1940: Public Health Service

Broadly classified, the principal authorized functions of the United States Public Health Service include the administration of National and interstate quarantine laws and regulations, research in the cause and prevention of disease, operation of the marine and other hospitals for certain legal beneficiaries (principally American merchant seamen), control of the manufacture and sale of biologic products, collection and publication of morbidity statistics, issuing health information, and co-operation with the States in all health matters.

Formerly, official public health activities were confined largely to matters of environmental sanitation and immunization against those communicable diseases for which such procedures were available. With the great reduction that has been achieved in the common communicable diseases of the early ages, the Public Health Service is now focusing its attention on the chronic diseases of the older age groups and the biological problems associated with aging, on more effective attack on specific diseases, such as tuberculosis, pneumonia, industrial diseases, and the venereal diseases, on nutrition, and on means of securing medical and hospital care for the medically indigent.

In order to secure better application of modern public health procedures and to achieve greater coordination of health services in the United States, the health sections of the Social Security Act (1935) and the Venereal Disease Control Act (1938) provided for Federal assistance to States, through grants-in-aid, for expanding State and local health services and improving the technical qualifications of their personnel.

Under the authorization of the Social Security Act, a total of $36,833,000 has been appropriated for allotment to the States up to and including the fiscal year 1940. In 1940, the annual appropriation for this purpose was increased from $8,000,000 to $11,000,000. This increase in funds is being used largely to strengthen or establish special programs for the control of pneumonia, tuberculosis, cancer, and malaria, and for dental and industrial hygiene activities.

As the result of this subvention, there has been a marked expansion in public health organization and public health services in the United States. As a concrete measure of some of the results of this Federal aid to states, it may be noted that in 1940, 1,577 counties were receiving full-time health service, as compared with only 1,370 counties with such service in 1939 and only 533 in 1933; there were 40 industrial hygiene units in state and local departments of health, as compared with 34 in 1939, and 4 in 1933; 19 states with pneumonia control programs; 38 states with dental hygiene units; and 1,142 persons were receiving technical training for public health work.

Similar advancement has been made in the expansion and intensification of public health services and activities relating to venereal disease control. (See MEDICINE: Venereal Disease Control.)

In research during 1940, an improved method of preparing protective vaccines for Rocky Mountain spotted fever, epidemic typhus fever, and other rickettsial diseases was evolved. The Eastern cotton rat and the white mouse were found to be susceptible to the virus of poliomyelitis, and therefore available for experimental purposes. A preparation was obtained which gives promise of providing effective immunization against pneumonia. Tularaemia infection was found in Montana streams. Advances were made in the study of nutritional diseases. Special studies were conducted in heart disease. Cancer investigations, including fundamental biological and chemical studies as well as clinical, were conducted at the National Cancer Institute, Bethesda, Md., and at the cancer clinic at the Baltimore Marine Hospital.

During the fiscal year, 1940, the Public Health Service continued to operate the 26 marine hospitals and 126 other relief stations. These, together with about 130 contract hospitals, provided more than 2,000,000 hospital-days of care to approximately 70,000 legal beneficiaries and a million and a half office treatments to 353,724 more, making a total of more than 423,000 patients receiving treatment during the year. In addition, the Public Health Service conducted two hospitals for the confinement and treatment of drug addicts (principally Federal prisoners), one at Lexington, Ky., and one at Fort Worth, Texas; furnished medical and psychiatric services in Federal penal and correctional institutions, and provided diagnostic psychiatric service to 10 Federal courts.

In the prevention of the introduction of disease into the United States from abroad, quarantine officers of the Public Health Service inspected 15,607 vessels carrying 489,157 passengers and 933,360 seamen, and fumigated 900 vessels because of potentially dangerous conditions aboard, such as rat infestation.

Medical officers of the Public Health Service examined 637,398 alien passengers and 551,489 alien seamen at various ports of entry during the fiscal year in accordance with the immigration laws. Of these, 18,793 passengers and 1,271 seamen were certified to the immigration officials as having mental or physical defects or diseases. A total of 64,442 applicants for immigration visas was examined by medical officers of the Public Health Service stationed at American consulates in foreign countries. Of these, 576 were found to be afflicted with conditions rendering their exclusion mandatory, while 15,046 were found to be suffering from conditions likely to affect their ability to earn a living.

In addition to these activities, inspections were made, at United States airports of entry, of 2,184 airplanes, carrying 35,667 passengers, of whom 11,171 were aliens.

Although quarantinable diseases were prevalent in many parts of the world during the year, only two cases of smallpox reached United States territory — one at Honolulu and the other at New Orleans. Detection and detention at quarantine prevented spread of the disease.

Health conditions remained generally favorable in the United States during 1939 and the first six months of 1940. The incidence of most of the important communicable diseases in 1939 and the first half of 1940 was below that for 1938 as well as below the median expectancy, while the mortality rates for the chronic diseases of the older age groups increased. The crude death rate for the first 6 months of 1940 was slightly higher than the corresponding rate for the two preceding years, apparently due to the increase in the chronic diseases of late adult life. Because of the increasing proportion of older persons in the general population, this is to be expected unless in the future we achieve greater success in our attack on these diseases than we have in the past.

No important Federal health legislation was enacted during 1940. An important measure providing for Federal construction of community hospitals, principally in rural areas, to be leased to the municipalities on condition that they would provide for upkeep and maintenance, was reported favorably by the committee but was not brought up for vote.

Little information is available regarding developments in public health services in Europe, except changes necessitated by war conditions. There is little doubt that unfavorable health conditions, as well as problems of nutrition, have become increasingly serious in some countries. Unverified reports have been received regarding outbreaks of disease such as typhus fever, and outbreaks of this disease and other diseases incident to crowding and the interruption of sanitary measures are to be expected.

In general, progress in public health administration in the Latin-American countries was in a direction similar to that in the United States, such as increase in and improvement of the qualifications of trained personnel, increase in hospital and research facilities, promulgation of sanitary legislation, and increase in health budgets.