1942: Public Health Service

The United States Public Health Service, a unit of the Federal Security Agency, carries the broad general responsibility of protecting the health of the American people. Its functions include: Enforcement of national quarantine laws and regulations for the exclusion of certain communicable diseases from ports of entry by sea or air; provision of medical, dental and hospital care to specified legal beneficiaries of the Federal Government; pursuit of scientific research on many fronts, ranging from the diseases of man and the pollution of inland waters to industrial hygiene and special problems of military medicine; control of the manufacture and sale in interstate commerce of biologic products such as vaccines, toxoids, serums, etc.; control of the interstate spread of diseases; provision of hospital and custodial care to the drug addicts among Federal prisoners and of medical and psychiatric service in all Federal prisons and correctional institutions; and the dissemination of health information.

Civilian and Military Health Program.

For the fiscal year ending June 30, 1942, the work of the Service in each of its divisions has been geared up to render the fullest health protection possible under war conditions to citizens of the 48 states, the District of Columbia, the territories, and the island possessions, through the Federal-State cooperative program administering funds appropriated by authority of the Social Security Act, Title VI. In addition, there has been direct cooperation with the military services on many sectors involving joint responsibility.

Liaison service was continued between civilian health authorities and the Medical Corps of the armed services to safeguard the health of troops in areas outside the jurisdiction of the Army and Navy. Facts based on the reconnaissance surveys undertaken during 1940-41, and continued to date, have guided certification by the Public Health Service to the Federal Works Agency for the construction of health and sanitation facilities in critical areas. Similar assistance was given to the War Production Board to determine priorities governing the release of health supplies and equipment.

More than 700 professional and technical personnel have been assigned to State health departments for duty in communities with war industry or extra-cantonment problems. Special attention has been given to the health and sanitation services in maneuver areas, as well as the task of securing safe and adequate local milk supplies for military authorities.

An extensive program for the control of malaria was initiated on the basis of careful preliminary study and was well under way before the 1942 breeding season of the malaria mosquito. Dog fly breeding was controlled in areas along the Florida Gulf Coast where it would have hindered the Air Corps training program; plague control operations were carried on in and near military areas in the west; and typhus fever control measures were instituted in rat-infested areas of the south.

With the help of Federal funds administered by the Public Health Service to relieve the shortage of trained nurses for both military and civilian needs, 214 schools of nursing increased their enrollment by 6,242 over the preceding year, and 44 institutions gave refresher courses or post-graduate training to 1,393 graduate nurses.

Emphasis was placed on the development of better industrial hygiene programs by the states, with special attention to disease of non-occupational origin such as tuberculosis and venereal disease. Medical and engineering personnel were assigned to develop the Emergency Medical Services of the Office of Civilian Defense, setting up blood and plasma banks on a country-wide scale for the emergency treatment of civilians as well as organizing for the medical and hospital care which must be available in the event of enemy action.

The Service also supervised medical aspects of the relocation of Japanese aliens from the West Coast.

The 26 Marine Hospitals and 124 relief stations were severely taxed during the year by the increase in the number of patients treated which rose from 547,178 in 1941 to 752,994 in 1942; and also by the growing difficulty of obtaining and retaining qualified hospital personnel especially in the less skilled categories.

In the District of Columbia, 17 medical units were operated for first-aid treatment of 39,048 Government employees among various units of the Treasury Department, the Reconstruction Finance Corporation, Labor Department, the War Production Board and the Office of Government Reports.

Medical, dental and nursing care is provided at various alien detention camps and a medical and sanitary program has been maintained in connection with the Alaska Highway Project of the Public Roads Administration. Prompt care has been made available for sailors wherever they come ashore from vessels destroyed by enemy action.

Nearly 100 medical and dental officers have been detailed to the War Shipping Administration for duty in connection with the examination of Merchant Marine candidates and with medical care at the Maritime training stations. A substantial number are on duty with the Coast Guard.

National Institute of Health.

Among many of the important accomplishments of this research arm of the Public Health Service, have been the results of projects undertaken at the request of the Army and Navy which must remain confidential. This is aside from the assistance of the Institute to the two Medical Corps in securing enormous supplies of biologic and chemical products needed for the protection of the armed forces, including dried normal human plasma, tetanus toxoid, vaccines for cholera, plague, typhus and yellow fever, and various arsenical compounds.

Research in chemotherapy and nutrition produced interesting results, indicating that diets deficient in riboflavin or thiamine increased the susceptibility of experimental animals to infection with pneumococcus, Type I. Sclerosis and calcification of the blood vessels occurred in animals given sulfaguanidine in purified diets over a long period. Liver cirrhosis produced in rats on deficient diets was prevented and successfully treated by use of choline.

Compounds related to sulfanilamide were synthesized and their chemotherapeutic properties studied. Sulfone derivatives showed bacteriostatic action against the tubercle bacillus in vitro.

A new disease of man and its cause was discovered. An organism found in low-grade stained cotton was shown to be the cause of a disease tentatively termed 'cotton sickness' which has been observed among workers in textile mills.

An improved antigen was developed for the complement fixation test for amebiasis and is expected to simplify diagnostic procedures. Studies on water chlorination pointed to new methods in preventing the transmission of amebic dysentery from emergency water supplies.

In the field of cancer research, the production of cancer cells outside the body was demonstrated for the first time. Evidence was obtained to show that certain types of cancer in mice can be inhibited by a diet low in organic sulphur and that various types of vitamin-deficient diets retard the growth of malignant tumors.

Venereal Disease Control.

Activities during 1942 were accelerated by the routine testing of Selective Service candidates and other special groups; by expansion of treatment centers in war areas; and by the greatly augmented program for the control of gonorrhea.

More than 20,000,000 serological tests were made for syphilis, which is about a 25 per cent increase over 1941. Laboratory tests for gonorrhea increased by nearly 12 per cent. The number of clinics treating venereal disease now totals more than 3,500. Notable progress has been made in the evaluation and increased application of the newer methods of treating both syphilis and gonorrhea. The Eagle intensive treatment of syphilis was employed at a number of Marine Hospitals without serious complications. At another hospital, the 5-day massive intravenous-drip method with mapharsen was used in treating 52 carefully selected patients. Typhoid-vaccine therapy, massive-drip technique, was used successfully for gonorrheal patients.

Morbidity and Mortality.

As indicated by reports of communicable diseases and of mortality rates, the health of the nation remained good during 1941, the last year for which complete figures are available.

Epidemics of influenza and measles occurred in 1941. Reported cases of influenza numbered 681,969 as compared to 429,837 in 1940. Reported cases of measles numbered 891,652 as compared to 291,162 in 1940. A total of 9,057 cases of poliomyelitis was reported in 1941 as compared to 9,826 in 1940.

Diphtheria cases numbered 18,061; 1,374 cases of smallpox were reported, the lowest number in the records of the Public Health Service. As usual the prevalence of smallpox was greatest in the states which have resisted control measures.

The general death rate in the United States was 10.5 per 1,000 population, the lowest ever recorded. The maternal mortality declined for the twelfth consecutive year, reaching a new low of 3.0 per 1,000 live births. The infant rate, 45 per 1,000 live births, showed no change.

The death rate from tuberculosis was 42.2 per 1,000 population as compared to 43.8 for 1940. Heart disease and cancer continued to take the highest toll, the rates being 295.4 and 121.2 per 1,000 population, respectively. The death rate from automobile accidents increased from 24.3 in 1940 to 27.5 in 1941.

The epidemics of measles and influenza resulted in slightly higher mortality from these causes, but it is significant that the death rate from pneumonia (a common complication of these diseases) declined sharply from 53.2 per 100,000 in 1940 to 46.6 per 100,000 in 1941.

Mortality from diphtheria, digestive diseases, malaria, pellagra and scarlet fever declined for the fifth consecutive year.

At the close of the fiscal year, 524 officers of the regular commissioned Corps of the Public Health Service and 402 reserve officers were on active duty. The staff of the National Institute of Health totalled 1,615. As of Mar. 31, 1942, the total personnel of the Public Health Service numbered 17,053, of whom 5,152 were collaborating epidemiologists and assistant collaborating epidemiologists receiving only nominal compensation for the collection of morbidity data.

Approximately $34,500,000 was available for the work of the Public Health Service in 1942. In addition, $11,500,000 was allocated to the states under Title VI of the Social Security Act.

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.

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.