Michigan __________
Minnesota _________
Mississippi__ _______
Missouri_ __________
Montana ___________
Nebraska ___ _______
Nevada ____________
New Hampshire ___
New Jersey ________
New Mexico _______
New York ___ ______
North Carolina _____
North Dakota ______
$229, 928. co
177,039.00
60,609.00
125,433.00
185,598.00
280,289.50
175,935.63
181, 992.88
207,109.40
44,958.00
59,311.00
23,548.00
33,052.15
135, 150. 50
69,157.00
659,620.00
314,406.00
66,415.25
Ohio _______________
Oklahoma __________
Oregon _____________
Pennsylvania ______
Rhode Island ______
South Carolina _____
South Dakota ______
Tennessee __________
Texas __________ ____
Utah _____________ __
Vermont_ __________
Virginia ____________
Washington ________
West Virginia ______
Wisconsin __________
Wyoming __________
$344, 918. 32
173,065.00
64,544.00
383,700.00
55,633.00
182,902.00
64,718. 50
255,296.00
302,811.30
58,409.00
38,142.87
214,972.00
100,439.00
158,929.00
137,402.25
18,729.50
TotaL _______ 7, 765, 203. 33
Since the total payments w·ere less than the total amount available
by $1,116,655.67, the latter sum was carried forward and added to the
appropriation for the fiscal year 1938.
Although the distribution of these funds for the years 1936 and
1937 was based on (1) population, (2) special health problems, and
(3) financial need, as prescribed in the Act, these factors were given
different weights; 57½ percent of the fund was allotted on the basis
of population, 22½ percent on account of special health problems,
and 20 percent as a differential in recognition of financial need.
Some idea of the impetus given to State and local health departments through the use of these funds may be gained from the following table, whjch shows a classification of the major purposes for
which they were budgeted:
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PUBLIC HEALTH SERVICE
General purposes for which funds were budgeted by States
Purpose
Local health services ________ -------------------------------------Training of public health workers ________________________________ _
Venereal disease controL _________ --- -------- ---------- ----------- Promotion and supervision of local health services _______________ _
Other central administrative services _____ ________ _____________ __ _
Sanitary engineering_• ___________________ -- - -- - - - - - - -- -- - - - -- - - - Prevention of communicable diseases ____________________________ _
Laboratory services _______________________ - - - - - - - - -- -- - - - -- - -- - - - Industrial hygiene ________________________ - - - -- - - - -- - - - -- - - - - - --- Tuberculosis control_ _____________________ - --- - -- - - -- - - - - - - - - - - - - Vital statistics ________ ________________ - - - - - - -- - - - - -- -- - - - - - - - - - - --
t~~~~tif~!~:~;~~~~C= ============ == ====== ======================
Health education _________ ---------------------------------------Child hygiene _________ ------------------------------------- -- ---Oral hygiene ________________ ___ _______ ____ ____ -------------------Trachoma controL ____ _____ _______ ___ _-- -- ----------------- - - - ---Cancer control_ ______________ - _-- -- - - --- - - - - - - - - - - - - - - - - --- - - - - - -Malaria controL __________________________ - - - - - - - - - - -- -- - - - - - - - - - Milk sanitation _________________________________________ -- __ - - -- __
1
M~~t!
n~y8:~~efnspection=========================================
Pneumonia
controL ______ ____________________ -- -- _------- ---- ----
Environmental sanitation _______________________________________ _
Goiter controL
___ _------------------------------- --------- - -----_
Hookworm
control_
____ __________________________________________
Psittacosis control ______________ ------------------------ ____ _____ _
Number of
States
4'6
51
34
35
45
42
32
34
19
17
24
16
6
15
7
8
4
5
3
2
3
4
1
1
1
1
1
TotaL ____ ________________ ___ _______ ________________________ ____________
t
Amount
$3,603,478.35
1, 395, 208. 83
686,969.10
529,277.14
384,830.39
367,019.95
356,616.03
328,155.59
286,071.40
211,260.02
111,400.30
100,236.43
60,883.39
54,563.85
54,105.00
50,853.85
32,936.00
32,217.40
30,683.34
27,600.00
24;970. 00
18,560.00
11,771.39
8,400.00
4,900.00
2,400.00
1,503. 00
18, 776, 870. 75
Percent
41. 06
15. 90
7.83
6.03
4. 37
4.18
4.06
3. 74
3. 26
2.41
1. 27
1.14
.69
,62
,62
.58
.38
.37
,35
. 31
.28
. 21
.13
.10
.06
.03
.02
100. 00
Includes balances carried forward from preceding year.
CooPERATION WITH THE S·rATES AND THE Al\rnRICAN RED CRoss IN THE
0Hro-}fISSISSIPPI FLOOD DISASTER
At the request of health officers of the States affected by the Ohio
and Mississippi Rivers flood in January-February 1937, and after a
meeting of the President's Emergency Flood Committee, 16 medical
officers and 25 sanitary engineers from the regular corps of the
Public Health Service were detailed for emergency field flood duty.
In addition, there were 48 sanitary engineers secured from various
State and local health departments throughout the country and given
temporary appointments in the Public Health Service for the period
of need. This force was further augmented by 93 sanitarians and
sanitary engineers drawn from the personnel in supervisory charge
of Works Progress Administration sanitary projects.
The duties of these officers, detailed to emergency stations at various points from West Virginia down through the flooded territory
to Louisiana, were as folows: (1) To cooperate with and aid State
and local health authorities in the prevention and control of communicable diseases in the emergency. This activity included assistance to the health authorities of the States in epidemiological investigation of existing health conditions, the establishment of emergency facilities for the prevention, isolation, and treatment of communicable disease, the procurement of vaccines and biologics needed,
and in some instances the actual operation of emergency prophylactic,
diagnostic, and treatment clinics upon request of the State: health
authority. Two medical officers were furnished to one city to render
emergency sputum-typing service for the control of pneumonia; (2)
to serve as liaison officers between the American Red Cross, publio
health agencies, and local physicians. In the conference of th~
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PUBLIC HEALTH SERVICE
President's Emergency' Flood Committee it was agreed that the Red
Cross would furnish all medical and nursing personnel needed for
medical relief and that the Public Health Service would furnish
liaison officers. The medical officers who were assigned for this duty
were men who had been accustomed to dealing with the State and
local health departments and with individual physicians and who
were experienced in emergency as well as routine administration. In
one instance, the Public Health Service officer acting in this capacity
was asked to act also as Red Cross Medical Director Jf three States.
Another Public Health Service officer was in charge of the distribution of all medical supplies for the lower Ohio and Mississippi
Valleys; (3) to serve as liaison officers between the Works Progress
Administration and the public health agencies. The former, in the,
conference previously mentioned, agreed to furnish relief labor for
the safeguarding and cleaning up of public and private water supplies, for the protection of pasteurizing plants and for the construction and maintenance of emergency excreta disposal facilities where
needed. The engineer officers asigned for this duty furnished technical advice to State and local Works Progress Administration
organizations in so far as sanitary work carried on by the Works
Progress Administration was concerned. Further discussion of this
phase of the flood relief work will be found in the report of publio
health engineering activities.
·
Early in the flood period, arrangements were made to supply, for
use in the prevention and treatment of communicable disease within
the flood area, typhoid vaccine and other biologics to the various
States affected. The estimation of the type and quantity of biologics
needed was made a prime responsibility of the medical officers of the
Public Health Service assigned to the States in the emergency. All
requests from these officers for biologics were transmitted to the
Public Health Service in Washington, where the office was open 24
hours a day to receive the messages, to place orders with the firms
and organizations that supply such material, to arrange for its transportation to the flooded area and to coordinate its distribution so
that there would be an adequate supply where needed without waste
through duplication of orders.
As the result of previous experience with flood disasters, the Publio
Health Service, the International Health Division of the Rockfeller
Foundation, and the American Red Cross agreed that the most
effective measure, following such a catastrophe, to protect the population from the ravages of disease, was to establish full-time health
departments in the affected areas.
As a means of assisting the States in the establishment of such
departments following the flood of 1937, medical officers of the.
Public Health Service were assigned to various States to act as advisers to the States in this matter and to serve as the directors of
the local health departments until such a time as trained health
officers could be employed. Seventeen such medical officers were in
the flood area doing rehabilitation organization work on July 1, 1937.
The total expenditure of the Public Health Service as of June 30,
1937, for emergency and rehabilitation work made necessary by the
flood was $1,026,099.28. Of this total $39,361.38 was from that sum
appropriated in H. R. 10919 for the prevention of epidemics.
Joint Public Resolution 7, approved February 24, 1937, authorized the allocation of funds by the President for health and sanitation activities in the areas recently stricken by floods. Under this
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PUBLIC HEALTH SERVICE
19
authorization, $837,176 was expended as grants to States for emergency health work incident to the flood; $111,394.90 for medical
supplies, including equipment and biological materials; and $38,167
in the pay of salaries of medical officers, engineers, and others and
for travel in the flood area. The pay of regular commissioned
officers who were detailed to this work is not included in any of the
above items.
Although there was a small outbreak of meningitis in one of the
concentration camps in Arkansas, there were no unusual epidemics
of communicable disease as a result of the flood. The incidence of
influenza and pneumonia was slightly above the expected incidence,
but the same was true for most of the United States during the same
period. Despite the fact that hundreds of thousands of people were
homeless for weeks, often living under emergency conditions, there
was no significant increase among these people in the incidence of
those diseases that often become epidemic when the usual facilities
for housing, water and food supply and waste disposal are disorganized or destroyed. (For a more detailed report of sanitary engineering activities in cooperation with the States, see page 29.)
COOPERATION WITH STATES IN PREVENTING THE SPREAD OF
EPIDEMIC DISEASES
PLAGUE-SUPPRESSIVE MEASURES IN WESTERN STATES
Prevalence of wild-rodent plague.-Since June 30, 1936, bubonic
plague has been demonstrated among wild rodents of Utah and
""T ashington, making 7 Western States now known to be plagueinfected. Thus far the infection has not been discovered east of the
western boundary of ·wyoming nor south of Utah except in California.
However, there are reports of rodents dying in large numbers in
certain areas east and south of the known plague foci, and these
are being investigated. The most northern point in the United
States in which plague infection has been discovered is in Adams
County, Washington, about 150 miles from the Canadian border.
During the past year three additional species of ground squirrels,
OiteUus beecheyi fisheri, Oitellus grammurus and Oitellu,3 townsendi,
have been found to harbor plague infection, so that now seven members of the genus Oitellus are implicated in the spread of the disease.
Other rodents found plague infected, or from which infected fleas
have been collected during the year, include a tree squirrel (Scirrus
douglasii ablolimatus), chipmunks ( Eutamias sp.), marmots (Marmota ftav iventris nosophora and M armota fiaviventris engelhardti),
and prairie dogs ( Oynomys par,v idens). Plague had not been demonstrated among any of these rodents prior to this year. It is
possible that the infection is widely distributed among marmots and
prairie dogs, as there are many reports of suspicious fatal epizootics
occuring in different regions among these animals.
Plague was shown still to exist in the three Oregon counties of Lake,
Grant, and Wallowa, where it was discoverd in 1935. Two new foci
were demonstrated in California, one in San Bernardino County
and the other in the vicinity of Lake Tahoe, involving Placer and
Eldorado Counties, California, and Douglas County, Nevada. Bannock County, Idaho, in the southeastern part of the State, is also a
new focus, as well as Adams County, Wash., and Garfield, Beaver,
and Sevier Counties, Utah.
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PUBLIC HEALTH SERVICE
Human cases of plague reported from July 1, 1936, to Jime 30, 1937
Month
Age
Sex
. July _____________
July _____________
July _____________
May____________
Male ___________ _ Years
10
Female _________ _
50
Male ___________ _
7
Male __ ·- _______ _
60
County
State
Results
San Bernardino.__________
Placer _________ ••.• ________
Beaver ____________________
Douglas _____ 0 _____________
California_______
California ____ . __
Utah____________
Nevada.________
Recovered .
Recovered.
Recovered.
Recovered.
Rodent plague demonstrated by inoculation of animal tissue from July 1, 1936,
to June 30, 1937
Number
infected
rodents
Month
July ______________ _
July_______________ _
July _______________ _
July ______________ _
July__ ____________ _
August __________ ___
October _________ ..
April._ __ . ____ . ____ _
May. _____________ _
June
------------~_
June __
______________
1
2
2
2.3
17
2
1
22
1
1
1
I
( 2)
Species
County
State
Citellus orego'flus ____ ___________________
Citellus orego'flus. ______ ___________ ____
Citellus beecheyi__ ______________________
Citellus grammurus ____________________
Marmota f/av. englehardti. _____________
Cynomys parvidens____________ ________
Eutamias sp___________________________
Citellus oregonus ______________________
Cite/lus oregonus_______________ ________
Citellus cotumbianus ___________________
Citellus armatus_______ ________________
Lassen_ ·---------Modoc ____________
Santa Cruz________
Beaver _____ ·-----Beaver____________
Garfield___________
Eldorado__________
Grant_____________
Wallowa._________
Wallowa __________
Bannock________ __
California.1
California.I
California.I
Utah.
Utah.
Utah.
California.
Oregon.
Oregon.
Oregon.
Idaho.
Reported by the California State Department of Health.
Pooled.
inoculation of parasites.-The inoculation of parasites, particularly
fleas, collected from rodents, as reported last year, has proved to be
of great value in locating plague foci among wild animals. The
California Department of Public Health has reported positive results from 19 such inoculations during the year, and in this manner
has shown that plague was present in the counties of Monterey, San
Benito, San Bernardino, and Placer, where no plague-infected animals were discovered during the year. Two inoculations of fleas
collected in Adams County, Wash., were found to be infected
with Bacillus pestis, but no infected animals have yet been discovered
in this region.
During the year 940 specimens of parasites were received for inoculation, including approximately 74,000 fleas, 3,000 lice, and 1,600
ticks taken from 22,000 rodents. In many cases the specimens were
divided in two or more inoculations. The positive results from these
inoculations are tabulated below :
Plague demonstrated by inoculation ·of parasites from July 1, 1936, to June 30,
1937
Parasites inoculated
Month
Fleas
Lice
County
State
Ticks
July__________
153 ___ __________ _
July ___ _____ ________ _
26 ------July__________
315
August_______
45
April_________
33
April.._______
18
5 ------April.._______
56
1
1
June________ __
56
1 ------June__________ 1 264
1 These
Number and species of rodents
obtained
7 Marmotafl.av. nosophora ______ _ Beaverhead ____ _ Montana.
Marmota fl.av. nosophora ________ _ Beaverhead ____ _ Montana.
Citellus grammurus ________._ __ Sevier. _________ _ Utah.
11
23 Cynomys parvidens ___________ _ Garfield ________ _ Utah.
Citeltus townsendi__ __________ _ Adams _________ _
13 Citeltus townsendL __________ _ Adams _________ _
Citettus oregonus _____________ _ Lake ___________ _
7 Citellus armatus ______________ _ Bannock _______ _
56 Citeltus cotumbianus _________ _ Wallowa _______ _
21
36
Washington.
Washington.
Oregon.
Idaho.
Oregon.
fleas were divided and inoculated into 2 guinea pigs, with postive results in both cases.
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PUBLIC HEALTH SERVICE
The facilities of the Public Health Service Laboratory in San
Francisco for the examination of material collected in the field have
been made available to all of the States. During the year, 400 of
the specimens examined were submitted by the field units operated by
the States of Washington, Oregon, Idaho, Utah, and Montana.
FIELD SURVEJYS FOR PLAGUE
In July, 3 additional trucks were equipped by the Public Health
Service as mobile laboratories for field work. Including the five
units operated by the States, nine field crews are now employed in
searching for plague foci besides those engaged in similar investigations in California, which has three laboratories in the field. During
the year, the 4 Public Health Service units operated in 10 States, cooperating with the mobile laboratories of the different States for the
purpose of instructing the personnel of their field crews and also to
increase the scope of the work in these large western States. At present the Public Health Service field units are engaged chiefly in searching for nevi' plague foci in regions east of known infected areas,
where suspicious fatal epizootics have been reported among wild
rodents during the past 2 years. Upon the request and sanction of
the heal~h departments of Wyoming, Colorado, and Arizona, surveys
have been conducted in these States. So far no positive evidences of
plague have been found in the 3 States. A consolidated report of the
extent of plague surveys conducted by the United States Public
Health Service and State operated units, with the exception of those
of the California Department of Public H ealth, is presented in the
following table :
Scope of field surveys conducted from July 1, 1936, to June 30, 1937, for wild
rodent plague
State
Rodents examined for plague
Number
counties
surveyed Ground
MiscelPrairie laneous
squirrels Marmots
dogs
animals
Parasites collected for inoculation
Fleas
Lice
Ticks
--- --- --- --- ------ --Washington _________
Oregon _______ _______
California ___________
Idaho _______________
Nevada ______________
Montana ____________
Wyoming_. _________
Utah ________________
Colorado ____________
Arizona. ____________
9
16
19
20
5
16
9
14
1
2
911
4,511
938
3,046
1,187
1,826
2.808
1; 640
258
11
284 ---------31 ---------------------------51 ---------2
164
94
52
17
10
814
1,087
2
35
424
13
284
10
31
---- 1,054
------ ----------------------------
5,106
6,699
14,878
6,391
2,775
11,541
7,455
11,878
592
3,621
854
212
305
308
93
278
573
330
1
35
8
263
16
468
26
307
547
107
81
39
Besides the wild animals examined for plague as noted in the table,
631 domestic rats were also secured for the same purpose in California, Nevada, Oregon, and Utah. The tabulation does not include
8,000 wild rodents examined macroscopically for evidence of plague
and from which fleas were collected for identification.
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PUBLIC HEALTH SERVICE
FLEA INVESTIGATION
During the year over 36,000 fleas from wild rodents have been
received at the laboratory for identification. As the laboratory lacks
an expert in this work, many fleas have been sent to the Rocky Mountain Laboratory for classification. Approximately 45 different species
of fleas have been identified and there is a considerable number of
unlmown species on hand awaiting identification.
Experiments to determine the ability of eight different species of
fleas to transmit plague after feeding on plague-infected guinea pigs
were conducted during the winter and a detailed report of this work
has been made. During these experiments it was found that X enopsylla cheopis transmitted plague much more readily than any other
fleas from rats or the five species of fleas from wild rodents. One
positive transmission of plague was obtained with a Diamanus montanus female 84 days after it had fed on a plague-infected guinea
pig. Thi.s experimental work will be continued again as soon as the
routine of the laboratory permits. It is believed that as soon as we
learn the relative importance of different species of fleas in the transmission of plague it may be possible to determine the regions of the
United States that will eventually be foci of wild rodent plague and
also have a better idea of what measures should be used for controlling
the epizootics.
·
A fl.ea survey of the domestic rats of San Francisco, begun in December 1935, has been continued. To date, 15,551 fleas have been
obtained from 2,209 rats and identified as follows: Xenopsylla cheopis, 6,705; N osopsyllus fasciatus, 6,842; and Otenopsyllus segnis,
2,004.
CONTROL ACTIVITIES IN SAN FRANOIBCO
Activities in San Francisco were continued in cooperation with the
city health department, and consisted in investigating all complaints
of rat infestation made by householders, which totaled 2,205 during
the year; the trapping of rats; autopsy examination of all rats caught
by trappers or shipped to the laboratory from other San Francisco
Bay points; and consultations with the city health authorities regarding ratproofing of buildings or other means of rat abatement.
Eleven rats infected with rat leprosy were discovered at autopsy
during the year.
PUBLIO HEALTH
SERVICE LABORATORY, SAN FRANCISCO
During the year the routine work of the laboratory has increased
greatly over that of former years, owing to an increase in serological
tests as well as to the enormous increase in animal inoculation, for
plague determination, of material from the Federal and State operated field laboratories.
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Consolidated report of miscellaneous laboratory examinations at the Public
Health Service Laboratory, San Francisco, from July 1, 1936, to June 30, 1937
Macroscopical examinations of rodents for plague:
Rats caught in San Francisco and examined ____________________ _
Rats caught in Oakland and examined _________________________ _
Rats from fumigated ships examined ___________________________ _
Ground squirrels from Alameda County examined _______________ _
Serological examinations:
Wassermann reactions ________________________________________ _
Kahn tests _________________________________________________ _
Agglutination tests __________________________________________ _
Bacteriolo£rical examinations:
Bacteriological examinations, water ____________________________ _
Bacteriological examinations, meningitis ________________________ _
Animal inoculation tests:
Tuberculosis ________________________________________________ _
Virulence tests, diphtheria ____________________________________ _
Leptospira, infectious jaundice ________________________________ _
Plague _____________________________________________________ _
21,281
1,074
110
11
9,301
9,301
5
511
290
56
3
3
1,516
PLAGUE-SUPPRESSIVE MEASURES, ISLAND OF MA ur, TERRITORY OF HA w All
Operations were continued throughout the year in cooperation
with the Territorial Board of Health. No human case of plague
was reported and only one plague-infected rat was found.
An intensive campaign carried on during the two preceding years
in what was believed to be the plague zone, resulted in a reduction
of the rat population in this zone to such a low point that plague
was probably starved out. The measures carried out consisted of (1)
the elimination of rat harborages in the open country by clearing
infested areas and treating the burrows thus exposed with carbon
bisulphide; (2) trapping; (3) applying poison bait to cleared areas;
(4) applying calcium cyanide to rock piles and other rat harborages
where this procedure appeared to be. effective; ( 5) clearing of underbrush in forests to prevent rats from building nests in the trees;
and ( 6) ratproofing of buildings.
During the period covered by this report, the same measures were
applied to a belt around the supposed plague zone in order to pick
up any infection which might have spread or have been present in
this area. This resulted in the finding of a plague focus on October
20, 1936, in a camp about one-half mile distant :from the scene of
any previous operations. Although only one plague-infected rat was
found, inquiry revealed that at least five dead rats were discovered
in or about the place in question during a period of 3 weeks prior
to October 20 and were burned on the premises.
Ratproofing regulations were placed in effec~ by the Territorial
Board of Health during the year which made it possible to obtain
better results in the ratproofing program for camps and other
buildings.
Approximately the same number of rats were trapped as during
the preceding year, but the percentage of R. hawaiiensis increased
:from 67 percent in 1936 to 74 percent in 1937; that of R. alewandrinus
decreased from 23 percent to 18 percent; and that of R. rattus de-
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PUBLIC HEALTH SERVICE
24
creased from 10 percent to 8 percent. The increase in the percentage
of R. hawaiiensis, or field rats, recovered by trapping may be attributed to intensive trapping in outlying fields, and the decrease in
the number of R. alexandrinus and R. rattus is undoubtedly due to
ratproofing of buildings and the clearing of forests, the tree population consisting of R. alexandrinus and R. rattus having been markedly reduced. The species of R. norvegicus is not present in the
section of the Island where plague has occurred.
In addition to operations in a zone around the plague focus, there
remains a task of destroying burrows in old pine.apple fields of certain companies which do not permit the burning of the fields. The
ideal and simple solution of the rat problem in old pineapple fields
has been found to be setting fire to the field, which burns off the
dry coverage and clears the field sufficiently to permit the detection
of burrows. It has even been found that, in the burning process,
many rats are destroyed in the. burrows by the intense heat created
as the burning takes place near the surface of the ground. The objection by certain companies to this process is based on the allegation
that some destruction of humus takes place, resulting in a lower
output from the next planting, although no figures are at hand to
show that such is the case. Unless these companies can be induced to
permit burning, some other method of treating the fields to kill the.
rats will have to be devised.
The United States Biological Survey, cooperating with the Hawaii
Agricultural Experiment Station, conducted experimental work
throughout the year in an effort to develop a poison bait which would
be taken readily by rats. However, nothing was found which was
able to reduce the rat population, even temporarily, based on trapping
results.
The work was supported financially during the year in satisfactory measure by local plantations and others, as shown in the table.
of expenditures. During the past two fiscal years, the total expenditures amounted to $322,040.69, an average of over $161,000 per year.
It is believed that the program for the next fiscal year can be carried
out at much less expense, and that a routine sampling program will
be satisfactory in the not distant future.
Expend-itures by various agencies in the plague campaign on the Island of Maui
during the fiscal year ended June 30, 1937
Maui Agricultural Co _____________________________________________ $36, 149. 00
Works Progress Administration ___________________________________ 35,783.15
Board of H ealth ________ ___ ______________________________________ 19,498.06
Agricultural Adjustment Administration-----------------------~--- 14, 361. 00
U. S. Public Health Service_______________________________________ 11, 724. 90
Hawaiian Commercial & Sugar Co_________________________________ 10, 635. 00
Maui Quarantine Tax Fund Commission___________________________
6, 943. 43
Hawaiian Sugar Planters' .Association_____________________________
5, 000. 00
Wailuku Sugar Co_______________________________________________
4,607.50
Social Security .Act______________________________________________
1,200.00
Kahului Railroad Co_____________________________________________
323. 16
Total ________________ ______________________________________ 146,225.20
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25
Summary of activities for the fiscal year ended June 30, 1937
Classification of rodents trapped and killed:
R. hawaiiensis________________________________________________
R. alexandrinus_______________________________________________
rattus_____________________________________________________
R. norvegicus_________________________________________________
M. musculus__________________________________________________
R.
Number
42, 398
10, 710
4,455
4
38,899
Mongoose____________________________________________________
117
Rats trapped, totaL___________________________________________
54, 643
Rats trapped in Port of KahuluL______________________________
1, 527
Rats killed by shooting, etc___________________________________
2, 691
Rats found dead______________________________________________
233
Rat-trap days, totaL __________________________________________ 1, 498, 615
Rats per 100 traps per day (all districts)______________________
3. 64
Rats per 100 traps per day (Kahului) -------------------------2. 21
Man-hours, rat harbor elimination_____________________________
404,232
Acres of land cleared_________________________________________
1,627
Burrows treated with carbon bisulphide________________________
196, 323
Pieces of poison placed_______________________________________
209, 400
Inspections of buildings and premises__________________________
3,474
Reinspections of buildings and premises________________________
4, 977
Noncompliance notices issued (major changes)_________________
5
Outhouses condemned and abolished __ ..:.________________________
~76
Dwellings condemned and abolished___________________________
108
Pig pens condemned and abolished_____________________________
194
Cesspools condemned and abolished____________________________
8
Wood floors condemned and abolished__________________________
394
Dwellings built or ratproofed__________________________________
14~
Dwellings repaired and ratproofed_____________________________
268
Outhouses built or ratproofed__________________________________
88
Yards cleared of rat harborages_______________________________
3, 079
Houses connected to sewer____________________________________
137
Rats received at laboratory___________________________________
57, 567
Total rodents received at laboratory___________________________
96,583
Rats examined macroscopically________________________________
56, 879
Rats examined microscopically-------------------------------14
Mass inoculations made_______________________________________
296
Single inoculations made __________________________________ ...,___
9
Cases of human plague __._____________________________________
0
Cases of rodent plague_________________________________________
1
Date of last case of human plague: Sept. 18, 1932.
Date of last case of rodent plague: Oct. 20, 1936.
PUBLIC HEALTH (SANITARY) ENGINEERING
The administration o:f public health engineering in the Public
Health Service has been conducted as heretofore as a branch o:f the
Domestic Quarantine Division. For the purpose o:f closer contact
with field problems, district offices :for the administration o:f the
routine work o:f public health engineering are located in the :following-named regional centers: New York, N. Y.; Washington, D. C.;
Chicago, Ill. ; New Orleans, La. ; and San Francisco, Cali:f. The
Office o:f Stream Sanitation at Cincinnati, Ohio, and the Office o:f the
Regional Consultant at Pittsburgh, Pa., :for the technical supervision
o:f the Works Progress Administration project for the sealing o:f
abandoned bituminous coal mines also came under the supervision o:f
the section.
The major activities o:f the engineering section may be enumerated
as :follows:
1. Supervision o:f water supplies used by common carriers, including cooperation with the several State health departments in the
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certification of water supply sources, inspections of water supply
systems on vessels, and railway sanitation administration.
2. Cooperation with the shellfish-producing States for the maintenance of efficient State control of the sanitary features of the industry.
3. Cooperation with the State health departments in matters of
sanitary engineering, including consulting ad vice through the regional consultants of the Public Health Service in connection with
the State health programs being developed with funds provided
throu~h the health provisions of the Federal Social Security Act.
4. t,;ooperation with other Federal agencies and other divisions of
the Public Health Service in public health engineering work, principally with respect to public water supply, sewage disposal, milk
supervision, mosquito control, and general sanitation problems for
the solution of which sanitary engineering assistance is needed.
5. Technical supervision by Interstate Sanitary District No. 1 of
a project covering plumbing inspection of Federal buildings conducted in cooperation with the Works Progress Administration in
New York, N. Y., and Detroit, Mich.
6. Technical supervision in cooperation with certain bituminous
coal producing States of the projects for sealing abandoned coal mines
being conducted under the Works Progress Administration.
7. Technical supervision by Interstate Sanitary District No. 2 of a
Works Progress Administration project for the control of mosquito
breeding in the District of Columbia.
8. Cooperation by the Office of Stream Sanitation with States and
governmental agencies having stream pollution problems involving
Federal interests or concerning which consulting technical assistance
was needed, and the preparation of special reports of studies or
investigations on certain phases of these problems.
9. Emergency sanitation activities in connection with the Ohio
and Mississippi Valleys flood of January and February 1937 and in
connection with other special occasions, such as the Boy Scout Jamboree in Washington, D. C., at the close of the fiscal year.
10. Activities of a quasi-official nature such as the preparation and
the issuance of the public health engineering abstracts and the maintenance of cooperative relationship with organizations interested or
engaged in improving the public health, with particular respect to
sanitary engineering.
SUPERVISION OF WATER SUPPLIES USED BY COMMON CARRIERS
One of the important functions of the Public Health Service in
preventing 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. This work is conducted in
cooperation with the State health departments. During the calendar
year 1936, of 2,096 water supplies ( of which 1,713 were public supplies) reported by common carrier companies as sources of water
supply for drinking and culinary purposes on their equipment, 91
percent were inspected by State health department personnel and
certified favorably, provisionally, or unfavorably, according to their
sanitary quality, and 56 supplies were prohibited for use after
inspection.
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While it has required practically 100-percent inspections and certification of water supplies in a considerable number of States in
order to achieve the average certification of 91 percent for the calendar year for the entire United States, there should be a definite
increase in the results obtained during the next few years as a consequence of the strengthening of the sanitary engineering divisions
of the State health departments by funds provided under title VI
of the Social Security Act. While the certification of water supplies
for interstate carrier use is incidental, from the standpoint of the
State health departments, to the general problem of proper water
supply protection, the increased activities of the State health departments in water supply and sewage disposal matters should have a
beneficial effect in safeguarding the sanitary quality of the water
provided for drinking and culinary use on interstate carrier
equipment.
SUPERVISION OF WATER SUPPLY SYSTEMS ON VESSELS
Vessels engaged in interstate traffic are required to comply with
certain requirements for protecting the sanitary quality of the drinking and culinary water while it is being stored and distributed for
use. During the calendar year 1936, 1,875 vessels were amenable to
these regulations, 55 percent of which were inspected by the personnel of the interstate sanitary districts and certified favorably. If
additional personnel, which has since been made available to the
interstate sanitary districts, had been engaged in this inspection work
in 1936, a greater number of vessels would have been inspected with
rnference to s:mit.a.ry facilHies and checked for physical defects.
Temporary certificates based upon the shipmaster's affidavit that his
vessel was in compliance with the specified requirements were issued
to 610 vessels, or 32.5 percent of the total number under inspection.
"Not approved" certificates were issued to six vessels. A considerable
improvement in this respect is expected during the next fiscal year,
t:ince it will be possible to increase the number of vessels having regular certificates. A total of 1,135 samples of water from drinking
water supplies on vessels operating in interstate traffic on the Great
Lakes and the inland rivers were examined by laboratories of city
health departments at various points. During a 2-month period from
April 19 to June 22, 1937, 441 water samples were collected at New
York, N. Y., from 122 vessels operating interstate and examined for
organisms of the coli-aerogenes group; 11.3 percent gave results (in
which 3 or more of the 10-cubic-centimeter dilutions were positive for
organisms of this group) which would tend to indicate the desirability of augmenting the laboratory facilities of the interstate sanitary districts to make possible routine systematic checking of the
bacteriological quality of water actually being used for drinking and
culinary purposes on vessels ~nd railroad equipment.
Plans for the water supply systems of 10 new vessels were submitted for review. In some instances the vessels are intended for
foreign trade routes, but the specifications called for the builders to
satisfy the Public Health Service requirements.
While typhoid fever cases reported from passengers or crews of
vessels has been steadily decreasing, 20 cases were reported during
23690-37-3
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Federal Reserve Bank of St. Louis
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PUBLIC HEALTH SERVICE
the fiscal year; 12 of these occurred on vessels operating in interstate
traffic, 2 of which were reported from commercial vessels operating
on the Great Lakes, being the first cases reported on such vessels in
3 years.
RAILWAY SANITATION
One of the important phases of railway sanitation is the proper
handling of the drinking and culinary water in coachyards, terminals,
and other watering points, and the protection of milk and other food
supplies. Inspections pertaining to these items as well as relating to
general sanitation were made of 2'63 coachyards, terminals, and
watering points, and of 125 dining cars and commissaries. In several
of the States inspections of this character are being made by the
sanitary engineering personnel of the State health departments.
This procedure is being encouraged, and it is anticipated that a number of additional States will extend their sanitary inspection work to
cover such watering points.
Cooperation with the Association of American Railroads through
the Joint Committee on Railway Sanitation has continued.
During the year a special study was made of the quality of water
contained in the water tanks or coolers on the cars of nine railroads
entering terminals in New York City or adjacent New Jersey stations. In a total of 1,090 samples collected and examined for organisms of the coli-aerogene,s group, 63 samples, or 5.8 percent, gave
results in which 3 or more 10-cubic-centimeter portions were positive
for organisms of that group. These samples presented a very excellent
picture of the quality of water being served to the traveling public
and in two instances provided definite information that improvement
jn the methods of water handling being employed would be necessary.
SHELLFISH SANITATION
Cooperative work with the shellfish-producing States for the sanitary control of shellfish production was continued as in previous
years. The Public Health Service serves as a liason agent between
the shellfish producing States and the other States. The adequacy
of the control measures of the producing States is given continuous
consideration. It is in large measure through the publication and
distribution of the list of shellfish growers and packers certified by
the producing States as meeting acceptable sanitary requirements
that markets are maintained for the shipment of shellfish products.
During the year, 2,424 certificates issued by approved producing
States were listed, and 7 growing areas and 478 shucking and packing
plants were inspected in connection with the surveys to determine the
efficiency of State control. Continuance of the disapproval of the
control measures of one State has been necessary during the year.
The policy of refusing approval of State control in instances where
the sanitary control is inadequate resulted in placing a competent
sanitary engineer in charge of the work in another State.
An investigation was made in cooperation with the Federal Department of Health of Mexico and the Food and Drug Administration of
the United States Department of Agriculture on sanitary conditions
with respect to the collection, handling, and shipping of shellfish from
Mexico into the United States.
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29
COOPERATIVE WORK IN SANITARY ENGINEERING
COOPERATION WI'I'H STATES
With the increased availability of funds for the development of the
sanitary engineering work of the State health departments, there
has been an increase in the amount of advisory service requested of
the interstate sanitary districts. Assistance was given in several instances in the training of newly employed State engineering personnel,
including lecture courses at training schools. Arrangements were
being perfected at the close of the fiscal year for more coordinated
advisory service to the State sanitary engineering units in cooperation with the regional consultants so that additional utilization of
the Public Health Service technical facilities may be possible.
COOPERA'I'ION WITH OTHER FEDERAL AGENCIES
The sanitary engineering assistance given to other Federal agencies
and to other branches of the Public Health Service has continued to
occupy a very considerable portion of the activities of engineering
personnel, 29 percent of the time of the engineers being devoted to
this work. Cooperation with the National Park Service, Office of
Indian Affairs, and Mosquito Control in the District of Columbia
required 481, 406, and 105 days of engineering service respectively.
Samples of coperative engineering work of this character are as
follows:
The Department of Justice, Bureau of Prisons, was given assistance
with reference to sanitary engineering matters at institutions under
its jurisdiction; the Department of Agriculture, Forest Service, with
respect to camps and reservations; and the Interior Department,
National Park Service, in connection with sanitation of national
parks; Office of Indian Affairs in the sanitation of hospitals, schools
and other institutions, and reservations; and Bureau of Mines, in
the investigation of water pollution by chemical wastes from a helium
plant. Engineering advice and assistance were also given the War
Department, Post Office Department, and other agencies of the
Treasury Department, to the Civilian Conservation Corps, Resettlement Administration, Public Works Administration, Works Progress
Administration, National Resources Committee, and the Tennessee
Valley Authority.
COOPERATION WITH STATES AND OTHER AGENCIES RELATIVE TO STREAM
SANITATION
During the year the . Office of Stream Sanitation cooperated with
the State of Minnesota and the Province of Ontario, Canada, relative
to a proposed sanitary survey of certain international boundary
waters to be undertaken during the next fiscal year, and with the
Tennessee Valley Authority in an advisory capacity with respect to
procedures for industrial waste pollution studies.
For the Regional Water Consultant of District No. 5, of the
National Resources Committee, there was prepared in report form,
together with tabulations and diagrams, a summary of existing information relative to pollutional conditions in the Ohio River. Probable
future conditions in the Ohio River were forecast, and a program for
the control and prevention of pollution in the river was outlined.
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PUBLIC HEALTH SERVICE
30
For the Special Advisory Committee on Water Pollution of the
National Resources Committee data were collected from the State
health departments on the extent of sewerage facilities, sewage disposal, and industrial waste treatment in the United States to supplement the data assembled in the spring of 1935 by the Public Health
Service for the same committee.
WATER 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, and a medical officer served on
the subcommittee on drainage. Considerable time of the engineering
staff has been devoted to the work of these committees.
COOPERATION WITH ST.ATES IN CONNEOTION WITH THE FLOOD EMERGENCY
In order to meet the health emergency caused by the Ohio Valley
flood in January 1937, 25 engineer officers were assigned to duty in
the flood area to assist the State health departments in the work of
rehabilitation, 1 sanitary engineer officer being assigned to each State
to act as coordinating representative between the State health department and the Works Progress Administration in the flood relief activities and to direct the work of all Public Health Service engineers
assigned to that State. In addition, 48 sanitary engineers lent by
State and city health departments of States not affected by the flood
were given temporary appointments in the Public Health Service
and were utilized until the termination of the emergency. There
were also available, and assigned to duty from 1 to 3 months, 93
persons ordinarily employed in the technical supervision of community sanitation, malaria control, and mine sealing in the States
affected by the flood.
Among the major emergency engineering activities in the flooded
areas were (1) reconditioning of public water supplies, including
emergency chlorination; (2) cleaning and disinfection of private
water supplies; (3) sanitation of milk pasteurization plants, including disinfection of all equipment; ( 4) maintenance and repair of
sewerage systems, including flushing of sewer lines and rehabilitation
of sewage treatment works; ( 5) establishment of temporary facilities
for water supply, excreta disposal, and refuse disposal in cities and
smaller communities, refugee camps and elsewhere as needed; (6)
proper disposal of garbage, refuse, dead animals, spoiled foods, and
decomposable organic matter; (7) replacement of usual excreta disposal :facilities where destroyed by the flood; and (8) general cleanup, including flushing of streets, removal of debris and mud, and
pumping out basements and cellars when necessary as a sanitary
measure.
In at least 68 towns and cities the public water supplies were
:forced to suspend operations. Failure of the water supply also meant
failure of the sewer system. In spite of the unprecedented hazards
to public health as a result of the flood, the incidence of communicable · diseases among flood sufferers exceeded but little, if any the
normal expectancy, due in large measure• to the extraordinary' precautions taken by public health authorities.
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31
BOY SCOUT JAMBOREFl AT WASHINGTON, D. O.
At the request of the National Boy Scouts of America considerable attention was given at the end of the fiscal year to preparations
for the Boy Scout Jamboree held in Washington, D. C., in July 1937,
involving measures for control of mosquito breeding, protection of
water, milk, and other food supplies, and to general sanitary measures. A Public Health Service engineer officer was assigned to serve
as chief sanitary inspector during the period of the encampment.
RECIPROCITY WITH CANADA
Cooperation with the Department of Pensions and National
Health of the Dominion of Canada was continued in the 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 operated internationally. The
Canadian authorities were supplied with 8 reports on water supplies
located in the United States and used by the United States carriers
operating in Canada, and with 63 certificates covering water supplies
in the United States used by Canadian carriers. The Department
of Pensions and National Health of Canada, in turn, supplied the
Public Health Service with 43 certificates on Canadian water sup• plies used by United States carriers operating in the Dominion.
Copies of all certificates issued shellfish shippers by the producing
States under the Public Health Service approval were supplied to the
Canadian authorities and 68 certificates on Canadian shippers were
supplied to the Public Health Service.
wORKS
PROGRESS ADMINISTRATION PROJECTS
MALARIA-CONTROL DRAIN AGE
A course of instruction in malaria control was made available to
the State health department trainees, with the collaboration of the
Malaria Research Laboratory of the Public Health Service at Savannah, Ga. ; the Rockefeller Foundation Malaria Research Laboratory
at Tallahassee, Fla.; the Bureau of Entomology and Plant Quarantine Research Station at Orlando, Fla.; and the facilities of the Tennessee Valley Authority at Muscle Shoals, Ala.
It is planned that the course of instruction will be made available
to three groups of trainees, viz, medical malariologists, sanitary engineers, and entomologists. This course of instruction is most opportune, in view of the fact that many of the State health departments
in the southern States are establishing, within existing divisions,
malaria-control units, the personnel of which will be composed of
specialists in the three fields above mentioned. A plan of operation
was suggested by this office to the State health departments concerned. It is advised that a plan for "State-wide control of malaria"
should include the elimination of the major foci of malaria in each
county, prevention of man-made malaria, maintenance of existing
and new control projects, and an educational campaign.
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32
PUBLIC HEALTH SERVICE
During the year technical supervisors, assigned to the State health
departments by the Public Health Service, gave technical direction
to the malaria-control drainage program of the Works Progress
Administration.
Compiled reports of accomplishments show that approximately
4,000 miles of average size ditch was constructed during the year.
On an average, approximately 18,000 men per day were employed on
this work throughout the year, bringing the total ditch construction
with relief labor ( since the creation of the Civil Works Administration) to the estimated total of 26,000 miles, resulting in the drainage
of approximately 425,000 acres of Anopheles mosquito-breeding areas.
It is estimated that approximately 15,000,000 to 16,000,000 people
live within 1 mile of the projects.
COMMUNITY SANITATION
It is a well-known fact that human excreta, disposed of in such a
way as to be accessible to flies and to make possible the contamination
of water: and food supplies, is a menace to the health of a community.
It is, therefore, the purpose of the "community sanitation" projects
to remove these hazards to community health through the constructi911 of sanitary privies where sewer connectjons are not available.
The community sanitation program was injtiated in December
1933, under the Civil Works Administration, and has been carried on
continuously, in turn, under the auspices of the Federal Emergency
Relief Administration and the Works Progress Administration. During the fiscal year 1936-37 the progTam was conducted on substantially the same basis as in 1935-36. Through funds made available
by the Treasury Department, the Public Health Service has supplied
the technical supervisory personnel to the State health department
in each State in which Works ProgTess Administration community
sanitation projects were in operation.
At the beginning of the fiscal year 1936-37, community sanitation
projects were in operation in 1,252 counties in 38 States, with 19,036
relief workers employed. On January 17, 1937, the program was
initiated in Nevada, and at the close of the year community sanitation projects were in operation in 1,385 counties in 39 States, with
19,615 relief workers employed. At the peak of activity, projects were
in operation in 1,422 counties, with 21,070 relief workers employed.
The average number of workers employed was 19,875, and the average number of counties in operation was 1,327 for the fiscal year. The
accomplishments for the year consisted of the installation of 470,009
sanitary privies, the restoration of 25,824 insanitary privies to sanitary condition, and the construction of 379 septic tanks on public
property, with 90,214 feet of absorption field to provide proper disposition of the effluent. The installations were made at homes,
schools, dairies, churches, and public places in urban and rural sections where no sanitary facilities existed or insanitary facilities were
being used.
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33
Average number of counties, by States, in which W. P. A. comm·unUy sanitation
projects were in operatfon, average number of laborers employed, nitmber of
sanitary privies installed, and the number and percentage which were of the
concrete slab type during the perfod July 1, 1936---June 30, 1937
Aver~ge
Average Total num- Total num- P ercent
bcr of
number of numher of
ber of con- of conprivies
crete
crete
counties
laborers
installed
privies
privies
operating employed
State
Alabama ___________________________________ _
Arizona _____________________________________ _
Arkansas ___________________________________ _
California __________________________________ _
Colorado ___________________________________ _
Delaware ___________________________________ _
Florida ___________________________ - _________ Georgia _____________________________________ _
Idaho __ _______________ - _-_- _- _-_------------Illinois _____________________________________ _
Indiana _____________________________________ _
Iowa _______________________________________ _
Kansas _____________________________________ _
~T;!o!~ft~~~~
=== == === ====== ========== == ====_
Wyoming __________________________________
17
13
56
21
30
1
16
46
23
59
82
16
49
45
20
11
78
1
18
40
4
10
8
55
45
78
45
14
54
46
27
74
48
15
55
17
54
26
10
296
144
873
383
439
27
193
343
261
857
1,213
237
655
540
341
144
954
9
181
479
82
266
117
790
506
1,288
483
216
868
804
236
1, 285
1,178
256
627
320
1,604
289
91
2,718
4,258
18,719
6,288
7,026
625
3,460
7,926
4,363
14, 089
26,622
3,504
11,961
14,403
8,533
3,649
25,268
205
3,644
4,462
364
4,475
4,162
31,055
8,180
29,665
17,020
4,089
14, 110
21,992
3,708
40,487
12. 532
5;894
41,145
4,657
48,348
4,640
1,623
2,631
4,258
18, 719
6,288
7,026
625
2,432
3,564
4,363
14,089
26,622
3, 504
11,961
14,403
2,785
1,978
24,917
205
3,644
4,462
364
4,475
4,162
12,510
8,180
29,665
17,020
4,089
14,110
20,281
3,708
2,543
12,532
5,894
1,745
4,657
16,747
4,640
1,623
97
100
100
100
100
100
70
45
100
100
100
100
100
100
33
52
99
100
100
100
100
100
100
40
100
100
100
100
100
92
100
6
100
100
4
100
35
100
100
Total (39 States) ______________________ _
1,327
19,875
470,009
327,421
69. 66
fg~i~i~!K:: ==== === == == == ==== == ==== ======== ==
Erit;1ti
==== == ========== == ==== === == == =====
Montana ___________________________________ _
Nebraska ___________________________________ _
Nevada ___________________________ _________ _
New Jersey __ _______________________________ _
New Mexico ___ ____________________________ -North Carolina ___________________ __________ _
North Dakota ______ __________ ______________ _
Ohio _______ ________________________________ _
0 klahoma ______________________ ----- _-_- _--Oregon.
__ ___ ______
--------------------------_
Pennsylvania
__ _____________________________
South Carolina ________ _____________________ _
South Dakota _____________________________ __
Tennessee _______________________ -- _---_----T4:\Y'l,S_ - - - -- - - - - - - - - - - - - - -- -- ---- -- -- -- - - - - - -
~[:g~nia===
===== ==== == ====== == ==== == == === ===_
Washington=________________________________
Number of new privies installed in each State from week ending Dec. 16, 1933,
to June 30, 1937, under 0. W. A., E. R. A., and W. P. A. programs ( as compiled
from reports submitted by various State health depalf'tments)
State
Privies installed under W. P. A.
program
Total num> - - - - - - ~ - - - - ~ - - - - , ber of privies
installed
under
Total,
C.
W. A.and
July 1, 1936, July 1, 1935, July
1 1935
E.R.A.
to June 30, to June 30, to Ju~e 30 '
programs
1937
1936
1937 '
__ -- ----- --------------------_
Alabama_________________
Arizona
_____________
Arkan!'-as _____________________________ _
California ____________________________ _
Colorado _______ ______________________ _
Delaware ______________________ _______ _
Florida _________________________ _____ __
Georgia ______________________________ _
Idaho ________________________________ _
Illinois _____________________ --- -- - _---Indiana ______________________________ _
Iowa ______________________________ ---Kansas _____ ________________ --- -- -----Kentucky ____________________________ _
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2,718
4,258
18, 719
6,288
7,026
625
3,460
7,926
4,363
14, 089
26,622
3,504
11,961
14,403
2,277
3,527
17,074
7,972
3,713
301
548
7,787
4,195
5,717
24,030
931
5,448
14, 780
4,995
7,785
35, 793
14,260
10,739
926
4,008
15,713
8,558
19,806
50,652
4,435
17,409
29,183
3,256
250
27,548
1,872
-------- -----168
9,187
19,687
-------------2,801
25,228
376
8,037
18,006
Total number of privies
installed
under
C.W. A.,
E. R. A.,and
W.P.A.
programs to
June 30, 1937
8,251
8,035
63,341
16,132
10, 739
1,094
13,195
35,400
8,558
22,607
75,880
4,811
25,446
47, 189
PUBLIC HEALTH SERVICE
34
Number of new privies installed in each State from week ending Dec. 16, 1933,
to June 30, 19"3"1, under C. W. A., E. R. A., and W. P. A. programs ( as compiled
from reports submitted by various State h ealth departments ) -Continued
Total numTotal num- ber of privies
ber of privies
installed
installed
under
Total,
under
C . W. A.,
Julyl,1936,Jul yl,1935,Julyl 1935 C.W.A . and E.R.A.,and
to June 30, to June 30, to Ju{ie 30 '
E. R. A.
W. P.A.
1937
1936
programs
programs to
1937 •
June 30, 1937
Privies installed under W. P. A.
program
1- - - - - - - - , - - - - - , - - - - - i
State
Louisiana_---------------------------8,533
2,589
11,122
41, 763
52,885
M aryland_---------------------------3,649
2,233
6,022
6,481
12,503
140 _____________________ - -- __________ - - - - ________ - - - - - Flood_____________________________
Massachusetts 1 _________ _ ____________________________________________________________________________ _
Michigan 2 _ ___________________________ ____________ ____________ _____ _ ______
3,016
3,016
Minnesota a__________________________________________________________________________________________ _
Mississippi____________________________
25,268
16,349
41,617
23,227
64,844
205
27
232
5,321
5,553
Missouri_______________________ _____ __
Montana ________ ______________________
3,644
2. 277
5,921
124
6,045
Nebraska __ -- ------------------------4,462
370
4,832 ______________
4,832
Nevada_-----------------------------364 ___ _______ __
364 ______________
364
New Jersey _ _____________ __ ___________
4,475
596
5,071 ______________
5,071
New Mexico __ __________________ ______
4,162
4,643
8,805
409
9,214
North Carolina________________________
31, 055
14,916
45,971
62,089
108,060
North Dakota_________________________
8, 180
3,939
12, 119
443
12,562
Ohio __________________________________
29,665
24,330
53,995
15,671
69,666
Oklahoma__________ _____ _____________ _
17,020
40,066
57,086
26,534
83,620
Oregon________________________________
4,089
3,484
7,573 ______________
7,573
Pennsylvania_________________________
14,110
2,642
17,558
963
18,521
Flood_- -- ------ - ------------------ ____________
806
South Carolina________________________
21,992
15,011
39, 621
76, 624
37, 003
South Dakota __ ____ ___________________
3, 708
1,044
4,752 -------------4,752
Tennessee_____________________________
40,487
22,365
43, 778
106, 630
62,852
70, 370
90, 817
20,447
2, 052
16, 706
14,654
26, 330
96, 970
70,640
796
6,722
5,926
75,869
163, 436
87,567
5,547 -------------5,547
2,207 -------------2,207
TotaL __________________________ _
1,375,418
561,273
814, 145
470,009
344,136
i~~i~~~;11=tt=~II(t :it: i~~l jjm~l
;~i~~;=============================
1 Discontinued June 30, 1936 .
2 Discontinued Nov. 15, 1935.
a Discontinued Apr. 30, 1936.
The number of sanitary privies installed during the fiscal year 1937
was 125,873 greater than for the preceding fiscal year, indicating that
a higher degree of efficiency has been attained in the operation of
these projects. In like manner, also, the quality of construction has
progressively improved.
The community sanitation projects are particularly suited for operation as emergency relief projects, since the proportion of funds
contributed through the sponsor is relatively high, averaging around
35 percent of the total cost of the projects in practically all cases,
and they may be expanded or contracted on short notice according
·
to the availability of labor.
The accompanying table shows the average number of counties,
the average number of laborers employed, the total number of privies
installed in each State during this fiscal year and the number and
percentage of which were of the concrete slab type.
There is also presented a table which shows in detail the States in
which the program was in operation and the number of sanitary
privies constructed under each of the emergency relief programs
from December 16, 1933, to June 30, 1937. It will be noted that, as of
June 30, 1937, 1,375,418 sanitary privies had been installed. Although
this number is indeed impressive, attention is invited to the fact that
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
35
many times that number of homes, schools, dairies, and business places
remain to be provided with proper sanitation; and so the job is far
from complete.
I t is not possible to cite definite figures showing the extent of reduction in the filth-borne group of diseases directly attributable to
the work done under the community sanitation projects~ since certain
other factors, such as immunizations and the protect10n of public
water and milk supplies, have been involved in the control o-f these
diseases. It is not the purpose of this report to claim entire credit
for progress made in the reduction of filth-borne diseases ; but it is
nevertheless beyond question that the community sanitation program
has contributed its full share to this cause and has therefore ably
served the purpose for which it was intended.
Beginning in October 1935 a representative of the Public Health
Service has acted as liaison officer between the Service and the Works
Progress Administration. This arrangement has been helpful in adjust ing difficulties and solving various problems which have arisen
concerning the projects since that date. Under the plan as agreed
upon, clearance of the, community sanitation, malaria-control drainage, and the sealing of abandoned coal mines projects by the Public
Health Service was required before approval was given by the Works
Progress Administration. Applications covering other phases of public health activity have also been reviewed by representatives of the
Service, and recommendation was made as to the desirability and suitability of the proposed work from a public health standpoint. This
system of clearance of :{>rojects has made possible the elimination of a
number of projects which were not regarded as desirable or suitable
for operation under the Works Progress Administration auspices.
The relationship with the officials of the Works Progress Administration in Washington and in the field has been most cordial; and they
have cooperated wholeheartedly in furthering the program. Without this cooperation the results enumerated could not have been
obtained.
The State health departments in those States affected by the flood
waters in the early part of 1937 were authorized to utilize the ser vices
of the supervisory personnel employed in connection with the technical supervision of the Works Progress Administration community
sanitation and malaria-control drainage programs in handling the
emergency sanitation and health problems which were created by the
flood waters. The salaries and travel of this personnel in the emergency activities were paid out of the allotment for technical supervision of the Works Progress Administration community sanitation
and malaria-control drainage programs.
The absence of this personnel from their regular duties, for periods
ranging from a few weeks to three months, obviously reduced the
achievements in the regular programs. However, on account of the
magnitude and serious nature of the problems involved, and since the
regular personnel of the State health departments was inadequate
to handle the situation, it is not doubted that the assjgmnent of this
personnel to duty in the flooded areas was justified.
FEDERAL BUILDING PLUMBING INSPECTION INVESTIGATION
The technical supervision of the Federal building plumbing investigation, which consisted of the inspection by Works Progress Ad
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PUBLIC HEALTH SERVICE
36
ministration personnel, under the guidance of the Public Health
Service engineers, of the plumbing of Federal buildings in New York
City and Detroit, Mich., was continued during the year. The purpose of the investigation was to determine whether the existence of
defective plumbing was a possible public health hazard and to
develop improved methods of inspection.
Field work in Detroit and New York City was completed in
November 1936 and April 1937, respectively. In Detroit, the project
included 94 buildings having a floor area of 1,653,000 square feet,
and in New York City it included 803 buildings with a floor area of
17,975,000 square feet.
Although the project was closed on June 30, 1937, a few members
of the persopnel have been continued on a temporary basis to complete the reports, which were being forwarded as soon as completed
to the Government departments concerned. In general, the reports
indicate a number of potential public health hazards from the defective plumbing in Federal buildings of the character investigated.
SEALING ABANDONED BITUMINOUS COAL MINES
The supervision of the project for sealing abandoned bituminous
coal mines under the Works Progress Administration auspices was
continued in cooperation with the State health departments of Alabama, Indiana, Kentucky, Maryland, Ohio, Pennsylvania, and West
Virginia. The purpose of this work is ta prevent contamination of
the streams by excessive amounts of sulphuric acid carried in minedrainage waters from abandoned mines. By the air-sealing of abandoned mines, the formation of sulphuric acid and its discharge in
mine drainage, thereby affecting public water supplies, is prevented.
At the close of the fiscal year, work was being carried on in 101
counties where projects have been set up in these 7 States, the average
number of men employed exceeding 3,100. At the close of the year,
1,369 mines had been closed, involving the sealing of 62,126 openings.
The estimated amount of acid prevented from reaching streams by
the work already done is 235,160 tons annually; the amount of acid
that will be excluded from the streams by work in progress at the
close of the year is estimated at 379,977 tons.
The State health departments have the immediate technical direction of this work, advisory service being provided by the Public
H ealth Service. Supervis_o ry personnel employed under the State
health departments is furnished through funds made available to the
Treasury Department.
MOSQUITO CONTROL IN THE DISTRICT OF COLUMBIA
Technical supervision of a limited mosquito control project in the
District of Columbia conducted with District of Columbia and Works
Progress Administration funds was continued on a restricted basis
during the fiscal year, work having been discontinued during the
winter months and not reinstituted until June 1937. Satisfactory
control was maintained in the more important mosquito-breeding
areas in the summer of 1936; but because of an inadequate number of
motorcycle oilers, control in the outlying sections of the District was
not possible.
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37
Exceedingly heavy mosquito breeding was discovered on Columbia
Island in June 1937, just prior to the Boy Scout Jamboree, and was
eliminated in order to make the Scouts' visit more comfortable, as
well as to protect the downtown portion of the city. There is need
of informing the people of Washington concerning the mosquitocontrol work and of obtaining their assistance for the reporting of
mosquito breeding places and the existence of mosquito nuisances.
ANNUAL CONFERENCE OF THE SURGEON GENERAL WITH STATE AND TERRITORIAL HEALTH OFFICERS
The Annual Conference of State and Territorial Health Officers
with the Surgeon General, held in Washington, April 7 and 8, 1937,
was attended by representatives from 48 States and Territories and by
a number of guests from foreign countries. A review of the activities
and accomplishments under Titile VI of the Social Security Act
occupied a prominent position iu the preliminary discussions. Special
emphasis was placed upon the :facilities for training of public health
personnel, the venereal disease program, nutritional problems, automobile trailer sanitation, health problems among transients, popular
health education for children and adults, and many other subjects of
importance to public health. Following the general discussions, committees were appointed to consider all the problems presented and to
:make formal reports for consideration and adoption bJ1 the
conference.
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Federal Reserve Bank of St. Louis
NATIONAL INSTITUTE OF HEALTH
{DIVISION OF ·ScrnNTIFIO RESEARCH)
Asst. Surg. Gen. L. R.
THOMPSON,
Director
The Division of Scientific Research, conducted as an administrative
division of the Public Health Service since 1901, was merged with
the National Institute of Health on February 1, 1937, by authority o:f
the Secretary of the Treasury. Effective on and since that date the
Division has operated as a part of the Institute. The purpose of this
step was the reduction of adminjstrative overhead, with a corresponding increase in scientific output through a single directorship.
Coincident with the reorganization, Asst. Surg. Gen. L. R.
Thompson, chief of the Division of Scientific Research, became the
director of the Institute.
The following statements describe briefly the activities of this
branch of the Public Health Service·during the year.
DIVISION OF BIOLOGICS CONTROL
Senior Surg. W. T.
HARRISON
in charge
Immunological studies, testing the validity of claims for products
to be used in the treatment of cancer and tuberculosis, for the purpose
of preventing the distribution of worthless biological products for
the treatment 0£ these diseases, were conducted during the year.
Studies on the specificity of diagnostic sera for typing pneumococci
were begun, since these diagnostic sera have a direct bearing upon
specific therapy.
Staphylococcus preparations.-Studies of the staphylococcus products were continued. United States standard staphylococcus antitoxin and United States control staphylococcus toxin have been supplied to a number of commercial biological concerns, to medical
schools, and to individuals engaged in this line of research. Estimation was made of the potency of a number of commercial samples o:f
staphylococcus antitoxin officially submitted for checking. A bulletin has been submitted detailing new tables and standard procedures
for the potency estimation of concentrated staphylococcus antitoxin.
The application of the principles of adsorption to hemolysis by staphylococcus exotoxin was studied and a report was submitted. Some
preliminary work was done on the nature of "metabolites" as food
poisoning agents present in culture filtrates of some staphylococcus
ftrains.
Standardization of gas gangrene antitowins.-(1) Sordellii antitoxin: The standardization of Sordellii antitoxin was undertaken and
dried toxin and antitoxin were prepared. Fifty grams of dried
serum and 200 grams of toxin were furnished to the State Serum
Institute of Copenhagen, Denmark, to be used as international stand38
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ards. A unit for the measurement of the potency of the antitoxin
based on the unit proposed by Sordellii was established, which is to
be submitted as the provisional unit to the Permanent Commission on
Biological Standardization of the Health Organization of the League
of Nations.
A comparative study of Ol. sordellii and Ol. biferment(Jffl,8 was begun, as Ol. bifermentans has been reported as a nontoxic variant of
Ol. sordellii.
(2) P erfringens antitomn: Work has been done on a method for
the testing of P erfringens antitoxin in mice rather than in pigeons.
The results obtained thus far have been irregular, as complete neutralization has not been obtained with all sera. This incomplete neutralization appears to be due to the presence of certain nonspecific
substances, which may occur in different lots of toxin even when produced from the same culture. Various synthetic media have been
prepared with a view to obtaining good toxins which are free from
the nonspecific substances.
Cultures of meningococci.-Work in this field has dealt chiefly with
a study of methods for the preservation of specificity, antigenicity,
and virulence of cultures of meningococci, with studies of current
strains of these bacteria, efforts to find a more satisfactory method of
evaluating therapeutic antimeningococcic sera, improving antimeningococcic sera, and with drug therapy in meningococcus infection
in mice. Substantial progress has been made.
Of the first importance has been the choice of standard strains of
meningococci which represent in seroloiical pattern the original
types of the Gordon and Murray classitication. The specificity of
type of these strains has been determined by intensive study. By
means of the Flosdorf-Mudd lyophile apparatus it has been feasible
to freeze and dry these cultures in vacuo. The sealed ampules, stored
at ordinary refrigerator temperatures, remain viable over a long
period of time, and they can be easily shipped. Heretofore it has
been almost impossible to compare studies of meningococci made in
different countries because the meningococci are delicate and seldom
remain viable during long journeys.
There is evidence that the cultures treated by this lyophile method
wiU preserve their serological specificity and virulence as well as
their cultural characteristics over a long period of time.
One hundred and seventy strains of meningococci have been received since July 1, 1936. These have been typed and their cultural
characteristics and virulence for mice have been studied. E specially
virulent strains have been frozen and dried in vacuo by the lyophile
process and stored for later use in experimental meningococcus infection in mice.
Ninety-one percent of these strains have fallen into the I-III serological group of meningococci and 9 percent into the II group.
A study of the influence <)f different culture medium on virulence
and immunological reactions of meningococci has been undertaken.
Apparently the various serological types do not behave identically
in this respect. Studies with Type IV strains have been practically
completed.
Special research has been directed toward finding another method
of testing the efficacy of antimeningococcic sera which will measure
the therapeutic value of the sera better than the agglutination test.
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A generalized infection can be produced readily in mice with virulent cultures of meningococci, and this virulence is enhanced by suspending the organism in a solution of mucin. Different antimeningococcic sera protect mice against su~h an infection in varying degrees.
Advantage has been taken of these facts to test the efficacy of sera
by this method but too many inconsta1,1t factors have been involved
to allow experiments ,done in various places to be compared. Special
attention has been given to making these :factors more constant for
the purpose of standardizing the test as :far as possible. Progress
has been made in prolonging the virulence of meningococci by preserving them in a lyophile state, so that usable strains will be available and will not have to be changed so often.
The correlation of the results of this mouse protection test ·w ith
simpler, less expensive in vitro tests is being sought.
The effect of the drug sulfanilamide and its derivatives has been
studied in collaboration with the Division of Pharmacology. Two
reports have been published. One of these shows that sulfanilamide is effective in protecting mice to a considerable degree against
meningococcus infection. The second report shows that antimeningococcic serum plus the drug protects mice far better than the snm
of protection offered by the two separately. The action seems to be
synergistic and not mere.ly additive.
Infectious anemia of horses.-In view of the occurrence of infectious anemia in horses in this country, and especially of reports of its
presence in horses producing serum in licensed establishme11ts, a study
was made during the year, with the cooperation of the Bureau of
Animal Industry of the Department of Agriculture, on the effect of
certain preservatives and the effect of processing of antitoxins upon
this virus in serums and in antitoxins intended for human use. The
result of this study showed the virus to be destroyed both by the
standard preservative and by the refining processes applied to
antitoxins.
·
Arsenical p-reparation.s.-The results of studies on the therapeutic
efficiency of neoarsphenamine against experimental syphilis in the
rabbit continue to support the reported observation of the apparent
uniformity in the spirocheticidal efficiency of the various brands of
neoarsphenamine. There is some indication that the sterilizing efficiency_ of neoarsphenamine is directly affected by the virulence of the
orgamsm.
Licensed establi..((hment8.-At the close of the fiscal year, 37 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 CHEMISTRY
Prof. CLAUDE
s.
HUDSON in charge
Sugar researches.-Studies were continued on oxidations in the
carbohydrate group. The cleavage type of oxidation, first discovered
through the oxidation of a-methyl-d-mannopyranoside with barium
hypobromite and later improved by oxidation with periodic acid,
has been shown to .be widely applicable among the glycosides and
carbohydrates containing a glycoside-like structure. This type of
oxidation has. been developed into a new method for determining ring
structures and alpha and beta configurations of glycosides.
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This new method has already been applied to studies on cellulose
and starch and for proving the ring structures and configurations of
12 methyl glycosides in the pentose and hexose series.
These studies have also laid the foundation for fruitful work in
many related fields, including the preparation from carbohydrates of
many new compounds, improved methods for the preparation of stereoisomers, such as d- and 1-glyceric and lactic aldehydes and the corresponding acids, and a direct method for correlating the configuration of the sugars with the glyceric acids.
Studies were carried out on the open chain compounds of a-galaheptose which resulted in the successful preparation of aldehydo-da-galaheptose, the first crystalline open chain acetate of a sugar having
the cis arrangement on carbon atoms 2 and 3 of the sugar chain. A
series of new compounds, leading to the synthesis of d and racemic
aldehydo arabinose tetraacetates, was prepared.
An extensive investigation was carried out on possible transformations of fi-methyl-d-arabinopyranoside. This work resulted in the
isolation of a series of new crystalline acetal derivatives, the final
product being dimethyl acetal of d-arabinose. The latter is the firstof its type that has been isolated.
Investigations were continued on the rearrangement of sugar acetates by aluminum chloride, and the work on the rearrangement of
cellobiose octaacetate- was completed. Experimental evidence was
obtained showing that celtrobiose is 4-fi-d-glucosido-d-altrose. Preliminary work on the rearrangement of glucose pentaacetate by aluminum chloride showed that the products are the acetochloro derivatives
of d-glucose, d-mannose, d-altrose, and probably d-allose. The last
two may serve as a convenient source for the preparation, by degradation, of d-ribose, which is of importance in certain biological investigations, particularly in the synthesis of lactoflavin ( vitamin B2).
A study was made of the oxidation of the d- and l-forms of altrose
and of arabinose by an alkaline ferricyanide reagent and by four
modifications of an alkaline copper reagent containing the d-, l-,
racemic, and meso forms of tartaric acid, respectively. It was found
that the reagents which are optically inactive show no difference in
their relative oxidizing power on the d- and l- forms of the sugar;
but the reagents which are optically active oxidize the d- and l-forms
of the sugars asymmetrically. A similar study was made of the behavior of 12 other sugars toward the d-, l-, and racemic copper reagents. The results obtained may prove of practical value in the
identification of sugars.
Ten sugars were catalytically reduced and their corresponding
alcohols isolated in crystalline condition. In the case of eight of
these sugar alcohols, the acetates also were prepared and isolated in
crystalline condition.
'
Compounds prepared and studied included the following: a-galaheptose oxime, semicarbazone, diethyl mercaptal and its acetate aldehydo hexaacetate, aldehydo oxime hexa- and hepta-acetates, aldehydo
semicarbazone hexaacetate, aldehydo octaacetate, and a-galaheptonic
acid nitrile hexaacetate; a- and fi-galaheptonic lactones and phenylhydrazides, fi-galaheptose, galactose, a-methyl guloside, a-glucoheptonic lactone, sodium glucoheptonate, a-glucoheptose, glucooctonic
acid, barium a- and fi-glucooctonates; d-a-mannoheptose, fi-methyl-dgalactoside, fi-methyl-d-arabinoside triacetate,two isomeric pentaacetyl
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methyl hemiacetals of d-arabinose, two isomeric l-chloro-1-methyl-darabinose tetraacetates, and dimethyl acetal of d-arabinose tetraacetate; the a-methyl mannuronides of brucine and of potassium, amethyl-d-guloside and its tetraacetate, a-methyl 1-rhamnoside, amethyl mannoside, and tetraacetyl ,8-methyl d-mannoside; d-mannoheptulose, perseitol, and a-methyl glucoside; a-galaheptonic lactone,
a-galaheptose monohydrate, levo-glucose and its triacetate; d- ( a-galaoctonic) lactone and eight of its derivatives; d- ( a-galaoctose) and five
of its derivatives; d-gulonic and d-idonic lactones, d-gulose calcium
chloride compound, idonates of cadmium and of sodium, ,8-thionaphthol d-glucoside and its tetraacetate, brucine a- and ,8-glucoheptonates.
Enz11me researches.-Work on invertase was continued. Two new
adsorbents for invertase have been obtained. One of these is the
clay known as "bentonite.'' The other new adsorbent for invertase
is zinc sulphide. A more extensive study of the use of lead sulphide
as an adsorbent for invertase has resulted in improvement of this
method. Improvements were also effected in the use of alcohol and
acetone as precipitants. Likewise, the methods for increasing the
invertase content of brewer's yeast have been greatly improved.
Ohemico-bacteriological studies.-These investigations included
studies on the behavior of various micro-organisms toward the sugar
of the avocado pear, d-mannoheptulose. It was found that only one
bacterium, Li,sterella monocytogenes, the cause of monocytosis in rabbits, which has recently been found also in connection with human
disease, could ferment d-mannoheptulose. This result, therefore, probably could be made the basis of a test for distinguishing this genus
of bacteria. Studies were also carried out which have as their aim
the application of bacteriological technique to determine small
amounts of impurities in biologically important sugars; and certain
experiments were made in connection with a study of serum complement in liver disease, utilizing a strain of Leptospira icterohemorrhagiae, which causes severe liver lesions.
Biological fiuoride studies.-Experiments were carried out to determine quantitatively the effect of the ingestion of sodium fluoride
in the food as compared with ingestion in the drinking water. It
was found that 225 parts per million of fluoride in the drinking water
produced fatal results in rats, while a control group given food containing as much as 600 parts per million survived. Differences in
effect were still noticeable at a level of 135 parts per million of fluoride,
but the termination was not fatal with this amount even in the case
of the drinking water.
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. '
Analytical work.-About 258 various analyses of miscellaneous
material were made-111 chemical examinations of water, 128 analyses
of arsphenamine and neoarsphenamine, and also 136 micro determinations in connection with the sugar researches.
Nutrition investigations.-During the year the Office of Nutrition
Investigations became part of the Division of Chemistry.
The studies on the ascorbic acid ( vitamin C) content of plants
grown in nutrient solutions were continued throughout the fiscal year.
It was necessary, in order to pursue these studies properly, to determine the distribution of ascorbic acid in various portions of the plant.
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The results of this study show that the organs with the highest ascorbic
acid content in the cowpea plant are those having the greatest cellular
activity, namely, the mesophyll of the leaves, the young ovary, the
embryonic and elongating regions of the root and stem, and the leaf
and blossom buds. It was also found that there is a comparatively
high concentration of ascorbic acid in the unripe seeds as compared
with the dry seeds, which suggests the desirability of using the unripe
seeds as a food in preference to the dry seeds.
Studies on the effect of sunlight and temperature on the production
of aserobic acid in the plant were in progress at the close of the fiscal
yeF~rther evidence that riboflavin (vitamin G) is not the pellagrapreventive factor was obtained from experiments carried out on do$s.
These experiments showed that riboflavin is without value in the
treatment of blacktongue, The results of experiments in progress at
the close of the fiscal yea.r indicate that a deficiency in riboflavin
in the dogs' diet produces a serious pathological condition, appaently different from that produced by riboflavin deficiency in rats.
The results of experiments with preparations containing the chick
filtrate factor indicate that these substances also have blacktonguepreventive value, and experiments were in progress at the close of
the fiscal year with a view to proving whether or not the chick-filtrate
factor and the blacktongue-preventive factor are identical.
Experiments on the blacktongue-preventive value of whey powder,
delactosed whey powder, and American cheese were completed during
the year, and the results indicated that these substances are relatively
poor sources.
The experiments on the e~ect of small quantities of cystine-amine
on young rats fed on diets deficient in cystine were continued.
The attempts to secure concentrates of the pellagra-preventive factor which have been in progress for the past several years were continued. During the year more satisfactory concentrates were obtained, although none suitable for large scale use in the treatment of
pellagra has as yet been secured.
Rat tests were made on several different waters treated by special
filtration processes for the removal of fluorine. The results of these
experiments indicate that the processes used did not satisfactorily
remove fluorine.
Experiments on the effect of several different deficient diets on the
incubation period of rat leprosy were completed. The strain of
human leprosy which had been transferred to rats was lost on
attempts at repeated transfer.
A new line of work was undertaken through establishing a consultation service to State health departments interested in nutrition.
The purpose of this service is to assist those departments in establishing satisfactory nutrition services and to give assistance to their
nutritionists in planning and carrying out their programs.
DIVISION OF INDUSTRIAL HYGIENE
Senior Surg. R. R. SAYERS in charge
On February 1, 1937, the Office of Industrial Hygiene and Sanitation Investigations and the Office of Dermatoses Investigations became
the Division of Industrial Hygiene of the National Institute of
23690-37-4
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Health. The purpose of the Division is the development of means
for the protection and improvement of the health of the working population. Its activities include field investigations, laboratory research,
and services.
Dust sturlies.-Asbestos: An analysis of data on 543 persons in
asbestos textile plants shows that the maximal concentration of asbestos dust to which workers may be exposed without contracting abbestosis is in the neighborhood of 5 million particles per cubic foot,
and it was determined by appropriate engineering control measures
that the dust concentration could be reduced to less than 2.5 million
particles per cubic foot.
Ceramics,' Feldspar, mica, and keolin,· Granite: In the first two
industries, engineering surveys were made, and 2,428 and 1.,200 persons, respectively, were examined; in the granite industry, as many
as possible of the 972 granite cutters examined in 1924-25 are being
reexamined.
Anthracosilicosis: A discussion of the medical aspects of anthracosilicosis, based on previously published data (Public Health Bulletin No. 221) concerning 2,711 employed anthracite miners and 135
disabled anthracite miners, emphasized that the . disease is a pneumoconiosis caused by the inhalation of anthracite dust and free silica
for long periods of time, usually 15 years or more.
Pathology: Lungs of men who had been employed in dusty trades
were sent in for examination through the kindness of practicing
physicians. After a complete pathological examination, specimens
were mounted for display. Tests on the physiologica~ effect of dusts
of industrial importance have been continued; the results of the
jntraperitoneal injection of 33 dusts have been reported.
Heavy metals.-Chronic m erC'Urialism: Several reports based on a .
medical and engineering study of health hazards in the hatters'
fur-cutting industry have been published. A total of 529 men and
women, representing over one-fourth of the employed fur-cutters
in the United States, was examined. Symptoms of chronic mercurialism. developed among individuals working in_atmospheric concentrations ranging from 0.6 to 7.2 mg per 10 cubic meters. Lead:
With the use of laboratory animals the toxicity of various lead compounds is being investigated experimentally by intraperitoneal injections, :feeding, and inhalation. Blood calcium is being· studied
and tissues are being analyzed. Work is in progress to increase the
precision of measurement of small quantities of lead; spectrographic.,
colorimetric, and photometric methods are under investigation. A
survey of 26 lead storage battery plants has been made preliminary to
a study of the health hazards. Chromium: An engineering study
o:f the air flow required to maintain the CrO 3 concentration below
1 mg per 10 cubic meters in the vicinity of chromium plating tanks
has been published.
Organw compounds.-Chlorinated diphenyls: Experimental work
has been undertaken to determine the toxicity of a series of commercial chlorinated diphenyls. Phenyldichlorarsine: Commercial oilPDA mixtures of phenyldichlorarsine contain 0.06 pound PDA per
gallon and produce burns on rabbits when one drop is applied to ~
shaved area of skin. H exone: Severe jrritation of the mucous membranes occurred when guinea pigs were exposed to more than 0.1
percent hexone by volume; on exposure to air saturated with hexone
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vapor (5.5 percent by volume), coma occurred, on the average, in 30
minutes.
Other studies.-Selenium: A 10-minute exposure to 0.57 mg of
H 2 Se per liter is fatal to guinea pigs. Selenium oxychloride ( 0.01
cc) when applied on the skin of rabbits proved fatal in less than
24 hours. On man the material causes a third degree burn which is
painful and slow to heal; no burn results when water is immediately
applied. Oarbon monoxide: Work is in progress to test the effect of
carbon monoxide on the central nervous system. Dermatitis: A study
of the incidence, cause, and control of dermatitis among 390
plate printers of the Bureau of Engraving and Printing has been
completed.
Physical methods.-A program of research on the photochemistry
of the sterols was initiated. A study is being made of natural illumination in two counties differing in their tuberculosis rate. Standards
of adequate illumination are being investigated for various industrial
activities. A report of measurements of ultraviolet radiation and
illumination in American cities during the year 1931 to 1933 has been
published.
Studies of sickness among industriial workers.-lncidence of disabling illness : The analysis of monthly reports from a group of 30
industrial sick-benefit organizations providing sickness insurance for
about 170,000 male industrial employees was continued during the
year and published quarterly. Occupational moribiclity and mortality study: A study, with the a.id of funds allotted by the Works
Progress Administration, of the effects of particular trades and
occupations on the health of workers which covers approximately
550,000 persons in 450 industrial establishments was continued.
Tabulation and analysis of the data from several industries are in
progress. An occupational analysis of the cement, clay, and pottery
industries is in press; similar analyses of other industries are in
progress. A paper on the implications of morbidity and mortality
statistics has been published.
Workmen's compensation for· occupational injuries.-Data for
study were obtained from the United States Employees' Compensation Commission and the State of Wisconsin. Three papers have
been published. The total Federal compensation paid since 1916 in
the instance of incomplete cases with disease as a complicating factor
was over 7 million dollars; the average per case was $5,343.
Age of gainful workers.-As a result of the recognition of the
growing interest in problems involving the age of gainful workers,
a series of 5 or more studies was begun. The question primarily
asked was, Was there in the different occupational groups of 1920
and 1930 a dearth or excess of workers in the child, middle-aged, and
old-aged groups '~ Three papers have been published. The broader
aspects of population growth and distribution were discussed in
a review of a recent book.
Services.-8ervices were rendered through cooperation with Federal and State governmental agencies, industry, and national and
international organizations. The Federal Department of La lior was
assisted in the promotion of health and safety standards for the
protection of the health of workers. Conferences with the Bureau
of Mines resulted in a cooperative agreement through the Interdepartmental Committee to Coordinate Health and Welfare Activities.
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The Division was called upon to assist the National Silicosis Conference in the guidance of its medical and engineering committees and
in the preparation of the reports of these committees. Assistance was
given in the development of industrial hygiene units in the States.
A total of 25 State departments of health are now actively engaged
in industrial hygiene work or are planning to inaugurate such programs at the beginning of the fiscal year. The number of persons
engaged in this work has increased during the past 18 months from
about 10 to 119, while the expenditures for this new activity are
now well over the half-million mark. All but approximately 3 million of the 15 million persons engaged in industrial pursuits are
located in States which have industrial hygiene programs. In addition, the following services were furnished by the Division: Guiding
personnel in the conduct of preliminary surveys of industries in
States for the purpose of determining the scope of the problem in
each State; furnishing technical aid, either by having divisional personnel conduct the studies or furnishing instruction of this nature to
the State personnel; conducting studies in several States, at which
time it was possible to train personnel in the methods employed by
the Division; lecturing at 3 of the universities selected by the Public
Health Service as traming centers for public health personnel, and
other universities; and conducting a second comprehensive industrial
hygiene seminar of 3 weeks' duration attended by 42 persons from 22
States and the District of Columbia. From time to time the Division
has contributed material on the subject of housing and health. Considerable work has also been done on certain phases of a standard
public health code, and in the preparation of a code pertaining to the
illumination and ventilation of buildings. During the year approximately 100 addresses were made and over 100 conferences and committee meetings were attended.
Dermatoses investigations.-During the past year the studies of
occupational and other forms of contact dermatoses were continued.
An outbreak of occupational dermatitis was investigated among the
office workers of the
orks Progress Administration in New York,
N. Y. Recommendations were made and a report was submitted for
publication. A study was made of the skin hazards in the citrus
:fruit industry. Consultations regarding outbreaks of dermatitis
were held with 6 organizations and with various dermatologists of
New York. Studies were made, in 6 di:ff erent plants, of skin hazards
connected with the manufacture of munitions, carbon paper, and
hectograph ink, and with the making of photoengravings.
Publications.-A total of 36 publications, including 5 bulletins,
was issued during the fiscal year.
,v
DIVISION OF INFECTIOUS DISEASES
Senior Surg. R. E. DYER in charge·
'l'yphus-Hocky M ountarin spotted fever.-Th~ investigations on
typhus and Rocky Mountain spotted fever were continued at the
National Institute of Health and at the field laboratory in Mobile,
Ala. The studies comprised the following:
( 1) Rickettsial diseases .-The rickettsiae of endemic (murine)
typhus fever were cultivated through 17 passages in modified Maitland media in Erlenmeyer flasks using guinea pig serum, Baker's
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solution, and guinea pig tunica. Luxuriant growth was obtained in
many of the flasks.
The rickettsiae of European typhus were cultivated in the same
media through 6 passages. The rickettsiae of Rocky Mountain
spotted fever were cultivated in similar media using both chick
embryo chorio-allantoic membrane and guinea pig tunica as tissue.
Better growth was obtained with the guinea pig tunica as the tissue
component of the medium, but it was less luxuriant than that of the
typhus fever- rickettsiae.
( 2) A study on the effect of climate on typhus in guinea pigs.
( 3) Determination of the susceptibility of various species of native
animals to endemic typhus. During the year two species of rats, two
species of mice, a flying squirrel, and a house cat were found to be
susceptible.
(4) Attempts were made during the year to isolate typhus virus
from native rodents trapped in neighborhoods where typhus cases
had occurred. A successful isolation of the virus was made from an
old field mouse trapped in southeastern Alabama.
( 5) Assistance was given to physicians and health officers in the
diagnosis of cases of spotted fever. An extension of the geographical distribution of spotted fever was noted in western North Carolina and eastern Tennessee.
Relapsing /ever.-Investigations have demon~trated hereditary
transmission of relapsing fever spirochetes from experimentally infected female ticks, Ornithodoros turicata, through the egg to the
resultant larval stage and first nymphal stage. These stages infected
mouse, monkey, and man on which they fed.
Tularaemia.-This disease was reported by State health officers
from 36 States and the District of Columbia, a total of 903 cases
being reported in 1936 as compared with 780 cases in 1935. Czechoslovakia recognized the disease for the first time and has reported
416 cases. Austria recognized the disease in 1935 and has reported
a total of 200 cases.
Lymphocytic choriomeningitis.-Virus neutralization tests demonstrated the presence of antibodies against the virus in the sera of
11 percent of 1,248 persons, many of whom gave no history of any
central nervous manifestations, thus suggesting that meningeal involvement is exceptional in infection with this virus. Protective
antibodies were present in only 1.2 percent of sera from 396 children
under 17 years of age, as compared with 18.7 percent for 486 sera
from older persons.
Encephalitis ( St. Louis type) .-It was demonstrated that the
brain pathology of this virus infection in mice was subject to seasonal
variation. Partially immune mice when inoculated mtracerebrally
:frequently developed a cord type of paralysis not encountered in
normal controls.
Poliomyelitis.-Approximately 2,000,000 persons employed the
picric acid-alum spray against poliomyelitis during 1936, in Alabama Tennessee, and Mississippi. The method of application, as
!argeiy practiced, probably failed to cover the olfactory area in many
mstances.
Brucellosis.-Field studies on chronic brucellosis have been completed in Charlotte, N. C., and Kansas City, Kans. In both areas
cultures of Brucella were obtained from blood or other material from
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a number of patients with prolonged disease. The study is being
continued in San Antonio, Tex.
j}J edical mycology._.:._The investigations under way relate especially
to a comparison of various molds obtained from patients and grown
under laboratory conditions. A number of specimens from tonsils
have been given particular attention.
Olaissificat-ion of hemolytic streptococci.-Studies on the classification of hemolytic streptococci are being continued, correlating the
grouping according to precipitin reactions with the grouping according to phage sensitivity and fermentation reactions. The descriptions of two species, S. pyogenes and S. equi, have been published.
Protozoology and spirochaetology.-Activities in this field were
devoted mainly to two lines1of study: One of them, infective jaundice (Weil's disease), comprised the development of an agglutination
test for diagnosis, an improved culture medium for the growth of
Sri,rochaeta interroga;ns icteroh;emorrhagiae, determination of the
susceptibility of various species of wild rodents to this organism,
transmission studies, and assistance to health officers and practicing
physicians in diagnosing the disease. The second, Americam human
trypanosomiasis (Chagas' disease), included studies of the distribution of 15 species of Triatoma in the 1 nited States and their infective agent, T rypanosoma 01"11,zi / it was fonnd that the fecal excretion
of the bug containtng Trypanos01na cruzi is infective when deposited
on the injured skin, but the bite of the insect is not infective.
Macroscopic agglutination, precipitation, and complement fixation
tests were developed and utilized in diagnosing American trypanosomiasis.
Heart disease.-As heretofore, the studies were largely confined
to the subject of rheumatic heart disease. During the year under
report, the incidence of this disease was remarkably reduced below
that usual for Washington, D. C., where clinjcal studies are made,
and these studies were therefore hampered by lack of su:fficjent material. This condition of reduced prevalence appears, according to
verbal reports from several outside observers, to have been rather
general among Eastern cities, and leads to renewed speculations as
to the possible influence of general phenomena, such as the prevailing weather conditions, and similar general conditions. In Washjngton, at least, the months preceding the season of prevalance of
rheumatic fever were characterized by heavy -precipitation and unusually high temperatures, conditions simulating those in parts of
the country where this disease is normally of a low prevalence.
Unfortunately, since this disease is not generally reportable, these
speculations will have to remain unverified for the present, although
reports from agencies scattered over the country may throw some
light on the question when received and analyzed.
The question of streptococcic infection in the etiology of the
disease still remains unanswered, in spite of much favorable evidence adduced by certain observers. Our own analysis of onr 1936
series of cases reveals the fact that in about one-fourth of them no
evidence, either serological or bacteriological, of infection with
hemolytic streptococci could be found. This and other evidence
leads one to entertain considerable skepticism regarding the essential
role of streptococci. On the other hand, the demonstration of a
filtrable virus in connection with rheumatic fever has thus far failed
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in our hands as well as in those of others who have attempted to
verify and expand the work of Schlesinger.
In both the clinical and the animal experimentation fields our
studies have sought to discover some intrinsic factor which may predispose to the infection. The facts that rheumatic fever commonly
subsides when a patient becomes diabetic and that there appears to
be an intimate association between thyroid dysfunction .and the
disease strongly suggest an associated metabolic or endocrinal condition. More than 20 different phases of study related to these factors
have been carried out to the extent that time and materials would permit. It is interesting to note here that the scurvy-streptococcus lesion
of the heart valves previously studied can be induced by endocrinal
means without scurvy. This lesion, while admittedly not identical
with those of rheumatic fever, is of interest to the extent that it is a
nonbacterial proliferative lesion which may conveniently be studied
in guinea pigs.
A study of the anemia of rheumatic fever, a subject which appears
to have suffered undeserved neglect, was hampered by lack of clinical
material. It is the impression that if treatment were to be diverted
from the present overinsistence on salicylate therapy in the direction
of treating the general condition of the patient, especially the
anemia, much benefit to the individual case might ensue.
Epidemiological investigations have some·w hat expanded. A
large amount of information concerning the incidence and distribution of rheumatic and other forms of heart disease is being systematically collected from schools, colleges, hospitals, health departments, and other organizations, which are sufficiently dispersed
throughout the United States to afford da,ta of nation-wide significance. All known cases of rheumatic fever and heart disease, and
chorea, in Philadelphia are being followed up as far as practicable
to obtain epidemiological data, including the familial incidence of
other cases. The present figures indicate such an incidence in about
40 percent of the families. A control group is being simultaneously
studied. An effort is being made to ascertain the incidence of cardiovascular syphilis in a large number of hospitals throughout the
·country.
A keen interest has been taken in the subject of heart disease
statistics in the belief that it would be a distinct service to public
health to secure improvement of them. The present imperfections
apply pertinently to rheumatic heart disease.
Fundamental imm unology.-The antigenic constitution of bacteria
belonging to the Typhoid-Salmonella group was studied with special
reference to the Vi-antigens; methods were found and descriptions of
them published for the quantitative determination of H-antigens
(India ink reaction) and for the titration of Vi-antibodies. Special
attention was given to the study of certain colloids ( rosin, goldsol)
in flocculation reactions. The problem of blood coagulation was
studied with the help of new methods pertaining to colloidal science.
Variation of infecting bacteria induced by specific influence of
certain infected organs was found and studied.
The basic fundamentals of the new conception of "antigenic stage
of infectious diseases" were established on ascaris infestation, typhus
and typhoid-infected animals. "Protein splitting" by circulating
blood was studied.
1
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Classification and uientification of 'ttnknown bacteria.-Assistance
was rendered to outside hospitals, clinical laboratories, medical
schools~ and individuals engaged in bacteriological research in the
identification and classification of different strains of bacteria, and
in the preparation of autogenous vaccines.
Bacterial variants and mutants.-The results obtained during the
preceding years again have been confirmed. Results of experiments
indicate that a change in the rate of oxidation by bacteria occurs
during the period of radium rays effect. This increased oxidation
enhances the fermentation properties of the bacteria, both in the
direction of the intensity of fermentation of individual carbohydrates and in the number of carbohydrates fermented. The increased intensity of ferment ation gradually subsides, but the increased number of fermentable carbohydrates is retained.
Chemical and biological processes.-These studies cover three
phases of investigations, as follows :
(1) The development of an adequate statistical treatment of the
Arrhenius expression for the dependence of rate of reactions on
temperatures. Claims have frequently been made that the two constants in the Arrhenius expression are not true constants, but that they
vary with temperature. It was shown that one of the Arrhenius constants ( the energy of activation) is a true constant for a given chemical or biological process. Indications were obtained that the other
constant ( the limiting value of the velocity constant) may be universal as a constant both for purely chemical and for biological
reactions.
(2) Adsorbents for negative ions (fluorides, sulphates, selenates,
oxalates, and certain "filtrable" viruses). The following facts were
developed: Fluorides can be removed from solution by suitably activated carbon. Basic (hydroxo) compounds, of which calcium
~drowy-phosphat~ (apatite), magnesium hydroxy-chloride (hydraulic cement), and zmc hydrowy-phosphate ( dental cement) are types,
and are very effective in the removal of fluorides and other negative
ions from solution. On the basis of chemical composition, it appeared
that filters capable of removing fluorides, etc., should also be effective
in removing "filtrable" viruses from solution and, conversely, that .
filter materials hitherto used only for the retention of "filtrable"
viruses should also be effective in removing fluorides.
(3) A study of "bio-adsorption," recently undertaken, refers to the
isolation and identification of specific adsorbents from bacterial
systems.
H emolytic streptococcus diseases.-A method of purifying and precipitating the erythrogenic toxin of the scarlet fever streptococcus
has been developed. Thei use of such material for active immunization against scarlet fever greatly reduces the objectionable reactions
and at the same time increases its immunizing properties. The practicability of the method has been tested in a group involving over
10,000 persons. This trial showed that three graduated intradermal
doses will produce immunity in approximately 85 percent of susceptible grammar school children. About 95 percent of the treated children experience no disagreeable reactions.
A study of the degree of specificity of over 200 strains of erythrogenic toxin was undertaken. This work is nearing completion.
A study of the stability of the diluted Dick test toxin has also been
started and this should be completed soon.
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0 hronic endemic dental ftU()ros-is .-The study of the epidemiology
of chronic endemic dental fluorosis (mottled enamel) was continued.
There are at present about 350 reported or surveyed endemic areas
in the United States distributed among 26 States. The number of
known endemic areas will doubtless be increased considerably in the
near future as a result of the extensive chemical studies now being
carried on by several State health departments and other State·
agencies. The quantitative relation between the fluoride concentration of the communal water supply and the degree of clinical severity
seems firmly established. Fluorides in a common water supply, not
exceeding one part per million, apparently are of no public health
significance.
The accumulation of quantitative data from surveys of 15 cities
having either the requisites for quantitative evaluation or an interfering variable subject to reasonable appraisal, provided sufficient material for statistical analysis. An index of clinical severity based upon
weighted averages was developed for the purpose of working out a
toxicity curve which would point out the probable clinical effects following the continued use of waters of different fluoride concentrations.
The size of the clinical sample in relation to the fluoride concentration
of the water was studied and tentative limits suggested.
During the year, 3,277 children were exammed in Oklahoma,
Illinois, Iowa, and Virginia.
Fwld studies of tuberculosis.-Headquarters for these studies were
established on July 4, 1936, at Montgomery, Ala., in office space furnished by the Alabama State Health Department. Active cooperation
was obtained from the Tennessee Valley Authority, the State Health
Department of Alabama, the State Health Department of Tennessee~
the health departments of Giles County, Tenn., and Coffee County,
Ala. The medical societies and the officials and citizens generally of
Coffee and Giles Counties have given their hearty support to the
studies.
Eight experienced public health nurses reported for duty at the
headquarters on July 15. After being given detailed instructions at
headquarters, the nurses were divided into two forces and assigned to
work in the field.
Coffee County, Ala., and Giles County, Tenn., were selected for the
intensive detailed studies because they are, respectively, representative of two large regions, one with low and one with high recorded
mortality from tuberculosis, and because they present comparable
conditions in some respects, such as distribution and general character of population, and very different conditions in other respects, such
as soil and geological formation and general economic resources. In
the 5-year period 1929-33, the recorded average annual mortality rate
from tuberculosis per 100,000 population was 13.1 for white and 54.6
for colored in Coffee County and 120.3 for white and 208.9 for colored
in Giles County.
.
The main purposes of the studies are ( 1) to determine as accurately
as practicable the actual incidence of damaging tuberculosis in the
two counties, and (2) the differences between the two regions in all
conditions which reasonably may be supposed to influence tuberculosis mortality. In order to obtain some of the basic data, the nurses
began a house-to-house survey and family canvass in these counties.
In this survey an exhaustive questionnaire is used. At the end of the
275:1
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fiscal year, 2,764, or about 41 percent, of the homes in Coffee County
and 3,539, or about 54 percent, of the homes in Giles County had been
covered by the detailed canvass and survey.
The data collected and tabulated so far support the view that the
rates of incidence of damaging tuberculosis and of mortality from
tuberculosis are very much higher in Giles County than in Coffee
·county and that general living conditions, in the usual sense of the
term, including especially the per capita consumption of red meats,
milk, and eggs, are very considerably better in Giles than in Coffee
County.
ROCKY MOUNTAIN LABORATORY
The study of Rocky Mountain spotted fe ver , tularaemia, and of
other diseases of like nature communicable to man has be.en continued
at the Rocky Mountain Laboratory.
Spotted fever.-The gross amount of preventive vaccine manufactured was 591.2 liters, the largest quantity made in any previous year.
There was available for 1937 distribution an amount sufficient to
vaccinate about 80,000 persons. The total amount of vaccine distributed was approximately 292 liters, the. bulk of which was sent
directly to physicians. More than one-third, however, was used for
the immunization of field personnel of various Federal services. It
has been impossible to meet all requests for the vaccine, although distribution has exceeded that of 1936 by 75 liters. This increasing demand is being partly met y improved methods for rearing the infected ticks needed for vaccine production and by extending the
manufacturing season. Data from the growing number of reports
pertaining to the occurrence of Rocky Mountain spotted fever in
vaccinated persons suggest that full protection against the less
virulent strains of the virus may not be as general as was expected
from the records for the first few years' use of the vaccine. Research
studies are being made. in the hope that some method of vaccine manufacture can be evolved which will be less expensive, less tedious, and
less dangerous to persom1el than that now in use.
Rocky Mountain spotted fever has been reported, for the first time,
from four additional counties west of the Mississippi River during
the current year, viz, Liberty County, Tex., Faulk County, S. Dak.,
Logan County, Colo., and Jackson County, Iowa. Dnring the spring
of 1937 there was an unusually small number of cases in most parts
of the Rocky Mountain region and adjacent areas. This was due to
the exceptionally cold spring. On the other hand, a relatively larger
number than normal was reported during the. early summer.
Relapsing fev er.-It has been determined that the hitherto unknown transmitting agent of relapsing fever in southwestern Kansas
is an argasid tick, 0rnithodoros tu,ricata. A strain of spirochetes
causing relatively mild infections in laboratory animals has been
isolated from 0. parkeri collected in Beaverhead County, Mont. It
is not known whether or not this strain is responsible for human infection; however, two cases of relapsing fever have originated in
areas where 0. parrkeri is the only tick of this genus known to be
present. No cross immunity has been found between strains of relapsing fever isolated from 0. turicata from Texas and 0. parkeri
from Montana; also, strangely enough, no cross immunity has been
found between three strains isolated from 0. turicata from Kansas
and those isloated from ticks of the same species from Texas. Data
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obtained from Arizona indicate that cases in that State occur only
at high altitudes and that O. he1·msi is the probable vector.
Sylvatic plague.-Studies of sylvatic plague have been continued
at the temporary summer field station at Dillon, in the endemic section in southwestern Montana. The purpose of these studies is to
obtain data relating to the mechanism of the maintenance of the
infection in nature, the means of spread and of surviving the winter.
Persistence of infection in relatively small areas is indicated by the
finding of infected ground squirrels ( Oitellus elegans ) for three successive ye.ars in the same local focus. Plague-infected fleas (Tkrassis
acamantis) and lice (Neohaematopinus marrnotae) were collected
from a woodchuck in Small Horn Canyon in the summer of 1936.
Casts from certain predacious birds, which had ingested infected
anjmal tissue, have been repeatedly found infectious. Crows and
magpies have been shown mildly susceptible under laboratory conditions. Considerable information has been acquired on the local flea
fauna and its host relationships; also on the insect fauna of 'rodent
burrows and nests.
Tick-borne conditions of u-nknown etiology.-Each year a number
of cases of supposed tick-borne disease of unknown etiology are reported. The number of such records recejved during the spring of
1937 has been exceptionally large. Most have come from the States
of Colorado, California, Utah, Idaho, Oregon, and V{yoming.
Miscellaneous st'ltdies of tick.'3 and disease.-0. turicata has been
found on the following a:njmals or in their nests, burrows, or under
other habitat conditions: Ground squirrels, cottontajl rabbits, jackrabbits, prairie.-dog owls, terrapinsl and a variety of snakes. 0.
parkeri has been collected in Wyommg, Utah, Montana, and ·wash:ngton. A systematic study of the United States ticks of the genus
Dermacentor has been completed and a similar study of the ticks
of the genus l xodes has been initiated. Cooperative studies of infection in ticks of the genus Dermacentor- occuring ju their respective
States have been undertaken at the request of State health authorities
of Iowa, Minnesota, and Idaho. The demonstration of B acteriwm
tularense in the tick I xodes ricinus californicus in southwestern
Oregon suggests that this species may be an occasional carrier 0£
tularaemia to man.
M ALARIA INVESTIGATIONS
Activities of the past year comprised research and advice to State
health departments and other agencies, including consultation service
to the Tennessee Valley Authority advisory board for malaria control.
Research studies were conducted in field stations located at Columbia, S. C.; Savannah, Ga.; Memphis, Tenn.; .A.neon, Canal Zone;
Miami, Fla.; and Washington, D. C.
0 olumbia, S . 0.-Research studies at this station were conducted
in cooperation with the South Carofo1a State Hospital. The major
undertaking ,,·as an effort to perfect the culturing of malaria sporozoites for the dual purpose of supplying infective malaria material to
psychiatric hospit.als for use in the treatment of paresis, and for
studies of the fate of the sporozoites after introduction into man.
The viability of sporozoites has been maintained outside. the mosquito
for a period of at least 26 days. The problem of sterilizing cultures
has not yet been solved. However, contaminating organisms have.
been found to be, at worst, only minor pathogens. Attempts have
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been made to find some material which will show a definite affinity
for organisms except the protozoal and clear the material of bacterial
contamination.
Studies were conducted to compare, by aspiration of sternal bone
marrow material, the infe.ction present in bone marrow and the
peripheral circulation. Parasites were recovered from the sternal
bone marrow when none appeared in . the peripheral circulation.
When parasites were present in the peripheral circulation, they were
three times as numerous in bone marrow material.
Savannah, Ga.-This station was established during this fiscal year
for the principal purpose of conducting investigations of the bionomics of the Anopheles mosquito, with the view of disrupting or influencing the environment of Anopheles by natural and self-perpetuating means. Epidemiological studies of malaria were also
planned.
Studies inaugurated include types of r.,nopheline production areas,
influence of shade and light on larval devel<Jpment, experiments in
indoor rearing of anophelines, the infecti vity of A. quadrimaculatus
to D. immitis, the rates of malaria infections in parts of several
southern States, and the mechanical trapping o:f anophelines to determine species distribution.
Further research included limnological stud ies in connection with
natural bodies of water and artificial impoundages, in various degrees of biological evolution. The physiology of anopheline eggs
was studied in the experiments conducted with various chemicals to
determine their ovicidal properties.
Mernphi8, Tenn.-The principal research activity conducted at this
station consisted of studies of lining inverts of drainage ditches with
different thicknesses of concrete, with and without reinforcement, and
with and without curing. During the first season of exposure to
weather conditions in western Tennessee, ditch linings 2 inches in
thickness were observed not to be seriously affected by low temperatures. Studies were made relative to the prevention of erosion of
ditch banks by means of sodding, and experimental work was done
to determine the possibilities of preventing erosion by use of different combinations of gravel, sand, clay, and asphaltic emulsions.
Observations made on the early emergence of· A. quadrimaculatus
in western Tennessee resulted in the capture of males in the early part
of May.
Special studies determined that A. walkeri in western Tennessee are
attracted by lights. They do not remain in daytime resting places
where other Anopheles are found. None was found in habitations or
stables during the daytime. The adults of this species have been
found during the daytime in dense saw-grass rooted in water.
Ancon, Canal Zone.-Th.e greater portion of time at this station
was devoted to taxonomic studies of mosquitoes, particularly to the
medically important groups, the vectors of human disease. Material
was collected from Trinidad, British Guifma, and eastern Venezuela,
to study the habits of the mosquito carriers, known or suspected, of
malaria and jungle yellow fever.
A study of the distribution of A. albimanus, the most dangerous
carrier of malaria in the Caribbean area, was made. It was not
found to occur in any of the areas mentioned above, although it had
hitherto erroneously been reported present.
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The results of the studies made will be incorporated in the revision of the Anopheles mosquitoes of the Caribbean area. Data and
material collected permitted a complete revision of the little-known
subgenus Kerteszia, an anopheline group containing the species believed to be the chief vector of malaria in the cocoa plantations in
Trinidad.
Other material collected permitted the revision of the subgenus
Stetlwmyia, another widespread tropical anopheline group, about
which little has been known.
Miami, .Fla.-The work at this station consisted of investigation of
ways and means suitable for fumigating airplanes against the presence of mosquitoes, and the investigation of spraying materials suitable for such fumigation; the inspection of airplanes arriving from
Southern and Central American ports for the presence of mosquitoes;
and conducting a mosquito survey of the Mmmi area to determine
the normal mosquito population of the area.
Studies of the possibilities of utilizing the ventilating ducts of
airplanes as a means of distribution of insecticide spray within airplanes showed that this mean;:; is impracticable- at present. A special
type of hand-operated sprayer, capable of delivering measured
amounts of st:1ndard insecticide, is being developed.
Limited experiments with various insecticides against the mosquito Aedes aegypti seem to indicate that pyrethrum base insecticides ( and deobase oil carrying vehicle) are more efficient than other
products so far tested.
Two hundred and fifty-two inspections were made of airplanes
from South and Central American ports, and 88 planes were found
to contain insects of various sorts; 72 of these planes carried live insects. A total of 24 planes carried mosquitoes, 18 planes carrying
dead mosquitoes, and 13 carrying live specimens. A total of 33 mosquitoes (14 alive, 19 dead) was found, representing 12 species and 2
unidentified specimens.
Twenty-five thousand three hundred six adult mosquitoes were
taken in six light traps in the Miami area during the period September 15, 1936, to May 31, 1937. Eighteen species were reported in these
collections.
Headquarters and thick film laboratory, Washington, D. 0.-Fifteen th<?,usand blood specimens taken in the field by local, State, and
Public Health Service field workers were stained and examined at
the thick film laboratory. Of this number of slides, approximately
6 percent were positive for malaria plasmodia.
Considerable time was devoted to the preparation of a complete
new set of notes for thick film malaria technique, and also in collecting, classifying, mounting, and filing about 500 positive blood
films for demonstration and teaching purposes.
A colony of Aedes aegypti mosquitoes was kept throughout the
year. Several minor experiments were conducted in the conditioning
and storing of mosquito eggs, nutrition requirements of larvae, and
feeding and rearing of adult mosquitoes. Some time was given to
experiments with larvicides.
A course of instruction in thick film technique was given to a number o:f State health department laboratory technicians.
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EPIDEMIOLOGICAL STUDIES
The last annual report noted the attention which was being directed by this Office to acute infections of the central nervous system.
The most frequent of the reportable diseases of this group is poliomyelitis. In vital statistics, this disease does not figure prominently
as cause of death, yet each year there is renewed evidence that
scarcely any epidemic disease enlists general concern to a greater extent. The appreciation of this concern gives emphasis to the recommendation previously made, 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. Full reporting is fundamental for every effort at
investigation or control, yet no community should be unduly penalized by the report of a number of cases in excess of the number which
would be reported from other communities with a similar prevalence.
This recommendation is apparently being followed to a considerable
extent; in the epidemic which prevailed during the summer of 1936
in Alabama, Tennessee, and Mississippi, an effort was made by the
State authorities to confine the weekly published number of cases to
definite cases with demonstrable localized weakness. It was clear
that in different communities the proportion of nonparalytic or doubtful cases which might be reported would vary by· several hundred
percent.
In an effort to prevent the permanent paralyses and deformities
which, rather than the deaths, constitute the great menace of this
disease, a manual on the early preventive measures in the handling
of patients, written by the staff of the Children's Hospital School of
Baltimore, is being prepared for publication by the Public Health
Service. The principles of rational protection against the undue
stretching or stimulation of weakened muscles, elaborated in this
pamphlet, are those which have been urged by this Service for some
years. It is believed that this exposition will be of value, even for
some of those most experienced in this disease.
The study of the peculiar epidemic among hospital personnel at
Los Angeles during the 1934 outbreak of poliomyelitis in that city
has been completed and the report submitted. Epidemiologically, the
behavior of the disorder was consistent with its being poliomyelitis
spread by contact with cases and carriers, in the communicable disease wards, the admitting room, and the nurses' quarters, and this is
the simplest explanation of the phenomenon. Some of the important
implications of such a conclusion are obvious. No outbreaks of poliomyelitis among nurses and physicians had previously occurred in any
part of the world, so far as known.
.
Partly stimulated by the California epidemic, a study of trends in
age distribution of poliomyelitis and other acute infectious diseases
has progressed. The results of this study should furnish indications
as to possible changes in disease characteristics.
During the past 10 years, the weekly telegraphic reports of the incidence of poliomyelitis, smallpox, meningococcic meningitis, typhoid
fever, diphtheria, scarlet fever, measles, and influenza, gathered in
the Division of Sanitary Reports and Statistics from the State health
authorities, have been consistent enough to foster the belief that they
gave a true picture of the periodic variations of the diseases, perhaps
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more fundamental on account of the wide territory covered, than reports from any other part of the world. Plotted graphs based on
these reports have been published by that Division and similar graphs
have been plotted and studied in this office. Their continued study is
important. For poliomyelitis and t yphoid fever the disease year,
from trough to trough of each wave, has been taken as the same as
the calendar year, January 1 to December 31. For the other, and at
present numerically more important, diseases, the disease year is different from the fiscal year, and has been taken by this office as beginning September 1. Each wave of prevalence thus becomes a unit
instead of being divided between two calendar years. For all diseases except influenza the curves plotted in this Office are now based
on a straight arithmetical scale. On account of the wide variation
in the reported incidence of influenza, however, that disease has been
charted on a geometrical, or semilog scale.
In addition to the outbreak of meningitis in Charleston, S. C.,
mentioned in the last annual report, observation of the disease in
other southern seaboard cities has suggested the spread of the infection through Negro stevedores, and the importance of crowding in
such spread.
LEPROSY INVESTIGATIO N S
Studies at the Leprosy Investigation Station, Honolulu, and the
care and treatment of the patients in the adjoining Territorial
Leprosy Receiving Hospital were continued.
The studies of the relation of nutrition to the susceptibility and
progress of leprosy have been continued from the preceding year. The
investigations so far completed show that in vitamin B 1 -deficient rats
the incubation period of rat leprosy is shorter than in normal, well
nourished rats ; also, that generalization of the infection develops
earlier in the vitamin B 1 -deficient rats than in normal rats following
intranasal instillation and intravenous, intraperitoneal, and subcutaneous inoculations. The local leproma at the site of subcutaneous
inoculation develops more rapidly and becomes much more extensive
in the normal, well nourished rats than in the vitamin B 1 -deficient
rats.
Studies of the effect on rat leprosy of vitamin deficiencies other
than vitamin B 1 and of malnourishment produced by means other
than vitamin deficiencies, suggest that the results obtained in the
vitamin B 1 -deficient rats are not produced by a specific vitamin B 1
deficiency but by a condition of general malnutrition.
From the investigations conducted during the year it can be definitely stated that undernourished rats are more susceptible to rat
leprosy than are well-nourished rats.
There are several leprologists who believe that a relation exists
between the incidence of leprosy and humidity. Although such a
belief is not supported by the known epidemiological facts, experiments on the relation of humidity to rat leprosy were conducted. The
results of the experiments gave no evidence that the development of
rat leprosy in the white rat is affected by an environment of high
humidity.
Laboratory animals have proved resistant to human leprosy.. Believing that use of a susceptible animal would lead to advances h1
investigations in leprosy, attempts have been made to lower the
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resistance of the white rat to human leprosy and thereby render it
susceptible. Knowing that vitamin B 1 -deficient rats have less resistance to rat leprosy than have normal rats, it was thought that such
rats might be susceptible to human leprosy. The results of the experiments so far performed have given no evidence that vitamin Bideficient rats are more susceptible to human leprosy than are normal
white rats.
Another attempt to render laboratory animals susceptible to human
leprosy was in progress at the end of the year. Evidence has been
obtained which suggests that injections of one of the vital staining
dyes render the white rat more susceptible to rat leprosy. Attempts
to lower the resistance of white rats and monkeys to human leprosy
by this method were in progress during the latter part of the year.
Attempts were also made to find some animal other than the usual
laboratory animals susceptible to rat and human leprosy. The mongoose was the only one which showed any indication of being susceptible to rat leprosy. One month after subcutaneous inoculation o-f
infective material of rat leprosy some of the mongooses had developed
lesions which were similar to those seen in white rats, and from these
the disease was reestablished in the white rat. Evidence has been
obtained which leads one to believe that after one month the resistance of the animal overcomes the infection. The mongoose has so far
resisted all attempts to in-feet it with human leprosy.
Throughout the year attempts have been made to cultivate the
causative agents of human and rat leprosy. These attempts have met
with failure. However, two interesting organisms have been cultivated from human cases. The two types of organisms most frequently
cultivated from cases of human leprosy and believed by some to be
the causative agents, as reported in the literature, are acid-fast bacilli
and diphtheroids.
An acid-fast organism has been cultured from a lesion which, in its
early stages, could not be distinguished from a lesion of leprosy.
Smears from the lesions contained but an occasional acid-fast organism. The organism cultivated from the lesion, after once being established, grows very readily on the ordinary laboratory media. Animal
inoculations so far conducted sug~est that it is pathogenic and produces a granulomatous reaction. lnvestigations to date do not lead
one to believe that this acid-fast organism is the etiological agent of
human leprosy.
A diphtheroid organism has been isolated from the discharge from
a chronically draining ear. Examination of •smears made with the
discharge revealed both acid-fast and nonacid-fast diphtheroids.
This diphtheroid organism has been carried in ordinary laboratory
media for over 1 year and at no time has examination revealed ·anything but nonacid-fast organisms. Fourteen months after isolation
this organism was inoculated into minced chick embryonic culture
media. After 48 hours the growth was made up almost entirely of
acid-fast organisms. Seven to 10 days after inoculation the organisms
were mostly nonacid-fast. There has been obtained no evidence to
suggest that this diphtheroid has any etiological relation to human
leprosy. Similar acid-fast diphtheroids have been demonstrated in
smears :from the nasal mucous membrane.
The- finding of these two organisms in human cases of leprosy is
of diagnostic importance. The demonstration of acid-fast organisms
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from leprous-like skin lesions and from the nose of an individual does
not necessarily signify that the individual is afflicted with leprosy.
Investigations have been conducted with strains of rat leprosy
obtained from three distinct sources, San Francisco, Jacksonville, and
Honolulu. Studies of these strains suggest that they vary in their
degree of virulence and possibly in the reaction which they produce
in the animal tissue. The existence of such differences is extremely
important, since the disease of rat leprosy is extensively employed in
researches conducted at the various leprosy investigation centers and
may account for some of the varying reports from these centers.
During the last half of the year the staff of this station was augmented by the addition of a pathologist. In addition to studies of
the pathology of human and rat leprosy, the tissue reaction to injections into animals susceptible and resistant to rat leprosy, and
the tissue reaction in laboratory animals to injections with human
leprous material have been studied.
DrvrSION
Surg. R. D.
OF
LILLIE
p ATHOLOGY
in temporary charge
During the year, 1,688 surgical specimens were examined for marine hospitals, penitentiaries, Indian Service hospitals, and other
agencies. Material from 247 autopsies was received, largely from the
same sources, including also material from special studies on un+r.eated syphilis being conducted by the Division of Venereal Diseases
in Alabama, yellow fever material from South America and fron;i.
the files of the Army Medical Museum, Weil's disease, post-vaccination and other virus and bacterial encephalitides, from suspected
cases of leprosy and tularaemia, and from one case of pulmonary
moniliasis. In connection with this service, studies are being made
on the incidence of pinworm infestation of the appendix in relation
to appendiceal pathology, and the incidence of various types of
tumors in seamen and other Public Health Service beneficiaries and,
recently, in American Indians. This material is further utilized
in the preparation of reports of unusual cases and in training junior
officers in pathologic histology.
The service of diagnosing psittacosis infections in parrots and parrakeets for State and local health department and for national quarantine stations has been continued, though fewer birds have been
submitted than in previous years.
A studi of the pathologic histology of vanadium poisoning is
being made for the foods and nutrition division of the Bureau of
Home Economics.
In experimental pathology, studies have been made of the pathol•ogic anatomy and histology of various conditions under study in
,o ther divisions of the Institute, covering a total of 1,647 animal
autopsies. Among the subjects studied were two new questionable
viruses in which the pathologic findings indicated fairly definitely
that they were pyogenic bacterial infections. The studies of the
pathology produced by the toxins of the pathogenic anerobes were
continued, including Ol. sordellii and Ol. perfringens. Studies were
initiated in the experimental pathology of vVeil's disease, relapsing
fever, and American trypanosomiasis. Certain dietary deficiencies
have been studied from the histopathologic standpoint. A study of
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the influence of season and temperature on the pathologic reactions.
in typhus and encephalitis is nearing completion. Finally, various
experiments have been made in the alteration and improvement of
histologic technical methods and the results applied to the material
studied.
Diagnostic examinations of experimental cancers, of typhus and
encephalitis brain pathology, of tularaemia, poliomyelitis, tuberculosis, and intercurrent animal diseases made for other divisions of
the Institute acounted for a considerable share of the experimental
material. Also, the toxicologic anatomy of selenium and various.
drugs in various animals is being investigated.
DIVISION OF PHARMACOLOGY
Pharmacologist Director CARL VoEGTLIN in charge
Cancer research.-Further work was done on the influence of cer-tain diets on the growth rate of a strain of spontaneous mammary
carcinoma in mice. Tumor growth is inhibited if the animals arefed on a diet deficient in the amino acid tryptophane. Similar
studies were carried on with a diet deficient in methionine. The results were inconsistent and further work is necessary to establish
the function of methionine in tumor growth. A considerable retardation of tumor growth is observed in animals fed on a diet in
which casein is the principal source of protein irrespective of
whether casein represents 12 or 20 percent of the total diet. The
results of the nutrit ional studies obtained so far seem to indicate·
that a carefully controlled low protein diet might constitute a beneficial treatment for some cancer patients.
Studies were made on the same tumor strain with a view to discovering, if possible, synthetic chemicals with therapeutic proper-ties. For this purpose a series of organic sulphur compounds has
been synthesized and submitted to toxicity tests on normal miceprevious to their administration to mice with tumors. One of these
chemicals, on repeated injection, showed an unquestionable thera-·
peutic action, and attempts are being made to improve therapeutic·
efficiency by the synthesis of related compounds.
A new strain of the '\Valker 256 rat carcinoma has been under con-tiimed cultivation in vitro for 15 months in a medium containing fresh
normal horse serum and chick embryo extract. At present the growth
is luxuriant and typical of epithelial malignant cells. This success
in the long-term cultivation of an epithelial tumor is exceptional, as
similar work by other laboratories, with one known exception, has.
yielded only negative results.
The action of a highly potent carcinogenic chemical, methylcholanthrene, on tissue cultures of rat subcutaneous connective tissue is;
under investigation with a view, if possible, to converting normal cells
into cancer cells in vitro. It was found that methylcholanthrene ishighly toxic. In high concentrations it rapidly kills the cultures and
even in exceedingly low concentrations (0.2 gamma (0.002 mg) per cc·
of culture medium) it exerts a toxic action. Striking cell changes
were revealed in these cultures by microcinematography.
A comprehensive cytological study of liver tumors produced by
aminoazotoluene is in progress. Young rats fed on a diet containingthis dye have shown a definite inhibition of growth as compared with
controls. The precancerous liver changes have been studied in detail.
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In a continuation of the study o-f the relation of enzymes to cancerous growth, experiments were made on the purification and concentration of the proteolytic enzyme, cathepsin, from tumor and normal
tissue. This enzyme appears to be held tenaciously in combination
with certain tissue proteins.
During the second half of the fiscal year research was begun for the
purpose of elucidating the relation of hormones of the anterior pituitary gland to cancerous growth. This work included devising an
improved apparatus for the study of basal metabolism in small laboratory animals.
Chemistry of cell growth and cell division.-The stndy of the intracellular distribution of the physiologically important SH gronp in
Amoeba,e showed that it is largely concentrated in the nucelus, but not
apparently in the chromatin. Marked changes in the distributior
occur during interkinesis and mitosis.
On the basis of previous results obtained in the study o:f tumor
enzymes, the effect of variation in oxygen tension on nnclear growth
and cell division is now being studied. A subnormal oxygen tension
in conjunction with a relatively high SH concentration causes an
inhibition of the growth of the nucleus and prevents cell division if
exposure is made during interkinesis. These effects are reversible.
Pharmacology and toxicology of seleniurn.-A series of human
urines from seleniferous areas in Wyoming, South Dakota, and
Nebraska were analyzed for selenium to determine the extent of
absorption of selenium by man in selenium endemic regions. The
results of this study proved conclusively that man absorbed in many
instances appreciable amounts of selenium.
To determine the probable significance of this selenium absorption,
an investigation was conducted to ascertain the acute, subacute, and
chronic toxicity of selenium in several species of laboratory animals
with a view to determining the limits of tolerance and the earliest
manifestations of doses exceeding them. The questions of acquired
tolerance, increased susceptibility, and cumulative effects were stndied.
The effects of the continued administration of small doses of selenium
on various tissues and organs were investigated to serve as a guide
£or :further studies on possible functional disturbances resulting from
the continued ingestion of selenium.
A second and more detailed field study restricted to four counties in
South Dakota and Nebraska, a relatively virulent selenium area, was
made for the purpose (1) of correlating clinical evidence of selenium
intoxication with the excretion level of selenium in the urine, and (2)
for obtaining information which might be helpful in defining more
precisely the sources of selenium to which man may be exposed. A
report on this work is now in preparation, and when completed it
should be of practical aid in controlling this health hazard.
Since there has been no known method for estimating the probable
intake of selenium in man, an investigation was made of the excretion
level of selenium in relation to dosage in chronic poisoning of experimental animals. A definite relationship has been found to prevail
which appears to furnish a basis for estimating the probable intake
in man from a knowledge of the amount excreted in the urine.
The problem of the effects of selenium on tissue oxidation has been
studied in the hope that it may shed some light on the mechanism of
action of selenium and thereby possibly lead to means of its detoxification. Studies have been made on the effects of the selenite and sel
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enate ions on the oxygen uptake of various tissues, such as liver,
kidney, muscle, and brain. The minimum effective concentrations
of selenium for these tissues in buffered solutions with glucose as substrate have been determined. Marked differences in the susceptibility
of different tissues to selenite and selenate ions have been found, and
the effects of glutathione, lactate succinate, and other compounds upon
tissue susceptibility to selenium have been examined.
Chemotherapy of infectious diseases.-Several contributions were.
made to this rapidly expanding field, partly in collaboration with
the Divisions of Infectious Diseases and Biologics Control. Eleven
compounds were synthesized. Sulfanilamide was found active
against types I, II, and III pneumococcus infections. The drug was
shown to be highly bacteriostatic and bactericidal to pneumococci in
the test tube. Di-sulfanilamide, a new drug, is twice as active in
streptococcus and meningococcus infections as sulfanilamide and
-0ne-fifth as toxic. It was shown that, in meningococcal and pneu.mococcal infections in mice, combined drug and serum therapy are
more effective than either therapy alone. It is believed that the
.mortality rate for these diseases can be lowered by combination
therapy.
Prontosil was shown to exert a curative action on mice with choriomeningitis. This appears to be the first record of successful chemotherapy in a virus disease.
Cooperation with Federal Trade Oommission.-A considerable numb~r of technical opinions were prepared and expert testimony was
given.
CANCER STUDIES IN BOSTON
X-ray investigations.-The results so far obtained with the new
X-ray tube are indeterminate. An experiment was carried out to
determine whether exposure to X-rays would sensitize to the action
of bacterial filtrates of refractory transplantable tumors. The results
were negative.
Action of supersonic oscillations upon tumor cells.-Tumor cells,
derived from a transplantable mouse tumor originally induced by
dibenzanthracene, were suspended in saline and subjected to supersonic vibrations. Injection of the suspension of disintegrated cells
into mice gave rise to tumors in substantially the same time period
as in controls. When the experiment was repeated with a piece of
solid tumor, instead of a suspension of cells, the tumor was also
disintegrated, but injection of the disintegrated particles into mice
failed to produce tumors. The discrepancy is probably due to the
fact that, in the experiments with suspensions, some cells at the
periphery escaped the disintegrating action of the supersonic waves;
whereas in the solid piece of tumor, all cells were subjected to this
action.
Action of 1, 93, 5, 6-dibenzanthracene when ooministered intravenously, s u,boutaneously, and orally.-This work has consisted in the
1
prepar~tion and administr_ation to mice, th~ough variou~ channels, of
dispersions of 1, 2, 5, 6-dibenzanthracene m ho~se or. m dog ser'?ll
and in the study of ~he results. The se!um dispers10ns, when ~njected intravenously, mduced lung and hver tm:r:iors, a1:-d. w~en mjected subcutaneously produced tumors at the site of mJection, as
·well as lung and _liver . tumors. The hy1rocar~on, ther~fore, can
induce tumors at sites distant from the pomt of mtroduction.
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Observations made on the fate of dibenzanthracene in the organism
may ?e sum~arized as follows: Et~er ~xtracts were made of organs
of mJected m1ee removed after var10us mtervals subsequent to injection, and the extracts examined spectrascopically for the presenc6
of dibenzanthracene. . In no case could dibenzanthracene be detected 2 week~ afte! injection. Upon intravenous injection of the
horse-serum d1spers10n, traces of d1benzanthracene are found in the
blood, liver, and spleen 8 minutes after injection. Mos~ of the
compound appears to be equally divided between the liver and the
lungs. After a few days it has disappeared from the blood within
a week from the liver and, after that time only traces wer~ found
in the lungs. After 2 weeks it could no longer be detected in these
organs. ·when dibenzanthracene, dissolved in oil, was fed to rats
over a period of 10 days, extraction of the pooled feces showed no
trace of dibenzanthracene, although each rat received approximately
3 milligrams daily. The absorption spectra of the fecal extracts of
rats and mice, collected over a 5-day period, showed no traces of
dibenzanthracene after intravenous administration of the compound.
Apparently the hydrocarbon, when ingested, is either completely
absorbed in the alimentary tract or is changed to some other substance. Although neither the blood nor the viscera reveal traces of
dibenzanthracene within a comparatively short time after intravenous injection, yet both lung and liver tumors make their appearance some time after the dibenzanthracene can no longer be detected.
Lung tumors induced by carcinogenic hydrooarbons.-Three papers
dealing with pulmonary tumors in mice were published. In two of
these it was shown that, in strain A mice, the lungs are very susceptible to the carcinogenic action of 1, 2, 5, 6-dibenzanthracene and
that this susceptibility is transmitted through hereditary channels as
a dominant trait. The results suggest that lung tumors in mice may
be induced by carcinogenic agents reaching the lungs by routes
other than by inhalation. The third paper recorded the serial transmission of some induced lung tumors by subcutaneous implantation
in mice of homologous strain.
Further studies may be summarized as follows: (1) The implantation of threads coated with dibenzanthracene in the lungs of mice
gave rise to lung tumors not only in strains subject to their sponitaneous development, but also in strains in which the occurrence
of spontaneous lung tumors is not observed. (2) Dibenzanthracene,
adsorbed on charcoal, was intravenously administered to strain A
mice. The charcoal localized in the lungs and induced macroscopic
lung tumors within 3 months. Dibenzanthracene adsorbed on charcoal, when subcutaneously injected, also produced tumors at the site
of injection. (3) When 0.5 mg of dibenzanthracene in a serum dispersion was injected intravenously in strain A mice, visable lung
tumors appeared 4 weeks later. Six to 8 months must elapse before
lung tumors are observed after the subcutaneous injection of the
same amount.
Liver tumors and rung tumors in various st-rains of mice follow_vng
dibenzanthracene injection.-It was shown that both lung and hver
tumors appeared in strain C 3 H mice after the subcu~aneo_us injection
of dibenzanthracene. It was suggested that CaH mice might pos~ess
an inherited tendency to develop spontaneously both lung and hver
tumors late in life, and, as in strain A mice, the injection of the
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carcinogenic compound accelerated their appearance. This view has
been supported by finding both spontaneous lung and liver tumors
in a small group of 0 3H mice which came to autopsy at ages ranging
from 20 to 27 months.
Relative susceptibility of pure strain mice to the action of carcinogenic compounds.-Remarkable strain differences exist in mice in
susceptibility to the induction of tumors by dibenzanthracene or by
methylcholanthrene. At the present time reciprocal cross-breeding
is in progress between strains of high and of low resistance to induced
lung tumors. The offspring of these crosses will be tested in order
to determine the mode of inheritance of this susceptibility.
Age of inculence of spontaneous tumon.-The mouse colony is
furnishing valuable data with respect to the development of spontaneous tumors in the various strains of mice being propagated. A
paper dealing with the incidence of spotaneous mammary carcinoma
in strain 0 3 H mice appeared in the Public Health Reports. Four
years of selective breeding have resulted in the development of a line
of 0 3 H mice in which the average age at which spontaneous mammary tumors appear is from 8 to 10 months. This, it is believed, is
the lowest average age of tumor incidence so far recorded for any
strain of mice.
Effect of foster-nursing upon the incidence of spontaneous tumors in
mice.-Special Expert J. J. Bittner, of the Roscoe B. Jackson Memorial Laboratory, has presented evidence that, in some strains of
mice, the mother's milk may be important in the transmission of
susceptibility to spontaneous mammary tumors. Two strains of mice
now being propagated, viz, the CaH and the 057 black strains, constitute excellent media through which these findings may be further
tested. In this experiment new-born mice of the 0 3H strain were
suckled by foster-mothers of the 057 black strain, and vice versa.
Since the C3 H mice develop mammary carcinomas at an early age,
while the 057 black mice are resistant to this type of tumor, it is
believed that the results in over 100 mice now under observation in
this study should be significant.
Studies of carcinogenic compoitnds.-The investigation of polycyclic hydrocarbons which is being carried out jointly with Prof. L. F.
Fieser of the Department of Chemistry of Harvard University and
his colleagues was continued during the fiscal year.
A considerable number of new compounds were tested for carcinogenic activity during the year. Many of the experiments are still
in progress. The results obtained so far may be summarized as follows : Increasing the complexity of the molecules of dibenzanthracene,
benzyprene, and methy lcholanthrene results either in prolonging the
latent period or in the loss of carcinogenic activity. This is in agreement with analogous results obtained with other related compounds
by Professor Kennaway and his London colleagues. On the other
hand, simpler derivatives were found to have high carcinogenic activity. Thus, cholanthrene, which differs from methylcholanthrene
by the absence of the methyl substituent in the 6 position, acts about
as rapidly as the latter. This was confirmed by the London group of
investigators.
As a step in the :further simplification of the molecule, Professor
Fieser and his associates have _prepared benzanthracene derivatives,
related to cholanthrene, which have but four instead of five rings, viz,
5,10-dimethy1-1,2-benzanthracene and 10-methy1-1,2-benzanthracene.
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These substances were found to rank with cholanthrene in carcinogenic
activity. 9-methyl-1,2-benzanthracene and 5,9-dimethyl-1,2-benzanthracene were found to be actively carcinogenic. This shows that a
five-ring structure is not essential, in polycyclic hydrocarbons of this
series, to carcinogenic activity.
Inhibiting action of certain coal-tar fractions.-This study, carried
•on in collaboration with Mr. Samuel Cabot, of Boston, is now drawing
to a close. The results show that certain creosote-oil preparations had
a pronounced inhibiting effect on the induction of skin tumors by
benzpyrene. Several of the fractions both prolonged the latent period
.and lessened the total number of tumors obtained, as compared with
,controls. One fraction, however, appeared to promote the development of tumors; mice treated with this fraction and with benzl?yrene
developed tumors more rapidly than the control series. This last
·o bservation appeared sufficiently im.p ortant to warrant repetition.
Behavior of tumor cells in solutions.-It was found that tumor cells,
to a greater extent than normal cells, take in considerable amounts of
water in isotonic and even in hypertonic solutions, as evidenced by
swelling of the cells and by the development of "bulges" in the cell
-contours.
The question arose as to whether this "bulging" indicated vital
injury or post-mortem change or whether it occurred in living cells in
good condition. The most suitable criterion of viability of such cells
appeared to be that of vital staining. In collaboration with Dr. M.
Belkin, the reaction of mouse tumor cells to vital dyes was studied.
The swelling phenomeno:Q. was next studied in salt solutions containing neutral red and other vital dyes. Applying the criteria of
viability supplied by the previous study to observations on the swollen
-cells, the following conclusions seemed justified:
(1) Cells of mouse tumors and of normal mouse tissues which
-swelled in salt solutions were alive, as judged by their staining behavior toward neutral red, methylene blue, and trypan blue.
(2) Taking vital staining as a criterion of viability, under the experimental conditions, some cells with "bulges" may live as long as cells
without "bulges."
( 3) This phenomenon is not a post-mortem change.
Further work in this field consisted in the collection of quantitative
-data as to the effect of variation of salt and of protein content, correlated with vital staining, upon mouse tumor cells.
'
Studies on the action of bacterial filtrates.-A variety of microorganisms were cultivated and the yield of hemorrhage-producing substances was compared. Growth curves were obtained, showing the
rate at which the hemorrhage-producing substance was elaborated.
It was found that B. prodigiosus· gave as large a yield ' of this substance as any of the organisms investigated. Since this organism is
regarded as nonpathogenic, it has been selected for use in the bulk
production of filtrates. At the present time some 150,000 cubic centimeters of active filtrate are ready for fractionation. Modifications in
the technique of concentrating and purifying the active fraction of
the filtrates are being worked out.
Action of colchicine.-The action of colchicine has been tested on
certain transplantable mouse carcinomas which have been consistently
refractory to the action of B. coli filtrate. The lethal and the effective
hemorrhage-producing doses for mice have been determined. The
effects of colchicine are cumulative in producing hemorrhage in trans
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plantable mouse tumors; that is, if one-hal£ the hemorrhage-producing
dose is injected and the other hal£ is given 24 hours later, a hemorrhage
is produced in test tumors. The results of this investigation will be
applied to the treatment of spontaneous mouse tumors.
H istopathology.-A considerable amount of material, consisting of
section or of fixed and imbedded specimens of subcutaneous tissues into
which carcinogenic substances had been introduced, awaited examination. Part of this material has been stuaied with special reference to
neoplastic evolution. Control experiments, consisting in a study of the
reactions due to the subcutaneous introduction of noncarcinogenic
foreign bodies, are in progress. A study was made of serial transplants of lung t umors. The original tumors were adenomatous, and
this structure was retained for a few transplants, but gradually underwent a change which consisted in the rapid proliferation of the stroma
which assumed a malignant appearance, overgrowing and choking out
the adenomatous elements. After the twelfth transplant, the tumor
was structurally a sarcoma with no evidence of an adenomatous appearance remaining. Sometimes, however, the adenomatous appearance of the tumor persisted upon serial transplantation. In one
instance the sarcomatous transition was abortive, and the growth
subsequently regained its adenomatous appearance. The sarcomatous
transition in the animal was heralded by a striking increase in the
growth rate of the tumor.
Exhibit at Atlantic Oity.-An exhibit of the work of this station
on carcinogenic compounds and on lung tumors was prepared for the
scientific exhibit of the American Medical Associat10n and received
honorable mention.
DIVISION OF PUBLIC H EALTH METHODS
Surg. J.
w.
MOUNTIN
in charge
During the fiscal year 1937, five offices, viz, Child Hygiene, Milk
Investigations, Stream Pollution, Public Health Methods, and Statistical Investi§o-ations, which hitherto constituted separate units in the
Division of cientific R esearch, were merged to form the Division of
Public Health Methods in the National Institute of Health. The
functions of the Division are threefold: Definition of public health
problems, evaluation and perfection of procedures, and performance
of consultation service. For purposes of presenting a summary report, it is necessary to describe activities according to a few categories, and to limit selection of items to a few that are illustrative of
the program as a whole.
NATIONAL HEAI,TH INVENTORY
The National Health Inventory was made possible by a grant from
emergency relief funds. A large amount of the field work and most
of the clerical service were performed with relief labor. However,
the planning of the study, its administration, and the analysis of the
data are responsibilities that occupied the full time of more than half
of the technical staff of the Division of Public Health Methods and
imposed somewhat lesser demands on the Division of Industrial
Hygiene.
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The chronic disease study has been designed to assay the nature
and extent of the more protracted types of illness together with their
social and economic implications. It will also throw some light on
the amount and character of medical care that is being obtained by
people living under different conditions. The sample in this study
embraced about 850,000 families in 19 States which contained slightly
more than 3,000,000 individuals. Some person, usually the housewife,
supplied information concerning illness of 7 days' duration or longer
that occurred in the family during the 12 months preceding the
interview. In slightly more than 50 percent of the cases that came to
medical attention, confirmation of diagnosis was obtained from the
physician, hospital, or clinic to which the patient went for medical
attention. The information secured affords possibilities for analyzing sickness experience that have not been attained in other studies
of this general nature.
Information regarding incidence and character of illness, time lost
on account of sickness, and mortality rates, specific for cause, for
industry, and for occupation, have been made available on about
550,000 individuals employed in some 400 corporations. This is by
far the largest survey of its kind ever undertaken. The data obtained
will serve as a guide:post in directing future public health activities
in the field of industrial hygiene and sanitation.
Another element of the National Health Inventory is the communicable disease survey. It embraces case incidence, mortality rec()rds, and immunization experience among persons under 25 years of
age in 250,000 families. Along with furnishing many points of gentral interest, the data will permit a check of the completeness of
reporting to health departments for some 13 acute communicable
diseases; and it will provide for the first time adequate data for
studying cases and deaths in relation to the age, sex, and social and
economic characteristics of the population.
Audiometric tests and otorhinolaryngologic examinations were
made on approximately 10,000 persons who had been enumerated in
the survey of chronic illness.
In order that individual experience with regard to illness might be
jnterpreted in relation to preventive measures and to opportunities
for securing medical care, a schedule of information was secured
from every agency organized for rendering preventive or curative
health service to inhabitants of areas covered by the chronic disease
survey. The facilities study which _pertained t.o hospitals proper and
to out-patient departments of hospitals was extended to all parts of
continental United States. Of special interest are the figures on
income and expenditures, since they reveal for the first time the complete financial structure of hospitals.
The American Medical Association contributed to the project by
making its hospital records available for study. The data derived
therefrom are being used especially to determine the present status
of hospital organization and to follow the behavior of institutions
during the last decade.
The National Health Inventory joined with the maternal health
committee of the Michigan State Medical Society in conducting a
special study of obstetrical practice. Schedules of information concerning prenatal history and confinement experience were obtained
directly from attending physicians for approximately 10,000 _preg-
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nancies; this number corresponds to about 50 percent o:f _the bir~hs
that occurred during the study year. As background material, certificates o:f all births, stillbirths, and deaths due to puerperal causes
were copied :from the records on file with the Michigan State Health
Department which applied to a period corresponding to that o:f the
study. These combined data will furnish a State-wide picture o:f
what may be regarded as a representative maternity situation. The
findings should form a basis for projecting programs designed in
such a way as to remedy detects in care that may be revealed by the
analysis.
MORBIDITY AND MORTALITY
The normal investigations o:f this Division with regard to illness
and death hav-e continued, although on a somewhat curtailed basis,
because of the demands created by the National Health Inventory.
It was possible, however, to pursue several important lines of inquiry.
The provisional mortality summaries prepared from preliminary
data supplied by State health departments are now prepared for
publication on a quarterly instead of a semiannual basis. These summaries, which include gross death rates and rates arising from a
number of specific causes, constitute the earliest available information
on current mortality experience. A comparison for preceding years
of the data in these provisional reports with the final mortality tabulations of the United States Census Bureau indicates that they are
a fair index of the trend of mortality in the various States.
Differences between groups of the population with regard to morbidity and mortality experience have been made the subject of special
inquiry, since it is conceivable that by social action the opportunities
for health might be equalized to some extent. Negroes of the southern States and the relief-receiving fraction oi'. the general population
were viewed from the standpoint of differential morbidity and mortality rates. Both studies represent continuation of work initiated in
earlier fiscal years. In the case of Negroes, recorded death rates
during the period 1931-33 were 71 percent above those of white persons in the same 14 States. There is, however, a hopeful sign in that
death rates from all causes and from specific causes show-the same
downward trend among the Negroes as among the whites. When
m ness records among persons on relief were studied, it was found that
health had suffered most in families hardest hit by the economic
depression. The illness rate was more than 60 percent higher among
them than it was among their more fortunate neighbors ·who had
suffered no serious drop in income. Sickness among the "new poor"
was more prevalent than among the "chronic poor" who had been
poverty stricken in 1929.
OHILD HYGIENE
During recent years efforts of public-health workers have been
directed toward the problem of the prevention and treatment of
nutritional deficiencies. These efforts have been hampered by the lack
of precise methods for measuring the nature and extent of such
deficiencies in the general population. Since investigations on the
utility of methods for determining specific nutritional deficiencies are
needed, one study has consisted of a critical evaluation of the dark
adaptation technique (biophotometer) for measuring vitamin A nu-
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tritional status. Approximately 600 children were given biophotometer tests. The outcome of this work indicates that the present biophotometer test is unsuitable for general school survey work and that
present criteria for interpreting dark adaptation tests are questionable; consequently this test furnishes little evidence for believing that
vitamin A deficiency is prevalent among chil<lren in the communities
studied. Our results, which fail to confirm previous reports on the
biophotometer test, should not be construed to mean that a dark
adaptation technique cannot be developed, nor do they prove that
vitamin A deficiency does not exist. Further intensive work on this
problem is needed.
Examinations of the teeth of 8,257 American Indian school children, representing 110 tribes living in widely separated geographic
areas in the United States, have revealed striking epidemiological
aspects of dental caries. Children of one tribal stock resemble, with
respect to caries, other Indian children living in the same locality
rather than children of the same tribe living in other parts of the
country. Despite these marked similarities of tribal groups living in
close proximity, outstanding differences of certain tribes indicate that
influences other than the locale of residence must play important roles
in the production of caries. The establishment of these facts led to
inquiries regarding climatic, geographical, dietary, and other factors.
As yet no definitive results have been derived from the studies,
although evidence has accumulated which suggests that certain elements m the drinking water and in the dietaries of the Indian children probably play significant roles in the production of caries.
Plans arQ being made to continue these investigations.
Other studies on dental caries include analyses, by actuarial methods, of tooth morbidity and mortality. Data are based on approximately 5,000 dental examinations made during the past year on school
children at Hagerstown, Md. By using an essentially new ap1;>roach
to the problem of caries, which is afforded by the application of
actuarial techniques, it has been possible to derive precise expressions
of caries attack rates based on "tooth age." While these analyses are
still incomplete, it is already apparent that differences in eruption
time of the individual permanent teeth, and therefore tooth ages,
explain largely if not entirely previous views that attack by caries
is different between boys and girls, between the upper and lower jaws,
between the right and left sides of the jaw, even as to specific teeth.
It is clear that these findings simplify to a significant degree a
number of aspects of the caries problem.
Cooperative studies with the Johns Hopkins University on heart
disease in childhood have been actively prosecuted during the year.
The incidence of rheumatic manifestations was studied among the
siblings, parents, uncles, aunts, and grandparents within families that
constituted two particular groups. One group was composed of
families in which one or more children were known to have some
form of rheumati c infection; the other was a control group. While
the general results of the study are not new it is believed that the
precise and complete character of the inform'ation, supplemented by
the data derived from an adequate control series, affords fairly
definite knowledge of the course of rheumatic infection through families thus affl,icted. The intervals in time between the onset of the
d~seas~ ~n p~rent~ and in their children suggests that hereditary predisposition is an important factor.
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From the cooperative studies on heart disease two other bodies
of data were derived. One included material for the analysis of
anthropometric characteristics of families with rheumatic manifestations, and the second supplied a series of protocols on children who
apparently have developed essential hypertension while under observation. The evidence suggests an etiological relation between hypertension and rheumatic infection in childhood.
In the continued studies of physical growth and development carried on at Hagerstown, Md., for the past 15 years, physical measurements were made on elementary school children. One report 2 based
on over 8,000 observed annual increments in weight, deals with the
relation between weight attained at the beginning of the year and
subsequent growth during the following year. Revised rates of
growth based upon the prmciple derived from this study have been
developed by means of which more exact comparisons may be made
of different groups of children than is possible when increments are
related only to chronological age. Another report deals with the,
relation between body build and sickness. Evidence is presented
therein which indicates that little information of practical value
regarding general health of children can be derived from static
measurements of height and weight.
During the year the third series of observations was made on
hearing acuity of a group of 600 Washington (D. C.) school children
who have been observed during the past 5 years. One report on this
study reveals the limitations of present case-fi!lding methods in school
health work. The second report presents evidence to the effect that
all forms of auditory defects which occur in adults also may be found
in children. A third study shows the changes which occur in audiograms over a period of years. Those found most frequently involve
tones in the conversational range. Other changes include decreased
perception of high tones which takes place even in children, and this
decrease is more marked in boys than in girls. Such results as these
represent the type of basic information which must be available before correct diagnostic interpretation can be made of individual
audiogram records. It is planned to continue the analysis of these
data during the coming year.
SANITATION
The Division has concentrated its sanitation work on polluted
water and on milk. The work on polluted water featured research,
while that on milk sanitation combined investigation and consultation
service.
Stream pollution.-Of particular interest to persons concerned with
sewage treatment are the results of recent studies which confirm an
earlier impression that bacteria are the effective agent in the activate,d sludge process. In general it can be said that by the action of
certain bacteria there is produced a substance which to a remarkable
degree resembles ordinary activated sludge. Confirmatory data have
also been obtained on the progressive production of activated sludge
by these organisms and on the rate of oxidation of organic material.
It is found that approximately 50 percent of the material, as expressed by the 5-day biochemical oxygen demand becomes oxidized
during the first 5 hours of aeration. This rate of biochemical oxidation is very greatly in excess of any previously observed. Current
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observations also are being made on the total purification accomplished. This total purification includes organic material remov~d
from sewage liquor by oxidation, by adsorp_tion, and by sy11:thes1s,
into new sludge material. From these data 1t should be possible to
calculate the respective portions of the purification that are attributable to adsorption and to synthesis.
Further studies have been made concerning the physiology and
morphology of Sphaerotilus natans, one of the higher filamentous
bacteria associated with poor settlement, commonly spoken of as
bulking in activated sludge plants. Sugars stimulate the growth of
the organism in pure cultures and in the activated sludge community.
Durmg the past year two extended series of experiments were
brought to a definite conclusion: One deals with rates of oxidation
of sewage sludge deposits in a closed recirculating channel under
stream-flow conditions; the other concerns the effect of sewage and
its various constituents on rates of atmospheric reaeration of freshwater streams. Results of the series of experiments mentioned first
indicate that the deoxygenating effect of sludge deposits may persist
over a long period of time, and that the spring rise in temperature
creates a disproportionately high oxygen demand in water overlying
deposits which occur in winter. The experiments on reaeration of
flowing fresh-water streams show conclusively that both suspended
sewage and sludge have a retarding effect on the rate of absorption
of atmospheric oxygen. However, this retarding effect was scarcely
perceptible in streams with very low velocity of flow when physical
turbulence ceased to be a factor in the rate of oxygen absorption.
That the retardation is not due to any material lowering of the dissolved oxygen saturation value in sewage is demonstrated by experiments now in progress. These indicate that the maximum oxygen
solubility level is nearly the same in undiluted sewage as in either
tap or distilled water.
A special laboratory was established at Chillicothe, Ohio, from
which point daily observations over a complete seasonal cycle are
being made of the present sanitary condition of the Scioto River
below Columbus. Observations are also being made on the rates of
oxidation for the purpose of determining the extent to which conclusions on stream oxidation developed from experimental equipment
may be applied to natural stream-flow conditions. It is proposed to
continue work on the Scioto River in order that comparative data
may be obtained following complete sewage treatment by the city of
Columbus .
.Milk.-Pasteurization, long accepted as the most important single
step in milk sanitation, is being looked upon more and more as the
final control measure to which all milk should be subjected. The
process, however, is not wholly effective unless it is properly performed. Investigations, therefore, have been directed toward simplifying and perfecting measures for determining the effectiveness of
commercial pasteurization. The first problem was to secure a harmless bacterium which, from the standpoint of resistance to heat,
would behave in a manner similar to that of pathogenic organisms
that are transmitted through milk. In the annual report of last
year mention was made of the fact that a particular strain of E. coli
( 3U) seemed to satisfy the requirements of such a test or index
organism. This year further studies were made of its characteristics,
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particularly with respect to behavior under conditions likely to be
encountered in actual milk-control ·practice.
In view of the fact that it might become necessary in testing commercial pasteurizers to accept milk as a medium of suspension in
place of buffered distilled water, experiments were conducted to
determine what effect preheating of milk by different methods might
have on the reactions of the index organism. These experiments in
general showed that the time required to effect 99.99 percent reduction in bacteria count tended to be shorter when milk, before being
reduced to the test temperature, was autoclaved rather than simply
heated without pressure.
Another study involved a comparison of the thermal resistance
manifested by the index organism in tests made under laboratory
,conditions with the resistance shown in tests adapted to the requirements of actual milk plants. Some variation between the tests was
noted at 160° F. which might readily be attributed to differences in
time required for cooling the medium. In any event, correcting for
this factor made the differences of little moment.
The first practical application of the index organism was made on
:a manually operated milk vat of 50-gallon capacity, the object being
to determine the fluctuation, or safety margin, in temperature which
might be permitted. By heating milk for 20 minutes and holding it
at 134 ° for 30 minutes. the same reduction in count of the index
organisms occurred as was obtained by instantaneous heating to 140°
and maintaining that temperature for 30 minutes. Since the latter
is considered lethal for the most resistant milk-borne pathogens, it
may be assumed that 9° F. is the margin of safety when 143° F. and
30 minutes are used for commercial pasteurization with the type of
equipment under study.
Information assembled by means of questionnaires addressed · to
State and local health departments revealed the following outbreaks
of milk-borne disease during the year 1936: Typhoid fever 14, paratyphoid fever 1, scarlet fever 12, septic sore throat 7, other 7.
A member of the staff was assigned for periods varying from 1 to
6 months to each of the following States : I daho, Illinois, Indiana,
Iowa, Colorado, Kansas, Missouri, Nevada, North Dakota, Ohio,
Oregon, Utah, Virginia, and ,vyoming. The service rendered embraced technical advice on milk sanitation, assistance in the organization of programs, and training of State and local personnel. The
cities of Chicago, Ill., St. Louis, Mo., and Oklahoma City~ Okla.,
were given special assistance on particular problems over and above
that which may have been rendered through their respective State
health departments.
HEALTH FAOILITJES
The Division of Public Health Methods recognizes among its main
functions the study of administrative problems which enter into the
organization and operation of facilities, such as health departments,
hospitals,' and clinics of various types. These problems may involve
finance, personnel, procedure, or community relationship.
During previous years there was projected a series of studies designed to determine, first, the suitability of county health department
programs to the needs of people residing within areas served by such
.organizations, and second, the effectiveness and economy with which
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specific procedures are carried into practice. The four county health
jurisdictions chosen for these studies were selected because among
them were sufficient variations in problems and practices to express
all but the very unusual types of health department organization.
The data have been collected and treated in such a way that it is
possible to show the nature and distribution of all service rendered
by the health department, and the extent to which specific problems
disclosed by case studies of a representative sample of families were
encompassed by the service which the health department actually
extended to . those families. All records obtained in one bicounty
health jurisdiction are now analyzed. Facts which were disclosed
afforded material for several papers, most of which have been published. The data derived from the other three counties are in different stages of treatment.
It appears that the same general conclusions will grow out of
studies in each of the several counties, notwithstanding the fact that
surface impressions would lead one to believe there are essential differences in problems and practices. Briefly, these conclusions are to
the effect that health departments have been developed on the assumption that people require, above all else, to be told what is necessary for health. The programs are not designed to cope with barriers that may so effectively prevent a people from obtaining those
things which they need. In the area of neglected and partially
attended il!ness occur most of the problems for which the communities make little or no provision of an organized sort. This gap in
the general welfare scheme aggravates many ills and allows remediable physical defects to end eventually in disability. That some
:agency does not provide medic~l care· in any appreciable a.egree for
the low income group may be regrettable; but this fact does not
detract from the essential worth of programs which are being carried out by health departments. In point of fact, the limited funds,
as expressed by annual budgets seldom exceeding 50 cents per capita,
which are placed at the disposal of health departments, do not permit
,of more than general educational and regulatory measures, together
with a limited amount of diagnostic service. If people wish . to
obtain full advantage of expanding knowledge regarding disease prevention and restorative measures, health deJ?artment programs must
be enlarged and enriched; but to do so will necessitate larger expenditures of funds than people are accustomed to having appropriated at the present time.
Several problems of internal administration in health departments
·w ere taken up as subjects for special inquiry. Of these, perhaps the
most important and perplexing is the turn-over of personnel, particularly health officers. An employment record has been constructed for every health officer whose name appeared at any time
in directories published since 1912 by the United States Public
Health Service. A companion record was prepared for each health
jurisdiction showing the roster of health officers for the same period
of time. Out of this study there should be developed a true measure
of insecurity of tenure, now only a matter of conjecture. By corre,
lating the employment record of health officers with such- matters
·as training, experience, and local personnel policy, some of the
underlying difficulties should be disclosed.
Since health agencies make such extensive use of educational
measures, it was decided to appraise their health education activities,
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first, in terms of the content of such instruction, and second, from
the standpoint of pedagogical techniques that are being utilized .. Inquiries along these lines, but limited to group and individual instruction given by public health nurses, were inaugurated toward the
close of the fiscal year covered by this report; consequently the
elapsed time was not sufficient for the accumulation of a body of
data from which conclusions might be drawn.
Inasmuch as the hospital is an established community institution
which plays such an important role in any scheme of medical serv-~
ice, special attention is being directed to the several factors involved
in its support and utilization. The main studies now under way have
already been referred to in connection with the discussion of the·
National Health Inventory. On the basis of preliminary analyses,.
two outstanding problems emerge from the Inventory data-one is
the unstable basis of financial support, and the other is the relative
inaccessibility of facilities in many areas, especially those remote·
from urban centers of population. Of the 6,346 hospitals in the
United States that offer care in general medicine and surgery and
the allied specialties, 16 percent are operated by government, 45,
percent by nonprofit corporations, and 39 percent are under proprietary control. In a sample, believed to be representative, of these,
general and allied hospitals controlled by nongovernmental agencies, approximately 90 percent of the revenue is derived from thecare of patients, and only 10 percent is obtained from endowment
and gifts. About one-third of the counties (1,076) report no hospital facilities for general care. While it is true that many of
these counties do not have sufficient population to justify the existence of a hospital, still this absence of an institution is one index of
inaccessibility of such facilities. These counties, which are largely
rural, represent a real problem in medical care. The underlying·
problems of rural hospitals are being explored through the collection of information concerning the modes of hospitalizing rural
people and the experience of hospitals that have been established in
the smaller cities. These preliminary investigations should serve to.
outline the problem as a whole and should aid in selecting particularfeatures that are in need of more intensive study.
DIVISION OF ZOOLOGY
Prof. Maurice C. Hall in charge
The Division of Zoology was expanded and reorganized on April
1, 1936, and the present report covers substantially its first year of
work as reorganized. Originally, the work was planned to cover
trichinosis and oxyuriasis as group research projects; subsequently
the amoebiasis project was transferred to the Division. These three
projects cover the three animal parasites of man which notably sur1nount our sanitary barriers, and these parasites present the outstanding problems in the field of control.
1
TRICHINOSIS
The contributions to the subject of trichinosis made by the Divisiort
during the year are as folows:
Life history of trichinae.-By means of a new technique, the number of trichina larvae produced by one female trichina has been ascertained with an accuracy not previously equaled.
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Incidence and epidemiology.-A preliminary study of incidence,
as ascertained by post-mortem examination of 300 diaphragms, has
been published. The incidence found was 13. 7 percent. Over 1,000
diaphragms in this series from ·w ashington and Baltimore have
now been examined, and in the first 1,000 the incidence was 17.4 percent. This study is being continued to round out population groups
to some significant figure.
To check the possibility that an incidence ascertained at necropsy,
on cases hospitalized for illness, might be higher, from the effect of
trichinosis as a morbid entity, than the incidence in a well and
ambulant population, a series of diaphragm examinations was begun to cover cases of traumatic deaths in which the factor of hospitalization for illness was absent. Of 36 diaphragms, approximately 14 percent showed trichinae.
To obtain an incidence figure for the entire United States, names
of hospitals were drawn at random from the names of approxi, mately 700 hospitals at which there was a necropsy service and at
which at least 100 necropsies were performed annually, and 10 hospitals were requested to send 10 diaphragms from every other necropsy up to every tenth necropsy, according to the number performed
annually. At present, the incidence for the first 70 diaphragms is 15.7
percent.
To ascertain the value of adherence to the Mosaic Code by Jews
under the complex conditions of modern life in the United States,
the diaphragms of orthodox Jews were requested from Montefiore
H ospitals, New York, with a check series of diaphragms from unorthodox Jews. At present, 57 diaphragms, the total of both series,
have been examined and all found negative.
To ascertain the incidence in States for which there is no record
of trichinosis, diaphragms have been and are being requested from
these States. Of 17 received from Oklahoma, 2 have shown trichinae up to date. A series from New Hampshire has just been begun. Dr. Long, of the National Reserach Council, is trying to make
arrangements to secure diaphragms from the· 4 other negative
States-Wyoming, Idaho, Nevada, and Arizona.
The indicated correlations of trichinosis and population groups,
on the basis of the first 300 examinations in our base series, have been
published.
Correlations between the incidence of trichina in man and swine,
wit h special reference to garbage-fed swine, have been covered in
a report which is now being published.
In a report which has not yet been published, the high incidence
of trichinosis in the United States is correlated with an economy ·o:f
abundance resulting in a garbage pail rich in pork scraps, and the
feeding of these scraps to swine.
Symptomatology.-A careful · study of the course of the eosinophilia in trichinosis is being carried out on experimentally infected
dogs.
A report has been published enumerating approximately 50 disease conditions which were the first diagnoses in cases subsequently
found to be trichinosis, and the associated symptoms correlated with
the life history stages and the activities of the worms.
Diagnosis.-ln a study of the skin test and precipitin test for
trichinosis, the; Division has developed a new and refined antigen
23690-37-6
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which is thermostable, has a much higher titer than the trichina
powder previously used, and can be supplied to physicians in ampules
in solution ready for use. The supply on hand is sufficient to test
approximately 1,000 cases of suspected trichinosis, and the new antigen has recently been used to advantage in an outbreak of trichinosis
among soldiers at ,vest Point.
·
OXYURIASIS
The contributions to the subject of oxyuriasis made by the Division
during the year are as follows:
Life history of organism.-Careful counts of the eggs produced by
the female pinworm have served to rectify the estimates and guesses
in the literature.
A number of studies have been made in regard to the longevity
of pinworm eggs under vadous conditions of temperature and moisture, and the effects of a large number of chemicals, of supposed
value in killing eggs when these chemicals were used as disinfectants
or in anal ointments, have been studied.
Observations in Washington have confirmed the observations of
German and Russian scientists to the effect that pinworm eggs become scattered about a household on floors, rugs, chairs, bedding, and
other articles.
lncidence.-Numerous studies of various population groups have
been made, with the finding of pinworms in approximately 35 percent
of about 1,000 noninstitutionalized persons. The incidence among
adults is approximately the same as among children, but the incidence in school children is higher than that among the preschool
group or among adults. The incidence for males and females is
almost identical. Surprisingly, the incidence among colored persons is approximately half that among white persons, a finding for
which we have as yet only theoretical explanations not yet given
critical consideration. One family of seven persons has had intensive study for approximately 10 months. Inc1ividuals under good
sanitary conditions in institutions are being studied as a contrast
group for the general population. In a necropsy series on children,
to ascertain the incidence and the distribution of pinworms in the
digestive tract, pinworms were found in 9 of 32 children, or 28.1
percent.
Symptomatolo,qy.-The subject of symptomatology, practicallY:
uninvestigated so far, is being studied on the basis of complete physical examinations of patients before and after treatment, and on a
consideration of behavior and performance at home and in the school
before and after treatment. Some of the physical, mental, and social
improvements noted in those individuals who are actually clinical
cases of oxyuriasis have been very striking, and promise to open a
new chapter in the subject of oxyuriasis.
Diagnosis.-Tests of anal swabs and scrapers of various types'
resulted in the development of a new and highly effective swab, a
report on this subject having been published in which the new swab
is named the NIH swab.
Pinworm antigen, used in dermal and intradermal tests on 108
persons, gave positive reactions in approximately 50 percent of infested individuals on the dermal test, and positive results in the other
infested individuals on the intradermal test. The dermal test is
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:remarkably specific, but the intradermal test gives some nonspecific
:reactions in persons infested with worms other than pin worms.
Therapy.-Studies of various drugs have developed the fact that
.a. single dose of tetrachlorethylene will effectively remove the pinworms present in many lightly infested indiYiduals, but will not
usually clear up heavily infested persons. A therapy, never previously employed for the treatment of oxyuriasis, consisting in the
administration of gentian violet three times a day for 10 days, has
proved very much better than any other form of therapy known to
us and tested by us, and apparently offers a method of controlling,
pinworms effectively, something we have never previously had. The
drug must be given simultaneously to all infested persons in a family.
Durmg the 10-day period, any pinworm eggs present in the patient's
surroundings die of drying, and the repeated doses of the drug
:apparently msure its entry into the cecum and appendix, both among
the sites of infestation.
~
AMOEBIASIS
The contributions to the subject of amoebiasis made by the Division during the year are as follows:
Post-epidemic studies.-Chicago cases from the epidemic traced
to hotels, are being followed up to ascertain cases of spontaneous
disappearance of infection.
Small- and large-cyst Amoebae.-Comparative studies of Amoebaei orming cysts of various sizes are being studied at Chicago.
lncidence.-A series of necropsies, following traumatic death, is
being made at New Orleans to ascertain the incidence of amoebiasis,
:and to make other observations.
Biology.-Autoinfection in the dog has been found in one case,
-following operative sealing of the anal aperture.
Infection of the dog by means of trophozoites has been obtained
in a number of cases.
OFFICE OF COOPERATIVE STUDIES
It is too early to evaluate any definite results accruing to the
body of publi.c health knowledge from cooperative studies in which
the Public Health Service has aided certain projects that are being
,carried on at universities and other institutions. Aid is being continued on these projects for the coming year in accordance with the
Tecommendations of the National Advisory Health Council. These
J)rojects include vaccination against tuberculosis among Indjans, control of tuberculosis by ambulatory pneumothorax treatment, variation in the output of bacilli by white and colored patients with tuber•culosis, the influence of natural and of artificially supplied sex hormones on tuberculosis, the capacity of different white blood cells to
take up and destroy tubercle bacilli, the action of other killed bacteria on tuberculosis, the identification of possible new fat-soluble
vitamins necessary for normal growth, the preparation of human
·serum in stable form which may be used for the prevention or
treatment of various conditions in man, the effects of various agents
,on cancer and other human cells grown in glass apart from the body,
the possibility of adapting endocrine gland growths for transplanting
to persons suffering from a deficiency, and the trial of different
methods for protection against diphtheria.
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DIVISION OF FOREIGN AND INSULAR QUARANTINE AND~
IMMIGRATION
Asst. Surg. Gen. C. L.
WILLIAMS
in charge
Senior Surg. C. L. Williams was appointed Assistant Surgeon .
General in charge of the Foreign Quarantine Division, relievingSenior Surg. F. A. Carmelia, July 7, 1936.
During the year, a plan of "Radio Pratique'' was evolved by which,.
for the first time since 1883, when the Marine Hospital Service
assumed the supervision of maritime quarantine, ships have been able
to proceed to dock without stopping in quarantine anchorage and
without being subjected to quarantine inspection prior to entering ·
a United States port. This plan, applying to passenger vessels only, _
with the approval of the Secretary of the Treasury, was inaugurated
by the Surgeon General of the Public Health Service at the port of ·
New York on February 1, 1937, and was put into operation at Boston
on February 15, 1937, following a short trial period at New York.
Also, due to the great reduction in infestation of ships, effected
by having regard to the importance of the elimination of rat harborage, the menace to the United States of ships trading with localitiesinfected, or suspected of being infected, with plague has been reduced
to a minimum.
In order that a uniform, efficient barrier to quarantinable disease, .
particularly plague, might be maintained, the smaller quarantine.
stations have been placed under the supervision of larger stations
in their vicinity, the personnel of which, formed into a mobile unit, .
provide expert fumigation and inspection service to shipping with
little delay. The principal stations have in turn been placed under ·
the supervision of central or key stations, one on each coast, New
York having supervision of the Atlantic coast, New Orleans, the ·
Gulf coast, while the Pacific coast has not as yet been organized in
this manner.
Coordinated with this supervision is a system of maintenance of ·
ships' register, classifying ships on the basis of their rat infestation
and itinerary as determined from data furnished by all stations to •
the central stations.
Certain reductions in physical facilities have become possible by
reason of this lessened menace, particularly in ports where there are ·
marine hospitals which may be used for the detention of persons .
jnfected, or suspected of being infected, with quarantinable disease.
The following properties have been declared surplus to the needs .
of the Public Health Service : House Island, Portland, Maine; a plot
of land at Newport, R. I., on which it was intended to build a new 78
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•quarantine station; Hoffman and Swinburne Islands, N. Y.; Cape
Fear Quarantine Station, Southport, N. C.; United States Quarantine
Station Georgetown, S. C.; United States Quarantine Station, Beaufort, S. U.; Uockspur Island, Savannah, Ga.; United States Quarantine
.Station, Brunswick, Ga.; United States Quarantine Station, Mullet
Key, Tampa, Fla.; and United States Quarantine Station, Santa
Rosa Island, Pensacola, Fla. Of these, definite disposition has been
effected in connection with Hoffman and Swinburne I slands, which
were leased to the city of New York; the plot of land at Newport
has been assigned to the Navy Department; Cockspur Island, Sa vannah, was taken over by the Department of the Interior; and Santa
Rosa I sland, Pensacola, was taken over by the Bureau of Fisheries.
The properties at Beaufort and Georgetown have been abandoned
:for a number of years, but were formally declared surplus during the
.fiscal year under report.
Potential detention facilities, as compared with marine hospital
facilities, are still available on the Atlantic coast at Gallops Island,
:Boston, Mass.; Marcus Hook, Pa.; Baltimore, Md.; Charleston, S. C.;
and Miami, Fla.; on the Gulf Coast at Tampa, Fla.; Mobile, Ala.;
Gulfport, Miss.; New Orleans, La.; Sabine Pass, Tex.; and Galveston,
Tex.; and on the West Coast at San Diego ( which station is at present
in a caretaker status), Terminal Island, Los Angeles, and Angel
Island, San Francisco, Calif., and Port Townsend, Wash. In order to
.-complete this program of reduction of facilities, certain of these
stations will be reduced to a minimum or actually declared surplus to
;the needs of the Public Health Service in the near future.
·
Amendments nos. 15 and 16 to the Quarantine Regulations have
lbeen approved by the Secretary of the Treasury, providing exemption from quarantine inspection and from obtaining bills of health
t? ships trading exclusively betwe~n countries on or near the frontiers of the Umted States and Umted States ports. These amend1ments, however, do not relax the surveillance providing for the suppression of the rat menace.
During the year it has become an established fact that there exists
in the simian population of South America a tremendous reservoir
,of yellow fever virus, which may be expected to persist for many
years. Aircraft communication, having been greatly perfected between the two continents, has greatly increased the menace from
·this disease in that travel by this means may be accomplished from
far southern ports in as short time as 4 days. It is to be expected
-that this will be materially shortened on the institution of night
:flying over these routes.
Considering these facts, certain measures for the control of the
:spread of yel1ow fever have become necessary and have been instituted in cooperation with the aircraft corporations connecting North
·and South America. These measures provide for immunization d
·a ircraft personnel by vaccination against yellow fever, and efficient
disinsectization of aircraft at stopovers en route and just 1)rior to
landing at United States ports, and a system of surveillance of air
travelers by means of certificates showing the area from which their
travel originated, and the further determination of itinerary after
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Federal Reserve Bank of St. Louis
80
PUBLIC HEALTH SERVICE
their arrival to complete 9 days from their departure from infected territory. Also, there is planned a definite campaign to•
secure, so far as possible, the eradication of mosquitoes from the·
regions surrounding airports of entry which might constitute vectors for the transmission of yellow fever.
New construction at the various quarantine stations consisted of
completion of the new Tampa Bay Quarantine Station at Gadsden
Point, Tampa, Fla., and the completion of additional nnits, consisting of single attendants' quarters and mess buildings, at San
Francisco, Calif., and Mobile, Ala. A site was acquired and plans
are being prepared for a new quarantine station at Jacksonville, Fla.
There was constructed, for addition to the :floating equipment of
the quarantine service one 70-foot, wrought iron, twin Diesel c11ttcr,
the B. W. Brown, which, on being placed in commissio11, was stationed at the United States Quarantine Station, Miami, Fla.
The various quarantinable diseases continued their us1tal prevalance in the same countries and localities in which they have been
appearing in recent years. Cholera remained limited, during the
fiscal year, to southern Asia and adjacent islands, with a high incidence in India, French India, French Indochina, and Siam. The
most formidable outbreak of cholera to occur in recent years in
Siam began in December 1936, and continued until June 1937, when
it appeared to recede somewhat.
Plague was of widespread distribution and attained high incidence
in the Far East, in Ceylon, India,._ and Dutch East Indies; in Africa,
as evidenced by reports from Kenya, Uganda, Union of ~euth
Africa, and Madagascar; in South America, as reported in Brazil,
Peru, Ecuador, and Argentina.
Yellow fever appeared to be limited mainly to Africa and South
America, in each of which it appeared to have widespread distribution. From Africa, reports originated in Sudan, Dahomey,
French Guinea, Ivory Coast, Gold Coast, Nigeria, Sierra Leone,
Senegal, and Nige.r; in South America, the disease was reported in
Brazil, Bolivia, and Colombia, with an outbreak of the jungle type
of yellow fever in the Perene region of Peru in April 1937.
Condensed statistical information showing the quarantine and
immigration activities for the year is presented in the appended
tables.
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Federal Reserve Bank of St. Louis
NEW TAMPA BAY QUARANTINE STATION AT GADSDEN POINT , FLA .
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
81
TRANSACTIONS AT MARITIME QUARANTINE STATIONS
TABLE
1.-Summary of transactions at maritime stations for the fiscal year 1931
Vessels
fumigated
Station
Deratization
Vessels
Vessels granted
ex- Passeninemp- gers in- Crew infree
spectpra- Oya- Sul- tion
spected spected
ed
tique nide phur certificates
issued
Bills of
health
and
port
sanitary
statements
issued
Amount
of bills
rendered for
quarantine
services
- - - - - - - - - - - - - - -- - - - ---Aberdeen, Wash-----~ -- -----Angel Island, Calif. (San
Francisco) ________ •• ____ • __ ._
Astoria, Oreg __________________
:Saltimore, Md _______________
Beaufort, S. c ________________
Boca Grande, Fla _____________
Boston, Mass _________________
Brunswick, Ga _______________
Carrabelle, Fla _______________
Charleston, S. c ______________
Corpus Christi, Tex.I _________
Eastport, Maine ______________
Eureka, CaliL ______ _________
Fall River, M ass _____________
Fernandina, Fla. (Cumberland Sound) ________________
Fort Monroe, Va _____________
Freeport, Tex ________ __ __ _____
Galveston, Tex _______________
Georgetown, S. c ______ _______
Gulfport, Miss ________________
Jacksonville,
Fla. (St. Johns
River) ______________________
Key West, Fla ____ _____ _____ __
Los Angeles, Calif. ____ ___ ____
Marcus Hook, Pa.2 ____ _______
Marshfield, Oreg. (Coos Bay)_
Miami, Fla _____________ ______
Mobile, Ala _________________ __
New Bedford, Mass __________
New London, Conn __________
New Orleans, La _____________
Newport, R. r_ _______________
New York, N. y_s ________ ____
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.f _____ _
Providence, R . r_ ___ __________
Sabine, Tex ___________________
Diego,
San
(Point
Calif.
Loma)
___ _____
__ ____________
Savannah, Ga ________________
Searsport, Maine _____________
South Bend, Wash ___________
Southport, N. C. (Cape Fear)_
Tampa, Fla ___________________
Vineyard Haven, Mass _______
West Palm Beach, Fla ________
3
0
0
0
1
126
314
$30. 00
436
41
685
0
10
922
3
17
188
100
1
1
3
298
30
631
0
9
772
3
17
184
72
1
1
3
33
9
41
0
0
48
0
0
13
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
105
0
175
0
0
83
0
0
8
0
0
0
0
27,027
710
265
0
17
31,105
0
0
829
4
0
0
0
32,346
1,626
21, 946
0
414
65,477
81
166
7,563
3,393
18
34
107
0
981
3,863
0
0
0
102
6
0
5S8
1
24
28
9,865.80
895. 48
11,983.24
0
120. 00
15,633. 6S
30.00
85. 00,
2, 750.31
1,174.89
10. 00
10.00
35.00
1
315
7
658
1
21
1
301
7
616
1
20
0
9
0
14
0
1
0
14
0
0
0
0
0
25
0
85
0
0
0
6,602
8
1,877
4
0
32
25,059
232
22,785
38
649
25
963
0
0
1
78
10.00
4,411.37
80.00
8,389. 09'
10.00
208.82
236
133
1,352
780
14
924
244
3
20
1,441
3,638
0
12
44
4
120
7
112
8
214
127
1,080
671
14
924
208
2
20
1,356
10
2,462
0
12
34
4
120
6
101
5
23
4
48
57
0
4
21
0
0
76
0
202
0
0
4
0
0
0
0
9
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
51
14
5,781
7
215 22,277
0
45
2
0
50 51,484
326
68
24
0
84
0
149 11,139
14
0
662 527,014
0
0
51
3
33
5
0
9
113
0
0
0
134
7
20
13
5,338
7,881
69,085
28,672
490
34,864
7,461
16
163
52,116
136
554,093
0
337
1,300
105
5,742
211
3,293
293
752
21
0
4,589
65
665
0
5
8
5,247
8
17,187
0
423
680
0
0
17
64
1,932
3,361.77
1,710.62
22,240.34
13,944.63
160. 00
9, 162.85
4,009.67
21.44
120. 00
25,918.40
55.00
64,862.32'
0
160. 00
807. 71
50.00
1,220.00
80.00
1,225.00
1,794.76
67
42
34
361
67
31
32
302
0
32
0
5
0
0
0
0
0
0
9
44
4
1
0
149
2,511
1,607
1,044
12,260
0
2,229
61
0
1,320.00
3, 7S8. 54
425. 00
3,911.50
560
114
554
103
10
10
9
56
251
0
121
222
0
121
1
5
0
0
0
22
0
0
0
0
0
0
4
0
0
0
35
0
0
1
6
27
0
0
11,103
56
0
0
13
495
0
136
26, 759
3,104
229
352
1,583
5,699
0
679
632
64
15
36
0
1,153
0
0
3,480.54
1,464. 97
100. 00
95.00
904. 39
2,935. 56
0
615. 00·
3
10
9
54
- - - - - - ---- -11,845
20 1,850 698,953
681
---------- --
Total. _______ --- -- ____ -- 14,140
Alaska:
Ketchikan ________________
Wrangell _________________
0
0
Includes Port Aransas, Tex.
2 Includes Reedy Island and Lewes, Del.
s Includes Perth Amboy, N. J.
' Includes all ports on Puget Sound.
1
0
0
0
0
0
0
0
0
-----------Total. __________________
0
0
0
0
0
- - - --- - - - - - -
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1,009,515
42,827 225,677.69
0
0
0
0
0
0
0
0
0
0
0
0
PUBLIC HEALTH SERVICE
82
TABLE
1.-Summary of transactions at maritime stations for the fiscal year
1937-Continued
Vessels
fumigated
Station
Deratization
Vessels
ex- PassenVessels granted
emp- gers in- Crew ininfree
tion
spected
spectJ?ra- Oya- Sul- cer- spected
ed
t1que nide phur tificates
issued
Bills of
health
and
port
sanit ary
statements
issued
Amount
of bills
rendered for
quarantine
services
- - - - - - - - - - - - - - - - - - - - - - ---Hawaii:
AhukinL _________________
Hilo
__ -------------------Honolulu
_________________
KahuluL _________________
Lahaina __________________
Mahukona ________________
Port Allen ________________
TotaL __________________
Philippine
Islands:
Cavite ____________________
Cebu _____________________
Davao ____________________
Iloilo _____________________
J olo _______________________
Legaspi __________________
Manila ___________________
Olongapo _________________
Zamboanga _______________
TotaL __________________
Puerto
Ri.co: _________________
Aguadilla
Arecibo ___________________
Arroyo _________ ----- ___ - -Central Aguirre ___________
F ajardo ___________________
Guanica __________________
Humacao __________________
Mayaguez ________________
Ponce _____________________
San Juan _________________
TotaL ___________ _____ __
Virgin Islands:
Charlotte Amalie _________
Christiansted _____________
Frederiksted ______________
2
10
163
9
0
0
4
2
10
152
9
0
0
4
0
0
22
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
8
42,332
0
0
0
2
73
456
40,576
333
0
0
151
54
199
785
183
51
43
94
0
139
94
98
19
44
1,130
2
77
0
2
2
1
19
0
183
2
2
0
5
0
0
0
0
53
0
0
0
95
0
68
0
0
138
0
22
0
4
0
0
0
0
13
0
0
0
834
1, 219
41l2
623
0
85, 338
0
1, 397
0
9, 512
5,767
5,462
695
1.809
110,897
39
3,434
0
488
143
201
29
77
l, 348
0
116
58
323
17
89, 873
$20. 00
60.00
4,139.66
100. 00
0
0
45.00
- - - - - - - - - - -- - - - - - - - --- - - - 41,589
4, 364.66
188
22
0
1,409
177
6 42, 342
---- --- =
------------=
----211
1,603
---------- --
0
0
0
0
0
0
0
0
0
- - - ------137,615
2,402
0
2
3
0
3
4
33
4
27
77
381
2
3
0
3
4
33
2
24
74
343
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
2
0
2
6
27
0
35
0
72
1
130
13
111
360
9,404
32
182
0
189
45
594
32
386
2,352
18,752
103
41
60
39
267
70
59
2Hl
323
800
15. 00
40. 00
0
40.00
25. 00
220. 00
25. 00
200. 00
660. 00
4,955.87
453
6
35
326
6
35
0
0
0
2
0
0
24
0
0
3,203
4
2,326
16,704
38
2,427
868
270
147
5,536.60
30.00
532. 00
- - - - - - - - - - - - - - - - --- -----22,564
6,180.87
534
488
2
1, 978
37 10, 126
6
------ - - - - - - - - - - - - - - - - =
- - - - - - - - - - - - ---- --- - - - --494
19,169
367
2
24
6,098.60
5,533
1,285
0
- - - - - - - - - - - - - -- - - - - - - --Total, all stations _______ 16,959 13,088
347 1,934 846, 827 1,230,452 49,901 $242,321.82
767
--TotaL ________________ --
TABLE
2.-Statement of quarantine services rendered at maritime quarantine
stations during the fiscal year 1931
Station
.Aberdeen, Wash __________________ ____________ _
Angel Island,
Calif. (San Francisco) __________ __
Astoria,
Oreg _________________________________
Baltimore, Md _______________________________ _
Beaufort, s. c ________________________________ _
Boca Grande, Fla ____________________________ _
Boston, Ma~s _________________________________ _
13runswick, Ga _______________________________ _
1
:8t1:r~~se/~~. ~
.\f::::::::::::::::::::::::::::::
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Inspection
services
Detention
services
$30
6,361
445
7,085
0
0
0
0
0
0
0
0
0
0
0
120
11,086
30
85
2,058
Special
services
0
$1,000.00
0
1,755.00
0
0
875. 00
0
0
80.00
Fumigation services
0
$2,504.80
450. 48
3,143.24
0
0
3,672.68
0
0
612. 31
Total
charges
$30.00
9,865.80
895. 48
11,983.24
0
]20.00 ·
15,633.68
30.00
85. 00
2,750.31
PUBLIC HEALTH . SERVICE
TABLE
83.
2.-Summary of quarantine senices rendered at maritime quarantine
stations during the fi,scai year 1937-Continued
Station
Corpus Christi, Tex 1________________________ _
Eastport, Maine_._. _________________________ _
Eureka, Calif. ____ •••• ________________________ _
Fall River, Mass ___________________ ________ __ _
Fernandina, Fla. (Cumberland Sound). ______ _
Fort Monroe, Va _____________________________ _
Freeport,
Galveston,Tex._.-----------------------------Tex ___ ____________________________ _
Georgetown, S. C ____________________________ _
Gulfport, Miss
__ -----------------------------Jacksonville,
Fla.
(St. Johns River) ________ ___
KeyAngeles,
West, Fla
___ ----------------------------Los
CaliL
__________________________ _
Marcus Hook, Pa.2 ___________________________ _
Marshfield, Oreg. (Coos Bay) ______________ __ _
Miami, Fla ____ _______________________________ _
Mobile,
Ala_---------------------------------New
Bedford,
Mass __________________________ _
New· London, Conn __________________________ _
New Orleans, La _____________________________ _
· ~:~?~~}t±l-'¥:c::::::::::::::::::::::::::
Ogdensburg, N. y ____________________________ _
Inspection
services
Detention
services
$1,115
10
10
35
3,210
80
6,965
10
205
2,010
1,609
17,062
8,645
140
8,603
2,273
15
120
16,160
55
42,357
0
120
445
40
1,220
80
1,155
70
1,170
415
335
3,145
3,106
1,185
100
95
560
2,010
0
615
0
0
0
0
0
0
0
0
0
0
0
0
$15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
60
4,080
100
0
10
Special
services
0
0
0
0
0
$290. 00
0
863. 25
0
0
140. 00.
70.00
2,180.00
1,450.00
20.00
500. 00
822. 50
0
0
3,110.00
0
7,045.00
0
40.00
50.00
10.00
0
0
70.00
805. 00
150. 00
230. 00
90.00
565.00
265. 00
100.00
0
0
245. 00
412. 50
0
0
Fumigation services
Total
charges
$59.89
0
0
0
0
$911. 37
0
560.84
0
3.82
1,211. 77
31.62
2,983.34
3,849.63
0
59.85
914.17
6.44
0
6,648.40
0
15,460.32
0
0
312. 71
0
0
0
0
919. 76
0
3,143.54
0
201.50
85.54
179. 97
0
0
99.39
513. 06
0
0
$1,174.89
10.00,
10.00,
35.00
10.00•
4,411.37
80.00·
8,389. 09
10.00•
208. 82
3,361.77
1,710.62
22,240.34
13,944. 6i
160. oo,
9,162.85
4,009.67
21.44
120. 00•
25,918.40
55.00•
64,862.32
0
160.00·
807. 71
50.00
1,220.00
80.00•
1,225. 00
1,794.76,
1,320.00
3,788.54
425.00
3,911.50
3,480.54
1,464.97'
100.co,
95.00
904.39·
2,935.56
0
615.00·
Panama City, Fla ____________________________ _
Pern;acola, Fla ____ ____________________________ _
Plymouth,
Mass __Fla
---------------------------Port Everglades,
_________________________ _
Port Isabel, Tex ______________________________ _
Portland, Maine ___ .-------------------------Portland, Oreg __ -----------------------------Port San Luis, Calif. (San Luis Obispo) ______ _
Port Townsend, WashJ _________ _____________ _
Providence, R. I ___ --------------------------Sabine,
TexCalif.
__ ----(Point
----------------------------San Diego,
Loma) __________ ____ _
Savannah, Ga ________________________________ _
Searsport, Maine _____________________________ _
South Bend, Wash ___________________________ _
Southport, N. C. (Cape Fear) ________________ _
T ampa, Fla ____ __________________ __ __________ _
Vineyard Haven, Mass _______________________ _
West Palm Beach, Fla _______________________ _
TotaL __________________________________ _ ----~----1--- - -1-----1- - - - 153,865
23,233.25
48,540.44
225,677.69
39
====~====l=====~====I=== ==
Alaska:
Ketchikan ________________________________ _
0
0
0
0
0
Wrangell _________________________________ _
Total. __________________________________ _
Hawaii:
AhukinL__________________________________
Hilo. ______________________________________
Honolulu________ __________________________
KahuluL__________________________________
Lahaina___________________________________
Mahukona______________ ______ __ _____ ___ __
Port Allen_________________________________
0
0
20.00·
0
0
60.00
9. 66
4,139.66
50.00
0
100.00
0
0
0
0
0
0
0
0
0
0
0
45
0
0
45.00·
0
- - - -~----1-----1
-----1----9.66
50.00
4,364.66
TotaL___________________________________
4,305 ===O=l======l=====I======
Puerto Rico:
Aguadilla_____________________________ _____
Arecibo____________________________________
Arroyo ________ ---------------------------Central Aguirre___________________________
Fajardo_._-------------------------------Guanici1.__________________________________
Humacao__________________________________
Mayaguez_________________________________
Ponce __ ----------------------------------San Juan__________________________________
15
40
0
0
0
0
0
0
0
15.00
0
0
0
40.00
0
0
0
40
0
0
40. 00·
0
25.00 ·
0
0
25
0
200
0
10.00
10.00
220. 00
25
0
0
0
25.00
200
0
0
0
200. 00 ·
20.00
0
660.00·
640
0
4,670
0
180.00
105. 87
4,955.87
- - - -1-----1-----1-----1----115.87
210. 00 l=====I========
6,180.87
Tota.l____________________________________
5,855 ===o= l=======
0
Virgin Islands:
5,439
O
84. 00
13. 60
5, 536. 60
Charlotte Amalie__________________________
Christiansted______________________________
30
0
0
0
30. 00Frederiksted______________________________
532
0
0
0
532. 00
TotaL ___________________________________ ~ ===o=l===8=4.=0=0=l===13=·=60=l:==6=,0=9=5.=6=0
Total, all stations________________________ $170,026
$39 $23,577.25 $48,679.57 $242,321.82:
1 Includes
2 Includes
Port Aransas, Tex.
Reedy Island and Lewes, Del.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
a Includes Perth Amboy, N. J.
' Includes all ports on Puget Sound.
PUBLIC HEALTH SERVICE
84
MEXICAN BORDER STATIONS
TABLE
3.-Summary of quarantine transactions on the Mexican border for the
fiscal y ear 1931
Station
Brownsville, Tex ___ _________
Calexico, CaliL _____________
Columbus, N. Mex ______ ; ___
Del Rio, Tex ___ _____________
Douglas, Ariz _______________
Eagle Pass, Tex _____________
El Paso, Tex.I _______ ________
Hidalgo, Tex ___ _____________
Laredo, Tex.i ________________
Naco, Ariz __________________
Nogales, Ariz ________________
Presidio, Tex __________ ______
Rio Grande City, Tex _____ __
Roma, Tex __________________
San Ysidro, CaliL __ ________
Thayer (Mercedes), Tex _____
Zapata, Tex _________________
TotaL _____ ____________
1
J
Number
of perfrom
interior
of Mexico
inspected
SODS
Total
Total
Number
Total number number
of local number of per- of persons
persons of persons sons
passed
inspected inspected disin- without
rested treatment
- - - - ---- --736,649
5,729
742,378
0
23,955
23,955
264
1,187
1,451
653
69,651
70,304
174
840
1,014
18,654
564,090
582,744
11,545 6,058,326 6,069,871
2,718
318,877
321,595
153,930 1,740, 587 1,894,517
21
3,033
3,054
4,544
1,655
6,199
1,112
56,816
57,928
267
7,606
7,873
1,820
50,289
52,109
2,355
5,374
7,729
41,525
88
41,613
25
17,300
17,325
741,904
0
22,751
0
1,288
0
69,547
98
906
0
581,162
163
25,233 6,040,728
319,352
0
271 1,892,290
2,588
0
5,972
127
53,975
240
7,592
0
51,275
0
6,821
0
41,161
30
16,583
0
473
1,199
162
692
108
1,419
3,910
2,243
1,956
466
100
3,713
281
834
908
434
742
203,899 9,697,760 9,901,659
26,162 9,855,895
19,640
----
Includes Fort Hancock, Guadalupe Gate, and Ysleta.
Includes Minera and San Ignacio.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total Total Total
number number pieces
of per- of sick of bagSODS
refused gage
vacci- admis- disinnated
sion
fected
---- --- - -- - -1
5
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
0
132
2,804
0
438
0
0
73
0
24
0
5
0
----3,52 2
7
TRANSACTIONS AT UNiTED STATES AIRPORTS
TABLE
OF
ENTRY
FOR
AIRPLANES FROM FOREIGN PORTS
4.-Summary of transactions at continental and insular stations for the fiscal year 1937
Location
Ajo, Ariz ............•................. .
ir:~~d~htatii.~=== ====== ============= =
Albany, N. Y .•......... .........•.....
Bangor, Maine 1•••• • •••• •••••••• •••• ••
Bellingham, Wash........... ..........
Brownsville, Tex.......................
Name of airport
Distance
in miles
to near•
est Pub•
lie Health
Service
station
Municipal Airport .. •--·· ·· ··················· ··
6
~~~;~~ai:agra~:
==========
Municipal Field.... ..................... .......
10
Bangor Municipal Airport 2•••••••• •••• ••••• •••••• ••••••••
Graham Airport'···· ··························· ..........
Municipal Airport ........... _..................
5
~ase·i.~-:::::::::::::::::=====
Buffalo, N. Y . . ........................ {~J1~c~ptia~~~Afrport2~.·.·.·.·.·.·.·.·.·:.·.·_-_-_-_-:====== ==========
D ate desig•
nated
Number
of air·
planes
arriving
from for·
eign
ports
Num,ber Number
of air• of p~r~ons
arnvmg
. planes
inspecte?, frol!l for•
bir~Jt~IC pi:Fsor
Service
places
Number
of persons
inspected
by Public
Heal.th
Service
Number
of aliens
inspected
by Public
Heal_th
Service
Number
of aliens
certified
for dis•
ease
0
0
0
0
0
0
Nov. 15, 1929
.:":~~~ .. ~~~~~. ·······49. ·······49· ...... ii34 ....... 634. ·······is· ·········o
Sept. 28, 1928
0
0
0
0
0
0
June 26, 1936 ........................................ . ....•.... . .........
0
0
0
0
0
0
Apr. 18, 1931
4,693
4
Jan. 8, 1930
4,693
436
436
764
~~;
~i: ~i:
0
0
0
0
0
0
0
0
0
0
0
0
2*:~t~iit~:i~~================= 2~:~:~ii~:!fi~i~~~~~;================= ========== i;~ ~: t!H ::::::::~: ::::::::~: ::::::::~: ::::::::~: ::::::::~: :::::::::~
Caribou, Maine 1•••••••••••••• •••• ••• ••
Charlotte Amalie, V. L......... . ..... .
Cleveland, Ohio ..... . ..................
Crosby, N. Dak.1............ ..........
Caribou Municipal Airport .•............ ............. ... .
Charlotte Amalie Airports ................................
Cleveland Municipal Airport . ...... ......................
Crosby Municipal Airport 2••• •••••• • •••••••• • ••••••••• •••
15
Wayne County Airport.........................
Detroit, Mich.... .......... ............ {Detroit Municipal Airport......................
5
Douglas, Ariz.................... ...... b~:g~~ri~~~·ort.·.~== ======= ==== ====== ======== === ==========
Duluth Mi n
{Duluth Municipal Airport 2••••••••••••••••••••• ••••••••••
'
n ··••············•········ Duluth Boat Club Seaplane Base 2••••••••••••••••••••••••
Eagle Pass, Tex........................ Eagle Pass Airport..............................
1½
El Paso, Tex ..................•........ Municipal Airport...............................
9
Fairbanks, Alaska 1.............. . ..... Weeks Municipal Airfield ........................•........
Glendale, CaliL... .................... Grand Central Air Terminal 3...................
12
Great Falls, Mont.I.. . . ................ Great Falls Municipal Airport 2••••••••••••••••• ••••••••••
Havre, Mont ........................... Havre Municipal Airport 2•••••• ••••• ••••••• •••••• ••••••• •
Honolulu, T. H........ ................ Honolulu Airport 3.............................. . . . . . . . . . .
Juneau, Alaska ......................... Juneau Airport.......... ........................
8
Ketchikan, Alaska..................... Ketchikan Airport. ..•.................•........ . ..••.....
Key West, Fla......................... Meacham Field.................................
4
Lakehurst, N. 1-•••••.•.•..••..•••••••• U.S. Naval Airports····· ···· -· --··---·-·-·---50
1 No 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
Oct. 31, 1932 .......... ······ · ·-· .........................•.... . .........
0
·········-·····
53
53
658
658
0
Sept. 23, 1932
0
0
0
0
0
0
June 28, 1934 ..... ..... ....................... . ......................... .
Feb. 10, 1931
0
June 19, 1931
123
0
273
0
0
fa~~Sept.
Sept.
Mar.
Aug.
Apr.
~i:
0
0
~:
0
0
0
0
4, 1931 }
0
0
0
0
0
0
4, 1931
5, 1930
0
0
0
0
0
0
23, 1932
4
4
10
10
0
0
1, 1935
······ ·- ······ ···- .•.......................•..............
...............
163
163
1,136
1,136
0
0
June 2, 1930 .....•......................................................
June 2, 1930
0
0
0
0
0
0
...............
48
48
745
745
15
0
June 18, 1930
0
0
0
0
0
0
June 18, 1930
0
0
0
0
0
0
Dec. 20, 1927
24
24
71
71
1
0
·····---·-··--·
8
7
744
744
505
0
00
~
TABLE
4.-Summary of transactions at continental and insular stations for the ftscal year 1937-Continued
Location
N rune of airport
Distance
in miles
to nearest Public Health
Service
station
Date designated
Number
of airplanes
arriving
from foreign
ports
N~ber Number
of air- of p~r~ons
. planes
arrivmg
inspect~ fro~ forby Public
eign
Heal.th ports or
Service
places
Number
of persons
inspected
by Public
Health
Service
00
~
Number
of aliens
inspected
by Public
Health
Service
Number
of aliens
certified
for dis-
ease
---------------•1-------------------1----1------1---- - - - - - - - - - - - - - - - - - - - Laredo, Tex ________ __------- ----------- Laredo Airdrome________________________________
3½
Malone, N. Y -------------------------- Malone Airport , _________________________________________ _
Pan American Field______ ______________________
14
Miami, Fla______ ____ __ _____ _____ ______ Dinner Key Seaplane Base_____ __ _________ ___ ___
11
{Viking Airport and Seaplane Base_______________
4
Nogales, Ariz __________________________ Nogales Municipal Airport______________________
7
~!!~~~~:ff.
~-ar.~~===~===============
n1!'X~~rorf_-=========================
-------5-Plattsburg, N.
Y .1________ ___ ___ ____ ___ ~~1ti!~~r
Plattsburg Municipal
Airport
Portal, N. Dak _________________________
Port Angeles, Wash-------------------Port Townsend, Wash_________________
Put-in-Bay, Ohio '- -------------------Rochester, N. Y __ __ _________ __ _________
Rouses Point, N. y ____________________
San Diego, Calif. ______________________
Sandusky, Ohio__ ___ _______ ____ ________
San Juan, P. R __ _. _. __ _____ _______ ____
Sault Ste. Marie, Mich_________________
::::~:: ::ni~::::~~:::~:::::::::::::::
Skagway, Alaska 1 ___________________ __
Spokane, Wash. 1 ______________________
Swanton, Vt.1 _____ . __ __________________
Tampa, Fla ____ __ ______________________
Watertown, N. Y.l __ ___________________
West Palm Beach, Fla_________________
Wrangell, Alaska _______________________
2__________________ ________ _ _
Portal Airport_ _____________________ _____________________ _
Port Angeles Airport____________________________
52
Port Townsend Airport__________ __ _____________
6
Put-in-Bay Airport.---------------------------- _________ _
Rochester Municipal Airport 2 _ __________________________ _
Rouses Point Seaplane Base, __ ___ _______________________ _
San Diego Municipal Airport___________________
6
Sandusky Municipal Airport. ____________________________ _
Isla Grande Airport. _____________________________________ _
Sault Ste. Marie Airport'----------------------- _________ _
{ir:~t~:~~f;aiXir-1Ne1c1~==================== ====::::::
Skagway Municipal Airport_ ______________ ____ __________ _
Spokane Municipal Airport 2____________________ _________ _
Missisquoi Airport.. __ _________ __ _____ _____ ______________ _
International Airport 2________ __________________
7
Watertown Mumcipal Airport 2__________________________ _
Roosevelt Flying Service Base __________________ ---------Wrangell Seaplane Base _______________________________ ___ _
Jan.
Apr.
Oct.
Mar.
May
June
Mar.
Feb.
June
Jan.
Jan.
June
Mar.
Nov.
July
Jan.
June
Jan.
Aug.
June
Sept.
Dec.
Nov.
June
July
Dec.
June
Mar.
Nov.
24, 1930
6
18, 1930
2
16, 1928
31
7, 1930
1,207
16, 1934
24
27, 1929
16
1, 1932
0
2, 1930
351
2, 1930 ---------8, 1930
0
8, 1930
0
18, 1930
0
12, 1934
0
7, 1936
14, 1932
0
24, 1930
233
1, 1937
0
19, 1929
341
4, 1933
0
2, 1930
0
11, 1928 }
910
27, 1928
30, 1931
2, 1931
18, 1930
-0
1, 1933
2, 1930
10, 1931
65
30, 1931
0
Total ___ - - - ____ --- - --- ------ - --- _ -- -- -- - - -- --- -- - -- -- -- --- - -------- -- ------ -- -- ---- - - -- -- - -- - - - -- -- -------- 1 No medical
2 Temporary
officer of Public Health Service on duty.
permission.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
4,094
0
1,841
14
0
135
24,771
84
42
0
0
0
0
10
3,678
15
1
0
0
0
0
0
19
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27
0
341
0
0
0
0
0
725
0
4, 929
0
0
4, 230
0
0
73
0
4, 929
0
0
0
0
0
0
0
797
0
0
0
-0
0
0
0
1
0
0
0
0
-----0
65
187
187
37
0
0
0
0
0
0
2,499
45,936
38,926
5,841
24
6
0
30
1,206
24
16
0
0
14
5
136
24,779
84
42
---------- ------------------------------------0
0.
0
0
-
0
--
~
0
87
PUBLIC HEALTH SERVICE
CANAL Z ONE
'TABLE
5.-Quarantine activities of the government of the OanaZ Zone during the
fiscal year 1931 1
Activities
Balboa
Cristobal
2,782
36
3,529
70
Vessels boarded and passed __----------··-·---·-··-······-···· .• ·--·-····Vessels granted pratique by radio ..•.•••••••••••••. _.•.....• •••••..•••....
Total number of vessels passed •• -··································
Crew passed at quarantine......•.••...• _•.•.•...•..•••. •..•.•...•.• ...•..
·Crew passed by radio ..•... ......... ·-··-·····-··· · ··· .... ········ ···-····
Total
6,311
106
2, 818
3,599
6,417
139,164
10, 307
226,278
22,387
365,442
32,694
- - - - - - --
---- ---- - ---
Total number of crew passed .•••••• ·-·· · ·-··························
149,471
248,665
398,136
Passengers p assed at quarantine .••••• ····-······-···· ··················-Passengers passed by radio . _--········--······-··· · .....•......... .....•.
45,466
2,131
114,004
0
159,470
2,131
Total number of passengers passed.• ·-- ········ . •.•.•...•••.•.•.••.
47,597
114,004
161,601
.Supplementary sanitary inspections of vessels....•.•.. . ..•...•...•.•.•••••
Vessels fumigated with HON gas . .•..•.•••• ·-·· · ···········-·······-·-···
Box cars fumigated with HON gas ...•.•.•...•...•...........•..• • • ·-·····
1,312
25
92
2, 495
44
154
3,807
69
246
Fumigation certificates issued to vessels.·--·············-··········· · ·····
Deratization exemption certificates issued.·-·······-·· ············ ········
Rodents recovered after fumigation .••••..•••.••••••.. ·--···············-·
15
11
316
44
5
80
69
16
395
Airplanes inspected and passed .••.•• ·-·-··-·············-······ ......•••.
-Crew of airplanes inspected and passed·--························· · ······
Passengers of airplanes inspected and passed .••• • •• •.......••••.•..•...•••
253
986
2,189
374
1,135
2,035
667
2,171
Vessels detained in quarantine .•.•..••.....•.• ·-··························
Crew detained on board ship for quarantine---········-················· ·
0
0
0
0
0
1
4,224
0
Surg. O. E. Denney, U . S. Public Health Service, detailed as chief quarantine officer.
MEDICAL INSPECTION OF ALIENS
6.-A.lien passengers and seamen inspected and cerUfie-d at maritime
ports in the United States and possessions during the fiscal year 1931
TABLE
Place
Alien passengers certified 1
Num•
ber of
alien
pas• Class A
sengers - - - Class Class Total
C
exam•
B
II
I
ined
- -
Num•
ber of
alien
sea•
men
exam•
ined
Alien seamen certified
1
Class A
- - - Class
B
-- ----- --
I
II
-
Class Total
C
----
--
ATLANTIC COAST
1 33
0 16,292
0
0
0
0
26
3
178
63
Baltimore, Md_ •.• ···-··-··
0
0
0
0
0
0
0
0
0
0
0
0
Beaufort:r}. O .••••• ·-······
2 81
5 11
381
397 69,098
Boston, ass .•••••••••.•. _. 6,175
0
59
0
142
0
81
0
0
0
0
0
0
0
0
0
0
Brunswick, Ga_·-·········-·
0
0
0
0
3,637
0
8
0
159
0
0
Charleston, S. 0 .••••••.•. - .
8
0
0
0
0
0
0
0
107
0
0
Fall River, Mass •••••••.• -.
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Fernandina, Fla.·- ·········
299
0
3
3
8,397
0 30
10
0
Fort Monroe, Va. 2
40
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Fort Pierce, Fla.··--···---·
2
0
0
0
0
0
0
0
0
0
0
0
Georgetown, S. 0 ..•••••• ·-·
228
0
0
0
0
0
0
0
0
0
0
0
Gloucester, Mass •••• ·--····
2
25
0
3,403
0
0
0
0
0
0
0
2
.Jacksonville, Fla.•••••••••••
1
26
26
0
0
899
0
0
0
1
0
Key West, Fla .•••••••• ·-··- 1,582
0
0
0
0
0
0
0
0
0
0
0
0
Lewes, Del. •• ·····-········
92
97 14,815
0
1
1
0
0
0
Miami, Fla .•• - •••••••.•••.• 17,854
3
0
14
42
18
18
0
0
0
1
1
·New Bedford, Mass .• _.••••
0
0
0
0
0
0
0
0
0
0
0
0
New London, Conn .•.••. -.
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Newport, R. L ..•... ·-· -·· ·
·New York, N. Y. (Ellis Is•
7
16
3 243
30 9,803 460,238
269
land) . • . ·····-···-·····-·· 157,647 36 56 9,681
2
Perth Amboy, N. J ••••••• __
1,206
0
0
2
0
0
0
0
0
0
0
0
0
110
0
5
6
Philadelphia, Pa ...•••••••••
0
0
0 20,365 69
80
Plymouth, Mass . ..••• ·-····
0
0
0
0
0
0
76
0
0
0
0
0
Port Everirlades, Fla ..•... _. •.••.••. -·-- _________________ -·----- --···--· ···- •••• ·····- ·-··-· -·-·-·
1 Class A-I: Aliens certified for idiocy, imbecility, feeble•mindedness, insanity, epilepsy, chronic alco•
bolism. Class A-II: Aliens certified for tuberculosis or other loa thsome or dangerous contagious disease.
Class B: Aliens certified for diseases or defects which affect ability to earn a living. Class C: Aliens certified
;for diseases or defects of less degree.
t Includes Norfolk and Newport News, Va.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
88
6.-A.lien passengers and seamen inspected and certified at maritime ports·
in the United States and possessions during the fiscal year 1937-Continued
TABLE
Alien passengers certified
Alien seamen certified
NumNumber of
ber of
alien
alien
pas- Class A
sea- Class A
Class Class Total men - - - Class Class
sengers
examC
B
examB
C Total
I II
I II
ined
ined
--- - - - - --- - --
Plare
-
- -
- -
COAST-Continued
Portland, Maine ____________
94
Providence, R. !_ ___________
0
Savannah, Ga __________ _____
56
Searsport, Maine _______ ____
Vineyard Haven, Mass _____
0
Washington, N. c ____ ______
0
West Palm Beach, Fla ______
63
0
Wilmington, N. C -- ------- Total. ________________ - - - -
--
ATLANTIC
0
0
0
0
0
0
0
0
0
0
0
0
0
·-o·
184,286
--- -
44
0
0
0
0
0
0
2,842
910
2,594
0
14
6
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
279
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
142
111
166
2,198
0
0
0
0
0
0
0
0
0
0
0
"ii5;112·
0
3
0
0
1
0
0
0
4
332
4,982
18
0
8
19
0
10
0
0
14
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
16
0
0
0
0
0
0
0
0
28,851
96
0
957
0
0
7
0
0
0
0
0
0
0
0
95
0
0
8
0
0
10
0
0
0
0
0
0
0
0
0
PACIFIC COAST
INSULAR
Hawaii:
Honolulu ______ _________
0
0
0
0
0
0
0
0
0
O•
0
0
0
0
0
0
0
0
0
0
0
0
0
O·
0
-·--o- --··o-
4
14
0
9,207
3,125
10
---T
0
0
0
1
0
0
42
0
0
0
0
0
0
1
0
24
0
0
0
0
0
0
0
40
0
19
0
168
o,
0
8
0
0
10,
11
-- - - -- -- ------- -66,879
17
33 152
47
2
24
256
20
--- - - - - - - - - - - - - - - =
0
0
0
0
0
126
0
0
0
0
0
4
0
0
0
402
0
21
0
0
429
0
0
0
181
9,477
1,522
0
0
51,651
0
0
0
0
7
18
10
0
0
103
9
0
0
0
24
0
0
0
0
2
27·
10 ·
0
0
136-
0
0
1
2
0
0
34
0
490
0
302
5, .505
2,181
0
10,551
352
0
0
0
0
0
0
1
0
0
0
13
1
14
0
8
0
0
0
0
0
15
0
4
0
0
0
0
13
1
19
0
0
0
1
0
0
1
0
0
0
0
0
0
0
6
0
6
0
157
0
0
3
0
0
0
1
1
0
0
0
0
0
18
0
0
9
0
0
0
0
0
0
29
0
0
0
13·
0
- - -------- 33- - -647- --82,157
52
579
2
8 167
229·
--- - - - - - - - - - - - - - - =
-6
29
-
0
0
0
0
0
0
0
0
0
0
0
O·
3,678
0
6
26
3
35
33,4!l2
0
0
6
0
6
0
0
0
0
0
82
0
0
0
0
0
0
0
0
1
1
0
0
0
125
0
0
0
0
0
0
68
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
--- Philippine
Islands:
Cebu ___________________
6
Davao __________________
205
Iloilo. __________________
21
J olo ___________ ------ -- -347
Legaspi._ _______________
Manila. __________ ______ 26, 1670
Zam boanga. ____ • ____ • __
112
--Tota}. ________________ 26,858
0
0
0
0
0
0
0
-
1
1
0
0
0
43
0
- 0 -45
---- -
a Includes all ports on Puget Sound.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
---··o-
~-
0
0
0
2
0
0
0
2
--- -
A laska:
Ketchikan ______________
0
- --- - - - - - - - - - - - - - .- -49 10,344 595,481 89 409
632·
68 10,183
26
108
- ---- - --- --- - - - - - - =
GULF COAST
Bo<'a Grande, Fla ___________
0
1
Brownsville, Tex .. ______ --0
0
Carrabelle, Fla. __ . _________
0
0
Corpus Christi, Tex. _______
2
0
Freeport, Tex ___ __ _____ _____
--ii--i;408Galveston, Tex._----------Gulfport, Miss .••... _______
0
0
Mobile, Ala ________ ___ ___ ___
0
198
Morgan City, La. (Atchafalaya) ___________ ------ -- •
0
0
New Orleans, La ____ ____ __ __ 1,549
1
Panama City, Fla ___ _______
0
10
0
0
Pascagoula, Miss .• --------Pensarola,
Fla __________ ____
0
11
Port Aransas, Tex . . ________
0
0
Port St. Joe, Fla ____________
0
0
Sabine, Tex _________________
0
32
Tampa, Fla __ _______________
0
175
Total. ________________ - - - - 1 3,386
--- - -
Aberdeen, Wash ___ _________
1
Angel Island, Calif., (San
Francis<'o) . _______________ 6,586
Astoria, Oreg _______________
45
Eureka, Calif... ___ _________
0
Fort Bragg, CaliL __________
0
Los Angeles, Calif__ _________ 4,470
Marshfield, Oreg. (Coos
0
Bay) _____ ----- -----------Monterey,
CaJiL ___________
0
3
Portland,
Oreg
..
---------~-San Diego, Calif. ___________
711
San Luis Obispo, CaliL ____
4
Santa Barbara, Calif.. ______
0
Seattle, Wash.a _____________ 2,682
South Bend, Wash _________
0
-Total. ________________ 14,502
0
0
0
--- - ---- --- -
- - - - - - - - --- 82
127
68
0
0
--- - - --- --- -
-
0
0
0
0
0
0
0
-----0
0
0
0
0
0
-- -O·
- 0 -0
0
=
,
=
89
PUBLIC HEALTH SERVICE
6.-Alien passengers and seamen inspected and certified at maritime ports
in the United States and possessions during the fiscal year 1937-Continued
TARLE
Place
Alien passengers certified
Number of
alien
pas- Class A
sengers - - - Class Class Total
B
examC
I II
ined
- -
NumAlien searrien certified
ber of
alien
sea- Class A
men - - - Class Class Total
exams
B
C
I II
ined
--- - - --- --- -- --
--
-
INSULAR-continued
Puerto
Rico: _______________
Aguadilla
0
0
0
0
0
0
25
0
0
Arecibo _________________
0
0
0
0
62
0
0
0
18
Arroyo __________________
0
0
0
0
0
C
0
0
0
Central Aguirre (Jobos) _
40
0
18
0
0
0
0
0
0
Fajardo _________________
176
0
0
0
0
0
C
0
0
Guanica. _______________
7
0
0
0
0
338
0
0
0
Humacao _______________
22
13
0
0
0
0
0
0
0
Mayaguez ______________
13
227
1
0
0
0
0
0
0
Ponce ___________________
71
0
0
0
0
893
0
0
0
San Juan _______________ 4,815
14
1
2
17
9,786
0
0 22
-- - - ----- --TotaL _______________ -4,955
1
14
2
17 11,569
1 22
0
--- - - --- --- - Total, all stations _____ 237,665 52 148 10,901
89 11,190 789,646 131 750
--
-
--
TABLE
0
0
0
0
0
0
0
1
0
0
0
0
.o
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
24
216
52
1,149
2
-----3
0
26
------
7.-Aliens inspected and certi"fied at international border stations during
the fiscal year 1931
Place
Number
of
persons
making
permanent
entry examined
Number
of
Total
persons Other
making persons number
of
tempo- exam- sonsperexrary en- ined
amined
try examined
Aliens certified
Class A
Class
B
Total
I
II
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 __________________ -CANADIAN BORDER
Bellingham, Wash _____________
Blaine, Wash __________________
Buffalo,
N. Y -----------------Calais, Maine
__________________
Chicago, Ill ____________________
Detroit, Mich _________________
Duluth, Minn _________________
Eastport, Idaho ________________
Eastport, Maine _______________
Erie, Pa _______________________
Halifax, N. S., Canada_________
Havre, Mont. _________________
Houlton, Maine _______________
I nternational Falls, Minn ______
J ackman, Maine _______________
1
0
471
439
0
24
38
179
363
58
1,311
21
347
7
3
2
379
0
0
0
0
436
119
43
0
5
15
8,437
7
1,593
0
156
3
0
0
937
0
0
207
2,000
360
23,396
1,297
8,395
971
11,038
8,842
737
85,783
3, 0.33
1,301
1,283
135
5
6,313
209
281
166
0
109
117
0
6
89
60
1,595
88
227
242
302
140
11
2
172
31
67
0
0
5
5
0
0
8
7
50
6
9
13
11
2
0
0
7
0
25
0
0
6
17
0
0
35
3
205
6
20
40
56
37
8
0
17
1
22
0
0
52
52
0
6
17
31
1,325
23
194
92
130
!15
3
1
148
22
17
0
- - - - - - - - - --- -- - - ----148
3,642
473 2,208
11,958 155, 54.5 171,145
3,258
=
=
0
498
444
505
0
2,701
0
205
5
0
356
0
14
80
42
=
0
0
0
0
826
0
0
588
6
2
19
756
2,627
0
65,474
0
63
lil
416,555
1,086
1,276
507
19
4,709
3,157
465
65,479
0
747
10
70
420,496
37
71l
1, 2.'i2
530
260
0
0
328
10
5
3,861
0
0
Includes Fort Hancock, Guadalu.Pe Gate, and Ysleta.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2,000
1,267
23,954
1,340
8,419
1,014
11,232
17,642
802
88,687
3,054
1,804
1,293
138
7
7,629
209
281
373
0
226
333
9
17
506
2
10
1
0
304
0
7
44
39
0
16
16
2
0
101
0
0
1
0
5
0
2
3
4
0
4
0
1
12
24
0
1
0
0
6
0
4
1
0
0
50
123
5
5
381
2
9
0
0
111
0
1
38
9
0
46
43
0
0
29
19
15
53
4
97
105
6
0
1
0
8
3
0
4 29
0
156
194
1
0
0
0
0
0
0
182
0
0
2
26
PUBLIC HEALTH SERVICE
90
TABLE
7.-Aliens inspected and certified at international border stations during
the fiscal year 1937-Continued
Place
Number
of
persons
making
permanent
entry examined
Number
of
Total
persons Other
making persons number
of
tempo- exam- sonsperexrary en- ined
amined
try examined
Aliens certified
Class A
Class Class
B
0
Total
I
II
- - - - - - - - - - - - - - - - - - - -BORDER-continued
Lewiston, N. y __ ___________ __ _
Malone, N. ¥ _________________
Montreal, Canada _____________
Newport, Vt ___________________
Niagara Falls, N. y ___________
Noyes, Minn ________ __________
Ogdensburg, N. y _____________
Oroville, Wash ________________
Portal, N . Dak _______________ _
Port Angeles, Wash ___________
Port Huron, Mich _____________
Quebec, Canada _______________
Rouses Point, N. Y ____________
St. Albans, Vt_ ________________
St. John, N . B., Canada _______
Sault Ste. Marie, Mich ________
Scobey, Mont _________________
Sumas, Wash __________________
Sweetgrass,
Van Buren, Mont---~---------MRine _____________
Vanceboro, Maine _____________
Vancouver, B. C., Canada _____
Victoria, B. C., Canada __ ______
Winnipeg, Man., Canada ______
Yarmouth, N. S., Canada _____
CANADIAN
Total_ --- ---- -.. .. -------Total, all stations ________
TABLE
0
1
2,678
180
325
9
14
8
15
0
295
528
43
87
411
4
6
15
436
36
261
0
277
1,014
0
0
8
0
2
213
0
7
19
0
1
291
2,097
0
1
180
0
0
31
0
6
1,482
789
156
368
34
0
30
0
529
827
26
0
44,129
6
0
670
755
143
52
0
0
268
49
5,202
1
13
0
0
4,080
37
0
39
2,678
711
1,365
35
21
44, 156
21
1
1,256
3,380
186
140
591
4
274
95
5,638
43
1,756
789
433
5,462
71
0
4
493
149
84
20
11
0
7
0
181
320
44
22
39
3
0
26
2
5
0
172
80
1,349
37
0
0
44
8
9
5
3
0
1
0
14
5
9
7
3
1
0
0
2
0
0
11
4
11
4
0
1
0
0
1
3
0
0
0
0
4
0
6
1
0
2
0
2
0
1
0
3
0
5
2
0
0
372
4
56
10
5
0
2
0
128
263
28
11
24
0
0
24
0
3
0
156
37
1,139
31
39
194
0
12, 757
542,995
567,245
4,546
291
84
3,027
1,144
0
3
77
137
18
2
3
0
4
0
35
52
1
3
12
0
0
0
0
1
0
2
--- --- - - - --- ---- - - -- --- -11,493
15, 135
-- = = - - =
=24,715 =698,540 =738,390 -7,804
439
557 5, 235 1,573
8.-Alie,n, seamen inspected and certified at international border stations
during the fiscal year 1931
Alien seamen certified
Place
Number
of alien
seamen
examined
Class A
Class B
I
Bellingham, Wash _______________________ _
Buffalo,
Y --___________________________
---------------------------_
Chicago, N.
Ill ..•
Duluth, Minn ___________________________ _
Eastport, Maine .• _______________________ _
Erie, Pa._-------------------------------Ogdensburg,
Y -----------------------Port
Angeles,N.
Wash
______________________ _
Port Huron, Mich _______________________ _
Sault Ste. Marie, Mich _________________ __
TotaJ. ___ • --- --------- -- -- ---- -- ----
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
369
13,129
1,420
75
268
762
138
63
258
97
Class 0
Total
II
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
46
54
1
0
0
0
0
25
0
0
98
2
0
0
0
0
0
4
0
0
144
61
1
0
0
0
0
29
0
------------------126
104
235
16,579
0
5
91
PUBLIC HEALTH SERVICE
TABLE
9.-Distribution, according to class, of applicant~ for immigration visas
who were medically examined during the fiscal year 1937
Total
number
of applicants examined
Country and consular office
Number of applicants in
each class
Quota
Nonquota
Nonimmigrants
---- ---- --WESTERN HEMISPHERE
'Cuba· Habana __ ·--------~---------------------------------------
1,151
702
449
0
Canada, totaL _-- ----- ------- ---- --------------- --- -- -- -- --- -----
18.039
4,995
12,448
596
412
4,299
1, 448
4,606
1,735
259
0
1,652
386
1, 120
211
14
412
2,647
1,062
3,486
965
245
0
0
0
0
559
0
19,190
5,697
12,897
596
33,524
24,781
8,734
2,650
582
174
418
13,674
2,005
326
104
245
13,130
645
248
69
173
544
0
8
1
0
0
1,804
9, 320
1,673
9,042
131
278
0
0
896
1,436
389
476
587
860
885
324
360
452
36
551
65
116
135
0
0
0
0
0
MontreaL.
___ ------ --------------- ---- -- -----------------. ___
Quebec ______________________________________________________
Toronto _____________________________________________________ _
Vancouver _____ -------------- _____________ __--- _________ ____ _
Windsor _____________________________________________________
---------------------------------------------------_
Winnipeg
Yarmouth __________________________________________________ _
-- ---- ---1,612
3,631
5,280
37
All countries, Western Hemisphere ________________________ _
EASTERN HEMISPHERE
Europe, totaL _________ ----- _____________________________________ _
Belgium: Antwerp ______ -----------------------------------England:
______ -------------------------------------Irish
Free London
State: Dublin
__________________ __________________ _
Northern Ireland: Belfast ___________________________________ _
Scotland: Glasgow ____________________ ----------------------Germany, totaL __ ------------------------------------------Berlin ____________________________________________ ______ _
Hamburg ________________________________________ _______ _
Stuttgart ___ __ ____ -- -- ------ -- ______ -- ---- ______ _____ - ___ _
:Holland: Rotterdam ________________________________________ _
'Poland: Warsaw _____________ ______________ ________ _________ _
Denmark:Oslo
Copenhagen
__ ---------------------------- __ _____ __
Norway·
_______________________________________________
·Sweden, totaL _---------------------------------- -- -- ---- ---Goteborg _____
------------------------------------------_
Stockholm
___________
------------------ _________________
9
-----------0
811
881
70
-- - -135
---- ---0
2,415
2,550
---0
---------223
72
295
292
229
63
0
Italy·
Naples _____
------------------------------------------Czechoslovakia:
Prague
_____________________________________ _
Austria: Vienna _____ ----------------------------------------
8,564
2,162
635
3,139
1,602
538
5,425
560
97
0
.Philippine Islands: Manila ___ ----------------------------------All countries, Eastern Hemisphere ________________________ _
199
153
65
33,723
24,914
8,799
'23690-37--7
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
0
0
10
DIVISION OF SANITARY REPORTS AND STATISTICS
.Asst. ·Surg. Gen.
ROBERT OLESEN
in charge
The chief functions of this Division, the collection, publication, and
dissemination of data relative to the prevalence a:nd outbreaks of
diseases both in the United States and in foreign countries, and public
health education, were continued through the fiscal year 1937. Information regarding the prevalence of diseases, reports of scientific
investigation, and other articles relating to health and sanitation
were published in the Public Health Reports, which is issued each
week by the Division. The year 1937 marked the 52d annual
volume of this publication. The Division also has charge of the
distribution of Public Health Service publications.
MORBIDITY AND MORTALITY REPORTS
J
UNITED STATES
Through the cooperation of the State and local health officials, who
hold appointments from the Public Health Service at a nominal
salary, the collection and publication of reports of notifiable diseases
continued, and State and local health officers, as well as others, were
kept currently informed, through the Public Health Reports and by
other means, of the prevalence of the important communicable
diseases.
Weekly reports showing the current prevalence of diseases by
States were received by telegraph from the State health officers,
while weekly mail reports were received from health officers of citjes.
of over 10,000 population.
The information contained in the State telegraphic reports, showing the current rise or fall in the incidence of the notifiable diseases,
was compiled, issued promptly in mimeographed form, and released
to all State health officers. The same data were published later in
the Public Health Reports, which also included the compilations from
the city reports and the monthly summaries, giving additional data.
The annual summaries from States and cities showing the number
of cases of notifiable diseases and deaths from these diseases for the
calendar year 1935 were published during the year.
The accompanying tables give a comparison of the numbers of
reported cases of the principal notifiable diseases, with recorded
deaths, in the United States for the calendar years 1934, 1935, and
1936.
92
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
93
PUBLIC HEALTH SERVICE
Nitmber of cases of certain communicable diseases and cases per 100,000 population in large groups of States in the United States during 1934, 1935, and
1936
Number of
Statesi
Disease
Aggregate population
(in thousands)
1934
Chicken pox ______________
Diphtheria ________________
Influenza ______ . _______ .. __
Malaria. __ .• _________ ... __
Measles ___________________
Meningococcus
Mumps
________meningitis.
__________ _
Pellagra ____ . _________ . • ___
Pneumonia (all forms) ____
Poliomyelitis _____ .•. ______
Scarlet fever _________ . __ ___
Smallpox ______ . ____ . ___ . __
Tuberculosis (all forms) ___
Tuberculosis (respiratory
system) __ ___ _________ ___
Typhoid fever and paratyphoid fever_ __________
Whooping cough __________
1935
1936
Cases per 100,000
population
Cases
1934
1936
1935
1934
1935
1936
- - - - - - - - - - -- - - - - - - - - - - -42
46
46
45
46
40
37
45
45
46
46
46
46
106,456
124,079
124,079
117,243
124,079
117,319
82,801
117,243
119,744
124, 079
124,079
124,079
124,079
107,429
125,020
125,020
118,313
125,020
117,907
83,253
118,313
120,645
125,020
125,020
125,020
125,020
108,177 225,823 243,062 202,717 212.1 226.3 187.4
125,898 42,624 38,705 29,633 34.4 31.0 23. 5
125,898 -------- -------- -------- ------ ------ -----119,185
125,898 -788~992 742,177 298~430 635.9 593.6 -231:0
6,878
2.0
4.8
5.S
2,314
5,613
118,887
84,000 92,419 127,969 171, 745 111.6 153. 7 204.5
119,185 -------- -------- -------- ------ -----121,473 -------- -------- -------- ------ ------ -----7,490 10,744
4,461
6.0
8.6
3.5
125,898
125,898 . 219, 178 260,202 243,611 176.6 208.1 193. 5
7,820
6.2
125,898
7,897
6. 3
5,288
4.3
125,898 -------- -------0
------
40 109,526 110,161 110,944
-------- --------
-------- ------ ------ ------------- ------ ------ ------
46 124,079 125,020 125,898 21,835 18,003 15, 582 17.6 14.4 12. 4
46 124,079 125,020 125,898 263,792 179,379 146, 894 212.6 143.5 116. 7
Number of deaths and deaths per 100,000 population from certain communicable
diseases, with number of cases reported for each death r egistered, in large
groups of States in the United States during 1934, 1935, and 1936
reported for
D eat hs per lOO,OOO Cases
each death regispopulation
tered
Deaths
Disease
1934
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
119
4,102
20,103
3,798
5,710
1,000
61
3, 224
98,503
851
2,417
19
69,577
55,094
3,919
6,955
1935
1936
141
115
3,694 2,938
27,472 32, 939
3,793 3,485
3,676 1,195
2,382 2,720
67
81
3,252 3,396
99, 140 112, 327
970
723
2,610 2,417
24
33
68,118 69,617
54, 013 55, 399
3,296 2,973
4,427 2,556
1934
0.1
3.3
16. 2
3. 2
4.6
•9
.1
2. 7
82.3
.7
1.9
(2)
56.1
50.3
3. 2
5.6
1935
0.1
3. 0
22.0
3.2
2.9
2.0
.1
2. 7
82. 2
.8
2.1
(2)
54.5
49.0
2. 6
3.5
1936
1934
1935
1936
0. 1 1, 898 1, 724 1, 763
2. 3
10
10
10
26. 2 ------ ------ -----2. 9 ------ ------ -----.9
138
202
250
2. 3
2
2
3
. 1 1, 515 1, 910 2, 120
2. 8 -- ---- ------ -----92. 5 ------ ------ -----.6
9
11
6
1. 9
91
100
101
(2)
278
329
~7
55. 3 ------ ------ -----49. 9 ------ ------ -----2. 4
6
5
5
2.0
38
4I
57
In addition to the number of States given, the District of Columbia is also included.
Less than 0.1 per 100,000 population.
A general rise in the mortality rate from all causes was recorded
for the United States in 1936. The preliminary death rate for 25
selected States of 11.3 per 1,000 population represents an increase of
about 5 percent over 1935.
The provisional infant mortality rate for 1936 was 56.9 per 1,000 live
births, as compared with 55.7 for 1935.
The preliminary rates for 25 selected States indicate a reduction in
maternal mortality in 1936, which, if borne out by the final figures,
will make the 6th consecutive year in which the number of deaths
incident to pregnancy and childbirth has declined.
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94
FOREIGN COUNTRIES
Reports from foreign countries are received :from officers o:f 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.
The accompanying table gives the countries o:f the world in which
the quarantinable diseases are most prevalent and the numbers of cases
and deaths reported for the calendar year 1936, according to information compiled :from the above-mentioned sources. The figures compiled :from these reports must be considered only as a bare minimum,
by no means as complete or final.
Numbers of cases and deaths from cholera, plague, smallpox, t11phus fever, and
. yellow fever reported in certain countries during 1936
I
Country
Cases
I
Deaths
Cholera
India ••• _...•••••••••••••.•• •••
Siam ..•....•.•••.•.•.•.•..•.•.•
French India ..•..•.•...•.....•
French Indo•China .••.•••.•...
Ceylon ••••.... ~ •.•.•...•.•.••.
India .•......••••••••...•.•....
Tanganyika ......•••••.•.....•
Indo•China ...........•.•.•.•.•
Chosen .........•.........•.•.•
249,777
5,043
933
74
44
(1)
(1)
(1)
(1)
(1)
India ••......•....••••...•.•..
Java and Madura .••...•.•.•..
Madagascar ...••••••.•.•.•••••
Uganda .•...••••...•.•........
Kenya .............•.•••...•••
Union of South Africa .... . .. . .
Peru .••.•....••...•.....•.....
····I
1
J
I Deaths
23,883
(1)
2,010
971
239
233
153
10,542
e.2J6
1,914
918
(1)
141
72
Typhus fever
216,956
7,820
4,841
2,873
1,700
1,620
1,400
54,462
33
611
41
46
225
371
Yellow fever
:Brazil. .....•..•...•.•.....•
Colombia .•......••••••••••.•••
:Bolivia....••••.•.•.•.••••••..•
Cases
Plague
Smallpox
~fiBelgian
!~!~.t~:~====
::::::::::::::
Congo ...••••.•...•...•
I
Country
Rumania .•.••.•.....•.•.•...•
Poland ...•••.•.............•.•
Chile ....•.................•..
Egypt .•..•....•.•.•.•.•...•.•
United States ....•...... .• .•..
Chosen •..•.•.... . ....•.•......
Algeria ... ..•.•.•...... .....•..
7,132
3,678
2,981
2,705
1,732
1,302
1,157
2
(1)
356
233
792
372
112
145
Yellow fever
(1) 1791
16
(1)
37
178
·····················I
Sudan
. ....•...........•......
Senegal..
Nigeria
. ••.•.•••••.• .•.•••••.•
'1 I
7
2
3
Figures not available.
Incomplete.
An increasingly important :function o:f this Division is the dissemination of information relating to the broad fields o:f public health
and medicine. Each year many thousands o:f questions are receiYed
by mail, telephone, and in person. The majority of the questions
-can be answered by sending suitable pamphlets and specially prepared statements while others require library research. The increas:m g number of queries plainly reflects the desire of the people to be
well posted on matters of personal and community hygiene. Unfortunately, it is impracticable to give advice as to treatment for,
obviously, examination and observation by a competent physician are
essential to the success of such efforts.
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95
OFFICE OF PuBLIO HEALTH EoucATION
The Office of Public Health Education, established late in the preceding fiscal year, was continued under the direction of Senior Surg.
R. R. Spencer. The activities may be roughly divided into two
parts. The first is the publication known as The Health Officer,
which has been considered an experiment in public health educational methods. This is a monthly bulletin reproduced by the multilith J?rocess, the circulation of which is limited to State, municipal,
district, and county health officers and members of their staffs, commissioned officers of the Public Health Service, departments of Hygiene and Preventive Medicine in medical schools, and to certain welfare agencies. The chief purpose of this bulletin is to keep public
health personnel throughout the country abreast of the times, and to
serve as a unifying medium of exchange. Highly technical articles
are not used. Although no efforts have been made to increase the
circulation of The Health Officer, the mailing list has doubled during
its first year.
Judging from the favorable response and comments from sanitarians, health officers, and editors of other health periodicals, The
Health Officer has made for itself a definite field of usefulness. The
limited circulation has prevented sending it to private physicians,
although a large number of requests to be placed on the mailing list
have been received.
The second major activity of the Office of Education has been the
expansion of the training given young commissioned officers of the
Public Health Service. Since the inception of this Office in March
1936, two classes of officers have received training. As it is believed
that such training has now become an essential part in the development
of the Service, and because of the expanding duties and obligations
of a Public Health Service officer, this course now covers a period
of about 9 months. Under the supervision of the Surgeon General,
this course has become a feature in the post-graduate training of commissioned officers, being set up under the following headings:
1. Miscellaneous lectures.
2. Field trips, lectures, and demonstrations conducted by other
Federal bureaus and public agencies.
3. Epidemiology of communicable diseases.
4. The analysis of mass data.
5. Laboratory technique and demonstrations.
6. The control of venereal diseases.
7. Public health administration.
8. The social aspects of medicine.
NEGRO HEALTH
w ORK
There was a significant increase in the number of persons reached
in Negro health activities and advancement in coordinating State
and local health problems with the National Negro Health Week
and year-round programs proposed for educational stimulation of
health consciousness and in cooperation with official and voluntary
health agencies.
Tabulation of the year 1937 National Negro Health Week reports
shows a total of 1,475,820 persons reached m 3,200 communities, including all Southern States and an equal number of Northern States
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with large Negro populations, through cooperation of State and
local agencies, official and voluntary, whfoh sponsor and direct the
Health Week programs.
Clean-up activities were effected by 83,000 homes. Lectures and
Health Week sermons informed audiences totaling 1,100,000 persons.
Special features, such as exhibits, plays, pageants, and motion pictures, were attended by over 250,000 adults and children. Nearly
200,000 health publications were distributed. Examination, treatment, and advisory service were rendered 91,000 children and adults
in over 800 clinics and doctors' offices. It is estimated that unreported activities would increase these figures by 50 percent.
·
One hundred and thirty days of field service for the Negro Health
Work section included 39 communities in 13 States. Lectures, conferences, demonstrations, and exhibits, sponsored by nearly 200 cooperating agencies, reached a total of over 100,000 persons, and 21,000
copies o:f special publications were distributed.
Year-round programs undertaken as the result of reported activities maintain the interest stimulated by the Health Week program
and intermittent field service. Correspondence and requests for advice and materials indicate that State and local health services are
effectually aided as the result of the cooperative educational activities
of the Public Health Service for improvement of the health of the
colored population.
PUBLICATIONS ISSUED BY THE DIVISION
The fifty-first annual volume of the weekly Public Health Reports
was completed with the issue o:f December 25, 1936. The Public
Health Reports contains a summary of current reports of communicable diseases for the information of State and local health
authorities, as required by law, and reports 0£ the results 0£ current
research activities and other health and sanitary intelligence for
the information of the public as authorized by acts of Congress.
The 52 numbers printed during the fiscal year under report comprised volume 51, part 2, and volume 52, part 1, and contained 1,715
pages of text and tabular matter, exclusive of title pages and tables
of contents, as compared with 1,828 pages in the fiscal year 1936,
1,751 pages in 1935, and 1,578 in 1934. In earlier years these annual
volumes averaged approximately 3,000 pages. This reduction in
recent years of almost 50 percent was made necessary by reduced
printing funds and has greatly restricted the prompt publication of
reports on current research activities and of statistical analyses of
morbidity reports. This publication is especially important as a
means of presenting current morbidity statistics for the information '
of health officers and others concerned and of making a permanent
record of such statistics for future comparjson and analysis, and also
as a journal for the prompt recording of scientific reports.
During the year 76 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
also permitting the printing of additional copies for sale by the
Superintendent of Documents, Government Printing Office. In the
preceding fiscal year 65 such separates were issued, as compared with
60 in 1935.
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97
Eleven supplements to the Public Health Reports were issued durjng the year, as follows: No. 120, International Sanitary Convention
for Aerial Navigation; No. 121, The Relief of Pain· in Cancer
Patients; No. 122, Clinical Studies of Drug Addiction-The Absence
of Addiction Liability in "Perparin"; No. 123, The Scientific Exhibit,
"The .Story of Life" at the Texas Centennial Exposition, Dallas,
Tex., June 6-November 29, 1936; No. 124, Ground Water SuppliesProgress Report of the Committee on Ground Water Supplies, Conference of State Sanitary Engineers, 1936 ; No. 125, Clinical Studies
of Drug Addiction-II. "Rossium" Treatment of Drug AddictionWith a Report on the Chemistry of "Rossium"; No. 126~ The Public
Health Program Under the Social Security Act; No. 127, SuggestibHity in Delmquent and N ondelinquent Adult White Males; No. 128,
Clinical Studies of Drug Addiction-III. A Critical Review of the
Withdrawal Treatments With Method of Evaluating Abstinence
Syndromes; No. 129, The Bedbug. Its Relation to Public Health,
Its Habits and Life History and Methods of Control; No. 130,
Some Public Health Service Publications Suitable for General
Distribution.
New editions of several existing publications were secured during
the year, many of which were completely revised and brought up to
date. It is the present purpose to keep revised, in accordance with
the latest information, all publications distributed by the Public
Health Service.
The Hospital News, a semimonthly collection of reports from
hospital personnel, reproduced by the multilith process, was edited in
this Division and issued regularly during the year. The purpose
of the Hospital News, the issues of which are designated by volume
and number for convenience in referring to particular reports, is to
bring information regarding case histories, clinical research,
practices, observations, and improvements in the marine hospitals to
the attention of all hospital personnel. Unfortunately, this does not
constitute publication in the scientific sense, as distribution is limited
to Public Health Service personnel and no copies are sold.
The Health Officer was issued monthly during the year by the
Office 0£ Public Health Education, as reported elsewhere.
The National Negro Health Week publications-Bulletin, Leaflet,
and Poster-were edited and issued by this Division early in the
calendar year. The Public Health Service cooperates in this way in
the observance of National Negro Health ·week, the object of which
is the improvement of the health of Negroes by stimulating interest
in health activities, intensive for one week each year, but with a yearround program.
PUBLICATIONS DISTRIBUTED AND EXHIBITS PREPARED
There were 99 new publications distributed by the Di vision, as
compared with 83 during the preceding year. A total distribution
of 261,199 copies of new publications and of editions of previously
published documents was made. Of these, 179,030 were sent in
response to individual requests for information and 82,169 were
distributed to Service mailing lists .
.Thirty-six requests for the loan of stereopticon slides were received;
and in response to these requests, 1,969 slides were lent to universi-
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PUBLIC HEALTH SERVICE
98
ties, health officers, public health lecturers, officials of the Public
Health .Service, and others.
For a number of years the Public Health Service has had a small
appropriation for the preparation and display of exhibits relating to
public health. · Exhibits have been prepared on various diseases of
1mportant public health significance, which are available for display
at medical and public health meetmgs in the United States, as a
means of providing scientific health information relating to such
diseases. During the year much of this material was used at such
meetings. Additional material was prepared for the permanent
exhibit room of the Public Health Service at the administration
building in Washington.
The following is a list of publications distributed by the Division
during the fiscal year :
RElPRINTS FROM THE PUBLIC HEALTH REPORTS
1740. History and frequency of smallpox vaccinations and cases in 9,000 families.
Based on Nation-wide periodic canvasses, 19~·8-31. By Selwyn D.
Collins. April 17, 1936. 37 pages.
1741. Public Health Service publications. A list of publications issued during
the period July-December 1935. April 17, 1936. 3 pages.
1742. An occupational dermatitis due to heat decomposition of dyes. By Louis
Schwartz and C. D. Hocker. April 24, 1936. 1 pages.
1743. Mortality in certain States during 1935 with comparative data for recent
years. May 1, 1936. 10 pages.
1744. The significance of infant mortality rates. By Mayhew Derryberry and
Edgar Van Buskirk. May 1, 1936. 7 pages.
1745. A comparative study of certain characteristics of 1,000 inmates of the
Northeastern Penitentiary. I. Age. By Barkev S. Sanders. May 8,
1936. 21 pages.
1746. Studies of sewage purification. IV. The use of chlorine for the correction
of sludge bulking in the activated sludge process. By Russell S. Smith
and W. C. Purdy. May 15, 1936. 7 pages.
1747. Acute response of guinea pigs to vapors of some new commercial organic
compounds. X. Hexanone (methyl butyl ketone). By H. H. Schrenk,
W. P. Yant, and F. A. Patty. May 15, 1936. 8 pages.
1748. Sickness among male industrial employees during the final quarter of 1935
and the entire year. By Dean K. Brundage. May 22, 1936. 3 pages.
1749. Engineering control of occupational diseases. By J. J. Bloomfield. May
22, 1936. 13 pages.
1750. The preparation of a concentrate of vitamins B1 and B2 from brewers'
yeast. By Maurice I. Smith and Atherton Seidell. May 29, 1936. 4
pages.
1751. Application of the preliminary sanitary survey to flooded areas. By J. M.
DallaValle and J. J. Bloomfield. May 29, 1936. 6 pages.
1752. Rat-proof construction and its effect on the control of rat life on ships.
Instances of permanent and apparent automatic control effected by this
type of construction observed on 50 ships at the port of New York. By
B. E. Holsendorf. May 29, 1936. 13 pages.
1753. Smallpox immunity in 5,000 college students. By R. C. Bull and S. L.
Rankin. June 5, 1936. 14 pages.
1754. The development of a technique for measuring the knowledge and practice
of midwives. By Mayhew Derryberry and Josephine Daniel. June 12,
1936. 15 pages.
1755. Marine hospitals and beneficiaries of the Public Health Service. By S. L.
Christian. June 19, 1936. 13 pages; 3 plates.
1756. Acute response of guinea pigs to vapors of some new commercial organic
compounds. XI. Secondary amyl acetate. By F. A. Patty, W. P. Yant,
and H. H. Schrenk. June 19, 1936. 9 pages.
1757. Relation of physical defects to the physical growth of children of !::•l
States. Physical measurement studies no. 3. By William M. Gafafer.
June 26, 1936. 11 pages.
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99
1758. History and frequency of typhoid fever immunizations and cases in 9,000
families. Based on Nation-wide periodic canvasses, 1928-31. By Selwyn D. Collins. July 10, 1936. 30 pages.
1759. Post-mortem findings in fatalities due to the use of the arsphenamine
group. A review of 44 autopsies. By S. S. Cook. July 10, 1936. 9
pages.
·1760. Important causes of sickness and death. By Rollo H. Britten. July 17,
1936. 23 pages.
1761. Communicable diseases and activities for their control in the BrunswickGreensville area. Brunswick-Greensville health administration studies
no. 7. By J. 0. Dean and Elliott H. Pennell. · July 24, 1936. 23 pages.
1762. Report on market-milk supplies of urban communities. Compliance of the
market-milk supplies of urban communities with the Grade A pasteurized and Grade A raw milk requirements of the Public Health Service
Milk Ordinance and Code ( as shown by ratings of 90 percent or more
reported by the State milk-sanitation authorities during the period July
1, 1934, to June 30, 1936). August 14, 1936. 5 pages.
·
1763. Mortality from automobile accidents among children in different geographic regions of the United States, 1930. Studies on the fatal accidents of childhood no. 1. By William M. Gafafer. August 7, 1936.
8 pages.
1764. Extent of rural health service in the United States, December 31, 1931, to
December 31, 1935. August 14, 1936. 17 pages.
1765. An estimate of the monetary value to industry of plant medical and safety
services. By Dean K. Brundage. August 21, 1936. 15 pages.
1766. Directory of whole-time county health officers, 1936. August 21, 1936.
11 pages.
1767. Time changes in the relative mortality from automobile accidents among
children in different geographic regions of the United States, 1925 to
1932. Studies on the fatal accidents of childhood no. 2. By William M.
Gafafer. August 2-8, 1936. 9 pages.
1768. Tabulation of health department services. Report of committee on records
and reports to State and Territorial health officers and the United
States Public Health Service in thirty-fourth annual conference, Washington, D. C., April 13-14, 1936. September 4, 1936. 16 pages.
1769. Acute response of guinea pigs to vapors of some new commercial organic compounds. XII. Normal butyl acetate. By R. R. Sayers, H. H.
Schrenk, and F. A. Patty. September 4, 1936. 8 pages.
1770. The official United States and international unit for standardizing gas
gangrene antitoxin (histolyticus). By Ida A. Bengtson and Sara E.
Stewart. September 11, 1936. 10 pages.
1771. Public Health Service publications. A list of publications issued during
the period January-June 1936. September 11, 1936. 4 pages.
177Z. 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. By William M.
Gafafer. September 18, 1936. 9 pages.
1773. Acute response of guinea pigs to vapors of some new commercial organic
compounds. XIII. Methyl formate. By H. H. Schrenk, W. P. Yant,
John Chornyak, and F. A. Patty. September 25, 1936. 9 pages.
1774. Studies of sewage purification. V. Oxidation of sewage by activated
sludge. By P. D. McNamee. July 31, 1936. 11 pages.
1775. Resistance of various strains of E. typhi and Coli aerogenes to chlorine and
chloramine. By Lucy S. Heathman, G. 0. Pierce, and Paul Kabler.
October 2, 1936. 21 pages.
1776. Audiometric studies on school children. I. The consistency and significance of tests made with a 4-A audiometer. By Antonio Ciocco.
October 9, 1936. 15 pages.
.
1777. Lysine and malignant growth. I. The amino acid lysine as a factor controlling the growth rate of a typical neoplasm. By Carl Voegtlin and
J. W. Thompson. October 16, 1936. 8 pages.
1778. Lysine and malignant growth. II. The effect on malignant growth of a
gliadin diet. By Carl Voegtlin and Mary E. Maver. October 16, 1936.
9 pages.
1779. State and insular health authorities, 1936. Directory, with data as to
appropriations and publications. October 23, 1936. 19 pages.
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1780. The selenium problem in relation to public health. A preliminary survey
to determine the possibility of selenium intoxication in the rural population living on seleniferous soil. By Maurice I. Smith, K. W. Franke, and
B. B. Westfall. October 30, 1936. .10 pages; 1 plate.
1781. Plague eradicative measures on the Island of Maui, Territory of Hawaii.
By A. L. Dopmeyer. November 6, 1936. 24 pages; 4 plates.
1782. The efficiency of rapid sand filters in removing the cysts of the amoebic
dysentery organisms from water. By John R. Baylis, Oscar Gullans,
and Bertha Kaplan Spector. November 13, 1936. 9 pages; 1 plate.
1783. City health officers, 1936. Directory of those in cities of 10,000 or more
population. November 13, 1936. 18 pages.
1784. Audiometric studies on school children. II. Types of audiometric curves.
By Antonio Ciocco. November 20, 1936. 13 pages.
1785. The evaluation of health services. By Joseph W. Mountin. November 27,
1936. 8 pages.
1786. Time changes in the mortality from accidental mechanical suffocation
among infants under 1 year old in different geographic regions of the
United States, 19Q5-32. Studies on the fatal accidents of childhood no.
4. By William M. Gafafer. November 27, 1936. 6 pages.
1787. The physiological response of peritoneal tissue to certain industrial and
pure mineral dusts. By John W. Miller and R. R. Sayers. December
4, 1936. 13 pages; 10 plates.
1788. Duration and cost of Federal compensation cases with disease as a complicating factor .. By William M. Gafafer. December 11, 1936. 12
pages.
1789. History and frequency of diphtheria immunizations and cases in 9,000 families. Based on Nation-wide periodic canvasses, 1928-31. By Selwyn
D. Collins. December 18, 1936. 38 pages.
1790. An organization for promoting mental hospital services in the United
States and Canada. By Walter L. Treadway. December 25, 1936. 9
pages.
1791. Report on market-milk supplies of urban communities. Compliance of the
market-milk supplies of urban communities with the Grade A pasteurized and Grade A raw milk requirements of the Public Health Service
Milk Ordinance and Code (as shown by ratings of 90 percent or more
reported by the State milk-sanitation authorities during the period Jan.
1, 1935, to Dec. 31, 1936). January 29, 19'37. 4 pages.
1792. Disabling illness among industrial employees in 1935 as compared with
earlier years. By Dean K. Brundage. January 1, 1937. 8 pages.
1793. Toxicity of fruit sprays. A study of lead spray residues in Iowa-grown
fruit, with reference to manifestatio:ns in c·o nsumers. By Ralph H.
Heeren and Helen B. Funk. Jamiary 1, 1937. 9 pages.
1794. Six years' intensive observation on the seasonal prevalence of a tick p0pulation in western Montana. A preliminary summary. By Cornelius
B. Philip. January 1, 1937. 6 pages.
1795. Further study of the duration and cost of Federal compensation cases
with disease as a complicating factor. Cases classified into accidental
injuries, occupational diseases, and hernias. By William M. Gafafer.
January 8, 1937. 16 pages.
1796. Studies in chemotherapy. II. Chemotherapy of experimental pneumococcus infections. By Sanford M. Rosenthal. January 8, 1937. 6
pages.
.
1797. Distribution of tuberculosis mortality in the white population of the United
States. By C. C. Dauer. January 15, 19'37. 6 pages.
1798. Rat harborage and ratproofing. By B. E. Holsendorf. January 15, 1937.
7 pages.
1799. Sources of infection and seasonal incidence of tularaemia in man. By Edward Francis. January 22, 1937. . 10 pages; 2 plates.
1800. Salient public health features of rheumatic heart disease. By 0. F. Hedley. February 5, 1937. 8 pages.
1801. Control of chromic acid mists from plating tanks. By Edward C. Riley
and F. H. Goldman. February 5, 1937. 3 pages.
1802. Studies in chemotherapy. · III. The effect of p-aminobenzene sulphonamide
on pneumococci in vitro. By Sanford M. Rosenthal. February 12, 1937.
5 pages.
1803. Pulmonary tumors in mice. I. The susceptibility of the lungs of albino
mice to the carcinogenic action of 1, 2, 5, 6-dibenzanthracene. By H. B.
Andervont. February 19, 1937. 9 pages.
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PUBLIC HEALTH SERVICE
101
1804. The determination of mercury in carroted fur. By F. H. Goldman. February 19, 1937. 3 pages.
1805. Lactoflavin in the treatment of canine blacktongue. By W. H. Sebren,
D. J. Hunt, and R.H. Onstott. February 26, 1937. 5 pages.
1806. Age of gainful workers of the United States, 1920 and 1930. Studies on the
age of gainful workers no. 1. By William M. Gafafer. March 5, 1937.
13 pages.
1807. The distribution of Brucella melitensis variety melitensis in the United
States. By Alice 0. Evans. March 12, 1937. 9 pages.
1808. Pulmonary tumors in mice. II. The influence of heredity upon lung tumors
induced by the subcutaneous injection of a lard-dibenzanthracene solution. By H. B. Andervont. March 12, 1937. 12 pages.
1809. Some aspects of blanket coverage of occupational diseases in the United
States. March 19, 1937. 6 pages.
1810. Pulmonary tumors in mice. III. The serial transmission of induced lung
tumors. By H. B. Andervont. March 26, 1937. 9 pages.
SUPPLEMENTS
118. Experiments on the tolerance and addiction potentialities of dihydrodesoxymorphine-D ("desomorphine"). By Nathan B. Eddy and C. K. Himmelsbach. 1936. 33 pages.
119. The notifiable diseases. Prevalence in States, 1935. 1936. 12 pages.
120. International sanitary convention for aerial navigation. 1936. 24 pages.
121. The relief of pain in cancer patients. By Ernest M. Deland. 1936. 5
pages.
122. Clinical studies of drug addiction. I. The absence of addiction liability in
"perparin." By C. K. Himmelsbach. 1937. 4 pages.
123. The scientific exhibit "The Story of Life," at the Texas Centennial Exposition, Dallas, Tex., June 6-November 29, 19>36. By Paul T. Erickson. 1937.
28 pages; 10 plates.
124. Ground-water supplies. Progress report of the Committee on Ground-Water Supplies, Conference of State Sanitary Engineers, 1936. 1937. 24
pages.
125. Clinical studies of drug addiction. II. "Rossium" treatment of drug addiction. By C. K. Himmelsbach. With a report on the chemistry of
"rossium." By Lyndon F. Small. 1937. 18 pages.
126. The public health program under Title VI of the Social Security Act. 1937.
23 pages.
PUBLIC HEALTH BULLETINS
227. A survey of dental activities of State departments and institutions of the
United States. By F. C. Cady, H. T. Dean, and C. T. Messner. June 1936.
217 pages.
228. Epidemiological studies of poliomyelitis in Kentucky. By L. L. Lumsden.
August 1936. 56 pages.
229. Skin hazards in American industry. Part II. By Louis Schwartz. September 1936. 80 pages; 38 plates.
230. Experience of the health department in 811 counties, 1908-34. By Joseph
W. Mountin, Elliott H. Pennell, and E. Evelyn Flook. October 1936. 40
pages.
231. Studies of heart disease mortality. An analysis of the accuracy of deaths
recorded as being due to heart disease in Washington, D. C., during 1932,
with a discussion of the defects of the present method of tabulating
deaths, and suggestions for a new system' based upon etiological factors.
By 0. F. Hedley. October 1936. 49 pages.
232. Review of plague in Seattle (1907) and subsequent rat and flea surveys.
By L. D. Fricks. November 1936. 28 pages.
233. Measurements of ultraviolet radiation and illumination in American cities
during the yea rs 1931 to 1933. By James E. Ives and W. A. Gill. March
1937. 36 pages.
234. A study of chronic mercurialism in the hatters' fur-cutting industry.
Medical studies by Paul A. Neal and Roy R. Jones. Engineering studies
by J. J. Bloomfield and J. M. DallaValle. Statistical analysis by Thomas
I. Edwards. May 1937. 70 pages; 21 plates.
236. Evaluation of the industrial hygiene problems of a State. By J. J. Bloomfield and Mary F. Peyton. June 1937. 126 pages.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
102
NATIONAL INSTITUTE OF HEALTH BULLETINS
167. The pathology of tularaemia. I. The pathology of tularaemia in man. By
R. D. Lillie and E. Francis. II. The pathology of tularaemia in the Bel_gian hare ( Oryctolagus cuniculus). By R. D. Lillie and E. Francis.
III. The pathology of tularaemia in the black-tailed jack rabbit (Lepus
:ap.). By R. D. Lillie and E. Francis. IV. The pathology of tularaemia
in the cottontail rabbit ( Sylvilagus floridanus). By R. D. Lillie and
El. Francis. V. The pathology of tularaemia in the cotton rat ( Sigmodon
hispidus). By R. D. Lillie and E. Francis. VI. The pathology of tulara-emia in the California ground squirrel ( Citellus beecheyi beecheyi). By
R. D. Lillie and E. Francis. VII. The pathology of tularaemia in the
mouse (Mus musculus and M. musculus albinus). By R. D. Lillie and
E. Francis. VIII. The pathology of tularaemia in the white rat (Rattus
norvegicus albinus). By R. D. Lillie and E. Francis. IX. The path<'>logy of tularaemia in the guinea pig (Cavia cobaya). By R. D. Lillie
and E. Francis. X. The pathology of tularaemia in the sheep ( Ovis
aries). By R. D. Lillie, E . Francis, and R. R. Parker. XI. The pathology -of tularaemia in the opossum (Didelphis virginiana). By R. D.
Lillie -and E. Francis. XII. The pathology of tularaemia in other mammals. By R. D. Lillie and E. Francis. XIII. The pathology of tularaemia in the quail ( Colinus virginianus). By R. D. Lillie and E. Francis.
XIV. 'The pathology of tularaemia ip. other birds. By R. D. Lillie, E.
Francis, and R. R. Parker. February 1936. 217 pages; 88 plates.
168. The experimental pathology and pathologic histology produced by the toxin
of vibrion septique in animals. By Joseph G. Pasternack and Ida A.
Bengtson. August 1936. 46 pages; 13 plates.
169. Strundardization of antipneumococcus horse sera and concentrates. By
Lloyd D. Felton and H. J. Stahl. February 1937. 58 pages.
MISCELLANEOUS PUBLI ATIONS
11. Official list of commissioned and other officers of the United States Public
Health Service. January 1, 1937. 64 pages.
UNNUMBER.ED PUBLICATIONS
Index to Public Health Reports, volume 51, part 1, January-June 1936. 24 pages.
Index to Public Health Reports, volume 51, part 2, July-December 1936. 24
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 effective attack upon the community's
disease problems. Twenty-third annual observance. 1937. 8 page folder.
National Negro Health Week poster. Twenty-third annual observance. 1937.
National Negro Health Week leaflet. Twenty-third annual observance. 1937.
2 pages.
ANNUAL REPORT
Annual Report of the Surgeon General of the United States Public Health
Service for the fiscal year 1936. 158 pages.
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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 Hospital Division, through the marine hospitals and other
relief stations, has continued its function of furnishing outpatient
and hospital treatment to American seamen and other legal beneficiaries in 154 ports in the United States and its possessions. Contracts were maintained with 144 hospitals located in ports not served
by the 25 marine hospitals. At the close of the year, 5,272 patients
remained in the hospitals, including 170 insane in St. Elizabeths
Hospital, 31 insane in 6 California State hospitals, and 365 patients
at the National Leper Home.
As in previous years, the volume of work showed a substantial
increase. · The marine hospitals and contract hospitals treated a daily
average of 389 more patients than they did in 1936. The ope-ration
of the hosJ?itals on an efficien_t ~asis was carried out with diffic1_1lty
because of madequate appropriat10ns for the employment of suflic1en1t
personnel. In some hospitals, owing to an insufficient number o:f
nurses, it was necessary to place one nurse in charge of two or three
wards during the night tour of duty, and in all hosritals the number
of nurses and attendants was insufficient to enable the Hospital Division to comply with a 44-hour work week. The average number of
hours of the ·work week was 56. In spite of these handicaps, the
volume of work and the success attained indicates a high degree of
devotion to duty on the part of available personnel. In order to
operate with available appropriations it was necessary to practice
strict economy throughout the year. The per-diem cost was: kept
down to the very low figure of $3.38. Medical officers in charge of
hospitals and relief stations were admonished to request only those
supplies, repairs, and replacements which were urgently needed;
nevertheless it was necessary to carry over into the fiscal year 1938
requisitions totalling approximately $60,000.
Recommendations for increases in salary for personnel could not
be carried out, owing to a lack of funds. This condition has: caused
great dissatisfaction on the part of personnel at various places :md
many have resigned in order to accept employment elsewhere. A
large number of employees receive pay which is less than that usually
considered a living wage. It is felt that, with continued improvement
in economic conditions, the Hospital Division will lose, through resignations, many employees and will be forced to replace them with less
efficient personnel unless an increase in salary for those who, have
given years of meritorious service is made possible.
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, Coii,st and Geodetic Survey, Veterans'
103
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Federal Reserve Bank of St. Louis
GROUP
Other ~
OF
HOSPITALS
Total Reller Days
65,518
rort Stanton. N.M.
4.19
l.95
.66
1.58
TUHKRCUI.OSIS
SANAWRIUM
Cost
132,724
Carville, La.
2.93
1.68
274,663.35
.46
.79
LEPROSARIUM
Cost
Per diem cost for all hospitals
3.38
2.00
389,326.69
.44
.94
ALL
Relier days ror all hospitals 1,903,683
cost
$6,439,904.91
(a) In-patient department or station closed.
Average per-diem cost of inpatient relief, United States marine hospitals, fiscal year 1937
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
105
Administration, Bureau of Fisheries, Civilian Conservation Corps,
Civil Works Administration, and Works Progress Administration.
Emergency medical relief was furnished to employees of the Treasury Department and certain other Government agencies in Washington through 25 medical relief units under the supervision of the Hospital Division. Physical examinations were given 397 special agents
of the Federal Bureau of Investigation, Department of Justice.
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 108 to 112.
CLASSES OF BENEFICIARIES AND AMOUNT 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
PerPerPercent Num- Ct>nt
Number cent
of Number of
ber
of
total
total
total
-- ------American merchant sea- 1,184,734 58.04
men.
Vetetns ________________-__ 181,959 8. 91
608,271 43. 87 31, :l20 19.44 Communicable
1,269
.09
2,006
1. 25
~.;_
Lepers.··-·------···---·-·
133,202
6.53
8 ---- --
Coast Guard personneL ..
91,590
4.49
141,939 10. 24
Injured Federal employees.
______-_________
Immigrants
86,961
4.26
117,379
33,378
1. 64
5,855
.42
1,384
.86
:Seamen, Engineer Corps
and Army Transport
Service .
.Seamen from foreign vessels .
.Seamen and keepers,
Lighthouse Service.
Civilian Conservation
Corps.
Civil Works Administration.
Works Progress Administration.
Alaska cannery workers
leaving United States.
Pilots and other licenses ___
50,503
2.47
24,547
1. 77
1,659
1. 03
lio>IJl\1!
4.00
8. 47 24,019 14. 91
. 01 Pay patients.
9,637
.47
1,493
.11
16
17,359
.85
8,955
.65
255
.16 Medical supplies also furnished
102,205
5.01
1,032
.07
219
.14 Patients of the Civilian Con-
159
.01
37
3,060
• 15
115,272
5. 65
31,254
1. 53
to lighthouse vessels.
.02
147,906 10.67 30,667 19.04
806
.06
--------- -------------- ------ --------- -----.Civil Service applicants --------- ------ --------- -----and employees.
:Shipping Board ___________
--------- ------ --------- ------
All others entitled to treatment.
3 ····-6,437
diseases are
reported to local health of•
ficers.
Patients of the Veterans' Administration.
National Leper Home, Carville, La.
All medical services and sup•
plies, ashore and afloat.
Patients of the Employees'
Compensation Commission.
Patients of the Bureau of Immigration.
Civilian employees on Army
vessels.
8,529
5.29
8,502
5.28
32,500 20.18
454
.28
326,827 23.57 13,072
8.11
--------------
servation Corps.
Patients of the Civil Work~
Administration.
Patients of the Works Progress
Administration.
Vaccinations and other preventive measures.
For the Steamboat Inspection
Service.
For the Civil Service Commission.
To determine fitness for sea
duty.
From Bureau of Fisheries,
Army, Navy, Mississippi
River Commission, Coast
and Geodetic Survey, etc.
Total_ •• ---------··- 2,041,114 100. 00 1,386,446 100.00 161,079 100. 00
DENTAL TREATMENT
During the fiscal year, 173,598 beneficiaries were given dental treatment by full-time officers at an average cost of $1.66 per patient.
Had the dental treatment rendered been procured at authorized fees
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
106
by contract, the average cost would have been $10.62 per patient.
The major items of treatment are shown in the following list:
Number of patients treated ___________________________________________
X-rays _____________________________________________________________
Prophylactic treatments (hours) _____________________________________
Vincent's stoma ti tis treatments ( cases)------------------------------Pyorrhea treatments (hours)________________________________________
Extractions _________________________________________________________
Alveolectomies
--------------------·----------------------------------Alloy fillings ________________________________________________________
Gold inlays_________________________________________________________
Porcelain crowns____________________________________________________
Silicate cement fillings___ ____ _________________________________________
Dentures (full and partial)__________________________________________
Fracture cases (hours)--------------~------------------------------Number of treatments (outpatient) __________________________________
Number of treatments (inpatient) ___________________________________
173, 598
37,722
19,077
4,930
5,237
88,506
4, 632
41,918
1,081
85
18, 5~
9,326
1,796
509,491
210,075
Total number of treatments ____________________________________ 719, 566
Contract dentists on a fee basis tr_e ated .2,840 beneficiaries at 40
smaller stations at a total cost of $13,938.83 or an average of $4.91 per
patient.
A study of focal infection is being conducted at the United States
Marine Hospital, Baltimore, Md.
A motorized dental trailer manned by one dental officer and an
assistant was put into operation in November 1936 to provide dental
care for Coast Guard personnel at isolated stations, and this dental
unit has rendered very satisfactory service. It is planned to purchase an additional trailer to augment this service.
Senior Dental Surg. C. W. W ekenman is in charge of the dentaI
activities of the Service.
COAST GUARD
The average number of Coast Guard beneficiaries on active duty
and retired was 10,325. Medical services furnished in recent yearsare shown in the following table :
Numerical strength of Coast Guard and
medical services given
Year
1923 ____ _--- ---- -- -- -- -- -- _--- -1924 ______ • -- ----- -- __ -- ---- -- -1925 ________________ -- ___ --- ____
1926 __ - _- - - _-- - - - - -- - - - - - - - - - - - 1927 __ -- -- ------ ---- ---------- -1928 __ -- _-- _- _- - - - - -- - -- - - - - -- -1929 ________ - __ -- _-- __________ -1930 ____ -- - - -- -- -- - - -- - - - - -- - - - 1931_ ___ -- ---- -- -- ------------ -1932 _________ --- -- __ -- -- ________
1933 __ -- -- -- ____ ______ -- __ -- ____
1934 __________ -- -- ____ -- ____ -- __
1935 __________ -- - __ -- _-- -- - - - _- _
1936 __ - _- _- -- _- - -- - - - - - - - - - - - - - 1937 __ --- ------- ------ _--- ---- --
Average amount of medical
services per person
Number
of Coast Hospital
Guard
days
personnel
OutOutPhysical Hospital patient
Physical
patient examinaexaminatreatdays
treattions
tions
ments
ments
- - - - - - - - - - - - - - - - - -·
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
10,325
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
91,590
32,530
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
141,939
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
6,437
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
8. 9
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
12. 1
13. 7
0.9·
1. 5,
1. 9
1.9
1.T
1. 41. 4
1. 1
.6
.9
.T
.&
.!l
•5
• 6,
Twelve medical and dental officers are. assigned to duty with the
Coast Guard and 103 local physicians serve under appointment as
acting assistant surgeons, furnishing medical and surgical relief
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
107
and performing physical examinations of Coast Guard and L ighthouse Service personnel at isolated units.
During the year seven new cutters were completed and the very
latest hospital equipment placed thereon. Two of the.se vessels have
taken stations in ports outside of the continental limits of the United
States and have full-time medical officers who will be able to utilize
the new equipment furnished on these vessels.
Medical officers have been assigned as heretofore to the cutters on
the International Ice Patrol, to those on the cadet practice squadron
in European waters, and to the Bering Sea Patrol Force operating
in the North Pacific. Full-time medical officers are assigned to
vessels having their base at Honolulu, T. H., Juneau and Cordova,
Alaska, and San Juan, Puerto Rico. During the period of the Bering
Sea Patrol Force, a medical officer and a dental officer were assigned
to duty at Unalaska, Alaska, to render relief to the personnel of the
small craft basing at Unalaska. As was the case last vear. the medical
officer utilized the Indian Affairs Hospital at Unalaska for providing
necessary relief.
During the year a study was made of the causes for retirement for
physical disability in the Coast Guard, which it is hoped will materially assist in reducing the number of retirements for future years.
Medical Director H. McG. Robertson is assigned to duty at Coast
Guard Headquarters as representative of the Surgeon General and
Chief Medical Officer of the Coast Guard.
OPERATING COSTS IN MARINB 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 Personal services ------------------------------------------- $3, 985·, 864
0200 Janitor and laundry supplies, X-ray films, etc_________________
69, 819
0210 Medical and hospital supplies________________________________
359, 390
0220 Scientific and educational supplies___________________________
7,304
0230 Fuel ------ ------------------------------------------------19il, ~W8
0250 Forage___ __________________________________________________
24,30~
0260 Provisions __________________ _______________________________ 1,092,040
0280 Sundry supplies_______________________________ ______ ________
49,656
03 Subsistence and support of per sons ( contract care, etc.)______
370, 265
04 Oare of animals and vehicles________________________________
112
0500 Telegraph service___________________________________________
1,725
0510 Telephone service___________________________________________
31,276
06 Travel expense_____________________________________________
61,634
07' Freight ---------------------------------------------------64, 702
10 Furnishing heat, light, power, and water___________ __ _________
232, 44-0
1100 Rent of buildings and offices_________________________________
8, 410
6, 36.0
1110 Other rents------------------ - --------------------- ---------1280 Repairs and parts for motor equipment_____ __________________
6,, 199
1290 Repairs and alterations, other equipment_____________________
24,145
1373 Laundry service____________________________________________
32,817
1375 Ash and garbage removaL___________________________________
3, OH5
1380 Miscellaneous services--------------------------------------6, 221
2250 Burials_____________________________________________________
17, 9li0
3000 Passenger-carrying vehicles_________ ____________ ___ __________
6, 7-U
3010 Furniture, furnishings, and fixtures__________________________
111, 211
3.020 Scientific equipment_________________ _____________ ___________
75 , 441
3040 Livestock____________________________________________________
18
3050 Other equipment________________________________ ____________
57,357
TotaL _____________________________________________________
23690-37--8
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Federal Reserve Bank of St. Louis
6,897,845
PUBLIC HEALTH SERVICE
108
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 193"1
Fiscal year
Sick
and disabled
patients
furnished
relief
Prior to reorganization:
1868 _______ --- ---- -1869 ______________ -1870______________ --
After reorganization:
1871__ ________ ---- -1872__________ ---- __
1873 _____ ---- __ -- _-1874 _______ _______ -1875 ______________ -1876 _______ - -- -- -- - 1877-----1878
_____ -----------___ -- ___ _
1879 _____ -- _- _-- - - - 1880_____ --- __ -- - - - 1881_ ____ -- -- ______ _
1882________ -- __ -- -1883 _____ ---- - - - - - - 1884______ -- -- -- -- -1885_____ -- --- __ --- _
1886 _____ --- __ -- -- -1887 _______________ _
1888 ________ -- ___ -- _
1889 _______ ___ ____ -189(:) ____ - - - - - - - - - - -1891__ ____ -- -- ___ -- _
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
52,992
Sick
and disabled
patients
furnished
relief
Fiscal year
After reorganizationContinued.
1892 ____ ---- __ ---- __
1893 __________ -----1894 __ ____ -- ____ -- -1895 __ ______ -- ---- - _____ - - - - - -- -- - _1896 _______________
1897
1898 _____ --- __ -- -- __
1899_____ -- --- - --- - 1900 __ __________ -- -1901_ _________ -----1902____ -- __ -- ---- __
1903 ____ -- -- __ -- -- __
1904 ____________ ---1905 ______ - - - - - - -- - 1906 _______ -- - - - - - -1907 ----- -- _-- - - -- -1908 __________ - - --- 1909 ______ ____ __ -- -1910________ -- -- -- - 1911__ __ -- ___ -- __ -- _
1912 _______________ _
_1Ql3 _______________ _
, 1914 _______________ _
1915 ____ -- ___ -- --- --
1
Fiscal year
Sick
and disabled
patients
furnished
relief
Arter reorganizationContinued.
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
53,226
55,782
1916___-__ --- -- - - _- -1917 ----- -- ___.____ -1918 __________ --- --1919 __________ -----1920_______ -------- _
1921__ ____________ -1922______ -- -- _--- __
1923 2 _____________ _
1924________ __ -----1925 ___________ __ _-1926 ____ -- -- -- _--- __
1927-------- -------1928 ______ -------- - 1929 ______ -- -- ----- _
1930__________ -- __ __
1931__ ____ -- ____ -- __
1932______ ---- -----1933-_ _____________ _
1934 ____ -- -- -- -- ___ _
1935 ____ -- -- -- -- -- __
1936 ______ -- __ -- ___ _
1937------ ---- ---- --
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
350,386
t 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; 1936, 3,970; and 1937, 5,424.
2 In this year, and subsequently, the practice of recounting out-patients applying for treatment in more
than 1 calendar month was discontinued.
TABLE
2.-Transactions at United States marine hospitals and other relief
stations
Hospital or relief station
Total
number
of patients
treated
Numbar of
patients Died
tr.eated
in hospitals
Patients
remainingin
hospitals
June
30, 1937
Num- Number
ber of of times NumNumber patients
bar of
of days
office
physifurrelief in nished
relief
cal exhospitals office was fur- aminanished
tions
relief
----
--- --Grand totaL ______________ 355,810
FIRST-CLASS STATIONS
1,567
4,000
2, 135
830
429
2,123
2,744
2,309
2,062
754
376
2,406
626
1,102
140
39
14
24
25
107
166
44
21
23
51
9
34
--- --- ---
Marine hospitals
Baltimore, Md __________________ 14,555
Boston, Mass ____________________ 11,872
Buffalo, N y ___________________
Carville, La _____________________ 5,061
1,776
Chicago, IlL ____________________ 8,604
Cleveland, Ohio _________________ 10,032
Detroit, Mich ___________________ 4,900
Ellis Island, N. y _______________ 4,972
Evansville, Ind ___ • _____________ 1,529
Fort Stanton, N. Mex ___________ 1, 729
Galveston, Tex __________________ 7,618
Key West, Fla __________________ 1,789
Louisville, Ky ___________________ 2,022
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
59,722
5,272 2,041,114 296,088 1,386,446
----
325
139
57
365
168
204
218
306
61
161
165
43
86
135,387
66,331
20,688
132, 724
69,099
80,353
84,496
105,715
21, 135
65,518
64,607
17,975
30,978
10,555
9,737
4,231
1,347
6,481
7,288
2,591
2,910
775
1,353
5,212
1,163
920
76, 181
41,984
26, 741
2,000
30,467
27,890
13,488
7,279
2,300
6,262
23,092
4,856
4,366
161, 079
9,727
8,627
3,572
4
6,145
3,893
3,324
981
204
105
4,234
131
593
PUBLIC HEALTH SERVICE
TABLE
109
2.-Transactions at United States marine hospitals and other relief
stations-Continued
Hospital or relief station
Total
number
fi~~f;
treated
~e~f
patients
Died
~reated
m hospitals
Patients
remaining in
hospitals
June
Num- Number NumNumber ber of or times ber of
of days patients office
physi!urrelief in
relief
cal exhospitals n~:~d was fur- aminanished
tions
relief
30, 1937
------------ --- --- - - - - - - - - - - --.- - ---- --FIBST-CLASS STATIONS-continued
Marine hospitals-Continued
Memphis, Tenn ________________ _ 4,473
------------------Mobile,
Ala __ La
New
Orleans,
_______________ _ 6,279
Y ----------------_
New York,
Norfolk,
Va N.
____________________
Pittsburgh, Pa_----------------Portland, Maine ________________ _
St. Louis, Mo __________________ _
San Francisco, CaliL ___________ _
Savannah, Ga __________________ _
----------------_
Seattle, Wash
Stapleton,
N. ___
Y ________________
Vineyard Haven, Mass _________ _
Contract overflow hospitals _____ _
14,068
40, ~43
10,453
4,152
1,649
4,227
19,120
4,441
12,251
17,638
315
147
TotaL ____________________ 216, 115
1,737
1,524
5,207
25
28
128
--s:222- ----iiif
1,039
493
1,136
4,423
1,634
3,409
7,731
156
147
16
10
14
102
44
126
145
6
7
53, 754
1,451
2,736
4,755
8.,.861
40, 4'43
7,231
3,113
1,156
3,091
14,697
2,807
8,842
9,907
159
11,160
27,071
38,034
250,.204
39,920
8,988
14,168
13,887
85,780
10,247
21,400
42,317
275
1,447
1,878
4,815
25,593
3,879
2,894
724
3,571
5,056
1,608
11,602
3,818
8
4,954 1,916, 711 162,361
830,357
108,433
1,032
243
301
119
936
1,118
862
36
152
1,306
679
697
54
271
140
1,643
5
176
3,525
1,305
198
362
645
988
1,026
98
111
530
1,421
999
81
441
303
514
659
238
4
951
703
682
379
124
3,951
5,405
266
2,067
601
2,399
9
647
7,497
342
86
172
609
131
5
147
57
76
139
461
38,277
48,411
l5Q, 311
____ .J ___
228
69
47
85
387
171
307
631
20
35
98,390
26,450
19,177
39,341
151,367
62,343
120,327
237,255
8,028
13,028
-------- ---------- --------
SECOND- AND THIBD-CLA.SS
STATIONS
Aberdeen, Wash _________________
Albany, N.Wash
Y ___ ________________
-----------•---Anacortes,
Apalachicola, Fla ________________
Ashtabula, Ohio _________________
Astoria, Oreg ____________________
Balboa B~ghts, C. z____________
Bangor, aine __________________
Bath, Maine ____________________
Beaufort, N. c __________________
Bellingham, Wash _______________
Biloxi, Miss _____________________
Boothbay Harbor, Maine ________
Brunswick, Ga __________________
Burlington, Iowa________________
Cairo, IlL _______________________
Calais, Maine ___________________
Cambridge, Md _________________
Cape May, N. J_ ________________
Charleston, S. c _________________
Cincinnati, Ohio ________________
Cordova, Alaska ________________
Corpus Christi, Tex _____________
Crisfield, Md ____________________
Duluth, Minn ___________________
Eastport, Maine ________________
Edenton, N. C __________________
Elizabeth City, N. C ____________
El Paso, Tex ____________________
Erie, Pa _________________________
Escanaba, Mich _________________
Eureka, Cal!L __________________
Everett, Wash._ •• ______________
Fall River, Mass ________________
Gallipolis, Ohio __________________
Gary, Ind _______________________
Georgetown, S. c _______________
Gloucester, Mass ________________
Grand Haven, Mich _____________
Green Bay, Wis _________________
Gulfport, Miss __________________
Hancock, Mich __________________
Honolulu, T. H _________________
Houston, Tex ___________________
Indiana Harbor, Ind ____________
Jacksonville, Fla •• ______________
Juneau, Alaska __________________
Ketchikan, Alaska ______________
La Crosse, Wis __________________
Lewes, DeL _____________________
Los Angeles, Calif_ ______________
Ludington, Mich ________________
Machias, Maine _________________
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
575
161
172
28
399
745
1,069
34
90
369
259
468
35
92
126
803
2
99
1,628
714
113
261
438
665
694
31
29
135
267
420
48
183
184
180
335
149
2
374
329
226
138
97
1,566
1,649
202
922
369
1,105
11
249
3,416
240
41
--------------- -·-----------------25- ------3- --------------42 -------- -------259
3
17
1 -------7
-----66° -------- ------335
20
1
1
19
19
6
8
--------
1
-------- --------------- --------
-----36- -------- -----·2·
132
1
6
53
74
7
36
64
7
78
1
1
1
1
1
1
---------------
------3------i-
293
155
127
---- 188
161
3,·778
79
439
129
76
36
553
766
4
30
237
954
156
639
259
53
1,266
2
.. _______
--------------------32
----------------- --------------------i- -------- -------- 4
--------------475
17
30
7
24
26
15
26
4
-------- ---·-·4·
---------------------- ----------·------------------ --------
--------------- -------19 -------- -------22 -------- -------12 -------- -------15 -------- -------4
1
105
121
4
75
28
129
3
41
154
11
3
1
7
--------
--------2 --------------- --------2
--------------1
3
2
5
353
53
250
111
196
151
18
130
198
77
69
56
1,751
545
43
704
319
1,039
24
415
1,888
146
-------- ----------------- ---·---- --------
540
141
153
28
374
703
810
27
90
303
240
462
27
92
90
671
1
93
1,575
640
106
225
374
658
616
31
29
134
250
390
41
159
158
165
309
145
2
355
307
214
123
93
1,461
1,528
198
847
341
976
8
208
3,262
229
41
-----ii4
11
8
506
8
8
102
27
105
20
56
353
228
10
-------8
634
19
------is
274
781
6
24
6
66
74
42
------iii
281
31
13
31
726
139
---i;3M
137
75
34
15
2,466
2
23
PUBLIC HEALTH SERVICE
110
TABLE
2.-Transactions at United States marine hospitals and other relief ·
stations-Continued
Hospital or relief station
Total
number
of patients
treated
Number of
patients Died
treated
in hospitals
P atients
remainingin
hospitals
June
30, 1937
Num- Number
ber of of times NumNumber patients
ber of
of days
office
physifurrelief in nished
relief
cal exhospitals office was fur- aminanished
tions
relief
- - - - - - - - - - - - - - - - - - - - ---SECOND· AND THTRD·CLASS
STATIONS-continued
Manila, P. !. __ _____________ _____
Manistee, Mich _________ ____ ____
Manitowoc, Wis ______ ___________
Marquette, Mich ______ ____ __ ____
Marshfield, Oreg ______ ________ __
Menominee, Mich _______________
Miami, Fla __ ___ ________________ _
Milwaukee, Wis. ________________
Morehead City, N. c ___________
Muskegon, Mich ________________
Nantucket, Mass ________________
Nashville, Tenn _________________
Natchez, Miss _____________ ______
Newark, N. J ____________________
New Bedford, Mass _____________
New Bern, N. C ________________
New Haven, Conn ___ ___________
New London, Conn _____________
Newport, Oreg ______________ ____
Newport, R. !. ___________ _______
Newport News, Va ______________
Ogdensburg, N. y ___ ___________ _
Olympia, Wash __ __________ __ __ _
Oswego, N. y _______ _______ _____
Paducah, Ky ____________________
Panama City, Fla _________ ______
Pensacola, Fla_. ______________ ___
Perth Amboy, N. J_ ___ ___ _______
Petersburg, Alaska ______________
Philadelphia, Pa ________________
Ponce, P. R _____________________
Port Angeles, Wash _. ___________
Port Arthur, Tex _____ ___ _____ __ _
Port Huron, Mich _______________
Portland, Oreg __________________
Port Townsend, W ash __________
Providence, R . !_ ___ _____________
Provincetown, Mass __________ ___
Reedville, Va ____________________
Richmond, Va ______ _____ ___ ____
Rock Island, Ill _____________ ___ _
St. Thomas, V. !_ _______________
San Diego, CaliL _________ ___ ___
Sandusky, Ohio _________________
San Juan, P.R. ______ ____ _______
San Pedro, Calif. ________________
Sault Ste. Marie, Mich __________
Seward, Alaska. _________________
Sheboygan, Wis _________________
Sitka, Alaska ___________ _________
South Bend, Wash ______________
Southport, N. c _________________
Superior, Wis ____________________
Tacoma, Wash __________________
Tampa, Fla. __________ ______ ___ _
Toledo, Ohio. ___________________
Unalaska, Alaska ________________
Vicksburg, Miss _________________
W ashington, D. c _______________
Wasbington,
D. C. (Dental
Clinic). _______________________
782
827
63 -------6
81
4 -------- --- ----67
321
20
179
1 -------13
135
269
1 -------13 -----·-- -------189
197
7 -------- -------49
115
1,464
229
1
1,867
7
184
1,364
2, 335
1 -------445
38
4
702
3
191
13
1 -------61
124
29
7 -------- --- ----79 -------- -------- -------- ---------70
422
871
2
1
23 -------- -------- -------- ---------44
397
250
3 -------192
26
276
1 -------19
221
163
-------- -------1,719
19 -------- -------239
2 -------- -------127
15
252
45 -------- -------1,032
266 -------- -------- -------- ---------2
13
99
1
12
72
1
8Fi
1
20 -------32
240
1
1,436
13
1
53
12
82
531
1
54 -------471
456
1
9
72
103
1 -------124
20
256
1
448
5,231
8,968
3
9
302
156
30 -- -----1
26
344
1 ---- ---86
32
2,854
167
1 -------13 ----- --- -------98
439
341
4,158
3,472
6
10
3 -------- -------4
83
~27
430
40 -------2
277 -------- -------- -------- ---------583 -------- -------- -------- ---------291
96
10 -------1
7,523
7 -------- -------38
275
11 -------- -----·-106
1,132
2,203
80
1
3
110
9 -------- -------38
74
2
967
979
1
4,381
5,431
13
354
14
1,057
792
129
1
8
377
53
708
1 -------2
60
6
1 -------618
2 -------- -------10
83
26
216
1
1,022
1,574
118
10
3
52 -------484
636
1
264
127
15 -------- -------903
79
745
5
1
2
699
70
2
636
12
11
3 -------- -------529
25
3
78
3,974
6,802
253 -------13
764
77
301
256
176
108
1,638
1,180
407
178
117
79
801
23
353
166
144
1,700
125
207
266
97
73
220
1,423
519
417
94
236
8,520
126
318
2,822
426
3,131
80
390
277
583
86
7,516
264
1,052
101
905
4,027
663
324
58
616
57
904
432
249
824
629
8
504
6,549
1,543
618
555
645
362
274
5,092
2,794
1,477
260
293
189
1,842
42
687
276
254
2,566
304
319
590
244
96
483
4,044
1,648
1,362
161
661
29,873
253
570
10,145
768
12,394
363
961
888
1,680
127
27,208
710
4,393
169
2,784
12,663
1,094
601
139
859
112
1,147
757
692
1,466
1,261
12
1,589
37,087
-------- -------- -------- ---------120
10 -------- ------------------------------- -------79
1
586
28
257
3 --------
2,304
89
840
473
176
18,035
174
2,617
1,131
362
--------
190
344
147
Washington, N. c _______________
White Stone, Va ________________
Wilmington, N. C _______________
Wrangell, Alaska ________________
2,304
99
840
552
204
FOURTH-CLASS ST.AtI0NS
Ashland, Wis ____________________
Bay City, Mich _____ ____ ________
Bridgeport, Conn ________________
Chattanooga, Tenn ______________
Hartford, Conn __________________
Nome, Alaska ___________________
Portsmouth,
N.__________________
H--------------Saginaw, Mich
Wilmington, DeL _______________
222
125
54
2
3
15
30
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
11
34
32
5
17
1
3
2
1
1
292
1, 051
51
22
305
52
50
356
1,559
4
16
8
210
118
171
102
9
168
168
7
34
12
77
-------83
252
37
73
109
8
4,698
18
17
255
1,058
3,207
33
1,044
7
13
38
1,174
7
1,483
30
649
3,066
81
43
15
333
13
13
30
99
608
481
-------397
15,987
3
11
165
--------
42
276 -------120
-------- -------442
37
43 ---------------------1
1
10
1
-------- -------7
-----------------1
-------- --------------18
13
11
-------- -------45 -------30
-------- ----------------- -------19 -------11
------3- -------- -------21
31
67
--------------- --------
111
PUBLIC HEALTH SERVICE
' TABLE
2.-1'ransactions at United States marine hospitals and other relief
stations-Continued
Total
number
of patirnts
treated
Hospital or relief station
Number of
patients
treated
in hospitals
Died
Patients
remainingin
hospitals
June
30, 1937
Num- Number Number of of times ber of
Number patients
physiof days
office
furrelief
cal ex•
relief in
amlna•
hospitals nished
was
furoffice
nished
tions
relief
- - - - - - --- ---- - - - ----
---
:MISCELLANEOUS
Curtis Bay, Md. (U. S. Coast
Guard) __________ --------------
u.New
s. Coast
Guard Academy,
London, Conn ___________
St. Elizabeths Hospital, Washington, D. C _____ ______ ______ __
Special acting assistant surgeons
for Coast Guard and Lighthouse Service __________________
U.bases
S. Coast
vessels and
____ ___Guard
____ _______________
2,023
1,477
193
-------- -------- -------- ---------4
2,144
193 -------193
7
170
60,806
2,023
7,076
20
1,284
4,730
284
-------- ---------- --------
752
650
13,444
4,028
-------- -------425
48,126
9,778
-------- -------- -------- ---------Emergency medical relief activities, Treasury Department. ___ 36,586
36,586
227,602
715
-------- ---·---206
240
Emergency __ • __ .. __ ---- --- -- -- -216 ----132- -------- -------835
84
-----Total. ••• __________________ 139,695
52,646
5,968
124,403 133,727
556,089
116
318
--- --- - - - ---Grand total. ______________ =
4,142
355,810
TABLE
114
9,778
59,722
1,567
5,272 2, 041,114 296,088 1,386,446
161,079
3.-Medical services for various classes of beneficiaries
Beneficiary
Total
number of
patients
treated
Number of
patients
treated
in hospitals
- -American seamen ______________
Foreign seamen ________________
·Coast Guard __________________
Bureau of Fisheries _______ ___ __
Army _________________________
:Navy and Marine Corps ______
·Mississippi River Commission_
.Engineer Corps and Army
Transport Service ____ _______
Lighthouse Service __________ __
·Coast and Geodetic Survey ____
Employees' Compensation
Commission _________________
·veterans' Administration ______
.Immigration Service ___________
.Public Health Service officers
and employees _______________
Lepers __ ____________________ ___
·Civilian Conservation Corps __
·Civil Works Administration ___
Works
Progress
tion ______
_____ __Administra_______ _____
.Miscellaneous _________________
172, 369
1,014
33,639
61
475
300
3
31,178
475
3,668
14
98
94
P atients
remaining in
Died hospitals
June30,
1937
Number
of days
relief in
hospitals
Number
of pa- Number Numtients
of times ber of
furoffice re- physical exnished lief was aminaoffice furnished tions
relief
--- - - - ---- - - - - - -3,021 1,184, 734
9,637
26
211
91,590
473
-------- --------1,277
1
-------1,207
2
2
141,191
539
29,971
47
377
206
3
608,271
1,493
141,939
124
1,069
780
3
756
11
28
-------- -------- --------- ----------
--31,320
16
6,437
1
201
96
--------
7,857
2,878
811
1,579
489
99
35
17
1
125
46
3
50,503
17,359
2,569
6,278
2,389
712
24,547
8. 955
3,467
1,659
255
28,379
5,424
3,490
3,750
5,276
1,572
24
562
7
224
511
119
86,961
181,959
33,378
24,629
148
1,918
117,379
1,269
5,855
24,019
2,006
1,384
13,197
448
4,559
211
1,315
445
3,890
149
24
24
36
52
365
235
5
20,363
133,202
102,205
3,060
11,882
3
669
62
83,452
8
1,032
159
3,079
3
219
37
37,846
42,849
5,365
266
312
14
115,272
5,365
32,481
42,583
147,906
238,738
30,667
59,258
-------31
9
422
- - - - - ---- - - - ---- ----- -1,567
Total. ___________________ --355,810 59,722
5,272 2,041,114 296,088 1,386,446 161,079
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
112
TABLE
4.-0lassification of outpatient treatment,s furnished at United States
marine hospitals and other relief stations
s
i0+> ·~~
~
~
a
i
~
i:I
~
0
Marine hospitals ___________
Other relief stations ________
Special
acting assistant surgeons _____________________
Coast Guard vessels and
bases- __________ - ·- -- -- -Emergency medical relief
activities,
Treasury Department_ ________________
Emergency___________ -- ---Total ________________
A~
:g
~+>
'O
0
...-1:1
I
A
- A
~o:s
fa;l
>,
~
~
~
z
8,188
347
904
6,246
A
>,
~-~
~>,
O:Sen
en
0
en
...
o:s
~
...
s-~ ~~
.s < - - - s
>
--- - - - - - ---
'3
8
]
.bl)
~
,c
0
~
8
96,264 271,295 42,453 191
66,952 27,614 17,571 175
15,612 12,647
'O
,;,
~
en
en
rJ.l
r; ~
~~
~
A
o+>
·+> o:s
A
S·s
OQ
Q
o:s
-~"O
~
I>
en A
~o:s
502 120,274 72,486 6,131 24,048 196,713
516 89,509 18,063 10,362 7,792 23,427
16
2
10
80
0
8
P-t
830,357
261,981
49 1,517
161
719
13,444
8,827 4,188 2,566
682
1,998
52,856
1,541
129,154 ------- 44,922 ---- --- -- 53,526 --·--- ·-·- -- ------ ------- 227,602
206 ------- ------- ---- - ~-- ------- -- ---206
- - - - - - -- --- - - - - - - --- ----316,376 311,903 112,096 392 1,100 273,677 94,786 20,576 32,683 222,857 1,386,446
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
~
DIVISION OF VENEREAL DISEASES
Asst. Surg. Gen. R. A.
VoNDERLEHR
in charge
CONFERENCE ON VENEREAL DISEASE CONTROL
w ORK
A national Conference on Venereal Disease Control Work was held
in Washington, D. C., December 28-30, 1936, under the auspice~
of the United States Public Health Service. This conference was.
called by the Surgeon General for the purpose of considering basio
principles underlying a national plan for the control of venereal
diseases.
President Roosevelt sent a message of greeting in which he expressed gratification over the recent mcrease in public interest in the
problem of venereal disease control. Miss Josephine Roche, Assistant Secretary of the Treasury, in charge of Public Health, read the,
President's message and paid glowing tribute to the scientists who·
laid a deep and sound foundation making possible swifter progress
in the control of these diseases, so damaging to the lives of our people
and so costly to the economic life of the N at10n.
The conference was attended by leading clinicians, scientists, health
officers; private physicians, representatives of voluntary agencies,
nurses, social workers, teachers, newspaper reporters and a great.
many interested laymen. The total attendance numbered over 900
persons coming from 45 States, Hawaii, Puerto Rico, the District of
Columbia, and 10 or more foreign countries. Throughout 3 days.
of formal and informal deliberation from the speaker's platform, in
the committee rooms, and in the corridors, the control of venereal
diseases was discussed with intense interest and enthusiasm .
. ~he press of th~ Nation rendered inest~mable ;1;n1;blic service by
'g1vmg the transactions of the conference wide pubhc1ty.
The increasing cooperation and widespread support of the venerea]
disease control program on the part of private physicians, voluntary
agencies, and the public in general are doubtless due in considerable
measure to the stimulus provided by this great national conference.
EVALUATION OF SERODIAGNOSTIC TESTS FOR SYPHILIS
At the request of the American Society of Clinical Pathologists,
the United States Public Health Service has sponsored a project for
determining the reliability of serocl.iagnostic tests for syphilis originated by American serologists, and also the efficiency of State and
local laboratories in performing such tests. It was found that, in
general, the tests are reliable, and in most State laboratories the per-formance of the tests is entirely satisfactory.
The Committee on Evaluation of Serodiagnostic Tests for Syphilis.
has recommended that an annual comparison of the work of Statelaboratories be made under the direction of the Public Health Service..
During the past year, 39 States accepted the invitation of the Surgeon.
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PUBLIC HEALTH SERVICE
General to participate in such an evaluation study. Analysis of the
results of this study indicated that some of the State laboratories
were qualified neither to perform efficient serodiagnostic service nor
to inaugurate any system of State licensure or approval of local
laboratories within their respective States. On the other hand, in
many of the State laboratories the performance of serodiagnostic tests
for syphilis is maintained at a highly efficient level and the results
-obtained compared favorably with the control tests as carried out by
the originators of the methods.
These extraordinary variations lead the Committee on Evaluation
to make certain recommendations, among them being ( 1) that provision be made for training State local laboratory technicians in the!
laboratories of the originators of the methods employed in the respective laboratories; (2) that a system of periodic inspection of State'
laboratories by serologists of the United States Public Health Service..
be inaugurated and made available upon the request of State health
officers; (3) that the facilities available at the Stapleton laboratory
be utilized for the training of personnel from State laboratories;
(4) that provision be m~de to approve and subsidize qualified local
laboratories for the performance of serodiagnostic tests for syphilis.
The committee has also studied the reaction to the various tests in
the bloods of patients with malaria or leprosy, and whose history and
physical examination were negative for syphilis. The results reported by the serologists varied greatly for both groups of patients.
It is the opinion of the committee that both malaria and leprosy can
be the cause of positive reactions to the serodiagnostic tests for
syphilis. The fact that positive reactions can be due to diseases.
,caused by such biologically different organisms as an acid-fast bacillus,
a Treponema, and a Plasmodium suggests that the etiology of certain
of these diseases, notably leprosy, is in need of investigation.
CooPERATIVE CLINIC.AL STUDIES
During the year progress has been madP, in the studies conducted by
the Division working with the Cooperative Clinical Group composed
of the directors of five of the large syphilis clinics in the United States.
In two of the cooperating clinics material for a study on conjugal
syphilis has been completed and is ready for evaluation. The objective
of this study is the more exact determination of the period of communicability of syphilis. Work has been continued on the follow-up
·o f patients with earl:v syphilis who have been adequately treated. The
purpose of this study is to determine what the chances are of the
development of late complications of syphilis in treated patients. It
has been shown that in untreated syphilis these conditions develop
oftenest in the third and fourth decade after infection. Since the
modern treatment era covers only the past 25 years, extensive followup must be maintained to justify the present-day promise of "cure".
Progress has been made in following up the records of apparently
normal infants born of syphilitic parents. This study is time-confluming, since it begins with children who are at the age of puberty
or beyond, and requires tracing their history back to birth. As
a part of this study, the examination of family groups is also carried
-out.
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Two statistical evaluations were begun, one on ocular syphilis for
the purpose of preparing a standard treatment procedure for ocular
syphilis, and one on bemgn late syphilis.
Plans for a thorough evaluation of both specific and nonspecific
methods of treating neurosyphilis were completed. Eight institutions are collaborating in this study. The case records of patients
who have been treated during the past 20 years are being abstracted
and completion of the study during the next year is anticipated.
A number of papers based on the work of the Cooperative Clinical
Group were prepared and published during the year. Among them
were the following: Asymptomatic Syphilis, Dr. Paul O'Leary of
the Mayo Clinic, spokesman; Continuous and Intermittent Treatment for Early Syphilis-Critical Review of American and League
of Nations Investigations, Dr. John H. Stokes, University of Pennsylvania, spokesman; The Effect of Specific Therapy on the Prophylaxis and Progress of Cardiovascular Syphilis, Dr. Harold N.
Cole, Western Reserve University, spokesman; Late Congenital Syphilis with Special Reference to Interstitial Keratitis, Dr. Cole, spokesman; Syphilis in Mothers and Children in the United States, by Lida
J. Usilton, M.A., Washington, D. C.
COOPERATIVE WORK WITH STATE HEALTH DEPARTMENTS
During the past year many State health departments have requested advice and assistance in the organization of a venereal
disease control program. The scarcity of specially trained officers
available has limited the time and assistance which could be given
to each State. Some advisory assistance was extended to the health
departments of Idaho, Illinois, Indiana, Kansas, Maryland, Minnesota~
Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and West Virginia.
Because of special problems and conditions in a few States, officers:
have been detailed to the health departments for extended periods.
With an allotment from Social Security funds, facilities for the
training of physicians in the clinical management and public health
control of syphilis and gonorrhea have been established at several
clinics and universities. Trainees for this course of instruction must
be selected and recommended by State health officers. This postgraduate training will make available a group of adequately trained
physicians to act as venereal disease control officers, directors of
venereal disease clinics, or special consultants.
The demand by State and National medical and public health associations for speakers is constantly increasing. During the year
about 50 scientific papers and popular lectures were given by members
of the staff; two were radio broadcasts.
During the year, 336,147 new cases of syphilis and 182,435 cases of
gonorrhea were reported to the State health departments; 965 clinics
sent morbidity reports to State health departments. These clinics.
reported 101,347 new cases of syphilis and 46,039 new cases of
gonorrhea. They discharged as arrested or cured cases 68,515 patients and gave a total of 3,757,770 treatments, including 1,143,354
doses of arsphenamine.
Evidence that the program for the control of venereal diseases is
meeting with a gratifying measure of success is furnished by these
figures, all of which show substantial increases over those reported
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last year. Cases of syphilis and gonorrhea reported to the State
boards of health show an increase of approximately 69,000 and 19,000,
respectively. The number of clinics has increased by 250. Nearly
22,000 more cases of syphilis and 2,000 more cases of gonorrhea were
treated in these clinics during the current fiscal year than in the
preceding year. The increase in the number of treatments ( exclusive
of baths at Hot Springs) given in the clinics amounted to more than
400,000, and the doses of arsphenamine given was increased by more
than 200,000.
COOPERATION WITH OTHER AGENCIES
Under the provisions of the Social Security Act the United
States Public Health Service is cooperating with a number of leading hospitals and research centers in the investigation of important
questions relating to the public health control and clinical management of syphilis and gonorrhea. At the Strong Memorial Hospital
and the University of Rochester, Rochester, N. Y., the effectiveness
of pyretotherapy in gonorrhea and syphilis is being investigated.
The period of communicability of gonorrhea is being studied at the
penal institution of Riker's Island, N. Y., and the treatment of
svphilis by the administration of certain lipoids at Vanderbilt University. Nashville, Tenn.
At Johns Hopkins Research Center the biologic properties of
,Spirochaeta pallida are being studied and attempts at cultivating this
organism have been made. Efforts to grow the organism in symbiosis
with other bacteria and in tissue culture were unsuccessful. Its culture in chick embryos is now being tried. Other studies in progress
or projected include the experimental production of arsphenamine
·sensitivity and its relation to that observed in human beings, the
placental transfer of antibodies ( diphtheria antitoxin) in syphilitic
mothers as contrasted with nonsyphilitic mothers, and the relation·ship of Wassermann reagin to immunity in syphilis.
The clinical efficacy of sulfanilamide in the treatment of gonorThea is being investigated at Brady Institute, Johns Hopkins University.
UNTREATED SYPHILIS IN THE NEGRO
Observations have been continued on the group of 400 male Negroes with untreated syphilis and also on the group of 200 presumably
nonsyphilitic adult male Negroes.
It is planned to keep a representative number of the individuals
,comprising these two groups under observation until death and then
to secure the pathologic examination necessary for the confirmation
of the original clinical and laboratory findings. During the past 12
months permission was granted for performing necropsies on 7 of
the 11 who died. These necropsy studies have been made possible
through a grant from the Millbank Memorial Fund. The pathologic
-examinations are conducted by the Public Health Service in cooperation with the Tuskegee Institute, the Macon City Health Department,
.and the Alabama State Health Department.
PREVALENCE STUDIES
· The growing interest in the venereal disease problem in the United
:States 1s also manifest in the many requests from various localities
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-for the cooperation of the United States Public Health Service in
determining the present status of syphilis and gonorrhea in their
.communities.
Maximum service could not be furnished all the communities from
which requests were received, but some consultant and statistical
:assistance was given to each locality.
In cooperation with State and local health authorities, extensive
surveys were made in the States of Kansas and Nebraska, and the
,city of Richmond, Va. The results of these surveys were compiled
·and, together with recommendations of the local medical societies,
have been published in the journals of these societies. Recent surveys
have included more data than those made in former years. In addition to the prevalence and incidence of syphilis and gonorrhea, information has been assembled on the economic status and age of
patients, and comparative data on the amount of antisyphilitic treatment furnished by private physicians and by public clinics. In addition, the Division prepared a recapitulation of all the existing data
on prevalence, incidence, and trend of syphilis in the United States,
for presentation to the Conference on Venereal Disease Control Work
held in Washington, D. C., December 28-30, 1936.
EDUCATION AL AND INFORMATIVE ACTIVITIES
Requests for all types of educational material have steadily in<Creased during the year. Some 20 feature articles have been released
for publication in newspapers and magazines. The following new
·publications were issued during the year:
REPRilNTS FROM VENERIDAL DISEASE INFORMATION
No. 56. Vener€al disease control programs of the State departments of health.
July 1936. 33 pages.
No. 57. Syphilis in a large industrial organization. By G. H. Gehrmann.
August 1936. 3 pages.
No. 58. The occurrence in leprosy of positive serodiagnostic tests for syphilis.
By H. H. Hazen, Thomas Parran, Arthur H. Sanford, F. E. Senear,
Walter M. Simpson, and R. A. Vonderlehr. September 1936. 7 pages.
No. 59. Untreated syphilis in the male Negro. By R. A. Vonderlehr, Taliaferro
Clark, 0. C. Wenger, and J. R. Heller, Jr. September 1936. 6
pag-es.
No. 60. The control of syphilis. A critical examination of some of its problems.
By J. H. Stokes. November 1936. 27 pages.
No. 61. The efficiency of State and local laboratories in the performance of
serodiagnostic tests for syphilis. By Thomas Parran, H. H. Hazen,
Arthur H. Sanford, F. E. Senear, Walter M. Simpson, and R. A. Vonderlehr. January 1937. 8 pa ges.
No. 62. Cooperative clinical studies in the treatment of syphilis: Asymptomatic
neurosyphilis. By Paul O'Leary, Harold N. Cole, Joseph Earl Moore,
John H. Stokes, Udo J. Wile, Thomas Parran, R. A. Vonderlehr, and Lida
J. Usilton. March 1937. 61 pages.
No. 63. Continuous and intermittent treatment for early syphilis. A critical
review of the American and League of Nations investigations, with
additional evaluations. By John H. Stokes and Lida J. Usilton. March
1937. 18 pages.
No. 64. Late prenatal syphilis with special reference to interstitial keratitis, its
prev·ention and treatment. By Harold N. Cole, Lida J. Usilton, Joseph
Earle Moore, Paul A. O'Leary, John H. Stokes, Udo J. Wile, Thomas
Parran, and R. A. Vonderlehr. April 1937. 15 pages.
No. 65. The philosophy of case holding. By Louise B. Ingraham and John H.
Stokes. May 1937. 5 pages.
No . .66. The evaluation of serodiagnostic tests for syphilis upon the spinal fluid.
H. H. Hazen, Thomas Parran, Arthur H. Sanford, F. ID. Senear, Walter
M . .Simpson, and R. A. Vonderlehr. May 1937. 11 pages.
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SUPPLEMENTS TO VENERF..AL DISEASE INFORMATION
No. 2. The control of syphilis. A symposium. 70 pages.
No. 3. Proceedings of conference on venereal disease control work. 154 pages ..
No. 4. Hospitals and dispensaries for treatment of venereal disease. 20 pages.
VENEREAL DISEASE BULLETINS
No. 59. The wonderful story of life. Revised. 19 pages.
No. 90. The prevention of venereal disease. A bulletin for merchant seamen..
5 pages.
No. 91. Syphilis. Its cause, its spread, its cure. 8 pages.
No. 92. Gonorrhea. Its cause, its spread, its cure. 7 pages.
New exhibit material has been prepared, including sjx three-color·
posters ("Competent medical care vs. self-treatment"; "Acqu;ired
syphilis"; The duties of the health department in syphilis control";:
"Syphilis wrecks marriage"; "Syphilis strikes one out of every ten
adults"; "Syphilis kills babies"), and two 16 millimeter films ("Syph-ilis, its nature; prevention, and treatment", and "Syphilis of the central
nervous system, a preventable djsease").
The distribution of the publication Venereal Disease Information·
has shown a considerable increase. The monthly average of paid subscriptions was 8,067, an increase of more than 2,000 over the preceding·
year. The average distribution of free copies was 2,695 monthly.
During the year the Service sent out 43,570 pamphlets and bulletins
on venereal disease in response to 8,677 requests. In addition 5,'l34requests were referred to State departments of health for compliance.
VENEREAL DISEASE RESEARCH LABORATORY, STAPLETON, STATEN
ISLAND, N. Y.
The work of renovating and equipping the new laboratory at the ·
United States Marine Hospit~l at Stapleton has been completed. The·
technical staff has been increased by the addition of a bacteriologist..
The employment of a physical chemist is contemplated as soon as an
applicant with suitable qualifications becomes available.
This increase in physical and technical facilities will make possible
the study of a greater number of the specially signjficant public health
problems pertaining to syphilis and gonorrhea. It is also planned'
to have this laboratory participate in certain field projects, such as
the evaluation of serodiagnostic tests for syphilis, and to utilize the·
facilities available for the training of personnel from State laboratories in serologic technics.
Experimental work in the prophylaxis of syphilis has been con-•
tinned and interesting results are accumulating in regard to active·
acid radicals when applied to the exposed area after an exposure to
the syphilis spirochete of one hour.
The question as to whether syphilis can be transmitted by means of
the seminal fluid in latent and inadequately treated cases is being-investigated.
Lymph gland transfer as an index to clinical cure was investigated·
and found to be not a suitable method as a criterion of cure. Inguinal
lymph glands from syphilitics in various stages of the disease were·
implanted into animals. Only the glands from early and inadequately
treated patients gave positive results.
From a study of the effect of ultrashort-wave therapy in experimental syphilis it was found that both continuous and intermittent
temperature elevations lead to bacteriologic sterilization of the animaL
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The serologic response in expe.r imental syphilis in animals was investigated and the results were published in two papers, one dealing
with the serologic response in infective rabbits and the other with
the lack of a measurable response in infective guinea pigs.
Further studies in the life cycle of Spirochaeta pallida have been
,carried on in an effort to determine whether hitherto unrecognized
forms may represent stages in the life cycle of the. parasite. The
results thus far have been negative. Attempts to demonstrate multiplication of the syphilis spirochete in chick-heart tissue culture have
also produced negative results.
·
Studies have been conducted in an effort to determine the role
played by the reticulo-endothelial system in the production of the
Wassermann substance. Further work in this field, looking toward
a better understanding of the serologic response, has been projected.
Cultivation of the virus of lymphogranuloma inguinale was attempted and the results obtained failed to confirm published work
reporting the artificial propagation of this virus.
Studies for the purpose of determining the practical usefulness of
the complement fixation procedure in the diagnosis of gonococcal
jnfections have been continued.
The laboratory is participating in a study of the period of communicability of gonococcal infections among the inmates of the
Riker's Island Penitentiary. It is expected also that reliable data on
the value of this test and on culture methods in the diagnosis of
gonococcus infections will be obtained from this study.
A comprehensive and extensive study looking toward a clarification
of some of the biologic characteristics of the gonococcus in both the
human and the experimental animal has been projected.
VENEREAL D1sEASE CLINIC,
HoT
SPRINGS,
ARK.
The United States Public Health Service Venereal Disease Clinic
conducted at Hot SprinO's, Ark., in cooperation with the National
Park Service, surveyed the medical noods of 6,806 indigent citizens
of the United States during the fiscal year under report. Of this
number, 3,948, or 58 percent, were afllicted with venereal disease.
Three hundred and sixty-three of these applicants had two or more
specific infoctions, making a total of 4,326 cases of venereal disease2,974 cases of syphilis, 1,243 of gonorrhea, 94 of chancroid, 10 of
granuloma inguinale, and 5 of lymphogranuloma inguinale.
A total of 110,336 venereal disease treatments were administered,
divided as follows: 24,068 intravenous injections, 45,853 intramuscular injections, and 40,415 gonorrhea treatments. Ninety-seven patients
were given fever therapy for neurosyphilis or complications of gonorrhea; 65 patients received 281 treatments in the hypertherm cabinet
and 32 were inoculated with malaria. In the Government free bathhouse, 89,618 therapeutic baths were given.
Studies of the efficacy of mapharsen in syphilis and of sulfanilamide in gonococcus infections were conducted during the year.
Favorable results have been obtained thus far with both drugs.
Sources of infections and possible contacts of patients in the clinics,
when ascertained, were re_ported regularly to the State health officers
concerned. The proper State health officer was also notified when
patients potentially dangerous to the public health left the clinic
without permission presumably to return to their former places of
residence.
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On October 1, 1936, the United States Public Health Service,.
through the Venereal Disease Clinic, assumed administrative responsibility of the Hot Springs Transient Medical Center, formerly the Hot
Springs division of the Arkansas 'l'ransient Bureau. During the
fiscal year 2,000 individuals were provided domiciliary care while
undergoing treatment in the clinic. The funds necessary to operate
the Hot Springs Transient Medical Center were provided by the
Arkansas Works Progress Administration. Provision for the domiciliary care of indigent, transient, infectious individuals with venereal
disease is unquestionably an indispensable factor in the effective
administration of this clinic.
1.-Report of State departments of health showing t}l,e numbor of cases
of syphilis and gonorrhea reported, the annual ra.tes per 1,000 inhabitants.
amount of arsphenamine distributed, and the laboratlJry examinations made
from July 1, 1936, to June 30, 1937
TABLE
Number of cases
State
Laboratory examinations
Annual
rate for
syphilis
andgonSyphilis orrhea
and
Syphilis Gonor1,000
gonor- I?er
rhea
mhabirhea
tants
Doses of
arsphenamine dis- Serologic
tributed tests made
Microscopic
examinations
for
Spirochacta
pallida
---
-----Tota} ______ -- ------ -- 336,147 182,435 518,582
-----Alabama __________________ 12,710
4,025
16,735
Arizona ____________________
1,101
1,526
425
Arkansas _____________ ----2,382
6,636
4,254
California __________________ 19,877
39,091
19,214
Colorado! _________________
1,141
662
479
Connecticut __________ ·---1,521
4,182
2,661
Delaware ______________ ---2,536
1,987
549
District of Columbia. _____
4,231
2,092
2,139
Florida _______________ ----3,238
2,456
782
Georgia ______________ -----6,496
22,697
Idaho. ____________________ 16,201
913
414
499
Illinois. ___________________ 21,015
35,786
14,771
Indiana ____________________
1,404
3,313
1,909
Iowa. _____________________
2,111
4,355
2,244
746
2,209
1,463
Kansas _______ _------------
---
f;~i;~~!!:_:===============
Maine _________ • -- ---- ----Maryland. ________________
Massachusetts ___ ·- -- -----Michigan ____________ --- _-Minnesota ___________ --- --Mississippi__ ______________
__ -- -----------Missouri..
Montana __________________
Nebraska __________________
__________________
2
Nevada
New Hampshire ___________
New Jersey ________________
New Mexico a_____________
New York ______ ___________
North Carolina __________ -North Dakota ___________ ·---------------- -- --_________________
Ohio.
Oklahoma
Oregon ____________________
Pennsylvania ______________
Rhode Island ______________
South Carolina ____________
South Dakota. ____________
Tennessee_---------------Texas. ____________________
Utah'---------------------
~==:::-.-.-==========
~r:~~i~~
_______________
Washington
West Virginia _____ ________
Wisconsin'---------------Wyoming'---------------For 8 months.
'Not reoorting.
3,262
2,329
519
9,556
6,061
6,930
3,417
21, 151
4,306
527
731
2,566
1,384
594
3,139
6,246
6,661
3,504
27,427
2,756
589
929
5,828
3,713
1,113
12,695
12,307
13,591
6,921
48,578
7,062
1,116
1,660
154
7,875
934
92,444
23,008
265
11,923
3,318
802
9,423
1,111
3,913
531
8,106
7,695
176
3,393
456
23,432
6,002
708
4,112
2,702
1,751
2,173
748
4,395
373
3,839
3,239
330
11,268
1,390
115,876
29,010
973
16,035
6,020
2,553
11,596
1,859
8,308
904
11,945
10,934
250
9,119
2,779
2,988
303
324
3,419
4,115
1,339
1,772
574
12,538
6,894
4,327
2,075
Microscopic
examinations
for gonococcus
4. 07
1,567,030
2,618,159
10,682
410,970
---
5. 84
73,671
107,866 -------- 16,853
3. 76
--------------20,517
3. 28
34,394
1,122
9,833
6. 45
181,247
127,511
1,101
39,868
1. 61
1,940
21,412 -------2,415
2. 41
20,205
146,737
52
8,874
9. 79
10,323
11,860
28
2,346
6.84
16,660
9, 058
77
9,072
1. 97
4,177
9,491 -------521
7.42
85,969
133,967
714
7,251
1.88
3,306
27,763
2,844
10
4. 56
123,136
110,892
3,075
51,169
. 96
44,566
161,685 -------7,190
1. 71
1,753
216
3
121
1.17
9,966
39,856 -------2,697
2.02
14,785
10,518
148
3,122
1. 75
1,802
37,622
62
2,997
1. 30
7,852
20,836
166
3,547
7. 58
61,470
16,705
50
4,180
2. 78
93,369
177, 115 -------- 12,872
2. 84
34,810
41,060
------ 33,079
2. 63
12,545
193,451 -------- 13,370
24.19
8,936
71,804
3,365
1. 78
31,708
37,084 -------5,082
2.10
1. 22 _____
✓ 4,974
34,594
21 --T91s
,_ _____
. 65
3,079
11,173 -------- ---2:917
2. 60
47,069
68,140 -- ------ 15,111
3. 59
2,199
2,257 -------125
8. 96
130,353
370,218
780
27,304
8. 39
102,160
193,307
10,630
236
1. 38
1,899
15,382
2
2,386
2. 39
38,123
30,065
1,595
9,193
2. 38 ----------- ---~ --- ---2. 51
2,323
9,840
32
4,466
1.14
74,345
83,977
15,863
2. 73
8,409
33,935 -----398,780
4. 47 -----------------1. 31
7,730
7,983 -------- ---i;iw
4.17
75,679
54,782
9,372
381
1. 79
77,992
18,964
478
12,097
1
ll°months.
a For
cases of syphilis In the infectious stage are reported.
, Only
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1. 65
4. 69
4.20
2.36
• 71
1,774
40,794
19,278
43,603
20,534
6,715
28,108
59,598
31,473
8,745
----------- -----------
4
187
131
122
66
---f25i
4,125
27,878
3,487
6,210
PUBLIC HEALTH SERVICE
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TABLE 2.-Report of 116 correctional and penal institutions cooperatin,{1 with,
State departments of health 1
New Syphilis
cases admitted:
________________________________________________________ _
Gonorrhea ______________________________________________________ _ 7,055
2,978
112
Chancroid------------------------------------------------------Total ---------------------------------------------------------- 10, 145
Cases discharged as arrested or cured _______________________________ _ 6,044
Treatments given __________________________________________________ _ 356,314
Doses of arsphenamines administered _______________________________ _ 86,189
Serologic tests made _______________________________________________ _ 53,588
Microscopic examinations for gonococcus ____________________________ _ 18,674
1
Includes 27 pri:a1on camps.
TABLE
3.-Report of 965 clinics, furn,i shed through State health departments,
July 1, 1936, to June 30, 1931 1
State
New cases admitted
Total
Cases
dismonthlyrecharged
as
arports
Gonor- Chan- rested
receiv- Total Syphirhea croid or cured
lis
ed
Treatments
given
Doses of
arsphena- Serologic
mines
tests
admin- made
istered
--- ---
--- --- --- - -
TotaL ____
8,993 149,472 101,347 46,039
2,086
--- --- --- --- ---
Alabama ________ a 481
.Arkansas _______
12
California _______
634
Connecticut _____
226
Delaware. ______
72
District of Columbia ______ __
12
9
Florida'-------Georgia _________
191
Idaho 6__________
5
Illinois __________
272
Indiana _________
156
Iowa ____________
19
Kansas 6___ ____ _
12
330
Kentucky'----Louisiana _______
12
Maine __________
194
Maryland _______
508
Massachusetts __
318
Michigan _______
148
Minnesota ______
51
Mississippi__ ____
72
Nebraska_______
47
New Hampshire.
59
New Jersey_____
369
New York _____ _ 1,387
617
North Carolina_
Ohio __ __________
371
Oregon __________
12
Pennsylvania ___
960
Rhode Island ___
69
Tennessee _______
682
Texas ___________
107
Virginia _________
109
Washington _____
43
295
West Virginia•••
Wisconsin_______
132
9,694
3,047
12,176
1,395
1,081
8,226
1,980
6,675
993
806
1,378
982
5,433
402
265
4,262
886
8,603
14
13,555
2,302
126
230
3,521
378
919
5,990
5,251
4,972
, 828
1,574
758
200
5,656
6,221
11,680
5,586
477
8,278
744
8,618
9,641
5,271
1,586
3,057
895
2,139
572
7,075
14
8,299
1,210
71
147
1,568
237
446
3,833
2,850
2,434
373
1,527
416
93
3,679
4,187
10,014
3,479
238
6,575
484
6,103
6,696
4,389
742
2,273
504
Microscopic
examinations
for
gonococcus
68,515 23, 757, 770 1,143,354 674,863
262,377
90
85
68
1,402
1,794
5,156
1,034
498
138,680
2 196,403
325,373
56,018
18,845
73,671
20,517
79,306
14,662
8,667
6,819
27,616
68,423
6,817
3,989
1,262
9,761
33,959
1,096
1,313
2,092
248
1, ~63
31
66
165
366
171
6,194
1,061
55
82
1,944
141
463
1,763
2,401
2,515
455
37
341
107
1,954
2,034
1,503
1,941
239
1,672
259
2,316
2,568
850
843
779
390
31
68,221
10,224
159,183
197
445,900
111,720
5,448
5,819
47,233
7,497
21,868
156,672
16,660
4,177
66,977
153
119,948
34,804
1,753
2,068
13,030
1,802
7,843
61,059
9,058
9,491
30,592
1,301
94,133
9,925
216
1,290
10,318
4,547
2,186
16,609
9,072
521
2,616
74
47,572
3,075
121
283
2,998
432
617
3,873
3,181
4,364
4,730
686
34,538
34,077
63,318
27,369
1,152
3,255
14,951
52,809
16, 754
28,108
24,764
9,624
8,745
2,645
79
4,097
438
14,790
12,698
4,677
8,509
1,069
1,388
3,308
8,691
11,989
4,125
24,101
1,956
6,210
------10
------------5,163
93
------1
9
--- -- --13,870
1,400
12
100
795
-------------10
294
394
------23
------.
10
1
------23
------163
166
-------
31 .
1
199
377
32
1
5
.l
2,247
1,366
2,317
313
186
181
200
4,610
6,973
2,464
2,303
456
1,807
608
2,592
3,724
526
1,145
928
483
--------------------------- -------166,878
29,184 39,108
32,962
40,765
21,997
24,153
11,435
235,028
282,111
157,439
162,223
19,053
185,423
31,180
220,016
175,780
66,869
52,558
72,685
56,876
5,518
10,382
4,974
3,049
46,461
88,604
91,309
36,840
2,323
66,366
8,409
71,581
65,101
37,298
12,816
29,029
7,013
1 States which did not report and those which have no clinics have been omitted from the above table.
They are Arizona, Colorado, Missouri, Montana, Nevada, New Mexico, North Dakota, Oklahoma, South
Carolina, South Dakota, Utah, Vermont, and Wyoming.
2 Includes 89,618 baths given at the U.S. Public Health Service Clinic, Hot Springs National Park,
Ark.
a County reports.
' For 9 months.
• For 5 months.
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PUBLIC HEALTH SERVICE
122
TABLE
4.-Report of cooperative clinic activities furnished, through State health
departments from 1919 to 193"1
TreatCases disNumber
Total
ments
cases treatments
charged as per
of clinics New
new
arrested
reporting admitted
given
case
or cured admitted
Year
167
383
442
541
513
504
495
416
425
451
445
477
512
533
572
616
656
713
965
1919 ____ -- -- __ -- -- __ -- -- --- -- ___ --- __ -- -- ---- -1920 ______ - - - __ -- -- -- -- - -- - - - - - -- - - - - - - -- - _- - - _
192L ______ ---- ____ -- --------- --- -------------1922 ___ -- -- -- -- ---------- ------ ------ --- ------1923 ______________ -- -- -- -- __ ---- -- -------------1924 __ --- _-- _-- -- -- ---------- _----- -- ---------1925______ - - - - -- -- __ -- -- -- -- ____ -- ____ - - -- -- ___ _
1926 _____ - - - - - _- _- - - - - - __ - - - - - ___- ___ - ________ _
1927 ___ - _- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1928 _____ -- -- - - -- - - - - - -- - - - -- -- - - - - - -- - -- -- - - - 1929 ___ -- -- ---- ---- -- ---------------------1930 _______ - - - - - - - - - - - - - - - - - - -- - - - - - - - - -- - - - - - 1931 __ --- -- ---------- --- - -- ------ ---- ------ ---1932 __ ----- ---- -- -- -- -- -- -- ---- ---- -- ---- -- ---1933 ___ ---- ---- ---- ---- ---- - - -- ------------ - --1934 ___ -- ---- -- -- -- ---- ---- -- -- -- -------- -- - - - 1935 .•• -- --- _-- -- ------------ ----------- - -----1936. __ - - -- - - - - - - - - -- -- -- - - - - -- -- -- - - - -- - - - - - - 1937 ___ - - -- - - -- - - - - -- - - - - -- -- -- -- -- -- - - - - - - - - --
TABLE
69,092
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
149,472
627,392
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
3,757,770
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
68,515
8.02
12, f\O
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
25.14
5.-Annual report of the U. S. Public Health Service clinic at Hot Springs
National Park, Ark., from July 1 1936, to June 30, 193"1 1
Total applicants_____________
VenereaL _____________ _
N onvenerea1 ___________ _
Did not return _________ _
2
6, 806 Gonorrhea (new cases)_______
982
Acute _________________ _
Chronic _______________ _
684
298
3, 948
2,579
279
Syphilis ___________________ _
2,974
New cases _____________ _
Readmitted cases _______ _
Rejected ______________ _
1,980
335
659
Gonorrhea _________________ _
1,243
New cases _____________ _
Readmitted cases _______ _
Rejected ______________ _
982
41
220
====
Syphilis (new cases) ________ _
Primary _______________ _
Secondary _____________ _
Tertiary _______________ _
Neuro ________________ _
Congenital ____________ _
1,980
247
615
1,077
15
26 .
Total treatments given _______ 199,954
Arsphenamine __________
Heavy metaL ___________
Other intravenous _______
Gonorrhea ______________
Baths __________________
20,517
45,853
3,551
40,415
8~,618
Laboratory examinations _____
72,568
Complement ,f ixation tests
Precipitation tests _______
Icterus indices __________
Darkfields ______________
Gonococcus smears ______
Urine analyses __________
Special_ ________________
17,198
17,198
17, 198
1,138
9,147
10,027
662
1 From the annual report of the clinic.
1 The total of 3,948 venereal disease patients represents 4,326 cases of venereal disease, since 363 patients
had both syphilis and gonorrhea or chancroid.
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PUBLIC HEALTH SERVICE
TAnLE
123
6.-Report of the U. S. Public Health Service clinic at Hot Springs
National Park, Ark., from July 1, 1936, to June 30, 1937
Number of cases
Year
Number of
applicants
Total. •..•...•••.•••• ~···············
1922.. •••••..••.••••....••••••..•••••••••..
1923_.. •••••••.•••.•.••••••••..•••.••.•••..
1924... •••• •.•. .• •• •••••••..•••.....•.• •. •.
1925.......................................
1926.......................................
1927 •• ••••••••··••·•••••·•·••••••••··••••••
1928.......................................
1929 •• ••••·•••••••••··••••••••••·••••••••••
1930.......................................
1931 .•• ··•·•••••••••••••••••·•·•·•••••···••
1932.• •••·••·•••••••·•••••••·•·•••····•·•••
1933 ••• ••••••••••••••••·••••••••·•••••••·•·
1934 .•••••.•.••.•••.••• ' ···················
1935.•••.•.•.•.•. ·•••·•···••• .• .. • ••. •.• •• •
1936 .•• ••••••••·••·•••·•••·••·••··••••·•• •.
1937 .••••.•...•••.••• •··••••·•... .• • .•• •• ••
1
Total
venereal
diseases
Syphilis
Gonorrhea
Treatments
given 1
88,906
66,147
42,320
23,827
1,334,180
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
6, 806
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
4,217
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
3,368
2,974
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
1,243
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
110,336
1-------1-----
Baths not included.
TABLE
7.-Statistical summary of activities in the controZ of venereal diseases for
the fiscaZ years 1936 and 1937
1937
19361
Medical activitiu
A. Cases of venereal disease reparted to State health departments:
I. Syphilis .•.••••••••••••••••.•••••••••••.•••••.•...•••.•.••••••••••.••••.
II. Gonorrhea •••••••••••••••••••••••••••••••.........•••.•••.•••••••••••••.
III. C hancroid •.•••••.•.•••.••••••••••••••••••••.••••••.••.•••••••••••••••••
336,147
182,435
4,271
267,717
163,465
3,817
522,853
434,999
1,567,007
1,321,369
281
965
56
713
149,472
68,515
3,757,770
1,143,354
674,863
262,377
127,564
64,330
3,372,229
941,931
579,825
238,699
Educational actiritie8
A. Pamphlets:
.
I. Requests for pamphlets received by the Public Health Service•.••••••••
14,411
12,449
IJ. Pamphlets distributed:
a. By the Public Health Service to State health departments and
others .•....................••••••••..•.•....•.•••.•..........•.
b. By State health departments •••••••••••.•.••••...•••••.••••••••••
75,913
1,092,172
70, 719
641,815
1,168,085
18
712, 53~
4
2,058
99
40
1,707
81
58
Total. ••••••••••••.•••••••••••••••••.••••• •••••••••••••••••••••·•••••••
B. Doses of arsphenamines distributed by State health departments..••.••••••••
C. Clinics:
I. Clinics established during the year....•.•••.•.•.•.·•.•.•.••••••••..••••••
II. Clinics reporting to State health departments .•••.•••••..••.•••••.•••••.
III. Report from clinics:
a. New cases admitted ••••.•..•••.•.•...•.••.•.•.•...•.•.••••.••••..
b. Cases dischar~ed as arrested or cured •••...••.•••...•.••••••••••••
c. Treatments given .•...................•.....•.•.•••.••••••••..••••
d. Doses of arsphenamines administered .•....•..••.......•....•.•••.
e. Sero logic tests made ........ ............•.....•...•.•.••.••••••••.
/. Microscopic examinations for gonococcus ....•••.••••...••.•••••...
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
Data for 1936 were changed from previously published figures because of the receipt of additional reports.
23690-37--9
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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, 1937, marks the seventh 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 were continued during the year at the United States Public Health Service
Hospital (Narcotic Farm), Lexington, Ky. In correlation with these,
observations were continued for determining the addiction liability
of certain specific derivatives of opium. "Perparin", a derivative of
the iso-quinoline nucleus of o~ium, was studied with reference to its
addiction liability when substituted for the drug 0£ addiction in the
course of routine treatment. The results indicate that "Perparin"
does not possess addiction liability but is without apparent value in
the treatment of the abstinence syndrome seen in opium addiction.
Other specific substances were studied as to their addiction liability,
being furnished for this purpose through a cooperative arrangement
between the Public Health Service and the Committee on Drug
Addiction of the National Research Council, the latter being supported by a grant-in-aid from the Rockefeller Foundation.
Studies at the Public Health Service Hospital at Lexington, Ky.,
embrace an intensive investigation of the physical, chemical, psychological, and psychiatric changes resulting from single therapeutic
doses of morphine, from repeated doses of morphine used when necessary during the course of routine care of patients when addiction
must be stabilized, and also during that period subsequent to withdrawal of the drug of addiction. Observations of patients during tha
latter, or post-withdrawal, stage have indicated that some symptoms
characteristic of abstinence may be detected during 15 days subsequent to the withdrawal of the drug of addiction, and in some instances the patient does not "level off" to normal until 30 or, in some
cases as long as 60, days subsequent to withdrawal. Further observations with special reference to measuring these post-withdrawal deviations are under way. They include special studies, both physical and
mental, of the personality involved. It is believed that such studies
124
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PUBLIC HEALTH SERVICE
125
may assist in understanding more clearly the :factor of time and the
manner of recovering physiological equilibrium after addicting drugs
are withheld or discontinued.
Broadly the investigations at Lexington include those relating to
metabolic changes and psychological reactions. In a more specific
sense the metabolic studies embrace metabolic rates, caloric values,
and distribution of food substances, gaseous exchanges, water balance,
and carbohydrate metabolism. They also include studies in blood
cytology and blood concentration. On the other hand, the more
specific investigations in the psychological field embrace studies of
the effect of morphine on the reaction to certain standardized situations and its effect on certain physiological reactions or responses to
psychological stimuli. These latter observations may be of value as
an objective measure for determining, in a more accurate way, that
vexing problem of the relationship of chronic opium poisoning to
so-called emotional degradation. The correlation and coordination of
these studies is thought to be important and necessary for formulating a more rational form of treatment, since treatment in terms of
specificity must rest upon a more intimate knowledge of the nature
of drug addiction. Certain aspects or phases of these investigations
will be the subject of special reports from time to time which will
be made available to the medical profession and the general public
when deemed desirable. Some features of these investigations have
not heretofore been undertaken, and it is believed the results will add
materially to the sum total knowledge of drug addiction.
In an effort more accurately to evaluate the abstinence phenomena
seen in chronic opium poisoning, a system of recording observations
has been inaugurated. These records are not only complete in an
objective sense but are reasonably quantitative in nature. The inauguration of such a system supplies comparable data which lends
itself to statistical study and analysis. Thus, the measurable components of the abstinence syndrome are made available for comparative study. Moreover, such a method of approach tends to furnish
a truer picture of the composite abstinence phenomena, tends to
reduce to a minimum the personal equation in evaluating the importance of specific findings, and has value in more accurately
determining the scientific merit of any system or form of treatment.
A special study dealing with the kidney excretion of recoverable
morphine was undertaken during the year. This has not been completed but is considered of importance as a possible method for the
detection and positive identification of drug addiction-a :factor of
medico-legal significance.
Preliminary work on a program of study in the field of electroencephalography in relation to drug addiction was begun during
the year, involving a study of the electrical potential or action currents within the brain. The application of this particular study
should be of value in carrying forward objective records of the
phenomena of euphoria associated with the administration of opium
or its derivatives. It is thought that such studies may show some
factors relative to the fundamental nature of addiction and especially
with reference to relapses in the use of such drugs. The study also
bears a relation to the objective measurement of the effects of emotional stress and may throw more light upon the addiction potentiality of various substances in correlation with the chemical structure
of the drug involved.
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126
PUBLIC HEALTH SERVICE
During the year experiments were conducted in the treatment of
certain selected cases of addiction by suggestion through the medium
of hypnotism, the object being the building up of a resista,nce to
narcotics. The value of this method of approach may he open to
some question.
Other experiments were conducted through the application of the
Darrow behavior polygraph, with special reference to the nature
of hypnotism. Further psychological studies were carried on by the
application of this instrument, among them being a comparison of
the records 1 hour after injection of a therapeutic dose of morphine
with those obtained 4 hours after such injection. These observations
gave evidence of significant differences in reactions between the two
periods. These preliminary observations furnish several leads concerning the psychological significance of various reaction patterns
that are primarily physiological. Observations have also been made
on the effect which emotion has upon autonomic functions. These
may be profitably extended with special reference to the effects of
morphine on pain.
A review of the literature on the treatment of the so-called
"wit.hdrawal" stage of opium addiction was in progress during the
year. This is being made for the purpose of establishing a fundamental base line on the present status of knowledge dealing with this
particular aspect of drug addiction.
Studies on the addiction liability of certain derivatives of opium
as possible substitutes for morphine were continued during the year.
Such studies involve one aspect of the program of the Committee on
Drug Addiction of the National Research Council, the Public Health
Service undertaking to determine the addiction liability of ne,v
chemical compounds derived from opium whose chemical structure
and physiolo~ical action on lower animals have already been determined through other cooperative units of that committee.
Certain inferences may be drawn as a result of these so-called substitution studies with special reference to the relationship between
chemical structure and addiction liability. Thus, from a pharmacological and clinical standpoint, it would appear, from data at hand,
that compounds having high potency, rapid onset, and brief duration
in physiological action have proportionately greater addiction liability than compounds of lesser potency, slower onset, and longer duration in physiological action. In the former group addiction becomes
much more rapidly established. Such observations tend to correlate
with the known chemical structure of the substance involved. These
observations are of significance in connection with a program which
seeks to develop a substitute for morphine that possesses the desirable therapeutic properties of that drug without or with greatly
diminished addiction potential.
Of the drugs studied for determining their addiction liability, sjx
are new substances which have been developed at the Cobb Chemical
Laboratory, University of Virginia, and studied as to their physiological action at the Department of Pharmacology, University of
Michigan, before their application to man. In addition, b,·o other
substances, "Acedicon" and "Eukodal", that have been known for
some years, were subjected to similar observation. All the drugs
investigated thus far were found to possess addiction liability and
most of them offer no distinct advantage over morphine.
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Two new substances, however, beta-chloromorphide and methyldihydromorphinone, appear to possess the property of maintaining dependence rather incompletely. The analgesic, or pain-relieving
properties were equal to those of morphine, while those properties
which satisfy dependence or addiction were of less duration than
those of morphine. This disassociation of dependence, or addiction
properties, from other physiological action was more pronounced in
the latter drug. Such findings may serve as a significant guide
for further investigations of the relationship of chemical structurn to
selective physiological action. Further studies of methyldihydromorphinone and allied substances seem justified.
As an indication of another forward step in the evolution of a
new type of social machinery bringing together agencies for the
promotion of public welfare, includmg governmental, semi-governmental, and voluntary, having to do with a single medico-social
problem, mention may be made of the disposition of letters patent
for some of the newer substances derived from morphine.
Letters patent for "Ethers of morphine and its dihydro<Yenated derivative, and methods of production" was granted by the Commissioner
of Patents to Dr. Lyndon F. Small, Consultant in Alkaloid Chemistry, United States Public Health Service, on October 27, 1936. This
patent was presented to the Secretary of the Treasury on December
1, 1936, as ex-officio custodian of United States property, in order
that he should have general supervision over experimental studies
with these substances. It is believed that the presentation of the
results of this work to the Government will make easier the handling
of the narcotic problem in the United States. Furthermore, an
application was made by Dr. Lyndon F. Small on October 24, 1936,
for a patent on "Ethers of morphine and dihydromorphine and their
respective N-oxides.''
·
Clinical studies of the analgesic and other properties of morphine
and related substances were continued in connection with the relief
of pain among cancer patients, and for the relief of cough in tuberculous patients. These studies were conducted in cooperation with
the Massachusetts State Department of Health and bear a relation
to the indispensable uses of opium in the legitimate practice of
medicine, and indirectly to the prevention of further addiction.
Studies wer~ continued dealing with the behavior responses of the
chimpanzee to certain habit-forming drugs. These have been conducted in cooperation with the Division of Comparative Psycl1obi•
ology of Yale University. The primary purposes of the investigation
are the determination of the occurrence, methods of evolution, and
nature of induced drug addiction, and such descriptions of the psychobiological picture of the effects on the chimpanzee of continued
administration of morphine as should render possible profitable
comparison with the human picture of morphine effects.
The results are definite and in the main strikingly similar to those
obtained with human subjects~ These studies are being continued
and their completion during the coming year is anticipated.
Studies have also been continued on the use of rats for assaying
the addiction liability and tolerance-producing properties of narcotics and other drugs, and have been carried on in cooperation with
the Department of Pharmacology of the Western Reserve University,
Cleveland, Ohio. Morphine, codeine, heroin, dilaudid, two members
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of the barbiturate series of drugs, and acetanilid have been studied
in this connection. The results obtained were determined by measuring the degree of abstinence hyperirritability in the rat when
subjected to uniformly comfortable situations.
Dilaudid was found to possess definite addiction liability, whereas
the barbiturate series, including phenobarbital and pentabarbital, and
acetanilid do not have addiction liability in the sense of increased
irritability following withdrawal of the drug.
Morphine addiction in rats was unmodified by the administration
of insulin. Addiction to morphine was as readily produced in rats
when the drug was orally administered as when administered subcutaneously. Tolerance to oral administration of fractional doses of
morphine appeared to reach a maximum more slowly than when the.
same dosage was given in a single injection.
DISSEMINATION OF INFORMATION
A symposium on drug addiction was held in October at the United
States Public Health Service Hospital, Lexington, Ky., in which the
general program for research and study was discussed. Five papers
were presented at this meeting and later published in the Hospital
News for December 1, 1936.
Several other articles pertaining to the work of the Division were
published during the year, including the following: "The Absence
of Addiction Liability in 'Perparin' ", "'Rossium' Treatment of Drug
Addiction", ''Experiments on the Tolerance and Addiction Potentialities of Dihydrodesoxymorphine-D (Desomorphine) ", "The Relief
of Pain in Cancer Patients", "Comment on Estonian Sterilization
Law", "An Organization for Promoting Mental Hospital Services in
the United States and Canada."
The :following articles were approved :for publication: "A Critical
Review of the Withdrawal Treatments with Method of Evaluating
Abstinence Syndromes", "Suggestibility in Narcotic Addicts", and
"Suggestibility in Delinquent and N ondelinquent Adult White
Males."
Advisory consultant services were rendered various agencies with
reference to the drug addiction problem.
STUDIES OF THE ABUSIVE USES OF AND THE MEDICINAL AND SCIENTIFIC
NEEDS FOR NARCOTIC DRUGS
Studies were continued relative to the abusive uses of, and the
medicinal and scientific requirements of the United States for, narcotic drugs. Conferences were held and recommendations made relative to the matter of increasing the reserve supply of narcotic drugs
and maintaining stocks for normal commercial flow. During the
year there has been a very large increase in the sales of codeine. This
increase has been occasioned by three factors, difficult to evaluate.
They involve increased sales to replace stocks or to increase stocks
against a possible rise in price ; an increase in the use of codeine, a
trend which has been going on for some time in the legitimate practice of medicine; and destruction of stocks incident to and following
the flood in the Ohio River Valley. The replacing of these stocks ,
has resulted-in a considerable drain on the normal commercial flow
of narcotic drugs in legitimate commercial channels. A readjustment
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was therefore made of the quantities of raw material necessary for
the manufacture of drugs for medicinal and scientific purposes.
Studies to obtain a systematic evaluation of the minimal effective
clinical antitussic and an·algesic dose of codeine, morphine, and related
substances were carried on. These studies have indicated that, in the,
treatment of tuberculous cough, the amount of codeine necessary for
controlling this situation may be reduced to one-third the customary
. dose.
NARCOTIC FARMS
The facilities at the United States Public Health Service Hospital,
Lexington, Ky., were fully developed during the year so that by
January 1937 it was in a position to take care of its normal capacity
of 1,000 patients; but for several months inadequate funds in the
travel budget prevented bringing to the hospital a number of patients
who were ready for it. Additional funds were made available later
on and at the end of the year the patient population was 976.
In January 1937 the Governor of Kentucky asked that the hospital
assist the State in an emergency produced by the Ohio River flood
situation that compelled the evacuation of all prisoners from the
State Reformatory at Frankfort. This was done to the full extent
of the hospital's emergency capacity, and between January _25 and
March 21 a total of 18,506 days of relief was furnished to 468 State
prisoners.
A wider use was made of the probation feature of the law during
the year and a greater -number of sentenced patients were received
directly from the courts. This is a gratifying development, and it is
hoped that in time all convicted addicts will be sent to the hospital
directly, either on probation or by definite sentence, so that they can
be studied and classified. By this means those prisoners who are
unsuited for treatment at the hospital or who are less likely to be
benefited by it can be evacuated to prisons, thereby making room for
more hopeful cases who will thus escape the stigma and . certain
environmental handicaps of residence in penitentiaries.
During the year, 182 voluntary patients were received and 131 left
against medical advice. The leaving of so many patients against
medical advice is unfortunate, but there is no remedy in law for it.
Because of insufficient treatment a large proportion of these patients
relapse shortly after leaving the hospital; others with distorted personalities and no real desire for cure come in because of pressure,
and so cure is not to be expected; but information is received from
some indicating that they have been cured in spite of the short period
of treatment.
Occupational therapy administered through means of the farm,
shops, and various maintenance activities in the institution has been
utilized to the greatest advantage in treatment. The number of
patients receiving oceupational therapy, 85 percent, was approximately the same as that for last year.
Minimum custody has been granted to a large number of patients,
and discipline continues to improve. Three of the patients in whom
confidence had been placed violated their trust by escaping, but were
apprehended within 24 hours. Two of these patients were found to
be psychotic and were not prosecuted. One was prosecuted and given
an additional sentence of a year, and one prisoner who had escaped
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during the preceding year was apprehended and given an additional
sentence of 2 years. It is felt that the psychological benefits derived from placing· confidence in a large number of patients who
deserve it more than compensate for the occasional mistake that is
made resulting in the elopement of a trusted but not dangerous
prisoner who proves not to be trustworthy.
The accompanying table presents a summary report on admissions
and discharges at the institution during the year:
Statistical summary of patient movement, U. S. Public Health Service hospital,
Lexington, Ky., for the fiscal year 1937
Population June 30, 1936 _____________________________________________ 761
Admitted during the fiscal year 1937
Prisoners 1______________________________________ _
Probationers ____________________________________ _
Voluntaries _____________________________________ _
Ex-prisoners _____________________________________ _
Conditional release violators ____________________ .:. __
Parole viola tors _________________________________ _
Probationers returned for further treatment _________ _
Prisoners returned from escape ____________________ _
1, 157
114
184
1
37
8
2
4
1,507
Discharged during the fiscal year 1937
Prisoners:
Transferred _________________________________ _
Death ______________________________________ _
Parole ______________________________________ _
Conditional release ___________________________ _
Maximum
expiration sentence _________________ __
Escaped
____________________________________
Probationers:
Cured ______________________________________ _
Rearrested __________________________________ _
Court order _________________________________ _
Death _____________ · ________________________ _
Voluntaries:
Maximum benefit_ ___________________________ _
Cured ______________________________________ _
Against medical advice _______________________ _
Death ______________________________________ _
Escaped ____________________________________ _
Arrested ____________________________________ _
1
505
8
30
416
74
3
1,036
69
2
l
2
74
20
22
131
5
3
1
182
1,292
Increased population___________________________________________ 215
Population June 30, 1937 _____________________________________________ 976
Average daily population, including the State prisoners,
for the fiscal year___ _______________________ ____ ______ ______________ 926
Readmissions (included in total admissions): 2
Former voluntary patients_____________________
33
Former probationer patients___________________
4
37
C. R. violators 3 ______________________________
Former prisoners_____________________________
20
Parole violators______________________________
8
102
1 Including
468 State prisoners.
'Includes patients discharged since the opening of the hospital in 1935.
.
a A large proportion of conditional-release violators who were returned had not relapsed to narcotics.
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A contract was awarded for the construction of the initial group
of buildings for the United States Narcotic Farm at Fort Worth,
Tex., on July 27, 1936, and construction was begun on August 26,
1936. This unit consists of the administration building, clinical ward
building, maximum custody ward, nurses' home, and roads. The cornerstone was laid with appropriate ceremonies on February 13, 1937.
A second contract was awarded on February 27, 1937, for the construction of the dining hall, two industrial buildings, boiler house, and
water tank. It is anticipated that funds will be made available for the
completion of this institution and _that it will be ready for operation
by the Public Health Service late in the calendar year 1938.
MEDICAL AND PSYCHIATRIC SERVICES IN FEDERAL PENAL AND CORRECTION AL INSTITUTIONS
The Public Health Service continued the work of supervising and
furnishing medical and psychiatric services for the Federal penal
and correctional system, with 18 medical units in connection with
the various institutions under the control of the Department of
Justice. These include six penitentiaries, three reformatories ( one
for females)~ four jails, four independent prison camps, and one
hospital for defective delinquents.
As in the previous year, there has been a continued increase in
the prison population, resultino- in an increased demand for the
services of the medical and technical staff at the various units as
well as in an increased consumption of medical and hospital supplies. Funds made available for this purpose during the past year
have not been sufficient for rendering adequate medical services.
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 been continued but because of dearth in personal services this program was
not uniform in institutions of comparable purposes and function.
Periodical sanitary inspections by the medical staff at the various
institutions have aided in maintaining sanitary conditions at- a higher
standard.
·
Routine physical, psychiatric, psychometric, and laboratory examinations of all new admissions have been continued.
A survey of the psychiatric and psychologic procedures in the
Federal prisons for the purpose of standardizing these procedures for
all the penal institutions under control of the Department of Justice
was undertaken during the year, and work started on the standardization of a new group psychological test to be used in the Federal
penal institutions.
During the course of the year's work at the Leavenworth Penitentiary, a relatively high incidence of . toxic thyroid was observed
among prisoners. In 14 instances thyroidectomies were performed
with most gratifying results. During the year, 151 spinal anesthesias were administered for operations below the diaphragm, making
a total of 989 cases in which this form of anesthesia has been used
at that station. The results indicate that it is the choice anesthesia
for use in institutions of this type.,
Experiences at Leavenworth and other institutions performing
similar functions indicate that special medical attention should be
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given to the emotionally unstable and functionally nervous prisoner,
including the hysterical, psychoasthenic, and neurasthenic groups.
They also indicate the need for more direct medical supervision and
guidance for these prisoners as a means for di;minishing the ad-:
ministrative and disciplinary problems of institutional management
and aiding in the adaptation of the individual to the changed circumstances of his life.
During the year a new hospital wing was completed and occupied
at the penitentiary at McNeil Island, Wash., to provide more ade~
quately for the surgical, X-ray, and urological services. Space!
formerly occupied by the surgical ol>erating room is used as a diet
kitchen, a much needed adjunct, while the space formerly occupied
as quarters for the administrative staff is devoted to a much needed
psycho_pathic ward, new administrative space being provided in the
new wmg.
Of the 685 admissions to the penitentiary during the year, 235 were
admitted to the hospital, and of the 255 new admissions to the nearby /rison road camp for which medical service is provided by the
sta at McNeil Island, 84 patients were admitted to the penitentiary
hospital for treatment, making a total hospital admission of 319.
Moreover, during the year 525 needed surgical operations were.
performed.
At the Northeastern Penjtentiary at Lewisburg, Pa., there has
been a slight increase in the incidence of syphilis among newly admitted prisoners, and at the Atlanta Penitentiary there has been a
notable increase in the number of prisoners seeking and continuing
treatment for this disease. The latter is due to a concerted program
of education conducted at this institution. Because of limited funds
some features of the medical rehabilitation program for prisoners were
drastically curtailed, notably the furnishing of artificial limbs, special
appliances and repairs, and replacement of medical equipment.
The high admission rate and population increase at the Chillicothe.
Reformatory during the year have imposed an additional load upon
the medical personnel. The medical service, however, has continued
to conduct a school for student prisoner attendants assigned as
hospital orderlies. It has served to increase confidence of the inmate
body in the medical personnel and has made available a limited
number of men partially trained in nursing technique.
At the reformatory at El Reno, Okla., a considerable increase was
noted in irritative lesions of the mucous membranes of the eyes, nose,
and throat, thought to have been associated with frequent dust
storms. An epidemic of influenza occurring among prisoners taxed
the hospital facilities beyond their limit so that it became necessary
to use improvised facilities made available by utilizjng other parts
of the institution for hospital purposes. The water supply at this
institution is obtained from a public utility company whose source
of water is from shallow wells. During the late summer and autumn
of 1936 the source of water was contaminated by Bacillus coli and
it was necessary to institute the precaution of boiling all drinking
water until the source of pollution could be corrected. This situation was investigated by officers of the Public Health Service and
recommendation for correcting the situation made to the Bureau of
Prisons.
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UNITED STATES NARCOTIC FARM AT FORT WORTH , TEX .
Designed to accommodate 1,200 patients of the more tractable type of drug addict, or those req uiring minimum custody. Expected to be completed in the late fall of 1938.
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The women's reformatory at Alderson, W. Va., experienced an outbreak of rabies in the dairy herd. Two cows died of the disease, a
rather rare experience with rabies. A large number of the inmates
and officers employed at the dairy were exposed to the sick animals.
As a result, 27 persons were inoculated against rabies and no further
extension of the disease occurred.
Limited medical personnel at this institution made it difficult to
meet all the medical problems which arose. Facilities in the hospital
kitchen were improved and supplemented during the year by the
jnstallation of a new stove and more adequate refrigeration. The
demands upon the dental services were unusually heavy, partly because of the large number of drug addict prisoners admitted, who
notoriously have very bad teeth, and because of an epidemic of Vincent's angina among prisoners. Fortunately, this epidemic was suppressed through timely isolation, segregation, and treatment of those
afflicted and the application of strict precautions to prevent its
spread.
The inmate body at the Federal jail at Milan, Mich., constitutes a
problem of medical concern. The inmates are of both sexes and
comprise prisoners with both long- and short-term sentences demanding both maximum and median custody. Because of this situation it is difficult to develop a concerted medical program for this
jail.
At the New Orleans jail there was a notable increase in the number of treatments given venereally diseased prisoners. This is
thought to be the result of a more concerted educational program
jn reference to the necessity for treatment for these diseases. Physical improvements in this jail were accomplished during the year,
notably with reference to the dining room, kitchen, and bathing
facilities. These changes greatly improved sanitary conditions.
The medical work at the reformatory camp at Petersburg, Va.,
has been rendered more difficult during the past year because of an increase in the admission rate, and because of a greater increase in the
number of short-term prisoners having less than a year's sentence,
many of whom are physically infirm and are primarly a medical
problem. Because of short sentence the physically infirm prisoners
are not eligible for transfer.
At the prison camp at Montgomery, Ala., a new and larger "sick
bay" was developed, adding greatly to the facility for meeting the
medical problems. All prisoners requiring hospitalization are
admitted to the Army hospital adjacent to the camp while the
milder and emergency cases are treated at the camp. During a
State-wide epidemic of poliomyelitis in the autumn of 1936 all
prisoners and employees were given nasal sprays of picric acid
and alum on alternate days as a prophylactic measure against the
disease. No case of poliomyelitis developed.
Adequate medical services at the prison camp at Kooskia, Idaho,
are difficult to render because of its remote location, being 30 miles
from any center of population. Every precaution has been taken,
however, to bring about as favorable a condition as possible from
the standpoint of health by vaccination against Rocky Mountain
spotted fever of inmates and personnel, and the careful selection
on the basis of health of all recruits for transfer to this camp.
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At the Federal jail at La Tuna, Tex., the chief medical officer continued to render medical services for that institution and also for
Federal prisoners confined at the county jail in El Paso, Tex. An
epidemic of influenza among the prisoners during the past year taxed
the hospital facilities beyond capacity.
The mmate population at the United States Hospital for Defective D elinquents at Springfield, Mo., comprises two separate
and distinct groups: First, defective delinquents, and second,
a prison-camp service. · There has been a gradual and constant
jncrease in the number of defective delinquents admitted since
th~ institution opened in the fall of 1933. Approximately ' one-half
of the defective delinquents are afilicted with serious mental disorders requiring close and sometimes maximum custodial supervision. The remainder are classified as tuberculous and chronic infirm patients.
At the close of the fiscal year the census included 467 .defective
delinquent inmates and 131. prison-camp inmates. Patients are received by transfer from other Federal penal and correctional •institutions throughout the United States. They are admitted to the
receiving ward and there detained for a minimum period of 30 days
for intensive study and observation. During this period a complete
routine physical and mental examination, including routine clinical
laboratory work and special tests when indicated, is carried out.
Interviews and examinations are also conducted by custodial officers,
the supervisor of education, and chaplains. Each official prepares
an abstract of his findings which forms part of the . classification
report. At the end of the quarantine period all of the findings are
consolidated and a program is outlined for the subject by the classification committee. The sources of therapy available for both mentally and physically infirm patients have included extensive use
of ~hysiotherapy, hydrotherapy, occupational therapy, and library
service.
An important problem in connection with the medical and custodial care of sick prisoners has been the proper training of attendants. Throughout the year special instruction has been given them
in the form of lectures and demonstrations. All guard attendants
and attendants were urged to enroll in a special 6-week course in
physical t raining and defensive tactics which was prescribed as part
of the t r aining course for cust odial officers. A total of 49 attendants
participated in the course.
Because of difficulties encountered in the safekeeping and care of
dangerous insane pat ients it was necessary to make certain alterations
on the first floor of the psychopathic building. Two wards and
several single rooms were converted into single strong rooms of uniform size and strength. The alterations have made it possible to
maintain a unit of 30 strong rooms for insane patients who require
maximum custodial supervision. The rooms have been occupied for
8 months and have satisfactorily filled the purpose for which they
were designed.
A situation, largely peculiar to this institution, involves discipline
and morale among the mental patients. Misconduct is common to
the majority of them. Abnormal behavior, loss of self-control, and
violation of regulations occur frequently and constitute both custodial
and medical problems. The policy has been to consider such
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patients from both a psychiatric and custodial viewpoint. The degree of custodial supervision prescribed for mentally ill inmates is
based largely on the criminal record, the character of the offense,
conduct, and mental condition of the individual, as in the case of
normal prisoners. However, restrictions of liberties or privileges_
when indicated are always cited as therapeutic measures 2 training,
or discipline when administered to mentally incompetent inmates.
Those under maximum custody have marked restrictions and are
restrained in single strong roq:i;p.s. These patients are usually violent,
destructive, or dangerous. Limitation of their activities is necessary
for their own good as well as for the protection of others. This
restrictive treatment is not ·necessarily permanent, since by such
measures, including daily contact with ·medical officers, the unfortunate mental patient occasionally recovers his self-control to such an
extent that he can safely be placed on close or medium custody.
Mental patients are transferred from ward to ward as improvement
occurs. Improvement is measured largely by conduct and obedience
so far as assignment to particular wards or the degree of custodial
supervision is concerned. Transfer to a ward which provides more
liberties and less supervision is an inducement to many patients to
control themselves. It is a reward for progress in the training or
discipline prescribed for them and is helpful in maintaining morale.
During the year distinct improvement has taken place in the collection of personal history information. Procedures have been so
organized that comprehensive data are received with less expenditure
of time and effort.
Academic work for patients is being carried on in a class which
meets during the forenoons on 5 days each week. Special attention
is given to illiterates, although there are also a number of intermediate students in the class. A number of advanced students are taking
supervised reading courses of various types and their work ranges
well up into the college level. Other work of an academic nature
is carried on by means of both outside and institutional correspondence courses.
Much vocational work is being carried on inc_identally throughout
the institution, but due to limitations of facilities and personnel no
great amount of this work is being done by the school at this time.
Extension work, by means of correspondence courses, is of great
value and is gradually being expanded.
The curriculum at present includes the common branches up to
and including about the eighth grade level, with instruction at
higher levels available through work assignments (which provide
vocational training), correspondence courses, special reading courses
and consultations with officials.
Educational tests are given to all men who are capable of taking
them, provided they were not given such tests prior to coming to this
institution. Tests of educational progress here have not thus far
been given; most of the men who have made definite progress to date
have been in school for but a short time, due to release from the
institution or changes in work assignments. Such tests will be used
where indicated.
Objectives include mental therapy, improved attitudes on the part
of men toward their present and future situations, and an improvement in the ability of the men to make future social adjustments.
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The size of the active student body has shown a slow but steady
increase since the present school started.
tDuring the year the following articles were published in connection with the medical work in the Federal penal and correctional institutions: "An Analysis of the Mental Test Scores of 2,000 Federal
Reformatory Inmates", "Some Factors Affecting the Learning Ability of Adult Illiterate Reformatory Inmates", "The Problem of Nervous Indigestion", "A Case of Chronic Enlargement of the Salivary
Glands", "Evipal Anesthesia for the Extraction of Teeth", "Observations on a Method for Securing Intranasal and Postnasal Hygiene
with Relation to Sinus Pain and Deafness-With Case Reports",
"Mesenteric Vascular Occlusion with Recovery-With a Case Report", "Spinal Anesthesia Repeated Fourteen Times on the Same
Patient-With Case Report", "Case Report ofOmentopexy in Cirrhosis of the Liver With Ascites", "The Control of Dermatophytosis
(Ringworm of the Feet, 'Athlete's Foot')."
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: Durino- the fiscal year 1937
there were furnished 385,708 hospital relief days, and 900,034 outpatient relief days, involving the employment of 281 persons on
various professional and technical positions.
STUDIES AND INVESTIGATIONS OF THE CAUSES, PREVALENCE, AND MEANS
FOR PREVENTION AND TREATMENT OF MENTAL DISEASES
The psychiatric diagnostic service for United States district courts
initiated at Boston, Mass., in May 1936, was extended during the
fiscal year to include district courts located in New York City;
Philadelphia, Pa.; Baltimore, Md.; Denver, Colo.; Detroit, Mich.;
and Kansas City, Mo. In addition to these definitely established
units, all the preliminary arrangements were completed and recommendations made and approved for the extension of the service to the
district courts located in Pittsburgh, Pa. ; Atlanta, Ga. ; and Minnea polis and St. Paul, Minn.; thus making a total of 11 metropolitan
centers where the Federal judges may have the benefit of a psychiatric opinion to assist them in determining the mental state of a
defendant where they consider it an important element in the problem
of disposition of the case.
It is not generally appreciated that mental illness constitutes a
national medico-social-economic health problem. Its solution may
be approached through six fields of activity, including (1) the recognition and the early and adequate treatment of the mentally ill, (2)
investigations into the nature and underlying causes of such illness,
(3) the training of personnel for undertaking the duties involved in
this particular field, (4) the adoption of measures to render less
threatening a possible increase in the number of the mentally ill, ( 5)
a more satisfactory solution of the economic problems associated with
mental illness, and ( 6) measures uprooting community sources of
mental invalidism, disease, and defect. During the past year, the
Service has been concerned directly with the first and sixth avenues
of approach.
The rapid growth in the population of the United States, coupled
with the necessity for securing immediate institutional provisions for
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those groups making the strongest appeal, has resulted in piecemeal
development of facilities for the recognition, amelioration, treatment,
and care of adverse mental states. Because of this piecemeal development and lack of adequately balanced programs, every stage in
the evolution of public facilities and pu~lic policies for meeting the
problems of treatment for the mentally 111 may be found somewhere
represented in the United States today. There is need, therefore,
for improvements and a more equal distribution of measures and
facilities to meet the problem of early recognition and treatment.
No community, State, or local jurisdiction has kept pace with the
needs of the mentally ill. Nevertheless, in those jurisdictions where
this administrative task is directed by medically trained persons, the
facilities and public policies concerned with the problem are more
nearly approaching a solution than those jurisdictions where domiciliary facilities alone represent the assumed total of a community's
obligation and responsibility.
Medical leadership appears necessary for bringing about those
changes that involve better solution of the problem of mental illness.
Such leadership must formulate and execute more adequately balanced programs to the end that mental illness may attain early
recognition, adequate forms of treatment, and that there may be
more equal distribution of measures and facilities for this purpose.
To serve this purpose, a committee has been organized for promoting mental hospital services in the United States and Canada. This
committee is composed of one or more representatives of the Amerj can Psychiatric Association, the American Neurological Association,
the American Medical Association, the American Board of Psychiatry
and Neurology, the National Committee for Mental Hygiene, the
United States Public Health Service, the Canadian Committee for
Mental Hygiene, and the Canadian Medical Association.
The objects of this committee are to stimulate the interest of the
several States in the adequate care of the mentally ill, to bring about
greater equality and wider distribution of facilities therefor, to
standardize and make more uniform policies in this connection, and
to improve the facilities for undergraduate and post-graduate instruction in the psychiatric field. The chief of the Mental Hygiene
Division of the Public Health Service is chairman of this committee,
and an officer of the Service has been assigned as associate director:
The committee's activities are being subsidized in part by the Rockefeller Foundation through grants-m-aid to the National Committee
for Mental Hygiene, by special appropriation made by the Psychiatric
Association for the purpose, and by contribution in terms of personal
services by the Public Health Service.
During the year, 24 State hospitals in Canada, New Hampshire,
New Jersey, Pennsylvania, Oklahoma, Arkansas, Alabama, Louisiana,
Mississippi, and South Carolina were carefully surveyed at the request of local authorities and recommendations submitted to them.
In addition to these, 29 hospitals in 14 States were visited to obtain
specific information concerning their administration and activities.
A special study was inaugurated with reference to hospitalization
rates, medical and nursing personnel employed, and maintenance costs
involved. These data will permit comparison in the practice of
various areas or regions of the United States as regards these factors.
An attempt has also been made to analyze the legal administrative
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Federal Reserve Bank of St. Louis
138
PUBLIC HEALTH SERVICE
provisions and the administrative practices existing in each State
with special reference to the care of the mentally ill. This has
involved a digest of State laws and an analysis of administrative
practices.
It is evident that the first year of residence in a mental hospital
is the most crucial period in terms of hope for recovery and restoration to the community. Rehabilitation and recovery of these patients
demand both material facilities and trained personal services. In
other words, the community's obligation toward these unfortunate
wards of the State does not end with the translation of an idea into
brick and stone alone. It has a further and much more significant
obligation of providing adequately trained personal services in order
properly to meet the many and diversified needs in the process of
restoring patients to their family circle and fireside.
Special studies have been undertaken under the auspices of this
committee for the purpose of analyzing the present status of the
professional and subprofessional personnel engaged in the public
care of the mentally ill. Attention has also been focused on that
phase of the problem which relates to what is being done for the
newly admitted case during the first year of residence. The results
of these investigations will be the subject of a special report to be
made available to the medical profession and general public if deemed
desirable.
As a result of the activities of this committee, interest has been
aroused among several Stata health departments in the administrative problems affecting the care of the mentally ill. Modern preventive medicine may exert "beneficent influence for carrying out
those measures and policies that have for their object the promotion
of security and social progress and, indirectly, may promote the
health of the population.
It is known that much of the behavior of man, including many
symptoms of ill health, is a direct reaction to his social environment.
It is also known that if remedial and preventive medicine is to undertake its full responsibility, it is essential that it take cognizance of
the many forces at work in the community. The study of such forces
as they affect the mass or groups of the population is a function
peculiar to epidemiology and sociology. Problems encountered by the
demands being made in the practice of preventive medicine are
increasingly seeking :for their solution an absorption of the methods
and technique of sociology. Sociological and epidemiological methods
in their broadest application appear to have some contribution to
make towards a better understanding of the prevention of mental
illness and the promotion of positive good mental health.
During the year, special studies embracing the sixth avenue of
interest in the solution of the problem of mental illness were undertaken in Fayette and Scott Counties, Ky., in cooperation with the
State and local health authorities and with the State University.
The purposes of these studies are to determine where, when, and
under what conditions mental disorders arise in a typical American
community, with the ultimate object of attempting to determine
whether, from a sociological and epidemiological standpoint, the settings or situations influencing the evolution of mental disorders and
the economic problems involved group themselves into etiological categories. Another objective is to determine if there is a pattern ap-
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
139
proach to this problem from the standpoint of the place which mental
hygiene might occupy in a regularly constituted health organization.
Such studies may point the way to the formulation of a public policy
aiming to uproot or ameliorate the sources of mental invalidism in a
community. Moreover, the results of such studies will make possible
more specific recommendations concerning the role that a regularly
constituted public health agency may justifiably perform in the field
of mental hygiene.
Since the work was inaugurated, on September 1, 1936, it has been
necessary to utilize the study area both as a source of basic data and
as a proving ground to determine the practical nature of administrative measures. The results of this stud,¥ will be the subject of reports from time to time to be made available to the medical profession and the general public as deemed desirable.
23690-37-10
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Federal Reserve Bank of St. Louis
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
unchanged during the year. Through a personnel section, a finance
section, and a property-record section, all matters relating to appointm€nts, separations, and other changes in status of personnel, estimates of appropriations, allotments, and encumbrances, records of
expenditures, including administrative audit, and all records of nonexpendable property are administered under the supervision of the
Assistant Surgeon General in charge of the Dhrision.
There is urgent need of additional funds with which to provide
more medical officers and other classes of personnel essential to the
proper operation of marine hospitals and other stations. In order
to help conserve the limited appropriation available for the maintenance of hospitals, medical internes have been assigned to perform
duties to which more experienced doctors should be assigned. In all
of the hospitals the numbers of nurses and attendants are insufficient
to enable the Service to comply with the 44-hour week. Numerous
complaints have been received from Members of Congress and employee unions regarding inadequate pay, long hours, and denial of
annual leave. In most mstances the complaints are fully warranted.
PERSONNEL
COMMISSIONED OFFICERS
On July 1, 1936, the regular corps of the Public Health Service
consisted of the Surgeon General, 8 Assistant Surgeons General, 53
medical directors, 1 pharmacologist director, 45 senior surgeons, 1
senior sanitary engineer, 68 surgeons, 14 dental surgeons, and 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 passed assistant dental
surgeon, and 2 assistant pharmacists were on waiting orders,
During the fiscal year the following changes occurred in the several
grades : 1 Assistant Surgeon General reverted to the grade of senior
surgeon and 1 senior surgeon was assigned to duty in the bureau as
Assistant Surgeon General; 1 medical director and 1 surgeon on
active duty and 2 medical directors on waiting orders status died
during the year; 2 medical directors, 1 passed assistant surgeon, and
1 passed lil,ssistant dental surgeon were placed on waiting orders
140
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
141
status; 1 passed assistant surgeon and 1 assistant surgeon each resigned ; 1 senior surgeon was promoted to the grade of medical
director, 1 senior sanitary engineer was promoted to the grade of
sanitary engineer director, 11 surgeons were promoted to the grade
of senior surgeon, 7 sanitary engineers were promoted to the grade
of senior sanitary engineer, 8 passed assistant surgeons were promoted to the grade of surgeon, 3 passed assistant dental surgeons
were promoted to the grade of dental surgeon, 2 assistant surgeons
were promoted to the grade of passed assista.nt surgeon, 1 assistant
dental surgeon was promoted to the grade of passed assistant dental
surgeon; 27 doctors were appointed to the corps in the grade of assistant surgeon, 5 dentists were appointed to the corps in the grade of
assistant dental surgeon, and 7 doctors were appointed to the corps
in the grade of passed assistant surgeon.
On July 1, 1937, after these changes had occurred, the regular
corps consisted of 2 Surgeons General (1 on waiting orders), 8
Assistant Surgeons General, 52 medical directors, 1 sanitary engineer
director, 1 pharmacologist director, 54 senior surgeons, 7 senior sanitary engineers, 64 surgeons, 17 dental surgeons, 8 sanitary engineers~
111 passed assistant surgeons, 23 passed assistant dental surgeons, 9
passed assistant sanitary engineers, 8 passed assistant pharmacists, 70
assistant surgeons, 9 assistant dental surgeons, and 2 assistant pharmacists-a total of 446 officers. Of this number, 1 Surgeon General,
17 medical directors, 7 senior surgeons, 14 surgeons, 5 passed assistant
surgeons, 1 passed assistant dental surgeon, 1 assistant dental surgeon,
and 2 assistant pharmacists were on waiting orders.
At the close of the fiscal year 1937, 3 medical directors, 4 senior
surgeons, and 1 surgeon were serving by detail as assistant surgeons
general in charge of administrative divisions of the Bureau in
accordance with acts approved July 1, 1902, July 9, 1918, and April
9, 1930; 1 medical director was on duty as director of the public
health district, New York, N. Y.; 1 senior surgeon, 2 surgeons, and 2
passed assistant surgeons 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.; 2 senior surgeons, 2 surgeons, 3 passed
assistant surgeons, and 1 passed assistant pharmacist were serving
on detail to the Bureau of Indian Affairs, Department of the Interior, in connection with the control of communicable diseases
among the Indians; 1 medical director, 1 senior surgeon, 1 dental
surgeon, 2 passed assistant dental surgeons, and 5 assistant surgeons
were serving on detail with the United States Coast Guard; 1 senior
surgeon was assigned as medical director to the Rural Resettlement
Administration; 1 sur·geon was assigned to the Social Security Board
as consultant in connection with the program of assistance to the
blind; in connection with mental-hygiene activities, 1 senior surgeon
was assigned as consultant to the Director and staff of the Bureau
of Prisons, 1 surgeon, 1 passed assistant surgeon, and 2 assistant
surgeons were assigned for duty at various penal and correctional
institutions; 1 medical director, 6 passed assistant surgeons, 1 passed
assistant dental surgeon, and 1 _passed assistant pharmacist were
assigned to duty at the United States Public Health Service Hospital (narcotic farm) at Lexington, Ky.; 1 senior surgeon, 1 sur-
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
142
geon, 2 passed assistant surgeons, and 1 assistant surgeon were assigned on special field studies in mental hygiene; and 1 senior surgeon was detailed to duty in connection with the organization of
psychiatric services for Federal courts.
RESERVE OFFICERS
On July 1, 1936, the reserve commissioned officers on active duty
numbered 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.
On June 30, 1937, the number of reserve officers on active duty .
was 84, consisting of 7 surgeons, 1 dental surgeon, 13 passed assistant surgeons, 2 passed assistant dental surgeons, 54 assistant surgeons, and 7 assistant dental surgeons.
ACTING ASSISTANT SURGEONS
On July 1, 1936, there were 698 acting assistant surgeons in the
Public Health Service, and by July 1, 1937, this number had increased to 732.
Of the 732 acting assistant surgeons, 88 were on _duty at marine
hospitals; 435 were engaged in immigration, relief and maritime,
border, insular, and foreign quarantine work; 7 were engaged for
duty in connection with the field investigations of public health; 129
were detailed for duty with the United States Coast Guard and
Lighthouse Services; 4 were serving with the Employees' Compensation Commission by detail ; 38 were serving at various penal and
correctional institutions; and 31 were engaged in antivenereal disease activities as part-time employees at nominal compensations.
Twelve of the 31 acting assistant surgeons engaged in antivenereal
disease activities held appointments as collaborating epidemiologists.
ATTENDING SPECIALISTS
On July 1, 1936, there were 585 attending specialists in the Service,
and during the year this number increased to 635, of which 304
were consultants to marine hospitals, while 43 were- available for
call at second- and third-class relief stations ; 46 were engaged in
an'tivenereal disease activities; 119 were serving at various penal and
correctional institutions; and 123 were consultants in connection
with quarantine, immigration, and scientific research activities.
INTERNES
On July 1, 1936, there were 187 medical and dental internes in the
Service; on July 1, 1937, there were 172. 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, 1936, there were 14 pharmacists and o2 administrative
assistants in the Public Health Service. During the year, 1 chief
pharmacist died and the grade of 1 chief pharmacist was changed
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
143
to that of principal clerk; 1 administrative assistant was retired for
disability during the year, and the services of 1 were discontinued,
but an addition of 4 was made in the administrative corps1 making
a total at the end of the fiscal year of 12 pharmacists ( 6 chief pharmacists, 4 pharmacists, and 2 junior pharmacists) and 54 administrative assistants.
NURSES, DIETITIANS, AND RECONSTRUCTION AIDES
On July 1, 1936, there were on duty 620 nurses, 31 dietitians, 33
aides, 71 guard attendants, and 2 social workers. On June 30, 1937,
there were 662 nurses, 41 of which were on a temporary status, 47
aides and physiotherapy assistants, 9 of which were on a temporary
status, 37 dietitians, 3 of which were on a temporary status, 2 librarians, l _hospital worker, and 73 guard attendants assigned as follows:
Hospital Division-nurses, 620; dietitians, 35; physiotherapy aides
and assistants, 44; librarians, 2, and social worker, 1; Menta] Hygiene
Division-nurses, 34; dietitians, 2; aides, 3, and guard attendants,
73; Foreign Quarantine Division-nurses, 3; Scientific Research Division-nurses, 5. In the permanent service, 74 nurses, 5 dietitians,
3 aides, and 10 guard attendants resigned, and 26 nurses were discontinued. Of this number, 7 were retired for physical disability
and 6 became beneficiaries of the United States Employees' Compensation Commission. There were 22 resignations and 78 discontinuances in the temporary group. The turn-over in the nursing
service has been large, owing primarily to the improvement in economic conditions throughout the country. It is becoming increasingly difficult ·to secure the required number of junior nurses from
the Civil Service Commission to keep the regular positions fi1led, with
the result that nurses have to be appointed locally for temporary duty,
which is obviously unsatisfactory. There have been no new activities
inaugurated during the year, although there has be.en considerable
expansion of those already in effect. In addition to studies already
being made, nurses have been assigned to the Germantown Dispensary
and Hospital, Germantown, Pa., to assist in the study of respiratory
diseases being made as part of the social security program. Four
nurses have taken courses in anesthesia. Two additional_ emergency
rooms under the Treasury Department have been supplied with
nurses, and a nurse has been detailed to the out-patient office of the
marine hospital at Boston, Mass. The staff at the marine hos<pital
at Stapleton, N. Y., has been increased one-third.
CONTRACT DENTAL SURGEONS
On July ·1, 1936, there were 51 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 1937 this number had increased to 55 ;
7 were at marine hospitals, 40 were at second- and third-class relief
stations, 7 were serving at various penal and correctional institutions,
and 1 was detailed to the United States Coast Guard for duty.
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Federal Reserve Bank of St. Louis
144
PUBLIC HEALTH SERVICE
EPIDEMIOLOGISTS
During the year thb number of assistant collaborating epidemiologists was decreased from 4,725 to 4,565. 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 on duty on July 1, 1937, was 34. These appointees
are officials of the State boards or departments of health and are on
duty in the different States.
NATIONAL INSTITUTE OF HEALTH
The scientific staff of the National Institute of Health comprised
212 members, of whom 66 were commissioned medical officers and 146
other research workers. The staff was assisted by 58 technicians and
278 other subordinates, making a total of 548.
PROPERTY RECORDS
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 $17,721.25 was turned in to "Miscellaneous receipts" from
sales of property. This includes $822.21 for unserviceable property
not desired by other Government departments; $14,693.24 for surplus
boats not desired by any other Government department; hides and
wool, $1,434.37; scrap metal, $11.50; old X-ray films, $167.20; unclaimed baggage, $20; miscellaneous surplus,?, $572.73. Property surplus to the Public Health Service valued at <1'4,867.58 was transferred
to other Government departments. Surplus property o-f other Government departments valued at $97,209.59 has been received by the
Public Health Service. This includes $17,630 for cars, $28,789.74
for electric refrigerators, $2,768.35 -for gas and electric ranges,
$13,628.02 for electric washing machines, $8,542.10 for sugar, and
$25,851.38 for miscellaneous supplies and equipment. Property
valued at $61,168.14 has been transferred from Public Health Service
stations where it was surplus to stations where it could be used. By
the exchange value on old typewriters turned in on the purchase
price of new machines, $1,545 has been saved. By the exchange
value of old automobiles turned in on the purchase price of new
machines, approximately $1,271.41 has been saved.
ACCOU TS 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.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
145
PERSONNEL STATEMENT
The accompanying tabular statement shows the personnel of the
Service as of July 1, 1937. Of the 12,240 employees shown in the
table, 4,599 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 diseases. The personnel statement also includes all
part-time employees, those employed on a per-diem basis, and those
whose compensation is on a fee basis.
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Federal Reserve Bank of St. Louis
Consolidated personnel report as of July 1, 1937
Regular corps
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Hospital division:
Marine
hospitals:
Baltimore,
Md_________ ____ ________________ _____ _ _____ _ ______
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Boston, Mass_ ______________ ____________ __ _____ __ _____ _
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Buffalo, N. Y ---- ------------------------ -- ______ __ ____ ______
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Carville, La _____ __ ______________________ ___ ______ __ ___ _
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Chicago, Ill______ ______________________________________
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Cleveland, Ohio________________ ___ __ ___ ____ ______ ______
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Detroit, Mich______________________ ____ ____ ___ ___ ______ ___ ___ ______
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Ellis Island, N. y ____ ______________________ ______ ______
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Evansville, Ind___ ____ ____ _________ ____ ___________ ____ __ ____ _
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Fort Stanton, N. Mex_______________ ____ __ _ ______ ______ _____ _ _____ _
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Galveston, Tex_ ___ _____ ____ _______ ____ _____ ______ ______
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Hudson Street, N. y ______________ _____ ___ _ ______ __ ____
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Key West, Fla_____________________ __ _____ _ ______ _____ _ ______ ______ ____ __
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Louisville, Ky______________________ __ ____ ________ ____ __ ____ _
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New Orleans, La______ ___________________
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Norfolk, Va___________________ ______ __ _____ _____ ____ ___
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Pittsburgh, Pa_____ __ _______________ _______ ______ ______ ______
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Portland, Maine_____ ___ _________ ____ ______ ______ ______
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St. Louis, Mo______ __ ___ ___________________ ___ __ ___ ___ __ _____
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San Francisco, CaliL ____ _________ ____ _____ ______ ______
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Savannah, Ga______________________ ____ ___ _ ______ ______ ______
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Stapleton, Staten Island, N. y _______ __ ___ _ ______ ____ __
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Vineyard Haven, M~--------------------· ______ • _____ ______
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Federal Reserve Bank of St. Louis
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~...•...1 ...•.......................•........
··•· 1· ..... . .................. ·····Ellis Island (also immigration) .••. ·-·······............
1 ......
Fort Monroe, Va .•..........• ·-············ .•..•. .....•
Galveston, Tex .....•......•••..••. ·-······· ····-· ...•..
Laredo, Tex .....•..• ·-····················· -····· ·-·-··
Marcus Hook, Pa ..••........•........•••.. ····-·......
New Orleans, La•.. •·················-·-··· ·-···· ....•.
Rosebank, N. Y .•.......•••..................•.•• ···- ··
San Francisco (also immigration) •......... _ ...•.. ··-···
Foreign ports.-............................. . .•.•. .....•
All other stations ..•.....•••... ·-··-··-····· ·-···· ···-··
1 .................. ··-··· ............................. .
·-···· ..•...
1 .......•.... ··-··· -····· ................. .
......
1 ..•.•.....•............. -····· ................. .
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1 .........•......................................
..••.. ......
1 ...•..
2 . ................. -····· ..... .
..•...
1 ......
3 ...... ···-·· ............ ···-·· ..... .
1 ...... ...... ......
2 ............................. .
2
2
2
9 ........................ -····· -·····
2
3
7
9
4 .... ......................... .
1
1
2 -·······
1 - ·······
16
1
2
4
1 . ..••.
2 ......
6 -·····
2 ......
34
2
200
1 ·· ·····-····· . • • •.. ....•.
-····· ...... ...•..
1
1
-····· .••••. •.••..
2 ·•••·•·•
...... . . . ... ......
1 ......•.
-····· • •..•. ···••· -····· -·······
1 ···-·· -·-···
Domestic Quarantine Division .. -...••..•.....••......... ····-··-·-·· ..•... ···-·· .................. -····· .................. -··· · · -·····-·····
Interstate sanitary activities .....••............. ·--·-- ·-·-·· ......
1
3
2 .................. ·· ··-· -····· ...... --···· ............
Rural health cooperation·-·············-·····-····-··............
1
9
3
8 .....• -····· ...... -····· ............ -····· ......
All other activities •..•......• ·-·--·-·········-·· ...•.. ··-··" ...•..
3
3
3
8 .................. -····· -····· .............•....
2
5 · ······•
............ -····· ....... .
-····· ...... · ··· ·- -·······
-···· · ......
1 -·······
-····· ·····- ·····- . ...... .
Scientific Research Division .......•. ·-···-···-···-· ··-··· ....•....... -····· ...... ·····- ..•... ·-···· ...•.........•.•.............. -····· -····· -····· ...................•
National Institute of Health·-·······-·········· ...... ·-····
3
3
4
7
6 ........................ -·····
1
26 -··· · · ...... ......
2 . .. . . .. .
fnWu:!t~rJi~;:f~:e~~~a;~~~fation~~=:::::::::::: :::::: :::::: :::::: -···1· ···-1·
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Malaria investigations ...•............ ·-·····-·· ..••.. ·---··
1
2
1
3 ··--·· -····· .............................. -····· .................. . ..... -·······
Milk investigations ••••••... ·-·················· ....•. ·-···· ......
2
1 -····· -··-·· ............ -····· -····· ...... ···-··
21 . ........... ·····- ···· ·- · ······Stream pollution ••.......•.... -·-···--···-····· ..........•. ····-·
2 ·-···2 ...... ·-···· ···-·· ..•... ·-···· -····· ......
2 ............ . ..... -··· · · · ······Statistical office ... ······-·········-·-·········· ·····- ..•.•. ··-··· ..•........................•........ ···-·· ............ ···-··
5 ........................ ·······Public health methods__·······---················-·-·-···- ·····- ·--···
1
3
1 ....•. ...... ...... ...... ...... .•••..
2 ............................... .
Rocky Mountain spotted fever ....••........... ··-··· .•..•....•....•••...•.•.....•..••••..•••.....•.. ····-· ............ ·····1 ...... -····· ......
1 . ..•....
All other activities....................•.•• ·-·-·· ...... ·····5 -·····
2
3
4 .••... ··-··· ...... ...... ..•...
1
18 .•.•.•..........................
i ....~. :::::: :::::: :::::: :::::: ::::::
:::::: ....~. :::::: :::::: ::::::::
Division of Sanitary Reports and Statistics .••••••• --···· ····-- ..•••..••.••.•..•. ______ .•.•••.•••••.•••...••••. ·····- .•.•...•.•..
Division of Venereal DiseMes •.•...•••••••.•••••••••..••••••••••..••••.•.•.•
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a ...... ...... ...... ...... ......
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Division of Mental Hygiene ___ _______________ ____ __ ____________ ____________ ______ ________________________ _____ _________ ____ ____________ __________ ___ __________________ _
Alcatraz Island, Calif___________________________ ______ ______ ______ ______ ___ ___ ______ _____ _ ______ ______ ______ ______ ______
1
1
1
1 ______
1 _______ _
.Alderson, W. Va____________________________ ___ ______ _____ _ ______ ______ ______ ______ ______ ______ _____ _ _____ _ ______ ______
5
2 __ ____ ______ __ __________ - ------Atlanta, Ga______________ _________ __________ _________ ______ ______ ______ ______ ______ ______ ___ __ _ ______ ______
1
1
2
5
4 ______
1
Chillicothe, Ohio_____ __________________________ ______ ______ ______ __ ____ _____ _ _____ _ ______ ______ ______ ____ __ ______
3
2
5 ______ ______ ______
1
El Reno, Okla________ ______________ ___________ _ _____ _ _____ _ ______ ______ ___ __ _ ______ ______ __ ____ ______ ______
1 ______
2
3
2 ______
1 ------- Fort Leavenworth, Kans____ ____ ___________ ____ ___ __ _ ______ ______ ______ ______ ______
1 ______ ______ __ ____
1
1
3
1
1 ______
1 _______ _
La Tuna, Tex_ __________________ ____________ _________ ____ __ ______ ___ ___ ______ ___ ___ ______ _____ _ ______ _____ _ ___ __ _ ____ __
1
5
1 ____ _________ ___ __ -------Leavenworth, Kans______ ____ ____________ ______ ______ ______ __ ____ ____ __ _____ _
1 _____ _ ______ ______ ______ ___ ___
2
2
2
2
1
Lexington, Ky___________ __ ____ __ ____________ __ ______ ______
1 ____ __ ______
8 ___ ___ ______ ______ _____ _ ______ ____ __ _____ _
5
7
2 ------- Lewisburg, Pa____________________ ________ ______ ______ ______ ______ ______ _____ _ ______
1 ______ ____ __ ______ ____ __
2 ____ __
10
1 ___ ___
1 _______ _
McNeil Island, Steilacoom, Wash_______________ ______ ______ ___ ___ ______ ______ ______ ___ __ _ ______ ______
1 ______ ______
1
4 ____ __
1 ______
1 -------Milan, Mich _________________________ ___ _______ _____ __ ______________________ __ _______________________ ____________ _
1
6
1 ___ ___ ____________ -------New Orleans, La____________ ___________________ ______ ______ ______ ______ ____ __ ______ ______ ______ ______ ______ ______ ______
4
1
1 ___ ______________________ _
Petersburg, Va_______________________ ___ ___ ____ ______ ______ ______ ______ ____ __ ____ __ ___ __ _ ______ ______ ______ ______ ___ ___
3
2 - - ---- _____ _ ____________ --- ----Springfield, Mo_____________________________ ____ ___ ___ ______ ______ _____ _
1 _____ _ ______ ______ _____ _ ____ __ ___ ___
4
3
7
1 ____________ - ------Tucson, Ariz _____ _________ _______________ ______________________ __ ____ ____ ___ _ -----·· _____ _ ______ _____ _ ______ __ ____ ___ ___
1
1
1
1 ____________ -------All other activities ______________________________ --,--- ______ ______
2
1
2
1 _________________ ___ ____ -----··
7
59
2 - ----- _______ ____ _ - ------Miscellaneous ______________________________________ ____ ___ _____ ___________ __ ____ _ ______________ ________ ___________ ____ ___ ____ __ _______________________ ___ _________ ____ _
Detailed to other offices __________ _____ _____________________
2
5
6
5 ______ ______ ______ ______
3
1 ----- - ------ ----- - ------ ___ _________ ----- --On waiting orders (commanding officers)_______
1 ______
17
7
14
6
3 ___ __ ____________________________________________________________________ _
All others________________ ____ ______________ _____ ______ ______
1
2
1 __________________ ____ ____________________ -----1 ----- - _______ __________________ _
____
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Grand total ______________ --------------------
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54
61
89
151
81 - -- --- - -----
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FIELD
Hospital division _______________________________________________________________________________________________________________________________________________ _
Marino hospitals:
42
14
21
244
16
87
15
259
4
5
Baltimore, Md ____ -----------------------------------5 ------ ------ -----17
2
9
17
8
143
42
16
135
Boston, Mass-----------------------------------------1
1
2
2
1
4
14
6
13
3
59
61
Buffalo, N. Y ------------------------------------------ ______
1 _____ _
1 ___________ _
Carville, La___________________________________________
1
115
1
306
169
3
305
6 ------ -----Chicago, !IL_____ ____________ _____ ____ ____ __ _______ __ __ ______
1
2
2
17
19
6
173
20
10
167
60
5
18
66
8
9
151
3
160
Cleveland, Ohio_----------- -------------- ------------1 ___________ _ 28
9
51
143
26
1
7
13
10
133
1
2
Detroit, Mich ____ -----------------------------________
9
232
38
2
146
8
223
6
Ellis Island, N. Y ____ --------------------------------1
4
Evansville, Ind________________________________________
1 ___________ _
1
62
3
3
7
4
28
59
2
1
7
82
6
139
145
10
30
Fort Stanton, N. Mex_--------------------------- ----- ______
2
2
4
35
111
117
20
6
16
6
1
Galveston, Tex_------------------- -- ----- - ------------ ______ ______
2 -- ---- ------ -----9
15
11
114
6
5
27
108
Hudson Street, N. Y ___ ------------------------- -----1
6 _____ _
3 ------ ------ -----Key West, Fla __________ ___ __ ___________________ _______________ ___ ______ _
3
17
1
36
3
1
35
6
4
4
9
25
4
6
71
67
3 ------ ------ ------
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_
Mobile, Ala___________________ __ _______________________
______
l
1
3
4
New Orleans, La__ ____________________________________
1
2
Norfolk, Va____________________________________________ ______
Pittsburgh, Pa_________________________________________
1 ___________ _
Portland, Maine ________________________________________________________ _
St. Louis, Mo ___________________________________________________________ _
3
San Francisco, Calif __ --------------------------------- ____ __ · 3
Savannah, Ga_________________________________________
1 ______
1
1
1
2
Seattle, Wash___________________________ _______________
2
4
4
Stapleton, Staten Island, N. Y ------------------------Vineyard Haven, Mass ________________________________ ------ ------ ------
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Federal Reserve Bank of St. Louis
11
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56
29
7
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5 ------ ------ ----- -
3 ------ ------ -----1 ------ ------ ------
14
40
16
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66
4 ------ ------ ------
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1 ------ ------ -----1 ------ ---·-- ------
2 ------ ------ ------ ------
5
19
6
3
3
12
5
13
8
4
3
84
91
7
15
292
307
16
184
1
12
10
8
2
176
16
49
4
4
53
51
57
76
18
251
78
205
385
14
222
13
1
2
29
8
9
13
47
78
164
6
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3
9
24
5
11
4
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36
39
127
85
23
114
26
6
29
44
2
4
17
20
1
81
84
72
269
82
405
15
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Hospital division-Continued.
Relief stations:
Second class------------------------------------------- ______ ______ ______
23
6 ______ ______ ______
14 ______
7
10
2
16
126 142 _______ _
Third class____________________________________________ ______ ______ ______ ______ ______ __ __ __ ______ ______
6 ______ ______ ______ ______ ______
193
193 -- -----Coast Guard and Lighthouse Services___ ____ ______________ ___ ___ ______ ______
1 ______ ______ ______ ______ ______ ______ ______ __ ____ ______
11
133
144 _______ _
Departmental emergency relief___________________________________ ________ __________________________________________ __________________________________ _______________ _
Perry Point supply station________________________________________________________________________________
4 _____ _ ______ ______
6
1
10
11 _______ _
2 ___ ___ ______ ______ ______
5
7
12 _______ _
All other activities_________________________________________ ______ ______ ______ ______ ______ ______ ______ ______
Foreign Quarantine Division ________________________________ ___ _________________ ____ ____ _____ _______________ _______________________ _____ _______________________ _
938
Quarantine stations:
Baltimore, Md______________________________________________________________ ________
2 _____ _
8
4
1
19
20
1
---------Boston, Mass_ ______ ___________________________________ ______ ______ ______ ______ ___ ___
3
2
1
7
1
2
5
21
23
6
Ellis Island (also immigration)_________________________ ______ ______ ______ ______ ______ _____ _ ______
2
1
4
25
29
Fort Monroe, Va______________________________________ ______ ______ ______ ______ ______
2
1 _____ _
1
5
15
5
16
1
2
2
3
Galveston, Tex______________________________________________________________________
1
4
1
16
15
Laredo, 'l'ex_ ------------------------------------------ _____ . ______ ______ ____ __ ______ ______ ____ __
8 _________________ _
2
1
1
15
16
Marcus Hook, Pa______________________________________ ______ ______ ______
2 ______
2
2
2
1
10
26
27
5
1 ------ -- ---4
4
10
New Orleans, La______________________________________ ___ ___ ______ ______ ______ ______
2
2
4
29
32
3
Rosebank, N. y _______________________________________ ______ ______ ______ ______ ______
6
5
23
18
29
7
4
96
100
San Francisco (also immigration)________________________________________
1 ______
4
2
7
17
2
5
41
44
3
1 ______ ______ -----19
Foreign ports____________________________________ ______ ______ ______ ______
15
62
3
3
77
All other stations_______________________ ___ ____________
1 ______ ______
2 ______
17
15
66
125
63
25
513
16
538
Domestic Quarantine Division _______________________________________________________________ ------ _____________·___________ ___ ___ ------ ___ __________ ___ ____ -----490
Interstate sanitary activities_________________ _____ _________ ______
1 __________________ ------ ------ ______
3 ____________ -----69
6
73
79
Rural health cooperation__________________ ___ _____________________________________
6 ______ ______ ______
6 ____ __ _____ _ ______
3
21
16
37
All other activities.---------------------- --- --------------- ______ ______ ______ ______
2 ------ ______ ______
2 ______ 323
2
28
17
357
374 -- ------
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Federal Reserve Bank of St. Louis
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National Institute or Health_______________________________ ______ ______ ______ ______
66 ______ ______ ______
23 ______ ______ ______ 119
23
237
260
Child hygiene investigations_______________________________ ______
1 ______ ______
4 ______ ______ ______
11 ______ ______ ______
3
2
34
36
Industrial hygiene and sanitation__________________________ ______ ______ ______ ______
16 ______ ______ ______
11 ______ ______ ______
16
9
78
87
Malaria investigations_____________________________________ ______ ______ ______ ______
8 ______ ______ ______
8 ______ ______
12
7
29
36
Milk investigations_______________________________________ _ ______ ______ ______ ______
7 ______ ______ ______
3 ______ ______
2
3
34
37
Stream pollution___________________________________________ ______ ______ ______ ______
10 ______ ______ ______
2 ______ ______ ______
10
4
24
28
Statistical office____________________________________________ ______ ______ ______ ______
7 ______ ______ ______
7 ______ ______ ______ ______ ______
19
19
Public health methods_____________________________________ ______ ______ ______ ______
4 ______ ______ ______
10 ______ ______ ______
1
5
17
22
Rocky Mountain spotted fever____________________________________________________
9 ______ ______ ______
7 ______ ______ ______
36
54
54
All other activities_________________________________________ ______ ______ ______
8
13 ______ ______ ______
10
67
19
14
137
151
Division or Sanitary Reports and Statistics ____________________ ·----- _________________ _
4,608 4,608
2
3 ------ ------ -----3 ------ ------ -----Division or Venereal Diseases _______________________________________ _
112
123
3
14
11
7 ------ -----1 ------ -----10 ------ ------ -----Division of Mental Hygiene ••• -------------------------------- ____________________________________________________________________________________ -------- _____ _
Alcatraz Island, Calif______________________________________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
4
9
9
5 ______ ______ ______ ______ ______ ______ ______ ______
1
13
13
Alderson, W. Va___________________________________________ ______ ______ ______
Atlanta, Ga________________________________________________ ______ ______ ______
3 ______ ______ ______ ______ ______ ______ ______ ______
1
2
16
18
Chillicothe, Ohio__________________________________________ ______ ______ ______
3 __________________ -~---- ______ ______ ______ ______
3
3
14
17
El Reno, Okla_____________________ ________________________ ______ ______ ______
2 ______ ______ ______ ______ ______ ______ ______ ______
1
1
11
12
Fort Leavenworth, Kans_--------------------------------- ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
4
3
10
13
La Tuna, Tex_______________________ ______________________________________________________________________________________________
3
10
10
Leavenworth, Kans________________________________________________________
3 ______ ______ ______ ______ ______ ______ ______ ______
4
3
14
17
Lexington, Ky_____________________________________________
1
1
2
10
6 ______ ______ ______
26 ______ ______
113
73
9
246
255
~~se~fffia;t-stei"iacoom~-w~ii~========::=:=:::==:=:=:::
:::::: :::::: :::::: ~ :::::: :::::: :::::: :::::: :::::: :::::: :::::: :=:::: ____ :_2
Milan, Mich_______________________________________________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
f
New Orleans, La_----------------------------------------- ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
4 ______
Petersburg, Va____________________________________________________________________________________________________________________
3 ______
Springfield, Mo____________________________________________
1
2 ______
4
2 ______ ______ ______ ______ ______ ______
57
15
5
Tucson, Ariz_______________________________________________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
3 ______ ______ ______
4 ______ ______
3
4
6
All other activities_________________________________________ ______ ______ ______ ______
Miscellaneous_____________________________________________________________________________ · __________________________ --·--Detailed to other offices____________________________________ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
On waiting orders (commanding officers) _______________________________________________________ -----·· __________________
All others__________________________________________________ ______ ______ ______ ______ ______ ______ ______ ______
1 ______
Grand total______________________________________________
19
35
37
610
231
41
35
145
384
225
1
i
10
10
8
92
4
82
4,608
123
611
~
10
10
8
97
4
88
Ul
[:i'.j
~
~
H
________________________________ ------ ---- 76
______ ______ ______
22 ________
22 _______ _
:---- ______ -----48 ________
48 -------______ ______ ______
4
2
6 _______ _
683
1,874 1, 132
530
11, 710 ------
0
[:i'.j
12,240
l-'-
01
......
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Federal Reserve Bank of St. Louis
CHIEF CLERK'S OFFICE
DANIEL l\'IASTERSON,
Chief Clerk and Administrative Officer
DEPARTMENTAL PERSONNEL
Punctuality of employees in reporting for duty was substantially
perfect during the fiscal year, the average amount of tardiness being
less than one case per employee for the entire year, while threefourths of the employees were not tardy once. The amount of sick
leave also reflected an encouraging condition, the average absence
per employee because of sickness being 6.87 days, as compared with
8.1 days for the preceding year. Some of this reduction was probably due to the recently enacted legislation by which unused sick
leave may be accumulated for use in succeeding years.
At the end of the fiscal year 1937 the departmental force comprised
224 employees, as compared with 217 at the close of the preceding
fiscal year. The seven additional employees represented two payable
from the appropriation Salaries, Office of the Surgeon General and
five from the appropriation Diseases and Sanitation Investigations,
Social Security Act. The departmental personnel on duty at the
end of the year were distributed as follows with respect to the appropriation from which paid: 164 from the appropriation Salaries,
Office of the Surgeon General, 34 from the appropriation Diseases
and Sanitation Investigations, 10 from the appropriation Expenses,
Division of Venereal Diseases, and 16 from the appropriation
Expenses, Division of Mental Hygiene.
During the year 11 employees resigned, 1 employee died, and 10
employees were transferred to other Government agencies. Four
administrative promotions were granted, one chargeable to the appropriation Salaries, Office of the Surgeon General, one to the
appropriation Expenses, Division of Venereal Diseases, and two
to the appropriation Diseases and Sanitation Investigations. Reallocations of positions were made by the Civil Service Commission
to the number of 15, of which 12 resulted in salary increases. Twentynine employees were advanced to higher grades by promotion to
vacancies caused by resignation, death, or transfer of incumbents.
The average salary at the end of the year was $1,900.45, as compared
with $1,907.58 at the beginning of the fiscal year.
The emergency room maintained in the administration building
reported a total of 1,955 visits for the year. In 521 of these cases
there was attendance by a Service medical officer.
The one death among the personnel was that of Mr. Jason Waterman, administrative assistant in the Division of Sanitary Reports
and Statistics, which occurred on January 12, 1937. Mr. Waterman
had a total of 41 years of continuous and efficient Government service, of which more than 23 years were spent in the administrative
headquarters of the Public Health Service.
152
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
153
PRINTING AND BINDING
The total sum available £or printing and binding for the entire
Public Health Service for the fiscal year 1937 was $95,017.85. This
aggregate fund was obtained from several sources, viz, $58,000 as
an annual allotment from the general printing appropriation from
the Treasury Department, $13,000 from the deficiency appropriation
act, $21,467 frQm the appropriation Diseases and Sanitation Investigations, Public Health Service, and $2,550.85 from Emergency Relief
appropriations. Figures showing actual expenditures are not _all
available, but the total will closely approach the foregoing amount.
The continued growth in the required activities of the Service was
reflected in the increased needs for printing and binding. This
applies not only to the matter of publications on health subjects, but
also to the printing of blank forms, records, letterheads, and post
cards found essential to the business transactions of the · Service.
The additional legislation and appropriations expanding the work
and activities of the Public Health Service promise to accelerate this
increase.
OFFICE QUARTERS, SUPPLJES, AND EQUIPMENT
The problem of providing office space for the additional personnel
required in connection with increased functions of the Service has not
yet been solved, owing larRely to the acute shortage of available office
space in the District of Columbia. The proposed extension of the
administration building in accordance with the original design of the
architect was placed before the Bureau of the Budget by the Department with a view to obtaining funds for the extension. However,
it was decided that the project should be postponed until definite plans
are completed for the War Department Building.
New equipment in the photogrnphic laboratory installed during
the year makes it possible to produce photographic work of great
value in connection with educational functions which have recently
been undertaken. The acquisition of additional equipment in the
duplicating unit enables the Service to produce health bulletins and
other circular material of a far better type than could be obtained
from the old equipment.
During the year an air-conditioning system was installed in the
dental clinic located on the basement floor of the administration building. The system has been in operation since June 10, 1937, and has
been of great benefit to the staff and to the beneficiaries of the Service
who are served by this clinic.
PUBLIC HEALTH SERVICE LIBRARY
Additions to the library during the year comprised 495 bound
volumes, of which 66 were purchased, and 225 pamphlets. Approximately 14,631 volumes and 7,875 pamphlets are now in the library
stacks. There were received regularly 258 journals and periodicals,
of which 34 represented paid subscriptions. Bulletins were also
received regularly from health departments in foreign countries, as
well as from those in States and cities of our own country.
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Federal Reserve Bank of St. Louis
154
PUBLIC HEALTH SERVICE
The library is gradually assembling a vast amount of data on
health matters from all parts of the world and is steadily increasing
in activity and usefulness in line with the growth of the Public
Health Service in general. During the year over 6,500 books were
loaned, and more than 4,500 readers visited the library.
EMPLOYEE ACTIVITIES
The Public Health Service Federal Credit Unio:i, operated at
administrative headquarters, progressed steadily, and had assets of
$7,000 at the end of the year. Its operations are under the supervision of the Farm Credit Administration, and it provides for the
employees an attractive and convenient method of saving as well as a
valuable source of credit for provident and productive purposes.
The relief association, which furnishes aid to employees in urgent
need of assistance, also added to its resources during the year.
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Federal Reserve Bank of St. Louis
APPENDIX
FINANCIAL STATEMENT
The following is a statement of expenditures from appropriations
of the Public Health Service for the fiscal year 1937:
Received
Appropri- from
other
ated
sources
Appropriation
Obligations
Salaries, Office of Surgeon ~neraJ _________
1 $8,132
$316,268
$308,410
2 171, 902
Pay, etc., commissioned officers _______ ____ 1,775,810
1,941,784
Pay of acting assistant surgeons ___________
323,580
340,200 -----------Pay of other ·employees ____________________ 1,000,000 -----------978,366
Freight, transportation, etc ________________
25,450
25,083
Maintenance, National Institute of Health_
62,606
64,000
Pay of personnel and maintenance of hospitals ________________ -- -- __ -- ------------ 5,870,000 a 1,104,000
6,905,889
Quarantine Service ________________________
361,450 --------·--349,354
249,747
Preventing the spread of epidemic diseases_
260,000 -----------Interstate quarantine service ______________
33,537
36,535 -----------43,986
45,000 -----------Control of biologic products ___ -----------Expenses, Division of Venereal Diseases ____
78,440
80,000
Expenses, Division of Mental Hygiene _____
4 655,428
663,220
Educational exhibits ______________________
1,000 -----------980
Diseases and sanitation investigations ______ 1,320,000
I 4,039 G 1,268,585
Working-capital fund, narcotic farm,
7 91,600
59, 170
Lexington, Ky __ ------------------------ -----------Payment to officers and employees in foreign countries due to appreciation of foreign currency. ___________________________ -----------844,000
32,000
TotaL _______________________________ 12,151,075
1,423,673 13,324,803
Grants to States for public-health work,
Social Security Act_ ____ ____ _____________ 8,000,000
9 881,859
7,765,204
-----------------------
-----------------------
-----
Unobif-gated
balanc&
Liquidated
Incurred
$316,268
1,941,784
318,720
973,598
21,818
61,337
$274
5,92&
16,620
21,634:
367
1',394
6,770,140
297,519 I
240,865
32,439 I
41,590 I
77,063' :
626,508
527 I
1,160,613
68,111
12,09~
10, 25~
2,9981',01,
I, 560
7,792'
20
55,45f
55,97,0
32,~(J
31,.406
lZ,000
12,968,165
249,945
7,765,204
1, 1115, 655
$8,132, reimbursement from diseases and sanitation investigations, Social Security Act, Public Health
Service, 1937.
2 $18,143, medical and hospital service, penal institutions (Justice transferred to Treasury, Public Health
Service) 1937; $17,891, Employees' Compensation Commission; and $135,868, diseases and sanitation investigations, Social Security Act, Public Health Service, 1937.
a $682,682, Veterans' Administration; $384,125, hospital care of members of Civilian Conservation Corps;
Employees' Compensation Commission, $10,415; and Department of Justice $2,250; saving bonds, $1,475;
Railroad Retirement Board, $2,449; and Army and Navy (care beneficiaries) $9,695; AIIied soldiers, $1,405;
supplies (various divisions), $9,504.
4 Includes $15,000 transferred to working capital fund.
• $4,039 received from Social Security Board.
e Includes $135,868 transferred to pay, etci., commissioned officers, 1937, and $8,132 transferred)o salaries
Office of Surgeon GeneraL.
7 Balance July 1, 1936, $13,295; earnings, $63,306; transferred from Mental Hygiene, $15,000.
• $4.4,000, Public Health Service allotment from Secretary of the Treasury.
v $881,859, transferred from 1936.
1
FUNDS MADE
AvAIL.ABLE
FROM OTHER SoURCES
Funds made available to the Public Health Service from other
appropriations and other sources and expenditures therefrom during
the fiscal year 1937 were as follows :
.Appropriation
Medical and hospital service, penal institutions (Department of Justice) ____
Mosquito control (District of Columbia) ____________________________________
Texas CentenniaL ______________________ ___ ______ __ ________________________ __
Greater Texas and Pan American Exposition ________________________________
Emergency relief, Treasury, Public Health Service, 1936-37 (health survey) ___
Emergency relief, Treasury, Public Health Service (health and sanitation
activities, act Feb. 24, 1937) for expenditures in flood stricken areas ________
Available
E':!!pended
$500, ooo:
4,100
19,675
2 4,000
1,318,000
$495, 44l
2,705
7,765
700
1,278,076
a 1,072,677.
964,346
2,749, 03 4
2,908,452
1
2
3
$2,000 of this amount returned to master account (Texas Centennial Exposition Jan, 22, 1937),,
$3,000 of this amount available for expenditure in 1938.
$108,332 of this amount rescinded by President's letter.
23690-37--11
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Federal Reserve Bank of St. Louis
155-
PUBLIC HEALTH SERVICE
156
Miscellaneoua receipts
Source
Amount
General fund receipts:
Quarantine charges ____________________________________________________________________ _
i~!Pi;~h~f:t~~c:nd expenses __________________________________________________________ .
Sale of occupational 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 .••... __ •• _·- ••••••••. _•••••.••. _•. ·- .• __ •..• _._ •••••••• _._ •••••••••••• _.
$235, 248. 00
37,136.33
13,839.52
592. 70
16,912.59
5,663.25
247. 60
2,003.95
I, 550. 63
417. 29
2,655.73
Total. .•• ·- .• ·---.. ······-·----·-·-·-·-·- .•.••• •··-·-·-···-·-··•--·•·······-·········
Trust fund receipts:
Sale of effects of deceased patients ••••• ·--··-··-·-···--·--··-····-----------·-·-----··-Inmates' funds·---------------------------·-----·-----------------------------··---·--·
316,267.59
Grand total------------------------------------------·---·---------------------------
381,134.54
1,844.15
63,022.80
QUARANTINE SERVICE-EXPENDITURES BY STATIONS
Name of station
Pay of
officers and
employees
Maintenance
Total
CONTINENTAL QUARANTINE STATIONS
Baltimore, Md __ --- ·--··-··-··-··-·-··· ·-··- -··-···--· _••.•..
Biscayne Bay (Miami), Fla.---·····-·----··-··--------·-···Boca Grande, Fla· --·--···--····-·-······--···-· ••••.. -·-· •• ·Boston, Mass .. _---·-·-·-··-- •••••• --·--·- ••. -· ..••• -··----·._
Brownsville, Tex._----·-··-·--·····-·-··-----··----------····
Brunswick, Ga ____ .•. _.••• ·-·--·--_--·-··.·-·-.·-·· .•••.• ___ .
Calexico, Calif. ... ___ .-··--· ______ .. ---·---- __ •• _____ ·----··-Cape Fear (Southport), N . C-·-·--·-----··---·------···--·--Charleston, S. C-·-. -.. -- -- -.. -----· ·-· ·--- ·-- ---------------. Columbia River (Astoria), Oreg _______··-··--·-·---·------··-·
Corpus Christi, Tex __ -··········--··-·---··--···--·-·---·---Cumberland Sound, Oreg·----------------·----------------·-·
Del Rio, Tex _---·------ --------··-·--------·---------·---·-··
. Eagle Pass, Tex·-····---·-···-----------··-····--····-·--·····
El Paso, Tex __ -----··--··-----------·-·--·---··--··-·-----·-·
Eureka, CaliL _____ ·-··----·····-· ____ --·- ---··------- ______ ••
Freeport, Tex_. ___ -·----- ____ --·---·._·-.·-·-·-· ____ -· __ -··-··
g~w;~~1n1'ii!t· -· ··-----------· -----·-·-·-------· ---·· -----··
Hidalgo, Tex __ ._-··-----···----··-------·-· __ ---·---··----·-Key West, Fla·-······-----··- •••• ·--··-·-_---· _______ .·-· ••••
~~~is
'fr~~k,-Pa
___ .. -·-· •• ·-·-···------··---·-·--·-··.
_____ _
Mercedes,
Tex ______________________________________
._________
$37,052.30
26,625.00
900. 00
46, 336. 31
17,681.92
2, 160. 00
1,232. 00
10, 670. 00
20,167.25
8, 222. 50
2, 061. 00
600. 00
6, 360. 00
10, 581. 59
29, 967. 01
1, 560. 00
365. 00
25, 312. 40
5, 025. 00
5,411. 00
3,250.00
27, 381. 82
932. 79
50,
3,750.00
$51,873. 07
10,148.24
70. 00
15, 200. 51
2,989.67
374. 93
922. 81
6,213.96
1, 769. 80
50. 57
723. 57
461. 80
1, 989. 74
4. 00
5, 718. 86
598. 28
473. 77
176. 31
1, 722. 50
12, 810.
59
644.16
g~
~ic~:l°A.rtia· -·------·-----·----------------------------------- ---- 23,079. oo_
8, 3~~:
New Orleans, La_____________________________________________
66,931.73
18,593.86
Newport, R. I_-·------- ----- ------------------------------··· ·······------50. 00
New York (Rosebank), N. Y-·--·-----·-·-·--··-·-····--·--·186,223.00
64,687.09
Nogales, Ariz.----· ----- -· -·· ···----···-·-·-··-··----··----···
5,903.00
259. 63
Norfolk (Fort Monroe), Va.---·-·-·-·······-·--··-·······---·
32,321.00
7, 777. 75
Paseagoula, Miss_.--······--··-·················-···-·-····-1, 200. 00 --··-·-·····-·
;:~:~~b!t~·N-r--·----·--···--·---·-·-----···-········--- __ ._12,578. 30_
Portland, Maine __ ··----·····-·-·-··-·--····---·-····-····-··12,970.00
;~~i1!i,~<;n~~~~.-Wasii===========::::::::::::::::::::::::::::: 2f'. ~i: gg
~~~1J~~~~ii ·r·--··-·-·········--··-·----·--·---·--·---··- ..... 6,853. oo _
lSt.
a~::lAndrews
.~~t~;;==============================================
(Panama City), Fla •••• ---·-----··-------·----·St. George's Sound, Fla·--·----···-·····-······---····----··-St. Johns River (Jacksonville), FlB-------·--·-------··--··--·
San Diego (Point Loma), Calif_-·----·--·--·--·----··----·-··
San Francisco, Calif. .•..•. ·-···--··----··-·-··---·-···-·--·-San Pedro (Los Angeles), CaliL __ ·-----··--·····-·-·----··--·
Savannah, Ga·----·----·-··--------·-··----·--·-·· ---------·-
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Federal Reserve Bank of St. Louis
i :!~: gg
1,200. 00
300. 00
7,532. 00
21,898.80
61, 344. 00
43,055.32
111,765.00
1,489.65
600. 00
2,572.19
930.54
6,489.46
905.09
290. 00
348. 35
616.15
2,722. 09
78.00
1,677. 31
5,373.88
13,814. 45
9,465.83
4,753.04
$88,925.37
36,773.24
970.00
61,536.82
20,671.59
2,534.93
1,232.00
11,592.81
26,381.21
9,992.30
2,111.57
600. 00
7,083.57
11,043.39
31,956.75
1,564. 00
365.00
31,031.26
5,623.28
5,884.77
3,426.31
29,104.32
63,743.38
4,394. 16
31,423.47
36.52
85,525.59
50.00
250,910.09
6,162.63
40,098. 75
1,200.00
14,067. 95
600.00
15,542.19
3,156.54
27,589.44
7,758.09
290.00
8,849. 85
5,416.15
18,143.09
1,278.00
300. 00
9,209.31
27,272.68
75,158.45
52,521.15
20,518.04
PUBLIC HEALTH SERVICE
Name of station
Payo!
officers and
employees
CONTINENTAL QUARANTINE STATIONS-continued
Seattle, Wash ______________________________________________________________ _
Tampa, Fla___________________________________________________
$18,025.00
Ysleta, Tex___________________________________________________
1,680.00
Zapata, Tex ___ ----------------------------------------------2, 340. 00
Freight and miscellaneous __ ---------------------------------- _____________ _
Total, continental quarantine stations__________________
INSULAR QUARANTINE STATIONS
Hawaii__----------------------------------------------------Philippine Islands____________________________ ________________
Puerto Rico __ -----------------------------------------------Virgin Islands________________________________________________
Total, insular quarantine stations_______________________
157
Maintenance
$2,193.01
4,988.65
9.46
360. 00
56,067.36
Total
$2,193.01
23,013.65
1,689.46
2,700. 00
56,067.36
1------1------1-------
911,852.52
330, 430. 97
1, 242, 283. 49
l=====i======i=====
39,397. 96
22,263.00
40,181.07
13,922.31
7,925. 48
8,453.43
2,544.12
47,323. 44
22,263.00
48,634.50
16,466.43
1------1------1-------115,764.34
18,923. 03
134,687.37
Grand total, all stations_________________________________ 1,027,616.86
349, 354. 00
1, 376, 970. 86
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Federal Reserve Bank of St. Louis
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Federal Reserve Bank of St. Louis
INDEX
Page
.Accounts section, report of___________________________________________ 144
.Acting assistant surgeons, number on duty______________________________
142
Administrative assistants, number on duty __________________________ 142-143
Aides, number on duty________________________________________________ 143
.Airports of entry, United States, summary of transactions at_ _________ 85-86
.Aliens:
7-8
Medical inspection of______________________________________________
Summary of medical inspection of ________________________________ 87-91
.Amoebiasis, studies of________________________________________________
77
Attending specialists, number on duty________________________________ 142
:Beneficiaries, marine hospitals ____________________________________ 10, 103-105
Coast Guard ___________________________________________________ 106-107
Summary of services by class of _________________________________ 105·, 111
Biologics control, studies of_ ____________________________________ 3, 38-40, 62
Bituminous coal mines, sealing of abandoned___________________________
36
Boy Scout Jamboree, sanitary measures provided for____________________
31
Brucellosis, studies of_ _______________________________________________ 47-48
Buildings:
Federal, investigation of plumbing inspection ______________________ 35-36
New construction _________________________________________________ 10, 80
Quarantine, declared surplus _______________________________________ 78--79
Canada, reciprocity with, in sanitary control work____________________
31
Canal Zone, summary of quarantine transactions at_____________________
87
Cancer studies ____________________________________________________ 5-6,60-61
In Boston________________________________________________________ 62-66
·C hart, average per-diem cost of inpatient relief, marine hospitals_________
104
Chemical and biological processes, studies of_________________________
50
<Jhemistry, report of division of_ ______________________________________ 40--43
Chemotherapy and chemical research_________________________________
3
Chief clerk's office, report of________________________________________ 152-154
Child hygiene, studies of_ ____________________________________________ 68-70
<Jholera, prevalence of ________________________________________________ 8,80
Clinic, venereal disease, Hot Springs, Ark ____________________________ 119-120
Annual report of _______________________________________________ 122,123
Coal mines, bituminous, sealing of abandoned__________________________
36
Coast Guard beneficiaries, medical services furnished to ______________ lOS---107
Commissioned officers, number on duty ______________________________ l40-142
Common carriers, supervision of water supplies used by ________________ 2S---28
<Jommunicable diseases, summary of____________________________________ 93; 94
Community sanitation program _______________________________________ 32-35
-Conferences :
Surgeon General with State and Territorial health officers___________
37
Venereal disease control work_____________________________________
113
Consultation service to States under Social Security Act_ _______________ 15-16
·Contract dental surgeons, number on duty______________________________
143
Cooperative public health work _____________________ 2, 13, 17-19, 45--46, 115-116
Cooperative studies, report of office of_________________________________
77
-Costs, marine hospitals :
Average per diem, inpatient relief, chart showing__________________
104
Operating-------------------------------------------------------107
Death, leading causes of_ _______________ .:______________________________
10
Death rate, United States---------------------------------------------- 9,93
159
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Federal Reserve Bank of St. Louis
160
INDEX
Page
Dental surgeons, contract, number on duty_____________________________ 143
Dental treatment furnished _________________________________________ 105-106
143
Dietitians, number on duty____________________________________________
Diseases:
Communicable, summary of ______________________________________ 93,94
Infectious :
62
Chemotherapy of_____________________________________________
Report of division of__________________________________________ 46-59
4-5
Studies of____________________________________________________
80
Quarantinable, prevalence of______________________________________
Domestic quarantine, report of division of ______________________________ 15-37
Drug addiction, studies of the nature and treatment of ______________ 124-128
Employee activities____________________________________________________ 154
47
Encephalitis, studies of ____________________________________________ ,__
Engineering activities ___________________________________________ 17-19, 25-32
144
Epidemiologists, number on duty______________________________________
Epidemiology, studies of ______________________________________________ 56-57
98
Exhibits prepared___________________________________________________
Federal building plumbing inspection, investigation of__________________ 35-36
Federal prisoners, medical and psychiatric services furnished to ____ 12, 131-136,
21
Field surveys for plague______________________________________________
Financial statement, tabular ________________________________________ 155-157.
22
Flea investigations___________________________________________________
Floating equipment, new ______________________________________________ 80, 107
Flood emergency, cooperation with States in ________________________ 17-19, 30
Foreign and insular quarantine, report of division of _______ _: ____________ 78-91
Fort Worth, Tex., U. S. Narcotic Farm at_ ___________________________ 12,131
Fumigation and inspection of vessels__________________________________ 7, 78155
Funds made available from other sources, tabular statement__________
Grants-in-aid, Social Security---------------------------------------- 16-17
Health conditions in 1936_____________________________________________ 8-10
Health facilities, studies of ___________________________________________ 72--74
Health inventory _________________________________________________ 6-7,66-68
Heart disease, studies of ______________________________________ 5,48-49,69--70
Hot Springs, Ark., venereal disease clinic at __________________________ 119--120
Annual report of _______________________________________________ 122,123
Immigrants. See Aliens ; Quarantine.
:
Industrial
of_____________________________________________
of division
Report hygiene
Studies of________________________________________________________
Infantile paralysis. See Poliomyelitis.
Infectious diseases :
Chemotherapy of_________________________________________________
Report of division of_____________________________________________
Studies of________________________________________________________
Inpatient relief, chart showing average per-diem cost__________________
Internes, number on duty_____________________________________________
Interstate quarantine. See Domestic quarantine.
Investigations:
Federal Building plumbing inspection _____________________________
Flea_____________________________________________________________
Leprosy __________________________________________________________
Public health problems____________________________________________
See also Studies.
43-46;
3-4
62'
46-59
4-5
104
142'
35-36
22
57-59
2-7
Laboratory:
Public Health Service, San Francisco__________________________ 21, 22--23
Venereal disease, Stapleton______________________________________ 118-119
Leprosy investigations _______________________________________________ 57-59
Lexington, Ky., United States Public Health Service Hospital at__ 11, 12, 129--130
Library, .Public Health Service ______________________________________ 153~154
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161
Malaria :
PageControl drainage _________________________________________________ 31-32
Studies of ______________________________________________________ 5,53,-55
Marine hospitals :
Beneficiaries furnished treatment_ ________________ 10,103,105, 106-107, 111
Costs:
Inpatient relief, chart showing________________________________ 104
Operating---------------------------------------------------- 107
New construction------------------------------------------------10
Patients treated annually_________________________________________ 108
Reports, consolidated and detailed ______________________________ J0&-112
Marine hospitals and relief, report of division oL ____________________ 103-112
Maritime
quarantine stations, tabular summary and statement of serv- 81-83
ices at _____________________________________________________________
Maui, island of, plague suppressive measures in ________________________ 23-25
Medical and psychiatric care of Federal prisoners _________________ 12, 131-136
Medical inspection of aliens___________________________________________
7-8
Summary of______________________________________________________ 87-91
48
Medical mycology, studies of----------------------------------------10
Meningococcus meningitis, prevalence of_______________________________
Mental hygiene:
'
Activities of division of __________________________________________ 11-13
Report of division of ____________________________________________ 124-139
Studies of ________________________________________________ 12--13,136-139
Methods, Public Health, report of division of ___________________________ 66-74
Mexican border stations,.. summary of quarantine transactions at________
84
Milk sanitation studies ______________________________________________ 6,71-72
Miscellaneous receipts, tabular________________________________________
150Morbidity
andofmortality
:
Reports
_______________________________________________________
92-94
Studies of________________________________________________________
68
Mosquito control, District of Columbia _________________________________ 36-37
Mottled enamel studies_______________________________________________ 6, 51
Narcotic drugs, studies of ___________________________________________ 128-129
Narcotic farms, operation of__________________________________ 11, 12, 129-131
National health inventory------------------------------------------ 6-7, 66-68National Institute of Health:
Divisions of______________________________________________________
2'
Number on duty__________________________________________________
144
Report of ________________________________________________________ 38-77
Negro health work---------------------------------------------------- 96-96
Nurses, dietitians, and reconstruction aides, number on duty_____________ 143·
Office of Public Health Education, report of___________________________
950.ffice quarters, supplies and equipment_________________________________ 153
Operating costs in marine hospitals_____________________________________ 107
Outpatient treatments, summary of classification of_____________________ 112'
Oxyuriasis, studies of_________________________________________________ 76-77
Pathology, report of division oL _______________________________________ 59-60•
Patients treated annually, hospitals and relief stations___________________ 1()8:
Personnel:
Departmental_____________________________________________________ 152
154Employee activities_______________________________________________
Tabular statement of ___________________________________________ 146-151
See also Personnel and accounts.
Personnel and accounts, report of division of__________________________ 140-151.
Pharm·a cists and administrative assistants, number on duty ___________ 142-143
Pharmacology, report of division of ____________________________________ 60-66,
Plague:
Control activities in San Francisco________________________________
~
Field surveys for_________________________________________________
21
Prevalence of______________________________________________ 8,9,19-20,80·
Studies of ________________________________________________________ 5,53
Suppressive measures inIsland of Maui, Hawaii_ ______________________ .:...: ______________ 23--25•
Western States----------------------------------------------- 19--23-
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~162
~
Poliomyelitis :
Page
Prevalence of_____________________________________________________
9
Preventive measures---------------------------------------------47
Studies of________________________________________________________
56
Printing and binding__________________________________________________ 153
~ Property records section, report of_____________________________________
144 •
Publications issued and distributed ________________________ 96-102, 117-118, 128
: Public health :
Education, report of office of_______________________________________
95
Methods, report of division oL ___________________ .:._ _________________ 66-74
Problems, investigations of________________________________________
2-7
: Public Health Service :
Cooperative activities oL _______________________ 2, 13, 17-19, 45-46, 115-116
Laboratory at San Francisco ____________________________________ 21,22-23
Library------------------------------------------------------- 153--154
Recommendations for _____________________________________________ 13-14
Sanitary engineering in _____________________________________ 17-19,25--32
Social Security program! under ____________________________________ 15-17
· Quarantinable diseases, prevalence oL_________________________________
80
7-8
,. Quarantine and immigration activities__________________________________
· Quarantine inspection, new rules applying to____________________________
78
Quarantine service, tabular statement of_ ____________________________ 156-157
· Quarantine stations :
Declared surplus _________________________________________________ 78-79
New construction_________________________________________________
80
· Quarantine transactions :
Airports of entry, United States, summary of ______________________ ~
Canal Zone, summary of___________________________________________
87
Inspection of aliens ___________________________________________ 7-8,87-91
Maritime stations, tabular statement of_ ____________________________ 81-83
Mexican border stations, summary of_______________________________
84
- Railway sanitation____________________________________________________
28
Recommendations for Public Health Service____________________________ 13-14
~ Reconstruction aides, number on duty---------------------------------143
Relapsing fever, studies of ________________________________________ 4,47,52-53
: Reports:
Marine hospital, consolidated and detailed _______________________ 108-112
Morbidity and mortalitY------------------------------------------- 92-94
Personnel,diseases
consolidated--------------------------------.-------Venereal
_______________________________________________ 145-151
120--123
Reserve officers, number on duty______________________________________
142
: Rocky Mountain spotted fever, studies of_______________________________ 5, 52
Rural health service___________________________________________________
15
: San Francisco, plague control activities in______________________________
22
Public Health Service laboratory in _____________________________ 21, 22-23
: Sanitary engineering activities __________________________________ 17-19, 25-32
Sanitary reports and statistics, report of division of_ ___________________ 92-102
Sanitation program, community ________________________________________ 3,2 -35
Sanitation, studies oL ________________________________________________ 70-72
· Scarlet fever immunization, studies oL_________________________________
50
Scientific research, division oL________________________________________
38
Serodiagnostic tests for syphilis, evaluation of_ _______________________ 113-114
Shellfish sanitation _______________ _:____________________________________
28
: Smallpox, prevalence of_ _____________________________________________ 8, 9-10
Social Security, public health program under ___________________________ 15-17
Stapleton, N. Y., venereal disease research laboratory at_ ______________ 118-119
· Stream pollution, studies oL _________________ __________________________ 70-71
~studies:
Amoebiasis------------------------------------------------------77
Biologics
control _____________________________________________ 3,38-40,62
Brucellosis------------------------------------------------------- 47-48
Cancer------------------------------------------------------5-6, 60-61
In Boston____________________________________________________
62-66
Chemical ______________________________________________________ 40-43,50
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INDEX
163 -
Studies-Continued.
Page
Chemotherapy and chemicaL______________________________________
3
Child hygiene _____________________________________________________ 68-70 ·
Cooperative______________________________________________________
77
Drug addiction, nature and treatment of _________________________ 124-128 •
Encephalitis
-----------------------------------------------------47
Epidemiological
___________________________________________________ 56-57
Health facilities __________________________________________________ 72--74
Heart disease _____________________________________________ 5,48-49,69-70 ,
Industrial hygiene ____________________________________________ 3-4,44--46
Infectious diseases________________________________________________
4-5
Malaria --------------------------------- ----------------------- 5, 53-55 .
Medical mycology________________________________________________
48
Mental hygiene ___________________________________________ 12-13,136--139
Milk sanitation _______________________________________________ 6, 71-72
Morbidity and mortality__________________________________________
68 .
Mottled enamel of teeth __________________________________________ 6,51
Narcotic drugs _________________________________________________ 128-129
Oxyuriasis---------------------------------------- --------------- 76--77
Plague---------------------------------------------------------~- 5,53 .
Poliomyelitis----------------------------------------~----------56
Relapsing fever _____________________________________________ 4, 47, 52-53 .
Rocky Mountain spotted fever ____________________________________ 5,52
Sanitation-------------------------------.:.---------------------·- - 70-72 .
Scarlet fever immunization______________________________________
50
Stream pollution ______________________·___________________________ 70-71
Syphilis-----------------------------· ------------------------- 113-115
Ticks and disease________________________________________________
53 ·
Trichinosis ______________________________________________________ 74-76
Tuberculosis-------~------------------------------------------ 4, 51-52
Tularaemia______________________________________________________
4
Typhus ________________________________________________________ 4, 46-47 ·
Venereal diseases _____________________________________ 113-115, 116--117
See also Investigations.
Supplies and equipment______________________________________________
153
Syphilis studies ____________________________________________________ 113-115 •
Tables:
Airports of entry, summary of transactions at_ ___________________ 85-86 ·
Canal Zone, summary of quarantine transactions at________________
87
Beneficiaries of marine hospitals, summary of services by class of__ 105, 111
Coast Guard beneficiaries________________________________________
106
Communicable diseases ___________________________________________ 93,94
Community sanitation projects ____________________________________ 33, 34 .
Financial statement ________ __ __________________________________ 155-157
Funds made available from other sources__________________________
155
Hospitals and other relief stations, transactions at_ _____________ 108-112
Maritime quarantine stations, transactions at ______________________ 81--83
Medical inspection of aliens ______________________________________ 87-91
Medical services for various classes of beneficiaries________________ 111
Mexican border stations, quarantine transactions at________________
84
Miscellaneous receipts____________________________________________
156
Operating costs in marine hospitals______________________________
107
Outpatient treatments, classification of____________________________
112 ·
Patient movement, Lexington, Ky________________________________
130
Patients treated annually, 1868 to 1937 ---------------------------108
Personnel statement ____________________________________________ 146--151 .
Quarantine service _____________________________________________ 156--157
Venereal disease reports _______________________________________ 120-123
See also Chart.
Ticks and disease, miscellaneous studies of____________________________
53
Trichinosis, studies of ________________________________________________ 74-76
Tuberculosis, studies of_ ___________________________________________ 4, 51-52
Tularaemia :
Prevalence of____________________________________________________
47
Studies of------------------------------------------------------4-
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164
I NDEX
Page
Typhoid fever, prevalence of ______________________________________,__ 27-28
'Typhus fever :
Prevalence of____________________________________________________
8-9
Studies of ____________________________________,________________ 4, 46--47
:United
States:
Death
rate in ___________________________________________ .________
Health conditions in ______________________________________________
9,93
9-10
W enereal diseases :
Clinic, Hot Springs, Ark ________________________________________ 119-120
Annual report of __________________________________________ 122,123
Conference on control work _____________________ ~----------------113
Control program _________________________________________________ 10--11
Cooperative clinical studies ____________________________________ 114-115
Educational and informative activities __________________________ 117-118
Prevalence of _____________________________________ 115-116, 120, 121, 122
Report of division of ___________________________________________ 113-123
Research laboratory at Stapleton, N. y __________________________ 118-119
State health departments, cooperative work with ________________ 115-116
Studies of _____________________________________________ 113-115, 116-117
Tabular statements relating to __________________________________ 120-123
Untreated syphilis in the Negro ____________________________,______
116
Vessels:
Fumigation and inspection of____________________________________ 7, 78
Supervision of water-supply system on ___________________________ 27-28
Water supplies, supervision of, on common ·carriers ____________________ 26-28
Works Progress Administration projects_______________________________ 31-37
World health conditions______________________________________________
8-9
Yellow fever :
Immunization against_ ___________________________________________ 79--80
Prevalence of______________________________________________________ 9, 80
:zoology, report of division of__________________________________________ 74-?T
0
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