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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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis - - - - - - • - - - Price 60 cents (cloth) TREASURY DEPARTMENT Document No. 3089 Public Health Service https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. m https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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~~~~~~~== ====== === ==== = ======================= =====_ 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis V l 15· 15 15 16 17 19 19 23 25 26 27 28 28 29 29 30 30 31 31 31 37 38 38 40 43 46 52 53 56 57 59 60 62 66 66 68 68 70 72 74 74 76 77 77 78 81 84 85 87 87 VI CONTENTS Page 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_____________________ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 92 92 95 95 96 97 103 105 105 106 107 108 113 113 113 114 115 116 116 116 117 118 119 120 124 124 128 128 129 131 136 140 140 144 144 145 152 155 155 155 156 156 / 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. 1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 2 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 3 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 4 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 5 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 6 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 7 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 9 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 14 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. https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 16 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: https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 17 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~ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 20 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 21 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 23 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 26 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 27 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 28 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEAL'rH SliJRVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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 ____________________________ _ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 39 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 40 PU:f3LtC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 41 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 42 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 43 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 44 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 45 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 46 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 47 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 48 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 49 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 50 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 51 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 52 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 53 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 54 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 55 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 56 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 57 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 58 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis • PUBLIC HEALTH SERVICE 59 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 23.6 90-37-5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 60 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 61 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 62 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 63 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 64 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 65 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 66 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 67 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 68 PUBLIC HEALTH SERVICE 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 69 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 70 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 71 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, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 72 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEAL'l'H SERVICE 73 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, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 74 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 75 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 76 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 77 :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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 79 •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 https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 96 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 100 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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. 113 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 114 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 115 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 116 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 117 -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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 118 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 119 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 120 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis --------- 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 121 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 127 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 128 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 129 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 130 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 131 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 132 PUBLIC HEALTH SERVICE 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 133 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 134 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 135 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 136 PUBLIC HEALTH SERVICE 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PUBLIC HEALTH SERVICE 137 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 https://fraser.stlouisfed.org 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- https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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- https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Consolidated personnel report as of July 1, 1937 Regular corps d (I) (I) 0 (I) bO !3 r:t.J .8 0 f = d .5 0 ·j Q) i = ~ .... d 0 (I) bO ~ .8 0 Q) .!:: d 0 Q) (I) t,I) ~ d 0 Q) ~ ;l = .5 ·; ...."' .!!30') :§i:l oaS (I) .... ~] I 1 d 0 <D t,I) ~ .a <D = <P::::::..a t,DOcn ~CJ• .... t>O ~'t.1-a - 2§ ·§ ~~:g ~ f .... (I) °'aS 8-ii'og. ·1 ....§ ....0 0 do ~ aS d .a ;a ] §~.9 0 bO "C ....0 f .s Q 1:i El ;a ~ bO bO 'Cl bO :§ <D a ~~~ ~ ·a ·a <D 'gi gJ i:l'Cl 0 "C 0 0 .d ~ !3 !3 !3 ] ::g ~ 0 Pol Pol 00 00 r:t.J r:t.J r:t.J Pol ~ -< < -< -< -< -< - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - (I) 0 d 0 (I) .... I ;a <il 0 bO ~ d 0 i= "C (I) (I) (I) Administrative and departmental_ ________________ _ 0 (I) ~ ... d § d 0 t,I) 0 Q) d 0 d (I) d ..!.,o "C f f Noncommissioned personnel Reserve corps 8 -- ---· 2 "C bO (I) Q) Q) I d e,oo "C ell (I) = (I) 3 -----· ----·· -----· ----·· ------ -- --- - --- - -- - ----- ------ - ----- - ----- ------ ----- --- FIELD Hospital division: Marine hospitals: Baltimore, Md_________ ____ ________________ _____ _ _____ _ ______ 3 5 Boston, Mass_ ______________ ____________ __ _____ __ _____ _ 1 1 2 Buffalo, N. Y ---- ------------------------ -- ______ __ ____ ______ 1 1 ___ ___ Carville, La _____ __ ______________________ ___ ______ __ ___ _ 1 _____ _ ____ __ ____ __ Chicago, Ill______ ______________________________________ 1 _____ _ 2 1 Cleveland, Ohio________________ ___ __ ___ ____ ______ ______ 1 1 2 2 Detroit, Mich______________________ ____ ____ ___ ___ ______ ___ ___ ______ 1 3 Ellis Island, N. y ____ ______________________ ______ ______ 1 1 _____ _ 2 Evansville, Ind___ ____ ____ _________ ____ ___________ ____ __ ____ _ 1 _____ _ 1 Fort Stanton, N. Mex_______________ ____ __ _ ______ ______ _____ _ _____ _ 3 1 Galveston, Tex_ ___ _____ ____ _______ ____ _____ ______ ______ 1 ______ ______ 3 Hudson Street, N. y ______________ _____ ___ _ ______ __ ____ 1 ______ 1 2 Key West, Fla_____________________ __ _____ _ ______ _____ _ ______ ______ ____ __ 1 Louisville, Ky______________________ __ ____ ________ ____ __ ____ _ 1 ___ __ _ 1 ~~hlftx1re_~============================___________ ====== ====== ====== 2 New Orleans, La______ ___________________ __ _______ ----i- 1 ~ 3 2 Norfolk, Va___________________ ______ __ _____ _____ ____ ___ 1 ______ ______ 3 Pittsburgh, Pa_____ __ _______________ _______ ______ ______ ______ 1 _____ _ 1 Portland, Maine_____ ___ _________ ____ ______ ______ ______ 1 ______ _____ _ 1 St. Louis, Mo______ __ ___ ___________________ ___ __ ___ ___ __ _____ 1 _____ _ 2 San Francisco, CaliL ____ _________ ____ _____ ______ ______ 1 ______ 4 5 Savannah, Ga______________________ ____ ___ _ ______ ______ ______ 1 1 Seattle, Wash____________ ___ ______________ ___ ______ ____ 1 2 1 5 Stapleton, Staten Island, N. y _______ __ ___ _ ______ ____ __ 1 2 2 8 Vineyard Haven, M~--------------------· ______ • _____ ______ 1 ______ ______ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 __ ____ _____ _ 1 ____ __ 4 2 ______ ______ _____ _ 1 ______ ______ _____ _ _____ _ _____ _ ____ __ ____ __ ____ __ ______ ___ ___ _____ _ __ __ __ ____ __ ____ __ ______ ______ ____ __ 2 1 ______ ______ _____ _ __ ____ 2 ____ __ ______ _____ _ 1 1 4 2 ______ ______ ______ 1 2 ____ __ ______ ______ __ ____ ______ 1 1 ______ ____ __ __ ____ ______ 1 1 ______ ______ ____ __ _____ _ 1 _____ _ ______ _____ _ 1 __ ____ 1 _____ _ __ ____ ______ __ ____ ___ __ _ ____ __ _____ _ ______ ___ ___ _____ _ ______ 2 1 ______ 2 ______ ______ ______ ______ _____ _ ___ ___ 2 ______ ______ ______ ___ ___ __ ____ _____ _ ____ __ _____ _ __ ____ ____ __ ____ __ __ ____ ______ ____ __ 4 ______ _____ _ 1 ____ __ ___ ___ __ ____ 2 4 __ ____ ______ ___ ___ 5 _____ _ __ ____ ______ ___ ___ ______ __ ____ ______ ~ 5 5 2 3 4 5 7 3 4 2 27 16 1 - ------18 7 - ----1 - ------8 4 1 ------ -------4 - --- -- -- -- -1 1 -------- 21 2 ------ -- 8 10 3 - ----2 16 2 1 - --- -8 - --- -4 - - - --1 10 1 ----- · --- --- ----·3 2 - ----- ------ - --- ----------- ------------ ---- ----- 3 11 1 2 13 8 1 17 1 -------- 1 1 1 - ------- ~ 4 10 5 1. 1 1 3 _____ _ ______ 2 1 ___ ____ ____ _ ____ __ 1 2 1 2 5 ______ ___ __ _ 7 1 3 1 ___ ___ 2 8 ______ ______ 1 ~ 13 10 10 12 15 25 8 --·-2· 1 ~ ~ ====== ======== 4 - ----- - --- -· -------1 1 21 1 10 2 3 1 2 1 1 ----- - -----· - ------14 -----· 2 -- -----2 1 ------ -------- 22 11 6 1 20 2 --- ----- 3 - ------- ""d d to t:-t H a p::1 ti:J ~ 8 ~ U2 ti:J ~ ~ H a ti:J Relief stations: Second class ________ ••••••••..••••••••••••••.••••. -·-··· 2 1 ...... 3 2 ·····- ...... -····· -····· 8 19 33 9 1 ··-·-· 2 ....... . Third class_··-······-·····················- ····-- ··---· ..•.....••.. ··-··· ·-···· ··-··- ····-· ..•••• ...... ...... ...... 146 10 31 ..... . ···-·· · -··-· -·-····· Coast Guard and Lighthouse Services •.. -..••.. -·---· -·-··· 1 1 1 2 5 ···-·· ···-·· ···-·· 1 ....•. 129 2 1 · ··-·· ............ ·····-·· Departmental emergency relieL ••.•...••.•••. _.........•.•. ····-· ····-- ......••...........•.•....•............•........ -····· .•.. .:. -····· ...... . ........... . ...... . rT{~Ih~~i~;tf!WfeZ~~~~~~~===========:::::::::: ====== ====== :::::: :::::: ·-··1· ~ ....if::::::::::::::::::======:::::: -···4- :::::: ====== ::.:::: ====== ····1- :::::::: Foreign Quarantine Division_ ....•...•...••..•...• _ --···· ··-··· .••••...•••...•.•. ··-·-· ....•. ·····- ...... ···-·· -···-· -····· ...... -····· .... . . -···· · ...•.. -····· --·-···· Quarantine stations: ~~;i~~~~~~·················-·······-··.~:... ···--· ····21· .••....... ~...•...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 ..•.•.....•............. -····· ................. . ....•• 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· ~ ~~ 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 •.•...•••••••.•••••••••..••••••••••..••••.•.•.• https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 a ...... ...... ...... ...... ...... a1 4,599 46 .••••• ··•·•• .•.....•.•.. ··••···· U2 trJ ~ <1 H 0 trJ Consolidated personnel report as of July 1, 1937-Continued Regular corps A A Cl) A 0 Cl) ~ ::l C1.l Cl) 0 A 0 <I) ~ ::l rll 1:l ~ ! ... B 0 f ;a ti! 0 ;a <I) ~ i:i A 0 CD b.O ...~ ·a A igj 0 "O b.O i 0 <I) <I) ~ <I) Cl) Cl) b.O g 0 0 Cl) 0 A A 0 CD '§ -.!.,6 "O ~A A Noncommissioned personnel Reserve corps b.O b.O A 0 CD b.O g 1:l !i ~ < g ... B 0 f ;a .;; 0 ;a <I) ~ A 0 +-> I -~ A 0 CD i... 0 ·a <I) A 0 CD b.O g i:i .j "O CD t,,O ~ CD gi g A j al 01) :§ 0 "' 0. al al "' :-§1:l Oal +-> -~Cll Cl)+-> ;;f~ A b.QO Ao ;a A E ~ - - -- - - - - - - - -- - - - - - - - - --<- - - - - C1.l C/J ~ C1.l -< ~ C1.l 1:l A 0 j Cl) b.O g al ti! Cl) i:iCD +-> "O "' ·c:i ..., 0 e 1:l0 <I) 8 .s <I) ~ -+-> b.00., 0"6iJ ~'2~ _g s ~~:g lil 8·bl)g, i its c:I :§ .Q ~ "O ~ Cl)- .s s -~~e lZ"O o -< -< - -- -- -- --- 0 FIELD-continued 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 ----- - _______ __________________ _ ____ 0 Grand total ______________ -------------------- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 8 54 61 89 151 81 - -- --- - ----- 8 15 61 732 635 55 172 12 54 4,599 >--r::, §3 t'-1 H 0 ~ t;j > t'-1 1-3 lJ:1 U1 t;j ~ ~ H 0 t:i::J Consolidated personnel report as of July 1, 1987-Continued N oncommissionod personnel-Continued -g a 8 CD'"' i:lO A""' "C .... "' "6iJ b.O e A tllO "' 8 6 Cl) $A of A ~ ~;@ i::J p. § "6iJ A e>- A ~::s CD .... Cl) i::J ·,:: ! >, "C Q) A C) "' 0 CD ~.::- s~ A "'"' 0 Totals i::J Z~ 'e p."' ]'3 i:lb.O C) 0 CD+> .s·i t-- ·srf1"' "' CDCD .§~ a Pt -i1CD 6 A >, 0 -a s ~ CD "C CDCD ~ t~ s Pt s ~ "' A "C "' ~---C)CD 1Eogie CD "C ... CD"C i:li::J Q) oce <i:l ·iaa ·s-a s~ ob al :; s A A 0 CD "C CD §~ :1f s Pt 0 0 I ~~ .....,..., .E 3 _£ .s -~I> ;a ~~ 3~ .E "C A 0 -~ :::l ::s ii; ~ 0 5"' A rf1 ::s"' E-< z rf1 ~ z -~_g A ~ -- -- -- -- -- -- -- -- -- ---- -- ----- -- --- "O .Q 0 Administrative and departmental______________________ ___ _____ ______ ______ ______ ______ ______ ______ ______ ______ ______ 225 U) 0 Cl) 57 ------ ------ 15 A .c 282 297 297 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 ------ ------ ------ ~~;gJ:; flrm_ -------------------------------------- ----(1 ___________ _ 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 ________________________________ ------ ------ ------ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 11 14 56 29 7 7 4 1 ====-- ==---- ------ 5 ------ ------ ----- - 3 ------ ------ -----1 ------ ------ ------ 14 40 16 40 3 ------ ------ ------ 66 4 ------ ------ ------ 1 ==---- ==-=-- ------ 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 2 3 9 24 5 11 4 5 1 36 39 127 85 23 114 26 6 29 44 2 4 17 20 1 81 84 72 269 82 405 15 4,367 ...... Consolidated per&onnel report a3 of July 1, 1937-Continued Cl 0 Noncommissioned personnel ~-;:: 0 "' -~... 8 ::, Q) tlD tlD A ~ ... AO §~ "'0 ~ .g.; 'O A A i ~ ::, :gi ., 8A ~s rg_~ ..... c:c 'O A '8a .,., 8 Q) Q) .s bC A Q) ... .9 (I) A ] 'l'otals ... § 0 ~~ 0. al ·- s i:'.8 ., ~,, ~'3 A bD Q) >, A Q) 0 ~ 'a s s"' Q) Q)/p 'O ~ >, ... B~ E~ 0. ~ 0. s Q)Q) 0 ~ ~ >, c:) ~ al 'O A co ~ ... Q) -E0 "'15,,__ oa> !St 0~ Q) s Q) 'O Q) A"' 'O ... <D 'O 0 Q) •-Q) 0., ·- 0 AA ·v3,._. ·-:3 "'"' Sb.I) Sf o,,__, gi >, ss 0. 0 c:) A A 0 I ~~ ,,__,~ ~ ] 0 ~ 6 A ii: 0 ::s w ~ z w w < A z ~] -- -- -- -- -- -- -- -- -- -- -- -- -- --- - 'O Q) (I) (I) ~ $ ~ ~ A 0 ::, .8 -~I> ;a ~~ '--'al ~~ ~ 'O A ., c'5 --- FIELD-COntinued 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 -- ------ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis m t;J ~ H 0 t;J Scientific Research Division _______________________________________________________________________________________________________________________ -------- ______ ---- 730 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 ...... https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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. https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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·----·----·-··--------·-··----·--·-·· ---------·- https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INDEX 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INDEX ~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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis