59097_1925-1929

SECRETARY OF THE TREASURY 107

The expenditures of the Mint Service during the .fiscal year 1925 amounted to $1,846,646.36, and the income which was derived from charges on purchased bullion, recoveries in the various.operations on the precious metals, and seigniorage amounted to $9,108,120.73.

SILVER

Purchases of silver were limited to the coraparatively small amounts in gold deposits. Deliveries ofsilver purchased under the terms of the act of April 23, 1918, were completed in October, 1924, and 17,908,000 dollars remain to be coined from the silver purchased under the terms of the act cited. , '..

The price of silver ranged from $0.66125 on July 1,1924, to $0.72375. per ounce on October 9,, 1924. The average price of silver for the fiscal year was $0.68813 per ounce, against $0.64517 for the fiscal year 1924. , ^ • ....-

The annual examination of the books of the coinage mints and assay office at New York showed that the coin and buDion charged to the respective officers were properly accoimted for.

The Assay Commission appointed by the President each year met at the mint in Philadelphia in February, as required by law, and founds upon actual test that the pyx coins from each of the mints were within the legal requirements as to weight and fineness.

PUBLIC HEALTH SERVICE

The Public Health Service has continued to operate efficiently, completing the one hundred and. twenty-seventh year of its existence. Among its duties are the extension of relief, the, application of research to problems involving the cause and prevention of, disease, the prevention of the introduction of quarantinable diseases, the prevention, of the admission of diseased aliens from abroad, the control of com-muhicable diseases within the.United States,, the prevention of the, spread of these from one State to another and to foreign, countries, the safeguarding of biologic products used in the prevention and treatment of disease, and other miscellaneous duties.

The investigations of • diseases of man have been continued in accordance with the program previously adopted. This included studies of cancer, clonorchiasis, leprosy. Rocky Mountain spotted fever, tularaemia, pellagra, epidemiological investigations of diphtheria, the effects of endemic goiter, the accumulation of data on the prevalence and means of spread of influenza and minor respiratory diseases, and further efforts to work out methods for reducing the amount of malaria. The general topics of industrial hygiene and sanitation, child hygiene, mental health, stream pollution, public health

. administration, and milk in its relation to health and disease have been studied with good results. Reports of findings and recommendations have been published and furnished to interested persons.

Digitized for FRASER http://fraser.stlouisfed.org/ Federal Reserve Bank of St. Louis

Fiscal Year Ended June 30, 1925

1 0 8 REPORT ON THE FINANCES

The examination of biologic products and inspections of establishments desiring licenses have been made as in former years by the Hygienic Laboratory.

The last annual report of the Surgeon General called attention to the probability that bubonic plague would reappear in one or another of our ports and emphasized the possibility that the reservoir of plague existing in ground squirrels in certain parts of California would lead to rat infection and thence to human infection in cities. Rodent plague did reappear in New Orleans, La., and Oakland, Calif., and, upon the invitation of the State and loca,] authorities, cooperative control measures were 'immediately inaugurated by the Surgeon General, with the approval of the Secretary of the Treasury, and the disease was promptly suppressed, no human cases having appeared in these cities.

Unfortunately, there had occurred in Los Angeles a widespread rodent infection and plague had claimed a number of human victims in that city before it was known by the Surgeon General that Los Angeles was infected, the first intimation that plague was present in Los Angeles coming from private sources.

.Immediately upon the receipt of authoritative information of the existence of plague in Los Angeles the Surgeon General tendered the assistance and cooperation of the Federal Government in combating the disease, notified foreign countries, and inaugurated measures to prevent the spread of the disease to other States and to foreign countries. The city of Los Angeles generously provided funds for the suppression of the disease, but in the early part of the work the tender of aid from the Federal Government was not accepted, the State board of health preferring to attempt the eradication of the disease with the means placed at its disposal by the city authorities without other aid. Shortly before the close of the fiscal year the Surgeon General was asked by the city authorities to assume control of all plague-suppressive measures in Los Angeles with a view to facilitating the work and thereby removing the necessity for quarantine meas-ures directed against San Pedro, the port of Los Angeles. While the request of the municipal authorities was not concurred in by the State board of health, it was believed that participation by the United States Public Plealth Service, was necessary in order to msiire the prevention of the spread of the disease to other States and to safeguard other countries in accordance with the terms of our international agreements. Accordingly, Asst. Surg. Gen. Rupert Blue assumed charge on June 9, 1925, with sufficient service personnel to enable him to conduct adequate supervision.

At the end of the fiscal year the work was progressing satisfactorily and an early relief from quarantine measures is anticipated.



SECRETARY OF THE TREASURY 1 0 9

During the month of December an excessive prevalence of typhoid fever was recognized in Chicago, New York, and a number of other cities. An unusual feature of this incidence was the fact that an undue proportion of those who were stricken were persons of wealth or associated with wealth, and many we're persons of prominence.

An investigation rapidly conducted by the Public Health Service sin a number of cities simultaneously led to the definite conclusion that the increased prevalence of typhoid fever was due mainly to infected shell oysters distributed by a producing company in the vicinity of West Sayville, N. Y.

The popular apprehension about the safety of oysters as food resulted in a marked reduction in the industry, ranging from 25 to 75 per cent for different producing areas. The consequent financial loss was large and serious suffering resulted from the deprivation of wages among the thousands of persons dependent upon the industry for a livelihood.

On February 19, 1925, the Surgeon General called a conference of State and municipal health officials, members of the shellfish industry, and representatives of other governmental agencies concerned, to consider measures for insuring the future safety of shellfish and the rehabilitation of the industry. This conference, consisting of approximately 150 representatives, adopted resolutions to serve as a basis for the permanent control of shellfish pollution and called on the Public Health Service to assume an active part in the carrying out of their provisions. An appropriation of $57,600 was later made by Congress to enable the Public Health Service to do this work.

The Surgeon General as Director of the Pan American Sanitary Bureau, and as a representative of the Government of the United States, the Assistant Surgeon General in charge of the division of foreign quarantine as Vice Director of the Pan American Sanitary Bureau, and Surg. R. H. Creel, also representing the United States Government, attended the Seventh Pan American Sanitary Conference, held at Habana, Cuba, November 5-15,1924. At this conference

. the Pan American sanitary code was adopted, subsequently ratified by the United States Senate, and approved and promulgated by the President of the United States. I t is believed that this treaty will, have a profound bearing upon the. administration of quarantine in the Western Hemisphere. By its terms, when ratified by the signatory powers, the Pan American Sanitary Bureau is made the central, cooperating agency of the various member Republics. This convention is designed to establish minimum standards in the treatment of vessels arriving at quarantine from a foreign port, tp promote the-free interchange of information, and to insure cooperation in these and other measures for preventing the spread of communicable diseases among the countries of the Western Hemisphere. This.




treaty has attracted marked attention throughout the sanitary world, and will doubtless be given due consideration by the International Sanitary Conference of Paris at its next meeting. The carrying out of the terms of the Pan American sanitary code should prove a measure of inestimable value in the promotion of the public health and the facilitation of international cominerce.

Early in June of this year, with the concurrence of the Department of State, an officer of the Public Health Service was detailed as sanitary advisor to the Government of Chile, to assist in the reorganization of the health department of that Republic.

Arrangements have been made with the health authorities of Great Britain, certain ports in Ireland, Canada, and Australia, by

. which vessels are fumigated in accordance with the United States quarantine regulations, thereby rendering it possible for the Public Health Service to accept the certificates of those fumigations when properly visaed by American consular officers

Upon the recommendation of the Secretary of the Treasury, Congress provided for the exemption from the operation of the quarantine regulations of vessels plying between Canadian ports and ports of the United States when conditions warrant such exemption. I t is gratifying to note the cordiality and cooperation between the health authorities of Canada and the United States.

Six persons suffering from smallpox, seven suffering from leprosy, and one from bubonic plague arrived at quarantine during the year; in addition, plague-infected rats were detected on two arriving vessels. An outbreak of smaUpox at Vancouver, British Columbia, made it necessary to require the vaccination of all unprotected persons leaving that city for the United States.

At no time in the recorded history of yellow fever has the incidence of this disease been so low and there has been no detention of passengers and crews on account of yellow fever during the fiscal year, the first time in the history of our quarantine system.

Cholera was reported in many parts of Asia, but with the exception of European Russia, this disease was not reported from other world divisions, although there has been a marked increase in the number of cases of this disease in India over last year.

Plague continues to be widespread and reports of this disease were received from 49 countries or dependencies, including cases at many important ports and shipping points. Nine countries in the Western Hemisphere, including the United States, reported plague. More than 400,000 deaths from this disease were reported in Asia, and there is little doubt that many more occurred.

Following a memorandum prepared by the Surgeon General, representatives of the State, Treasury, and Labor Departments met in conference and agreed upon a system of preliminary inspection at




ports of embarkation, of aliens destined for ports in the United States. This plan has been concurred in by Great Britain and the Irish Free State, and is in operation in ports of those countries. I t is known to be favored by other nations of Europe. The advantages of this arrangement are obvious, and if appropriations for additional personnel are made available, it is believed advisable to extend this plan to other countries requesting it, at least to such ports as are obviously adapted to its application.

The work of securing and publishing reports of the diseases of man both in the United States and abroad has been successfully continued during the year, but with a clerical force in the bureau that is inadequate for the proper utilization of these fundamental data. A plan for making the collection of this important information more effective received the unanimous approval of the State health officers in their annual conference with the Surgeon General in June, 1925.

Preliminary reports of births and deaths in the United States for the calendar year 1924 indicate a slightly higher birth rate and a lower death rate than for the calendar year 1923. Reports so far received indicate a death rate of 11.9 per 1,000 in 1924 as against 12.4 in 1923. An important item in the record of deaths for the year 1924 is the reduction in the number of deaths of infants under 1

^year of age from 77.7 per 1,000 births in 1923 to 71.9 in 1924. But little change is apparent in the number of deaths of mothers as a result of causes incident to childbirth. The deaths from accidents due to the operation of automobiles has risen from less than 1 per 100,00b in 1906 to nearly 15 per 100,000 in 1923, and incomplete reports for 1924 indicate a still higher rate for that year. This means that more than 16,000 people per annum are being killed by automobiles at the present time.

The death rate for diphtheria in the registration area has dropped from 43.3 per 100,000 in 1900 to 12.1 in 1923. Provisional reports from 35 States indicate a still further reduction in 1924, and with improved methods of treatment and demonstrated methods of prevention the hope is expressed that this disease may be considered to be one that can eventually be practically eliminated from our population, provided parents can be induced to protect their children by proven methods of immunization.

Studies of goiter made by the Public Health Service have so far revealed no deleterious effects on the mentality of goitrous persons. Effort is being made to evaluate the prophylactic measures which are being used to combat this disease.

Although cases of malaria in the United States are t e r j inadequately reported, the death rate from this disease shows that in certain parts of our country malaria is still quite prevalent and a very



112 REPORT OK THE FINANCES

deterrent factor in the economic development of the communities in which it exists. The death rate from malaria fluctuates from as low as 0.1 per 100,000 or less in certain States to as high as 38.2 per 100,000 in others.

Preliminary reports for the calendar year 1924 indicate a still further reduction in tuberculosis, but reports for the first six months of 1925 suggest a slight general increase in typhoid fever. No great change is indicated in the trend of measles, scarlet fever, whooping cough, and pneumonia.

For a number of years there has been a small but steady increase in the number of deaths from heart disease, diabetes, and cancer, in striking contrast to the general i'eduction seen in the rates of most other diseases.

The United States Marine hospitals and other relief stations furnished the largest amount of hospital and medical treatment to merchant seamen since the inception of this work, 127 years ago. The increase over the previous year in total amount of relief furnished was 8.9 per cent in hospital days and 22.3 per cent in out-patient transactions. Not only are merchant seamen applying in greater numbers, commensurate with the growth of merchant shipping, the poits, and the Nation, but greater demands are being made for medical services by the Coast Guard, Employees' Compensation Com-, mission. Bureau of Pensions, Civil Service Commission, Lighthouse Service, Steamboat Inspection Service, and other designated governmental agencies, as well as for the lepers, who are being assembled in steadily increasing numbers at the National Leper Home (Marine Hospital No. 66), Carville, La. The hospital at Ellis Island was operated as heretoforej for the Department of Labor, detained immigrants constituting the majority of patients.

A number of the most important marine hospitals are very old structures in dilapidated condition, too small for the demands, obsolete in type, and so inflammable as to present serious hazards to the lives of helpless inmates. The hospitals at New Orleans and San Francisco should be rebuilt. Fire-resisting wards of modern character are needed at several other hospitals to replace frame buildings and increase capacity. Nurses' homes and other quarters are required as a measure of economy to reduce rentals and to increase efficiency.

Attention is invited to my letter dated February 20, 1923, with which was transmitted to the Congress a list giving estimates of cost of new construction, improvements, and repairs required to enable the Public Health Service to function efficiently and economically. The need for these improvements is cumulative.

The work of the division of venereal diseases during the past year was carried on in compliance with specific provisions of law, which




impose the duties for the study, investigation, and prevention of venereal diseases and for cooperating with the State boards of health in their control. The activities of the preceding year have been continued and a special effort has been made to stimulate a larger body of physicians to fortify themselves for the detection of these diseases and to cooperate actively with the health departments in the problem of eradicating them.

Si^bscriptions to the publication ^ Venereal Disease Information,'' which is prepared by the division for use in its cooperative work with the State departments of health, have materially increased. This publication reaches all official and unofficial classes who are especially interested in the venereal disease problem.

Likewise, the bulletin/'Social Pathology" conveys information on the socio-economic aspects of the venereal diseases to official non^ medical groups as well as to interested unofficial groups who have to do with the control of venereal diseases. The printing of this bulletin by the Government Printing Office and opening it to sub* scriptions would greatly increase its circulation and effect economy in its preparation and distribution.

The unusual interest which is being displayed by colleges, high schools, industries, life insurance companies, etc., bears evidence to the continued and active public interest in the control of venereal diseases.

In accordance with provisions in the act of July 1, 1902, the annual conference of the Public Health Service with State and Territorial health officers was held in Washington, D. C , on June 1 and 2, 1925, and was attended by delegates from 30 States and 2 Territories. A two-day program was carried out in which were discussed a plan for the establishment of a morbidity area, a State-wide program of milk control, the routine reporting of county health work, the occurrence of plague in the United States since the last annual conference and control and measures taken, the practicability and desirabihty of utilizing the services of advanced and selected medical students during the summer months in the field of public health, stream pollution as a public health matter, cooperative measures for the sanitation of shellfish areas and shucking houses, and a progress report of studies of administrative health practice. Demonstrations were given to the officers assembled of the preparations used in the prevention and control of scarlet fever, on narcotic-drug addiction, on tularaemia, and on methods for the control of smallpox.

Cordial relations and mutual cooperation have existed between the Public Health Service and other agencies of the Federal, State, and local governments, and with unofficial civic bodies, perhaps to a greater degree than ever before. Similar cooperation has also existed between the service and representatives of our great industries.




An important research was begun late in the year to determine the possible health hazards associated with tetraethyl lead gasoline. This was undertaken after a conference at which interested Government bureaus, the industry, and labor were represented.

The importance of milk as a food, and the danger that it may convey disease can not be overestimated. The widest variance has existed in the methods adopted by State and city authorities to secure a safe and wholesome milk, hardly any two States or cities attacking the problem in just the same way. One of the investigations which is being pursued by the Public Health Service is for the purpose of determining whether it is possible to unify measures for the safeguarding of our milk supplies. At the close of the fiscal year 1925, mainly through the efforts of the Public Health Service through cooperation with State and local authorities, 8 States and 53 cities had adopted uniform measures for the sanitation of milk.

The total personnel of the service at the close of the fiscal year was 8,976, which includes 4,285 persons designated as collaborating epidemiologists and assistant collaborating epidemiologists. These appointees are nearly all officers or employees of State and local health organizations, who receive nominal compensation of $1 per annum for services rendered in connection with the compilation of morbidity statistics. The total personnel increased somewhat during the year. The increase was due to a much greater volume of hospital and relief work; to the reappearance of bubonic plague infection in New Orleans and on the Pacific coast, for which Congress made a deficiency appropriation of $165,994; and to cooperative work with State and municipal health authorities in investigations of shellfish sanitation, for which a special appropriation of $57,600 was made.

As pointed out in my last annual report, the efficiency of the personnel would be increased and economies effected by legislation enlarging the permanent commissioned corps of the Public Health Service, and I have again to invite attention to the recommendations of the Surgeon General with respect to new construction and repairs of buildings at hospital and quarantine stations, in which recommendations I concur.

PUBLIC BUILDINGS

There is a pressing need for the construction of Federal buildings in many communities not already so provided, and for the extension and enlargement of those Federal buildings in which congestion exists, due to the growth and expansion of the public business.

There has been no effective legislation enacted to care for the Government's public building needs since the act of March 4, 1913. During the interim the normal growth alone of the public business would have resulted in an overcrowded condition calling for relief



SECRETARY^ OF THE TREASURY 377

90 claims disallowed or withdrawn July 1, 1925.__._ $498, 413. 94

1 claim disallowed July 1, 1925 to July 1, 1926 .__._•_ 2, 400. 00

Total - - ^ 501, 813. 94

Total amount paid . 2, 625, 029. 55 Total disallowed and withdrawn 501, 813. 94

Total - 3, 126, 843. 49 57 claims awaiting audit, amounting to_ 1 109, 359. 53

Amounts may be more or less in final audit. 2 claims awaiting court decision 22, 931. 51

Expenditures from July 1, 1925, to June SO, 1926, contract liabilities charged against appropriations, and unencumbered balances

s t a t u t o r y roll Sites and addi t ional land Const ruct ion of new bui ldings Extensions to bui ldings Miscellaneous special i t e m s . . . R e n t of bui ldings _ Veterans ' hosp i t a l s . Remodel ing and enlarging publ ic bui ldings Relief of contractors , etc. , for publ ic bui ldings u n d e r

Treasu ry Hospi ta l construct ion, Pub l i c Hea l th Service Hospi ta l facilities, etc. , for war pa t ien ts '..... L a n d s and other p roper ty of the U n i t e d S t a t e s . Repa i r s and preservat ion Mechanical e q u i p m e n t Vaul ts and safes Operat ing s u p p l i e s . . General expenses ^ F u r n i t u r e and repairs Operat ing force Addi t ional lock-box e q u i p m e n t

Tota l . .

Expend i tu re s

$267,167.09

1. 564, 933. 92 403, 912. 99

40, 708. 20

493,331. 65

48,933. 58 3,120. 20

20,884. 74 23.42

888,896.04 520,446.85 102,025. 78

2,872, 276. 79 467,145. 78 807,221.85

5,509,032.26 88,376.99

14,098,438.13

Cont rac t liabilities charged against appro

priat ions

$1,058,571.00 888,635.12 103,373. 93 33, 940. 25

324,852. 09

23,519. 73 43, 789. 63

182,216. 97 118, 021.34 37, 536.18

314, 780.16 30,175.46

165. 688. 92 504.307.55

11,103. 70

3,840,512.03

Unencumbered balances,

J u n e 30,1926

$1,854.91 1,849,700.00 6,669,280.67 1,276,811.36

40, 997. 24 35, 000.00 30, 223. 48

8,297.05

24,970.45 16, 290. 08 26, 743. 45

76.58 9,250. 82

36,343.00 1,828.51

1 448,895.46 2 77.195.96 313,808.37

21.869.48 619.31

10.689,956.18

1 Includes $20,000 reserve, 1926. «Includes $5,000 reserve, 1925; $5,000 reserve, 1926. 3 Includes $5,000 reserve, 1926.

P U B L I C H E A L T H S E R V I C E

The activities of the Public Health Service during the fiscal year ended June 30, 1926, are summarized by the Surgeon General as follows:

Scientific research

The scientific research division has continued its field and laboratory studies of the diseases of man and methods for their prevention, and has carried on the inspections and tests required in the enforcement of the law of July 1,1902, which provides for Federal control of viruses, serums, toxins, and analogous products in interstate traffic.

Surveys made by the office of industrial hygiene and sanitation during the year have included investigations of dusty trades where employees are exposed to cement dust, granite dust, hard-coal dust, soft-coal dust, cotton dust, and dust from silver polishing; a broad



3 7 8 , REPORT ON THE FINANCES

survey of benzol poisoning in industries where benzol is manufactured and used,especially in dry-cleaning and paint-spraying establishments; studies of the effect of illumination on the eyesight and production; investigation of the health hazards connected with the manufacture, distribution, and use of tetraethyl lead, ethyl fluid, and ethyl gasoline; investigation of the posture of healthy individuals and those in sedentary trades; causes of sickness, and sickness rates in a group of some 40 industries employing approximately 200,000 persons, and a health study of 10,000 industrial workers in 10 major industries in the United States.

The principal stream^ pollution^ investigations have been the completion of the study of the sewage pollution of Lake Michigan in the vicinity of the Indiana-Illinois State line; cooperation in a study of the pollution of the upper Mississippi River; laboratory studies of the biology of wastes and water purffication, which have already found practical applications in the improvement of methods for testing sewage and polluted streams and in facilitating the calculations necessary in planning control measures; and laboratory and field studies of the efficiency of water purification plants using rapid sand filtration and chlorination.

The statistical investigations of morbidity have been continued, and now embody a considerable volume of records of ill-health from different causes among persons of both sexes and all ages living under typical conditions, as well as of school children and of persons engaged in industry. These data have been added to materially during the past year, especially for respiratory diseases, which form the basis of a new epidemiological study of the common cold, bronchitis, tonsillitis, and other conditions, and of interepidemic influenza.

The child hygiene office continued its studies of the growth of school children; the vision of school children; natural illumination of school buildings; the physical and mental status of colored children in Georgia, and the dental condition of children in a county in New Mexico. '

Epidemiological studies of malaria and studies of fish control of mosquito production, the latter in cooperation with the Bureau of Fisheries, which have been continued during the past few years, have been completed. Studies of Anopheline mosquitoes were made at the two field laboratories. The field studies of malaria continued during the year included investigations of rural malaria control, drainage, impounded water projects, and screening.




Two contributions of interest have been made during the year in the study of nutritional diseases—one, that the white rat is apparently admirably adapted for use in nutritional studies of pellagra; the other, that a dietary factor which has been considered as homogeneous is probably composed of two distinct agents.

Two additional States have adopted the State milk-control program recommended by the service and 47 additional cities have passed the standard milk ordinance, making 10 States and 100 cities in all. The work of measuring the milk sanitation status of these cities was continued and a new study of pasteurization machinery was begun.

The following studies have been carried on by the Hygienic Laboratory: Studies of tularaemia were continued; an increase in the geographical distribution of the disease has been noted, it now having appeared in 24 States. A vaccine for Rocky Mountain spotted fever has been evolved and is now being given a practical test in the field. Work on tuberculosis was confined largely to the chemistry and biology of the cell bodies. Investigations of epidemic encephalitis resulted in the isolation of a streptococcus from a case dying of an acute attack; a syndrome in many respects similar to epidemic encephalitis was produced in laboratory animals inoculated with the organism. An investigation of 3S cases of post-vaccinal tetanus confirmed observations made earlier, which have resulted in recommendations for discontinuing the use of vaccination dressings. Cultural and pathological studies of trachoma have been carried on throughout the year at the branch laboratory in Rolla, Mo. Further investigation of drug addiction develops the fact that the estimate of 110,000 addicts in the United States made in 1924 would be somewhat too high for the present. The standardization of antidysenteric serum has gone forward and a unit has been suggested for comparative purposes in the testing of products at manufacturing; establishments. A standard scarlet-fever toxin was prepared and put to use by manufacturers as a control toxin against which commercially produced toxins may be measured. Work has been continued on the toxic reaction of arsenicals; in general, a high standard has been observed in the chemical quality of these products. Researches upon pneumonia and typhus have been carried OYcr from the preceding year. Investigations of oxidation reduction have gone forward satisfactorily.

Other studies carried on throughout the year have included the following subjects: Cancer, chlonorchiasis, goiter, leprosy, typhus fever, and mental hygiene.

Twenty-two bulletins giving the results of the research work and 79 special articles by the division personnel were published during the year.




Division of domestic quarantine

The plague campaign at New Orleans, La., which, was begun in December, 1924, terminated September 30, 1925. During this period 266,916 rodents (mice included) were captured, of which 12 were found to be plague infected. The first plague rat was discovered December 2, 1924, and the last was found on January 17, 1925.

The plague campaign at Oaldand, Calif., which was begun in December, 1924, terminated February 28, 1926. During this period 81,755 rats (mice not included) were captured, of which 21 were found to be plague infected. The first plague rat was discovered December 11, 1924, and the last was found March 3, 1925.

The plague campaign at Los Angeles, Calif., which was begun by the State and city authorities March 6, 1924, terminated June 30, 1926. The Public Health Service began operations July 1, 1925. During the entire period there were 41 cases of human plague, with 34 deaths. The number of rodents captured throughout the campaign was 474,099 (including mice), of which 202 were plague infected. The first case of human plague was diagnosed October 31, 1924. The last human case occurred January 5, 1925. The first plague-infected rat was determined November 15, 1924, and the last was found November 6, 1925.

Plague in ground squirrels exists over a large section of California and constitutes a continuous public-health menace. Present methods of operation are not sufficiently extensive to eradicate this source of infection. s. Hospitals for the eradication of trachoma conducted in cooperation with State and local authorities were operated at Knoxville, Tenn., RussellviUe, Ark., Rolla, Mo., and Eveleth, Minn.

Mosquito-control measures.in counties along the Texas-Mexican border for the prevention of the spread of yellow fever were turned over to the local authorities completely on June 30, 1926.

Activities pertaining to the certification of water supplies used on trains and vessels engaged in interstate traffic were conducted, as heretofore, as were activities relating to the sanitary control of shellfish and to sanitation in the national parks. , The twenty-fourth annual conference of State and Territorial health authorities with the Public Health Service was held May 24 and 25, 1926.

Division of foreign and insular quarantine and immigration

Quarantine transactions.-—During the fiscal year 1926, 26,698 vessels and 3,010,539 persons were inspected by quarantine officers. Of these 17,056 vessels and 1,777,064 passengers and seamen were inspected upon arrival at stations in the continental United Std;tes,




2,868 vessels and 378,414 passengers and seamen were inspected at insular stations, and 6,774 vessels and 855,061 passengers and seamen were inspected at foreign ports prior to embarkation for the United States.

Of the passengers who embarked at European ports 159,279 were vaccinated and 107,024 were deloused under the supervision of medical officers of the service. Their clothing and baggage, amounting to 111,720 pieces, were disinfected.

During the year 7,562 vessels were disinfected or fumigated either because of the occurrence of disease on board or for the destruction of rodents; 30,979 rats were destroyed, of which number 21,731 were examined for plague infection.

The efforts of the service to exclude quarantinable disease from the United States and its possessions were successful. During the year 30 cases of smallpox, 7 of leprosy, and 1 case of cholera reached our quarantine stations. No case of plague, yeUow fever, or typhus arrived at quarantine. The prophylactic measures applied by Public Health Service officers at foreign ports of departure undoubtedly contributed to this result.

Medical inspection of aliens.—There were 614,972 alien passengers and 872,842 alien seamen examined by medical officers at the various stations. Of this number 23,876 passengers and 2,038 seamen were certified in accordance with the act of Congress approved February 5, 1917.

The most important causes of certification of alien passengers were: Trachoma, 408; tuberculosis, 195; feeble-mindedness, 212; insanity, 86; syphilis, 147; and gonorrhea, 364.

Of the alien seamen certffied, 129 were for trachoma, 25 for tuberculosis, 255 for syphilis, 336 for chancroid, and 540 for gonorrhea.

In accordance with the agreement among the Secretaries of State, Labor, and the Treasury, the medical inspection of aliens was inaugurated at certain European ports. ' From August 1, 1925, to the^ end of the fiscal year, 59,052 applicants for immigration visas were examined by medical officers. Of this number 834 were reported to the consular officers as affiicted with one or more of the diseases listed in class " A " as mandatorily excludable, and 6,333 were reported as afflicted with a disease or condition listed in class ^^B" as liable to affect their ability to earn their own living. All of the a^pplicants reported in class ' 'A" and 2,341 of those reported in class ' ^ B " were refused immigration visas by the consular officers because of the result of the medical examination.



3 8 2 REPORT ON THE FINANCES (

Division of sanitary reports and statistics

Duruig the fiscal year reports of the prevalence of diseases dangerous to the public health were better than ever before, though much remains yet to be done in this field. Through the health section of the League of Nations regular wireless and c4ble reports of quarantinable diseases were received from ports in the Far East, where these diseases are often present. These reports, together with the improvement in the reports received from other parts of the world, enabled our health officers to learn earlier than was possible heretofore of conditions which might be a menace to our people.

Officers of the Public Health Service stationed abroad and American consular officers sent information regarding health conditions, and there was an increase during the year in the official reports received from foreign governments, some of these reports being sent pursuant to the provisions of sanitary conventions.

Information as to diseases in the United States has been received from officers of the Public Health Service; from agents in State, county, and municipal health departments, who were appointed'as Federal officers for the purpose of securing the information; and from State and local health officers throughout the United States.

The data received were carefully checked, tabulated when practicable, and published for the information of health officers and other sanitarians.

The collection, compilation, and publication of laws, ordinances, regulations, and court decisions pertaining to public health were continued during the year.

During the latter part of the fiscal year blanks were sent out for* the collection of data regarding the mentally diseased, feeble-minded, and epileptic inmates of institutions in the United States. Comprehensive statistics as to these classes in the United States are needed.

' The Public Health Reports were issued weekly throughout the fiscal year. They contained information as to the prevalence and geographic distribution of preventable disease, articles relating to the cause, prevention, and control of disease, and other information regarding sanitation and public health.

Radio broadcasts on subjects pertaining to health were prepared and sent to stations in the United States and Canada. In this way valuable information on health matters is presented to many thousands of listeners each month.

The distribution of publications of the Public Health Service and the loan of lantern slides for use by lecturers are other important means of informing the public of facts which may vitally affect the health of many persons.




Division of marine hospitals and relief

Owing to a large increase in the personnel of the Coast Guard, for which the Public Health Service is required to furnish medical and hospital services and to supply medical and dental officers to ships and bases, the demands for medical services were increased. The act of May 22, 1926, also increases the amount of medical services rendered to the Lighthouse Service. The work performed for the Employees' Compensation Commission is growing in volume. The number of lepers segregated at the National Leper Home has been increased to 259. Civil service applicants and persons applying for retirement or pension have been given physical examinations in larger numbers than ever before. The American merchant seaman is, of course, the most numerous class of beneficiaries and receives 66.4 per cent of the total amount of hospital relief furnished. The volume of hospital care was reduced, however, by restricting admissions and hastening discharges.

Listing the principal beneficiaries in the numerical order of their importance, there were 107,594 American seamen treated during the year; 56,993 of the Coast Guard; 47,245 patients of the Employees' Compensation Commission; 16,524 of the Civil Service Commission (physical examinations only); 6,521 of pilots and other ships' officers (physical examinations only); 5,733 of the Immigration Service, hospital patients at Ellis Island; 3,749 of the Veterans' Bureau; 1,761 of the Lighthouse Service; and 6,169 others, totaling 248,889 patients receiving medical service. There were furnished 1,321,309 patient days ih hospital, 572,139 outpatient treatments, and 91,553 physical examinations not related to treatment but requiring special written reports to meet some Government requirement.

To prevent deterioration and waste, the surplus stock of medical supplies taken over from the Army after the World War has been reduced chiefly by transfer of the excess to various departments of the Government, which received, with the coordinator's sanction, $456,006.21 worth of this material at the inventory value, which was 75 per cent of the original purchase price. Sales were made to States and to charitable organizations of property valued at $149,785.13. The total value of the excess disposed of amounted to $605,791.40.

Division of venereal diseases

For the fiscal year 1926 the amount appropriated for the division of venereal diseases was $75,000—$74,000 less than the appropriation for the previous year. With no provision for allowances to the States for cooperative work in venereal disease control, the division is greatly handicapped in carrying out an effective campaign.




Several of the venereal disease publications, printed and sold at cost, are not, however, affected by this curtailment and are more widely used each year.. ''Venereal Disease Information," a monthly periodical prepared for the use of those interested in the medical aspect of venereal disease control, has completed another successful year. I t is printed by the Government Printing Office and can be purchased at a small subscription price covering the cost of printing. This year nearly 12,000 issues have been distributed each month.

Equally valuable is "Social Pathology," designed to acquaint official and nonofficial agencies with the venereal disease problem in all of its social implications. I t is felt that its usefulness would be greatly enhanced were it possible to give this to the public on the same terms as ''Venereal Disease Information" is offered.

The most important venereal disease bulletin issued in the past year was, "Venereal Disease Manual for Social and Corrective Agencies." This book was prepared especially for probation officers, social workers, matrons of detention houses—all who come in contact with delinquent and defective persons. I t is sold at cost by the Government Printing Office. The manual has met with widespread approval, and in the first three months since its publication over 1,800 copies have been sold by the Superintendent bf Documents.

The program of sex education was carried forward by means of lectures, exhibits, and conferences. Intensive work in the schools is an important part of the program. Efforts have been directed toward interesting officials of railroads, steamship companies, and large manufacturing plants in the detection and eradication of venereal diseases among their employees. Special work has been done along these lines in Georgia, Indiana, and Tennessee, and in the New England States.

A new departure in venereal disease control was inaugurated in Kentucky. Under this plan at least one doctor in each county was asked to serve as cooperative clinician. A school of instruction was established at State board of health headquarters in order to prepare these physicians for their special work. The purpose of the plan is to provide for treatment of patients unable to pay more than a nominal fee and to bring treatment within the reach of all infected persons living in remote districts. Drugs and appliances are procured at cost price, one-half of the amount being borne by the State board of health. The clinicians report to the board of health. During the short time that this plan has been in operation the encouraging reports indicate that the solution of one of the most perplexing problems of treatmeh-E may have been found.

Activities of 416 clinics were reported to the State boards of health during the year. New cases admitted to these clinics amounted to a total of 100,776, an average admission per clinic of 242; 58,297 cases of syphilis, 39,636 cases of gonorrhea, and 2,843 cases of



SECRETARY^ OF THE TREASURY 3 8 5

chancroid make up the total. In diagnosing these cases, 291,803 Wassermann tests and 188,674 examinations for gonococcus infection were made. The total number of treatments given was 1,881,380.

Cases of venereal diseases reported to the State boards of health by clinics, physicians, hospitals, etc., amounted to 389,231, an increase of 4.40 per cent over cases reported for 1925. Of this number there were 215,547 cases of syphilis, 166,655 cases of gonorrhea, and 7,029 cases of chancroid.

The division of venereal diseases received during the year 640 requests for medical advice. Each request is referred for answer to the board of health of the State from which the query comes. Requests for educational material to the number of 12,235 v/ere also received by the division. In response 46,014 pamphlets were distributed.

State boards of health purchased or reprinted 731,044 educational pamphlets and placards. Ninety-five exhibits, 2 sets of slides, and 35 films were also purchased or borrowed by State boards of health.

I t is now eight years since''the division of venereal diseases was established, and it would seem an appropriate time to make an appraisal of the legal measures which have been in force for a period of years. Accordingly a general inquiry was sent to each State health officer asking for an expression of opinion. With one or two striking exceptions the replies indicate that the laws and regulations are considered adequate. But there is a general feeling that certain of the rulings are not capable of rigid enforcement—that the cooperation of those concerned is necessary but can not, in the nature of the case, be forced. The inevitable conclusion is, therefore, reached that it is only by the willing cooperation of the members of the medical profession, the legal profession. State administrative officers, and the lay public that effective control can be accomplished. I t is felt that this is a matter of gradual achievement and that the progress of the past years is satisfactory.

/ . • • •

Division of personnel and accounts

On June 30, 1926, the regular commissioned corps of the service consisted of 213 officers, which included the Surgeon General, 3 assistant surgeons general at large, 22 senior surgeons, 135 surgeons, 19 passed assistant surgeons, and 33 assistant surgeons. Eighteen officers were on waiting orders. Four resignations and four deaths occurred during the year.

The number of reserve officers on active duty at the close of the year totaled 64, and included 1 assistant surgeon general, 4 surgeons, 4 dental surgeons, 11 passed assistant surgeons, 12 passed assistant dental surgeons, 26 assistant surgeons, and 6 assistant dental surgeons.



386 REPORT ON THE FINANCES

The following statement shows the total of all personnel on duty June 30, 1926: Commissioned medical officers, regular corps : 213 Commissioned officers, reserve corps 64 Acting assistant surgeons. 483 Attending specialists and consultants •> ^ 219 Contract dental surgeons 31 Internes 16 Scientific personnel, general 24 Pharinacists 35 Administrative assistants . 17 Druggists -12 Nurses 351 Aides - : 34 Dietitians • 21 Laboratorians ^ 28 Scientific—Hygienic Laboratory . 29 Pilots ^ . 34

' Marine engineers. 38 Clerks . 1 459 AU other employees 2, 315

Total.. 4,423

There are employed, in addition, 4,442 officers and employees of State and local health organizations, at nominal compensation, who assist in the collection of epidemiologic data.

Financial statement A statement of appropriations and expenditures for the fiscal year

1926 foUows:

Appropriation title Appropriated Expended

Public Health Service proper: Salaries, office of Surgeon General.. Pay, etc., commissioned officers and pharmacists . . . Pay of acting assistant, surgeons__• Pay of other ernploye^s. Freight, transportation, etc .. Maintenance, Hygienic Laboratory Preparation and transportation of remains of officers Books.. .,.-.' 1. Pay of personnel and maintenance of hospitals Quarantine service _ Preventing the spread of epidemic diseases Field investigations of public health Interstate quarantine service Studies of rural sanitation _ Control of biologic products Expenses, division of venereal diseases.

Total, Public Health Service proper.^

Allotments from U. S. Veterans' Bureau: Medical and hospital service, Veterans' Bureau Salaries and expenses. Veterans' Bureau..

Total, U. S. Veterans' Bureau funds

Grand total

$101, 1,125,

315, 1,020,

25, 43, 3,

' 5,650, 470,

2 469, 282, 4 71,

76, 4.5, 75,

560.00 000.00 000.00 000.00 000.00 400. 00 000.00 500.00 037. 72 000.00 173. 59 054.00 691. 80 000.00 000. 00 000. 00

9,671,417.11

357,175.00 6,047. 67

363,222. e

$100, 1,124,

305, 1,007,

24, 43,

5, 529, 461,

3 449, 277, 6 69,

" 73, 44, 65,

928.35 143.20 154.78 719. 97 584.01 055.69 479. 57 493.68 213.12 972.49 624.70 663.66 798.98 000.00 960.17 280.88

9,678,073.11

356,662.00 6,047. 67

361, 609. 67

10,034,639.78 9,939,682.78

1 Includes $302,554.72 reimbursement for care and treatment of U. S. Veterans' Bureau patients and miscellaneous.

2 Includes $102,874.29 of deficiency appropriation available for the fiscal years 1925 and 1926. 8 Includes $99,225. 67 of deficiency appropriation available for the fiscal years 1925 and 1926. 4 Includes .$49,161.80 of deficiency appropriation available for the fiscal years 1925 and ,1926., • »Includes $48,697.20 of deficiency appropriation available for the fiscal years 1925 and 1926i




The activities of the Public Health Service during the fiscal year ended June 30, 1927, are summarized by Nthe Surgeon General as follows:

Division^ of sanitary reports and statistics

Reports of the prevalence of diseases dangerous to the public health were received throughout the fiscal year hy telegraph and mail from all parts of the United States and from foreign countries. They came from officers of the Public Health Service, American consuls. State and local health officers, foreign governments, the health section of the secretariat of the League of Nations, the International Office of Public Hygiene at Paris, the Pan American Sanitary Bureau, and other sources.

Some of the telegraphic reports were summarized and mimeographed copies sent to State health officers. In this way early notice was given of the prevalence of diseases which must be especially guarded against.

The data generally are tabulated, comparisons are made with preceding years, and the resulting statistics are published in the weekly Public Health Reports or in supplements issued from time to time.

The reports from the United States of the prevalence of diseases dangerous to the public health are not as complete or accurate as they can be made. The establishment of definite standards of reporting and the inclusion in a registration area of all States and cities which reach these standards would do much to increase our knowledge of the prevalence of communicable diseases in the United States.

The weekly Public Health Report was issued regularly during the fiscal year. This publication is now in its forty-second year.

The obligations imposed upon our Government by sanitary conventions to notify foreign governments of the appearance of quarantinable diseases and the prevalence of certain communicable diseases were met during the fiscal year, and sanitary information was exchanged between the Public Health Service and the Pan American Sanitary Bureau, the health section of the League of Nations, and the International Office of Public Hygiene at Paris.

Another volume was added to the series of annual compilations of Federal and State laws and regulations pertaining to public health.

224




Laws and regulations pertaining to smallpox vaccination were collected, compiled, analyzed, and published, together with abstracts of all (iecisions on this subject by courts of last resort in the United States.

Many requests were received for information as to the laws and regulations on subjects pertaining to health. These requests were complied with as far as possible.

The dissemination of health information of a popular nature by radio was continued by the Public Health Service throughout the fiscal year. Two broadcasts were sent out each month through 49 cooperating stations.

Reports to the Surgeon General indicate that health conditions throughout the country were unusually favorable during the fiscal year. During the first three months of 1927, although there was a widespread epidemic of influenza in Europe, the United States was fortunate in having comparatively few cases of this disease, and these were generally mild, with few cases in which pneumonia developed.

The record for the calendar year 1926 is not so favorable. The general death rate increased slightly over that for 1925, and the infant mortality rate also increased. These increases were due, largely, if not entirely, to the epidemic of influenza which occurred during the winter and spring of 1926. Measles was unusually prevalent at the same time.

There was a continuation of the reduction in the death rate from tuberculosis, although the difference between the rates for 1925 and 1926 was small.

In 1925 the death rate from typhoid fever showed a reaction from the steady decline which had been observed for three decades at least. In 1926, however, the typhoid fever death rate in 40 States was 6.7 per hundred thousand, as compared with 8.3 in 1925.

The case and death rates for diphtheria for the year 1926 were the lowest ever recorded in the United States, but during the first six months of 1927 the incidence of this disease increased, although the .numbers of cases and deaths were much smaller than those reported a few years ago.

During the fiscal 3êar there was not much change in the number of ports reporting cases of quarantinable diseases. Plague and typhus fever were widespread and cholera was confined to Asia, but appeared to be spreading at the close of the fiscal year. Yellow fever has been eliminated from many places where it was formerly a, scourge, but it still exists in parts of Africa and occasional cases appear in South America.

Plague was reported from nearly all parts of the world with which we carry on commerce. I t appeared in Asia, Africa, Europe, and South America. Sporadic or imported cases, reported from ports



2 2 6 BEPQR.T ON THE FINANCES

where the disease is unusjial, emphasize(i the necessity for (constant vigilance. Although the numb.er of cases decreased in countries where the disease is usually prevalent, there was little, if ainy, decrease in the number of potts in which plague appeared.

The number of cases qf plague reported in India was less than the number reporte(i for the preceding fiiscal year. Inciia is the prin-: cipal center of infection for this disease. The incicienGe of plague also decreased in Siam, French Indo-China, and Java.

The Japanese steamship Manila Maru, from Pacific ports and ports in South America, arrived at New Orleans on Ocjtqber 24 with twQ human cases of bubonic plague. The cases were removed in quarajii-tine, where one patient subsequently clied. Diagnosis in both cases was confirmee! clinically and b.acteriologically. Repeated cyani.de fumigations were made during the (iischarge of ca,rgo under supervision into barges alongside. After complete discharge the Yessel was given thorough fumigation throughout and was then surveyed to locate the breeciing places of rats on the ship an(i perinanently to eliminate all these in so far as possible. The vessel left New Orleans on November 17, 1926, bound for Cristobal, Canal Zone; San Pe(iro, Calif.; Honolulu, Hawaii ; and Japan.

Cholera was prevalent during the fiscal year in In(iia, Siam, French Indo-China, China, Manchuria, and Korea. There was a s<evere epidemic during the summer of 1926 in Shanghai. Just after the close of the fiscal year the disease spread to ports in the Persian Gulf, Iraq, and Persia.

There has been a decrease in the number of cases of typhus fever since shortly after the close of the World War, but the disease is still a serious problem in the IJkraine, Russia, Poland, Rumania, and other parts of Eastern Europe and Asia. The disease is prevalent in Mexico and along the western coast of South America. Cases were reported in the Irish Free State.

Yellow fever was reported at Bahia, Brazil, early in the fiscal year. The only other cases of this disease reported were in Africa—Liberia, the Gold Coast, Togoland, Dahomey, Nigeria, and French West Africa. In some parts of this territory the disease was more prevalent than it has been for several years.

Smallpox was reported from Europe, Africa, Asia, North and South America, and many isolated ports.

Division of foreign and insular quarantine and immig^'ation

Quarantine transactions.—Duving the fiscal year 29,229 vessels and 3,054,594 persons were inspected by quarantine officers. Of these, 20,284 vessels, 820,793 passengers, and 1,140,922 seamen were inspected upon arrival at stations in the continental United States;




2,991 vessels, 169,461 passengers, and 226,373 seamen were inspected at insular stations; and 5,954 vessels, 424,172 passengers, and 272,873 seamen were inspected at foreign ports prior to embarkation for the United States.

Of the passengers who embarked at European ports 60,774 were vaccinated and 62,995 were deloused under the supervision of medical officers of the sfetvice. Their clothing aiid baggage, amounting to 63,472 pieces, were disinfected.

A total of 7,116 vessels were fumigated either because of the occurrence of disease on board or for the destruction of rodents, 31j073 rats Were recovered, of which nuinber 18,334 were examined for plague infection.

The efforts of the service to exclude quarantinable disease from the United States and its possessions wer^ successful. During the year 17 cases of smallpox, 2 of leprosy, and 2 of human plague reached our quarantine stations. No case of yellow fever, typhus, or cholera arrived at quarantine. The prophylactic measures applied by Public Health Service officers at foreign ports of departure undoubtedly contributed to this result.

During the past year quarantine officers were authorized to stccept as competent evidence, fumigation certificates properly visaed by a United States consul, provided the certificate contains the same, or substantially the same, information as Certificates of Fumigation of the United States Public Health Service, and, in addition, indicates the treatment of substantially all parts of the vessel, and if, after a thorough inspection of the vessel the medical officer accepting the certificate is satisfied that the fumigation has been performed in accordance with the requirements of the United States Public Health Service, and the vessel shows a satisfactory freedom from rat infestation.

I n view of the fact that the yield of rats after fumigation of oil fcanl5:ers is relatively low, the extension of the period between fumigation of such vessels has been authorized^ provided, upon actual detailed inspection they show no evidence of rat infestation. The necessity for fumigating tankers is now based upon the presence or absence of observed rat infestation and iiot upon previous ports of call or time elapsed since last acceptable fuiiiigation. If, after inspection, tankers are not free of rats, they will be fumigated. I t is expected that this procedure will materially diminish the nuniber of tankers fumigated.

In November of the past fiscal year medical officers of qtiarantine stations were authorized to begiii the use of Zykloii-B in the fuiniga-tion of ships. Fumigation with this HCN material not only greatly reduces the amount of equipment necessary, as compared with other




fumigants, but allows the work to be done with much less personnel and will reduce the cost of fumigation.

In conformity with the Pan American Sanitary Code, the Public Health Service has now printed and is now using the form of bill of health set forth in the appendix of said code and adopted as the standard bill of health.

During the past year a great deal of consideration has been given to the possible exemption from fumigation of ships from noninfected ports, provided they show no rat infestation and very slight rat harborage under a careful inspection of all parts of a vessel. In order to maintain a vessel in a rat-free condition, or at least to have the rat population reduced to an unimportant number, fumigation is necessary at least every six months or the vessel must be relatively rat-proof, and a great many steamship companies have come to realize in the past year the importance and economic value of rat-proofing their vessels.

i n accordance with article 28, International Sanitary Convention of Paris, 1926, a combined form of deratization or deratization exemption certificate was drawn up and was submitted at the last meeting of the Office International in April of this year. This certificate was received very favorably and is now in use at a number of the quarantine stations of the Public Health Service for recording results of inspections for rat infestation and rat harborage.

At the meeting of the First Pan American Conference of Directors of Health, which met in Washington, September 27-29, 1926, a committee was appointed to formulate a program for the investigation of plague. This committee consisted of Dr. Lucas Sierra, of Chile; Dr. Pablo A. Suarez, of Ecuador; and Dr. S. B. Grubbs, United States Public Health Service. This committee recommended that the Pan American Sanitary Bureau request each of its signatory powers to begin in one or more places, preferably ports, a plague survey of rats and fleas. Some of this work has now been started and reports of these surveys are being received, particularly from Ecuador. Rat-flea surveys are now being conducted in New York; San Juan, P . R.; Savannah, Ga.; and Norfolk and Newport News, Va.

Medical inspection of aliens.—There were 881,699 alien passengers and 996,198 alien seamen examined by medical officers at the various stations. Of this number 24,292 passengers and 3,117 seamen were "certified " in accordance with the act of Congress approved February 5, 1917.

The most important causes of certification of alien passengers were trachoma, 412; tuberculosis, 213; feeble-mindedness, 168; insanity,. 87; syphilis, 96; and gonorrhea, 354.

Of the alien seamen certified 112 were for trachoma, 44 for tuber-^ culosis, 420 for syphilis, 428 for chancroid, and 915 for gonorrhea.




Examination of alien passengers abroad.—There were 148,539 applicants for immigration visas examined by medical officers abroad. Of this number, 1,502 were reported to the consular officers as afflicted with one or more of the diseases listed in class A as mandatorily excludable; 11,485 were reported as afflicted with a disease or condition listed in class B as liable to affect their ability to earn their own living; 1,496 of the applicants reported in class A and 5,084 of those reported in class B were refused immigration visas by the consular officers because of the result of the medical examination.

Of 141,959 aliens who had been given a preliminary medical examination abroad and to whom visas had been issued, only a total of 9 were certified upon arrival at a United States port as being afflicted with class A diseases, resulting in mandatory deportation.


Public health problems resulting from the Mississippi flood were immediately met by the detail of Public Health Service officers to work in cooperation with the American Red Cross headquarters and with the State health officers in the flood area. Through the Public Health Service public health personnel for the affected area was secured not only from the Federal Government but from State and local health organizations throughout the country. In addition to trained personnel, biologic products such as smallpox vaccine, antityphoid vaccine, and the like were obtained from State and municipal agencies in the large quantities required. Response to the appeals for assistance were so prompt and generous that all needs were supplied within a few days from the beginning of the flood.

Upon the return of the people in the flooded area to their homes a comprehensive plan of county health work was developed; which, in the opinion of Federal and State health officials. Red Cross representatives, and representatives of the Rockefeller Foundation, will meet the needs during the rehabilitation period, and afford a foundation for the development of permanent health service. This plan was developed at a conference of public health officials and others held in New Orleans, La., on June 5,1927.

As presented to the department and approved, the plan provides for the establishment of county health units in the affected counties to be conducted under the immediate direction of the State boards of health and county authorities and made possible through the financial cooperation of the United States Public Health Service and the Rockefeller Foundation. I t is proposed that this arrangement continue for a period of 18 months from the time of its establishment, when it is believed that the States and communities will be in position to assume a much larger proportion of the expense, and that a reorganization of the plan will be in order.




Ninety counties in 7 States (Kentucky, Tennessee, Mississippi, Missouri, Louisiana, Illinois, and Arkansas) are iiicluded in the plan: During the fiscal year 1928, the cost of the work to the several agencies is estimated as follows:

State departments of health.- , $198,245 Counties 365, 390 United States Public Health Service. 262, 000 Rockefeller Foundation :__ 130,000

955, 635

Through its participation in the plan as indicated, the United States Public Health Service will be enabled to prevent the spread of smallpox, trachomaj and typhoid fever within the flooded areas and to other States, and to meet any emergencies due to other epidemic diseases that may arise. 'Th rough the program of work thus promptly inaugurated, grave apprehension on the part of the people in the flooded region as to the likelihood of widespread occurrence of pestilential disease followirig the flood has been allayed and confidence in health protection and conservation is being restored.

A serious epidemic of typhoid fever, resulting in approximately 5,000 cases of that disease and 500 deaths, developed in Montreal, Canada, beginning about March 1, 1927. The problems in connection with the prevention of the spread of the disease to the United States became so acute that a board of commissioned officers was detailed to make a survey of the typhoid fever situation in Montreal, permission having been granted by Canadian health officials. I t was ascertained that the cause of the epidemic was infected milk, and the conclusions of the board were to the effect that Montreal for the time being was not a comparatively safe place for visitors. - In addition health authorities of the States receiving shipments of milk and cream from Canada were strongly advised to see that all such products were pasteurized or otherwise processed under official supervision, so as to be rendered free from typhoid, tuberculosis, or any other infection liable to endanger human health.

Immediately upon notification of the hurricane disaster in Florida two medical officers and three sanitary engineers were dispatched to the disaster area for the purpose of aiding State and local health authorities in emergency measures for the protection of the public health. Smallpox vaccine and other biologic products were made available, and advice and assistance were given in the safeguarding of water supplies, sanitary disposal of wastes, and prevention of mosquito breeding.

No human plague has occurred in the United States during the current fiscal year. Plague in ground squirrels continues to exist over a large section of California and is a continuous public health




menace. Present methods of operation are not sufficiently intensive to eradicate ground-squirrel plague.

Hospitals for the eradication of trachoma, conducted in cooperation with State and local authorities, were operated at Rolla, Mo.; Knoxville, Tenn.; RussellviUe, Ark.; and Richmond, Ky.

Activities pertaiiiing to the certification of water supplies used on trains and vessels engaged in interstate traffic were conducted as heretofore, as were activities relating to the sanitary control of shellfish and to sanitation in national parks.

The Twenty-fifth Annual Conference of State and Territorial Health Authorities with the Public Health Service was held on May 20 and 21,1927.

Division of scientific research

Although the intensive student of public health is constantly observing the humanitarian and economic benefits which accrue from the application of scientific research in his subject, these benefits are often less apparent to those immersed in other affairs and to the public, unless some large emergency brings them conspicuously to light. During the past year the great emergency precipitated by the Mississippi floods gave opportunity for the application on a large scale of methods which had been developed in the kind of researches carried out by the Public Health Service and here briefly summarized. The malaria researches developed methods of screening the ill-constructed cabins commonly encountered in certain malarious regions, so that a great measure of protection against the mosquito carriers of the disease was afforded at moderate costs. The nutrition researches have ascertained the pellagra-preventing properties of many common foodstuffs, so that it is possible to select a dietary calculated to prevent pellagra. Aside from certain diseases, the method of prevention of which was already known, malaria and pellagra were the most serious menaces to the flood-stricken populations, and these researches have furnished the most practicable and economic means for minimizing the danger.

The stream-pollution studies have furnished during the year additional instances of the value of resorting to scientific inquiry rather than to legal controversy in the settlement of sanitary questions arising from the pollution of interstate waterways, as well as of the indispensable nature of fundamental studies which made these inquiries possible.

The areas in which,Rocky Mountain spotted fever is prevalent are becoming opened up more and more to tourist and commercial invasion, thus magnifying the danger of increasing the number of infections with this often fatal malady. The administration of a vaccine devised and prepared by research workers of this service

64761—FI 1927 17




appears to have greatly reduced the number of infections and absolutely prevented fatal outcomes for the exposed persons who received it.

Diversified studies in pressing health problems encountered in industry have continued to furnish reliable and up-to-date information of value both to employers and employed. The studies of certain aspects of child hygiene have been continued with satisfactory progress. The sanitary studies of milk supplies have been of noteworthy benefit in the places where they have been carried out, resulting not only in improving to a marked degree the safety of milk from a health standpoint, but in actually increasing the total supply of market milk, while the administrative difficulties of health officials have been reduced and the producers encouraged to improve their methods. In view of the disasters which can be caused by improperly controlled milk, as illustrated during the year in a large Canadian city, the importance of these studies is self-evident.

The survey of the salt-marsh mosquito menace completed its first full season with several reassuring developments. The problem, which is serious enough from an economic standpoint, appears, however, not to have the stupendous scope which was assumed from a preliminary study of the maps. The immense potential mosquito-breeding area appears to be producing only in certain spots, and it is believed that sufficiently cheap methods of eradication may be developed greatly to ameliorate conditions.

At the Hygienic Laboratory studies of great diversity have been prosecuted, ranging from those in the underlying sciences on which modern health practice is founded to investigations of acute practical problems demanding early solution. Among the latter is the somewhat disturbing increased prevalence of typhus fever in this country, which offers some unexplained differences from the accepted conception of European typhus, although evidently due to an identical ultimate agent.

Among other studies in which satisfactory progress has been made are those of leprosy, goiter, infiuenza, Malta fever, and trachoma. In the case of tularaemia, accumulating evidence shows this disease, discovered during researches conducted by the service, is widespread throughout many parts of the country, although the actual number of .human infections has fortunately been relatively Small. The means of avoiding this infection having been shown, it is hoped that still fewer cases will be encountered in the future.

I t is apparent that no matter how much knowledge may be avail-.able regarding the means of avoiding disease and improving health

^ these ends will not be achieved unless the knowledge becomes applied. * For this reason the Public Plealth Service attempts to bring this knowledge to the attention of health officials, physicians, and the




general public by all available measures. Among these perhaps none is more helpful than the publishing of the results of surveys of health administration in States and cities. During the past year the assembled surveys of the 100 largest cities of the United States were published by the service, thus enabling health officials to become acquainted with current practice in many places and to profit in their own jurisdiction by the advances or the mistakes which were being made elsewhere.

Division of 7narine hospitals and o elief

The American merchant marine, which in 1789 carried only 201,562 tons of cargo, now carries more than 17,000,000 tons annually and employs nearly a quarter of a million seamen. The medical care and treatment of merchant seamen was undertaken by the Federal Government in 1798 and has been continued, without interruption, as a tangible contribution to the effort to keep the merchant flag on the seas. Many merchant seamen are still living who contributed to the Marine Hospital fund directly from their wages according to laAvs existing previous to 1884, Avhen direct levies Avere discontinued and the tonnage tax on vessels was imposed. Among these seamen and some others there is a widespread belief that sums greatly in excess of expenditures were thus collected by the Government between 1798 and 1884. This fallacy has sometimes resulted in criticism of the Federal Government and merits a correction. All collections from seamen from 1799 to 1884, inclusive, aggregated $15,794,807.63, the amounts collected from each seaman by the customs officers being 20 cents per month from 1799 to 1870, and 40 cents per month from that time until 1884.

Cost of cooistruction, repairs, and maintenance of maiîne hospitals, fiscal years 1798-188J , inclusive

Fiscal year

1798-1877 1878 1879 1880 1881

Cost of construction,

repairs, etc.

$3,304,704.80 8,140. 01 5, 051.17

12,050. 74 2,042.76

Cost of maintenance

$13,302, 667. 06 367,950. 32 375,164.01 402,185.49 400,404.46

Fiscal year

1882 1883 . 1884

Total

Cost of construction,

repairs, etc.

$54,192.02 45,138.16 37,460. 08

3,468,779. 73

Cost of maintenance

$413, 928.14 434,525. 29? 456,767. 37

16,153,592.14

I t is evident from the above statement that the sums collected from seamen did not equal the expenditures for the period, which aggregated for maintenance and construction purposes $19,622,371.8Tc.

During the fiscal year ended June 30, 1927, approximately 300,000 beneficiaries applied at the 25 United States marine hospitals and 12S other relief stations of the Public Health Service, of whoin 41,951 were treated in hospitals, 210,252 in out-patient offices, and 62,008




were given physical examinations not related to treatment and re-quiring a written report to the master of an American vessel or some requesting agency of the Federal Government. Civilian seamen from American merchant vessels continued to be the principal beneficiaries, a complete list of which follows:

Seamen, American merchant marine. Oflacers and enUsted men, United States Coast Guard. Officers and seamen, United States Coast and Geodetic Survey. Keepers and assistant keepers, United States Lighthouse Service. Seamen, vessels of the United States Army (Engineer Corps and Army

Transports). Seamen, Mississippi River Commission. Patients of the United States Employees' Compensation Commission. Lepers.

PAY PATIENTS

Patients of the United States Veterans' Bureau. Personnel of the Army, Navy, and Marine Corps. Foreign seamen and nonbeneficiary seamen. Immigrants.

PHYSICAL EXAMINATIONS ONLY

Civil service applicants and employees. Civil service employees for retirenient. Civil service employees suspected of having tuberculosis or other communi

cable disease. Applicants for pilot's license. Able-bodied seamen, for rating. Applicants for military pensions. Applicants for Officers' Reserve Corps, United States Army. Applicants for citizens' military training camps. Food handlers on vessels engaged in interstate trade. Applicants for aviator's license to the Department of Commerce.

Medical officers on duty at marine hospitals and relief stations, in addition to their other duties, instruct and examine all ships' officers for American vessels in first aid; give medical advice by radio to inquiring ships at sea; issue permits to ships for medicinal liquor and narcotics and bills of health to outbound vessels; make special investigations of claims for compensation for injury for the Employees' Compensation Commission and for the Committee on Claims, House of Representatives; vaccinate Government employees engaged in handling mail or in interstate or foreign travel; inspect immigrants; treat sick immigrants and detained Federal prisoners; and serve on all Coast Guard boards for admission, promotion, and retirement. Twenty-four medical and dental officers are detailed to the commandant. United States Coast Guard, for duty aboard cruising cutters and elsewhere, and 99 contract physicians provide emergency medical care for small Coast Guard stations remote from marine hospitals and other regular relief stations. Medical supplies are furnished to all ves-




sels and shore stations of the Coast Guard and vessels of the Lighthouse Service. The personnel of the Coast Guard now numbers 10,984 officers and men, an increase of 11.62 per cent for the year, and furnish approximately 14 per cent of the hospital and out-patient clientele.

The number of physical examinations has increased rapidly within recent years, particularly among civil service applicants and post-office employees, and it was not possible to comply with all requests, although a careful physical examination by an impartial medical officer is of great value in determining fitness for specified duties, in preventing sickness and disability, and to safeguard against fraudulent claims for compensation.. I t is of much greater value than what President Harding termed " the friendly certificate of the family physician." The secretary of the Civil Service Commission, in a letter dated June 27, 1927, states that because of recent legislation enlarging the benefits to employees under the retirement and the employees' compensation statutes an increasing number of physical examinations will be required. The chairman of the Employees' Compensation Commission, in a letter dated June 21,1927, has also requested a much larger amount of service than that previously rendered because of the longshoremen's and harbor workers' compensation act, affecting approximately 400,000 longshoremen and harbor workers and requiring examinations involving a very special degree of care, amounting often to complete medical surveys. The Post Office Department, in a letter dated June 22, 1927, requests additional services involved in the physical examination of post-office employees to determine fitness for certain duties and for first aid in the large establishments. To comply with the above requests it will be necessary to increase the appropriations to augment the personnel at the relief stations concerned, and estimates to the desired end have accordingly been made by the Surgeon General.

Division of venereal diseases

Various phases of research in connection with venereal diseases were undertaken during the year. One of the most important of these has been the effort to determine the prevalence of these diseases in the general population, which has been carried out in a number of cities and rural districts. As a result of these studies it has been found that on an average 1.5 per cent of the population of the cities studied are constantly under treatment for gonorrhea or syphilis.

The venereal-disease clinic at the Hot Springs National Park has been continued, 3,682 patients receiving 58,489 treatments during the year. This clinic serves as a laboratory in which various practical phases of venereal-disease control can b„e investigated. Attention




was given to the prevention of venereal diseases among beneficiaries of the service by the utilization of the facilities offered in certain of the marine hospitals for study of more effective measures of prevention and treatment. A publication was issued which was designed primarily for merchant seamen giving the facts concerning venereal diseases and their prevention. During the year studies were undertaken to determine the value of nonspecific methods of therapy in syphilis, to investigate the immunity which is developed during the course of this disease, and to investigate certain bacteriological problems in gonorrhea.

Although no money has been appropriated since 1925 for allotment to States for venereal-disease control, active cooperation of the States has been maintained, and reports are being received regularly from nearly- 500 venereal-disease clinics in which 107,688 patients were given 1,964,233 treatments during the year.

Educational work consisted of informing the public through bulletins, pamphlets, and motion pictures of the importance of the venereal diseases, in furnishing material to more than 200 summer schools upon which they based courses in sex education, and a study of methods being employed in the high schools of the country in connection with sex hygiene and venereal-disease control. This study initiated such a large volume of requests for information from school authorities that a symposium on sex education was issued and is being distributed to them.


At the close of the fiscal year the regular commissioned officers of the service numbered 228, which included the Surgeon General, 3 assistant surgeons general at large, 21 senior surgeons, 135 surgeons, 21 passed assistant surgeons, and 47 assistant surgeons. Eighteen officers were on waiting orders. Four resignations and four deaths occurred in the regular commissioned corps during the year.

Seventy-two reserve officers were on active duty July 1, 1927, including 1 assistant surgeon general, 1 senior dental surgeon- 6 surgeons, 3 dental surgeons, 9 passed assistant surgeons, 16 passed assistant dental surgeons, 31 assistant surgeons, and 5 assistant dental surgeons.

The following list shows the total personnel on duty July 1, 1927:

Commissioned medical officers, regular corps 228 Commissioned officers. Reserve Corps 72 Acting assistant surgeons 496 Attending specialists and consultants 224 Contract dental surgeons : : . 34 Internes 18 Scientific personnel, general 24



SECRETARY OF THE TREASTJRY 237

Pharmacis ts 35

Administrative assistants 16

Druggists :— 11

Nurses 342

Aides 2. 35

Diet i t ians ^ 21

Uaboratorians 26

Scientific^—Hygienic Laboratory. . . — _ — 26

Pilots - — 36

Marine engineers — - - 36

Olerks — 414

All other employees •- 2,305

Total - - — . - — - — 4, 399

This total does not include 4,418 persons appointed, at nominal compensation, to assist in the collection of epidemiologic data. They are fbr the most part officers or employees of State and local health organizations who transmit to the service reports of disease preva-, ience gathered by those agencies.

Financial statement

A statement of appropriations and expenditures for the fiscal year 1927 follows:


Public Health Service proper: . Salaries, oflQce of Surgeon General Pay, etc., commissioned oflBcers and pharmacists Pay of acting assistant surgeons . Pay of other employees Freight, transportation, etc Maintenance, Hygienic Laboratory _._. Preparation and transportation of remains of officers Books - -. Pay of personnel and maintenance of hospitals Quarantine service 1. Preventing the spread of epidemic diseases Field investigations of public health Interstate quarantine service. Studies of rural sanitation. . ..-_ Control of biologic products..

•. ExpenseSi-division'of;venereal diseases Survey of salt-marsh areas. South Atlantic and Gulf States

Total, Public Health Service proper

Allotments from U. S. Veterans* Bureau:

Medical and hospital service. Veterans Bureau

Total, U. S. Veterans'Bureau funds

Grand total

$101,000.00 1,175,000.00

300, 000.00 1,000,000.00

25,000.00 43,000. 00

1,500.00 500. 00

5,517,966.31 460,000. 00 430,000.00 280,000.00 69,000.00 75,000.00 45,000.00 75.000. 00 25,000. 00

$98,982. 30 1,171,648. 83

292,065. 67 977,113.74 24,696.30 42,495,86

348,00 498. 96

6,4.76,377. 94 455,846.16 229,126. 79 273,825. 20

64, 859. 61 70,562.18 44, 468.99 74,749.37 18,474.04

9, 622. 966. 31 9,316,139. 94

2 262,895. 40 262,895.40

262, 895. 40 262,895.40

9, 885,861. 71 9,579,035.34

1 Includes $267,966.31 reimbursement for care and treatment of U. S. Veterans' Bureau patients and miscellaneous.

2 Includes $13,695.40 obligations not yet reimbursed.

r



8 6 REPORT ON THE FINANCES

The salient features of these agreements are as follows: (1) The direct exchange, between the Treasury Department and

the corresponding office in the foreign country, of information and evidence with reference to persons engaged in the illicit traffic. This includes such information as photographs, criminal records, finger prints, Bertillion measurements, description of the methods which the persons in question have been found to use, the places from which they have operated, the partners they have worked with, etc.

(2) The immediate direct forwarding of information by letter or cable as to the suspected movements of narcotic drugs, or of those involved in smuggling drugs, if such movements might concern the other country.

The following Governments are parties to these agreements: France, Great Britain, Germany, Belgium, Czechoslovakia, Italy, Spain, Netherlands, Japan, Free City of Danzig, and Greece.

During the fiscal year, at its October, 1927, term, the United States Supreme Court rendered two decisions in cases which involved the act of December 17, 1914, known as the Harrison narcotic law, as amended. One of these decisions again upheld the constitutionality of the principal penal provision of'section 2 of the act, and the other sustained a conviction under section 1 of the act in a case involving unauthorized possession of narcotic drugs. Both of these decisions have the effect of strengthening the position of the Government with reference to the usual types of prosecution under this law.


Health conditions generally were relatively good throughout the world during the year, and final figures will probably show an unusually low death rate for the United States. In this country the death rates from infiuenza and pneumonia were low, and the death rate for typhoid fever in 41 States was 5.5 per 100,000 population— 19 per cent lower than the rate for 1926 and 35 per cent lower than tha t for 1925. At the beginning of the century the rate was 30 per 100,000. The tuberculosis death rate for 41 States was 77.3 per 100,000 population—the lowest ever recorded for those States.

Outbreaks of yellow fever occurred in both hemispheres during the fiscal year 1928, indicating that endemic foci exist and that this disease must still be regarded as a potential danger. The disease was reported in the Belgian Congo, on the West Coast of Africa, and toward the close of the fiscal year occurred in several ports as well as points m the interior of Brazil.

Bubonic plague, spread by commerce, is present on every continent. During the fiscal year it was reported from one district on the island of Hawaii, and two human cases were reported in California, where the infection came from ground squirrels.




Although the acute phases of the Mississippi flood occurred for the most part prior to July 1, 1927, the task of preventing the development and spread of epidemics and communicable diseases began when the refugees returned to their homes, and lasted throughout the year. Through the plan of establishing efficient whole-time county health departments in 86 counties most seriously affected by the flood, satisfactory health conditions have been maintained.

In July and August of 1927 there was a somewhat alarming increase in the number of cases of pellagra, a disease which is due to the lack of a properly balanced diet and which commonly follows periods when people are compelled to restrict their diet. The distribution of brewers' yeast to those affected was recommended by the Public Health Service, and the yeast was made available through the offices of the American Red Cross. The use of this substance arrested a large number 'of cases and prevented the development of others. The county health units in the flood area provided an effective means for the distribution of the yeast and instruction in its use." The yeast, while allaying the symptoms and preventing the, disease to

^some extent, can by no means be considered a satisfactory substitute for the proper kinds of food.

The marine hospitals and other relief stations of the Public Health Service have continued to furnish medical and hospital care to seamen from American merchant vessels and to other legal beneficiaries. The Congress has, from time to time, extended these benefits, espe^ cially to Government employees with duties related to maritime industries. The longshoremen's and harbor workers' compensation act, approved March 4, 1927, the increase in the personnel of the Coast Guard from less than 5,000 in 1923 to nearly 12,000, and the act of May 18, 1928, entitling retired officers and retired enlisted men to medical treatment at marine hospitals and out-patient offices have greatly increased the demand for medical relief. The Director of the Veterans' Bureau has requested that facilities be made available in marine hospitals for increased numbers of patients at Cleveland, Detroit, Buffalo, Baltimore, New Orleans, and Portland, Me., and has continued to use all beds not otherwise needed at the marine hospitals in Pittsburgh, Key West, Evansville, Louisville, and other ports where Veterans' Bureau hospitals are lacking. The merchant marine act, approved May 22, 1928, will probably lead to a rapid expansion of the American merchant marine under private ownership, with a further increase in the demand for medical services.

To meet these growing obligations, larger and better marine hospitals have been authorized in certain important ports—^v^, Detroit, New Orleans, San Francisco, and Galveston. Provision has been made for the purchase of a suitable building for an out-patient office in Philadelphia. I t is anticipated that funds authorized by the act approved February 24, 1928, will be allotted for the con-



SB REPORT ON THE FINANCES .

struction of fireproof buildings at the marine hospital, Stapleton, N. Y., to replace inflammable structures and increase the capacity, and also to provide new marine hospitals at Baltimore and Seattle and additional hospital facilities in other important ports.

Following the ratification by the Senate, the President on June 21, 1928, proclaimed the International Sanitary Convention, signed at Paris in 1926, which revised the convention of 1912 and brought up to date provisions for the international control of dangerous communicable diseases.

At the request of the British Ministry of Health, the Surgeon General, who was in Europe at the time attending an international meeting, and Surgeon J. P. Leake sat with distinguished scientists who had been appointed to investigate the public health dangers consequent upon the use of certain chemicals used in motor fuel. I t is gratifying to know that the British Government reached the same decision with reference to the lack of danger from these substances which' had already been reached by the committee of scientists -appointed by this Government to consider the question.

The plan for conducting abroad the medical examination of intending immigrants, which proved extremely advantageous in other •countries, was with equal success extended early in the fiscal year to 'Genoa, Naples, and Palmero, Italy; and to Prague, Czechoslovakia.

Modifications were made in the quarantine practice which relieved from quarantine inspection vessels engaged exclusively in trade between ports in the United States and ports in the possessions and dependencies, unless quarantinable diseases should be prevalent at the port of departure.

Another beneficial modification in quarantine procedure, as concerns vessels plying exclusively between United States ports and uninfected foreign ports, was to base fumigation of such vessels for rodent destruction on the presence of rat infestation' as shown by inspection. Heretofore this class of vessels had been fumigated periodically. The new system is logical and in conformity with the spirit of the International Sanitary Convention of 1926.

In the administration of the work of the Public Health Service, the need of additional officers in the regular commissioned corps is one that has been pressing in the past few years. Since the beginning of the examination of intending immigrants at American consulates in the country of origin, which has been in operation in Europe and the British Isles since 1925, the number of medical officers required for this work has increased until at the present time approximately 16 per cent of the regular corps are assigned to this duty. The many advantages of performing the medical examination of intending immigrants prior to the granting of consular visas have been so apparent that the existing procedure will not doubt continue; and since it has been necessary to withdraw officers from other work to meet the




need abroad, provisions should be made for their replacement for work in this country.

RECOMMENDATIONS FOR LEGISLATION

Austrian debt

I recommend that the Congress enact the bill introduced in the last session authorizing the Secretary of the Treasury, in his discretion, to subordinate, for a period not exceeding 30 years from January 1, 1929, the lien of the United States on Austria's assets and revenues to the extent necessary to permit the flotation of the new loan proposed, subject, of course, to satisfactory notiflcation that the other governments and the Reparation Commission agree to take similar action; and authorizing the Secretary of the Treasury, with the approval of the President, to conclude an agreement for the settlement of the indebtedness of Austria to the United States upon terms and conditions no less favorable than the terms and conditions granted by Austria to any of the other relief creditor governments. The Austrian debt situation is summarized on pages 55 to 57.

Greek debt

I recommend that the Congress enact the bill introduced in the last session authorizing the Secretary of the Treasury to conclude a debt agreement with the Greek Government. The proposed settlement will assure to the United States the repayment in full over a period of 62 years of the $18,125,000 to be funded. I t will discharge what may fairly be considered a moral obligation, resulting from the 1918 agreement, by advancing a sum of money to be wholly devoted to constructive work of great humanitarian as well as economic value, which loan will bear an adequate rate of interest and be amply secured by pledged revenue. The Greek debt situation is summarized on pages 53 to 55.

Tax exemption of Federal bonds

I recommend that the Congress consider an amendment of the second Liberty loan act, as amended, authorizing the Secretary of the Treasury to exempt further issues of securities from the surtax as well as the normal tax.

The enactment of such an amendment would not interfere with the subsequent adoption of a constitutional amendment permitting the Federal and the State Governments to tax so-called tax-exempt securities, should the Congress and the States deem such an amendment desirable. But pending the adoption of such an amendment, there is no reason why the Treasury Department in marketing securities should be at a disadvantage as compared with States and




Division of sanitary repoo^ts and statistics

Reports of the prevalence of diseases dangerous to the public health were received from the United States and from countries throughout the world wherever records are kept. The reports from this country were secured largely through the cooperation of State and city health departments. Reports from foreign countries were received through officers of the Public Health Service stationed abroad, American consuls, and from foreign governments. The Public Health Service cooperates with the health section of the League of Nations, the International Office of Public Hygiene, and the Pan American Sanitary Bureau in the collection and prompt dissemination of information mutually valuable regarding the outbreak and prevalence of communicable diseases.

During the year the method of tabulating the reports of quarantinable diseases from foreign countries or ports as published in the Public Health Reports was changed so as to enable quarantine officers to see at a glance the prevalence and immediate progress of the disease in each place from which reports are received.

The weekly Public Health Reports, publication of which was continued throughout the fiscal year, contains current information of the prevalence of diseases dangerous to the public health in the United States and abroad and articles on subjects of interest to public health workers, especially the results of scientific investigations in the realm of public health. The more important of these articles are reprinted for economical distribution and some are issued as supplements to the Public Health Reports.

The collection, compilation, and publication of laws, ordinances, and regulations pertaining to the public health were continued during the fiscal year. Abstracts of court decisions of interest to health workers were prepared and published from time to time. Work was done on the compilation of laws, regulations, and court decisions pertaining to the collection of morbidity reports.

A revision of the mailing lists of the Public Health Service during the year resulted in a reduction of approximately 5,000 addresses. A total of 236,728 copies of publications were distributed, as compared with 319,471 during the preceding fiscal year. The reduction was necessary because of the limited appropriation available for printing.

201



2 0 2 REPORT ON THE'FINANCES

Nearly 4,000 stereopticon slides were loaned to universities, officers of the Public Health Service, and others during the year. Lack of funds for replacements and new slides has restricted the usefulness of this service.

Radio broadcasts were issued regularly twice each month, and these were sent out by the Navy radio station at Washington, D. C , and 53 other stations throughout the country.

Division of foreign and insular quarantine amd inwiigration

Quarantine transactions.—During the fiscal year 25,091 vessels and 2,787,631 persons were inspected by quarantine officers. Of these, 18,667 vessels, 887,912 passengers, and 1,085,385 seamen were inspected upon arrival at stations in the continental United States; 2,964 vessels, 158,407 passengers, and 223,296 seamen were inspected at insular stations; and 3,460 vessels, 314,285 passengers, ,and 118,346 seamen were inspected at foreign ports prior to embarkation for the United States.

Of the passengers who embarked at European ports, 56,320 were vaccinated and 66,509 were deloused under the supervision of medical officers of the service. Their clothing and baggage, amounting to 66,324 pieces, were disinfected.

A total of 5,637 vessels were fumigated either because of the occurrence of disease on board or for the destruction of rodents; and 23,371 rats were recovered, 18,821 of which were examined for plague infection.

The efforts of the service to exclude quarantinable disease from the United States and its possessions were successful. During the 3?'ear only 7 cases of smallpox, 1 case of leprosy, and 2 cases of typhus fever reached our quarantine stations. The prophylactic measures applied by Public Health Service officers at foreign ports of departure undoubtedly helped to prevent the arrival of cases of plague, yellow fever, and cholera.

At the suggestion of the Surgeon General, the Panama Canal Zone authorities adopted the international standard form of bill of health as prescribed for use under the Pan American Sanitary Code. This now permits the elimination of the requirement for quarantine inspection at the United States port of arrival for those vessels engaged in intercoastal trade which have not called at foreign ports enroute, but which have stopped in the Panama Canal Zone and taken on cargo or passengers. I t will facilitate the movement of intercoastal vessels and remove a requirement which has been frequently the basis of technical quarantine violations, resulting in the infliction of mitigated penalties.

The form of certificate covering ship fumigation for deratization, and also used for reporting deratization exemption, which was




evolved and used bj^ the Public Health Service for the past year and a half, has been formally adopted by the Office International d'Hygiene Publique, and is now prescribed for international usage under the terms of the International Sanitary Convention.

During the year the requirements for taking out American bills of health in foreign ports have been clarified and somewhat modified, which will benefit shipping without lessening the quarantine precautions; and this, too, is expected to result in the removal of a fairly frequent basis of technical violation of quarantine requirements.

The schedule of charges for quarantine services rendered at the national quarantine stations was revised, principally downward, during the year so that such charges are now better equalized and representative of the average actual cost of such services.

The Public Health Service took over from the local boards of health and during the past fiscal year assumed charge of the quarantine activities in the ports of Beverly, Salem, Lyiin, Plymouth, and New Bedford, Mass., and New London, Conn. Arrangements were also made for the performance of the necessary quarantine and medical immigration inspections in connection with the establishment of air ports of entry in a number of ports.

A new station was opened at Roma, Tex., to serve the newly constructed bridge crossing the Rio Grande at that point, which opened March 1, 1928. There are also now pending or under actual construction several other international bridges across the Rio Grande at various points, and w^hen these are completed it will be necessary to make further provision for the medical examinations required, Similarly, the administration of the medical examination of arriving aliens along the Canadian border has been strengthened and extended, particularly east of the Great Lakes, in which sector increased facilities have been provided.

Medical inspection of aliens,—There were 1,178,482 alien passengers and 928,423 alien seamen examined by medical officers at the various stations. Of this nuinber, 16,473 passengers and 2,117 seamen were "certified" in accordance with the act of Congress, approved February 5, 1917.

The most important causes of certification of alien passengers were: Trachoma, 548; tuberculosis, 186; feeble-mindedness, 167; insanity, 131; syphilis, 160; and gonorrhea, 444.

Of the alien seamen certified, 77 were for trachoma, 35 for tuberculosis, 291 for syphilis, 356 for chancroid, and 627 for gonorrhea.

Examination of alien passengers abroad.—There were 167,033 applicants for immigration visas examined by medical officers abroad. Of this number, 2,409 were reported to the consular officers as afflicted with one or more of the diseases listed in class A as mandatorily ex-




cludable; 14,868 were reported as afflicted with a disease or condition listed in class B as liable to affect their ability to earn a living; 2,408 of the applicants reported in class A and 5,342 of those reported in class B were refused immigration visas by the consular officers because of the result of the medical examination.

Of 159,283 aliens who had been given a preliminary medical examination abroad and to whom visas had been issued, onlj^ 17 were certified upon arrival at a United States port as being afflicted with class A diseases, resulting in mandatory deportation.


The plan for meeting the health problems in the area affected by the Mississippi flood in the spring of 1927 has been carried out and has proved successful. No epidemics have developed and there has been no great increase in the incidence of communicable diseases either in refugee camps or among the inhabitants of the flooded area after returning to their homes.

As provided by the plan, county health units consisting in most instances of a medical health officer, a public health nurse, a sanitary inspector, and an office assistant were established in 83 counties in 7 States, as follows: Louisiana, 21; Kentucky, 24; Arkansas, 20; Mississippi, 9; Missouri, 5; Tennessee, 3 ; and Illinois, 1. In every county the local authorities recognized their obligation to meet the share of expense allotted to them, and with few exceptions the money w as appropriated and made available. In a few instances in which the counties were unable to pay, the other agencies carried on the necessary work with the understanding that such counties would assume their share as soon as funds were available.

The organization, establishmerit, and supervision of the county health units were accomplished for the most part by officers of the Public Health Service who were assigned to the various State departments of health for this purpose. The cooperative agencies, consisting of the Public Health Service, the State departments of health, the county authorities, and the Rockefeller Foundation, carried out the provisions of the original plan described in the report for the preceding year and worked in perfect accord. The assistance of the Rockefeller Foundation was of inestimable value, not only in contributing funds and acting in an advisory capacity but also in establishing a training center at Indianola, Miss., for health officers, public health nurses, and sanitary inspectors prior to their assignments in the counties.

The activities of the county health units in the flood area are outlined briefly as follows:




1. Sanitation: InstaUation of sanitary toilets. Restoration of old or inadequate toilets. Installation of septic tanks. Effecting sewer connections. Effecting water connections. Safeguarding and improving wells and cisterns. Safeguarding milk supplies. Safeguarding food supplies. Screening and otherwise protecting against flies and mosquitoes. Abating nuisances.

2. Communicable disease control: Visits to cases, carriers, contacts, suspects. Isolation or quarantine of above.

• 3. Immunizations: Antityphoid vaccinations. Antismallpox vaccinations. Toxin-antitoxin administrations for prevention of diphtheria.

4. Child hygiene: Examinations of school children and securing correction of defects

found. Instruction of midwives. Instruction in health habits and hygiene.

5. Laboratory examinations: Securing specimens of blood, sputum, throat cultures, etc., necessary

for diagnosis of communicable diseases and forwarding to State laboratories for examination.

Securing and forwarding water and milk samples for examination. 6. Educational:

Lectures. Distribution of literature. Preparation of newspaper articles. Personal conferences. Office visits.

The occurrence of two cases of bubonic plague in California, in which the infection was acquired from ground squirrels, and the reports of these plague-infected animals in various parts of that State point impressively to the fact that this dangerous reservoir of infection is an endemic focus of bubonic plague in the North American Continent, and emphasizes the menace to the public health which exists as a result of failure to combat this condition by adequate measures.

Measures for the prevention of interstate shipments of shellfish from polluted waters have been carried out in cooperation with State boards of health and conservation commissions. Approval of State certificates as to safe growing areas is given by the Public Health Service when justified, and lists of dealers in producing States who have met the requirements of the State and Federal authorities are published for the information of health authorities in consuming States. Information concerning States whose facilities and methods




are not approved, with the reasons for failure to receive approval, are also forwarded to health authorities of consuming States when necessary. No such notifications have been necessary during the year.

Measures for insuring safer water supplies on interstate carriers are in operation, as are those for preventing the interstate spread of disease by infected persons or things.

Trachoma eradication work is in progress in Missouri, Tennessee, Kentucky, and Arkansas. Assistance in the diagnosis and control of this disease has also been given the State health authorities of other States upon their request.

The twenty-sixth annual conference of State and Territorial health authorities with the Public Health Service was held at St. Paul,

' Minn., June 8 and 9, 1928, with representatives of 33 States in attendance.


The Public Health Service has continued during the past year to prosecute studies of public health subjects which fall within the domain of a Federal health service. These studies, as has been stated in previous reports, may be grouped into two categories which are more or less w ell defined, although overlapping occurs with advantage : The investigation of principles of basic sciences which apply to public health problems and the solution of immediate difficulties which are encountered in practical health work. In this way not only is the daily work of the health official facilitated but the foundation is laid for more enlightened work in the future.

The continuation of studies, described under the same captions for several years past, has been desirable either on account of the exceptional difficulty of the subject or of its inclusive nature, or because changes in the human environment have necessitated a shifting of the points of attack. The work on Rocky Mountain spotted fever is an instance of a problem of extreme difficulty where an aggregate of many years' work reached its culmination in the preparation of a vaccine which has a high protective power against this disease. During the year successful efforts were made to simplify and improve the process of manufacture so that an adequate supply might be produced. The stream pollution investigations are an example of studies continued over a long period of time because of the inclusive nature of the subject. When the multiplicity of conditions imposed both by nature and by man are considered as they affect the pollution and the purification of streams, the complexity of the problem becomes evident. Some of these studies above mentioned have been directed to the formulation of generally applicable principles; and others to the solution of immediate difficulties, such, for example, as are en-




countered when tw o or more States desire to cooperate in remedying a menacing pollution of boundary waters. As an example of studies long continued under the same caption because changing conditions-have altered the problem, the malaria investigations may be chosen. I n this case, although natural conditions continue to offer difficult problems for rural populations, the activities of man himself have brought up new and important questions of malaria control. The vast scale of hydroelectric water impounding projects in naturally malarious regions has made this potential source of increased malaria prevalence very important. At the same time the practical development of the airplane, used to distribute Paris green dust over mosquito-breeding areas, has furnished a remedy which the Public Health Service investigations have shown to be effective under selected conditions.

The investigations, grouped under the heading "Industr ial Hygiene," have continued to yield information of value both to employers and employed in industry, and furnish an excellent example of the satisfaction to be derived from recourse to the experimental method for the solution of apparent difficulties of adjustment. The studies of specific dust hazards have been virtually completed, and the emphasis has been shifted to dangers which are introduced by new methods, chiefly chemical, which are spreading rapidly in industry.

Progress has been made iri the child hygiene studies of the service,. and a number of publications have been prepared based upon material gathered from the same population group over a period of several years. The studies of the sanitary control of milk by cities have progressed favorably. The advantages of adopting uniform methods over a considerable geographic ,area have become apparent in the-resulting improvement of the sanitary quality of milk, which has gone hand in hand with a remarkable increase in the consumption of the product of progressive producers.

The studies of the salt marsh mosquito problem have made satisfactory progress and .a report, covering the varied conditions encountered throughout the vast coast line and the existing remedies-for them, will be forthcoming upon their completion.

The H3^gienic Laboratory has continued to produce valuable information on a wide variety of timely public health subjects. I ts standardization of the new scarlet fever biological products has put the modern attack upon this disease upon a safe and practicable basis.. I t s further investigations into undulant fever, transmitted to man from cattle and swine suffering from contagious abortion, have stimulated interest among the public health and medical professions, resulting in the discovery of an unsuspected prevalence. In one State-

13606—29—FI1928 16



2 0 8 , REPORT ON THE FINANCES

this disease in man has beeri estimated to outrank, in importance, typhoid fever and the paratyphoid fevers combined. Means of prevention have been suggested.

Increased interest and activity in the great cancer problem has characterized" the work of the service during the past year. This has been due to the development within the service of several promising lines of investigation. Upon seeking the counsel of a group of some of the most prominent cancer students of the country the prosecution of this work on an enlarged scale was indorsed and a suitable program laid down. The encouraging work has consisted in the main of the successful treatment of cancers in the lower animals by electric currents of extremely high frequency and of the development of a new means of measuring cellular activity.

Division of nnarine hospitals and relief

The segregation of lepers in accordance with the act approved February 3,1917, has been continued with marked success, the various States sending their leper patients to the marine hospital (National Leper Home) at Carville, La., instead of maintaining, as formerly, many small segregated groups in various parts of the country. Approximately 300 lepers are now under treatment there, of whom 73 from 18 different States were admitted during the past year. Eighteen patients died and 11, having recovered, were discharged. The results of treatment are very encouraging and a hopeful spirit prevails among the patients, who are cooperating with commendable zeal in the routine and rigorous therapeutics.

A total of 349,199 beneficiaries applied at the marine hospitals and other relief stations of the Public Health Service for medical services, of whom 244,040 were patients requiring treatment and 105,159 were applicants for physical examinations for purposes other than treatment. Of those applying for treatment, the majority were, as usual, seamen from American merchant vessels. One million three hundred and fifty-four thousand five hundred and forty-five hospital days and 638,794 out-patient treatments were furnished. The hospitals admitted many injured beneficiaries and many with acute surgical diseases, as well as considerable numbers afflicted with tuberculosis, syphilis, and other contagious diseases. Nine hundred and fifty-three deaths occurred. Large numbers of seamen were given physical examinations to assist^the Department of Commerce to comply Avith the shipping act approved March 5, 1915, which provides that 65 per cent of all seamen on American vessels must be. able-bodied seamen with certain minimum physical requirements. Large and increasing numbers of physical examinations are also made for the Civil Service and the Employees' Compensation Commissions.



' SECRETARY OF THE TREASURY 209

Yision and color-vision tests of all pilots, masters, and engineers •seeking licenses have been routinely made for the Steamboat Inspection Service, and ship's officers instructed and examined in the principles of first aid. Special examinations have been made for the 'Committee on Claims, House of Representatives, and special medical investigations for the Employees' Compensation Commission. In cooperation with the customs officers and the Bureau of Prohibition, certificates for medicinal liquors have been issued, after determination of needs in each instance, to 8,726 vessels, American and foreign. Permits for the purchase of narcotics required for use aboard vessels have also been issued, as the departmental regulations require, to 185 vessels. Medical advice has been furnished by radio to many ships at sea. This means of communication is also frequently used by vessels to secure prompt ambulance service. Whenever requested by the Department of Labor, detained immigrants are received and treated by the Public Health Service. The marine hospital on Ellis Island was operated, as heretofore, for the Bureau of Immigration, although an average of more than 200 merchant seamen, for whom accommodations are lacking in the overcrowded marine hospital at Stapleton, are constantly under treatment. Money collected for the care of immigrants, foreign seamen, and other pay patients, and from miscellaneous sources for sundry services, and turned into the General Treasury, amounted to $260,921.06. To enable the Public Health Service to meet its growing obligations, it will be necessary to increase the appropriations in order to augment the personnel at certain relief stations.

Division of veniereal diseases

The development of scientific research for the more effective prevention and treatment of syphilis and gonorrhea continued to occupy the major part of the attention of the division of venereal diseases. Field studies were continued to determine more accurately the prevalence of gonorrhea and syphilis in the general population. These studies now have been made in communities having a total population of more than 12,000,000 and have shown marked variation in the prevalence of these diseases, being relatively infrequent in rural communities but very prevalent in the urban areas.

Laboratory and clinical studies were initiated at the United States marine hospital at Stapleton; studies were made in a series of cases of syphilis treated by nonspecific protein therapy; the effect of hot baths on the course of syphilis was observed at the Hot Springs clinic; further studies in immunity in syphilis were conducted; and studies of the immunologic problems in connection with gonorrhea were continued.



2 1 0 REPORT OF THE FINANCES

Particular attention was given to the development of effective methods of preventing venereal diseases among beneficiaries of the Public Health Service. Cooperation with the several State boards of health was continued by the assignment of trained personnel to a number of States to study and recommend improvements in their venereal-disease control measures.


Peo'sonnel.—At the end of the fiscal year the regular commissioned corps of the Public Health Service included the Surgeon General, 3 assistants surgeons general at large, 24 senior surgeons, 133 surgeons, 23 passed assistant surgeons, and 64 assistant surgeons. Twenty officers of the service were on waiting orders. During the year one death and four resignations occurred in the.corps.

On June 30, 1928, 65 reserve officers were on active duty, this number including 1 assistant surgeon general, 1 senior dental surgeon, 8 surgeons, 7 dental surgeons, 8 passed assistant surgeons, 14 passed assistant dental surgeons, 23 assistant surgeons, and 3 assistant dental surgeons.

Following is a list showing the entire personnel of the service as of July 1, 1928:

Commissioned medical officers, regular corps 248 Commissioned officers. Reserve Corps . 65 Acting assistant surgeons 488 Attending specialists and consultants 265 Contract dental surgeons 36 Internes • 12 Scientific personnel, general 25 Pharmacists _ 35 Scientific personnel. Hygienic Laboratory 24 Administrative assistants 19-Druggists '- 10 Nurses 406-Aides 3a Dietitians 17 Laboratorians 2^ Pilots— — ~— 35 Marine engineers '. 36 Clerks - 434 All other employees 2, 543

Total 4, 760-

This total includes all part-time employees and all persons who are paid on a fee basis or on a per diem basis when actually employed. I t is exclusive, however, of 4,450 persons appointed, at nominal compensation, to assist in the collection of information and reports relating to disease prevalence. These persons are for the




most part officers and employees of health departments. State and local, who transmit to the bureau epidemiologic data collected by those agencies.

Financial statement.—A statement of appropriations and expenditures for the fiscal year 1928 follows:


Salaries, oflQce of Surgeon General." Pay, etc., commissioned oflQcers and pharmacists Pay of acting assistant surgeons Pay of other employees Freight, transportation, etc Maintenance, Hygienic Laboratory Preparation and transportation of remains of oflQcers. Books.. Pay of personnel and maintenance of hospitals Quarantine ser vice. _ , Preventing the spread of epidemic diseases Field investigations of public health Interstate quarantine service Studies of rural sanitation Control of biologic products Expenses, division of venereal diseases Survey of salt marsh areas, South Atlantic and Gulf States..

$103,000.00 1,200, 000.00

300,000.00 990,000.00 25, 000. 00 43, 000. 00 2,000.00

500.00 I 6,816,963. 22

485, 000.00 495, 388.00 280, 000.00

• 71, 000.00 85,000.00 45, 000. 00 70, 000.00 16, 525.96

$102,428.96 1,199,860. 36

297,017:61 983,827.99 24,961. 36 42,983.93

496. 59 6, 795,840. 23

474, 678.42 400,042.15 278, 893. 64 68, 361. 75 80,173.84 44, 458. 55 69,456. 33 16,522.39

Total 10,028,377.18 9,880,004.10

1 Includes $363,057.30 reimbursement for care and treatment of Veterans' Bureau patients and $4,014.92 miscellaneous reimbursements.

The revenues derived from operations of the Public Health Service during the fiscal year 1928 and covered into the Treasury as miscellaneous receipts are as follows:

Source

Inspection, fumigation, and disinfection of vessels at national quarantine stations... Care and treatment of pay patients in hospitals and at relief stations (other than Veterans'

Bureau patients) Sale of rations : Sale of obsolete, condemned, and unserviceable property Commissions on pay telephones installed in Service buildings Rent of land and buildings Unclassified -

Total -

$537, 673. 52

86, 757. 71 16, 986. 61 29, 584. 71

328. 97 150. 00

1, 058. 32

672, 539. 84





The outstanding public-health event during the year was the epidemic of influenza, which reached its height about the 1st of January. Comparatively few cases of influenza were reported in 1928 until the spring months, when there was an increase instead of the usual decrease in the incidence of the disease. Late in October a sudden increase occurred in the number of cases in some cities on the Pacific coast and the disease soon involved the Pacific and Mountain States and extended rapidly eastward. The greatest number of cases in the country as a whole was reported about the close of 1928, although at that time the disease was decreasing in the West. In general, the disease was much less virulent than during the pandemic of 1918, but the general death rates in some localities rose to several times the normal. During January and February the number of cases reported decreased rapidly, and conditions were about normal before the last of March.

With respect to other diseases, hea,lth conditions generally were relatively good during the year. Diphtheria and typhoid fever both recorded new low records for the calendar year 1928, and havebeen decreasing in prevalence for more than a quarter of a century. Meningococcus meningitis (epidemic cerebrospinal meningitis) has been increasing in the United States for several years, the rates for 1928 being the highest since 1918. There has been an increase in the prevalence of pellagra during the last few years, and in 1928, 6,652 deaths from this disease were reported to the Public Health Service by 43 States. The incidence of infantile paralysis in 1928 was about half that for 1927, and the number of cases reported during the first six months of 1929 was considerably less than for the corresponding period of 1928. The lowest annual tuberculosis death rate ever recorded by the Public Health Service was 77.4 per 100,000 population for the calendar year 1928, a rate about two-fifths of that prevailing at the beginning of the present century. More than 38,000 cases of smallpox were reported in 43 States in the calendar year 1928. For several years the United States has had the unenviable distinction of reporting more cases of smallpox than any other country in the world except India. Cholera or yellow fever did not appear in the United States during the fiscal year, but there were two cases of bubonic plague in California during the summer of 1928. The source of infection was probably ground squirrels.

During November, 1928, vessels began to arrive at Pacific coast ports from the Orient with cases of meningococcus meningitis (epidemic cerebrospinal meningitis) among the steerage passengers. The number of cases on board increased so rapidly as the winter season advanced that the âvailable facffities of the local health authorities at the ports of San Francisco and Seattle became over-




taxed, and the Public Health Service was requested to extend the use of the Federal quarantme stations at these ports. By early spring the quarantine facffities of both the local and Federal health authorities were overburdened. This resulted finally in the promulgation of Executive Order No. 5143 of June 21, 1929, providing temporary restriction and supervision of transportation of passengers from ports in China and the Philippuies to United States ports under regulations prescribed by the Secretary of the Treasury. Notwithstanding the more favorable climatic conditions of the summer season, cases of this disease contiaue to arrive at Pacific coast ports, and it is probable that only strict enforcement of this Executive order will meet the situation another winter.

During the fiscal year the prevalence of yellow fever increased along the east coast of South America between the mouth of the Amazon River and Rio de Janeiro. It finally became so serious that an officer of the Public Health Service was detailed in each of the American consulates at Buenos Aires, Argentina, and Rio de Janeiro, Brazil, to prevent the transportation of the infection by vessels destined for ports in the United States. Near the close of the fiscal year the disease was reported to have spread to Magda:lena River ports in Coloiribia, Socorro in the interior being most affected. Because of the close maritime relations with Colombia, the dangers of the possible introduction of yellow fever into the United States are increased.

At the close of the fiscal year negotiations for a reciprocal quarantine arrangement between the Government of the United States and the Dominion of Canada were being perfected, whereby vessels from foreign ports, entering the international waters of Puget Sound on the Pacific coast or the Great Lakes via the St. Lawrence River on the Atlantic coast, that call at ports of both countries would be subjected to but one quarantine inspection. This agreement is in accord with the provisions of articles 56 and 57 of the International Sanitary Convention of Paris, 1926; and such an arrangement would greatly facilitate the movement of shipping.

At the May, 1928, meeting of the health committee of the League of Nations held in Paris, a commission on ship fumigation was appointed, of which the Surgeon General of the Public Health Service is chairman. The purpose of this commission is to make a detailed study of certain problems relating to the fumigation of ships by means of hydrocyanic acid gas for the prevention of the introduction of plague. These research studies are progressuig at the New York quarantine station.

The county health unit plan of applying practical public health knowledge has been receiving wider interest and attention as its benefits become more generally recognized. The success of county health units in meeting the health emergencies of the Mississippi




flood in 1927 has attracted the attention of health authorities throughout this country and abroad. There appears to be no doubt that such local health units provide the machinery through which all public health activities may be conducted in proper sequence and in proper relation one to the other, thereby insuring to communities a well-balanced, general program of public health work. This plan also affords the best possible means for preventing the intrastate and interstate spread of disease.

Various investigations are being pursued and publications issued. During the winter months, the Public Health Service collected nationwide statistical information regarduig the incidence, mortality, and geographical distribution and spread of influenza with a view to learning more of its method of spread through populations, its clinical manifestations, and related problems. Evidence collected indicates that undulant fever has existed in considerable numbers of persons and over a wide geographical area for a long time without bemg recognized. Investigations made include the collection of clinical and epidemiological data to determine its significance and if possible to devise improved methods of prevention. Studies have been undertaken at the Hygienic Laboratory to improve the therapeutic efficacy of the polyvalent sera used in the treatment of, epidemic cerebrospinal meningitis, because of a considerable increase in the prevalence and virulence of this disease.

For 131 years the Government has furnished medical care to disabled seamen as an aid in developing and encouraging the maintenance of American merchant ships. The marine hospitals and other relief stations of the Public Health Service serve 155 ports in the United States and the possessions, reflecting in some measure the revival of public interest in American shipping and the effects of recent legislation designed to develop a merchant marine. Other important classes of beneficiaries are lepers, detained immigrants, foreign seamen, jand patients of the Veterans' Bureau, Coast Guard, Employees' Compensation Commission, Coast and Geodetic Survey, Lighthouse Service, and the Bureau of Fisheries.

The marine hospital building program has been continued. The new marine hospitals in Cleveland and Detroit are approaching completion. Funds are available and plans are in course of preparation by the supervising architect for new marine hospital buildings in New Orleans, San Francisco, Galveston, Baltimore, and New York, and for a larger and better out-patient office in Philadelphia. A marine hospital is also proposed for Seattle, where a site has been donated by the city. A number of miscellaneous small projects are contemplated to improve existing facilities at the marine hospitals in Boston, Buffalo, Evansville, Louisville, Mobile, Pittsburgh, Key West, Norfolk, Portland (Maine), Fort Stanton, and Carville, La.



SECRETARY OF- THE TREASURY 89

In the control of the venereal diseases impetus was given to further research by the cooperative arrangement between the Pubhc Health Service and the committee on research in syphilis whereby an officer of the service acts as a technical adviser in connection with a coordinated program of research in which 15 of the leading scientific institutions in this and other countries are participating.

An act approved January 19, 1929, and authorizing the establishment of two institutions for the confinement and treatment of persons addicted to the use of habit-forming drugs, created within the office of the Surgeon General of the Public Health Service a new administrative division known as the narcotics division, which is charged with the responsibffity of managing these institutions, and with the disciplinary problems and methods of treatment for those admitted.

The need for additional medical officers in the regular corps of the service, set forth in my report of last year, is even more pressing than a year ago. The Department of State desires to extend to 14 places in Canada and Mexico the work of examining prospective immigrants at American consulates in the country of origin, before the issuance of immigration visas, and trained medical officers for this work are not available. The present compensation of a medical officer in the entrance grade of assistant surgeon is attracting a gradually decreasing number of applicants with the required educational arid professional qualffications.

TABLET COMMEMORATING THE WEBSTER-ASHBURTON TREATY

A bronze tablet commemorating the signing of the Webster-Ashburton treaty, placed on the northeast corner of the Treasury Building, was unveiled with appropriate ceremonies on April 30, 1929. The inscription on the tablet is as follows:

Friendship between the United States and ^ Canada was developed and strengthened by

the signing of the Webster-Ashburton Treaty, on August 9, 1842, in the old State Department Building which stood on this site. This treaty established the north

eastern boundary between the two countries. This tablet placed by

The Kiwanis Club of Washington in cooperation with the Committee on Marking Points of Historic Interest

April 30, 1929

The treaty was executed by Lord Ashburton (Alexander Baring), envoy of Great Britain, and Daniel Webster, representing the Government of the United States. It defined the boundary line between Canada and the United States as far west as the Rocky Mountains,




Division of sanitary reports and statistics

The division of sanitary reports and statistics is charged with the work of collecting and disseminating information as to the prevalence and geographic distribution of diseases dangerous to the public health both in the United States and in foreign countries.

In the United States information is secured tlirough officers of the Public Health Service and State and local health departments. In order to facilitate the collection of the necessary data, officers of State and local health departments have been given appointments as officers of the Pubhc Health Service at nominal salaries ($1 per year). These officers advise the Pubhc Health Service of outbreaks of communicable diseases, the progress of epidemics, and the prevalence of endemic diseases. During the fiscal year these reports were collected, statistics were compiled, and the information was pubhshed in the weekly Public Health Reports. Some of it was distributed by means of special bulletins.

Important changes have been made during the last few years in the international reporting of diseases dangerous to the public health. The International Sanitary Convention of January 17, 1926, and the Pan American Sanitary Code, signed at Habana, November 14, 1924, have made it possible to secure from foreign countries much earher and more nearly complete reports of the prevalence of the more important diseases than were available before these conventions went into force. In accordance with the provisions of the conventions, notice of first cases of quarantinable diseases and of the progress of epidemics in the United States has been given to the International Office of Public Hygiene at Paris and to the Pan American Sanitary Bureau. In addition, the required information has been sent to foreign governments through the Department of State.

The Public Health Reports were issued each week during the fiscal year (annual vol. 43, pt. 2, and vol. 44, pt. 1). In addition to statistical matter, this publication contained articles reporting the results of research in public health and other articles of interest to public health workers. Sixty-one of these articles were reprinted during the year for more economical distribution.

Work was continued on the compilation and publication of Federal and State laws and regulations pertaining to public health and municipal ordinances and regulations of special interest to pubhc

216




health workers. Current legal digests were searched for court decisions relating to public health and abstracts of these decisions were pubhshed in the Public Health Reports.

Two lectures on health subjects were prepared each month for delivery over the radio. At the close of the fiscal year 54 broadcasting stations were cooperating with the Public Health Service by sending out these lectures. This is an effective way of reaching many citizens who need the information to teach them how to avoid disease and prolong life.

Material was prepared for several health exhibits,' but it has not been possible to accomplish much because of lack of funds available for the purpose. Information was compiled for a large number of requests pertaining to public health, including statistics, the provisions of health laws, and other subjects.

Division of foreign and insular quarantine and immigration

Quarantine transactions.—Dunng the fiscal year 27,867 vessels and 3,320,959 persons were inspected by quarantine officers. Of these, 19,529 vessels, 933,035 passengers, and 1,134,906 seamen were in-s|)ected upon arrival at stations in the continental United States; 2,937 vessels, 138,947 passengers, and 203,182 seamen were inspected a t insular stations; and 5,401 vessels, 544,127 passengers, and 366,762 seaimen were inspected at foreign ports prior to embarkation for the United States.

Of the passengers who embarked at European ports, 43,047 were vaccuiated and 92,603 were deloused under the' supervision of medical officers of the service. Their clothing and baggage, amounting to 95,816 pieces, were disinfected.

A total of 5,488 vessels were fumigated either because of the occurrence of disease on board or for the destruction of rodents; and 22,765 rats were recovered, 17,888 of which were examined for plague infection.

During the year only three cases of smallpox and no cases of plague, cholera, yellow fever, or typhus fever arrived at quarantine in the United States. However, in 10 instances during the fiscal year plague occurred on vessels at foreign ports, and in April a vessel arrived at Glasgow from Bombay with cases of smallpox on board, following which France imposed quarantine restrictions against persons coming from Great Britain. There also occurred a severe epidemic of smallpox in Hong Kong, which spread along the. China coast. The preventive measures applied by Public Health Service officers at foreign ports of departure is reflected in the small number of quarantinable diseases on vessels arriving at our quarantine stations.

Although but a small number of quarantinable diseases arrived at our quarantine stations during the year, there have arrived, since Novem-



SECRETARY OF THE TREASURY 217'

ber, 1928, at Pacific coast ports from the Orient, a total of 21 vessels with 360 cases of cerebrospinal meningitis on board. Cerebrospinal meningitis is not classed as a quarantinable disease, and therefore the small numbers of earlier arrivals were taken care of by the local health authorities. The number of arriving cases increased so rapidly as the winter season advanced that the facilities at the command of the local health authorities at the ports of Seattle and San Francisco became overtaxed, and at the request of the local health authorities the Public Health Service extended the use of the facUities at the Federal quarantine stations at these ports for the isolation and care of the cases and contacts. This was made possible through the promulgation of an amendment to the quarantine regulations authorizing quarantine officers to detain arriving cases of communicable but nonquarantinable diseases and persons exposed to such diseases at the national quarantine stations when local authorities do not have facilities for their isolation and care. By early spring the quarantine facilities of both the local and Federal health authorities were becoming overtaxed, and other measures to prevent the spread of this disease into the United States were con^dered, which resulted finally in the promulgation of Executive Order No. 5143, under date of June 21, 1929, having for its purpose the restriction and supervision of the transportation of passengers from ports in China and the Philippines-to United States ports under regulations of the Secretary of the-Treasury. Notwithstanding the onset of the more favorable climatic conditions of the summer season, cases of this disease continue to arrive at Pacific coast ports, and it is considered probable that with the onset of another winter season only strict enforcement of the-provisions of this Executive order and the regulations issued thereunder will meet the situation.

On July 1, 1928, a new quarantine station was opened at Portland,, Oreg., in order better to serve the maritime interests of that port heretofore served by the quarantine station at the mouth of the Columbia River at Astoria. Approximately 80 per cent of all vessels-entering the Columbia River are destined for Portland, and the arrangement for quarantine inspection at Portland instead of at Astoria for such vessels considerably facilitates the movement of shipping. The station at Astoria is still maintained to take care of shipping entering the port of Astoria and other river ports between Astoria and Portland.

During the fiscal year 1929 three amendments to the quarantine regulations were promulgated:

Amendment No. 11, issued December 22, 1928, amended paragraph 2 of the quarantine regulations so as to exempt aircraft from foreign ports, or ports in the possessions or dependencies of the United States, from the necessity of obtaining bills of health except during



2.18 REPORT ON THE FINANCES

the. prevalence of quarantinable disease in such ports of departure or call. Aircraft'will, however, still be subject to the application of other provisions of the quarantine laws.and regulations of the United States upon arrival at airports of entry in the United- States, its possessions or dependencies. Quarantine services at ports of arrival are rendered at present to aircraft without cost. fc; Amendment No. 12, issued December 26, 1928, amended paragraph 40 of the quarajUtine regulations so as to authorize quarantine officers to. detain arriving cases of communicable but nonquarantinable diseases and persons having been exposed to such.cases at the national quarantine stations when local authorities do not have facilities for their isolation and care. This amendment was promulgated in order to meet the emergency imposed by' the' arrival of a large number of' cases of cerebrospinal meningitis at Pacific coast ports of the United States from the Orient, which overtaxed the available facilities of the local health authorities, particularly at Seattle and San Francisco. . Amendment No. 13, issued January. 24, 1929, amended paragraph 37 of the quarantine regulations so as to permit the quarantine officer soine exercise, of. discretion, within ;limits, respecting the heretofore mandatory muster of passengers and crews of certain vessels which carry a medical officer arriving in quarantine from ports classed as uninfected. This amendment principally facilitates the passage through quarantine of North Atlantic vessels arriving at the port of New York. . -

During the past year the Public Health Service made arrangements for the performance of the necessary quarantine and immigration inspections in connection with the establishment of airports of entry in a number of ports. These arrangements were completed at Buffalo and Albany, N. Y.; Seattle, Wash.; Los.Angeles, Calif.; Brownsville, Tex.; West Palm Beach, Fla.; San Diego, Calif.; Miami, Fla.; San Juan, P. R.; and Nogales, Ariz. Similar arrangements were completed during the preceding year at Key West, Fla., where Meacham Field, on the Island of Key West, was officially designated an airport of entry on December 20, 1927. Information was also received of the designation of airports of entry at St. Paul, Minn., and Newark, N. J.; but there being no Public Health Service medical officer stationed in or near these ports and funds for the employment of additional medical personnel not being available, it was impracticable to make suitable arrangments for the required quarantine and immigration examinations incident to the arrival of aircraft at these ports.

Several new international bridges were constructed across the Rio Grande along the Mexican border, resulting in increased quarantine and immigration activities at those ports. On this account it became necessary to open a new quarantine station at Thayer, Tex., on September 1, 1928, and one at Zapata, Tex., on April 1, 1929.



SECRETARY OF THE TREASURY 21.9

Medical inspection of aliens.—There-were 978,354 alien passengers and 984,771 alien seamen examined by medical officers at the various stations. Of this number 24,939 passengers and 1,956 seamen were ^'certified'' in accordance with the act of Congress, approved February 5, 1917. ; The most important causes of certification of alien passengers were: Trachoma, 590; tuberculosis, 195; feeble-mindedness, 137; insanity, 124; syphffis, 199; gonorrhea, 674.

Of the alien seamen certified 39 were for trachoma, 25. for tuberculosis, 269 for syphilis, 413 for chancroid, and 589 for gonorrhea.

On November 1, 1928, an officer of the Public Health Service was detailed for duty at the United States immigration station at North-port, Wash., in connection with the medical examination of arriving aliens. At the same time the Public Health Service officer who had previously been detailed for duty at the United States immigration station at Marcus, Wash., for this purpose was discontinued; this was done because the port of entry for persons crossuig the border at this point was transferred from Marcus to Northport.

Exarnination of alien passengers abroad.—There were 173,740 applicants for immigration visas examined by medical officers abroad. Of; this number 2,379 were reported to the consular officers as affhcted with one or more of the diseases listed in class A as mandatorily excludable; 15,468 were reported as affiicted with a disease or condition listed in class B as liable to affect their abffity to earn a living; all of the applicants reported in class A and 5,589 of those reported in class B were refused immigration visas by the consular officers because of the findings of the medical examination.

Of 165,772 aliens who had been given a preliminary medical examination abroad and to whom visas had been issued, only 22 were certified upon arrival at a United States port as being affficted with class A diseases, resulting in mandatory deportation.

; There has been no material change during the past year in the system of making medical examinations of applicants for immigration visas in their countries of origin. The many advantages of this system of the examination of intending immigrants have been amply demonstrated duriag the four years in which the plan has been in operation. The policy of making medical examinations, on request of the consul, of the family units accompanying heads of famffies intending to emigrate to the United States leaving the family behind has done much to eliminate criticism of immigration enforcement on the ground that it causes separation of families.


At the begianing of the fiscal year 1929 the health units in the 83 counties in the area affected by the Mississippi flood of 1927, which had been established under the emergency appropriation, were trans-




ferred to the regular appropriation for rural sanitation work. These health units have been effective in avertiag outbreaks of disease which threatened to occur as the result of the destruction of water supply and sanitation systems, together with lowered resistance of the population due to stress and strain and poorer economic conditions. A determiaed effort is being made to place these units on a permanent basis and thus insure the continuation of this much-needed health service to the people after outside assistance has been withdrawn.

There are in the United States approximately 2,500 counties or districts comparable to counties in which the county health unit plan is applicable. At the beginning of the calendar year 1920 there were 109 county health units in operation; on January 1, 1929, there were 467. The annual net gain in this period has been 40, but at that rate of progress about 51 years will yet be required before all of the rural communities in the United States wiU be receiving adequate health service.

It is estimated that, apart from the loss in human life and health,, the national annual economic loss in wages and other items incident to preventable sickness because of lack of efficient county health service is more than $1,000,000,000, whereas the cost of such service would amount to $20,000,000.

The Public Health Service is at the present time cooperating ia 204 counties in 22 States. In each county unit important health measures are being carried out, such as communicable disease control,, sanitation of private homes and pubhc places, tuberculosis control,, iafant and maternity hygiene, venereal disease prevention, school hygiene, and the like. Various special activities, such as malaria prevention, goiter prevention, pellagra prevention, are included in county health programs when the need exists.

Because the vast majority of communities are unaware of the advantages to be gained through the application of public health measures, outside stimulus and assistance are essential in order to secure the establishment of such local health service; and because in many communities in which the need is most dire, the resources are so small as to make the proportional cost excessive, outside financial assistance is necessary until such time as the resources are sufficient to provide health service at a cost in proportion to that enjoyed by an average community.

Plague infection contiaues to exist in ground squirrels over large areas ia the central and coast counties of California south of Carquinez Straits, and must be recognized as a menace to the public health. Foci of ground squirrel infection have been found in the counties of Alameda, Contra Costa, Monterey, San Benito, San Luis Obispo, Ventura, and Santa Barbara during the fiscal year, and if




hunting operations had been more intensive it is believed that the infection would have been fouiid still to exist in all of the 14 counties in which it has been known to be present in past years. Two cases of human plague occurred in Santa Barbara and Monterey. Coun ties in July and August, 1928. " The activities of the Public Health Service in the control of ground

squirrels have been conducted in close cooperation with the horticultural commissioners and have been confined to areas around centers of population in Alameda, Contra Costa, San Francisco, and San Mateo Counties. In these districts the joint operations have yielded excellent results and the squirrel infestation has been markedly reduced.

At the request of the health officer of San Francisco, two experienced rat trappers have joined with four trappers furnished by the city in conductiag a survey of the city by trapping and examining rats to determine whether any evidence of rodent plague infection exists in San Francisco. The results have been negative. A limited survey was also conducted in Oakland.

The Public Health Service plague laboratory has continued in operation as in previous years, the work being devoted mainly to the routine examination of rodents from the counties and the city of San Francisco, to determine whether plague infection exists. The information thus provided is used in directing control operations.

Small trachoma hospitals, with an average capacity of about 30 patients each, have been in operation at Rolla, Mo.; Knoxville, Tenn.; and Richmond, Ky., throughout the year. It has been found that the best results are secured by maintaining a treatment center in one locality until practically all trachoma cases within traveling distance have been rendered noninfectious.

It is interesting to note that the recent establishment of several county health units in counties in which trachoma is prevalent has aided greatly ia the location and follow-up of cases and has been instrumental in spreading knowledge regarding prevention and eradication of the disease. Practicing physicians have visited the hospitals and clinics in order to obtain precise information regarding diagnosis and treatment.

^ Routine measures for insuring safe water and milk supplies on interstate carriers, both trains and vessels, have been conducted as heretofore with gratifying results. State and municipal health departments, as well as the various railroad and steamship companies, have extended cordial cooperation to the Public Health Service, so that a vast amount of work has been accomplished at very low cost to the Federal Government.

'The Public Health Service has also received satisfactory cooperation from State health departments. State conservation commis-




sioners, and shellfish producers in maintaining the present system of insuring the sanitary control of shellfish in interstate traffic. As the result of this work no outbreaks of disease due to infected shellfish have occurred during the year.

Supervision of sanitation in the national parks has been furnished at the request of the National Park Service as heretofore. This activity is of increasing importance, as the number of visitors to the parks becomes greater each year and new areas are opened to the public.

The twenty-seventh annual conference of State and Territorial health officers with the United States Public Health Service was held in Washington, D. C , June 3 and 4, 1929, and was attended by representatives of 34 States and the Territory of Hawaii. Because of the importance of the subjects presented for consideration, it was the consensus of opinion that this was the most valuable conference which has been held in many years.


The scientific research division has continued to carry on investigations under the law empowering the Public Health Service to undertake researches into the diseases of man and the conditions affecting their propagation and spread. I t has also supervised the enforcement of the,law of July 1, 1902, regulating the sale of viruses, serums, toxins, and analogous products in interstate traffic:

The cancer studies being conducted both at the Harvard Medical School in Boston and at the Hygienic Laboratory are making some solid contributions to the fundamental nature of our knowledge of this disease. This work has consisted chiefly of the treatment of cancers in laboratory animals by electric currents of very high frequencies and of tissue, studies.

The Rocky Mountain spotted fever vaccine which has been developed by Public Health Service officers, has been prepared and distributed to physicians and health officers upon request. Results thus far indicate that the vaccine has a definite field of usefulness, and studies are being made to devise if possible more economical methods for its production.

The stream, pollution investigations station continues to be looked upon as a chief source of information in this country on underlying scientific principles relating to the effect of various kinds of pollution of streams and on the processes of natural and artificial purification which render the waters susceptible of subsequent usfe for drinking purposes. .

Reports of the successful operation of the ^'standard milk ordinance'^ iil communities where it has been adopted continue to be received.



SECEETARY OF THE TREASURY. 2 2 3

Studies are under way to determine, if possible, the cause of a definite increase in malaria observed in certain areas for the first time in a number of years. The development by service officers of a power hand blower for the distribution of Paris green has brought this method for the control of the production of mosquitoes within the means of almost any community. The practicability of various mêthods of malaria control on a county-wide basis have been demonstrated in two widely separated counties.

The studies of industrial hygiene have included occupational health .hazards, industrial poisons, industrial morbidity and mortaht}^, and daylight illumination. The child hygiene investigations have been confined very largely to a statistical analysis of an immense bulk of material based upon defects and infectious disease in a sample population of children.

The preliminary survey of salt marsh areas of the Atlantic and Gulf Coast States was terminated at the end of the fiscal year and a report of the data collected during the period of this survey is in preparation. The goiter studies were also discontinued during the year and a manuscript was prepared summarizing the data collected during the past six years.

The statistical office has been engaged in studies of influenza and other respiratory diseases, morbidity statistics, current mortality statistics, current prevalence of disease, and negro mortality.

Immediately following the influenza epidemic of 1928-29 an influ'-enza morbidity survey was made in 11 cities in' the United States in order to obtain an accurate record of morbidity from this disease comparable to that previously compiled foi the epidemic of 1918.

The investigations of undulant fever have been enlarged to include the collection of clinical and epidemiological data in cooperation with State and local health authorities. Undulant fever has proved to be a disease of considerable public health significance. -

Investigations of the problems in the basic sciences having relation to public health, as well as public health problems demanding immediate solution, have continued to engage the attention of the four divisions qf the Hygienic Laboratory. The division of pathology and bacteriology have carried on studies of infectious diseases, nutritional diseases., and biological products.

Knowledge of tularsemia, which has been largely developed at the Hygienic Laboratory, continues to increase, and two additional animal hosts, the muskrat and the opossum, have been found. Studies on the distribution, mode of transmission, and spread of endemic typhus in the southeastern United States have been continued. The evidence collected indicates that the typhus fever which exists in the southeastern United States has common origin with the typhus of Mexico and is not dependent upon immigration from the typhus-




infected countries of Europe. The role of the vaccination dressing in complications following vaccination against smallpox has been studied and a paper published setting forth the results. The search for the etiological agent in trachoma has been continued at the branch laboratory at Rolla, Mo.

Studies in nutritional diseases have been continued, special attention having been given to pellagra and the testing of individual foodstuffs to determine their pellagra-preventive value.

The control of biologic products in accordance with the act of July 1, 1902, is administered from the Hygienic Laboratory and iur volves considerable research work in addition tp the routine testing of specimens and the inspection of biologic establishments. Cerebrospinal meningitis has appeared in a number of serious epidemics during the past year. I t has been observed that the specific serum used for the treatment of this disease appeared to have unequal or irregular results. This has led to a vigorous attempt to improve the therapeutic efficiency of these serums.

The division of zoology has been engaged primarily in the preparation of a series of bulletins on the parasites of man and their relation to animal hosts, and in the examination of intestinal parasites. The division of pharmacology, in addition to its cancer researches, has been engaged in studies of the pharmacological action of tuberculo-protein and ergosterol, and correlation of chemical and functional changes in living tissue and the biological assay of ergot. The work of the division of chemistry has included application of the specific tests for cysteine and cystine developed by this division, sugar researches, and preparation of a general review and bibliography of synthetic culture media, and the testing of arsenicals.

Division of marine hospitals and relief

Of the 379,731 patients applying to the marine hospitals and other relief stations of the Public Health Service, the majority were, as usual, seamen from American merchant ships, who receive approximately 76 per cent of all the hospital care provided for all classes of beneficiaries, excepting immigrants, foreign seamen, and others for whose care a reimbursement is made. More than 300 lepers are under treatment at the National Leper Home, Carville, La., and 19 such patients were discharged to their homes during the year with disease arrested. The Coast Guard, whose personnel now exceeds 12,000, requires, in addition to hospital and out-patient care at the regular rehef stations, medical services aboard cruising cutters and at important shore stations. Twenty-two medical and dental officers are assigned to this exclusive duty, and 101 part-time medicaL officers serve the life-saving stations and other isolated units operated by the Coast Guard. The usual cooperation was given to the Bureau of




Prohibition, and 9,070 certificates for medicinal liquor and 128 for the purchase of narcotic drugs were issued to vessels. Patients of the Veterans^ Bureau were admitted to all the marine hospitals where facilities permitted. More than 100,000 physical examinations are performed each year for various groups of persons and to serve official agencies, including the following: Applicants and employees, for the Civil Service Commission; apphcants for pilot's license, for'the Steamboat Inspection Service; able-bodied seamen, for masters and shipping commissioners; apphcants for mihtary pension and retirement, for the Bureau of Pensions; longshoremen and Government employees claiming compensation, for the Employees' Compensation Comniission; air pilots, for the Department of Commerce; civil service employees suspected of having communicable diseases, for various Government offices; and applicants to citizens' mihtary training camps, for the Army.

A daily average of 4,006 patients of all classes was treated in all hospitals and 741,103 out-patient treatments were given. There were 1,058 deaths in the marine hospitals and contract institutions. The marine hospital on Ellis Island was operated for the Bureau of Immigration primarily for the treatment of detained immigrants, but also, by special arrangement, for a daily average of more than 200 merchant seamen, representing the overflow^ from, the marine hospital at Stapleton.

Division qf venereal, diseases Venereal diseases continue to constitute one of the most important

of the national health problems, although there is evidence that progress is being made in lessening somewhat the prevalence of syphilis.

The major effort in this field is the conduct of scientific research by the Public Health Service and cooperation with the committee on research in syphilis in the development of research in leading scientific institutions of this and other countries which relate to clinical, laboratory, and epidemiological aspects of this problem.

Cooperative activities with States have been continued and expanded. Particular attention was given to the problem of control of venereal diseases in rural districts and among the negro population.

New activities undertaken by the division of venereal diseases during the course of the fiscal year included the inauguration of an intensive campaign for the prevention of venereal diseases among beneficiaries of the Public Health Service employed in the Coast Guard and in the merchant marine, and a survey of the problem of disabffities among railway employees in their relation to the cause of accidents. The active cooperation of a number of the large steamship companies has been obtained, and effort now is being made to secure the participation of the railroads in a general movement looking toward the adoption of routine examinations and reexamina-

71799—30—FI 1929 17




tions of all employees, together with the provision of treatment for venereal diseases without cost to the employee. It is believed that a material reduction in the prevalence of venereal diseases among beneficiaries of the Public Health Service eventually can be brought about, and that there can be thus effected a large saving in the cost of medical care for the class of patients who must now be treated for an ffiness which is entirely preventable. It is also believed that frequent examination of railroad employees throughout the country, attended by the discovery of disabffities seriously aft'ecting the efficiency of the men, particularly of those who handle trains and signals, would be an important step toward the prevention of accidents due to human failure.

At the clinic operated by the Public Health Service in cooperation with.the State health department at Hot Springs, Ark., the work continued to increase. The number of new cases admitted during the past year was 101 per cent greater than the number of admissions for the first year of operation of the clinic, and there has been a 53 per cent increase in the number of patients since 1926, with the result that the facilities now available for the medical care of those who apply for treatment have been severely overtaxed. It is considered essential that these facilities be extended in order that proper treatment may be given to these indigent patients who come from nearly every State in the Union and who suffer from infections which make them a serious menace to others.

The educational work wffich has been carried on by the division of venereal diseases through the publication and distribution of literature, the circulation of moving-picture films, and the presentation of papers, lectures, and practical talks to selected groups by various members of the staff, was continued.

Narcotics division

During the fiscal year 1929 a new administrative division was created in the office of the Surgeon General of the Public Health Service, pursuant to an act approved January 19, 1929. That act authorized the establishment of two institutions for the confinement and treatment of persons addicted to the use of habit-forming drugs who have committed offenses against the United States and for those addicts who may voluntarily commit themselves thereto. The new division, known as the narcotics division, is charged with the responsibffity of managing these institutions, the discipline, and the methods of treatment of those admitted.

A deficiency appropriation for preliminary expenses incident to operating the new division was made available on March 4, 1929. Preliminary studies were immediately begun dealing with the subject of the epidemiology of drug addiction in the United States, with




special reference to the geographical location of the two proposed institutions. The results of this prehminary survey were assembled during the fiscal year 1929. Plans have been perfected for continuing studies along this particular line.


The regular commissioned medical corps of the Public Health Service at the close of the fiscal year included the Surgeon General, 3 assistant surgeons general at large, 25 senior surgeons, 133 surgeons, 26 passed assistant surgeons, and 48 assistant surgeons. Of these 236 officers, 2 assistant surgeons general at large, 13 senior surgeons^ 5 surgeons, and 2 passed assistant surgeons were on ''waiting orders."

The number of reserve officers on active duty at the end of the year was 65, which iacluded 1 assistant surgeon general, 1 senior dental surgeon, 8 surgeons, 7 dental surgeons, 8 passed assistant surgeons, 14 passed assistant dental surgeons, 23 assistant surgeons, and 3 assistant dental surgeons.

The following list shows the entire personnel of the service as of Ju ly l , 1929: Commissioned medical officers, regular corps 236 Commissioned officers, Reserve Corps 65-Acting assistant surgeons . 596' Attending specialists and consultants 291 Contract dental surgeons 37 Internes 62 Scientific personnel, general 24 Pharmacists 31 Scientific personnel. Hygienic Laboratory 33 Administrative assistants 20 Druggists 9 Nurses 442 Aides 33 Dietitians 19 Laboratorians 30 Pilots 36 Marine engineers . 39 Clerks _._ 466 All other employees 2, 594

Total___ 5, 063

This tabulation includes all part-time employees, all persons paid on a fee basis, and all who receive compensation on a per diem basis when actuaUy employed. In addition, there are 4,555 appointees of the service who assist in the collection of current information relating to the prevalence of communicable disease most of whom are either officers or employees of State and local health departments, who receive only nominal compensation, and who send in to the bureau morbidity statistics gathered by the State and local health agencies.



228 REPORT ON THE FINANCES

Financial statement.—Following is a statement of appropriations and expenditures for the fiscal year 1929:

Appropriation title Appropriated

$319,480.00 1,229, 574. 00

328,140.00 1,078,670.00

29,000. 00 43,000. 00

2,000.00 500. 00

16,086,766.00 550,310.00 400, 000. 00 317, 540. 00

72, 080. 00 347, 000 00

45,000 00 73,780 00 15,000 00

2 10,000 00

10,947,840 00

Expended

$316,989.38 1, 225,658. 76

327,358.21 1,071,139. 78

28,491. 64 42, 517. 65

695.24 . 487.91

6,053, 618.16 549,870.85 240,690. 68 316,926.34

71,767.91 337, 376. 61 44,845. 56 72,871.11 13,482.67

955.30

10,715, 743. 76

Salaries, oflQce of Surgeon General Pay, etc., commissioned officers and pharmacists Pay of acting assistant surgeons Payof other employees i Freight, transportation, etc .' Maintenance, Hygienic Laboratorj'-Preparation and. transportation of remains-ofofficers, Booksî.:....:.!. .-... Pay of personnel and maintenance of hospitals Quarantine service .' Preventing the spread of epidemic diseases Field investigations of public health Interstate quarantine service Studies of rural sanitation , Control of biologic products Expenses, division of venereal diseases Survey of salt marsh areas Narcotic farms

. Total - . . „ .

1 Includes $595,306 reimbursement for care of Veterans' Bureau patients, and $3,800 miscellaneous reimbursements.

2 Appropriation available for fiscal years 1929 and 1930.

The revenues derived from operations of the Public Health Service during the fiscal year 1929 and covered into the Treasury as miscellaneous receipts are as follows:

Source • Amount

Inspectioh, fumigation, and disinfection of vessels at national quarantine stations Care and treatment of pay patients in hospitals and at relief stations (other than Veterans'

Bureau patients) .". '. Sale of rations __-- - -Sale of obsolete, condemned, and unserviceable property Commissions on pay telephones installed in service buildings Rent of land and buildings Other revenues -

Total - - - -

$559,970.60

60,985.18 16,945.06 8,068.12

554. 38 150.00

4,138. 62

650,811.96

