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ANNUAL REPORT
OF THE
SURGEON GENERAL of the
PUBLIC HEALTH SERVICE
of the UNITED STATES
FOR THE FISCAL YEAR.
19 3 9
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON: 1939
For .ale by the Superintendent of Documents, Waahington, D. C. •
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- • • - • • • • • Price 75 cents (cloth)
TREASURY. DEP AR TM ENT
Document No. 3104
Public Health Service
II
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LETTER OF TRANSMITTAL
TREASURY DEPARTMENT,
OFFICE OF THE SECRETARY,
Washington, January 3, 1940.
Code, title 42, section 4,
States
United
with
Sm: In accordance
I have the honor to transmit herewith the report of the Surgeon
General of the Public Health Service for the fiscal year 1939.
Respectfully,
H. MoRGENTHAU, Jr.,
Secretary.
The SPEAKER OF THE HousE OF REPRESENTATIVES.
III
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CONTENTS
Foreword ________________________________________________________ _
Division of Domestic Quarantine (States Relations) ___________________ _
The cooperative public health program __________________________ _
Consultation services to the States ______________________________ _
Nutrition ________________________________________________ _
Malaria controL _________________________________________ _
Public health nursing _____________________________________ _
Cooperation
with other agencies in the administration of medical care_
programs __________________________________________________
Plague-control activities _______________________________________ _
Plague-suppressive measures in Western States _________ __- - - - Plague control, Territory of Hawaii_ _______________________ - _
Public health sanitation activities----.-- - ---------------------- - Supervision of water supplies used by common carrier,s ________ _
Vessel sanitation _______ __________________________________ _
Railway, air carrier, and motorbus sanitation _________________ _
Shellfish sanitation _______________________________________ _
Cooperative work in public health engineering _______________ _
Mosquito control in the District of Columbia ________________ _
Special activities _________ ________________________________ _
Works Progress Administration Projects ________________________ - Sealing of abandoned bituminous coal mines _________________ _
Community sanitation ____________________________________ _
Annual Conference of the Surgeon General with State and Territorial
Health Officers _______________________________ ________ ______ _
National Institute of Health _______________________________________ _
Division of Biologics ControL __________________________________ _
Division of Chemistry _________________________________________ _
Nutrition investigations ___________________________________ _
Division of Industrial Hygiene _________________________________ _
Division of Infectious Diseases _________________________________ _
Rickettsial diseases _______________ _____ __-.- _______________ _
Virus diseases ________ ____________________________________ _
Heart diseases __________________ _________________________ _
Tuberculo~s---------------------------------------------Leprosy
_________________________________________________ _
Malaria _________________________________________ ________ _
Other studies ______ ______________________________________ _
Division of Pathology _________________________________________ _
Di vision of Pharmacology _____________________________________ _
Selenium studies _________________________________________ _
Bacterial chemotherapy ___________________ __ ______ ________ _
Division of Public Health Methods _____________________________ _
Morbidity and mortality __________________________________ _
Health problems of transients ______________________________ _
Cancer __________________________________________________ _
Pneumonia ______________________________________________ _
Child hygiene ____________________________________________ _
Environmental sanitation __________________________________ _
Public health facilities ____________________________________ _
Divi¥~~hfn~~~l~~=~===========================================
Oxyuriasis __________ __ ____________________________ ______ __
Amoebiasis __________ __________________________ ____ ______ _
Offices of Cooperative and Epidemiological Studies _______________ _
Cooperative studies _______________________________________ _
Epidemiological studies __________________________________ - Publications __________ _____________ _________ --- - - - - - - - ----- --National Cancer Institute ______________ _________ ______ ________ _
The National Advisory Cancer CounciL ____________________ _
Cancer research __________________________ _____ _____ - __ - - - V
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Division of Foreign and Insular Quarantine and Immigration___________
Transactions at maritime quarantine stations_____________________
Mexican border stations_____________ _____ ______________________
Transactions at United States airport_s of entry for airplanes from
foreign ports ______________________________________ _____ _____
Canal Zone__ _______________________________________________ __
Medical inspection of aliens_____________________________________
Division of Sanitary Reports and Statistics___________________________
Morbidity and mortality reports______ __________________________
Publications and distribution_ _ ___________ ______________ ________
Office of health education_______________________________________
Negro health work___ _____________________________ ___ _________
List of new publications issued during the year____________________
Division of Marine Hospitals and Relief___ ___________________ ________
Classes of beneficiaries and amount and character of services rendered_
New construction_ _ _ _ _ _ __ _ _ __ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ _ __ __ __ _ _ _ __ _ _ _ _
Repairs and improvements_______________________ _______ _______
Supplies and equipment________________________________________
Dental treatment_____ ___ ___________________________________ ___
United States Coast Guard_________ ____________________________
Consolidated and detailed reports________ _______________________
Division of Venereal Diseases_ ______________________________________
The Venereal Disease Control Act_ ______________________________
Cooperative work with State health departments_ _________________
Cooperation with other agencies________ _______ ____ ______ ________
Venereal disease medical center, Hot Springs National Park, Ark____
Educational and informative activities___ ____________________ ____
Venereal disease research laboratory , Stapleton, Staten Island, N. Y _ _
Hot Springs conference of laboratory directors and serologists_ _ __ _ _ _
Cooperative Clinical Group studies______________________________
Syphilis control in industry_ ____________________________________
Prevalence studies_____ _____ ______ _____ ___ ___________ _________ _
Tabular summaries____________________________________________
Di vision 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 ______________________________ ~ _ _ _ _ _ __ _ __ _ _
Hospitals for drug addicts__ ____________________ _____ ___ __ ______
U.S. Public Health Service Hospital, Lexington, Ky__________ _
U.S. Public Health Service Hospital, Fort Worth, Tex_______ __
Medical and psychiatric services in Federal perial and correctional
institutions___ ________ _____ _____________________________ ____
Studies and investigations of the causes, prevalence, and means for
the prevention and treatment of mental disease_ ________________
Division of Personnel and Accounts__________________________________
Personnel_______________________________________ _____________
Property records_____ _____________________________________ ____
Accounts section___________________________________ ___________
Personnel statement___ ____ _____________________ ___ ____________
Chief Clerk's Office__ ______________________________________________
Departmental personneL _ _ _ _ __ _ _ __ _ __ _ _ __ _ _ _ _ _ _ _ __ _ _ __ _ _ _ __ _ _ _ _
Printing and binding___ ________________________________________
Office quarters, supplies, and equipment___ _________________ ______
Library ____ ____ _______________ _________ ___ ____ ______ ________ _
Mail and records____ __________________________________________
Reorganization _______________________________ ___ ____ ______ ____
Employee activities _________ ________ ___________ __ ________ ______
Appenrlix__ _______________________________________________________
Financial statement____ __________________________ ______________
F..- Funds made available from other sources__ _____________ ___ ______ _
,. .,... Miscellaneous receipts _________________ _______________________ __
- Quarantine service-Expenditures by stations___ ________ __________
Index __________ __ ________ __________________ ______ _______ _________
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ANNUAL REPORT OF THE SURGEON GENERAL
OF THE PUBLIC HEALTH SERVICE
UNITED STATES PUBLIC HEALTH SERVICE,
Washington, D. 0., October 15, 1939.
Sm: In accordance with the act approved July 1, 1902 (U. S. C.,
title 42, ch. 4), I have the honor to submit for transmission to Congress the sixty-eighth annual report of the transactions of the United
States Public Health Service for the fiscal year ended June 30, 1939,
which is the one hundred and forty-first year of this organization's
existence.
At the close of this fiscal year the Public Health Service was transferred from the Treasury Department to the Federal Security Agency,
created in accordance with the Reorganization Act, approved April 3,
1939, and the first plan on Government reorganization submitted by
the President to the Congress on April 25, 1939. In his message
transmitting the reorganization plan, the President stated:
The Public Health Service is transferred from the Treasury Department to the
Federal Security Agency. It is obvious that the health activities of the Federal
Government may be better carried out when so grouped than if they are left in
the Treasury, which is primarily a fiscal agency, and where the necessary relationships with other ~ocial security, employment, and educational activities now must
be carried on by an elaborate scheme of interdepartmental committee work.
While the Public Health Service welcomes the congenial association
with organizations having related functions in the new Agency, it
naturally regrets the termination of relationships which it has enjoyed
in the Treasury Department. The past 141 years have witnessed the
evolution of the Service from a small organization, devoted solely to
the medical care of American merchant seamen, to a national health
agency, broad in scope and manifold in functions which affect directly
or indirectly the health of the people. To the Treasury Department
and its secretaries should go much of the credit for this sound growth.
Within the framework: of Congressional authorizations, the Service has
consistently enjoyed the greatest professional and scientific freedom.
The Public Health Service anticipates that, as a member unit of the
Federal Security Agency, it will continue to be of increasing public
service through the promotion of national health and the extension
of basic knowledge in the prevention and control of disease.
NATIONAL HEALTH PROGRAM
In February 1938 the Interdepartmental Committee to Coordinate
Health and Welfare Actiyities submitted to the President a report on
national health needs and an outline of a health program designed to
meet these needs on a national basis. At the suggestion of the President, a National Health Conference was called by the committee to
meet in Washington on July 18- 20, 1938. The conference membership included p;h.ysicians, dentists, nurses, hospital administrators, officials of public health and welfare agencies, educators, and representatives of organized farm and labor groups, civic organizations, industry,
and the -press. The findings and recommendations of the Technical
Committee on Medical Care were presented to the participants, and
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the proposals of the committee for a national health program formed
the basis of discussion.
It was the sense of the conference that national needs for health
and medical services were being met inadequately. In accordance
with its declared purpose, however 1, the conference made no formal
endorsement of proposals considerect during its deliberations.
The report and recommendations on national health made by the
Interdepartmental Committee were transmitted to Congress by the
President in a special health security message, on January 23, 1939.
The President recommended the report for careful study by the Congress, and legislation designed to bring the recommendations of the
Interdepartmental Committee into a practical reality was introduced
during the first session of the Seventy-sixth Congress.
The studies of the Interdepartmental Committee and its technical
advisers revealed that health and medical services are but unevenly
supplied throughout the country. National health needs of such magnitude and diversity were disclosed that greatly expanded Federal cooperation with the States was felt to be essential if needs are to be
adequately supplied. The committee felt that a comprehensive program designed to meet the Nation's health needs should provide:
Basic heal th services for the prevention and control of disease in all
parts of the United States; adequate services for medical care of the
sick; sufficient and accessible hospital beds and other physical facilities
which are essential to modern diagnosis and treatment; and compensation of the gainfully employed for wage loss resulting from temporary
or permanent disability caused by nonindustrial sickness.
The principle underlying the committee's proposals for the implementation of the program was that of Federal grants-in-aid to the
States. The function of the Federal Government would be the provision of professional, technical, and financial assistance to cooperating States. Programs based on local health and medical care needs
would originate within the States, and State authorities would retain
administrative responsibility for the operati9n of their programs. The
widest possible latitude would be allowed the States in the choice of
plan. The proportion of Federal financial participation, in each instance, would be determined by the economic needs, health problems,
and existing facilities of the several States. It was felt that a plan
of variable grants-in-aid would promote the provision of adequate
services in the relatively poor States.
Sound first steps have been taken by the Federal Government in
developing Federal-State cooperative health programs. The time
seems opportune to extend the amount and scope of these services
to enable every community in the country to be provided with the
basic essentials of a modern health service; to insure adequate general
and special hospitals and other health facilities where needed; to make
available satisfactory medical care for those groups of the population
unable to provide for such care out of their own resources; and to
develop schemes for cash compensation of workers, unemployed on
account of sickness, comparable to those now in effect for unemployment due to economic causes.
The needs are great. The opportunities for life saving and for
enhancing national efficiency are very real. It is hoped that the
Congress will give prompt and careful consideration to developing a
comprehensive program for national health.
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COOFERATIVE PUBLIC HEALTH WORK WITH THE STATES
The essential function of the public health activities of the Service
is to cooperate with the State health authorities in the solution of broad
and specific health problems and in the furtherance of sound programs
for the health protection of the public. In the body of this report, it
will be found that scarcely a division of the Public Health Service fails
to report specific cooperative services to the States. Certain broad
prog~ams of cooperation merit special attention.
STATE AND LOCAL HEALTH SERVICES
Active assistance to the several States and Territories was continued
under title VI of the Social Secutrity Act by the allocation of Federal
grants, and by the provision of consultative and technical assistance.
The results of the Federal-State cooperative program in public health
work may be measured partially by the expansion of health services.
The numper of counties under the admini.stration of a medical
health officer employed full-time reached a new high of 1,371. In
response to the demand for trained personnel, essential in the rapid
expansion and organization of these health services, approximately
1,500 individuals received public health training for positions in official
agencies during the current year.
A total of $44,861,322 in State and local funds (exclusive of funds
of large cities) was made available for public health services in those
health jurisdictions under which Federal funds were budgeted. This
sum shows an increase of $13,265,454 over the amount budgeted four
years ago. Thus, it is seen that Federal financial assistance has
served to stimulate rather than to decrease State and local responsibility for the health of the people.
Consultative and technical services have been provided for State
and local authorities by personnel of the Public Health Service experienced in health administration and specific public health techniques.
The enactment of new health legislation in a number of States and the
increasing public demand for health protection give further evidence
of the effectiveness of Federal-State cooperative planning and activity
in the health field. · The provision of sound health protection to the people cannot be
accomplished except through further intensification ot the health
services under the direction of trained personnel.
One obstacle to efficient administration in the States lies in the
rapid ·t urnover of personnel due to partisan political considerations.
During the fiscal year, one-sixth of the State health officers were
replaced. Such replacements are too often accompanied by the disruption of State and local health organization. The disastrous effects
on morale and on programs of service, when appointments are not
made on a merit basis, are such that appointment to all responsible
professional positions in the State and local health organizations should
be made under a merit system in each State. The establishment of
such a merit system should be made a legal prerequisite to the receipt
of Federal funds for health work.
VENEREAL DISEASE CONTROL
During this, the first full year of operation of the Venereal Disease
Control Act, outstanding progress was made in developing an effective
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control program. Federal funds allocated to the States in the amount
of $2,400,000, supplementing funds amounting to $4,300,000 derived
from State and local sources, have enabled the States to increase
appreciably the provision of minimal services fbr the control of venereal
diseases.
The number of clinics reporting durip.g the year has more than
doubled, and the number of patients brought under treatment has
shown a steady increase. Laboratory facilities have been expanded,
educational activities among physicians and laymen have be~n extended. Follow-up services have been made available in most of
the clinics.
Free antisyphilitic drugs for treatment of the medically indigent
are now being distributed to physicians in all of the States; and, in an
increasing number of States, drugs are being distributed without cost
to physicians, regardless of the economic status of the patient. Thes.e
services to physicians have stimulated increased reporting of cases.
The rapidly expanding program has created a great demand for
trained personnel. In order to meet this need, many health agencies
have provided post-graduate training for qualified individuals.
New State Jegislation designed to aid in preventing the spread of
syphilis and gonorrhea was enacted during the year. Nineteen States
have passed laws requiring applicants for marriage licenses to obtain
a physical examination, including a blood test for syphilis, and 15
States require blood tests for syphilis on all expectant mothers. Similar legislation is now being contemplated in a number of other States.
Progress was made in research activities for the improvement of
diagnostic methods, treatment, case-finding, and case-holding. In
therapy studies, several new drugs were investigated, with very promising results. Cooperative studies and demonstration projects in
strategic areas have developed effective case-finding and case-holding
methods.
The evaluation of serodiagnostic tests for syphilis. was continued,
and a system for the general improvement of the performance of
serological tests has been put into operation. Minimum standards
for serodiagnostic tests must be met by State and local laboratories
receiving funds under the Venereal Disease Control Act; and laboratories receiving funds under the act must demonstrate by suitable
methods that the serodiagnostic tests performed therein are accurate
and reliable. Many wealmesses in the performance of serodiagnostic
tests for syphilis were revealed in past evaluation studies. More
recent surveys have shown a decided improvement in the standard
of serodiagnostic efficiency in the various participating laboratories.
The serologic tests for syphilis hold a key position in the present
control program. In order to promote free discussion of problems
bearing on the serodiagnosrs of syphilis, a conference of laboratory
directors and serologists was held at Hot Springs National Park, Ark.,
October 21 and 22, 1938, under the auspices of the Committee on
Evaluation of Serodiagnostic Tests for Syphilis. The conference was
attended by physicians, health officers, and laboratory- workers from
44 States and the District of Columbia. I't ts safe to say that rapid
progress in the development of superior laboratories for the serodiagnosis of syphilis will result from the exchange of opinion and experience
afforded by the conference.
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After careful consideration of Federal assistance to the States for
venereal disease control work, the Congress felt that convincing evidence had been presented to indicate that the States have the necessary
executive machinery to insure economical administration of the full
$5,000,000 authorized for this purpose; that results in the control of
venereal diseases is in direct proportion to the allocation of funds by
the Federal Government, which, in turn, encourages the States and
localities to appropriate funds in a common fight; that provision for
treatment should be included in control measures; and that venereal
diseases are Nation-wide in prevalence, presenting a real national
problem for immediate solution through available control measures.
For the fiscal year 1940 the sum of $4,379,250, or 86.9 percent of the
total amount available, has been allotted to the States, and every
effort is being made to use these funds in accordance with the wishes
of Congress that administrative costs be held down and that the funds
be utilized, to the greatest possible extent, for diagnostic and therapeutic services.
The national interest in the control of thA venereal diseases has resulted in the formation of a working organization which is beginning
to show results. At this time it is vitally important that funds continue to be appropriated in increasing amounts in accordance with
the Venereal Disease Control Act of 1938, in order that the control
of the venereal diseases on a national scale may become a. reality.
A good start has been made in attacking the problem. A few
States have developed effective programs, but in many localities the
problem is so extensive that it is impossible for the population to
organize adequate services without additional Federal assistance.
Venereal diseases cannot be confined to endemic areas. If we are to
control these diseases, those States which have good programs in
operation must maintain their services at present or enhanced levels,
and we must direct our effort to assisting the less wealthy communities
in establishing necessary facilities. Ultimately to win the fight, we
must intensify our efforts until the program is effective on a Nationwide basis- in all States and communities.
INDUSTRIAL HYGIENE
With the development of national programs for social welfare and
public health, greater attention is being paid to the health of workers
and to health hazards in industry. Marked development in the provision of industrial hygiene services has occurred in the State health
departments. Under the impetus of grants-in-aid under title VI of
the Social Security Act, the number of industrial hygiene units in State
health departments has increased from 4 in 1936 to 25 at the close of
this fiscal year.
The essential features of an industrial hygiene program include
fundamental research, application of research, and educational activities designed to preserve and improve the health of some 50 million
workers. State and local health departments are, by the very nature
of their organization and their responsibility, most fitted to carry out
the last two phases of the program, leaving the investigative activities
to Federal, university, and other research a.gencies. From the standpoint of public health, industrial hygiene forms an important and
integral part of any program designed for the improvement of the
welfare of the population as a whole. For this reason, the various
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States have been encouraged to develop industrial hygjene services,
so functioning as to integrate the industrial hygiene program with
all the other basic health services in the department of health.
The 25 State health departments now engaged in rendering industrial
hygiene services have limited personnel and are functioning on meager
budgets. Twenty-one States, three Territories, and the District of
Columbia have no industrial hygiene program. It is urgently recommended, for purposes of conducting adequate industrial hygiene programs, that added funds be made available to the States and to the
Division of Industrial Hygiene of the National Institute of Health,
for the above purposes.
OTHER COOPERATIVE WORK WITH STATES
Services to the Pacific Coast and Mountain States in the suppression
of plague were continued. Inoculation tests were made of 66,000
animal parasites and 47,000 small wild animals were examined microscopically for evidence of plague. Plague infection has now been
demonstrated in wild rodents in Washington, Oregon, California,
Idaho, Montana, Wyoming, Utal:i, Nevada, Arizona, an<l New Mexico.
The known infected area now includes all States west of the Rocky
Mountains, except Colorado-Arizona and New Mexico· having been
added to the list during the year.
Technical supervision of Works Progress Administration projects
for the sealing of abandoned bituminous coal mines was continued in
cooperation with the State health departments. The purpose of these
projects is to reduce the amount of sulfuric acid drainage discharged
·into streams from aban.d oned mines. Since the inception of the Works
Progress Administration projects in October 1935, the amount of acid
discharged into streams has been reduced by more than 350,000
tons a year. Improvements in water supply conditions affecting the ·
public health have been noted consistently in the bituminous coal
mining areas of the States which have participated in this program.
The malaria control projects and the community sanitation program,
which have been carried on by the Works Progress Administration
under the technical supervision of the Public Health Service and the
State health departments, have had a material effect in reducing the
incidence of malaria and of various intestinal diseases, such as typhoid
fever and dysentery, within the areas in which the projects have been
conducted. The community sanitation projects have been in operation as a part of the several emergency relief projects for more than
five years, during which time over two million sanitary facilities for
excreta disposal have been installed at homes, schools, dairies, and
other places where the installation of a sewer system was impracticable.
During the fiscal year, the community sanitation projects were in
operation in 1,291 counties in 39 States.
In the malaria control projects in operation in 16 States, approximately 3,700 miles of drainage ditches were constructed, and over
46,700 acres of Anopheles-producing water area were e]iminated during
the fiscal year, affording protection to approximately a million and a
half persons who live within the mosquito flight range of the work.
It is recommended that both the community sanitation and the
malaria control programs be continued and extended to a larger number of counties in the States in which the projects are now in operation,
and to additional States in which it is apparent that these types of
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work are needed, and that the necessary funds for providing adequate
technical supervieion of the work be made available.
COOPERATION WITH OTHER AGENCIES
Medical care programs.-The Public Health Service provides a reservoir of professional personnel from which are furnished, upon request,.
medical officers to organize, promote, and administer health programs.
in other agencies. The fact that such requests are made is the logical
outgrowth of the functions of the Public Health Service.
During the fiscal year, 12 medical officers were assigned to other
agencies to act as consultants or to administer medical care programs.
An officer on duty with the Social Security Board acts in a dual
capacity as medical consultant for aid-to-the-blind . programs .under
title X of the Social Security Act and for medical programs administered by the several State departments of welfare.
Two officers served with the Farm Security Administration and were
engaged chiefly in the development and administration of sanitation
and medical care programs for low-income farm families who are
beneficiaries of the Farm Security Administration. A special program
of medical care was developed for indigent migratory agricultural
workers in Arizona and California.
A medical officer experienced in administration and in control of
the communicable diseases was assigned to the South Carolina Public
Service Authority for the purpose of organizing a Health and Sanitation Division for the Santee-Cooper project. The 'objective of the
newly organized Division is to provide adequate health service and
medical care for Santee-Cooper employees.
Services to Federal agencies.-Advisory and technical services were
extended to all departments of the Federal Government. The fields
of these cooperative activities of the Public Health Service are almost
as varied as the functions of the several Federal agencies themselves.
Much of this work requires the assignment of technical personnel on
a full-time basis.
Services of diverse types were rendered to the Department of Justice, the Department of Commerce, the Department of the Interior,
the Corps of Engineers of the United States Army, and the Federal
Trade Commission.
Acknowledgment of reciprocal assistance.-In connection with services
rendered by the Public Health Service in cooperative health work with
other agencies, mention and grateful acknowledgement must be made
of the reciprocal aid received not only from other Federal agencies
but also from State and local health departments and from various
universities and hospitals.
INTERNATIONAL HEALTH RELATIONS
The Tenth Pan American Sanitary Conference.-The Tenth Pan
American Sanitary Conference was held in Bogota, Colombia, September 4-14, 1938. In spite of the comparative inaccessibility of the
city, it was in many ways the most successful conference ever held in
Latin America. All of the Pan American countries were represented
by competent health officials of the respective governments. The
most important results were the approval of the increase in contributions by the several governments to the Pan American Sanitary
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Bureau, the formal recognition of the existence of the "jungle" type
of yellow fever and of the need of vaccination therefor, and the approval of, and resolution regarding, "career" health services. The
reports read and the papers presented indicated progressive expansion
and improvement in public health work in all of the countries
represented.
Interdepartmental Committee on Cultural R elations with the American
Republics.- At the request of the State Department, through the
Secreta,ry of the Treasury, representatives of the Public Health
Service participated in the meetings of the Committee of Representatives of Executive Departments and Independent Aiencies to Consider the Question of Cooperation with the American Republics.
This committee was appointed by the President in 1938.
It was the consensus that the cooperative activities of the Public
Health Service with the American Republics and the Pan American
Sanitary Bureau had met with general approval and had been of
exceptional value in improving public health conditioll\S and in developing cordial relationships in the Western Hemisphere. It was believed
that the objectives of the committee to foster and extend cultural
relationships might well be served by expanding the work of the
Public Health Service in directions that had already proved successful.
At the request of the State Department, an estimate was prepared
for submission to the Bureau of the Budget and to Congress which
would enable the Public Health Service to extend its cooperation with
the American Republics in yellow fever research, in the prevention of
the introduction and spread of communicable diseases, in the formulation of plans for the improvement of public systems of water supply
and sewage disposal, and in rodent control, by the establishment and
development of public health nursing activities, and by affording such
consultation and advisory services in public health administration as
might be desired. At the end of the fiscal year the matter was before
an appropriations committee of Congress for consideration.
European health relations.- The recognition of the importance of
public health was shown in both the spring and autumn sessions of the
Permanent Committee of the International Health Office. In spite
of the critical situation in Europe, nearly all of the countries signatory
to the Sanitary Convention were represented at both meetings. The
principal action taken was formal approval of the method of vaccination against yellow fever and of methods recently adopted for the
diagnosis of yellow fever. Preliminary suggestions as to a future
International Sanitary Conference were discussed.
The technical work of the Health Section of the League of Nations
has continued. All important commissions and committees continue
to include American representatives. The work which has been done
in the international standardization of biologics, the progress in the
preparation and the adoption of the international nomenclature of
diseases, the work of the Malarial Commission, and of the Commission
for the Serological Diagnosis of Syphilis, and the studies made by
the Health Section in problems of nutrition, housing, and physical
training-all have been of value and interest to this country.
INVESTIGATIONS OF PUBLIC HEALTH PROBLEMS
Definite progress has been made in researches conducted at the
National Institute of Health and in the field. In addition, the build
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ing program for the new headquarters of the Institute has progressed
satisfactorily. On December 1, 1938, the first three buildings on the
Bethesda, Md., site were occupied qy the Division of Public Health
Methods, by a par't of the Division of Industrial Hygiene, certain
field offices, and most of the administrative staff of the Institute.
About the same time, construction was begun on two more research
buildings; and on June 24, 1939, the cornerstone of the National
Cancer Institute was laid. Construction of quarters to accommodate
14 officers was initiated about the middle of the year. At the rate
at which work is proceeding on these buildings, they should be ready
for occupancy in the latter part of the fiscal year 1940. All these
buildings are situated on 70 acres of land donated for the purpose by
the late Mr. Luke I. Wilson and Mr--3. Wilson.
Scientific knowledge has increased and has become so complex
that no one individual can possibly become skilled in all fields of
investigation. Research in the biological sciences continually becomes
more closely interrelated with other branches of study. As a result
of evolutionary advances, to which the Public Health Service has made
distinguished contributions, the National Institute of Health has become a closely cooperative unit composed of several groups of investigators in various fields. The few attainments here summarized must
serve briefly to mark the character of the manifold research activities
of the Public Health Service. Much more has been and is being done
in our pursuit of additional knowledge of the causes and prevention of
disease.
INFECTIO US DISEASES
New foci of Rocky Mountain spotted fever were noted in some of
the Eastern States. The disease has now been reported in all but
seven States, and demands for the protective vaccine were unprecedented during the year.
An accidental laboratory infection with a new rickettsia isolated
in Montana was found to be closely related to "Q" fever, a rickettsial
disease of Australia. Two years' research has culminated in obtain.;
ing evidence that "nine-mile fever," a tick-borne disease, occurs
spontaneously in man. Further studies during the year have also
indicated a close relationship between "nine-mile fever" and the "Q"
fever of Australia.
Endemic typhus fever in the Southern States has continued to
spread and is now found in northern Alabama and Tennessee. In
certain sections of the South, the disease has lost its urban limitations
and now includes distinctly rural areas.
W eil's disease was recognized for the first time in New Jersey and
Nevada. Dogs from Nevada, New York, and Pennsylvania were
found to be suffering from the disease, and rats captured in New
York were found to harbor a virulent strain of the causative
organism.
A completed study of acute diarrheal disorders in New Mexico
and early investigations of similar conditions in Georgia and New
York have indicated that a very high percentage of these disease,s
are predominantly Shigella dysenieriae infections. The highly communicable nature of these infections indicates that the prevention of
mortality and morbidity from diarrheal diseases should be accepted
as a public health problem of communicable disease control.
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An inverse relationship has been found between endemic dental
fluorosis and dental caries. In the study areas, 16 times as much
dental caries was found among school children in communities with
domestic water supplies having a low fluorine content, as among
children in communities with water supplies having a relatively high
fluorine content. The factors in this inverse relationship are now
being sought.
VIRUS DISEASES
The National Institute of Health is studying five virus diseasespoliomyelitis, influenza, encephalitis, rabies, and lymphocytic choriomeningitis.
Significant observations which may contribute to the epidemiology
of choriomeningitis were made. Spontaneous infection with the virus
was demonstrated in mice trapped in the homes of three proved cases
of the disease in Washington, D. C., and eight other foci of infected.
mice not associated with known human cases were found. The in-fection has also been transferred from monkey to monkey by means
of monkey lice. Studies of blood from persons in various parts of
the United States showed that more than 12 percent were immuneto choriomeningitis, and in some localities the proportion of immune·
bloods in small sample groups was as high as 60 percent. This evidence indicates that the virus is widely distributed throughout the·
country.
HEART DIS E AS E S
Continued investigations on heart diseases during the year com-prised clinical and laboratory studies conducted in Washington, D. C.,
and epidemiological studies in the field .
Rheumatic heart disease was studied in the clinic and in the laboratory, with a view to determining an outside infectious agent and
the conditions within the host which may predispose to, or accompany the disease. Significant findings were reported with respect to•
prognosis and therapy. In the search for an etiological agent,
attempts to demonstrate a filter-passing noncultivable virus failed.
A survey of rheumatic heart disease, rheumatic fever, and chorea.
in Philadelphia hospitals showed a high incidence of these conditions
among the needy. Over 93 percent of persons hospitalized for thesecauses were ward patients.
The importance of rheumatic heart disease is indicated by the fact.
that this condition accounts for at least 80 percent of all heart disease among children and youth. Rheumatic fever leaves in its wake
large numbers of heart cripples, many of whom could be partially orcompletely restored to a normal life by proper convalescent care.
Studies made by the Public Health Service indicate that existing·
facilities for such care are totally inadequate in extent to meet theneeds, although much excellent work is being done.
Statistical analysis of a large number of deaths from acute coronary
occlusion, occurring in Philadelphia in the 5-year period 1933- 1937,
revealed an increase in total mortality from this cause of over 125,
percent during the study period. The increase occurred almost
entirely among white persons.
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NUTRITIONAL PROBLEMS
Dietary deficiency diseases of various kinds continue to be widely
prevalent in the United States, and health authorities throughout
the country have become increasingly aware of the great importance
of proper nutrition in relation to the public health. The growing
recognition of the public health aspects of nutrition has resulted in
the development of educational programs for improved nutrition as
a preventive measure in many State and local health departments.
The Public Health Service is cooperating in an advisory capacity
with the _health departments in the establishment of this important
new service.
Fundamental research on the effects of nutrition upon health and
on the requirements of adequate diet have immeasurably increased
the possibilities of improving the health status of the population.
We should now do more than cure or prevent dietary deficiency diseases; we should begin to apply our scientific knowledge with the
objective of securing the effects of better nutrition on the positive
health and development of the people. We should be able to lower
our infant mortality rate, to produce healthier and stronger babies
with less drain on the constitution of the mother, and to develop an
entire population more resistant to disease.
The Public Health Service has conducted research on nutritional
diseases for many years and has contributed facts of striking applicability in this field. During the current year, Public Health Service
investigators discovered the existence of a new vitamin deficiency
disease in man. They also demonstrated the means for its prevention and treatment. The disease results from a deficiency of riboflavin and probably has existed in this country for many years. For
diagnostic purposes, the term "ariboflavinosis" was suggested as a
name for the condition which is characterized by mouth lesions.
A survey of diets of the poor in Washington, D. 0., showed the
major deficiencies and furnished valuable data on a new method for
conducting studies of this kind. In another study, complete data on
the diet, physiological status, and medical condition of a large group
of needy children in New York City high schools, are being gathered.
CANCER
During the second year of its operation, the progress of the N ationa 1
Cancer Institute can be recorded. Grants-in-aid, totaling $85,962.50,
were recommended by the National Advisory Cancer Council for
research projects and have been awarded to 13 institutions. Sixteen
research fellows were on duty during thefear and 29 physicians were
appointed as trainees in the diagnosis an treatment of cancer.
Nine and a half grams of radium were purchased and standardized.
The entire amount has been loaned to hospitals and other institutions
for the treatment of cancer patients. All institutions receiving loans
of radium are required to assume responsibility for the care and the
proper use of the element. Loan agreements stipulate that no charge
may be made to patients for the use of federally-owned radium.
Fundamental cancer research comprised studies of lung tumors,
breast cancer, liver tumors, and other forms of neoplasm. Research
was for the most part directed toward the action of carcinogens, the
188796-40-2
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properties of malignant tissues, synthetic compounds, therapeutic
studies, and biophysical problems.
Among these studies, particular interest attaches to the genetic
studies of spontaneous breast cancer in mice. Further work on the
influence of foster-nursing upon the occurrence of breast cancer
yielded interesting results. It was shown that when the young of a
cancer-producing strain of mice are nursed by foster-mothers of a
noncancerous strain, the incidence of breast cancer is reduced from
25 percent to nearly 100 percent.
In cooperation with the United States Bureau of Standards and the
Carnegie Institution of Washington, a broad program on the biological
effectiveness of high energy radiation has been initiated. The importance of this program rests in its future application to the treatment of
cancer with X-rays and artificial radioactive materials.
Statistical studies on the epidemiology and therapy of cancer have
been continued, and ma~lrnd progress has been made in the collection
of essential data.
INDUSTRIAL HAZARDS
Engineering and medical field studies made during the year were
productive of much additional knowledge regarding the causes and
prevention of industrial hazards. A study of employees of the pottery
industry revealed that silicosis is a hazard for workers exposed to dust
concentrations in excess of 4,000,000 particles per cubic foot. Inves ...
tigations of four outbreaks of occupational dermatoses revealed the
causes, and recommendations were made for control. Examinations
of a group of employees of the felt-hat industry showed that 11 percent
had chronic mercurialism, and suitable recommendations were made
for prevention. Investigations showed that long-continued inhalation
of mica dust is capable of causing pneumoconiosis.
In laboratory investigations of organic compounds, it was found that
wh~n methyl bromide is used in the fumigation of foodstuffs, only
slight absorption of the gas occurs in the majority of substances, fatty
foods and milled grains being the important exceptions. Extensive
studies of the action of ultraviolet radiation on a variety of microorganisms has indicated not only lethal action but a high percentage
of mutants. Other studies of the current year related to illumination,
air-borne bacteria, tmricity of solvents, and sickness among industrial
workers.
CHEMICAL, PHARMACOLOGICAL, AND CHEMO'l'HERAPY STUDIES
Basic studies relating to the structure and configuration of the
carbohydrates, with special reference to practical application in the
medical and biological sciences, were continued. By means of the
periodic acid oxidation method, it was found possible to test the
homogenicity of certain qlasses of carbohydrates and to prepare many
new compounds for which no other method of synthesis was known.
In studies of drug addiction, a large number of drugs synthesized
from carbazole, phenanthrene, and dibenzofuran were found to possess
good analgesic action but undesirable toxicity. Clinical tests of a
new morphine derivative, methyldihydromorphinone, showed it to be
twice as active as morphine, to establish tolerance slowly, and to
have very low addiction liability.
Intensive research on sulfanilamide and its derivatives was continued in several Divisions of the Public Health Service, and from as
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many approaches, with a view to gaining more precise knowledge of
these valuable substances. In addition to fundamental chemical and
pharmacological studies, these compounds have been studied in
experimental infections and in the treatment of patients in the marine
hospitals.
The chemotherapeutic activity of several sulfanilamide derivatives
was demonstrated as being superior to that of sulfanilamide in experimental hemolytic streptococcic infections. A comparative study of
the protective action of sulfanilamide and sulfapyridine indicated that,
in experimental meningococcus infection, a . combination of therapeutic serum with either drug gives far better results in mice than
either drug or serum alone. Beneficial results from sulfanilamide and
sulfapyridine therapy have been obtained in the marine hospitals.
Sodium sulfanilyl sulfanilate and sodium sulfanilate, used in the
treatment of lymphopathia venereum, were effective to a degree that
patients in the tertiary stage of the disease were apparently cured.
We do not yet know by what action sulfanilamide and its derivatives
exert their therapeutic effects, nor is the relation of the chemical
structure of these compounds to therapeutic action well understood.
,f ore knowledge as to toxic effects and to conditions influencing toxicity is needed. The effectiveness and safety of chemotherapy depends
to a large extent upon such fundamental knowledge.
THE CONTROL OF BIOLOGIC PRODUCTS
Work on. the standardization of Sordellii (gas gangrene) antitoxin
has been completed and a unit adopted for testing the potency of this
product.
Correct typing of the invading organism in pneumonia is the prerequisite of modern pneumonia control activities; hence, increased
attention h as been devoted to the standardization of pneumococcus
typing serums. Specificity and potency tests were formulated and
minimum requirements for typing serums were adopted. Studies on
the standardization of therapeutic antipneumococcic serums were
continued.
Investigation of the stability of the arsphenamines led to an amendment of the arsphenamine regulations which shortens the period in
which arsenicals may be stored before using to a maximum of 5 years
for sulfarsphenamine and arsphenamine and 3 years for neoarsphenamine.
At the close of the fiscal year, 66 establishments, 15 of which were
foreign , held licenses to engage in the interstate sale of 164 different
biologic products.
OTHER PUBLIC HEALTH PROBLEMS
The demand upon the Public Health Service for the collection and
interpretation of mass data in reference to national, State, and local
health problems and to existing facilities and procedures for their
solution has continued to increase. Morbidity and mortality studies
have been continued at headquarters and in the field. Tabulations
of the massive data collected in the National Health Survey were completed, and 24 preliminary reports issued. Other studies designed to
define problems, to appraise existing public health procedure, and to
perfect methods of public-health practice have been continued in such
varied fields as pneumonia control, dental hygiene, milk pasteuriza
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tion, and staff organization and training of public health personnel
in the United States.
Definite progress can now be reported in the Ohio River pollution
survey authorized by the Rivers and Harbors Act of 1937 and conducted by the Corps of Engineers of the United States Army in
cooperation with the Public Health Service. At the close of the fiscal
year, it was estimated that the water and sewage treatment investigations for that portion of the Ohio watershed between the mouths
of the Kanawha and Kentucky Rivers were approximately 70 percent
completed. The cooperation of the Public Health Service has been
requested by numerous Federal, State, and local authorities in connection with diverse water-pollution problems. · .
Because the pollution of streams and lakes is a health problem of
interstate importance, consideration should be given to the adoption
of an abatement and prevention program which is national in scope.
As the President stated, in his message of February 15, 1939, to the
Congress on water pollution in the United States, the time is overdue
for the Federal Government to take vigorous leadership in the solution
of this problem.
MENTAL HYGIENE
The Public Health Service continued to supervise and furnish
medical, psychiatric, and other technical services in the Federal penal
and correctional institutions. The progressive improvement in the
medical and psychiatric services to these institutions has been the
result of long-range planning inaugurated 9 years ago when the present
system was put into effect by legislation.
The problem of the constitutional psychopathic inferior is important,
and measures for the intensive study of this problem in the Federal
penal and correctional system has been inaugurated by the establishment of specially designed research and therapeutic units at Chillicothe, El Reno, and Springfield. The unit at Chillicothe, the first to be
completed and put in operation, has proved such a success that the
entire institutional staff, lay as well as medical, are enthusiastic over
its results. These units are unique, and while they have never been
tried out before, it is felt that they constitute one of the major steps
in psycho-medical penology.
Diagnostic psychiatric services for United States District Courts
were continued by the units previously established in connection with
10 selected courts.
The usefulness of psychiatric service to Federal courts h as been
clearly demonstrated, but the work has been restricted because of
lack of funds. It is recommended that this service be extended to all
Federal courts and that funds be made available for this purpose either
by appropriation direct to the Public Health Service or to the Department of Justice for transfer to the Service.
The study of mental hospitals, which was conducted in cooperation
with the Mental Hospital Survey Committee, produced ample evidence of the marked variations in the extent and quality of care
afforded mental disease patients in public institutions. Surveys were
made of 24 State institutions for mental patients in 8 States. Several
of the States, in which mental hospitals were surveyed by the Public
Health Service at the request of the committee, have put into effect a
number of the recommendations arising from the studies, with the
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result that the care and treatment of mental cases in those States
have materially improved.
Information obtained from these surveys indicates, however, that
the general situation of State mental hospitals is unsatisfactory be-cause of overcrowding, inadequate buildings, shortage of personnel and
insufficient appropriations.
Provision should be made, in any national health legislation for
.assistance to the States, to improve the care and treatment of the
mentally ill and to apply all known preventive methods to reduce the
volume of mental illness.
Field studies in mental hygiene were continued throughout the year
in Fayette County, Ky., in cooperation with the State and local health
authorities and the University of Kentucky. The purpose is to determine, by a study of mental health conditions, practices, and facilities,
.a general pattern for the application of mental hygiene measures in
any community, and to define the role of the public health department
in community organization for mental health.
The Public Health Service Hospital at Fort Worth, Tex., was
formally dedicated on October 28, 1938. The first 50 patients were
admitted on November 8; and at the close of the fiscal year, the
patient population numbered 295, which exceeds the planned capacity
-of the initial group of buildings in operation during this period. It is
-e xpected that the prolonged-treatment building, with a capacity of
717 beds, will be completed· by December 1, 1939, and will bring the
total capacity to 1,000 beds. Admissions from the date of opening to
.June 30, 1939, totalled 432. The institution is operated with minimal
emphasis on custodial features, and approximately 90 percent of the
patients have been on minimum supervision (trusty) status, with no
escapes.
The Public Health Service Hospital at Lexington, Ky., operated at
full capacity during the year with an average daily population of 960.
During the last 2 or 3 months, the population of the institution often
exceeded normal capacity. There were 1,169 admissions during the
year, and discharges totalled 1,110. · Although approximately 46
percent of the patients were granted trusty privileges, there were no
escapes during the year. Of 10 patients released on parole, only 2
were returned as parole violators, whereas during the fiscal year 1938,
28 were released on parole and 10 were returned as parole violators.
The number of conditional release violators returned to the institution showed an increase of 14 over the number returned last year.
Occupational therapy has played an important part in treatment.
Through careful placement of patients, the opportunities afforded by
the industrial activities for developing good work habit8 and learning
new types of activities have been fully utilized.
Special studies concerning the nature and treatment of drug addiction were continued during the year in cooperation with other agencies
interested in this problem. A reexamination of the addiction liability
of codeine was completed and a report will be published. The chemical, pharmacological, and clinical results of 7 years study of the drugaddiction problem were published in a special report. These studies
are being conducted cooperatively by the Public Health Service, the
Committee on Drug Addiction of the National Research Council,
and other agencies.
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Mental and nervous diseases and epilepsy together represent the
largest unsolved problem in medicine. Hospitals caring for mental
disease have on their books more than 500,000 patients, and more than
117,000 additional patients are cared for in hospitals for mental defectives and epileptics. These figures represent only an undetermined
fraction of the total problem of mental and nervous diseases and
epilepsy. Millions of dollars are spent each year for the care and
treatment of such patients; but very little is expended for fundamental
research which might lead to a measurable control of the problem
through discoveries pointing the way to effective measures of prevention and cure.
To remedy this defect, the Public Health Service in its 1938 report
recommended the establishment of an institute for the study of mental
and nervous diseases. The idea has been warmly approved by
authorities in the field. Based on a study of existing facilities and the
problems that the institute would be designed to solve, it is believed
that the institute should have 350,000 cubic feet of laboratory space
for fundamental research; that it should have access to 200 patients.
for clinical and laboratory work; that it should be accessible to adequate library facilities and within the stimulating influence of extensive activities and informed personnel in the nervous and mental
disease field.
ew York City answers the two last requirements;
moreover, if the new institute were built on the present site of the
New York Marine Hospital, a considerable saving both in initial
outlay and upkeep would be effected. In order to meet an existing
need, plans have already been projected for an addition to the New
York Marine Hospital for the care of mental patients. The institute
should have access to these patients. But, in order to provide a larger
and more comprehensive body of clinical material, it is proposed that
the institute build 100 addit10nal beds at the hospital and that the
Public Health Service be authorized, in the utilization of these facilities, to accept, for purposes of study, patients who are not now beneficiaries of the Service. Such patients would be treated on a voluntary
basis, and admission would be effected by transfers of committed
patients from State or local public hospitals, through arrangements
with State and local authorities. The institute should be operated as
an independent unit, but in close cooperation with the marine hospital.
It is proposed also that the institute should have at its disposal
funds to be allotted to competent groups throughout the country,
who are in a position to study various phases of nervous and mental
disease, and that the entire work should be supervised by a national
advisory council composed of leaders in the fields of neurology,
psychiatry, and related sciences.
In order to carry out the plan as outlined, it is recommended that
funds be provided for the necessary new construction and extension of
existing buildings on the site of the New York Marine Hospital.
MARINE HOSPITALS AND RELIEF STATIONS
The oldest activity of the Service- medical care for merchant
seamen and other legal beneficiaries- was continued in 26 marine
hospitals and 124 relief stations located in the chief ports of the
United States and its possessions. Medical service was contracted
for with 133 hospitals located in ports not served by marine hospitals.
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A total of 405,424 eligible persons were furnished hospital and office
t_reatments: 65,317 in-patients were furnished 2,028,264 hospital days
relief and 340,107 out-patients were furnished 1,391,785 office treatments. In addition, 197,853 physical examinations were performed,
an increase of approximately 20 percent over the preceding year. At
the close of the fiscal year, 5,163 patients remained in the hospitals.
Merchant seamen, as might be expected, were the most numerous of
the beneficiaries treated, but the number of seamen patients was
slightly less than during the past two years. There was a marked
increase in the number of Works Progress Administration patients,
and a slight increase in the number of veterans.
The average length of hospitalization and period of disability for
patients afflicted with gonorrhea and certain other diseases have been
further reduced by the wider use of sulfanilamide. Mortality in
pneumonia has been greatly reduced by the use of specific serum, and
a further reduction may be expected from chemotherapy, especially
from the use of sulfapyridine. Research was continued in arthritis
and psoriasis. Intensive studies are being conducted on the use of
sulfanilamide in gonorrhea, lymphogranuloma inguinale, and chanchroidal infection, and excellent results have been obtained to date.
The act of April 26, 1939, authorized the detail of medical officers
of the Public Health Service for duty on vessels of the United States
Coast and Geodetic Survey and added the dependent members of the
families of Coast and Geodetic Survey personnel to the list of beneficiaries of the Service.
The physical facilities for the provision of medical, surgical, and
other services at the marine hospitals and relief stations were expanded
during the current fiscal year. The equipment of a cancer clinic at
the Baltimore Marine Hospital is virtually completed, and it is
expected that the clinic will open in September 1939. The new
marine hospital at St. Louis, Mo., with a planned capacity of 144
beds, should be ready for occupancy about September 1, 1939. Early
in 1940 it is expected that the new marine hospital at Boston, with a
bed capacity of 336, and the extension providing 300 additional beds at
the recently constructed marine hospital at Stapleton, Staten Island,
N. Y., will be completed arid ready for occupancy. Improvements in
facilities and minor repairs were made at several other marine hospitals
during the year, and funds are available for a continuation of this
work. The sum of $4,100,000 was provided for the general rehabilitation of the leprosarium at Carville, La.
Efforts were continued to secure funds for the purpose of initiating
the 44-hour week at marine hospitals during the fiscal year 1940, but
without success. However, the House Appropriations Committee has
indicated its desire that the Bureau of the Budget investigate the
matter "with a view of finding out if all hospital services are treated
alike and whether additional funds are necessary to correct any lack
of uniformity and treatment." It is confidently believed that this
inquiry will indicate the need for additional personnel.
In the body of this report the detailed needs of the Public Health
Service for additional hospitals and for remodeling and extensions of
existing hospitals are listed. The most urgent need for new construction is for a new marine hospital on the mainland of Florida and
another at, or near, Los Angeles, Calif. The Los Angeles hospital
should be provided with facilities for the sanatorium treatment of
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tuberculosis. If this is done, the need reported in previous years for a
separate tuberculosis hospital in southern California will have been
met.
Consideration should be given also to the construction of a hospital
for the exclusive treatment of tuberculosis at some point climatically
s uitable to serve the east coast.
QUARANTINE AND IMMIGRATION ACTIVITIES
No case of quarantinable disease reached any United States port
during the current fiscal year, although world prevalence of these
diseases remained practically unchanged.
'
Surveillance of air passengers from Hong Kong and the Philippines
and search for cholera carriers among persons from infected ports was
continued. Measures to prevent the introduction of yellow fever into
the United States from South America were actively prosecuted. A
mosquito control unit was continued on duty at Miami and Key
West, Fla., and an adequate supply of yellow fever vaccine was held
in readiness by the Rockefeller Foundation at its New York laboratory.
Radio pratique, through which permission is granted by wireless
for certain vessels to come to dock without undergoing inspection at
quarantine, has become an established procedure. First inaugurated
at New York City, it was later extended to other ports. The successful operation of this practice has clearly demonstrated that it is a
practical procedure which saves much time and may be safely operated
under reasonable precautions.
The maritime quarantine regulations were amended during the year
to provide for bacteriologic examination of shaving brushes, to prevent
the introduction of anthrax, and to require six months detention of
birds of the parrot family to prevent the introduction of psittacosis.
During the year quarantine officers of the Public Health Service
inspected 15,525 vessels, carrying 707,977 passengers and 1,218,552
seamen, and fumigated 830 vessels. Examinations for plague infection
in rats recovered from ships after fumigation were negative.
Inspections were made of 1,878 airplanes, carrying 25,842 passengers,
of whom 8,521 were aliens, at United States airports of entry.
In accordance with the act of Congress approved February 5, 1917,
medical officers at the various United States ports of entry examined
1,040,280 alien passengers and 812,058 alien seamen. Certifications
were made to the proper immigration officials that 22,248 of these
passengers and 1,088 of the seamen were afflicted with some mental
or physical defect or disease, forbidding their entrance into this
country.
Approximately 72,500 applicants for immigration visas were examined by medical officers of the Public Health Service stationed at
American consulates in foreign countries; of these, 1,021 were reported
by the medical officers to the American consuls as being afflicted with
one or more of the defects or diseases requiring exclusion, and 13,466
were certified as being afflicted with a disease or condition likely· to
affect their ability to earn a living. Only two of the aliens who had been
given a preliminary medical examination by Public Health Service
officers in foreign countries, and to whom visas had been issued, were
certified upon arrival at a United States port as being afflicted with
a condition requiring deportation. ·
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The Foreign Quarantine Division has been undergoing considerable
reorganization during the past three years, the principal features of
which have been the reduction of certain facilities at maritime quarantine stations and the building up of stations where air traffic involving a
quarantine hazard enters the United States. It appears at present
that, for the most part, this reorganization is accomplished. It has
been accompanied by a net reduction of cost which is reflected in the
reduced appropriation for quarantine service.
Because of the present disturbed world conditions and the prospect
of epidemic disease spread resulting therefrom, the present quarantine
facilities should be retained and no further major changes in quarantine
functions and no relaxation of procedures should be considered. In
fact, it may be necessary as a result of wars in various parts of the
world to adopt more stringent measures than are now employed.
PREY ALEN CE OF DISEASE
WORLD PREVALENCE
In the present era of extensive foreign commerce and rapid international travel, current information on world prevalence of disease
continues to play an important role in preventing the introduction of
diseases from foreign countries.
The Public Health Service receives reports of the incidence of
diseases in foreign countries from officers of the Service, the American
consulates, the Pan American Sanitary Bureau, the International
Health Office in Paris, the Health Section of the League of Nations,
foreign health services, and other organizations.
During 1938, cholera was confined principally to India, China, and
Indochina, with a few cases reported in Afghanistan, Thailand, and
Japan. India reported 356,373 cases with 174,213 deaths, as compared
to 169,908 cases and 83,914 deaths for 1937.
The principal countries which reported plague in 1938 were India,
Java and Madura, Madagascar, Uganda, the Belgian Congo, Ceylon,
Egypt, Kenya, and the Union of South Africa. India reported 20,305
cases with 9,930 deaths, as compared to 33,460 cases and 17,036 deaths
for 1937. Java and Madura reported 1,801 deaths, indicating a high
incidence of unreported cases. The foregoing figures show where
plague was most prevalent but by no means represent the total
number of cases.
A total of 124,269 cases of smallpox was reported for 1938 as compared with 137,856 cases for 1937. India reported 83,283 cases with
20,742 deaths, and the United States reported 14,939 cases as compared to 11,673 for 1937.
According to reports received, yellow fever was confined to localities
in Africa and South America. In South America, yellow fever decreased, probably as a result of extensive vaccination in the principally
affected areas.
All continents reported the prevalence of typhus fever with a combined total of 27,326 cases of both types of the disease. The countries
reporting the greatest number of cases were, in the order named, as
follows: China, Morocco, Poland, Egypt, Tunisia, Rumania, and the
United States.
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MORBIDITY AND MOR'fALITY IN THE UNITED STATES 1
Health conditions in the United States continued to improve.
No cases of cholera, yellow fever, or human plague occurred in the
United States in 1938. Measles and smallpox ~ere more prevalent
than usual. A total o_f 822,811 cases of measles was reported- the
largest number recorded for any year since reliable figures have been
available. Fewer cases of poliomyelitis (1,705) were reported in 1938
than in any other year since these preliminary annual compilations
have been made, but toward the close of the fiscal year the disease
became mildly epidemic j,n a limited number of States. During the
first half of 1939, the total number of cases reported was 40 percent
higher than that for the corresponding period of 1938.
The number of reported cases of smallpox in the United States iu
1938 (14,939) was nearly twice the number representing the 1933- 37
median. The incidence of smallpox has been increasing in this country
since 1930, when slightly more than 5,000 cases were reported. This
increase apparently continued into 1939, as 8,273 cases were reported
for the first 26 weeks of the current calendar year.
The number of cases of smallpox reported in the United States was
exceeded by only one country in the civilized world- that is, India.
Since a number of other nations have succeeded in eradicating smallpox
the situation prevailing in this country reveals a curious public indifference to the existence of a disease which can be controlled so easily
and so readily.
During 1938, the case incidence of diphtheria, influenza, meningococcus meningitis, scarlet fever, and typhoid fever stood well below
the 5-year median for these diseases. A total of 2,294 cases of fleaborne typhus fever was reported, as compared to 2,393 cases for 1937.
Four hundred and thirty-four cases of Rocky Mountain spotted
fever were reported from 32 States, as compared to 431 cases from
30 States for the preceding year.
Preliminary reports of the National Health Survey on chronic
disease in the United States indicate the magnitude of this problem.
These reports were based on a house-to-house canvass of approximately 800,000 families including nearly 3,000,000 persons in 83 cities
and 23 rural areas in 19 States. The estimated prevalence of specified
chronic diseases in the United States is presented on page 102.
With the decline of the more serious infectious diseases, which has
been due to more effective control in the younger age groups, there
has been a definite increase in the chronic degenerative diseases-byproduct of an aging population. This results in a logical shift of
emphasis in public health effort, concerted action naturally being
directed into the field where there is the greatest apparent need and
which affords the promise of the greatest saving in physical values.
The favorable mortality rates indicated for the first part of 1938
continued throughout the year and resulted in the lowest general
death rate yet recorded. The provisional rate for 1938, recorded by
the United States Census Bureau, was 10.6 as compared to 11.2 for
1937, and to 10.7 for 1933, the lowest general mortality rate recorded
prior to 1938. The 1938 provisional infant mortality rate of 50.9 per
1,000 live births was the lowest on record since the birth registration
1 The following statements are based upon preliminary data for the calendar year 1938, accumulated by
the Public Health Service from 41 States, the District of Columbia, Hawaii and Alaska, and representing
about 90 percent of the total population of the country .
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21
PUBLIC HEALTH SERVICE
area was established (1915), and no doubt the lowest in the history of
the country.
The decline in maternal mortality continued throughout 1938,
making the ninth consecutive year in which a decrease has been
recorded. The provisional rate for 1938 was 4.0 per 1,000 live births
and was about 10 percent less than for 1937 and 30 percent less than
the 1933 rate.
For the following diseases, or groups of diseases, the provisional
mortality rates reported during 1938 were the lowest on record:
Typhoid and paratyphoid fever, scarlet fever, diphtheria, poliomyelitis, epidemic cerebrospinal meningitis, tuberculosis, malaria, pellagra,
diseases of the digestive system, nephritis, and diseases of pregnancy
and childbirth.
The mortality rates from influenza, pneumonia, and accidental
causes were the lowest in recent years. Accidents, nevertheless,
-continue to take a heavy toll of lives. Automobile accidents alone
account for one-third of the total accidental mortality and cause
practically three times as many deaths as do typhoid fever, measles,
·scarlet fever , whooping cough, and diphtheria combined.
For the first time since preliminary mortality figures have been
available from an appreciable number of States, the death rate from
tuberculosis was less than 50 per 100,000 population. Although the
rate of decline in the number of deaths from tuberculosis has been
-decreasing, there is every reason to believe that further substantial
reductions can be made, since several States reported rates lower than
30 per 100,000.
Death rates at all ages from whooping cough, encephalitis, cerebral
hemorrhage and diabetes, and from diarrhea and enteritis among
-children under 2 years of age, were about the same as in immediately
preceding years.
Cancer and heart disease were the only major causes of death for
which higher rates were recorded in 1938. The trend in mortality
from both these diseases has been consistently upward for several
_years-an increase due, in part at least, to the larger proportion of the
population reaching the older age periods in which cancer and heart
disease are more prevalent.
The recording of a low general mortality rate should not lull the
public into false security, nor should it be the excuse for a relaxation
of public health effort. It should always be borne in mind that the
general mortality rate is a national average in which are obscured
significantly high rates among certain groups of the population and in
certain localities. Moreover, mortality rates do not take account of
the great losses incident to protracted disability from certain diseases,
nor of the shocking increments of sickness and suffering resulting from
lack of medical care, nor of the many thousands of nonfatal cases of
preventable illness. Analysis of the improving death rates for certain
diseases would indicate, in some measure, what has been done and
what can be accomplished by concerted attack. In this broad field,
there are many battles yet to be won; they challenge our best efforts
despite the disarmingly low national death rate.
THOMAS P ARRAN,
Surgeon General.
Hon.
Jr.,
Secretary of the Treasury.
HENRY MoRGENTHAU,
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Federal Reserve Bank of St. Louis
DIVISION OF DOMESTIC QUARANTINE(STATES RELATIONS)
Assistant Surgeon General
CLIFFORD
E.
WALLER
in charge
THE CooPERATIVE PUBLIC HEALTH PROGRAM
In the 3 years and 5 months since funds first became available
under title VI of the Social Security Act for grants-in-aid to the States
for public health work, a total of $27,333,000 has been appropriated
by the Congress for this purpose. The accomplishments that have
been achieved in the establishment and improvement of health services under this cooperative program have been unequalled in any similar period of time.
Experience has shown, and most State health authorities have
realized, that if specific causes of morbidity and mortality are to be
controlled effectively, the attack must be made through local health
units, directed by a whole-time medical officer and staffed by an adequate number of full-time employees who are trained in the various
required techniques. On January 1, 1935, there were 594 counties in
the United States that had local health departments under the fulltime direction of a medical health officer. Under the stimulus of Federal grants on a matching basis, the number of such counties in 1939
reached a total of 1,371, an increase of 130.6 percent.
This expansion of basic services on the local level has been achieved
not only through the use of the Federal grants but also through the
use of local and State appropriations. On January 1, 1939, annual
appropriations for health work, in the cooperative projects alone, from
local and State sources totaled $44,861,322, an increase of more than
$13,000,000 in 4 years.
The provision of a health department directed by a medical officer
and staffed by trained, full-time personnel is a sine qua non for adequate health service. However, the number of such persons in a health
department may, and does, vary from one sufficient to deliver only
the barest minimum of service to a complete staff organized to operate
health services in all the approved specialties.
One significant trend during the operation of the grant-in-aid program has been the addition of personnel to established health departments in order to improve the quality and widen the scope of activities.
This has occurred on both the State and local levels, but particularly
on the State level. Thirty-seven State departments now have divisions or bureaus concerned with the promotion and supervision of
local health services; 27 have bureaus or divisions of industrial hygiene;
35 States have dental units or bureaus; 17 States carry on pneumonia
control programs; 5 State departments have cancer control programs;
and practically all States have improved their public health nursing ►
engineering, and vital statistics functions.
22
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PUBLIC HEALTH SERVICE
23
Probably the most gratifying result of the grant-in-aid program has
been the large number of individuals given technical training for positions in official health departments. From February 1936 to the close
of the fiscal year 1939, public health training was provided, in whole
or in part, from Federal funds for some 5,400 individuals, approximately 1,500 of whom received training during the fiscal year 1939.
Among these were some 1,200 medical officers, 2,600 nurses, 270 engineers, 820 sanitarians, 272 laboratory technicians, 13 dentists, and 38
statisticians. This program of training for particular types of work is
one of the soundest carried out in present-day public health practice,
and is an essential to the development of full health protection for all
the people.
For the fiscal year ending June 30, 1939, a total of $8,207)941 was
allotted to the States under the provisions of title VI of the Social
Security Act for public health purposes. This was made up of an
annual appropriation of $8,000,000, and a balance of $207,941 remaining unpaid to the States from the previous year. The allotments to
the several States for the fiscal year 1939 are shown in table 1.
TABLE
!.-Allotments to States under Section 601 of the Social Security Act for the
fiscal year ending June 30, 1939
State
Alabama ___________ _________ __ ___ __ _
Alaska _____________________________ _
Arizona ___ _____ ____________________ _
Arkansas ___________________________ _
California __________________________ _
Colorado ______ ___ _________ _______ ___
Connecticut ___ _____ ___ _____________ _
Delaware ___ -----------------------District of Columbia _______________ _
Florida __ ___________ ____ --- ------ -- --
i:~~iL
__=-Idaho __________
======-==
==-==---====---====-==-==-==
Illinois __________________ ---------- -Indiana - __ _-- - -- -- -- ------ -- ---- -- -Iowa ____________________ -- - - -- -- -- -Kansas ___________________ - -- - -------
"ti:Hs~~~r==
==========---====-==
====--===
Maine
___ --------------=
---Maryland
___________ ________
_____
__ _
Massachusetts __ -- _________________ _
Michigan __________ _______ ________ __
Minnesota _____ _______ ________ ___ __ _
m~~~~~t~i====
========== =
=========_==
Montana __ ______________
__________
_
Total allotment
$234, 016. 00
35,855.00
54,878.00
171,945.00
306,178. 00
84,354.00
93,895.00
29,957.00
58,726.00
137,184.00
266,435.00
58,111.00
67,458.00
362,428.00
197,723.00
167,771.00
121,547.00
215,291.00
153, 039.00
64,089.00
123,487.00
231,808.00
260,399. 00
178,127.00
181,587.00
219, 589.00
58,595.00
State
Nebraska __ ___ __ ____ __ ________ _____ _
Nevada
_______ -------------------New Hampshire
______ _____________--_
New Jersey_------------------------
mt
North~;rt~~========================
Carolina ____________________ _
North Dakota ______________________ _
0 bio _________ ___ ___________________ _
Oklahoma ___ ___ ___ __ _______________ _
Oregon ______ _______________________ _
Pennsylvania ______________________ _
Rhode Carolina
Island _______________________
------------------- --_
South
South Dakota ______________________ _
Tennessee ___ ____________________ ___ _
Texas ______________________________ _
U tab ___________________ ____________ _
Washington==
____
_________
_
~r:iii~~==
====___________
========== =
===== ====
;r:Jo!!t~~==
======
=== ==== ==____
== ==
Wyoming ___________
_________
__==
_
Total allotment
$80,000.00
37,631.00
47,053.00
199,531.00
71,439.00
537,843.00
305,960.00
69,094.00
338,856.00
163,672.00
88,239.00
464,856.00
58,875.00
196,033.00
68,723. 00
236,777.00
370,174.00
59,974.00
44,808.00
199,402.00
109,836. 00
139,300.00
156,395.00
28,998.00
TotaL _______________________ _ 8, 207, 941. 00
The amounts paid to the States for the fiscal year 1939, on the basis
of approved budgets, amounted to $7,985,120 and was distributed as
shown in table 2.
In table 3 is shown the distribution of budgeted funds from all
sources in the cooperative health program by the purpose for which
it was budgeted for the fiscal year. lt is important to note that, in
these budgets alone, the funds paid from Social Security grants
amount to less than 16 percent of the total budgeted.
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24
PUBLIC HEALTH SERVICE
TABLE
2.-Payments to States under Section 601 of the Social Security Act for the ·
fiscal year ending J une 30, 1939
State
Alabama ___ ___ ____ ____ __ -- -- --- ----Alaska ____________________ -- -- _____ _
Arizona ____________________________ _
Arkansas ____ __•· - __________ -- ___ __ __ _
California. ______ ________ ____ _______ _
Colorado ___ _____________________ ___ _
Connecticut __ _______ ________ ______ __
Delaware ____ _____ __ _______________ _
District of Columbia ________ _______ _
Florida_. _______ ___ ___ ______________ _
Georgia ______ ______ __ ______________ _
Territory of Hawaii_ __ ______ _______ _
Idaho _______ : _________ ___ ___ __ _____ _
Illinois _____ ________________ ____ __ __ _
Indiana ____ _____ ______ _______ _____ __
Iowa ____ ______ ____ ___ ___ __ ___ ______ _
Kansas ____ __ ______ _________________ _
Ei~i~i~~r=:: ===== : ======::::: :: ==: :
Maine ___·- - ----------- -- -------Maryland
__ -____
__ __ _________
______ __
Massachusetts ___________ ___ ____ ___ _
Michiµ-an __ ___ _____________________ _
m~si::i~tic:=
== ==
===::: :____
==: ==
== == ==_
Missouri.
___ _____
_______
_______
Montana ____________________ __ ___ __ _
TABLE
Total payment
$234, 016. 00
35,855. 00
54,878. 00
171,945.00
305,248.00
84, 354.00
93,8%. 00
29,957.00
58,726.00
137,184. 00
266,435.00
58,111.00
67,458. 00
362,428.00
188,073.00
167,771.00
108,235.25
21/i, 291. 00
153,039.00
64,089. 00
123, 487.00
231,808.00
247,003. 67
178,127.00
181,587. 00
219,589.00
53,145. 00
Total payment
State
Nebraska ____ ______________________ _
Nevada _________ ___ __________ ______ _
New Hampshire ________ ___ _______ __
New Jersey ·- _______ ____ __ ____ _____ _
New Mexico ____________ _____ _____ __
New York ______ ____ ____ ______ ____ __
North Carolina _____________ __ _____ _
North Dakota __ ____________________ _
Ohio .. _________ ___ ______ ______ ___ ___ _
Oklahoma ______________ ______ ______ _
Oregon __ _________ __________________ _
Pennsylvania _____ ___________ _____ _
Rhode Island _____ ________ ______ ___ _
South Carolina ___ _______ ______ _____ _
South Dakota ______ ____ ___ ___ ___ ___ _
Tennessee ____ .___ ______ _________ _--- ·
Texas ___ __ ____________ ____ ____ ___ ___
Utah _____ _______ _____ ______ _.. ____ __ _
~r:~ii~~==
== ========__==
===______
======_
Washington==__________
__==
_=
--·
West Virginia __________ ________ ____ _
Wisconsin ____ ____________ ______ _____
Wyoming _________ ________ _________ _
$45, 465. 43 :
28,700. 00 ·
47,053. 00
199,531.00
71,439.00 •
517,987.50
305,960.00
19,089.37
334, 121. 22 163, 672. 00
88, 176. 00
460. 456. 00
58,875.00 ·
196,033.00
88,723.00
236,777.00
352, 112.94
59,974. 00
43. 432. 92 ·
199,402.00
86,766.00 ·
139,300.00
156, 395. 00 ·
13,943. 31
TotaL ______ ________________ __ $7. 985,119. 61
3.-Funds budgeted in cooperative health work for the fiscal year 1939, from .
all sources, by purpose
Purpose
Amount
Percent
Amount
Percent
~;~;\~t-~!~!~~~~~i~~=:
== : ::: == =::: =:: : : : ==== == =:: == =: === :: : ==:: : : : : : : : : ::: : : : :
State-wide health services:
Preventable disease control:
2. 37
Venereal diseases ________________ $1,207,636. 61
GeneraL ___ ___ __ ________ __ ______ 1,179,662.25
2. 31
Tuberculosis ________ ___ __ __ ______
720,193.39
I. 41
Cancer_ ______ ____ ________________
459,035. 64
. 90
Pneumonia__ ________________ ____
424,326. 17
. 83
Malaria____ ______________________
159,094. 99
. 31
Rodent plague_ __________________
149,568.22
. 29
Trachoma_ ______________________
46,910.20
. 09
TotaL ___ _____ ________ ________
Laboratory__________________________
Sanitary engineering _________________
Maternal and child health ______ _____
_____ ___ __ ___ ___ ____
___ ____ ____ __ ___ ____
_:_ ______ ___ _ ___ ____
____ _________ . ___ ___
¥~\~t~t~~~N~nursinrs::=: :::: ::=::::: : :=:::::::= := :::::::
Supervision of local health services_ _ __ ________ ___ ______ _
Food and drugs_____ _________________ __ ______ __ ___ _____ _
Aid to crippled children______ ___ ___ __ __ ___________ ___ __ __
Industrial hygiene ____ _____ __________ .. _____ ______ _ ___ __ __
Public health education__ ___ ______ ______ _____ __ ___ ____ ___
School inspection _____ ___ ___ __ ___ ____ ___ __ ___ ___ __ __ _____
Dental hygiene _____ _________________ __ ______ _____ ____ ___
t~fc~ctti~dr~~~g~iror:::::: :::::::::: ::::::::::::: ::: ::: :
Menical care, transients __ __ _____ _____ ________ ____ _ ___ __ __
~:~i~1lhc;~fen1!~~-a-i~ :::: : ::::::::: :: ::::: :::::: :: ::::: ::
Embalming and undertaking___ ____ __ __________ ___ ___ ____
Board of examiners and registration___ _______________ __ __
Health survey____ __ ________ __ _______ _________ ____ _____ __
t~!io~Y!~~~-_::::::::::::::::::::::: ::::::::::::: :::::::
$4,346,427.47
3,762,650.18
2,561,054.60
2,141,136.05
i: 1n:
m:~!
899,834.98
524,531.23
,506, 418. 42
468,504.24
416,290.74
230,086.00
187. 377. 52
lg~:
~~6: gg
A2, 200. 00
!~:
~~t 66
30,610. 00
22,871.57
3,600.00
4, 11~:
~~g: g~
Percent
Amount
4. 95 2. 9:a...
$2, 530, 436. 21
1, 493, 078. 58
8. 51
7. 37
5. 01
4. 19
2. 55
2. 30
1. 76
l.03
. 98
. 92
. 81
. 45
. 37
. 21
. 13
. 10
.10
. 09
. 06
. 05
. 01
. 01
9. 36
Tota!_ _____________ ____ ________ ___________ __ _____ __ _______ ______ ___ ____ 23,685,134.91
Local health services_ ____ ____ _________ ___ ___ ________ __ __ ___ __ ___ _______ ___ ___ ____ 23,367,711.37
:
46. 37"
45. 75·
Grand totaL __________ _____ ___ ___ _ _______ __ __________________ ___ __________ 51,076,361.07 100. 00•
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PUBLIC HEALTH SERVICE
25
The development of public health administration in the United
States until very recently has been restricted, in general, to the provision of the basic preventive services and to therapeutic measures.
when active therapy of the afflicted was the best method of protecting·
the healthy population. Within the last few years, however, the,
growing · realization, the incessant demand has been that the official
health agency should be concerned not only with the protectjon of the
public from attacks of preventable djsease but also with the organization of forces withjn the community in order to minimize the losses of
time, of earning power, and of life from all types of existing disease ..
A beginning has been made by the participation of some official health
agencies in the treatment of trachoma, pneumonia, malaria, and
cancer, and it is probable that this type of activity will play an increasingly important role in future programs of official health agencies.
CONSULTATION SERVICES 'IO THE STATES
An expansion in the number of health departments and in the type&
of service being rendered, such as has occurred in the grant-in-aid
program, must be planned and analyzed carefully, if the purposes of·
the expansion are to be carried out.
In order to supply to the States, when needed, consultation service
on matters of public health and in order to guide and direct the expansion of local services made possible by the funds available under title VI of the Social Security Act, there were organized and established five regional offices in New York, N. Y., Washington, D. 0.,
Chicago, Ill., New Orleans, La., and San Francisco, Calif. Each of'
the regional offices is under the direction of a medical officer well
qualified by training and experience in public health administration.
There are also available to the States, in each regional office, consult...
ants in sanitary engineering, venereal disease control, and public
health nursing. The demands made upon the time of all these consultants are such that it probably will be necessary very soon to
increase the number of regional offices and to decrease proportionately
the number of States served by each.
In addition to the consultants in regional offices, advisory and consultant services to the States were furnished during the year from the
central office, upon request, in (1) public health administration; .
(2) laboratory methods; (3) public health engineering; (4) milk
sanitation; (5) shellfish sanitation; (6) public health nursing; (7) industrial hygiene; (8) dental hygiene; (9) nutrition; (10) malaria
control; (11) cancer control; (12) infantile paralysis control; (13) pneu- .
monia control; (14) public health education; (15) the evaluation of
health facilities; and (16) recording of health work.
NUTRITION
Visits were made to 10 State health departments for the purpose of'
assisting and observing nutrition activities.
In general, certain lines of procedure seem to be developing in
practically all of these States. The nutrition personnel has become
better adjusted, and the programs appear to have more definite objectives than they had last year.
The most successful lines of procedure appear to be in educational
work with the public health nurses and in the promotion and assistance .
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PUBLIC . HEALTH SERVICE
given to school lunch programs. The work to date indicates that there
is a definite place for a nutritionist in the State health department
organization. It also indicates that most county health departments
are not ready to employ such highly specialized personnel. The
nutrition programs, on the whole, show better organization, more
clarity of purpose, and definitely better methods of carrying out the
work than were shown last year. The teaching of proper nutrition in
public health education courses appears to be one of the most valuable
innovations.
MALARIA CONTROL
The time of one commissioned officer and one assistant has been
devoted almost exclusively to giving consultation service to the States
on their malaria control programs. Specifically, this has consisted of
educational work, lectures, assistance in planning, technical supervision of the installation of permanent types of linings for malariacontrol ditches, surveys, and reports. Instruction was given in thickfilm laboratory technique to 30 selected technicians at two State
laboratories.
Cooperation was extended through the State health departments to
the Aedes aegypti control campaigns in Miami and Key West, Fla.,
and Charleston, S. C.
PUBLIC HEALTH NURSING
The annual count of public health nurses in the United States and
territories was made in cooperation with the several State and Territorial health departments. The total number of public health nurses
employed by State and local health agencies on January 1, 1939, was
20,061. This number is exclusive of the public health nurses employed
by industries and national agencies, and of the number employed by
universities and colleges as public health nursing instructors. The
Northeastern and North Central States employ about 73 percent of all
the public health nurses in the country. However, the largest increases
during the past 8,years have been in the western and southern districts,
as will be seen from table 4. During the past 8 years, the increase in
the south central district was a little over 50 percent, and the increase
in the other districts was just under 50 percent. At present, the
estimated population per public health nurse is about 6,500 for the
country as a whole. The average population per nurse in the northeastern district is about 4,000; in the south central district the average
population per nurse is approximately 12,000.
TABLE
4.-A comparison of the number of public health nurses employed by state
and local health agencies in 1931, 1937, 1938, and 1939 1
District
Northeastern __ __--------------------------------------South Atlantic____ _____ _______________________ ___ ______
North CentraL . ----------- --- ----- -- -----------------South CentraL________________________________ ________
Western __ ___ . __________________________________________
1931
2
1937
1938
1939
7, 769
8. 547
~. /i90
1. 553
J, 726
1. 867
4,526
4,856
5,050
1,546
1, 771
2,134
2, ~2.5
1, 526
2, !112
2, 116
2. 229
1----1----1----1---TotaL. __________ ___ ___ __ _______________ _________
15, r,n7
17, 631
19, 379
20, 061
1
2
7,389
l, 251)
4, 196
Exclusive of industrial and part-time public health nurses and those employed by national agencies.
1931 census of public health nursing made by the National Organization for Public Health Nursing.
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PUBLIC HEALTH SERVICE
27
One of the most important functions of the nursing consultants of
the Public Health Service is to strengthen and increase the nursing
-consultation services of the several State health departments. All of
the States, the Territories of Hawaii and Alaska, and the District
·of Columbia now have fairly well organized public health nursing
units. In 25 States, the Territory of Hawaii, and the District of Columbia, nursing is organized as a separate bureau or division of the State
m Territorial health department. In 7 States it is organized as a unit
under central administration and functions much the same as a
·separate bureau. In 7 States, nursing is a unit under "local health
·service," and in 10 States it is administered by the divisions of maternal
and child health.
On January 1, 1939, there were 179 full-time general public health
nursing supervisors and 79 special nursing consultants employed by
State and Territorial health departments. In addition, there were 83
nurses who served both in a supervisory capacity and as part-time
field workers. There was no increase in the number of general con·s ultants during the current fiscal year, but there ·was an increase of
about 20 percent in the number of special consultants during that
·period. Most of the special consultants serve in programs for maternal
.and child health, crippled children, or venereal disease control.
During the year the 6 public health nursing consultants made 145
visits to State health departments and spent 649 days in the seve:ral
States visited.
At the request of State health departments, 146 local health agencies
were visited, the visits varying in length from a half to several days.
The majority of the local services visted were rural health departments which are being used as field-experience centers for public
health nursing students. Reports and recommendations with regard
to facilities for rural field-experience are furnished to the Education
Committee of the National Organization for Public Health Nursing
upon request.
Assistance in conducting institutes for public health nurses has
-continued to be one of the services most frequently requested by the
,s everal State health departments. During the past year the nursing
-consultants assisted at 11 institutes on syphilis control, 11 on public
health nursing supervision, 9 on health teaching, 6 on program
planning, 2 on acute communicable disease nursing, and 1 on tuberculosis control. It has been the general policy that each institute
group be limited to 20 nurses, that definite assignments and reference
reading be done in preparation for the institute, and that the in·s titute be followed by local staff meetings and individual conferences
with State supervising nurses in order to insure practice of the
·knowledge gained.
The regional nursing consultants have participated in four rather
extensive community surveys of public health nursing facilities during
the year. The surveys were conducted in Broome County, N. Y.;
El Paso County, Colo.; San Mateo County, Calif.; and Los Angeles
City, Calif.
Numerous requests have come from the State health departments
for participation by the nursing consultants in national, State, and
local public health meetings. During the year, 62 meetings were
addressed by the regional and central nursing consultants.
188796-39-3
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PUBLIC HEALTH SERVICE
Thirty visits were made to the universities and colleges which
offer approved courses of study in public health nursing, for the
purpose of acquainting the students with the program and policies of
the Public Health Service and of aiding in the correlation of the
theoretical work offered by the colleges with the rieeds of the field.
COOPERATION WITH OTHER AGENCIES IN THE ADMINISTRATION OF
MEDICAL CARE PROGRAMS
One of the major functions of the Public Health Service, since
it was first established, has been the administration of a medicalcare program for persons designated by law as beneficiaries of the
Service for such care. There are now 17 classes of beneficiaries,
including such large groups as American merchant seamen, officers
and enlisted personnel of the United States Coast Guard and their
families, and beneficiaries of the United States Employees' Compensation Commission. A description of this program is given elsewhere 1 in this report.
In the experience gained in administering this program and the
knowledge accumulated from .numerous studies of the incidence of
illness carried out by the ational Institute of Health, the Public
Health Service has acquired as highly authoritative sources of information as any available in this country on the administration of medica]
care programs.
Other agencies, both Federal and State, have drawn upon the
Public Health Service for officers to administer programs of medical
care for their respective beneficiaries or to act as consultants on related
problems. Twelve officers were assigned to other agencies on details
of this type during the year. One officer was detailed to the Social
Security Board to act as consultant on the medical phases of the
aid-to-the-blind program under title X of the Social Security Act.
He also acts as consultant to the Board on programs of medical care
proposed or operated by the welfare departments of the several
States.
Two medical officers of the Public Health Service are assigned to
the Farm Security Administration, one acting as chief medical officer
and the other serving in the ca,pacity of assistant medical officer in
the field.
These officers are enga.ged chiefly in the development of medical
care programs and in the promotion of environmental sanitation for
the 60,000 low-income farm families aided by the several programs
of the Farm Security Administration. The medical and sanitation
programs apply to rural rehabilitation families, who are scattered
throughout the counties in the various States, and to the families
located in the community projects which have been constructed by
the Farm Security Administration. Physical examination of families
who apply for participation in the tenant purchase program is under
the direction of these two medical officers.
It has been found that physical handicaps frequently interfere
with progress toward successful rehabilitation of the families aided
by the Farm Security Administration programs. Therefore, attention
is being given to the study of this factor in those families who have
been assisted by the Farm Security Administration for 1 or more
1
Division of Marine Hospitals and Relief, pp. 114 to 123.
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years but who have not made satisfactory progress toward rehabilitation.
Under agreements with State medical associations, these officers
have developed medical care programs for borrowers from the Farm
Security Administration in certain counties in Alabama, Arkansas~
Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana,.
Maine, Mississippi, Missouri, New Jersey, Nebraska,, New Mexico,..
North Carolina, Ohio, Oklahoma, South Carolina, South Dakota,,.
Tennessee, Texas, Virginia, Utah, and Wyoming.
A special program of medical care has been developed for the~
indigent migratory ·agricultural workers in Arizona and California,
who are the responsibility of the Farm Security Administration,
At the request of the South Carolina Public Service Authority,
endorsed by the State Board of Health, the Public Health Service
detailed an officer to the Authority for duty in connection with the
Santee-Cooper project. He organized a health and sanitation division
in the Authority for the purpose of promoting sanitation, malaria
control and safety, and of providing medical care for the employees
of the project.
One other important cooperative activity of the Service in the
field of medical care, not a part of the function of any Division, is.
the detail of eight officers to the Department of the Interior, Office:
of Indian Affairs. These officers are charged specifically with the
control of communicable diseases among the Indians and with the
central and field administration of a medical care program for Indians.
Offices are maintained for this purpose at Washington, D. C.; Albuquerque, N. Mex.; Juneau, Alaska; Minnea,polis, Minn.; San Francisco,
Calif.; Spokane, Wash.; and Talihina, Okla.
PLAGUE-CONTROL ACTIVITIES
PLAGUE-SUPPRESSIVE MEASURES IN WESTERN STATES
Field surveys to locate plague foci .- Seasonal activities to locate
regions where plague exists among wild rodents were continued this
year as in the past. From its central laboratory in San Francisco,
the Public Health Service operated four mobile laboratories which
conducted investigations in 8 States west of the Rocky Mountains.
One of these field units was operated in Arizona from September to
March, inclusive, while the other three were kept in storage because
of the unfavorable conditions for field work in most States during this
part of the year. During the year the four Public Health Service
field parties shot and trapped over 47,000 small wild animals which
were examined microscopically at autopsy for evidence of plague,
and they sent over 66,000 animal parasites to the laboratory for
inoculation tests.
The States .of Washington, Oregon, and Montana continued the
operation of their field laboratories and sent the material they collected to the Public Health Service laboratory in San Francisco for
examination. Idaho and Utah discontinued the operation of their
field units in July 1938. From the State-operated units the laborator
received for inoculation tests 15,000 parasites, collected from ove-r
7 ,000 animals, and 21 specimens of tissue.
,H1.iman plague.- No cases of human plague have been reported
from the Western States since August 1937.
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PUBLIC HEALTH SERVICE
Wild rodent plague.-During the year the California State Department of Public Health reported that wild rodent infection was
demonstrated by laboratory tests of 13 specimens of tissue and 13
pooled flea specimens. The animals from which this material was
taken were obtained in 8 counties, 4 located on the coast and 4 in
the Sierra Nevada Mountains. Plague had been previously demonstrated in all of these counties.
Of the specimens sent to the Public Health Service Laboratory
for examination during the past year, the following were found to
have been plague infected: 64 specimens of pooled fleas, 4 specimens
of pooled lice, 2 specimens of pooled ticks, and 32 animal tissue
specimens. The States and counties in which wild rodent plague was
discovered and the species of animals from which this infected material
was obtained are listed in table 5 below.
In August 1938 a severe epizootic of plague was discovered among
prairie dogs (Cynomys gunnisoni zuniensis) in Catron County, N. Mex.,
and the next month infected fleas were collected from prairie dogs in
Apache County, Ariz. Plague had not been proved to exist in either
of these States before this year. Plague infection is now known to
involve wild rodents of all States lying west of the Rocky Mountains
except Colorado, and suspicious epizootics have been reported among
ground squirrels in the northern part of that State.
This year the prairie dog and the kangaroo rat, Dipodomys ordii,
were added to the list of. wild rodents among which plague is being
disseminated in the Wes tern States; and the first dead plague-infected
cottontail rabbit was found in an area where an epizootic was known
to be in progress among ground squirrels.
5.-Location of plague-infected foci and animals among which evidence of
infection was found during the period from July 1, 1938, to June 30, 1939
TABLE
State
County
Species of wild rodents found
plague infected
Material and number of specimens found infected
Fleas Lice Ticks Tissue
= - - - - ~~ - - -- 1- - - - - 1 - - - - - - - - - - - 1 - - - - - - - - -
Tot al specimens ______________ ----------- -- - -----------------plague infected.
1
64
32
Wild-rodent plague was first discovered in these counties during the past year.
Plague infect~on of . test animals from. the . separate _i~o?ulation
of ticks was attamed this year for the first time smce parasitic mocula
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tions were adopted as a routine procedure in conducting field surveys
for wild rodent plague in the Western States.
Flea investigations.-During the year, fleas that were collected
from over 17,500 small wild animals were sent to the laboratory for
identification and for determining the prevalence of different species
in regions where field investigations of plague have been conducted.
A number of undescribed fleas have been encountered, and 2 new
species were described for publication this year.
During the winter months, laboratory experiments to determine
the ability of different species of fleas to transmit plague were continued, and a complete report was made of these investigations,
covering the 3 years in which they were in progress. In the course of
these experiments, 894 fleas, comprising 31 species, were infected
with plague; and 81 fleas of 15 different species transmitted the disease
to 165 guinea pigs in the laboratory.
PLAGUE-CONTROL ACTIVITIES IN SAN FRANCISCO
Rodent control activities in cooperation with the health department
of San Francisco were continued as in past years. During the year,
3,082 complaints of rat infestation by householders were investigated.
Rodents were trapped and shot, and 96,000 pieces of poison bait were
distributed. In the course of the year, 27,386 fleas which were collected from 1,800 rats, and 18,936 fleas taken from ground squirrels
shot within the city limits, were tested for plague by inoculation.
Only 8 leprosy-infected rats were encountered among those examined
at autopsy.
PUBLIC HEALTH SERVICE LABORATORY, SAN FRANCISC O
During the year, 14,585 specimens were received at the laboratory
for examination; this number exceeded that of last year by 1,000.
6.-Consolidated report of miscellaneous laboratory examinations at the
Public Health Service Laboratory, San Francisco, from July 1, 1938, ~o J une
30, 1939
TABLE
Macroscopical examinations of rodents for plague:
Rats caught in San Francisco ____________________ ___ __________ _ 28,330
Ground squirrels shot in San Francisco _________________________ _
429
Rats caught in Oakland ____________________ ___ ____ ___________ _
12
Ra ts from fumigated vessels ___ ____ ____ ______________________ - _
111
Serological examinations:
Wassermann reactions ___ ______ ____ ___________ ___ _________ ___ _ 10,779
Kahn tests _____ _______________________ - - - - - - - - - - - - - - - - - - - - - - 10,779
Agglutination tests __________________ ____ _____ ___ _____ - - - - - _- 187
Bacteriological examinations:
Bacteriological examinations of water __ _____________________ __ __
714
Miscellaneous _______________________________________________ _
148
Animal-inoculation
tests:
Plague _______________________
____ ___ __ _____________________ _ 2,459
Tuberculosis ___________________________________ - _- _- - - - - - - - - 56
Virulence tests ____ _______________________________ - - - - - - - - - - - 13
Friedman tests for pregTI;ancy __ _____ _______ ____ ______________ - _
23
PLAGUE CONTROL, TERRITORY OF HAWAII
Operations were continued during the fiscal year in cooperation
with the Territorial Board of Health. In the Island of Maui where a
rather comprehensive program had been in force since December
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PUBLIC HEALTH SERVICE
1937, no case of human or rodent plague was reported during the
fiscal year. In the Island of Hawaii, the same type of work was
begun in the latter part of August 1938. By the end of the fiscal
year, 129 plague-infected rats had been found, but no human case
was reported. Human plague has not been reported in the Island of
Maui since 1937, nor in the Island of Hawaii since 1935.
The principal measure used for the eradication of rats was the
placing of poison bait, a procedure developed in the latter part of
1937. The bait consists of pieces of banana loaded with a paste containing phosphorous. In addition to this, trapping was carried out
to obtain an index of the rat population from month to month.
Calcium cyanide in dust form was applied, by means of foot-pumpdusters, to certain types of rat harborages, and carbon bisulphide
was used to kill rats in ground burrows. Sodium arsenite solution
was used for killing off vegetation in certain heavily rat-infested areas,
but its application was limited.
In December 1938 and February 1939, respectively, two sanitary
engineers were obtained from the mainland and employed on a permanent basis by the Territorial Board of Health. The first was assigned
to direct plague control work in the ·Island of Maui, and the second
to direct similar activities in the Island of Hawaii. These sanitary
engineers now act also as health officers for the respective islands.
Since continued success attended the use of the phosphorousbanana bait, efforts were initiated at the Kahului laboratory in February 1939 to develop a formula for a phosphorous paste which would
be as satisfactory as the commercial product in use, and possibly
less expensive. By the end of the fiscal year, the sanitary engineer
employed at Maui was able to prepare a paste which appeared to be
equally as effective as the commercial product and which could be
made locally at about one-third the cost. The importance of this
development is indicated by the fact that large quantities of the
material probably will be used not only by the Territorial Board of
Health to eradicate plague but also by the sugar plantation companies
to prevent rat damage to sugarcane.
The chambers of commerce on both islands continued to support
the programs financially during the year; in addition, plantations
furnished labor as needed. The Works Progress Administration
furnished a certain amount of labor in both islands until it became
necessary to terminate these projects on March 22, 1939.
Table 7 summarizes the work accomplished during the fiscal year.
Table 8 shows the amount of money expended by various organizations for this campaign during the fiscal year.
TABLE
7
Classification__of r?dents trapped and killed:
Maui
R. hawaiiensis ____________________________ __ ______ 11,425
R . alexandrinus ___________________________________
3,292
R. rattus___ ______________________________________
l, 586
R. norvegicus ____ __ ___________________________________ ___ _
Unclassified__ ____________________________ ______ __
2, 581
M. musculus _ ____________________________________ 6, 251
Mongoose _______________________________________
26
Number of rats trapped iro. Port of KahuluL _____________
349
Number of rats trapped in Hilo City ___ ___ _____ _____ ____ ____ __ __
Number of rats trapped, totaL _____ ____________________ 13,345
Number of rats killed by shooting, etc____ ___ _________ __
4, 018
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Hawaii
27,750
25,314
2,772
22,596
- -- -----37, 775
256
1,685
70,400
627
33
PUBLIC HEALTH SERVICE
TABLE 7-Continued
1\foui
Number of rats found dead _____________ __ _____ __ ____ __
1,521
Number of mice found dead_____ ______________________
141
Number of rat trap days, totaL _________ _____________ __ 482,324
Number of rats per 100 traps per day (all districts) _______
2. 77
Number of rats per 100 traps per day (Kahului)____ ______
1. 04
umber of rats per 100 traps per day (Hilo City) _____ __________ _
umber of man-hours, rat harborage elimination____ _____ 19,309
Number of burrows treated with carbon bisulphide_ _ _ _ _ __ 15, 686
Number of burrows treated with calcium cyanide___ ______ 31,881
Number of pieces of poison bait placed__________________ 575, 227
Number of inspections of buildings and premises_____ ____
1, 826
Number of reinspections of buildings and premises__ __ ____
2, 502
Number of dweDings built or ratproofed_ _ _ _ _ _ __ __ _ ___ __ _
2
umber of dwellings repaired or ratproofed __ _ __ _ __ __ __ _ _
251
umber of houses connected to sewer__ _______ _________ _
209
Number of rats received at laboratory___________________ 17, 140
Number of rodents received at laboratory_____ _______ __ _ 22, 070
Number of rats examined macroscopically___ ____________ 12, 934
Number of rats examined microscopically_ ______ _________
1,793
Number of mass inoculations made (Kahului) ___________________ _
Number of mass inoculations made__ ____ ____ ___________
19
J. umber of single inoculations made_____ ___________ _____
1
Number of cases of rodent plague ________________________ ______ _
Number of cases of human plague __ _______________ ____________ _
TABLE
8
l\liaui
Territorial Board of Health ________________________ $26,473.45
Works Progress Administration_____ ______ __ ________
6,585.88
United States Public Health Service ________________
6, 270. 00
Maui Quarantine Tax Fund Commission_____ _______
5, 336. 96
Plantations_ _____________________________________ 26, 903. 00
Hilo Shippers' Wharf Committee ______________________ _______ _
Social
Security
Fund, United States Public Health
Service
__________________________________________________
_
TotaL _ _ ______ __ ___ __ _ __ _ __ _ _ _ __ __ _ _ _ __ _ __
71, 569. 29
Hawaii
7,405
856
742,803
9.48
7. 76
4,867
1,363
6,715
1,533,399
1,020
386
55
23
5
78,432
116,463
71,820
199
108
129
Hawaii
$28,544.23
2, 934.96
21,079.43
10, 152. 41
620. 00
63, 331. 03
PUBLIC HEALTH SANITATION ACTIVITIES
Activities relating to public health sanitation have been administered as heretofore under the immediate direction. of a section in the
Division of Domestic Quarantine. Prior to April 15, 1939, this section was designated as the Public Health Engineering Section, but
:Since that date it ha.s been known as the Sanitation Section. Activities
under the supervision of the Section relate to the field application of
,existing knowledge of environmental sanitation as distinguished from
fundamental research in this phase of public health work. Since May
16, 1939, administration of the functions of the Office of Milk Sanitation, other than research activities, has been under the direction of
the Sanitation Section. The work of the Section is carried on at
central administration headquarters in Washington, D. C., and at
district field offices in New York, N. Y., Chicago, Ill., ew Orleans,
La., and San Francisco, Calif. Other units under the technical direction of the Section are the Office of Stream Sanitation and the Ohio
River Stream Pollution Survey, both at Cincinnati, 0., and field offices
.at Pittsburgh, Pa., Huntington, W. Va. , Chattanooga, Tenn. , and
Vincennes, Ind. , for technical supervision of Works Progress Administration mine sealing projects.
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PUBLIC HEALTH SERVICE
The major activities of the Sanitation Section during the fiscal year
1939 included: Supervision of water supplies used by common carriers
operating in interstate traffic; shellfish sanitation; consultation services.
to State health departments; cooperation with Federal agencies and
the District of Columbia_; technical supervision of Works Progress.
Administration mine sealing projects; steam pollution activities, 'in-eluding the Ohio River pollution survey; and miscellaneous activities
including the preparation and distribution of Public Health Engineer-ing Abstracts and the maintenance of cooperative relationships with.
organizations interested in or engaged in public health sanitation ~
These activities are discussed in detail in the following sections.
SUPERVISION OF WATER SUPPLIES USED BY COMMON CARRIERS
In cooperation with State health authorities, the Public HealtlL
Service continued to exercise its function of preventing the interstate
spread of water-borne diseases by supervision of the sanitary quality
of water used for drinking vnd culinary purposes by common carriers.
operating in interstate traffic, including railroad, vessel, airplane, and.
bus companies. During the calendar year 1938, common carriers.
operating in interstate traffic reported the use of 1,958 water supplies,
of which 1,593 were public supplies, as sources of drinking and culinary
water on their equipment. Of these supplies, 1,927, or 98.4 percent,
were inspected during the year by State health department engineering
personnel and were recommended to the Public Health Service, for
certification; thus, the proportion of water supplies with completed
certification increased by almost 5 percent over that reported in 1937,
and almost 10 percent over 1935.
The increase in the percentage of completed certifications since
1935, the year preceding full operation of the public health program
under title VI of the Social Security Act, reflects the increased activity
in State health departments for effectjve supervision of State water
supplies, which has been made possible by the additional personnel
and facilities afforded the States by Federal grants-in-aid under title
VI.
. A total of 4,024 certificates were issued to common carriers by the.
Public Health Service in the calendar year 1938, following these inspections. Upon the recommendation of State health officers, 57
sµpplies were prohibited for use because of defective conditions or on
account of potential health hazards involved in the use of these particular supplies. Action on 31 supplies located in 1 State was pending
at the end of the calendar year 1938. One hundred percent certification would have been achieved if these supplies could h ave been
recommended for certification by the State health officer.
VESSEL SANITATION
Vessels engaged in interstate commerce must comply with certain
requirements for protecting the sanitary quality of the drinking and
culinary water while it is aboard the vessels. During the calendar
year 1938 a total of 1,072 vessels, or 64 percent of the 1,676 vessels
coming within the scope of the regulations, were inspected and issued
favorable certificates. Because of inability of the field personnel to
reach certain vessels, temporary certificates were issued to 344 vessels,
or 21 percent of the total number under supervision, on the basis
of shipmasters' certified statements that the vessels were complying;
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with the regulations. " ot approved" certificates were issued to 6
vessels, since the vessel operators failed repeatedly to comply with the
regulations.
Sixteen cases of typhoid fever occurred among seamen on vessels
operating in interstate traffic during the year, one of which occurred
on a Great Lakes vessel. Sixteen additional cases of typhoid fever
occurring on vessels not coming within the jurisdiction of the interstate quarantine regulations were reported by the marine hospitals
and quarantine stations.
Plans for the water supply systems of 31 new vessels were received
for review. The majority of the new ships are being constructed as
a part of the ship construction program of the United States Maritime
Commission. Although many of the new vessels are in tended for
foreign traffic where interstate quarantine regulations do not apply,
the practice of seeking approval of the Public Health Service on specifications for water supply systems and other sanitary facilities has
been continued by an increasing number of shipyards.
Six hundred and sixty-five samples of water from the drinking and
culinary water supply systems of vessels operating in interstate traffic
on the inland rivers and on the Great Lakes were examined bacteriologically by the laboratories of several municipal health departments
and by a branch laboratory of the Ontario (Canada) Department of
Health. In accordance with a plan described in former reports, these
bacteriological examinations are submitted to district representatives
of the Public Health Service who in turn notify the vessel operators
when the examinations indicate that the water is not satisfactory and
that disinfection of the vessel water supply systems is required. In
addition to the supervision of vessel water supply systems, attention
has been given to their general sanitation, including the sanitation of
milk supplies, dining rooms, galleys, pantries, and other food-handling
departments. ·
RAILWAY, AIR CARRIER, AND MOTORBUS SANITATION
In previous years it has been reported that, in a number of States,
supervision of water supplies used by common carriers in interstate
traffic has been extended to include inspection by State health authorities of water-handling procedures for servicing vehicles in railroad
-coachyards and terminals, at airplane landing fields, and at motorbus terminals. The Public Health Service has continued to render
.assistance to the States, in connection with this extended activity,
by aiding in local surveys of water-handling methods, by training
State personnel in the technique of carrier watering-point inspection,
and by coordinating such activities with a view to securing uniform
procedure in the several States.
In addition, the Public Health Service has continued to inspect
,coachyards and watering-point facilities in the larger yards and
terminals where State health authorities are not yet prepared to
.a ssume responsibility for the inspectional work. Inspections were
made by Public Health Service personnel of 169 coachyards and
terminals, 188 watering points including those used by airplane and
motorbus carriers, 260 dining cars, and 50 commissaries. During the
year, efforts were made to secure the use of only grade A pasteurized
milk ·aboard interstate ca.rriers in areas where it is available, and the
use of the best available grade elsewhere.
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An increasing tendency to employ more elaborate facilities for the
provision of drinking and culinary water aboard busses and airplanes.
has been observed among motorbus and air carriers; in fact, one of
the large bus companies during the past year began to equip its busses.
with water systems. There is every reason to believe that the tend-ency in this direction will continue, and will, in the future, dema,nd
increasing attention from Federal, State, and local health agencies.
The Sanitation Section was charged with the sanitary supervision
of the royal trains conveying Their Majesties, the King Bnd Queen of
England on their visit to the United States in June 1939. The plans.
of the railroads engaged in moving the two trains which served theroyal party were specia1ly investigated, and satisfactory arrangements.
for servicing the trains were made with the cooperation of the railroads. Drinking and culinary water was inspected at the seve-ral
watering points, and waste-disposal methods were supervised.
SHELLFISH SANITATION
Cooperative work with the shellfish-producing States for the sanitary control of the shellfish industry was continued as in previous.
yea.rs. Since 1925, under a voluntary agreement with the States,
the Public Health Service has acted as a clearinghouse for information.
and in a rating or judging capacity concerning the adequacy of the
sanitary control of the shellfish industry by the various States. This.
arrangement is designed to enable the consuming States to protect
themselves against the danger of the spread of disease from shellfish_
produced under unsafe conditions. The adequacy of the control
measures of the producing States are subject to frequent check by
personnel of the Public Health Service. The Public Health Service
publishes and distributes periodic lists of shellfish growers and packers.
certified by the producing States as meeting acceptable sanitary
requirements.
Under this procedure, 2,133 certificates issued by 19 shellfishproducing States, whose control methods are satisfactory to the
Public Health Service, were endorsed and included in the semimonthly
list of shellfish shippers issued by the Public Health Service. Onehundred and eighteen growing areas and 879 shucking and packingplants were inspected by personnel of the Public Health Service todetermine the efficiency of the control methods employed by the States.
Endorsement of the State certifications of 1 State has been held in
abeyance because the control measures of that State were inadequate.
At the close of the fiscal year, another State had been informed that
improvements in its control machinery would he necessary if the
Service were to continue to endorse certificates.
COOPERATIVE WORK IN PUBLIC HEALTH ENGINEERING
COOPERATION WITH STATES
Advisory service hae been furnished to the State health departments in connection with sanitation activities relating to public watersupply protection, treatment of sewage and industrial wastes, county
and local health facilities, and allied work. Assistance has also been
given to the regional coPsultants of the Public Health Service in reviewing the sanitation features of proposed State budgets under title.
VI of tbe Social Security Act. Surveys have been made of the-
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engineering divisions of a number of State health departmenfa~ for
the purpose of ascertaining the details of their programs, the activities
undertaken, and the need for the extension of the service. Numerous
conferences were held with State health officials in connection with
the development of their sanitation programs.
COOPERATION WITH OTHER FEDERAL AGENCIES
During the fiscal year 1939, the engineering personnel of the Division of Domestic Quarantine devoted approximately one-third of
their time to work of this kind. The subjects dealt with included
water supplies and water-treatment plants, sewerage and sewagetreatment plants, garbage disposal, milk supplies, food-handling establishments, swimming pools, malaria control, mosquito control- practically the whole gamut of environmental sanitation and public health
engineering activity. Surveys and laboratory reports were made;
plans were prepared or reviewed; conferences were held; and investigations were made. The importance of this work rests in the fact
that State and local health authorities do not have jurisdiction over
federally controlled property. Not only are the interests of the
Government served, but also public health protection is afforded to
the occupants of, and persons having access to , the Federal institutions, reservations, and buildings, through these cooperfttive activities with Federal agencies.
Agencies of the Federal Government given the greatest amount of
service were the National Park Service, Offioe of Indian Affairs,
Bureau of Prisons, and . the District of Columbia, which received
664, 464, 281, and 184 da.ys of engineering service, respectively.
The list of Federal agencies which received cooperative assistance in
sanitation work during the year included the following-Treasury
Department: Coast Guard Service, Procurement Division; War
Department: Air Corps, Corps of Engineers, Quartermaster Corps;
Department of Justice: Bureau of Prisons; Post Office Department;
Navy Department: Bureau of Aeronautics; Department of Agriculture:
Biological Survey, Forest Service; Department of Commerce: Bureau
of Fisheries, Lighthouse Service; Department of the Interior: Office of
Indian Affnirs, National Park Service, Reclamation Service, St.
Elizabeths Hospital; Department of Labor; independent establishments: The District of Columbia, Maritime Commission, National
Resources Committee, Smithsonian Institution; Tennessee Valley
Authority, Works Progress Administration.
STREAM SANITATION
The primary function of the Office of Stream Sanitation is to
provide consultant and advisory services for Federal, State, and other
agencies interested in water pollution abatement. During the past
year, the principal activities of the office were:
(1) Cooperation with the National Resources Committee by
collecting statisticF from State health agencies for a revision of the
census on sewerage and sewage disposal in the United States; by
supplJing technical information to the various drainage-basin committees; by preparing material on the effects of pollution for the report
of the Special Advisory Committee on Water Pollution in the United
States.
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PUBLIC HEALTH SERVICE
. (2) Advisory services to the Tennessee Department of Public
Health and the T ennessee Valley Authority in connection with the
stream pollution surveys being conducted by these agencies.
(3) Review, with recommendations, of reports by the Corps of
Engineers, United States Army, on the effects of culm in the Schuylkill
River and on the feasibility of raising the proposed flood control dam
on the Allegheny River in order to augment low summer flows in the
lower Alleheny and upper Ohio Rivers and to improve the stream
pollution situation in the Pittsburgh area.
(4) Advisory services to the North Carolina State Board of Health
in connection with proposed experimental studies of the disposal of
sewage from schools and small institutions.
(5) Assistance to the 16 Kentucky municipalities in the Cincinnati
metropolitan area, in the formulation of a plan for a preliminary
study (with the Works Progress Administration and the Kentucky
State Department of Health) to consider the collection and treatment
of sewage from this area.
(6) Assistance to the city of Cincinnati, which has been making a
survey of sewage collection and treatment for the Duck Creek section
of the Little Miami River and Mi11 Creek Valley. It was possible to
plan the work of the Ohio River Survey so as to make available
information pertinent to the investigations being conducted by the
city of Cincinnati.
(7) A survey of the engineering and sanitation activities of the
Knoxville Health Department, in cooperation with the Tennessee
Department of Public Health.
(8) Administrative supervision over that part of the Ohio River
Pollution Survey relating to the collection of jnformation on the sources
and effects of pollution. This investigation is being made in cooperation with the S_tream Pollution Investigations Station of the Public
Health Service, the Corps of Engineers of the United States Army,
and the State health agencies of the Ohio drainage basin.
OHIO RIVER POLLUTION SURVEY
Progress has been made in the survey of pollution of the Ohio
River authorized by the Rivers and Harbors Act, approved August 26,
1937, which provided for the cooperation of the Public Health Service
with the Corps of Engineers of the United States Army. At the
suggestion of the President, this survey is under the supervision of a
committee composed of an officer of the Corps of Engineers, an
engineer officer of the Public Health Service, and a civilian expert on
water pollution. Since October 1938 the Public Health Service, at the
request of the Secretary of War, has been engaged actively in the
conduct of the field and laboratory investigations, of which such a
survey essentially consists, with funds transferred hy the War Department for that purpose.
In cooperation with the State health departments and other agencies, field data have been obtained during the year for that portion of
the Ohio River watershed between the mouths of the Kanawha and the
Kentucky Rivers, and for the entire Tennessee aDd Cumberland
River watersheds. The present work is mainly designed to ascertain
the location and effect of sources of pollution and to estimate the extent
of corrective measures which may be necessary.
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39
At the close of the fo:cal year, it was estjmated that the water and
sewage treatment investigations for that portion of the Ohio River
watershed, under extensive investigation during the present year,
were approximately 70 percent completed, and that the industrial
waste investigations were approximately 40 percent completed. In
the field surveys on sources, amounts, and effects of pollution there
have been made 97 water-supply, 98 sewage-disposal, and 42 i_n dustrialwastes investigations.
WATER RESOURCES COMMITTEE
An engineer officer of the Public Health Service has continued to
serve as a member of the Water Resources Committee and of the
Special Advisory Committee on Water Pollution, and a medical
officer has served on the subcommittee on drainage. Cooperation was
furnished to the Special Advisory Committee on Water Pollution in
the preparation of a report on water pollution in the United States,
and the findings of the committee contained in earlier reports were
revised and extended. The current report, entitled "Water Pollution
in the United States," was transmitted to the Congress by the President on February 15, 1939, with a message outlining his opinion as to
the form which Federal participation in pollution abatement should
take. The various district engineers of the Service have continued
to serve as members of the drainage-basin and subhasin committees
of the Water Resources Committee.
POTOMAC VALLEY COMPACT
An engineer officer of the Public Health Service served during the
year as representative of the Treasury Department in connection
with the consideration being given by Maryland, Pennsylvania,
Virginia, West ,- irginia, and the District of Columbia, to a compact
agreement for control and abatement of the pollution of the Potomac
River.
The act of Congress authorizing the formation of a compact agreement provided that a represePtative of the Treasury Department
should participate in the deliberations of the compact commissioners.
A compact agreement, providing for three Federal members of the
compact authority in addition to the members representing the
States, has been prepared. Approval of the proposed agreement by
the Congress and the State legislatures is pending.
RECIPROCITY WITH CAN ADA
Cooperation with the Department of Pensions and National Health
of the Domjnion of Canada was continued in the inspection and certification of drinking and culinary water supplies used by common car-riers operating between the two countries. The endorsement of the
certifications by the shellfish shippers transacting business in the two
countries, and the inspection of dining cars operated internationa1ly
were continued on the same basis of cooperatjon as in previous years.
Canadian authorities were supplied with 49 reports on water supplies
located in the United States and used bv United States carriers
operating jn Canada, and with 67 certificates on wa,ter supplies in the
United States used by Canadian carriers. In turn, the Department
of Pensions and
ational Health supplied the Public Health
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Federal Reserve Bank of St. Louis
40
PUBLIC HEALTH SERVICE
Service with 45 certificates of Canadian water supplies used by
United States carriers operating in the Dominion.
Copies of all certificates issued to shellfish snippers in the United
States by the producing States under the Public Health Service
endorsement were supplied to the Canadian authorities, and 43
certificates for Canadian shippers were supplied to the Public Health
Service.
MOSQUITO CONTROL IN THE DISTRICT OF COLUMBIA
The Public Health Service continued to exercise technical supervision over the mosquito control project being conducted by the District
of Columbia with the assistance of a Congressional appropriation and
labor furnished by the Works Progress Administration. While the
project is operated primarily to control the breeding of pest mosquitoes, a malaria control problem has developed because Anopheles
quadrimaculatus mosquitoes are breeding in the heavy growth of water
chestnut which has covered increasingly the shallow waters of the
Potomac River during recent years.
.
A report entitled "Mosquito Control in the District of Columbia,
Season of 1938" was prepared and distributed to interested agencies.
Mosquito breeding in the District was materially reduced during the
1938 season. Increased efficiency in the various phases of the control
program was responsible for the major part of the improvement.
Although mosquito breeding in the city still exists to a certain extent,
trap records and the small number of complaints indicate that breeding was kept well below the maximum average daily catch (12 per day),
which has been accepted by other mosquito-control agencies as a
standard to secure freedom from mosquito annoyance.
SPECIAL ACTIVITIES
A case of anthrax occurring in North Dakota was found to have
been caused by the use of a shaving brush imported from Japan.
Acting upon the information that the brush contained anthrax spores,
the Public Health Service, with the cooperation of State and local
health authorities, collected and disposed of about 35,000 brushes
which had been received in the same shipments from Japan and distributed in a number of States and the Dominion of Canada. A number of additional specimen brushes collected at various places of sale
were examined and found to contain anthrax spores. Excellent co'operation was obtained from the distributors and health authorities
in withdrawing the brushes from the market.
A number of technical papers were prepared for publication during
the year, among which were the following: "Plan and Organization ~f
the Ohio River Pollution Survey"; "Cross Connections"; "Certam
liea~th Aspect~ of Plumbing Installations'.'; "~lumbin_g _Ha~ards a°:d
Their Evaluation"; "Undergraduate Engmeermg Trammg m Pubhc
Health and Related Activities in Engineering Colleges of the United
State&''; "The Public Health Significance of Modern Plumbing";
"Interconnections in Plumbing"; "Wide Research Proved Need for
Better Plumbing Fixtures"; "Administrative Actions Directed at
Removing Plumbin__g Interconnections"; "Some Factors Influencing
Quality of Water Delivered by Plumbing Fixtures"; "Vacuum Frequency in Internal Water Supply Piping"; and "Rating Plumbing
Hazards."
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PUBLIC HEALTH SERVICE
w ORKS
41
PROGRESS ADMINISTRATION PROJECTS
SEALING OF ABANDONED BITUMINOUS COAL MINES
In cooperation with the State health departments of Alabama,
Illinois, Indiana, Maryland, Ohio, Pennsylvania, and West Virginia,
tech.meal supervision of Works Progress Administration projec'ts for
the sealing of abandoned bituminous coal mines was continued.
Since. the initiation of the projects in 1935, more than 3,900 mine
units have been sealed, and the amount of sulfuric acid discharged by
drainage water from abandoned workings into the streams has been
reduced by 350,000 tons or more per year. Consistent improvement
in water supply conditions affecting the public health have been noted
in the coal mining areas where this program has been in progress.
For example, entire communities in Alabama now obtain their water
supplies from ground-water reservoirs created by sealed mines; in
many of these localities, no other potable water supply is available.
In Pennsylvania, waterworks operators report a marked decrease in
the amount of chemicals required in the operation of water-treatment
plants. In West Virginia, a study of the Monongahela River at
Morgantown shows that, in the 9-year period of study, the condition
of the river has changed from predominantly acid to alkaline. Various
industrial plants throughout West Virginia report greatly reduced use
of boiler-water compounds. Improved water supplies for farmers,
improved recreational facilities, and the reappearance of fish in the
streams are being reported in the regions where the abandoned mine
workings have been sealed.
At the end of the fiscal year, the work was in progress in 60 counties
in Alabama, Indiana, Maryland, Ohio, and West Virginia, employing
an average of 2,000 persons. During the year, 1,385 mines were surveyed preliminary to sealing ; 6,882 water samples were examined to
determine the amounts of acid being discharged; and 344 mine units
were sealed, including the closure of 716 drainageways and 2,937 construction surface jobs on air shafts, cave-ins, and other openings. It
is estimated that the original acid discharge from these mines has been
reduced by approximately 45 percent as a result of the year's work.
COMMUNITY SANITATION
Wherever insanitary methods of human excreta disposal obtain,
there is always the danger of an outbreak of typhoid fever, dysentery,
or some other filth-borne disease. Recent surveys show that hookworm disease, with its attendant hazards to the health of children and
the economic security of the population, is still an important health
problem in certain areas. In the Southern States, the lack of sanitary
devices for the disposal of excreta is almost wholly responsible for
hookworm infestation.
The community sanitation projects of the Works Progress Administration in cooperation with the Public Health Service and the State
health departments have for their purpose the provision of sanitary
outdoor toilets for homes, schools, dairies, and other places wher~ no
adequate facilities exist or where existing facilities are of an insanitary
type. The public health importance of this work is unquestioned.
Further appreciation of the need for community sanitation may be
gained by examining existing information on the extent of sanitary
disposal of human excreta in the United States. According to a recent
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Federal Reserve Bank of St. Louis
42
PUBLIC HEALTH SERVICE
report of the National Resources Committee, 44 percent of the population of this country were not served by sewers at the close of the
calendar year 1936. It is believed that at least 75 percent of the
homes in this group of the population are served by outdoor toilets,
the majority of which are of an insanitary type. In other words,· it
may be estimated that approximately 11,000,000 sanitary toilets were
needed at the close of 1936 to serve the estimated population of
44,000,000 persons without adequate sewage-disposal facilities. Thus,
it may be seen that although the community sanitation projects have
installed 2,212,581 sanitary toilets during the period from December
16, 1933, to June 30, 1939, a widespread need for the provision of
rudimentary sanitation still exists in this country.
Now that the community sanitation projects have been in operation
for more than 57~ years, it is possible to report significant evidence of
the results of the program. The State health departments of several
of the States in which the program has been in operation report a
substantial decline in the incidence of, and deaths from, typhoid fever,
following the work done on the projects. In Mississippi, where
120,000 sanitary privies have been constructed, 161 deaths from
typhoid fever and 917 cases of the disease were reported in 1932; in
1937, only 77 deaths and 349 cases were reported. In Tennessee,
308 deaths and 1,898 cases were reported in 1932, and in 1937, only
145 deaths and 763 cases occurred. More than 175,000 sanitary
privies have been installed in this State. In West Virginia, where
more than 245,000 sanitary privies have been installed, a very substantial reduction in the prevalence of typhoid fever has been noted;
1,265 cases and 218 deaths occurred in 1932, as compared to 350
cases and 78 deaths in 1937. Mississippi also reports that reductions
in hookworm disease and dysentery were due largely to the improvement in sanitation made possible by the community sanitation
program.
During the fiscal year, the program was operated substantially on
the same basis as in previous years. To insure proper performance
of the work, an allotment of funds was made by the Works Progress
Administration to the Public Health Service for the provision of
technical supervisory personnel to each State health department in
which the program was in progress. However, the allotment of funds ,
which totaled $500,000, was less than half the sum made available for
this purpose during the preceding year, and the number of technical
personnel employed by the Public Health Service for assignment to
the States was drastically reduced. The deficiency in personnel was
met in part by the State health departments and in part by the Works
Progress Administration.
Installations of sanitary privies during the year totaled 435,892,
of which 376,255, or 89.5 percent, were of the concrete slab type; the
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
43
number of privies installed was 38,521 in excess of that installed last
year. In addition, 25,546 insanitary privies were restored to a
sanitary condition; 184 septic tanks were constructed on public
property, the majority at schools; and 190,504 feet of open-joint tile
were laid to provide an adequate absorption field for the proper
disposal of effluent from the septic tanks. The increasing interest of
officials and citizens in the program was likewise indicated by a
progressive improvement in the quality of construction. More
privies were painted to prolong the life of the structure, and there was
a 5-percent increase in the proportion of concrete slab type privies.
Because of the inability of the State health department to meet the
requirements of the Ohio State Works Progress Administration,
particularly the regulation requiring 50 men per project, the work
on all Works Progress Administration community sanitation projects
in Ohio was terminated by mutual consent on February 28, 1939.
The community sanitation projects provide useful work for the
unemployed; and since the projects may be expanded or contracted on
short notice, according to the availability of labor, they are well
suited for operation as work relief projects. Another favorable
factor is that the proportion of funds contributed · by sponsors is
relatively high, averaging about 35 percent of the total cost. The
peak of operations during the fiscal year was reached during the
July- September 1938 quarter, when an average of 22,018 workers was
employed on projects in 1,309 counties. The low mark was reached
in the April- June 1939 quarter when an average of 18,069 workers
was employed in 1,206 counties. The annual average number of
workers employed was 20,496, and the average number of counties
was 1,291, about 47 percent of the total number of counties in the 39
cooperating States.
Table 9 shows the number of counties in each State, the average ·
number of counties in which projects were in operation, the average
number of laborers employed, the total number of privies constructed,
and the number and percentage of concrete slab type privies installed
during the fiscal year.
Table 10 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 the week ending December 16,
1933, through June 30, 1939.
Since worthwhile results have been accomplished and since much
yet remains to be done, the community sanitation program should be
continued and expanded; and these activities should be intensified
in order that the greatest possible number of the population of the
United States may be afforded rudimentary protection against the
filth-borne diseases. The investment would yield a vast return in
illness prevented and lives saved.
188796-39--4
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44
PUBLIC HEALTH SERVICE
9.-Average number of counties in which Works Progress Ad:ministration
community sariitation projects were -in operation, average number of ivorkers employed, number of sanitary privies installed, and the number and percentage which
were of the concrete slab type, during the period July 1, 1938- J une 30, 1939
TABLE
State
Number
of counties in
State
I
A labam a _______________________ ____
A rizona ____________________________ _
A rkansas ___ ____ __________ __________
C alifornia _____________________ ___ __ _
C olorado _________________________ __
67
14
75
23
32
14
22
8
24
3
37
49
17
52
87
12
48
53
41
6
74
5
17
55
6
18
7
59
46
5
39
19
53
45
42
76
52
15
48
12
55
29
9
775
123
328
183
351
39
383
560
163
799
813
138
646
704
652
117
1, 288
78
164
672
97
408
105
1,079
421
222
453
185
814
853
499
1,576
1, 353
313
593
230
1,805
426
88
11,579
3,865
5,984
2,521
5,074
681
7,241
13, 009
2,411
12,547
13, 291
1,868
10,435
13, 113
15, 866
2,964
31 , 662
I 608
3,466
11,340
1,045
6,162
2,302
34,158
Q;,763
22,067
9,984
3,059
13,810
23,894
11,586
46,402
19, 755
5,780
28,835
2,645
45,979
4, 097
1,044
11,549
3,865
5,984
2,521
5,074
681
6; 199
10,071
2, 411
12,547
13, 291
1,868
10,435
13, 113
6,719
1,697
31,604
608
3,466
11,340
1,045
6,162
2,302
32,057
5,763
2,067
9,984
2,823
13,810
22,315
11,586
20,602
19, 755
5,780
11,396
2,645
45,979
4,097
1, 044
2,771
2,771
1,291
1,162
20, 496
18, 624
437,892
399. 271
376, 255
324,627
58
63
3
67
159
44
102
92
99
105
120
64
23
82
114
56
93
17
21
31
100
53
88
77
36
67
46
69
95
254
29
100
39
55
71
D elaware __ ___________ __ ____ _-- - -- - F lorida ________ __________ ___ __ - ----G eorgia ___________ _____________ - - - - Id aho __ __ __________________ _________
Ill inois _____ ___________ - --- - - - - - - - - - In diana ___________________ __ ______ __
Io wa __ ____ ________________ ______ ___ _
K ansas ___ ______________ __ __________
K entucky ____________________ ______
Lo uisiana _____ ______ ___ _____________
M aryland ______ ____ ________________
M ississippi ____________________ ___ __
M issouri 1 _____________________ _ ____
M ontana ___ ____________ ,____________
N ebraska __ _____________ ____________
N evada ______ ___ ____ _______ ___ _____ _
N ew Jersey ____ ________ _____ ___ _____
N ew Mexico ___ _____ ___________ _____
N orth Carolina ___ ___ ___ __ __ ________
N ortb Dakota ___________ ___________
0 hio 2____ __________________ ________
0 klahoma ______ ____ ___ _______ ______
0 regon ___
Pe nnsylvania __________ ___ ____ ____ __
So uth Carolina ___ _________ __ ____ ___
So uth Dakota ______________________
T ennessee _______ ____ ___ -- __ --- --- -T exas _______ _____ __ ________ ____ __ ___
u tah _________ __ ___ ____ ______________
V irginia ____________________________
ashington ____ _________________ ___
w est
Virginia _____________ ____ _____
w isconsin
______ _____ ____ ______ _____
w yoming ____________
________ ____ ___
w
Total (39 States) ___ ___________
Ju] y 1, 1937, to June 30, 1938 _________
1
Average
Average Totalnum- Total
number
number of number of
ber of
workers
privies
of concounties
installed
operating employed
crete
Majority school units.
2
Percentage concrete
99. 7
100
100
100
100
100
85.6
77.4
100
100
100
100
100
100
42.3
57. 2
99.8
100
100
100
100
100
100
93. 8
100
100
100
92. 3
100
93.4
100
44. 4
100
100
39. 5
100
100
100
100
- -- -
85. 9
81.3
Operation discqntinued Feb. 28, 1939.
10.-Number of new privies installed in each State from week ending Dec. 16,
1933, to June 30, 1939, under C. W. A., E. R. A., and W. P. A. programs
TABLE
[As compiled from reports submitted by various State health departments]
Privies installed under W. P.A. program
State
Alabama ________ ______ _________ ___
Arizona ______ __ ________________ ___
Arkansas ________ _______ _______ __ __
California _______________ ___ ___ ____
Colorado ____ _______________ ___ ____
Delaware __ ___ ____________ ___ ____ __
Florida _____ __ ____ __ _______ ________
Georgia ___ ____ ______ _____ ___ ___ ____
Idaho ________ ___ ______ ____________
Illinois ______ _________ ___________ __
Indiana ___ ____ ______ ___________ ___
Iowa __ ___ __ ____ __ __________ _______
Kansas __ _____ __ ___________ ___ _-- --
fi~t~~:r~ =========== ===== ====== ==
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Federal Reserve Bank of St. Louis
July 1, 1935,
to June 30,
July 1, 1938,
to June 30,
1938
1939
10,061
11,925
42, 120
18,136
15,603
1,640
10,170
23. 667
12, 711
32,603
69, 260
7,417
31,827
40,559
23,098
11,579
3,865
5,984
2,521
5,074
681
7,241
13,009
2,411
12, 547
13,291
1, 868
10,435
13, 113
15,866
Total-July
1, 1935. to
June 30,
1939
Total privies installed
Under
C . W.A.
and
E.R.A.
programs
21,640
3, 256
15, 790
250
48,104
27,548
20,657
1, 872
20,677 - ----------2,321
168
17,411
9,187
36,676
19,687
1/\ 122 - - -- - - ---- -45,150
2,801
82,551
25, 228
9. 285
376
42,262
8,037
53,672
18,006
38,964
41,763
Under
C.W.A.,
E . R.A.,and
W . P.A.
programs to
June 30, 1939
24,896
16, 040
75,652
22, 529
20,677
2,489
26,598
56,363
15,122
47,951
107,779
9, 661
50,299
71,678
80,727
45
PUBLIC HEALTH SERVICE
10.-Number of new privies installed in each State from week ending Dec.16,
1933, to June 30, 1939, under C. W. A., E. R . A., a-nd W. P. A. programsContinued
·
··
'TABLE
Privies installed under W. P .A. program
State
July 1, 1935,
to June 30,
1938
July 1, 1938,
to June 30,
rn::i9
Total-July
1, 1935, to
J~iJo,
Total privies installed
Under
C.W.A.
and
E . R. A.
programs
Under
C . W.A.,
E. R.A.,and
W.P.A.
programs to
June 30, 1939
Maryland _________ ___ _____________
7,785
. 2,964
10,749
6,481
17,230
Massachusetts 1 _ ________________________________________________ ____ ___________________ _ ____ _ _ __ __ __ _ _
Michigan 2_ _ __ _ ___________ _ _______ ____ ____ __ ____ ___ _ __ ________ _______ _ ___ ___
3,016
3,016
Minnesota a____________________________ ____ _____________________ ______ ____ __________________________ __
Mississippi__ _____ _______________ __
65,959
31,662
97,621
23,227
120,848
Missouri. __ _______________________
656
608
1,264
5,321
6,585
Montana___ _________ ______________
9,614
3, 466
13,080
124
13,204
Nebraska__ ___ ___ _______________ ___
15,080
11,340
26,420 ____________
26,420
Nevada ___ ________________________
1,020
1,045
2.065 ____________
2,065
New Jersey___________________ __ ___
10,748
6, 162
16,910 __________ __
16, 910
New Mexico __________________ ____
11,301
2,302
13,603
409
14,012
North Carolina____ ________________
78,363
34, 158
112, 521
62,089
174,610
orth Dakota________ _____ ___ _____
20, 225
5, 763
25,988
443
26, 431
Ohio 1 _ _ _____ __ _ ______________ _ ____
60, 119
2,067
62, 186
15, 671
77, 857
Oklahoma___________ __ _____ _______
66,826
9,984
76, 810
26,534
103, 344
Oregon _________ ___ ______________ __
10, 182
3,059
13,241 __ __ ___ _____
13,241
Pennsylvania __________ ___________
33,210
13,810
47, 020
963
47,!l83
South Carolina_____ ________ __ _____
60, 180
23,894
84,074
39,621
123,695
South Dakota________ _____________
15,095
11,586
26,681 ___ ___ ____ __
26,681
Tennessee ______________ ____ _______
98,496
46,402
144,898
43, 778
188,676
Texas ____ __ ___________________ ___ _
33,{)9.I)
19,755
53,754
70,370
12J,124
Utah _____ __ _____ ·__ ________________
17,923
5,780
23,703
2,052
25,755
Virginia________________ _________ __
99,766
28,835
128,601
26,330
154,931
Washington ____ ________ ___________
9,330
2, 645
11,975
796
12,771
West Virginia_________ __ _________ _
123,481
45, 979
169,460
75,869
245,329
Wisconsin_______________________ __
9,500
4,097
13, -~97 -- ---------13, 597
Wyoming _________________________
3,761
1,044
4,805 ___ _________
4, 805
TotaL __ ___ ___ __ __ __ ____ ____
Average per month ______ __ __ ____ __
Installed from July 1, 1937, to June
1, 213,416
33,706
437,892
36,491
30, 1938 ______ ____ __ -- -- -- -- -- -- -- ___ __ ____ -- ---
399, 271
Average per month, July 1, 1937,
to June 30, 1938 _________ ________ _ ___ _____ ____ __
33,273
1
2
Discontinued June 30, 1936.
Discontinued Nov . 15, 1935.
1,651,308
561,273
2, 212,581
a Discontinued Apr. 30, 1936.
Discontinued Feb . 28, 1939.
4
ANNUAL CONFERENCE OF THE SURGEON GENERAL WITH STATE AND
TERRITORIAL HEALTH OFFICERS
In accordance with the act of Congress, July 1, 1902, the Thirtyseventh Annual Conference of State and Territorial Health Officers
with the Public Health Service met on April 24 and 25, 1939. Repre·s entatives from 44 States and the Territories of Alaska and Hawaii
were present.
Reports of the committees on professional training and qualifications, cooperative public health program, records and reports, venereal
disease and cancer control, yellow fever, and interstate problems, were
presented to the conference for consideration and approval. In addition to the committee reports, the following papers were presented:
The Need for Cooperation of All Agencies in the Development of
County Programs for the Enhancement of Living Standards, Related Responsibility of Administrators of Health and Welfare Agencies, Statist.ical Data Required in Connection With the Administration of the Social Security Act, State Cancer Control Programs,
'Garbage Disposal Methods as Related to Trichinosis, and Development by the Public Health Service of Environmental Sanitation
Codes.
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Federal Reserve Bank of St. Louis
ATIOITAL INSTITUTE OF HEALTH
Assistant Surgeon General
LEWI S
R.
THOMPSON,
Director
The fiscal year ending June 30, 1939, was marked by the occupancy
of three of the group of five buildings of the National Institute of
Health proper and by the laying of the cornerstone of the National
Cancer Institute, the sixth building of the entire group now nearing
completion at the new site near Bethesda, Md. More significant was
the progress made in scientific researches, a brief description of which
follows.
DIVISION OF BIOLOGICS CONTROL
Senior Surgeon
WALTER T. HARRISON
in charge
Diphtheria.-Studies to determine the relative efficacy of the various
diphtheria immunization procedures were continued by estimating
the antitoxin response of children. The following immunizing
methods were used: One dose of fluid toxoid, two doses of fluid toxoid
at 3-week interval, three doses of fluid toxoid at 3-week intervals, one
dose of alum precipitated toxoid, and two doses of alum precipitated
toxoid at 3-week interval. The last of these procedures was found
to be the most effective, producing practically perfect immunity
under the conditions of. the study.
Smallpox vaccine.- Tbe field study of smallpox vaccine prepared
by the usual method in the skin of the calf, as compared to recent
modifications of this product, was continued. Failures in primary
v:accinations with calf vaccine were less frequent than with the modified vaccines studied; and the latter were found to be unsatisfactory,
since they produced either poor immunity or unduly severe local and
general reactions which resulted in excess scarring.
Standardization of gas gangrene antitoxins.-The study on the standardization of Sordellii antitoxin has been completed, and a unit has
been adopted for testing the potency of this product. Tests for the
purpose of establishing an international unit have been done in collaboration with three foreign laboratories, under the auspices of the
Permanent Committee on Standardization of the Health Organization
of the League of Nations.
Studies on the antigenic structure of the toxins of the Cl. perjringens
groups were continued. It was shown that, under certain conditions,
the type A organism produces at least three toxin components which
are dependent on the composition of the culture medium used, two of
these being hemotoxins. It has been demonstrated that it is important
for antitoxins to have antibodies against these two types of hemotoxin.
Meningococci.-Progress has been made in the standardization of a
mouse protection test for the evaluation of antimeningococcus
serums. Since the mouse protection test requires a balance between
the susceptibility of the animal and the concentration or viscosity
of the mucin, a pure line of inbred Swiss mice and a better preparation
46
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of mucin have been used. Hence, a tentative procedure has been
developed, and a tentative unit value, based upon the type specific
carbohydrate antibody nitrogen, has been assigned to a control
serum for experimental purposes.
The samples of therapeutic polyvalent antimeningococcic serums
submitted by manufacturers have been evaluated by this mouse
protection method, by the "halo" method developed last year, and by
agglutination, both at 56° C. and 37° C. Mouse protection and
"halo" production are closely correlated. Agglutination at 37° C.
gives results more nearly comparable with these two methods than
does agglutination at 56° C.
A comparative study of the protective action of sulfanilamide and
sulfapyridine in meningococcus infection of mice, alone and in combination with therapeutic antimeningococcus serum, is under way.
The combination of serum with either drug gives far better results m
mice than either drug or serum alone.
Strains of meningococci received routinely from various parts of
the country, as well as from Washington, D. C., hospitals, were typed
with standard type serums. The incidence of meningococcus meningitis was very low during the year. Of the 41 strains received, 25
were from cases and 16 from carriers. The strains were distributed
as follows: From cases, 13 in group I and 12 in group II; from carriers,
4 in group I, 7 in group II, and 5 in no definite group.
Other meningitides.~The apparent increase in Pfeiffer ·bacillus
meningitis has made it necessary to give some attention to this form
of the disease. The Pfeiffer bacillus ranks second only to the meningococcus as the cause of meningitis among children 3 years old or
younger; 20 to 30 percent of all cases of purulent meningitis in this
age group were found to be caused by this organism. Gonococcus
meningitis also has required attention, as it has been found to be a
more common infection than it is usually thought to be. Several
cases of pneumococcus meningitis have been studied.
Pneumococci.- Because of the importance of correct typing in specific therapy and in epidemiological studies of pneumonia, considerable attention was given to the standardization of pneumococcus
typing serum. Studies were continued on the specificity and potency
of commercial typing serum. Definite tests for specificity and potency
were formulated, and minimum requirements for pneumococcus
typing serum were adopted on the basis of these tests.
In addition, studies were continued on the standardization of
therapeutic antipneumococcic serum. Progress was made in developing a procedure to determine, for control purposes, the unit value of
serums of types other than I, II, V, VII, and VIII, for which control
serums have been adopted.
Antipneumococcic rabbit serums for all types were distributed
commercially, and unit values based upon antibody nitrogen determinations were accepted in lieu of mouse protection tests for types
relatively avirulent for mice.
A collection of 31 standard type specific strains of pneumococci
were kept on special culture media with frequent mouse passage
to maintain virulence for experimental purposes and for distribution
to commercial laboratories.
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Standardization of rabies vaccine.-In developing a method of testing
immunity produced by rabies vaccine in mice, it has been found that
fixed virus intracerebrally gives results comparable with those obtained
whoo. street virus is used under conditions simulating natural infection
in man. For the purpose of determining the most efficient yet safest
strain of virus available for making rabies vaccine, seed viruses used
for preparing vaccine in 31 commercial establishments and laboratories were compared as to antigenicity, invasive properties, and resist-ance to chemicals.
Arsenical preparations .- Studies of the therapeutic efficiency of the
arsphenamines in experimental syphilis in the rabbit were continued.
Preliminary examination of several brands of sulfarsphenamine agreed
with Voegtlin's early observation that this compound is equally as.
active as arsphenamine and neoarsphenamine, in terms of arsenic
injected.
Investigation of the stability of the arsphenamines when kept under
good storage conditions, or subjected to artificial temperatures (56° C.
and 70° C.), showed sulfarsphenamine to be the most stable, arsphenamine the next in keeping quality, and neoa,rsphenamine the least
stable. Accordingly, the arsphenamine regulations were amended to
require an expiration date of not more than 5 years for sulfarsphenamine and arsphenamine and of not more than 3 years for neoarsphenamine, the maximum moisture content of which shall be 1.5 percent.
Othet studies.--Studies of the standardization of tuberculin have·
been continued. An experimental investigation has been undertaken
to determine the hazard, if a,n y, of sensitization following the administration of alum precipitated tetanus toxoid. Results of the field study
of vaccination against pertussis with alum precipitated vaccine have
been somewhat delayed because of the low incidence of the disease
in the study area.
Licensed establishments.- At the close of the fiscal year, 66 establishments, 15 of which were foreign, held licenses to engage in the intersta.te
sale of biologic products. The licenses covered 164 products.
DIVISION OI<' CHEMISTRY
Professor
CLAUDE
S.
HUDS ON
in charge
Sugar researches.- Fundamental studies relating to the structure
and configuration of the carbohydrates were continued. The periodic
acid oxidation method continued to prove a most useful tool ·in this
connection. By means of this method, it has been found possible to
test the homogeneity of certain classes of carbohydrates; and it enabled
the preparation of many new compounds for which no other methods
of synthesis were known. Its application to sucrose confirmed the
glucopyranosido-fructofuranoside formula. In the case of levoglucosan, it furnished confirmatory evidence that the two rings were 1,5
and 1,6; and the work carried out for this proof has established a basis
for the similar study of any hexose anhydride having two rings similar
to those of levoglucosan. In the raffinose study, it indicated the
pyranoside structure for two of the hexose components and the furanoside structure for the third hexose component. ,vith trehalose, the
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results proved ea,ch of the two glucose components of the a, a-trehalose
molecule to possess the pyranoside structure. Many other studies
utilizing this method have been carried out, including oxidation studies
on diacetone dulcitols, ketosides, and anhydro compounds, and certain
methyl aldo-hexomethylo-pyranosides. Included in the work on the
last were the isolations of eight crystalline compounds serving as
reference substances which may be employed to learn the ring structure
and the a- and ,B-classification of any methyl pyranoside of other
aldohexomethyloses or any methyl furanoside of the aldopentomethyloses.
The study of the oxidation of sugars in alkaline solution by oxygen
was continued. The oxidative degradation of sedoheptulose to
D-altronic acid confirmed the formulation of the sugar as D-altroheptulose. And since D-altronic acid is a source for the rare sugars
D-altrose and D-ribose, this work led to the description of a method
for the production of D-ribose from ca!Gium D-altronate. D-altrosan
has been isolated in crystalline condition for the first time; the related
sedoheptulosan has been shown to possess an unusual structure, one
o_f its rings being an ethylene oxide form and the other a septanoid
rmg.
The systematic study of the preparation and properties of the higher
sugars and their derivatives was continued. Large quantities of
a-glucoheptose have been prepared and reduced to the corresponding
alcohol. In the a, a-gluco-octose series, conditions have been determined for obtaining the sugar as a monohydrate, two isomeric
hepta-acetates have been isolated, and a methyl glycoside has been
obtained in crystalline condition.
A study was carried out on the stereoisomeric changes which occur
in the recrystallization of a-methyl-D-a-mannoheptoside pen ta-acetate.
This study led to results indicating that isomerization of one form may
be effected by means of ultra violet light. Analysis of this process.
by means of monochromatic light has shown that it occurs in two steps,.
namely, a preliminary change of volume followed by the rotational
change. The latter appears to be specific for one wave length. Preliminary studies of this type were also carried out on several more
compounds.
Work was continued on the systematic preparation of the sugar
alcohols and their higher rotating acyl derivatives. Eight such
compounds were prepared and their constants determined. Two of
these compounds had not been reported previously in the literature.
Other researches in this field included a study of the reaction of
o-phenylenediamine with aldonic lactones, improvements in the
preparation of L-tartaric acid through resolution by a substituted
benzimidazole base, certain studies relating to the isorotation rules, a
search of natural sources for certain rare sugars, a study of the structure of the isomeric diacetone dulcitols, and a preliminary study of the
action of bromine on methyl glycosides.
Researches on starch.-The periodate oxidation was appli~d to
starch. A preliminary conversion of the starch into a soluble form
was found advantageous. A procedure, based on treatment with
hydrochloric acid, was developed which served the purpose of yielding
starch solutions of very low reducing power and yet of sufficient
clarity when oxidized with periodate to permit following the reaction.
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polarimetrically. The reaction consumed one mole of the metaperiodate. No formaldehyde and only a slight increase in acidity
could be detected. After appropriate further oxidation with bromine,
erythronic acid was isolated in addition to oxalic acid.
From a practical point of view, the results obtained are of interest
as indicating a comparatively simple method for preparing erythronic
acid-otherwise difficult to obtain-and possibly in good yields.
The periodate oxidation was also applied to ,B-dextrin. One mole
of the metaperiodate was consumed. In the preparation of the pure,
crystalline ,B-dextrin for this investigation, evidence was obtained
indicating that much of the controversy in the literature over the
nature of ,B-dextrin has been occasioned by the study of compounds
which have been insufficiently purified.
Optimum conditions were determined for the preparation of levoglucosan from cornstarch.
Enzyme researches.-The study of the method for the purification
of invertase by adsorption on bentonite was continued. In addition
to the factors previously found to be of importance, the following
have been observed to influence appreciably the products obtained ,
by this method: (1) The temperature during dialysis, (2) the rate of
dialysis, (3) the presence of toluene or thymol during dialysis, (4) the
pH of the dialyzed autolysates during the preliminary treatment with
acid for the removal of inert proteins, and (5) the pH of the solutions
during aging of the dialyzed autolysates. With these factors given
due consideration, the method can be simplified considerably.
A new method for the purification of invertase has also been investigated. This method is based on the direct precipitation of invertase
with acetic acid.
Some experiments in which emulsin and maltase were used showed
that celtrobiose is cleaved by emulsin but not by maltase. These
results represent confirmatory evidence for a ,B-glucosidic linkage
in celtrobiose.
Ohemico-bacteriological studies.-Cultures of Aerobacillus macerans
were collected and tested for their activity in the formation of
crystalline dextrins from potato starch. This study led to the finding
that the activity of the bacterial cultures is due to an enzyme which
is also active in the bacteria-free culture filtrate. The characteristics
of this enzyme and the optimum conditions for its activity were
investigated. The most favorable pH for its development is 6.8, but
the pH range for digestion is 6.8 to 5.4. Only traces of reducing
substances are formed in the digestion, but liquefaction is very rapid.
The color reactions with iodine are the same as for digestion of starch
with other amylases, but a microscopic iodine test shows characteristic
-0rystals of the iodine compounds of the dextrins. By this test it was
found that Aerobacillus acetoethylicus is identical with A. macerans.
Biochemical dental studies.-In order to study dental caries from a
biochemical point of view, certain preliminary experiments were
-0arried out. The properties of salivary amylase were studied, induding the effect of fluorides. The amylolytic activities of 66 samples
,of saliva from children living in Quincy, Ill., and of 89 similar samples
-0btained in Galesburg, Ill., were determined. The pH of coagulation
-0f salivas from different individuals was studied to determine a possible
relation to dental caries.
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Fluoride removal from drinking water.-Experiments were continued
on the removal of fluoride from drinking water by means of magnesium
oxide. In these experiments the magnesium oxide was used as a
filter. The results obtained indicated the possibility of suitable
arrangements which would serve approximately to double the capacity
of the magnesium oxide for fluoride removal.
Analytical work.-About 202 various analyses of miscellaneous
material, 2 examinations of urine for lead, 64 chemical examinations
of water, 47 analyses of arsphenamines and neoarsphenamines, 10
examinations of pharmaceuticals, and 331 microdeterminations in
connection with the sugar researches were made.
NUTRITION INVESTIGATIONS
It was demonstrated at the Milledgeville, Ga., field station that a
clinical syndrome due to riboflavin deficiency can be produced in
human beings. Evidence was obtained also that this syndrome in
the past has been confused with pellagra, and that, in all probability,
it is a widespread disease in the southern United States. The symptoms do not respond to treatment with nicotinic acid, but disappear
in a few days under treatment with riboflavin. Additional observations made at Milledgeville show that even small doses of nicotinic
acid (30 mg. per day), if continued, produce unpleasant but harmless
reactions. Observations on the human requirements for nicotinic
acid and riboflavin are in progress
The ascorbic acid studies have shown the importance of light in the
synthesis of vitamin C in plants. It was found that plants grown
under conditions of low light intensity contain less vitamin C than
those grown under greater illumination. Other experiments showed
that cow pea.s and vegetable soybeans contain an active factor which
causes oxidation of ascorbic acid. The ascorbic acid can be protected
from oxidation by using an adequate volume and concentration of
acid or by cooking. These results indicate that the possibility of
preserving the relatively large amount of vitamin C in the green seeds
of cow peas and soybeans during cooking should be considered in
evaluating their usefulness as foods.
In collaboration with the Division of Infectious Diseases, a bacterial
growth method for determining nicotinic acid and its derivatives in
urine was developed and applied to dogs on nicotinic acid-deficient
diets. An experiment is in progress to determine whether this tes
is applicable to human urine. Mouth lesions were produced in monkeys on diets deficient in various members of the vitamin B complex.
These results suggest that certain uleeration8 occurring in the mouth
in human beings may be due to dietary deficiencies. Experiments
on the effect of a chronic deficiency in calciL1m and vitamin C in
monkeys, and attempts to determine the riboflavin content of urine
and tissues of dogs are in progress. Determinations of the coenzyme·
content of various tissues of experimental animals are under way.
Further experiments with cystamine confirmed an earlier observation that this substance is a very toxic amine, producing extensive
bone changes in rats. An experiment to determine the practical
importance of this observation is in progress.
Supervision over the mineral analyses of Tenneraee and Alabam
foods was continued, twd these studies are being extended.
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Pl: BLIC H E ALTH SERVICE
The nutritionists in several State health departments were visited
for the purpose of observing the development of their activities and
a ssisting with the programs.
DIVISION OF IND U STRIAL H YGIEN E
Senior Surgeon RoYD R. SAYERS in cha rge
The Division has as its objective 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 to State and local health departments.
Dust studies.-Pottery: A report (Public Health Bulletin No. 244)
has appeared, containing the results of a medical study of 2,516
potters and of an engineering and chemical study of the nine factories
in _which they were employed. Silicosis is a hazard for workers
exposed to dust concentrations in excess of 4 million particles per
cubic foot. Through the application of engineering and chemical
methods of control, lead poisoning has been virtually eliminated in
pottery factories. Asbestos: A study of asbestosis in the asbestos
textile industry was published (Public Health Bulletin No. 241 ).
Asbestosis, a lung disease caused by long-continued inhalation of
asbestos dust, was the principal physical defect found in medical
examination of 541 men and women employed, or recently employed;
in three asbestos textile factories. The three cases of asbestosis found
among workers exposed to a dust count below 5 million particles per
-cubic foot were diagnosed as doubtful; well-established cases occurred
at higher concentrations. It appears from the data that if asbestos
dust concentrations in the air breathed are kept below this limit new
-cases of asbestosis will not appear. Mica and pegmatite: A study of
pneumoconiosis among mica and pegmatite workers is in press and
will appear as a Public Health Bulletin. Pathology: 15 dusts were
tested biologically to determine their pneumoconiosis-producing
potentialities. These experiments continued to support the biological
classification of dusts reported by this Division in 1934. Further
-e xperiments with mixed dusts indicate that such dusts in combi- .
nation react in the tissues as the individual components would alone.
Spray residue studies.- Epidemiological field observations on the
effect of lead arsenate spray residue have been continued in apple- and
pear-growing districts. A 12-month clinical study, which has been
completed, comprised over 2,500 examinations and reexaminations
of orchardists and nonorchardists. Blood and urine samples from all
-subjects and stool specimens from selected subjects were collected for
,chemical analysis of lead and ars-enate content. More than 350 of the
1,231 original subjects were consumers with no orchard exposure.
A like number of subjects had used lead arsenate spray mixtures for
more than 10 years ; almost 100 had used this material in orchard
practice for 25 years or more and also had ingested varying amounts of
commercially unwashed fruit. In the engineering phase of the study,
435 samples were obtained. The air (impinger) samples totalled 267.
Both chemical analysis of environmental and biological samples and
the statistical analysis of the data are progressing.
The field investigations have been supplemented with various
laboratory researches, two of which have been submitted for publicat ion. Other investigations include the following st udies: (1) The
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toxicity of lead arsenate with reference to its molecular constituents, in
progress for 22 months; (2) the lead content of blood and urine under
conditions of nonexposure to lead; (3) the microscopic demonstration
of lead.in bone tissue; and (4) limited experimental work, in progress
for the past 9 months, in which dogs have been fed massive doses of
lead arsenate and other lead salts.
Motor transport study.- A study was undertaken to determine the
effect of long working hours on the health and the psychological and
physiological status of truck drivers engaged in interstate commerce.
The study involved the following procedures: A battery of simple and
easily administered psychological tests (reaction time, reactioncoordination time, speed of tapping, manual steadiness, body sway,
estimation of the size of familiar objects, and the De Silva driving
tests); 5 visual tests (the speed of saccadic movement, the critical
fusion frequency for a flickering light, the De Silva glare test, and the
determination of visual acuity by the Lythgoe and Snellen methods);
total and differential white blood cell counts and hemoglobin determination; and 2 blood chemical tests (total base and potassium
determinations). Twelve hundred ~ets of the above tests, together
with medical examinations, were administered to 889 commercial
truck drivers from approximately 100 companies located in 3 cities.
The report is in process of preparation.
Dermatoses investigations.- Occupational skin hazards were studied
in 48 plants. In addition, 4 outbreaks of occupational dermatoses
were studied and the causes determined: (1) Among painters, due to
the thinner used in the paint; (2) in the felt hat manufacturing industry, due to acid mercury nitrate and friction with the rough felt;
(3) in a chemical company, due to the wearing of acid-cured rubber
gloves; and (4) in an insecticide manufacturing plant, and in other
plants buying the product, due to a new synthetic insecticide, alphanaphthyl-iso-thiocyanate.
For the first time in this country, occupational dermatitis and melanosis due to photosensitization by coal tar derivatives was studied and
reported in two of the five published papers resulting from these investigations. A report of a study of dermatitis among plate printers
was published as a Public Health Bulletin.
Compressed air illness.- A total of 325 men was examined, and records of 400 additional compressed air illness cases were secured from
company records. Two experiments on prophylaxis were performed;
these involved about 15,000 decompressions by oxygen. The use and
efficacy of helium-oxygen mixtures were also determined. Oxygenhelium apparatus has been developed for the administration of varying concentrations of oxygen and helium. The report is being
prepared.
Heavy metals.- Lead: Chemical analysis of lead content of blood
and urine specimens obtained during medical examination of 766
storage battery workers in the fall and winter of 1937- 38 has been
completed, and the analytical values are being correlated with the
atmospheric lead concentrations to which workers were exposed and
with other laboratory findings. A forthcoming bulletin will discuss
these and other findings in relation to the medical and engineering
control of plumbism in lead-using industries. Mercury: The records
of the medical and engineering study of the hatting industry are being
analyzed. A preliminary report on the occurrence and control of
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chronic mercurialism in the hatting industry has appeared. Manganese: A report on the incidence of manganese poisoning occurring
in a manganese dioxide crushing plant is in press and will be issued as a
Public Health Bulletin.
Organic compounds.-Toxicity of ketones: Work on the acute
responses of guinea pigs to the inhalation of ketone vapors was continued, and the data on acetone were published. Papers now in
preparation cover butanone, pentanone-2, hexanone-2, acetonyl
acetone, mesityl oxide, heptanone-2, octanone-2, and cyclohexanone. Methyl bromide: Analyses were made on various types of
foodstuffs before and after fumigation with methyl bromide. Results.
indicate that the absorption of methyl bromide during fumigation is.
but slight in the majority of substances, fatty foods (cheese, nut
meats) and milled grains being the important exceptions. It has been
suggested that the use of methyl bromide in fumigating fatty foods
and milled grains be limited until further work can be completed
which will show the safe limits for bromide content of these foodstuffs.
Animal feeding experiments in progress are designed to show the
results of extended feeding of fumigated foodstuffs.
Physical methods.-Spectroscopic analysis of urine for mercurywas.
carried out on some 568 workers in connection with the felt hat study.
A paper presenting a discussion of the sensitive line emission method
of spectroscopic analysis for heavy metals in body fluids has been
accepted for publication. Special optical equipment was designed
and constructed for determining critical fusion frequency. Both
visible and ultraviolet radiation have been continuously measured,
and integrated values have been obtained for 3 field stations, establishing environmental factors in connection with epidemiological
studies on tuberculosis. An automatic recording spectrophotometer
has been develo.,Ped which will make possible rapid spectroscopic
analysis of a large number of samples. Routine methods of ultraviolet absorption spectrophotometry using a continuous hydrogen discharge have been developed. Extensive cooperative studies of the
action of ultraviolet radiation on a variety of micro-organisms has
indicated not only lethal action but a high percentage of mutations.
The action spectrum of genetic effects has been studied. Investigations of air-borne bacteria have been carried out in connection with
the ventilation of buildings. A simple sampling device has been
developed for determining the bacterial population of air. Survival
of bacteria under a variety of conditions has been studied. Methods
of removing bacteria from the air, such as filtration and precipitation,
have been tested. A method for following air movement in airconditioned buildings has been developed, and the spread of bacteria
in an air-conditioning system has been studied. Investigations have
been made on the influence of ultraviolet irradiation of an acetylated
mannoheptose.
Studies of sickness among industrial workers.-Incidence of disabling
sickness: 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
was published quarterly. Occupational morbidity and mortality
study: Analyses were continued. A report on disabling sickness and
nonindustrial injuries among drivers and other employees of certain
bus and cab companies has appeared. Drivers were found to have a
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higher frequency of disabling sickness and nonindustrial injuries and
a greater average number of days of disability per person than nondrivers in the corresponding companies. On the other hand, the
average number of days per case was less among drivers than among
nondrivers. Three additional papers have been- submitted for
publication, and others are in preparation. Other studies: A paper
on time lost by industrial workers from disabling sickness and accidents during the early days of disability has been published. Of the
total days of disability from the respiratory diseases, 67 percent
among the males and 62 percent among the females occurred during
the first 7 days of disability after onset. The corresponding percentages for all causes were 45 for the males and 52 for the females.
A published report on nonindustrial injuries among male and female
industrial employees showed that females were absent from work
more often and for a longer time because of nonindustrial injuries
than were males. Additional reports are in preparation.
Consultation services to the States.- The Division has continued to
render consultation services upon request to numerous State and
local health departments in the development of industrial hygiene
activities. Whereas last year emphasis was placed on defining the
problem in each locality, this year actual accomplishments in
industrial hygiene can be recorded. It should be borne in mind that
the official industrial hygiene units mainly serve to evaluate the health
problems of workers, suggest ways and means for their control,
develop standards of good practice, furnish technical guidance, and
conduct educational programs. It is gratifying to note that these
various demand,s made upon the health departments for industrial
hygieu,e services are beiiJig successfully met. Durinig the past year
assistan_te has been given the various States in studies of health
haz~rds associated with mining, pottery, glass and brick manufacture, foundry operations, lead storage battery production, felt hat
manufacture, and other industries.
There are 25 active industrial hygiene units jn State health departme_p,ts, with a total persotinel of 132 a:nd a budget of more than
$500,000. Two States are (}>ngaged i1n limited activities in this field,
a:o.d 2 others have recently enacted legislation authoriz;ing i\ndustrial
hygiene work.
Consultation services on admipistrative and technical subjects were
given during the past year to 29 States, 19 of which were visited one
or more times. Five different studies of the health of workers and
working conditions were made in cooperation with 10 States. Lectures were delivered at several universities and before numerous associations and Federal agencies. Various manuscripts issued by State
industrial hygiene units have been reviewed, and in-service training for new personnel was arranged with several of the older State
industrial hygiene units. In addition, services were rendered in tiie
preparation of codes for the safe and healthful conduct of various
industrial operations.
This Division again acted as host to the National Conference of
Governmental Industrial Hygienists, at which approximately 80
persons were present. The registrants represented 22 States, 3
Federal agencies, 1 foreign country, and 3 universities. Eleven
committee reports were presented on various industrial hygiene
subjects.
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The several States have been encouraged to develop industrial
hygiene services so functioning as to integrate the industrial hygiene
program with all other basic services in the health department. In
other branches of public health, the responsibility has been shared by
national, State,- district, county, and city departments of health.
Today, the States are being urged to develop industrial hygiene
services on the same basis, so that large cities and industrial areas will
have individual programs in cooperation with the State. Such
coordinated effor·t is now functioning in several of the States.
DIVISION OF INFECTIOUS DISEASES
Senior Surgeon
ROLLA
E.
DYER
in charge
RICKETTSIAL DISEASES
Laboratory investigations of the rickettsioses in the East and in
the South were carried out during the year at the National Institute
of Health in Washington, D. C., at Mobile, Ala. , and at Albany, Ga.
At the Institute, studies were made of freshly isolated strains of
Rocky Mountain spotted fever recovered in the East from certain
human cases which indicated a more virulent infection than any
hitherto noted in that region. The studies in Alabama, now completed, dealt with the determination of the susceptibility of various
species of native rodents. Investigations in Georgia embraced the
following phases: Clinical study; epidemiological study, especially of
rural cases; dissemination of infection in rats; study of the specificity
of the Weil-Felix reaction. Search is being made for a possible
reservoir in wild animals which may serve as a source of infection for
D. variabilis in the East.
An accidental laboratory infection with a new rickettsia isolated in
Montana was found to be closely related to "Q" fever, a rickettsial
disease of Australia.
. Prevalence .-During the year new foci of spotted fever were noted
in some of the Eastern States. The disease has now been reported
from all of the 48 States except Maine, New Hampshire, Vermont,
Connecticut, Rhode Island, Wisconsin, and Michigan. The demands
for spotted fever vaccine trebled in the spring of 1939. Typhus in the
Southern States has extended to include northern Alabama and
Tennessee; and in certain sections, particularly in Alabama, Georgia,
and Texas, the disease has lost its urban limitations and includes
distinct1y rural areas.
Treatment with drugs.-Prontosil was tested in guinea pigs infected
with spotted fever or endemic typhus. No benefit could be demonstrated; in fact, the treated animals did not do as well as the controls
that received infectious material but were not treated. Similar
results were obtained with the use of sulfapyridine in spotted fever.
Cultivation of rickettsiae.-Studies on the cultivation in vitro of the
rickettsiae of Rocky Mountain spotted fever for the purpose of
vaccine production were continued. Increased yields, of the order
of 300 to 400 cc., were obtained from the infected tunica and heart.
muscle of a single guinea pig in modified Maitland media. These
cultures treated with 0.1 percent formalin afforded protection against
the disease after either one or two subcutaneous inoculations of 1 cc.
each. The vaccines were as effective after 6 to 10 months storage in
the refrigerator as when used soon· after preparation.
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Experiments were carried out to determine the effect of reducing
the serum content of the Maitland media. The results obtained with
a serum content of 5 percent were almost as good as those obtained
with a 25-percent content. Although a certain amount of growth
was obtained in media without serum, vaccines made from such
cultures were without protective value.
Studies were made to determine the concentration of rickettsiae
in the various parts of infected chick embryos, with the objective
of using such material in Maitland media cultures. Inoculations of
blood or serum from infected guinea pigs into the allantoic cavity
yielded allantoic fluid and chorio-allantoic membrane infective in
high dilutions.
The yolk sac of the developing chick has been found superior to
other media for growing the rickettsiae of the Rocky Mountain spotted
fever and typhus groups and of "nine-mile fever." Rickettsiae thus
grown are of exalted virulence and -so abundant that these cultures
are used for preparing agglutinating suspensions. A vaccine that protects against endemic typhus has been prepared from yolk-sac cultures.
Rocky Mountain spotted f ever and preventive vaccine.- Case reports
have been received from 51 additional counties in ew Jersey, orth
Carolina, Virginia, West Virginia, Alabama, Mississippi, Arkansas,
Tennessee, Kentucky, Ohio, Indiana, Illinois, Iowa, ebraska, and
Utah. Spotted fever virus has been transmitted repeatedly by the
tick 0rnithodoros parkeri, in laboratory experiments.
The demand for preventive vaccine has been unprecedented; a
gross amount of 756 liters was prepared. The amount distributed
totalled 495 liters, which was 132 liters in excess of that distributed
in the preceding fiscal year. More than 156 liters, including 129
distributed to Civilian Conservation Corps camps, were used for the
immunization of Federal field personnel. A new vaccine which satisfactorily protects guinea pigs has been prepared from the embryonic
tissues of developing chicks.
Relapsing fever. - The finding of spirochete-infected 0rnithodoros
hermsi in the endemic area west of Denver suggests that this tick is
the previously undiscovered local vector of relapsing fever. This
record extends the known range of this vector over 600 miles eastward.
ew areas of occurrence of 0. parkeri have been found in Utah, Colorado, Wyoming, and Washington. In central Washington this tick
utilizes burrowing owls as hosts and is found consistently in their
burrows. Spirochete-infected 0. tala_je have been collected from
kangaroo-rat burrows in western Arizona. Developing chick tissues
are excellent media for the cultivation of relapsing fever spirochetes_
Colorado tick f ever.- A temporary field laboratory for the study of
this infection has been established at Boulder, Colo. An unknown
organism has been grown in the yolk sac of developing chicks inoculated with patients' blood.
"Nine-mile f ever."-Four years research has culminated in obtaining evidence that this tick-borne disease occurs spontaneously in man.
Apparently authentic cases have occurred this year in Montana, Idaho,
Washington, and possibly in California. Natural infection in ticks
has been demonstrated in Montana, Wyoming, Oregon, California,
and possibly in Texas. An agglutination test has been developed.
Vaccine prepared from infected ticks, tick feces, or infected chick
yolk sac confers full protection. Va,ccine from ticks infected with
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both spotted fever and "nine-mile fever" protects against both diseases. The virus in ticks and tick feces remains virulent after protracted refrigeration. The virus has been recovered from houseflies
collected near infected guinea pigs. Viable virus has been recovered
from 0. turicata and 0. parkeri 648 days and 360 days, respectively,
after the infective feeding. The name Rickettsia diaporica has been
given this virus.
Tularaemia.-Bacterium tularense has again been recovered from
Haemaphysalis leporis-palustris collected in Alaska. Infected ticks
of this genus have been found in Alaska previously (1937). A rabbit
was found infected in central Germany in 1939. Viable Bact. tularense has been recovered from 0. turicata and 0. parkeri 674 days and
606 days, respectively, after infective feeding.
In 1938, a total of 2,081 cases of tularaemia were reported from 40
States and the District of Columbia, as compared to a total of 960
cases in 1937.
Amblyomma maculatum irifection.-This apparently new rickettsial
infection, found in 1937 in ticks from Texas, has also been demonstrated in ticks from Georgia. In guinea pigs it is a mild but typical
infection. Rabbits and monkeys appear but slightly susceptible.
Sylvatic plague.- Heavy infestations .of Pulex irritans hav:e been
found in the nests and on fledglings of burrowing owls.
Sy,stematic studies.-Monographs on the tick genera 0rnithodoros
and Ixodes in North America are being prepared. Three new species
of fleas and three of ticks have been described.
VIRUS DISEASES
Lymphocytic choriomeningitis.- Studies on the occurrence of neutralizing antibodies in human sera collected from various parts of the
United States have been continued. A surprisingly high percentage
of positive sera from the western part of the United States was found.
Spontaneous infection with the virus has been demonstrated in mice
(Mus musculus) trapped in the homes of 3 proved cases of the infection in Washington, D. C. Eight additional foci of infected mice, not
associated with known human cases, have been found among 235 mice
trapped in the poorer sections of the city. The infection has been
transferred from monkey to monkey by means of monkey lice (Pedicinus longiceps) .
The virus of lymphocytic choriomeningitis has been maintained in
serial passage during a period of 9 months by weekly transfer in
Maitland medium, consisting of tyrode solution, rabbit serum, and
mouse embryo tissue. Transfers were accomplished by adding a small
amount of supernatant fluid from one passage to fresh media for the
next passage. Titrations of the culture virus and of mouse passage virus
indicate at least a 25-fold increase of the virus in the Maitland
medium and that of the mouse brain used as a basis for comparison.
The Maitland media cultures, injected subcutaneously or intraperitoneally into mice in 1 cc. amounts, afforded protection against
symptoms and against death in all cases when virus was injected
intracerebrally, although the presence of brain lesions, varying from
very slight to marked, showed lack of complete protection. Formalin~zed cultures afforded less complete, though definite protection in
mrne.
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Attempts to repeat previous work in maintaining the virus by
passage in chick embryos revealed a decline in pathogenicity for the
chick embryo. This material afforded no protection in mice against
intracerebral inoculation of mouse passage virus, unless the embryo
was shown to be infected.
Encephalitis.-Serum virus protection tests, carried out on the sera
of recent cases of encephalitis from Colorado, Minnesota, and orth
Dakota, indicate that cases of equine encephalitis (Western strain),
as well as cases of encephalitis (St. Louis type), were represented.
Sera from horses recovered from the former ailment showed a degree
.
of protection also against the St. Louis strain of encephalitis virus.
Poliomyelitis.-Three strains of virus, two from cords and one from
feces, were isolated and identified. Several animal species have been
tested for susceptibility to infection, without any definitely positive
findings.
.
Injluenza.-A well-known strain of influenza virus has been studied
in reference to its characteristics. Attempts have been made to
modify the action of the virus in mice by various physical and chemical
agents.
HEART DISEASES
Heart disease investigations were pursued under two categories:
(1) Clinical and laboratory studies in Washington, D. C., and (2)
epidemiological studies in Philadelphia, Pa.
1. Material obtained from patients with rheumatic heart disease,
at the bedside and at necropsy, were investigated by laboratory
methods at the National Institute of Health. Animal experimentation has been utilized to supplement and clarify the phenomena
observed in patients. The investigation followed two principal
directions: One toward the discovery of the factors within the host
which may predispose to or accompany rheumatic heart disease, and
the other toward the determination of an outside infectious agent in
the disease.
A continuation of the study of acetyl choline esterase content of the
blood showed that the inverse ratio to the severity of the disease,
reported preliminarily in 1938, is applicable only to the acute stage
of the disease. When the febrile stage has passed, a high esterase
content indicates continued carditis and contraindicates the resumption of activity by the patient. Prostigmine, a drug which is, in a
sense, antidotal to esterase, was administered to selected patients;
it was of no value during the febrile stage but appeared to be of value
afterwards.
.
Further attempts to confirm the value of complement fixation tests
in the diagnosis of rheumatic infection, as reported by others, have
thus far failed.
A study was made of the relation between hyperthyroidism and
rheumatic fever.
In the search for an etiological agent, no success attended attempts
to demonstrate a filter-passing noncultivable virus. Immediately
after reports had implicated an organism resembling that of pleuropenumonia in cattle, investigation of this organism was begun.
Several cultures resembling those reported were isolated, but their
relation to rheumatic fever remains to be determined.
188796-40-G
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2. Epidemiological s,tudies principally: to ascertain the mass effects
of rheumatic and coronary heart diseases in the United States were
continued.
In a survey in 36 Philadelphia hospitals, covering the 5-year
period 1930-34, it was found that the number of annual admissions
for rheumatic heart disease, rheumatic fever, and chorea totalled
more than 1,200, of which over 900 were new admissions. The
annual cost of care of these patients, exclusive of physicians' fees,
was over $250,000. A high incidence of rheumatic heart disease,
rheumatic fever, and chorea among the lower economic groups is
indicated by the fact that over 93 percent of persons hospitalized
for these conditions were ward patients. Fatal and nonfatal cases
were studied as to clinical course and distribution according to age,
race, and sex.
Analysis of• 5,116 deaths from acute coronary occlusion, occurring
in Philadelphia in the 5 years 1933-37, showed an increase in mortality from this cause of more than 125 percent during the study
period. The increase was almost entirely among white persons. The
mean age for all deaths was 61.2 years, nearly 42 percent of all deaths
occurring at ages under 60 years. Deaths were less frequent among
females than among males, especially during middle age. Rates
were notably high among natives of Russia and Austria-Hungary.
Although the Negro rates were distinctly lower than the white, the
mean age at death among Negroes was lower by more than 9 years.
Since rheumatic heart disease accounts for at least 80 percent of
all heart disease at ages 5~24 years, a study was made of United
States Census data on heart disease mortality in these age groups
from 1922 to 1937. In the specified age groups, a substantial reduction in heart disease deaths was apparent for the country as a whole.
In some areas, moderate increases occurred, but reductions were noted
in the New England, Middle Atlantic, East North Central, and
Pacific Coast States.
Rheumatic fever leaves in its wake large numbers of heart cripples.
Many can be partially or completely restored to useful life by proper
convalescent care. The existing facilities are totally inadequate in
extent to meet the needs, although much excellent work is being done.
Visits have been made to most of the larger institutions serving
patients of this type; and many facts, which will be needed in the
appraisal of such factors as organization, methods, accomplishment,
and costs, have been collected. This is a continuing study of a most
important public health problem.
Completed work in all phases of these heart disease investigations
has been brought before the medical and public health professions
through publications and addresses at scientific meetings.
TUBERCULOSIS
Laboratory studies.-Studies have been made on type strains of
tubercle bacilli from two areas in the South, widely different in morbidity and mortality, to evaluate the possible significance of these
strains in the epidemiolgy of the disease. Studies have been carried
out on the techniques of isolation and on the cultural characteristics,
metabolism, and .rare strains of tubercle bacilli. Studies on the
etiology of atypical pulmonary disease of children and adults in the
South have been initiated.
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The more general studies, hitherto pursued, of adsorption in biological systems ("bio-adsorption") were definitely referred to the
tubercle bacillus. The primary objective in these studies has been
to determine whether the main epidemiological findings regarding the
role of silica in tuberculosis could be reproduced under laboratory
conditions and thus be made the basis of convenient experimentation.
Numerous freshly isolated strains have been grown, both with and
without the addition of silica, to determine whether this element does
stimulate the growth in vitro of the tubercle bacillus. Although results in a preliminary series of experiments .h ave been inconclusive,
this failure to secure a definite response may perhaps be ascribed to
faulty experimental conditions.
Freshly isolated strains, regardless of the addition of silica, grow
poorly on a medium originally designed for the growth of the stock
laboratory strain, H37. When growth does occur it is difficult to
give quantitative expression to the results. A new approach to the
problem appears to have been secured through the recent development
of a new technique for evaluating growth.
Field studies.-Intensive epidemiological studies of population and
environment in selected areas of two regions in the Southeastern
States with widely contrasting tuberculosis incidence and[mortality
were continued.
A complete survey of a typical county in each region showed that
the populations of the two counties have a similar racial composition,
but that the people in the county having a low tuberculosis rate eat
less "preventive" foods (milk, eggs, ~reen vegetables, etc.) and more
of the diet characteristic of the reg10n-flour, sirup, and fat meat.
They also have fewer luxuries and conveniences, larger families,
poorer and more crowded houses; yet they have about one-tenth the
mortality from tuberculosis that the other county has.
Specific environmental studies show the region of high tuberculosis
mortality to be generally coextensive with the paleozoic limestone
regions of Tennessee and Kentucky, whereas the low mortality area is
in the coastal plain. Analysis of 408 water samples and 104 soil
samples from the 2 representative contrasting counties showed that
the ground water is more alkaline and contains more calcium, and
that the soil contains more calcium, phosphorus, and fine-grained free
silica in the limestone county with the high tuberculosis rate than in
the sandy county with the low rate. Analysis for 8 different mineral
constituents of 10 samples from each county of each of 9 different
staple food articles showed higher calcium, phosphorus, and potassium ,
and higher Ca/Mg ratios in foods from the county with the high
tuberculosis rate than in foods from the county with the more favorable tuberculosis experience. Continuous measurement, for 1 year,
of solar ultraviolet radiation in the anti-rachitic zone, and measurements, for 3 years, of visible daylight show that the county with the
low tuberculosis rate has significantly more such radiation during the
winter months than the contrasting county.
Tuberculin (Mantoux) tests of 11,000 persons in the 2 contrasting
counties showed: (1) About the same percentage of reactors among
children of school age in both counties; (2) definitely higher percentages of reactors among adults in the high tuberculosis county than in
the contrasting county. X-ray examination of these 11,000 persons
showed about 50 times as many calcified lesions in the lung fields of
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school children in the high tuberculosis county. Such lesions occurred
almost as frequently among tuberculin-negative as among tuberculinpositive individuals.
To study further the relationship between residence in a limestone
bedrock region and intrathoracic calcification, X-ray examinations
were made of 500 school children in each of 3 selected counties in
Alabama, 3 in Tennessee, 5 in Kentucky, and 2 each in Ohio and
Indiana. In the localities studied, pulmonary calcification is largely
limited to limestone regions.
Pathological studies of these calcifications in Tennessee and pathological, bacteriological, and mycological studies of typical native
cases of tuberculosis in the 2 contrasting areas were undertaken during
the year and are still in progress.
LEPROSY
In the continental United States.-An analysis of certain data collected during the preceding year has been made, but without significant results. One is constantly impressed by the extreme slowness
of the evolution of leprosy, not only in the individual patient but
especially in the community. For example, in the most heavily
infected smaller communities (population 30,000 or less), only one
or two cases of leprosy are discovered annually. Even in the largest
city in the South which, with a population of about half a million,
constitutes an important focus of leprosy (perhaps the most important
in this country, according to the number of new cases reported),
less than a dozen cases are discovered each year.
It is the opinion of this Division that the reporting of such a small
number of new cases is due not 'to the failure of physicians and health
officers to recognize the disease, as is so often charged, but rather to
the fact that few new cases have actually developed. It is believed
that the great majority of cases are ultimately recognized. The
terminal stages of leprosy usually are so characteristic that the condition scarcely could be overlooked if the case receives medical
attention during the last years of life. If some method were available
whereby all cases of leprosy could be disclosed at one time, probably
several times the number now reported would be found; even if this
could be done, it is probable that very few new cases would come to
light for several years thereafter.
The experience of the past year has confirmed the impression that
infections acquired in the United States are extremely rare, except in
Florida, Louisiana, and Texas.
In Hawaii.-The activities of the Leprosy Investigation Station,
Honolulu, T. H., have comprised investigations into various phases
of leprosy, and care and treatment of patients in the adjoining Territorial Receiving Hospital. The studies of the fiscal year have
included the following:
1. Attempts have been made to infect the white rat with human
leprosy. Seventeen months after the inoculation of one series of
animals, lesions were noted in a few of them at the site of subcutaneous
inoculation. Histologically, the lesions resembled those of rat
leprosy. A second group of rats was inoculated with inoculum
prepared from these lesions. After 6 to 7 months, similar lesions
appeared in the second generation rats.
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2. Some interesting facts have been obtained from a review of
the history of the Territorial home for boys of leprous parents, whic
was abandoned during the year after 30 years of existence. The homewas opened in May 1908, at which time 35 boys were transferred from
Kalaupapa Settlement. Five of these boys were declared to be lepers
within 4 years and 7 months after their arrival at the home. Prior
to their arrival, they had resided in the settlement from birth until
they had reached the ages of 2 to 5 years. A sixth boy, who arrived
at the home 1 year later, was declared to be a leper 3 years and 5
months after his arrival. He had resided in the settlement until he
was 21 months of age. The 6 cases were removed from the home and
segregated. After ihis, for a period of 17 years, no cases of leprosy
were detected among the residents of the home.
At the end of the 17-year period, a boy of 5 years was removed
from the home as a cutaneous, bacteriologically positive case of
leprosy. This child had lived with his leprous mother for 13 months
before he was placed in the home. W'ithin 7 years and 4 months after
the removal of this case, 11 additional cases developed among the
residents. In short, for 17 years no case had developed; following
the introduct.ion of a case from the community, 11 cases developed
among boys residing at the home.
3. Investigations on the relation between nutrition and rat leprosy
were continued. Rats deficient in vitamin B 1 or in calcium were found
to be much more susceptible to rat leprosy than were normal rats.
However, when calcium-deficient rats were fed vitamin B 1 in purified
form, they were no more susceptible than normal rats . These
observations suggest a possible relation between calcium and vitamin
B 1 metabolism. The results of further studies strongly suggest that
the increased susceptibility of the calcium-deficient rat was due to
vitamin B 1 deficiency and not to calcium deficiency. For example,
ats deficient in vitamin B 1 , although highly susceptible to the infec·.on, were not deficient in calcium, whereas calcium-deficient rats
'ere also deficient in vitamin B 1 . Likewise, the amount of vitamin B 1
L the blood of rats deficient either in that vitamin or in calcium
was found to be the same for both groups. Estimation of the amount
of calcium in the bones of rats deficient in vitamin B 1 showed the
percentage of calcium to be the same as in normal rats. Calciumdeficient rats were apparently incapable of utilizing the vitamin B 1
available in the calcium-deficient diet. When additional vitamin B 1
was given to rats maintained on the calcium-deficient diet, they
showed a greater gain in weight thn,n rats on the same diet without
the addition of vitamin B 1 ; and a third group of rats on the calciumdeficient diet, which were fed additional vitamin B 1 and additional
calcium, showed a greater gain in weight than those which received
the addition of vitamin B 1 only.
MALARIA
Research studies were continued in field stations located at Memphis, Tenn.; Columbia, S. C.; Savannah, Ga.; Miami, Fla.; Ancon,
C. Z.; <1,nd Washington, D. C.
Research in the biological control of Anopheles mosquitoes has
been continued. A tentative classification has been made of potential
Anophe 1es-producing ponds based on characteristic desmids. Studies
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were continued on the physical and chemical factors associated with
Anopheles larvae. The results are as yet indeterminate.
One season's study of malaria prophylaxis by means of atabrine
was concluded and a second season started. In addition, a similar
study with quinine was initiated. Sin ce a rise in m alaria prevalence
is expected within the n ext year, these studies must be continued for
several seasons before definite conclusions can be drawn.
Research in the malaria therapy of general paralysis was continued. Evidence indicates that many paretics and even patients with
earlier syphilis showed marked improvement when inoculated with
P. malariae. Sulfanilamide causes P. malariae parasites to disappear
more slowly than when quinine is used.
•
Mapharsen was found to have no appreciable effect on the parasites
of P. malariae when used for the treatment of malaria. However,
some relief was obtained where P. vivax was concerned, although
quinine was also necessary. Studies of the synchronicity and periodicity of P. ma.lariae and of double infections of,P. falciparum and P.
malariae in Negroes were made. No definite conclusions from these
studies have been reached.
The study of pigeon malaria, P. relictum, has been continued.
Attempts to transmit the disease by the pigeon fly, Culex pipiens, and
Aedes aegypti have been unsuccessful. The sporulation time of
P. relictum in pigeons has been determined to be 27 hours. P.
relictum has been observed for the first time in a magpie captured near
the Rocky Mountain Laboratory at Hamilton, Mont.
Satisfactory monolithic cement .linings for malaria control ditches
have been developed, and further research has been directed toward
finding a cheaper substitute for portland cement. Rammed earth and
asphaltic mixtures have been' used for linings, but only long exposure
will demonstrate their suitability. Shading studies for the control
of Anopheles larvae were continued. No definite results are yet
available.
Studies on the bionomics of A. walkeri have not yet been concluded.
Observation shows this species to be more adept in entering screened
houses than is A. quadrimaculatus. Flight studies indicated that the
range of this species was much farther than the 1 mile usually
attributed to A. quadrimacu atus.
Further studies have been made of the mosquitoes of Central and
South America. A monograph on the Anopheles of the Caribbean
area was practically completed. A reclassification of the mosquitoes
of Costa Rica was initiated.
Investigations were commenced for the development of a more
satisfactory means of tracing the dispersion of mosquitoes from the
propagating areas. No definite results are yet available.
The routine spraying of intercontinental aircraft in flight for the
destruction of insects has been shown to be impractical, and plans were
evolved for the disinsectili';ing of these planes at a port of call.
The thick film laboratory has been engaged in bringing up to date
the lectures and slides used for teaching purposes. Research has also
been made relative to the possibilities of reproducing photomicrographs
of malaria parasites in natural color. Considerable time has also been
devoted to instruction of State laboratorv technicians and the checking of slides handled by these technicians.
1
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Research was continued in malaria immunology, and several
promising leads were developed and followed. This work is still in
an experimental stage .
OTHER STU DIES
Pneumonia.- Work has progressed on the study of pneumonia from
the following approaches: (1) Antigenic substance of pneumococcus,
(2) concentration of antipneumococcus rabbit plasma, and (3) synthesis and testing of organic compounds for possible chemo therapeutic activity against pneumocodcus.
1. Characterization of antigenic polysaccharide has gone forward ,
showing that there is no correlation between acetyl groups, optical
rotation, or hydrolyzable sugar content and antigenicity for mice ,
rats , or man. Antigenic polysaiccharide has been used as a possible
measure of susceptibility of an individual to pneumococcus infection
as tested by antibody content in sera and by skin reactions of approximately 750 individuals.
2. Antipneumococcus rabbit plasma has been concentrated 20-fold
by three different methods. The lipoid content of the product is very
low, and from previous experience this would indicate that any one
of the methods could be used for a preparation for intravenous therapy
in humans without production of thermal reactions.
3. Four hundred and forty compounds have been t,ested in mice
against pneumococcus. Although some showed definite activity,
none were as active as sulfapyridine, and any having activity were
more toxic for mice than sulfapyridine. In addition, some compounds were tested against streptococcus, meningococcus, and influenza virus in view of the discovery of a possible relationship between
chemical constitution and chemotherapeutic activity. Continuation
of the work on lymphopathia venereum revealed that sodium sulfanilyl sulfanilate and sodium sulfanilate were effective to a degree
that patients in the tertiary stage with rectal strictures were cured, as
measured by improvement in general health, disappearance of profuse
discharge, and absorption of the rectal stricture .without surgical aid.
Dental hygiene investigations.- Major activities during the year were
chiefly centered on a study of the inverse variation betw.een endemic
dental fl.uorosis and dental caries. This phenomenon was studied
from the standpoints of epidemiology, bacteriology, biochemistry, and
analytical chemistry.
A detailed study of the relation of domestic water to dental caries,
including epidemiological aspects of oral L. acidophilus , was made of
885 white children, 12 to 14 years of age, in four Illinois cities. Galesburg and Monmouth, using a domestic water closely similar in source
and mineral composition, show almost the same low dental caries
rates , 201 and 205 carious permanent teeth per 100 children. Two
nearby cities, Macomb and Quincy, using domestic water dissimilar in
both type and mineral composition to that of Galesburg and Monmouth, disclosed caries rates double and treble the rates recorded at
Galesburg and Monmouth. The Macomb and Quincy waters contain
0.2 parts per million of :fluorine; those at Galesburg and Monmouth.
1.8 and 1.7 parts per million, respectively. Using the approximal
surfaces of the four superior incisors as a basis of measurement , 16
times as much interproximal caries was found in Macomb and Quincy
as in Galesburg and Monmouth.
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Epidemiological aspects of oral L. acidophilus in saliva closely
reflected differences in the dental caries rates of Galesburg and Quincy.
No group population differences were noted in these two cities with
respect to the quantity of amylase in the saliva. It is difficult from
an epidemiological standpoint to ascribe these differences to any cause
other than the common water supply.
Enteric diseases. - Prevailing opinion regards the acute diarrheal
disorders as a group of diseases. Evidence accumulated in this
Division tends to support this view, but the cases studied in New
Mexico, throughout a 3-year period, and in Georgia and New York,
during the first months of new investigations, have been predominantly
Shigella dysenteriae infections. Some pathogenic member of this,
species was isolated from approximately 70 percent of the cases adequately examined in New Mexico, and other cases in the New Mexico
series were identical in clinical type with the Shigella infections,
although the cultures were negative. The most important factors in
the transmission of Shigella dysenteriae infection appear to be the
common occurrence of clinically insignificant cases and the presence
of totally asymptomatic carriers, in insanitary areas.
The epidemic diarrhea of the newborn, observed and described in
New York, N. Y., is evidently an entirely different entity, but it is
obviously a highly communicable disease. Therefore , the prevention
of mortality and morbidity from diarrheal diseases should be accepted
as a public health problem of communicable disease control.
H emolytic streptococcus diseases.-The epidemiological study of
active immunization against scarlet fever, using as the antigen a
highly purified and tannic acid precipitated toxin, has been continued.
Approximately 1,200 additional children have been added to the
treated group. No loss of immunity with the lapse of time is apparent,
as indicated by any greater occurrence of cases among those treated
earliest. Similarly, retesting of a representative group, 20 months
after the last immunizing dose, showed 88.1 percent Dick-negative
subjects as compared with 84 .1 percent in the sa me children 1 month
after the last dose. The morbidity reports continue to show a great
preponderance of cases among the untreated control group .
The last half of the fiscal year was given over largely to the study of a
suspected metabolic deficiency as a possible factor in a disease hitherto
commonly suspected of having a streptococcal e.tiology. The study
is being continued. Studies were continued on the classification of
hemolytic streptococci, with special attention to a certain group of
strains resistant to phage C. This characteristic is correlated with ·the
epidemiologic characteristic of predominance in cases of septic sore
throat. The group is compared with a group of strains with similar
characteristics, except that those compared are sensitive to phage C.
Strains of the latter group were found to predominate in cases of
scarlet fever. Biochemical studies are in progress to determine what
substance in the streptococcal cell determines sensitivity to phage.
Diphtheria.-The possibility of an extra-human reservoir of diphtheria in the Southern States was explored as part of an effort to
explain the high natural immunity level of the human population in
these areas. Cultures were obtained from 600 horses, mules, and
cattle, but no diphtheria bacilli were isolated. A few diphtheroids
incidentally recovered are being studied for possible antigenicity.
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Pertussis.- Young white rats have been inoculated with Hemophilus
pertussis. The pathological picture has been studied in cooperation
with the Division of Pathology. A semisynthetic culture medium
for H. pertussis has been developed.
Vincent's injection.-In cooperation with the Division of Chemistry,
the possible relation of dietary deficiencies to mouth lesion was
studied in 40 monkeys. The published results indicate that certain
of the dietary deficiencies tested are associated with the development
of varying manifestations of gingivitis, stomatitis, periodontal disease,
and noma. Comparable animals maintained on adequate diets showed
little or no evidence of such oral pathology. In addition, monkeys
maintained on a stock diet showed no evidence of gingivitis or stomatitis when material from affected monkeys was transferred directly
to them.
W eil's disease.-This disease was recognized in New Jersey and
Ne ada for the first time. A few dogs from evada, New York, and
Pennsylvania were found suffering from leptospirochetosis. Two
rats captured in New York were found harboring a virulent strain of
L eptospira icterohemorrhagiae . Diagnostic a.id was given to . the
following States: Florida, Iowa, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Ohio, Virginia,
and West Virginia. Serological studies and typing of various strains
of Leptospira icterohemorrhagiae were continued.
Chagas' disease.-In the course of a field study conducted in Texas,
Triatoma gerstakeri (blood sucking insects) were found naturally
infected with Trypanosoma cruzi . Over 200 live bugs received from
Bell and Live Oak Counties were found infected with Trypanosoma
cruzi. In certain sections of Texas these infected bugs are present
in large numbers.
Epidemic jaundice.- Several epidemics including from 40 to 200
~ases and occurring mostly in school children were recognized in
Michigan, Minnesota, Ohio, and Pennsylvania.
Medical mycology.-Study of 228 specimens received during the
year has yielded fungi causing histoplasmosis, coccidioidomycosis,
chromoblastomycosis, and meningitis. Research studies based on
part of this material are being pursued. Material received from
physicians in Washington, D. C., and San Antonio, Tex., was studied
to determine the fungi causing tinea in these localities.
In cooperation with the Division of Industrial Hygiene, the effects
of ultraviolet radiation of spores of dermatophytes have been studied.
By using large numbers of cultures, consistent results were secured,
showing that wave lengths 2537 A to 2560A are most fungicidal and
most effective in producing mutants, and suggesting that nucleic
acids may be the sensitive components of the cell. The fungicidal
properties of Santophen and Santobrite are being investigated.
Basidiomycetes were isolated during the year from several sputum
specimens. One of these produced mushrooms freely in culture and
has been studied extensively. Monkeys were sensitized to it, and the
fungus could be recovered in culture several weeks after inoculation
of monkeys and guinea pigs, but no progressive lesions were produced.
Its possible significance in pulmonary disease is still being investigated. An investigation is being made in Coffee County, Ala., and
Giles County, Tenn., as a part of an extensive cooperative study, to
determine whether fungi are the etiologic agents in some atypical
·pulmonary diseases.
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Chemotherapeutic investigations. - Preliminary to chemical and
pharmacological investigations on antimalarials, a survey of existing
data in tbis field was made. Synthesis of carbazole derivatives having
potential plasmodicidal action was carried out.
Tropical disease studies in Brazil.-The possibility of the importation into the United States of insect disease-vectors by airplane has
made it advisable to detail a medical officer to Brazil for investigative
work. During the past 8 months he has intensively studied the
Aedes aegypti control program and the viscerotomy service being
maintained in the Brazilian State of Minas Geraes. Particular
attention has been given to aU phases of the program in Minas Geraes
-the methods for searching out hidden foci, the work of special inspectors, the legal aspects of enforcement, the statistical methods
and reports, maps, charts, and the details of the viscerotomy service.
DIVISION OF PATHOLOGY
Surgeon
RALPH
D.
LILLIE
in charge
The amount of experimental pathologic material studied during
the current fiscal year increased about 50 percent over that of the
preceding year, including a total of 2,134 animal autopsies.
Studies were made in cooperation with the Division of Infectious
Diseases on the pathology of poliomyelitis, torulosis, lymphocytic
choriomeningitis, typhus, Rocky Mountain spotted fever, pertussis,
American trypanosomiasis, W eil's disease, my co tic infections, malaria,
maculatum virus infection, influenza virus infection, and tuberculosis.
A decidedly atypical cerebral lesion has been produced in poliomyelitis
by an unusual route of inoculation with a "bulbar" strain of virus.
A viscerotropic strain of lymphocytic choriomeningitis virus is producing marked fatty changes in the liver as well as other unexpected
visceral lesions in mice. Typical brain lesions resembling, but not
identical with, those in guinea pigs have been studied in typhus and
spotted fever infections of house and field mice of various species.
In cooperation with the Division of Pharmacology, studies were
made of the toxicology of sulfanilamide and sulfanilyl sulfanilamide,
of inorganic and organic selenium compounds, and of phenyl hydrazine. With sufficient dosage, important Iesions were produced by the
sulfanilamides. In certain diets, a striking nodular hepatic cirrhosis
was produced by the ingestion of organic selenium.
In cooperation with the Division of Chemistry, studies were made
of the pathology of vitamin deficiencies in monkeys, of scurvy, of
vitamin B 6 deficiency, of low protein diets, of nicotinic acid and riboflavin -deficiencies, and of intoxication with cystineamine. Th e oral
lesions produced in monkeys were strikingly similar for the various
deficiencies. Adrenal lesions are frequent in rats with B 6 deficiency.
The striking bone lesions reported some years ago from cystineamine
poisoning have not been reproduced in the present study.
Studies of the pathology and pathogenesis of trichinosis have been
initiated in cooperation with the Division of Zoology.
One hundred and eleven human tumors and 410 experimental animal tumors have been examined and diagnosed for the National Cancer
Institute.
In November and December 1938 several strains of psittacosis virus
were isolated from a bird colony which was incriminated as the source
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of three human cases. Material for study of the pathology of psittacosis in mice was accumulated and is under study. A lack of cross
immunity with "nine-mile fever" and "Q" fever viruses was shown.
During the year a project tJo study the pathology and bacteriology
of pulmonary calcifications occurring in children in the central Tennessee area was initiated in cooperation with the Division of Infectious
Diseases, and an officer was detailed to the Department of Pathology
of Vanderbilt University Medical School to · secure the necessary
autopsy material.
The study of the topographic distribution of the brain lesions of
poliomyelitis was continued. A grant of $10,000 was received from
the National Foundation for Infantile Paralysis for this study. The
services of an additional pathologist have been engaged for the ensuing
year under the terms of this grant.
Studies of the relation of pinworm infestation to pathologic lesions
in the a:Q.Pendix and of the type of incidence of malignant tumors in
Public Health Service beneficiaries according to age, sex, race, and
occupation are now -being summarized. A study of the behavior of
hemosiderin in relation to acids, fixatives, and other reagents was
completed. The study of the post-mortem pathology of untreated
syphilis in Negroes, initiated several years ago in cooperation with
the Division of Venereal Diseases, has been continued. Nine autopsies
were added during the year, bringing the total to 39.
Autopsy material from other infectious diseases was received from
26 cases, including Rocky Mountain spotted fever (4), tularaemia (4),
trichinosis (3), encephalitis (3), yellow fever (2), histoplasmosis (2),
single cases of Weil's disease, Oroya fever, pertussis, bacillary dysentery, malaria, rabies, and two meningoencephalitides of probable virus
etiology.
Studies are in progress on the effect of pH of storage. formalin on
subsequent staining of ti,ssues after various storage intervals. It is
indicated that the deterioration incident to storage in acid formalin
may be prevented by proper buffering of th_e formalin, and that hyperalkalinity of the formalin is even more harmful. The optimum pH
for storage has not yet been determined.
During the year 2,060 surgical specimens and material from 334
autopsies were received from marine hospitals, Indian Service hospitals, penitentiaries, and other institutions. This material supplied
all the human pathologic material previously referred to, and further
served for the training of junior officers in pathologic diagnosis and
description, and in the preparation of reports of unusual cases for
publication.
DIVISION OF PHARMACOLOGY
Pharmacologist Director
CARL
V OEGTLIN in charge
SELENIUM STUDIES
Toxicity.-A series of experiments was completed to determine the
effects of the continued ingestion of naturally occurring food selenium
in doses comparable with those ingested by man in selenium-endemic
areas. The following results have been obtained:
1. Under favorable nutritional conditions selenium may be tolerated
for many months with no apparent ill effects in daily doses up to 0.3
to 0.5 milligram per kilogram. At this level of intake the excretion
level of selenium m the urine may be as high as 300 to 500 micrograms
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percent. The concentration of blood selenium is usually half that of
the urinary selenium. The deposition of selenium in the hair parallels
that in the tissues, and it may be used as a means of estimating the
extent of selenium storage in the body and the length of time of exposure. The limit of tolerance to selenium is much lowered under
·unfavorable nutritional conditions. On a low protein intake, 0.1 to
0.2 milligram seleniuTI?- per kilogram per day may cause some injurious
effects.
2. The injurious effects produced by the chronic ingestion of naturally occurring food selenium at a toxic level consist of gastric irritation, liver injury, blood destruction, and serous effusions. Gastric
acidity has not been found to be altered in any constant manner.
The blood destruction results in a secondary hypochromic anemia
with a high percentage of reticulocytes. The liver injury is in the
nature of a chronic interstitial hepatitis which may progress to the
stage of atrop~c diffuse nodular portal cirrhosis. Bilirubinemia is
usually slight or absent. Lowered liver efficiency may be demonstrated by any of the following methods: (a) Impairment of the
conjugation of hippuric acid following a standard dose of sodium
benzoate; (b) abnormal retention of intravenously injected bilirubin;
(c) abnormal retention of intravenously injected rose bengal. The
last-named test has been found most sensiti ve and most specific in
discerning liver dysfunction in chronic selenosis.
The nature of selenium in grain and in animal tissues.- It has been
known for some time that selenium in foodstuffs is intimately associated with the proteins. Work done during the past year has shown
that the selenium could be separated quantitatively from seleniferous
wheat or oat protein by such oxidizing agents as bromine in hydrobromic acid or H202. The selenium so split off appears to behave like
inorganic selenium, and it affords no clue as to the chemical nature of
the naturally occurring -compound. Work on the distribution of selenium in the liver and blood proteins in chronically poisoned animals
has been in progress, and the results so far seem to indicate that it is
most intimately associated with the globulins. Tryptic digestion of
the liver proteins appears to liberate the selenium, almost quantitatively, in its naturally occurring form.
The mechanism of action.-The work on the effects of selenium on
respiratory and other enzymes was continued. Experiments were
completed indicating that the primary stimulating phase of oxygen
uptake by certain tissues under the influence of selenium is due to
increased aerobic glycolysis. From this it would appear that selenium
mobilizes intermediary carbohydrate metabolites, the complete oxidation of which is prevented by the poisoning action of selenium
on dehydrogenase. Experiments on the effects of selenium on
cholinesterase, urease, and arginase have shown no effect on the first,
inhibition of the second, and some augmentation of the last. The
evidence appears to indicate that selenium may have specific and
differential effects on certain enzymes concerned with metabolic
processes.
The detoxification of selenium.-Recent experiments have shown
that the toxic effects of the continued ingestion of selenium in its
naturally occurring form can be greatly mitigated in rats by certain
dietary factors. High protein, and also to some extent high fat,
appear to afford considerable protection against selenium; its toxicity
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is greatest in a low-protein, high-carbohydrate diet. The factors
involved in this partial detoxification of selenium are not known.
In experiments with some selenium compounds of known chemical
composition it appears that there may be different detoxification
mechanisms. Thus sodium selenite has been found to be antagonized
to some extent by glucosamine, but diselenodiacetic acid, which is a
convulsant, is not affected by glucosamine, but is antagonized to some
extent by amytal. Some experiments with the selenium analogue of
cystine indicate that it is hepato- and nephro- toxic and that its toxicity
is unaffected by glucosamine.
BACTERIAL CHEMOTHERAPY
R elation of chemical structure to therapeutic action .- It was shown
that sulfur is not essential to antibacterial activity. A large series
of compounds corresponding to sulfanilamide and the diphenylsulfones
was prepared, in which sulfur was replaced by arsenic. Arsenic compounds corresponding to sulfanilamide were inactive ag~inst streptococcic infections in mice, but highly active arsenic compounds
corresponding to the sulfones were obtained. Further study of
related compounds demonstrated that: (1) Nitro groups were more
important than amino groups, the greatest activity being shown in
the nitroacetylamino diphenyl arsenic compounds; (2) acetylation of
the amino group improved the therapeutic index. This led to the
study of simple nitro compounds; and therapeutic activity, chiefly •
against experimental pneumococcus infections, was shown for paranitrobenzoic acid and some derivatives. Other stages of oxidation,
such as amino- or nitroso-benzoic acids, were inactive. This confirmed the importance of the nitro group and also the fact that sulfur
is not essential.
In therapeutic index, these compounds are inferior to sulfanilamide,
but they afford two new types of chemical substances, in a study of
which the chemical approach to the p10blem can be developed.
Mechanism of action of sulfanilamide.-The importance of the nitro
group suggested that the amino group of sulfianilamide might be
oxidized in the body to a more active compound. Because of its high
bacteriostatic and antica.talase properties in the test tube, thehydroxylamine oxidation product has been suggested by other investigators
as the compound formed in the body from sulfanilamide which is
responsible for its therapeutic effects .
. No satisfactory methods were available for the estimation of the
oxidation products of aromatic amines in body fluids. Colorimetric
methods have been developed for this purpose, particularly applicable
to hydroxylamines. It has been possible to demonstrate hydroxylamine derivatives as well as further oxidation products of the
amino group in the urine of the rat, rabbit, dog, and man after oral
administration of sulfanilamide. This is further evidence that
sulfanilamide may act through its oxidation products. The colorimetric tests which have been developed have possible application to
the study of many other aromatic amines.
Virus irifections.-The protective action of Prontosil against
choriomeningitis virus infections in mice, previously reported by this
Division, has been questioned by the work of others. We have
confirmed our original findings of a weak action of Prontosil and of
the inactivity of sulfanilamide against this virus.
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Toxicity studies.-The toxicity of sulfanilamide and of sulfanilyl
sulfanilamide ("di-sulfanilamide") upon repeated administration to
rabbits and chickens gave a picture different from the acute toxicity.
Cumulative and delayed effects were seen. This emphasizes the fact
that acute toxicity is no reliable index of results to be obtained on
repeated administration. A relation of toxicity to diet was also
suggested by this study. Rabbits on an oats diet were much more
susceptible to toxic effects than those on a cabbage diet.
DIVISION OF PUBLIC HEALTH METHODS
Senior Surgeon JosEPH W. MouNTIN in charge
This Division has centered its attention on problems of health and
sanitatjion which confront workers in State and local health departments. Most of the investigations conform to three general types:
Definition of national, State, and local health problems; appraisal of
existing procedures; and perfection of methods applicable to current
health department practice. In other instances the pursuit of basic
research seemed essential to further progress. For purposes of clarity
in presentation, the several and often related lines of inquiry are
summarized under a few descriptive categories.
MORBIDITY AND MORTALiTY
•
There has accumulated in this Division a large mass of morbidity
material that is being used for studies of the incidence of various
diseases and the medical care received, in relation to occupational
class, income, sex, age, and other factors. In such studies mortaliity
data are used to supplement sickness survey records.
Current reports.-Provisional mortality summaries continue to be
prepared on a quarterly bas~s from data supplied by State health departments. These· summaries include not only the death rate from
all causes but also rates for a number of specific conditions, together
with comparative data for p:re,ceding years; they constitute the
earliest available material on mortality in the United States.
Baltimore survey.-The study of illness in the general white population of the Eastern Health District of Baltimore, Md., was continued
throughout the fiscal year. Visits to the 1,500 families under observation have been made regularly at monthly intervals. Facts about
illness and all medical and dental care, whether preventive or therapeutic, are meticulously recorded; and an equally careful record is
kept of changes in employment and wages for each member of the
household. These sets of records will afford accurate observations,
recorded near the time of the events, for a careful study of illness
and medical care in relation to changes in economic status. Emphasis
is placed upon the occurrence of chronic diseases in relation to the
family's economic status after the development of the disease, with
special reference to the effect of catastrophic illness on the stability of
the family, the education of the children, 'and other sociological
factors.
Communicable diseases.-,-Analysis of the data on communicable
diseases in 200,000 families, surveyed in connection with the National
Health Survey, bas been continued. Although the common communicable diseases of childhood-measles, whooping cough, chickenpox, and mumps-are commonly thought of as occurring only in frank
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and typical attacks, these data indicate that a number of mild,
unrecognized cases of these diseases do apparently occur. Another
significant indication from this survey is that diphtheria is now
more prevalent in the South than in the North, although the reverse
was true about 25 years ago. Part of this shift seems to be attribut. able to a greater use of artificial immunization by toxin-antitoxin or
toxoid in the North, but other factors seem to be at work also.
National Health Survey.- Tabulations were completed during the
year for this study of illness and medical care, begun in 1935 and
covering a population of about 2,800,000 persons in 84 cities in 19
States, and in certain rural areas. The processing, analysis, and presentation of material were continued as a part of the regular work of
the Division, including a computing unit in Philadelphia, Pa. A series
of preliminary reports (1 introductory, 11 on sickness and medical
care, 5 on population, and 7 on hearing) were issued during the year,
bringing this stage of the work to completion. A number of articles
presenting National Health Survey data were published in outside
journals. Analysis has reached the stage of preparing final reports,
two of which have already been completed.
HEALTH PROBLEMS OF TRANSIENTS
Tabulation and analysis of case data have been completed for a
sample of the transient population of 15 States. In the manuscript
now being prepared for publication are embodied findings as to the
medical problems; the social, economic, and administrative difficulties; and the legal concepts that are involved in the presence in communities of persons called "transients." The case histories discussed
and summarized were secured by interviewing applicants for public
assistance in over 200 agencies in 20 cities and towns. In all, about
1,900 families and 9,000 transient unattached persons,· representing
over 16,000 individuals, were studied. Interviewing was done by
trained case-workers and nurses familiar not only with the localities
in which they worked but also with the specific characteristics of the
migrants found there. The principal difficulty found in handling the
so-called migrant population is a legal one, caused chiefly by the diversity of settlement laws and poor laws among the States. It is quite
possible for a family or individual to lose the right to public assistance
in his home community before being able to gain that right anywhere
else. A solution for the major part of the problem appears to lie in
the direction of intelligent control of unnecessary migrati9n, adequate
local medical care facilities for dependent groups, and reexamination
of t,he legal concepts of settlement with a view to uniformity of laws.
CANCER.
Statistical investigations of cancer, although functionally a part of
the National Cancer Institute program, are carried out under the
administrative direction of the Division of Public Health Methods.
An intensive study of the trend in the recorded mortality from cancer
was made from basic tabulations obtained from the Division of Vital
Statistics, Bureau of the Census. This investigation included a detailed analysis of the trend in mortality from cancer in different
geographic area,s and among the various age, sex, and racial groups
of the population.
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A study of the incidence of cancer was begun in the early spring of
1938 and continued throughout the past fiscal year. The plan necessitates the collection of reports from all physicians, hospitals, and
clinics located within selected study areas, of all patients with a diagnosis of cancer who came under the observation of the physicians or
institutions during the preceding 12 months. In the epidemiological
study conducted by tms Division, an attempt is made to determine
the extent to which a variety of factors (occupational, environmental,
familial, racial, dietary, medical, and social) may be related etiologi ..
cally to cancer. Special interest centers around those factors which
for many years have been popularly regarded as important in th~
occurrence of cancer, but for which no convincing data are available.
A study on the effect of cancer therapy comprises the collection of
pertinent data from the case records at selected hospitals and the
combination of these data to represent the aggregate experience of
these institutions with the various methods of treatment of cancer
at different sites and with varying degrees of severity. Anticipating
a gradual expansion of State and local cancer control programs, and
the consequent increase in demands upon the Public Health Service
for technical consultation and aid, this Division has established contact
with the various cancer control programs in the country.
PNEUMONIA
A survey of pneumococcus type incidence was undertaken in six
localities which were considered representative of large regions known
to have either consistently high or consistently low pneumonia mortality rates. This survey has been intimately bound up with the
development of State pneumonia control programs. Bacteriologic
examinations incidental to the study have led to the widespread
adoption of checks. on the performance of local laboratories; this, in
turn, has resulted in improved standards of laboratory work. An
acutely controversial situation in the field of pneumonia therapy, and
the resultant confusion among administrators of control programs, led
to the initiation of a statistical evaluation study of the most widely
used methods. Although this study has been commenced on a very
modest scale, it will be extended as funds permit, in order that a
prompt evaluation of both established and newly introduced procedures may be made and a sound basis for administrative action
provided.
CHILD HYGIENE
Dental ca,ries.-Upon a background of intensive work in this field,
reports published during the year dealt with the relative immunity
and susceptibility of the different morphological types of teeth to
attack by caries, with the relationship between time of tooth eruption
and subsequent history of caries, and with familial characteristics of
dental disease. As indicated last year, the technique for determining
"tooth age" and the application of this concept to the study of caries
have served an important function in reducing the complexities of
investigations on this disease. In addition to the systematic ".'tudy
of basic factors, other reports dealt with the needs for dental service
in the general population and with methods for measuring these needs.
Heart disease.-Studies on rheumatic fever furnished further details
regarding familial factors. Of particular interest are the findings that
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relatively more female than male offspring of rheumatic mothers
manifest the disease and that a higher incidence is found among the
maternal than among paternal aunts and uncles of index cases of
rheumatic fever. Studies of the electrocardiograph-stethograph continue to indicate that this technique offers an objective methodology
of considerable value in school health examinations. While additional
work is necessary before conclusive results can be claimed, it, is apparent that useful diagnostic criteria based on objective cardiometric
records will be made available.
Defects of hearing.-Results of studies in this field show the significance of early impairment of hearing acuity for high tones; other
studies on children with marked hearing defects show that complete
loss of auditory acuity is rare, and point the way to possible remedial
measures.
Tuberc11losis.-Work was continued at Hagerstown, Md., for the
purpose of clarifying differences of opinion regarding recent reports
on the place of the tuberculin test in health service programs. Children and adults were given X-ray examination of the chest and were
tested with several commercial tuberculin products. Results indicated wide variations in the reactions obtainable with different tuberculin products. While there is general agreement on the interpretation
of X-ray evidence of active tuberculosis, there is considerable variation
in the interpretation of primary calcified lesions.
Nutrition.-During recent years there has been a growing conviction that new paths to better health are to be found in improved
nutrition and a more efficient utilization of the Nation's abundance
of foodstuffs. Several studies bear~ng on this problem were undertaken. One, a survey of diets of the lower economic class in Washington, D. C., showed the character of major deficiencies and furnished valuable information on a new methodology for studies of
this kin,d. Another study was ·designed to giv_e relatively complete
data on the diet, physiological status, and medical condition of a
large group of needy children of high-school age in New York City.
Results of the interpretation of the records are expected to show the
principal dietary deficiencies, and their important physiological consequences, and to point the way for better health through improvement in nutritional status.
Obstetric care.-Records for 10,000 Michigan women show extreme
variation in both the quantity and quality of medical service received during pregnancy and childbirth. If the procedures adopted
by specialists in obstetrics are taken to represent standards of good
practice, serious defects appear in the practice of many birth a.ttendants. The most striking of these are the use of pituitrin before
delivery, manual dilatjon of the cervix, manual reinoval of the placenta, failure to use aseptic techniques, and frequent vaginal examinations and use of forceps. A relatively large share of deficiencies in
service fall upon women in the lower economic groups, upon those
delivered at home and those living in rural communities.
ENVIRONMENTAL SANITATION
The Stream Pollution Investigations Statjon at Cincinnati, Ohio,
has been materially expanded during the year to carry out the assignment of stream examinations comprising a part of the Ohio River
188796-40--6
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Pollution Survey authorized by the Rivers and Harbors Act of 1937,
in cooperation with the United States Army Corps of Engrneers.
Sewage treatment.-The fundamental biochemical and biologic reactions motivating the oxidation of organic matter in liquids, as
exemplified by the activated sludge method of sewage treatment,
have been under continued observation. Research work completed
and published during the year has established the influence of bacterial
numbers on oxidation rates and the variations in the oxidation, adsorption, and synthesis components of total purification as related to
the quality and quantity of both sludge and nutrient material in the
aerated mixture. This knowledge is of immediate practical application, in effecting more consistently efficient operation of activated
sludge sewage treatment plants.
Stream recovery.-This study was undertaken to evaluate, in terms
of stream improvement, the activated sludge process of sewage treatment. Observations on the Scioto River were continued throughout
the fiscal year, following the inauguration of activated sludge treatment of Columbus, Ohio, sewage. Sufficient data have been obtained to estimate the permanent improvement that may be expec.t ed
in the sanitary condition of a river when sewage treatment is
provided.
Inventory of sanitation works.-A continuing inventory of water
purification and sewage treatment works and of water pollution problems in the United States was inaugurated during the latter part of
the year. This activity should provide information of value in the
future study of water pollution problems and in the planning and
design of works for their abatement.
Stream oxidation.-Measurements of oxidation rates in samples of
Scioto River sludge deposits were continued unt,il mid-August, when
they were discontinued, after a full year of observations, in order to
accommodate certain preliminary arrangements for the laboratory
phase of the Ohio River pollution survey. The results of these observations are the only portion of the study thus far unpublished.
Ohio River Survey.-A major activity instituted during the year
has been the laboratory work in connection with the Ohio River
Pollution Survey covering 280 miles of the Ohio River between the
mouths of the Kanawha and Kentucky Rivers and some 37,000 square
miles of tributary area draining into this stretch of the river. This
work is being done at the Cincinnati laboratory, in a floating laborato:ry located near Ashland, Ky., and in two mobile laboratories which
will cover the upper portions of the tributary areas. The results
thus far obtained have shown certain definite zones of pollution in
the Ohio proper and also numerous aTeas of pollution in the main
tributaries below sewered communities.
Diarrhea-enteritis outbreaks.-An epidemiological study has been
inaugurated to establish more definjtely, if possible, the origin and
mode of transmission by which such infections are conveyed, in order
that proper control measures may be established. The epidemiological observations are confined to the area of the Ohio River watershed, with more intensive efforts concentrated upon the Cincinnati
metropolitan district.
.
Milk pasteurization.-Work was continued on the development of
a method for determining the relative margins of safety afforded by
various time and temperature combinations for pasteurization. In
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this connection, study has been made of a strain of Escherichia coli
(Strain 3U) to determine its usefulness as a test organism in studying
the efficiency of pastemization equipment and of the bactericidal
treatment of milk containers and equipment.
Temperature differences in pasteurizers.-At the present time the
most satisfactory method for determining simultaneous temperature
differences in pasteurizers is by means of thermocouple-potentiometer
equipment. However, since very few health departments have the
necessary thermocouple-potentiometer equipment for making this
test, study has been given to the development of a simple field test
which would be suffimentJy accurate to use for routine testing work.
Paraffining of containers.-Discussion has arisen as to the bactericidal effect of the paraffining process for paper containers. There- .
fore, a study was begun to determine by what percentages the numbers of the test organism, Escherichia coli (Strain 3U), on small pieces
of container board, are reduced after paraffining at different temperatures for various periods of time.
Phosphatase test.-The laboratory participated in two studies of
the phosphatase test, at the request of the associate referee appointed
by the As.s ociation of Official Agricultural Chemists to study and
report upon methods for the determination of the proper pasteuriza- ·
tion of milk and dairy products.
Sanitation codes.-Owing to the variation, and hence the confusion,
in ordinances and regulations pertaining to sanitation, the Division
has devoted particular attention to the development of model codes
that might be submitted, upon request, for local adoption. The first
to be perfected several years ago was the Public Health Service Milk
Ordinance and Code which has been accorded wide acceptance. A
frozen desserts ordinance and accompanying code was released during
the year in tentative draft for experimental use. Other ordinances
and codes being formulated cover water supplies and establishments
serving food or beverages.
Advisory service in milk sanitation.-In connection with the pasteurization studies and the development of the milk ordinance, this
Division was called upon to render a large amount of advisory service
to State and local health departments. Since this work seemed more
allied with the functions of the Division of Domestic Quarantine
(States relations), a transfer of field consultant activities to the
Sanitation Section of the latter Division was effected late in the
fiscal year.
·
PUBLIC HEALTH FACILITIES
Personnel.-The public ·health administrative structure of the
United States as a whole was examined from the standpoint of staff
organization and training. To this end, detailed personnel blanks
were secured from some 18,000 full-time employees in 1,115 State,
county, and municipal health departments. Data thus assembled
will show both the strong and the weak points of health organization,
and more especially the training needs of personnel.
Perjormance of health agencies.- In cooperation with the Division
of Domestic Quarantine, data were assembled showing the total
volume of service rendered by all health departments aided under
title VI of the Social Security Act and, in a more detailed fashion,
current practice in a representative sample of county health depart-
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ments. From the analysis of this material it is possible to obtain
both a general review of operation for local health service as a whole
and a more meticulous appraisal of activities on a sampling basis.
Health education.-To estimate the level of popular understanding
in health matters, persons visiting the Public Health and Medical
Building at the New York World's Fair were invited to complete a
test form for immediate rating by an automatic scoring device. The
health exhibit as an instrument in education is evaluated by another
procedure which elicits the reaction of visitors to models on display.
During the year, processing and analysis were continued on the stenographic record of nursing visits to the home, a study designed to
evaluate the spoken word as a technique in health education.
. Medical care.-Studies have been made of certain medical service
plans for clients of the Farm Security Administration. In North
Dakota and South Dakota, it has been possible to obtain detailed
data on the scope, volume, and cost of medical services. Systems of
reporting are being worked out for other States and counties, in order
to make available an accurate picture of the operation of these medicalservice plans each month.
Hospitals.-The hospital, and the facilities it represents, seems
destined to occupy a position of increasing importance in the movement for better health. The Division, therefore, has made studies
to determine the distribution of hospitals throughout the United
States and the availability of hospital service to persons of different
economic circumstances.
DIVISION OF ZOOLOGY
Professor
WILLARD
H.
WRIGHT
in charge
During the year, the research work of the division was centered
mainly on the problems of trichinosis, oxyuriasis, and amoebiasis,
conditions caused by animal parasites which are widely distributed
and difficult to control.
TRICHINOSIS
Incidence and epidemiology.-Surveys on the incidence of trichina
infection in man have been continued in an effort to determine the
extent of the trichinosis problem and to provide information which
might aid in the control of the disease.
.
The original series of examinations of diaphragms froin hospitals
in Washington, D. C., Baltimore, Md., and several other cities in the
East was completed, the number of examiµations having reached the
statistically significant total of 3,006, of which 488, or 16.2 percent,
were positive for trichinae.
In a series comprising diaphragms from hospitals selected at random
in various parts of the United States, 617 diaphragms have been
examined, of which 112, or 18.2 percent, were positive for trichinae.
A so-called rural series was inaugurated during the year; this series
consists of diaphragms from persons who had resided on farms or in
villages of 1,000 population or less. Because of differences in the
type of exposure, it was anticipated that persons in rural areas might
be less frequently infected with the parasite than those in the urban
groups. In this series, 118 diaphragms have been examined, of which
only five, or 4.2 percent, were positive for trichinae.
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The above-mentioned examinations, together with those in other
series, have brought the total number of diaphragms examined to
4,163, of which 678, or 16.3 percent, were positive.
In a survey designed to determine the relation of municipal garbagedisposal methods to the dissemination of the trichina parasite, replies
to a questionnaire were received from health officers in 764, or 79.3
percent, of the 964 cities having a population of 10,000 or over. A
total of 398, or 52.1 percent, of the 764 cities disposed of municipal
garbage in whole or in part by feeding it to swine. As garbage from
only 29 of the 398 cities was cooked before its consumption by swine,
it is apparent that American municipalities are contributing substantially to the spread of trichinosis.
Biology.-In attempts to determine the variation in individual
susceptibility of albino rats to trichina infection, litter mates of known
genetic lineage were infected with equal numbers of counted encysted
larvae. In spite of extreme care in technique, there was a marked
individual variation in the number of trichinae obtained post mortem
in the various rats, the larval counts varying by 50 percent or more.
Judgment must therefore be exercised in interpreting results of experiments in the immunology and therapy of trichinosis when rats are employed as experimental animals.
Diagnosis.-Facilities have been taxed to meet the increased demand
for the improved trichina antigen developed in the Division. During
the year, over 4,000 intradermal doses of this antigen were forwarded
to physicians and hospitals in the United States, Canada, and Mexico.
An extensive outbreak of trichinosis at Bellows Falls, Vt., gave staff
members an opportunity to confirm previous observations concerning
the efficiency of the antigen both in intradermal and precipitin tests.
Therapy.-A total of 844 mice was used in experiments designed
to evaluate the efficacy of 26 different dyes in the treatment of trichinosis. Most of the dyes were without promise. However, compounds
of diazotized benzidine coupled with amino-naphthol-sulfonic acid
(alkaline) and 1-amino-8-naphthol-3,6 disulfonic acid seemed to
warrant further study.
OXYURIASIS
l ncidence.- During the year, approximately 910 persons in or near
Washington, D. C., were examined, bringing the total number examined io about 3,060. Included in these findings was an incidence of 12
percent in 180 institutionalized boys. The remaining patients were
from the general population of Washington and were contacted for
the most part through a clinic at Providence Hospital. Pinworms
were found in 43 percent of 440 white persons and in 19 percent of
290 Negroes. In children in nursery schools, there was an incidence
of 42 percent in 69 white children and an incidence of 17 percent
in 77 T egro children. This racial difference in incidence conforms
to findings of previous yea.rs.
Biology.- A study was made of the chemical nature of the various
layers of the shell of the pinworm egg, with a view of ascertaining
the type of chemical necessary for the destruction of the ova. It
was concluded that an ovicide must be capable of dissolving both
proteins and lipoids in order to reach the embryo within the egg.
Pinworm eggs were found in dust collected from all levels of all
rooms examined in homes of infected individuals. The results apparently indicate that the eggs are carried by air currents, an<l that
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infection by inhalation is theoretically possible and should be considered in the prophylaxis and therapy of oxyuriasis.
Unsuccessful attempts were made to establish infection with the
human pinworm in rats on a vitamin A-deficient diet. Apparently
the rat is not a suitable animal for use in biological studies with this
parasite.
In cooperation with the Division of Industrial Hygiene, the effect
of monochromatic ultraviolet radiation on pinworm eggs was investigated. Wave lengths below 2400A were found most effective in
destroying the ova. There was a close inverse relationship between
the percentage of larvae surviving and the amount of energy used.
Larvae which hatched from irradiated ova remained viable for shorter
periods of time than did those from nonirradiated ova.
Diagnosis.-The comparative efficiency of single and multiple NIH
anal swab examinations was determined on two series of patients. In
one group of 329 persons, the use of four swabs on different days, but
not on consecutive days, disclosed 208 cases of pinworm infection, of
which 64 percent were revealed by the first swab. In another group
of 265 persons, four swab examinations revealed 42 cases, of which
50 percent were found on the first swab.
The comparative efficacy of various techniques in disclosing pinworm infections was studied at New Orleans, La. In a total of 136
children, brine flotation detected 14 percent of the positives, the zinc
sulfate flotation, 18 percent, and the first NIH swab examination, 73
percent. A total of 7 swab examinations detected over 99 percent of
the infections.
Symptomatology and therapy.-At Washington, case histories were
obtained on 220 patients, while 197 individuals were treated experimentally. Very satisfactory results have been obtained with the use
of gentian violet tablets provided with a water-soluble coating. At
New Orleans, controlled experimental treatment with these tablets on
135 patients confirmed in full the results of the Washington tests. As.
a result of these and previous experiments, a satisfactory treatment
for pinworm infection is available for the first time.
AMOEBIASIS
Jncidence.-Incidence studies were continued by the Tulane Amoebiasis Unit, New Orleans, La. In three children's institutions,· Endamoeba histolytica was found in 26 percent, 4.4 percent, and O percent 1
respectively, of the inmates. The highest incidence was found in a
suburban institution in which cesspool drainage may have been a factor
in the spread of the infection.
Diagnosis.-In the New Orleans studies, the zinc sulfate flotation ·
method was found eminently superior to other methods for the isolation of amoeba cysts and helminth ova from stools.
In an effort to obtain uncontaminated cultures of E. histolytica for
antigen purposes, a special microisolation apparatus was designed. A
large number of single-cell isolations were made both of trophozoites
and cysts. While many of the culture tubes remained sterile following
the transfers, amoebae failed to reproduce in any of the cultures.
Attempts are being made to obtain growth in symbiotic environments.
with single species of bacteria.
Pathogenicity.-In cooperation with the Office of Nutrition, parasitological surveys were made on institutionalized patients on a pel
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lagra-producing diet. High incidences of E. histolytica and other intestinal parasites were encountered. A resurvey, after the use of the
diet for approximately 6 months, indicated that it in no way influenced infection with any of the intestinal parasites. Clinical observations failed to disclose any exacerbations in the amoebic infection
in any of the patients. Because of the absence of frank symptoms of
amoebiasis, the pathogenicity of several strains of the parasite was
determined by inoculation into kittens. Evidence indicated that the
strains were of very low virulence.
OFFICES OF COOPERATIVE AND EPIDEMIOLOGI CAL STUDIES
Medical Director
JAMES
P.
LEAKE
in charge
CO OPERATIVE STUDIES
A cooperative study designed to show the power of rapid vibrationof the order of sound vibration-to extract important substances from
bacteria was carried out in the department of bacteriology, University
of Pennsylvania. When subjected to "sonic" disintegration, young
cultures of the whooping cough bacillus yielded a soluble substance
capable of absorbing from powerful antiserum the immune bodies
which produce agglutination. No other extracts obtained in the experiments were capable of producing this result.
At Johns Hopkins University School of Medicine, attempts have
been made to produce hormones, including some of the sex hormones,
from cultures of human gland cells grown in glass outside the body.
Studies on the physical character, chemistry, and biology of leprosy
bacilli and leprous nodules are in progress in the department of anatomy, Washington University, St. Louis, Mo. A method has been
devised to separate the bacilli from the tissue of the leprous lesion
successfully. The mineral content of the bacilli has been found to be
very small.
At Johns Hopkins University School of Hygiene, fundamental
studies on nutrition were continued. Following the discovery, mentioned in last year's report, that supposedly fat-free diets did actually
contain appreciable fat, a much more nearly fat-free diet was devised.
R ats fed on the new diet grew and reproduced normally. Thus it
appears to be probable that all the fat-soluble vitamins necessary for
the normal development of the rat have been discovered. During the
year, it was proved that a deficiency in the supply of vitamin Eis at
least one of the factors responsible for nutritional muscular dystrophy
in the rabbit.
At George Washington University School of Medicine, a systematic
study of the techniques used for finding the tubercle bacilli in fluid
from tuberculous meningitis has resulted in demonstrating the superiority of chloroform when used in concentration of the bacilli for microscopic diagnosis.
EPIDEMIOLOGICAL STUDIES
The proved occurrence of equine encephalomyelitis in man during
the past year has been a disturbing discovery. All the evidence points
to mosquito-transmission of the Eastern type of this disease in horses;
and it has been assumed that this method of transmission, feasible
experimentally, holds for the Western type in nature. The demonstrated human cases of the Eastern type have been predominantly in
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children. The proved cases of the Wes tern type have not been so
numerous, so localized, nor so definitely juvenile. In addition to the
38 cases of the eastern type discovered in Massachusetts, on which
reports have been made from the Massachusetts Department of
Health, the Harvard Medical School, and the Rockefeller Institute,
three probable cases were found in Rhode Island.
North D akota reported the heaviest incidence of encephalitis
during the autumn of 1938, among the 48 States. It appeared likely
that some of these cases were of the St. Louis type, in distribution
and character; on the other hand, some may have been of the Western
equine encephalomyelitis type. Mosquito protection would appear
to be reasonable as a preventive measure, although mosquito eradication over the wide range of the equine disease seems impracticable.
PUBLICATION S
In the past year, three National Institute of Health Bulletins and
nine Public Health Bulletins have been prepared. Two bulletins
published prior to 1938 were revised and reprinted.
The number of scientific articles recommended for publication in
Public Health Reports totaled 137, while 25 others were issued in
other Service publications.
T wo hundred and ninety-two papers were approved for presentation
before scientific meetings and subsequent outside publication, or for
outside publication alone. In addition, 56 scientific papers were
reviewed critically in response to requests from other divisions of the
Public Health Service, or some other department of the Government.
NATIONAL CANCER INSTITUTE
Pharmacologist Director
CARL
V OEGTLIN in charge
'I'HE NATIONAL ADVISORY CANCER COUNCIL
The National Advisory Cancer Council met five times during the
year. Forty-nine applications for grants-in-aid have been considered.
In several instances it was deemed advisable to appoint special
subcommittees to study individual applications and to report to
the council. Thirteen grants to the following applicants were
recommended:
University of Chicago, Chicago, Ill.
Dr. B. R. ebel, New York State Agriculture Experiment Station,
Geneva, N. Y.
University of Cincinnati, Cincinnati, Ohio.
Dr. Harrison S. M artland, City Hospital, Newark, N. J.
The American College of Surgeons, Chicago, Ill. (2 grants).
Dr. John J. Bittner, Jackson Memorial Laboratory, Bar. Harbor,
Maine (2 grants).
Meharry M edical College, Nashville, T enn.
Cornell University, Ithaca, N. Y.
University of California, Berkeley, Calif.
Society of the New York Hospital, New York, N. Y.
Barnard Free Skin and Cancer Hospital, St. Louis, Mo.
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Ten of these grants, amounting to $68,002.50, were paid during
the fiscal year; and three , amounting to $17,960.00, will be paid early
in the fiscal year 1940.
·
The terms of two members of the
ational Advisory Cancer
Council, Dr. James Ewing and Dr. Francis Carter Wood, expired in
November 1938. The vacancies were filled by the appointment of
Dr. James B. Murphy, of the Rockefeller Institute, and Dr. Mont R.
Reid, of the University of Cincinnati Medical School.
Sixteen research fellows were on duty during the year, eight working
on studies directed by the ational Cancer Institute, and eight on
studies under the immediate direction of other institutions.
Twenty-nine new trainees in the diagnosis and treatment of cancer
were appointed during the fiscal year.
In accordance with section 5 (a) of the ational Cancer Institute
Act, 9}~ grams of radium were ordered by the Institute in June 1938.
Approximately 1 }~ grams will be retained by the Institute for fundamental cancer research and for use in the clinical cancer research center
at the Marine Hospital, Baltimore, Md.; 8 grams are available for
loans to hospitals. All of the radium h as been delivered to the United
States Bureau of Standards, where testing is progressing as rapidly as
the staff is able to handle it.
Many details have had to be worked out in preparation for the
making of radium loans. In order to avoid injury to persons or goods,
particularly films, radium 'must be packed in lead containers before it
is shipped. As a preliminary to setting up specifications for the
Institute's shipping containers, a conference was held with the
R ailway Express Agency, radium companies, and manufacturers of
films. Standards were established for thickness of lead to be used in
shipping various quantities of radium, and containers conforming to
these standards were ordered.
Fifty-five applications for loans of radium have been received from
institutions in the United States and Hawaii. These applications have
been carefully considered by a committee appointed to report upon the
qualifications of the radiologists who will administer radium treatment
in the hospitals, the standards of the instituticm, the number of cancer
patients treated, and the amount of radium already available in the
community. Forty-three applications have been approved so far, and
decision on others is pending.
Borrowers of the radium will be required to sign a contract binding
them to replace any lost radium, to make no charge to patients for the
actual use of the radium, to give preference in the use of the radium to
patients in the low-income group, and to permit treatment to be given
only by radiologists whose qualifications are the equivalent of those
required of diplomates of the American Board of Radiology. It is
expected that the first shipments will be made early in the next fiscal
year. Instructions on how to store radium in order to prevent injury
to personnel have been prepared and will be sent to each borrower.
Dr. John E. Wirth, formerly director of the Tumor Institute of the
Swedish Hospial, Seattle, Wash., has been appointed director of the
clinical cancer research center at the Marine Hospital in Baltimore.
The new construction and renovation necessary to provide adequate
quarters for the research center is virtually complete a,nd the major
portion of the equipment has been purchased. It is expected that the
center will be opened on or about September 1, 1939.
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In response to a resolution passed by the Conference of State and
Territorial Health Officers in April 1938, requesting the National
Cancer Institute to prepare a model cancer control law for the information and guidance of the States, an analysis was made of existing State
cancer control legislation. A model law was drafted and was submitted
to the same organization for consideration at its meeting in April 1939.
A summary of the cancer control activities conducted by State
health departments and State cancer commissions was prepared and
mimeographed for distribution. An educational folder on cancer for
general distribution to the public has been prepared and will be available early in the next fiscal year.
·
Statistical studies by the Division of Public Health Methods, concerning the mortality, incidence, and effectiveness of treatment of
cancer, were supported by funds from the National Cancer Institute.
CANCER RESEARCH
The Committee on Fundamental Cancer Research, appointed last
year, has submitted its report and recommendations concerning the
lines of research which merit investigation. The report has been
printed and made available to the scientific professions.
Lun'g tumors.- Precise information was obtained on the time of
appearance of pulmonary tumors in strain A mice by injections of
carcinogenic hydrocarbons and on the results of transplantation of
both induced · and spontaneous pulmonary tumors. The primary
tumors are all similar in appearance, but on several transplantations
three types of tumors were obtained: (1) A glandular tumor resembling the primary growth; (2) an atypical growth of carcinomatous
appearance; and (3) a spindle type cell growth. Lung tumors were
induced in strains of mice which are very resistant to spontaneous
pulmonary tumors. They can also be induced in strain A mice by
2-amino-5-azotoluene or by 3 :4 :5 :6-dibenzcarbazole. On the other
hand, injections of radioactive substances (ores and thorotrast) failed
to produce lung tumors.
Air dusts and soot were collected and subjected to chemical fractionation. Upon injection into mice, some of the fractions produced
sarcomas. Mice born and raised in a dust-free atmosphere were
found to be just as susceptible to induced lung tumors as control mice
exposed to dusty cages, a fact which suggests that dust per se is not a
factor in etiology of these chemically induced tumors. Further
observations were made indicating important differences among
different mghly inbred strains of mice with respect to susceptibility to
induced lung tumors.
A systematic investigation of the histogenesis of chemically induced
Jung tumors in mice indicates that (l) the development of these
tumors is not preceded by an inflammatory reaction, and (2) that
perhaps all such tumors arise from the alveolar lining cells. The
latter point is being investigated from the embryo]ogical standpoint.
No proliferation of supporting cells has been observed. A study of
pulmonary metastases in mice indicates that they were blood borne .
. Breast cancer.- Investigations of breast cancer were continued
partly in collaboration with the Roscoe B. Jackson Memorial Laboratory. Practically all of the virgin female C 3H mice developed spontaneous breast cancer; thus, the particular value of this strain for
research on this subject is indicated. Diethylstilbestrol, though a
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potent estrogen, did not evoke breast tumors as readily as did
estrin. Testrosterone injections inhibit the appearance of breast
cancer in breeding 0 3H female mice.
Further work on the influence of foster-nursing upon the occurrence
of breast cancer yielded interesting results. Foster-nursing of 0 3H
young by 057 black mothers lowered the incidence in the young from
nearly 100 percent to 25 percent, if the young had been left with their
natural mothers 17 hours or less. This shows that very little 0 3H
milk is necessary for the development of mammary tumors, and suggests that some of the 0 3H young might develop tumors without having
nursed from their natural mothers at all. Foster-nursing young C57
black mice to 0 3H mothers increased the breast cancer incidence from 1
percent to 9 percent. Thefirstmilkisnotessential to tumorformationthat is, the causative agent is present in the milk throughout the
lactation period. This work was extended to include reciprocal
hybrids made by crossing representatives of inbred high (A) and low
(B) tumor strains of mice. Preliminary data indicate that females of
the first hybrid generation, used as breeders, having high or low
tumor strain maternal parent, but nursed by high cancer stock
females, have a high breast cancer incidence. Animals derived by the
same matings, but nursed by low tumor strain females, are producing
a low incidence. The second generation animals are giving results
jndicative of a one factor ratio.
A theory of breast cancer etiology has been advanced which postulates: (1) A "breast cancer producing influence" transferred in the
milk of cancerous stock females to their progeny; (2) an inherited
breast cancer susceptibility, probably a single dominant; and (3) a
hormonal stimulation of the mammary gland.
Foster-nursing of male mice of strains both relatively susceptible
and resistant to the chemical induction of tumors did not alter the
susceptibilities of the mice to the formation of tumors induced by
hydrocarbons.
Liver tumors.- Five strains of mice, injected with 2-amino-5azotoluene, revealed considerable differences in susceptibility to the
formation of liver tumors. This indicates that the genetic constitution
is a factor in the etiology of liver tumors. Some of these tumors have
been cultured in vitro for several months. An improved medium for
the culture of liver tissue has been developed. Cytological studies of
such cultures were made.
Miscellaneous tumors.- The gastric hyperplasia observed in strain I
mice is more pronounced in males, is being inherited as a recessive
characteristic, and apparently is not due to infections or vitamin A
deficiency.
The claims of tumor production by feeding rats with ether-extracted
wheat germ oil have not been confirmed so far.
Benzene extracts of normal and cancerous human livers, and similar
extracts of livers of mice with spontaneous tumors, have not induced
tumors.
Extensive studies have failed to demonstrate virus protein or virus
activity in papillomas of domestic rabbits. A virus inhibitor was
separated from domestic rabbit papilloma. Quantitative methods
were devised for the estimation of cottontail rabbit virus protein and
its infectivity.
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Mode of action of carcinogens.-In continuing the studies on the
action of methylchol.anthrene on cultures of adult mouse fibroblasts,
the following significant results were obtained: Cultures exposed in
excess of 100 days to the carcinogen with subsequent removal of the
carcinogen resulted in striking changes characterized by (1) the cells
showing a greatly exaggerated tendency to lateral adhesion with the
formation of sheets typical of epithelia] cultures and entirely unrecognizable as any type of normal fibroblast culture; (2) severe central
necrosis in about 15 days following transplantation; (3) increase in
cell granularity and a definite ruffling of the cell membrane, suggesting
pinocytosis. These and other characteristics are quite similar to those
of cultures of sarcomas induced by methylcholanthrene. The
carcinogen treated cultures are radically different, morphologically
and physiologically, from the normal cultures from which they arose;
and the indications are that they represent a new cell type.
Studies on the histopathology and transplantability of tissues
surrounding methylcholan threne-cholesterol pellets in mice during
the latent period of tumor development suggest that factors other
than the presence of malignant-appearing cells are necessary for the
formation of tumors.
Work was continued on the so-called co-carcinogenic action of
certain chemicals. Ten fractions of coal tar bases have been examined.
Preliminary experiments indicate that the quinoline, iso-quinoline,
indole, skatol, and tryptophane possess co-carcinogenic potency. It
is significant that the last three of these chemicals occur in the animal
body.
Synthetic compounds.-Forty-two compounds prepared by the Department of Chemistry of Harvard University and Ohio State University were tested for carcinogenic activity. Eight of the chemicals
produced tumors. One of these compounds is of special interest, since
it is a carbamide derivative of an aromatic polycyclic hydrocarbon.
The importance with respect to carcinogenesis of the IO-position of
1:2-benzanthracene was further substantiated by the finding that
10-methyl-1:2:5:6-dibenzanthracene and 5-methyl-3:4-benzpyrene
produced subcutaneous tumors in mice very rapidly. In order to
bring this investigation closer to substances of biochemical interest,
work with certain phenanthrene compounds was carried out.
Because certain animal fats, used as solvents for carcinogenic compounds, have been suspected of having co-carcinogenic effects, chemically pure tricaprylin has been prepared as a substitute for the natural
fats of uncertain composition.
A survey of the literature through 1938, relating to carcinogenic
compounds, is in progress. Results on about 350 compounds have
been reported.
Properties of malignant tissues.-Research was continued relating to
the biochemistry and physiology of cell proliferation. Particular
attention was given to the function of certain normal cell constituents
such as cytochrome C, cozymase, and riboflavin. Data in the literature refer to malignant tissues as being deficient in cytochrome C and
showing an abnormal ratio or cozymase to dehydrocozymase. These
oxidation-reduction biocatalysts were first studied with respect to
their toxic action and their effect on cell division in Amoeba proteus.
Cytochrome C and cozymase stimulate cell division and are relatively
nontoxic. Riboflavin is relatively nontoxic and favors the recovery of
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
87
cells that have been damaged by prolonged exposure to intense
visible radiation. A method has been devised for the study of the
action of compounds on the initiation of fission.
Studies were conducted on the influence of injections of cytochrome
C and of cozymase, prepared in pure form, on the growth rate of
breast cancer in mice. No significant effect was observed. This
suggests that these cell constituents are not specifically concerned in
the growth of this spontaneous tumor.
Studies on the relation of amino acids to tumor growth have been
continued. The tumor growth rate, following a preliminary period on
a methionine deficient diet, was definitely increased after the addition
of methionine. A new and improved vitamin supplement, consisting
largely of pure vitamins, was found satisfactory for nutrition studies
with mice.
Progress was made in the separation of the enzyme cathepsin from
malignant and normal tissues. Further work has confirmed the
synthesis of proteins in fibrin-papain-glutathione digests and a report
was published describing in detail the necessary conditions for this
purpose.
Therapeutic studies.-The investigation dealing with the action of
bacterial filtrates on tumors was continued. It was found that
ascorbic acid prevents the appearance of hemorrhage and the resulting
regressions of transplanted tu:mors in mice injected with bacterial
filtrates. This phenomenon is thought to be due to the reducing
power of ascorbic acid.
The manufacture, chemical fractionation, and testing in mice of
filtrates of B. prodigiosus was continued.
One hundred and sixty-eight phenanthrene derivatives have been
tested on transplanted sarcomas and spontaneous breast carcinomas
in mice. None of the compounds had any apparent influence on the
spontaneous tumors, but several compounds markedly increased the
regression rate of the transplanted tumors.
Extracts derived from (a) human urine and (b) tissues of mice
were tested in long-term experiments. The extracts did not cause
regression of transplanted or spontaneous tumors in mice, but a
growth-inhibiting fraction from human urine appeared to limit the
formation of tumors induced by a cancer-producing compound.
Biophysical studies.-A broad program of research on the biological
effectiveness of high-energy radiation has been made possible by
arrangements for cooperation with the United States Bureau of
Standards and the Carnegie Institution of Washington. Facilities in
the National Cancer Institute will provide for high-intensity irradiation in the soft X-ray region of 50 kilovolts and in the conventional
range of 200 kilovolts. Super X-ray irradiation in excess of 1 million
volts is being provided at the Bureau of Standards. Particle bombardment, including neutrons and alpha and beta rays at from 1 to 5
million volts, is being carried out at the Terrestrial Magnetism Laboratory of the Carnegie Institution. Artificial radioactive materials are to
be available in large quantities through the construction of one of
the largest cyclotrons at the Carnegie Institution. During the latter
part of the year preliminary researches were begun on the biological
action of high-energy beta rays. The Bureau of Standards is investigating the standardization of gamma radiation, using 0.5 gram of
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Federal Reserve Bank of St. Louis
88
PUBLIC HEALTH SERVICE
radium in a right cylinder of platinum supplied by the National Cancer
Institute for intercomparison with X-ray measurements.
In collaboration with the Memorial Hospital in New York City, a
careful research was carried out on the roentgen output by a point
source of radon. This work is of particular interest on account of
certain biological experiments which have been performed under
similar conditions. Papers have been published on the radiosensitivity
of various types ·of cells and organisms, on the influence of biological
factors upon radiosensitivity, and on genetic changes induced by
high-energy radiation.
Research on the photocausation of skin cancer is now in progress.
Methods have been devised for the irradiation of photosensitized
rats, first establishing the effect of a noncarcinogenic photosensitizer,
rose bengal, to serve as a basis for comparison for determining the
effects of photosensitizers which have also been shown to be carcinogenic. Quantitative studies, designed to throw light on the mechanism
of action, have been carried out on the photosensitization of cells by
methylcholanthrene. It was shown that photosensitization by this
hydrocarbon takes place only in the presence of molecular oxygen,
indicating tentatively that the process is similar to that of other noncarcinogenic sensitizations.
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Federal Reserve Bank of St. Louis
DIVISION OF FOREIGN AND INSULAR QUARANTINE AND
IMMIGRATION
Assis tant Surgeon General
CHARLES
L.
WILLIAMS
in charge
During the year no case of quarantinable disease reached any
United States port.
Cholera remained prevalent in a number of Chinese cities and again
spread to Japanese ports where, however, it was quickly brought under
control. Virulent smallpox subsided in Hongkong and has not reappeared. Various outbreaks of disease in the interior of China were
reported but, on the whole, the quarantine menace of the Far East
has been less than in 1938.
No cases of disease were seen among air passengers from Hongkong
or the Philippines. Planes were searched for mosquitoes but only two
were found alive at Honolulu.
Yellow fever in South America decreased in prevalence. Mostly,
it was reported as the jungle type, but occasional restricted human
outbreaks in small communities were noted. Measures to prevent
the introduction of this disease by aircraft have been maintained.
No suspicious illness was seen among air passengers and but five live
mosquitoes were found on airplanes from South America. The
Aedes Aegypti Control Unit was given further training at Miami and
Key West. A moderate reserve supply of yellow fever vaccine is
available and can be utilized immediately for immunization of persons
in infected areas.
Typhus fever continued prevalent in Morocco, with numbers of
cases in or near Casablanca. No cases, however, were seen on ships
from that port. Typhus also became epidemic in Tunisia.
Except for the epidemics cited herein, the quarantinable diseases
occurred in the same areas and in about the same degree as heretofore.
The continued operation of radio pratique at New York and Boston
has met with widespread approval and has saved a tremendous aggregate of time for passenger vessels.
Concentration of expert personnel at central stations for duty over
wide areas has progressed and has operated very well indeed, even
though all stations could not be fully supplied with automotive equipment, a deficiency which will be met during the ensuing year.
The quarantine regulations were amended to provide for bacteriological examination of shaving brushes to prevent importation of those
infected with anthrax. The regulations concerning the importation
of psittacine birds were also amended to provide for 6 months' detention and laboratory examination of samples from each lot.
ew construction during the year consisted of one combination
garage-storage-shop and parrot-detention building (including landscaping) at Los Angeles, Calif.; nine new officers' quarters (eight apartmen ts for junior officers and one residence for the medical officer in
charge) at the ew York Quarantine Station, and a detention hospital,
single attendants' quarters, and detention compound at Honolulu.
Construction was commenced on two additional junior officers'
quarters, one combination storage-shop and parrot-detention building,
and a boat landing at Miami, Fla.
89
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Federal Reserve Bank of St. Louis
90
PUBLIC HEALTH SERVICE .
Three 24-foot gasoline launches, one 33-foot gasoline launch, and
one 36-foot gasoline launch were added to the floating equipment of
the quarantine service to replace boats that had become unserviceable.
Because of unsettled conditions in Europe, the volume of applications for immigration visas again increased during the year. The
State Department requested one additional medical officer to provide
for medical examinations on a full-time basis at two consulates where
the function had previously been on a half-time basis. This has necessitated the detail of one additional officer to duty in Europe.
The Foreign Quarantine Division has been undergoing considerable
reorganization during the past 3 years, the principal features of which
have been the reduction of certain facilities at maritime quarantine
stations and the building up of stations where air traffic involving
a quarantine hazard enters the United States. It appears at present
that, for the most part, this reorganization is accomplished. It has
been accompanied by a net reduction of cost which is reflected in the
reduced appropriation for quarantine service.
Because of the present disturbed world conditions and the prospect
of epidemic disease spread resulting therefrom, the present quarantine
facilities should be retained and no further major changes in quarantine
functions and no relaxation of procedures should be considered. In
fact, it may be necessary as a result o "' wars in various parts of the
world to adopt more stringent measures than are now employed.
Condensed statistical information showing the quarantine and
immigration activities for the year is presented in the appended tables.
TRANSACTWNS AT MARITIME QUARANTINE STATIONS
TABLE
1.-Summary of transactions at maritime stations for the fiscal year 1939
Station
Vessels fumigated
Vessels
Vessels granted
infree
spected praSultique Cyafur
nide
Aberdeen, Wash ____ _____ __
6
Astoria, Oreg ___ ___________
37
Baltimore, Md __ __ ________
598
Beaufort, S. c ________ _____
0
Boca Grande, Fla _________ _
7
Boston, Mass ______________
808
Brunswick, Ga _____ ___ ____
3
Carrabelle, Fla. (St.
Georges Sound) _________
9
Charleston, S. c __ ___ ______
207
Corpus Christi, Tex.t ______
232
Eastport, Maine ___________
1
Eureka, CaliL ________ _____
1
Fall River, Mass ________ __
0
Fernandina. Fla. (Cumberland Sound)_ _____ ____
7
Fort Lauderdale, Fla.
(Port Everglades) ______ _
22
Fort Monroe, Va ____ ______
399
Freeport, Tex ___ __________ _
11
Galveston, Tex ___ _______ __
917
Georgetown. S. c _____ ___ __
8
Gulfport, Miss _____ ________
13
Jacksonville, Fla. (St.
Johns River) ____ _____ ___
279
Key West. Fla __________ ___
36
Los Angeles, Calif _________ 1,423
Marshfield, Oreg. (Coos
9
Bay) _____ -------------- -Miami, Fla ________________
93
Mobile Ala __________ _____
299
1
---
0
0
23
0
0
35
0
1
187
209
1
1
0
0
4
0
0
0
0
--- 0
0
0
0
0
0
0
0
0
253
0
0
81
0
0
0
752
0
5
31, 100
2
202
1,319
20,053
0
261
58,986
98
91
0
0 - - -----0
7,670
10
670
0
2
8,432
8
0 ------ -- ----- - - - ----- - --- 0
0
0
35
1
0
0
0
244
1. 441
6,048
0
0
2,967
141
$60. 00
365. 00
10, 692.39
0
90.00
10,811.71
30.00
6
443
1,075
26
26
45. 00
2,634.49
2, 985.00
10. 00
10. 00
10. 00
45
70.00
---- --
6
0
0
0
0
21
343
11
895
7
12
0
34
0
14
0
0
0
0
56
0 ------ -0
93
1
0
0
0
26
4,913
4
366
36
12
257
26
741
12
0
26
0
0
0
27
5
235
231
43
17,648
6, 645
690
68,068
954
48
7,568
2, 787.62
272. 26
21. 066. 80
9
78
224
0
2
19
0
0
0
0
39
60
0
6,573
114
292
8,439
9 475
201
705
2 670
90. 00
1,624.444
4 054.14
Includes Ingleside and Port Aransas, Tex.
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Federal Reserve Bank of St. Louis
-
6
23
556
0
7
660
3
Bills of
D eratihealth Amount
zation
and
of bills
exemp- Passen- Crew in- port rendered
tion gers in- spected
sani- for quarcertifi- spected
tary
antine
cates
statements services
issued
issued
- - - - - - - - --
4
205
695
0
225. 00
62, 317
1, 218
4,839.12
406 - - -- --110.00
3n, 577
6, 181 11, 235. 47
302
90.00
0
391
78
130. 00
91
PUBLIC HEALTH SERVICE
TRANSACTIONS AT MARITIME QUARANTINE STATIONS-continued
'TABLE
1.-Summary of transactions at maritime stations for the fiscal year 1939Continued
Station
Vessels fumigated
Vessels
Vessels granted
infree
spected praCya- Sultique
nide
fur
Bills of
Deratihealth Amount
and
zation
of bills
exemp- Passen- Crew in- port rendered
sani- for quartion gers in- spected
tary
certifi- spected
antine
statecates
ments ser vices
issued
issued
--- --- - - ---
New Bedford, Mass _______
1
0
4
5
22
66
0
6
ew London, Conn _______
0
27
0
17
27
373
0
23
ew Orleans, La ______ ____ 1,156
1, 044
23
5,436
195 14, 858
0
51, 136
ewpor t, R . !_ _______ __ ___
0
0
6
6
91
0
2
3
N ew York, . y_2 ___ _____ _ 3,552
118
0
1, 655
560, 848 17, 607
543 489,108
·Ogdensburg, . y _________
0
0
0
0
0
0
0
0
-Panama City, Fla. (St.
Andrews Bay) __ _________
1
0
11
11
402
0
24
524
Pensacola, Fla . __ _________ _
2
31
0
1, 982
45
3
623
30
-Philadelphia, Pa. (Marcus
Hook) _____ _____ _________
31
632
472
0
165
1,004
26, 245
4,492
Plymouth. Mass ___________
0
0
4
4
120
0
0
10
-Port Isabel, T ex. (Brownsville) _____________ _______
0
0
616
15
15
38
0
3
Portland, Maine ___ _____ ___
2
0
109
103
511
3,351
5
105
Portland, Oreg ____ _____ __ __
16
0
2, 977
39
78
75
2,760
87
Providence, R. !. __________
0
0
1
25
24
801
45
3
Sabine, Tex ___ ___ _______ ___
2
0
459
453
16,468
67
121
0
San Diego, Calif. (Point
Loma) ____ ___ ____ ________
0
0
245
5,213
190
53
999
763
'San Francisco, Calif.
(Angel Island) __ __ _
12
0
500
384
12 17, 469
30,008
0
San Luis Obispo, Calif."
(Port San Luis) ____ __ ___
2,233
0
0
57
0
57
10
3
·Savannah, Ga _______ ____ __
0
0
99
22
3,340
l , 592
88
78
Sean;port, Maine __ ________
0
0
258
0
0
3
6
6
·Seattle, Wash .a _____ ____ ___
10
3,128
0
34
2, 113
59
· 59
15
South Bend, Wash ________
5
0
0
222
5
0
51
0
·Tampa, Fla _____ __ ___ ______
22
250
222
0
22
421
5, 354
1,586
Vineyard Haven, Mass ____
0
0
0
0
0
0
0
0
-West Palm Beach, Fla _____
4
4
31
0
0
39
0
3
-Wilmington, N. C . (Cape
F ear) ____________________
48
1,671
0
0
0
56
3
23
- - - - - - - - - - - - - -- - - Total ___ ____ _____ __ __ 12, 830 -9.409
4
2, 037 586,914 1,007,568 70,854
271
- - - - - - - - - - - - - - - - - - - -- - - .Alaska:
Ketchikan _____________
0
0
0
0
0
0
0
0
Wrangell __ ____ ____ ____
0
0
0
0
0
0
0
0
Total. __ _____________ - -- - - - - - - - - - - - - - - - -- - - -0
0
0
0
0
0
0
0
$50. 22
180. 00
17, 083. 26
35. 00
42, 783.1 4
0
275. 61
654. 32
10,175.3 2
40. 00
204. 25
1,314. 28
2,234. 48
353.1 1
4,859.49
2,245. 00
8,475.3 2
1, 145. 00
1,406. 50
60. 00
1,725. 54
55. 00
2,567.86
0
25. 00
815. 00
173, 101.14
0
0
0
--- --- --- - - --- --- - --- --"Hawaii:
Ahukini ____________ ___
0
0
0
53
0
0
0
0
0
Hilo __ ___ ________ __ ____
45. 00
fl
200
0
209
0
5
0
0
Honolulu ____ __________
1,53
3, 940. 58
9
0
148
41,293
659
10 40, 641
Kahului_ _____________ _
0
0
0
0
167
0
0
0
0
Lahaina . _____ ______ ___
0
47
0
0
0
0
0
0
0
Mahukona _____________
0
46
0
0
0
0
0
0
0
Port Allen ___ __ ____ ____
30. 00
1
2
2
0
78
105
0
0
Total __________ _____
161
41, 580
58
1, 277 ~
11 40,641
9
0
155
- - --- --- - -- - --- ---- ---p hilippine Islands:
Aparri __________ ___ ____
0
143
0
0
8
3
0
0
3
Cavite __________ _______
0
2
245
0
0
0
2
0
7
Cebu _____ ___ _____ _____
0
6,439
1
102
475
118
4
1,539
11
Davao ___ _____________ _
0
104
3,816
0
0
440
79
1
0
Jloilo ____ ___ _________ __
0
214
3,948
92
49
1
0
0
395
.Tolo, Sulu _____ _________
0
23
948
28
0
0
0
0
394
Jose Panganiban _______
0
125
5,588
139
0
0
0
0
0
Legaspi _______ _________
0
1,224
34
66
0
0
0
6
0
Manila ____ __ __ __ __ ____ 1,098
0
122
1, 331
115,447
2 69,537
259
91
Olongapo _______ ______ _
0
0
0
0
0
3
0
0
0
Zamboanga __ _. ________
0
2,827
104
1
2, 604
0
35
68
1
Total ___ _____________ 1, 642
0
2,472
277
140,625
123
268
14 74, 925
------ --- - uerto Rico :
Aguadilla ____ __________
20.00
112
0
0
3
0
0
39
3
Arecibo ___ ______ ___ ____
40.00
34
26
209
0
0
3
3
0
Arroyo ______ .--- ________
5.00
65
0
0
0
1
1
10
0
Central Agmrre________
3
30.00
58
11
173
0
0
0
1Includes
-3 Includes
1
P erth Amboy, N. J.
all ports on Puget Sound .
796-40--7
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Federal Reserve Bank of St. Louis
92
PUBLIC HEALTH SERVICE
~RANSACTIONS AT MARITIME QUARANTINE STATIONS-continued
TABLE
1.-Summary of tran.sactions· ~t maritime stations for the fiscal year 1939Continued
Bills of
health Amount
Vessels fumi- Deratiand
zation
gated
Vessels
of bills
Vessels granted 1_ _--,-_ _ 1 exemp- Passen- Crew in- port rendered
sani- for quartion gers infree
inStation
t ar y
certifl- spected spected
spected praantine
services
i~;~-:d
tique
_ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ issued _ _ __
- -- ,,....,....----=---,-----::-- i-- Puerto Rico-Continued .
Fajardo ________ ------ -77
0
0
0
2
2
227
0
$25. 00
Guanica ______________ _
616
193
1
22
22
0
0
180. 00
38
Humacao ____________ __
79
0
0
0
4
0
4
46
30. 00
Mayaguez __ __________ _
281
6
0
11
0
11
0
65.0ti
208
Ponce __ ___ ____________ _
94
258
1,
0
6
482
0
00
63
395.
66
San Juan ____ _____ ____ _
1,740
4, 986
8
275
33
0
3. 222. 88
288
742
-80
40
_
___________
__
Total __
2, 070 ~ 2,012
4, 012. 88
~ ~
- -- - - - - - - - - - - - - - - - - - - - - - - -- Virgin Islands:
5,177. 00
951
19. 468
2,947
11
0
0
260
428
Charlotte Amalie ______
55. 00
303
73
12
0
0
0
9
9
Christiansted __________
503. 00
95
1,510
468
0
0
0
52
52
Frederiksted ___________
5. 735. 00
1. 349
21. Ofil
3. 427
11
O
O
321
489
TotaL ______________
Total, all stations____ 15, 525 10, 402 ~ ~ 2.llif' 707, 977 1, 218, 552 77, 964 186 864.60
~fd~ ~~~-
TABLE
::~i~
2.-Statement of quarantine services rendered at maritime quarantine stations
during the fiscal year 1939
Station
Inspection
services
DetenTotal
Special Fumigation
services services se~~i~es charges
$60. 00
0 - -0-0
365. 00
0
0
0
0
$2, 530. 00 $1, 893. 39 10, 692. 39
$60. 00
Aberdeen, Wash _________ __________________________
365. 00
Astoria. Oreg __ _________________ ____________ _______
6. 269. 00
Baltimore, Md ____ __________ __ ____________________
o
Beaufort, S. c _____________________________________
0
0
0
0
70.00
Boca Grande, Fla_____ ___ ________________ __________
90. 00
0
20. 00
0
8,334. 00
Boston, Mass ______________________________________
0
790. 00 1, 687. 71 10,811. 71
30. 00
Brunswick, Ga ______ __ ______ __ ____________________
0
30. 00
0
0
45. 00
Carrabelle, Fla. (St. Georges Sound)_________ ______
45. 00
0
0
0
49
634.
0
2,
49
323.
00
130.
2,181.00
Charleston, S. C --- - --- - -------------------------2,985.00
Corpus Christi, Tex.I ____ __________________________
0
2,985.00
0
0
10. 00
Eastport, Maine ________ _______________ .____________
0
10.00
0
0
10. 00
10.00
0
Eureka, Calif.. ____________ ~------------------- - --0
0
0
Fall River, Mass ____ _____ ___________ ______________
10. 00
0
0
10. 00
70.00
Fernandina, Fla. (Cumberland Sound) ____________
0
70.00
0
0
205. 00
Fort Lauderdale, .Fla. (Port Everglades) ___________
225. 00
0
0
20. 00
3,088.00
Fort Monroe, Va __________________________________
0
4, 839. 12
530. 00 1, 221. 12
0
110.00
0
0
110. 00
Freeport, Tex __ -------- - ------------------------ -9, 660.00
Galveston, Tex____________________________________
0
641. 47 11, 235.47
934. 00
0
90. 00
0
10. 00
80. 00
Georgetown, S. c ___ -----------------------·-----~
0
130. 00
0
130. 00
0
Gulfport, Miss ____ ---- -- -- -- - --- -- ---------- - ----2, 243. 00
Jacksonville, Fla. (St. Johns River)_______________
0
2, 787.62
264. 62
280. 00
205.00
Key West, Fla __________ __________________________
272. 26
0
27. 26
40. 00
Los Angeles, Calif_______ __________________ ____ ____ 16, 402. 00
0
2, 330. 00 2, 334. 80 21, 066. 80
90. 00
Marshfield, Oreg. (Coos Bay) _____________________
0
90. 00
0
0
1, 110. 00
Miami , Fla_____________________ ___________________
0
1, 624. 44
124. 44
390. 00
0
4, 054.14
484. 14
590. 00
2, 980. 00
Mobile, Ala _-------------------------------------30. 00
New Bedford, Mass _______________________________
50. 22
0
20. 22
0
180.00
New London, Conn _______________________________
0
IB~OO
0
0
New Orleans, La__ ______________________ __________ 13, 291.00
0
1, 990.00 1,802. 26 17, 083. 26
0
35. 00
0
0
35. 00
Newport, R. L _-------------------------------- -New York, N. Y.2 __ _______________________ ~------- 28,169. 00
0
5,465.00 9, 149. 14 42, 783. 14
0
Ogdensburg, N. y __ _______ ______ _________ _________
0
0
0
0
130. 00
Panama City, Fla. (St. Andrews Bay) ____ ________
0
275. cl
145. 61
0
455. 00
0
654. 32
Pensacola, Fla ___ ___ ______ -- --- -----------------169. 32
30. 00
6, 654. 00
Philadelphia, Pa. (Marcus Hook)_________________
0
1,650. 00 1,871.32 10, 175.32
40. 00
Plymouth , Mass ____ ___ ____ _______________________
0
40. 00
0
0
204 . 25
P ort Isabel, T ex. (Brownsville) __ __________________
0
204.. 25
0
0
1,314. 28
158. 28
50. 00
0
1, 106. 00
Portland, Maine ____ -----------------------------0
2, 234. 48
430. 00 1,009. 48
795. 00
, Oreg __ ------ ------ - --------------------Portland
260. 00
Providence, R. !_ _______ __________________________
353. 11
83. 11
10. 00
0
4,130. 00
Sabine, T ex__________ ________ __ ___________________
0
4, 859. 49
59. 49
670. 00
1,715. 00
San Diego, Calif. (Point Loma).__________________
2, 245. 00
0
530. 00
0
6, 609. 00
San Francisco, Calif. (Ane:el Island). _________ _____
$44. 00 1, 190. 00
8, 475. 32
632. 32
1,045. 00
San Luis Obispo, Calif. (Port San Luis) ___________
1, 145. 00
0
100. 00
0
1, 174.00
Savannah. Ga_____ ________________________________
1, 406. 50
0
232. 50
0
60. 00
Searsoort, Maine ___ ____ _____________ __ ___ ____ _____
60. 00
0
0
0
590. 00
Seattle. Wash. 3 ________ _ ___________________________
0
1, 725. 54
825. 54
310. 00
0
55. 00
0
0
55. 00
South Bend, Wash _-- -- - - ------------- - -- -- ----- -Tampa. Fla _________ _______ _______________ __ ___ ___ 2,005. 00
2,567.86
342. 86
220. 00
0
0
Vineyard Haven, Mass_______ _________________ ___ _
0
0
0
0
1 Includes Port Aransas, Tex.
a Includes all ports on Puget Sound.
2 Includes Perth Amboy, N. J.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
93
PUBLIC HEALTH SERVICE
TRANSACTIONS AT MARITIME QUARANTINE STATIONS-continued
TABLE
2.-Statement of quarantine services rendered at maritime quarantine stations
during the fiscal year 1939-Continued
Inspection
services
Station
Deten•
tion
services
Special
services
Fumiga•
tion
services
Total
charges
- -- - - - - - - - -- -- - - - - - 1- - - - - ·I- -- - - - -- - -- - - - - $25. 00
0
W est Palm Beach, Fla ...... .. ....................
$25. 00
0
0
815. 00
Wilmington. N. C. (Cape Fe~r). ..................
785.00
$30. 00
0
0
---- ---Total.. .. ..... . .............................. 126, 274. 25
$44. 00 21,511. 50 $25,271.39 173,101.14
- - -- ---- ---Alaska:
0
Ketchikan......................... ............
0
0
0
0
0
Wrangell. ............................... .. ....
0
0
0
0
1-----1·--- - - - - - - - - - - - 0
TotaL . .. . . .. .. .. . .. . .. .. ... . ...... .... ......
O
O
0
0
Hawaii :
l== ===l== ===I==== - - - - - - - 0
AhukinL ........................... ..... . .. ..
0
0
0
0
45. 00
Hilo...................... .. .......... ....... ..
45. 00
0
0
0
3,940.58
69.58
Honolulu... . ............ ............ ......... .
3,771.00
O
100. 00
KahuluL ............... .. .. . . .. . . . .. . . . .. . . . .
0
0
0
0
0
Lahaina.......................................
0
0
0
0
0
Mahukona.. . . . . . . . . . . . .. . .. . . ... . .. . . . . . . . . . .
0
0
0
0
0
Port Allen .... ... ................ ..... ...... ...
30. 00
0
0
0
30.00
1 - -- - • I-- - - - - - - - - - - - - TotaL .. . .. ... .. . . . .. . . . . ..... .. ..... .. ... ..
3, 846. 00
O
100. 00
4,015. 58
69.58
Puerto Rico:
l=====I====
Aguadilla.. . ... . ... ....................... . ...
20. 00
0
0
0
20.00
Arecibo ... .. ........... . ........ ..............
40. 00
0
0
0
40.00
Arroyo .......... ..... ..... ............... . ....
5. 00
0
0
0
5. 00
Central Aguirre.................... . ..........
30. 00
0
0
0
30.00
Fajardo .......................... . ............
25. 00
0
0
25.00
0
Guanica.................................. . ....
175. 00
0
5. 00
180. 00
0
Humacao. . .. .......... ..... ............ . . .....
30. 00
0
0
0
30.00
Mayaguez .. ........ . . .. . ... ..... . .. .. ......• ..
65. 00
0
0
65. 00
0
Ponce .........................................
395. 00
0
0
0
395. 00
San Juan .................. .................. . . ,__3_,0_4_8_.oo_,_ _ o__
110.00
64.88
3,222.88
Total. ............ . . ................ . .......
3,833. 00
0
ll0. 00
69.88
4, 012. 88
Virgin Islands·
l=====l=====I== = = - - - - - - - Charlotte Amalie............... . ..............
5, 167. 00
0
10.00
0
5,177.00
Christiansted...... . ...........................
55. 00
0
0
0
55.00
Frederiksted .... .. .. . .. ... . . . . . .. . . . .... . . .. ..
503. 00
O
0
0
00
,- - - - - , - - - - - - - - - - - - - -503.
-Total.. ...... . .. . ........ ....................
5,725.00
0
0
5,735.00
___!QJ1Q_
1
Total, all stations .. .... . . ... .......... ...... =1:::::3=Y,===6~78:::::.2:::::5=l ==4=4=_::;::
oo= 21,731.50 25,410.85 186,864.60
MEXICAN BORDER STATIONS
TABLE
3.-Summary of quarantine transactions on the Mexican Border for the fiscal
year 1939
Station
Brownsville, 'l'ex ...........
Calexico, Calif.. ............
Columbus, N . Mex .........
Del Rio, T ex .. .............
Douglas, Ariz ..............
Eagle Pass, Tex ............
El Paso, T ex.I .... . ...... ...
Hidalgo, Tex ...... . ........
Laredo, T ex.2 ...............
aco, Ariz .................
Nogales, Ariz ... _...........
Presidio, Tex __·-··-····-·-Rio Grande City, Tex ___ . __
Roma, Tex __ ·----··· · ···-·San Ysidro, Calif.. ........ .
Thayer (Mercedes), Tex ....
Zapata, Tex .... ............
Num•
ber of
per•
Number
sons
Total
from
number
of local
interior persons of persons
inspected inspected
of
Mexico
in•
spected
12, 306
0
422
1,163
55
16,802
12, 722
11,270
140, 642
7
4,247
1,560
202
644
l, 892
142
0
832,833
31,906
597
96, 155
614
486,707
6,653,336
337,111
1, 876, 290
2,641
2,260
68,586
7,300
58,662
3,003
43,660
14,304
845,139
31,906
1,019
97,318
669
503,509
6,666,058
348,381
2,016, 932
2,648
6,507
70, 146
7,502
59,306
4,895
43,802
14,304
Total.. ....... ----·-·· 204,076 10,515,965 10,720.041
1 Includes Fort Hancock, Guadalupe Gate, and Ysleta.
2 Includes Minera and San Ignacio.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total
num•
ber of
per·
sons
disin·
rested
Total
number
of persons
passed
without
treat•
ment
Total Total Total
num•
num•
ber of ber of pieces
of
per• sick re• baggage
sons
fused
disin•
vacci• admis• fected
nated
sion
0
0
0
6
0
0
0
1
0
0
239
0
0
0
0
5
0
844, 622
30,626
627
96,506
574
501,803
6,662,660
345, 065
2,015, 854
2,351
6,140
69,127
7,400
59,202
4,168
43, 4U
14, 152
517
1,280
392
805
48
1, 701
3, 395
3,313
1,078
297
127
1, Oa.9
102
104
727
386
152
251 10. 704,288
15, 443
--- --0
0
0
1
47
5
3
2
0
0
1
0
0
0
0
0
0
0
0
0
2
0
4
0
0
0
0
0
122
0
0
0
59
128
0
0
- - - - --
TRANSACTIONS AT UNITED STATES AIRPORTS OF ENTRY FOR AIRPLANES FROM E10REIGN PORTS
TABLE
Location
Ajo, Ariz _____ _________ ____ _
Akron, Ohio' -- - ----------Alameda, CaliL ____ ___ ____
Albany, N . Y ____ ________ __
Baltimore, Md__ ______ _____
Bangor, Maine 1 _ _ _ _ _ __ _ __ _
Bellingham, Wash _________
Brownsville, Tex ___________
4.-Summary of transactions at continental and insular stations for the fiscal year 1939
Name of airport
Distance in
miles to
nearest
Public
Health
Service
station
Municipal Airport______ _____ ___ ______________
6
Muniripal Airport 2______ _________________________________
Alemada Seaplane Base 3______ ___ _____________________ ___ _
Municipal Field______ ________ ________ ____ ____
10
Baltimore Airport 3_ _ __ _________________ __ ____
20
Bangor Municipal Airport 2_____ ________ ______ ____________
Graham Airport 2 ________ _ ______ _ ___ ____ ______ ---"-------Municipal Airport__ _____ _________ _______ _____
5
Date designated
of Number of Number of Number of
Number of Number
aliens in- Number of
persons
persons
airplanes
airplanes
arriving
inspected spected by; aliens cerinspected
arriving
by
Public
Public,11 tilied for
from
forby
Public
from forHealth
disease
eign ports
Health
Health
eign ports
Service
or places
Service
Service
Nov. 15, 1929
2
0
7
0
0
0
Apr. 8, 1929 __ __________ ____ _______________________________ _______________________ __
40
40
704
704
51
0
Sept. 28, 1928 ____ ___________ _______________ ______ __ __ __ _____ ________________________ _
-- ------ -- - ---14
14
230
230
9
0
June 26, 1936 _______________________________________________________________________ _
Apr. 18,1931
0
0
0
0
0
0
Jan. 8, 1930
430
430
4,189
4,189
848
6
----------- ----
m~ }
m~
Buffalo, N. y ______________ {Wuiw1f~P~a~i~r~~rpoiT2====================== ============ }~; ~:
179
0
370
0
0
0
Burlington, Vt.I ___________ _ Burlington Municipal Airport 2__ _________________________ June 29, 1934 ______________________________________________________________ ___ ______ _
2
4
4
8:~:i~~~~~~\;~-~-y-_--====== g:~:~~n~~f1f:io~t~~:~- ================== ============ ~;~. ~:
Caribou, Maine 1__ _ ___ _ ___ _ Caribou Municipal Airport_ ______ __ _________ __________ ___ Oct. 31, 1932 ______________ __ _______________ ________________________________________ _
Charlotte Amalie, V. L ____ Charlotte Amalie Airport 3_ _______________________________ --------------54
54
534
534
0
0
Cleveland, Ohio ______ ___ ___ Cleveland Municipal Airport _________________________ ____ Sept. 23, 1932
0
0
0
0
0
0
Crosby, N. Dak.l __________ Crosby Municipal Airport 2_______ _____ _______ ________ ____ June 28, 1934 ___________________________ ___ _________________________________________ _
Detroit Municipal Airport____________________
5
June 19, 1931 }
Detroit, Mich ___ ___ ___ ____ _ Ford Airport _____ ______ _____ _____________________________ Aug. ·1, 1929
154
0
384
0
0
0
7
{Wayne County AU"port_______________________
1.5
Feb. 10.1931
Douglas, Ariz ______ ________ Douglas Airport _____ ____ ___ ___ ______ ______ ____ _____ _____ __ Jan. 8, 1930
0
0
0
0
0
0
Duluth, Minn _________ __ __ {guluth Municipal Airport _______ ______ _____________ ______ Sept. 4, 1931 }
2
0
0
0
0
8
nluth Boat Club Seaplane Base ____________________________ __do _______ _
~f~;s~:is{~;:~== ===== =====
Fairbanks, Alaska 1 ________
Fort Yukon, Alaskfl. I______
Glendale, CaliL ___________
Great Falls, Mont.1 ________
~~~~Y{i~
~8:: 2i: 1935
mi
6
6
5
5
~
g
18
18
2i
J
2g
8
~£i1cf;!f :t~gg:L==========================
~½
WBeks Municipal Airfield _______________ __________ __ __ ____
Fort Yukon Airfield 2_ ____ _ _ _ _ _ ___ ___ ___ __ ____ __ ____ __ ____
Grand Central Air Terminal 3__ ______ _________
12
Gre'lt Falls Municipal Airport 2___________________ ____ ____
--------------153
153
1,675
1,675
0
0
June 2, 1930 __________________________ _______ __ _ ___________________________________ _
~~~~Yu~uf;;ifo~1 t~~~~~~============ ======== ============
Juneau Airport____ _________ ___ ________________
8
Ketchikan Airport_ ____ ___ ______ ___________ ___ ·· ------- --- Meacham Field__ _____________________________
4
Laredo Airdrome ..__ ____ _____ ____ _________ _____
3½
Malone Airport 2___ ___ ________ ___ _________ _ __ _____________
=====~~----======
June 18, 1930
_____ do'~----- -Dec. 20.1927
Jan. 24, 1930
Apr. 18, 1930
Apr.
July
1,
___________ __ ___ ________ _______________________________________________ _
6, 1938 ________ ________________ __________ ___ __________________________________ _
0
-r\c ===== =====
Juneau, Alaska _____________
Ketchikan, Alaska ___ ______
Key We,t, Fla _____ ________
Laredo, Tex __ __ ______ ______
Malone, N. y __ __ ______ __ __
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
3~
0
0
1
7
4
3~
0
0
1
7
0
71~
0
0
2
23
7
71~
0
0
2
23
0
lg0
g0
0
0
0
0
o
0
0
0
Pan American Field___ __________ ____________ __
14
Oct. 16, 1928}
Miami, Fla ________________ Dinner Key Seaplane Base_______ ____ ____ ____ _
11
Mar. 7, 1930
{ Chalks Flying Service Airport 2_ _ _ _ _ ___ _ _ _ _ _______ _ _ _____ _ Sept. 17, 1937
Niagara Falls, N. y ________ Niagara Falls Municipal Airport 2____________ _ _____ __ __ _ _ _ July 2, 1938
Nogales, Ariz ___________ ___ Nogales Municipal Airport ____________ ______ __
7
June 27, 1929
Ogdensburg, N. y _________ Ogdensburg Harbor_ __ __________________ ________ ______ __
Mar. 1, 1932
Pemhina, N. Dak __________ Fort Pembina Airµort.__ __ _______ ______ _______ _
5
Feb. 2, 1930
Plattsburg, N. y,1 _________ Plattsburg Municipal Airport 2___________ _____ ___________ June 2, 1930
Portal, N. Dak ____ __ _______ Portal Airport_ _____ _____________________________ __ __ ______ Jan. 8, 1930
Port Angeles, Wash________ Port Angeles Airport________ __________________
52 _____ do ____ ___ _
Port Townsend, Wash ____ _ Port Townsend Airport__________ __ ___________
6
June 18, 1930
Port Washington, N. y ____ Port Washington Airport 3__________________ ____ ____________ __ ___ _ ___ ___ _
Put-in-Bay, Ohio 1______ ___ Put-in-Bay Airport_ _____ _________________________________ Mar. 12, 1934
Rochester, N. y __ __________ Rochester Municipal Airport 2 __ _ _________________________ Nov. 7, 1936
Rouses Point, N. y ________ Rouses Point Seaplane Base ___ ______________________ ____ __ July 14, 1932
San Diego, Calif ___________ San Diego Municipal Airport___________ ____ __
6 Jan. 24, 1930
Sandusky, Ohio 1______ ____ John G. Hin<le Airport 2 ________________________________ __ June 1, 1937
San Juan, P. R ____________ Isla Grande Airport_ ______________________________________ Jan. 19, 1929
Sault Ste. Marie, Mich _____ Sault Ste. Marie Airport 2 __ __________________________ ______ Aug. 4, 1933
Seattle Wash
{Boeing ~unicipal Air Field___________________ ____________ Sept. 11, 1928}
'
-------------- Lake Umon _____________________________________________ __ DAc. 27, 1928
Skagway, Alaska t _ ________ Skagway Munir.ipal Airport_ _______________ ______________ Nov. 30, 1931
Spokane, Wash.I ___________ Spokane Municip~l Airport 2___ __ ___ _ _____________________ June 2, 1931
Swanton, Vt.1 ______________ Misc;isquoi Airport_ __ _____ ______ ________________________ __ July 18.1930
Warroad, Minn.I ___________ Warroad Seaplane Base 2 ___ _______________________________ Sept. 2, 1937
Watertown, . Y, 1_________ Watertown Municipal Airport 2___________________________ June 2, 1930
n~~n~~lg fst~:J
479
37,618
8,221
6,186
88
0
0
0
13
3
899
13
32
2
0
0
32
8
3,130
0
0
0
0
0
0
0
0
0
0
0
0
161
0
0
96
0
0
0
161
0
0
4
0
0
0
3, 529
0
0
356
0
3, 529
0
0
52
451
451
5, 864
5, 864
0
0
0
0
0
0
1,345
o·
0
0
0
0
0
718
- -- - - -00
16
-----------ii
O
O
1
-----------ii
618 --
0
0
O
O
1
0
1, 203
5, 653
0
____ _______ ____ __________ ___ ____________ __ ____ __ __ _____________________ _
________________________________ _ ·-- ________________ ___ ________________ _
__ __ ____ _____ ____ ___________________________ ___ ___ _____________________ _
________________ ___ ______________________________________________ ______ _
_________ __ _____________________ ____ ________________ ___________________ _
-~~-~o-~·-~~~~- ============
============
====== ======
======== ==4==-=--==----29-- ------------o
101
20
462
Wellesley Island, N. Y,i ___
:;i!~f:~:-ifi~e2============== ============
West Palm Beach, Fla __ __ _ Roosevelt Flying Service Base_ __________ _____ _________ ___ Mar. 10, 1931
Wrangell, Alaska _________ __ Wrangell Seaplane Base _____ _____________________________ _ Nov. 30, 1931
TotaL _________________________________________ ________ ______ __________________________________ _
0
O
O
O
o
o
5,363
1,878
65,568
25,842
8,521
96
m
t_:::j
;:d
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
~
H
0
t_:::j
96
PUBLIC HEALTH SERVICE
CANAL
TABLE
ZONE
5.-Quarantine activities of the government of the Canal Zone during the
fiscal year 1939 1
Number
Activities
Vessels inspected and passed ________________________________________ _____________________ ____
6, 726
Vessels granted pratique by radio_ _________________________________________ ___________ _______
321
1----TotaL _____ ______ ___ ___ __ ______ ___ ___ __ ________ ____ ____________________ ________ _____ ___
7, 047
Crew passed at quarantine ____ ________ ________ ______ __________ ____ ___________________________
369,628
Crew passed by radio __________ __ ---- -------------------------- ----- ------- --- ------- - ---- - -126,539
Passengers passed at quarantine ___ __________________ _________________________ ________ ________
130, 731
Passengers paclsed by radio _______ ____ ___ _____ __ __ _____ ___________ __ ________________________ __
3,018
-- TotaL ____________ ___ ___ ____ ___ ______ _____________ ___ ________ ______ ______ __ __ _____ ___ __1 - -629,916
Airplanes inspected and passed _______ ______ ____ ____________________ ___ ________________ ____ __ _
761
!: m
~~;:iie
~~~~a~~~l~irse1~;
~ e~~~l:~~e~as
sed : ==== ==== == ==== ==== === ======== === =====_____
=====_______
== ====1---7-,9-2-2
TotaL
_____________________
________________________________________________
Vessels detained in quarantine ________________________________________________________________
0
Crew detained on board ship for quarantine________________ __ _______________________ _________
0
Immigration cases admitted to station___________________________ _______________ _______ _______
1,015
Number of detention days ______________________ ------------------------------------- --- ----9, 039
Persons held for investigation and released_ __ ______________________________________ _____ __ ___
640
Persons deported undC'r immigration laws ____ ____ __________________________ _______________ ___
1,339
Supplementary inspection of vessels___________ __ ______ _______________ ________________ ________
3, 827
Vessels fumigated ______________ _________________ _________ __ __ __ ______________________________
41
Box cars fumigated __ _______ _____ ___ ____ ______ ____________________ ___ ________________________ _
266
Number of "special demand" night boardings__________________ ____ ___________________ _____ __
65
1
Surgeon 0 . E. Denney, U.S. Public Health Service, detailed as chief quarantine officer.
MEDICAL INSPECTION OF ALIENS
TABLE
6.-Alien passengers and seamen inspected and certified at maritime ports in
the United States and possessions during the fiscal year 1939
Plate
Num- Alien passen!!ers certified 1
ber or
alien
passen• Clas~ A
gers - - --- Class Class Total
examB
C
ined
I II
-- -
- - - - -- - -
NumA lien seamen certified
ber of
alien
sea- Class A
men
Class Clas1-: T()tal
examB
C
ined
I
II
- - - -- - - - - ---
--
.A TL.ANTIC COAST
Baltimore. Md ______ _____ __
541
0
0
0
Beaufort, S. c ________ ___ ___
0
0
0
0
Boston, Mass ____________ ___ 5,336 14
9
715
Brunswick, Ga _____ ________
2
0
0
0
Charleston, S. C ____________
45
1
0
0
Fall River, Mass ____ __ ___ __
0
0
0
0
Fernandina, Fla. (Cumherland Sound) ____ _____ __
0
0
0
0
Fort
Lauderdale,
Fla.
(Port Everglades) _____ ____
12
0
0
0
Fort Monroe, Va.2 ____ __ ___ _
44
0
0
0
Fort Pierce, Fla _____ _______
0
0
0
0
Georgetown, S. C __ ______ ___
2
0
0
0
Gloucester, Mass ______ __ ___
0
0
0
0
Jacksonville, Fla ___ _______ __
46
0
0
0
Key West, Fla ______________ 2,902
1
0
29
Miami, Fla _________________ 19,236
4
249
8
New Bedford, Mass ____ __ __
21
2
0
0
New London, Conn _____ ___
0
0
0
0
Newport, R. !. _____________
0
0
0
0
New York, N. Y. (Ellis
Island) ___________________ 182,662 36 73 14, 126
Perth Amboy, N. J_ ________
2
0
0
0
Philadelphia, Pa.a _______ ___
189
0
0
0
Plymouth, Mass ____________
10
0
0
0
Portland, Maine ____________
99
1
0
0
Providence, R. r_ ___________
13
0
0
0
Savannah, Ga ______________
78
0
0
0
Searsport, Maine ______ _____
0
0
0
0
Vineyard Haven, Mass _____
0
0
0
0
Washington, N. C _________ _
0
0
0
0
West Palm Beach, Fla ___ ___
57
0
0
0
Wilmington, N. c ______ __ __
20
0
0
0
TotaL _______________ 211,317 58 90 15, 120
For footnotes, see end of table.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
0
0
136
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0 14,077
0
0
874 54,698
0
98
1 3, 553
0
0
1
0
6
0
0
0
21
0
90
0
5
0
13
0
36
0
1
0
3
0
9
0
2
0
38
0
141
0
8
0
126
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
22
0
0
0
6
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
23
0
0
2
6
0
1
0
0
0
0
614
0
0 10, 101
0
0
0
3
603
0
5,469
0
497
30
261 6,981 ·
9
3
0
0
0
0
99 14,334 462,495
0
0 1,082
0
0 18, 774
0
0
120
1 2,847
0
667
0
0
0 2,402
0
0
0
258
0
0
0
0
0
0
329
0
0
0
0 1,266
236 15,504 587. 069
5 266
1
0
38
0
0
0
0
8
0
5
12
0
1
0
0
0
0
0
1
0
1
0
64 427
24
4
299
0
1
0
7
0
45
0
0
0
4
4
16
1
0
6
0
0
12
0
0
1
0
0
0
0
0
0
0
0
1
0
0
1
60 -----50
601
===
97
PUBLIC HEALTH SERVICE
MEDICAL INSPECTION OF ALIENS-continued
6.-Alien passengers and seamen inspected and certified at maritime ports
in the United States and possessions during the fiscal year 1939-Continued
TABLE
Place
Alien pasi:engers certified
um•
bl'r of
fllien
paS5C'n• Class A
Class Class Total
gers
pxam- ----·
B
C
II
I
ined
-GULF COAST
Atchafalaya. La _...... ... ..
0
Boca Grande, Fla .. _... ... . _
5
-:Brownsville. Tex .. _·- __ -···
3
Carrabelle, Fla ............ _
0
Corpus Christi, Tex _.. ··- · ·
10
Freeport, Tex.-· .......... . _
2
Galveston. 'fex ... ·-·-·· --··
65
Gulfnort, Miss _.. _... _. . __ ._
0
Mobile, Ala .-- --·······---·.'i2
New Orleans, La ... _. .... _. 1,891
Panama City, Fla. (St.
Andrews Bav) .. __ .. . .. _..
8
Pascagoula, Miss. ___ ..... __
0
Pensacola, Fla ·· · ·· · -- -·-·13
Port Aransas. Tex _. ........
0
Port St. Joe, Fla. _· - · -· ··- -·
0
Sabine, TPx __· · · · · - · ·- ···· ·29
194
Tampa, Fla·--·-····-· · ···-·
--· Total .......... . . ... .. 2. 272
P ACIFTC COAST
-
-
--- -
Aberdeen, Wash _...........
0
Astoria, Oree: _...... __ . _. _. _
0
Eureka, Calif ............. .
0
Fort Bragg, Calif . ____ ......
0
Los Angeles, Calif. (Termi·
nal Island) --············-- - 6, 3i2
Marshfield, Oreg.(CoosBay).
0
Monterey, Calif. .· · ·-··-- __
0
Portland, Oreg . ............
21
San Diego, Calif.. .. _.... . ·674
an Francisco, Calif. (Angel Island). ... ... ... ... .. . 4,304
San Luis Obispo, Calif.. ... _
0
Santa Barbara, CaliL .... . .
0
eattle. Wash-4 . _. -······-·· 2,058
outh Bend, Wash ... -· ....
0
Total. . •.• .... .•.•.... 13. 399
INSULAR
Alien 5eamen certified
um•
ber of
alien
sea- Clas~A
mrn - - - - Class Class Total
B
exam·
C
II
I
ined
0
0
0
0
0
0
0
0
0
1
- - - - - --
-
-- ---- -- -
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
53
0
17
76
0
0
0
0
0
1
0
4
0
0
0
0
0
0
0
0
170
()
o.
0
0
0
0
0
0
0
0
0
0
8
0
0 1,141
0
0
0
0
0
0
0
0
0
0
55.'i
0
0
0
0
0
0
0
0
0
0
0
0
1
1 13, Of\O
3
0 19
0
0
0
1
0 12
2!l7
- -7 - - -1 - -0 -3. - - -06
- --2
14
14
7. 717 17 153
0
0
-
0
0
0
0
0
0
0
0
0
7
0
0
0
120
0
581
0
!ll
0 7, 2!l3
0
371
0 24,771
0
4!l
0 6, 5111
13 29, 702
--- --- - - --- -
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
1
0
124
0
0
3
44
0
0
0
0
1
0
0
0
0
0
2
13
l
141'\ 15, 4W
132
0
0 1,852
0
0
0
0
0
0
0
2
4
22 10, 2.'i2
16
0
0
0
0
222
--- --- -- - - 16
343 89. 242
319
6
-
202
1,210
0
0
0
0
0
0
124 53,669
0
292
0
0
4 2, 84fl
47 3,268
2
0
0
1
2
0
0
0
0
0
0
0
0
0
0
47
0
0
67
0
0
0
0
0
0
0
0
17
0
0
0
0
0
0
0
6
0
0
6
--- ---
2
11
0
0
88
10
0
31
0
0
0
0
0
0
0
0
0
1
0
0
8
1
0
0
0
0
0
0
0
23
13
19()
--
2
11
0
0
91
10
0
40
3
23
1
0
0 22
7
7
0
0
0
0
0
0
0
0
10
1
1
8
0
0
0
-0
- --120 - --01 - Hl7
5 179
- - --- - - --- - - --- --- - .Ala,ka: Ketchikan _. __ .··-0
0
0
0
0
0
0
0
0
0
0
0
Hawaii: Honolulu _..... . .. . 4. 201'\ - 1 - 8 - -,- 0 - -.- 4 ~ '.l() 4-~2 -6 - 4 - - 8 - -0 --1-2
-- -- -Philippine Islands:
Aparri _.. . .. ......... _..
0
0
0
0
0
0
0
0
0
0
3
0
Davao _. .. ............. _
0
0
0
0
0
0
0
0
45
0
0
0
Iloilo .... _..............
0
0
0
0
2
0
0
0
12
0
0
0
Jolo _..... .. .. . .... _.....
0
0
0
0
150
0
0
0
0
0
0
0
Legasni ......... _... _. __
0
0
0
0
0
0
0
0
0
0
0
0
Manila .. . . ..... .. ..... _ 14, 281\
0
0
0
1 63
21
0
0
0
82
18
0
Zamboanga .. . . .. .... ...
0
2
0
0
0
0
0
0
0
0
0
- -()
-- - -- --- -Total. . .•..• .......... 14. 488
0
1 63
0
0
0
82
18
0
33
- - - - - - --- -- - - - - - - - - - uerto Rico:
0
Aguadilla ... . . -........ _
0
0
0
0
0
0
0
35
0
0
0
Arecibo _.... . ... .... .. __
0
0
0
0
0
19
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
Arroyo· -··············0
Central Aguirre (Jobos) _
0
0
0
0
0
0
0
0
0
0
10
Fajardo ___ ..............
0
0
0
15
0
259
0
0
0
0
0
0
1
Guanica ._ ........... _..
0
1
0
22
301
0
0
0
0
0
0
Humacao . . . .. ______ ___ _
0
0
0
0
0
0
0
0
0
0
39
0
Mayaguez ______________
0
0
157
0
0
0
0
0
0
0
3
0
8
0
Ponce . ___ _. -·------- -- -0
23
8
0
0
0
0
0
503
0
San Juan __ ______ · -·- · -- 2,747
18
0
0
1 17
8
0
0
8 5.829
0
--0
27
2.
820
0
0
0
Total. .. __ -·-- ·--··- __
8
0
8 7. lf\2
1 26
, 15.
, 974 801. 67.'i. 87 78 9
T otal. all stations .. __ 248 . ..'i02 66 169 15. 482
941
57 1 027
2.'i7
1 Class A-1: Aliens certified for idiocy, imbecility, feehle•mindedness, insanity, epilepsy, c~ronic
alcoholism. Class A- II: Aliens certified for tuberculosis or other loathsome or dangerous contagious disease.
Cla~~ B : Alien~ certified for diseases or defects which affect ability to earn a living. Class C: Aliens certified
for diseases or defects of less degree.
z Includes Norfolk and Newport News, Va.
3 Includes Gloucester, N. J., Lewes, Del., Marcus Hook, Pa.
' Includes all ports on Puget Sound.
--
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
98
PUBLIC HEALTH SERVICE
MEDICAL INSPECTION OF ALIENS-continued
TABLE
7.-Aliens inspected and certified at international border stations during the
fiscal year 1939
Place
Number of
persons
making
permanent
entry
examined
NumAliens certified
ber of
Total
persons Other nummaking persons
Class A
ber of
tempor- exam- persons
ary
Class
Class
ined
exam- Total
entry
B
C
ined
examI
II
ined
------ --- - - -- -- --- ---
MEXICAN BORDER
Ajo, Ariz ____ ___________ ______ __
96
0
0
0
0
0
0
0
96
Brownsv ille, Tex __________ __ ___
24
324
133
482
61
587
5
43
1,393
Calexico, Calif_ ________________ _
348
1
125 31,433 31,906
90
6
o·
83
Columbus, N. Mex _____________
1,019
0
0
0
0
0
0
0
1,019
Del Rio, Tex _______ ____ _______ _
4
15
28
1
0
3
0
0
43
Douglas, Ariz _________ _______ ___
10
71
21
29
685
11
18
37
740
E agle P ass, Tex ______ __________
4
227
32
20
3
5
5 12, 114 12,346
El Paso, Tex.I _______________ ___
262
2,929
11
865
642
534
8,159 11,730
58
Hidalgo, Tex _______ ____________
31
84
129
309
4
0
33
16
438
Laredo, Tex ________ ____________ 1,588
1
155
13
4
1,876 70,356 73,820
137
Naco, Ariz ___ ____________ _______
74
204
2,641
13
4
76
41
3
2,648
Nogales, Ariz _____ ______ _______ _
3
244
242
126
72
2,121
292
8
2,655
Presidio, Tex __ ___ __ ______ _____ _
2
18
26
4
813
59
6
0
831
Rio Grande City, Tex _______ ___
4
3
1
0
70
3
0
73
Roma, Tex ___ __________________
0
0
0
0
0
0
0
0
San Ysidro, Calif_ _____ ___ ______
132
99
20
3,672
13
696
533
4,901
Thayer (Mercedes), Tex ___ _____
2
28
9
0
0
0
0
28
Tucson, Ariz __ ___ _________ _____
1
18
254
20
75
0
36
0
254
Zapata, Tex. ____ _____ ___ _______
0
0
0
0
0
358
417
59
TotaL ___ _____ _________ ___ 4,268 ~ 134,444 145, 338
24
2,161
1,237
526
152
- - - - - - - - - - -- - - - - - - - - - - CANADIAN BORDER
Bellingham, Wash ____ ___ __ _____
0
0
0
0
0
0
0
0
Blaine, Wash __ ___ ______ ________
2,5
21
4
310
538
64
1,256
26
1,819
Buffalo,!',;. y ____ ___ _________ __
11
185
0
2
892
303
350
1,242
0
Calais, Maine _________ _________
12
1
0
766
4
0
3
766
Chicago, IIL
1
11
5
176
5
0
0
176
28
777
34!l
247
358
74
3,199
Detroit, Mich __=--------------- 2, 064
Duluth, Minn _____________ ___ __
1
2
2
1
0
3,085
533
3,620
0
Eastport, Idaho ___ _____________
1
22
0
114
2
39
79
66
259
Eastport, M aine _______ _____ ____
1
1
0
0
4
0
0 78,300 78,304
Erie, Pa _________________ _______
0
0
0
0
0
0
0
0
Halifax, Nova Scotia, Canada __
17
271
87
4
2
394
32
190
616
Havre, Mont. _____________ _____
0
0
0
7
0
0
0
7
Houlton, Maine __ ___ ___________ _
2
0
1
4
4
79
26
109
International Falls, Minn __ ____
36
49
31
0
4
127 454, 51'15 454, 741
Jackman , Maine ______ ___ _____ __
1
25
20
0
41
6
61
0
0
Malone, N. y _____ __________ __ _
10
l1
I
0
24
1
41
6
Montreal, Canada ______________ 2,431
I
244
173
0
57
0
2,431
0
Newport, Vt_ ______ ___ ________ _
0
0
0
0
0
0
0
0
Niagara Falls, N. y __ ___ _______
137
9
28
1,394
175
436
106
1, 936
Noyes, Minn ____ ___ _____ ______ _
47
0
3
44
0
0
187
187
Ogdensburg, N. ¥ _________ _____
1
0
2
8
4
10
14
0
Oroville, Wash . ______ ____ ____ __
12
0
0
0
36 56,027 56,075
0
Pembina, N. Dak ___ __ ________ _
1
0
0
1
0
0
3
3
Portal, N . Dak ___ ___ ___ __ ______ -------- ------ -- - - -- -- -· -------- ------- - ------ -- - -- - --- - -- -· -------Port Angeles. Wash _________ ___
0
0
0
0
0
0
0
0
Port Huron, Mich ______________
2
172
109
4
32
245
373
1, 393
775
Quebec, Canada ________________
8
248
1
2,115
0
335
563
3,332
654
Rochester, N. Y ___________ __ __ _
0
0
0
0
0 26,976 26,976
0
Rouses Point, N. y _____________
17
21
0
117
3
0
51
168
St. Albans, Vt ______ ____________
12
1
23
0
32
9
50
83
St. John, New Brunswick,
Canada _. ------------ ________ 2
4
2
39
165
65
343
531
23
Sault Ste. Marie, Mich ___ ____ __
1
1
2
61
0
0
61
0
Scobey, Mont . ______________ ___ ------ -- -------- ------- - ------ -- ----- -- - -- ---- ---- -- ------- - ---- -- Sumas, Wash ________ ____ _______
17
27
25
3
27
5
26
80
Sweetgrass, Mont. _____________
1
7
23
0
4
338
0
338
0
Van Buren, Maine ___ __ ________
0
1
2
3
32
0
32
0
Vanceboro, M aine ___ __ ____ _____
0
0
0
0
176
986
810
0
Vancouver, British Columbia,
Canada . . ____ ________ ______ ___
106
122
5
11
741
741
0
0
Victoria, British Columbia,
Canada . ___ __ ________ ________
4I
44
2
8
158
95
176
334
0
Winnipe!!, Manitoba, Canada __ l, 380
1, 175
160
1,351
3
13
4,063
237
5,680
27
0
0
1
28
Yarmouth,Nova Scotia, Canada_
0
54
99
45
--- --- --- --- -- -- --Total_ ____________________
10,862
7,749 627,829 646,440
4,113
344
76
2,764
- - - ---- - - - - - - - - - - - - - - - Total. all stations __ _______ 1-'i. mo 14. 375 71'12. 273 791. 778
4. 001
602
496
6. 274
1 Includes Fort Hancock, Guadalupe Gate, and Ysleta.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
-
92 9
1. 175
99
PUBLIC HEALTH SERVICE
MEDICAL INSPECTION OF ALIENS-continued
TABLE
8.-Alien seamen inspected and certified at international border stations
during fiscal year 1939
Place
Alien seamen certified
Number
of alien
seamen
examined
Class A
I
Class B
II
Class C
Total
---- ---Bellingham, Wash _________ __ ________ ____ _
Buffalo, N. Y.l __________________________ _
Chicago, IlL _____ _______________ _____ ___ _
Cleveland, Ohio _____________________ ____ _
Duluth, Minn ___ ________________________ _
Eastport, Maine _________________________ _
Erie, Pa __________ ___ ____________________ _
Ogdensburg, N. y ____________ ___________ _
P ort Angeles, Wash __________ _________ ___ _
Port Huron, Mich ____________ ___________ _
Rochester, N. y ______ _______ ____________ _
St. John, New Brunswick, Canada ____ __ _
Sault Ste. Marie, Mich ______________ ___ __
Total________________________ _______
1
40
6,200
1,075
325
160
203
342
149
0
268
1,534
3
84
0
0
1
0
0
0
0
1
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
8
0
3
0
0
1
0
24
0
0
0
0
0
17
0
0
0
0
0
0
3
0
0
0
0
0
26
0
3
0
0
2
0
29
1
0
0
36
20
61
- - - - ---- - - - - ---- ---- - - 10, 383
Includes Niagara Falls, N. Y.
TABLE
9.-Distribution, according to class, of applicants for immigration visas
who were medically examined during the fiscal year 1939
Number of applicants in each class
Total
number of 1 - - - - - - - . - - - - - - : - - - - - - - - applicants
Nonquota NonimmiQuota
examined
grants
Country and consular office
WESTERN HEMISPHERE
Cuba: Habana ____ _____________________________________ ·
4,906
4,198
708
0
1== = =1=====1=====1====
Canada, totaL ___ ___ ___ ______________ __ ___ ___ __________
13, 734
3,801
9,232
701
1-----1-----·1-----i-----
MontreaL __ ____ ___________________ ________ _______ _
Niagara Falls _____ _________________________________
Quebec_____ ______ __ ________________________________
Toronto__ __________________________________________
Vancouver___ ____ ________ ______ _______ _____________
4, 777
422
324
1,450
1,471
3,081
34
311
1
324
0
948
0
1,046
0
2
~~~~fi~g____ ________ __________ _____ _______________
66~
• ~g~
Yarmouth______ _________________ _______________ ___
225
33
192
0
l=====l=====i,====,1=====
All countries, Western Hemisphere_____________
18,640
7,999
9,940
701
tit~
1,662
110
0
502
425
m
1====~====1=====1====
EASTERN HEMISPHERE
Europe, totaL____ __________________ ________ _________ __
Belgium: Antwerp____ _____________________________
Bohemia: Prague ____ _____ _________________________
i~~~~~rL~~~~1:i~~~~~~===========================
Germany, totaL _______________________
____ __ ______
53,708
47,115
6,567
26
1=====1=====1°====1====
l, 750
1,69.5
55
0
3,525
3,128
397
0
m
Holland: Rotterdam _______________________________
Ireland, Northern: Belfast__ _____ __________________
Irish Free State: Dublin ___________________________
Italy: Naples __ ------------------------------------
~il~~~r.J>:~~aw===================================
Scotland: Glasgow_ ____________________________ ____
Sweden, totaL _____________________________________
~~:
6~~
g
5,650
2,427
10,421
8,008
5,439
2,374
10,177
7,837
211
53
240
171
0
O
4
0
2,288
112
1,018
7,962
2,241
83
871
4,259
47
29
127
3, 701
0
0
20
2
6~
2, :
:
204
104
5.
5,
26,506
25,827
675
4
l-----1-----1-----1-----
BerJin' --------- -- ------------ -- -- ______ ________
Hamburg__ ___________________________________ _
Stuttgart______ ____ ___ ___________ ________ _______
Vienna___ ____ ____________ ____ ________ _______ ___
3, 308
Ji
g
0
--=-_o
____
45_6_ _ _ _ _38_0_ _ _ _ _ _
76_ ___
1
1
1
1
~t~~e~hirni-_-~:::::::============================ l====~====l=====t====
~t;
rn~
~~
.g
Philippine Islands: Manila _______ _____________________
All countries, Eastern Hemisphere_______________
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Federal Reserve Bank of St. Louis
140
70
70
0
l====b====l=====I====
53,848
47,185
6,637
26
DIVISION OF SANITARY REPORTS AND STATISTICS
Assistant Surgeon General
CHARLES
V. AKIN in charge
Senior Surgeon Charles V. Akin was appointed Assistant Surgeon·
General in charge of the Division of Sanitary Reports and Statistics on
June 1, 1939, relieving Medical Director Robert Olesen.
The activities of the Division during the fiscal year have been much
the same as in the past. They have included: (1) the collection and
dissemination of official reports on the prevalence of reportable diseases
in the United States and of quarantinable diseases in foreign countries;:
(2) the editing, publication, and distribution of various publications
of the Public Health Service; and (3) the interpretation of public
health activities and scientific knowledge to the general public through
various educational media.
MORBIDITY AND MORTALITY REPORTS
UNITED ST A TES
The trend of communicable diseases throughout the United States is
indicated by the composite of weekly telegraphic reports received in
this Division from the State and Territorial health officers. These·
data on disease trends are made available through the weekly publication of Public Health Reports, which also publishes monthly summaries of disease prevalence by States and reports from a selected
group of 140 large cities. Through the correlation of these data with
mortality reports derived from other sources, a statistical picture
of health conditions in the United States is obtained.
The accompanying tabl~s show the number of cases of the principal
notifiable diseases and recorded deaths from these causes for 1938, as·.
compared to similar data for 1936 and 1937.
Number of cases of certain communicable diseases and cases per 100,000 population in large groups of States in the United States during 1936, 1937, and 1938'
0
Disease
ti
.0..,
s.s
ow
z
Chickenpox _______________ _
Diphtheria ________________ _
Influenza __________________ _
Malaria __________________ __
Measles ___________________ _
Meningitis, meningococcus_
Mumps ___________ ___ __ ___ _
Pellagra ___________ ________ _
Pneumonia (all forms) ____ _
Poliomyelitis ______________ _
Scarlet fever _____________ ___
Smallpox ______ ____________ _
Tuberculosis (all forms) ___ _
Tuberculosis (respiratory
system) _________________ _
Tyn,boid and paratyphoid
fever ___________________ __
Whooping cough_ ·------ - - 1
45
47
47
47
46
43
40
47
47
47
47
47
47
Aggregate population
(in thousands)
1936
1937
--- --- 118,921
127,921
127,921
127, 921
125,898
124,382
95,392
127,921
127,921
127,921
127, 921
127,921
127,921
119,655
128, 747
128, 747
128, 747
126,699
125, 183
96, 002
128, 747
128, 747
128, 747
128, 747
128, 747
128,747
1938
Cases per 100,000 1
population
Cases
1936
1937
1938
120, 512
129, 703
129, 703
129, 703
127,628
126, 111
96, 714
129, 703
129, 703
129, 703
129, 703
129, 703
129, 703
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Federal Reserve Bank of St. Louis
1937
1938
-
221,885 272,336 276,335 186. 6 227. fi 229. 3·
30,005 28, 523 30,495 - 23. 5 22'.2 23. 5·
----- -- - -- ----- - -------- ----- - ------ ------- --- --- -------- - - ------ - ----- ------ ------
298,430 318, 991
5,421
7,303
191, 077 141,013
----- --- --------------- --- ----9, 486
4,518
244,035 228, 41~
7,834 11,673
----- - -- --------
814,535 237. 0 251.8 638. ?
2. 3
5. 9
4. 3
2, 854
147,990 200. 3 146. 9 153. 0
-------- ------ ------ ------------- ------ - -- --- --- ---
1.3
7. 4
1,702
3. 5
189, 181 190. 8 177. 4 145. 9
9. 1 11. 5,
14,939
6.1
--------
-- ---- ---- -- ------
42 121,823 122,585 123,473 -- -- - - -- ----- --- --- - ---- -- --- - ------ - -- - - 47 127,921 128, 747 129, 703 15,887 16, 021 14,889 12. 4 12. 4 11.5
47 127,921 128, 747 129, 703 147, 141 214,309 227, 168 115. 0 166. 5 175. 1
In addition to the number of States given, the District of Columbia is also included.
100
1936
--- -- -- ----- -
101
PUBLIC HEALTH SERVICE
N u mber of deaths and deaths per 100,000 populati on from certai n communicable
diseases , with number of cases reported for. each death registered, in large grou ps
of States 1 in the United States during 1936, 1937, and 1938
D
Deaths
Disease
1936
1937
1938
h
Cases reported for
eat s per lOO,OOO
each death regispopulation
tered
1936
1937
1938
1936
1937
1938
- - - - - - - - - - - - - 1 - - - - - - - - - -- -- - - - - - Chickenpox _____________________________
127
116
Diphtheria _____________________________ 3,027
2,610
Influenza ____________ ______ _____ ____ ___ _ 34, 129 39,033
Malaria ___ ________ ______ __________ ______ 3,905
2,700
Measles ________ ___ ___ ________________ __ _ 1, 19::l
1,390
Meningitis, m eningococcus __ ___ ___ ___ __ 2,939
2, 132
Mumps _____________________________ ___ _
92
56
PeJlagra _________ ___ ____________________ 3,634
3,160
Pneumonia (all forms) _____________ _____ 118,509 109,630
Poliomyelitis ______ _____________________
l , 432
739
Scarlet fever ________________________ ____ 2,432
1,759
Smallpox ________ ______________ ____ _____
33
30
Tuberculosis (all forms) _______ __________ 70,750 68,722
Tuberculosis (respiratory system)_ ______ 59,960 58,610
Typhoid and paratyphoid fever ___ ______ 3,107
2,690
Whooping cough __________ __________ ____ 2,578
4,913
1
2
102
2, 556
16, 712
2,307
3,135
1,080
54
3, 176
87,484
478
], 210
46
63,007
53,677
2,392
4,716
0.1
2. 4
26. 7
3. 1
0. 9
2. 4
.1
2. 8
92. 6
.6
1. 9
(2)
55. 3
49. 2
2. 4
2.0
0. 1
2. 0
30. 3
2. 1
1.1
1. 7
.1
2. 5
85. 2
1.1
]. 4
(2)
53. 4
47.8
2. 1
3. 8
0.1
2. 0
12. 9
1.8
2. 5
.9
.1
2. 4
67. 4
.4
.9
(2)
1,747 2,348
10
11
2,709
12
------ - ----- ----- -
--- --- -- ---- - --- --
250
229
2
3
2,077 2,518
260
3
2,741
------ -- ---- ----- ------ ------ --- --6
100
237
7
130
389
4
156
325
48. 6 ------ ------ -----43. 5 -- ---- ------ -- ---1.8
5
6
6
44
48
3. 6
57
The same States as those for which cases are reported in the preceding table.
L ess than 0.1 per 100,000 population.
An appreciable decline in the general death rate for the United
States was indicated by the provisional rate of 10.6 per 1,000 population for 1938 as compared to the final rate of 11.2 for 1937. This is
the lowest rate since the death registration area was established by
the United States Bureau of the Census in 1900.
The outstanding items of interest in public health statistics for the
year are discussed more fully in the foreword of this report.
The principal causes of death in 1938, according to provisional
figures , were as follows, and in the order named: Diseases of the heart,
cancer, cerebral hemorrhage (including embolism and thrombosis),
nephritis, all accidents, pneumonia (all forms), diseases of the digestive
system, and tuberculosis (all forms).
It will be noted that only two of these conditions (pneumonia and
tuberculosis) are reportable to State health departments, and hence
to the Public Health Service. Therefore, information on the prevalence of nonreportable conditions must be derived chiefly from estimates based upon data obtained in morbidity studies of representative
samples of the general population. Since the majority of the principal
causes of death for 1938 were chronic degenerative diseases , a preliminary bulletin on the chronic disease problem in the United States,
published during the year by the National Health S~rvey, 1 is of
interest. This bulletin affords data on the prevalence of a -number of
chronic degenerative diseases not reportable by the States. According
1 This report was baserl on a house-to-house canvass of some 800,000 families representative of the general
population of the United States. See page 73.
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Federal Reserve Bank of St. Louis
102
PUBLIC HEALTH SERVICE
to these data, the estimated prevalence of specified chronic diseases in
the United States in 1937 was:
Disease
Number of cases
Rheumatism, including arthritis, gout, neuralgia, neuritis, lumbago,
etc______ ___________ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ __ _ _ _ _ _ _ _ _ __ _ _
Heart disease ______ _______________ ______________________ - _ __ _ _
Arteriosclerosis and high blood pressure, including cerebral hemorrhage,
embolism, and paralysis _____________________________________ - Hay fever and asthma_________________________________________
Hernia__ ____________ _______________________ __ ________________
Hemorrhoids ___ _____ _____ __________ _________ ____ __________ ____
Varicose veins ______________ ___________________________________
Chronic bronchitis ______________ ________ _________________ - _ _ _ _ _
Nephritis and other kidney diseases ______________________________
Nervous and mental diseases ____________________________________
Goiter and other thyroid diseases________________________________
Sinusitis ______________________________________________________
Cancer and other tumors ___________ ___ _________________________
Diseases of the female organs___________________________________
Tuberculosis, all forms _________________________________________
Diabetes mellitus____ ____ _ _ ____ __ ____ _____ _ ____ __ _ _ _ _ __ _ _ _ _ _ _ _ _
Diseases of gall bladder and liver___ _____________________________
Other diseases of the circulatory system__________________________
Chronic tonsillitis and other throat infections ___ ___ _______________
Ulcers of stomach and duodenum ________________________________
Diseases of bladder and urethra_ _ _ _ _ __ _ _ _ _ _ _ _ __ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _
Chronic diseases of the skin_____________________________________
Anemia_ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
Chronic appendicitis___________________________________________
Chronic diseases of the eye_____________________________________
Chronic diseases of the ear______________________________________
Chronic pleurisy_____ ______ ______________ ____ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __
Diseases of the prostate and male genito-urinary organs____________
6, 850, 000
3, 700, 000
3, 700, 000
3, 450, 000
2, 100, 000
2, 000, 000
1, 750, 000
1, 700, 000
1,550,000
1,450,000
1, 200, 000
1, 150, 000
930, 000
720, 000
680, 000
660, 000
640,000
440,000
380, 000
330,000
270, 000
270,000
240, 000
170, 000
150,000
100,000
90, 000
80, 000
In another preliminary bulletin published by the National Health
Survey, it was estimated that 30,000 accidents which disable the victims for one or more days occur daily in the general population of the
United States, or an annual total of 10 million such accidents.
FOREIGN COUNTRIES
During the calendar year 1938, reports relative to health conditions
in foreign countries were received from Public Health Service officers
and from the International Health Office in Paris, the Pan American
Sanitary Bureau, the Health Section of the League of Nations, and
other sources. The accompanying table indicates the countries in
which quarantinable diseases were most prevalent in the calendar
year 1938. These reports are known to be incomplete (in many
instances, fragmentary) and must be considered as representing a bare
minimum ·of disease prevalence.
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PUBLIC HEALTH SERVICE
Number of cases and deaths from cholera, plague, smallpox, typhus fever, and yellow·
fever reported in certain countries during 1938
I Oases I D eaths
Country
Cholera
Plague
India ____________ ______________ ___ 356, 373
China __________ __ __ ___ ____ _______ 13,347
French Indochina____________ ____ _ 8,507
French India ____ ___ __ _______ _____
143
Chosen .____ ______________________
48
Afghanistan________ ______________
18
Japan_____ ___ _____________ ________
14
Siam ____ _______________________ __ _
3
174,213
2,835
6,628
73
30
(1)
7
3
India _______________________ _____ _ 20,305
Java and Madura ______________ __ 1,801
Madagascar _____ ____ __ ______ ____ _
611
Uganda . ____________ ____ ____ __ __ _
385
Union of South Africa __________ _
88
Belgia:p. Congo ________________ __ _
28
Kenya . __ __________ _____ __ __ __ __ _
27
Egypt__ __ __ __ __ ____ ________ __ ___ _
11
Smallpox
9, <l30
(1)
561
375
(1)
54
13
Typhus fe ver
India _______ _______________ __ ____ _ 83, 283
United States ___ _______ __________ _ 14,387
~~~~fj~-~--~
===== ==______________
========== == =_=
China __ __ ___ =
_______
Belgian Congo ____ ___ _________ ___ _
French West Africa __ ____ ______ __ _
M exico. _________________________ _
Tanganyika ____ ___ ______________ _
Portuga.I ________ _________________ _
6,688
6,288
3,905
2, 936
2,286
1,796
1,119
706
20,742
46
1,356
1,222
2, 350
49
142
(1)
28
54
Morocco ___ __ _________ ________ ___
Poland ___ _____ _______ ______ ___ __ _
Egypt__ ____ -- ----- ---- - - -- - -- -- - -
~~~~i_
a_-::====
====__=__
== =
== === =
====
United States
__ ___
______
____
_
Algeria __________ ----------- - -- - -China _____ _______ ________ _______ _
Union of South Africa __ ____ ____ __
M exico ______ ___ __ __ ______ _______ _
Yellow fever
7, 437
3,457
2,803
2,284
2, 327
2, 141
1,551
1, 092
1, 071
1,032
Yellow fever
Brazil__ _____ ________________ ______
Ivory Coast_____ _______ _____ _____
Colombia,_ __________ ______ _______
Gold Coast______________ ______ ___
Belgian Congo____ ___ ________ _____
1
I Oases I Deaths:
Country
(1)
25
(I)
14
14
2
111314
8
i1~::ta=-~=
==_______
========________
========
==_=
Senegal _____
__==
___
French W est Africa _____________ _
Dahomey __ ______ ____ ___________ _
10
10
2
2
1
7
6
1
I
1
Figures not available.
PUBLICATIONS AND DISTRIBUTION
This Division is responsible for the editing and publication of a
number of Public Health Service publications and for the distribution
of these and publications of other Divisions of the Service. The
following classes of publications are edited and published by this
Division: Public Health Reports, Supplements to Public Health
R eports, Reprints from Public Health Reports, the Annual Report of
the Surgeon General of the Public Health Service, Hospital N ~ws,
National Negro Health Week publications, and miscellaneous publications.
PUBLIC HEALTH REPORTS
Public Health Reports, issued weekly, is one of the oldest periodicals published by the Federal Government. It was founded in 1878
under the title "Bulletins of Health." For several years, the Bulletins.
of Health contained only reports of the current prevalence of communicable diseases in the United States and foreign countries, a
required by law. Since 1912, however, articles on the cause and prevention of disease and other contributions of Public Health Service
investigators to preventive medicine and public health science have
been added to these reports, as authorized by acts of Congress. The e
articles deal with the various fields of research, industrial hygiene.,
mental hygiene, public health administration, stream pollution and
water purification, quarantine work, and many other subjects with
which the Public Health Service is concerned in its functions of research and public health protection.
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104
PUBLIC HEALTH SERVICE
More than 160 articles were published in Public Health Reports.
during the year. Among the outstanding contributions were: Studies
of the cause, prevalence, and prevention of trichinosis; new methods
for the diagnosis of brucellosis (undulant fever); investigations of the
incidence of rheumatic heart disease among college students; a series
of studies on rheumatic fever and carditis; an analysis of over 5,000
deaths due to coronary occlusion; the frequency of dental services
received and of illnesses treated surgically in 9,000 canvassed families;
studies of the incidence of dental caries among school children; studies
in immunizing agents for use in certain types of pneumonia; a series
of studies on the induction of cancer in mice and the genetic factors
involved.
Summarized reports of the current prevalence of communicable
diseases in the United States and reports of quarantinable and other
diseases in foreign countries are published weekly for the information
of State and local health authorities and of the quarantine officers
stationed in ports of the continental United States and insular possessions. Through current knowledge (such as is made available in
Public Health Reports) of when and where cases of communicable
diseases are occurring, heal th officials and quarantine officers are
materially aided in their work of preventing and of controlling the
spread of communicable diseases. When outbreaks of particular
communicable diseases occur, the latest available information is
published, in order that health authorities and the public may be
promptly informed.
.
The publication in Public Health Reports of current investigations made by Public Health Service workers serves to inform other
investigators in similar fields of the progress made by the research
staff of the Service. Similarly, physicians and other interested persons are kept in touch with the work of the Public Health Service in
the field of preventive medicine.
During the fiscal year, volume 53, part 2, and volume 54, part 1,
of Public Health Reports were issued, comprising 52 numbers and
containing 2,439 pages of text and tabular matter, exclusive of title
pages and tables of contents, as compared to 2,156 pages in the fiscal
year 1938, 1,715 pages in 1937, and 1,828 pages in 1936. The increase
in the num.ber of articles submitted for publication is largely the result
of the expansion of scientific investigations undertaken by the Service
in accordance with the provisions of the Social Security Act and the
National Cancer Institute Act. Indexes to Public Health Reports
are issued during the year for parts 1 and 2 of the yearly volumes.
Reprints of the most important articles appearing in Public Health
Reports have been issued, providing for more economical and extensive distribution to persons especially interested in the particular
subjects, and permitting the printing of additional copies for sale by
the Superintendent of Documents. During the fiscal year 1939, 133
such reprints were issued, as compared to 11 7 in 1938, and 7 6 in 193 7.
Special studies jn the field of preventive medicine and public health
and articles intended for popular distribution are issued as Supplements to Public Health Reports. During the fiscal year, 10 supplements were issued, the titles of which appear in an accompanying list.
One miscellaneous publication, No. 30, The Communicable Diseases, was in preparation during the year, and is scheduled for early
publication. A series of 10 articles on experimental studies of natural
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PUBLIC HEALTH SER.VICE
105
· purification in polluted waters, previously issued as reprints, was
:bm,m d in order to preserve this valuable series for purposes o~ reference.
New editions were issued of five reprints, one supplement, and one
miscellaneous publication, several of which were completely revised
.and brought up to date. In issuing new editions, it is the purpose of
this Division to keep revised, in accordance with the latest information, the publications distributed by the Public Health Service.
Hospital News, a multilithed collection of reports by personnel
of the marine hospitals, was edited in this Division and issued semimonthly during the year. It contains information regarding case
histories, clinical research, practices, and observations, and improvements in hospital management and techniques. Distribution of
Hospital News is limited to Public Health Service personnel, and
·it is not for sale. Much of the material presented, however, is of
definite clinical interest and value and merits a more extensive
-distribution.
The National Negro Health Week annual publications-bulletin,
leaflet, and poster-and ational Negro Health News, a quarterly
bulletin, were issued by this Division during the year.
OFFICE OF HEALTH EDUCATION
The work of the Office of Health Education included the writing
·and revision of educational publications of the Public Health Service;
planning of improved printing format for all Service publications;
the development of graphic materials, including photographs, exhibits,
·art work, and motion pictures; planning circulation of educational
·material for maximum effectiveness; and special educational projects,
·such as that already undertaken in connection with syphilis control.
During the past year the office has assisted in the production of
the following publications: Syphilis and Your Town, You Can End
'This Sorrow, Gonorrhea- The Crippler, 20 Questions on Gonorrhea,
High Schools and Sex Education, We Grow Up, Communicable Dis·eases, What to Know and What to Do About Cancer.
Press releases from the Public Health Service were handled by this
-office, and a number of special statements and articles were also prepared. More than 200 such items were issued during the year. The
-office has assisted in the preparation of numerous radio scripts, one
-of which was used by the ational Emergency Council for broadcasting by local stations in most of the larger cities of the country.
Primary responsibility for production and distribution of the film
'Three Counties Against Syphilis rested with this office. During
the past 12 months 9 prints have been sold to State Health Departments and other interested agencies. Forty-three prints purchased
·by the Service for general use have been kept in almost constant
circulation.
Approximately 2,400 photographs were added to the files. The
acquisitions include special series on Rocky Mountain spotted fever,
taken at Hamilton, Mont.; on malaria control, taken in the south·eastern part of the country; on cancer therapy and research; Public
Health Service Hospital for narcotic patients at Lexington, Ky.;
,quarantine activities at New Orleans, New York, and Miami; Marine
Hospitals at Baltimore and ew Orleans; work of the venereal disease
·trailer clinic, Brunswick, Ga.; Venereal Disease Medical Center,
:Hot Springs, Ark.
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Federal Reserve Bank of St. Louis
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PUBLIC HEALTH SERVICE
Numerous exhibits were prepared for various organizations, including the American Public Health Association, the American
Medical Association, the Southern Conference for Human Welfare,
and the International Congress of Military Surgeons.
NEGRO HEALTH
w ORK
The National Negro Health Week program continued under the
administrative direction of this Division. The year 1939 was marked
by the celebration of the twenty-fifth anniversary of National Negro
Health Week, an educational program founded in 1915 by the late
Dr. Booker T. Washington. The campaign is devoted to the development of health consciousness in the Negro population and the stimulation of racial and inter-racial cooperation in the solution of his
particular health problems.
The silver anniversary celebration of this movement had for its
objective the promotion of the Negro citizen's responsibility for
community health. R eports for the 1939 health week reflect the
serio.u s purpose of the participants. A total of 2% million persons
in 4,009 communities in 34 States and the Virgin Islands participated
in the campaign. Accomplishments of the year are summarized as
follows: Attendance at lectures, 1,543,210; health sermon congregations, 490,075; exhibits, demonstrations, and motion pictures, 344,670
visitors and participants; radio broadcasts, 457; cleanup, insect and
rodent control activities, house repair and improvement of premises
including installation of sanitary facilities, 102,113 homes. In addition, 103,885 persons were examined or treated in 1,221 clinics
and doctors' offices. Half a million pieces of health literature were
supplied by the Public Health Service, State departments of health,
and voluntary agencies. Newspaper articles totaled 2,621.
Thirty localities in 15 States were visited in the interests of Negro
Health Work. One hundred and eighty-two organizations and institutions received 110 days of field service, providing 455 lectures and
conferences for 61,200 persons. Health publications were received by
24,665 people and 12,700 attended motion pictures.
"National Negro Health News," a quarterly bulletin providing
information on the health status of the Negro and on related problems
and programs, was made available to 3,500 officials and other persons
in he~lth departments and in related health, education, and welfare
agenmes.
Following the health-week activities, emphasis on the health of
the Negro is sustained by means of year-round contacts and communication with the cooperating organizations, by educational
demonstrations and other services. These activities are valuable in
the maintenance of health consciousness, in the appraisal of the
publications prepared and distributed, and in determining the need
for advisory and field services from the Public Health Service.
The expanding program of the Public Health Service has favorably
affected Negro health. It has stimulated interest in Negro health
problems on the part of official and voluntary health agencies and
civic organizations which function among large groups of the Negro
population. Moreover, definite consideration is being given to the
means by which the Negro _m ay effectively benefit by the various
health services, and there has been an increase in facilities and
personnel. Notable in the latter accomplishment are the increase in
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
107
clinics for the treatment of the venereal diseases and tuberculosis; the
training of Negro physicians in improved methods of diagnosis and
treatment; the training and employment of public health nurses;
and the preparation and utilization of health educational materials.
The monies made available by Federal appropriations to the Public
Health Service for aid to State departments of health are making
possible the larger service which the great need of the egro requires.
LIST OF
EW PuBLICATIO
s IssuEn DuRING THE YEAR
REPRINTS FROM THE PUBLIC HEALTH REPORTS
1913. Toxicology of phenyldichlorarsine. I. Experiments with animals. By
H. C. Dudley and B. F. Jones. March 4, 1938. 10 pages; 1 plate.
1917. History and frequency of clinical scarlet fever cases and of injections for
artificial immunization among 9,000 families. Based on J ation-wide
periodic canvasses, 1928-3 1. By Selwyn D. Collins. March 18, 1938.
19 pages.
1924. Frequency of sickness and nonindustrial accidents causing disability lasting
eight calendar days or longer among 60,000 white male railroad employees, 1930-34, inclusive. By William M. Gafafer. April 15, 1938.
19 pages.
1925. Occurrence of tularaemia in the rabbit tick (Haemaphysalis leporis palustris) in Alaska. By Cornelius B. Philip and R. R. Parker. April 15,
1938. 2 pages.
1926. Frequency of surgical procedures among 9,000 families, based on Nationwide periodic canvasses, 1928- 31. By Selwyn D. Collins. April 22,
1938. 42 pages.
1929. Studies on trichinosis. V. The incidence of trichinosis as indicated by postmortem examinations of 1,000 diaphragms. By M. 0. Nolan and John
Bozicevich. April 29, 1938. 22 pages.
1932. Studies on dental caries. I. Dental status and dental needs of elementary
school children. By Henry Klein, Carroll E. Palmer, and John W.
Knutson. May 13, 1938. 14 pages.
1933. Experimental vanadium poisoning in the white rat. By Esther Peterson
Daniel and R. D. Lillie. May 13, 1938. 13 pages; 2 plates.
1936. The incubation period in undulant fever. By A. V. Hardy, S. Frant, and
M. M. Kroll. May 20, 1938. 7 pages.
1937. Trend of mortality and morbidity during 1937 and recent preceding years .
Based on provisional data for all years . May 6, 1938. 19 pages.
1938. Stud.ies on blood coagulation. I. General considerations. By Lazlo Detre.
May 27, 1938. 22 pages.
1939. Age of delinquents in relationship to Rorschach Test scores. By M. J.
Pescor. May 27, 1938. 13 pages.
1940. Lighting for low-cost housing. By James E . Ives. June 3, 1938. 8 pages.
1941. The sanitation of isolated dwellings. By H. A. Whittaker. June 3, 1938.
8 pages.
1942. A further study of the purification and tannic acid precipitation of scarlet
fever toxin. By M. V. Veldee. June 3, 1938. 5 pages.
1943.
umb er and length of nursing visits as indices of nursing service. By
Helen Bean. June 3, 1938. 9 pages.
1944. The effect of moisture and age on stability of neoarsphenamine. By T. F.
Probey and W. T. Harrison. June 10, 1938. 6 pages.
1945. The effect of the age of neoarsphenamine on reaction expectancy. By
C . S. Stephenson, T. F. Probey, and W. T. Harrison. June 10, 1938.
4 pages.
1946. Flea infestation of domestic rats in San Francisco, Calif. By C. R. Eskey.
June 10, 1938. 4 pages.
1947. The prevention and control of cancer. A plan for ration-wide organization. By J. W. Schereschewsky. June 17, 1938. 9 pages.
1948. Effects of intramuscular injections of vitamin B1 on acute leprous neuritis
and of oral administration on the general disease. A preliminary report.
By L. F. Badger and D. W. Patrick. June 17, 1938. 10 pages.
188796-40--8
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1949. Studies on oxyuriasis. XVI. The number of eggs produced by the pinworm, Enterobius vermicularis, and its bearing on infection. By Lucy
Reardon. June 17, 1938. 6 pages.
1950. Rocky Mountain spotted fever. Geographical and seasonal prevalence,
case fatality, and preventive measures. By Brock C. Hampton and
Harry G. Eubank. June 17, 1938. 8 pages.
1951. Studies on the epidemiology of poliomyelitis. By C. C. Dauer. June 24,
1938. 18 pages.
1952. Studies on dental caries. IV. Tooth mortality in elementary school
children. By John W. Knutson and Henry Klein. June 24, 1938.
12 pages.
1953. Metal fume fever and its prevention. By R. R. Sayers. July 1, 1938.
6 pages.
1954. Studies on trichinosis. VI. Epidemiological aspects of trichinosis in the
United States as indicated by an examination of 1,000 diaphragms for
trichinae. By Maurice C. Hall. July 1, 1938. 20 pages.
1955. Mortality during periods of excessive temperature. By Mary Gover.
July 8, 1938. 22 pages.
1956. Directory of whole-time county health officers, 1938. July 8, 1938. 20
pages.
1957. The relative amount of ill health in rural and urban communities. By
Harold F. Dorn. July 15, 1938. 16 pages.
1958. Studies on the fate of selenium in the organism. By M. I. Smith, B. B.
Westfall, and E. F. Stohlman. July 15, 1938. 18 pages.
.
1959. Two new species of Meringis jordan (Siphonaptera). By Glen M. Kohls.
July 15, 1938. 5 pages.
1960. The absorption and excretion of lead arsenate in man. By Lawrence T.
Fairhall and Paul A. Neal. July 22, 1938. 15 pages.
1961. The persistence of the viruses of endemic (murine) typhus, Rocky Mountain spotted fever and boutonneuse fever in tissues of experimental
animals. By Cornelius B. Philip and R. R. Parker. July 22, 1938. 6
pages.
1962. Endemic typhus virus in mice. By George D. Brigham. July 22, 1938.
6 pages.
1963. Frequency and duration of disabilities causing absence from work among
the employees of a public utility, 1933- 1937. By William M. Gafafer
and Elizabeth S. Frasier. July 29, 1938. 16 pages.
1964. Antagonism between species of malaria parasites in induced mixed infections. Prelimina.ry note. By Bruce Mayne and Martin D. Young.
July 29, 1938. 3 pages.
1965. Toxicology of phenyldichlorarsine. II. Response of man to PDA-oil mixtures. By R. R. Sayers and H. C. Dudley. July 29, 1938. 10 pages;
3 plates.
1966. Public Health Service publications. A list of publications issued during the
period January- June 1938. July 29, 1938. 5 pages.
1967. A case of human infection with B. pseudotuberculosis rodentium. By
orman H. Topping, C. E. Watts, and R. D. Lillie. August 5, 1938.
13 pages; 2 plates.
1968. Studies on dental caries. V. Familial resemblance in the caries experience
of siblings. By Henry Klein and Carroll E. Palmer. August 5, 1938.
12 pages.
1969. Report on market-milk supplies of certain urban communities. Compliance
of the market-milk supplies of certain 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 compliance (not safety)
ratings of 90 percent or more .reported by the State milk-sanitation
authorities during the period July 1, 1936, to June 30, 1938). August
12, 1938. 5 pages.
1970. Methods of making sanitation ratings of milksheds. By Leslie C. Frank,
Abraham W. Fuchs, and Walter
. Dashiell. August 12, 1938. 14
pages.
1971. A comparison of the precipitation reaction in immune serum agar plates
with the protection of mice by antimnrini?;ococcus serum. By Margaret
Pittman, Sara E . Branham, and Elsie M. Sockrider. August 12, 1938.
9 pages: 1 plate.
1972. State and insular health authorities, 1938. Directory, with data as to
appropriations and publications. August 12, 1938. 21 pages.
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109
1973. Endemic fluorosis and its relation to dental caries. By H. Trendley Dean.
August 19, 1938. 10 pages; 1 plate.
1974. Silicosis and similar dust diseases. M edical aspects and control. By
R. R. Sayers and R. R. Jones. August 19, 1938. 20 pages.
1975. Studies on trichinosis. VII. The past and present status of trichinosis
in the United States, and the indicated control measures. By Maurice C.
Hall. August 19, 1938. 14 pages.
1976. The flora and fauna of surface waters polluted by acid mine drainage. By
James B. Lackey. August 26, 1938. 9 pages.
1977. Studies on chronic brucellosis. IV. An evaluation of the diagnostic laboratory tests. By Alice C. Evans, Frank H. Robinson, and Leona Baumgartner. August 26, 1938. 19 pages.
1978. A compariti ve study of two strains of Rocky Mountain spotted fever virus
with special rPference to the Weil-Felix reaction. By Gordon E. Davis
and R. R. P arker. August 26, 1938. 8 pages.
1979. Frequency of disabling illness among industrial employees during 1932- 37
and the first quarter of 1938. By William M. Gafafer and Elizabeth S.
Frasier. September 2, 1938. 10 pages.
1980. Changes in the types of visual refractive errors of children. A statistical
study. By Antonio Ciocco. September 2, 1938. 8 pages.
1981. Percentage of illnesses treated surgicall y among 9,000 families. Based
on Nation-wide periodic canvasses, 1928- 31. By Selwyn D. Collins.
September 9, 1938. 24 pages.
1982. Two new species of ticks (Ixodes) from California. (Acarina: Ixodidae).
By R. A. Cooley and Glen M. Kohls. September 9, 1938. 6 pages.
1983. Incidence of rheumatic heart disease among college students in the United
States. Based on replies to a questionnaire. By 0. F. Hedley. September 16, 1938. 13 pages.
1984. Susceptibility of mice to spontaneous; induced, and transplantable
tumors. A comparative study of eight strains. By H. B. Andervont.
September 16, 1938. 19 pages.
1985. The incidence of induced subcutaneous and pulmonary tumors and spontaneous mammary tumors in hybrid mice. By H. B. Andervont. September 16, 1938. 7 pages.
1986. Studies on dental caries. VII. Sex differences in dental caries experience
of elementar y school children. By H enry Klein and Carroll E. Palmer.
September 23, 1938. 6 pages.
1987. Studies of sewage purification. VII. Biochemical oxidation by activated
sludge. By C. C. Ruchhoft, P. D. McNamee, and C. T. Butterfield.
September 23, 1939. 29 pages.
1988. Cancer mortality in the United States in 1936 and recent preceding years.
By Brock C. Hampton. May 20, 1938. 5 pages.
1989. Mottled enamel survey of Bauxite, Ark., ten years after a change in the
common water supply. By H. Trendley Dean, Frederick S. McKay, and
Elias Elvove. September 30, 1938. 13 pages; 3 plates.
1990. A simple method of concentrating vitamin E. Ry C. G. Mackenzie, Julia
B. Mackenzie, and E . V. McCollum. October 7, 1938. 4 pages.
1991. City health officers, 1938. Dire-ctory of those in cities of 10,000 or more
population. October 7, 1938. 18 pages.
1992. Poliomyelitis: Prevalence since 1915 and during first half of 1938. By
Brock C. Hampton. July 8, 1938. 5 pages.
1993. REport of two cases of Rocky Mountain spotted fever in Ohio. By Merlin
L. Cooper, Meyer A. Kurzner, Armine T. Wilson, and R. E. Dyer.
October 7, 1938. 5 pages.
1994. Provisional mortality rates for the first six months of 1938. October 14,
1938. 8 pages.
1995. Effect of sodium selenite and selenate OP. the oxygen consumption of mammalian tissues. By C.. I. Wright. October 14, 1938. 12 pages.
1996. The assay of urine in canine blacktongue by the use of Shigella paradysenteriae (Sonne). By H.F. Fraser, N. H. Topping, and W. H. Sebrell.
October 14, 1938. 8 pages.
1997. Studies on immunizing substances in pneumococci. VII. Response in
human beings to antigenic pneumococcus polysaccharides, types I and II.
By Lloyd D. Felton. October 21, 1938. 24 pages.
1998. Studies on immunizing substances in pneumococci. VIII. Report on
field tests to determine the prophylactic value of a pneumococcus antigen.
By G. M. Ekwurzel, J. S. Simmons, Louis I. Dublin, and Lloyd D. Felton.
October 21, 1938. 17 pages.
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110
PUBLIC HEALTH SERVICE
1999. Studies of sewage purification. VIII. Observations on the effect of
variations in the initial numbers of bacteria and of the dispersion of sludge
floes on the course of oxidation of organic material by bacteria in pure
culture. By C. T. Butterfield and Elsie Wattie. October 28, 1938. 24
pages.
2000. The isolation of Actinomyces bovis from tonsillar granules. By C. W.
Emmons. November 4, 1938. 9 pages; 1 plate.
2001. The incidence and future fxpectancy of mental disease. By Harold F.
Dorn. November 11, 1938. 14 pages.
2002. Studies on the mechanism of experimental intranasal infection in mice. By
Charles Armstrong. November 11, 1938. 9 pages.
2003. The U. S. Marine Hospital ( J ational Leprosarium), Carville, La. Review
of the more important activities for the fiscal year ended June 30, 1938
By H. E. Hasseltine. November 18, 1938. 13 pages.
2004. Protozoan planktc•n as indicators of pollution in a flowing stream. By
James B. Lackey . November 18, 1938. 22 pages.
2005. Comparison of modified Eijkman medium and standard lactose broth in
the examination of oysters, clams, and shellfish-growing waters. By
Velma Payne. November 18, 1938. 6 pageR.
2006. Susceptibility of animals to endemic typhus virus. (Second report.) By
George D. Brigham. November 25, 1938. 2 pages.
2007. The manipulation and counting of river plankton and changes in some
organisms due to formalin preservation. By James B. Lackey. November 2.5, 1938. 14 pages.
2008. Fundamental cancer research. Repcrt of a committee appointed by the
Surgeon General. December 2, 1938. 10 pages.
2009. Studies on trichinosis. XII. The preparation and use of an improved
trichina antigen. Bv John Bozicevich. December 2, 1938. 9 pages.
2010. A study of the economics of pneumonia. The costs of diagnosis and treatment of 625 casts in New York City. By Joseph Hirsh. December 9,
1938. 22 pages.
2011. Ixodes marmotae- A new species of tick from marmots. (Acarina: Ixodidae) . By R. A. Cooley and Glen M. Kohls. December 9, 1938. 8
pages.
2012. The problem of drug addiction. By Thomas Parran. December 16, 1938.
5 pages; 2 plates.
2013. Spontaneous lung carcinoma in mice. By John J. Bittner. December 16,
1938. 5 pages.
2014. A supplementary basic technique for the recovery of protozoan cysts and
helminth eggs in feces. (Preliminary communication.) By Joseph S.
D' Antoni :md Vada Odom. D ecember 16, 1938. 2 pages.
2015. Longevity of the tick Ornithodoros turicata and of Spirochaeta recurrentis
within this tick. By Edward Francis. December 23, 1938. 22 pages;
3 plates.
2016. Use of yolk sac of developing chick embryo as medium for growing rickettsiae of Rocky Mountain spotted fever and typhus groups. By H erald
R. Cox. D ecember 23, 1938. 8 pages.
2017. A filter-passing infectious a~ent isolated from ticks. I. Isolation from
Dermacentor andersoni, reactions in animals, and filtration experiments.
II. Transmission by Dermacentor andersoni. III. Description of the
organism and cultivation experiments. IV. Human infection. By
Gordon E. Davis, H erald R. Cox, R. R. Parker, and R. E. Dyer. D ecember 30, 1938. 24 pages.
2018. Riboflavin deficiency in man. A preliminary note. By W. H. Sebrell and
R. E. Butler. D ecember 30, 1938. 9 pages.
2019. The health of the Nation. By Thomas Parran. January 6, 1939.
7 pages.
2020.
onindustrial injuries among male and female industrial employees. By
Hugh P. Brinton. January 6, 1939. 12 pages.
2021. Undergraduate engineering training in public health and related activities
in engineering colleges of the United States. By Arthur P. Miller.
January 13, 1939. 7 pages.
2022. Evaluation of odor nuisance in the manufacture of kraft paper. By J. M.
DallaValleandH. C. Dudley. January 13, 1939. 9pages.
2023. Amblyomma philipi- A new tick from Texas and Mexico, with a key to
known species of Amblyomma in the United States. (Acarina: Ixodidae.) By R. A. Cooley and Glen M. Kohls. January 13, 1939.
4 pages; 2 plates.
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PUBLIC HEALTH SERVIUI•}
111
2024. Basal metabolism tests on disturbed patients. By C. K. Himmelsbach
and Othilia T. M ertes. January 20, 1939. 4 pages.
2025. Do case records guide the nursing service. By Mayhew Derryberry.
January 20, 1939. 11 pages.
2026. Studies in chemotherapy. VIII. Some toxic effects of repeated administration of sulfanilamide and sulfanilyl sulfanilamide ("di-sulfanilarnide'!) to rabbits and chickens. By Sanford M. Rosenthal. January
27, 1939. 12 pages.
2027. Histopathological changes in hens and rabbits following administration of
sulfanilamide and sulfanilyl sulfanilamide (di-sulfanilamide). By A. A.
Nelson. January 27, 1939. 21 pages; 3 plates.
2028. The protein tyrosin reaction. A biochemical diagnostic test for malaria.
By H. 0. Proske and Robert B. Watson. February 3, 1939. 15 pages.
2029. Chronic ulcerative cecitis in the rat. By Benjamin F. Jones and Harold
L. Stewart. February 3, 1939. 4 pages.
2030. Report on market-milk supplies of certain urban communities. Compliance of th e market-milk supplies of certain 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 compliance (not
safety) ratings of 90 percent or more reported by State milk-sanitation
authorities during the period January l, 1937, to December 31, 1938.
February 3, 1939. 5 pages.
2031. An epidemiological study of poliomyelitis in the District of Columbia.
By C. C. Dauer. February 10, 1939. 8 pages.
2032. Mottled enamel in South Dakota. By H. Trendley Dean, Elias Elvove,
and Richard F. Poston. February 10, 1939. 16 pages.
2033. The effect of artificial temperatures on stability of neoarsphenamine.
By T. F. Probey and W. T. Harrison. February 10, 1939. 5 pages.
2034. The formal-gel reaction in rheumatic fever: an aid in the diagnosis of
active carditis. By Mark P. Schultz and Edythe J. Rose. February 17,
1939. 16 pages .
2035. The concentration of glutathione in the erythrocytes of patients with
rheumatic fever. By Mark P. Schultz. February 17, 1939. 5 pages.
2036. Public Health Service publications. A list of publications issued during
the period July- December 1938. February 3, 1939. 6 pages.
2037. Studies of the acute diarrheal diseases. I. Differential culture media.
By A. V. Hardy, James Watt, T. M. DeCapito, and Maxwell H. Kolodny.
February 24, 1939. 14 pages.
2038. Clegg's amoeba culture method for growing Mycobacterium leprae. By
Florence L. Evans. February 24, 1939. 5 pages.
2039. Glucose tolerance in rheumatic fever. By Mark P. Schultz. February 24,
1939. 6 pages.
2040. Preventive clinic facilities available in 94 selected counties of the United
States. By Anthony J. Borowski and Margaret Lovell Plumley.
March 3, 1939. 8 pages.
2041. The catalytic potency of the blood in rheumatic fever. By Mark P.
Schultz and Edythe J. Rose. March 3, 1939. 10 pages.
2042. A study of quartz-fusing operations with special reference to the measurement and control of silica fumes. By Edward C. Riley and J. M.
DallaValle. March 3, 1939. 8 pages.
2043. The association between rheumatic fever and exophthalmic goiter. By
Mark P. Schultz. March 10, 1939. 8 pages.
2044. Breast and lung carcinoma in "A" stock mice. By John J. Bittner.
March 10, 1939. 13 pages.
2045. The complement fixation reaction of Lleras in leprosy. By Sam H. Black
and Hilary Ross. March 10, 1939. 8 pages.
2046. Mouth lesions associated with dietary deficiencies in monkeys. By N. H.
Topping and H.F. Fraser. March 17, 1939. 16 pages; 4 plates.
20:47. Oral pathology in monkeys in various experimental dietary deficiencies.
By T. H. Tomlinson, Jr. March 17, 1939. 8 pages; 3 plates.
2048. A study of experimental pertussis in the young rat. By J. W. Hornibrook
and L. L. Ashburn. March 17, 1939. 6 pages; 3 plates.
2049. Disabling sickness and nonindustrial injuries among drivers and other employees of certain bus and cab companies, 1930-34, inclusive. By
Hugh P. Brinton. March 24, 1939. 10 pages.
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112
PUBLIC HEALTH SERVICE
2050. Studies of sewage purification. IX. Total purification, oxidation, adsorption, and synthesis of nutrient substrates by activated sludge. By
C. C. Ruchhoft, C. T. Butterfield, P. D. McNamee, and Elsie Wattie.
March 24, 1939. 29 pages.
2051. Engineering problems in milk sanitation. By Leslie C. Frank. March 31,
1939. 14 pages; 2 plates.
2052. Induction of carditis by the treatment of infected guinea pigs with insulin.
By Mark P. Schultz and Edythe .J. Rose. March 31, 1939. 6 pages;
3 plates.
2053. Insects found on aircraft at Miami, Fla., in 1938. By E. V. Welch. April 7,
1939. 6 pages.
2054. Studies on oxyuriasis. XIX. Examinations of children in a private
nursery school over an 18-month period. By Eloise B. Cram and
M. 0. Nolan. April 7, 1939. 8 pages.
2055. A simple device for sampling air-borne bacteria. By Alexander Hollaender
and J : M. Dalla Valle. April 7, 1939. 4 pages; 1 plate.
2056. The antigenic and synergistic action of a toxic serum extract of hemolytic
streptococci. By Mark P. Schultz and Edythe J. Rose. April 14, 1939:
12 pages.
2057. Silicosis and lead poisoning among pottery workers. Summary of report
of study made in West Virginia. April 14, 1939. 4 pages.
2058. Frequency of dental servicEs among 9,000 families, based on Nation-wide
periodic canvasses, 1928-31. By Selwyn D . Collins. April 21, 1939.
29 pages.
SUPPLEMENTS
138. Studies on drug addiction. With special reference to chemical structure of
opium derivatives and allied synthetic substances and their physiological
action. By Lyndon F. Small, Nathan B. Eddy, Erich Mosettig, and C. K.
Himmelsbach. 1938. 143 pages.
139. Report of the Joint Committee on Bathing Places, Confuence of State Sanitary Engineers and American Public Health Association, 1937. 1938.
37 pages.
140. Syphilis control in industry. By R. R. Sayers. 1938. 9 pages.
141. A brief history of bacteriological investigations of the United States Public
Health Service. By A. M. Stimson. 1938. 83 pages.
143. A statistical analysis of the clinical records of hospitalized drug addicts. By
Michael J. Pescor. 1938. 30 pages.
144. Suggestibility in chronic alcoholics. By Victor H. Vogel. 1938. 6 pages;
1 plate.
145. The abuse of codeine. A review of codeine addiction and a study of the
minimum cough-relieving dose. By Lowrey F. Davenport. 1938. 7 pages.
146. The mentally ill and mentally handicapped in institutions. By Joseph
Zubin. 1938. 20 pages.
147. The notifiable diseases. Prevalence during 1937 in States. 1939. 12 pages.
148. Measles. By R. D. Wright. 1938. 6 pages.
149. Good teeth. By F. C. Cady and John W. Knutson. 6 pages.
150. What every person should know about milk. By Leslie C. Frank. 1939.
11 pages.
153. Marital status of delinquents in relationship to Rorschach test scores. By
M. J. Pescor. 1939. 6 pages.
PUBLIC HEALTH BULLETINS
241. A study of asbestosis in the asbestos textile industry. By Waldemar · C.
Dreessen, J. M. DallaValle, Thomas I. Edwards, J. W. Miller, R. R.
Sayers, H. F. Easom, and M. F. Trice. August 1938. 126 pages; 65
figures (47 halftones; 18 line cuts).
243. Hospital facilities in the United .States. I. Selected characteristics . of
hospital facilities in 1936. By Joseph W. Mountin, Elliott H. Pennell,
and Evelyn Flook. II. Trends in hospital development, 1928-1936.
By Joseph W. Mountin, Elliott H. Pennell, and Kay Pearson. September
1938. 53 pages.
244. Silicosis and lead poisoning among pottery workers. By Robert H. Flinn,
Waldemar C. Dreessen, Thomas I. Edwards, Edward C. Riley, J. J.
Bloomfield, R. R. Sayers, John F. Cadden, and S. C. Rothman. February 1939. 178 pages; 78 figures (48 halftones; 30 line cuts).
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113
245. Milk supplies and their control in American urban communities of over
1,000 population in 1936. By A. W. Fuchs and L. C. Frank. December
1938. 70 pages.
246. Dermatitis and coexisting fungous infectioniS among plate printers. By
Paul A. Neal and C. W. Emmonds. April 1939. 56 pages; 6 halftones.
NATIONAL INSTITUTE OF HEALTH BULLETINS
170. Graphic reproduction of the life cycle of the malaria parasite in the mosquito
host. By Bruce Mayne. June 1938. 15 pages _; 26 plates.
171. The genera Dermacentor and Otocentor (Ixodidae) in the United States,
with studies in variation. By R. A. Cooley. December 1938. 89 pages;
21 plates; 9 lithographs.
MISCELLANEOUS PUBLICATIONS
31. Regulations for the control of the manufacture, importation, and sale of
arsphenamine and its derivatives, referred to collectively as "the arsphenamines." 1938. 3 pages.
UNNUMBERED PUBLICATIONS
Index to Public Health Reports, volume 53, part 1, January-June 1938. 26 pages.
Index to Public Health Reports, volume 53, part 2, July-December 1938. 28
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-fifth observance, April 1-30, 1939. 12 pages.
National Negro Health Week poster. Twenty-fifth observance. 1939.
National Negro Health Week leaflet. Twenty-fifth observance. 1939. 2 pages.
ANNUAL REP,ORT
Annual Report of the Surgeon General of the United States Public Health Service
for the fiscal year 1938. 184 pages.
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DIVISION OF MARINE HOSPITALS AND RELIEF
Assistant Surgeon General SANDERS L. CHRISTIAN in charge
The Hospital Division, through 26 marine hospitals and 124 relief
stations, continued the oldest function of the Service, i. e., outpatient and hospital treatment to merchant seamen and other legal
beneficiaries in the chief ports of the United States and its possessi0ns.
Contracts were maintained with 133 hospitals located in ports not
served by marine hospitals. A total of 405,424 accredited persons
were furnished hospital and office treatments. A total of 65,317
in-patients were furnished 2,028,264 hospital days relief and 340,107
out-patients were furnished 1,391,785 office treatments. A total of
197,853 physical examinations were performed, an increase of approximately 20 percent over the fiscal year 1938. At the close of the
year, 5,163 patients remained in the hospitals, including 177 insane
in St. Elizabeths Hospital, Washington, D. C., 36 in State hospitals
in California, and 365 patients at the National Leprosarium at Carville,
La.
Merchant seamen continued to be the largest class of beneficiaries
treated, although slightly fewer in number than in the past 2 years.
However, there was a sharp increase in the number of Works Progress
Administration patients physically examined and treated and in the
number of hospital days relief furnished to that class of beneficiary.
There was also a slight increase in the number of veterans hospitalized,
given out-patient treatments, and physical examinations. Cooperation was continued with other Government departments in Washington in furnishing emergency medical relief to employees and supervising 20 medical relief units in various offices under the Treasury
Department and the following agencies of the Government: Farm
Credit Administration, Federal Reserve Board, Securities and Exchange Commission, Federal Housing Administration, Reconstruction
Finance Corporation, and the Department of Labor.
For a complete statement of relief furnished at the marine hospitals
and relief stations and the customary collateral functions performed
by the hospitals for the Coast Guard, Army, Navy, Employees'
Compensation Commission, Civil Service Commission, Bureau of
Marine Inspection and Navigation, Lighthouse Service, Immigration
Service, Coast and Geodetic Survey, Veterans' Administration,
Bureau of Fisheries, Civilian Conservation Corps, Works Progress
Administration, and others, see pages 119 to 123.
While not particularly reflected in general statistics, the average
length of hospitalization and period of morbidity for patients afflicted
with gonorrhea and certain other diseases have been further reduced
by the wider use of the drug sulfanilamide. Mortality in pneumonia
has been greatly reduced by the use of specific serum, and a further
reduction may possibly be expected from the use of the drug sulfapyridine.
By the act of April 26, 1939, medical officers of the Public Health
Service may be detailed for duty on vessels of the United States
114
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COST ff:R PATIENT DAY
GROOP
OF
110SPITAIS
Salaries -
t-cl
q
GENERAL
to
t'4
H
140
63
119
21?
TOto.l Relier Do1•
960
28?
610
212
134
4 4?
.39
.42
.4?
.42
. :18
,?B
1.02
1.0?
3.?0
2.31
.42
.9?
3 ?l
Cost
1,687,238
70,653
l'ort Stanton, N.M.
0
2.32
1.59
2.29
2 2?
3.02
3.55
lfl
t_,rj
$6,246,490.68
1.82
.5?
1.16
~
H
0
'rol!BRCULOSIS
t_,rj
SA!IAl'0RIUII
Cost
129,923
conillo. La.
2.9?
l.?5
U:PROSARillN
Coet
Per diem cost tor all
3 .65
hospital ■
$
2.25
250,606.02
.44
•
.?B
:185,?65.43
.43
.9?
ALL
Relier 407• for o.11 hoapl to.la
1,887,814,
cost
$6,882,862.13
(a) ID-p.t1ent department ot station closed.
Average per diem cost of in-patient relief United States marine hospitals, fiscal year 1939.
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1---l
1---l
Clt
116
PUBLIC HEALTH SERVICE
Coast and Geodetic Survey, and all dependent members of the families
of the personnel of the United States Coast and Geodetic Survey are
entitled to treatment and hospitalization in the same manner as
dependent members of the families of United States Coast Guard
personnel.
Research ·was continued in pyretotherapy, arthritis, and psoriasis.
Intensive studies are being carried on in the use of sulfanilamide in
gonorrhea, lymphogranuloma inguinale, and chancroidal infection.
Valuable results have been obtained to date. Building facilities for
the projected Tumor Clinic at the Baltimore Marine Hospital were
75 percent completed at the end of the year, and it was expected that
this clinic for research in cancer would open in September 1939.
CLASSES OF BENEFICIARIES AND AMOUNT AND CHARACTER OF
SERVICES RENDERED
Summary of services by class of beneficiary
Hospital
days
Out-patient
treatments
Physical examinations
(not related
to treatment)
- - - - . - - - - 1 - · - -·- ·- - - - · l - - - - r - - 1
Remarks
PerPerPerNum- cent Num- cent Num- cent
of
of
ber
of
ber
ber
total
total
total
- - - - - - -- - - 1 - - -- - - - - - - - - - - - - - - - - 1 - - - - - - - - - - -American merchant sea- 1, 062, 576 52: 39 536, 413 38. 54 22, 404 11. 32 Communicable diseases are reported to local health officers.
men.
Veterans __ _______________ _ 217,137 10. 71
1, 198
. 09 2,595 1. 31 Patients of the Veterans' Administration .
Patients afflicted with
. 01 National Leprosarium, Car129, 957 6. 41
5
8
ville, La.
· leprosy.
Coast Guard personneL __
89,456 4. 41 103, 189 7. 41 5,581 2. 82 All medical serv·ces and supplies, ashore and afloat .
Coast Guard dependents __
3,658
26, 284 1. 89
104
. 05 Pay for hospital care.
. 18
86,706 4. 27 132, 947 9. 55 26, 694 13. 49 Patients of the Employees'
Injured
Federal
employees.
Compensation Commission.
Immigrants ______________ _ 39,531 L 95
. 52 Patients of the Bureau of Im5,865
. 42 1,034
migration.
Seamen, Engineer Corps
19, 721 L 42 2,570 1. 30 Civilian employees on Army
42,085 2. 08
and Army Transport
Yessels.
Service.
O P ay patients.
Seamen from foreign ves11,248
1, 144
. 55
.08
sels .
Seamen and keepers,
. 17 Medical supplies also furnished
15, 782
9,259
340
. 78
. 67
Lighthouse Service.
to lighthouse vessels.
Civilian Conservation
66, 747 3. 29
121
. 06 Patients of the Civilian Con•
754
. 06
Corps.
servation Corps.
Civil Works Administra832
12
. 01 P atients of the Civil Works
35
. 01
0
tion.
Administration.
229,620 11. 32 259,050 18. 61 66,024 33. 37 Patients of the Works Progress
Works Progress Administration.
Administration.
Alaska cannery workers __ ____________ _
. 88 Vaccinations and other pre1,854
.13 1, 745
leaving United States.
ventive measures.
Pilotsandotherlicenses ______ __________________ _________ 8,432 4.26 For the Steamboat Inspection
Service.
Civil Service applicants _____________________ _________ 43,320 21. 90 For the Civil Service Commisand employees.
sion.
Shipping board ___ _______________ ______________ ________ _
96
. 05 To determine fitness for sea
duty.
All others entitled to treat32, 929 1. 62 294, 067 21. 13 16, 772 8. 48 From Bureau of Fisheries,
ment.
Army, Navy, Mississippi
River Commission, Coast
and Geodetic Survey, etc.
Class of beneficiary
TotaL _.. ___________ 2, 028, 264 100. 00 1, 391, 785 100. 00 197, 853 100. 00
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
117
NEW CONSTRUCTION
The new Marine Hospital at St. Louis (Kirkwood), Mo., which will
have a capacity of 144 beds, is nearing completion and will probably
be ready for occupancy on or about September 1, 1939. Work in
connection with the new Marine Hospital at Boston (Brighton),
Mass., is progressing satisfactorily and this institution, with a bed
c~pacity of 336, should be completed and ready for occupancy in the
early part of the calendar year 1940. An extension to the recently
constructed hospital building at the Marine Hospital, Stapleton,
Staten Island, N. Y., which will provide approximately 300 additional
beds, should be completed and ready for occupancy about February 1,
1940.
.
The erection of a new laundry, shops, and garage building, the
remodeling of the surgical building, and the conversion of the old
administrative building into officers' quarters at the Marine Hospital,
Memphis, Tenn., will be completed about September 15, 1939.
The extension and remodeling of the hospital building in B altimore,
Md., to provide a cancer treatment center is about 75 percent completed. A duplex house to prnvide quarters for junior officers at this
station was recently completed.
At the Marine Hospital, Detroit, Mich., a new double set of quarters
for junior officers and additional garage facilities were provided. '
Amounts of $4,100,000 for general rehabilitation of the Marine
Hospital at Carville, La., $130,000 for the construction of a recreation
building at the New Orleans Marine Hospital, $265,000 for the construction of a nurses' home and attendants' quarters at the Fort
Stanton Hospital, and $75,000 and $50,000 respectively, for certain
major repairs and improvements at the Pittsburgh and Hudson Street
(New York City) Hospitals are now available.
The preparation of plans and specifications covering these projects
is under way and it is anticipated that work in connection therewith
will be on the market during the latter part of this year.
REP AIRS AND IMPROVEMENTS
Many repairs and improvements were made at various marine
hospitals during the year. At the marine hospitals in !Jouisville, Ky.,
Mobile, Ala., Cleveland, Ohio, and Evansville, Ind., painting of the
exterior and interior of most of the buildings was accomplished. At
Pittsburgh a new passenger elevator was installed. At Chicago a
new nurses' call system was provided. At Detroit and Savannah the
operating suites were air conditioned. At Fort Stanton the general
rehabilitation of many of the buildings, which comprised numerous
repairs and improvements of a major character, was accomplished
by the station force augmented by Works Progress Administration
labor and Civilian Conservation Corps enrollees.
SUPPLIES AND EQUIPMENT
The sum of $1,086,894, which included Works Progress Administration funds, was expended for supplies and equipment for all hospitals,
including equipment for the new Marine Hospital at St. Louis (Kirkwood), Mo.
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Federal Reserve Bank of St. Louis
118
PUBLIC HEALTH SERVICE
DENTAL TREATMENT
During the year 208,384 beneficiaries of the Service were given
dental treatment by 52 full-time dental officers, 2 part-time dental
officers, and 52 dental internes. The major items of treatment and
a comparison with the preceding year are shown in the following list :
Fiscal year
Fiscal year
1938
1939
Number of patients treated ________ ________________ __ _
X-rays _____________________________ _______________ _
Prophylactic treatments (hours) ______________________ _
Vincent's stomati tis treatments (cases) ________________ _
Pyorrhea treatments (cases) _ ___ ____ _________________ _
Extractions ________________________________________ _
Al veolectomies _____________________________________ _
Alloy fillings _______________________________________ _
Gold inlays __________________ _____ _________________ _
Porcelain crowns __ __________ ___ ____________________ _
Silicate cement fillings _______________________________ _
Dentures (full and partial) ___________________________ _
Fracture cases (hours) ________ __ ________ _____________ _
Number of treatments (out-patient) ___ ______ __ ______ _ _
Number of treatment s (in-patient) ___ __ ___________ ____ _
194,437
40,450
22,583
2,638
7,228
96, 341
4,528
42, 391
807
110
20, 060
10, 589
1,328
521, 598
226, 611
Total number of treatments ______ ________ ______ _
748, 209
2
2
2
208,384
40,751
26,584
1,952
6, 409·
92,476
4, 56847,970
1,292
13,
22,732
9,857
1 293,
342, 470
143, 625,
486, 095
Cases.
General Circular No. 38 (revised Februar y 8, 1938) standardi zed the m eth od of computing den tal treatm ents, thus accounting for the great d iffe rence in the number of dental treatm ents for the year 1938 and 1939.
1
2
A second motorized dental unit was put into operation during the
early part of November 1938 to serve Coast Guard personnel at
isolated stations along the Great Lakes and the West Coast.
Full-time dental officers were assigned to the new United States
Public Health Service Hospital, Fort Worth, Tex., three Maritime
Service training stations, the Federal Correctional Institution,
Sandstone, Minn., and the Federal Jail, Terminal Island, San Pedro,
Calif.
Dental Surgeon C. W. Wekenman was in charge of the clinical
dental activities of the Service during the fiscal year. He was
relieved from the assignment in June 1938 and replaced by Dental
Surg. N. Y. Hooper.
UNITED STATES COAST GUARD
The average number of Coast Guard beneficiaries on active duty
and retired was 11,566. Medical services furnished in recent years
are shown in the following table:
Numerical strength of Coast Guard and
m edical services given
Year
Number
of Coast Hospital
days
Guard
personnel
--- 1935 __ -- _-- _-- __ -- _-- - - - __ -- -- -1936 __-- - ___-- -- _- - - _- - - _____ - - 1937 -- --- -- _-- - - _- - - - _____ -- _- -1938 __-- __ - -- ___ - - -- _- _- _- __ - - - 1939 ___ _____ ____ _____ _______ ____
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Federal Reserve Bank of St. Louis
9,413
10,748
10,325
10,014
11, 566
80,196
88,325
91,590
84,784
89,456
Outpatient
treatm ents
Average amount of m edical
services per person
Physical
examina- Hospital
days
tions
Outpatient
treatments
Physical
examinations
16.1
12.1
13. 7
12. 2
8. 9
0. 9
.5
.6
.8
.5
- - ------------
151, 744
130,206
141,939
121 , 849
103,189
8,966
5,149
6,437
8, 234
5,581
8. 5
8. 2
8. 9
8. 5
7. 7
119
PUBLIC HEALTH SERVICE
Thirteen medical and dental officers are assigned exclusively to
Coast Guard duty and 103 local physicians serve under appointments
as acting assistant surgeons to furnish medical and surgical relief and
conduct physical examinations of Coast Guard personnel at isolated
units remote from any Public Health Service relief station.
During the year three Maritime Service 't raining stations and one
Maritime Service training vessel were commissioned under the direction of the Coast Guard to train personnel for the American merchant
marine. Five medical officers and four dental officers were assigned
to full-time duty with these activities.
.
Two motorized dental units served the needs of the Coast Guard
in isolated communities. One operated on the Atlantic and Gulf
seaboards and the other on the Pacific Coast •and Great Lakes.
As has been the custom for many years, medical officers were assigned to the cutters on the International Ice Patrol, to the vessels on
the cadet practice cruise in South American waters, and to the cutters
of the Bering Sea Patrol Force operating in North Pacific waters and
the Bering Sea. A medical and dental officer are assigned to duty
ashore at the Coast Guard Dispensary, Unalaska-, Alaska, to render
relief to beneficiaries basing on that port. Full-time medical officers
serve on the cutters basing at Honolulu, T. H.; Cordova, Alaska,
Juneau, Alaska; and San Juan, P.R.
Medical Director M. C. Guthrie continued to serve as representative of the Surgeon General at Coast Guard headquarters and as chief
medical officer of the Coast Guard.
CONSOLIDATED AND DETAILED REPORTS
T A BLE
!.-Number of patients treated annually, 1868 to 1939
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. _____ __ ____ ___ _
1890 __ __ ___________ _
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
Fiscal year
After reorganizationOontinued.
1892 _______________ _
1893 ___ ____ ___ ___ __ _
1894 __________ -- __ -1895__ ____ ___ ___ ___ _
1896 __ ____ ____ -- -- -1897_______________ _
1898 _______________ _
1899 _______________ _
1900 _________ ______ _
1901__ ___-- _-- - - __ -1902 _______________ _
1903 ___ _____ _______ _
1904 ____ ___________ _
1905 _______________ _
1906 ________ -- -- ___ _
1907_______________ _
1908 _______________ _
1909 ______ -- -- -- -- __
1910 _______________ _
1911 _______________ _
1912 ___________ ____ _
1913 ___________ __ __ _
1914 __ _____________ _
1915 _______________ _
Sick
and disabled
patients
furnished
relief
1
Fiscal year
Sick
and disabled
patients
furnished
relief
After reorganizationOontinued.
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 _______________ _
1933 ________ _____ ___
1939 ____ ------------
58,357
64,022
71,614
79,863
110,907
144,344
153, 63a
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
560,973
398,133
1 These figures do not include patients treated in connection with veterans' relief activities of the Ser vice,
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; 1937, 5,424; 1938, 5,958; and 1939, 7,291.
2 In this year, and subsequently, t he practice of recounting out-patients applying for treatment in more
t han 1 calendar month was discontinued.
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Federal Reserve Bank of St. Louis
120
TABLE
PUBLIC HEALTH SERVICE
2.-Transactions at United States marine hospitals and other relief stations
NumPatients
remain- Ntimber her or Number Numof
days
patients
of times ber of
ing in
Hospital or relief station
Died hospitals
relief in
furo!fice re- physie:al
June 30, hospitals n~f;ed r~~~;:i!d
1939
relief
- - - - - - - - - - - - 1 - - - - - - - -- - - - - - - - - - - - - - - - - - - Grand totaL _______ _____ 405, 424 65,317
l , 566
5, 163 2, 028, 264 340, 107 1, 391, 785 197, 85-3
Total
number or
patients
treated
Numbe_r of
patients
!reated
m _hos•
p1tals
;:fr:;~-s
FIRST-CLASS STATIONS
Marine hospitals
Baltimore. Md ________________ 16, 996
5,029
173
Boston, Mass _________________ 16,223
2,243
38
Buffalo, N. y _________________ 5,484
20
826
423·
1,529
34
Carville,
La·_----------··Chicago, Ill ____ ___ ___ _________ 18, 790
2,823
38
Cleveland, Ohio _______________ 16,041
3,498
148
Detroit, Mich ______ _______ ____ 7,708
2,671
126
Ellis Island, N. y _____ ________ 6,102
49
2,617
Evansville, Ind _______________ 1, 834
14
719
Fort Stanton, . Mex. ________ 2,036
19
372
Galveston, Tex _______ _____ ____ 9, 165
2,448
56
Key West, Fla __________ ______ 2,014
26
821
Louisville, Ky __ ____ ___ ___ ____ 2,870
1, 496
38
Memphis, Tenn ___ ___________ _ 3,959
14
1,826
M obile, Ala ___________________ 7,783
2, 118
29
N ew Orleans, La ______________ 14,029
134
4,877
New York, N. y ______________ 44,674 --- ----- -- ----- Norfolk, Va ________ ___ ________ 13, 127
3,376
70
Pittsburgh , Pa ______ __ ________ 5, 170
1,357
7
Portland, Maine __ ______ ______ 2. 436
9
523
St. Louis, Mo ___ ______ ___ _____ 5; 540
21
1,291
San Francisco, CaliL __________ 18, 993
4,689
85
Savannah, Ga ______ ___ ________ 4,410
1,625
43
Seattle, Wash _________________ 12, 4::11
127
3,397
Staten Island, N. y ____ _______ 18,639
140
8,103
Vineyard Haven, Mass _______ _
7
307
150
Contract overflow hospitals ___
77
4
77
TotaL ________ ___________ 258,367 59,395
1,469
--- ---
--
SECOND- AND THIRD-CLASS
STATIONS
393
119
49
365
182
207
110
343
57
183
148
53
76
103
153
426
-- -------223
61
45
106
344
162
305
557
16
39
134,389
60,866
22,453
129,923
71,271
87,958
84,340
129,934
20,844
70,653
57,266
18, 113
31,360
40,667
63, 051
148,394
11,967
13,980
4,658
1,106
15, 967
12,543
5, 0::!7
3,485
l , 115
. 1,664
6,717
1, 193
1,374
2,133
5,665
9, 152
---- - --- - 44,674
9, 751
89,387
24,838
3,813
18,097
1,913
36,807
4,249
140, 960 14. 304
2,785
63,287
119,610
9,034
217,212 10,536
6,134
157
14,299 ------ --
4,825 1,902,113 198,972
71,078
35,413
20,325
1,834
34,695
35. 852
19,886.
8,124
4,760
5,214
22,858
4,622
5,390
6,886
18,686
41,383
272,917
39,850
9,793
9,222
12,912
68,609
13, 01 5
27. 780
40, 715
341
739
5. 376
34,634
3,290
3,549
701
4,769
4,591
1,401
5,054
4,397
21
--------
---------- - - --832, 160 129,507
---
Aberdeen, Wash _____ _________
399
22
176
377
812
Albany, N. y _____ _______ __ ___
180
12 ________ __________
153
168
227
Anacortes, Wash ____________ __
189
15 ________ __________
80
174
450
Apalachicola, Fla_____ _________
37 ________ _____ ___ __________ ____ __ ____
37
156
Ashland, Wis ______ ___________
150
14 ___ ___ __ _____ ____ _
178
136
245
Ashtabula, Ohio __ ___ __________
244
13
2
1
85
231
816
Astoria, Oreg __________________
859
46
3
266
813
1,381
Balboa Heights, C. z __________ l , 110
212
9
2,692
898
937
Bangor, Maine ________________
31
3 ________ _________ _
37
28
31
Bath, Maine __________________
129 ________ __ ____ __ _______ ___ ______ ____
129
234
Beaufort. . c __ ____ ______ ____
707
77
2
2
583
630
2,733
Bellingham, Wash __ __ ________
472
10 ________ __________
59
462
805
Biloxi. Miss ________ __ ___ ______
432
16 ________ __________
164
416
665
Boothbay Harbor, Maine _____
36
5 ___ _____ __ ________
37
31
72
Brunswick, Ga ________________
102 ________ ________ ___ ___ __ __ ___ _______
102
365
Burlington, Iowa_____ _________
192
65 ___ _____
2
856
127
235
Cairo, rn ______________________
496
56
1
1
423
440
1,537
Calais, Maine ________________________ _ ___ ____ _ ___ ___ ___ ___ ______ ------- ___ -- -- --- - ------ ---Cambridge, Md ______ ___ ______
86
6 ____ ____ __________
19
80
170
Cape May, N . J_ ___ ___ _______ _ 1,577
42 ________ __________
240
1,535
3,839
Charleston, S. c _____ _________ 1,187
79
3
1,138
1,108
3,713
Charlotte Amalie, V. !_ ___
207
7 ________ __________
54
200
1,043
Cincinnati, Ohio _____ _____ ____
92
6 ___ __ ___ ____ __ ___ _
62
86
328
Cordova. Alaska ______________
374
46
2
3
706
328
473
Corpus Christi. Tex___ ________
599
41
1
1
199
558
924
Crisfield, Md ___ ____ _____ ______
420
10 ______ __ __________
25
410
758
Duluth, Minn ______________ ___
496
58
445
438
680
Eastport, Maine ___________ ___
34 __ __ ____ ________ __________ ________ __
34
86
Edenton, . c __ ______________
18 ________ ___ _____ __________ __________
18
66
Elizabeth City, N. c_ _________
179
2 ________ __________
14
177
595
El Paso, Tex ___________ _______
222
16 ___ _____ _________ _
362
206
1,250
Erie, Pa__ ___ _________ _______ __
311
15 ___ ____ _
140
296
1, 100
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Federal Reserve Bank of St. Louis
7,869
10,675
4, 34-3
57
16,570
8,012
5,895
633
324
307
3,212
120
966
2,002
131
652
41
8
34
19
709
99
1
57
10
12
5
114
28
103
7
3
59
430
14
518
2
6
651
40
2
83
443
365
121
PUBLIC HEALTH SERVICE
TABLE
2.-Transactions at United States marine hospitals and other relief stationsContinued
Hospital or relief station
Total
number of
patients
treated
N umber of
patients
treated
in hospitals
Died
NumPatients
ber of
umber
remainumber patients
of times
ing in
of days
furreoffice
hospitals relief in nished lief was
June 30, hospitals office furnished
1939
relief
Number of
physi(:8
exam1nation
- - - - -- - - - - - - - - - - - - - - - - - SECOND- AND TffiRD-CLASS
STATIONS-continued
Escanaba, Mich ______ _________
Eureka, CaliL ________________
Everett, Wash ________________
Fall River, Mass ______________
Gallipolis, Ohio _______________
Gary, Ind ____________ __ _______
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 ______ ___ _______
L ewes, Del. ___________________
Los Angeles, Calif__ ___________
Ludington, Mich __________ ____
Machias, Maine ___ ____________
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 _____ _______
ew London, Conn ___________
ewport, Oreg ____________ ____
ewport, R. !_ __________ ______
ewpor t ews, Va ___________ _
Ogdensbu rg, N . y _____________
Olympia, Wash _______________
Oswego, . y _________________
Paducah, Ky __________________
Panam a City, Fla _____________
P ensacola. Fla ____________ _____
P er th Amboy, N. J_ ___________
Petersburg. Alaska ____________
Philadelphia, Pa ______________
Ponce, P. R _______ ___ _________
Port AnJ?"eles, Wash ___________
Port Arthur, Tex ______________
Port Huron, Mich _____________
Portland, Oreg ________________
Port Townsend, Wash ________
Providence, R . !_ _____________
Provincetown, Mass ___ ________
R eed ville, Va ___ ______ ___ _____
Richmond, Va ________________
Rock Island , Ill__ _ ---------San Diego, CaliL _____________
Sandusky, Ohio _____ __ ________
San Juan, P . R ___ _____________
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
38
166
196
l/i5
312
91
368
350
129
107
60
2,138
1,637
130
801
381
1, 171
20
332
6,291
187
37
383
77
246
171
262
82
1,926
1,295
614
115
105
43
515
3
435
238
171
1,237
141
273
371
98
57
258
746
543
468
97
275
6, 913
151
346
2, 961
367
5,270
71
624
399
636
109
9,553
831
72
1,228
7
18
18
5
21
1
13
47
13
10
5
2fi4
61
4
55
37
116
7
35
608
5
-------- ---------2
----------
-------- - - ------ --------- ---------1 ----------------- - -- -- ----4 ----------------- ------------ ---- - ----------------- ---------------- - ---------6
10
- ----- -- ----------------- ---------2
3
------ - - -------2
2
-------- ---------1
------ -·
1
22
-------- --------------- -- - - ------ ---------34
7
16
21
18
3
130
156
47
10
8
2
42
-------49
40
7
29
3
28
--------
3
1
1
---------- ----- ----------------- ----------------- ----------------- ---------6
2
4
2
3
1
81
72
92
29
141
9
64
368
71
78
llO
4,414
2ll
39
541
462
928
54
354
7,813
13
--------- 475
61
86
178
112
19
936
1,829
672
157
61
148
230
-------- ---- - ------------ ----------------- --------- 1
--------------- - --------- ---------332
1
-------241
-------- - -- -- - -- -88
-------- ---------257
-------- ---------15
1
-------1
666
------------- -- ---------- -------- -84
- - ------ ---------99
-------- ---------58
-------- ---------28
-------- ----------
4
15
19
5
1
12
80
2
356
1
37
3 -------- ---------10
22 -------199
1
3,958
4
10
325
524
1
1
26
126
1 ----- ----30
13
1 ---------6
27
6 -- ---- -- -- -------4,477
13
8
336
-------- -------- ---------- ------- --592
1
46 --------
-------- --- - ---- ---------- ----------------- -------- --- ------- --------- 114
12 -------- ---------66
6 ----- --- ---------2
61 -------4 ------- - ---------56 --- - ----
1,537
21
843
31
148
178
150
291
90
355
303
116
97
55
1,874
1,576
126
746
344
1,055
13
297
5,683
182
37
349
70
2?0
150
244
79
1,796
1, 139
567
105
97
41
473
3
386
198
164
1, 208
138
245
371
94
42
239
741
531
431
94
253
6,588
125
316
2,955
361
4, 934
71
578
399
636
97
9,547
770
68
1,172
81
443
367
422
761
172
997
633
351
2!i6
99
6
15
9
76
58
48
14
282
32
48
40
89 5
23 8
6,044
5, 5 0
159 -- --- - 1,597
1, 398
422
ll 2
2, 440
92
10
27
675
34
6, 27 9
19, 996
6
330
5
64
817
1, 209
528
33
2
433
75
772
51
369
171
27
5,3 0
56 1
1,405
2,30113
1,688
9
162
7
320
16
5
71
48
1,438
14
7
125
725
314
5
136
281
1, 538
127
292
4
33
356
7,64
22
39
231
2
64
97
403
3,161
330
19
2, 050
74
1, 3 5
121
30
2
997
5, 77 9
27,580
18
154
36
491
1, 56 2
10,995
1.055
801
4,024
15,528
18
143
1, 20 6
1,556
19
1,473
14
1, 734
185
38
2,67 1
29,733
1, 04 9
2, 691
130
33
564
4, 868
122
PUBLIC HEALTH SERVICE
TABLE
2.-Transactions at United States marine hospitals and other relief stationsContinued
Hospital or relief station
-
-
-
-
-
Total
number of
p.3.tients
treated
Number of
patients
t~et~es~
pitals
Died
NumPatients
ber of Number
remain- Number patients
of times
ing in
of days
hospitals relief in
June 30, hospitals office furnished
1939
relief
nf~~;d 1:t~~~-
Number of
1
Pe~!~<'f:
nations
- - - - - - - 1- - - - - - - - - - - - - - - - - - - - - - - - - -
--
SECOND- AND THIRD-CLASS
STATIONS-continued
.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 _____ _______ ___
·Washington, D . C ______ ______ _
Washington, D. C. (dental
clinic) ______________ ________ _
Washington, N. c __ ___ ___ ___ __
·white Stone, Va __ __ _________ _
Wilmington, N. c ___ _________ _
·Wrangell, Alaska ____ _______ ___
5.108
1, 341
407
77
192
6l2
1, 394
252
315
1,201
566
138
428
8, 640
1,999
117
880
741
266
16
495
5
3
95
2
49
1 ---------2
2
7
---------8 -------- ---------3
147
2
1
17
1
11
2
2
76
2
42
3
31 -------- -------- -1
13
1
18
361
4
5,341
853
494
20
52
50
1, 774
197
41
629
451
471
122
4,429
6 ---- --- - - - --------
63
114
1
1
23 --- -- --- ---- - -----
897
265
4,613
1, 246
358
75
185
54
1, 247
235
304
1, 125
524
107
415
8,279
18,282
1, 845
731
162
609
104
1,447
394
838
2,332
1, 168
187
1,580
48, 126
2,622
114
58
7
8
4
1
45
54
594
301
4
83
22, 778
1,999
111
880
627
243
9,578
157
3,065
1,394
604
5
16
76
5
FOURTH-CLASS STATIONS
:.Bay City, Mich __ _______ _____ _
Bridgeport, Conn~•--·--- -------,Chattanooga, 'I'enn ___ - ____ ___ _
.Fort Yukon, Alaska __________ _
Hartford, Conn __ ____ ______ __ __
Nome, Alaska ______ __________ _
:Portsmouth, N. H ______ _____ __
:Saginaw, Mich _____ __ __ ______ _
·Wilmington, DeL ___ _______ ___
94
34
4
8
1
17
15
8
22
3
11
-------2
1
3
-------- -- -- - - --------
- ---------------- - - - ---- - ------- -- - - ------- - -----_----- - - - ------
----- - --- -- - - -------- - ------- -- -- - - -- ---- - ---- - -------- --------- - ----- - -----------
19
91
239
136
23
28
--- -- ----4
6
15
6
7 --- -- - -5 -- - ----- -- - - ------ ------ -13
14
21
1
---------15
19
- - -------8
15
- --------22
43
MISCELLANEOUS
,Curtis Bay, Md. (U. S. Coast
Guard) _________ _______ __ ____
U. S. Coast Guard Academy,
New London, Conn ___ _____ _
-St. Elizal.:>ethsHospital, Washington, D . C _______________ _
,Special acting assistant surgeons for Coast Guard and
Lighthouse Service _________ _
1U. S. Coast Guard vessels and
bases _______________________ _
TU. S. Maritime Service, Coast
Guard and Maritime Service
personneL __________ ______ ___
'M otorized dental ~tations ____ _
·)Emergency medical relief activities, Treasury Department ___________ ____________ _
'Emergency medical relief activities, other agencies ______ _
.E mergency ___ ________ ________ _
1,844
2,622
163
2
2
1,500
187
187
3
177
62, 412
4, 554
140
2,459
8,344
295
3,503
11, 317
509
6,557
6,557
27,866
421
5,047
1,599
5, 047
1,599
14,534
5,363
2,339
23,472
23,472
129,605
689
10,253
151
10,253
76
71,032
186
83
559, .625
68, ~46
5, 163 2, 028, 264 340, 107 1, 391, 785
197, 853
3, 558
--- -
55 - - -- -- -- ----------
75 -- -- -- -- - - --------
544
- - - - - ----1----1---
TotaL ____ __ ____________ 147,057
5,922
97
Grand totaL ____ ________ 405, 424
65,317
1,566
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Federal Reserve Bank of St. Louis
446
1,844
338
126, 151 141,135
---- - - -
123
PUBLIC HEALTH SERVICE
TABLE
3.-Nledical services for various classes of beneficiaries
Total
number
of
patients
treated
Beneficiary
Number of
patients
treated
in hospitals
NumPatients
ber of Number
remain- Number patients
of times
ing in
of days
furoffice
hospitals relief in nished
relief
was
June 30, hospitals office
furnished
1939
relief
Died
- - - - -- - - - - - - - - - - - - American seamen ______________ 167, 247
Foreign seamen ___ _____________ 1, 192
Coast Guard ___ -- ------------- 30, 705
Coast Guard dependents ______ 7,367
Bureau of Fisheries _______ ____ _
70
Army __ _______________________
411
Navy :ind Marine Corps ______
239
Mississippi River Commission _________________________
2
Engineer Corps and Army
Transport Service ___________ 6,703
Lighthouse Service ____________ 3,528
Coast and Geodetic Survey ____
740
Compensation
Employees'
Commission __ ____ ___ ________ 32,103
Veterans' Administ~,a tion ____ __ 7,291
Immigration Service ___ ________ 3,869
Public Health Service officers
and employees ____ ____ _______ 15,295
427
Patients afflicted with leprosy _
Civilian Conservation Corps ___ 3,104
C ivil Works Administration ___
52
Works Progress Administration ________________ _________ 79,249
Misc!Mlaneous __ _____________ __ 45,830
27, 795
547
3,352
12,083
414
64
25
TotaL _____ ________ _____ 405,424
65,317
1, 566
700
6
18
1
565
9
120
82
2, 631 1,062, 576 139,452
32
11,248
645
89,456 27. 353
208
3. 658
6,802
11
l
337
61
1
639
291
1, 145
5
157
------ 2
4
--- --536,413
1, 144
103, 189
26,284
145
867
644
22,404
1
5,581
104
2
302
50
2
6
--- -----
1,461
548
107
23
20
2
109
35
6
42,085
15, 782
2,400
5,242
2,980
633
19, 721
9,259
2,470
2,570
340
401
4,496
7,196
2,007
25
607
7
235
502
111
86, 706
217, 137
39, 531
27,607
95
1,862
132, 947
1, 198
5,865
26,694
2,595
1,034
21,490
129,957
66, 747
832
13,819
1
517
6
66,090
754
35
2,690
8
121
12
229,620
6,918
67, 166
45,416
259,050
225,699
66,024
66,920
5, 163 2,028,264 ::140, 107 1, 391, 785
197,853
------ - ------- - - - - - - - - - - --- -------
1,476
10
47
426
34
366
2,587
18
166
46 -------- ---------677
20
--- --- --- ---- -
TABLE
Number of
physical examinations
--
5
4.- Classification of out-patient treatments furnished at United States marine
hospitals and other relief stations
3fo...,
A a,
_£
"'......c..,
Q.)'u
~@
;>,
~
Marine hospitals _____ ___
Other relief stations______
Special acting assistant
surgeons ___________ __ _
Coast Guard vessels and
bases ____ _____________
U.S . Maritime Service___
Motorized dental stations ___ ______________
Emergency m edical relief activities, Treasury Department__ _____
Emergency medical relief activities, other
agencies ________ _______
Emergency ______ ______ ..
ll3, 585 154, 472 49, 327
64, 789 18, 896 18, 146
(/J
·~
~
55al
~
(/J
~
·;;;
0.
~
.0
~
E-<
U1
~
~
0
t3
z
::l
Q.)
:a
'bi,
;:i
]
Q.)
A
t
:>,
'O
~~
(/J
0.
al:>,
'"'al
Q.),_,
0
-~
~
...,A
ol·-
-'-'
::l'-'
'-'"'I>
0
.:l
,.q'
(/J
...,p,4
"§
-~"O
'i:i
"' A
;>,O:,
,.q
P-,
Q.)
~
:§
0
E-<
--- - - - - - - - - - - - - - - - - - -
207
J:34
7,833
84
474
13, 542
7,265
4, 706
424
4,630
26
545
l
467 158, 078 71, 157 7,407 28,337 249, 123
485 103, 494 21,528 12,973 13,046 37,887
802
5, 363
!<32, 160
291,378
29 l, 93::l
57
94
11,317
151 7, 142 l. 481 1,665
2il 4, 7?2
1. 082
396
99
2,471
105
36,210
14,534
------ ------ ---- - ------ --- - ---
5,363
70, 3)H
20, 93'2 ___ - __
3~, 352 ___ _ ______ _____ ______ _
129, 6()5
44,082
186
12,673 ___ _
J4, 277 - - ---- ------ ------ --- --- -
71,032
186
---r---+----1- - - - 1 - - - - - - - - - - - - - - - - -
TotaL _____ _____ __ 12:1, 603 183,945 106, 727
188796-40--9
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
372 1, 110 323, 227 94, 436 28, 750 °41, 935 289,680 1. 391. 785
1
1
DIVISION OF VENEREAL DISEASES
Assistant Surgeon General
RAYMOND
A. V ONDERLEHR in charge
THE VENEREAL DISEASE CoNTROL AcT
Recent intensive educational efforts have focused the attention of
the Nation upon the seriousness of the venereal disease problem.
The aroused interest has demanded immediate action-action which
could only be taken through the provision of additional funds for
the establishment of more adequate diagnostic and treatment facilities.
The Venereal Disease Control Act, signed by the President May 24,
1938, authorized the expenditure of Federal funds for the prevention,
treatment, and control of venereal diseases. For the fiscal year 1939,
$3,000,000 was appropriated by the Congress to carry out the provisions of this act, and of this amount $2,400,000 was · allotted to
health departments of the States, the District of Columbia, and the
Territories. During the year $2,360,586.04 was paid to the he8'lth
departments and used to supplement State and local funds, which
exceeded $4,300,000, for the execution of effective venereal disease
control programs.
The allotment of this Federal money has made possible the improvement of facili6es in existing clinics and the establishment of new
clinics in many areas where facilities were lacking. An increasing
number of patients have been brought under treatment, and casefindin g activities have been intensified . In m any areas follow-up
procedures designed to hold cases under active treatment have been
augmented and made available to private physicians.
Laboratory facilities have been expanded to take care of the
growing demand for serologic tests for syphilis. Free antisyphili tic
drugs were distributed to physicians in all of the States for the treatment of the medically indigent, and an increasing number of St ates
are finding it adva.n tageous to distribute free drugs to physicians
regardless of the economic status of the patient.
Edum1 tional activities among physicians and laymen have been
emphasized, and the interest in the venereal disease control problem
in both lay and professional groups has been intensified. These
services to physicians, together with the Nation-wide educational
efforts, have stimulated increased reporting of cases.
The rapidly expanding program has resulted in a demand for additional trained personnel, and the Public Health Service has recejved
numerous requests from State health officers foYadvice and assistance
in connection with the organization and expansion of their control
programs . The Public Health Service has given valuable help to
the States not only through consultation with the Chief of the Division
of Venereal Diseases and the regional venereal disease control officers
but also by assigning commissioned officers specially trained in
venereal disease control to several State health departments. Postgraduate training courses in the clinical management and public
124
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
125
health control of syphilis and gonorrhea, which had previously been
made available through regional medical centers, were continued to
meet the need for additional trained personnel.
The widespread public interest in the venereal disease problem has
resulted in the enactment of new legislation to aid in preventing the
·spread of the venereal diseases. Fifteen States require physicians to
have blood tests for syphilis performed on expectant mothers, and 19
States now require an examination (including a serologic test for
syphilis) of both applicants for marriage licenses. Similar laws are
being considered in other States, and it rs probable that a number of
them will enact such laws at the next session of the legislatures.
After careful consideration of the entire subject of Federal assistance
to the States for venereal disease control work, the Congress felt that
convincing evidence had been presented to indicate: (1) That the
States have the necessary executive machinery to insure economical
administration of the full $5,000,000 authorized for this purpose;
(2) that results can be obtained in the matter of controlling the
venereal diseases in direct proportion to the willingness of the Federal
Government to allot funds that will in turn encourage the States and
localities to appropriate funds in the common fight; (3) that it is
wise to make provisions for the control of these diseases through
treatment; and (4) that venereal diseases are Nation-wide jn their
prevalence, and that their immediate control and eventual eradication
presents a real national problem. In appropriating these funds, the
Congress charged the Public Health Service and State health departments to hold the administrative costs of the venereal disease control
program to a minimum, thus making available a large proportion of
the funds for the development of diagnostic and therapeutic services
in the va,rious localities throughout the Nation.
For the fiscal year 1940, $4,379,250, or 86.9 percent of the total
amount available, has been allotted to the States, and every effort
will be made to keep Federal and State administration costs at the
lowest possible level consistent with efficiency and economy. The
health agencies of the Nation are organized and ready for action.
Progress depends largely on the provis10n of ample public funds from
Federal, State, and local sources over a period of years to provide
effective control measures. It is the joint responsibility of all health
agencies and legally empowered appropriating bodies to obtain results
in the control of the venereal diseases comparable with those achieved
in other countries.
COOPERATIVE
vv ORK
WITH STATE HEALTH DEPARTMENTS
The Public Health Service, with the advice of a committee of experts
appointed by the Surgeon General, has set up certain basic principles
which are recognized to be effective in the control of the venereal
diseases. A control program based on these principles, with required
modifications to meet the needs of particular localities, must be put
in operation simultaneously in all sections of the country if success·
is to be achieved in controlling the venereal diseases.
The unprecedented expansion of venereal disease control activities
has created an increasing demand for personnel trained in the ne\rnr
methods of diagnosis, treatment, and control. As a result of this·
acute shortage of personnel, the Public Health Service is constantly
receiving requests for advice and assistance from State and local
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Federal Reserve Bank of St. Louis
126
PUBLIC HEALTH SER VICE
health departments. In order to coordinate efforts of the various
States and to achieve a unity of purpose, commissioned officers with
special training in venereal disease control have been assigned as
venereal disease control officers in the five regional offices of the
Public Health Service to serve as consultants to State health departments. In addition, two officers are serving as consultants-at-large,
one in the field of industrial syphilis.
In some of the States. where the problem is more pressing, additional
assistance has been given by the assignment of a Public Health Service
officer to th_e State 1:ealth department to act i~ an advisory capacity,
or to substitute while the regular venereal disease control officer is
obtaining postgraduate training. During the year additional officers
were detailed to this type of duty, and at the close of the year 13 commissioned officers were detailed to as many States. In addition,
Public Health Service officers were loaned to several metropolitan
areas to 8,SSist them with their programs, particularly where snch
areas were strategically located for the control of the interstate
spread of the venereal diseases.
In considering basic principles upon which to build a sound, longrange control program, future needs must be kept in mind. The
training of carefully selected physicians, public health nurses, medical
:s ocial workers, and serologists to meet the ever-increasing demand for
:s killed personnel is a wise and profitable investment. In order to
make available a supply of trained workers, a further effort has been
made to assist State health departments by developing facilities for
postgraduate training through cooperative arrangements with a number of specially equipped medical schools.
The present treatment of syphilis is a long and costly procedure
requiring weekly visits to the physician or clinic over a minimum
period of 18 months. Personal follow-up by trained public health
nurses or medical social workers is necessary in order to encourage
patients who lapse treatment to return to their physicians, and to find
and bring contacts to treatment.
In order to evaluate present methods under diverse conditions and
to develop, if possible, more effective and economical control measures,
field demonstration projects have been established in a few socially
and geographically representative areas in cooperation with several
State and local health departments . . These demonstrations have
resulted in improving and expanding treatment and control facilities
in the localities which they serve. They are also used as models and
for training centers for physicians and health officers in nearby
communities.
Continued cooperation with the Georgia Department of Public
Health and the Brunswick District Health Department has made
possible the. continuation of the field demonstration project in Camden, Glynn, and McIntosh Counties, designed to study the most
modern methods of syphilis control in the rural South, and particularly
to note the efficacy of a traveling treatment unit in the control of
syphilis. The population of these counties is predominantly rural
and to a large extent is composed of workers in the turpentine, lumber,
and fishing industries. The general income level is insufficient to
support adequate facilities for medical care. · The progress of this
study is being watched with much interest.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
127
The first intensive resurvey of the cases in the study of untreated
syphilis in adult Negro men was completed during the year. This
study, which was begun in Macon County, Ala., in 1932, originally
included 400 persons with syphilis whose age grouping was paralleled
by 200 nonsyphilitic controls and by a comparable group who have
received adequate therapy. The Milbank Memorial Fund has continued its grant for the purpose of obtaining autopsy studies, and since
the beg-inning of the investigation necropsies have been obtained in
one-half of the 78 deaths that have occurred . This study is now
und er the supervision of a commissioned officer specially trained in
the diagnosis of cardiovaEcular syphilis, and during the year over 80
percent of the remaining number of the group were given a complete
and thorough reexamination. Final analysis of this work will undoubtedly yield valuable information on the course of untreated
syphilis in the Negro, since no similar study has ever been attempted.
Cooperation of the Alabama Department of Public Health, the Macon
County Health Department, and the Tuskegee Institute have made
possible the detailed follow-up of these persons.
COOPERATION WITH OTHER AGENCIES
The Division of Venereal Diseases has continued its research program in accordance with the recommendations of a:r! advisory committee to the Public Health Service, composed of experts in the fields
of public health, syphilology, urology, and serology. Past experience
has demonstrated that advance in medical knowledge along these lines
can best be accomplished through coordinated group effort. Arrangements were made with leading clinics and medical centers in the country where the services of highly trained personnel, necessary clinical
material, and special laboratory facilities are available.
The syphilis research center at Johns Hopkins Hospital has continued under the direction of a commissioned officer. A study of the
chemotherapeutic action of the arsenical drugs for use in the treatment
of syphilis has continued to be the major activity. Approximately
60 arsenoxides have been prepared and their spirocheticidal properties
tested. Definite correlations between the chemical structure and
spirocheticidal activity have appeared; and, as a result, 4 compound:,
have been prepared with a chemotherapeutic index sufficiently favor ..
able to warrant an intensive study of their potential therapeutic
utility.
Data on the incidence of false positive serologic reactions in n
college population of nearly 25,000 have been collected and are being
analyzed. The results of this study should throw considerable light
on the significance of positive tests in the absence of clinical evidence
or history of syphilitic infection.
Studies are being carried on with respect to the supposed presence
of reagin in normal serum and the so-called provocative reaction.
Special cooperative studies are in progress which are designed to
determine the infectiousness of individuals in different stages of the
disease and on the outcome of syphilis as influenced by treatment
administered during the various stages of the disease.
The prevention of congenital syphilis has received special attention,
and studies have been continued in an attempt to set up a standard
procedure for its management.
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The thermal death point of Spirochaeta pallida and the use of
mechanically induced fever as a therapeutic agent for the treatment
of syphilis have been investigated. In addition, the toxicity and
mode of action of various drugs have received study.
Further investigations have been ma.de relative to the specificity
and sensitivity of serologic tests for syphilis. The diagnosis and
treatment of lymphopathia venereum has received special attention.
The diagnostic differentiation of chancroid, granuloma inguinale,
and lymphopathia venereum and the development of treatment
procedures for these diseases have been investigated.
The study of prostitution as it relates to the venereal diseases,
particularly with a view to arriving at recommendations for policies
and methods for meeting the problem, and a study of quacks and drugstore practice in relation to syphilis and gonorrhea have been subjects
for cooperative investigations.
On January 17, 1939, the Public Health Service, in cooperation
with the Civil Service Commission, began a study of the medical
records of all civil service applicants · who bad had a diagnosis of
syphilis, for the purpose of determining those who were physically
eligible for employment in the Government service. The medical
records of 193 applicants have been reviewed. Twenty-two were
recommended for permanent appointment. Fifteen have been
recommended for probational appointment pending the out.come of
treatment and observation. Eighteen were found to be ineligible
for employment because of disabling manifestations of late syphilis,
due chiefly to involvement of the cardiovascular and nervous systems.
Thirty-three applicants either failed to cooperate in furnishing essential information or to submit to special examinations.
The action on 120 cases is still pending because of insufficient
information. Special examinations not included in tbe medica]
record were necessary in many instances. When applicants were
unable to pay for these examinations, they were made by the State
health departments or the Public HeaJtb Service.
VENEREAL
D1sEASE
MEDICAL CENTER,
PARK, ARK.
HoT
SPRINGS
NATIONAL
Until the beginning of the past fiscal year, the Veneieal Disease
Medical Center Infirmary, where all in-patients are provided domiciliary care or hospitalization, had been operated on previously
appropriated emergency relief funds. This year a direct allotment
was made from the appropriation of the Division of Venereal Diseases
for maintenance and operation of this activity. Subsequently, the
employees, who had been in a temporary or emergency status, were
blanketed under the civil service.
The medical center completed physical examinations on 5,272
indigent patients from 46 States and the District of Columbia. Of
these, 2,291 were found to have nonvenereal conditions and were
referred to the out-patient clinic of the Leo N. Levi Memorial Hospital, a cooperating agency. The medical center provided medical
care for 2,743 patients afflicted with one or more of the venereal
diseases. There were 2,074 cases of syphilis, 797 cases of gonorrhea,
53 cases of chancroidal infection, 29 cases of lymphopathia venereum
and 4 cases of granuloma inguinale. Two hundred and thirty-eight
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applicants presenting themselves for examination at the medical
center did not return for treatment.
A total of 101,169 venereal disease treatments were administered21,235 intravenous injections of the arsenicals, 44,009 intramuscular
injections of the heavy metals, 32,873 treatments for gonorrhea, and
3,052 other intravenous medications.
In the in-patient department, 1,687 patients were provided domiciliary care. Of these, 695 patients were admitted to the medical
center hospital where 64 were given 436 fever treatments in the hypertherm cabinets and 64 were treated with therapeutic malaria. Two
hundred and forty treatments of local hyperpyrexia with the Elliott
apparatus were administered in cases of pelvic inflammatory disease
and gonorrheal prostatitis. One thousand one hundrnd and three
lumbar punctures, 392 minor operations, and 23 major operations
were performed in the hospital. Eleven b abies were delivered.
In the clinic and hospital laboratories the following work was
performed: 37,961 serologic tests for syphilis, 281 darkfield examinations, 13,808 slide examinations for gonococci, 8,759 urine analyses,
1,078 spinal fluid examinations, and 496 special tests. In the dental
clinic, 8,104 dental treatments were given.
At the request of the National Park Service, 3,246 monthly physical
examinations were made on the bath attendants employed in the
various bathhouses. In addition to these, 117 complete physical
examinations were performed on new applicants for positions as
bath attendants.
During the year, 796 notifications were sent out from this office to
the proper health authorities furnishing information of sources of
infection, possible contacts, and delinquent patients from this clinic.
One hundred and seventy responses were received from State health
departments indicating that appropriate action had been taken, and
164 replies indicated that the persons in question could not be located.
New construction continued throughout the year at the medical
center infirmary under Works Progress Adminjstration projects. A
garage, an animal house, and an addition to the hospital have been
erected, and work has been begun on a fireproof warehouse.
EDUCATIONAL AND IN FORMATIVE ACTIVITIES
During the year, 19,528 letters requesting literature pertaining to the
venereal diseases and sex education were received, an increase of 20
percent over the preceding year. These requests came from individuals.,
community organizations, and civic groups. Numerous letters requesting advice regarding treatment of the venereal diseases were also
received from both patients and physicians.
The demand for literature was met by distribution of the existing
series of venereal disease bulletins and folders, free copies of the
monthly periodical Venereal Disease Information, supplements to
Venereal Disease Information, reprints of special articles which had
appeared in that publication, and various popular articles, totaling
244,290 copies.
During the year the average monthly subscriptions to Venereal
Disease Information were 11,818. This was an increase of 771 over
1938. Venereal Disease Information has the largest paid subscription list of any Government publication. The additional average
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monthly distribution of free copies was 2,918, making a total of 176,832
copies.
In addition to the regular paid subscriptions to Venereal Disease
Information, over 1,350,000 pieces of venereal disease literature were
sold by the Government Printing Office during the fiscal year. Of
these, 850,000 were copies of Venereal Dises,seFoldersNos. 1, 2) and 3.
Folder No. 1, Syphilis, Its Cause, Its Spread, Its Cure, wss prepared
during the previous year.
New publications issued during the year are as follows:
VENEREAL DISEASE FOLDERS
No .
No.
2. Syphilis and your town.
3. You can end this sorrow.
REPRINTS FROM VENEREAL DISEASE INFORMA'l'ION
No. 89. Service provided physicians by the health department. By A. J.
Casselman. 4 pages.
No. 90. Scope of activities of the follow-up worker. By Edith M. Baker. 4
pageE.
No. 91. Regulations governing allotments and payments to States, fiscal year
1939. 5 pages.
No. 92. Next steps in the control of gonococcal infections. A round-table
discussion. 7 pages.
No. 93. The organization and function of follow-up service in venereal disease
clinics. By Lena R. Waters and Louise B. Ingraham. 5 pages.
No. 94. The treatment of the severe complications of gonorrhea with hyperpyrexia produced by the Kettering hypertherm. By T. J. Bauer and
H. L. Cecil. 6 pages.
No. 95. The management of gonorrhea in the male . Procedures recomm ended
by the American N eisserian Medical Society, May 17, 1938. 4
pages.
No. 96. The management of gonorrhea in the female. Procedures recommended
by the American Jeisserian Medical Society, May 17, 1938. 5
pages.
N o. 97. Direct costs of treating syphilis and gonorrhea in New York City.
By Jacob A. Goldberg. 12 pages.
No. 98. Presidential address American Medical Association 1876. By J.
Marion Sims. 13 pages.
No. 99. The chance of acquiring syphilis and the frequency of its disastrous
outcome. By R. A. Vonderlehr and Lida J. Usilton. 9 pageE.
No. 100. Cooperative clinical studies in the treatment of syphilis : Tabes dorsalis.
By Paul A. O'Leary, Harold N. Cole, Joseph Earle Moore, J ohn H.
Stokes, Udo J. Wile, Thomas Parran, R. A. Vonderlehr, and Lida J.
Usilton. 30 pa.ges.
No. 101. Serology of syphilis in relation to the Chicago syphilis control project.
By Reuben L. Kahn . 6 pages.
No. 102. Si:rriple method of determining attendance and delinquency in a syphilis
clinic. By R. H. Kampmeier. 4 pages.
No. 103. Progress in venereal disease control in t_h e States, June 30, 1938. 3
pages.
No. 104. Effect of tuberculoEis on serologic reactions for syphilis. By Thomas
Parran and Kendall Emerson . 5 pages.
No. 105. Serologic reactions for syphilis in blood transfusion donors. By A. E.
Kell Pr and W. S. Leathers. 4 pagee.
No. 106. Sulfanilamide therapy in gonorrhea. By John E . Dees and Hugh H.
Young. 8 pages.
No. 107. Making gold sol for cerebrospinal fluid tests. By Benjamin S. Levine.
2 pages.
No. 108. Hoepital, clinic, and laboratory costs of syphilis in Buffalo. N. Y., with
a comparison of similar costs in Baltimore, Md. By W. A. Brumfi eld. Jr. 12 pages.
No. 109. The role of the physician in the control of syphilis. By G. W. Barnett.
5 pages.
No. 110. Cost and loss from syphilitic blindness in the United States. Ry C. F-1
Rice. 5 pages.
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SUPPLEMENTS TO VENEREAL DISEASE INFORMATION
No. 4. Hospitals and dhpensaries for the treatment of venereal diseases (revised). 4 7 pages.
No. 8. The gonococcus and gonococcal infections. By Ruth Boring Thomas.
78 pages.
No. 9. The serodiagnosis of syphilis. Proceedings, Assembly of Laboratory
Directors and Serologists, under Auspices of the Committee on Evaluation of Serodiagnostic Tests for Synhilis and the U . S. Public Health
Service, October 21-22, 1938, Hot Springs National Park, Arkansas.
224 pages.
No. 10. Control of the venereal diseases in the United States. Present and
future plans. 23 pages.
In addition to the distribution of publications, 103 sets of posters
on syphilis were furnished to interested groups, and 186 loans made
of four motion-picture films. One of these fi]ms, Three Counties
Against Syphilis, portraying the work being done by the mobile
syphilis unit in Camden, Glynn, and McIntosh Counties, Ga., was
completed during the year. Forty-three copies of this film are now
available for circulation. Two copies are being shown at the New
York World's Fair, 17 are on deposit for loan from various State
universities, and 15 are on deposit for loan from the Department of
A~-riculture, Division of Motion Pictures.
The manuscripts of folder No. 4, Syphilis on the Job, and folder
No. 5, Gonorrhea the Crippler, were completed and sent to the
printer. A revision of High Schools and Sex Education, a Manual
for Teachers was undertaken and, although the manuscript was not
completed, many requests have already been received for the revised
edition. Revision of Venereal Disease Bulletin No. 6, a pamphlet
for young men, was also undertaken. Manuscripts for two new
bulletins, Twenty Questions on Gonorrhea and We Grow Up, were
.
completed and sent to the printer.
An exhibit, based on the use of the Georgia mobile clinic for the
control of the venereal diseases, was prepared and shown at the
annual meeting of the American Public Health Association.
A second exhibit, presenting the high points of the national problem
of syphilis, was prepared and shown at the annual meeting of the
American Social Hygiene Association in Washington, D. C. This
exhibit proved so popular that it is being revised for publication and
national distribution.
A third exhibit was prepared on Nonspecific Therapy of Paresis
and was shown at the annual meeting of the American Medical Association.
Through the cooperation of such organizations as the American
Social Hy~iene Association, the National Education Association, the
National Congress of Parents and Teachers, General Federation of
Women's Clubs, National Conference of Mayors, American Youth
Commission, American Youth Congress, and the National Student
Federation of America, a comprehensive program of sex education
was mapped out.
With the cooperation of a large metropolitan health department, a
study was designed to evaluate the effectiveness of visual educational
material. This project has been set up in recognition of the fact that
the ultimate outcome of a venereal disease control program rests upon
the success encountered in bringing the facts pertaining to venereal
diseases not only to professional groups but also to the lay population.
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VENEREAL DISEASE RESEARCH LABORATORY, STAPLETON, STATEN
ISLAND, N. Y.
Continuing the policy established in previous years, the work of
the Venereal Disease Research Laboratory has been directed toward
prevention and control. The program has followed broad lines with
regard to gonorrhea and syphilis, but more circumscribed efforts have
been directed toward lymphopathia venereum and chancroid.
A moderate expansion of facilities and personnel has been possible
during the year. The increases have led to the establishment of a
fully equipped and staffed section devoted to physical chemistry and
biochemistry, the main objectives of which will be the pursuance of
studies bearing upon the basic nature of the antigens used in the
serodiagnosis of syphilis and gonorrhea and upon the evaluation of
various fractions as to their ability to serve as satisfactory antigens.
The completed studies in gonorrhea include one on therapy, in
which a controlled group of male patients were treated with sulfapyridine. The results of this study indicate the practical superiority
of this product over previously available chemotherapeutic agents.
In a second study, the possibility of curtailing the spread of the disease
through the hospitalization and chemotherapeutic treatment of infected prostitutes was surveyed. This approach to the problem of
shrinking the reservoir of infection which is maintained in this class
of disease carrier seems to present practical possibilities. Additional
studies were directed toward the clarification of confusing factors
concerned in the serodiagnosis of gonorrhea and an investigation of
the basic reliability of culture diagnosis. Means of improving culture
methods have been sought.
In accordance with the recommendations of the report of the
Committee on Licensing or Approval of Laboratories for the performance of serologic tests · for syphilis made at the Hot Springs Conference, the Public Health Service has inaugurated a program of periodic
evaluation of the performance of these tests in all State laboratories.
Ten laboratories did not participate in the evaluation survey conducted this year, as they had previously been rated as satisfactory on
the basis of preceding evaluation studies. However, these 10 laboratories will participate in the evaluation studies of the coming year.
Of the remaining 39 laboratories of the States and the District of
Columbia, 38 participated in the study and were rated during the
year. Of these, 16 were found to be performing tests of sufficient
sensitivity and specificity to warrant immediate approval. In the 22
laboratories rated as unsatisfactory in the performance of 1 or more
of their diagnostic tests, 30 individual procedures were used, representing 7 flocculation techniques and one complement fixation technique. In the evaluation study, all of these tests were controlled by
the originators of the respective tests, and their performance was used
as a standard upon which to base the ratings.
In 7 of the tests, failure to meet standards was caused by decreased
specificity; and in the other 23, failure was caused by decreased sensitivity. In those tests failing because of lowered specificity, from 1.8
to 9.6 false positive results were reported, and of the failures because
of decreased sensitivity, the reports failed by from 17 .0 to 43.3 percent
to meet the sensitivity attained by the originators performing the
same tests on identical specimens.
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At the close of the year, 26 of the 49 laboratories of the States and
the District of Columbia were approved by the Public Health Service
for the performance of serodiagnostic tests for syphilis. Of the remaining 23 laboratories, all but 5 have been visited by a representative
of the Service, or have indicated by correspondence that steps are
being taken to raise the standard of performance of serologic tests.
As a result of this rating, steps have been taken to train personnel in
10 of the laboratories, and a large majority which failed to qualify
have taken comprehensive steps to increase their standards of performance.
In visits to State laboratories, it was found that without exception
all personnel were earnest in their desire to improve the quality of
their work. No obsolete technical methods were in use, and it was
felt that with additional training the general performance of serodiagnostic tests for syphilis would become of uniform high quality.
In addition to a heavy routine of serologic work, the research laboratory has been able to serve as a control center for several States
which have undertaken the evaluation of test performances within
their respective areas. It has also continued to function in an advisory and referee capacity in instances of atypical serologic reactions,
to supply a limited group of hospitals with antigens and lyophile
complement, and to carry out several pertinent research studies in
the general field of serology.
In the field of experimental syphilis, search has been continued for
an effective personal prophylactic against syphilis. None of the substances studied gave promise of supplying the type of prophylaxis
which would meet the requirements for use in the general population.
Some additional experimental studies designed to consider the possibility of demonstrating the existence of a life cycle of Spirochaeta
pallida have been inaugurated.
The impetus recently given to chemotherapy has renewed interest
in the possibility of developing a new preparation for the treatment
of protozoa! diseases, especially syphilis. Several suggestions along
this line have been presented to research chemists, and the value of
the resulting products will be studied in animals. The entire field
will be closely scrutinized, and suitable investigations of any of the
new products offering promise in chemotherapy will be conducted.
HoT SPRINGS CoNFERENCE oF LABORATORY DrnEcToRs AND
SEROLOGISTS
The serologic tests for syphilis hold a key position in the present
control program. Such tests must be performed in all kinds of laboratories by different types of technicians under the most varying
conditions. Many problems having a bearing on the serodiagnosis of
syphilis have not yet been solved, although opinion is rapidly crystallizing. In order to make possible the free discussion of a number of
these issues in open forum, an assembly of laboratory directors and
serologists was held at Hot Springs National Park, Ark., October 21
and 22, 1938, under the auspices of the Committee on Evaluation of
Serodiagnostic Tests for Syphilis and the United States Public Health
Service. The purpose of this assembly was to consider means and
methods which could be used to make serologic tests for syphilis more
reliable and less difficult to obtain.
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A total of 335 physicians, health officers, and laboratory workers
from 44 States, the District of Columbia, 2 of the Territories, and
Canada attended this meeting. In addition to formal papers by some
of the Nation's .leading serologists, committees composed of leading
authorities in the field presented pertinent recommendations on the following subjects: (1) The need for adherence to conventional techniques
in the performance of reliable serologic tests for syphilis; (2) the improvement of methods for determining the efficiency of performance
of the serologic tests; (3) minimal educational and training qualifications for laboratory directors and technicians; and (4) the licensure
or approval of laboratories for the performance of such tests.
The Committee on the Need for Adherence to Conventional
Techniques strongly recommended that any modification of serologic
tests which involved considerable divergence from the conventional
technique described by the originators should not be attempted except
:as a research project. It is incumbent upon the originators to describe in utmost detail every step in the procedure and to be available
for inquiries from any serologist who experiences difficulties in the
performance of the test.
Further recommendations were made that. in the event anv of the
acceptable serologic tests for syphilis are modified by the orrginator,
such modification should be published and distributed free of cost as
soon as possible to all laboratories performing serologic tests for
syphilis. To insure complete distribution of these revisions, it was
suggested that the Public Health Service, in cooperation with State
health officers, t ake a census of central and branch municipal, hospital, and private laboratories. Above all, persons responsible for
the performance of the tests should be thoroughly conversant with the
principles of the reactions, the properties, preparation and titration
of the reagents, and the sources of variation inherent in the tests. In
order that trained personnel be available, it was considered necessary
and desirable that State health officers use Federal funds to provide
the necessary training. The Committee on the Improvement of
Methods for Determining the Efficiency of Serologic Test Performance
made specific recommendations on the procedures to be carried out
in the evaluation of laboratory performance.
The Committee on Licensing or Approval made recommendations
that the Public Health Service establish an office of serology, the
duties of which should be to aid in the improvement and extension of
laboratory service in the diagnosis of syphilis throughout the United
States by establishing standards for approval of laboratories, and to
lend aid to State laboratories in meeting these standards. It was
further recommended that, in the event either State or local laboratories fail to be approved because of inability to develop reliable and
efficient tests, Federal grants-in-aid or reallocation of Federal funds
to local laboratories be withheld. In accordance with these recommendations, the Surgeon General, in promulgating regulations governing allotments and payments to the States for venereal disease control
activities for the fiscal year 1939, has directed that on and after
January 1, 1940, "The State laboratory, and any local serologic
laboratory receiving funds under this act shall demonstrate by a
suitable method that the tests for syphilis performed therein have a
satisfactory sensitivity and specificity rating. Such rating shall be
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<letermined in the case of the State laboratory by the Public Health
Service."
COOPERATIVE CLINICAL GROUP STUDIES
Investigations of the results of treatment of syphilis by the Cooperative Clinical Group in cooperation with the Public Health Service
have been continued, and cooperative studies have been undertaken
in the field of gonorrhea by a group of specialists in the field. The
studies actively carried on in the past year include:
Nonspecific therapy in the treatment of ne urosyphilis.- The objective
of this study is a determination of the relative effectiveness of the
various types of nonspecific therapy in the treatment of neurosyphilis.
The case records of patients with paresis have been tabulated, and th ·
results of these tabulations analyzed.
Symptomatic neurosyphilis.- This study was undertaken to deteYmine the most effective treatment procedure in the various types of
neurosyphilis. A paper on the treatment of tabes dorsalis was published during the year. Statistical tabulations of the cases of general
paralysis, taboparesis, and vascular neurosyphilis have been completed, and tabulations of the cases of meningeal and meningovascular
neurosyphilis are in progress.
Confugai syphilis.- The material on this study to deteTmine the
period of communicability of syphilis has been abstracted and a preliminary analysis of the data has been made.
Efficacy of modern treatment in early syphilis.- Observation of
patients who have received standard treatment for early syphilis has
continued. Statistical data have been compiled at one of the cooperating clinics and the report is in process of preparation.
Cardiovascular syphilis.- This study, the purpose of which is t(!
establish satisfactory criteria of early diagnosis, is progressing slowly
owing to the difficulty in obtaining patients.
Correlation of autopsy •and necropsy findings. - A determination of
the frequency with which syphilis is a primary or contributory cause
of death is the objective of this study. Ten thousand five hunderd
autopsy reports and 5,000 clinical reports have been reviewed and
abstracted preparatory to analysis.
Follow-up of apparently normal children born of syphilitic parents.In order to determine the significance of the blood test during the first
few months of life, approximately 1,200 records of family groups have
been abstracted and are ready for statistical evaluation.
Interstitial keratitis.- The objective of this study is the development _
of a treatment procedure which will obtain the maximum results ,
The case records of 600 patients with interstitial keratitis have been
abstracted and are in the process of tabulation.
E xamination of source of injection of patients with early syphilis.This study also was designed to establish the period of communicability qf syphilis . . It requires the examination of all contacts reported by patients with early syphilis. To date, 250 patients with ,
early syphilis and all available contacts have been examined.
Gonorrhea.- During the year a study was begun on the evaluation
of the results of sulfanilamide therapy in gonorrhea in men. This
study was made possible through the cooperation of a group of specialists in the treatmeI1t of gonor:r:hea. The material includes approximately 2,000 case records of patients treated in the cooperating clinics
with var;_ous schemes of sulfanilamide therapy. All of these records
1
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have been abstracted, coded, and a preliminary evaluation of the
material has been presented to the cooperating clinicians for analysis.
SYPHILIS CONTROL IN INDUSTRY
Since its inception in November 1937 the problem of syphilis
control in industry has received the full-time attention of a commissioned officer with training in industrial hygiene. Control programs
have been developed with the cooperation of manufacturers in a
variety of industries, and it has been possible hy ('Ooperative arrangements with State and local health departments, private physicians,
and industrial physicians to arrange treatment facilities for workers
so that adequate treatment may be made available and treatment
secured with a minimum economic loss. The program has received
the whole-hearted cooperation of labor and health organizations.
During the fiscal year industries, including manufacturing, transportation, wholesale and retail trade, public service, professional,
domestic, and personnel services, have directed their efforts toward
controlling syphilis in industry. Serologic survevs have been completed in industrial groups having a total population of over 66,000.
In addition, surveys are in progress in industrial plants having a total
population of a little over 500,000, and arrangements have been made
for similar surveys in plants having a total population of over 600,000.
State and local health departments participate in the program in
each locality, contribute free diagnostic laboratory service and assume
leadership in the program.
PREVALENCE STUDIES
In order to deal effectively with any communicable disease, the
health officer must know how many cases exist, where these cases are,
and whether the control measures instituted are effective.
For the purpose of assembling basic data necessary to determine
the extent and nature of the problem and to evaluate the efficacy of
the control program, the Public Health Service has conducted surveys
on the incidence and prevalence of syphilis and gonorrhea in socially
and geographically representative areas during the past 12 years.
During this year, surveys have been conducted in two large metropolitan areas and a western State.
A system which utilizes mechanical tabulating equipment to facilitate the gathering of such data has been developed.
This mechanical system not only prepares up-to-date, accurate
reports on the venereal disease patient-load for individual clinics, but
in addition, presents the color, age, sex, and stage of the disease of the
patients constituting this load. A break down of control activities is
given-number of treatments, laboratory tests and physical examinations performed, and the number of case-finding and follow-up visits
made.
It is obvious that such reports will be a great aid to clinic directors,
and further, that by the use of consolidated reports from all treatment
sources, State and Federal health agencies can obtain accurate information on the prevalence and incidence of the venereal diseases, as
well as data on the effectiveness of case-finding and case-holding procedures.
During the year, units have been installed which service communities in 16 States. The total population represented exceeds 38,000,
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000. It is expected that in these areas the service will be extended to
include a great majority of the treatment sources, and that within a
relatively short time the system will be used in enough representative
areas to make constantly available an accurate, Nation-wide picture
of prevalence and incidence, upon which a trend for the venereal diseases may be established. It is only thus that accurate plans for the
control of the venereal diseases can be made.
1.- Report of State departments of health showing the number of cases of
syphilis and gonorrhea reported, the annual rates per 1,000 inhabitants, the amount
of ar,<>phenam1'.ne distributed, and the laboratory examinations made from July 1,
1938, to June 30, 1939
TABLE
Number of cases
State
Laboratory examinations
Annual
rate for
syphilis Doses of
Microscopic
Syphi- and gon- arsphenaExamiorrbea
mine
disSerologic
examiSyphi- Gonor- lis and per 1,000
nations
tests
nations for
gonor- inhabi- tributed
rhea
lis
gonmade
for Spirorhea
ococcus
tants
chaeta
pallida
Alabama _______ ____ _______
Alaska ___ __________________
Arizona _______ ___ ___ ______
Arkansas ___ ___ _____ _____ -California _________ ____ ____
Colorado ____ _______ _______
Connecticut_ ______________
Delaware __ ________________
District of Columbia ___ ___
Florida ____ ________________
Georgia____________________
Hawaii__ ____ _____ __ __ ___ __
Idaho ___ __________________
Illinois ____ ________________
Indiana ____ _____ __________
Iowa _____ __ ___ ____ _______ _
Kansas _______ __ ____ _______
20,957
115
2,141
10,296
23,101
1,607
2,287
3,051
6,278
13,559
26, 741
972
339
31,342
5,365
2,915
3,019
10,519
fi~i~i~~r-========
========_ 9,530
Maine
______ _____ _________
446
Maryland _____________ ____ 12,930
Massachusetts ___ ___ _______ 5,240
Michigan _____________ _____ 14,398
Minnesota ____ ______ ______ _ 3,000
Mississippi_ ___ _________ __ _ 27,545
Missouri ______ _____ _______ 11,229
Montana ____ ______________
687
Nebraska __ ____ ______ __ ____
699
Nevada __ _____ ____________
257
New Hampshire ___________
283
New Jersey __ ___ ___________ 10,387
New Mexico ____ __________ _ 1,465
New York _____ __ __________ 64,269
North Carolina _____ __ __ ___ 27,137
North Dakota ___________ __
377
Ohio _____ ___ __ __ __ __ __ __ __ 16,934
Oklahoma ___ ____ __________ 6,327
Oregon ________________ ____ 1,243
Pennsylvania __ ___ _____ __ __ 215, 217
Puerto Rico _______________ 6,063
Rhode Island __ ___ __ ____ __ _ 1,311
South Carolina _____ _______ 10,812
South Dakota __________ __ _
235
Tennessee ____ _______ ___ ___ 12,920
Texas _____________ ____ ____ 31, 197
Utah ____ __________________
234
Vermont. ___ __________ ____
197
Virginia __________ ___ ______ 20,111
Virgin Islands ___ __________
79
Washington __ _____________ 3,241
West Virginia ___ ___ _______ 4,679
Wisconsin _____ ____ __ ______
636
Wyoming ___ ______________
48
--- -----------------3,313 24,270
231
346
1,487
3,628
2,940 13,236
15,810 38,911
2,485
878
3,527
1,240
549
3,600
3,893 10,171
1,227 14, 786
4, 161 30,902
867
1,839
212
Ml
15, 702 47,044
1,166
6,531
1,800
4,715
1,244
4,263
3,708 14,227
1,032 10,562
496
942
3,332 16,262
9,970
4,730
6,699 21,097
2,088
5,088
30,584 58,129
2,390 13,619
320
1,007
711
1,410
163
420
120
403
2,975 13,362
398
1,863
23,355 87,624
3,578 30,715
451
828
4,298 21,232
2,921
9,248
1,492
2,735
2,033 17,250
1, 176
7,239
556
1,867
6,129 16,941
296
531
4,862 17, 782
6,875 38,072
533
299
204
401
3,524 23,635
91
170
6,320
3,079
1,612
6,291
1,343
1,979
39
87
8.38
5. 52
8. 81
6. 46
6. 32
2.32
2. 03
13. 79
16. 22
8.85
10. 02
4.54
1.12
5. 97
1. 88
1.85
2. 29
4.87
4. 95
I. 10
9. 69
2. 25
4. 37
1. 92
28. 73
3. 41
1.87
1. 03
4. 16
. 79
3. 08
4. 41
6. 76
8.80
1.17
3. 15
3. 63
2. 66
1. 70
4. 01
2. 74
9. 04
. 77
6. 15
6. 17
1. 03
1. 05
8. 73
4 7. 73
3. 81
3. 37
. 68
. 37
l
TotaL ___ _________ __ 485 967 184,679 670 646
1
2
Estimate based on reports for 11 months.
Cases in infectious stage only.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
216,134
193,987
295
18,580
8,000
3,200
32
150
38,571
56,408
12
1,995
138,894
123,927
347
15,819
503,593
196,227
3,196
68,290
32,318
84,143
5
3,416
42,019
93, 617
35
5,831
21,391
29,984
35
3,115
52,268
22,000
101
18,442
9,374
260,834 -- ---- --- 30,219
242,692
339,619
7,211
1,446
13,367
12,856 ---- -- -- -1,232
7,799
51, 715
22
2,761
355,873
301,667
128,590
4,663
74,633
147,093
8,033
33,451
80,586
5,039
6
58,742 -- -------38,403
3,957
116,618
88,963
6
4,913
109,324
95,000
104
3,997
36,942 ---------11,310
4,761
93,565
25,749
664
4,255
245,208 ---------79,384
12. 700
62,598
60,384
2, 070
37,596
19,776
256,284
19
12. 038
135,430 ---- -----215,828
4,934
71,557 ---- - --- -43,563
12,626
45,062
16,882
11
1,601
9,970
46,321
7
4,451
4,616
7,904
16
4,513
8,992
28,222 -- ----- - -2,939
84, 978
160,663 -- -------9,966
8,187
56, 723 ---------2,029
145, 557
596,105 ---------17,492
381,962
388,686
23,520
206
40, 731
5,799
2,437
10
14,380
29,519
1,972
10
70,770
82. 210
14
5,287
17,235
7,057
62
5, 436
131,379 ---------233,109
17,664
131,860
312, 675 ---------- - - -------65, 106
JO. 449
7,876
43
35,994
40,000
145
5,137
34,912 ------ ---6,226
1,089
151,305
276,411
19, 167
867
50,374
123,518
2,376
134
(3)
48,141 ------ --- 1,635
14,064
3,213
5
1,531
92,319
227, 759
508
6,956
(3)
---------- ---------- ---------46,308
90,511
204
28,244
121 ,841
24,933
314
2,825
25,997
55,833
175
8,988
406 ---------- --------- - ------ ----
5.10 4. 677 757 15,588,285
15,789
Not reported.
4 Estimate based on reports for 5 months.
3
605,531
138
PUBLIC HEALTH SERVICE
2.-Report of 119 correctional and penal institutions cooperating· with State;
departments of health during period from July 1, 1938, to June 30, 1939
TABLE
Syphilis
Gonorrhea Charicroid
Total new admissions during year_ _____ ___ _____________
5,062
1,473
186
Monthly average number of patients under treatment_ __
2,746
392
15
2,145
1,233
Total number of patients discharged as arrested or cured
92
I 143, 9::\6
Total number of treatments administered during year __ .
96,596
1. 444
243,570
Total number of laboratory tests performed during year _
14,059
574
Total number of social service visits to contacts, etc. ___ __ ------------ --- --------- ---- ------- 1
2
Total
6,721
3, 153
3,470
241,976
58, 2031,628
Includes 68,999 doses of arsphenamines.
Includes 42,790 blood serologic tests, 3G2 darkfields, and 418 spinal punctures.
3.- Report of 39 State hospitals and other institutions for the treatment of
mental diseases, submitted through State departments of health for period J uly 1,
1938, to June 30, 1939
TABLE
Syphilis
Gonorrhea Chancroid
Total new admissions during year _____ __________ _______
2,797
182
Monthly average number of patients under treatment_ __
2,802
90
l, 242
139
Total number of patients discharged as arrested or cured _
I 134,450
24,108
Total number of treatments administered during year ___
237,240
5,222
Total number of laboratory tests performed during year _
Total number of social service visits to contacts, etc. _____ ----------- - --- - -------'1
· '. j
Includes 69,758 doses of arsphenamines.
Includes 32,530 blood serologic tests, 853 darkfields, and 3,857 spinal punctures.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
---------- ----------- ---------- -------- ----- -
-----------------------
Total
2,979
2,892
1,381
158,558
42, ~6
47
TABLE
4.-Report of 2,085 clinics, furnished through State health departments, J uly 1, 1938, to J une 30, 1939
...,.
00
r
I
-t
0
Monthly average number of patients
under treatment
Doses of Laboratory tests made forarsphenamine ad•
minisChanChan- Other Total Syphilis Gonor- Chan- Other
Total Syphili, Gonor•
Syphilis Gonortered
rhea
croid
rhea
croid
croid
rhea
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - --- - - - - - -New cases admitted during year
00
State
Cases discharged
as arrested or
cured
Total. ______________________ 314, 594 249,464 62,835
227 259,979 229,292 29,930
172
585
2,068
--- --- - -- --- --- --- --- --- --- --16,543 15,539
94
9, 444
9.150
283
11 --- -- --56 ------1, 495
1, 752
1,097
1 -------395
1, 605
146
3 --------
Alabama ____________ ____ __ ___ ___
Arizona2 _____________ __ _________
Arkansas ______________________ __ _
California _______________________
Colorado 2______________________ __
Connecticut ____________________ __
Delaware ___ __ ______ _____________
District of Columbia __________ __ _
Florida ____ ______________________
Georgia ___ ____________ __ _________
Idaho ____ ---------------------- Illinois ________ - __ -- -- __________ __
Indiana ______________________ __ ___
Iowa _____________________________
Kansas ________ --- ____________ ___ _
ti~~~~~r----~==:====
======:::::=::
Maine 2_______________________
__ __
Maryland . ______ - ---- -- - - -- __ --- Massachusetts _____ --- __________ __
Michigan _______________________ __
4,442
24,206
1, 487
1,424
1,644
4, 379
6. 975
1 , 303
152
25,338
3,387
874
2,008
3 7,248
2, 345
1,010
7,520
4,803
6,754
879
19,358
4,692
63
592
100
184
7,480
684
6,236
28,794
:= :: :: ::: :=: ==
~l~s~;;ti;i'.~:: :::::
Missouri 2 ______________________ __
l\!Iontana 2________________________
Nebraska __ ___ ___ _________________
Nevada 2______________________ ___
New Hampshire ________ __________
N ew Jersey _______________________
New Mexico _____________________ _
New York 4
North Carolina ____ __ __________ ___
orth Dakota 1_________________ __ - --- ---Ohio
4,556
Oklahoma 2___________________ __ __ 3,435
Ore gon __________ _________________
869
Sefl footnotes at end of tab~e.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1,322
1,307
41
3,010
69
14, 854
9,209
143 - - ------ 17,364
512
96
7 -------- 2,575
416 -------- -- -- ---- 1,852
1, 00
322
4 -------- 1,723
1,318
2,507
6,496
4
1, 2
40
6, 391
51
66 ------:f 4,307
16,023
1, 933
13,990
345
163
152 --- -------- -- ------ - 16,440
8,705
146 25,218
47
997
6,920
2,379
11 ------441
425
1, 196
8 - --- - -- 1,454
546
8 -- ----- - 2,044
(1)
7,248
- - ------ ·-- ----- 39,723
2, 176
169 --- --- - - ------- - 2,768
498
504
8 ---- ---- 1,225
5,484
1,855
181 -- ------ 8. 611
2, 140 ---- --- - -------- (l)
2,663
2,415
4,119
7,004
214
6
534
345 -------- -------- 2,209
19, 197
156
5 ----- iii" 7,702
704
3,954
18
68
12 -------- -------51
51
212 -------- -------380
540
81
19 -------- -------63
67 -- -- -- -- -------823
117
2,133
15 -------- 11,961
5,332
648
36 --- ----- ---- ---706
4,573
1. fi63
-------- 9. 055
26,272
2,335
187 ---- ---- 17,949
-Toso3, 197
569
-----
is1,476
235
3 -- -----300 ---- - -- -- -- - -
----·12-
969
14, 500
2, 159
1,622
1,601
4,613
4,200
12, 794
163
21,001
5,799
965
1, 30
9, 723
2,674
788
6. 815
(l)
311
2,838
415
230
120
1,871
100
1,090
20
7
24
2
1 --------
-------2 --------
--------
11
1
7 ------g"
9
------- --- - ---- --------
4, 109
23
5
1, 118
3 --- --- -228
3 -------211
3 ------ -(1)
-------- -------92
2 -------432
5 -------91 -- -----1, 705
(l)
(l)
(l)
2
5,635
1,563
7,677
770
45
350
58
652
10, 24
693
, 275
17, 261
1,289
646
24
95
6
190
5
171
1, 136
13
780
649
11, 775
1,570
1. 200
12
15
1,828
42
1 ---- ---100 -- - - - - - - ------ --
78
------ -- --- - ---1
2
1
102,880 7,923,958 3,166,342 1,919,625 431,070
928
387
2,150
11 ,439
505
768
446
9 7
903
3,521
60
33,606
561
01
413
3 252
276
501
3,610
1,455
2,227
711
887
(1)
3
129
10
173
5,360
63
3,524
5, 073
-------- ----------------------------- ------ - 1 --------------- --------------- -------39 --------if630- -------- -------- -- ----- - -------- ---- -1,613
1 300
--------
'l'reatments
given
3,312
392
116
152, 701
33,649
108,978
663,605
59,410
60,623
53, 193
105,579
100, 142
401,023
2,000
1,049,573
164. 291
44,836
69,052
3 298,296
79,722
38, 292
222, 218
(1)
242,858
54,812
251,202
86, 122
850
24,885
2,656
10,595
303. 116
18, 748
267, 188
594,617
77,000
15,204
26,533
194, 165
13, 4
19, 244
24, 43
25,662
5 ,354
208,560
1, 000
320,821
60,736
13,222
24, 799
145,272
29,955
11,640
99, 743
(1 )
5,520
24,108
190,950
4, 431
7,122
5,232
16,043
47, 198
66, 990
17, 791
441, 727
31, 14
3,074
13, 776
(l)
19, 113
3,030
27,971
(l)
(l)
61,974
10, 176
136, 015
33,664
478
5,047
1,305
3,744
65,495
9,077
97,557
328, 707
61,565
11,931
58, 168
28,068
116
6,551
380
1,072
55,456
4,672
33,949
182,298
(1)
1, 540
13,849
67,624
3,066
1, 523
1,955
12, 716
2, 56
3,051
1. 406
94,294
4,210
2,105
4. 454
(l)
2,937
--(1)
1
8
711
4
-- - -- ---
4
--- -----
7
413
----- - ---------
23
---- ---(l)
7
1,513 ------- 13
1, 183
1,218
5,266
(l)
(1)
2
38,459
2
4,321
1
1,038
2
7,294
61 -- -- ---3,691 - - -----42 --- -- - -307 -- --- --3
19,063
2
328
8,555 - ------20
10,008
- ------- - -- ---------- ---------- -- - ----- -- --- -- 293,553
55, 49!
36 000
110, 000
31,536
l 0' 800
521,573
17. 269
5 619
5 24
57,042
234 -------5 607 --------
~
q
t::d
t'i
.-I
0
tJ:l
t_::rj
>
t'i
1-3
~
Ul
t_::rj
~
.-I
0
t_::rj
TABLE
4.-Report of 2,085 clinics, furnished through State health departments, July 1, 1938, to June 30, 1939-Continued
J-,l
~
0
New cases admitted during year
State
Monthly average number of patients
under treatment
Cases discharged
1 - - - ------,-- - - - - - , - - - - 1 - - - - - - - - - - - - - - - - 1 as arrested or
cured
Treatm ents
given
Doses of Laboratory tests made forarsphenamine ad- 1------,-- - - - ministered
Syphilis
~~o~~-
°r°t~'it
Pennsylvania __________ __ ___ ___ ___ 14, 057 11,779
2,245
33
14,143 12,238
1,847
7
51
2,555
462,551
186,092
94,780 20,192
112
Rhode Island___________ ______ __ __
751
405
341
5 ________ 1,420
1, 165
254
'1 ________
281
31,827
12,946
17,460
2,805 _____ __ _
South Carolina 2______ ________ ___ _ 11,999 11,143
805
51 ________ 5,057
4,924
124
9 ____ __ __
734
148,656
83,628
54,766
6,518
22
South Dakota 1______ ______ _ _____________ ___ _________ _ ___________________ _ _ _______ _ _ ________ __ _____ ___ ___ _____ _ _____ _________ _ __ __ _ _ _____________ ___ _________ _______ _____ _
Tennessee _______ ___ ______________ 11,930
8,380
3, 453
97 ________ 10,162
8, 778
1,348
36 ________
4, 578
310,083
132,198
76,848 16,965
30
Texas 2 _ ----------------------- --- 16,625 13, 669
2, 752
2Q4 ________ 8,455
7,508
905
42 ________
1,919
246, 769
129,900
36,462
7, 794
36
Utah t ____________________________________________________ -~------ ______ __ ________________________________ _____ ___ _____ _________ __ ____ __________ __ __ ___ _________ _______ __ _
Vermont 1_ _ ___________________ ___ _____ _______________________________________________________ __ _____ ___________________ ___ ___________________ __ ___ _______________________ _
Virginia ______________ ____________ 10,598
9,401
1,176
21 ________ 8,387
8,126
258
3
1,518
253,163
137,243
93,016
8,611
7
Washington 2___________ ____ ______ 1,908
1,155
749
4 ________ 1,579
1,390
188
1 ________
1,572
81, 162
25,992
52,523 24,966
4
West Virginia ____ ____ ______ ___ ___ 6,767
4,342
2,396
29 ________ 6,084
5,586
495
3 ________
1,556
160,850
72,746
26,805
5,328
47
Wisconsin ________________________ 1, 744
1,298
444
2 ________ 3,625
2, 171
1,453
1 __ ______
774
81,908
22,039
25,814
8,478 ____ ___ _
Wyoming I _____________ ___ _ _______ _ __ __ __ _____ ___ ______ ____ _______ _ ____________________ __ __________ __ ____________ _ ______ ________________ ____________ __ ___ _ ______________ _
Hawaii 2__ ___ __ __ __ _ ______ __ ___ ___
648
476
168
4 ________ 1,200
1,135
64
1 ________
192
29, 080
13,996
4,604
1,912 _______ _
Puerto Rico 2_ _______ ___________ __ 16,864 13,390
3,312
162 ________ 5,211
4,463
706
42 ________
1,472
157,990
68,134
22,674
3,220
26
Virgin Islands 2_________ __ ______ __
444
296
148 ________ ________
504
489
15 ________ ________
180
10,040
5,252
4,296
62~ _______ _
No report.
Annual total estimates, based on partial reporting.
Syphilis only.
4 Does not include New York City.
1 Partial data for year.
1
2
3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
141
PUBLIC HEALTH SERVICE
TABLE
5.-Report of cooperative clinic activities furnished through State health
departments from 1919 to 1939
Year
1919 ___ -- _----- -- -- -- - - -- -- __ -- _-- ___-- __
1920_ - - -------- -- -- ------ - - -- - - - - - - -- -- - 1921- __ -- --- ----- -- ---- __-- --- _-- -- _-- __ _
1922 ___ -- ------- _--- _-- -- ----- ____ -- -- --1923 ____ -- ___ -- --- --- -- -- -- -- ____ -- -- _--1924_ - _- - ----- --- -- _--- -- -- _-- --- _-- _-- -1925 ___ -- -- -- ---- --- --- __-- __ -- -- -- - - __ -1926
-- --_____
---- --- -- -- -- ___
-- _____
1927 ___
______
__ -___--__________
______
_______
1928 __ - ---- -- __ -- - - -- --- - -- _- -- __ - - __ -- -1929
-- __ ---- ----------- ----- --- - -_
1930 ___
__ ______________
- ________
___ -- -_______
1931- - - - ----- -- -- -- --- -- --- --- ----- -- - - -1932 __
-- ____________
_--- ----------- ___
_------- ___
___ __
1933
______
-- __
___---- ____
1934 _. _-- -- -- ---- - - ------ _____ -- _-- -- -- -1935_ - _---------- ---- -- - - - - -- -- _----- -- __
1936
--------------- - - -- -- - -------- __
1937 ___
__ _______
-- _______________
-- _- - -_____
1938_. - -- -- -- -- -- ___ • __ ... _. _. _•..• .. ___ _
1939. ___ --- -- -- -- -- ___________ - ____ -- ___ _
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total
Number of New cases
treatments
clinics
given
reporting admitted
167
383
442
541
513
504
495
416
425
451
445
477
512
533
572
616
656
713
965
1,122
2,085
59,092
126, 131
140,748
141, 279
119,217
118, 023
110, 372
100, 776
107,688
110,756
120,315
127,978
143, 982
150,906
154,302
129, 293
134, 720
126,271
149,472
197,303
314,594
527,392
1,576,542
2, 108,003
2,045, 232
1,992,631
2, 147,087
2, 088,494
1,881,380
1,964, 233
2,174,832
2,128,417
2,547,162
2,847,024
2,979, 730
3, 263,927
3,085, 401
3,359, 632
3,344,257
3, 757, 770
5,177,827
7,923,958
Cases discharged as
arrested or
cured
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
78,042
102,880
Treatments
per new case
admitted
8. 92
12. 50
14. 98
14. 48
16. 71
18. 19
18. 92
18. 67
18. 24
19.64
17. 69
19. 90
19. 77
19. 75
21.15
23.86
24. 94
26. 48
25.14
26. 24
25. 19
TABLE
6.-Budgetary allocation of Federal funds appropriated under the Venereal Disease Control Act for the fiscal year 1938-39
Purposes for which budgeted
State
Alabama __ ___ ______ ____ ______ _____ ~-Alaska __ __ _______ · · · · · · · · · · · · · · · · · · · Arizona ..... ·-·_ ........ ... _... _. _.-·
Arkansas .. . .. . .. -· .. _..... .. -· ..... .
California ... . . _............. .... .... .
Colorado . .. . -- ._ ......... . .. . ..... . . .
Connecticut .. _....... . ............. .
D elaware .... ·-_ . . ...... ·-._·-·· -· · __
District of Columbia ..... .. --··--··-Florida.~ .. · - _. __ _. _....... __ . -· · - . __
ii~~~if_-:
====...
====
==...
===-·
==...
===.==
==-=.=
Idaho . . -. =
.=
__=....
. ..
. -=-Illinois.·-·· · . .... . . ...... .. .. ....... .
Indiana ..... . . ..... . . .. ............. .
Iowa .. . . .. .... .... . ............ .. . .. .
Kansas . .. .. · · - -- .. .. -· ..... -· .. . ... .
f;~i\Y~!t.
·_·.~ === =:= ===::::::: =:: ==:
Maine .. . .... .. ... ............. . .... .
=
Maryland .......................... .
Massachusetts . .... ................ . _
Michigan ........................ .. -·
~ff~!;~~~~~========================
Montana .... ···-·-······---·-· .. -·-.
Nebraska .. -·. __ .- · __ ._ .... ·-. ____ ...
Nevada ...... ·-----·······----- ·-·- -·
New Hampshire·-- --·-·······-·-····
New Jersey ____ . __ .. -· ........ ... ... .
New Mexico .. . ... . ........ ... . ..... .
New York ...... . _... . __........... . .
North Carolina ... .. ................ .
North Dakota .. . . • •·········· ··-- ·· ·
Ohio .. ... ..... . .. .... ... ........... .
Oklahoma ... . ..... . ... . ............ .
Oregon .... _...... . _.. .. . .... . .. . . .. .
Pennsylvania . ........... __ _...... .. .
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total allotted
$72,294
2,701
9,639
47,650
103, 791
18, 228
26,518
5,283
16,860
38, 055
77,134
8,088
8,019
125,299
59,380
43,564
31,909
57,318
50,871
13,486
31,892
69,623
77,206
42,324
54, 119
67,376
8,575
22,833
2,475
8,775
71,327
9,023
193, 724
84,259
12,340
110,784
46, 342
16,077
165,082
Total payments
$72,294.00
2, 701.00
9,639. 00
47,500.00
103, 791.00
18, 228.00
26,518.00
5,283.00
16,860.00
38,055.00
77, 134.00
8,088.00
8, 019. 00
125, 299.00
57,600.20
43,564.00
31,909.00
57,318.00
50,871.00
13,486.00
31. 892. 00
69,623.00
75,891.29
42,324.00
54,118.58
67, 376. 00
6,431.25
10,463.50
618. 75
8,775.00
71,327. 00
9, 023.00
193,724.00
81,259.00
12,340. 00
110, 784.00
46, 342.00
16,077.00
165,082.00
Total bud•
geted
$72, 294.00
2,701.00
9,639.00
47, 500.00
103,791.00
18, 228.00
26,518.00
5., 283. 00
16,860.00
38,055. 00
77,134.00
8, 088. 00
8,019.00
125,299.00
59,266.32
43,564. 00
31,909.00
57,318.00
50,871.00
13,486. 00
31,892.00
69,623.00
75,891.29
42,324.00
54,118.58
67,376.00
8,575. 00
22,833. 00
618. 75
8,775.00
71,327.00
9,023.00
193,724.00
84,259.00
12,340.00
110, 784.00
46,342.00
16,077.00
165. 082. 00
Administration
Case findConsultation, etc.
Education
c~! ~~l~- Laboratory T{a~~fw:~t
ing
$5, 820. 00
$3, 260. 00
$791. 65
$600. 00
.... . .. . . ....... . . . . .... ·- ..... . .. . _ .... .... . ··-·· · ·-··•· ·· ··· · ·· ····-·
900.00 ·····- -- - - - -- -- - --- ·--.
1,537. 50 - -·-··- - ·--- -- - · ------ ..
700. 00
5,614.58
11,300. 00
6,830.00
. .. ...... .. . ·- · ........... ··-··· .. - 2,485.00
1,020. 00
7,820.00 ·-·····--·-4,800.00
1, 800. 00
50. 00 _. _-·- . ·- .. . . - - --- _-· .. .
5,600.00 ·-·· ·· .. ··-- . .. . ·-- · .. : .
1,000.00
5, 200. 00
6, 600. 00
2, 400. 00
1, 200. 00
·----··-··-·
2,265.00 ·---·-· ·- -· · -- - · --- -·- -·-· - ···-····
1,750.00 · -·--· ·· ··· · ·--- ······ ··
·-· ---··-··.
450. 00
200. 00 ·--·-··-····
5, 250. 00
12, 543. 71
5, 755. 00
30, 346. 20
3,300.00
5,625.00
5,200.00
4,882.50
3,225.00
8,760. 00 ... . . ... . .. .
970.70
--··-··---· ·
1,029. 00
1,000.00
1,700. 00
646. 53
1,500.00
6,636.58 ············
4, 650. 00
4, 249. 10
1, 300. 00
5, 745. 00
_-· - ----- ·-939. 00
750. 00 ---· -· .. . · · · -- ····- -- ·100. 00
100. 00
10,337.00
--- · ·· -·····
9,690.00
1,000.00
9,630. 00
2,927.50
16,987. 52 ·- ····· ·· ··6,332.51
- ··----- ·· -6,121.54
4,050.00
10,833.46
4, 287.58 -·· - · · ·-· ...
3,900.00
. .... .. .. . ..
4,275.00
4,815.00
1,175. 00 -·-· ·- ·-····
3, 500.00
1, 250. 00
1,250. 00 ---- ···- ·- ··
3, 000.00 -- - ·-- ··-·- - - - - --· -·-··5,100.00
9,207.00
5, 325. 00
12, 060. 00
----·- -- --- - -- .. .. ·-·-·. 10,220.16
8,954.84
4,693.00 ·- ·. ··· - · .. . ··-· · -- -··· 270. 00
260. 00
2,830.00 --- ·· .. .. . ..
18, 315.34
4,000.00
10, 000. 00
12, 050. 00
12,748.26
8,749.22
8, 330. 92
1,818.95 -- -··--····· --·-- ··· ···2,483.05
17,995.00 -·-- · · ·-··-· 40, 524.00
Drugs
Training
$30, 600. 00 $18, 282. 35 $10,840.00
$2,100. 00
2,051.00 -----------650. 00 .......... . .
2,205.25 ---- -- -----500.00
6,033.75
22,550.00
2,900.00
5,842.26
14, 670. 24
3,646.43
20,724.99
29,200.00
25, 775. 00
3,833.00 --- ------ --· -- ··· ··--·· 11,910.00
2,200.00 -- -------- -4,778.00
5,900.00
3,433.00 --- --- -- --- ··-- .. . ·- -- . . - -- -· ·- ·-- _
1, 400.00
191.10
--- -·-· · - - · 8, 668. 90
5, 300. 00
600. 00
14,255.00
2, 500.00
53, 299.00
340.00
10, 010. 00
11,220. 00
2,125.00
2,913. 00
1,300. 00 ---- ------ . 2,494.00
1,425.00
3,450.00 ----···-· · _.
2, 500. 00
54, 268. 09
9,636. 00
5,000.00
17,075. 00
18,983.82
3,200.00
1, 000.00
16,208.34
1,825.00
12, 574.96 ----- - - -- - - 5,500.00
4,710.00
9,375.00
8,595.00
20,702.33 ----- - --- --12,646.56
15,186.00
800. 00
7, 565. 00
23, 201.00
3,360.90
1,072.00
1,125.00
----·- ----·.
9,600. 00
5,500.00
2,850.00
2,567.00
10,438.00
28,435.00
9,318. 00 --- - -------11,550.00
25, 000. 00
13,467.50
10,676. 26
500.00
4, 500.00 -- --- - -----13,924.00
2,895.00
26,595.50
1,380. 00
14, 725. 50
3,230. 00
7,500.00
5,425.00
10,111.00
34,075. 00
2,575.00 ---- --- - ---·····-·- ·--· -· -···- - ····
2,368.00
1,685.00
- -- -·-·-·-·- 10,680. 00
618. 75 ------ -- - -- 1,100.00
3,193.27
1,065.10
3,416. 63
12,680.00
12,055. 00
20,000.00 -- -------- - 2,020.25
7,002.75 -- ---- --- --75,805.00
62,924. 00 -- -- ---- ---35,820.00
51,157.23
3,884.47
17,524.30
7,000.00
4,790.00
750. 00
100. 00
3,340.00
40,634.16
9, 784. 50
16,000.00 ---- - - --- --4,921.60
10,132.00
1,460.00
·- --·- ·· ·· · ·
4, 562.20
4,685.00
1,032.80
1,495.00
75,296.00
1, 350. OQ
28,917.00
1,000.00
1-tj
q
to
ti
H
0
~
M
>
ti
1-3
~
U)
M
~
H
0
M
Rhode island _________ • ___ ._________ _
South Carolina___ ________ __ _________
South Dakota ________ ______ ______ ___
Tennessee______ _____________________
Texas_ .. ______________ ________________
Utah ___ ---- --------------------- -- -Vermont __________ ___________________
Virginia_____ ____ _________ _____ __ ____
Washington ______ __________ ___ ______
12, 062
52,522
12,420
66,644
128, 950
9, 183
6,286
58,983
25, 358
;r:Jo!!t~i~--:======================
Wyoming____________________________
:;:4,148
~~~
Puerto Rico _______________ __________
Virgin Islands _____ ____ ____ _____ ___ __
TotaL___ ______________________
35, 587
949
12,062.00
52,522.00
9,156.00
66,644.00
128,950. 00
9,183. 00
6,286.00
58,983.00
19,018.50
32,297.00
35,602.34
4,148.00
34,156.63
949. 00
12,062.00
52,522.00
9,156.00
66,644.00
128,950.00
9,183.00
6,286.00
58,983.00
25,358.00
32,297.00
40,768.00
4,148.00
34,156.63
949. 00
1,940. 00 -- ----- ----3,600.00
5,615.00
3,120.00
300. 00
1. 331. 00 ------- --- -5,880.00
2,700.00
1,920.00
4,475. 00
11,100.00
375. 00
2,460.00
1,700.00 -- --- - ----------------- ------------ -----------14, 111. 82 -- --- - ---- - 1,440. 00
1,695.00
1, 000.00
------ -----1,900.00
2,412.00
885. 47
3,000.00
8, 005.00
1,500.00
------ ----- - -- -- --- --- -- -- -- ---- ---3,333.30
3,198. 41 -- ----------- -- -- - ---- -
- - ------ ----------- -- -525. 00
4,200.00
11,210.82
----------------- -- -- -150. 00
2, 520.00
3,100.00
-----------------------
o, 346. 25
----------- - ------------ ------------ --------- ---
1- - - -- 1- - - - - -1- - - - --1- - - - -1-- - -
2,400,000
2, 360, 586. 04 12,388,270.57
84. 908. 85
231,226.89
83,096.50
217,310. 73
4,662.00 -----------4,460.00
13,840.00 --- --------- 25,762.00
4,300.00
300. 00
1,500.00
14,320.00
35,044.00
2,580.00
5,800.00
32,048.36
63,940. 82
5,023.00 ----- ------- -----------3,600. 00
2,686.00
-----------4,320.00 ---------- -- 38,961.18
11, 338.00
6,645. 00
1,700.00
4,000. 00
1, 500.00
14, 000.00
14,453.00
3,810.00
10,000.00
4,148.00 ------------ -------- ---2,000.00
17,883.17 - - -- -- ---- -499. 00 -----------450. 00
326,403.86
679,049.87
651,518.11
1,000.00
585.00
900. 00
---- -- ---- - -- - - -- ---------------------- _.----_______
____
460. 00
4, 499.53
--------------- -- -- ----
1,395.50
-------- ---114, 755. 76
1 The difference between total payments and total budgeted is explained by the fact that some of the activities for which budgets were submitted were not operative for the full
period covered by the budget.
Ul
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https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
144
PUBLIC HEALTH SERVICE
7.-Domestic sales of arsenical drugs, estimated in number of doses, during
the calenda1' years 1933 to 1938, inclusive, as reported by manufacturers and distributors
TABLE
Number of
doses of
arsenical
drugs 1
Calendar year
1933 _______________________ ---------1934 ________________ ·---------------1{135 ________________________ ·________ _
5, 787, 278
6,769,338
6,521,312
Number of
doses of
arsenical
drugs 1
Calendar year
J936 ________________________________ _
1937 _______ --- ___ --- __ - -- - - - -- - -- -- -1938 _____ -- -- -- - - -- - - - - - - -- ---- - - - ---
7,717,953
9,808, 27Z
10,656.253
1 E stimated on basis of 0.3 gm. average dose of arsphenamine (salvarsan); 0.2 gm. average dose of silverarsphenamine, sulfarsphenamine, neosilverarsphenamine, etc., 0.5 gm. avera 6e dose of neoarsphenamine;
and 0.05 gm. aYerage dose of mapharsen.
TABLE
8.-Statistical summary of activities in the control of venereal diseases for
the .fiscal years 1938 and 1939
1939
A.
B.
C.
A.
B.
C.
D.
1938
Medical activities
Cases of venereal disease reported to State health departments:
I. Syphilis ____ __ _____ ___________________ ________ ____________ __________ ____
485,967
480, 140
II. Gonorrhea. -------------------- ---- -------_____________ _______ __ ________
184, 679
198,439
III. Chancroid ______________________________________ ________________________ 1___3...;.,_44_2_ ____5_._07_8
1
Total. ________________________________________________________________ ==67=4=.0=8=8=!===6=8=3.=6=57
1
Doses of arsphenamine distributed by State health departments ___ ___ ___ ___ .__ 4,677,757
2,799,110
Clinics:
I. Clinics reporting to State health departments ________ ____________________
2,085
1, 122
II. Report from clinics:
a. New cases admitted__ ________ __ ___________________ ___________________
314,594
197,303
b. Cases discharged as arrested or cured_________________________________
102,880
78,042
c. Treatments given_ ---- -- - -- ----- - -- ---------- --- ---------- --- -------- 7,923.958
5,177,827
d. Doses of arsphenamine administered__ ________________________________ 3. 166, 342
1,854,735
e. Serologic tests made .____ ___ ________ __________________ ______ __________ 1,919,625
I, 001, 478
f. Microscopic examinations for gonococcus.________ ___ _________________
431,070
321,699
Publications:
Educational activities
I. Requests for publications received by the Division ______________________ _
19,528
14,673
II. Publications distributed:
l=====I=====
a. By the Division to State health departments and others____ ____ ______
244,290
198, 784
b . By State health departments ___________________ ___ ___________________ 1_2...;.,_4_62_._20_6_ __2_,~48_0_._79_7
1
Tota!__ ______ ______ ____ _____________________________________________ 2,706,496
2,679,581
III. Venereal disease publications issued by the Public Health Service__ ____
27
25
Lectures, exhibits, and film showings reported by ~tate health departments:
I. Nmnber .. ________________ _______________ _____ __ _______ ___________ ______ __
6, 442
4, 192
II. Average attendance____ _________ ___ ____________________ ___ ______________ _
108
100
Motion-picture films lent by the Division____________________________________
118
173
Posters digtributed, sets____________________ __________________________________
103
493
9.-Annual rates per 1,000 population for syphilis and for gonorrhea in 35
cities with a population of 200,000 or over, as reported by city health officers for
the months July 1938 to June 1939, inclusive
TABLE
City
Annual rates per 1,000
population
Syphilis
Atlanta, Ga ________ _____ ___
Baltimore, Md _____________
Birmingham, Ala ____ _______
Boston, Mass ______ ___ ______
Buffalo, N. y ______ ___ ____ _
Chicago, IlL _______________
Cincinnati, Ohio! ____ ______
Cleveland, Ohio ____________
Columbus, Ohio ____ ___ ___ __
Dallas, Tex.2 ______________ _
Dayton, 0.1 ________ ____ ___ _
Denver, Colo.2 _____________ _
Detroit, Mich ______________
Houston, Tex.4_________ ___ _
Indianapolis, Ind.I _________
Jersey City, N . J,1 ____ ______
Kansas Oitv, Mo.1_________ _
Louisville, Ky ___ ------- - --
Annual rates per 1,000
population
Syphilis Gonorrhea
Gonorrhea
12. 78
3. 37
9. 51
2. 75
2.17
13. 68
2.46
2. 20
2. 94
. 82
5. 88
3. 03
2. 23
5. 40
1.0/i
3. 03
2.44
.84
9. 17
4. 25
3. 83 ----------- 1.84
2. 93
1. 77
3. 81
10. 55
3. 33
. 81
. 77
1. 10
. 36
1. 91
. 26
9.32
2. 99
1 Estimate based on actual reports for 11 months.
i Estimate based on actual reports for 10 months.
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Federal Reserve Bank of St. Louis
City
Memphis, Tenn.I ___________
Minneapolis, Minn.I _______
Newark, N. J.l ____ _________
New York, N . y ___________
Oakland, Calif.3 ____________
Omaha, Nebr __ ________ ___ _
Philadelphia, P a.I ________ __
Pittsburgh, Pa ____________
Portland, Oreg _____________
Rochester, N. y ____ _______ _
St. Louis, Mo .2 ________ ____ _
St. Paul, Minn.1 __________ __
San Antonio, Tex.I _________
San Francisco, Calif__ _______
Seattle, Wash _________ ___ __
Syracuse, N. y _____ ________
Washington, D. c __ _____ __ ._
12. 04
1. 54
8.10
3. 83
1.14
3. 52
2. 37
1. 52
. 99
6. 39
1. 92
1.48
2.85 ----- ----- - . 38
5.16
2. 46
2. 39
1. 32
1. 32
1. 53
5. 23
. 78
1. 65
2. 79
5.80
3. 35
2. 91
3.40
3. 24
. 76
4.43
6. 21
10. 01
s Estimate based on actual reports for 8 months.
'Estimate based on actual reports for 7 months.
145
PUBLIC HEALTH SERVICE
TABLE
10.-Report of the U.S. P ublic H ealth Service clinic at Hot Springs National
Park, Ark., from July 1, 1938, to J une 30, 1939 1
Total applicants _______________ 5,272 Gonorrhea (new cases)_______
720
Acute _________________ _
Chronic _____________ __ _
581
139
Venereal 2 ________________ 2,743
NonvenereaL ______ ___ ____ 2,291
Did not return 3 ___________
238
Syphilis______________ __ ______ 2, 074
New cases____ ___ _________ 1, 507
Readmitted cases__________
345
Rejected_ _ _______________
222
Gonorrhea_______ _______ ______
797
New cases____ ________ ____
Readmitted cases__________
Rejected___ ___________ ___
720
53
24
Syphilis (new cases)___________ 1, 507
Primary__________________
Secondary___ _________ ____
Tertiary_____ _____________
Neuro___________________
Congenital_______________
136
308
971
77
15
Total treatments given ___ ..; ___ 172,633
Arsphenamine _________ _ 21,235
Heavy metaL __________ _ 44,009
Other intra venous ______ _
3,052
Gonorrhea _____________ _ 32,873
Baths _________________ _ 71,464
Laboratory examinations____ _
77, 959
Complement fixation tests_
Precipitation tests_______
Ka~n. q_uantitative prec1p1tat10n____ _________
Icterus indices_________ _
Darkfields____ __ __ _____ _
Gonococcus smears___ ___
Urine analyses__________
SpeciaL _________ ___ ___
16, 654
16, 654
Spinal fluid examinations_____
====
At Public Health Service
Medical Center ______ _
At Levi HospitaL ______ _
1
2
3
4, 653
16, 654
281
13, 808
8, 759
496
1, 191
1,078
113
From the annual report of the clinic.
Represents 2,957 caSP$ of venereal disease, i.e., 214 patients with two or more infections.
Did not return for physical examination.
TABLE
11.-Report of the U.S. P ublic Health Service clinic at Hot Springs National
Park, Ark., from July 1, 1922, to J une 30, 1939
Number of cases
Year
Number of
applicants
Total venereal disease
pr.tients
Syphilis
Gonorrhea
Treatments
given 1
Total ________ ______ ___ _________ ___ _
100,387
72,554
47,257
25, 702
1,543,686
1922 __ -- ____ - - -- - - - ___ ---- ___ ______ -- -- __
1923 __ ___ -- ____ -- -- ____ - --- -- -- - - - - - - - - - 1924 _____ -- --- _-- __-- - - -- ________ __-- _- - _
1925. __ __ ----- ___ - - -- ___ -- - -- - _-- - - -- - - - 1926 __• ______ - --- ___ -- _-- ___________ ____ _
1927 ________ ____ ________________ ____ ____ _
1928 __ ___ ____ -- ____________ - - __ -- _-- - - - -1929 _____________ _______ _____________ ___ _
1930 __ _____ -- - - ___________ - - - -- - - - - - - - - - 1931_ _____ ------- - - - - -- -- ---- --- ----- ---1932 ____ -- -- -------- - ------------- ----- -1933 ______ -- ___ -- __ - ___ - _- -- -_- - --- - - - - - 1934 ______ ___________ _______ - --- --------1935 __ _____ ________________ - _- _- _- - - - - - - 1936 __ __ __ _____________ ____ _____________ _
1937- - _____ __ -- -- ____ -- -- ________ - - - - __-1938 _______ ________ __ ____ ___________ __ ___
1939 _____ _- -- --- - - - -- - - -- - - - - -- - - - - - - - - - -
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
6,209
5,272
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
3. 664
2; 743
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. 31i8
2;974
2,863
2,074
593
528
739
771
853
1, 178
1,508
1, 4.74
1,698
2,312
2,9!l6
1,635
2,277
2,760
J, 262
1,243
1,078
797
43. 830
41,559
50,683
50,608
54,590
58,489
72,466
75,519
79.180
66,246
93, 707
73,406
124,004
198,051
141,446
llO, 336
108, 337
101, 169
1
Baths not included.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
DIVISION OF MENTAL HYGIENE
Assistant Surgeon General
LAWRENCE
KoLB in charge
Medical Director Lawrence Kolb was assigned as assistant surgeon
general in charge of the Division of Mental Hygiene on July 1, 1938,
relieving Assistant Surgeon General Walter L. Treadway. The functions of the Division continued unchanged during the year.
, 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, Lexington, Ky.
Follow-up studies of the mental and physical deviations of patients
during addiction, following withdrawal, and for 9 months thereafter,
were continued on a few patients. It is anticipated that this series
will be built up to a significant number during the ensuing year.
Continued use of the point scale of withdrawal severity, described in
last year's report, has confirmed our prediction as to its general usefulness, and it has been extended to the mensuration of changes
which occur from hour to hour. This has proved useful in measuring the degree and duration of effect of morphine derivatives and
other drugs on the abstinence syndrome.
Further work has been done in the elaboration of a point rating
scale for use in evaluating certain pyschi atric changes occurring in
addicts under various conditions. This scale has been modified
somewhat in that at the present time the only aspects of behavior
which are being studied by this method are those which are purely
objective and which can be recorded accurately by trained attendants.
This limitation has narrowed the field to six categories of behavior,
viz, appearance, speech, motor activity, cooperation, mood, and
degree of sociality. Further studies have pointed more clearly to
the fact that physiological stabilization is not synonymous with
emotional stabilization, since it seems that after the physiological
needs are satisfied an additional amount of narcotics must be taken
to attain emotional tranquillity. Codeine and morphine have been
tudied by this method as well as some other members of the morphine series.
Definite progress has been made in the past year on metabolic
studies in the drug addict. Comprehensive analyses h ave been made
for fat, carbohydrates, protein, and water intake in the food and
liquids given two patients receiving morphine during the course of
their treatment. These analyses comprise a portion of the data
necessary in the study of general and standard metabolism. In addition to these, determinations of insensible weight loss and acid-base
constituents of the blood were made before and after an injection of
morphine at given intervals during the course of treatment. Blood
volume, extracellular water, and morphine excretion were studied
whenever changes were made in the course of treatment. These
studies are not yet complete, hence no definite results regarding the
nature of the findings can be given at this time.
146
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A study of urinary excretion of codeine has been completed, and
a new quantitative method for its determination in urine has been
developed. It was found that approximately the same percent of
codeine as morphine is eliminated in the urine. The absolute quantities excreted are, however, very much higher for codeine since the
codeine intake is correspondingly higher.
Studies of the excretion of morphine in the urine of morphine
addicts under varying doses administered, as well as after a single
dose in nonaddicted individuals, are still in progress. The procedure
for determining quantitatively minute amounts of morphine, as after
a single dose, has been improved. It is now possible to follow the
excretion of 10- to 15-milligram doses in urine and feces. A study
of the excretion of a morphine-like substance in urine following heroin
administration has been started.
The study of blood concentration was completed and reported before the Federation of American Societies for Experimental Biology
in Toronto. A study of choline-esterase concentration in serum has
been started for the purpose of determining what changes, if any,
are associated with addiction.
Electroencephalographic studies have been continued, and a careful study of the comparative effects of codeine and morphine in
addicts has been completed. Significant differences were _found
between the cortical action of the two drugs; these differences are of
importance not only for a better understanding of the action of
codeine, but for obtaining insight into the fundamental nature of
addiction.
Methyldihydromorphinone, dihydromorphine, and dihydrodesoxycodeine-D have been studied in a similar manner, but the data have
not yet been completely analyzed.
A large series of records has been obtained from patients during
addiction. These are being analyzed and compared with records
from a series of patients who have received no opiates for at least
1 year. These records show significant deviations from the normal
patterns as found by other workers.
During the year an intensive psychological study has been conducted to determine the effects of morphine and morphine addiction
upon mental efficiency and emotional reactivity. There are many
who believe that the stabilized morphine addict is capable of normal
or above normal mental performance. The purpose of the abovementioned study was in part to answer this question, as well as to
investigate the general effects of morphine upon mental and emotional adjustment.
Tests of simple and choice reaction times, sensitivity, tapping
speed, motor control, speed of subtraction, cube fluctuations, learning and memory tests were periodically administered before, during,.
and following morphine addiction. Weekly runs of the Darrow
photopolygraph were made to determine the physiological response
(blood pressure, pulse rate, galvanic skin reflex, respiratory rate, and
tremor) to disturbing and nondisturbing word stimuli. A variety of
intelligence, aptitude, vocational, and personality tests and rating
scales have been applied during addicted and nonaddicted states.
Although the study is still in progress, sufficient data have accumulated to indicate that morphine addiction is associated with marked
impairment of mental efficiency, especially with reference to reaction
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time, both simple and choice. Sensitivity also is significantly
decreased.
A comprehensive medicosociologic study has been started on all
patients received at this hospital since July 1, 1938. Comprehensive
data are being compiled on the psychobiological characteristics of
each patient being treated; the time, kind, and amount of treatment
administered; and the results of treatment. A full-time worker has
been assigned to this task, and arrangements are being made to follow
up cases through the fifth year after discharge. Preliminary investigations are being carried out on the results of treatment on discharged
patients, through the use of questionnaires and information obtainable from certain governmental agencies.
Conductivity measurements on 5 alkaloidal bases and 26 alkaloidal
salts have been completed. From these data the dissociation constants of morphine, dihydromorphine, codeine, dihydrocodeine, and
tetrahydromorphinethine have been determined. It was found that
the two hydrogenated compounds are stronger bases than their corresponding unhydrogenated forms. The equivalent conductances of the
salts at infinite dilution have been calculated. As far as can be determined, there is no correlation between the clinical properties of the
drugs and the values of either the dissociation constant or equivalent
conductance at infinite dilution.
Studies of the addiction characteristics of members of the morphine
series have been continued and six new members have been added to
the series. During the ensuing year studies will be made on at least
six additional new derivatives, which will make possible several new
group comparisons. Additional studies were required to complete
the thorough reexamination of the addiction liability of codeine mentioned in last year's report. These have been completed, and the
entire report will be submitted for publication early in the coming
fiscal year.
In addition to the investigative work on methyldihydromorphinone
carried on at the Lexington Hospital, studies of this substance and its
comparison with morphine, codeine, and dihydrodesoxymorphine-D
have been continued at the Marine Hospital in Baltimore, Walter
Reed Hospital in Washington, D. 0., the University Hospital in
Ann Arbor, and at certain hospitals under the jurisdiction of the
Massachusetts Health Department.
Studies of the analgesic action of this substance made at Ann
Arbor thus far indicate that complete relief of pain is obtained within
10 to 20 minutes after subcutaneous injections of 7 milligrams and
the analgesia lasts more than 2 hours. A sedative effect and partial
relief of pain continues for a longer time. No evidence of respiratory
depression, an emetic action, or any other untoward result has been
observed. These findings are based on the administration of over
400 doses of methyldihydromorphinone to more than 100 patients.
The work done indicates that this substance has considerable value,
but the studies have not reached a point where a final report can be
made.
Clinical studies of the analgesic and other properties of morphine
and related substances when used for the relief of pain in terminal
malignancy cases and for relief of cough in tuberculous patients were
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,continued in cooperation with the State Health Department of
Massachusetts and the Committee on Drug · Addiction of the National Research Council. Included in these studies has been the use
-of methyldihydromorphinone in bronchoscopy work which has given
·very promising results.
DISSEMINATION OF INFORMATION
The results of 7 years' studies of certain phases of the drug addiction problem carried on cooperatively by the United States Public
Health Service, the Committee on Drug Addiction of the National
Research Council, and other agencies having responsibility for the
solution of this problem, have been made the subject of a special
report dealing with their chemical, pharmacological, and clinical
aspects. It is entitled "Studies on Drug Addiction" and was published as Supplement 138 to the Public Health Reports.
A number of other articles pertaining to the work ,of the Division
·o n drug addiction were published during the year, in both Service and
outside publications, and include the following: "Treatment of Drug
Addicts at the Lexington Hospital"; "The Determination of Morphine in the Urine of Morphine Addicts"; "Addicts on Probation";
"Suggestibility in Chronic Alcoholics"; "Suicide Among Hospitalized
Drug Addicts"; "The Abuse of Codeine, a Review of Codeine Addiction and a Study of the Minimum Cough Relieving Dose"; "Marihuana"; "A New Electrode for Recording Electrical Brain Potentials";
"Drug Addiction Among Women"; "Basal Metabolism Tests on
Disturbed Patients"; "Studies of the Addiction Characteristics of
(a) Dihydromorphine ('Paramorphan'), (b) Dihydrodesoxymorphine-D ('Desomorphine'), (c) Dihydrodesoxycodeine-D ('Desocodeine'), and (d) Methyldihydromorphinone ('Metopon')"; "Group
Tests in the Clinical Field"; "The United States Public Health Service
Narcotic Hospitals"; "Narcotics Control by Law in the United
States"; "Some Thoughts on the Theories and Treatment of Drug
Addiction"; "Drug Addiction as a Public Health Problem"; "The
Problem of Drug Addiction"; and "The Effect of Age on Speed-power
Relationship with Special Reference to Tests of Intelligence."
Several radio addresses and talks to interested groups on the subject of drug addiction were given, and advisory consultant services
were rendered to various agencies with reference to the drug addiction
problem.
STUDIES OF THE ABUSIVE USES OF AND THE MEDICINAL AND SCIENTIFIC NEEDS FOR NARCOTIC DRUGS
The clinical studies of the use of codeine in the treatment of tuberculous cough indicate that the accepted dosage of codeine in the
treatment of this condition is unnecessarily large. They also indicate
that the average patient in sanatorium practice win•obtain relief from
one-sixth grain of codeine repeated every 4 hours, and larger doses are
never justified in ambulatory patients. The addiction liability of
codeine as used in routine medical practice is not fully recognized.
A report on this subject was prepared and published during the year.
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HOSPITALS FOR DRUG ADDICTS
UNITED S'l'ATES PUBLIC HEALTH SERVICE HOSPITAL, LEXINGTON, KY~
In addition to the research work on the nature and treatment of
drug addiction carried on at the United States Public Health Service
Hospital, Lexington, Ky., the functions of the institution included
the reception, general care, treatment, custody, and disposition of
patients, and the operation of industries of an agricultural, mechanical,
and manufacturing nature.
A reorganization of the admission clinical work-up was developed
which pointed toward a well-formulated therapeutic program for each
individual. There was a redirection in the point of view of reclassi-fication toward a checking up of the formulation which was made at
classification and an improvement and simplification of the vocational,.
domiciliary, and custodial assignments.
An attempt was made during the year to stratify the patients of the
institution according to personality make-up , approximate ability for
improvement, and physical and cultural standards. As a result , there
has been a segregation of the least desirable individuals as well as a
congregation of the most worth-while individuals into separate units~
This has proved valuable both from the administrative and psychiatric standpoints. It has been found that individuals of about the same
stratum are more congenial when living together than when quartered
with patients from higher or lower strata. They have been found to be
more receptive to psychotherapy and more favorably disposed towards
hospitalization when living with congenial fellows. This stratification
has stimulated a sincere desire for improvement in many patients in an
effort to qualify for a better section. It has been possible, around this
stratification scheme, to intensify psychotherapy and to offer to
patients some definite and immediate reward in return for an improvement in mental attitude. In association with this stratification plan
there has been a definite increase in medical supervision, and patients
in the continuous-treatment wards have had much more contact with
their physicians than was possible previously.
Recommendation of parole and presentation of cases before the
Parole Board was placed in the hands of the patient's physician, and a
formulation by the psychiatrist was a part of the data submitted. The
same procedure was extended to conditional release.
Although approximately 46 percent of the patients were granted
trusty privileges, there were no escapes during the year.
The number of patients recp,ived direct from the United States
courts has practically doubled in the past year, and the number of
patients received by transfer from Federal penitentiaries exceeded
that of the preceding year by 88. Of 10 patients released on parole,
only 2 were returned as parole violators, whereas during the fiscal
year 1938, 23 were released on parole and 10 were returned as parole
violators. The number of conditional-release violators returned to the
institution showed an increase of 14 over the number returned last
year.
The working capital fund, under which the industries operaiied, had
an unobligated balance on hand on July 1, 1938, of $49,696.00.
During the fiscal year receipts totaled $68,527.00 and expenditures
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.a ggregated $72,045.00, leaving a balance in the working-capital fund,
as of June 30, 1939, of $46,178.00. The reasons for this deficit were
the rather large investment in equipment during the year and the
purchase of raw materials for the garment shop toward the end of the
year for orders on hand but not yet completed. The garment shop
continued to manufacture uniforms for personnel and all clothing for
the patients, including civilian clothing issued to them on discharge.
Orders for operating gowns, mattress covers, uniforms, laundry bags,
aprons, and nurses' uniforms were completed for various marine hospitals and for the United States Supply Station at Perry Point, Md.
At the end of the fiscal year, orders were on hand for large numbers
of operating gowns and aprons to be supplied to stations of the Service.
During the year, work was started on a shop building and material
shed to be utilized in establishing a woodworking industry under the
working capital fund. It is expected that this will be completed about
November 1, 1939.
Approximately 40 percent of the food supplies used by the Dietetics
Department was obtained from the farm, which delivered to the institution during the year products having a total value of $45,090.65.
These included dairy products, meats, poultry, and fresh and canned
vegetables.
The industries have been of great benefit, both clinically and ad,
ministratively, to the hospital. They have supplied the institution
with a high grade of produce at a nominal price; but their important
function has been the opportunity afforded to the patients for occupational therapy and rehabilitation work. Through careful placement of
patients, these opportunities for developing good work habits and
learning new types of activities have been fully utilized.
Formal occupational therapy as applied to patients physically or
mentally unable to work in the institution or in the industries was
improved during the year by the employment of a full-time occupational therapy aide. This made possible a beneficial extension of
occupational therapy to a larger part of the hospital population,
thereby improving the morale of the considerable number of patients
under prolonged treatment.
The administrative and maintenance work of the institution and the
care of property functioned well through the year, ·w ith progress and
improvements achieved in the safeguarding and handling of property,
the operation of the perpetual inventory system, and the establishment
of a cost accounting system for the hospital.
Throu~h nomination for probational appointment from the register
of eligibles established by the Civil Service Commission, 76 of the
attendants were brought into the classified civil service.
During the year several changes in matters of clothing issue, commissary purchase and issue, dining-room service, and control of
patient traffic within the institution were instituted 1 much to the
benefit of patients and institution.
Considerable progress was made in the construction of a large
athletic field. This is conveniently located adjacent to the institution proper and will, when finished. afford opportunity for a definite
increase in recreational and athletic activities for patients.
Funds jn the amount of $1,315,000 were allotted by the Interdepartmental Committee for ·construction, alterations, and improvements
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at the institution, which will provide for a nurses' home and quarters.
for senior and junior officers, a 100-bed unit for the care and treatment of women patients, additional facilities for male patients,
extension of inmate dining and educational facilities, alterations forthe use of patients of that portion of the main building now being used
for quarters for nurses and attendants, and resurfacing of roads, etc ..
The sketch plans for this construction work have been approved
and working drawings and specifications are being prepared. It is.
anticipated that bids for construction will be solicited in the near
future, and the buildings completed and ready for occupancy some
time during the year 1940.
UNITED STATES PUBLIC HEALTH SERVICE .HOSPITAL, FORT WORTH, TEX.
A skeleton staff selected from experienced personnel on duty at.
the Public Health Service Hospital at Lexington, Ky., was assigned to
duty at the United States Public Health Service Hospital, Fort Worth,
Tex., on July 1, 1938, to carry out the same general administrative
policjes which had been found effective at the Lexington Hospital.
Dedication exercises were held on October 28, 1938. The formal
opening exercises were attended by 900 persons and during the 4
days following, when the hospital was open to the public, 20,000
made conducted tours of inspection.
The first 50 patients were admitted on November 8, 1938. ·
The preliminary experience with a drug addiction facility having
minima] emphasis on custodial features has been very encouraging.
It has been found practicable, with the selected patjents under treatment to date, to djspense with armed attendants and to have up to
90 percent of the patjents on minimum supervision (trusty) status.
Increased numbers of patients are being admitted directly from
the courts, as a result, in part at least, of conferences held with
United States district judges, district attorneys, marshals, and chief
probation officers. Such conferences have afforded opportunity for
coordinated effort aimed at the rehabilitation of addicts.
Information concerning drug addiction and related problems was
given to local scientific and lay audiences through the medium of 4 7
addresses bv members of the staff.
An extensive construction program was in progress throughout the
fiscal year, but this djd not interfere seriously with the operatjon of
the hospital. Six sets of quarters for commissioned officers and
seven sets of quarters for noncommissioned officers have been practically completed. The prolonged-treatment unit having a capacity
for 717 patients will be completed by December 1, 1939. This will
bring the total capacity of the hospital to 1,000 beds.
Landscaping has necessarily been delayed pending the completion
of the construction program. Thjs should go forward immediately
thereafter and meet a great need, since there is at this time a complete absence of trees and no natural lawn.
The accompanying table presents a summary report on admissions
and djscharges at the two institutions during the year.
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Statistical summary of patient movement at the United States Public Health Service
hospitals, Lexington, Ky., and Fort Worth, Tex., for the fiscal year 1939
Lexington
Population June 30, 1938 ___ ____ _______ __________ __ ______ __ ______ ____ __
Fort Worth
971
0
ADMITTED DURING FISCAL YEAR 1939
Prisoners:
Received direct from United States district courts ________________
Received by transfer from Federal prisons ________________________
Parole violators returned ____ ------------------------------------Conditional-release violators returned __ _____ ____ ______ ___ ________
421
308
64
243
0
2
87
4
818
Probationers received direct from Unlted States courts_______ _________
Voluntary patients ______________________ ----------------_____________
Received from United States marshal, held awaiting triaL__ ___ ______
Ex-prisoner patients _____________________ ________ ______ __ _______ ___ _._
311
11
85
264
1
1
Total admissions_----------------------------------------------
110
0
0
1, 169
432
2, 140
432
DISCHARGED DURING FISCAL YEAR 1939
Prisoners, c.ured:
On parole, prognosis good __ ______________________________________
10
On parole, prognos_is guarded______ _______ ___________________ __ __ _
0
On conditional release, prognosis good_____ ____ _________________ __
21
On conditional release, prognosis guarded___ _____ ___ _____ _____ ____ 309
On conditional release, prognosis poor_ _--- ---------------------- 65
On conditional release, prognosis very poor__________ _____________
14
Short-term expiration (old law), prognosis guarded______________ _
2
Prisoners, improved:
Full-term expiration, prognosis poor _________________________ _____ 105
Transferred
to Federal penal
institutions ___ ---------------------Death . _________________
.___________________
______________ ________ 166
13
'fo United States marshal for triaL__ ___ __ _________________ __ __ ___
1
Order United States court, writ of habeas corpus________ _________
1
Escape ______ __ __ _____ . __ . ________ __ ___ ___ ________ ________ ______ _.
O
Probationers:
Cured, prognosis good _____ __________________________________ .____
Cured, prognosis guarded____________ _________ __________ ___ _______
Cured, prognosis poor _____ ______ __. ______________ _____ -____ ___ ___
Cured, prognosis very poor__ _________ _____ ______ _________ ________
Death __ ___ ______________ __ ________________ ____________ --- ___ ___ __
Escape _____ _________ -- __ ---- ------ _________ ___ __ _____ _-- ___ ______
Surrendered to United States marshal, detriment to station,
prognosis poor_ _____ ____ ____ ---- -- ____ . . _._______ __ _____ _____ ___
Furloughed to probation officer, prognosis good ___________________
2
1
7
23
15
1
0
1
0
0
0
0
0
707
50
24
5
1
0
0
0
0
0
0
0
1
0
0
1
77
16
124
Voluntaries, cured:
Prognosis good. __________________ .__________________________ ___ __
9
Prognosis guarded __________________________________________ ._____
36
Prognosis poor ___ ___ _________________ _____________________________
5
Voluntaries, maximum benefit:
Prognosis guarded _________________________________ __ __ - __ _______ _
2
Prognosis poor __ --------------------------_____________ __________
1
Other voluntaries:
Against medical advice, prognosis poor__ ____________________ _____ 217
Detriment to station __ __ ____________________________________ _____
2
Death ___________ __ ______________________ ___ ______________________
5
1
Eloped ______ __ ______ ______ --- - -- --- -- __ - ______ __ ______ -- _-- - _____
Not a proper charge of the Government_ __ ----------------------1
2
1
0
0
0
81
1
1
0
0
279
86
Total discharges ____________ .. __ ______ _____ _______ . ____ --- -- ___ _
1, ll.O
137
Popul~tion June 30, 1939 __________ . ___________ . ___________________ ___ _
1,030
295
Average daily population for the fiscal year_ _________________________ _
960
180•
iEDICAL AND PSYCHIATRIC SERVICES IN FEDERAL PENAL AND
CORRECTIONAL INSTITUTIONS
The fiscal year 1939 marks the ninth consecutive year during which
the Public Health Service furnished and supervised the medical,.
technical, and psychiatric services in Federal penal and correctional_
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institutions under the jurisdiction of the Bureau of Prisons, in accord.
ance with the act of May 15, 1930. Three additional medical units
were provided during the year, one each at the new Federal Correctional Institutions at Sandstone, Minn., and Tallahassee, Fla., and
one at the new Federal Prison Camp, Mill Point, W. Va. This
makes a total of 22 independent units which provide complete service
for 24 institutions, classified as follows:
Institution
Chief Medical Officer
Penitentiaries (6):
Atlanta, Ga .. ... ... .. .. ........... ... ................ Acting Asst. Burg. C.R. F. Beall.
Alcatraz, CaliL ........ . . . . ..... ... ... . . . ... ... ... ... Surg. (R) R . M. Ritr.hey.
Leavenworth, Kans .. .. . . . . . . . . . ... ...... ....... ..... Senior Burg. C.H. Waring.
Ft. Leavenworth, Kans . ..... .. ..... . .......... ..... . Passed Asst. Burg. (R) J. 'l'. Anderson .
Lewisburg, Pa . . .. ...... . . ... . . . ....... . ... ... . ..... .. Acting Asst. Burg. C. W. Mangun.
McNeil Island, Wash_ . .. . . ........ . . . . . . ... . . . ... ... Passed Asst. Burg. (R) R . 0. Settle.
Reformatories (4) :
Chillicothe, O .. . .. . .. .. . . .... ... . .... . . .... .... ...... Acting Asst. Burg. R. P. H agerman.
El Reno, Okla .. ... . . . . . . . .... . .................. ... . Acting Asst. Surg. W. K. Dyer.
Petersburg, Va . .. . ..... . . . . . ..... . .. .. . .. . . ... . . . .... Acting Asst. Burg. C. I. Pi rkle.
Alderson. W. Va. (women) . . .......... . . . . . . . ... . . . .. Acting Asst. Burg. E. von Bose.
Correctional Institutions (5):
La Tuna, 'rex .... .... . . .. .... . . .. . ..... . ..... ........ Acting Asst. Burg. T. H. Smith .
Los Angeles, CaliL .... . .... ....... . . ..... . ... . . ..... Acting Asst . Burg. G. Hoss.
Milan, Mich ...... .. ... . ............. ..... . . ......... Acting Asst. Burg. B . H. Shallow.
Sandstone, Minn (new, opened Apr. 10, 1939) .... ... . Asst. Burg. (R) M.A. Ruona.
Tallahassee, Fla. (new, opened Nov. 3, 1938) ... .... . . Acting Asst. Burg. J. K. Johnston.
D etention Headquarters (2):
New York, N. Y ...... . ..... ... . . . . ................ . Asst. Burg. B. Highman.
New Orleans, La .. . ... . ... . ..... ... . ....... . . . ... ... Acting Asst. Burg. B . L . Newell.
P rison Camps (6):
Kooskia, Idaho ........ . ..... .. .. . . . . .. ... . . ..... . . . . . Acting Asst. Burg. J. Verberkmoes .
Tucson, Ariz .... . . . . . . . ... . ........... .. . . . . . . ....... Acting Asst. Burg. H. E. Thompson.
Dupont, W ash .. ...... ..... . ... ... ..... ..... . ...... .. Served from McNeil Island, Wash.
Montgomery, Ala .. . . . . ............. ... . . . . . . . ....... Acting Asst. Burg. D. N. Rappaport.
Mill Point, W. Va. (new, opened Dec. 1, 1938) .. .. . .. Acting Asst. Burg. K. J. Hamrick.
Springfield, Mo ... . . ... ......... . . ... .. . . . . . . ... ..... Served fro m Medical Cen ter.
Medical Center (1) :
Springfield, Mo .. . . . .. .. .. .......... . ...... . . . . ... . .. Surg. M. R. King.
Plans were perfected for providing medical units at the following
additional institutions which will be opened during the fiscal year
1940: A penitentiary at Terre Haute, Ind.; a reformatory (for women)
at Dallas, Tex.; 4 correctional institutions located at Ashland, Ky.,
Danbury, Conn., Denver, Colo., and Texarkana, Tex., respectively;
and the National Training School for Boys at Washington, D. C.,
which is to be transferred to the jurisdiction of the Bureau of Prisons on
July 1, 1939, in accordance with the President's Second Reorganization
Plan.
A broad program for the conduct of the prison medical service was
formulated at the time the Public Health Service assumed this responsibility. Each succeeding fiscal year has marked the accomplishment
of definite steps in the realization of this program. During the fiscal
year 1939 the crystallization of three major steps into concrete,
permanent form was accomplished.
The first was recognition, in practical form, of the necessity for
definitely providing funds for a system of personnel advancement.
In no other way is it possible to attract and hold a desirable type of
personnel. The prison medical service now can promise reasonable
security and advancement, as well as scientific opportunities.
The second accomplishment was recognition of the necessity for
further improvement in physical facilities by means of extensive
alterations at 13 of the hospitals, where the efficiency of the medical
service had been seriously hampered by obsolete plants. In line with
this, a definite program of alterations and additions has been carried
on during the year.
The third accomplishment, efforts at medical rehabilitation , marks
an exceedingly significant milestone in the progress of the Federal
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penal medical service. Theoretically, "rehabilitation" of offenders is
presumed to have a strong influence in the reduction of crime which
is the ultimate object of modern criminology. The medical part of
such a rehabilitation program should provide for the correction of
remediable physical and mental conditions and diseases, thus affording
the actual or potential offender a better chance to compete in a lawabiding manner with his fellow men and hence less liable to be tempted
to violate constituted laws.
There are two distinct phases to such a program of medical rehabilitation. The ,first .phase, in the Federal service, .has been what
might be termed the obvious phase, characterized by such things as
the development of well-equipped modern hospitals, efficient staffs,
psychiatric representation at every institution, a detailed plan for the
classification of prisoners, acceptable clinical histories, complete psychometric studies, record forms for general medical and psychiatric
data, and so on. In accordance with this phase, as fast as funds and
personnel permitted, physical plants have been brought up to date,
equipment and supplies have been modernized and provided in
sufficient quantity, and staffs brought up to an acceptable level both
numerically and in professional ability. The fiscal year 1939 marked
the attainment in every Federal penal and correctional institution, of
acceptably satisfactory standards in the ordinary practice of medicine
as defined by the American College of Surgeons, the American Medical
Association, and the Public Health Service.
Having reached this level in the discharge of such obvious obligations, it has become possible. to devote serious attention to the second
phase of the medical rehabilitation effort. This relates to less obvious and less clearly understood factors which therefore appear to be
more complicated and difficult. One such factor is presented by
the fact that the incidence of crime is on the increase in this country;
that this constitutes a problem of major concern to the country at
large; that the increase may be explained, in part at least, on a
psycho biological basis; that the problem probably has very definite
medical connotations; and that, therefore, it is a mandatory duty of
the penal medical service to make a concerted effort to gather new
data as well as to make better use of the vast store of old data that
has accumulated during the past 9 years- to plan, in other words,
for an integrated, coordinated, Service-wide research study of the
causes and prevention of crime.
A major move in such a coordinated plan was inaugurated in the
fiscal year 1939 with the placing in operation at the Federal Reformatory, Chillicothe, Ohio, of the first of three "constitutional psychopathic inferiority" units. The purpose of these units is to study
intensively "sane," "border-line" psychopathic prisoners, who, it has
been charged, are responsible for the commission of a considerable
percentage of offenses both inside and outside penal institutions.
The constitutional psychopathic inferior is usually regarded as "sane"
in a legal sense, hence is committed but infrequently to State hospitals.
Usually, when such persons become sufficiently obnoxious to society,
they are isolated from society at large in prisons, rather than in
hospitals. Medical units at the prisons have been heretofore characteristically understaffed, and hence unable to devote any serious
effort to the investigative problem presented by these "conduct
disorder problem cases." Such cases have not, therefore, been studied
188796-40-11
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Federal Reserve Bank of St. Louis
156
PUBLIC HEALTH SERVICE
with the same intensity that the insanities have been studied. Therefore, comparatively little is known about them.
Two other units are in course of construction, one at the reforma-_
tory at El Reno, Okla., the other at the Medical Center, Springfield,
Mo. Brief experience with the Chillicothe unit raises the hope that
such units may eventually come to occupy a prominent place in every
penal institution.
An accomplishment of no little significance to the efficient operation of the prison service was an arrangement for the careful fitting
of all shoes issued to inmates by officers who have been expertly
trained in such matters, and the dissemination among inmates of
information on control of foot infections. Arrangements were made
to print for distribution to administrative officers of the prison system, a pamphlet "The Human Foot and its Relation to Footwear,"
based on United States Army experience. Through this means it is
hoped to eliminate much needless loss of time to the institutions due
to foot conditions.
Several stations have noted that the incidence of traumatic surgery
has :been lower this fiscal year than ever before. This is apparently
due to the activity of the institution's safety council.
During the fiscal year, classification procedures were provided at
all camps and materially improved reconstruction phases of the camp
medical program.
'
Publications during the year, in connection with the prison work,
comprised a book, "Problems in Prisorr .Psychiatry" and several
articles, as follows: "Marital Status of Delinquents in Relationship
to Rorschach Test Scores," "Classification-in Relation to ~ndividual
Discipline," and "A Health Program for Prisons." A n;Umber of
other articles were prepared and submitted. for approval for publication.
An indication of the scope of the medical services rendered during
the fiscal year and of the steady growth in this service during the
past 7 years is given in the accompanying tables and graphs:
'.rABLE 1.-United States Public Health Service work in Federal penal and correctional institut1:ons by fiscal years ending June 30, 1933, to 1939, numbers, amounts,
and rates
1
[Based upon reports furnished to the United States Public Health Service by medical departments of the
Federal penal and correctional institutions]
Item
1933
1936
1937
1938
1939
-- --- --- --- ---1934
- - -1935
Treatments:
· Number __________ _________ ___ __ 598,318 595,570 786,718
859,771 894,706 1, 116,679 1,268,091
. Per inmate __ _______ __________ ___
44.8
50. 3
58.4
55. 2
55.9
68. 7
70.0
Expenditures for health services:
. Amount (in dollars) _____ __ _____ _ 297,300 389,961 431,847 484,715 498,299
560,482
657,700
Per inmate ____ _____ _________ ___ _
22. 3
33.0
32. 0
31. 2
31. 1
34. 5
36.3
Examinations: 2
Number ___ __ __ _______ __ ___ ____ _ 99,300 106, 400 122,600 Ul9, 900 147,700
177,700
160,221
Per inmate ___ ___ ___ ______ _____ __
7.4
9. 0
10. \}
9.1
9. 0
9. 2
8.8
flospitalized inmates:
Average number _______________ _
618. 7
690.1
851. 4
969. 0 1,056. 7
1, 072. 1
1,275.6
Per 100 total inmates _________ ___
4.6
5.8
6. 3
6. 2
6. 6
6. 6
7.0
Personnel (Public Health Service):
Average number 3_ ___ __ _ _______ _
127. 8
206. 2
259. 4
236. 7
283. 5
313. 0
340.0
. Per 1,000 inmates ___ _____ ____ ___ _
9.6
17. 4
17. 6
16. 7
17. 7
19. 3
19.4
Deaths in institutions:
· · Number _____ ~- ----------------107
82
86
103
92
88
93
Per 1,000 inmates_ _______________
8. O
6. 9
6. 4
6. 6
5. 7
5. 4
5.1
Average daily inmate population ___ _ 13, 354
11, 82Q
13, 481
15, 562
16, 017
16, 255
18, 108
. ' 1 Rates based upon average daily inmate population .
• 2 ilncludes medical, dental, psychiatric, and psychological examinations; does not include urologieal , eye,
·
ear, nose, and throat examinations. Figures estimated in part.
' ~ Covers all Public Health Service personnel, including full-time and part-time medical and dental
officers, psychologists, administrative assistants, nurses, and offi<'er-attendants,
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Federal Reserve Bank of St. Louis
157
PUBLIC HEALTH SERVICE
UNITEO STATES PUBLIC HEALTH SERVICE WORK IN FEDERAL
PENAL AND CORRECTIONAL INSTITUTIONS
IY FISCAL YEARS ENDING ,IIIN[ 30,
It»
TO 19!9
NU... Ut
---
1,400,000
l,Z00,000
I
1,000,000
NUMBER OF TREATMENT~
eoo,ooo
•00,000
__,,,,,, -- ----
EXPENDITURES (IN DOLLARS)
400.000
300,000
l00,000
--- -
~
~
-
NUMBER OF EXAMINATIONS
I
I
l&0,000
I
~
J--+---t
100,000
-
20,000
AVERAGE DAILY INSTITUTION POPULATION
I
--r
l&, 000
~
10,000
I
I
I
I
I
I
1,1.00
~
I
1,000
----
•oo
100
&00
~ AVERAGE
UAILY HOSPITAL POPULATION
I
---
--~ - -- -I
I
I
NUMBER OF P. H. S. PERSONNEL
V
100
•o
•o
/
-
_J.,-----
.....
NUMBER~ DEATHS
I
10
1933
1934
1935
1936
1939
1937
UNITED STATES PU.BLIC HEAL TH SERVICE
WORK IN FEDERAL PENAL AND CORRECTIONAL INSTITUTIONS
9Y ,iscAL YEARS ENDIN G JUN[ 30, IIJ3 TO 193t
80
r----,r----ir----,,-----,,-----,-----,
80
ro
~
,o 1 - - - - t - -_-__,.,.
-~--_.. ,'"•--•='=-==.=.:.:.:+-...:=:..::__-+:~.-:::.-+-----l eo
&O
30
15
10
IS
~---t-----t---
9
1934
1936
cal lilUMl[ II " " 1,000 INIUTU ••
IC:) AVUAU NUMIU
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Federal Reserve Bank of St. Louis
o,
INIIIIATU
AVUAH
INITITUTIONAI.
IN MOSPtTAL, PU
1938
1931
♦
POPULATION
100 IIII IIIIATU
IN
AVUAH
TOTAL ltllllTUTIOU.L
POPUlATION
158
TABLE
PUBLIC HEALTH SERVICE
2.---,----United States Public Health Service personnel, expenditures, treatments,
tion, for each Federal institution, for the
[Based upon reports furnished to the United States Public Health Service by
Penitentiaries
=
a)
Total
Item
.
"'
a)~
1'.;i
.
...,
"'
~
~
~
=
~
a)
I>
"'
~
0
~
=
"'
~
::::
bl)
~
Ho
"'
~
-
"O
~0
I>
a,..cl
Reformatorle..Q
a)
I
:a
a)
-~
z
a)
~
c:.,
H
bl)
.cl
~
0
=
1
a)
~
a)
~
0
P--1
=
~
t
"O
'.;i
- - --- - - - - - -- - - --- - - - - - Personnel:
Medical officers-ful!l
time ·--- ------------Medical
officers-part
time _____
______ __ ____
Dental officers- full.
time_---------------Dental
officerstime _________
____part
____
All
other
Public
Health Service ______
Total Public
Health Service __
Inmate personneL ____
Hospital bed capacity
(normal) __ ___ ___ ________
Average daily institution
population ______________
Average daily hospital
population ______________
Out-patient departments:
Treatments:
MedicaL __________
SurgicaL _______ ___
UrologicaL ___ _____
Eye, ear, nose, and
throat ________ ___
DentaL ______ _____
Psychiatric __ ______
Psycho1ogical ____ __
Physiotherapy_____
X-ray _____________
54
2
5
4
6
5
3
3
3
2
1
82
1
5
2
4
11
4
5
4
3
4
25
1
3
2
3
2
2
2
2
1
1
------- ------- --- ... --
___ ,.. __
8 --- ---
171
5
5
5
340
616
9
3
18
136
1
------ ---- ·-- ------ -----8
5
3
6
3
- - - - - - --- - - - - -8
7
13
113
21
84
25
58
12
30
175
181
84
85
1,726
23
146
18,108
298
3,116
1,760 2, 974 1,596 1,067
1, 275. 6
12. 4
112. 2
112. 5 134. 3
53.0
63. 2
18
40
14
30
73
9
16
13
25
40
28
57
1,470 1,059
741
547
27. 4
17. 7
54. 7
33. 6
579,204 29,518 109,639 68,094 28,980 6,197 37,107 66,444 30,453 36,722 37,289
107,480 1, 446 30, 169 10,106 4,631 1.2, 839 2,830 8,866 6,547 3. 139 1,716
392 30,057 16, 179 17, 115 21, 122 5,351 7,476 13, 159 12, 245 31, 163
196,019
106,390 2,496 11,902 11,452 15,916 15, 183 2,459 8,784 2,613 4,132 7,914
148,127 1,406 23,617 8,865 16,379 12,330 12,265 17,249 12, 779 12,485 4,872
354 1,653 9,771 6,282 1,452 . 2, 17~ -----80 5,078
29,054
915
464 2,378 2,792 -----66
10,333
886 . 2;669 ------ -----145
87,748 1,289 14,002 6,154 8,281 4,496 3,755 3,928 3, 771 4,321
251
162 1,0li9 -----168 ------- 2,081
3,736 -----3
59 ------
---
---
--- -- - - - ---- - - - - - -TotaL ____ _____ 1,268,091 36,772 224,698 121,668 97,414 84,733 70,211 116,144 74,166 73,103 84,120
Examinations:
MerlicaL _______ ___
75, 557 33,084 14,299 4,191 4,340 2,973 9, 029 3, 038 4, 195 4,235 4, 668
Urological _________
86,942
163 11, 902 3,707 14,035 24,507 3, 471 3,661 2,275 3,949 1,674
Eye, ear, nose, and
throat_ __ ____ ____
150 5,809 3,137 6,915 7,702 2,416 6,737 1,325 1.600
39,768
378
DentaL ___ ________
982 1,498 1,373 3,167 1, 510
24,045
534 3,553 1,262 2,281 1,907
Psychiatric _____ ___
38,493
200 7,744 3,302 9,693 2,499 7,497 1,786 1,694
302
9
PsychologicaL ____
603 8,061 3,586 ------ -----22, 126 ----- 3,783 1,672 3,698
303
-TotaL ______ __ 286,931 4,131 47,090 17,271 40,96'.! 39,891 23,998 24,781 14,448 12,960 8,532
X-ray-number of films
developed _____ __________
247 2,804 1,504 1,712 1,550
928
14,936
865
480
416
5
X-ray-number of fl.uoroscopic examinations ___ __
244 1,031
1
839
3,574
218
300
80
7
62 -----Laboratory service-num572 10;973 8,717 41,327 17,007 3,231 9,814 3,650 6,673 7,412
,ber of tests, etc _- ·------- 194,822
Pharmacy service-pre•
scrlptions dispensed_ ·--· 405,629 7,112 80,362 36,140 64,249 38, 723 33,007 6,322 14,105 22,792 25,663
Surgical operations ________
46 a 4,000
12,842
850 1,066 1,856
363
606 1,030
43
309
Hospital relief-days __ ______ 465,116 4,525 40,057 41,059 49,033 19,347 23,058 12,276 9,993 6,455 19,983
Deaths ____________________
14
2
12
1
8
13
93
2
5
1
3
---
t
---
Figures also cover Prison Camp, Du Pont, Wash.
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Federal Reserve Bank of St. Louis
---
159
PUBLIC HEALTH SERVICE
examinations, hospitalization, and deaths, compared with average inmate porpulafiscal year ending June 30, 1939
medical departments of the Federal penal, and correctional institutions]
Medical
center
Detention head•
quarters
Correctional institutions
Prison camps
'c:I
'c:I
~
bl)
-~
0
0
0
i:l
"'§
~
8
E-s
H
0
1W
0
::s
~
~
~
tl.l
s
~
·s
il-t
s
i"'
q:l
~
"'
~
:;::l
!
~
tl.l
§
~
al
a:>
i:l
~
.a
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8
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~
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'.:!
.!3
slo
0
~
~
a:>
a:>
z
z
--- ~-- - - - --- --- - - - --- - - - --- --- - - - --10 -- ------ -
---------
3
2
7
2 ---------
-----·--
1
1
1
5
1
1 ---- -- --
1
1 -- - ---- -
2
2
2
6
7 --------
3
--------- -------- -------- --------
1
1
--------
1
1
1
1
1 --------
96
1
1
1
1
2
3
115
37
5
1
4
1
5
7
5
1
11
10
13
7
----- ---
1 --------
z
z
1 --------
--------
1
1
3
3
3-
3
3
3 --------
10
·7
6
5
8
2
1
- - - - - - - - - --- --- - - - - - - --- - - - - - - --- --16
2
21
21
28
8
26
10
10
734
135
'69
236
180
505
563
2164
2 62
314
267
251
574.3
.3
a .3
6. 2
.4
21.4
11.1
.9
21.5
22. 6
7.6
8.0
3.010
11,343
6,157
5,651
95
339
I, 246
553
68
9,695
1,485
4,128
29,775
31
960
18,775
2,405
8,111
23,375
1,234
4,964
1. 273
37
65
2.838
1,320
831
18.039
4,635
5,731
13,994
565
6,947
21,090
1,488
3,459
1,016
435
7,077
430
1,264 --------920 ------- -376
27,053
185 ---------
444
105
1,487
1,204
33
199
5,566
1,021
4,121
7,976
99
435
368
93
4,881
2,302
2,121
4,739
2,968
~9
57,444
7,907
2,639
18,693
11,011
37,162
43,556
I, 969
5,606
38,556
28,447
32,072
2,003
3,650
373
75
452
300
1,051
1,219
2 950
3 400
3,552
4,906
2,619
1,835
91
47
203
271
2,190
1,804
2,056
1,554
6,565
1,537
31
78
671
253
6 -- --- - --
12
51
654
381
9
305
718
327
48
76
45
2
908
1
311
908
50
190
926
25
824
--------
692
----- ---- ---------
2
9 -------- -------21
--------- -------- -------- -------13
-------- -------- -------- -------- ---------------- -------- -------- -------2,755
156
2,968
81
51
1,865
1,284
694 -------217
--------------13
--------------- -------- -------- -------6 -------- - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - ---
666
478
1,525
139
3,302 --------412 ---------
-11,558
- - - -1,065
-
---------------- - - - - --------
-------- --------
174
2
8
1,089
2,972
--I, 413
9,502
5,204
387
553
5,263
4,751
9,110
52
48
301
491
--------
9
205
143
414
4 ------- -
--------
40 ----- ---
1
2,735
7
20
540
---------
9
64,571
24
225
4,851
3,387
1,171
7
104
209,636
19 ---------
1,449
2
-------- ----- ---
--------
--------
54
_.., _______
798
301
4,741
7,214 34,000
55
11
2,255
163
1 --------
19,450
661
7,802
2
Based on the number of days actually in operation.
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Federal Reserve Bank of St. Louis
85 --------
113
10
152
5,065
2,026
763-
22,028
I, 268
2
59
75
4,043
5 --------
2,782
16
363
4,103
457
8,238
3
•.ml
26
142
2,929
1
6,770
--------
1 Estimated.
92
2,768
1
160
PUBLIC HEALTH SERVICE
STUDIES AND INVESTIGATIONS OF THE CAUSES, PREVALENCE, AND
MEANS FOR THE PREVENTION AND TREATMENT OF MENTAL DISEASE
The psychiatric diagnostic service for Federal courts was continued
during the year at the United States district courts located at Atlanta,
Baltimore, Boston, Denver, Detroit, Kansas City, Mo., Minneapolis,
New York City, Philadelphia, and Pittsburgh. A total of 114
persons was examined and 15 of those examined were hospitalized for
further observation. Owing to dearth of funds no extension of this
service to other courts was possible.
The United States Public Health Service continued during the
year its cooperative work with national and international medical and
psychiatric organizations in the study of mental hospitals throughout
the United States and Canada through the Mental Hospital Survey
Committee. Surveys were made in Montana, Washington, Oregon,
Wyoming, Missouri, Massachusetts, Florida, and New Jersey, covering a total of 24 State institutions for the care of mental patients.
The 4 State institutions of Kentucky were visited for the purpose
of assisting the State director of mental hygiene in the preparation of
administrative regulations.
A report on medical personnel in mental hospitals is in course of
preparation and a summary of the laws of State administration of
mental hospitals is nearing completion. A summary of the laws
governing the commitment of mentally ill patients was prepared and
will be published early in the coming fiscal year.
The Mental Hospital Survey Committee was organized in 1936 to
engage in a 3-year program of surveying as many as possible of the
mental hospitals to determine the adequacy of facilities for the care
of the mentally ill and bring about improvements where indicated,
i11; order to raise the general standards for such care.
During the 3 years of this cooperative activity, studies of 169 hospitals in 40 States were made by the committee's field staff. These·
studies have shown that the care and treatment of the mentally ill
throughout most of the United States is greatly in need of improvement. The great majority of the State hospitals are understaffed in
relation to medical, nursing, and other personnel, and much reconstruction of old buildings to improve present conditions and new construction to relieve overcrowding are necessary. However, the governors
and legislatures of several of the States surveyed, notably Kentucky,
Michigan, and Virginia, have been so responsive as to put into effect
many of the recommendations made in the survey reports, which has
resulted in materially improving the care and treatment of the
mentally ill in their States. Nevertheless, much remains to be done.
The 3-year period of the Mental Hospital Survey Committee's
activity has expired, and the cooperative work was discontinued as of
June 30, 1939. However, since the work done by this committee has
such a vital bearing on raising the standards of care and treatment
of the mentally ill in the various States, its continuance seemed imperative to the organizations represented by the committee, and the
United States Public Health Service was requested to assume responsibility for it. This was agreed to by the Service, and accordingly,
a Section on Mental Health Methods will be set up in the office of the
Surgeon General under the administrative direction of the Mental
Hygiene Division. This Section will carry on the survey work and
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Federal Reserve Bank of St. Louis
PUBLIC H E ALTH SERVICE
161
engage in research and other activities relating to mental hygiene,
utilizing the majority of the personnel that was engaged in the cooperative work with the committee.
.
Field studies in mental hygiene conducted in Fayette County, Ky.,
in cooperation with State and local health authorities and the State
university have been continued throughout the year. The immediate
objective of this activity was to study mental health conditions ~
Lexington and Fayette County, Ky., and further objectives were to
determine a general pattern for the application of mental hygiene
measures to any community and to define the place that a public
health unit should occupy in a community mental health organization.
Progress has been made in these studies, and experience gained thereby
indicated that the area of investigation of certain phases of these
studies was too limited. It was therefore extended from Fayette
County to the State of Kentucky. The studies will be continued
during the coming year.
In connection with the studies relatins- to mental disease, the
following articles were published: ''Socio-biological Types and
Methods for Their Isolation," "Regional Differences in the Care of
Mental Defect and Epilepsy," "The Mentally Ill and Mentally
Handicapped in Institutions." A number of other articles dealing
with various phases of this work have been approved for publication.
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Federal Reserve Bank of St. Louis
DIVISION OF PERSONNEL AND ACCOUNTS
Assistant Surgeon General PAUL M. STEWART in charge
The organization of this division, which supervises all operations of
the Service relating "to personnel and accounts work and the maintenance of property records, has remained unchanged during the year.
Through a personnel section, an accounts section, and a :property.'.
record section, all matters involving appointments, 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 division.
Because the appropriations for conducting the hospital work of the
Service were inadequate, a sufficient number of doct0rs, nurses, and
other classes of personnel essential for proper hospital operation could
not be employed. In order to conserve funds it was necessary, in
many instances, to utilize the services of internes in the performance
of duties to which more experienced doctors should have been assigned. Many positions in the field service cannot be allocated to
grades comparable with the grades established for departmental
personnel doing similar work because of the lack of necessary funds.
Administrative promotions ·within the grade have been most infrequent and there is urgent need for additional funds with which to
carry out a definite policy whereby all employees whose efficiency
ratings make them eligible would receive a one-step salary increase
every 2 years.
PERSONNEL
COMMISSIONED OFFICERS
· The following table shows the commissioned officers in the Regular
Corps of the Public Health Service on July 1, 1938, and July 1, 1939:
July 1, 1939
July 1, 1938
Grade
Active
Surgeon GeneraL ________ ___________ ___ ___ ___________ __
Assistant Surgeon Genera!. ___________________________ _
M edical director ___ -- ---- --- -- ----- ---------------- ---Sanitary engineer director __________ ______ _____________ _
Pharmacologist director. ______________ ______ ___ ________
~:~~g~ ~~~,i~~-
5
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Federal Reserve Bank of St. Louis
Waitin!!'
orders~
Active
1
8
25
28
1
1 ----- - ----- -
====_
=================
engineer~==========
50~
__________________
__ _____ ______
Surgeon ________________
18
Dental surgeon______ _______________________ ___ _________
9
Sanitary engineer ______ _____ ______ __________ ___________
138
P assed assistant surgeon _____________ _________ ______ ___
27
P assed assistant dent al surgeon________________________
6
Passed assistant sanitary engineer _______ __ ______ ___ __ __
6
Passed assistant pharmacist _________ ___________ ____ __ __
64
Assistant surgeon ____ ________ ____ __ __ __ _____ ______ _____
4
Assistant dental surgeon._______ __________ __ ____ _______
Assistant pharmacist _______ ---- ---- ------ -- ------------ - ---- -- - ---T otal. ________ ______ ___________ ___ ___ ____ _______ _
421
162
W aiting
orders
8
15
l
8 - - ------ -- --
27
32
1
1 ---- -------49
7
11
60
15
18
8
135
27
5
2'
5 ---------- -3
5
99
1
2
60
5
-- ----------
460
67
163
PUBLIC HEALTH SERVICE
CHANGES DURING THE YEAR
Promoted New ap•
point·
to
next grade ments
Retired
Deaths
Rcsigna•
tions
--------------------1·-----1---- ---- ---- ---Medical director· ·-._ ... _______ . ... _____ ........ _..
-Senior surgeon... .. . ...............................
·Surgeon.... ..................... ......... .........
anitary engineer..................................
Passed assistant surgeon...........................
Passed assistant dental surgeon............. . ......
Passed assistant sanitary engineer....... ... . ......
Passed assistant pharmacist. .... .. ...... .. ........
Assistant surgeon. .................................
Assistant dental surgeon..... .............. ........
Assistant pharmacist.. . .......... ..... ............
_. _.......... ........ _
7 .............. . .... .
5 . ...... ••. •..••...•.
I . ........ .
4
I . . ........
1 ... ...... .
2 .................... ·······-· · ·········14
2 . ......... ......... .......... .
... ......... ..........
1 ····-····· . .......••
1' ·········- . .. ............•.... ·· ·······-
............ ·······-··
I .... ...... ·········9
46 . ......... ..........
2
I
2 .......... ····-····· ·········. ........•.. ......... . ..........
I
Total ... . ·-· ............•............... ·-·-·
36
2
9
51
SPECIAL DETAILS TO OTHER ACTIVITIES
Medical
director
Senior
surgeon
Surgeon
Passed
Passed
assistant !~~Jiit
surgeon
surgeon
~s!~\!Yt
-----------------1----l----,----1---- ---- ---Employees' Compensation Commission .. .......... ....... ...
3 . ......... · ········Pan American Sanitary Bureau... ........ ..........
I
1 ..... ..... · ···· ····-.Sureau of Indian Affairs..................
1
2
2
2 . ......... .. ....... .
U.S . Coast Guard........................
I
1 .• . .......
I
4
3
Farm Security Administration ...... ~.... . . .........
1
I . . . ....... . ...... •... .........
·social Security_Board.. .. . ................ . ......... .... ......
1 ................ .. ............ .
Fe(leral Trade.......... . .... .... . ..................
1 ... ................• ..... ..... ········ ·Total. ..........••••.•.... ..........
2
4
3
RESERVE OFFICERS (Active Duty)
Grade
July 1, 1938
July 1, 1939
7
·Surgeon . .............................. . ................. ···-····............
7
Dental surgeon..............................................................
1 ............. .
1
·Sanitary engineer................................................ .................... ... .. .
21
Passed assistant surgeon ....................... ·····················-····....
19
2
'Passed assistant dental surgeon..............................................
2
53
54
Assistant surgeon............................................................
18
Assistant dental surgeon... . . ... . . ......................... . .... . ........... .
8
Total. ........ _................... _..... _. .......... ................. .
91
102
ACTING ASSISTANT SURGEONS
In marine hospitals ............... . ......................... . . ........ . ..... .
Immigration, relief and maritime, border, insular, and foreign quarantine
work _... ... . __ .... __ .............. .. .. _............... . .................. .
Field investigations of public health ......................... . .............. .
·C oast Guard and Lighthouse services ....................................... .
Employees' Compensation Commission .......... ........ ................... .
Penal and correctional institutions .. ......... . ....... _....... _............. . .
Anti venereal disease activities . ....... . ........... . . ............. ........ . .. .
Total. ............................................................... .
81
91
440
438
6
128
7
126
4
3
36
32
49
37
726
752
6
5
37
5
CONTRACT DENTAL SURGEONS
1n marine hospitals . ... _. .. ..... _.. . . _........ _...... _.......................
Second and third class relief stations. . ... ....................................
Penal and correctional institutions....... . ...................................
·Coast Guard ..... . ... . . ....... ... . ..........................................
TotaL. .. .. .. .. ...... .. ...... .. . . .. ...... .. .. .. .. .. ... .... .. .. .. .... ..
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Federal Reserve Bank of St. Louis
33
7
8
7
1------1·----54
54
164
PUBLIC HEALTH SERVICE
ATTENDING SPECIALISTS
Consultants in marine hospitals ___ ---- -- --- - -- --- --- -- -- ---- -- --- - -- ------ ·_
317
310
Second and third class relief stations______ _________ ______ __________________ __
52
51
Anti venereal disease activities ______ ___________ ___ _______________________ __ __
57
90
Penaland correctional institutions __ - -- - - -- --------------- -- -- ---------- ---131
131
Consultants in quarantine, immigration and scientific research activities_ ___
160
153
- - - -717-1- - - TotaL_.__ ___ ____ ____ _____ _____________ ___ _____ __ ______ ____ ______ __ __ _1
735
INTERNES
Medical and dental internes __ ______________________________________
---------!
1671
140
PHARMACISTS AND ADMINISTRATIVE ASSISTANTS (CIVIL SERVICE)
151
60
15
73
NURSES, DIETITIANS, AND RECONSTRUCTION AIDES
Nurses _______________ __ --- - ----- ---- -- - --- ---- -- ---- - - -- - - -- -- --- --- -- -- -- -Dietitians
__ __ ________ _____ __ ______ ___ _____ ______ ________ ___ ____ ___________ __
Physiotherapy aides and assistants ___________ ___ ___ ____ . _____ _______ _____ __
Hospital service worker _____ ___ ____________________ ___ _____________ _____ ___ _
Librarian __ __________ ___ ___ _______ ____ ___ _______ ___ _______ ___ _____ ____ ___ ___ _
Druggist ________________________ ___ ___ __ ____________________ __ __ __________ __
Medical technician __________ ___ __ ___ _______ ___ _____________ __ __ ____ : ______ __
Guard attendant. _______ ___ ___ _______ ____ __ ____ ____________________ ___ ___ __ _
686
41
47
1
2
1
1
82
708
41
49
2
2
1
1
106
EPIDEMIOLOGISTS
During the year the number of assistant collaborating epidemiologists was decreased from 5,817 to 4,791. 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
epidemi?logists on duty on July 1, 1939 was 41. 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
303 members, of whom 84 were commissioned officers and 219 other
professional workers. The staff was assisted by 245 technicians and
305 other subordinates, making a total of 853.
In addition to the regular corps, 161 persons held appointments as
consultants.
PROPERTY RECORDS
The Property Return Section accounted for all property of the
Service and 353 property returns were audited during the year. A
total of $5,856.78 was turned in to "Miscellaneous Receipts" from
sales of property.
Property surplus of the Public Health Service valued at $36,992.43
was transferred to other Government departments. Surplus property
of other Government departments valued at $50,675.86 was taken
over by the Public Health Service.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
165
Property valued at $73,644.61 was transferred from Service stations
where it was surplus to other ·stations where it could be used. By
exchange allowance on old typewriters and adding machines turned
in, $1,885.00 was saved.
AccouNTS SECTION
The Accounts Section of the Division of Personnel and Accounts
conducts all bookkeeping and accounting in connection with the
expenditure of Public Health Service appropriations. This includes
also accounts of miscellaneous collections, allotments, records of encumbrances, cost accounting, and the administrative audit. A statement of appropriations, expenditures, and balances, with miscellaneous
receipts, is published as an appendix to this report.
PERSONNEL STATEMENT
The accompanying tabular statement shows the personnel of the
Service as of July 1, 1939. Of the 13,425 emplo;yees shown in the
table, 4,832 listed as collaborating epidemiologists and . assistant
collaborating epidemiologists receive only nominal compensation.
They are mainly officers or employees of State and Joe.al 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 quarterly personnel report for quarter ending July 1, 19$9
[Prepared from records in the Division of Personnel and Accounts]
Noncommissioned personnel
Reserve corps
Regular corps
------------1·- -- - - - -- - - - - -- - -- Administrative and departmental __________________ -- --
8 2 4
4
- - - --- -
Totals
- - -- - - -- ·- - - - - - - -- --- -- ---
2 --- -- -- -- --- --- --- ---- ---- --- --- --- ------ --- ---- --- - -- ---- --- --- ---- --- 252
37 ----- -----
21
289 310
310
FIELD
Hospital division ___________________________________________________________________________ ---- ____________________________________________________________ _
Marine hospitals _________________________________________________ ---- ___ --- --- ------ --- ---- --- --- ---- --- --- ---- ___ ---- ---- _____ ----- ______________ 4,142 ·
Baltimore, Md __________________ 1 4
7 2 ____ 1 1 1 4 27 ---- 4 ___ 1 ------ 1
4 3 54
5 ______ ---- 16 ____ 18 130
15 17
282 299 _____ _
Boston, Mass ___________ ______ 1 1 1
1 2 __ __ __ 1 1 4 26 ---- 4 ___ 2 ------ 1
1 1 18
3 ______ ---- 13 ____ 18
49
16
8
156 164 _____ _
Buffalo, N. y ___________________ 1 1 ____ ___ __ __ __ ___ ___ 3
6 ---- ___ 1 ___ ------ ___
1 ___ 6 ---- ______ ---- 4 ____ 15
17
9
2
62 64 _____ _
8~1;!~~:
rt:============
== ==== -~ -i1 ===2 ---22 --2
Cleveland,
Ohio _________ ________
1 ==
__ ==
__ ==
__ ===
___ --i2
Detroit, Mich _________________ 1 __ ___
Ellis Island, N. y _____________ 2 __ ___
J;rr~;~~ib~~~--Mex===
Galveston, Tex ___ _______ ==
__ ====
____ ==
__ -i1
Hudson Street, N. y ____________ 1
--~1
3
3
2 __ __ __ ___
2 __ __ __ ___
~ ~
3
4
2 ___ ==
__ ==
__ ==
__ ===1 ===
__ _ --~1
1 ____ 3 __ __ __ ___ 1 10
Memphis, Tenn_________
__ ====
____ ==
__ ==
__ 1~ ---21 ===1 ==
__ ==
__ ==
__ ===
___
tiKi~i!f!:
I~:========= ==
Mobile, Ala ____________________ 1 ___
2 2 __ __ __ ___
New Orleans, La ______________ 1 1 2
Norfolk, Va _____ __ ______________ 1 ___
Pittsburgh, Pa___________________ 1
Portland, Maine________ __ ____ __ 1 ___
St. Louis, Mo _________ __ __________ 3
San Francisco, Calif ___________ 1 __ 3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
4
2
:7
~ ~
49 ====
====== --~1 ---2
=== ---==== ~7 ====
____ --32 --~
___ 2~ --------- ~1 ~r
31
3~ ===
______
____ --24
20
15 ____
11 ----
4 1 -- - -----5 ___ 1 - -----
lg---~
1
1
2
1
2 19
4 42
1 ______ ---2 --- ___ ----
7 ____ 15
6 ---- - ---
1
:
81
70
159
gi10 8~
1
22
10
10
9
~g}
174
~~~ ======
182
_____ _
162 172 _____ _
246 255 _____ _
f ---361 --2
1i 42~ ______
===
=== ---==== 166 ====
~5 16225~ t56 122
l~~ 1~t
1 21
______
____ ---~6
48
127 ======
_____ _
___ 4
---- 10 ____ 21
11
104 110 _____ _
15
1 ===2 ===1 ===1 ======
______ ___
14 ____ ___ 2 ___ ______ ___
~ ~
2 2 13
____ 5 ___ ===1 ======
______
1~ ---2
3 2
6 ____ 2 ___ 2 ______
4 2 __ __ __ 1 3 4 12 ____ 20 2 1 ______
5 3 __ __ __ ___ 1 2 10 ____ 3 1 2 ______
1 1 __ __ __ ___ ___ 2 11 ____ 2 1 ___ ______
1 _______ 1 1 ___ 11 ____ ____ 1 ___ ___ __ ____
1 1 ____ 1 ___ 2 1 15 ____ 1 ___ ___ ______
4 5 ____ 1 1 4 3 23 ____ 14 ___ 2 ______
i ---a
____ ::=
___ 17
===1 ====
t
1 ===
___ ===
___ ====
____ 3 ====
____
1 ____ 1 15
1 ______ ---- 4 ____
1
1 3 3
5 ______ ---- 20 ____
___
2 2 29
3 ___ ___ ____ 8 ____
___ ____ ___ 7
1 ___ ___ ____ 4 ____
___
1 ___ 7 ____ ___ ___ ____ 4 ____
___ ____ 1 12
2 ___ ___ ____ 9 ____
1
3 3 41
4 __________ 13 ___ _
11
1~
14
12
11
7
2
3
5
:39
46
135
94
18
17
31
116
~ l ~~ ~~ ======
9
12
26
19
1
10
8
43
5
8
14
10
3
4
8
19
102
106
245
186
54
53
83
271
107
114
259
196
57
57
91
290
_____ _
_____ _
_____ _
_____ _
___ __ _
____ __
_____ _
___ ___
U1
l:tj
~
0
l:tj
Savannah, Ga __ _________________ 1
Seattle, Wash __ __ _________ ____ 1 2
Stapleton, S. I., . y __ __________ 1
1
5
3
2 1 __ __ __ ___
2 3 __ __ __ ___
10 10 ____ 1 2
1
2
2
5
I
8
9 ____ 1 ___ ___ ______ ___
23 ____ 2 ___ 2 ______ 1
11 ____ 21 ___ 3 ______ 2
1
2
4
1 18
2 38
4 67
1 ___ ___ ____ 5 ____
2 ___ ___ ____ 9 ____
5 __________ 13 __ __
2
10
52
29
95
169
11
31
61
6
15
29
83 89 __ __ __
218 233 _____ _
420 449 __ ___ _
R~f~re~~1o!~~~~•-~-~::=
== ==== ==2 ==1 ===
: ====
Second class __ ___ ___ ____ _______
___ ___ :2 ===3 ==
__ ==
__ ==
__ ===2 ===7 __11: ---~
33 ___ :7 ===2 ===1 ===1 ======
______ ===
___ ====1 ===
___ __ :9 ====3 ===
___ ===
___ ====
____ __13
____ ====
19 ----~
12 ____ :4 ___17: ----=~
116 --=~
133 ---564
_____ _
Third class _______ ____ ___________ ·· - ________________ ___ ___ 159 11 30 ___ ___ ___ _________
Coast Guard and Lighthouse Service __ ___ ____ __ __ _ ____ 1 1 ___
4 4 ~- ___ _
8126
4
1 --- --- - ---- - --D epartmental emergency
relieL______ ____ __ __ __ ___ __ ____ __ __ ___ ____ ___ __ __ __ 1 __ _
1 -- - - ---- --- -- - --- --- --- --Perry Point- supply station______ ____ __ ___________ __________ _
2 ___ __ __ __ ___ ___ ___ __ __ ____ ___ ___ ___ ______ ___
···-- ___ ___ ____ __ _ ___ ____
---- --- ---
9 ____ ____ _____
1 ____
210 210 _____ _
21
139 160 -- - ---
1 --- --- --. - --- ---- ---- ----- -- ---
---- --- 21 ---- --- --- ---____ ___ ___ __ __ ___ ___ ____
1 ---- ---- ----4 ____ ____ _____
2
6
2
25
10
26 -----12 _____ _
For:~~
4te:r::N;!tbi\ision~=
-~ --~
__: :::
____ : ..____
:: ______
----=~ --~
Quarantine
stations_ ______ ==
__ ====
____ ==
__ ==
__ --~
__ _ -____
___ ==
__ ==
__ ==
__ --=
___ :::
___ --~
___ ---~
____ ====
____ ___
___ ..
___: ======
______ ===
___ ::::
____ ===
___ ===
___ ====
____ ===
___ ===
___ ::::
____ ..
___: ::::
____ ::::
____ :::::
_____ _____
____ ::::::
931
0
Baltimore, Md________ __ ____ 1
Boston, Mass _______________ 1
Ellis Island (also immigration) __ ______ ___ _____ 1
Ft. Monroe, Va _______________
Galveston, Tex________ __ ____ __
Laredo, T ex__ __ ______ _ __ __ __ __
Marcus Hook, Pa_ __ __ __ __ __ __
New Orleans, La ______ __ __ __ __
Rosebank, N. Y ____ __ __ ____ 1
San Francisco (also
immigration) ________ ______ 1
Foreign ports _______________ 2
All other stations ____ __ _____ ___ ____
Domestic
Quarantine
sion_____ ________
__ ____Divi__ ____ __ ____ __
__ ___
1 __ _ __ __ __ ___ ___
__ 1 __ __ 1 __ __ __ ___ ___
__ ___
1
__
__
__
__
__
___
___
___
___
1
1
2 ____ ____ ___ ___
1 ____ __ __ ___ ___
2 ______ ___ ____ ___ ___ ____
1 ______ ___ ____ ___ ___ ____
1
2
2 ____
1
1
2
3
21
17
23 ---- -20 ------
7
6
6
4
5 3 ____ ____
1 ___ __
2
__ __ 2 1 __ __ 1 ____ ____
4
2
1
____ 2 2
2 2 ____ ____ _____
4 ___ _
____ ___ ___
8 ___ ____ ____
2
1 ___ _
____ 2 2
2 1 ____ ____
11
2 ___ _
____ 4 3
9 2 ____ ____
1
4
2
1 6 6 23 6 ____ ____
15
28
2
24
11
16
14
27
26
12
16
14
27
30
95
1 ___________ _ ___ 15 ____ ____ ___ ___ ___ __ ____ ___ ____ ___ ___ ____ ___ ___
__ __ ___
__ __ ___
__ __ ___
____ ___
____ 1
__ __ ___
________ _
2 1
9
5 4
7
2
1
5
__ ___ ____ ___
__ __ __ __ _ ___ 1
__ __ __ ___ ___ 4
__ __ __ ___ ___ 3
__ __ __ ___ ___ 5
____________ . .4
__ __ __ __ _ ___ 6
---__
---__
---__
------___
____
____
____
____
____
____
____
____
____
____
____
____
___
___
___
___
___
___
___ ___ ______ ___ ____ ___ ___
___ ___ ______ ___ ____ ___ ___
___ ___ ______ ___ ____ ___ ___
___ 1 ______ ___ ____ ___ 1
___ 1 ______ ___ ____ ___ ___
___ 2 _____ _ ___ ____ ___ ___
--- 2 ------ 33
1
--- 190
1
___ ___ ____
----- - ---____
--- --- 1 ------ ---- - --- ··- -·--- - ----- 2 8 ------ --__ _ ___ ___ ______ ___
-------· - ____
6 1 ------ 1 ---- 2 2
--- --- ---- --- -- - 21 2 -·---- 1 ---- 18 10 52 19 ---___ ___ ____ ___ ___ ____ ___ ____
Interstate sanitary activities __ ________________ ____________ 4 3
2 ___ __ __ __ ___ ___ ___ ____ ____ ___ ___ __ _ ______ ___ ____ ___ ___ 11 ___ ___ ____
Rural health cooperation__ __ __ __ 1 1 4
4 ___ __ __ __ ___ ___ ___ ____ __ __ ___ ___ 1 ____ __ ___ ____ ___ ___
7 ___ ___ ____
All other activities ____ __ __________ 2 3
2 1 ____ l ___ ___ ___ ____ ____ ___ ___ 2 ______ ___ ____ ___ ___ 43 _________
Scientific Research Division __ __ ______________ _____ _________________________________________________________________
National Institute of
Health (Admin.) ________ __ ____ __ __ ___ ____ ___ __ __ __ ___ ___ ___ 38 ____ ___ ___ 6 ______ ___ ____ ___ ___
4 __________
Division of Chemistry___ ____ __ __ 1
2 ___ __ __ __ ___ ___ ___
4 ____ ___ ___ ___ ____ __ ___ ____
23 ___ ___ ____
Division of Pharmacology ___ _____ _____________ 1 __ 1 ___ _ 1 __ __ __ ___ ___ 1
3 ____ ___ ___ ___ ______ ___ ____ ___ ___ 14 ___ ___ ____
Division of Zoology___ __ ____ __ __ ___
1 ___ __ __ __ ___ ___ ___
2 ____ ___ ___ ___ ______ ___ ____ ___ ___ 13 ___ ___ ____
Division of Infectious
Diseases ____ ________ __ _____ 4 6 7
9 8 __ __ __ ___ ___ 2 17 ____ ___ ___ 1 ______ ___ ____ ___ 4 83 __________
Division of Public
Health Methods ____ __ ____ __ 3 2
9 1 __ __ 1 _____ _
45 --- --- ---49 ---- 1 --- 3 -·-- -- -·Division of Industrial
Hygiene_ ________ ____ __ __ __ 1
6 1 -- -- -- --16 ---- --- ··- --- ------ --- ---- --- --- 31 --- --- ---ational Cancer Institute _____________ _ ________ 2 1
2 2 __ •• __ ___ ___ ___ 16 ____ ___ ___ 1 ______ ___ ____ ___ ___ 63 __________
Cooperative projects___ __ ____ __ __ ___ ___ _ __ _ __ __ __ ___ ___ ___
5 ______________________ •••• ___ 2
3 ___ ___ ____
All otber activities __ _____ ___ ______ 1 1 4 2 __ •• _____ ••. ___
1 ••..••• ____________ ••• •••• ••• ••. 19 •••••. ____
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Federal Reserve Bank of St. Louis
1 ____ ____
1 ____ ____
28
93
------- --- -- --- -- -- -----------------
13
3
5
33 36 -------- 1
36 15
94 109 --------54 147 21
502 523 --------____ _____ _____ ____ ______ ____
310
6 ____ ____ _____
48
9
65 74
4 ____ ____ _____
1 10
13 23
19 ____ 99
5
36
9
204 213
•• _________________________________
26 ____ ____ _____
2 ____ ____ _____
108 ____
9
3
-- -- -----------1,025
182 182 -·-·-40 43 _____ _
2 ____ ____ _____
2 ____ ____ _____
10
4
3
1
27 ____ ____ _____
80
34
30 33 -----21 22 -----214 248 _____ _
76 ---- ---- -----
28
16
208 224 ------
16
11
2
2
18 11
13
7
2 ____
5
8
84 95 -----104 111 -----14 14 ••••••
•5 53 ••••••
---- ---- ----____ ____ _____
____ ____ _____
____ 18 ____
Ul
t,j
~
H
0
t,j
,-.....
Consolidated quarterly personnel report for quarter ending July 1, 1939-Continued
~
00
Regular corps
Non-commissioned personnel
Reserve corps
Totals
United States Public Health
Service
-------------------------
-------------------------------- -------
FJELD-COD.
Division of Sanitary Reports
and Statistics ____ ___ ______________ -- _____ -- -- --- -- ·- - -- - - - --- --- ---- -- -- --- --Division ofVenerealDiseases __________ 1 5 20 11 -- -- -- 1 --- 37 90 ---- -- - ---
1 4,832 --- ---- --- ___
1 --- 26
2 ------ 1
4 ___ --- ____ 6 ____ ____ _____
10
1
48 __________ 67 ____
l ____ 4,8444,844 4,844
362
324 362
41 38
Diviiiii~'.! ii ! ~l i! !i =~:!il ~: ! i! i '.ii ::i ::,--:, !i!! ::! !l! :'.i !i!!~i l!i i~!i !!: =;1 '.!'.! i ! l!! !!!! il ;!!! iii! !!ii!:::'.!'.'.::---]-] iii~
McNeil Is., Steilacoom,
Wash _____________________________ --- ---- --- - - -- -Milan, Mich _____________________ ___ ___ ---- --- -- -- -New Orleans, La ________ __________ __ --- ---- --- - - -- - Petersburg, Va _____ __________ ____________ __ ___ -- -- -2 _____ -- __
Springfield, Mo___ __ ____ __ __________ 3
Tucson, Ariz ______ _____ __ _____ __ ___ ___________ __ -- -·
6 11 ______
All other activities _______ _ ________ 1 ___
Miscellaneous ___________ _• _________ _ ____ --- -- -- __ _ -- - - - 6 __ ___ - - -Detailed to other offices __ _______ 1 6 6
On waiting orders (com•
2 -- -- - 10
15
7
32
__
__
1
_
___
_
.
missioned officers) __
All others _____ ____ ______ __ ____ __ 1 _____ ---- --- -- -· •.
Grandtotals _____ ______ _ 2
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
4 ---- --1 3 1
6 ---- -- --- 1 3
1 ---- ----- --- 3
2 - --- ----- 1 3
7 ---- 4
-- - 1 1
1 --1
--- --· 2
4 5
--- 2 11 65
--- --- --- ---- --- - ---- - 1 --- --- - -- -- ---
-------------------
1 -------- -------- -- --- --- -------- -------- -----4 -- - ----- -------- ------
--------1
-- 1
-----
------------2
--- 1
-------
-- - 2 ---- --- --- ----- - --- ---- ___ --- ____
--- --- ---- ___ --- ____
--- ___ ____ ___ ___ ____
1 ___ ___ ____
___ 4
_______________ _ .: ..
1 9 10 __________
___ ___ ____ ___ ___ ____
___ ___ ____ ___ ___ ____
8 12 _____ _
4
___ ____ ____ _____ _____
12 13 _____ _
1
3
__ _ ____ ____ _____
7 _____ _
7
3 ____
___ ____ ___ _ _____
9 _____ _
8
1
3
___ ____ ____ _____
124 130 _____ _
6
14
90
___ ____ ____
5 _____ _
5
1 ____
___ ____ ____ _____
236 256 _____ _
52 20
48
25 __ __ ___ _
88
___ ____ ____ _____ _____ ____ ______ ____
___ ____ ____ _____ _____ 20 ______ 20 ____ __
--- --- -- - ---- -- -· - - - --- --- ------ --- _______________________________ .•. . _____ _____
--- --- --- - --- --- - - -- --- --- ------ --- -- -- ___ ___ __ __ ___ ___ ____ ___ __ __ ____ _____ _____
86167101 182106 __ __ 8 23 71752 735
54140 15 734,832 19
67 ____ __
1 ______
67 _____ _
1 _____ _
44 40632 493 39 29 129591 252 4542, 0911,382 62912,796 ____ 13,425
CHIEF CLERK'S OFFICE
DANIEL MASTERSON,
Chief Clerk and Administrative Officer
DEPARTMENTAL PERSONNEL
On July 1, 1938, -the civilian departmental force consisted of 243
employees. A number of positions were added during the year, and
some were ·8Jbolished when the incumbents were transferred to the
field service, making a total of 256 employees on duty in the District
of Columbia on June 30, 1939. During the year, 29 probational
appointments were made, and there were 2 reinstatements of former
Government employees, 19 appointments by transfer from Public
Health Service field stations or other Government agencies, 3 retirements, 11 resignations, 17 transfers to field stations or other Government agencies, and 148 administrative promotions.
The average salary of departmental employees on July 1, 1938,
was $1,893.91, and on June 30, 1939, it was $1,887.66. This reduction was the result, in part, of the transfer of several employees in
higher grades to the field service and the abolishment of their departmental positions. The salaries of the 256 departmental employees
were paid from the following appropriations: 169 from the appropriation Salaries, Office of the Surgeon General; 43 from Diseases and
Sanitation Investigations, Social Security Act; 15 from Expenses,
Division of Venereal Diseases; 22 from Expenses, Division of Mental
Hygiene; 3 from Maintenance, National Cancer Institute; and 4 from
Medical and Hospital Service, Penal Institutions.
Sick leave for the year averaged 8.05 days per employee as compared with 6.88 for the preceding year. The record for punctuality
on the part of employees was substantially perfect.
Mrs. Mary C. von Ezdorf, assistant clerk, grade CAF-3, and Mr.
Thomas Manley, administrative assistant, grade CAF- 8, retired
under the provisions of section 4 of the Civil Service Retirement
Act, on October 1, 1938, and November 1, 1938, respectively. Mr.
John C. Schutrumpf, junior administrative assistant, grade CAF-7,
was retired on October 1, 1938, because of physical disability.
The number of emergency personnel who were employed outside
the scope of the Civil Service, but in accordance with Executive
Order 6746 of June 21, 1934, and whose salaries are paid from emergency relief funds, was reduced during the year from 57 to 43.
p RINTING
AND BINDING
The total expenditures for printing and binding for the year
amounted to approximately $102,908.50, an increase of almost 20
percent over the preceding year. Of the sum expended, $74,250 was
allotted from the Treasury Department's appropriation for printing
and binding, the remainder being transferred from available Public
Health Service appropriations to cover specific jobs. The increase
resulted principally from the expansion of activities in the Public
Health Service under the Social Security Act, the National Cancer
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170
PUBLIC HEALTH SERVICE
Institute Act, and the Venereal Disease Control Act. TherP, was
also a very noticeable increase in the printing of blank forms, necessitated by expansion o{ general operations of the Service, including the
opening of a new 1,000-bed hospital at Fort Worth, Tex.
Although it is the practice each year carefully to budget the printing allotment among the various items required by the Service, it is.
never possible to accomplish all the printing and binding for which
requisitions are presented. This year, because of insufficient funds,
several requisitions were returned from the Division of Printing,.
including two requisitions for much-needed binding for the libraries
at administrative headquarters and at the National Institute of Health.
OFFICE QUARTERS, SUPPLIES, AND EQUIPMENT
Congestion in the administration building at ineteenth Street
and Constitution Avenue was somewhat relieved during the year by
the transfer of certain field activities of the National Institute of
Health to new quarters at Bethesda, 1\1.d. However, the continued
increase of activity in headquarte;rs divisions largely offset this
advantage, with the result that, toward the close of the year, it became
necessary to seek a moderate amount of office space outside the administration building.
·
Upon the urgent recommendation of the Public Health Servicet
and after careful study by competent experts, a new landscaping
plan for the grounds of the administration building was approved,.
and contracts were awarded for the execution of the main portion of
the plan. The work should be completed in the autumn of 1939, and
should result in great improvement of the appearance of this building
and its approaches .
The sum of $31,100 was expended for stationery supplies for headquarters an'd field service from the stationery appropriation of the
Treasury Department, and approximately $10,500 from the Diseases
and Sanitation Investigations appropriation. Despite the fact that
a deficiency appropriation of $5,500 became available late in the year 1
it was necessary to postpone action on more than 100 requisitions from
field stations because the fund was exhausted. These requisitions ,
to be filled at the beginning of the new fiscal year, represented an
immediate encumbrance of over $5,000 on the funds for 1940. The
number of requisitions for these supplies and for blank forms handled
during the year exceeded 3,000.
For equipment, office supplies, and services, $10,000 was expended
for headquarters from the contingent appropriation of the Treasury
Department, and approximately $13,000 from the Diseases and Sanitation Investigations appropriation.
The work of photographic, photostatic, and duplicating units
showed material increase over the preceding year.
LIBRARY
,
The library at administrative headquarters contains about 15,875
bound volumes and a collection of pamphlets numbering 8,450.
D uring . the year 549 bound volumes were added, 68 of which were
purchased, .n d the remaining volumes included books received as
gifts, bound volumes of periodicals, and Federal and State documents.
About 325 additional pamphlets were received.
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Federal Reserve Bank of St. Louis
PUBLIC HEALTH SERVICE
171
Two hundred and seventy serial publications were received and
routed to the persons interested. Of this number, 35 were paid subscriptions to medical and health periodicals; the others were received
gratuitously or by exchange. Approximately 150 bulletins were contributed by State, city, and foreign welfare and health departments.
Books circulated totaled 7,385, including 148 sent into the field. Of
the total circulated, 6,048 were Public Health Service books and
1,337 were borrowed from outside libraries. Readers visiting the
library numbered 4,925, and there were 1,'242 telephone requests.
The chief purpose of the library is to collect and preserve all available material in the fields of medical science and organized health
service. The library has become an important research center, not
only for the personnel of the Public Health Service, but also for others
interested in these fields. Books are also lent to other Government
libraries almost daily, and requests are filled for special pamphlets
and documents that are not available at any other Library in Washington.
MAIL AND RECORDS
The following table shows the number of pieces of incoming and
outgoing mail and telegrams, and also the quantity of correspondence
classified, recorded, and filed:
Incoming mail pieces- - ---------------~ - - - ---- --- ------- 545,601
Incoming telegrams__ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ _ _ _
8, 390
Total incoming correspondence __ __ _________ ______________ _
Outgoing mail_ ___ ___ _____ ___ _____ ____ ____ ____ _____ __ __ 289,845
Outgoing telegrams_ _______ _____ __ __ ___ ____ ___ _________
5, 557
553, 99!
Total outgoing correspondence __ __ __ _____ ______ ___ ___ __ __ _
295, 40.Z
Grand totaL __ _________________________________________ _
Mail classified only ___________ __ __ __ ______ ____________________ _
Mail classified and recorded ___ ______ ___ ___ _____________________ _
Correspondence filed ___________ _______ __ __ _____________ _______ _
849,393
112,112
139, 956
214,332
REORGANIZATION
As a result of the President's Reorganization Plan No. 1, transferring the Public Health Service to the Federal Security Agency, the
Bureau of the Budget caused the following transfers of appropriations
to the use of the Public Health Service: From the appropriation for
printing and binding, $67,650; from the stationery supplies appropriation, $33,655; from the contingent expenses appropriation, $14,985;
and from appropriations for salaries, $4,320. With the shift of these
funds, there was likewise transferred the functions relating thereto
that had before been performed by the Treasury Department, viz (1)
the direct procurement of printing and binding from the Government
Printing Office and elsewhere and payment therefor, (2) the direct
procurement of stationery supplies through the Procurement Division
and otherwise for headquarters offices and the field stations, (3) the
stocking and shipping of blank forms and envelopes for use of field
activities, and (4) the direct obtaining through the Procurement
Division and otherwise of supplies , equipment, and service for headquarters offices that had previously been furnished through the Chief
Clerk's Office of the Treasury Department.
188796-40-
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12
•
172
PUBLIC HEALTH SERVICE
These transfers of funds and functions have the effect of eliminating
one complete step in the administrative procedure; they not only save
money, but increase markedly the speed and efficiency of the results
obtained. The change is givmg entire satisfaction.
EMPLOYEE ACTIVITIES
The Federal Credit Union, which was organized in the Public
Health Service in 1935 under the supervision of the Farm Credit
Administration, now has 280 active members. The report for . the
year-. ending July 1939 showed total assets of $20,875.07,,including an
mvestment of $8,000 in Federal savings and loan associations. Six
hundred and thirty-three loans, totaling $56,397.92, have been made
since the credit union was organized, and yearly dividends have been
declared, the last one amounting to 5}~ percent. The steady growth
in membership and the benefits derived by the members have proved
the success of this organization.
The Relief Association, which was organized more than a decade
ago to render emergency financial assistance to employees, made 13
loans during the year totaling $923. All of these loans were occassioned by illnesses or by circumstances having a direct connection
with illness. An outright gift in cash was made to an employee who
was forced to leave the Service on account of physical disability. As
of June 30, 1939, the association had a membership of 274 employees,
and total assets amounting to $4,946.15.
Membership in the Recreation Association, which was organized
on September 15, 1937, for the promotion of sports and cultural
activities among the Public Health Service personnel, has continued
to grow, the annual report showing a to~al of 198 members.
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Federal Reserve Bank of St. Louis
APPEND IX
FINANCIAL STATEMENT
The following is a statement of expenditures from appropriations
of the Public .H ealth Service for the fiscal year 1939:
Expenditures
Appropriation
Appropriated
Available
UnobliReceived
by trans- Reserve for obligaTransfer gated
Direct ob- to other balance
tion
fer
approligations
priations
-Salaries, Office of Surgeon GeneraL _________________________ $316,000
Pay, etc., commissioned officers_ 1,928,000
Pay of acting assistant surgeons ___________ _______ ___ ____
325,000
Pay of other employees ____ ____
990,350
Freight, transportation, etc ___ __
25,450
Maintenance, National Institute of Health __ ________ ______
115,000
Pay of personnel and maintenance of hospitaL ______ ______ 6,400,000
Quarantine service __ ___ __ ______
281,250
Preventing spread of epidemic
disease __ ____________ _________
280,000
Interstate quarantine service __ _
36,500
Control of biologic products __ __
55,000
Expenses:
Division of Venereal Diseases _________ __ ________ __ 3,080,000
Division of Mental Hygiene __ ______ ___ __ ______ __
950,000
Educational exhibits __ ___ ______
1,000
Diseases and sanitation investigations __ _____________________ 1,600,000
Maintenance, National Cancer
Institute ____________ _________
400,000
Working capital fund, narcotic
farm, Lexingto n, Ky., and
Fort Worth, Tex . ____________ -- -- --- ---Appreciation of foreign curren·
cies ______ ______ _____ __ _______
--- --- ----Expenses, Division of Mental
H ygiene, 1938-39 ___ __ ___ ____ _ --- ----- ---
$6,605
2 224,359
------------------------ ---------- ------- --------- -------- --------
$322,605
2,152,359
--- -- -- --- --------
I
325,000
990,350
25,450
$318,191 ---------2,151,092 ---------322,650
981,850
24,885
115,000
110,545
31,169,000 -------- 7,569,000
---- ------ -- ------ 281,250
7,523,582
276,250
247, 822
36,500
55,000
233,954
35,855
54,223
-- -- - - --- - -- ------ 3,080,000
2,997,755
- --------- $32, 178
-- --- ------ -- --- - --- -----
---- ------
-------- -- ---- ----- -------- -- ---- -7
46,276 - ---- -- - 1,646,276
------ --
400,000
134,499 --------
134,499
30,000 --------
30,000
157, 768 ----- - --
157,768
----- ---- 10
11
12
950,000
1,000
Total. __ _____ __ __________ 16,783,550 1,768, 507
Grants to States for public
health work, Social Security
Act. __ ____ ____ __ __ ___________ 8,000,000 13 207,941
8,207,941
2, 350
8, 500
565
------------------------·----------------- ----------------------------------------
4, 455
45, 418
5,000
13,868
645
777
3
• $33,292
932,700 612,300
845 -- --- - -- -1. 459,862
396,905
8
155
175,820
9
28,116
48,953
5,000
10, 594
2,425
670
53,252
81,247 ----------
--------- -
1,884
154,768 ----------
3,000
32,178 18,519,879 18,085,275
--------
$4, 41 4
1,267
212,522
222,082
7,985,120 ---- ------
II
222,821
1 $6,605 reimbursement from diseases and sanitation investigations, Public Health Service, 1939.
2 $12,154, Employees' Compensation Commission; $175,820, diseases and sanitation investigations, Public
Health Service, 1939; $36,.385 transferred from ·Justice ,Department.
a $814,169, Veterans' Administration; $250,489, hospital care of members of Civilian Conservation Corps;
Employees' Compensation Commission, $26,127; Justice Department, $80; Allied Soldiers, $3,522; Army,
Navy, and Coast Guard, $20,923; Savings bonds, $1,800; Accounts and deposits, $3,450; Securities and Exchange, $1,800; Department of Commerce. $19,151; Farm Credit Administration, $2,850; Interior Department $537; Labor Department, $3,926; Utilities (California), $408; supplies and services (various divisions),
$19.768
• $33,292 transferred to Procurement Division.
1 $39,414 of this amount transferred to 1940.
6 $12,300 transferred to working capital fund, narcotic farms.
1 $1,620, Social Security Board; $44,656, Interstate Commerce Commission.
s $175,820 transferred to pay, etc., commissioned officers, Public Health Service, 1939.
9 $670 transferred to Bureau of Standards.
10 Balance July 1, 1938, $49,698; $12,300 transferred from Expenses, Division of Mental Hygiene, Public
Health Service, 1939; Earnings, $72,501.
11 $:10,000 Public Health Service allotment from Secretary of the Treasury.
12 $157,768 continued in appropriation from previous year.
1a $207,941 transferred from 1938.
14 $222,821 transferred to 1940.
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PUBLIC HEALTH SERVICE
FUNDS MADE AVAILABLE FROM OTHER SOURCES
Appropriation
Transfers
from
Total
Available other available
appropriations
Expenditures
Direct
Transfer to
other
appropriations
Balance
--- ---Medical nnd hospital service, penal institutions (Department of Justice) _______________ $514,869
Mosquito control (District of Columbia) __ ____
4,100
Maintenance and improvement of existing
rivers and harbors (War Department) ______ 100,000
Emergency Relief, Treasury, Public Health
Service (Act 1938), hospitalization and sanitation ___________ . _. _........ .. .. __ .. _...... _ 1,211, 665
Emergency Relief, Treasury, Public Health
Service, 1939 (Act 1938), health survey_..... 188,875
TotaL . . . . .. . . -· _. . ... __ _..... _.. _..... _ 2,019,509
1$3, 258 $518,127
4,100
---------------
100,000
$516,627 -------3,961 -------70,996
2 $5,
000
188,875
139
24,004
-------- 1,211,665 1,175,727 --------
------- -
$1,500
35,938
188,591 ---- ----
3,258 2,022,767 1,955,902
5,000
284
61,865,
1$3,258 transferred from pay, etc., commissioned officers, Public Health Service, 1939.
2 $5,000 returned to War Department.
Miscellaneous receipts
Source
General fund receipts:
i~:~1f;l~ti:g~~g:~-d
-expenses~==========:============================:=======:=::::==::
Sale of subsistence ... _...................•....... ········-·· .... ·-·------·-··-_-· --·_--·
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 ___.. _... _._ . ........ . ... ···--······-·-·· .........• ·-·--- ..... .. _·-·· •...
TotaL ..... _. _. ..... _. _..... _. __ .. _... _____________ . _. _. _. ___________ . ___________ . _..
Trust fund receipts:
Sale of effects of deceased patients. ·-·----···-·-·······-···················· · ···········
Inmates' funds . ......... ....... . ..... ·- ________ .... ·-._._._ .. ·- .. _.. ___ . __ ._ .......... .
Grand total .. ·-··· ........... ···-----·-------·---------·-·---------·.----·--· _______ _
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Federal Reserve Bank of St. Louis
Amount
$181,401.07
66,346. 0514,997.87
649. 60·
6,288.91
6,540.90
186. 39,
2,426.91
3,199.21
1,011.01
l, 189. 71
284,237.63
1,594.60
52,733. 7'1:
338, 565. 95.
175
PUBLIC HEALTH SERVICE
QUARANTINE SERVICE-EXPENDITURES BY STATIONS
Pay of officers
and employees
Name of station
Maintenance
Baltimore, Md ___ -------------------------------------$44,668.03
$31,297.48
Biscayne Bay (Miami), Fla_________ _______________ ___ __
58,010.46
13,664.96
Boca Grande, Fla_______ _______________ _________________
1,100.00
45. 00
Boston (Gallops Island), Mass_______________ __ _______ __
43,332. 83
7,412.17
Brownsville, Tex___________________ ____________________
9,635.96
2,994.35
Brunswick, Ga_________________________ _________ _______
900. 00 ------------ ---Cape Fear (Southport), N. c_____________________ ______
5,657.00
300. 53
Charleston, s. c _______ ____________________________ _____
24,456.77
5,777.58
Columbia River (Astoria), Oreg_____ ___________________
3,548.00 ---------------Corpus Christi, Tex_--------------------------- -------2,068. 00
65. 00
Del Rio, Tex____ _____________ _____________ _____ ________
5,760.00
713. 95
Eagle Pas11, Tex _____ _______._____________________________
8,301.29
344. 81
El Paso, Tex_ ____________________ ___ ____ ________________
30,636.35
1,749.30
Eureka. CaliL _________________________________________ ---------------6. 75
Freeport, Tex_______ ____________________________________
513. 00 ------------ -- -Galveston, Tex_------------------- -- ----- --- ----------26,210.54
4,325. 85
Gulfport, Miss__________________________________________
11,112.15
2,215.02
Hidalgo, Tex_ ____ __ ___ ___________________ __ ____________
7, 933. 70
504. 17
Key West, Fla_________________ ________ _________________
5, 762. 00
234. 94
Laredo. Tex_________ ___ _______ ___ ___ ___________________
21,765.49
1,332.35
Lewes, DeL __________________________ __________________
1, 200. 00 __ ____ _____ __ ___
Mercedes. Tex__________________________________________
2. 085. 00
633. 00
Mobile, Ala__________ _______________ ________ __ __ ____ ____
27,282.86
17,372.64
Naco. Ariz________ ______________________________________
1,366.02
41. 33
New Orleans. La___________________ ___ _________________
61,348.10
12,987.70
Newport, R. !__ ______ __ ___ _____________________________ _____________ ___
35. 00
New York (Rosebank), N. y____ _______________________
170,093.58
40,803.99
Nogales, Ariz__________ ____________ _________ ________ ____
4,498.00
123. 76
Norfolk (Fort Monroe), Va_____ ____________ ____________
27,559. 40
5,520.91
u~~: ~g --
~~!~~~~F~~~~======================================
-------510~161,960.50
600. 00
57,436.42
12,580.08
6,482.84
807. fi8
14,776.84
891. 59
5,734.33
865. 75
3, 138. o5 _
~~::
Rio Grande, Tex_______________ __ _______ ______ ____ ______
1,680.00
88. 06
Roma, Tex______________________________ ________ _______
3,086.00
609. 78
Sabine, Tex_____________ ___ _____________________________
16,188.58
3,890. 00
St. Andrews (Panama City), Fla______ __ ___ ____________
1,400.00
63. 00
St . George Sound, Fla _- ------------ -------- -----------300. 00 ---------- -----St. Johns River (Jacksonville). Fla_____________________
8. 275. 84
10,480. 78
San Diego (Point Loma), Calif___ ______________________ _
12,457.00
1,926. 90
San Francisco, Calif __ ---------------------------------58,187.21
11,409.33
San Pedro, Calif________________________________________
41,978.29
8,832.99
Savannah, Ga __---------------------------------------4,905.00
694. 67
Seattle, Wash____________________________ ________ ___ ____
12,535.00
688. 42
Tampa, Fla_____________________________________________
21,833.00
5,850.22
Zapata, Tex____________________________________________
1, 740. 00
360. 00
Freight and miscellaneous __ ---------------------------- ________________
49,114.61
Perth Amboy, N. ]_____________________________________
Philadelphia, Pa__________________________________ ______
Portland, Maine_ ____ __________ ______________________ ___
Portland, Oreg___________________ ________ _____________ __
Port Townsend, Wash_____________________ __________ ___
~~~~1d~n!~ii -y--------------------------------------- _______
TotaL____________________________________________
..
INSULAR QUARANTINE STATIONS
Ha wan___ ____ __________________________________________
Philippine Islands ____ ____________ __________ _____ _____ __
Puerto Rico_____________________________________________
Virgin Islands___ ______________ _________________ __________
TotaL___________ ________________ ________________
Total
$75,965.51
71,675.42
1,145.00
50,745.00
12,630.31
900. 00
5,957.53
30,234.35
3,548.00
2,133.00
6,473.95
8,646.10
32,385.65
6. 75
513. 00
30,536. 39
13,327.17
8. 437. 87
5, 996. 94
23,097.84
1, 200. 00
2,718.00
44,655.50
1,407.35
74,335.80
35. 00
210,897.57
4,621.76
33,080. 31
ki:::
2,560.50
70,016.50
7,290.52
15,668.43
6,600.08
3,
1, 7fi8. 06
3,695.78
20,078.58
1,463.00
300. 00
18,756.62
14,383.90
69,596.54
50,811.28
5,599.67
13,223.44
27. 683. 22
2, 100. 00
49,114.61
~ti: g5
1------1------1-----889,833.61
34,823.44
25,046.71
38,878.22
8,939.92
261. 610.15
1. 151. 443. 76
6,461.90
41, 285. 34
25, 046. 71
46,819.66
9,130. 70
---------------7,941.44
190. 78
1------1------1-----122, 282. 41
14,594.12
107,688.29
t======l======I======
Grand total, all stations___________________________
1, 273, 726. 17
276,204.27
997,521.90
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Federal Reserve Bank of St. Louis
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Federal Reserve Bank of St. Louis
INDEX
Aoooun,t s •section,, report, oL ________________________________________ _
Airports of entry:
Quarantine transactions at _____________________________________ _
Summary of quarantine transactions at _________ __ ____________ __ _ _
Aliens:
Inspections of _____ ________________________________ ___________ _
Summary of medical inspection oL ___ ______ ______________ ______ _
Amblyomma maculatum infection, studies of _____ _____________________ _
Amoebiasis studies ________________________________________________ _
Annual Conference of the Surgeon General with State and Territorial
Health Officers ____ __ _____________________ __ ____________________ _
Anthrax, discovery of, in North Dakota ___ __________________________ _
Aribofla vinosis, discovery of new disease of man __ ____________________ _
Arsenate spray residue studies _________________________________ _____ _
Arsenical preparations, standardization of ___ _____________________ __ _ _
Page
165
18
94
18, 90
96- 99
58
80-81
45
40
11, 51
52
13, 48
Baltimore morbidity survey _________________________________________
72
Beneficiaries, marine hospitals ____ _______ ________ ____ __________ 17, 114, 118
Summary of services by class of__ ________ _________ _____ ________ _
116
Bethesda, Md., National Institute of Health buildings, at_______ __ _____ 9, 46
Biologic products, control oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13
Biologics Control, report of Division of_ ______________________________ 46-48
Bituminous coal mines sealing projects __ _ ____________________________ 6, 41
Bogota, Colombia, Tenth Pan American Sanitary Conference at___ ______
7- 8
Boston, Mass. Marine Hospital, construction oL _____________________ 17, 117
Brazil, tropical disease studies in___ _________________________________
68
Bureau of Standards, cooperative study with ___ ______________________ 12, 87
Canada, reciprocity with___ _________________ ____ ___________________
39
Canal Zone, summary of quarantine transactions at_ ___________________
96
Cancu research ________________________________________________ 11, 84-88
Cancer Research Center at Baltimore Marine HospitaL_ _ _ _ _ __ _ _ _ _ _ _ _ _ _ 17, 83
Cancer, statistical investigations of_ _____ __________________ ______ ____ 73, 74
See also National Cancer Institute.
Carnegie Institution, cooperative study with__________________________ 12, 87
Catron County, N. Mex., epizootic of plague discovered in_ _____________
30
Chagas' disease________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
67
Chief Clerk's Office, report of_ ____________________________________ 169-172
Child hygiene, investigations of_ _____ ___________ _______ __________ ___ 74-75
Chemico-bacteriological studies___ ___ __________ ___ __________________ _
50
Chemotherapeutic investigations ______________________________ 12, 68, 71- 72
See also sulfanilamide.
Cholera, world prevalence of_ ___________________________________ 19, 89, 103
Chronic disease, prevalence of in the United States _______________ 20, 101-102
Coast Guard beneficiaries, medical services furnished to_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
118
Colorado tick fever__ ______________________________________________
57
Committee on Evaluation of Serodiagnostic Tests for Syphilis _______ ____ 4, 133
Common carriers, supervision of water supplies used by ________________ 34- 36
Communicable disease survey___ __ ___________ _____________________ __
73
Communicable diseases :
Tabular summary of_ ________________________________________ 100-101
Community sanitation projects ____________________________________ 6, 41-45
Tabular summaries ____________________________________________ 44, 45
Compressed air illness study_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
53
Conference of Governmental Industrial H y gienists_ __________ __________ 55-56
Conference of Laboratory Directors and Serologists at Hot Springs National Park, Ark_____ _______________________________________ 4, 133- 135
Conference of the Surgeon General with State and Territorial Health
Officers, annuaL ____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
45
Conference, National Health___ _____________________________________
1- Z
Conference, Tenth Pan American Sanitary, at Bogota__ ________________
7
177
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Federal Reserve Bank of St. Louis
178
INDEX
Consultation services to States:
Page
Industrial hygiene_ ____________________________________________ 55-56
Malaria controL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
26
Nutrition _____________________________________________________ 25-26
Public health nursing__________________________________________ 26-28
Cooperative activities ______________________________________________
3-7,
11, 14, 15, 25-29, 36-39, 55-56, 81, 87-88, 125- 126, 160-161
Cooperative clinical group (venereal diseases)_____ __________________ 135-136
Cooperative public health program _____ _________________________ 3-7, 22-28
Tabular statement of funds budgeted for_______________________ ______
24
Cooperative Studies, report of Office oL _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
81
Coronary occlusion, acute_________________ _________________________ 10, 60
Constitutional psychopathic inferiority, units for study oL ____ ____ 14, 155-156
Costs, marine hospitals and relief stations:
Average per diem, in-patient relief, chart showing__________________
115
Dentalstudies ____ ________ ____ _______ _________________ 10,50-51,65-66,74
Dermatoses, occupational________________________________ ___________ 12, 53
Death rates (see mortality).
Deaths:
Foreign countries, from quarantinable diseases _ __________________ _
103
United States, from communicable diseases ______________________ _
101
Dental treatment furnished ________________________________________ _
118
Diarrhea-enteritis outbreaks, study oL ______________________________ _
76
Diphtheria ____________________ _____ _______________ _______________ _ 46,66
Diseases:
Chronic, estimated prevalence oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
102
Communicable, cases and deaths in the United States _____ _______ 100-101
Quaralltinable, ca~es and deaths in foreign countries___________ __ __
103
See also Infectious diseases.
District of Columbia, mosquito control in_ ____________ ________________
40
Domestic Quarantine, report of Division of ___________________________ 22-45
Drug addiction, studies of the nature and treatment of____ ___________ 146-149
Dust studies _________________________________ _____________________ 12, 52
Educational activities, venereal diseases__ _______ __ _____________ ____ 129-131
Encephalitis__ _____________________________________________ __ __ 10, 59, 81
Engineering, public health, cooperative work in _______________ ______ __ 36-40
Enteric diseases_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
66
Enzyme researches_________ ____ _____________ ____________________ ___
50
Epidemiological Studies, report of Office of_______________ __________ __ 81-82
Epidemiologists, assistant collaborating ______________·_________________
164
Environmental sanitation ___________________________________________ 75-77
Farm Security Administration, medical care program _____________ 7, 28-29, 78
Fayette County, Ky., mental hygiene studies in _____________ _________ 15, 161
Federal agencies, cooperation with_____________________ 7, 28-29, 37-39, 41-45
Federal penal and correctional institutions, medical and psychiatric services
in ________________________________________________________ 14, 153-159
Federal Security Agency____ ______________________________________ __ 1, 171
Federal Trade Commission, Public Health Service officer on duty with___
29
Financial statement, tabular __________________________________ ____ 173--175
Fluoride removal from drinking water________________________________
51
Fluorosis, endemic dentaL _____________ _______ ___________________ 10, 50-51
Foreign and Insular Quarantine and Immigration, report of Division of __ 89-99
Foreign quarantine activities__________________________________ ___ ___ 18-19
Fort Worth, Tex., Public Health Service Hospital at_ _________________ 15, 152
Fumigation and inspection of vessels and passengers ___________________
18
Tabular summary of___________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 90-92
Fumigation of foodstuffs, with methyl bromide _______________________ _ 12, 54
Galesburg, Ill. , dental studies in _____________________________________ 50-51
Gonorrhea studies_________________________________________________
132
Hagerstown, Md., tuberculosis studies at_____________________________
75
Hawaii, Island of, plague control activities in________ ____ _____________ 31-32
Hawaii, leprosy studies in_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 62-63
Health agencies, personnel and performance of________________________ 77-78
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INDEX
179
Page
Health conditions in 1938 ______ ______ _________ ______________________ 19-21
Health Conference, National, 1938_ ___ _ _ _ _ _ __ _ __ __ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ __
1-2
Health Education, Office oL _____ ___ _____ _____________ ____ ________ 105- 106
Health education, studies of_____ ___ ________________________________
78
Health problems of transients survey____________________ _____________
73
Health Program, National, of the Interdepartmental Committee to
Coordinate Health and Welfare Activities___________________________
1-2
Health relations, European_ _ _ _________________________ ___ __________
8
7-8
International_____________________________________ ____ _____ ____
Health Section of the League of Nations______________________________ 8, 19
Health services, State and locaL_____________________________________
3
Health Survey, National_ _______________________________ 13, 20, 73, 101-102
Hearing study_____________________________________________________
75
Heart diseases _______________________________________________ 10, 59-60, 74
Hot Springs Nationa] Park, Ark., Conference of Laboratory Directors and
Serologists at_______________________________________________ 4, 133-135
Venereal Disease Medical Center at ________________________ 128-129, 145
Hospital News____________________________________________________
105
Hospital studies__________________________________________________ __
78
Immigrants. See Aliens; Quarantine.
Industrial Hygiene, report of Division of__________________________ ___ 52- 56
Industrial hygiene services to States _____________________________ 5-6, 55-56
Industrial workers, studies of sickness among_ _ _ _ _ ____________ ____ ___ _ 54-55
Infectious disease investigations _____________________________________ . 9- 10
Infectious Diseases, report of Division of_____________________________ 56-68
Influenza _________________________________________________________ 10, 59
Inspection and fumigation of vessels and passengers ____________________ 90- 92
Institute for study of mental and nervous diseases propoeed___ _ ________
16
Interdepartmental Committee on Cultural Relations in the American Republics__________ ________ _______________________________________
8
Interdepartmental Committee to Coordinate Health and Welfare
Activities_________ ______ ________________________________________
1
International Health Officer at Paris_________________________________ 8, 19
Interstate quarantine. See Domestic Quarantine.
Investigations:
Child hygiene_ __________ ___ _______ __ ___ _________________ ___ ___ 74-7 5
Nutritional_ ____________________________________________ 11, 51- 52, 75
See also Studies.
Jaundice, epidemic_______________________________________________ __
67
League of N9tions, Health Section of_ _______________________________ 8, 19
Leprosy investigations_____ _______ __ ______ _____________ _____ __ ______ 62-63
Lexington, Ky., Public Health Service Hospital at ____________________ 15, 152
Library, Public Health Service ____________________________________ 170-171
Lymphocytic choriomeningitis _______________ .. ____________________ 10, 58-59
Macomb, Ill., dental hygiene studies in_______________________________
65
Mail and records, report oL _ _ ___ _________ __ _________________ ______ _
171
Malaria control in the District of Columbia _________________________ - 40
Control services to States______________________________________ _
26
Studies _______________________________________________________ 63-65
Marine Hospitale and Rehff, report of Division of_ __________________ 114-124
Marine hospitals:
Beneficiaries of_ ______________________________________ 17, 114, 116, 118
Consolidated and detailed reports ______________________________ 119-123
Dental treatment______ ________________________________________
118
117
ewconstruction______________________________________________
RepBirs and improvements_________ ___ _____ ____ __ _______________
117
Mam, island of, plague control activities in ______ ___ ________________ __ 31-32
Measles, preva]ence of, in the United States_ _________________________
20
Mortality from, in the United States_________________________ ___
101
Medical and psychiatric services in Federal pena] and correctional insti·~utions_ _______ ___ _____________ ___ _________________________ 14, 153-159
Charts _____________________________________________________ 156,157
Tabular summaries ________________________________________ -- 157-159
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INDEX
Page
Medical care studies_ _ _ _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _
78
Medical inspection of aliens, summary of _____________________________ 96-99
Medical mycc-logy _ _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
67
Medici> 1 services for various classes of beneficiaries, summary_________ 116, 123
Meningococci, studies of_ ___________________________________________ 46-47
Mental and nervous diseases, institute for study of proposed____________
16
Mental disease, studies and investigations oL _______________________ 160-161
Mental Hygiene, report of Division of_ _____________________________ 146-161
Activities and recommendations _________________________________ 14-16
Studies in Fayette County, Ky________________________________
15
Mental Hospital Survey Committee __________________________________ l4, 160
Metals, heavy, studies of_ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ __ _ _ __ __ _ _ _ _ _ __ 53-54
Michigan, obstetric care study in____________________________________
75
Milk sanitation studies __________ ______ ______ _______ ___ _____ __ ______ 76-77
Milledgeville, Ga., nutritional investigations in________________________
51
Miscellaneous receipts_____ __ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _
174
Monmouth, Ill., dental hygiene studies in_______________ ___ ___________
65
Morbidity and mortality in the United States _________________________ 20-21
Reports ____________________________________________________ 100-103
Studies _____________________________ _: _________________________ 72-73
Mortality rates for 1938 ________________________________________ 20-21, 101
Mortality studies _________ :._ ________________________________________ 72-73
Mosquito control in the District of Columbia_________________________
40
Motor transport studies ____ ___________________________ ______ _______
53
Narcotic drug addiction, see Drug addiction.
Narcotic drugs, studies of abusive use of and medicinal and scientific needs
for ________________________________________________________ 12, 149-150
National Advisory Cancer Council_ _______________________________ 11, 82-84
National Cancer Institute, report oL _____________________________ 11, 82-88
National conference of Governmental Industrial Hygienists ______ _______ 55-56
National Health Conference, 1938_ _ __ __ __ ____ __________ ____________ _
1-2
National Health Program, of the Interdepartmental Committee to Coordinate Health and Welfare Activities_______________________________
1-2
National Health Survey _________________________________ 13, 20, 73, 101-102
National Institute of Health, research at_____________________________ 8-14
National Institute of Health, report of_ ______________________________ 46-88
Division of Biologics Control, report of_ ______________ ______ ______ 46-48
Division of Chemistry, report of_ ________________________________ 48-52
Division of Industrial Hygiene, report oL ________________________ 52-56
Division of Infectious Diseases, report oL _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _ 56-58
Division of Pathology, report of_ ____ __ _____________ ______ _______ 68-69
Division of Pharmacology, report of_ ____________________________ 69-72
Division of Public Health Methods, report oL ____________________ 72-78
Division of Zoology, report of_ __________________________________ 78-81
Office of Cooperative and Epidemiological Studies, report oL _ _ ___ _ _ 81-82
Publications of__________ ______ __ ________ ________ ______________
82
Personnel on duty at__________ _________________ ______ __________
64
National Cancer Institute, report of_ ____________________________ 82-88
National Negro Health Week _____________________________________ 106-107
National Research Council, cooperative studies on drug addiction with __ 15, 149
National Resources Committee, cooperation with ___________________ 37, 39, 42
Negro health work ____ ___________________________________________ 106- 107
New York, N. Y., nutritional study in _______________________________ 11, 75
New York World's Fair, health education studies at___________________
78
"Nine-mile" fever, studies of_ ____________ _________________________ 9, 57-58
North Dakota, discovery of anthrax in_ _____________________ _________
40
Nurses, public health, employed by State and local agencies_____________
26
Nursing, public health, activities ____________________________________ 26-28
Nutrition, consultation services to States___ _________ ___ _______ _______ 25-26
Investigations ______________________________________________ 51-52, 75
Problems and recommendations_____ ____ ________ __________ _______
11
Obstetric care study in Michigan_ __ _________________________________
75
Occupational dermatoses ___________________________________________ 12, 53
Office quarters, supplies and equipment______________________ _____ ___
170
Ohio River pollution survey ________________________________ 14, 38-39, 75-76
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181
Page
Organic compounds, studies of_ _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ __ _ _ _ _ __ __ _ _ _
54
Out-patient treatments, summary classification of_____________________
123
Oxyuriasis studies_ _ _ _ __ _ _ __ _ _ __ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ __ _ __ _ _ _ _ _ __ __ __ _ 79-80
Pan American Sanitary Bureau _____________________________________ 7-8, 19
Pan American Sanitary Conference, Tenth____________________________
7-8
Pathology, report of Division oL __________________________________ :.._ 68-69
Patients treated annually, 1868 to 1939, hospitals and relief stations_____
119
Personnel and Accounts, report of Di vision of_______________________ 162-168
Personnel of the Public Health Service:
Departmental personneL _ _ _ _ _ _ __ _ _ __ __ _ __ __ _ __ _ _ __ _ _ __ __ __ _ __ _ _
169
Employee activities____________________________________________
172
Tabular statements relative to ________________________ 162-164, 166-168
Pertussis (whooping cough) studies________________ __________________
. 67
Philadelphia, Pa., heart disease studies in__________________________ 10, 59-60
Pharmacology, report of Division of_ _________________________________ 69-72
Plague:
Prevalence oL _ _ _ __ __ __ _ __ _ _ _ __ __ __ _ _ __ _ _ _ __ _ _ _ __ _ _ _ _ __ _ _ _ _ _ _ 19, 103
Suppressive measures in Hawaii_ ________________________________ 31-33
Suppressive measures in western States _________________________ 6, 29-31
Sylvatic______________________________________________________
58
Pneumonia, studies ________________________________________________ 65, 74
Pneumococcus typing serums, standardization studies_ __ __ __ __ _ __ _ _ _ 13, 4 7-48
Pneumoconiosis, caused by inhalation of mica dust_.___________________
12
Poliomyelitis______________________________________________________ 10, 59
Potomac Valley Com pact____ _ _ _ _ _ _ _ _ _ _ __ __ _ _ __ __ _ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
39
Prevalence studies, venereal disease________________________________ 136-137
Property retui,-n section, report of____________________________________
164
Prmting and binding________________________________________ _______
169
Psychiatric services in Federal penal and correctional institutions____ 14, 153-159
Publications ____________ 40, 53, 55, 82, 103-105, 107-113, 129-131, 149, 157, 161
Publications issued, lists oL ______________________________ 107-113, 130-131
Public health engineering___________________________________________ 36-40
Public health nursing ______________________________________________ 26-28
Public health facilities, studies of_ ___________________________________ 77-78
Public Health Methods, report of Division oL _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 72-78
Public Health Reports___________________________________________ 103-105
Public Health Service:
Cooperative activities________________________________ __ __ ____ 3-7, 11,
14, 15, 25-29,36-39, 55-56,81,87-88, 125-128, 160-161
Hospitals for drug addicts _____________________________ 15, 146, 150-153
Transfer from the Treasury Department_________________________
1
"Q" fever _______________________________________________________ _
Quarantinable diseases:
Cases of and deaths from in foreign countries ____________________ _
Quarantine and immigration activities _______________________________ _
Tabular summaries:
Airports of entry _____________________________________ ____ _
Canal Zone ______________________________________________ _
Inspection of aliens _______________________________________ _
Maritime stations ________________________________________ _
Mexican border stations ___________________________________ _
Quarantine regulations, amendment oL _____________________________ _
Quarantine service, expenditures by stations _________________________ _
Qus-rantine stations:
Floating equipment ___ __ _______________________________________ _
New construction _____________________________________________ _
Quincy, Ill., dental studies, in ______________________________________ _
9,56
103
18-19
94-95
96
96-99
90-93
93
18, 89
175
90
89
50-51
Radio pratique, operation of________________________________________
89
Rabies vaccine, standardization of_ __________________________________ 10, 48
Radium, purchased by National Cancer Institute ______________________ 11, 83
Railway, air carrier, and motor bus samtation_ _ _ __ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
35
Regional offices, location oL _ _ _ _ _ __ _ _ _ _ _ __ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _
25
Relapsing fever, studies oL _ _ _ _ _ _ __ _ _ _ _ _ __ _ __ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
57
Rheumatic heart disease studies _______________________________ 10, 59-60, 74
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182
INDEX
Page
Rickettsial diseases_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9, 56-58
Rocky Mountain spotted fever, study of and preparation of vaccine for__ 9, 57
San Francjsco, Calif., Public Health Service laboratory and plague control
activities at___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
31
Sanitary Reports and Statistics, report of Division of________________ 100-113
Sanitation activities ________________________________________________ 33-41
Codes________________________________________________________
77
Environmental, studies _________________________________________ 75-77
Projects ______________________________________ ~- ____________ 6, 41-45
Section, report of________ ___ ___________________________ _ _ _ _ _ _ _ _ 33-40
Santee-Cooper project, South Carolina Public Service Authority___ _____ 7, 29
Scientific research. See National Institute of Health.
Sealing of abandoned bituminous coal mines_______ _______ ___________ __
41
Selenium studies ____________________________________ ____________ __ - 69-71
Serodiagnostic tests for syphilis, evaluation oL __________________ __ 4, 132-134
Shellfish sanitation_________________________________________________
36
Shigella dysenteriae infections________________________________________ 9, 66
Sickness among industrial workers, studies of __________ ~______________ 54, 55
Silicosis in pottery industry_________________________________________ 12, 52
Smallpox, prevalence of_ _______________________________ 19, 20,100,101,103
Smallpox vaccine, studies of________________________________________
46
Social Security Act, title VI, Public Health work under__ _______ 3, 5, 22- 28, 34
Tabular statements relative to:
Allotments to States under ________________________________ _
23
Payments to States under _________________________________ _
24
Purposes for which funds were budgeted _____________________ _
24
Social Security Board, cooperation with _____________________________ _ 7, 28
Sordellii (gas gangrene) antitoxin, standardization oL _________________ _ 13,46
South Carolina Public Service Authority, Santee-Cooper project, medical
careprogram __ __________________________________________________ 7,29
Stapleton, Staten Island, N. Y., venereal disease research laboratory at_ 132-133
Starch, researches on _______________________________________________ 49-50
State mental hospitals, survey of_ ___________________________ 14, 15, 160-161
States Relations. See Domestic Quarantine.
Stream Pollution Investigations Station, Cincinnati, Ohio_ ______________
75
Stream pollution studies ____________________________________ ___ _____ 75-76
See also Ohio River.
·
Stream Sanitation, Office of_ ________________________________________ 37-40
Studies:
Amblyomma maculatum infection________________________________
58
Amoebiasis ___________________________________________________ 80-81
Arsenate spray residue _________________________________________ 52-53
Bacterial chemotherapy_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 71-72
Cancer _____ _____ _______________________________________ 73-74,84-88
Chagas' disease________________________________________________
67
Chemico-bacteriological _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
50
Colorado tick fever____________________________________________
57
Compressed air illness___________________________________________
53
Constitutional psychopathic inferiority__ _______________________ 155-156
Cooperative clinical group (venereal diseases)_____ ______________ 135-136
Coronary occlusion, acute ___ _ __________________________________ 10, 60
Dental ________________ ______________________________ 50-51, 65-66, 74
Diphtheria ____________________________________________________ 46, 66
Drug addiction________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 146-149
Dust_____ __________ __________________________________________
52
Encephalitis_______________________ ________________________ 59, 81-82
Enteric diseases _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
66
Environmental sanitation _______________________________________ 75-77
Enzyme researches_____________________________________________
50
Epidemic jaundice_____________________________________________
67
Epidemiological _______________________________________________ 81-82
Fleas and ticks__ _____________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
58
Fluoride removal from drinking water____________________________
51
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Federal Reserve Bank of St. Louis
INDEX
183
Studies-Continued.
Page
Gonorrhea____________________________ ___ ______________ _______
132
Health education_________________________________________ ___ __
78
Health problems of transients________________________ ___________
73
Hearing, defects oL _______________ _----------------------- - --- 75
Heart diseases ___________________________________________ 10, 59-60, 74
Heavy metals _________________________________________________ 53-54
Hemolytic streptococcus diseases_ _ ____ ______ ____ __ __________ ___ _
66
Influenza ________________________________ ~-------------------59
Leprosy _______________________________________________ _______ 62-63
Lymphocytic choriomeningitis____ _______________ __________ ___ 10, 58- 59
Malaria ______________________________________________________ 63-65
?4edic'a.lcare________________________________________________ __
78
Medical mycology____________________________________________ _
67
Meningococci ____________________________________ __ _______ __ __ 46-47
Mental disease _ ____________ _____________________________ __ __ 160-161
Milk sanitation ________________________________________________ 76-77
Morbidity and mortality _________________________________ 54-55, 72-73
Motor transport_______________________________________________
53
Narcotic
drugs,__ ______________________________
abusive uses of and medicinal and
scientific
needs
_________
___ 12,
149-150
for _________
National Health Survey _______ ______________________ 13, 20, 73, 101- 102
"Nine-mile" fever _____________________________ _____ ___________ 57- 58
Nutrition__ ___________ _________ ____ _____ ___________________ 51- 52, 75
Obstetric care in Michigan_____ _________________________________
75
54
Organic compounds_______ _________ ____ _________________ __ ____ _
Oxyuriasis ______________ ____________ __________ ___ ________ _____ 79- 80
Pathology ___ ____________ _________ ____________________________ 68- 69
Personnel and performance of health agencies_ ________ ___ _________
77
Pertussis (whooping cough) ___ ____________________ ·______________
67
Physical method~ in industrial hygiene __.. __________ ___ ___ ________
54
Pneumonia _____________ _________________________ _____________ 65, 74
Poliomyelitis__ ___ _________________________ ____ _________ _______
59
Prevalence, venereal disease _____ __________________ ____ ________ 136- 137
Public health facilities _______________________ __ __ ___ _______ ___ __ 77-78
Rabies vaccine________________________________________________
48
Relapsing fever____ __________________________ __________________
57
]3,heuma}ic heart d.,i&ease ____ _______________________________ 10, 59-60, 74
Rickettsiae and rickettsial diseases______ _______________________ 9, 56-58
Rocky Mountain spotted fever and preventive vaccine____ ______ ___ 9, 57
Selenium___ __________________________ _____ _________________ __ 69, 71
Sewage treatment_______ ______________________________________
76
Sickness among industrial workers _____ _____________ ________ ___ __ 54-55
Smallpox vaccine ______________________________________________
46
46
Sordellii (gas gangrene) antitoxin ________________________________
Starch, researches on_______ ___________ _____ ________ _________ ___ 49- 50
Sugar researches _____ _____________ ____________ ___________ ______ 48-49
Sylvatic plague____ ____________________________________________
58
Syphilis_________ _______________________________________ 132, 133- 136
Trichinosis ____ ________ _________________________ _______ ~ ___ __ __ 78- 79
Tropical disease ________________________________________________
68
Tuberculosis ___ ··- _______________________ ___________________ 60-62, 75
Tularaemia___ ________________________________________________
5g
Vincent's infection_____ _____ ________________________ ___________
67
Virus diseases _________________________________________________ 58-59
Weil's disease_____ _________ ___________ ________________________
67
See also Biologics control, Chemotherapy, Investigations.
Sugar researches ________________________________________________ 12,48-49
Sulfanilamide and its derivatives _____________ 12-13, 56, 65, 68, 71-72, 116, 132
Supplies and equipment_____ ________ ____________________ __ ______ ___
170
Sylvatic plague _______________________________________ ,____________
58
Syphilis control in industry______________________________________ ___
136
Syphilis studies______________________________________________ 132, 133-137
See also Venerea] diseases.
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Federal Reserve Bank of St. Louis
184
INDEX
Tables:
Page
Airports of entry, quarantine transactions at____ __________________
94
Beneficiaries of marine hospitals, summary of services by class of ____
116
Canal Zone, quarantine transactions at___ ________________________
96
Coast Guard beneficiaries______ _________________________________
118
Chronic diseases, estimated prevalence of_ ________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
102
Comm uni cable diseases in the United States_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 100- 101
Community sanitation projects, W. P. A _________________________ 44-45
Cooperative health work, funds budgeted_______________________ _
24
Deaths from communicable diseases in the United States___ ________
101
Deaths from quarantinable diseases in foreign countries _ _ _ _ _ _ _ _ _ _ _
103
Dental treatment furnished___________________________________
118
Fecl.eral penal and correctional institutions, work in ____ __________ 156-159
Financial statement______ ______ ____ _______ ________ ___________ 173-175
Funds made available from other sources____ _______ ________ __ _ _ _ _
174
Hot Springs, Ark., transactions at -- -- -------------- -----------145
Marine hospitals and relief stations, transactions at____ ___ ____ __ 120-123
Maritime stations, quarantine transactions at_ __ ___ ___ _______ _____ 90-93
Medical inspection of aliens__ ______________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 96-99
Medical services for various classes of beneficiaries_______________ 116, 123
Medical service in :Vederal prisons ___ __ ____ ______ ____________ __ 157-159
Mexican border stations, quarantine transactions at__ _______ _______
93
Miscellaneous receipts __________________________________________
174
Out-patient treatments, classification oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
123
Patient movement at Lexington, Ky., and Fort Worth, Tex., hospitals___________ ___________ ________ ___ _____________________
153
Patients treated annually in marine hospitals and relief stations,
1868 to 1939__________________ ___ ___ ___ __________ ___ __ ____ __
119
Personnel statement _______ _______ _____ _____ __________ _______ 166-168
Public health nursing________ ___________ ________ _______________
26
Quarantine service, expenditures by stations________________ ___ __ _
175
Social Security Act, allotments to States -under provisions of___ __ ___
23
Payments to States under provisions of_____ __________________
24
Venereal disease reports _____ ____ __________ ___ ___________ ___ _ 137-145
Tenth Pan American Sanitary Conference______________ ___ __ ___ ___ ___
7-8
Transients, health problems oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
73
Treasury Department ____ __ _____ ___ ________ ____ ____ ______ _______ 1, 39, 171
Trichinosis studies_____ ____ ______________________ __ ________________ 78-79
Tuberculosis studies_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 60-62, 75
Tularaemia_ ______________________________________________________
58
Typhus fever, prevalence oL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 19, 57
Ultraviolet radiation, action of, on micro-organisms____________________ 12, 55
United States:
Army, Corps of Engineers oL _______ __ ___ ____ ____ _________ 14, 38- 39, 76
Courts, psychiatric services to_______ _______ _______________ ________ 160
Estimated prevalence of chronic diseases in_ ___ ______ ___ _____ _____
102
Morbidity and mortality in ____ ______ _____ _____ ____ ___ __ 20-21, 100- 101
Venereal diseases:
Control act__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3-5, 124- 125, 142-143
Conference of laboratory directors and serologists _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4, 133-134
Cooperative work __ _________________ _________________________ 125-128
Educational activities ____ ______ _____ ____ ___________ ___________ 129- 131
Medical center at Hot Springs, Ark., report of_ __________________ 128- 129
Prevalence studies ____ ______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 136-137
Report of Division oL _______ __ _________ __________________ _____ 124-145
Research laboratory, Stapleton, N. Y., report of_ __________ ___ ___ 132-133
Serodiagnostic tests for syphilis, evaluation oL _________________ 4, 132-134
Tabular statements relating to __ ___________________ ______ _____ 137-145
Vessel sanitation ___ .., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
34
, essels, fumigation and inspection oL __ ____ _____ _____ ____ _____ __ __ ___ 90-93
Vincent's infection___ __________ _____ _____ ______ ______ _____ ___ _____ _
67
Virus diseases ___________ ______ ____ ___ _________ _____ ___ _________ 10, 58-59
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INDEX
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Page
Washington, D. C., heart disease studies in ------ -------------------Lymphocytic choriomeningitis infection in _____________ _____ _____ _
Survey of diets of poor in _____________________________________ _
Water Resources Committee. See National Resources Committee.
Water supplies used by common carriers_______ __ ____ _________________
Weil's disease__ ____________ ___ ___ __ _______ ________________________
Whooping cough studies____________________________________________
Works Progress Administration projects---------------------------- 6,
World prevalence of disease_____________________ ________ ____________
10, 59
10, 58
11, 75
34
9, 67
67
4Q-45
19
Yellow fever, prevalence oL _ _ ________________ ___ _________ ______ 19, 89, 103
Zoology, report of Division of_______________________________________
0
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