NEEDS OF THE SERVICE.

National quarantine. The question of making complete the national quarantine system by the acquisition of the few remaining stations not under Federal control is considered sufficiently important to be classified as one of the most important needs of the Public Health Service. During the fiscal year a resolution was passed by the New York Legislature authorizing the transfer to the Federal Government of the quarantine station of the port of New York, on the condition that reasonable compensation, to be arrived at by competent appraisement, should be paid to the State for the property. The city authorities of Baltimore also passed an ordinance indicating their willingness to turn over to the Government the station at that port at a reasonable rate of reimbursement to the city. These two points are the sole remaining ports of importance where quarantine measures are not under Federal control, and their acquisition awaits only appropriations by Congress for their purchase, as contemplated in the act of February 15, 1893, in the following language:

That whenever the proper authorities of the State shall surrender to the United States the use of buildings and disinfecting apparatus at a State quarantine station, the Secretary of the Treasury shall be authorized to receive them and to pay a reasonable compensation to the State for their use *

*

Quarantine procedure at American ports is closely interwoven with other Federal activities, such as customs and immigration, and uniform quarantine methods are necessary in the interest of facilitating commerce, protecting the country as a whole from the introduction of disease, and adjusting international questions involving quarantine practice. In the past, although the United States Government has been signatory to several international sanitary agreements, its representatives have not had control of quarantine procedure at several of the largest and and most important ports. The gradual enlargement of the national quarantine system, however, and the protection afforded all ports through its operation, have demonstrated its practicability and its necessity. Commercial interests have been quick to recognize the advantage of one set of quarantine regulations over numerous requirements at as many ports.

Since the outbreak of the war in Europe, more serious epidemics of typhus fever, smallpox, and cholera have occurred on the Continent than have been recorded. The alteration of established trade channels has resulted in the appearance of rodent plague at several British ports, four or five of them having reported the finding of plague-infected rats during the past fiscal year. The return of troops and the resumption of commerce with European ports after the war may well constitute a serious menace to the health of this country,

to guard against which the control of quarantine procedure at all ports should be in the hands of the Federal Government.

Additional commissioned officers. A recommendation that appropriations be provided which will permit of an increased number of commissioned medical officers in the Public Health Service is respectfully renewed. The need of additional trained men has at all times been felt in the development of the service during the past few years. The commissioned officers, serving under permanent appointment, enter the service as a life work, and their value to the Government increases with their years of training and experience.

Recent legislation has added materially to the duties which will henceforth constitute a permanent and growing responsibility. Under the immigration act, examination of arriving aliens by two medical officers is specifically required at many places where the work has heretofore been performed by one. This act also requires the physical examination of all alien sailors on vessels arriving at American ports. The hospitals and relief stations of the service have been opened to Government employees suffering injuries in the course of their employment. All seamen who apply for rating as able seamen are now required to pass a physical examination by service officers. Applicants for certain positions in the classified civil service are also given physical examination at the request of the Civil Service Commission. It is believed that the enlargement of the permanent medical corps should keep pace with the increasing activities of the service, and favorable consideration of increased commissioned personnel is earnestly recommended to Congress.

Proposed Sanitary Reserve Corps.-A bill to establish a Sanitary Reserve Corps of the Public Health Service (S. J. Res. 63) was passed by the Senate on June 18, 1917. The text of the measure follows:

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That for the purpose of securing a reserve for duty in the Public Health Service in time of national emergency there shall be organized, under the direction of the Secretary of the Treasury, under such rules and regulations as the President shall prescribe, a reserve of the Public Health Service. The President alone shall be authorized to appoint and commission as officers in the said reserve such citizens as, upon examination prescribed by the President, shall be found physically, mentally, and morally qualified to hold such commissions, and said commissions shall be in force for a period of five years, unless sooner terminated in the discretion of the President, but commission in said reserve shall not exempt the holder from military or naval service. Said officers shall consist of sanitarians, senior assistant sanitarians, and assistant sanitarians, and when ordered to active duty in the service of the United States shall receive the rank, pay, allowances, and leaves of absence of surgeons, passed assistant surgeons, and assistant surgeons, repectively.

SEC. 2. That for the purpose of carrying out the provisions of this act the sum of $300,000 be appropriated out of any money in the United States Treasury not otherwise appropriated.

In the House of Representatives, the joint resolution was referred to the Committee on Interstate and Foreign Commerce, which Committee on August 30, 1917, reported a substitute measure, reading as follows:

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That there is hereby established a Reserve Corps of the United States Public Health Service to be composed of officers of State, county, and municipal health organizations and other persons skilled in sanitary science.

Sec. 2. That appointments to the Reserve Corps of the United States Public Health Service shall be made by the President upon the recommendation of the Surgeon General of the United States Public Health Service with the approval of the Secretary of the Treasury and commissioned with grade of assistant surgeons, passed assistant surgeons, surgeons, or senior surgeons in the Reserve Corps of the Public Health Service for four years or during the war in which the United States is now engaged in accordance with rules and regulations prescribed by the President: Provided, That no person shall be appointed as a member of the Reserve Corps as aforesaid until his voluntary application for appointment has been filed with the Surgeon General of the United States Public Health Service.

Sec. 3. That said officers when ordered to active duty as members of the Reserve Corps of the United States Public Health Service shall be subject to the orders of the Surgeon General of said service and while so serving shall receive from the United States the same salaries and allowances of officers of the corresponding grade in the Public Health Service: Provided, That officers of State, county, and municipal health organizations shall not be commissioned in said Reserve Corps without the assent of the proper executive officers of their respective States, counties, or municipalities. Officers in the Reserve Corps of the Public Health Service may be promoted successively to the higher grades of the Reserve Corps of the Public Health Service under rules and regulations prescribed by the President.

Sec. 4. That when any person other than a commissioned medical officer of the Public Health Service shall be appointed chief of either the Division of Chemistry, Zoology, or Pharmacology of the Hygienic Laboratory he shall be commissioned by the President as zoologist, chemist, pharmacologist, or assistant pharmacologist, as the case may be, in the Public Health Service. Sanitary engineers, assistant sanitary engineers, epidemiologists, and assistant epidemiologists may, on the recommendation of the Surgeon General, with the approval of the Secretary of the Treasury, be commissioned as such by the President. The respective grades and order of promotion of such officers shall be prescribed by regulations of the Public Health Service.

Sec. 5. That the duties of the Reserve Corps of the United States Public Health Service shall be performed under instructions issued by the Surgeon General of such service, with the approval of the Secretary of the Treasury, and shall be directed toward the proper sanitation of ports and places within the United States or within the jurisdiction of the United States Government, including especially places in and near which industrial forces are or are to be mobilized and places in which military forces are to be mobilized and places near which military forces are mobilized.

Sec. 6. That it shall be the duty of the United States Public Health Service to cooperate with State, county, and municipal health organizations and with officials in charge of industrial establishments, with a view to coordinating the activities and making effective the work of the health organizations of the United States.

The purpose of the proposed legislation is evident from a reading of the text of the two measures. The necessity for an organization of trained sanitarians and health officers whose services could be utilized in the occurrence of epidemics or other emergencies of a public health character is one that has been felt on numerous occasions in the past. This need has been urgent in the work recently undertaken for the sanitation of areas adjacent to military cantonments and industrial establishments-work of vital importance that suddenly confronted the service with the entrance of the United States into the war. As indicated in the measure, the personnel of the reserve would be enrolled, but would receive compensation only when called upon to perform active duty. The resolution as orginally introduced had the endorsement of the bureau, the Treasury Department, and the Council of National Defense, and was strongly urged in resolutions unanimously adopted by the Conference of State and Territorial Health Officers at their meeting held in Washington

last April. It is believed that through the establishment of an organization such as outlined, a strongly organized and efficient force for the protection of the public health could be maintained under the supervision of the Federal Government, at an expense that would be comparatively small, and thoroughly justified by such circumstances as would result in its call to active duty.

Information of disease prevalence. In estimates submitted to Congress for the fiscal year 1919 request has been made for an appropriation of $25,000 for the purpose of securing better and more complete information of the prevalence of disease in the United States. There is nothing of such fundamental importance in publichealth work and disease control as dependable information of the localities where diseases are present, their relative prevalence in such localities, and the conditions under which cases are occurring. At this time the need of such information is especially acute, in order that diseases occurring among the civil population may be prevented from spreading to the military forces.

Publications.-Another need of the service that is at all times present is additional funds for the printing of publications. The increased activities along many lines of public-health work has stimulated the demand for literature on health subjects. There is no other way in which the Federal health agency can be of greater service to the public at large than by the publication and dissemination of information that will enable the individual to intelligently cooperate with the authorities, National, State, and local, who are striving to better health conditions. Although the number of publications distributed during the fiscal year has been larger than in any preceding year, the number of requests which could not be filled has also increased. Because of limited editions it has been necessary to refer many applicants for publications to the Superintendent of Documents, from whom copies could be purchased.

Bureau personnel.-In estimates submitted to Congress request has been made for several additional employees for the bureau. The assistance provided for administrative work has not kept pace with the increased work of the service in the field. The estimates submitted have been held down to what is considered minimum requirements, and it is earnestly hoped that the increase will be allowed. RUPERT BLUE, Surgeon General.

APPENDIX.

FINANCIAL STATEMENT.

Receipts and expenditures, Public Health Service, for the fiscal year ended June 30, 1917.

1 Includes $1,400 transferred to "Contingent expenses, Treasury Department, stationery, 1917." NOTE.-For expenditures by stations under marine hospitals and relief, see Statistical Table 2.

NOTE.-Payments amounting to $78,167.04 were made from pay items of appropriation Public Health Service, 1917," account of epidemic duty.

1 Includes $200 transferred to " Contingent expenses, Treasury Department, stationery, 1917."