1941: Public Health Service

Under the Federal Security Agency, the U.S. Public Health Service is integrated with governmental agencies concerned with health, welfare and education. The administrative offices of the Service are in Washington, D. C.

In general, the activities of the Service are to protect the nation from the introduction of dangerous, communicable diseases from abroad; to prevent the spread of communicable diseases from state to state; to study the diseases of mankind and learn how they may be prevented or cured; to investigate the pollution of inland waters; to insure safe and standard biologic products, such as vaccines, serums, antitoxins and arsenicals; to study mental diseases and drug addiction and to investigate the legitimate need for narcotic drugs; to extend and improve state and local health services through leadership, technical assistance and the administration of financial aid; to collect and publish reports of disease prevalence in the United States and regulations and court decisions relating to public health; and to disseminate health information to the public. (See also MEDICINE: Venereal Disease Control).

The Service operates the Marine Hospitals for merchant seamen and other legal beneficiaries; two hospitals for the rehabilitation of Federal prisoners who are narcotic drug addicts; and two other Federal institutions, namely St. Elizabeth's Hospital and Freedmen's Hospital. The Service also provides medical and psychiatric services in Federal prisons. The research division is the National Institute of Health at Bethesda, Md., which also maintains several branch laboratories.

States Relations.

The Federal-State cooperative public health program including local organization covers the forty-eight states, the District of Columbia, and the Territories, 110 state administrative districts, 151 multiple county units, 671 single county units and a number of cities not otherwise included in jurisdictions listed above. The combined funds from all sources in these areas increased from $83,754,231.72 during the fiscal year 1939-40 to $109,352,919.33 in 1940-41.

Through Federal financial grants for public works, water supplies throughout the country have been greatly improved and sewage systems extended. A study was completed on the possible uses of the Ohio River drainage area for water supply, disposal of wastes, recreation, and fish and wild life.

Health and National Defense.

As emergency situations materialized, every branch of the Public Health Service has been called upon. Upon Federal-State cooperative programs have fallen increased demands for general public health services, venereal disease control and industrial hygiene services. Financial assistance and technical guidance were furnished overburdened communities which could not provide pure water, sewage disposal and other sanitary facilities together with immunization against disease to Army and industrial concentrations of people. Three hundred defense areas have been surveyed to determine health facilities and resources. The Service recruited 500 physicians, engineers, nurses and other technical personnel and assigned them to State Health Departments for work in critical areas.

The Service was given administrative responsibility for allotment of funds to bring additional student nurses into training, provide refresher courses for inactive nurses and post-graduate training for nurses in training. Two thousand more students have been accepted by nursing schools; 3,000 inactive registered nurses desiring to return to duty are receiving refresher courses; 500 graduate nurses are able to get post-graduate training, through this plan to relieve a shortage of nurses.

Research.

Research also has been speeded up to meet defense needs. The national emergency found the National Institute of Health prepared to undertake defense problems, while continuing normal activities. Inspection of biologics designed for use in the Army and Navy has been a major activity. An alum-precipitated pertussis vaccine was developed — the only method suitable for wide public use which has demonstrated value against whooping cough.

Cancer research is proceeding steadily. Twelve grants-in-aid were made for cancer research to various institutions throughout the nation. Radium was loaned to 45 hospitals to treat indigent cancer patients.

Fundamental chemical studies relating to structure and configuration of the carbohydrates, applicable to medical and biological sciences, were continued.

Synthetic antimalarial drugs and substitutes for opium are being studied. A study is being conducted on the relationship between marginal vitamin deficiencies and susceptibility to infection. The human requirement for riboflavin (Vitamin B-2) was determined, the daily requirement estimated at 3 mgm. for an average adult. Studies were made of the tuberculocidal action of a series of sulfonamides.

A hyper-immune rabbit serum was developed which promises to be of therapeutic value in treatment of Rocky Mountain spotted fever. Studies of encephalitis, influenza and lymphogranuloma, and of antigenic polysaccharide of pneumococci in human beings and in experimental animals have been continued.

In connection with defense, a series of training courses in blood film diagnosis of malaria was given Army technicians. A survey was made for the War Department looking toward malaria control in the Caribbean area. Methods of protecting troops from mosquitoes were studied.

Forty-two state and local industrial hygiene units are in operation and their activities are closely integrated with those of the Public Health Service. Efforts are devoted to services to defense industries producing aircraft, military vehicles, munitions and ships.

Of immediate value are the following studies, in progress at the National Institute of Health: Toxicological research on synthetic rubbers, explosives, solvents and metals used in airplane construction or munitions: problems of aviation medicine with respect to decompression at high altitudes; development of methods for analyzing and sampling materials and explosives. Increasing attention is given to research on new dyes for staining human tissues, bacteria and parasites.

Mental Hygiene.

Fewer patients have been committed to hospitals established to treat narcotic addicts since war at sea has reduced narcotics available in the illegitimate trade. Six hundred and seventy beds are now being utilized for treatment of selected patients from St. Elizabeth's.

Medical, psychiatric and other technical services were furnished inmates of Federal penal institutions during the year. Surveys of 20 mental hospitals were made, and consultant services supplied in connection with mental hygiene programs in states and communities requesting assistance.

Studies of drug addiction and of certain nervous and mental diseases were undertaken during the year.

Medical and Hospital Care.

A total of 511,023 patients were furnished hospital and office relief. Of these 77,317 were hospitalized while 433,706 were furnished out-patient care. Physical examinations performed during the year totaled 234,924. Dental treatment was given to 120,039 beneficiaries.

A new tuberculosis annex of 150 beds was operated at Freedmen's Hospital during the year. The total bed capacity of the hospital is 552.

St. Elizabeth's Hospital.

St. Elizabeth's Hospital was established in 1885 for treatment of persons developing mental or nervous disability while in the service of the Army, Navy, Marine Corps, or Coast Guard. It admits certain classes of civilian patients designated by law. It was transferred to the jurisdiction of the U.S. Public Health Service June 30, 1940.

The Hospital operated with an average daily patient population of 6,663. The number of admissions during the year was the highest since 1919.

Morbidity and Mortality.

The provisional death rate from all causes for the calendar year 1940 was 10.5 per 1,000 population. Maternal mortality rate for 1940 was 3.6 per 1,000 live births. Infant mortality rate of 47 per 1,000 live births was lowest on record.

The death rate from tuberculosis was 43.8 per 100,000 as compared to 45.0 for 1939. Heart disease and cancer continued to take the highest toll, the rates being 288.9 and 117.8 per 100,000 population, respectively. The 1940 death rate from automobile accidents was 24.3 per 100,000 population.

Despite a widespread epidemic of influenza the death rate from this disease was 14.8 per 1,000 as compared to 16.4 for 1939. The death rate from pneumonia in 1940 was 53.5 per 100,000 population as compared to 58.6 for the previous year. Diphtheria, measles, scarlet fever and whooping cough caused about 25 per cent fewer deaths in 1940 than in 1939.

Influenza and poliomyelitis were unusually prevalent. Reported cases of influenza numbered 426,951.57 per cent greater than the 1935-39 median. Nearly 10,000 cases of poliomyelitis were reported in 1940, a 33 per cent increase over the 1935-39 median.

Diphtheria cases numbered 15,515. 2,795 cases of smallpox were reported. As usual the prevalence of smallpox was greatest in the states which have resisted control measures. See also MEDICINE: Venereal Disease Control; VITAL STATISTICS.