pounds, which have no toxic or sedative effects, are being used with considerable success in epilepsy of various types. More than 100 patients have been treated surgically for intractable seizures related largely to lesions of the temporal lobe. Although it is too early to evaluate results, it is estimated in view of past experience that 50 percent of the cases will be relieved of seizures, 25 percent partially relieved, and 25 percent will present no change. As a result of the combined work of scientists in NIAMD and NMI, the cause of one form of uveitis, a blinding eye disease, has been found, and a rational method of treatment has been established. The toxoplasma parasite has been isolated from the human eye and, in clinical trials, has yielded to treatment with daraprim and sulfadiazine. In multiple sclerosis, certain supporting cells of the nervous system, oligodendroglia, have been found to disappear at the site of destruction of myelin. These supporting cells are believed to play some role in myelin formation and nutrition. Isoniazid proved unsuccessful in multiple sclerosis patients. At a special conference in New York City in mid-December, the legislative committee of the American League Against Epilepsy, composed of a group of the country's leading neurologists, discussed and recommended radical revision of State laws affecting epileptics. These recommendations were made in the light of a two-year study, supported by an Institute grant. They concerned legislation regarding marriage, sterilization, employment, and operation of motor vehicles. Bureau of Medical Services The Bureau of Medical Services administers the programs of the Public Health Service which relate to care of the individual. It operates the hospital and outpatient facilities of the Service and exercises professional supervision over personnel assigned to other Federal agencies for the administration of medical and hospital programs. Other Bureau programs include the construction of hospital and medical facilities; the development of hospital, nursing, and dental resources; and foreign quarantine. Hospitals and Medical Care The Division of Hospitals conducts the medical care program for American seamen and other legal beneficiaries of the Public Health Service. Besides American seamen, beneficiary groups include officers and enlisted men of the U. S. Coast Guard, officers and crewmembers of the Coast and Geodetic Survey, commissioned officers of the Public Health Service, Civil Service employees of the Federal Government injured or taken ill in the course of their work, and several smaller groups. Persons with leprosy and men and women who are addicted to narcotic drugs as defined by statute also receive treatment in special facilities maintained by the Service. The Division of Hospitals also administers the Federal employee health program. Under it, Federal departments-at their requestreceive consultative help in establishing or improving health activities for their personnel. On a reimbursable basis, 18 separate health units are conducted through the Federal employee health program. In 1955, the Division maintained 16 hospitals, 25 outpatient clinics, and 96 outpatient offices; in addition, 58 physicians served active Coast Guard and Coast and Geodetic personnel. Of the hospitals, 12 provide general medical and surgical services, one is exclusively for patients with tuberculosis, two treat narcotic addiction and neuropsychiatric disorders, and one-at Carville, Louisiana-cares for persons with leprosy. Most of the hospitals are located in major port cities, such as Boston, New York, Baltimore, New Orleans, San Francisco, and Seattle. Outpatient clinics and offices are located in other areas with a high concentration of Service beneficiaries. Staffed by full-time personnel, the clinics provide a range of medical, dental and allied health services. Local physicians also provide outpatient services in their offices on a part-time basis, as needed. VOLUME OF SERVICES The volume of services rendered by the Division of Hospitals in 1955 showed only moderate declines, compared with the two previous years. Inpatient admissions in all of the Public Health Service hospitals fell 5 percent-from 48,282 in 1954 to 45,852 in 1955. Meanwhile, the average daily patient census dropped 4 percent-from 5,640 to 5,428. However, outpatient visits declined only 2 percent, and remained over the 1,000,000 mark. The general hospitals admitted 41,379 patients in 1955, compared with 43,329 in 1954. The daily number of patients at these stations averaged 2,768, or 6 percent fewer than the 1954 average. The tuberculosis hospital at Manhattan Beach, Brooklyn, N. Y., operated at slightly above its 325-bed constructed capacity. It maintained an average daily census of 339 throughout the year, a decrease of only 4 from 1954. The Public Health Service hospitals for narcotic drug addiction at Lexington, Ky., and Fort Worth, Tex., admitted 4,018 patients during 1955, a decrease of 11 percent from 1954. The average daily census of all addict patients remained unchanged from the previous year. 368636-56- -8 CLINIC SERVICES Several of the Division's outpatient clinics became part of the outpatient sections of hospitals in the geographic areas in which they are located. The clinics at Cleveland, Ohio, and Buffalo, N. Y., were merged with the Public Health Service Hospital at Detroit, Mich.; and the clinics at Pittsburgh, St. Louis, and Portland, Maine, with the PHS hospitals in Baltimore, Chicago, and Boston, respectively. The principal medical officers assigned to the clinics were designated as chiefs of their individual outpatient units, and, in day-to-day operations, represent the medical officer in charge of the hospital who has general supervisory responsibility. This procedure provides closer professional supervision over the smaller facilities, and promotes economy and efficiency in the utilization of the personnel, equipment, and resources available to the Division. PROFESSIONAL EDUCATION In 1955, eight Service hospitals were approved for postgraduate training of physicians by the American Medical Association. The American Dental Association also approved eight Service hospitals for dental internships. On July 1, 1955, 88 medical interns, 30 dental interns, and 111 residents were on duty. At several hospitals, qualified trainees participated in approved professional education programs in dietetics, pharmacy, physical therapy, occupational therapy, social service, medical record library science, anesthesiology, medical technology, X-ray technology, and hospital administration. During the year, the Division of Hospitals extended its training resources to the United States Coast Guard. Following a request. received last year from the Coast Guard, the nursing branch of the Division surveyed the course for hospital corpsmen conducted at the Coast Guard Training Station, Groton, Conn. Among the changes recommended were the addition of instruction in nursing arts and eight weeks of actual clinical nursing practice. This practice is being provided at the PHS hospital in Staten Island, N. Y., with a first class of 15 students which started in April. FREEDMEN'S HOSPITAL Freedmen's Hospital, the clinical teaching arm of the Howard University School of Medicine, has 335 general beds, 50 bassinets, and a 150-bed tuberculosis annex. In 1955, the hospital admitted 11,091 inpatients, a decrease of 655 from the year before. The 1955 daily inpatient census averaged 378, compared with 440 in 1954. The outpatient department reported 49,827 visits to its 33 organized clinics, for an average of 204 visits per day. Registration of new patients totaled 5,866. Each of these figures represents a decrease from 1954, when 56,061 visits, averaging 227 per day, and 6,487 new registrants were recorded. Forty-two residents, 3 interns, 17 externs, and 2 fellows received advanced medical training. There were also 2 dental interns at the hospital. Student enrollments at the School of Nursing totaled 103. Other approved hospital training programs conducted at Freedmen's included 10 dietetic internships, 2 pharmaceutical internships, and 1 administrative residency. During the year, the Secretary of Health, Education, and Welfare appointed a commission to study the hospital and make recommendations regarding its future. After a 3-month survey, the commission recommended the continuation of the hosptial and cited the need for new construction and for additional funds to care for indigent patients. The commission also recommended that the administration of Freedmen's be transferred from the Department of Health, Education, and Welfare to the Board of Trustees of Howard University, and that the Federal Government bear the initial expense of new construction and continue to support the hospital for a reasonable period of time thereafter. Foreign Quarantine For the second straight year, the Nation was free of cases of quarantinable disease-smallpox, cholera, yellow fever, plague, louseborne typhus, and relapsing fever. This is the second year in the country's history that no smallpox has occurred here. Yellow fever moved into two areas of Venezuela where it had been absent for many years. The first Aedes aegypti transmitted outbreak anywhere in 20 years occurred in Port-of-Spain, Trinidad. In its 7-year advance through Central America, yellow fever reached San Pedro Sula in Honduras near the border of Guatemala. The disease appeared near Belem, Brazil, after an absence of six years from that area. These outbreaks highlighted the need for revising the yellow fever provisions of the International Sanitary Regulations. An amendment initiated by the Division of Foreign Quarantine was approved by the Eighth World Health Assembly, and will become effective in October 1956. The amended Regulations provide for abolishing the yellow fever endemic zones and declaring any area where the yellow fever virus is present in man or other vertebrates an infected local area. Under the new system, measures may be taken promptly against any area where yellow fever is present. In France there was a smallpox outbreak of about 90 cases with 15 deaths. This disease is extremely prevalent in Colombia and Ecuador and several Brazilian and Bolivian cities. The British Virgin Islands were added to the areas from which ships and airplanes are usually exempt from quarantine inspection upon arrival in the United States. These Islands have been free from quarantinable diseases for many years. INTERNATIONAL TRAFFIC VOLUME International traffic subject to Service health requirements increased noticeably, as follows: airplanes inspected for quarantine or immigration-medical purposes from 47,307 in 1954 to 54,759 this year; ships inspected from 27,171 to 27,551; arriving persons subject to foreign quarantine regulations from 39,231,904 to 42,861,862; smallpox vaccinations given by quarantine officers from 283,456 to 481,190; persons released under surveillance (subject to further medical examination at destination) from 3,202 to 17,831; persons detained in isolation at ports from 15 to 229. MEDICAL EXAMINATIONS In the Refugee Relief Program of immigration, medical examinations were performed by Service officers in Austria, Belgium, England, France, Germany, Greece, Italy, Jordan, The Netherlands, Turkey, and the Far East. Among the 38,928 refugees examined abroad, 882 were found to be excludable under immigration law; and 4,628 had other physical conditions that may cause exclusion or require posting of bond. At United States ports 26,882 refugees were examined; 10 were certified for excludable disease and 3,022 for physical conditions that may have caused exclusion or required posting of bond. Of aliens other than refugees, the number examined abroad by Service officers increased from 147,539 in 1954 to 158,074 this year. Those examined in this country increased from 1,671,885 to 1,861,787. Aliens certified for excludable diseases abroad and in the United States numbered 3,950. The Farm Placement Program of recruiting agricultural workers from Mexico completed its fourth year under Public Law 78, 82d Congress, as amended. At "migratory centers" in Mexico, 263,376 applicants were examined under supervision of Service officers; smallpox vaccinations were also administered. The rejection rate for physical and mental diseases and defects was approximately 2.1 percent. At "reception centers" on the border, Service personnel gave further examination, including X-ray screening, to 240,070 arriving recruits, and complete examination to 100,000 making initial application at the border; the rejection rate for these two groups was approximately 1.7 |