THE NATIONAL GOVERNMENT AND 
PUBLIC HEALTH THE INSTITUTE FOR GOVERNMENT RESEARCH 
Washington, D. C. 
The Institute for Government Research is an association of citi- 
zens for cooperating with public officials in the scientific study of 
government with a view to promoting efficiency and economy in its 
operations and advancing the science of administration. It aims to 
bring into existence such information and materials as will aid in 
the formation of public opinion and will assist officials, particularly 
those of the national government, in their efforts to put the public 
administration upon a more efficient basis. 
To this end, it seeks by the thoroughgoing study and examination 
of the best administrative practice, public and private, American 
and foreign, to formulate those principles which lie at the basis of all 
sound administration, and to determine their proper adaptation to the 
specific needs of our public administration. 
The accomplishment of specific reforms the Institute recognizes to 
be the task of those who are charged with the responsibility of legis- 
lation and administration; but it seeks to assist, by scientific study 
and research, in laying a solid foundation of information and experi- 
ence upon which such reforms may be successfully built. 
While some of the Institute's studies find application only in the 
form of practical cooperation with the administration officers directly 
concerned, many are of interest to other administrators and of gen- 
eral educational value. The results of such studies the Institute pur- 
poses to publish in such form as will insure for them the widest 
possible utilization. 
Officers 
Robert S. Brookings, 
Chairman 
Harold G. Moulton, 
Vice-Chairman 
Frederic A. Delano, 
Treasurer 
Trustees 
Robert S. Brookings 
Frederic A. Delano 
George Eastman 
Raymond B. Fosdick 
Frank J. Goodnow 
Jerome D. Greene 
Vernon Kellogg 
John C. Merriam 
Harold G. Moulton 
L. S. Rowe 
Charles D. Walcott 
Director 
W. F. Willoughby 
Editor 
F. W. Powell THE INSTITUTE FOR GOVERNMENT RESEARCH 
STUDIES IN ADMINISTRATION 
THE NATIONAL GOVERNMENT 
AND PUBLIC HEALTH 
BY 
JAMES A. TOBEY, M. S„ LL. B. 
FELLOW, A.P. H.A. 
THE JOHNS HOPKINS PRESS 
BALTIMORE MARYLAND 
1926 Copyright, 1926, by 
THE INSTITUTE FOR GOVERNMENT RESEARCH 
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BALTIMORE, MD., U. S. A. PUBLICATIONS OF THE 
INSTITUTE FOR GOVERNMENT RESEARCH 
STUDIES IN ADMINISTRATION. 
The System of Financial Administration of Great Britain. 
By W. F. Willoughby, W. W. Willoughby, and S. M. Lindsay. 
378 PP- $3- 
The Budget. 
By Rene Stourm. 
T. Plazinski, Translator; W. F. McCaleb, Editor. 648 pp. 
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The Canadian Budgetary System. 
By H. C. Villard and W. W. Willoughby. 390 pp. $3. 
The Problem of a National Budget. 
By W. F. Willoughby. 234 pp. $3. 
The Movement for Budgetary Reform in the States. 
By W. F. Willoughby. 266 pp. $3. 
Teachers' Pension Systems in the United States. 
By Paul Studensky. 474 pp. $3. 
Organized Efforts for the Improvement of Methods of Administra- 
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By Gustavus A. Weber. 408 pp. $3. 
The Federal Service: A Study of the System of Personnel Ad- 
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By Lewis Mayers. 624 pp. $5. 
The Reorganization of the Administrative Branch of the National 
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By W. F. Willoughby. 314 pp. $3. 
The Development of National Administrative Organization in the 
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By Lloyd M. Short. 531 pp. $5. 
The Statistical Work of the National Government. 
By Laurence F. Schmeckebier. 590 pp. $5. 
Manual of Accounting and Reporting for the Operating Services 
of the National Government. 
By Henry P. Seidemann. 421 pp. $5. 
The National Government and Public Health. 
By James A. Tobey, 441 pp. $3. 
PRINCIPLES OF ADMINISTRATION. 
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By Lewis Meriam. 508 pp. $3. 
Principles of Government Purchasing. 
By Arthur G. Thomas. 290 pp. $3. 
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The Bureau of Animal Industry. (In Press.) 
The Hydrographic Office. (In Press.) 
The Bureau of Naturalization. (In Press.) PREFACE 
In 1923 the Institute for Government Research published its 
volume entitled "The Reorganization of the Administrative 
Branch of the National Government." That volume had for its 
purpose to consider the problem of the regrouping of the admin- 
istrative services of the government from the most general stand- 
point. It sought to determine the principles upon which those 
services should be grouped departmental!/ and the character of 
grouping that would result if those doctrines were put into prac- 
tice. These principles, which have received general acceptance 
from those who have given consideration to the problem during 
recent years, are: That all the operating services of the govern- 
ment, except those that are of a quasi-judicial or quasi-legislative 
character should be brought within a departmental grouping, thus 
restricting within the closest feasible limit the number of inde- 
pendent establishments; that the principle of grouping the ser- 
vices departmentally should be that of bringing together in the 
same department all services having to do with the same general 
purpose; and that, as far as practical considerations permitted, 
each department should be unifunctional in the sense that the 
services comprehended by it should have to do only with the 
same general purpose or function. 
Though, as stated, these principles have received general 
acceptance, certain difficulties are encountered in attempting to 
put them into practice. In the first place, rigid adherence to the 
principle of unifunctional departments would necessitate an addi- 
tion to the number of departments now in existence, a step which, 
for various reasons, is generally deemed inadvisable. Secondly, 
there are certain general functions, to the performance of which 
the national government is committed, which, though clearly dis- 
tinguishable, involve activities which are of direct concern to 
other operating services falling within other departmental group- 
ings. For example, the promotion and protection of the health 
of the Indians is manifestly a part of the general function of the 
VII VIII 
PREFACE 
promotion and protection of the public health, but, at the same 
time, it is an integral part of the work performed by the National 
Government for the care of its Indian wards. 
These two difficulties can be met in the following way: The 
first by the creation of bi-functional departments; that is by the 
creation of departments which will embrace services having to do 
with two functions which, though distinct, have a close relation- 
ship to each other; and the second, by the adoption of the principle 
that one department shall act as a supply or contracting agency 
for the performance of activities falling within its field which 
constitute essential parts of the work of other services or depart- 
ments. Thus, to illustrate, it is possible, and probably desirable, 
at the outset at least, to create a Department of Public Works 
and Public Domain instead of two separate departments, one each 
for public works and public domain. In such a department, the 
services having to do with each of these subjects can be separately 
grouped under an Assistant Secretary; and most, if not all, of 
the advantages of bringing together under a common direction 
of services performing the same general functions are thus secured. 
A second aspect of administrative organization appears when 
the primary purpose of one department is also a secondary purpose 
of another. A duplication of agencies to carry out this purpose is 
unnecessary. It is possible for one service, such, for example, 
as the Public Health Service, to act as the agency for performing 
the work of making physical examination of immigrants for the 
Immigration Bureau, thus avoiding the necessity for the latter 
service to organize a technical division of its own for such work. 
This statement of the general problem of the grouping of ser- 
vices departmentally has been given because it is impossible to 
consider the special problems of the grouping of any particular 
class of services or activities without having clearly in mind the 
points that have been mentioned. Especially is this so in respect 
to the services and activities to which the present volume relates, 
those, namely, having to do with the promotion and protection of 
the public health. As will appear in this volume, the national 
government is now maintaining at least eight distinct services 
whose principal or major function falls within the field of the 
promotion of the public health. In addition to these, there are a 
score or more of other services some of whose activities are more PREFACE 
IX 
or less connected closely with the public health. These services are 
scattered among the several departments. The prosecution of such 
work by so many different agencies raises very distinctly the ques- 
tion as to whether this distribution, which has resulted from no 
deliberate plan, is one best adapted to meet the ends sought. 
Viewed either from the standpoint of economy or that of efficiency, 
would it not be possible to improve this situation to a considerable 
degree by steps looking to the centralization under a common 
direction of those services which have as their major function 
the promotion of the public health, the assignment to such central 
agency of specific activities in the field of public health now being 
performed by other agencies as incidental features of their other 
work, and the larger use of this centralized service by other services 
as a supply or contracting agency to do for them work of a public 
health character in place of organizing and operating distinct ser- 
vices of their own for this purpose? 
These questions can be answered only after a most searching 
inquiry into all the work falling in the field of public health pro- 
motion and protection which is now being done by the several 
administrative services of the government. Such an inquiry should 
disclose the reasons why such work has been undertaken, and the 
relation that such work in each case bears to the other activities of 
the services performing it. It should extend to the advantages that 
might be expected to follow from having the public health activities 
more largely performed by those services whose major or primary 
function is that of public health promotion; and it should examine 
into the advantages of the grouping of these latter services under 
a common direction, either as a department of public health, or as 
a group of services under the direction of an assistant secretary 
in a department having charge, in addition, of some other primary 
function, such, for example, as education. 
The present volume gives the results of such an inquiry. If it 
errs at all as regards scope it is on the side of comprehensiveness. 
A word should be said regarding the circumstances leading 
to its inception. A group of distinguished sanitarians of national 
reputation, leaders in the field of American public health, came 
together as an informally organized National Health Conserva- 
tion Commission, with Dr. Haven Emerson, Professor of Public 
Health at Columbia University as its chairman, for the purpose X 
PREFACE 
of considering primarily how the work being done by the National 
Government in the field of public health could be put upon a more 
satisfactory basis. A committee of this group waited upon the 
President of the United States for the purpose of placing before 
him its views in respect to the desirability of the establishment of 
a greater centralization and coordination of the public health 
work of the government. The result of the conference was an 
indication that until a thorough investigation should be made 
of the issues involved, there was small likelihood of any action. 
It was in response to this situation that the National Health Con- 
servation Committee requested the making of the present study, 
which Mr. Tobey has also offered in partial fulfilment of the 
requirements for the doctorate in public health at the Massachu- 
setts Institute of Technology. The results are published in printed 
form in order that they may be available not only to the Com- 
mission and to the President but also to members of Congress 
and all others whose cooperation is required if action upon the 
recommendations is to be had. It is hoped also that this volume 
will present information of value to all persons interested in the 
public health problem. 
W. F. Willoughby. CONTENTS 
CHAPTER PAGE 
Preface vii 
PART I. THE RELATION OF GOVERNMENT TO HEALTH 
I. Introduction i 
II. The Development of the Relation of Public Health and 
Government 5 
Public Health in History 5 
The Foundation of Modern Public Health 9 
Public Health in the United States 10 
Pasteur and the Science of Bacteriology 13 
The Three Periods of Public Health 15 
The Modern Science of Public Health 16 
Results of Public Health Activities 17 
HI. Public Health in the Messages of the Presidents . ... 20 
John Adams and National Quarantine 21 
Other Early Quarantine and Relief Matters 21 
President Hayes and Quarantine 22 
The National Board of Health 23 
Cleveland and National Health 24 
Theodore Roosevelt 25 
Taft and the Movement for a National Bureau of Health . . 27 
Woodrow Wilson 29 
Harding and the Department of Welfare 30 
IV. The Growth of Federal Health Activities and Congressional 
Enactments 31 
A Haphazard Development 31 
The First National Health Laws 32 
The National Board of Health 33 
Developments After 1890 39 
Bureaus Added Since 1910 40 
Development of Federal Health Legislation and Public Health 
and Medical Activities 42 
V. Public Health and the United States Supreme Court ... 48 
Public Health and the Police Power 49 
Nuisances and the Police Power 51 
State versus State 53 
Animal Diseases and Quarantine 54 
Quarantine and General Health Matters 54 
Purity and Adulteration of Foods 56 
Industrial Conditions Affecting Health 57 
Miscellaneous Subjects Affecting Health 59 
Summary 59 XII 
CONTENTS 
CHAPTER PAGE 
VI. The Relation of the National Government to State and 
Local Administration 61 
Public Health Responsibility in the United States 61 
Source of Federal Health Powers 62 
The Federal Taxing Power 62 
Federal Subsidies to the States 63 
Control over Interstate Commerce 64 
Power over Territories; Treaties 65 
Investigation and Instruction 65 
Federal Recognition of State Health Authority 66 
Limitations on the Police Power 67 
Delegation of the Police Power 68 
Organization of State Health Work 68 
Actual Relation of the Federal Government to State Health 
Work 69 
Collection and distribution of information 70 
Cooperation with the states 71 
Interstate matters 73 
Foreign commerce and taxation 74 
PART II. DESCRIPTION AND ANALYSIS OF EXISTING 
FEDERAL HEALTH ACTIVITIES 
VII. The Department of the Treasury 75 
The Public Health Service 75 
The Unorganized Marine Hospital Service, 1798 to 1870 . . 76 
The Organized Marine Hospital Service, 1870 to 1902 ... 81 
Quarantine law of 1878 83 
National Board of Health, 1879 85 
Personnel system of 1879 86 
Development of the Service, 1883-1889 86 
Interstate control of diseases, 1890 88 
Medical inspection of immigrants, 1890 and 1891 ... 89 
Quarantine law of 1893 90 
Regulations of 1897 92 
Growth of the Service, 1898 to 1901 93 
The Public Health and Marine Hospital Service, 1902 to 1912 96 
Tests of biologic products 98 
Developments in activities and organization 98 
The Public Health Service Since 1912 102 
New activities 103 
Medical aid to deep sea fisheries, 1914 105 
Inoculation of government employees 105 
Fumigation of forecastles, 1915 105 
Studies of rural sanitation, 1916 105 
Control of biologic products, 1916 106 
National home for lepers, 1917 106 
Hospital treatment for injured government employees, 1917 106 
Medical inspection of immigrants, 1917 107 
World War activities 108 
Control of venereal diseases 110 CONTENTS 
XIII 
CHAPTER PAGE 
Hospital relief for the Army and Navy 114 
Influenza epidemic of 1918 115 
Organization of reserve corps, 1918 115 
New administrative units 116 
Increased compensation for commissioned officers, 1920 . 116 
Completion of national quarantine system 117 
Medical treatment of discharged soldiers 117 
Further revision of salaries 118 
Current Activities 119 
Medical relief U9 
Prevention of interstate spread of disease 123 
Rural sanitation 127 
Foreign quarantine 13° 
Medical inspection of aliens 131 
Control of venereal diseases 135 
Scientific research 138 
Industrial hygiene and sanitation 139 
Public health administration 141 
Milk investigations 141 
Child hygiene 142 
Mental hygiene 142 
Statistical research 143 
Stream pollution 143 
The hygienic laboratory 144 
Control of biological products 145 
Statistics and reports 148 
Organization 150 
Office of the Chief Clerk 151 
Inspection Service I52 
Division of Personnel and Accounts 153 
Hospital Division 153 
Division of Venereal Diseases 155 
Division of Domestic (Interstate) Quarantine .... 156 
Division of Foreign and Insular Quarantine and Immi- 
gration 157 
Division of Sanitary Reports and Statistics 158 
Division of Scientific Research 160 
Public Health districts 162 
Personnel 163 
Commissioned personnel 164 
Non-Commissioned personnel 175 
Appropriations 180 
The Bureau of Internal Revenue 181 
Taxation and Public Health 182 
Narcotic Law Enforcement 183 
Organization 184 
The Customs Service 184 
VIII. The Department of Agriculture 187 
The Bureau of Chemistry 187 
History and Development 187 XIV 
CONTENTS 
CHAPTER PAGE 
Current Activities 190 
Food and Drug Act enforcement 190 
Factory and local investigation I92 
Cooperation with states and cities 193 
Tea inspection 193 
Naval Stores Act enforcement 193 
Research 194 
Publications 195 
Organization 196 
Laboratories 196 
Field service 197 
Personnel 197 
Appropriations 197 
The Bureau of Animal Industry 198 
History and Development 198 
Current Activities 200 
Regulatory work 200 
Extension work 201 
Research 202 
Publications 202 
Organization 202 
Animal Husbandry Division 203 
Biochemic Division 203 
Division of Hog Cholera Control 203 
Division of Virus Serum Control 203 
Experiment Station 203 
Field Inspection Division 203 
Meat Inspection Division 204 
Office of Personnel 204 
Pathological Division 204 
Tick Eradication Division 204 
Tuberculosis Eradication Division 204 
Zoological Division 204 
Editorial Office 204 
Exhibit Office 204 
Field service 204 
Personnel 205 
Appropriations 205 
The Bureau of Home Economics 205 
History and Development 205 
Current Activities 208 
Publications 209 
Organization 211 
The Bureau of Dairy Industry 211 
History and Development 211 
Current Activities 214 
Publications 215 
Organization and Personnel 216 
The Extension Service 217 
History and Development 217 
Current Activities 219 CONTENTS 
XV 
CHAPTER PAGE 
Organization and Personnel 221 
The Bureau of Entomology 221 
The Bureau of Biological Survey 224 
The Bureau of Public Roads 226 
The Bureau of Agricultural Economics 228 
The Office of Experiment Stations 229 
The Bureau of Plant Industry 230 
The Forest Service 231 
IX. The Department of Labor 232 
The Children's Bureau 232 
History and Development 232 
The first work: Infant mortality studies 233 
Other early activities 234 
Administration of the first Federal Child Labor Law . . 234 
Special war work : Children's year 235 
The Maternity and Infancy Act 236 
Current Activities 238 
Infant and maternal mortality; Child Hygiene .... 239 
Child labor and industrial conditions affecting child welfare 243 
Dependency; Mothers' pensions; Delinquency; Juvenile 
courts; and Mental defects 246 
Publications 250 
Organization 250 
Office of the Chief 250 
Office of Assistant to the Chief 250 
Social Service Division 251 
Child Hygiene Division 251 
Industrial Division 251 
Maternity and Infant Hygiene Division 252 
Statistical Division 253 
Editorial Division 253 
Personnel 254 
Appropriations 254 
The Women's Bureau 254 
History and Development 255 
Current Activities 256 
Organization and Personnel 258 
Appropriations 258 
The Bureau of Labor Statistics 259 
History and Development . . 259 
Organization and Personnel 263 
The Bureau of Immigration 264 
History and Development 264 
Current Activities 265 
Organization and Personnel 267 
Appropriations 267 
X. The Department of the Interior 268 
The Office of Indian Affairs 268 
History and Development ..." 268 
Current Activities 270 XVI 
CONTENTS 
CHAPTER PAGE 
Organization 271 
Personnel 273 
Appropriations 274 
The Bureau of Education 275 
The Division of School Hygiene 275 
History and development 275 
Present organization and activities 277 
Publications 278 
The Alaska Division 279 
St. Elizabeth's Hospital 280 
Freedmen's Hospital 283 
The Geological Survey 283 
The National Park Service 285 
The Bureau of Pensions 289 
XI. The Department of Commerce 290 
The Bureau of the Census 290 
The Division of Vital Statistics 290 
History and development 291 
Current activities 292 
Organization 295 
Appropriations 295 
The Bureau of Mines 295 
History and Development 296 
Organization and Personnel 300 
Publications 301 
Appropriations 302 
The Bureau of Fisheries 302 
The Bureau of Standards 304 
Current Activities 304 
Organization 305 
The Patent Office 305 
The Steamboat Inspection Service 308 
XII. The Departments of State, Justice, and the Post Office . . 309 
The Consular Service 309 
The Department of Justice 310 
The Post Office Department 310 
The Division of Service Relations 311 
History and development 311 
Current activities 313 
Organization 314 
XIII. The Departments of War and the Navy 315 
The Medical Department of the Army 316 
History and Development 316 
Current Activities 317 
Organization 318 
The Medical Corps 318 
The Dental Corps 319 
The Army Nurse Corps 319 
The Veterinary Corps 319 
Enlisted Personnel 320 
Reserves 320 CONTENTS 
XVII 
CHAPTER PAGE 
Medical Administrative Corps 320 
The National Guard 320 
Hospitals 320 
Appropriations 320 
The Bureau of Medicine and Surgery of the Navy .... 320 
History and Development 321 
Current Activities 321 
Organization 322 
The Medical Corps 322 
Hospitals 323 
The Hospital Corps 323 
The Nurse Corps 324 
The Dental Corps 324 
Appropriations 325 
XIV. Independent Establishments 326 
The United States Veterans' Bureau 327 
History and Development 327 
Current Activities 332 
Organization 334 
The Federal Board for Vocational Education 338 
History and Development 338 
Current Activities 340 
Organization and Personnel 441 
The United States Employees' Compensation Commission . . 342 
Current Activities 342 
Organization 344 
The Federal Narcotics Control Board 345 
XV. Summary and Comment 346 
The Bureaus Involved 346 
Appropriations and Personnel 350 
XVI. Duplication in Federal Health Work 357 
Maternal and Child Hygiene 357 
School Hygiene 360 
Foods and Nutrition 362 
Industrial Hygiene 363 
Sanitary Engineering 365 
Rural Hygiene 365 
Tuberculosis 366 
Mental Hygiene 367 
Statistics 367 
Drug Control 368 
Publications 369 
Periodicals 372 
General Comment 372 
PART III. THE CORRELATION OF FEDERAL HEALTH 
ACTIVITIES 
XVII. Previous Attempts 373 
The National Board of Health 373 
President Cleveland's Recommendation 374 XVIII 
CONTENTS 
CHAPTER PAGE 
The Committee of One Hundred 376 
Progress in the Taft Administration 377 
Coordination During the World War 379 
Proposed Reorganization of the Executive Departments . . 38o 
Federal Board of Hospitalization 381 
Sundry Proposals 382 
XVIII. Proposal for Better Correlation 384 
Assembling Under a Common Direction of Services Whose 
Major Activity is in the Field of Public Health . . 385 
Public Health Service 386 
Division of Vital Statistics 387 
Children's Bureau 389 
Nutritional Research: Bureau of Chemistry and Bureau 
of Home Economics 390 
Medical Service, Office of Indian Affairs 392 
St. Elizabeth's Hospital 393 
United States Veterans' Bureau 393 
Public Health Services as Agencies for the Performance of 
Health Work for Other Services 394 
Proposed Grouping of Public Health Services as Exemplified 
by Other Governments 396 
Method for Achieving Coordination 396 
Coordination of the Group of Public Services .... 398 
Reorganization of the Personnel System 400 
An Advisory Council 401 
APPENDIX 
1. Resolutions in Favor of Correlation of Federal Health Activities . . 405 
2. Some Pertinent Quotations Regarding Federal Health Correlation . 408 THE NATIONAL GOVERNMENT AND 
PUBLIC HEALTH 
PART I 
THE RELATION OF GOVERNMENT 
TO HEALTH 
CHAPTER I 
INTRODUCTION 
Of the hundred or more major administrative units of the 
United States Government, at least forty are concerned directly 
or indirectly with some phase of the public health. This does not 
mean, of course, that all of these bureaus, divisions, or other 
branches of the executive departments carry on health work as a 
major activity. In many instances the health work is of minor 
concern in the more extensive scope of a particular bureau. Some- 
times it comprises only a small fraction of the activities of the 
bureau, or it may be entirely a side issue. In at least eight in- 
stances, however, public health constitutes the principal or only 
function of as many different bureaus or divisions, while in a 
number of others it is one of several primary duties of the bureau. 
The purpose of this book is to describe in detail the public 
health activities of the United States Government. In addition to 
such a description, a critical analysis of this public health work 
is attempted, and a plan for its correlation is suggested. The 
coordination of Federal health organizations has been advocated 
for many years by sanitarians who have watched the growth and 
development of such administrative units. That some form of 
effective correlation is now essential, is conceded by all persons, 
public health workers and political scientists alike, who have 
studied the problem. In this book will be given the reasons why 
more efficient results in the conservation of national vitality could 
1 2 
NATIONAL GOVERNMENT AND HEALTH 
be attained by a more business-like arrangement of the present 
public health work of the government. 
At the outset it should be stated that no new duties are recom- 
mended, nor is there any advocacy of expansion. Furthermore, 
the true scope of Federal health powers, as allowed by the Con- 
stitution, is adequately recognized. The first part of the book 
deals entirely with the relationship of health to government, and 
particularly the proper sphere of Federal activities for public 
health. This is discussed according to the present accepted legal, 
political, sociological, and economic theories which apply, with 
particular attention to the practical utility of such theories. Since, 
under our form of government, the promotion and protection of 
public health devolves primarily upon each individual state, a 
chapter in Part I is devoted to a discussion of the relation of the 
Federal Government to state and local health administration. 
A review of the literature on public health and also on political 
science shows that very little, if anything, has been written in this 
country on the relation of government to health. That is, there is 
to be found practically no thorough philosophical discussion of 
public health as an essential function of sovereignty. There are, 
of course, many works which give reasons for doing health work, 
or argue how public health should be officially administered, but 
none of them discuss the theory of government and the nature 
of its essential functions, demonstrating that health promotion is 
properly one of them. Perhaps this fact is taken for granted, as 
well it might be. In England more on this important subject may 
be found.1 The general relation of government to health is too 
important to be passed over without notice and without a con- 
sideration of some of its more important aspects, especially as they 
form a logical introduction to this volume. 
Part I, therefore, is concerned with the relation of government 
to health. It explains the modern science of public health, how it 
is administered in the United States, the constitutional basis for 
Federal health activities, their evolution and development, their 
present status, and their relation to local public health adminis- 
tration. 
1 Particularly, W. A. Brend's, Health and the state (1917). Dutton. INTRODUCTION 
3 
Part II presents a description and analysis of each of the ad- 
ministrative units of the National Government which are now 
undertaking public health work of any kind. The history and 
development of such activity is recounted, the present organiza- 
tion, personnel, and appropriations outlined, and the scope of its 
operations and their practicability indicated. An endeavor has 
been made to represent the health work of each bureau in the 
light of its true importance in the scope of that bureau and in 
its interrelationships with other bureaus or other units. Con- 
siderable space is accorded to the historical basis for much of the 
work. These facts reveal the reasons for the allocation of certain 
branches of work in the past and demonstrate why and how the 
activity has developed, considerations which may be of weight in 
endeavoring to effect practical coordination. 
Every type of health activity indulged in by the Federal services 
is included in this book. Many items may appear to be rather in- 
directly concerned with this topic, or even only allied to it in a 
very remote way. No endeavor has been made to include every 
possible activity which by any stretch of the imagination could 
possibly be classed as in the domain of health, merely in order 
to make a striking case for the ramifications of the subject in the 
Federal executive departments. On the other hand, a complete 
picture is desirable, and so an attempt has been made to present 
thoroughly a description of every type of actual health activity, 
even though many such functions would by no means be involved 
in any correlation scheme, or would be only slightly or partially 
affected by such a plan. It seemed better to err on the side of 
completeness, rather than that of superficiality. 
Although actual duplication of effort is not so great as would 
be expected, when some forty branches of the government are 
doing public health work and doing it, in the main, independently, 
nevertheless there is some overlapping. This is discussed in the 
final chapter of Part II, and specific examples of duplication are 
cited. These considerations obviously assist in pointing the way 
to more efficacious correlation. 
Part III contains a definite scheme for the coordination of our 
Federal health activities. The many previous attempts along simi- 
lar or remotely comparable lines are summarized and discussed. 
Here again, these past ventures are interesting and important 4 
NATIONAL GOVERNMENT AND HEALTH 
factors when future plans are to be considered. The outline of 
correlation as presented has been submitted to many eminent sani- 
tarians, experts in political science, and other persons interested, 
as well as to chiefs of bureaus involved, and it embodies, so far as 
possible, the ideas and recommendations of these individuals. It 
is believed to be practical, legal, and logical. It demonstrates an 
actual saving in annual expenditures and, what is of even greater 
significance, points the way to more efficient production, which 
in itself is true economy. Nor is it unreasonable to predict that 
improvement in the methods of conserving national vitality will, 
in the course of a few years, result in government savings in funds 
now needed to administer relief and cure for conditions which 
are not only remediable but preventable. 
Information has been secured from reports and bulletins of 
the various bureaus, by personal visits and interviews at the bu- 
reaus and with various Federal officers, from the Service Mono- 
graphs on the United States Government, prepared by the Insti- 
tute for Government Research, and from numerous other sources. 
In nearly every instance, the description of a bureau has been 
submitted to the chief of the bureau for comment, correction, and 
criticism. The data are, therefore, believed to be reliable and accu- 
rate and of reasonable value for the purpose intended, which is to 
demonstrate how and why Federal health activities should be 
correlated. CHAPTER II 
THE DEVELOPMENT OF THE RELATION OF PUBLIC 
HEALTH TO GOVERNMENT 
The protection and promotion of the public health is now con- 
ceded to be the duty and privilege of any sovereignty. " The gov- 
ernment," wrote Herbert Spencer, " which does not diligently pro- 
tect the health of its citizens is neither intelligent nor moral." The 
idea that the care of the public health is a proper function of the 
State is, in fact, an ancient one, though the real science of public 
health is comparatively new. Disease is as old as mankind itself, 
and society from its inception has realized the necessity for or- 
ganized efforts against it. From the dawn of civilization man has 
been coping with this ancient foe, not merely as an individual, 
but in an organized manner. The promotion of the health of the 
people as a whole is too important a duty to be entrusted solely 
to uncoordinated, individual action. As society has evolved into 
states, this doctrine has been adopted without question, though 
the procedure has often given rise to conflict. History, to which 
we look for precedent and inspiration, shows the fact to be true. 
Modern sociology confirms it. 
Public Health in History.1 Recorded history began some six 
thousand years ago. The labors of the archaeologist have re- 
vealed that the earliest known civilization was that of the ancient 
Sumerians, who inhabited the broad valley, now called Mesopo- 
tamia, between the Tigris and Euphrates rivers in Asia Minor? 
Although individual domiciles there had their cesspools and drains 
exactly the same as those of the modern Arab, no attempt at mu- 
nicipal disposal of sewage seems to have been made until the time 
of the Chaldean-Babylonian and Assyrian empires, which sue- 
1 See Tobey, Romance of sanitary science, Modern Medicine, September, 
1919. 
2 Recent excavations, however, seem to indicate an even older civilization 
in the valley of the Nile. Some authorities put it at 12,000 years ago. 
5 6 
NATIONAL GOVERNMENT AND HEALTH 
ceeded the Sumerian. Babylon and Nineveh, the capital cities of 
these two great peoples, were completely sewered and also sup- 
plied with public water supplies brought from long distances 
through channels. The city of London, it might be remarked, did 
not install a system of sewers until the eighteenth century after 
Christ. 
Another of the great civilizations of ancient times was that of 
Egypt, which flourished in the valley of the Nile three thousand 
years or more before Christ. From the writings of Herodotus we 
know that public hygiene was practised by those people, and there 
is no doubt that it profoundly affected the thought of the later 
civilizations of the Phoenicians and Hebrews, which existed side 
by side between the Mediterranean Sea and the Arabian Desert. 
The ancient Hebrews were, in fact, the real founders of public 
health and the laws of Moses, who was born about 1600 B. C., 
contain sanitary precepts which are as sound to-day as when they 
were promulgated. The Hebrews quarantined the leper and prac- 
tised sanitation as a community art. Jerusalem was well sewered 
and had a good water supply. 
The sea kings of Crete, who built the wonderful palace of 
Broad Knossus more than two millennia before Christ, con- 
structed with it an elaborate system of baths and drains, latrines, 
and sewers. Cyrus the Great, Emperor of the Persians in the 
sixth century B. C., believed in military hygiene and in public 
health. When he reported to his father that he had provided his 
army with competent physicians, he was admonished, " But these 
physicians, my son, of whom thou speakest, are like menders of 
torn garments, and thus, they cure those who have fallen sick. 
Thy chief anxiety should be to provide for health, for thou ought- 
est to take care to prevent thy army from falling into' sickness at 
all." These ancient words of wisdom epitomize the great principle 
of prevention which is to-day so generally acknowledged to be 
more valuable than cure. Modern ideas have gone a step further, 
however, and, as will be pointed out, have added the promotion of 
positive health to the prevention of disease. 
The golden age of Greece, the fifth century before Christ, saw 
notable achievements in the art of public health. The Greeks 
revered the human body and in order to assist it in the attainment 
of physical perfection, instituted a remarkable system of personal PUBLIC HEALTH AND GOVERNMENT 
7 
hygiene, which has never since been approached in the history of 
the world.3 It is startling to conceive how modern were these 
ideals and how much in consonance with present-day conceptions 
of positive health promotion. Even the Grecian temples to the 
sun may have been less pagan than we are sometimes prone to 
believe, for we know to-day that sunlight has definite therapeutic 
qualities and is actually curative of rickets and certain forms of 
tuberculosis. 
The Greeks fostered not only personal hygiene and physical 
training, but were likewise interested in public health as practised 
by government. In the classic report of the Massachusetts Sanitary 
Commission of 1850, it is stated that Plato and Aristotle thought 
that no community could exist without health officers.4 Such noted 
figures as Epaminondas, Demosthenes, and Plutarch served in that 
capacity, and Plutarch's rules of health are published and read even 
to-day. Hippocrates, the " father of medicine," was a sanitarian as 
well as a physician, and wrote three books on hygiene and sanita- 
tion. Greek engineers were probably responsible for the early sani- 
tary engineering of Carthage and Rome, though to the Romans 
belongs the credit for the most marvellous development of the art 
of public sanitation. If any one doubts the significance of public 
health in government, it might be observed that an epidemic dis- 
ease was undoubtedly a contributor to the passing of Greece and 
to its downfall. That disease was malaria. 
Two thousand six hundred and sixty years ago the Romans 
built the famous Cloaca. Maxima, used to-day, as it has been for 
centuries. Like the sewers, some of the ancient Roman aqueducts 
are also still in use. The first constructed in 312 B. C. by Claudius 
Appius, after Rome had decided no longer to tolerate drinking 
the polluted water of the Tiber, was eleven Roman miles (each 
4854 feet) long, mostly underground. During the next six hun- 
dred years, twenty aqueducts of varying lengths and sizes were 
built. One of them, the Marcia, was sixty-one miles in length. 
The best known are, perhaps, the Claudio and the Anio Novus, 
3 K. Sudhoff, quoted by C-E. A. Winslow in his Evolution and signifi- 
cance of the modern public health campaign (1923). This book of Wins- 
low's is the best concise history of the development of public health. See 
also Welch, W. H., Public health in theory and practice (1925). 
4 Report of the Massachusetts Sanitary Commission, 1850. 8 
NATIONAL GOVERNMENT AND HEALTH 
completed in 50 and 52 A. D., respectively. The former was 
forty-six miles long, the latter fifty-eight, and between them they 
doubled the water supply of the city. The. Romans likewise con- 
structed aqueducts in their colonies, and of these, that at Segovia, 
Spain, is the most perfect remaining and still in operation. 
Not only was sanitary engineering for the benefit of the public 
developed in Rome, but sanitary regulations were also promul- 
gated. In his History of Rome, Mommsen narrates5 that the 
duties of the sediles, whose office was created in 494 B. C., in- 
cluded the sanitary supervision of city districts, such as mainte- 
nance of the drains, cleaning and paving of streets, prevention of 
nuisances, regulation of food supplies, and special oversight of 
baths, taverns, and brothels. The Romans had excellent building 
regulations and rigid laws prohibiting stream pollution. 
The glory that was Greece and the grandeur that was Rome 
gave way to a period aptly known as the Dark Ages. In medieval 
Europe, sanitation and hygiene were neglected and forgotten, but 
even in this unclean and pestilence-laden era, some measures for 
public health had to be invoked by the State. Epidemic diseases 
were rampant and called for vigorous action for their suppression. 
Leprosy was particularly prevalent, accelerated in its spread by 
the Crusades of the sixth century. As early as 583 the Council 
of Lyons attempted to restrict the free migration of lepers, and 
other rulers and ruling bodies also endeavored by legal enact- 
ment to stem the tide of this scourge. The leprosy decretals of 
the Lateran Council in 1179, when the epidemics were at their 
height, were responsible for vigorous campaigns against the 
malady. Throughout medieval times in Europe " the State was 
continually taking measures, superstitious and futile though they 
were, to protect the people from disease." 6 
The Church, concerned primarily with men's souls, early dis- 
covered that death and disease were not conducive to its influence 
for spiritual advancement, and its enlightened princes interfered 
zealously in the task of saving lives. As early as 590 A. D., 
Gregory the Great ordained religious processions as a method to 
reduce mortality, a method which unfortunately was not success- 
8 Mommsen, History of Rome, Vol. Ill, p. 84. 
6 Brend, W. A., Health and the state (1917). PUBLIC HEALTH AND GOVERNMENT 
9 
ful. As leprosy began to decline in the fourteenth century, bubonic 
plague became unduly prevalent. In 1374 Venice imposed the first 
quarantine, a maritime one against infected ships and travelers. 
Other cities, as Ragusa and Marseilles, adopted similar measures 
shortly afterwards. In 1348, during the terrible plague epidemic, 
Venice had, for the first time in history,' appointed a board of 
health. The rules for forty days' isolation, made by these guard- 
ians' of the public health, gave rise to the term " quarantine." 
In France in 1350, King John II established the first system of 
sanitary police, a step which one writer8 has characterized as 
the beginning of the sanitary reform. The real inception of 
modern public health did not come until the middle of the nine- 
teenth century, however, and its foundation was laid almost simul- 
taneously in England and America. Going back to the thirteenth 
and fourteenth centuries, that period saw the promulgation of a 
number of sanitary laws in London. They were usually directed 
against filth and uncleanliness, which were thought to have a 
tremendous effect on salubrity, as well as comfort. In 1357, for 
instance, Edward III issued a royal order to the Mayor and 
Sheriffs prohibiting the throwing of filth into the Thames and 
the Flete. Prussia established a central medical bureau in 1685 
and appointed health officers to advise government officials on 
public health matters.0 
The Foundation of Modern Public Health. In medieval times, 
the concern of the State for the public health was, as Professor 
C-E. A. Winslow has pointed out,10 largely with the object of 
remedying foul conditions, and not so much with prevention and 
prophylaxis. Not until after the scientific renaissance of the 
eighteenth century did the sanitary awakening occur. This had 
been the period of the laissez-faire policy in government, a move- 
ment epitomized in the idea attributed to President Jefferson, 
that the government governs best which governs least. Some 
7 Kober, G. M., Progress in health conservation during the past fifty 
years. Public Health Service, Public Health Reports, April 6, 1923. 
8 Lemuel Shattuck, in Report of the Massachusetts Sanitary Commis- 
sion, 1850. 
9 Kober. 
10 Winslow, p. 6. 10 
NATIONAL GOVERNMENT AND HEALTH 
improvements in social and industrial conditions in England had 
been effected, nevertheless, in the eighteenth century. A notable 
poor law had been put into effect, as had also a number of reforms 
in the growing factory system. The Secretary of the Poor Law 
Commissioners had in 1838, the year after Queen Victoria as- 
cended the throne, instituted studies on the sanitary conditions 
which contribute to ill-health. This commissioner was Edwin 
Chadwick, and to him, as much as to any other one man, does 
public health, as developed to-day, owe its impetus. He was not 
a medical man, but a lawyer and sociologist. In 1842 the Poor 
Law Commissioners issued a comprehensive report on sickness 
and sanitation. This report created much comment, and in 1848 
Great Britain established a General Board of Health, of which 
Chadwick became a member. Thus, the first public health reform 
in England can be said to be really the direct consequence of 
the poor laws, for it was the desire to reduce the enormous ex- 
pense of caring for sickness which led to this public health act.11 
This first British health board was in existence only six years. 
In 1855 a new board replaced the old. It was parliamentary in 
character, its president being a member of the Government, and 
there was also a newly created office of Central Medical Officer. 
This position was filled by the appointment of Dr. (afterwards 
Sir) John Simon, who had been the first Medical Officer of 
Health of London, having occupied that place since 1848. The 
year before, Liverpool had appointed the first medical health 
officer in all England. John Simon held office with the General 
Board of Health until 1876 and during that time gave vast 
momentum to the public health movement. He was responsible 
for the passage of many new health laws, including the notable 
Sanitary Act of 1866. To him and to Chadwick is due the credit 
for the great sanitary awakening which was soon to become evi- 
dent in our own country. 
Public Health in the United States. While Old England was 
learning to cope with the ever-present problem of disease, New 
England, across the Atlantic, was also beginning to make progress 
in the conservation of health. Due to the inspiration of Chadwick 
11 Newsholme, A., Public health and insurance (1920). Chapter on the 
Historical development of public health policy in England. PUBLIC HEALTH AND GOVERNMENT 
11 
and Simon, Massachusetts had appointed a Sanitary Commission, 
which issued a remarkable report in 1850. This document recom- 
mends many public health duties which should be undertaken by 
the state. It was written by Lemuel Shattuck, who like Chadwick 
in England, was not a physician; he was a statistician. Of the 
report, Professor C-E. A. Winslow says, " This report, drafted 
. . . nearly three-quarters of a century ago, is worthy to rank with 
the best productions of English sanitary statesmanship-I am 
not quite certain that for breadth and clarity of prophetic vision 
it is not the most remarkable document in the history of public 
health." 
In the report, Shattuck makes several significant statements 
bearing on the relation of government to health. He says,12 " The 
condition of perfect public health requires such laws and regu- 
lations as will secure to man associated in society the same sani- 
tary enjoyments that he would have as an isolated individual; and 
as will protect him from injury from any influences connected 
with his locality, his dwelling house, his occupation, or those of 
his associates or neighbors; or from any other social causes. It is 
under the control of public authority and public administration; 
and life and health may be saved or lost, and they are actually 
saved or lost as this authority is wisely or unwisely exercised." 
And later on, he avers, " But whom does this great matter of 
public health concern? . . . The people are principally con- 
cerned, and on them must depend, in part at least, the introduction 
and progress of sanitary measures." 
Nearly twenty years were to elapse before Shattuck's wise 
recommendations were to receive proper recognition; but in 1869 
Massachusetts established the first real State Board of Health. 
In 1855, due to a severe epidemic of yellow fever, Louisiana had 
created a health body with state-wide powers, but it was more in 
the nature of a temporary quarantining authority than a state 
health board.13 It was reorganized in 1898 to assume broader func- 
tions. The Massachusetts idea was soon followed by the other 
states and boards of health were established in many of them in 
12 This report is reproduced in G. C. Whipple's State sanitation, Vol. I 
(1917). 
13 Kerr, J. W., and Moll, A. A., Organization, powers and duties of health 
authorities (1912). Public Health Service, Public Health Bulletin No. 54. 12 
NATIONAL GOVERNMENT AND HEALTH 
succeeding years.14 To-day every state in this country has a state 
health organization. Provision for some of these was made by the 
state legislature at the same time that local health service was 
authorized. On the whole, however, local health administration 
in this country has antedated state activity. 
In the early days of the colonies and on through the seventeenth 
and eighteenth centuries, public health was occupied mainly with 
attempts to control smallpox, the chief pestilence of those days, 
though some measures against yellow fever were also taken. The 
first sanitary legislation, in this country was an enactment of 
March, 1647 or 1648,18 by the General Court of Massachusetts, 
providing for a maritime quarantine, due to an epidemic of yellow 
fever in the West Indies. In 1666 the Selectmen of Boston made 
rules and regulations for scavengers. In 1669 Massachusetts 
passed another quarantine act, which, on account of its strin- 
gency, was not allowed by the Privy Council. Boston, Salem, and 
Plymouth adopted local regulations in 1678 to combat threatened 
14 Kerr and Moll give the chronological establishment of state health 
organization as follows: 
Porto Rico 1768 
District of Columbia 1822 
Hawaii 1851 
Louisiana 1855 
Massachusetts 1869 
California 1870 
Minnesota, Virginia 1872 
Michigan 1873 
Maryland 1874 
Alabama 1875 
Wisconsin 1876 
Illinois, Mississippi, New Jer- 
sey, Carolina, Tennessee.... 1877 
Connecticut, Kentucky, Rhode 
Island, South Carolina 1878 
Delaware 1879 
Iowa, New York 1880 
Arkansas, Indiana, New Hamp- 
shire, West Virginia 1881 
Missouri 1883 
Kansas, Maine, Pennsylvania.. 1885 
Ohio, Vermont 1886 
Florida, North Dakota 1889 
Oklahoma 1890 
Nebraska, Washington 1891 
Colorado, Nevada 1893 
South Dakota 1895 
Utah 1898 
Montana, Wyoming 1901 
Arizona, Georgia, Oregon, New 
Mexico ., 1903 
Idaho 1907 
Texas 1909 
15 There are a number of sources of historical information on early health 
legislation. These include: Chapin, C. V., History of state and municipal 
control of disease, in the book, A half century of public health (1921) ; 
Whipple, State sanitation (1917) ; Tandy, Local quarantine and inocula- 
tion for smallpox in the American colonies, American Journal of Public 
Health, Vol. XIII, p. 203 (1923) ; Tandy, Regulation of nuisances in the 
American colonies, American Journal of Public Health, Vol. XIII, p. 810; 
and Winslow, Health legislation in Colonial Connecticut, Bull. Soc. Med. 
Hist, of Chicago, December, 1924. PUBLIC HEALTH AND GOVERNMENT 
13 
outbreaks of smallpox, and in 1742 the colony itself passed a law 
to prevent smallpox and other infectious sickness. Connecticut 
passed temporary quarantine measures in 1663 and 1679, and a 
more comprehensive act in 1702. The Province of Massachusetts 
Bay had attempted to regulate nuisances in 1692, had provided 
for commissioners of sewers in 1702, and had passed an act regu- 
lating drains, all of which were privately owned, in 1709. 
South Carolina was early in the field of nuisance regulation, 
having passed an act dealing with swine and noisome weeds even 
prior to the Massachusetts enactment of 1692. This act and a later 
one in 1698 were aimed more at comfort than health, however; 
and the latter element did not appear until 1704, when slaughter 
houses were regulated in what was presumed to be the interests 
of the public health. In the Province of Pennsylvania, a law of 
1712 dealt with nuisances in Philadelphia. Yellow fever afflicted 
Philadelphia in 1793, and as a consequence a local board of health 
was established in that city the following year. New York followed 
suit in 1796, though it never had a really effective organization 
until 1866, when the famous Metropolitan Health Law was passed, 
after a sanitary survey which formed a part of the fight on the 
corrupt Tweed ring.10 
Honors for the first comprehensive state law authorizing the 
establishment of local health organization go again to Massa- 
chusetts, for this commonwealth passed such an act on June 22, 
1797. In accordance with its terms, Boston set up a board of 
health in 1799, with Paul Revere at its head. This law also served 
as an example for other states, though the growth of local health 
administration was rather slow. Chicago, for instance, did not 
have a board of health until 1867. In 1873 there were only 
thirty-seven local health organizations in this country. To-day 
practically all of the states have laws dealing with local health 
powers and duties, though the efficiency of the administration of 
them varies considerably among different states and within the 
states themselves. 
Pasteur and the Science of Bacteriology. At about the time 
of which we have been writing, that is, the latter half of the nine- 
teenth century, a more or less obscure French chemist was quietly 
16 Stephen Smith, The city that was >(1911). 14 
NATIONAL GOVERNMENT AND HEALTH 
working in his laboratories in Paris. He was Louis Pasteur, whose 
name is known and revered to-day throughout the civilized world. 
For Pasteur, by means of his brilliant researches, became the 
founder of modern preventive medicine, which is so large a con- 
tributor to the present science of public health. He was born in 
1822, began his noteworthy investigations in 1858, pursued them 
diligently for twenty years, and when he died in 1895 had seen his 
theories, derided and belittled at first, accepted by the world of 
science. Pasteur, through his researches on fermentation, estab- 
lished and proved the germ theory of disease, a theory which has 
been further proven without possibility of controversion many 
times since. In 1877 he and Robert Koch, another whose name 
also belongs to the roster of the founders of modern public health, 
each working independently, discovered the bacillus which causes 
anthrax. In 1882 Koch discovered the germ of tuberculosis, while 
the micro-organisms which produce cholera were found by him in 
1883 and those of diphtheria and typhoid fever in 1884 by Koch 
and Gaffky, respectively.17 
The latter part of the nineteenth and early portion of the 
twentieth centuries saw many wonderful achievements in the 
science of public health. Bacteriology became well developed, 
and the application of new ideas to disease prevention naturally 
revolutionized administrative practice. Since our concern is 
mainly with health in its relation to government, these discoveries 
and accomplishments must be passed over, but their study and 
the story of their evolution is a fascinating one.18 The work of 
the Massachusetts State Board of Health, which forms a land- 
mark in the history of sanitary science, should be mentioned, 
however. Under the guidance of Professor William T. Sedgwick 
of the Massachusetts Institute of Technology as consulting biolo- 
gist, and other leaders, it carried on pioneer investigations on 
sewage disposal. Professor Sedgwick was also the leading epi- 
demiologist of his time and as a teacher exerted an immense 
influence on the future of public health in this country. 
17 A history of bacteriology and its contribution to public health is given 
in A Half century of public health (1921), published by the American 
Public Health Association, 
18 The reader interested in following up this topic should consult W. T. 
Sedgwick's great classic, Principles of sanitary science and the public 
health (1902), the book by Winslow, and other references already cited. PUBLIC HEALTH AND GOVERNMENT 
15 
The Health Department of New York City, under the direction 
of Dr. Hermann M. Biggs, who later, from 1914 to the time of his 
death in 1923, served as State Health Commissioner, was also a 
center from which radiated the beneficial teachings and applied 
science of bacteriology and public health administration. Another 
notable health organization has been that at Providence, Rhode 
Island, where Dr. Charles V. Chapin has been Superintendent of 
Health since 1884. In 1910 Dr. Chapin published his classic book 
entitled " Sources and modes of infection," which, radical as it 
was then considered, performed much useful service in molding 
administrative opinions. 
The Three Periods of Public Health. Public health in its 
evolution has gone through three distinct periods. As Dr. Chapin 
has pointed out,19 the first of these, beginning in 1848, when the 
English Public Health Act was passed, and continuing for thirty 
or forty years, was dominated by the theory of filth as the cause 
of all sickness. The central idea was that putrefaction and noxious 
odors emanating therefrom gave rise to maladies. Thus, the term 
" malaria " is due to this idea of " bad air," though to-day it is 
well known that malaria is spread by the bite of infected mosqui- 
toes of the genus anopheles. The removal of the so-called 
nuisances was the chief aim of health administrators in those 
days. Municipal cleanliness is, of course, an admirable thing, but 
it alone cannot stay the progress of bacilli-disseminated maladies. 
The experience in Plavana in 1898 proved this fact; for yellow 
fever abated in no whit after Colonel Waring had made Havana 
the world's cleanest city. When, however, Colonel Gorgas rid 
Havana of mosquitoes, particularly the stegomyia, as it was then 
called (now the Aedes Calopits), yellow fever vanished. Disease 
does not breed in filth, though it may be carried by it, a fact which 
eventually came to be recognized. 
The second period in the evolution of public health began about 
the time a new Public Health Act was passed in England in 1879. 
This was a period of the quarantine and isolation of disease. It 
was the time when bacteriology was in its infancy and ideas of 
contagion were beginning to spread. Sanitarians then thought 
10 Evolution of preventive medicine, Journal of the American Medical 
Association, January 22, 1921. 16 
NATIONAL GOVERNMENT AND HEALTH 
that if every case of a disease were isolated the disease would be 
stamped out, and so, what has been called the " shot-gun " method 
of quarantine was invoked. Modern science considers quarantine 
of value, to be sure, but it recognizes that this is only one of many 
factors in coping with disease. During this second period, which 
lasted for a quarter of a century or so, the state used much compul- 
sion in the control of the public health. It took away men's liberty 
and men's property, sometimes, as we know, with little scientific 
justification. 
The first period was one of alleviation of disease, the second, 
one of suppression, the third period, dating from the early part of 
this century is one of prevention. More than that, it is one of 
health promotion as well as disease control. It is an educational 
rather than a police period, though law and its enforcement still is 
and must be for some time to come one of the fundamentals of 
public health administration.20 But, as the Earl of Derby remarked, 
" Sanitary instruction is more important than sanitary legislation." 
This fact has been realized and applied with marked success in the 
comparatively recent campaigns against tuberculosis and infant 
mortality. It has been particularly exemplified by the growth 
of the movement for public health nursing. In other words, 
modern public health is not merely the negative matter of fighting 
disease, important as is that duty, but it is the positive concept of 
promoting personal health and thereby contributing to the ad- 
vancement of the public health. 
The Modern Science of Public Health. Modern public health 
has been defined 21 as, " the science and the art of preventing dis- 
ease, prolonging life, and promoting physical health and efficiency 
through organized community efforts for the sanitation of the 
environment, the control of community infections, the education 
of the individual in principles of personal hygiene, the organiza- 
tion of medical and nursing service for the early diagnosis and 
preventive treatment of disease, and the development of the social 
machinery which will ensure to every individual in the community 
a standard of living adequate for the maintenance of health." 
20 See Tobey, Public health law, a manual of law for sanitarians (1925). 
21 Winslow, The untilled fields of public health (1920) ; Science (n. s.), 
Vol. LI; Modern Medicine, Vol. II. PUBLIC HEALTH AND GOVERNMENT 
17 
Public health, as conceived in these terms, is a science in itself, 
and not a branch of any other science. It draws upon preventive 
medicine, sanitary engineering, chemistry, sociology, economics, 
law, education, and psychology for its constituent parts. Those 
persons, medical and non-medical, who practice this science of 
public health to-day, are members of a distinct profession. For 
want of a better name, they are called " sanitarians." 
Modern public health activities should not be confused with 
state medicine, as that term is used to-day. Back in 1850, " state 
medicine " was a term often applied to the dawning science of 
public health. State medicine, as the words are understood to-day, 
however, connotes the furnishing of medical relief under the direct 
auspices of the state. Public health is not relief, but prevention 
of disease and promotion of hygiene. It does not aim to cure, ex- 
cept in those instances where curative measures are essential to 
prevention. In England to-day, with its system of insurance and 
the panel physician, there is what approximates state medicine. 
In the United States, the socialization of curative medicine is 
being gradually achieved, but that is quite a different matter from 
the practice of medical measures by the State. The increasing 
socialization of medicine is desirable, a fact conceded by all of 
the leaders of the profession, but whether state medicine is a neces- 
sary measure or not need not be dealt with here, for the question is 
not involved in this study and discussion. 
Results of Public Health Activities. In concluding this de- 
scription of the historical development and present status of public 
health, it may not be out of place to mention a few of the results 
achieved. The average length of life in the United States is now 
about fifty-eight years. In 1920 it was fifty-six years, in 1910 
from forty to forty-five, and in 1790 it is estimated that it was 
only about thirty-five years. In half a century, therefore, nearly 
fifteen years have been added to the span of life in the United 
States, but even with all of the achievements of sanitary science, 
the life span falls short of the Biblical three score and ten. Much 
of the real progress has been made in the last decade and it seems 
likely that the future will see even more brilliant accomplishments 
in the conservation of national vitality. In fact, the American 
Public Health Association definitely went on record in 1922 as 
believing that within the next fifty years as much as twenty years 18 
NATIONAL GOVERNMENT AND HEALTH 
may be added to the expectancy of life which now prevails 
throughout the United States. 
Although the best indication of sanitary progress is shown by 
figures for life expectancy, mortality statistics are also valuable 
as gauges of accomplishment. In the United States death rates for 
the country as a whole refer to the Registration Area, which 
represents only a little over 80 per cent of the total population. 
Data from states not in this area are not as yet considered suffi- 
ciently reliable for use. In 1880 the general death rate of the 
United States was 19.8 per 1000 population. At the beginning 
of the twentieth century it was 17.6; in 1910 it had dropped to 
15.0; and in 1920 it was 13.1. There has been a still further de- 
cline in subsequent years, and 1924 was apparently the banner 
year of them all. At present considerably over a million persons 
die each year in this country from various causes. 
As the general death rate has declined, so too has that of certain 
specific diseases gone down. Perhaps the most striking example 
of the accomplishments of the sanitarian is shown in the reduction 
in the typhoid fever mortality. In 1900 the United States, with 
a death rate from this cause of 46.5 per 100,000 population, oc- 
cupied a rather unenviable position among the leading nations of 
the world. To-day, due to improvement in public water supplies, 
sewage disposal, milk production, and other measures, the typhoid 
fever mortality is less than 7. Tuberculosis is another scourge 
which has shown a remarkable diminution. In a quarter of a 
century the death rate from, the so-called great white plague has 
fallen from nearly 200 per 100,000 in 1900 to less than 90 to-day. 
Many factors, economic and biologic as well as sanitary, have un- 
doubtedly contributed to this decrease but the efforts of the public 
health worker have certainly played a conspicuous part. Many 
other instances' of the conquest of man over the microbe could be 
given. The infant mortality rate, for example, has fallen from 
170 deaths under one year of age per 1000 live births in 1900 to 
about 83 in 1922. 
In spite of the generally favorable record in the conservation of 
national vitality in this country, much remains to be done. Prog- 
ress against the respiratory diseases has been slight, while the 
trend of the mortality from the organic or degenerative diseases, 
such as cancer, apoplexy, Bright's disease, heart trouble, and PUBLIC HEALTH AND GOVERNMENT 
19 
diabetes, is either stationary or slightly upward. Maternal mor- 
tality is also too high, and has shown no decline. At least six 
countries have a life span superior to that of the United States. 
During the first decade of the twentieth century, New Zealand, 
Australia, Denmark, Norway, Sweden, and Holland could each 
show an expectancy of life greater than ours, while that of Switzer- 
land was about the same, and England was close behind. In India, 
it might be remarked, the life span, unchanged for centuries, is 
only between twenty-two and twenty-three years. In New Zealand 
it is about sixty. 
In order the better to conserve our national vitality, a number 
of steps are necessary. Without being inclusive, some of these 
are: The development of more efficient state and local public 
health administration; the recruitment and training of more and 
better sanitarians, or professional public health workers; the more 
complete education of the general lay public in the principles of 
hygiene and sanitation, especially through the agency of the 
school; the increasing participation of the medical profession in 
the practice of preventive medicine; the extension of scientific 
research along public health lines; and, finally, the development 
of an effective central leadership, which shall make possible these 
advances, as well as others. There is no reason why such leader- 
ship and guidance should not be exercised by the National Gov- 
ernment, through a centralized health agency. This could be done 
without in any way disturbing or destroying the autonomy of the 
states in connection with public health matters. This idea will 
be more completely developed in the course of this book. 
" Public health," wrote Benjamin Disraeli, " is the foundation 
upon which rests the happiness of the people and the power of 
the state. The first duty of a statesman is the care of the public 
health." And Theodore Roosevelt, in a message to Congress in 
1908, said, " It is highly advisable that there should be intelligent 
action on the part of the nation on the question of preserving 
the health of the country." There are many other similar declara- 
tions by great statesmen, by eminent scientists, and by thinking 
people in all walks of life. The care of the public health is and 
must be an essential feature of government. That government is 
worthless which is not supported and maintained by a virile and 
physically powerful nation. CHAPTER HI 
PUBLIC HEALTH IN THE MESSAGES OF THE 
PRESIDENTS 
The care of the public health has been said to be the first duty 
of the statesman. The protection and promotion of the public 
health is certainly one of the essential features of sovereignty and 
those who are chosen to administer government must take cog- 
nizance of the physical welfare of the people. In the United 
States, public health, as part of the police power, is entrusted 
primarily to the individual states. The conservation of national 
vitality, however, is a matter of broader interest, and the Federal 
Government does have certain proper public health duties. These 
include the power of preventing the introduction of disease from 
without; the prevention of the interstate spread of disease; regu- 
lation of the health of wards of the government and citizens of 
the territories, the District of Columbia, and other Federal areas, 
and such public health matters as are incidental to treaties, taxation 
and one or two other matters. 
Comments and recommendations regarding national vitality 
ought, therefore, to be found in some abundance in the messages 
and papers of the Presidents. Of the thirty chief executives of 
this nation, however, only about one-third of them seem ever to 
have emphasized this phase of government. So far as disclosed 
by an examination of the nineteen volumes of the compilation of 
the messages and papers of the Presidents, prepared under the 
direction of the Joint Committee on Printing of the House and 
Senate, attention to the public health on the part of these states- 
men has been rather scanty. 
In connection with this study of the National Government and 
public health this review of the items referring to public health 
which are to be found in these messages is here presented. No 
attempt has been made to assemble all routine matters, such as 
the transmission of bureau or special reports to Congress. 
20 THE PRESIDENTS AND PUBLIC HEALTH 
21 
John Adams and National Quarantine. In the early days of 
the republic, severe epidemics of yellow fever were regular oc- 
currences. John Adams, the second President, began his second 
annual message to Congress, on December 8, 1798, by referring 
to this pestilence, and then took occasion to urge federal laws in 
aid of the health of the states. Since it was nearly one hundred 
years before another President made such a direct recommenda- 
tion the words of Adams are worth quoting in full, as follows:1 
But when we reflect that this fatal disorder has within a few 
years made repeated ravages in some of our principal seaports, 
and with increased malignancy, and when we consider the magni- 
tude of the evils arising from the interruption of public and pri- 
vate business, whereby the national interests are deeply affected, 
I think it my duty to invite the Legislature of the Union to ex- 
amine the expediency of establishing suitable regulations in aid 
of the health laws of the respective states; for these being formed 
on the idea that contagious sickness may be communicated through 
the channels of commerce, there seems to be a necessity that Con- 
gress, who alone can regulate trade, should frame a system which, 
while it may tend to preserve the general health, may be compatible 
with the interests of commerce and the safety of the revenue. 
Shortly afterwards, in February, 1799, Congress repealed a law 
of 1796 (1 Stat. L., 474), which had authorized the President to 
direct revenue officers and commanders of forts to aid the states 
in the execution of quarantine, and enacted a new measure (1 Stat. 
L., 619) which did little more, however, than recognize state 
rights over quarantine and again authorize Federal cooperation. 
Other Early Quarantine and Relief Matters. Thomas Jeffer- 
son seems to have dodged the quarantine issue. On February 24, 
1802, he sent to Congress without comment a report of the Secre- 
tary of the Treasury, calling attention to the need for action in 
establishing marine hospitals, though these were concerned with 
medical relief under the act of July 16, 1798 (1 Stat. L., 605), 
rather than with quarantine. In his fifth annual message, Decem- 
ber 3, 1805, Jefferson mentioned the recent affliction of two cities 
with fatal fever, and said, " Although the health laws of the states 
should be found to need no present revisal by Congress, yet com- 
merce claims that their attention be ever awake to them." 
1 See Garner, J. W., Federal activity in the interest of the public health, 
Yale Review, August, 1905. 22 
NATIONAL GOVERNMENT AND HEALTH 
James Monroe directed the attention of Congress on February 
17, 1825, to the need for legislation protecting the health of the 
people of the District of Columbia, saying, " This being the seat 
of the Government, its protection against such diseases must form 
one of its principal objects," but Congress took no action. Martin 
Van Buren, John Tyler, and Franklin Pierce, between the years 
1837 and 1853, sent messages to Congress regarding plans and 
sites for marine hospitals. Pierce must have recognized sanitary 
achievements, for in his first annual message in 1853, in discuss- 
ing population, he wrote, ". . . the increased average duration 
of human life known to have already resulted from the scientific 
and hygienic improvements of the past fifty years will tend to 
keep up through the next fifty." That he was right is shown by 
an increase in the average length of life from about forty years 
in Massachusetts in 1855 (the only State for which data are avail- 
able) to about forty-seven years in 1901. 
Cholera had become an international scourge, and on Febru- 
ary 10, 1866, Andrew Johnson sent to Congress papers relative 
to a proposed international conference on the subject to be held 
in Constantinople. On January 12, 1875, Ulysses S. Grant, trans- 
mitted to Congress a report on epidemic cholera, as authorized by 
that body on March 25, 1874 (18 Stat. L., 286). Yellow fever 
outbreaks occurred again in 1873 and in 1876, the epidemics being 
particularly severe, culminating in 1878 in the worst of them all 
so far in the history of the country. More than 130 cities and 
towns were afflicted, about fifteen thousand persons succumbed to 
the malady, and the pecuniary loss was estimated at $100,000,000 
by Surgeon General Wyman of the Marine Hospital Service. This 
Service had been created in 1870, but its duties consisted mainly 
of giving medical relief to certain beneficiaries of the government.2 
President Hayes and Quarantine. Rutherford B. Hayes in 
his second annual message, on December 2, 1878, took cognizance 
of this epidemic, described it, and recommended Federal quaran- 
tine, in these words: 
The fearful spread of this pestilence has awakened a very gen- 
eral public sentiment in favor of national sanitary administration, 
2 See page 81 of this book. THE PRESIDENTS AND PUBLIC HEALTH 
23 
which shall not only control quarantine, but have the sanitary su- 
pervision of internal commerce in times of epidemics, and hold 
an advisory relation to the state and municipal authorities, with 
power to deal with whatever endangers the public health, and which 
the municipal and state authorities are unable to> regulate. In view 
of the necessity for the most effective measures, by quarantine and 
otherwise, for the protection of our seaports and the country gen- 
erally from this and other epidemics, it is recommended that Con- 
gress give to the whole subject early and careful consideration. 
The National Board of Health. On April 29, 1878, Congress 
had passed a quarantine law (20 Stat. L., 27), but it still recog- 
nized state authority and was of little real effect. Its enactment 
was followed by the epidemic mentioned, and so Congress pro- 
ceeded to establish a National Board of Health, by acts of March 3, 
1879 (20 Stat. L., 484), and June 2, 1879 (2I Stat. L., 5), but 
gave the Board a term of only four years. The epidemic having 
subsided by that time, the Board was not continued, and the act 
creating it was repealed in 1893, when the first real quarantine law 
of national scope was passed. 
Chester A. Arthur in his first annual message, December 6, 
1881, called particular attention to the work of the National Board 
of Health, praising it in these words: 
The execution of the rules and regulations prepared by the 
Board and approved by my predecessor has done much to arrest 
the progress of epidemic disease, and has thus rendered substan- 
tial service to the nation. 
He also made these significant remarks : 
The health of the people is of supreme importance. All mea- 
sures looking to their protection against the spread of contagious 
diseases and to the increase of our sanitary knowledge for such 
purposes deserve attention of Congress. 
On October 12, 1881, President Arthur had sent to Congress, 
a report of an international sanitary conference called by the 
National Board of Health in Washington in January of that year, 
a conference which had also been announced to Congress by Presi- 
dent Hayes. On July 19, 1884, Arthur issued a proclamation 
directing those intrusted with the execution of quarantine to be 
particularly diligent in their measures against an epidemic then 24 
NATIONAL GOVERNMENT AND HEALTH 
prevalent in Europe. In his fourth annual message, December i, 
1884, he had mentioned this pestilence and told of the preventive 
measures taken by the Secretary of the Treasury, and since they 
were not entirely with authority of law, he requested Congress to 
uphold these actions, 
Cleveland and National Health. Grover Cleveland apparently 
took much interest in national health. In his first term he con- 
tented himself mainly with transmitting reports of bureaus and in 
sending a delegate, Major George M. Sternberg, afterwards Sur- 
geon General of the Army, to a sanitary conference in Rome in 
1885, and a representative to Spain and other countries in 
Europe to study the prevalence of cholera. The report of this 
representative, Dr. E. O. Shakespeare, was later (1890) sent to 
Congress by President Benjamin Harrison. 
In his second term, Cleveland came out wholeheartedly in his 
first annual message, December 4, 1893, for a system of national 
quarantine. He admonished Congress that "A more general and 
harmonious system than now exists, acting promptly and directly 
everywhere and constantly operating by preventive means to shield 
our country from the invasion of disease, and at the same time 
having due regards to the rights and duties of local agencies, 
would, I believe, add greatly to the safety of our people." Con- 
gress, however, had already passed a comprehensive quarantine 
act (27 Stat. L., 449), which is still in force, though amended in 
1901 (31 Stat. L., 1086). This law provided for the taking over 
by the National Government of all quarantine stations which 
should be transferred by the states, and to-day all of them have 
been thus turned over. 
In his second annual message, December 3, 1894, Cleveland 
advocated the creation of a national board of health. This part 
of his message is so significant, even though it was not acted 
upon by Congress, that it is quoted in full: 
I am entirely convinced that we ought not to be longer without 
a national board of health or national health officer charged with 
no other duties than such as pertain to the protection of our 
country from the invasion of pestilence and disease. This would 
involve the establishment by such board or officer of proper quar- 
antine precautions, or the necessary aid and counsel to local 
authorities on the subject; prompt advice and assistance to local THE PRESIDENTS AND PUBLIC HEALTH 
25 
boards of health or health officers in the suppression of conta- 
gious disease, and in cases where there are no such local boards 
or officers the immediate direction by the national board or officer 
of measures of suppression; constant and authentic information 
concerning the health of foreign countries and all parts of our 
own country as related to contagious diseases and consideration 
of regulations to be enforced in foreign ports to prevent the intro- 
duction of contagion into our cities and the measures which 
should be adopted to secure their enforcement. 
There seems to be at this time a decided inclination to discuss 
measures of protection against contagious diseases in international 
conference, with a view of adopting means of mutual assistance. 
The creation of such a National health establishment would greatly 
aid our standing in such conferences and improve our opportu- 
nities to avail ourselves of their benefits. 
I earnestly recommend the inauguration of a national board of 
health or similar national instrumentality, believing the same to 
be a needed precaution against contagious disease and in the 
interest of the safety and health of our people. 
Theodore Roosevelt. Like Cleveland, Theodore Roosevelt was 
deeply interested in social problems. His messages contain more 
references to the public health than do those of any of prede- 
cessors. The first of importance occurs in his fourth annual mes- 
sage, December 6, 1904, in which he recommended a better 
national quarantine law. This paragraph is as follows: 
It fs desirable to enact a proper national quarantine law. It is 
most undesirable that a State on its own initiative enforce quar- 
antine regulations which are in effect a restriction upon interstate 
and international commerce. The question should properly be 
assumed by the government alone. The Surgeon General of the 
National Public Health and Marine Hospital Service8 has re- 
peatedly and convincingly set forth the need for such legislation. 
Legislation looking toward purity of food's was recommended 
by Roosevelt in his next annual message, December 5, 1905, 
and Congress accordingly passed the well-known Pure Food and 
Drugs Act of 1906 (34 Stat. L., 768). In his seventh annual 
message, two years later, December 3, 1907, the President men- 
tioned how much good this law had accomplished. In this same 
3 The name of the Marine Hospital Service had been changed to Public 
Health and Marine Hospital Service in 1902 (32 Stat. L., 712). 26 
NATIONAL GOVERNMENT AND HEALTH 
message he devoted a paragraph to national vitality, in these 
words: 
There is a constantly growing interest in this country in the 
question of public health. At last the public mind is awake to the 
fact that many diseases, notably tuberculosis, are National 
scourges. The work of the state and city boards of health should 
be supplemented by a constantly increasing interest on the part 
of the National Government. The Congress has already provided 
a bureau of public health and has provided for a hygienic labora- 
tory. There are other valuable laws relating to the public health 
connected with the various departments. This whole branch of 
the government should be strengthened and aided in every way. 
In this message he also urged an improved medical service for 
the Army, citing the losses from disease in the war with Spain. 
Again, on December 8, 1908, in a special message, he strongly 
advocated legislation looking to the conservation of national 
vitality, in this language: 
It is highly advisable that there should be intelligent action on 
the part of the Nation on the question of preserving the health of 
the country. Through the practical extermination in San Fran- 
cisco of disease bearing rodents our country has this far escaped 
the bubonic plague. This is but one of the many achievements of 
American health officers; and it shows what can be accomplished 
with a better organization than at present exists. The dangers 
to public health from food adulteration and from many other 
sources, such as the menace to the physical, mental and moral 
development of children from child labor, should be met and 
overcome. There are numerous diseases, which are now known 
to be preventable, which are, nevertheless, not prevented. The 
recent International Congress on Tuberculosis has made us pain- 
fully aware of the inadequacy of American public health legis- 
lation. This nation cannot afford to lag behind in the world-wide 
battle now being waged by all civilized people with the micro- 
scopic foes of mankind, nor ought we longer to ignore the reproach 
that this Government takes more pains to protect the lives of 
hogs and of cattle that of human beings. 
In another special message, February 9, 1909, he transmitted 
to Congress the report of the Commission on Country Life, and 
suggested that the Department of Agriculture enlarge its scope 
to include among other things a consideration of sanitation, for, THE PRESIDENTS AND PUBLIC HEALTH 
27 
he said, " easily preventable diseases hold several million country 
people in the slavery of continuous ill health." 
On December 17, 1906, he sent a special message on his trip to 
Panama, in which he described in detail the work of sanitation 
then under way, the results of which, he declared, had been 
"astounding." On February 15, 1909, he sent a special message 
regarding a national conference on the care of dependent children, 
which had recently been held in Washington. 
Taft and the Movement for a National Bureau of Health. 
During the administration of William H. Taft, a determined 
movement for a national bureau of health was sponsored by the 
Committee of One Hundred of; the American Association for the 
Advancement of Science. Mr. Taft supported this campaign and 
in his first annual message, December 7, 1909, recommended the 
creation of such a bureau. The text of this part of his message is 
as follows: 
For a very considerable period a movement has been gathering 
strength, especially among members of the medical profession, 
in favor of a concentration of the instruments of the National 
Government which have to do with the promotion of public health. 
In the nature of things, the Medical Department of the Army and 
the Medical Department of the Navy must be kept separate. But 
there seems no reason why all the other bureaus and offices in 
the General Government which have to do with the public health 
or subjects akin thereto should not be united in a bureau to be 
called the " Bureau of Public Health." This would necessitate 
the transfer of the Marine Hospital Service to such a bureau. I 
am aware that there is a wide field in respect to the public health 
committed to the States in which the Federal Government cannot 
exercise jurisdiction, but we have seen in the Agriculture Depart- 
ment the expansion into widest usefulness of a department giving 
attention to agriculture when that subject is plainly one over 
which the States properly exercise direct jurisdiction. The oppor- 
tunities offered for useful research and the spread of useful infor- 
mation in regard to the cultivation of the soil and the breeding 
of stock and the solution of many of the intricate problems in 
progressive agriculture have demonstrated the wisdom of estab- 
lishing that department. Similar reasons, of equal force, can be 
given for the establishment of a bureau of health that shall not 
only exercise the police jurisdiction of the Federal Government 
respecting quarantine, but which shall also afford an opportunity 
for investigation and research by competent experts into ques- 
tions of health affecting the whole country, or important sections 28 
NATIONAL GOVERNMENT AND HEALTH 
thereof, questions which, in the absence of Federal Government 
work, are not likely to be promptly solved. 
Again in his second annual message, December io, 1910, he 
repeated this recommendation and deplored the opposition which 
had arisen: 
In my message of last year I recommended the creation of a 
Bureau of Health, in which should be embraced all those govern- 
ment agencies outside of the War and Navy Departments which 
are now directed toward the preservation of public health or 
exercise functions germane to that subject. I renew this recom- 
mendation. I greatly regret that the agitation in favor of this 
bureau has aroused a counter-agitation against its creation, on 
the ground that the establishment of such a bureau is to be in the 
interest of a particular school of medicine. It seems to me that 
this assumption is wholly unwarranted, and that those respon- 
sible for the government can be trusted to secure in the personnel 
of the bureau the appointment of representatives of all recognized 
schools of medicine, and in the management of the bureau entire 
freedom from narrow prejudice in this regard. 
Congress did not see fit at this time to establish such a national 
health bureau, though in 1912 the name of the Marine Hospital 
Service was broadened to Public Health and Marine Hospital 
Service, and the scope of the bureau was somewhat enlarged 
(37 Stat. L., 309). It also created a Children's Bureau in that 
year (37 Stat. L., 79) and imposed a prohibitive tax on the manu- 
facture of white phosphorus matches, in accordance with the 
wishes of the President, as expressed in his second message. 
In a special message on economy and efficiency in the govern- 
ment service, Mr. Taft listed " the promotion of the public 
health" as one of the principal governmental objects in which the 
people of the United States are interested. 
In the third part of his annual message of 1912, dated Decem- 
ber 19th, he mentioned the health of the Indians and urged an 
appropriation for improving it. He also outlined the operation of 
the pure food law. 
On January 16, 1913, he sent to Congress a special message 
giving the opinion of the American Consul General at Berlin on 
the Friedmann cure for tuberculosis. THE PRESIDENTS AND PUBLIC HEALTH 
29 
On January 22, 1913, he sent a special message recommending 
an appropriation of $30,000 as a contribution to the Fourth 
International Congress on School Hygiene at Buffalo. 
Woodrow Wilson. On April 3, 1917, when war with Germany 
was imminent, President Wilson issued an executive order mak- 
ing the officers and equipment of the Public Health Service avail- 
able for military duty. In order to coordinate all activities of the 
Federal government dealing with public health, on July 1, 1918, 
he issued another executive order placing all such work under the 
Public Health Service. The text of this order follows: 
Whereas, In order to avoid confusion in policies, duplication 
of effort, and to bring about more effective results, unity of con- 
trol in the administration of the public health activities of the 
Federal government is obviously essential, and has been so recog- 
nized by Acts of Congress creating in the Treasury Department a 
Public Health Service, and specially authorizing such service " to 
study the diseases of man and the conditions influencing the propa- 
gation and spread thereof " and " to cooperate with and aid state 
and municipal boards of health " ; 
Now, therefore, I, Woodrow Wilson, President of the United 
States, by virtue of the authority vested in me as Chief Executive, 
and by the Act " authorizing the President to coordinate or con- 
solidate executive bureaus; agencies, and offices, and for other 
purposes, in the interest of economy and the more efficient con- 
centration of the government " approved May 20, 1918, do hereby 
order that all sanitary or public health activities carried on by any 
executive bureau, agency, or office, especially created for or con- 
cerned in the prosecution of the existing war, shall be exercised 
under the supervision and control of the Secretary of the 
Treasury. 
This order shall not be construed as affecting the jurisdiction 
exercised under authority of existing law by the Surgeon General 
of the Army, the Surgeon General of the Navy, and the Provost 
Marshal General in the performance of health functions which 
are military in character as distinguished from civil public health 
duties, or as prohibiting investigations by the Bureau of Labor 
Statistics of vocational diseases, shop sanitation, and hygiene. 
In his eighth annual message, December 7, 1920, Wilson men- 
tioned the necessity for making rural life more attractive and 
healthful. 30 
NATIONAL GOVERNMENT AND HEALTH 
Harding and the Department of Welfare. While Warren G. 
Harding was President he was much interested in the proposition 
for a new department of welfare. In a special message to Con- 
gress on April 12, 1921, he recommended that consideration be 
given to the creation of such a department, saying, 
Government's obligation affirmatively to encourage develop- 
ment of the highest and most efficient type of citizenship is 
modernly accepted, almost universally. Government rests upon 
the body of citizenship; it cannot maintain itself on a level that 
keeps it out of touch and understanding with the community it 
serves. Enlightened governments everywhere recognize this and 
are giving their recognition effect in policies and programs. Cer- 
tainly no government is more desirous than our own to reflect 
the human attitude, the purpose of making better citizens-physi- 
cally, intellectually, spiritually. 
To bring these various activities together in a single department, 
where the whole field could be surveyed, and where their interre- 
lationships could be properly appraised, would make for increased 
effectiveness, economy, and intelligence of direction. CHAPTER IV 
THE GROWTH OF FEDERAL HEALTH ACTIVITIES 
AND CONGRESSIONAL ENACTMENTS 
A Haphazard Development. The growth and evolution of 
the executive departments of the United States Government has 
been likened to the gradual construction over a course of years of 
a rambling dwelling house. To the original small structure there 
have been added from time to time, as the opportunity arose, 
wings and gables and other appurtenances, with no attempt at 
homogeneity or architectural efficiency. The result represents a 
scattered, uncoordinated, and more or less inharmonious whole, 
useful for many purposes and providing shelter, at least, but a 
building which needs to be completely reconstructed in accordance 
with modern ideas in order to produce real utility and effectiveness. 
This simile is particularly apt when applied to the many 
branches of the government which are concerned with the public 
health. The forty administrative units which are interested 
directly or indirectly with some phase of national vitality have 
been created from time to time during the past 136 years, and 
to-day they are to be found in every cabinet department and several 
independent establishments. The eight bureaus which carry on 
public health work as their major activity are themselves in five 
different executive departments. The reason for this dispersion 
is a historical one. The various public health activities have been 
added to the Federal service according to the exigencies of the 
period. The story of their development is necessary to a complete 
understanding of the evolution of Federal public health functions. 
The evolution of each particular bureau or other unit is narrated 
more in detail in Part II, but a concise description of their devel- 
opment as a whole will not be out of place here. A chronological 
statement of the growth of Federal health legislation and public 
health and medical activities is presented at the end of the chapter. 
31 32 
NATIONAL GOVERNMENT AND HEALTH 
The First Health Laws. Although Congress had passed a 
law in 1794 providing that when unusual conditions of disease 
existed at the seat of government, Congress might be convened 
elsewhere (1 Stat. L., 353), and another in 1796 providing for 
Federal cooperation with states in the enforcement of their 
quarantine laws, the first real health legislation was the act of 
July 16, 1798 (1 Stat. L., 605). This act authorized the Collectors 
of Customs to collect twenty cents a month for each American 
seaman arriving from foreign ports, in order to provide a fund for 
medical relief, an activity which was the precursor of the Marine 
Hospital Service, afterwards the Public Health Service, though 
this service was not definitely organized until 1870. In the fol- 
lowing year, 1799, a new act (1 Stat. L., 729) was passed making 
the personnel of the Navy beneficiaries of this medical relief and 
authorizing the Secretary of the Navy to deduct twenty cents from 
the monthly pay of officers, seamen, and marines, and turn it over 
to the Secretary of the Treasury for the purpose. The latter act 
remained in force until 1811, when naval hospitals were placed 
directly under the jurisdiction of a Board of Commissioners of 
Navy Hospitals (2 Stat. L., 650), which was discharged in 1832 
and its powers vested in the Secretary of the Navy (4 Stat. L., 
572). The Bureau of Medicine and Surgery in the Navy was not 
created until 1842 (5 Stat. L., 579). 
The Medical Department of the Army antedates the beginning of 
the Marine Hospital Service by two months or so, as the President 
was granted authority on May 28, 1798 (1 Stat. L., 559), to 
organize a provisional army and to appoint certain officers, in- 
cluding a Physician General. Another act (1 Stat. L., 721) in the 
following year, specifically to regulate the Army Medical Establish- 
ment of the United States, provided for appointment of a Phy- 
sician General, an Apothecary General, and a Purveyor, together 
with a suitable number of deputies, surgeons, hospital mates, and 
stewards. 
After a considerable interval another national medical agency, 
the government hospital for the insane, was established in 1852, 
when an appropriation was made for it (10 Stat. L., 92), though 
the hospital was not organized until 1855 (10 Stat. L., 682). The 
Freedmen's Hospital, founded in 1871, was placed under the con- 
trol of the War Department in 1872 (16 Stat. L., 506), and trans- GROWTH OF FEDERAL HEALTH ACTIVITIES 
33 
ferred to the Interior Department two years later. In 1873 a 
Medical and Education Division was created in the Office of 
Indian Affairs, then, as now, in the Department of the Interior. 
The medical part of this division was in existence only four years 
and was not revived until 1909, when a Health Section was estab- 
lished in the Education Division. In 1922 this became the Medical 
Division. The first law pertaining to the health of Indians had been 
passed, however, as early as 1832, when Congress made provision 
for the vaccination of the Indian tribes (4 Stat. L., 514). 
Investigations of animal diseases were authorized in 1878 (20 
Stat. L., 240) and this work was gradually extended, until in 
1884 a Bureau of Animal Industry was established (23 Stat. L., 
31) under the Commissioner of Agriculture. This Bureau has 
developed extensively since that date until to-day it is one of the 
largest and most active in the government organization. Much 
of its work affects human health. 
The National Board of Health.1 The National Board of 
Health, which was in existence for a brief period during the latter 
part of the nineteenth century, represents an almost forgotten 
incident in the history of public health in the United States. The 
immediate cause of the creation of the National Board of Health 
was a disastrous epidemic of yellow fever. This epidemic, which 
apparently was introduced from Cuba, swept over the United 
States in 1878 and was the worst visitation of this pestilence for 
a century. Although the Southern states suffered most, the North- 
ern states also were severely attacked, and no part of the country 
seemed immune. It is estimated that 100,000 persons were 
stricken and that 20,000 died. The total loss to the country 
through this epidemic has been estimated by some at $100,000,000 
and by others at $200,000,000. It cost New Orleans alone about 
$10,000,000. A calamity is often necessary to focus popular atten- 
tion on a vital matter and this one naturally aroused some interest 
in national health. The President, Rutherford B. Hayes, in his 
annual message recommended to Congress the careful study of the 
protection of the country from epidemics. 
'A more extended treatment of this subject by the author will be found 
in the Nation's Health for January, 1926. 34 
NATIONAL GOVERNMENT AND HEALTH 
When Congress convened in December of 1878, a committee 
was immediately appointed to " inquire into the history and means 
of preventing and arresting of yellow fever and cholera." 
Twelve experts, eight from the South and four from the North, 
were employed, and the committee rendered its report in Febru- 
ary. Its conclusion was that yellow fever was not indigenous in 
any port of the South, but was generally introduced from foreign 
countries by means of commerce. In fact, of eighty-eight epidemics 
of yellow fever from 1683 to 1878, seventy-seven had been defi- 
nitely proven to have been of foreign origin. The committee recom- 
mended that a system of national quarantine be established. In its 
report occurred this significant statement, " Public health is second 
in importance to no question which addresses itself to the legis- 
lator." 3 
It was then incumbent upon Congress to act, and on April 29, 
1878, a law (20 Stat. L., 37) was passed which empowered the 
Surgeon General of the Marine Hospital Service, with the aid of 
customs officers, to impose and enforce maritime quarantine in 
cooperation with state and municipal officers. This act also directed 
consular officers to report to the Surgeon General sanitary condi- 
tions of the ports where they were stationed. The Marine Hos- 
pital Service had been organized in the Treasury Department 
by an act of June 29, 1870 (16 Stat. L., 169), its chief duties 
having been to afford medical relief to seamen of the American 
merchant marine.3 Such relief had, in fact, been given since 1798, 
in part in government hospitals, in part by contract with private 
hospitals and physicians, though the Marine Hospital Service had 
no definite status until the act of 1870. The National Board of 
Health was created about a year after this first quarantine law, 
by an act of March 3, 1879 (2O Stat. L., 484). On June 2 of the 
same year Congress passed a more comprehensive act to prevent 
the introduction of contagious or infectious diseases into the United 
States (21 Stat. L., 5), which also repealed portions of the act of 
April 29, 1878. This new law placed the enforcement of national 
quarantine, still in cooperation with the states and as an aid to them, 
2 Allen, W. H.; Rise of the National Board of Health, Annals of the 
American Academy of Political and Social Sciences, January, 1900. 
3 Schmeckebier; The Public Health Service. Institute for Government 
Research, Service Monograph No. 10. GROWTH OF FEDERAL HEALTH ACTIVITIES 
35 
upon the National Board of Health, which was authorized to 
promulgate necessary rules and regulations for the purpose. Bills 
of health to be issued by consular officers to vessels were also pro- 
vided for, and the Board was directed to obtain and publish sani- 
tary information from foreign and domestic sources. For these 
and other purposes half a million dollars was appropriated. The 
term of the act was definitely limited to four years, the intention 
apparently being to try it out for that period and also to cope only 
with the existing emergency. 
The National Board of Health, as created by the act of 1879, 
consisted of eleven members, seven appointed by the President, 
with the advice and consent of the Senate, three medical officers 
detailed from the Army, Navy, and Marine Hospital Service, 
respectively, and one representative from the office of the Attorney 
General. The original members, who met and organized on April 
2, 1879, were as follows :4 
James L. Cabell, LL. D., President 
John S. Billings, Surgeon, U. S. A., Vice-President 
Thomas J. Turner, Medical Director, U. S. N., Secretary 
Preston H. Bailhache, Marine Hospital Service 
Samuel F. Phillips, Solicitor General, Department of Justice 
Stephen Smith, M. D., New York 
Tullio S. Verdi, M. D., District of Columbia 
Samuel M. Bemis, M. D., Louisiana 
Henry I. Bowditch, M. D., Massachusetts 
Hosmer A. Johnson, M. D., Illinois 
Robert W. Mitchell, M. D., Tennessee 
There was also a clerk, W. P. Dunwoody. Professor Cabell 
continued as president throughout the existence of the Board, 
though the other officers and some of the members changed from 
time to time. In 1881, for instance, Dr. Charles J. Folger had 
become secretary-treasurer and Dr. Charles F. Folsom had suc- 
ceeded Dr. Bowditch. In 1882 Major Charles Smart of the Army 
took the place of Dr. Billings, likewise becoming secretary, while 
Dr. Stephen Smith was elected vice-president. New members in 
1883 were Dr. John M. Browne, Medical Director of the Navy. 
Thomas Simons, Assistant Attorney General, and Colonel George 
4 National Board of Health, Annual Report, 1879. 36 
NATIONAL GOVERNMENT AND HEALTH 
E. Waring, a noted sanitary engineer. The National Academy of 
Sciences was directed to assist the Board, and scientific aid was 
also obtained from the American Public Health Association, which 
had been founded in 1872 by Dr. Stephen Smith. Professor Cabell 
was president of this association when appointed to head the Board. 
The duties of the Board had been stated by Section 2 of the 
original law to be " to obtain information upon all matters affect- 
ing the public health, to advise the several departments of the 
Government, the executives of the several states, and the Com- 
missioners of the District of Columbia, on all questions submitted 
by them, or whenever in the opinion of the board such advice may 
tend to the preservation and improvement of the public health." 
About this time Pasteur was conducting his notable studies in 
France, and other scientists were working in England and on the 
continent on medical and sanitary research. The Board inaugu- 
rated, therefore, a number of investigations, which were under- 
taken by public spirited sanitarians in various parts of the country, 
who received no remuneration, except occasional grants for paying 
assistants or purchasing materials needed. 
Among the investigations which were begun or completed may 
be mentioned the following: 
1. An investigation of yellow fever in Cuba, by Dr. S. E. Chaille, 
Col. T. S. Hardie, C. E., Dr. John Guiteras, and Surgeon George 
M. Sternberg. It is interesting to note that the Board's report for 
1879 discusses this study in these words, " The facts presented do 
not confirm the theory of the spontaneous origin of the yellow 
fever poison on board ships, and make it improbable that the 
cleaning of the harbor of Havana and the constant renewal of its 
waters, however desirable, would prevent infection of the shipping 
at the port." Nearly twenty years were to elapse before the United 
States Army commission demonstrated that yellow fever was 
transmitted by the bite of an infected mosquito, a fact, the practical 
application of which by Gorgas, resulted in the eventual freeing of 
Havana from the disease and made possible the construction of 
the Panama Canal. 
2. An investigation of organic matter in the air by Professor 
Ira Remsen. 
3. Investigations of the effects of disinfectants and the merits 
of patent disinfectants. 
4. Investigations of the adulteration of foods and the diseases 
of food-producing animals. GROWTH OF FEDERAL HEALTH ACTIVITIES 
37 
5. Investigations of the flow in sewers and of various aspects 
of sewerage, by Colonel Waring. 
6. Investigation of diphtheria, by Dr. Elisha Harris. 
7. Investigation of the influence of various soils on drainage 
problems, by Prof. Raphael Pumpelly. 
8. Researches by Dr. Sternberg on suspended particles in the 
air of places of infection. Swamps came in for considerable atten- 
tion under the now discarded and erroneous theory of the miasmic 
causes of disease. 
9. Relations between meteorology and vital statistics. 
to. The etiology of malaria, by Sternberg. 
11. Effects of carbon monoxide, by Remsen. 
12. The sewerage of Europe, by Rudolph Hering. 
13. Sanitary conditions of summer resorts. 
14. Determination of organic matter in water. 
Other investigations were also conducted, sanitary surveys made 
in a number of cities, and an endeavor made to collect sanitary 
information from all over the country. A weekly bulletin, which 
superseded that formerly put out by the Marine Hospital Service, 
was issued from July 5, 1879, to July 1, 1882, when publication 
was suspended due to lack of funds. The bulletins were resumed 
in 1887 by the Marine Hospital (now the Public Health) Service. 
An international sanitary conference was held from January 5, 
1881, to March 1, 1881, with twenty-three countries represented, 
and a national vital statistics conference took place in Washington 
in May of 1880. Dr. Stephen Smith prepared a history of quaran- 
tine, and there was also a committee of the Board which attempted 
to codify and analyze all health laws and court decisions, though 
the results of this work are not to be found. Results of most of the 
studies were printed as appendices in the annual reports of the 
Board, some of these reports comprising nearly 700 pages. 
The main functions of the Board, however, had to do with 
maritime and interstate quarantine, and with the inspection of 
immigrants, chiefly to keep out smallpox; these other studies were 
more in the nature of side issues. Quarantine rules were drafted 
and recommended to the states for adoption. Inspectors were 
employed and a number of national quarantine stations established. 
Shortly after the formation of the Board, yellow fever epidemics 
appeared at New Orleans and Memphis. Some of the states, par- 
ticularly Louisiana, were not yet ready to acknowledge that quaran- 38 
NATIONAL GOVERNMENT AND HEALTH 
tine was national in scope, and a vast amount of friction developed 
during the next few years. Interference with commerce in the 
interests of health, no matter how humanitarian or important, also 
interfered with profits and finance, and trouble inevitably arose. 
The National Board was blamed for instigating a quarantine 
against New Orleans by the states of Tennessee and Mississippi, 
procedures which the acting governor of Louisiana denounced as 
" unnecessary, unwise, ungenerous, and unconstitutional." The 
Board was also charged with extravagance and usurpation of 
power. Its annual expenditures were as follows :8 
To June 30, 1879 $ 9,146.41 
Fiscal year 1880 266,762.16 
Fiscal year 1881 167,681.95 
Fiscal year 1882 98,523.07 
Fiscal year 1883 97,332.60 
The sundry civil appropriation act of August 7, 1882 (22 Stat. 
L., 315), restricted the duties and investigations of the National 
Board of Health to the diseases cholera, yellow fever, and smallpox. 
The emergency due to the epidemic conditions was now virtually 
over, and Congress began to lose interest. Although delegates from 
Ohio, Indiana, Illinois, Kentucky, Iowa, Tennessee, Missouri, 
Michigan, Wisconsin, Louisiana, Arkansas, and Mississippi met in 
April, 1883, and sent to President Arthur an expression of confi- 
dence in the work of the Board for interstate quarantine, and re- 
quested that a fund of $100,000 which had been authorized for 
emergency use (22 Stat. L., 613), be used for the purposes of the 
Board, interest continued to wane. For the fiscal years 1885 and 
1886 the only appropriations were deficiency ones for minor ex- 
penses, such as salary of the secretary, office, etc. The secretary 
sued the government for compensation up to July 31, 1886, though 
the Board had held no meetings after November, 1884, but the 
United States Supreme Court, in an opinion delivered in 1892, 
refused to uphold this suit, on the grounds that Congress had not 
made the necessary appropriations.6 The deficiency appropriation 
act of March 2, 1889, granted $1004 to store the records of the 
Board with the Surgeon General of the Army. 
The National Board of Health officially ceased to exist on Feb- 
ruary 15, 1893, when an act (27 Stat. L., 449) was passed granting 
5 National Board of Health, Annual Report, 1883. 
6 Dunwoody vs. U. S., 143 U. S. 578; 12 S. Ct. 465 (1892). GROWTH OF FEDERAL HEALTH ACTIVITIES 
39 
additional powers and imposing additional duties on the Marine 
Hospital Service. This was the first real national quarantine law. 
When the act of June 2, 1879, had become inoperative, due to the 
expiration of the four years which it was to run, the previous act of 
April 29, 1878, was again revived, according to an opinion of the 
Attorney General.7 Thus, the duty of cooperating with the states 
in matters of quarantine devolved once more upon the Marine 
Hospital Service after June 2, 1882, a function which was extended 
by the act of 1893. This later act, which is still in force and has 
been upheld by the courts,8 did not prohibit the states or municipali- 
ties from maintaining quarantine stations, but provided for the 
taking over of them by the Secretary of the Treasury. The last 
station, that in New York, was surrendered in 1921. The last sec- 
tion of the law repealed the act of March 3, 1879, establishing the 
National Board of Health and directed that all its records and 
furniture be turned over to the Secretary of the Treasury. An 
attempt was made in 1899 to re-establish the Board, but the final 
chapter in its history had evidently been written. 
Developments after 1890. Medical inspection of immigrants 
by Federal officials began in 1890 when officers of the Marine 
Hospital Service were charged with examining immigrants at the 
port of New York. In the following year the medical inspection of 
immigrants at all ports was placed in the control of this Service 
(26 Stat. L., 1084) and a Bureau of Immigration was established 
in the Treasury Department. It was transferred to the Depart- 
ment of Commerce and Labor in 1903 and to the Department of 
Labor in 1913. Medical inspection of immigrants is still conducted 
by officers of the Public Health Service who are assigned to the 
Bureau of Immigration for administrative purposes, though with- 
out giving up their status as officers under the supervision of 
the Surgeon-General. An act of 1893 charged consuls in foreign 
ports with the duty of reporting weekly on sanitary conditions and 
of issuing bills of health to vessels sailing to the United States 
(27 Stat. L., 449). Officers of the Public Health Service were 
7 20 Op. Att. Gen. 467. 
8 Compagnie Francaise vs. Louisiana State Board of Health, 186 U. S. 
396; 22 S. Ct. 811; 46 L. Ed. 1209 (1902). See Tobey, Public health law; 
A manual of law for sanitarians (1925). 40 
NATIONAL GOVERNMENT AND HEALTH 
authorized to be assigned to assist consuls, who are connected with 
the State Department, in this work. 
Collection of vital statistics by Federal authorities was started in 
1902 when an enabling act was passed (32 Stat. L., 52), although 
mortality statistics based on census returns had been published as 
early as 1850. A division of vital statistics was created in the 
Bureau of the Census, then in the Department of the Interior, 
transferred to the Department of Commerce and Labor in 1903, and 
later, in 1913, to the newly organized Department of Commerce. 
The Pure Food and Drugs Act of 1906 (34 Stat. L., 763) im- 
posed the duty of analyzing and investigating foods and drugs 
intended for shipment in interstate commerce on the Bureau of 
Chemistry, which had been elevated from a division to a bureau in 
the Department of Agriculture in 1897, though there had been a 
chemist since 1862. The control and licensing of biological products 
had been turned over by Congress to the Secretary of the Treasury 
in 1902 (32 Stat. L., 728) who assigned this duty to the Public 
Health Service, which issued regulations covering the subject in 
1903. 
Bureaus Added Since 1910. From 1910 on, numerous other 
bureaus concerned with public health have been set up in the 
National Government. In that year the Bureau of Mines was estab- 
lished in the Interior Department Tor the purpose of conducting 
inquiries into methods of mining with a view to promoting the 
safety of mines, improving conditions under which mining opera- 
tions are carried on, and conducting technological investigations 
relating to mining and metallurgy (36 Stat. L., 369). The original 
organic act was revised in 1913 (37 Stat. L., 681), and the activities 
as there set forth included the conduct of " inquiries and scientific 
and technological investigations concerning mining, and the prep- 
aration, treatment, and utilization of mineral substances with a 
view to improving health conditions and increasing safety "... 
etc. An act of 1917 (40 Stat. L., 146) authorized the detail of medi- 
cal officers of the Public Health Service to this Bureau. The Bureau 
of Mines was transferred to the Department of Commerce in 1925. 
In 1911 a Division of School Hygiene was created in the Bureau 
of Education by order of the Commissioner. Medical relief for the 
natives of Alaska, who are under the control of the Bureau of GROWTH OF FEDERAL HEALTH ACTIVITIES 
41 
Education, was first authorized separately in the sundry civil appro- 
priation act of 1915 (38 Stat. L., 862), though care of the health of 
the natives had been actively undertaken since 1909. An officer of 
the Public Health Service was detailed in 1912 to assist the Com- 
missioner of Education in this work. 
A Children's Bureau was created in the Department of Com- 
merce and Labor in 1912 (37 Stat. L., 79) and went over to the 
new Department of Labor when it became separate the following 
year. It was charged with the investigation of all matters pertain- 
ing to the welfare of children, especially infant mortality, the birth 
rate, dangerous occupations, accidents, and diseases of children, 
and various other matters. In 1917 this Bureau administered 
the first Federal child labor law until it was declared unconstitu- 
tional, and in 1921 it was charged with the administration of the 
Federal Maternity and Infancy Act (42 Stat. L., 135). 
In 1916 there was formed the Employees' Compensation Com- 
mission to administer medical relief and provide compensation to 
civil employees of the government (39 Stat. L., 742) ; and in 1917 
the Federal Board for Vocational Education was created (39 
Stat. L., 929) to study and supervise vocational rehabilitation of 
persons in the states aided by Federal grants. A Women in Indus- 
try Service had been set up in 1918 to consider industrial problems 
of women during the war and this was made a permanent Women's 
Bureau in the Department of Labor in 1920 (41 Stat. L., 987). 
Also as a war measure there was created in 1918 an Interdepart- 
mental Social Hygiene Board, consisting of the Secretaries of War, 
Navy, and Treasury, and of the three Surgeons General or their 
representatives (40 Stat. L., 886). This Board had supervision 
over medical and educational research in the field of venereal 
diseases and also over the work in the states resulting from Fed- 
eral subsidies. By the same act, a Division of Venereal Diseases 
was established in the Public Health Service. This latter is still in 
existence, but the Interdepartmental Board received no appropria- 
tions after 1922. 
The United States Veterans' Bureau came into being in 1921 
(42 Stat. L., 147), as an independent establishment, taking over 
the duties of the Bureau of War Risk Insurance, which had been 
established in the Treasury Department in 1914, and certain of the NATIONAL GOVERNMENT AND HEALTH 
42 
powers previously exercised by the Federal Board of Vocational 
Education and the Public Health Service as they related to reha- 
bilitation and hospital care of ex-service men. A Federal Narcotics 
Control Board, made up of the Secretaries of State, Treasury, and 
Commerce, was created in 1922 (42 Stat. L., 596) to make regula- 
tions governing the export and import of narcotic drugs. This 
Board functions through the Division of Customs of the Treasury 
Department, the law clerk of which acts as its secretary. 
The last two bureaus concerned with public health to be created 
are both in the Department of Agriculture, and both had been 
divisions of other bureaus before being themselves raised to the 
status of bureaus. These are the Bureau of Home Economics, set 
up in 1923 (42 Stat. L., 1289) and the Bureau of Dairying, the 
act for which was passed in 1924 (43 Stat. L., 243). The former 
was previously a division in the States Relations Service, which 
had been organized in 1914 as a continuation of the Office of 
Experiment Stations, dating from 1888. The Bureau of Dairying 
had been a division in the Bureau of Animal Industry since 1895. 
Development of Federal Health Legislation and Public 
Health and Medical Activities 0 
The following list shows in chronological order, important Fed- 
eral statutes dealing with health and medical matters, the inaugura- 
tion of especially important activities along these lines by the 
National Government, and other significant events relating to 
national vitality. 
1789 Federal Constitution adopted. 
1794 Authorizing the President to convene Congress at a place 
where there is no hazard to health.-Act of April 3, 1794 
(1 Stat. L., 353). 
1798 Authorizing the President to appoint a Physician General 
for the Army.-Act of May 28, 1798 (1 Stat. L., 558). 
Never called into service. Repealed in 1802 (2 Stat. 132). 
1798 Relief of sick and disabled seamen.-Act of July 16, 1798 
(1 Stat. L., 605). The foundation for the Marine Hos- 
pital Service. 
1799 Extension of this relief to the Navy and provisions for 
expenditure of funds.-Act of March 2, 1799 (1 Stat. L., 
729). 
"This list originally appeared in Public Health Reports for July 3, 
1925, and has been issued as Reprint No. 1024 by the Public Health Service. GROWTH OF FEDERAL HEALTH ACTIVITIES 
43 
1799 Regulating the Medical Establishment, providing for a Phy- 
sician General, an Apothecary General, and a Purveyor, 
and other personnel in the Army.-Act of March 2, 1799 
(1 Stat. L., 721). 
1811 Placing naval hospitals under a board of commissioners of 
navy hospitals.-Act of February 26, 1811 (2 Stat. L., 
650). 
1813 Encouraging vaccination.-Act of February 27, 1813 (2 
Stat. L., 806). Repealed in 1822 (3 Stat. L., 677). 
1813 Army medical establishment reorganized.-Act of March 3, 
1813 (2 Stat. L., 819). 
1818 Creation of Office of Surgeon General of Army.-Act of 
April 14, 1818 (3 Stat. L., 426). 
1821 Office of Apothecary General in Army abolished.-Act of 
March 2, 1821 (3 Stat. L., 615). 
1832 Provision for vaccination of Indian tribes.-Act of May 5, 
1832 (4 Stat. L., 514). The first law to deal with the 
health of Indians. 
1832 Navy hospitals transferred to Secretary of the Navy.-Act 
of July 10, 1832 (4 Stat. L., 572). 
1842 Bureau of Medicine and Surgery established in Navy 
Department.-Act of August 31, 1842 (5 Stat. L., 579). 
1848 Examination of imported drugs and medicinal preparations 
by customs officers authorized.-Act of May 17, 1848 
(9 Stat. L., 237). This act remained in force until the 
Pure Food Law of 1906. 
1850 First Federal report on mortality statistics. Based on Cen- 
sus enumerators' returns. 
1852 Appropriation of $100,000 for Government Hospital for 
the Insane.-Act of August 31, 1852 (10 Stat. L., 92). 
1855 Government Hospital for Insane organized.-Act of March 
3, 1855 (10 Stat. L., 682). 
1862 Chemist appointed (August 21) in the Department of Agri- 
culture, which had been created by the act of May 15, 
1862 (12 Stat. L., 387). 
1870 Marine Hospital Service definitely created.-Act of June 
29, 1870 (16 Stat. L., 169). 
1871 Dr. John M. Woodworth appointed (April) Supervising 
Surgeon of Marine Hospital Service. 
1871 Establishment of Freedmen's Hospital.-Act of March 3, 
1871 (16 Stat. L., 506). Placed under supervision of 
Secretary of War in 1872, transferred to Department of 
Interior in 1874. 
1873 Medical and Education Division created in Office of Indian 
Affairs.10 Abolished in 1877. 
la Information from Office of Indian Affairs. 44 
NATIONAL GOVERNMENT AND HEALTH 
1878 Investigation of diseases of animals authorized.-Act of 
June 20, 1878 (20 Stat. L., 240). Also act of May 29, 
1884 (23 Stat. L., 32), especially for that purpose. 
1878 First quarantine law of national scope, charging officers of 
Marine Hospital Service with its enforcement.-Act of 
April 29, 1878 (20 Stat. L., 27). Other quarantine laws 
extending Federal aid to state and local regulations were 
passed in 1796, 1832, and 1866. 
1879 National Board of Health established for four years.-Acts 
of March 3, 1879 (20 Stat. L., 484) and June 2, 1879 
(21 Stat. L., 5). Appropriations were made until 1885, 
then discontinued. The act creating the board was re- 
pealed in 1893 (27 Stat. L., 452). 
1880 Recognition in Federal statistics of a definite death registra- 
tion area.11 
1884 Bureau of Animal Industry established under Commissioner 
of Agriculture.-Act of May 29, 1884 (23 Stat. L., 31). 
1884 Bureau of Labor established in Interior Department.-Act 
of June 27, 1884 (23 Stat. L., 60). Became "Depart- 
ment " in 1888, transferred to the Department of Com- 
merce and Labor in 1903, and to the Department of 
Labor in 1913 as the Bureau of Labor Statistics. From 
the beginning the Bureau has investigated industrial 
hygiene, housing, and other socio-health conditions. 
1886 Tax on oleomargarine imposed.-Act of August 2, 1886 
(24 Stat. L., 209). Analytical work done by the Analyti- 
cal and Chemical Division of the Bureau of Internal 
Revenue until the passage of the Pure Food Law of 1906, 
when it was transferred to the Bureau of Chemistry. 
1890 First effective measure dealing with interstate control of 
disease.-Act of March 27, 1890 (26 Stat. L., 31). 
1890 Medical inspection of immigrants by Federal officers of the 
Marine Hospital Service begun (April) at the Port of 
New York. An act of 1882 (22 Stat. L., 214) was the 
first to place restrictions on the admission of defective 
aliens. 
1891 Medical inspection of immigrants extended to all ports.- 
Act of March 3, 1891 (26 Stat. L., 1084). 
1893 New quarantine act. Extension of activities of Marine 
Hospital Service.-Act of February 15, 1893 (27 Stat. L., 
449). Still in force. Amended in 1901 (31 Stat. L., 1086). 
1894 Appropriation of $10,000 to Department of Agriculture for 
a study of nutrition.-Act of August 8, 1894 (27 Stat. L., 
264). 
11 Information from Division of Vital Statistics, Bureau of the Census. GROWTH OF FEDERAL HEALTH ACTIVITIES 
45 
1901 Appropriation for Hygienic Laboratory under Marine Hos- 
pital Service.-Act of March 3, 1901 (31 Stat. L., 1137). 
It was not occupied until 1904. 
1902 Collection of vital statistics by Bureau of the Census 
(Department of the Interior; transferred to Department 
of Commerce and Labor in 1903, and to Department of 
Commerce in 1913) authorized.-Act of March 6, 1902 
(32 Stat. L., 52), amended by act of April 27, 1904 (33 
Stat. L., 362). An act of July 1, 1902 (32 Stat. L., 714), 
authorized the Public Health and Marine Hospital Ser- 
vice to prepare forms and compile vital statistics. 
1902 Division of Chemistry raised to status of a Bureau in the 
Department of Agriculture.-Act of June 3, 1902 (32 
Stat. L., 303). 
1902 Name of Marine Hospital Service changed to Public Health 
and Marine Hospital Service.-Act of July 1, 1902 (32 
Stat. L., 712). Various other new provisions. 
1902 Tests and control of biological products in interstate com- 
merce.-Act of July 1, 1902 (32 Stat. L., 728). This duty 
was turned over to Public Health and Marine Hospital 
Service, which issued the first regulations on February 
21, 1903. 
1905 Leprosy hospital established in Hawaii.-Act of March 3, 
1905 (33 Stat. L., 1009). Operated by Public Health and 
Marine Hospital Service. An investigation of leprosy 
had been authorized in 1899 (30 Stat. L., 976). 
1906 Pure Food and Drugs law. Increase of scope of Bureau of 
Chemistry.-Act of June 30, 1906 (34 Stat. L., 768). 
In 1918 detail of Public Health Service officers to this 
Bureau was authorized (40 Stat. L., 992). 
1906 Meat Inspection law. Increase of scope of Bureau of Animal 
Industry.-Act of June 30, 1906 (34 Stat. L., 679). 
Other meat inspection laws had been passed in 1890 (26 
Stat. L., 414), 1891 (26 Stat. L., 1090), and 1895 l2^ 
Stat. L., 732). 
1906 Extension of national control of quarantine by purchase of 
local stations.-Act of June 19, 1906 (34 Stat. L., 299). 
1909 First organized medical relief for natives of Alaska. Under 
jurisdiction of Bureau of Education (Department of the 
Interior). The first definite appropriation for this pur- 
pose was not made until 1915 (38 Stat. L., 822, 862). 
An officer of the Public Health Service was detailed to 
assist in health work in Alaska in 1912, following a 
survey made by the Service in 1911. 
1909 Creation of a health section in the Educational Division of 
the Office of Indian Affairs, presumably by department 
order. 46 
NATIONAL GOVERNMENT AND HEALTH 
1909 National Bureau of Health advocated by President Taft in 
his first annual message on December 7. He repeated this 
recommendation in his second message on December 6, 
1910. Bills to this end were introduced in Congress, but 
were not successful. 
1910 Bureau of Mines established in Department of the Interior. 
Act of May 16, 1910 (36 Stat. L., 369). This was revised 
in 1913 (37 Stat. L., 681). Investigations to improve the 
health and safety of miners authorized. An act of June 
12, 1917 (40 Stat. L., 146) authorized detail of Public 
Health Service officers to the Bureau. 
1910 Law prohibiting white slave traffic passed.-Act of June 25, 
1910 (36 Stat. L., 825). 
1911 Division of School Hygiene in the Bureau of Education of 
the Interior Department established by order of the Com- 
missioner of Education. 
1912 Children's Bureau established in the Department of Com- 
merce and Labor.-Act of April 9, 1912 (37 Stat. L., 79). 
1912 Tax imposed on white phosphorus matches.-Act of April 
9, 1912 (37 Stat. L., 81). 
1912 Name of Public Health and Marine Hospital Service 
changed to Public Health Service and field of action some- 
what extended.-Act of August 14, 1912 (37 Stat. L., 
3°9)- 
1914 Anti-narcotic law, the so-called Harrison Act, passed.-Act 
of December 17, 1914 (38 Stat. L., 785). 
1915 Recognition in Federal statistics of a definite birth registra- 
tion area.12 
1916 First Federal child labor law.-Act of September I, 1916 
(39 Stat. L., 675). Administered by Children's Bureau. 
Declared unconstitutional, June 3, 1918. 
1916 Federal employees' compensation law.-Act of September 
7, 1916 (39 Stat. L 742). 
1917 Federal leprosy hospital authorized.-Act of February 3, 
1917 (39 Stat. L., 872). Not occupied until 1920. 
1917 New immigration law.-Act of February 5, 1917 (39 Stat. 
L., 874). Provisions controlling medical examination now 
in force. 
1917 Federal Board for Vocational Education established.-Act 
of February 23, 1917 (39 Stat. L., 929). A previous law 
in 1914 had authorized Federal aid to the states (38 
Stat. L., 372). 
1918 The World War. An order placing all Federal health work, 
except that of the Army, Navy, and Bureau of Labor 
M Information from Division of Vital Statistics, Bureau of the Census. GROWTH OF FEDERAL HEALTH ACTIVITIES 
47 
Statistics, under the Secretary of the Treasury, through 
the Public Health Service, was issued by President Wil- 
son on July i, 1918. 
1918 A Division of Venereal Diseases created in the Public Health 
Service, and also an Interdepartmental Social Hygiene 
Board.-Act of July 9, 1918 (40 Stat. L., 886). The 
latter has received no appropriations since 1922. 
1918 The Women in Industry Service created in the Department 
of Labor.-Act of July 1, 1918 (40 Stat. L., 634). Be- 
came a Women's Bureau in 1920.-Act of June 5, 1920 
(41 Stat. L., 987). 
1918 The influenza epidemic. In October one million dollars was 
appropriated to enable the Public Health Service to com- 
bat and suppress the disease (40 Stat. L., 1088). 
1919 The child labor tax law, administered by the Bureau of 
Internal Revenue (40 Stat. L., 1138). Declared uncon- 
stitutional in 1922. 
1919 Public Health Service authorized to give medical relief to 
war veterans.-Act of March 3, 1919 (40 Stat. L., 173). 
The Service had already been doing this since October, 
1917, through an arrangement with the Bureau of War 
Risk Insurance. The work was turned over to the Vet- 
eran's Bureau when it was created in 1921.-Act of Au- 
gust 9, 1921 (42 Stat. L., 147). 
1921 Maternity and Infancy Law passed. Increase of scope of 
Children's Bureau.-Act of November 23, 1921 (42 Stat. 
U 135)- 
1922 Increase of compensation for commissioned officers of Pub- 
lic Health Service.-Act of June 10, 1922 (42 Stat. L., 
625). 
1922 Welfare Division established in the Post Office Department 
by order of the Postmaster General. Now known as the 
Service Relations Division. 
1922 Federal Narcotics Control Board created.-Act of May 26, 
1922 (42 Stat. L., 596). The act prohibits the importa- 
tion of crude opium for other than medicinal uses. 
1923 Bureau of Home Economics established in the Department 
of Agriculture.-Act of February 26, 1923 (42 Stat. 
1289). This Bureau had been a division of the States 
Relations Service since 1915, and previously studies had 
been made under the Office of Experiment Stations since 
1894- 
1924 Bureau of Dairying established in the Department of Agri- 
culture.-Act of May 29, 1924 (43 Stat. L., 243). This 
bureau had been a division of the Bureau of Animal 
Industry since 1895. CHAPTER V 
PUBLIC HEALTH AND THE UNITED STATES 
SUPREME COURT1 
The United States Supreme Court, as the court of final appeal 
in this country, has on numerous occasions been called upon to 
adjudicate matters directly affecting national vitality. Of the 
approximately 30,000 decisions handed down by this tribunal dur- 
ing its existence, about one hundred have been directly concerned 
with the public health. These opinions may also contain other 
important legal principles, and many of the numerous decisions not 
directly on this subject may, nevertheless, be of great significance 
to public health. This latter proposition is especially true with 
regard to cases involving the police power, as the care of the public 
health is an acknowledged part of the power. 
Under the American plan of government the protection and pro- 
motion of the public health is vested primarily in each of the indi- 
vidual states. The police power was possessed by the states before 
the Federal Constitution was adopted in 1789 and was not relin- 
quished by them at that time. The police power is, however, subject 
to constitutional limitations, and the legal questions which have 
arisen for determination have frequently concerned supposed or 
actual conflicts between the exercise of this police power by the 
states and certain parts of the Federal Constitution, including the 
commerce clause; taxation rights; privileges of citizens, such as 
guaranteed by the Fourteenth Amendment; freedom of contract; 
and various other matters. Thus, if the general subjects involved 
in these numerous opinions affecting public health are examined, 
it is discovered that they have dealt with such matters as: quaran- 
tine and inspection; stream pollution and water rights; nuisance 
control; milk and food supervision ; vaccination ; industrial condi- 
tions affecting health, such as hours of labor and child labor; 
1This chapter originally appeared as an article in the American Bar 
Association Journal, November, 1925. 
48 HEALTH AND THE SUPREME COURT 
49 
animal diseases and quarantines; narcotics; white slaves; and 
maternity and infancy. 
These cases have, of course, been often discussed by legal writers 
and political scientists, but there does not seem to be any treatment 
of them purely under the heading of public health. Such a discus- 
sion is of importance and value to sanitarians and public health 
administrators, especially in connection with the present study of 
the more effective correlation of the many scattered Federal health 
agencies. This survey of the pronouncements of the United States 
Supreme Court on public health is, in fact, a necessary part of the 
larger study on the National Government and public health. Else- 
where in this book the development of Federal legislation on this 
subject and also the interest manifested in public health, as shown 
by the messages of the Presidents, have been described. 
Public Health and the Police Power. The important deci- 
sions on public health range over a period of one hundred years, as 
the first to deal directly with the subject was not delivered until 
thirty-five years after the adoption of the Constitution. In 1824 
Chief Justice Marshall presented his famous opinion in Gibbons 
vs. Ogden,2 a decision which established the proposition that navi- 
gation is a part of commerce and that the regulation of interstate 
commerce is a Federal and not a state function. Since this case held 
unconstitutional a law of New York granting to Robert Livingston 
and Robert Fulton exclusive navigation privileges on the waters 
in that state, on the grounds that such regulation was a Federal 
matter, the court found it necessary to discuss the scope of state 
laws. Both sides in their arguments had used quarantine acts as 
examples upholding their particular contentions, and so Chief 
Justice Marshall paid some attention to the subject, saying of laws 
coming under the police power : 
They form a portion of that immense mass of legislation which 
embraces everything within the territory of the state, not surren- 
dered to the general government; all which can most advanta- 
geously be exercised by the states themselves. Inspection laws, 
quarantine laws, health laws of, every description . . . are com- 
ponent parts of this mass.8 
3 9 Wheat, i; 6 L. Ed. 23. 
3 9 Wheat. 205. 50 
NATIONAL GOVERNMENT AND HEALTH 
He also mentioned the Federal quarantine acts of 1796 and 1799, 
and wrote that the local laws on this subject are undoubtedly con- 
stitutional, but that Congress can, nevertheless, regulate commerce. 
A significant statement refers to " the acknowledged power of a 
state, to provide for the health of its citizens." This decision, 
though not induced by a health matter, is often cited as having 
established the proposition that while the care of the public health 
is a part of the police power, the regulation of commerce is exclu- 
sively for the National Government. More exact pronouncements 
of the relationship between state health regulations and the Federal 
control of commerce were to come frequently in later years. 
Three years after Gibbons vs. Ogden, another state law was 
held unconstitutional as an infringement on Federal rights and 
powers. This was in the case of Brown vs. Maryland,4 in which a 
requirement of licenses for importers and wholesalers was declared 
invalid. In the course of this decision, Marshall again took occa- 
sion to uphold inspection laws as an exception to the prohibition 
against state interference with interstate commerce, saying, " In- 
deed the laws of the United States expressly sanction the health 
laws of a state."0' The case for the state in Brown vs. Maryland 
was argued by Roger Taney who twenty years later, as Chief 
Justice of the Supreme Court was to deliver an opinion in the 
Licenses Cases.8 These decisions upheld state laws of Massachu- 
setts, Rhode Island, and New Hampshire requiring licenses for the 
sale of liquor. These licenses were justified on the grounds that 
they were within the police power of the states, especially with 
regard to the duty to protect the public health and the public morals. 
As Taney said, " A state ... is not bound ... to abstain from 
the passage of any law which it may deem necessary or advisable 
to guard the health ... of its citizens, although such law may dis- 
courage importation, or diminish the profits of the importer, or 
lessen the revenue of the general government. "7 There was much 
discussion in these cases of public health as a part of police power, 
412 Wheat. 419; 6 L. Ed. 678. 
B12 Wheat. 444. 
8 5 How. 504; 12 L. Ed. 256. 
7 5 How. 577. HEALTH AND THE SUPREME COURT 
51 
Justice McLean saying, " Everything prejudicial to the health or 
morals of a city may be removed." 8 
Just as the License Cases pointed to the extent of the police 
power, the Passenger Cases0 two years later (1849) indicated its 
limitations. This was the first instance of a controversy before this 
court which had arisen from what was apparently a health matter, 
as one of the laws assailed was a New York statute imposing on 
vessels a tax which was collected by the health commissioner. The 
revenue was not used for quarantine, however, and the court 
decreed that this law and a somewhat similar one in Massachusetts 
were unconstitutional as interfering with commerce. The act of 
New York was held not to be a true health law, for as Justice 
McLean said, " In guarding the safety, health, and the morals of 
its citizens, a state is restricted to appropriate and constitutional 
means." Another brief decision in 1873, Peete vs. Morgan,10 held 
that a state to defray quarantine expenses can not impose a tonnage 
tax on vessels. 
Nuisances and the Police Power. The last quarter of the nine- 
teenth century saw a number of decisions of significance to public 
health. In 1872 the Slaughter House Cases 11 upheld a state law 
regulating slaughter houses as a proper police measure, for the 
health and comfort of the people. This law, a Louisiana statute, 
had granted to one corporation the exclusive right to maintain 
slaughter houses in that state, and it was attacked on this ground. 
A divided court upheld the law, however. In 1878 another nuisance 
case arose, that of Fertilizing Company vs. Hyde Park,12 from 
Illinois. Here a municipal ordinance to abate nuisances was held 
superior to a charter granting certain privileges to a corporation. 
Nuisance abatement was declared to be a part of the police power. 
During the first decade of the twentieth century, a half a dozen or 
more decisions involving nuisance control were handed down. In 
1904 Dobbins vs. Los Angeles 13 held void a municipal ordinance 
fixing limits in which gas works might be erected, this being com 
8 5 How. 588. 
9 7 How. 283 ; 12 L. Ed. 702. 
1019 Wall. 581. 
1116 Wall. 36; 21 L. Ed. 394. 
13 97 U. S. 659. 
13195 U. S. 223. 52 
NATIONAL GOVERNMENT AND HEALTH 
sidered beyond the scope of the police power. The liberality with 
which courts should construe real health regulations, was, however, 
expressed by Justice Day in these words, " It may be admitted 
that every intendent is to be made in favor of the lawfulness of the 
exercise of municipal power, making regulations to promote the 
public health and safety, and that it is not the province of the 
courts except in clear cases, to interfere with the exercise of the 
power reposed by law in municipal corporations for the protection 
of local rights and the health and welfare of the people of the 
community." 14 
Shortly thereafter the court sustained municipal ordinances regu- 
lating the disposal of garbage, as health regulations. These cases, 
California Reduction Company vs. Sanitary Reduction Works13 
and Gardner vs. Michigan,10 were decided in 1905, Justice Harlan 
reading the opinion. Sanitarians to-day do not consider garbage 
disposal of great significance to public health and, in fact, class 
nuisance control as of relatively minor importance in health admin- 
istration." Nuisances have, however, always bulked large in pub- 
lic health law, perhaps improperly so. 
In 1907 the Supreme Court granted an injunction to restrain a 
manufacturing plant from discharging noxious fumes to the detri- 
ment of the inhabitants of a neighboring state. This was the case 
of Georgia vs. Tennessee Copper Co.ls Two years later a local 
ordinance prohibiting burials in city limits for sanitary reasons 
was upheld in Laurel Hill Cemetery vs. San Francisco,19 the court 
stating that if the legislature had seen fit to call this a public health 
matter, that must suffice. Modern sanitary science would not be 
inclined to admit it to be at all concerned with health. In 1916 a 
municipal ordinance relative to smoke abatement was sustained in 
Northwestern Laundry Co. vs. Des Moines,20 and in 1921 street 
cleaning was declared in Harris vs. D. C.21 to be a governmental 
14195 U. S. 235, 236. 
15199 U. S. 306. 
16199 U. S. 325. 
17 See Tobey, Public health law; a manual of law for sanitarians (1925). 
"206 U. S. 230; 27 S. Ct. 618; 51 L. Ed. 618. 
19 216 U. S. 358. 
"'239 U. S. 486; 36 S. Ct. 206; 60 L. Ed. 396. 
71256 U. S. 650; 41 S. Ct. 610; 65 L. Ed. 1146. HEALTH AND THE SUPREME COURT 
53 
function of municipalities for the protection of health. Previously, 
in 1913, a local ordinance requiring property to be connected with 
a public sewer had been sustained in Hutchinson vs. Valdosta.22 
State versus State. The Georgia vs. Tennessee Copper case in 
1907 had been preceded by several others of similar nature, involv- 
ing controversies between states themselves. Towards the end of 
the nineteenth century, yellow fever was prevalent in New Orleans 
and the State Health Officer of Texas placed a quarantine against 
persons and materials from that city. The State of Louisiana there- 
upon brought an original action against the State of Texas,23 but 
the Supreme Court in 1900, after much discussion as to what 
constituted a cause of action between states, dismissed the case on 
the grounds that the State Health Officer had exceeded his authority 
and, besides, that the State of Louisiana as such was not concerned. 
It is somewhat difficult to reconcile this opinion with later ones 
which arose between states relative to health matters. In 1901, for 
instance, Missouri brought suit against Illinois24 on account of 
danger of sewage pollution of the Mississippi River. Here Justice 
Shiras said, " But it must surely be conceded that, if the health and 
comfort of the inhabitants of a state are threatened, the state is 
the proper party to represent and defend them." The action was 
allowed to be brought, but after presentation of the case, the court 
in 1905 refused to grant the injunction.23 Tn 1925 the Supreme 
Court handed down an opinion in the case of the Sanitary District 
of Chicago vs. United States,28 enjoining the Sanitary District from 
drawing more water for sewage disposal than was permitted by 
the Secretary of War. In 1921 an injunction had been denied in 
the so-called Passaic Valley Sewage case, in which New York 
brought suit against New Jersey.27 The Court suggested that co- 
operation might be more effective than court action in solving this 
problem. 
"227 U. S. 303; 33 S. Ct. 290; 57 L. Ed. 520. Sweet vs. Rechel 159 U. S. 
380; 40 L. Ed. 188 (1895) had upheld taking of land to abate a nuisance. 
23176 U. S. 1, 20 S. Ct. 251, 44 L. Ed. 347. 
24180 U. S. 208, 21 S. Ct. 331, 45 L. Ed. 497. 
25 200 U. S. 496, 50 L. Ed. 572. 
20 266 U. S. 405 69 L. Ed. 
37 Public Health Service, Public Health Reports, June 3, 1921. 54 
NATIONAL GOVERNMENT AND HEALTH 
Animal Diseases and Quarantine. About the same time as the 
early nuisance cases, arose the first of a long line of decisions 
regarding the power of a state to regulate and control animals 
which are diseased. Hannibal vs. Husen,28 decided in 1877, held 
that a Missouri law prohibiting the driving of Texas cattle into 
Missouri between March and November was unconstitutional as 
more than a quarantine law. Justice Strong characterized it as an 
interference with interstate commerce, saying, " While we unhesi- 
tatingly admit that a state may pass sanitary laws, and laws for the 
protection of life, liberty, health, or property within its borders; 
while it may prevent persons and animals suffering under conta- 
gious or infectious diseases, or convicts, etc., from entering the 
state; while for the purpose of self-protection it may establish 
quarantine, and reasonable inspection laws, it may not interfere 
with transportation into or through the state, beyond what is abso- 
lutely necessary for self protection."29 A dozen years later, in 
Kimmish vs. Ball,30 an Iowa law providing a basis of damage 
actions for causing the spread of Texas fever in cattle was upheld, 
and in 1898, in Missouri, etc., R. Co. vs. Haber,31 a similar law was 
sustained. Rasmussen vs. Idaho,32 decided in 1901, approved a 
state cattle quarantine law, the distinction between this case and 
the earlier one of Hannibal vs. Husen being that in the earlier case, 
the law was discriminatory, while in this later one it was not. Smith 
vs. St. Louis,33 Reid vs. Colorado,34 and Asbell vs. Kansas33 follow 
the Rasmussen case. In all of these, there occurs considerable dis- 
cussion of the police power. 
Quarantine and General Health Matters. After the early 
decisions affecting health laws under the police power, a number 
of others of importance to quarantine and general health were 
delivered. Since 1885 such cases have, in fact, occurred almost 
28 95 U. 8.465524 L. Ed. 527. 
29 95 U. S. 472. 
30 129 U. S. 220. 
31169 U. S. 636. 
32181 U. S. 198; 21 S. Ct. 594; 45 L. Ed. 820. 
33181 U. S. 248; 21 S. Ct. 603; 45 L. Ed. 847. 
34187 U. S. 137; 23 S. Ct. 92; 47 L. Ed. 108. 
35 209 U. S. 251 (1908). HEALTH AND THE SUPREME COURT 
55 
yearly, and sometimes there have been several in a year. The deci- 
sion in Barbier vs. Connolly,38 rendered in 1885, upheld as a proper 
police regulation a San Francisco ordinance regulating laundries 
and requiring a certificate from the health officer and fire warden. 
In the following year, however, in Yick Wo vs. Hopkins,37 an 
ordinance of the same city was held void for discrimination against 
Chinese laundrymen. A state quarantine law was upheld in 1886 
in Morgan vs. Louisiana,38 even though fees were imposed. The 
Court in its decision recognized the right of the Federal Govern- 
ment to provide a national quarantine system, though such a law 
was not actually passed by Congress until 1893. Mugler vs. Kansas 
(1887),30 Lawton vs. Steele (1894),40 and Hennington vs. Georgia 
(1895)41 were cases of importance to public health in succeeding 
years, though none of them was directly on that subject but dealt 
with the scope of the police power. In 1902 occurred the decision 
in Compagnie Francaise de Navigation a Vapeur vs. Louisiana 
State Board of Health,42 which sustained a state law excluding 
healthy persons from unhealthy localities. This opinion also upheld 
the Federal quarantine law of 1893.43 A Federal law of 1903 
excluding aliens with contagious disease was pronounced valid in 
Oceanic Steam Navigation Company v^. Stranahan,44 decided in 
1909. 
Compulsory vaccination laws of a state were upheld in 1904 in 
the notable case of Jacobson vs. Massachusetts.45 Previously, in 
Lawton vs. Steele, the Court had remarked obiter that compulsory 
vaccination of children formed a part of the police power. In the 
Jacobson case, however, this issue was squarely before it and the 
Court decided that it was solely the function of the legislature to 
decide that vaccination was efficacious and necessary to preserve 
36113 U. S. 27; 5 S. Ct. 357; 28 L. Ed. 923. 
87118 U. S. 356; 6 S. Ct. 1064; 30 L. Ed. 220. 
3Sn8 U. S. 455; 6 S. Ct. 1114; 30 L. Ed. 237. 
89123 U. S. 623; 8 S. Ct. 273; 31 L. Ed. 205. 
40152 U. S. 133; 14 S. Ct. 499; 38 L. Ed. 338. 
41163 U. S. 299; 16 S. Ct. 1086; 41 L. Ed. 166. 
42186 U. S. 380; 22 S. Ct. 811; 46 L. Ed. 1209. 
43 27 Stat. 449. 
44 214 U. S. 320; 29 S. Ct. 671; 53 L. Ed. 1013. 
45197 U. S. 11; 25 S. Ct. 358; 49 L. Ed. 643; 3 Ann. Cas. 765. 56 
NATIONAL GOVERNMENT AND HEALTH 
public health. A law to this effect was a valid exercise of the 
police power and its administration could be delegated to local 
authorities. Again in 1922, in Zucht vs. King,46 exactly the same 
stand was taken. 
Purity and Adulteration of Foods. The United States Su- 
preme Court has been called upon to decide many cases having to 
do with foods and food products and their regulation either by 
states or the Federal Government. Some of these cases have, how- 
ever, pertained more to fraud than to the public health. The first 
of these, Powell vs. Pennsylvania,47 decided in 1888, was concerned 
with oleomargarine, and upheld a state law regulating this com- 
modity. A similar result was reached in 1894 in Plumely vs. Mass- 
achusetts,48 but in Schollenberger vs. Pennsylvania,49 in 1897, it was 
held that while oleomargarine could be regulated within a state, it 
could not be excluded from a state, being a proper article of com- 
merce. Capital City Dairy vs. Ohio50 in 1902 sustained a state law 
requiring analysis of oleomargarine by the state, and McCray VS. 
U. S.51 in 1904 upheld the Federal tax which had been imposed on 
this substance in 1886. 
Milk control regulations were found good in five important deci- 
sions in the early 1900's. The Reid vs. Colorado (1902) case, 
mentioned above, held that impure milk could be kept out of a 
municipality, while Fischer vs. St. Louis52 in 1904 refused to hold 
invalid a municipal ordinance, authorized by state legislation, which 
prohibited the erection of a cow stable within the city limits. 
Lieberman vs. Van De Carr,53 the leading case on this subject, sus- 
tained in 1904 a local sanitary code in regulating milk, and St. John 
vs. New York,54 which followed it in 1906, said that such legisla- 
tion might properly classify persons and objects for the purpose 
of regulation. 
48 260 U. S. 174. 
47127 U. S. 678; 8 S. Ct. 992; 32 L. Ed. 253. 
48155 u. S. 461; 39 L. Ed. 223. 
49171 U. S. 1; 43 L. Ed. 49. 
50183 U. S. 238; 46 L. Ed. 171. 
51195 U. S. 27; 24 S. Ct. 769; 49 L. Ed. 78; 1 Ann. Cas. 561 
83 194 U. S. 361; 48 L. Ed. 1018. 
88199 U. S. 552; 26 S. Ct. 144; 50 L. Ed. 305. 
84 201 U. S. 633; 26 S. Ct. 554; 50 L. Ed. 896. HEALTH AND THE SUPREME COURT 
57 
Other decisions pertaining to foods are those upholding the Fed- 
eral Pure Food and Drugs Act of 1906;05 an important decision in 
1908, North American Cold Storage Co. vs. Chicago/8 which held 
valid a municipal ordinance for the seizure and destruction of 
unwholesome food; while state laws regulating the quality of ice 
cream and the manufacture and sale of milk blended with fats 
other than milk fats were upheld in Hutchinson Ice Cream Co. vs. 
Iowa87 (1916), and Hebe Co. vs. Shaw 58 (1919), respectively. A 
general pure food law of a state was upheld in Price vs. Illinois 69 
in 1915. 
Industrial Conditions Affecting Health. Hours of labor and 
other industrial conditions affecting health which the states have 
attempted to control have presented some knotty problems to the 
Supreme Court. In 1898 in Holden vs. Hardy,80 a Utah statute 
restricting the labor of miners to eight hours a day was adjudged 
a good health law, and in 1903 an eight-hour day for state and 
municipal employees was pronounced valid in Atkin vs. Kansas.81 
In 1905, however, came the much discussed case of Lochner vs. 
New York,83 in which a divided court reversed the action of the 
Court of Appeals of New York and held unconstitutional a state 
law limiting the hours of labor of bakers. The reason given for 
this decision was that the law in question had exceeded the limits 
of the police power, was not valid as a health law, and was an im- 
proper interference with the freedom of contract. From the stand- 
point of public health, the opinion was wrong, and able writers 
have questioned its legal soundness. The Court set itself up as a 
fact-finding body, though that was the function of the legislature, 
a function which has been readily accepted in many other decisions, 
such as that of Jacobson vs. Massachusetts. At any rate, the Court 
subsequently has more or less ignored this decision and Bunting vs. 
55Hipolite Egg.Co. vs. U. S. (1911); 220 U. S. 31; 45, S. Ct. 364; 55 L. 
Ed. 364; McDermott vs. Wisconsin (1913), 228 U. S. 115 held void a state 
law conflicting with the Federal statute. 
56 211 U. S. 306; 29 S. Ct. 101; 53 L. Ed. 195; 15 Ann. Cas. 276. 
"242 U. S. 153. 
88 248 U. S. 297. 
''"238 U. S. 446; 36 S. Ct. 892; 59 L. Ed. 1400. 
80169 U. S. 366; 18 S. Ct. 383; 42 L. Ed. 780. 
81191 U. S. 207; 24 S. Ct. 124; 48 L. Ed. 148. 
82198 U. S. 45; 49 L. Ed. 937. 58 
NATIONAL GOVERNMENT AND HEALTH 
Oregon,65 decided in 1917, practically overruled it by upholding a 
state law regulating hours of labor. 
Industrial conditions especially affecting women have fared more 
liberally in the opinions, for in 1908 a state law regulating hours of 
labor for females was upheld in Muller vs. Oregon,04 as essential to 
the welfare of the race, and several similar measures were approved 
in 1914 and 1915.°° That this principle does not extend to compen- 
sation of women, was shown by a decision in 1923, holding uncon- 
stitutional the minimum wage law passed by Congress as a health 
and welfare measure for the women of the District of Columbia.08 
A state law prohibiting employment of women in restaurants in 
large cities between 10 p. m. and 6 a. m. was, however, declared a 
constitutional exercise of the police power in 1924 in Radice vs. 
New York.07 
On two occasions Congress has endeavored to cope with the evil 
of child labor. The first Federal law on this subject prohibited the 
shipment in interstate commerce of the products of child labor. It 
was held unconstitutional in 1918 in Hammer vs. Dagenhart,08 as 
an unwarranted interference with state control over internal mat- 
ters. Congress then placed a prohibitive tax on child labor, but 
this law was also declared unconstitutional in 1922 in Bailey vs. 
Drexel.09 In the latter case the decision was unanimous, while in 
the former the Court was divided. 
A case of somewhat similar interest was the recent one (1923) 
of Massachusetts vs. Mellon,70 in which the state and a taxpayer 
contested the constitutionality of the Federal Maternity and In- 
fancy Act granting subsidies to those states accepting the terms of 
the act. The Court denied the suit on the grounds that neither of 
the plaintiffs had sufficient status to bring a cause of action, and 
did not actually pass upon the constitutionality of the law. 
"243 U. S. 426. 
64 208 U. S. 412 ; 28 S. Ct. 324; 52 L. ed. 551. 
'"Riley vs. Massachusetts, 232 U. S. 671 (1^14) ; Miller vs. Wilson, 236 
U. S. 373 (1915) ; Bosley vs. McLaughlin, 236 U. S. 385 (1915). 
68 Adkins vs. Children's Hospital, 261 U. S. 525; 43 S. Ct. 394; 67 L. Ed. 
785. 
07 264 U. S. 292; 44 S. Ct. 325; 68 L. Ed. 690. 
08 247 U. S. 251; 38 S. Ct. 529; 62 L. Ed. 1101; Ann. Cas. 1918 E. 724; 
3 A. L. R. 649. 
"259 U. S. 20; 42 S. Ct. 449; 66 L. Ed. 817. 
70 262 U. S. 447; 43 S. Ct. 597; 67 L. Ed. 1078. HEALTH AND THE SUPREME COURT 
59 
Miscellaneous Subjects Affecting Health. The practice of 
medicine may be regulated by the state, and various conditions 
imposed on those desiring to practise healing arts, according to 
half a dozen decisions, of which the leading one is Dent vs. West 
Virginia,71 dating from 1889. 
Federal legislation regarding transportation of women in inter- 
state commerce for immoral purposes, the so-called white slave 
laws, have been upheld in several cases.72 The postal laws were 
held in 1902 73 not to debar the use of the mails to treatises on 
mental healing, when the efficacy of such measures was a matter of 
opinion and not necessarily a fraud. A state law regulating dogs 
was upheld in 1896 as a valid exercise of the police power.74 There 
have been a number of decisions to the effect that land may be 
taken by eminent domain by a municipality for a water works, but 
these need not be cited here. A review of legislation referring to 
the National Board of Health which was established in 1879, for 
a four-year period, appears in Dunwoody vs. U. S.70 
Summary. Legal precepts on public health, as enunciated by 
the United States Supreme Court, may be summarized as follows: 
The care of the public health forms a part of the police power of 
the states. This power may be exercised in any reasonable manner 
by the states, and so long as appropriate and constitutional means 
are employed, may even interfere with interstate commerce. Pro- 
tection of national health, by control over interstate commerce 
itself, is, however, a Federal matter. Just as the improper use of 
the police power by the states must not interfere with interstate 
71129 U. S. 114; 32 L. Ed. 623. See also: Hawker vs. New York (1897), 
170 U. S. 189; 42 L. Ed. 1002. Reetz vs. Michigan (1903) ; 188 U. S. 505; 
47 L. Ed. 563. Watson vs. Maryland (1910), 218 U. S. 173; 30 S. Ct. 644; 
54 L. Ed. 987. Collins vs. Texas (1911), 223 U. S. 288; 32 S. Ct. 286; 56 L. 
Ed. 439- 
72 Hoke vs. U. S. (1913), 227 U. S. 308; 33 S. Ct. 281; 57 L. Ed. 523; Ann. 
Cas. 1913 E. 905; 43 L. R. A. (N. S.) 906. Athanasaw vs. U. S. (1913) 227 
U. S. 326. Wilson vs. U. S. (1914), 232 U. S. 563. Caminetti vs. U. S. (1916), 
242 U. S. 470; 37 S. Ct. 192; 61 L. Ed. 442, Ann. Cas. 1917 B. 1168. 
73 American School of Magnetic Healing vs. McAnulty (1902), 187 U. S. 
94; 23 S. Ct. 33; 47 L. Ed. 90. 
74 Sentell vs. New Orleans (1896), 166 U. S. 705; 17 S. Ct. 693; 41 L. Ed. 
1169. 
75143 U. S. 578; 36 L. Ed. 269. 60 
NATIONAL GOVERNMENT AND HEALTH 
commerce, so too the control over interstate commerce by the 
Federal Government must not nullify the police power of the states. 
Constitutional requirements as to freedom of contract, due process 
of law, equal protection of the laws, religious freedom, and the like, 
must yield to the reasonable exercise of the police power when 
validly applied to the protection of the public health, as by the 
regulation of nuisances, by quarantine and inspection, by com- 
pulsory vaccination, by regulation of food, or by control of indus- 
trial conditions directly affecting health. There are limits to the 
extent of the police power, however, and when its administration 
exceeds a reasonable operation, contrary to constitutional inhibi- 
tions, such operation is invalid. Laws affecting national vitality 
may be enacted by Congress in strict accordance with the authority, 
express and implied, of the commerce clause, the taxing clause, and 
other apposite portions of the Federal Constitution. CHAPTER VI 
THE RELATION OF THE NATIONAL GOVERNMENT 
TO STATE AND LOCAL HEALTH 
ADMINISTRATION 
Public Health Responsibility in the United States. The 
federal government is now conceded to possess certain legitimate 
public health functions, but the care of the health of the individual 
citizen is to-day and always has been a responsibility entrusted 
primarily to the states themselves. In order to understand why 
there is apparently some division of responsibility between the 
national and state governments with respect to matters affecting 
the public health as a whole, it is necessary to have a clear concep- 
tion of the source of public health authority in this country, the 
exact role of the federal government in public health activities, the 
organization and functions of the states along these lines, and the 
inter-relationships of the central government and the forty-eight 
states in public health matters.1 
Long before the Federal Constitution was adopted, each of the 
colonies had to some extent attempted to control the health of its 
inhabitants. Quarantine laws had been passed, nuisances regu- 
lated, and such other measures as were then considered necessary 
had been taken to preserve the health of the people. The framers 
of the Constitution were evidently content to leave this duty with 
the individual states, for in none of the enumerated powers of the 
national government did they mention health. This power over 
the public health, not having been relinquished to the central gov- 
ernment, was, therefore, continued and maintained by the states 
after the Federal Constitution was adopted in 1789. 
The right of the states to exercise control over all internal mat- 
ters within their own jurisdiction is known as the police power. It 
has been defined as the inherent power of sovereignty to make rules 
1 The legal basis of public health is described in more detail in the 
author's book, Public health law. 
61 62 
NATIONAL GOVERNMENT. AND HEALTH 
and regulations in the interests of the health, safety, morals, and 
general welfare of the people. Such regulations are subject, how- 
ever, to the limitations contained within the Federal Constitution, 
which is the supreme law of the United States. From this docu- 
ment is derived the power of the Federal Government to under- 
take certain activities, such as to control commerce, impose taxes, 
etc., which may directly or indirectly affect national vitality. 
The source of public health authority in this country lies, therefore, 
in the powers granted to the federal government and enumerated 
in the Constitution, and in the inherent police power of the states. 
By implication this police power is specifically reserved to the 
states by the Tenth Amendment.3 
Source of Federal Health Powers. Although there is no men- 
tion of health in the Constitution, the term " general welfare " 
occurs twice, and this has been argued by some as encompassing 
public health. The preamble,8 for instance, states that one of the 
ends sought by adopting the Constitution is the promotion of the 
general welfare, but this preamble is merely declaratory of the 
purposes of the instrument, and has no real legal effect. Again, in 
the first paragraph of Section 8 of Article I, which sets forth the 
powers of Congress, occurs the term " general welfare," and it is 
there stated that Congress is authorized to lay and collect taxes, 
duties, imposts, and excises, to pay the debts and provide for the 
common defense and general welfare. There is no exact definition 
of this last term, and the determination of its real extent and limi- 
tations has given rise to much controversy. There is to-day no 
doubt, however, but that under the authority of this whole section 
Congress may pass measures which affect the public health. This 
is, therefore, one of the sources of the Federal authority over 
national vitality. 
The Federal Taxing Power. The power to tax has also been 
said to be the power to destroy. It carries with it the incidental 
2 " The powers not delegated to the United States by the Constitution, 
nor prohibited by it to the states, are reserved to the states respectively or 
to the people." 
3 " We, the people of the United States, in order to form a more perfect 
Union, establish justice, insure domestic tranquillity, provide for the com- 
mon defence, promote the general welfare, and secure the blessings of 
liberty to ourselves and our posterity, do ordain and establish this Consti- 
tution for the United States of America." RELATION TO STATE ADMINISTRATION 
63 
right to regulate, or even to prohibit, as well as to raise revenue. 
Thus, Congress has placed a tax on white phosphorus matches 
(Act of April 9, 1912; 37 Stat. L., 81), the effect of which has 
been to drive this poisonous industry out of business. This law 
has, however, never been contested in the courts. So, too, a federal 
tax was placed on Oleomargarine (Act of August 2, 1886; 24 
Stat. L., 209), and this has been upheld by the United States 
Supreme Court. Taxes on physicians who prescribe narcotics have 
similarly been upheld. There is a limit to this power, however, as 
has been shown by the fact that the Supreme Court declared un- 
constitutional a congressional enactment placing a prohibitive tax 
on products made within the states by child labor.4 This law was 
held invalid on the ground that it was clearly an attempt to en- 
croach on the prerogatives of the states and their right to adminis- 
ter their own internal affairs. 
Federal Subsidies to the States. Coincident with the taxing 
power is the authority to appropriate money for the purposes of 
government. Under this authority Congress has created various 
federal departments and bureaus and turned over to them certain 
duties and functions, the primary authority for which is derived 
directly or by implication from the Constitution. 
Under the appropriation power the federal government may 
also appropriate money to be used by the states in certain worthy 
projects. This procedure began in 1862 when public lands and 
funds therefrom were granted to the states to assist in the mainte- 
nance of certain educational institutions which later became known 
as "land grant" colleges (12 Stat. L., 503). Since that time the 
system has spread, and laws have been passed, among others, mak- 
ing federal grants to the states for purposes of agricultural educa- 
tion and aid (Act of May 8, 1914; 38 Stat. L., 372), vocational 
education (Act of February 23, 1917; 39 Stat. L., 929), control of 
venereal diseases (Act of July 9, 1918; 40 Stat. L., 886), and the 
promotion of the hygiene of maternity and infancy (Act of 
November 23, 1921, 42 Stat. L., 135). 
This last named law was contested in the courts, the Common- 
wealth of Massachusetts and a taxpayer of that state each having 
4 Bailey vs. Drexel Furniture Co., 259 U. S. 20. See page 58, Chapter V. 64 
NATIONAL GOVERNMENT AND HEALTH 
brought suit against the officers charged with its enforcement. The 
United States Supreme Court decided 5 that neither party had a 
status sufficient to justify a cause of action and did not pass directly 
upon the constitutionality of the law. Federal subsidies to states, 
although in operation for a number of years, have been severely 
criticized of late and have even been characterized as " bribes " and 
as costly measures which induce undue expenditures on the part 
of the states. Proponents of such grants believe that the soci- 
ological necessity for stimulation of state action over weighs all 
other arguments advanced by the opponents. According tO' the 
present temper of those in control of appropriations, Federal sub- 
sidies may have a precarious future. The operations undertaken 
in accordance with the terms of these various subsidy laws repre- 
sent, nevertheless, a definite relationship between the Federal and 
state governments in health matters, and so are described in some 
detail later in this chapter." 
Control Over Interstate Commerce. More important than the 
taxing power, where national vitality is concerned, is the power 
granted to Congress by the Constitution to regulate commerce with 
foreign countries and between the several states. Most of the 
federal health activity, in fact, is founded on this authority, as 
contained in the third paragraph of Section 8 of Article I. Under 
it, Congress has passed laws imposing quarantine, regulating the 
purity and adulteration of foods, prohibiting the shipment of filled 
milk, regulating biological products, penalizing interstate trans- 
portation of women for immoral purposes, providing for inspec- 
tion of meat, and controlling narcotics. All of these laws which 
have been tested in the courts have been upheld as constitutional 
exercises of the rights of the federal government.7 
As in the case of taxation, there is a limit beyond which the 
control of interstate commerce can'not go. The first federal child 
labor law (Act of September 1, 1916; 39 Stat. L., 675) was an 
endeavor to prohibit the shipment in such commerce of commodi- 
ties made by child labor, but the United States Supreme Court in 
6 Massachusetts vs. Mellon (1923), 262 U. S. 447. 
e See page 71. 
7 Up to 1925 the "filled milk" and narcotics import laws had not been 
contested in the courts. RELATION TO STATE ADMINISTRATION 
65 
a divided opinion, decided that this law was unconstitutional as an 
attempt to regulate methods of manufacture within a state. Such 
manufacture might be, and undoubtedly was, harmful to health, 
but the transportation of the articles could not be.8 It was, there- 
fore, a matter for the states to control for themselves. 
Power Over Territories and Treaties. Besides the taxing 
power and the control over commerce, the Federal Government 
may perform health duties through its supervision of the territor- 
ies, national reservations, and the District of Columbia. It may, 
further, concern itself with public health through the treaty-making 
power, though this last method has not been extensively used in 
health matters. The national government has, however, legislated 
extensively, though not always effectively, in behalf of the health 
of its wards, such as the Indians, natives of Alaska, and inhabitants 
of the territories and the District of Columbia. It has provided for 
the government insane and for the health of its soldiers, sailors, 
and the civil employees of the federal service. 
Investigation and Instruction. The conduct of research seems 
to be acknowledged as a fundamental function of the Federal Gov- 
ernment. In fact, collecting and disseminating useful information 
on appropriate topics is the only duty of many of the Federal 
bureaus. Others may have regulatory or administrative, or even 
quasi-judicial duties, as well as investigatory ones. Not until 1878, 
nevertheless, did Congress authorize any research of importance to 
the public health. In that year a study of the origin and causes of 
epidemic diseases, especially yellow fever and cholera was em- 
powered (Act of December 21, 1878; 20 Stat. L., 487), and investi- 
gations of diseases of animals were authorized in that and succeed- 
ing years (Act of June 20, 1878; 20 Stat. L., 240 and Act of 
May 29, 1884; 23 Stat. L., 32). Studies in nutrition were provided 
for in 1894 (Act of August 8, 1894; 27 Stat. L., 264), and a special 
investigation of leprosy was sanctioned in 1899 (Act of March 2, 
1899; 30 Stat. L., 976). In 1901 general authorization for investi- 
gations of contagious and infectious diseases was obtained (Act of 
March 3, 1901; 31 Stat. L., 1137) and a Hygienic Laboratory pro- 
8 See Goodnow, F. J., Constitutional foundation of federal public health 
functions. Public Health Service, Reprint No. 559 (1919). 66 
NATIONAL GOVERNMENT AND HEALTH 
vided for the purpose under the Marine Hospital (later the Public 
Health) Service. There have been many other laws pertaining to 
research in health matters. Unlike regulatory acts, these laws relat- 
ing to research impose no restrictions upon the scope of the work, 
and their extent is limited only by available appropriations.8 
Federal Recognition of State Health Authority. The ulti- 
mate jurisdiction of the states over public health matters has been 
recognized by Congress and by the federal Judiciary. The first 
federal enactment relating to public health, passed in 1796 (1 Stat. 
L., 474), authorized the President to direct revenue officers to aid 
in the execution of maritime quarantine and the health laws of the 
states, and similar recognition has been accorded in much subse- 
quent legislation of Congress. Comprehensive amendments to the 
National Quarantine Act of 1893 (27 Stat. L., 449), made in 1902 
(32 Stat. L., 712), authorized the Surgeon General of the Marine 
Hospital Service to call an annual conference of state and terri- 
torial health officers. The act of February 3, 1917 (39 Stat. L., 
872), establishing a federal leprosarium, empowered the Public 
Health Service to receive lepers consigned to it by state health 
authorities. The act of July 9, 1918 (40 Stat. L., 886), creating a 
Division of Venereal Diseases in the Public Health Service, author- 
ized that division to cooperate with state departments of health in 
the prevention and control of venereal diseases within the states. 
Many other similar instances of recognition of state health author- 
ity by the legislative branch of the federal government could be 
cited, but these are sufficient for the purpose. The attitude of the 
United States Supreme Court has already been set forth in some 
detail in the preceding chapter.10 The decisions of this court are 
clearly to the effect that the protection and promotion of the public 
health rests in the first instance with the states, that it will be upheld 
in every reasonable application of it and that it is subject only to 
certain proper constitutional limitations, which will be stretched 
as far as possible in upholding the rights of the states to regulate 
internal police matters, whether or not they affect life, liberty, and 
property. 
9 Kerr, J. W., Legal authority for federal public health activities (1925). 
Public Health Service, Reprint No. 1035. 
10 See page 48. RELATION TO STATE ADMINISTRATION 
67 
Limitations on the Police Power. The police power of the 
states, under the authority of which public health work is carried 
on, is subject to a number of limitations placed upon it by the 
Constitution. Many of the clauses of this basic law of the United 
States may give rise to conflicts between the exercise of the police 
power and the jurisdiction of federal authorities. As already 
pointed out, the control of interstate and foreign commerce is 
exclusively a federal matter. No state may interfere with such 
commerce, with the notable exception, however, that it may take 
necessary and reasonable measures in behalf of public health or 
safety. If such actions clash with the control of interstate com- 
merce, they will usually be upheld by the courts, provided they are 
actually essential to health and are reasonable and proper in their 
application.11 
The same principle holds good with respect to conflicts between 
the exercise of the police power and other portions of the Constitu- 
tion which may impose limitations upon it. Thus, no person can be 
deprived of life, liberty, or property without due process of law, 
nor can any person be denied the equal protection of the laws. A 
state can pass no legislation which impairs the obligation of a con- 
tract ; nor may a state, without the consent of Congress, lay im- 
posts on exports except to execute reasonable inspection laws; nor 
may a state enter into treaties or compacts with other states, except 
with the consent of Congress. All of these prohibitions may affect 
the administration of public health by the states, and apparently 
would seem to place difficulties and restrictions in the way of 
efficient exercise of the police power. The courts, however, have 
always been liberal in upholding the reasonable use of police 
measures. 
When an act which is needed to protect the public health runs 
counter to the Constitution, the question of whether the interests 
of public health will prevail depends upon the facts in the particu- 
lar case, and the controversy may often be determined by the 
reasonableness of the action in behalf of public health. Courts 
will uphold the interests of public health, provided they are not 
exercised in an unreasonable manner and there is no abuse of 
power and authority. The liberty of the individual citizen must be 
u See page 50. 68 
NATIONAL GOVERNMENT AND HEALTH 
maintained, but only so long as society as a whole will not suffer 
thereby. The legal authority for public health measures is, in fact, 
based on the maxims, " The greatest good to the greatest number," 
and " So use your own as not to do harm to others." 
Delegation of the Police Power. The police power of the 
states may be delegated to their political subdivisions. Thus, cities 
and towns, and other municipal corporations may be empowered 
by charter or by legislation to regulate and control public health 
within their own jurisdictions. Although every state has an official 
state-wide health organization, this delegation has been general, so 
that most local health administration is controlled by municipali- 
ties. The function of the state is, in general, to control inter- 
community affairs, to provide standards and guidance, to conduct 
research, and to enforce the state health laws, which usually set 
forth in detail the powers and duties of the state and local author- 
ities, respectively.12 
The federal government, through its appropriate bureaus and 
officers, may send information and advice to local health author- 
ities and, with their consent, may collect information from them. 
It may not, however, go into a community for the purpose of tak- 
ing charge of or directing public health activities, unless interstate 
or foreign commerce is involved, or unless such cooperation has 
been directly invited by state authorities. 
Organization of State Health Work.13 Every state has a 
department charged with the administration of state health activi- 
ties. This department may consist of a board of health with an 
executive health officer, or a single commissioner, sometimes with 
and sometimes without an advisory council. The exact type of 
organization varies throughout the country, and occasionally pub- 
lic health is administered by a state department of welfare, or 
" See Kerr, J. W., and Moll, A. A., Organization, powers and duties of 
health authorities. Public Health Service, Public Health Bulletin No. 54 
(1912). 
13 An investigation of state health administration by the Institute for 
Government Research was being undertaken in 1926. No complete survey 
of state health organization has been made since 1914, when Dr. C. V. Chapin 
conducted such a study for the American Medical Association. The United 
State Public Health Service issues annual directories of state health 
authorities. RELATION TO STATE ADMINISTRATION 
69 
health and welfare.14 The executive of the department is to-day 
usually a full-time officer, though five state health officers were 
employed on a part-time basis in 1924. The department is, as a 
rule, organized into divisions or bureaus, such as sanitary engineer- 
ing, vital statistics, child hygiene, food and drugs, etc., each in 
charge of a chief. The department usually maintains a laboratory 
and has other necessary equipment, the extent of which depends on 
the generosity of the legislature. 
Appropriations to all the state health departments in 1925 aggre- 
gated about $12,000,000, as compared with $11,000,000 in 1924, 
and $4,500,000 in 1914.10 The Federal Government in 1925 spent 
about $15,000,000 on public health activities, though this sum 
includes over a million dollars which was allotted to the states for 
maternity and infant hygiene or venereal disease control. The 
state health appropriations in 1924 varied from the lowest amount 
of $8800 in Nevada to the highest, $2,000,000, in Pennsylvania. 
Per capita appropriations vary from three to nineteen cents per 
year. The amount of money spent on public health by all cities in 
this country having a population of 30,000 or over was about $28,- 
000,000 in 1922, though this sum represents only about 2^4 per 
cent of all municipal expenditures. About $5,000,000 is spent 
annually by counties and rural communities for health work. 
The total annual amount spent on public health by all official 
agencies, federal, state, and local, comes to approximately $60,- 
000,000. This is the appropriation for prevention. It costs the 
states about a hundred million dollars annually to provide institu- 
tional care for the sick and the defective. The Federal Govern- 
ment spends three times as much for medical relief as it does for 
public health. Apart from governmental expenditure, it has been 
estimated that it costs the people of the United States over one 
thousand million dollars annually for hospital service, physicians, 
nurses, and other healers, and another three hundred and fifty 
millions for drugs. 
Actual Relation of the Federal Government to State Health 
Work. The source of legal authority over public health, the 
14 In Idaho, Nebraska, and New Mexico only. 
15 Moore, H. H., Public health in the United States (1923). This book 
has an excellent chapter on public economy and public health, in which 
figures as to relative expenditures are cited. 70 
NATIONAL GOVERNMENT AND HEALTH 
role of the federal government in protecting national vitality, and 
the functions and organization of the states in health matters, 
having been set forth, it remains to consider some of the actual 
instances of the relations between the federal government and 
the states in the interests of the public health. The operations of 
the federal government in connection with this relation may be 
summarized under the following heads, each of which will be 
briefly described: 
i. Collection and distribution of information 
2. Cooperation with the states 
3. Regulation of interstate commerce 
4. Control over foreign commerce 
5. Enforcement of Federal taxation 
Collection and Distribution of Information. Investigation of vari- 
ous phases of public health is undertaken by practically all of the 
Federal bureaus which do health work. The nature of this research 
varies in character, some of it being concerned with empirical 
scientific investigations; some with the collection, compilation, or 
analysis of data; and some with studies of administration. Ex- 
amples of original scientific research in the first class mentioned are 
the studies on the chemotherapy of syphilis, conducted by the Hy- 
gienic Laboratory of the Public Health Service, and the investiga- 
tions of metabolism made by the Bureau of Home Economics. Col- 
lection and analysis of data is exemplified in the studies of infant 
mortality, made by the Children's Bureau, and the compilation of 
accident statistics by the Bureau of Labor Statistics. Studies of 
administration consist of such matters as the surveys of municipal 
health department procedure, performed by the Public Health Ser- 
vice, or on current pasteurization practice, as ascertained by the 
Bureau of Dairying. Federal health bureaus which have no regu- 
latory or administrative functions, but are charged only with the 
collection and dissemination of useful information are: Division 
of Vital Statistics, Bureau of the Census (Commerce) ; Bureau of 
Labor Statistics (Labor) ; Women's Bureau (Labor) ; Division of 
School Hygiene, Bureau of Education (Interior) ; Bureau of 
Home Economics (Agriculture) ; Bureau of Dairying (Agricul- 
ture). These bureaus may be, and in several instances are, inter- 
ested in subjects other than those pertaining to public health. RELATION TO STATE ADMINISTRATION 
71 
The results of this assembled data are usually of great value to 
the states. They are able to look to a central source for authorita- 
tive information and guidance, though, as pointed out, the central 
source is, unfortunately, rather scattered itself. While a state or 
local officer can get all the health data which has been gathered by 
the national government by purchasing it from the Superintendent 
of Documents, he can get it free only by applying to the particular 
bureau which has produced it, which may be any one of thirty 
different bureaus. So, too, he may have to write to many federal 
agencies or, if he visits the Capital, he may have to travel all over 
the city and confer with many different officers. 
All of the various bureaus which make investigations also pub- 
lish them in pamphlet form. There are, in fact, over one thousand 
different bulletins on health subjects available. Some of these are 
technical, while others are more popular. Magazines and journals 
are also issued by several bureaus,16 and these often contain articles 
of health interest. There are apparently no inhibitions on the issu- 
ance of pamphlets and publicity material by the federal govern- 
ment except the limit imposed by the amount of appropriations. 
News items and magazine stories are often distributed and vari- 
ous other measures employed to secure publicity. 
Cooperation zvith the States. Federal activities undertaken 
under the authority to make investigations may also include the 
making of demonstrations.17 Thus, a federal health agency, with 
the consent of the state, or at its invitation, may, conduct a demon- 
stration in child hygiene, rural hygiene, or some other pertinent 
subject. Rural sanitation activities, to be participated in jointly by 
the federal government, states, and counties, and financed from 
all of these sources, are, in fact, sanctioned by acts of Congress. 
The International Health Board, an extra-governmental agency 
sponsored by the Rockefeller Foundation, also assists in this work, 
which is supervised by the Rural Sanitation Office of the Public 
Health Service. The number of counties on January 1, 1925, in 
which health work was being undertaken by whole-time health 
officers was 280,18 an increase of fifty over 1923. In 1921 the 
10 A list is given on page 372. 
17 McLaughlin, A. J., Proper relation of federal and state governments 
in public health work, American Journal of Public Health, August, 1919. 
18 Lumsden, L. L., Rural health service in the United States, 1921. Public 
Health Service, Public Health Reports, May 8, 1925. 72 
NATIONAL GOVERNMENT AND HEALTH 
number was 161. Only about 14 per cent of the rural population 
now has such rural health service. 
Rural hygiene is undertaken not only by the Public Health 
Service, but it also receives an impetus from the Extension Service 
of the Department of Agriculture. Under authority of the Smith- 
Lever Act (38 Stat. L., 372) and annual appropriation acts, home 
demonstration agents and county agents are employed in the states 
with Federal, state, local, and private funds. Much of the instruc- 
tion given by these agents is concerned with hygiene, sanitation, 
and other rural health problems.1' 
The Public Health Service has always maintained close relations 
with the state departments of health. On the theory that improved 
administration would result from strengthening state health author- 
ities, the Service has done everything in its power to bring this 
about. It has loaned its officers for temporary duty as state officers, 
and has endeavored to assist in building up the sanitary engineer- 
ing bureaus of the states. Such a step is obviously of importance 
to the interstate control of disease, as it serves to eliminate sources 
of infection within the states. The development of adequate state 
and local health machinery is considered one of the most important 
factors in the prevention of disease. 
The work of the Bureau of Mines of the Department of Com- 
merce in attempting to improve the health of miners throughout 
the country should also be mentioned. This bureau cooperates with 
the states and also maintains mine rescue cars and equipment, 
which can be dispatched to the scene of disasters.30 
The largest single appropriation for cooperative health work in 
the states is granted under the Sheppard-Towner Act of 1921 
(42 Stat. L., 224) for the promotion of the welfare and hygiene of 
maternity and infancy. This law makes available annually for a 
five-year period, federal funds to the extent of about a million 
dollars, to be allotted to those states accepting the act and matching 
the federal grant. In 1925 all the states except Connecticut, Illi- 
nois, Kansas, Maine, and Massachusetts had accepted the law and 
were conducting child hygiene activities with the cooperation of 
the Children's Bureau, which is charged by Congress with the 
19 See page 217 for a complete description of this work. 
20 See page 295 for more detailed description. RELATION TO STATE ADMINISTRATION 
73 
administration of the act. The Division of Maternity and Infant 
Hygiene of the Bureau consists of two physicians, as director and 
associate director, a public health nurse, an accountant, a secretary, 
and a stenographer, and members of this staff visit, at least once a 
year, all of the cooperating states. The actual work done by the 
states has been summarized in a report21 issued by the Bureau. 
According to this report, " as a successful federal aid measure 
the act has already demonstrated its value in that it has 
(1) Stimulated state activities in maternal and infant hygiene. 
(2) Maintained the principle of local initiative and respon- 
sibility. 
(3) Improved the quality of the work being done for mothers 
and babies by disseminating through a central source-the federal 
government-the results of scientific research and methods of 
work which have been found to operate successfully. 
(4) Increased state appropriations with the passage of the act." 
The continued activities along these lines are largely educational 
and consist of instruction to mothers in prenatal care, childbirth, 
and infant care; and in the development of more wide-spread medi- 
cal and nursing facilities so that adequate maternity and infancy 
supervision will be available. 
Regulation of Interstate Commerce. The prevention of the 
interstate spread of disease is a matter largely entrusted by law to 
the Public Health Service. The Service acts, however, only when 
state and local measures are inadequate, as when a distinctly 
national problem is involved. It has promulgated regulations for 
the sanitation of interstate carriers, such as railroads and vessels. 
It also controls all biological products shipped in interstate com- 
merce, and to this end tests them and licenses their manufacture. 
The Service also conducts various other activities affecting inter- 
state commerce. Its efforts to improve state health administration 
have already been mentioned.22 
Two other interstate matters of significance to health are admin- 
istered by the Department of Agriculture. These are the Pure 
Food and Drugs Act and the Meat Inspection Act. The analytical 
21 The Promotion of the welfare and hygiene of maternity and infancy 
(Report for Fiscal Year 1924). Publication No. 146. 
22 See page 72. 74 
NATIONAL GOVERNMENT AND HEALTH 
work under the Food and Drugs Act of 1906 (34 Stat. L., 768) is 
performed by the Bureau of Chemistry,23 preliminary to any legal 
measures for prosecuting offenders in the federal courts. Most 
of the states also have their own pure food laws and the Bureau, of 
course, has no jurisdiction over intrastate matters. It attempts, 
however, to work in harmony with state officers, and to this end 
maintains an office of cooperation. The Meat Inspection Act of the 
same year (34 Stat. L., 679), which forbids the shipment of meat 
in interstate commerce unless inspected and approved by Federal 
agents, is administered by the Bureau of Animal Industry,24 which 
has a corps of over two thousand inspectors for the purpose, many 
of these employees working directly in the great meat packing 
establishments of the country. 
Control over Foreign Commerce and Taxation. The control 
exercised by the Federal Government over foreign intercourse, as 
by examinations of immigrants, quarantines, collection of useful 
information concerning foreign sanitary conditions, and by other 
appropriate measures; and the enforcement of federal taxation, are 
matters which only indirectly concern the relationship of the federal 
government to the states, and as they have been described and dis- 
cussed elsewhere,23 will not be touched upon again in detail. 
Control of foreign matters affecting health is largely exercised by 
the Public Health Service, though the Consular Service and the 
Customs Service have certain duties. Collection of taxes and 
enforcement of regulatory provisions connected with such taxation 
is administered by the Bureau of Internal Revenue. 
23 See page 187. 
24 See page 198. 
23 See page 69. PART II 
DESCRIPTION AND ANALYSIS OF EXISTING 
FEDERAL HEALTH ACTIVITIES 
CHAPTER VII 
THE DEPARTMENT OF THE TREASURY 
The Department of the Treasury now contains the chief federal 
health agency, the Public Health Service. This bureau belongs to 
this department for historical and not fiscal reasons. Although 
there is an axiom among sanitarians that " public health is pur- 
chasable," administrative control over the Public Health Service 
by the Secretary of the Treasury has never resulted in lavish 
expenditures for the purposes of the bureau. Although general 
supervision over the Public Health Service is exercised by the 
Secretary, an Assistant Secretary is more directly in charge. This 
officer also supervises the work of a number of other non-fiscal 
agencies in this department, such as the Supervising Architects' 
Office. 
Two other bureaus of the Treasury Department are indirectly 
interested in public health. They are the Bureau of Internal Rev- 
enue, which administers the narcotic and prohibition laws, and the 
Customs Service, which cooperates in enforcing certain food and 
drugs laws. 
The Public Health Service.1 The Public Health Service is the 
chief federal health agency. It is, in fact, the only bureau whose 
sole concern is in the field of public health and medicine, though 
there are a half a dozen other bureaus which have a major interest 
in the subject of public health. 
JThe material regarding the Public Health Service is drawn largely from 
Schmeckebier, The Public Health Service. Institute for Government Re- 
search, Monograph No. io, where further details will be found. 
75 76 
NATIONAL GOVERNMENT AND HEALTH 
The functions of the Public Health Service as now determined 
by law, fall into three classes: (i) The furnishing of medical 
relief for designated persons; (2) the prevention of the spread of 
disease through interstate and foreign commerce, this duty involv- 
ing cooperation with state authorities; and (3) the conduct of 
research. In order to perform these functions, the following gen- 
eral activities are undertaken: The operation of hospitals and the 
supplying of medical relief to specified beneficiaries; the medical 
inspection of immigrants; the administration of maritime and 
border quarantine; the prevention of the interstate spread of 
disease; cooperation with state and local health authorities; the 
examination of biological products intended for shipment in inter- 
state commerce; the collection of morbidity and other statistics 
pertaining to health; the study and investigation of the diseases of 
man and all conditions which influence health and national vitality ; 
and the dissemination of information on public health. 
The Public Health Service is one of the oldest of the government 
services, its origin going back over a century and a quarter. It has 
always been connected with the Treasury Department. The history 
of the Service may be divided into four well defined periods, as 
follows: (1) The unorganized Marine Hospital Service from 1798 
to 1870; (2) the organized Marine Flospital Service from 1870 to 
1902; (3) the Public Health and Marine Hospital Service from 
1902 to 1912 ; and (4) the Public Health Service from 1912 to date. 
The Unorganized Marine Hospital Service, 1798 to 1870. 
The furnishing of medical relief to merchant seamen was one of 
the earliest of the Federal activities that did not relate to the actual 
operation of the government. The act of July 16, 1798 (1 Stat. L., 
605), provided that after September 1, 1798, the master of every 
American ship arriving from a foreign port should pay to the 
collector of customs the sum of twenty cents a month for each 
seaman, which amount he was authorized to deduct from the sea- 
man's wages. After September 1, 1798, vessels engaged in coast- 
wise trade could not obtain a new license until payment had been 
made at the rate of twenty cents a month per seaman for the period 
covered by the previous license. The President was authorized 
to use the money collected in this manner to provide temporary 
relief and maintenance for sick and disabled seamen, who were DEPARTMENT OF THE TREASURY 
77 
to be placed in hospitals already established; if no hospital was 
available, provision for relief was to be made in such manner 
as the President should direct. Special provision was made that 
the money was to be expended in the district where collected. 
The President was also authorized to accept cessions of build- 
ings and grounds, and donations. The surplus after paying expenses 
could be used to purchase buildings or grounds and to erect build- 
ings. The President was authorized to appoint directors of the 
marine hospitals of the United States in various ports at his dis- 
cretion, who were to hold office during his pleasure. Each director 
was to supervise the expenditures in the port to which he was 
assigned, to provide accommodations and govern the hospital under 
general instructions of the President, and to render an account 
quarterly to the Secretary of the Treasury or to some other person 
designated by the President. The directors were to receive no com- 
pensation except such as might be incurred in the actual discharge 
of their duties. The collectors of customs appear to have become 
directors ex officio.2 
The act of 1798 referred only to merchant seamen, but on March 
2, T799 (T Stat. L., 729), a new act was passed authorizing the 
Secretary of the Navy to deduct twenty cents a month from the 
pay of naval officers, seamen and marines, who were made benefi- 
ciaries of the marine hospitals. These deductions were transmitted 
quarterly to the Secretary of the Treasury. This act remained in 
force until the passage of the act of February 26, 1811 (2 Stat. L., 
650), which placed naval hospitals under the superintendence of 
the Secretary of the Navy and provided that the collection from 
officers and seamen of the Navy should be paid into a separate 
fund for the Navy. 
It was soon recognized that proper relief could not be given by 
expending the money entirely within the district in which it was 
collected, and the act of March 2, 1799 (1 Stat. L., 729), author- 
ized the President to expend the fund within a state adjoining the 
one in which the money was collected, with the exception of New 
Hampshire, Massachusetts, Rhode Island, and Connecticut. All 
money collected in these four states was required to be expended 
within their borders. Three years later these limitations on the 
23x Cong. 2 sess., S. ex. doc. 14, p. 5. 78 
NATIONAL GOVERNMENT AND HEALTH 
expenditures were abolished, and the fund was made a general one 
to be used throughout the country for the benefit of sick and dis- 
abled American seamen. 
The first marine hospital operated by the government was the one 
at Washington Point, Norfolk, purchased in 1800. By 1802 hos- 
pitals had been opened at Norfolk, Boston, Newport, and Charles- 
ton.3 The increasing use of the Mississippi River for transporting 
to market the lumber and other products of the Western territory 
made it desirable to provide hospital facilities at New Orleans, and 
the act of May 3, 1802 (2 Stat. L., 192), authorized the President 
" to take such measures as may be expedient " to provide medical 
assistance at that place if this could be done " with the consent of 
the government having jurisdiction over the port." At this time 
France still had possession of the Louisiana Territory, as the 
treaty ceding this area was not signed until the following year. 
The master of every boat or raft going down the Mississippi River 
was required to pay twenty cents per month for each person 
employed. The hospital tax was collected at Fort Adams, and no 
vessel or raft was to be cleared until the tax was paid. An appro- 
priation of $3000 was made for establishing the hospital, and the 
President was authorized to appoint a director of the marine hos- 
pital at New Orleans, whose duties were to be the same as those of 
directors of marine hospitals in the United States. The act of 
February 24, 1804 (2 Stat. L., 252), extended the laws relating to 
sick and disabled seamen to the territory acquired from France. 
The act of May 3, 1802, also provided $15,000 for the erection 
of a hospital in Massachusetts, authorized the admission of foreign 
seamen to hospitals at the rate of seventy-five cents a day, and 
allowed the directors of hospitals a commission of one per cent on 
the money expended. 
The settlement of the Northwest and Louisiana territories and 
the development of transportation facilities on the Great Lakes 
and Western rivers brought to the attention of Congress the neces- 
sity of establishing hospitals in that region. By the act of March 3, 
^37 (5 Stat. L., 189), the President was authorized to purchase 
sites for not exceeding three hospitals on the Mississippi River, 
3 Supervising Surgeon General, Marine Hospital Service, Annual Report, 
1872, p. 7. DEPARTMENT OF THE TREASURY 
79 
three on the Ohio, and one on Lake Erie. An appropriation of 
$15,000 was made for the purchase of sites, and the President was 
authorized to call upon the " medical men " of the Army to select 
suitable locations. The Secretary of War was directed to prepare 
plans and estimates, which were submitted to Congress in Decem- 
ber, 1837? Later acts provided funds for the erection of these 
Western hospitals, which were built under the direction of the 
Topographical Bureau of the War Department.5 
New hospitals were built at various times, but no important 
legislation affecting the service was enacted between 1837 and 1870. 
The act of March 1, 1843 (5 Stat. L., 602), provided that seamen 
engaged in the coasting trade should be beneficiaries of the service. 
These seamen were entitled to this service under the original act of 
July 16, 1798, but for " some cause not apparent the provisions of 
the act of July 16, 1798, including coasting vessels under the gen- 
eral law, had been suspended, by construction, since the year 1831.8 
By the act of July 20, 1846 (9 Stat. L., 38), canal boats were ex- 
empted from the tax, and the persons employed on them were 
denied the use of the hospitals. The act of March 3, 1849 (9 Stat. 
L., 368), carried an appropriation of $1000 to collect facts and 
information in relation to marine hospitals and the marine hospital 
fund and to report to Congress what changes were necessary. 
Dr. George B. Loring and Dr. T. O. Edwards were appointed to 
collect the necessary information; and their report, made in 1851, 
reviewed the general history of the service, described existing con- 
ditions, and made some recommendations, the most important being 
that the system should be placed under a chief surgeon.' Secretary 
of the Treasury Chase in 1861 stated that the number of marine 
hospitals " has been increased far beyond necessity or utility." 8 
Subsequently the act of March 1, 1862 (12 Stat. L., 348), author- 
ized the Secretary of the Treasury to rent marine hospitals to 
authorities of cities and to contract with hospitals for the medical 
treatment of seamen. By the act of April 20, 1866 (14 Stat. L., 
40), the Secretary of the Treasury was authorized to sell or lease 
1 Secretary of War, Annual Report, 1837, pp. 195-203. 
"31 Cong. 2 sess., S. ex. doc. 14, p. 25. 
6 Ibid., p. 3. 
7 Ibid., p. 30. 
'Secretary of the Treasury, Annual Report, 1861, p. 27. 80 
NATIONAL GOVERNMENT AND HEALTH 
such marine hospital lands and buildings as he deemed advisable, 
except the hospitals at Portland, Maine, and Cleveland, Ohio; no 
hospital was to be sold or leased if suitable accommodations could 
not be obtained. This act was amended by the act of June 27, 1866 
(14 Stat. L., 76), which provided that no hospital should be sold or 
leased if the relief furnished amounted to twenty cases a day. 
The tax on seamen was collected continuously from 1798 to 1870, 
except for the period of one year beginning April 1, 1837. The 
proceeds of the tax, however, were sufficient for the expenses of 
the service during only thirty-four of the seventy-three years. Dur- 
ing the other years it was necessary tO' appropriate money from 
the general funds of the government in order to maintain the ser- 
vice, and from 1841 to 1870 deficiency appropriations were made 
each year with the exception of 1846 and 1854. In addition, spe- 
cific appropriations were made for the purchase of sites and the 
erection of buildings. 
During this period medical relief was given in the hospitals oper- 
ated by the Service, in contract hospitals, and in private dwellings 
under contract with local physicians. Thirty-one hospital proj- 
ects had been undertaken by the government since the organization 
of the Service, but only nine of these were in use in 1870, seven 
being operated by the government and two being leased to private 
parties. Of the remainder, fourteen hospitals had been sold, one 
transferred to the War Department, one abandoned, one burned, 
one destroyed by flood and one by hurricane, one injured by earth- 
quake and abandoned, and two unfinished, the completion of one 
of these being regarded as impracticable. Hospitals had been built 
at points where there were no patients or not sufficient patients to 
justify the maintenance of the institutions. 
On the administrative side, the service during these years was 
characterized by an entire absence of any central supervisory 
authority. The act of 1798 placed all authority in the President, 
who seems to have delegated control to the Secretary of the 
Treasury,9 who had no supervisory machinery, the routine trans- 
actions being, at the end of this period, under the Revenue Marine 
Division of the Treasury Department.10 At first the President 
9 3i Cong. 2 sess., S. ex. doc. 14, p. 5. 
10 Sup. Surg. Gen., Annual Report, 1872, p. 26. DEPARTMENT OF THE TREASURY 
81 
appointed the surgeons in charge of hospitals, but these appoint- 
ments afterwards became a perquisite of the collectors of customs. 
In 1809 Secretary Gallatin authorized the collectors of customs to 
fix all rules for government of hospitals. Secretary Walker in 1848 
prescribed general rules for the government of all hospitals, but 
they do not seem to have been followed.11 In the absence of ade- 
quate supervisory authority each hospital was managed as an 
independent establishment. 
The Organized Marine Hospital Service, 1870 to 1902. 
Realizing the unorganized condition of this hospital service, Con- 
gress on June 29, 1870 (16 Stat. L., 169), passed a law which 
provided a central administrative agency for the Marine Hospital 
Service. The Secretary of the Treasury was authorized to appoint 
a supervising surgeon for the Service at a salary of $2000 and 
necessary traveling expenses. The duties of this officer as stated 
in the law were, under the direction of the Secretary of the Trea- 
sury, to supervise " all matters connected with the Marine Hospital 
Service, and with the disbursement of the fund for the relief of 
sick and disabled seamen." In the same act the hospital tax on 
seamen was increased from twenty to* forty cents a month. The 
proceeds of the tax were to be placed in a separate fund, which 
was appropriated for the expenses of the Marine Hospital Service, 
and which was to be " employed under the direction of the Secre- 
tary of the Treasury, for the care and relief of sick and disabled 
seamen employed in registered, enrolled, and licensed vessels of 
the United States." 
The office of Supervising Surgeon was first filled in April, 1871, 
by the appointment of Dr. John M. Woodworth, who promptly 
took steps to reorganize the service on a more efficient basis. The 
rules governing the service were gradually revised, and the new 
rules were codified in regulations approved October 1, 1873. Under 
the new regulations, appointments were made to the general ser- 
vice, and not to particular hospitals or stations, the surgeons being 
transferred from the smaller to the more important stations as 
vacancies occurred. This feature emphasized the national char- 
acter of the service, prevented appointments due to local political 
influence, and gave the general service the benefit of the experience 
1131 Cong. 2 sess., S. ex. doc. 14, p. 27. 82 
NATIONAL GOVERNMENT AND HEALTH 
acquired by its officers. More important was the requirement that 
appointments to the medical staff should be made only after exam- 
ination by a board of surgeons, the appointment being made by the 
Secretary of the Treasury on the recommendation of the Supervis- 
ing Surgeon.12 Compensation of all officers and employees was 
fixed by the Secretary of the Treasury, with the exception of the 
salary of the Supervising Surgeon which was fixed by statute. 
Supervising Surgeon Wood worth had been a medical officer of 
the Army, and evidently believing that a military plan of organiza- 
tion gave the best results, he placed the service on what was prac- 
tically a military basis. Officers were required to wear a regulation 
uniform when on duty, and the general discipline and administra- 
tion of the hospitals were modeled on military lines. In their basic 
features these regulations are in force at the present time, although 
modifications have been made in details as a result of the creation 
of additional grades of officers and changed conditions. 
The first annual report of the reorganized service was that 
for 1872, which reflected the change in general character. The 
earlier reports contained only statements of receipts and expendi- 
tures, while the report for 1872 included detailed medical statistics 
on cases treated and brief reports on the history of surgical cases. 
In the report for 1873 was begun the publication of more detailed 
technical and scientific papers dealing with cases of special interest. 
These papers continued to be published in the annual reports until 
1905, after which articles of this character were issued in separate 
form. 
The next legislation affecting the service was contained in the 
sundry civil appropriation act of March 3, 1875 (18 Stat. L., 377), 
in which the head of the service was called the Supervising Sur- 
geon General, and which provided that he should be appointed by 
the President, subject to confirmation by the Senate. The salary of 
the office was fixed at $4000 a year. No change was made in the 
method of appointing other officers and they continued to be 
appointed by the Secretary of the Treasury, who also fixed their 
compensation. By another act (18 Stat. L., 485) some changes 
were made in the method of collecting the tax, and the term " sea- 
men," previously undefined, was made to include all persons em- 
12 Regulations, 1879, Par. 51 and 52. DEPARTMENT OF THE TREASURY 
83 
ployed on vessels, in so far as the benefits of the service were 
concerned. Foreign seamen were allowed to obtain treatment at 
the hospitals at rates to be fixed by the Secretary of the Treasury, 
instead of at the rate of seventy-five cents a day prescribed by the 
act of May 3, 1802. Seamen on vessels not subject to the hospital 
tax were to be admitted on the same terms as foreign seamen, and 
under this provision persons employed on vessels of the Navy, 
Engineer Corps of the Army, Coast Survey, and Lighthouse Ser- 
vice 13 were given treatment, the expenses being paid by the various 
services. This law provided also that insane patients of the Service 
should be admitted to the Government Hosiptal for the Insane, 
now St. Elizabeth's Hospital, and that the Secretary of the Trea- 
sury might lease hospital buildings and use the proceeds for the 
maintenance of the Service. 
Quarantine Law of 1878. The first national quarantine law 
was the act of April 29, 1878 (20 Stat. L., 37), and the medical 
officers of the Marine Hospital Service were charged with the 
enforcement of regulations to be promulgated by the Secretary of 
the Treasury. Congress had passed quarantine laws in 1796, 1799, 
1832, and 1866, but these earlier laws merely extended Federal aid 
in the enforcement of local regulations. By the act of May 27, 
1796 (1 Stat. L., 474), the President was authorized to direct 
revenue officers and officers commanding forts and revenue cutters 
to aid in the execution of health laws of the states in such manner 
as may appear necessary. This law was repealed by the act of 
February 25, 1799 (1 Stat. L., 619), which provided that any 
quarantine established by or in conformity with the health laws of 
any state should be observed by collectors of customs and all other 
officers of the revenue, by masters of revenue cutters, and by 
military officers as directed by the Secretary of the Treasury. The 
act of July 13, 1832 (4 Stat. L., 577), gave the Secretary of the 
Treasury authority for one year to employ additional boats and 
officers if he deemed the revenue cutters and officers insufficient to 
enforce the quarantine regulations. By the joint resolution of 
May 26, 1866 (14 Stat. L., 357), the Secretary of the Treasury 
was directed to make quarantine regulations necessary to aid state 
or municipal authorities in guarding against the introduction of 
13 Sup. Surg. Gen., Annual Report, 1875, p. 6. 84 
NATIONAL GOVERNMENT AND HEALTH 
cholera. He was also authorized to direct revenue officers and 
commanders of revenue cutters to assist in the execution of the 
quarantine and health laws of the states. 
An epidemic of cholera in 1872 focused attention on the subject 
of quarantine, and the Secretary of the Treasury on September 8, 
1874, issued a general circular calling attention to the act of 
February 25, 1799 (R. S. 4792), which for some years had been 
practically a dead letter. In this circular, officers of the Marine 
Hospital Service and customs officers were directed to inform 
themselves fully regarding local health laws and regulations, and 
directed to give prompt assistance in their enforcement.14 
All the laws discussed above assumed that quarantine was a 
local function and that any action of the National Government 
should be merely for the purpose of assisting state or municipal 
authorities. The diversity in the regulations and the burden thrown 
upon foreign commerce by the unreasonable requirements at some 
ports led to the passage of the act of April 29, 1878 (20 Stat. L., 
37), which gave authority to the Supervising Surgeon General of 
the Marine Hospital Service, subject to the approval of the Presi- 
dent, to make rules and regulations governing the detention of 
vessels having cases of contagious diseases on board or coming 
from foreign ports at which contagious diseases exist. It was ex- 
pressly stipulated, however, that these rules and regulations must 
not " conflict with or impair any sanitary or quarantine laws or 
regulations of any state or municipal authorities." The Attorney 
General gave it as his opinion that this law authorized Federal 
regulations more stringent than local ones.15 
Officers of existing state or municipal quarantine systems were 
authorized to act as officers of the national quarantine system, and 
if the quarantine was considered necessary at other ports, the 
medical officers of the Marine Hospital Service were directed to 
perform such duties as might be assigned to them by the Supervis- 
ing Surgeon General. 
This act provided also that consular officers in foreign countries 
should advise the Supervising Surgeon General regarding the 
appearance of contagious diseases in any foreign port or the depar- 
11 Ibid., p. 16. 
15 20 Op. Att. Gen. 474. DEPARTMENT OF THE TREASURY 
85 
ture of any vessel from such a port for the United States. They 
were also required to report the departure of vessels from such 
ports to the health officer at the port of destination. In addition 
consular officers were required to make weekly reports to the 
Supervising Surgeon General on the sanitary conditions at the 
ports where they were stationed. The Supervising Surgeon General 
was required to notify the local authorities at the port of destina- 
tion regarding the departure of any vessel from an infected port; 
he was also required to prepare and transmit to the medical officers 
of the Marine Hospital Service, to collectors of customs, and to 
state and municipal health authorities in the United States, weekly 
abstracts of the sanitary reports received from consular officers, as 
well as other pertinent information. The act of March 3, 1879 
(20 Stat. L., 402), authorized the expenditure of $5000 from the 
permanent appropriations of the Marine Hospital Service, for the 
expense of collecting data for health bulletins. 
The provision for the distribution of the weekly abstracts of 
sanitary reports, contained in the act of April 29, 1878, was the 
first authority for the publication of the series now known as 
Public Health Reports. The first number, issued under the title 
" Bulletin of the Public Health," appeared July 13, 1878. 
Dr. J. M. Woodworth, the first Supervising Surgeon General of 
the Service, died on March 14, 1879, and was succeeded by 
Dr. J. B. Hamilton. 
National Board of Health, 1879. The duties and powers rela- 
tive to quarantine, reports from consular officers, and the distribu- 
tion of health bulletins conferred on the Marine Hospital Service 
by the act of April 29, 1878, remained in force only until June 2, 
1879, when a law was passed (21 Stat. L., 5) transferring these 
functions to the National Board of Health which had been created 
by the act of March 3, 1879 (2O Stat. L., 484).16 The act of June 
2, 1879, which repealed the portions of the act of April 29, 1878, 
relating to the quarantine and public health functions of Marine 
Hospital Service, provided that " this act shall not continue in force 
for a longer period than four years from its date of approval." At 
the expiration of the four years the repealed sections of the act of 
April 29, 1878, were revived by the expiration of the repealing 
18 See pages 33'39- 86 
NATIONAL GOVERNMENT AND HEALTH 
statute." The duties of the Marine Hospital Service in relation to 
quarantine were thus again in effect after June 2, 1883. 
Personnel System of 187g. The methods of appointment and 
promotion of the commissioned personnel of the Service were fur- 
ther defined by the regulations approved November 10, 1879, which 
in their basic features are in force at the present time, although 
some modifications have been made in the details. The regulations 
of 1873 had provided that appointments should be made only after 
passing a technical examination before a board of officers. The 
regulations of 1879 continued this provision, but in addition speci- 
fied that original appointments should be made to the lowest grade 
only-that of assistant surgeon-and fixed the age limits between 
21 and 30 years of age.18 
A new grade-that of passed assistant surgeon-was estab- 
lished, and it was provided that after three years' service an assist- 
ant surgeon should be promoted to the grade of passed assistant 
surgeon provided he passed a satisfactory examination. Vacancies 
in the grade of surgeon were to be filled by promotion of passed 
assistant surgeons in order of seniority, but promotion was made 
only after the officer had passed an additional examination.19 
Development of the Service, 1883 to 1889. After the control of 
quarantine was restored to the Marine Hospital Service on June 2, 
1883, sanitary inspectors were stationed at Havana, Vera Cruz, 
London, and Liverpool, in order to give notification of the sailing 
of vessels likely to carry infected passengers or commodities. 
Havana and Vera Cruz were important centers of yellow fever 
infection, while London and Liverpool were selected principally by 
reason of the fear of disease being carried by vessels transporting 
rags and other similar commodities which were shipped from 
places where cholera was prevalent and trans-shipped through 
English ports.20 
Until 1884 the expenses of the Service had been paid from the 
permanent indefinite appropriation derived from the proceeds of 
the hospital tax on seamen, supplemented by specific appropriations. 
The act of June 26, 1884 (23 Stat. L., 57), which took effect 
1120 Op. Att. Gen., 467. 
18 Regulations, 1879, Par. 24-26. 
13 Ibid., Par. 30-32. 
20 Sup. Surg. Gen., Annual Report, 1883, p. 52, DEPARTMENT OF THE TREASURY 
87 
July i, 1884, repealed all acts levying a hospital tax and provided 
that the expenses of the Marine Hospital Service should be paid 
from the proceeds of the tonnage tax imposed on vessels from 
foreign ports entering the United States. The receipts from these 
duties on tonnage were made a permanent indefinite appropriation 
for the use of the Marine Hospital Service. In some years the 
proceeds of this tax were insufficient to support the Service, and 
deficiency appropriations were made. The act of June 26, 1884, 
made no changes in the organization or activities of the Service. 
As a result of the growth of the Service a small laboratory for 
the manufacture of some preparations had been maintained in 
Washington as a part of the purveying depot, but no provision was 
made for systematic laboratory investigations in the field of hygiene 
until August, 1887, when a bacteriological laboratory was estab- 
lished at the Marine Hospital at New York.21 This laboratory was 
maintained at New York until 1891, when it was moved to Wash- 
ington. In 1887 the Service resumed the publication of the Weekly 
Abstract of Sanitary Reports, which had been discontinued in 1879 
when quarantine control was vested in the National Board of 
Health. 
The act of August 1, 1888 (25 Stat. L., 355), prescribed spe- 
cific penalties for trespassing on quarantine reservations as well as 
penalties for masters or pilots of vessels who might enter any port 
in violation of the act of April 28, 1878. This law also provided 
for the establishment of national quarantine stations under the 
Marine Hospital Service at the mouths of Delaware and Chesa- 
peake bays, on the Georgia Coast, and at Key West, San Diego, 
and Port Townsend. 
The Secretaries of the Treasury and the Supervising Surgeons 
General had repeatedly recommended that the rules of the Service 
requiring examination prior to appointment be given the force of 
law, but not until 1889 did Congress pass a law on this subject. 
The act of January 4, 1889 (25 Stat. L., 639), provided that all 
medical officers of the Service should be appointed by the President, 
subject to confirmation by the Senate. Prior to this act only the 
Supervising Surgeon General was appointed by the President. This 
act provided also that original appointments could be made only to 
21 Ibid., 1888, p. ii. 88 
NATIONAL GOVERNMENT AND HEALTH 
the rank of assistant surgeon and after an examination before a 
board of medical officers of the Service in accordance with rules 
prepared by the Supervising Surgeon General and approved by 
the Secretary of the Treasury and the President. It provided that 
an assistant surgeon could be promoted to the grade of passed 
assistant surgeon after four years' service and after passing a sat- 
isfactory examination. An examination was required also in the 
case of passed assistant surgeons promoted to the rank of surgeon. 
The President was authorized to nominate all officers already in 
the Service. 
The requirements of this act were embodied in the general regu- 
lations approved May 20, 1889, which provided also that the Super- 
vising Surgeon General should be selected from the surgeons in 
the Service.22 These regulations fixed the compensation of surgeons 
at $2500, passed assistant surgeons at $1800, and assistant surgeons 
at $1600. Longevity pay at the rate of 10 per cent of the annual 
salary for each five years' service was allowed to medical officers 
above the rank of assistant surgeon, with the limitation that the 
total longevity pay should not exceed 40 per cent. The beginning 
of a retirement system was evidenced by the provision that officers 
on " waiting orders " for more than two months should receive 
75 per cent of the pay of their rank, but there was no method pre- 
scribed for placing officers under " waiting orders." 23 
Interstate Control of Diseased, 1890. The first effective mea- 
sure in the direction of interstate control of disease was the act of 
March 27, 1890 (26 Stat. L., 31), which provided that whenever 
he deemed it necessary the President was authorized to cause the 
Secretary of the Treasury to promulgate necessary rules and regu- 
lations to prevent the spread of cholera, yellow fever, smallpox, 
and plague from one state or territory into another. These regula- 
tions were to be prepared by the Supervising Surgeon General of 
the Marine Hospital Service, and the Secretary of the Treasury 
was authorized to employ such inspectors as might be necessary 
to enforce the regulations. 
Violation of the regulations made in accordance with this act 
was made a misdemeanor, punishable by fine or imprisonment. It 
23 Regulations, 1889, Par. 1. 
23 Ibid., Par. 24. DEPARTMENT OF THE TREASURY 
89 
should be noted that this act does not confer general interstate 
quarantine authority, the diseases for which quarantine might be 
declared being cholera, yellow fever, smallpox, and plague. 
Medical Inspection of Immigrants, 1890 and 1891. The medi- 
cal inspection of immigrants was added to the duties of the Service 
in the early part of 1890, when this work at New York was made 
one of its duties, although legislation placing the medical inspection 
of immigrants at all ports under the control of the Service was not 
passed until March 3, 1891. The first act placing restrictions on the 
admission of defectives was the law of August 3, 1882 (22 Stat. L., 
214), which prohibited the landing of a "lunatic, idiot, or any 
person unable to take charge of himself or herself without becom- 
ing a public charge." As in earlier legislation relating to quaran- 
tine, Congress looked to state organizations to furnish the machin- 
ery for the administration of the law. The Secretary of the Trea- 
sury was charged with the duty of executing the provisions of the 
act, and " for that purpose " he was given " power to enter into 
contracts with such state commission, board, or officers as may be 
designated for that purpose by the governor of any state to take 
charge of the local affairs of immigration in the ports within said 
state." These boards examined the immigrants, and collectors of 
customs were required to refuse admission to any immigrants 
whose entry was prohibited by the law. The Treasury Department 
was apparently unable to make general provision for the medical 
inspection of immigrants, as this work appears to have been carried 
on at New York only.24 In April, 1890, the contract with the Board 
of State " Emigration " Commissioners at New York was abro- 
gated, and the Treasury Department undertook the inspection of 
immigrants at the port, the medical inspection being assigned to the 
Marine Hospital Service.25 
More specific provisions for the control of immigration and the 
medical inspection of immigrants were contained in the act of 
March 3, 1891 (26 Stat. L., 1084), whch took effect April 1, 1891. 
This law prohibited the admission, among others, of " idiots, insane 
persons, . . . persons likely to become a public charge, [and] 
persons suffering from a loathsome or a dangerous contagious 
2' Sup. Surg. Gen., Annual Report, 1890, p. 62; Secretary of the Treasury, 
Annual Report, 1890, p. Ixxiv. 
25 Ibid., p. 55. 90 
NATIONAL GOVERNMENT AND HEALTH 
disease." 28 It was provided that medical examinations were to be 
made by surgeons of the Marine Hospital Service, but if the ser- 
vices of a surgeon of the Service could not be obtained without 
unreasonable delay the inspector could cause the examination to be 
made by a civil surgeon whose compensation was to be fixed by the 
Secretary of the Treasury. Medical officers were immediately 
detailed for inspection of immigrants at the more important ports; 
at other places the regular officer on duty at the station was avail- 
able for this service. The inspection work at New York was made 
by a civil surgeon appointed by the Secretary of the Treasury, as 
the technical point was raised that the term " surgeon " in the act 
of March 3, 1891, meant an officer with the rank of surgeon. The 
Treasury Department maintained that the word surgeon was used 
in a general sense and meant any surgeon of the Service. The 
district court, however, sustained the point raised, and as there 
were not sufficient officers of the grade of surgeon available, it was 
necessary to suspend the inspection work at that port.27 This tech- 
nical objection appears not to have been raised at other ports, and 
the New York decision apparently was not used elsewhere to 
question the authority of the examining surgeons. This situation 
was remedied by Section 8 of the act of March 3, 1893 (27 Stat. 
L., 570), which provided that medical examinations might be made 
by any medical officer of the Marine Hospital Service detailed by 
the Secretary of the Treasury. 
On June 1, 1891, Dr. J. B. Hamilton resigned as Supervising 
Surgeon General and was succeeded by Dr. Walter Wyman. In 
this year the Bacteriological Laboratory was moved from New 
York to the Washington headquarters, which had just previously 
been moved to the Butler Building at New Jersey Avenue and 
C St. S. E. 
Quarantine Law of 1893. The necessity of an extension of the 
powers of the national government in preventing the introduction 
of contagious diseases into the country and their spread from one 
state to another resulted in the passage of the act of February 15, 
1893 (27 Stat. L., 449), which is still in force and which gives 
authority for all existing domestic and maritime regulations. While 
20 See also Chapter IX, page 264 on the Bureau of Immigration. 
27 Sup. Sur. Gen., Annual Report, 1891, p. 18. DEPARTMENT OF THE TREASURY 
91 
this act did not undertake to prohibit states or municipalities from 
maintaining quarantine stations, it provided that state officers might 
surrender local stations to the Secretary of the Treasury, who was 
authorized to receive and pay for them if he considered them 
necessary to the United States. It would probably have been im- 
possible to pass a law prohibiting states from maintaining quaran- 
tine stations, and the best results were thus obtained by allowing 
the states to surrender their quarantine functions from time to 
time as they realized the advantages of the national system. Gradu- 
ally the local stations have been surrendered by the states, the last 
one-at New York-having been acquired in 1921. While the act 
authorizes the Secretary of the Treasury to pay for the state quar- 
antine stations, this portion of the law is practically of no effect, as 
he cannot disburse money for this purpose without a specific appro- 
priation by Congress. 
This law places upon the Supervising Surgeon General of the 
Marine Hospital Service the performance of all duties relating to 
quarantine and quarantine regulations. That officer is specifically 
directed to examine the quarantine regulations of all state and 
municipal boards of health, and to cooperate with and aid the local 
boards in the enforcement of the regulations. If there are no regu- 
lations, or if the local regulations are insufficient, the Secretary of 
the Treasury is authorized to make additional regulations, which 
must operate uniformly and in no manner discriminate against any 
port or place. For the first time provision is made for quarantine 
regulations to prevent the introduction of contagious diseases other 
than cholera, yellow fever, smallpox, and plague, from one state 
or territory or the District of Columbia into another state or terri- 
tory or the District of Columbia. The rules and regulations for 
both national and interstate quarantine promulgated by the Secre- 
tary of the Treasury are to be enforced by the sanitary authorities 
of states and municipalities if these officers will undertake this 
duty, but if the local authorities fail or refuse to enforce the regu- 
lations the President is authorized to " execute and enforce the 
same and adopt such measures as in his judgment shall be neces- 
sary to prevent the introduction and spread of such diseases, and 
may detail or appoint officers for that purpose." 
This law provides also that vessels clearing from a foreign port 
or for any port in the United States must obtain a bill of health 92 
NATIONAL GOVERNMENT AND HEALTH 
from a consular officer or from a medical officer detailed for that 
purpose. The Secretary of the Treasury is authorized to make 
rules and regulations that must be observed by vessels sailing from 
a foreign port to the United States. 
Authority is given for the detail of medical officers to consulates 
for the purpose of furnishing information and giving bills of 
health. Consular officers at places to be designated by the Secre- 
tary of the Treasury are required to make weekly reports of 
sanitary conditions. The Secretary of the Treasury is also directed 
to obtain weekly reports of the sanitary condition of ports and 
places within the United States, and to publish weekly abstracts of 
the consular sanitary reports and other pertinent information. Pro- 
vision is also made that the Secretary of the Treasury shall " by 
means of the voluntary cooperation of state and municipal authori- 
ties, of public associations, and private persons, procure informa- 
tion relating to the climatic and other conditions affecting the 
public health." 
In order to furnish full protection against the introduction of 
contagious diseases the President was given authority " to prohibit, 
in whole or in part, the introduction of persons and property from 
such countries or places as he shall designate and for such period 
of time as he may deem necessary." 
Regulations of 1897. In 1897 the regulations of the service 
were again revised, and provision was made for increasing the 
efficiency of the Service by dropping assistant surgeons who were 
unable to pass the examination for promotion. These rules provided 
that an assistant surgeon failing in his first examination should be 
given a second one at the end of the year ; if he again failed to pass, 
it was further provided that he be reported to the Secretary of the 
Treasury as " not qualified for promotion " and " be requested by 
the Secretary of the Treasury to tender his resignation." A passed 
assistant surgeon fading in two examinations was to be placed in 
the register as " not in line of promotion." These regulations also 
provided for a retirement system for commissioned officers by 
placing them under " waiting orders." An officer reported to be 
unfit to perform his duties by reason of disease, injury, or age 
could be ordered before a board of officers for examination. If his 
disability was incurred in line of duty, the board was authorized to DEPARTMENT OF THE TREASURY 
93 
recommend that he be placed on waiting orders or given special 
duties of a light character. The pay of an officer placed on waiting 
orders was fixed at 75 per cent of the salary of his grade. These 
regulations likewise provided that acting assistant surgeons receiv- 
ing more than $300 a year should be appointed only after passing 
an examination prescribed by the Civil Service Commission. Pre- 
viously these officers had been appointed by the Secretary of the 
Treasury on the recommendation of the Supervising Surgeon 
General.18 
Growth of the Service, 1898 to 1901. The Spanish-American 
War in 1898 presented grave problems to the quarantine division 
because troops were being moved to and from an area which was 
badly infected with yellow fever. In cooperation with the War 
Department the Marine Hospital Service assumed charge of the 
sanitation on transports, and later when the troops were returned 
to the United States, a national quarantine station under the direc- 
tion of an officer of the Marine Hospital Service was established 
at Montauk Point at the request of the Secretary of War. 
At the conclusion of hostilities the quarantine laws of the United 
States were extended to Cuba and Porto Rico by the executive 
order of January 17, 1899" Medical officers of the Marine Hos- 
pital Service were immediately detailed to these islands, and 
quarantine service was organized at the principal ports. 
The inspection of immigrants at foreign ports was commenced in 
1899, when an assistant surgeon was sent to Naples for this pur- 
pose. This officer was detailed under the authority of the quaran- 
tine act of February 15, 1893, and he had definite authority only to 
issue bills of health and to require the sanitary measures specified 
by the regulations. He was, however, instructed to note, for the 
benefit of the immigration service, any physical infirmities or 
defects which might prevent the entry of the immigrant. There 
was no authority to prevent the embarkation of passengers who 
were not suffering from a communicable disease, but the transpor- 
tation of defectives was generally prevented by calling the attention 
of the steamboat company to the fact that the passenger would 
probably be refused admission under the immigration laws. This 
28 Regulations, 1897, Par. 17-52. 
29 Sup. Surg. Gen., Annual Report, 1899, p. 468. 94 
NATIONAL GOVERNMENT AND HEALTH 
plan worked well, although many persons who failed to pass inspec- 
tion at Naples, went to French ports and embarked for Canada.30 
For some time the treatment of leprosy and the segregation of 
persons afflicted with this disease had been attracting considerable 
attention, and on March 2, 1899, Congress passed an act (30 Stat. 
L., 976) directing the Supervising Surgeon General of the Marine 
Hospital Service to appoint a commission of medical officers of the 
Service to investigate the origin and prevalence of leprosy and to 
report on the legislation necessary to prevent the spread of the dis- 
ease. The expenditure of $5000 was authorized for this work, to 
be paid from the appropriation for preventing the spread of epi- 
demic diseases. This commission submitted its report in 1902, and 
recommended the establishment of a national leprosarium.31 Pro- 
vision for a national home for lepers was not made until Feb- 
ruary 3, 1917 (39 Stat. L., 872), and the institution was not opened 
until 1920. 
For several years the Service had been considering the advisa- 
bility of establishing a sanitarium for tuberculosis patients, and in 
1899 it was decided that the abandoned military reservation at Fort 
Stanton, New Mexico, was the most suitable site in possession of 
the government that was not being used for other purposes. The 
executive order of April 1, 1899, directed that this reservation be 
turned over to the Marine Hospital Service. The first patient was 
received at this institution on November 18, 1899, and on June 30, 
1900, forty-seven patients were under treatment. 
When provision was made for civil governments in Hawaii and 
the former Spanish Islands the quarantine duties of the Marine 
Hospital Service were extended to these possessions. The executive 
order of January 3, 1900, placed the quarantine administration of 
the Philippine Islands under the Marine Hospital Service and set 
aside $300,000 from the revenues of the islands for that purpose. 
Section 10 of the act of April 12, 1900 (31 Stat. L., 80), creating 
a civil government for Porto Rico, and Section 97 of the act of April 
30, 1900 (31 Stat. L., 160), creating a government for the territory 
of Hawaii, provided that quarantine stations should be established 
as directed by the Supervising Surgeon General of the Marine 
Hospital Service, and that quarantine regulations should be under 
30 Ibid., 1899, p. 577; 1900, p. 523. 
8157 Cong. 1 session., S. doc. 269. DEPARTMENT OF THE TREASURY 
95 
the control of the United States Government. The law relating 
to Hawaii stipulated that the health laws of the island should remain 
in the jurisdiction of the government of the territory, subject to 
the quarantine laws and regulations of the United States. 
A new building for the Hygienic Laboratory was provided for 
in the sundry civil appropriation act approved March 3, 1901 (31 
Stat. L., 1137), but the building was not occupied until 1904. This 
act appropriated $35,000 for the erection of " necessary buildings 
and quarters for a laboratory for the investigation of infectious 
and contagious diseases, and matters pertaining to the public 
health." The wording of this appropriation is significant in that 
there is recognition of the fact that the Marine Hospital Service 
was no longer concerned solely with medical treatment of specified 
beneficiaries, but had become the representative of the national 
government in health matters. At first the investigations made in 
the Hygienic Laboratory had been entirely in connection with the 
hospital branch of the Service. Gradually they had extended more 
and more into questions of public health and quarantine, owing 
mainly to demands made by states and municipal health organiza- 
tions.32 For many years the results of its work had been published 
as appendices to the annual report of the Surgeon General, but in 
1899 the reports had increased to such an extent that it was deemed 
advisable to issue them in the form of bulletins.33 
Further authority over quarantine anchorages was conferred on 
the Supervising Surgeon General by the act of March 3, 1901 (31 
Stat. L., 1086), which also made subject to quarantine regulations 
any vessel which might arrive within the territorial limits of the 
United States, but which did not attempt to enter any port. The 
act of February 15, 1893, applied only to vessels entering United 
States ports. 
In 1902 an appropriation of $250,000 was made for the purchase 
of the property used for a marine hospital at New York. At the 
most important port in the country, the hospital had never been 
housed in a government building. Until 1879 seamen were treated 
at various hospitals under contract, but in that year the use of 
Bedloes Island was obtained from the War Department, and the 
33 Sup. Surg. Gen., Annual Report, 1897, pp. 716-17. 
33 Ibid., 1899, p. 845. 96 
NATIONAL GOVERNMENT AND HEALTH 
hospital was operated' at that point for three years, when it became 
necessary to vacate because of the erection of the Statue of 
Liberty. After 1882 the hospital was quartered in rented buildings 
on Staten Island. 
In September, 1901, the Surgeon General submitted to the Secre- 
tary of the Treasury a plan for organizing a yellow fever institute, 
composed of officers of the Service and others specially qualified, 
who should become members by invitation. The object of this or- 
ganization was to " collect all facts concerning yellow fever, to 
designate the specific lines of inquiries to be made, and to make 
them." This institute became a part of the Division of Scientific 
Research, which was organized at the same time.84 The results of 
the work were published in the series known as " Bulletin of the 
Yellow Fever Institute." 
The Public Health and Marine Hospital Service, 1902 to 
1912. The historical development of the Public Health Service 
up to the beginning of the twentieth century shows that until the 
time of the short-lived National Board of Health, it was exclu- 
sively a medical relief agency. After the demise of this board about 
1883, quarantine activities also became a function of the Service. 
Toward the latter part of the nineteenth century, other duties were 
added, such as the interstate control of diseases and investigations 
in the interests of the public health. This increase in scope pointed 
to the advisability of changing the name of the Service and giving 
it more specific statutory powers. 
Four bills relating to the Service had been introduced during 
the first session of the Fifty-seventh Congress, and on July 1, 1902, 
the President approved the act which changed the name of the 
Service to the Public Health and Marine Hospital Service (32 
Stat. L., 712). The act also changed the designation of the head 
of the Service to Surgeon General, and fixed his salary at $5000 
a year. The salaries and allowances of the commissioned medical 
officers were to be the same as provided by existing regulations of 
the Service. Commissioned medical officers detailed in charge of 
administrative divisions in Washington were to have the rank of 
assistant surgeons general.'. The President was authorized to 
utilize the Service in time of war in such manner as would promote 
84 Surgeon General, Public Health and Marine Hospital Service, Annual 
Report, 1902, p. 439. DEPARTMENT OF THE TREASURY 
97 
the public interest without impairing the efficiency of the Service 
in filling the functions for which it was created. He was also given 
authority to prescribe regulations governing the administration, 
discipline, and uniforms of the Service. 
A definite organization was provided for the Hygienic Labora- 
tory, which had previously been operated under regulations of the 
Service, and which had been doing work in the field of bacteriology 
and pathology only.35 Provision was made for a director of the 
laboratory, detailed from the corps of commissioned officers of the 
Service. The Surgeon General was authorized to appoint heads of 
the Divisions of Chemistry, Zoology, and Pharmacology from out- 
side the Service at compensations to be fixed by the Surgeon Gen- 
eral if commissioned medical officers were not available for this 
duty. An advisory1 board of nine persons was created for the pur- 
pose of consulting with the Surgeon General relative to the investi- 
gations to be undertaken and the methods of conducting the work. 
This board was made up of the director of the laboratory, five per- 
sons skilled in laboratory work in its relation to the public health 
and not in the regular employ of the government, to be appointed 
by the Surgeon General, and three experts detailed from the Army, 
the Navy, and the Bureau of Animal Industry, by the Surgeon 
General of the Army, the Surgeon General of the Navy, and the 
Secretary of Agriculture, respectively. 
An important provision for furthering the coordination of na- 
tional and state operations was made in this act by requiring the 
Surgeon General to call an annual conference of the health author- 
ities of the states and territories and the District of Columbia. That 
officer was likewise authorized to call a special conference when 
" the interests of the public health would be promoted," and re- 
quired to call a special conference at the request of not less than 
five state or territorial boards of health, quarantine authorities, or 
state health officers. 
In order to secure uniformity in the registration of mortality, 
morbidity, and vital statistics, it was made the duty of the Surgeon 
General to prepare and distribute, after the annual conference of 
health officers, " suitable and necessary " forms for the collection 
and compilation of such statistics, which were to be published in the 
" Ibid., 1905, p. 218. 98 
NATIONAL GOVERNMENT AND HEALTH 
Public Health Reports. In the same year, however, Congress 
passed another law (32 Stat. L., 52), which authorized the Bureau 
of the Census to collect vital statistics.38 
Tests of Biologic Products. An additional duty was placed on 
the Service by another act approved July 1, 1902 (32 Stat. L., 
728), providing for tests of viruses applicable to the diseases of 
man and the licensing of manufacturers of these products. This 
law was passed in order to afford protection against infection 
from impure preparations and, to establish a standard of strength 
and purity. The act provided for a board composed of the Surgeon 
General of the Army, the Surgeon General of the Navy, and the 
Supervising Surgeon General of the Marine Hospital Service, 
which was given authority, subject to the approval of the Secretary 
of the Treasury, to promulgate regulations governing the licens- 
ing of establishments engaged in the " propagation and preparation 
of viruses, serums, toxins, antitoxins, and analogous products, 
applicable to the prevention and cure of diseases of man, intended 
for sale in the District of Columbia, or to be sent, carried, or 
brought for sale from any state, territory, or the District of 
Columbia, into any other state, territory, or the District of Colum- 
bia, or from the United States into any foreign country, or from 
any foreign country into the United States." The execution of 
the act was placed in the hands of the Secretary of the Treasury, 
but all tests and inspections have been made through the Public 
Health Service, as that was the only organization in the Treasury 
Department qualified to undertake work of this character. 
The first regulations under this act were promulgated on Febru- 
ary 21, 1903, and as the law required an interval of six months 
before the regulations became effective, they were not in force 
until August 21, 19035 Since that time inspections and exami- 
nations have been made continuously. 
Developments in Activities and Organisation. The Division of 
Zoology of the Hygienic Laboratory was organized August 16, 
1902,38 and the first annual conference of the state and national 
health authorities was held on June 3, I9°3-S' 
30 See page 290. 
87 Surg. Gen., Annual Report, 1904, p. 370. 
88 Ibid., 1903, p. 330. 
89 Ibid., p. 321. DEPARTMENT OF THE TREASURY 
99 
A new law regulating the admission of aliens, passed on March 
3, 1903 (32 Stat. L., 1213), did not materially change the status 
of the Service as regards the examination of immigrants. Epi- 
leptics were added to the lists of persons to be excluded, and pro- 
vision was made that physical and mental examination must be 
made by medical officers of the Service, who shall have had at 
least two years' experience in the practice of their profession 
after receiving the degree of doctor of medicine. If medical 
officers of the Service were not available, civil surgeons of not less 
than four years' experience might be employed by the Commis- 
sioner General of Immigration. The medical officers certified the 
facts to the immigration officers and boards of inquiry, and were 
not responsible for the execution of the statute. The Immigra- 
tion Service was required to reimburse the Public Health and 
Marine Hospital Service for all expenses incurred in making 
medical inspection of immigrants. 
The Division of Pharmacology in the Hygienic Laboratory was 
established March 1, 1904, and several weeks later the laboratory 
moved into the new building provided by the act of March 3, 
1901.40 The act approved March 18, 1904 (33 Stat. L., 104), 
making appropriations for the legislative, executive, and judicial 
expenses of the government for the fiscal year ending June 30, 
1905, contained a provision that the Public Health and Marine 
Hospital Service should remain under the Treasury Department 
until otherwise specifically provided by law. This legislation was 
designed to prevent the transfer of the service to the new Depart- 
ment of Commerce and Labor, created by the act of February 14, 
1903 (32 Stat. L., 825-830). Section 12 of the latter act provided 
that the President might transfer to the Department of Commerce 
and Labor the whole or part of any branch of the State, Treasury, 
War, Navy, Justice, Post Office, or Interior Departments engaged 
in statistical or scientific work. 
A joint resolution approved February 24, 1905 (33 Stat. L., 
1283), made specific provision for printing the bulletins of the 
Hygienic Laboratory and the Yellow Fever Institute. Authority 
was given to print not to exceed ten bulletins of the laboratory 
and five bulletins of the institute in any one year, the edition of 
each bulletin being limited to 5000 copies. 
40 Ibid., 1904, pp. 36, 68. 100 
NATIONAL GOVERNMENT AND HEALTH 
Officers of the Service had made a special investigation of 
leprosy in 1901, and at that time had recommended the establish- 
ment of a national home for lepers, but no action was taken by 
Congress. The prevalence of leprosy in the Territory of Hawaii 
led Congress to pass the act of March 3, 1905 (33 Stat. L., 1009), 
establishing a leprosy hospital and laboratory to be operated by 
the Public Health and Marine Hospital Service at Molokai, 
Hawaii. The Surgeon General was authorized to receive not 
exceeding forty patients, committed under legal authorization of 
the Territory of Hawaii. Fifty thousand dollars were appro- 
priated for the necessary buildings and $50,000 for maintenance 
during the fiscal year ended June 30, 1906. It was not possible 
to make a contract for the erection of buildings within the amount 
appropriated, and the Service undertook the necessary construc- 
tion work by day labor. This procedure involved considerable 
delay, and the hospital was not opened until December 23, 1909.41 
A change in the method of supplying money for the Service 
was made in the deficiency appropriation act of March 3, 1905 
(33 Stat. L., 1217). The permanent appropriation of the tonnage 
tax provided by the act of June 26, 1884 (23 Stat. L., 57), was 
repealed, effective June 30, 1906. The Secretary of the Treasury 
was required to submit detailed estimate for the fiscal year 1907 
and annually thereafter. Since June 30, 1906, no permanent in- 
definite appropriations have been available, and the Service has 
been dependent upon annual appropriations made by Congress. 
The organization of the Hygienic Laboratory was completed on 
June 20, 1905, with the appointment of a Chief of the Division of 
Chemistry.42 
The extension of the national quarantine system was recom- 
mended by a conference of governors and representatives of the 
Southern states, held in Chattanooga on November 9 and 10, 
1905.43 This had also been urged by President Roosevelt in his 
annual message to Congress on December 6, 1904. The result 
of the general demand for more effective national control was 
the passage of the act of June 19, 1906 (34 Stat. L., 299). While 
this act did not confer any additional authority on the Secretary of 
41 Ibid., 1910, p. 60. 
43 Ibid., 1905, p. 227. 
43 Ibid., 1906, p. 200. DEPARTMENT OF THE TREASURY 
101 
the Treasury, it did have the effect of extending the national system 
by the appropriation of $500,000 for the purchase of local quar- 
antine stations. By June 30, 1907, the Service had taken over the 
quarantine stations of South Carolina, Mobile, and New Orleans, 
and made arrangements to establish a station at Galveston. At 
that time the national system controlled the Pacific Coast, the 
Gulf Coast with the exception of Texas, and the Atlantic Coast 
with the exception of Baltimore, New York, Boston, and a few 
of the neighboring minor ports. 
On February 20, 1907, a new law (34 Stat. L., 898) governing 
immigration was enacted, but the duties of the Public Health and 
Marine Hospital Service as regards the inspection of immigrants 
were not changed. Two years later the sundry civil appropriation 
act of March 4, 1909 (35 Stat. L., 1027), repealed the portion of 
the immigration act of February 20, 1907, requiring the Public 
Health and Marine Hospital Service to be reimbursed by the 
Immigration Service for all expenses incurred in making medical 
inspections of immigrants, and thereafter this expense was met 
from the specific appropriations of the Public Health and Marine 
Hospital Service. 
The marine hospitals maintained by the Service gave excellent 
opportunity for the study of many diseases, but it was felt that 
the scientific work would be improved if there could be admitted 
to the marine hospitals patients who were suffering from diseases 
that it was desirable to study, but who were not entitled to hospital 
service under the law. Accordingly, Congress was induced to insert 
in the sundry civil appropriation act approved March 4, 1911 (36 
Stat. L., 1394), a provision that persons with infectious or other 
diseases affecting the public health may be admitted to marine 
hospitals for the purpose of study, not to exceed ten cases in any 
one hospital at one time.44 
During the next two years several additional lines of general 
health activities were undertaken in cooperation with other govern- 
ment bureaus or in connection with new legislation. In January, 
1911, a passed assistant surgeon was detailed to one of the mine 
rescue cars of the Bureau of Mines to make studies of the diseases 
of miners in West Virginia. In May of the same year the Chief of 
44 This provision was carried in each later appropriation act up to 1922, 
after which it was omitted. 102 
NATIONAL GOVERNMENT AND HEALTH 
the Division of Zoology was detailed with a mine rescue car to 
study hookworm among miners, and an assistant surgeon was as- 
signed to the mine rescue car at Pueblo in order to give advice 
regarding sanitary and medical matters and to make investigations 
of hygienic conditions in mines and of the influences of gases. 
In 1912 a medical officer was detailed to the Department of the 
Interior to assist the Bureau of Education in the supervision of 
measures relating to the medical and surgical relief of the natives 
of Alaska. 
The Public Health Service Since 1912. For several years 
prior to 1912 there had been a definite movement throughout the 
country for the establishment of a national bureau of health.46 The 
Republican and Democratic parties had advocated such a bureau in 
their platforms of 1908, and President Taft urged the creation of 
a unified Federal health agency in two of his annual messages to 
Congress. Bills to this end were introduced in Congress in 1910 
and 1912, but that body did not see fit to pass the desired legisla- 
tion. Instead, a law (37 Stat. L., 309) was passed changing the 
name of the Public Health and Marine Hospital Service to the 
Public Health Service, and extending the field of activity by the 
provision that the Service may " study and investigate the diseases 
of man and conditions influencing the propagation and spread 
thereof, including sanitation and sewage and the pollution either 
directly or indirectly of the navigable streams and lakes of the 
United States, and it may from time to time issue information in 
the form of publications for the use of the public." Under this law 
the Service has ample authority to make any studies relating to 
health and diseases for which funds are available. It will be noted 
that this law is permissive. In 1912 Congress established the 
Children's Bureau in the Department of Commerce and Labor and 
in its organic act (37 Stat. L., 79) required this bureau to investi- 
gate and report on all matters pertaining to the welfare of children 
and child life among all classes of the population, especially such 
questions as infant mortality, the birth rate, orphanage, juvenile 
courts, desertion, dangerous occupations, accidents and diseases of 
45 This movement is described more in detail in a subsequent chapter. 
See page 377. DEPARTMENT OF THE TREASURY 
103 
children, employment, and legislation affecting children in the sev- 
eral states and territories.40 
The law of July 1, 1902, had provided that the salaries and 
allowances of the commissioned officers of the Service should con- 
tinue as fixed by the existing regulations. The act of August 14, 
1912, which was the first law in which the salaries were stated, 
fixed them as follows : Surgeon General, $6000; Assistant Surgeon 
General, $4000; Senior Surgeon $3500; Surgeon, $3000; Passed 
Assistant Surgeon, $2400; Assistant Surgeon, $2000. The grade 
of senior surgeon was a new one; the number being limited to ten. 
Provision was also made for longevity pay for officers below the 
rank of surgeon general, at the rate of 10 per cent of the annual 
salary for each five years' service, but the longevity pay was not 
to exceed 40 per cent of the basic salary, and total of the basic 
salary and longevity increase was not to exceed $5000 for Assistant 
Surgeons General, $4500 for Senior Surgeons, and $4000 for 
Surgeons. Compensation was at the rates given above until Janu- 
ary 1, 1920.47 
New Activities. Duties in connection with the law imposing a 
tax on matches made of common poisonous white or yellow phos- 
phorus were imposed on the Service by regulations issued by the 
Commissioner of Internal Revenue on May 10, 1913, in accor- 
dance with the provisions of the act of April 9, 1912 (37 Stat. L., 
81 ).48 The purpose of this tax was to prevent the manufacture of 
matches made of common poisonous white or yellow phosphorus, 
the Commissioner of Internal Revenue being authorized to make 
the necessary regulations. As the officer had no administrative 
machinery for making the scientific examinations required by the 
statute, he delegated that portion of the work to the Public Health 
Service. The regulations provided that each manufacturer should 
furnish samples of his product and material for examination when- 
ever deemed necessary. In addition the Surgeon General was 
authorized to buy matches in the open market in order to determine 
whether poisonous material was being used. If the Surgeon Gen- 
eral found that white and yellow phosphorus was being used in any 
46 See page 232. 
47 See page 116. 
43 United States Internal Revenue Regulations No. 32. May 1913. Regu- 
lations governing white phosphorus matches under internal-revenue law. 104 
NATIONAL GOVERNMENT AND HEALTH 
form he was to make an examination of the factory and materials, 
as well as of the persons employed. The results of these examina- 
tions were to be reported to the Commissioner of Internal Revenue 
as a basis for determining whether the factory was subject to the 
tax.49 
The Indian appropriation act for the fiscal year 1913, approved 
August 24, 1912 (37 Stat. L., 519), appropriated $10,000 to enable 
the Public Health Service to report on the prevalence of contagious 
diseases among the Indians of the United States. Fourteen officers 
were assigned to this work and over 39,000 Indians were exam- 
ined.60 The results of the survey were published.51 
The deficiency act approved March 4, 1913 (37 Stat. L., 915), 
provided that the Director of the Hygienic Laboratory should 
receive the pay and allowances of a Senior Surgeon. 
The sundry civil act for the fiscal year 1914, approved June 23, 
1913 (38 Stat. L., 25), contained for the first time an appropria- 
tion for field investigations reading as follows: " Field investiga- 
tions of public health matters: For investigations of diseases of 
man and conditions influencing the propagation and spread thereof, 
including sanitation and sewage, and the pollution of navigable 
streams and lakes of the United States, including personal services, 
$200,000." This appropriation resulted from the increase in activi- 
ties incident to the passage of an act of August 14, 1912. 
During the fiscal year ending June 30, 1914, the additional work 
authorized by the act of August 14, 1912, and made possible by the 
increased appropriations, was conducted along two general lines, 
diseases of man and sanitation, and investigations of water sup- 
plies and sewage disposal.53 Among the general diseases of man 
investigated were beriberi, diphtheria, endemic goitre, hookworm 
disease, leprosy, typhoid fever, malaria, pellagra, trachoma, tuber- 
culosis, and typhus fever. The following studies of occupational 
diseases were made: (1) Health of garment workers in New York 
City, (2) tuberculosis in Cincinnati as related to certain industries, 
(3) sanitary survey of Indiana industries employing woman labor, 
(4) trachoma among steel mill workers, (5) mine sanitation stud- 
49 Surg. Gen., Annual Report, 1913, p. 46. 
60 Ibid., p. 25. 
"62 Cong. 3 sess., S. doc. 1038. 
62 Surg. Gen., Annual Report, 1914, p. 16. DEPARTMENT OF THE TREASURY 
105 
ies, and (6) metallurgical plant investigations; the two last being 
in cooperation with the Bureau of Mines.63 In addition, systematic 
investigations of rural sanitation, school hygiene, industrial hy- 
giene, and health organization and administration were taken up 
and enlarged. The investigations of water supplies and sewage 
included these distinct lines of research: (1) Pollution of rivers 
and coastal waters, (2) disposal of sewage, and (3) treatment of 
industrial wastes. All the work undertaken had a direct bearing 
on the protection of water supplies and the shellfish industry, and 
the sewage studies were of practical benefit to householders and 
small communities in the prevention of disease.64 
Medical Aid to Deep Sea Fisheries, 1914. Medical aid to crews 
of American vessels engaged in the deep sea fisheries was author- 
ized by the act approved June 24, 1914 (38 Stat. L., 387), which 
provided that the Secretary of the Treasury might assign a revenue 
cutter to this work and detail such surgeons and other persons of 
the Public Health Service as might be necessary. 
Inoculation of Government Employees, 1915. In order to pro- 
tect government employees against typhoid fever and smallpox, 
the Secretary of the Treasury on February 12, 1915, issued an 
order directing medical officers of the Service to perform vaccina- 
tion against typhoid fever and smallpox for all civil employees 
engaged in interstate travel or regularly engaged in handling mail 
or other material to be carried in interstate traffic.66 
Fumigation of Forecastles, 1915. The seamen's act of March 4, 
1915 (38 Stat. L., 1166), provided that the forecastles of merchant 
ships should be fumigated at such intervals as may be provided by 
regulations of the Surgeon General of the Public Health Service, 
with the approval of the Department of Commerce. 
Studies of Rural Sanitation, 1916. Studies of rural sanitation 
had been undertaken soon after the enlargement of the activities of 
the Service resulting from the passage of the act of August 14, 
1912, but the first specific appropriation for this work was made 
in the deficiency appropriation act approved February 28, 1916 
(39 Stat. L., 21), which made $25,000 available for this purpose. 
™ Ibid., pp. 46-52. 
"Ibid., p. 17. 
" Ibid., 1915, p. 277.  NATIONAL GOVERNMENT AND HEALTH 
106 
An appropriation has been made for this work in each subsequent 
annual appropriation act. 
Control of Biologic Products, 1916. The sundry civil act for 
the fiscal year 1917, approved July 1, 1916 (39 Stat. L., 279), con- 
tained the first specific appropriation for expenses of regulating 
the propagation and sale of viruses, serums, toxins, and analogous 
products required by the act of July 1, 1902.68 Up to this time the 
expenses of this work had been paid from the appropriations for 
traveling expenses and for the maintenance of the Hygienic 
Laboratory.5' 
National Home for Lepers, 1917. As early as 1902 the Service 
had recommended the establishment of a home for lepers, but this 
institution was not authorized until February 3, 1917 (39 Stat. L., 
872). The Secretary of the Treasury was authorized to obtain a 
suitable site and erect necessary buildings for a home for the care 
and treatment of persons afflicted with leprosy, this institution to 
be under the administration of the Public Health Service. This 
act provides that the home shall receive any person afflicted with 
leprosy, who presents himself or herself, who may be apprehended 
under the authority of the quarantine acts, or who may be " con- 
signed " to the home by the proper health authorities of any state, 
territory, or the District of Columbia. The Surgeon General is 
authorized, at the request of the state or territorial authorities, to 
send for persons afflicted with leprosy and to convey them to the 
home for detention and treatment; authority is given to pay trans- 
portation expenses if the transportation is undertaken for the 
protection of the public health. The World War interfered with 
the selection of a site and the home at Carville, Louisiana, was not 
opened until 1920. 
Hospital Treatment for Injured Government Employees, 1917. 
Compensation to employees of the government injured in the per- 
formance of their duties was provided for in the act approved 
September 7, 1916 (39 Stat. L., 742-750). The administration 
of this act was placed under an independent commission, the 
Employees' Compensation Commission, which was organized 
March 17, 1917, but the actual work of this Commission did not 
M See page 98. 
87 Sundry Civil Bill 1917. Hearings before subcommittee of House Com- 
mittee on Appropriations, p. 129. DEPARTMENT OF THE TREASURY 
107 
begin until April I, 1917.58 Section 9 of the act of September 7, 
1916, provides that " United States medical officers and hospitals " 
shall furnish reasonable medical, surgical and hospital services and 
supplies to any government employee injured while in the per- 
formance of his duty. This act added to the beneficiaries of the 
hospitals of the service, as the marine hospitals were generally 
closer to the homes of injured employees than those of the Army 
and Navy. Out-patient relief was given and physical examinations 
made at the other stations of the service. During the fiscal year 
1918 this class of patients received 15,291 hospital days relief and 
6181 office treatments; during the fiscal year 1924 this service had 
grown to 43,423 hospital days relief and 121,904 office treatments. 
Medical Inspection of Immigrants, 1917. The present law gov- 
erning the medical inspection of immigrants was passed February 
5, 1917, and became effective May 1, 1917 (39 Stat. L., 874). The 
classes excluded on medical grounds are " idiots, imbeciles, feeble- 
minded persons, epileptics, insane persons, persons who have had 
one or more attacks of insanity at any time previously, persons of 
constitutional psychopathic inferiority, persons with chronic alco- 
holism ; . . . persons afflicted with tuberculosis in any form or 
with a loathsome or dangerous contagious disease, [and] persons 
not comprehended within any of the foregoing excluded classes 
who are found to be and are certified by the examining surgeon 
as being mentally or physically defective, such physical defect be- 
ing of a nature which may affect the ability of such alien to earn 
a living." 
The general supervision of the admission of aliens is continued 
under the Bureau of Immigration of the Department of Labor, 
but the physical and mental examination of all arriving aliens is 
required to be made by medical officers of the Public Health 
Service who have had at least two years' experience in the prac- 
tice of their profession since receiving the degree of doctor of 
medicine. If medical officers of the Public Health Service are not 
available, civil surgeons of not less than four years' experience may 
be employed by the Immigration Service. An alien certified by the 
examining officer for insanity or mental defects may appeal to a 
BS Employees' Compensation Commission, Annual Report, 1918, p. 5. See 
Chapter XIV, page 342. 108 
NATIONAL GOVERNMENT AND HEALTH 
board of medical officers of the Public Health Service to be con- 
vened by the Surgeon General. 
As this act requires the physical and mental examination of all 
" arriving aliens " (Section 16), it applies also to all alien seamen. 
Under the earlier law it was necessary to examine only those sea- 
men who desired to land, but the necessity of examining all alien 
seamen on incoming ships added greatly to the work. For instance, 
at New York during one month in 1917 there were inspected 6799 
immigrants and 16,028 alien seamen.69 
The Secretary of the Treasury was given authority to detail 
medical officers of the Public Health Service to duty in foreign 
countries in connection with the enforcement of the law. 
World War Activities. On April 3, 1917, when it became evi- 
dent that war would be declared against Germany, the President 
put into effect the provisions of Section 4 of the act approved 
July 1, 1902, and issued the following executive order making the 
Public Health Service a part of the military forces of the United 
States:60 
Under the authority of the act of Congress, approved July 1, 
1902, and subject to the limitations therein expressed, it is ordered 
that hereafter in times of threatened or actual war the Public 
Health Service shall constitute a part of the military forces of the 
United States, and in time of threatened or actual war, the Secre- 
tary of the Treasury may upon request of the Secretary of War or 
the Secretary of the Navy, detail officers or employees of said 
service for duty either with the Army or the Navy. All the stations 
of the Public Health Service are hereby made available for the 
reception of sick and wounded officers and men, or for such other 
purposes as shall promote the public interest in connection with 
military operations. 
Since many local health authorities were unable to cope ade- 
quately with the health problems created by the establishment of 
military camps in or near their jurisdiction, the Public Health 
Service inaugurated a system of extra-cantonment sanitation and 
also of control over areas contiguous to important industrial 
centers. The American Red Cross assisted in this work by making 
available personnel and equipment to the Service. State and local 
authorities also supplemented the work with funds and personnel, 
89 Surg. Gen., Annual Report, 1917, p. 152. 
Ibid., p. 317. DEPARTMENT OF THE TREASURY 
109 
and gave to the officers of the Service necessary state or local 
authority. 
In the summer of 1917, such activities were under way by the 
Public Health Service in twenty-six extra-cantonment zones, and 
by the end of 1918 had been extended to forty-seven areas. All 
types of public health activities were undertaken, the personnel 
eventually consisting of forty-nine commissioned officers, seventy- 
two acting assistant surgeons, and about four hundred other 
technical employees. 
In order to prevent the interstate spread of disease by either the 
military forces of the civil population, the Secretary of the Trea- 
sury on May 16, 1917, issued an order that vaccination against 
smallpox, typhoid fever, and paratyphoid fever might be obtained 
free of charge by any person at places designated by the Surgeon 
General of the Public Health Service.61 
After the acquisition of the Virgin Islands a medical officer was 
sent to St. Thomas on July 24, 1917, with orders to report to the 
governor for duty as quarantine officer. The existing regulations 
were continued in force until the promulgation of the executive 
order of September 27, 1917, which extended the national quar- 
antine laws and regulations to the islands.62 
On July 1, 1918, President Wilson issued an executive order 
placing all sanitary and public health activities carried on by any 
executive bureau, except those of the Army, Navy, and the Bu- 
reau of Labor Statistics, under the control of the Secretary of the 
Treasury, which, of course, meant the Public Plealth Service.63 
The work taken over as a result of this order included the main- 
tenance of sanitary conditions in 170 shipyards; supervision over 
medical and sanitary matters in industrial plants having contracts 
with the Ordnance Department; medical supervision over nitrate 
plants at Nitro, West Virginia; Muscle Shoals, Alabama; Ancor 
and Toledo, Ohio; Nashville, Tennessee; and Richmond, Virginia; 
and the formulation, in cooperation with the Working Conditions 
Service of the Department of Labor of general sanitary codes to 
protect the workers in war industries. 
In the field of scientific research the war activities included 
studies of the relation of industrial fatigue to efficiency, undertaken 
81 Ibid., p. 251. 
83 Ibid., 1918, pp. 227-8. 
68 Ibid., p. 10. See page 279. 110 
NATIONAL GOVERNMENT AND HEALTH 
in cooperation with the Council of National Defense; the detection 
and prevention of trinitrotoluol poisoning; the nutritive value of 
various kinds of flour and bread; the influence of heat on the 
vitamine content of beef; the development of a protective varnish 
against dermatitis from parazol; the preparation of an antitoxin 
against gas gangrene; the examination of specimens of food sup- 
posed to have been contaminated by enemy agents ; and the formu- 
lation of toxicological and chemical standards for arsphenamine.'1 
Control of Venereal Diseases. The marked prevalence of 
venereal diseases at the beginning of the war proved to be such 
a grave menace to the manpower of the country that the military 
and civil authorities took prompt steps to control those diseases in 
order to protect the health of the military forces. The treatment 
of infected enlisted men was the function of the medical depart- 
ments of the Army and Navy, but it was the duty of the civil 
authorities to stamp out the sources of infection. 
The acts of May 18, 1917 (40 Stat. L., 83), and October 6, 
1917 (40 Stat. L., 393), conferred upon the Secretary of War 
and the Secretary of the Navy, respectively, police powers for the 
suppression of prostitution in the immediate vicinity of military 
and naval stations of every character, but these acts made no 
provision for the medical treatment of infected persons or for any 
general educational measures. The prevalence of prostitution in 
areas that could not be brought under the control of the military 
and naval authorities resulted in the infection of Army enlisted 
men, as well as of men who had not been called to the colors. 
In connection with the sanitation of the extra-cantonment 
areas by the Public Health Service, the American Red Cross, at the 
beginning of the war, provided funds for the operation of venereal 
disease clinics, which were under the supervision of the Public 
Health Service. These clinics were started in December, 1917, and 
by July, 1918, twenty-five were in active operation and 10,370 
persons had been treated.55 
At the beginning of 1918 only two states-California and Massa- 
chusetts-had adopted a comprehensive plan for combating 
venereal diseases. Early in January, 1918, the Surgeon General of 
64 Warren and Bolduan, War Activities of the United States Public Health 
Service. Public Health Service, Reprint 531 (I9I9)> P- I5- 
65 Surg. Gen., Annual Report, 1918, p. 98. DEPARTMENT OF THE TREASURY 
111 
the Public Health Service sent a telegram to all state health officers, 
requesting their cooperation in a campaign for the control of 
these diseases. The hearty and universal reply encouraged the 
preparation of suggestions to state boards and the outline of 
regulations. This extra-cantonment work was under the direction 
of the Division of Domestic Quarantine, which had authority to 
prohibit the transportation of infected persons in interstate traffic, 
but had no police power within the separate states. The Division 
of Domestic Quarantine, however, developed a plan for coopera- 
tion between the Public Health Service and the state authorities. 
Briefly summarized, the plan provided for the appointment of 
an officer in each state to direct the work of venereal disease con- 
trol. The salary of such officer, selected by the state health officer 
was to be paid by the state and federal governments jointly. 
Each state was at once to provide for the notification of all cases 
of venereal disease, and to make provision for the extension of 
facilities for early diagnosis- and treatment. Repressive measures, 
looking to isolation and treatment of dangerously infected indi- 
viduals, and educational measures for the general public as well 
as for the infected persons, were also to be provided for.66 
In addition, arrangements were made for (i) better cooperation 
between the Commission on Training Camp Activities and the 
Public Health Service officer in charge of extra-cantonment sani- 
tation; (2) provision for treatment of United States prisoners, 
and (3) distribution of free arsphenamine to clinics operated 
under joint state and federal control. On July 1, 1918, the Presi- 
dent, as stated above, issued an executive order centralizing all 
civil public health activities of the government in the Treasury 
Department, 
As the work developed it became evident that the states would 
not have sufficient funds to carry on any educational propaganda. 
At the annual meeting of the state health officers in June, 1918, 
the matter was discussed and a bill was drafted which had the 
approval of the Council of National Defense, and of the Surgeons 
General of the Army, Navy, and Public Health Service. This bill 
was introduced in the Senate as Senate bill 4608, but was incor- 
porated in Chapter XV of the army appropriation act for the 
fiscal year 1919, approved July 9, 1918 (40 Stat. L., 886). 
6a Warren and Bolduan, p. 20, 112 
NATIONAL GOVERNMENT AND HEALTH 
Section 3 of this act created a Division of Venereal Diseases in 
the Public Health Service " to be under the charge of a commis- 
sioned medical officer of the United States Public Health Service 
detailed by the Surgeon General of the Public Health Service, 
which officer while thus serving shall be an Assistant Surgeon 
General of the Public Health Service, subject to the provisions of 
law applicable to assistant surgeons general in charge of adminis- 
trative divisions in the District of Columbia of the Bureau of the 
Public Health Service. There shall be in such Division such 
assistants, clerks, investigators, and other employees as may be 
necessary for the performance of its duties and as may be pro- 
vided for by law." 
Section 4 prescribed that the " duties of the Division of Venereal 
Diseases shall be in accordance with rules and regulations pre- 
scribed by the Secretary of the Treasury, (1) to study and inves- 
tigate the cause, treatment, and prevention of venereal diseases; 
(2) to cooperate with State Boards or Departments of Health for 
the prevention and control of such diseases within the states; and 
(3) to control and prevent the spread of these diseases in interstate 
traffic; provided, that nothing in this chapter shall be construed 
as limiting the functions and activities of other departments or 
bureaus in the prevention, control, and treatment of venereal 
diseases and in the expenditure of moneys therefor." 
Section 7 appropriated $200,000 for the establishment and main- 
tenance of the Division of Venereal Diseases during the fiscal 
year 1919. 
This act provided also for other agencies for the suppression 
of venereal diseases. Section 1 created the Interdepartmental 
Social Hygiene Board, consisting of the Secretary of War, the 
Secretary of the Navy, and the Secretary of the Treasury as 
ex-officio members, and of the Surgeons General of the Army, 
Navy, and the Public Health Service, or of representatives desig- 
nated by the heads of the War, Navy, and Treasury departments. 
Section 2 authorized and directed the Secretary of War and the 
Secretary of the Navy " to adopt measures for the purpose of 
assisting the various states in caring for civilian persons whose 
detention, isolation, quarantine, or commitment to institutions 
may be found necessary for the protection of the military and 
naval forces of the United States against venereal diseases." DEPARTMENT OF THE TREASURY 
113 
Section 5 appropriated $1,000,000 for the fiscal year 1919, to 
be expended under the joint direction of the Secretary of War 
and the Secretary of the Navy to carry out the provisions of 
Section 2 quoted in the preceding paragraph. These secretaries 
authorized the Interdepartmental Social Hygiene Board to ad- 
minister this fund.07 
Section 6 appropriated $1,000,000 for each of the fiscal years 
1919 and 1920, to be paid to the states for the use of boards or 
departments of health in the prevention, control, and treatment 
of venereal diseases. This sum was to be allotted to each state, 
in accordance with rules and regulations prescribed by the Secre- 
tary of the Treasury, in proportion to the population of each state. 
For the fiscal year 1920 it was provided that each state should 
specifically appropriate or set aside for the same purpose an 
amount equal to the money allotted by the United States. The 
original draft of the bill08 provided that the Interdepartmental 
Social Hygiene Board should recommend rules and regulations 
for the expenditure of this sum, but the act as passed did not give 
that Board any part in preparing the regulations, which were 
drafted by the Public Health Service and approved by the Secre- 
tary of the Treasury. As the fund was to be disbursed by the 
Interdepartmental Social Hygiene Board, the regulations provided 
that the state allotment must be expended in accordance with an 
accounting system to be prescribed by that Board. 
There was appropriated also to the Interdepartmental Social 
Hygiene Board, $100,000 for each of the fiscal years 1919 and 
1920, to be paid to institutions for scientific research for dis- 
covering " more effective medical measures in the prevention and 
treatment of venereal diseases," and $300,000 to be paid to suitable 
institutions " for the purpose of discovering and developing more 
effective educational measures in the prevention of venereal 
diseases, and for the purpose of sociological and psychological 
research related thereto." 
The Interdepartmental Social Hygiene Board was directed to 
recommend to the Secretary of the Treasury, the Secretary of 
War, and the Secretary of the Navy, such general measures " as 
w Interdepartmental Social Hygiene Board, Annual Report, 1920, p. 171. 
68 Senate Committee on Military Affairs, Hearings on Army appropriation 
bill, 1919, p. 59. 114 
NATIONAL GOVERNMENT AND HEALTH 
will promote correlation and efficiency in carrying out the pur- 
poses of this chapter by their respective departments." An appro- 
priation of $100,000 was made for the fiscal year 1919, to be used 
under the direction of the Interdepartmental Social Hygiene 
Boards for any purpose for which any of the other appropria- 
tions in the same chapter were available.69 
The act of July 9, 1918, described above, establishing the Divi- 
sion of Venereal Diseases in the Public Health Service and impos- 
ing specific duties upon it is similar to the acts of 1893 and 1912 
authorizing the Public Health Service to " cooperate with and aid 
state and municipal boards of health " and " to study and investi- 
gate the diseases of man and conditions influencing the propaga- 
tion and spread thereof." Because of the magnitude of the venereal 
disease problem, however, and its constant menace to national 
health, Congress apparently considered it proper to create a special 
division empowered to give exclusive attention to the promotion of 
venereal disease control work along specific lines. After the crea- 
tion of the Division in July, 1918, the Secretary of the Treasury, on 
September 4, issued the regulations under which state boards of 
health could obtain their allotments of the million dollar fund ;10 and 
on November 19, 1918, regulations governing the interstate travel 
of persons infected with venereal diseases were issued by the 
Secretary.71 Additional clinics were established, the aid of physi- 
cians and druggists was enlisted, the state and city authorities were 
urged to suppress prostitution, and an extensive educational cam- 
paign was carried on by means of pamphlets, lectures and motion 
pictures. 
Hospital Relief for the Army and Navy. The executive order 
of April 3, 1917, provided that all the stations of the Public 
Health Service should be available for the reception of sick and 
wounded officers and men. This work, however, did not throw any 
extraordinary burden on the Public Health Service, as during the 
fiscal year 1918, the relief extended to Army and Navy patients 
amounted to only 31,267 hospital days out of 534,991 hospital days 
and the office treatments were only 4455 out of 96,064; during the 
6J For statements of the work of the Interdepartmental Social Hygiene 
Board, see Manual for the various agents of the Interdepartmental Social 
Hygiene Board, 1920, and Annual Report, 1920. 
70 Public Health Reports, September 13, 1918. 
71 Surg. Gen., Annual Report, 1919, p. 238. DEPARTMENT OF THE TREASURY 
115 
fiscal year 1919, the Army and Navy relief amounted to 46,197 
hospital days out of a total of 757,010 and 2697 office treatments 
out of 104,763. The hospital work did not increase materially until 
after the men were discharged from the Army and became bene- 
ficiaries of the Bureau of War Risk Insurance. 
Influenza Epidemic of 1918. Early in the fall of 1918 influenza 
became prevalent in the United States, and by the middle of 
September had spread throughout Eastern states. In order to 
supply information regarding methods of prevention, six million 
copies of a pamphlet for the use of the laity were widely dis- 
tributed. On September 26 the state health officer of Massachu- 
setts requested immediate aid from the Public Health Service, as 
not enough doctors and nurses were available. There was a short- 
age of doctors and nurses in other places, and by the first of 
October the situation had become so serious that Congress appro- 
priated a million dollars to enable the Public Health Service to 
combat and suppress the disease (40 Stat. L., 1008). Even after 
the money was provided it was difficult to obtain medical and nurs- 
ing personnel. The Service could not undertake to provide enough 
doctors and nurses to treat individual cases, although this was done 
wherever possible. The work of relief was decentralized by ap- 
pointing a director for each state, and the local resources were 
organized in advance of the height of the epidemic. " Plans were 
made for opening emergency hospitals as needed, volunteer nurses 
were organized, emergency kitchens established, etc., and in this 
way many communities were able to take care of themselves when 
the epidemic was well established." During the epidemic sixty- 
four commissioned officers were on influenza duty, in addition to 
1085 other physicians, 703 nurses and nurses' assistants, and 328 
persons doing work of a miscellaneous character.'2 
Organization of Reserve Corps. On October 27, 1918, Con- 
gress authorized a reserve for the Public Health Service along 
lines similar to the Officers' Reserve Corps of the Army and Navy 
(40 Stat. L., 1017). This act provides that the President, after 
such examination as he may prescribe, may commission officers in 
the reserve for a period of five years. Reserve officers are subject 
to call to active duty at any time, and when called to active duty 
72 Surg. Gen., Annual Report, 1919, pp. 81-85. 116 
NATIONAL GOVERNMENT AND HEALTH 
receive the pay and allowances of the grade in which they hold 
commissions. 
New Administrative Units. In order to extend and coordinate 
the educational work of the Service, a Section of Public Health 
Education was organized on April 7, 1919." 
The growth of the hospital work resulting from the treatment of 
discharged soldiers greatly increased the number of complaints of 
mistreatment of patients or mismanagement, and it was deemed 
advisable to create a separate administrative unit for the investiga- 
tion of charges. Accordingly, the Inspection Section was created 
on February 20, 1920, with a commissioned officer of the rank of 
assistant surgeon general in charge. On August 29, 1920, the title 
of this unit was changed to General Inspection Service.71 
Another administrative unit resulting from the growth of the 
work was the Purveying Service, organized April 9, 1920. For- 
merly there had been a purveying depot attached to the Division of 
Marine Hospitals and Relief. As this depot purchased supplies for 
all stations, and not for the hospitals exclusively, a separate unit 
reporting directly to the Surgeon General was created.75 
Increased Compensation for Commissioned Officers, 1920. In- 
creased compensation for commissioned officers of the Public 
Health Service, Army, Navy, Marine Corps, the Coast Guard, and 
the Coast and Geodetic Survey was provided by the act approved 
May 1, 1920 (41 Stat. L., 601). The increases granted to officers 
of the Public Health Service were $600 for assistant surgeons gen- 
eral and senior surgeons, $840 for surgeons, $720 for passed assist- 
ant surgeons, and $600 for assistant surgeons. The increased pay 
was to continue until June 30, 1922. A special committee consist- 
ing of five members of the Senate and five members of the House 
of Representatives was provided to investigate and to make recom- 
mendations relative to the readjustment of the pay and allowances 
of the officers in these organizations. Section 12 of this act pro- 
vided also that the government should furnish transportation for 
the wife and dependent children of officers of the organizations 
73 Ibid., p. 213. 
74 Ibid., 1920, pp. 13-14. 
76 The Purveying Service was discontinued in 1922, when a general sup- 
ply bureau for the entire Treasury Department was organized. DEPARTMENT OF THE TREASURY 
117 
mentioned above, whenever they are ordered to make a permanent 
change of station. 
Completion of National Quarantine System. Provision for the 
completion of the national quarantine system, begun by the act of 
February 15, 1893, was contained in the sundry civil appropriation 
act for the fiscal year 1921, approved June 5, 1920 (41 Stat. L., 
875), which carried an appropriation for the purchase of the New 
York, Baltimore, and Texas quarantine stations. The Baltimore 
and Texas stations were already being operated under lease, and 
after the acquisition of the New York station on March 1, 1921, 
quarantine functions at all ports came under the jurisdiction of 
the Public Health Service. 
Medical Treatment of Discharged Soldiers. From October 6, 
1917, when an act granting compensation and medical relief to 
disabled soldiers was passed (40 Stat. L., 406), until August 9, 
1921, when the United States Veterans' Bureau was created (42 
Stat. L., 147), one of the principal activities of the Public Health 
Service was the hospitalization and care of ex-service men. In 
fact, these duties for a while overshadowed all other work of the 
Service. 
The act of October 6, 1917, was administered by the Bureau of 
War Risk Insurance, which, like the Public Health Service, was a 
bureau of the Treasury Department. Early in 1918 the Service 
was requested to give the necessary hospital care to discharged 
soldiers, although Congress at that time had made no attempt to 
provide adequate facilities for the purpose. Such legislation was 
not passed until March 3, 1919 (40 Stat. L., 1302), and this was 
the first law which definitely recognized the Public Health Service 
as the instrumentality for furnishing medical relief to the benefi- 
ciaries of the Bureau of War Risk Insurance. This law appro- 
priated $9,050,000 for hospital facilities, and was followed up by a 
number of appropriations and deficiency acts for maintenance, 
aggregating more than $20,000,000. 
There followed an immediate expansion of hospital work by the 
Service.78 Ten new hospitals were opened between April 1, and 
June 30, 1919, and over two hundred reserve officers were called 
76 See Cumming, H. S., The work of the Public Health Service in the 
case of disabled veterans of the World War. Public Health Service, Reprint 
No. 682 (1921). 118 
NATIONAL GOVERNMENT AND HEALTH 
into active duty. By December of 1919, 7200 beds were available, 
though even this number was insufficient. By the middle of 1920, 
fifty-four hospitals were in operation, while a year later the num- 
ber had increased to sixty-two. Congress made additional appro- 
priations, a sum of $18,600,000 being granted for hospital facili- 
ties on March 4, 1921 (41 Stat. L., 1364). Shortly thereafter, on 
August 9, 1921, the Veterans' Bureau was created as an indepen- 
dent establishment (42 Stat. L., 147), and to it was transferred 
certain of the hospital work, though the Public Health Service 
hospitals which were caring for veterans remained under that Ser- 
vice. On April 29, 1922, the President transferred by executive 
order all but the marine hospitals to the Veterans' Bureau, though 
these continued to care for ex-service men. This order relieved the 
Public Health Service of all responsibility for treatment of 
veterans, and the hospital work resumed its pre-war status, 
though considerably increased in extent.7. The Service was left 
with twenty-four hospitals having a capacity of over three thou- 
sand beds. 
During its operations on behalf of the Veterans' Bureau, the 
Public Health Service cared for more than 275,000 veterans, to 
whom were given more than 14,500,000 hospital relief days. In 
the out-patient clinics there were given about 2,000,000 treatments 
and about 1,500,000 physical examinations. 
" The Public Health Service has been subjected to considerable 
criticism in the performance of this work, but when consideration 
is given to the volume of the work and the difficulties under which 
it is done, it is believed that it can be safely stated that the Public 
Health Service, in what was equivalent to a national emergency, 
successfully met the responsibility placed upon it by Congress." 78 
Further Revision of Salaries, 1922. On June 10, 1922, there 
was approved an act (42 Stat. L., 625) which established a new 
basis for fixing the salaries of the commissioned officers of the 
Public Health Service, Army, Navy, Marine Corps, Coast Guard, 
and Coast and Geodetic Survey. By this act the pay is fixed by 
rank and length of service, while the allowances for subsistence 
and quarters are determined by the rank and length of service, 
whether or not the officers have dependents. 
77 See Monograph No. io, The Public Plealth Service, for a much more 
detailed account of this work for veterans. Also Chapter XIV, page 327. 
78 Surg. Gen., Annual Report, 1922, p. 236. DEPARTMENT OF THE TREASURY 
119 
Current Activities. The functions of the Public Health Ser- 
vice, as previously stated, are to provide medical relief to certain 
beneficiaries, to prevent the introduction of disease into the United 
States, to prevent the interstate spread of disease, to cooperate 
with state health officials, and to conduct research into all phases 
of modern public health problems and make known the results of 
such investigations. 
Medical Relief. Medical treatment for merchant seamen was 
the purpose for which the Marine Hospital Service was created in 
1798, and this continued to be its only function for over three- 
quarters of a century. Gradually the service enlarged its activities 
in the field of quarantine, medical inspection of immigrants, sani- 
tation, hygiene, and general investigations relating to the public 
health, until by 1918 the hospital work, measured by personnel and 
expenditures, while still important, was no longer the major ac- 
tivity. By 1920 the medical and hospital treatment of patients of 
the Bureau of War Risk Insurance had again become the major 
activity of the organization in terms of persons employed and 
money expended, and it still has an important place in the activi- 
ties of the Service. 
The benefits of medical and hospital care, which were originally 
limited to seamen of the American merchant marine, have been 
extended from time to time by Congress, or by regulation in con- 
formity to Congressional enactments, until to-day many different 
classes of patients are eligible for such care and treatment. The 
beneficiaries of the Service may be summarized as follows: 
1. Entitled to Hospital Relief and other Benefits. 
a. Seamen of the Merchant Marine, that is, persons employed 
on vessels registered, enrolled, or licensed under the laws of the 
United States (Acts of: July 16, 1798, 1 Stat. L., 605; June 29, 
1870, 16 Stat. L., 595; March 3, 1875, Stat. L., 485; June 24, 
1914, 38 Stat. L., 387; March 3, 1919, 40 Stat. L., 1302). But not 
persons employed on canal boats (Act of July 20, 1846, 9 Stat. L., 
38; Joint Resolution of February 10, 1871, 16 Stat. L., 595). 
b. Officers and enlisted men of the U. S. Coast Guard (Acts of : 
August 4, 1894, 28 Stat. L., 229; June 24, 1914, 38 Stat. L., 387; 
March 3, 1919, 40 Stat. L., 1302). 
c. Officers and employees of the Public Health Service (Acts of 
June 23, 1913, 38 Stat. L., 24; September 7, 1916, 39 Stat. L., 743 ; 
March 3, 1919, 40 Stat. L., 1302). 120 
NATIONAL GOVERNMENT AND HEALTH 
d. Persons suffering from leprosy (Acts of March 3, 1905, 33 
Stat. L., 1909; February 3, 1917, 39 Stat. L., 872). 
e. Civil employees of the Government, patients of the Employees' 
Compensation Commission (Acts of September 7, 1916, 39 Stat. 
L., 743; March 3, 1919, 40 Stat. L., 1302). 
f. Officers and crews, U. S. Bureau of Fisheries (Act of July 1, 
1918, 40 Stat. L., 694). 
g. Officers, crews, keepers, and assistant keepers, U. S. Light- 
house Service (Act. of August 28, 1916, 39 Stat. L., 538; March 
3, 1919, 40 Stat. L., 1302). 
h. Officers and seamen, (U. S. Coast and Geodetic Survey 
(Regul. 1902; Treas. Dept. Cir. No. 11, 1905; Act of March 3, 
1919, 40 Stat. L., 1302). 
i. Seamen, Mississippi River Commission (Regul. 1897; Act of 
March 3, 1919, 40 Stat. L., 1302). 
j. Seamen, vessels of U. S. Army (Regul. 1897, 1902; Act of 
March 3, 1919, 40 Stat. L., 1302). 
2. Entitled to Physical Examinations. 
a. Personnel, U. S. Coast Guard (entrance, promotion, retire- 
ment) (Act of April 12, 1902, 32 Stat. L., 100; June 22, 1906, 34 
Stat. L., 452; June 28, 1915, 38 Stat. L., 800). 
b. Civil-service employees suspected of having tuberculosis 
(Exec. Order, February 28, 1906). 
c. Civil-service employees for retirement (Act of May 22, 1920, 
41 Stat. L., 616). 
d. Civil-service applicants and employees (Exec. Order, June 
18, 1923). 
e. Officers Reserve Corps, U. S. Army (Bur. Circ. No. 353, 
April 17, 1922 ; revised annually). 
f. Citizens' military training camps (Bur. Circ. No. 336, Febru- 
ary 23, 1922). 
g. Miscellaneous: applicants for pilot's license; able-bodied 
seamen; applicants for military pensions; etc. (Regulations, divi- 
sion circulars, and requests by bureaus concerned). 
3. Entitled to Vaccination against Smallpox and Typhoid Fever. 
a. Civil employees in interstate travel or handling mail. (Treas. 
Dept. Circ. No. 313, November 24, 1922). 
4. Pay Patients, Entitled to Hospital and Other Benefits. 
a. Foreign seamen, the cost charged to masters of vessels! (Acts 
of May 3, 1802, 2 Stat. L., 193; March 3, 1875, 18 Stat. L., 486; 
December 26, 1920; 41 Stat. L., 1082). 
b. Beneficiaries of the U. S. Veterans' Bureau (Acts of October 
6, 1917, 40 Stat. L., 406; March 3, 1919, 40 Stat. L., 1302; March 
4, 1921, 41 Stat. L., 1397; August 9, 1921, 42 Stat. L., 147). DEPARTMENT OF THE TREASURY 
121 
c. Discharged soldiers of allied nations (Act of December 24, 
1919, 41 Stat. L., 374). 
d. Personnel of Army, Navy, and Marine Corps (Exec. Order, 
April 3, 1917; general authority in Act of March 3, 1875, 18 Stat. 
L., 486). 
e. Immigration patients (Current appropriation acts). 
During the fiscal year 1925, a total of 209,304 patients received 
treatment; 43,287 were treated in hospitals and 166,017 furnished 
office relief. In addition, 76,661 were given physical examinations. 
These treatments and examinations were given in twenty-five 
marine hospitals ; 120 second'-, third-, and fourth-class stations; and 
in eight miscellaneous institutions. About half of the beneficiaries 
were American seamen. The comparative numbers of the various 
beneficiaries were as follows: 
Beneficiary 
Number of 
patients 
treated 
Number of 
days relief 
in hospital 
Number of 
physical 
examinations 
American seamen 
100,383 
888,915 
18,530 
Employees' Compensation Commission 
45,836 
55,580 
7,341 
Coast Guard 
34,052 
60,336 
13,394 
Immigration Service 
9,165 
76,594 
210 
Public Health Service 
4,576 
8,348 
1,075 
U. S. Veterans' Bureau 
4,360 
112,558 
920 
Seamen, U. S. Army 
2,225 
21,827 
73 
Lighthouse Service 
1,447 
10,963 
212 
Foreign seamen 
869 
13,631 
571 
Coast and Geodetic Survey 
556 
2,:227 
540 
Mississippi River Commission 
573 
6,282 
25 
Lepers 
308 
82,361 
U. S. Army 
296 
434 
532 
U. S. Navy and Marine Corps 
183 
1,177 
66 
Miscellaneous 
4,475 
778 
7,788 
Pilots 
6,606 
Civil service applicants 
18,778 
Total 
209,304 
1,342,011 
76,661 
All of the hospitals of the Service are devoted to general medi- 
cal and surgical patients, except that at Fort Stanton, New Mexico, 
which is for tuberculosis patients, and that at Carville, Louisiana, 
the National Leprosarium. All are under the supervision of the 
Division of Marine Hospitals and Relief. 
Leprosy Hospitals. Hospitals for the treatment of persons suf- 
fering from leprosy are operated at Kalihi, Hawaii, and Carville, 
Louisiana. The hospital at Kalihi was authorized by the act of 122 
NATIONAL GOVERNMENT AND HEALTH 
March 3, 1905 (33 Stat. L., 1909), but was not opened until 
December 23, 1909. The work at this station includes clinical 
and laboratory studies for the purpose of finding remedies, as well 
as medical care and treatment of persons suffering from the dis- 
ease. A national home for lepers was authorized by the act of 
February 3, 1917 (39 Stat. L., 872). That act provides that there 
shall be admitted to this home any person afflicted with leprosy who 
presents himself, who may be apprehended under authority of the 
United States quarantine laws, or who- may be " consigned " to 
the home by the proper health authorities of any state, territory, 
or the District of Columbia. The World War interfered with the 
selection of a site for this institution, and the hospital at Carville, 
Louisiana, was not opened until 1921. It was enlarged in 1924, 
so that it now has a capacity of 425 patients, which is estimated 
to be about half the number of lepers in this country. In 1925 there 
were 257 patients. 
Trachoma Hospitals. Trachoma eradication has been under- 
taken under the supervision of the Division of Domestic Quaran- 
tine since 1912. An intensive survey of the disease was made in 
eastern Kentucky in that year and, on account of the deplorable 
conditions discovered, a trachoma hospital was established at 
Hindman, Knott County, Kentucky, for three years. Another was 
opened at Jackson, Kentucky, in the spring of 1914 under authority 
conferred in the sundry civil appropriation act for the fiscal year 
1914 (38 Stat. L., 25). In this act the item for preventing the 
spread of epidemics authorized the President to aid state and local 
boards in preventing and suppressing the spread of certain epi- 
demic diseases, trachoma being expressly mentioned. In June, 
1915, a hospital at Hyden was transferred to London, Kentucky, 
and on June 30, a fourth hospital was opened at Colburn, Virginia. 
A fifth hospital was opened at Welch, West Virginia, on October 1, 
1915. In September, 1916, the hospital at Hindman, Kentucky, was 
moved to Pikesville, Kentucky, as Knott County, in which Hind- 
man is situated, had been practically cleared of the disease. While 
the hospital had been maintained at Hindman, the county health 
officers had been instructed in methods of diagnosis and treatment, 
and had become qualified to treat any additional cases that might 
develop. About this time an additional hospital was opened at 
Tazewell, Tennessee. The hospitals at Colburn, Virginia, and Lon- DEPARTMENT OF THE TREASURY 
123 
don, Kentucky, were closed toward the end of the fiscal year 1918, 
as the disease was under control in these localities. A new hospital 
was opened at Greenville, Kentucky, and on December 13, 1918, a 
hospital was opened at La Moure, North Dakota. At the close of 
the fiscal year 1924, trachoma hospitals were in operation at Knox- 
ville, Tennessee; Pikesville, Kentucky; Rolla, Missouri; and Rus- 
sellville, Arkansas. These hospitals were used as bases for field 
work. During 1924, trachoma work was carried on in cooperation 
with state boards of health in twelve states. 
Prevention of Interstate Spread of Diseas'e. According to the 
annual report of the Surgeon General for the fiscal year 1924,79 the 
activities of the Division of Domestic Quarantine to suppress epi- 
demics, and to prevent the interstate spread of disease consisted of : 
(1) Plague-suppressive measures, (2) activities for the eradica- 
tion of trachoma, (3) the conduct of studies and demonstrations in 
rural sanitation, (4) the carrying out of service policies for the 
prevention of epidemics by assisting state health departments in 
establishing and improving local health service, (5) the improve- 
ment of sanitary conditions in the national parks, (6) the control 
of water supplies used for drinking and culinary purposes by inter- 
state carriers, (7) supervision over sanitary and health conditions 
on interstate carriers, and (8) mosquito-control measures along 
the Texas-Mexican border to prevent the spread of yellow fever, 
should it be introduced. 
For many years the Marine Hospital Service had been active in 
assisting local authorities in the South in controlling epidemics of 
yellow fever, but the first effective measure in the direction of the 
interstate control of disease was passed in 1890. 
The act of March 27, 1890 (26 Stat. L., 31), gave authority for 
regulations to prevent the spread of cholera, yellow fever, small- 
pox, and plague from one state or territory to another. These regu- 
lations were to be prepared by the Supervising Surgeon General 
of the Marine Hospital Service, and a violation of the regulations 
was made a misdemeanor, punishable by fine or imprisonment. It 
should be noted especially that this applied only to the four dis- 
eases mentioned, and did not confer any general power with re- 
spect to other communicable diseases. The authority for the work 
79 Page 65. NATIONAL GOVERNMENT AND HEALTH 
124 
now carried on is conferred by the act of February 15, 1893 (27 
Stat. L., 449), which provides that the service shall 
. . . cooperate with and aid state and municipal boards of health 
in the execution and enforcement of the rules and regulations of 
such boards and in the execution and enforcement of the rules and 
regulations made by the Secretary of the Treasury to prevent the 
introduction of contagious or infectious diseases . . . into one 
state or territory or the District of Columbia from another state or 
territory or the District of Columbia; . . . and . . . where such 
regulations are, in the opinion of the Secretary of the Treasury, 
necessary to prevent the introduction of contagious or infectious 
diseases . . . into one state or territory or the District of Columbia 
from another state or territory or the District of Columbia, and at 
such ports and places within the United States where quarantine 
regulations exist under authority of the state or municipality which, 
in the opinion of the Secretary of the Treasury, are not sufficient 
to prevent the introduction of such diseases . . . into one state or 
territory or the District of Columbia from another state or terri- 
tory or the District of Columbia, the Secretary of the Treasury 
shall, if in his judgment it is necessary and proper, make such addi- 
tional rules and regulations as are necessary to prevent the intro- 
duction of such diseases . . . into one state or territory or the 
District of Columbia from another state or territory or the Dis- 
trict of Columbia, and when such rules and regulations have been 
made they shall be promulgated by the Secretary of the Treasury, 
and enforced by the sanitary authorities of the states and munici- 
palities, where the state and municipal health authorities will 
undertake to execute and enforce them; but if the state or munici- 
pal authorities shall fail or refuse to enforce said rules and regula- 
tions the President shall execute and enforce the same and adopt 
such measures as in his judgment shall be necessary to prevent the 
introduction or spread of such diseases, and may detail or appoint 
officers for that purpose. 
It should be noted that this act does not attempt to create 
machinery for the prevention of the interstate spread of diseases if 
the work of state and municipal authorities accomplishes this 
purpose. It is only when the local regulations are inadequate, or 
when a distinctly national problem is involved, that the Federal 
power is invoked. Recognizing that the method outlined in the 
law is one productive of the best results, the Public Health Service 
has confined its activities to the formulation of regulations govern- 
ing the interstate transportation of commodities and persons, the 
upbuilding of divisions of communicable diseases and sanitary DEPARTMENT OF THE TREASURY 
125 
engineering in state health departments, the giving of advice and 
assistance to local authorities, and the formulation of regulatory 
measures only when the local regulations or resources are inade- 
quate to meet the situation. 
Regulations affecting interstate carriers provide that vehicles 
and vessels must be cleaned, ventilated, and supplied with adequate 
toilet facilities; that forecastles of vessels must be fumigated; 
that clean bedding must be furnished; that spitting must be pre- 
vented except into receptacles provided for that purpose; that 
common drinking cups and towels must not be used; that drink- 
ing water and ice of a definite standard must be provided; and that 
all articles of food and drink must be obtained from a source free 
from infection. Carriers are forbidden to transport in interstate 
traffic milk from an infected source, oysters or clams grown or 
handled under insanitary conditions, shaving or lather brushes 
manufactured under insanitary conditions, or any article known to 
have been exposed to contagion, unless a certificate has been ob- 
tained from the proper health authority that all necessary measures 
have been taken to render the article free from infection. From 
March 15 to June 15, cattle, horses, sheep, goats, elk, deer, or hogs 
cannot be shipped from any locality where Rocky Mountain spot- 
ted fever is known to exist unless the shipment is accompanied 
by a certificate that the animals are free from wood ticks. The 
transportation of persons suffering from plague, cholera, yellow 
fever, smallpox, typhus fever, scarlet fever, poliomyelitis (infan- 
tile paralysis), Rocky Mountain spotted or tick fever, and epidemic 
cerebrospinal meningitis, is prohibited. Specific regulations are 
provided governing the transportation of persons suffering from 
typhoid fever, diphtheria, whooping cough, measles, tuberculosis, 
leprosy, and venereal disease. The only general regulation, in 
addition to those affecting interstate carriers, is the one providing 
that camps of migratory workers must be kept in a proper sanitary 
and vermin-free condition. 
The control over water for drinking purposes used by inter- 
state carriers is effected by requiring the carrier to use water from 
a source which is certified and approved as producing water of 
satisfactory quality and safety. These certificates may be issued 
by officers of the Public Health Service or by the state department 
of health having jurisdiction over the supply, and must be filed 126 
NATIONAL GOVERNMENT AND HEALTH 
whenever the Surgeon General of the Public Health Service may 
direct, but at least semi-annually, in March and September 
of each year. These certificates are based upon the relative free- 
dom of the water " from contamination or exposure to contamina- 
tion, by micro-organisms and substances recognized as harmful 
or deleterious to the consumer's health or liable to spread infec- 
tious or contagious disease, as determined through a survey of the 
sanitary conditions under which the supply is produced and the 
results of bacteriological and chemical analysis of samples of the 
water." 80 
During the fiscal year 1924 interstate railroad carriers obtained 
water for drinking purposes from 2789 sources of supply, of 
which 1712 were found satisfactory and seventy-three polluted. 
No determination was made of the character of the water from 
the remaining sources. As interstate carriers generally use mu- 
nicipal water supplies, the supervision of the water used by them 
often indirectly results in improvement in the character of the 
water used by municipalities. In addition, 244 water supplies of 
vessels were examined, of which 134 were found satisfactory and 
were accordingly certified. 
Sanitary Engineering. As the most effective method of pre- 
venting the interstate spread of disease is to eliminate sources of 
infection within the states, the Public Health Service has sup- 
ported the state authorities in establishing and developing divi- 
sions of sanitation for the study of water, sewage, and other 
public health engineering problems. The Public Health Service 
assists in building up the engineering work of the public health 
departments of the states by furnishing the services of trained 
sanitary engineers for temporary periods. These officers make 
specific investigations of water supplies and sewage disposal prob- 
lems, and organize or make recommendations regarding the estab- 
lishment of sanitary engineering divisions. The aim of the Public 
Health Service is not to work out all the problems involved in 
local sanitary measures, but to render assistance in planning the 
most urgent work and to point out the desirability of having a 
definite organization to carry on such work continually. Very 
largely as a result of the work done by officers detailed from the 
80 Amendment No. 8 to Interstate Quarantine Regulations, July 14, 1919. DEPARTMENT OF THE TREASURY 
127 
Public Health Service, sanitary engineering divisions were in 1925 
in existence in forty-one states. 
In order to carry on sanitary engineering activities effectively, 
six interstate sanitary districts have been set up throughout the 
country, with sanitary engineers in charge of the work in each dis- 
trict. These engineers supervise the water supplies of vessels and 
railroads, investigate typhoid fever, cooperate with state and local 
health departments, carry on rodent surveys and anti-plague 
measures, and perform various miscellaneous or special duties. 
Thus, during 1925, extensive studies of oyster pollution were 
conducted in certain seaboard states, on account of an epidemic of 
typhoid fever from that source. The sanitary engineers of one 
district assist in the sanitation of the national parks, being detailed 
at the request of the Secretary of the Interior.81 
Rural Sanitation. Special studies of and demonstration work 
in rural sanitation were started in the fiscal year 1914. During the 
fiscal years 1914, 1915, and part of 1916, allotments for this work 
were made from the appropriation for " Field Investigations of 
Public Health." The first specific appropriation for this work was 
one for $25,000 in the deficiency act for the fiscal year 1916, 
approved February 28, 1916. Beginning with the fiscal year 1917, 
specific annual appropriations were made for this work in the 
following amounts: 
1917 $ 25,000 
1918 150,000 
1919 150,000 
1920 5o,ooo 
1921 50,000 
1922 50,000 
1923 50,000 
1924 50,000 
1925 74,300 
1926 75,ooo 
As a result of special studies made in 1914, 1915, and 1916, 
in eighteen counties in sixteen states, the conclusion was reached: 
(1) That at less than 2 per cent of the rural homes in the 
United States are the most essential principles of sanitation con- 
sistently in practice; (2) that for less than 3 per cent of our rural 
population is local health service approaching adequacy provided; 
81 See page 285. 128 
NATIONAL GOVERNMENT AND HEALTH 
(3) that sustained efficient whole-time local health service is essen- 
tial to the establishment and maintenance of reasonably good sani- 
tary conditions in our rural districts; and (4) that duly efficient 
personnel for rural health work generally cannot be expected with- 
out active participation in the work by central agencies, such as 
official State and National health agencies, to prevent adverse 
influence of local politics.82 
Since 1916 the work in rural sanitation has been devoted almost 
entirely to demonstrating the value of proper sanitary measures 
and endeavoring to arouse interest in public health work. 
During the war the work in rural sanitation was largely confined 
to areas adjacent to military reservations, but after the military 
forces were demobilized regular work was again resumed. This 
work is undertaken only at the request of the state or local health 
authorities, and beginning with the fiscal year 1918 the appropria- 
tion acts have specified that no part of the appropriation shall be 
used for demonstration work unless the state, county, or munici- 
pality agrees to pay half of the expense. 
During the fiscal year 1925, the Public Health Service cooperated 
in demonstration projects in rural health work in seventy-nine 
counties, or districts comparable to counties, in nineteen states.83 
For the support of all this work, there was available $708,909.30, 
of which sum, $63,314.47 came from the Federal appropriation 
of $74,300 for the fiscal year; $569,510.66 was derived from 
state, county, and municipal government sources; and $72,084.17 
came from other funds, mostly extra-governmental, such as the 
International Health Board, Red Cross Chapters, and voluntary 
health associations. " Thus, this investment of the Federal funds 
appropriated for rural sanitation work was met by odds of over 
9 to 1." 
The results of these activities, as summarized by the officer in 
charge of the rural sanitation office of the Service, may be quoted 
verbatim, as follows: 
The 79 cooperative projects in the fiscal year ended June 30, 
1925, yielded results exceeding in value manyfold the cost of the 
work. Among the activities and results presented in the tabular 
83 Surg. Gen., Annual Report, 1920, p. 52. 
83 Lumsden, L. L., Cooperative rural health work of the Public Health 
Service in the fiscal year 1925. Public Health Service, Public Health 
Reports, Oct. 23, 1925. DEPARTMENT OF THE TREASURY 
129 
statement, to which especial consideration may be given, are the 
following: 
i. Public lectures presenting the principles and details of sani- 
tation to over 307,700 persons. 
2. Over 166,600 sanitary inspections of premises, with explana- 
tion of findings to occupants or owners of the properties. 
3. Physical examination of over 197,200 school children, of 
whom over 112,000 were found to have incapacitating physical 
defects, with notification to parents or guardians of defects found. 
4. Thirty-five thousand five hundred and twenty-four recorded 
treatments effecting correction of incapacitating physical defects 
among school children. These were brought about by written 
notification of defects found to parents or guardians, follow-up 
visits to home of the children, making available proper clinical 
facilities, and other activities of the county or district health 
departments. 
5. Bringing about treatments for correction of serious physical 
defects in 1175 infants and 1897 pre-school children. 
6. Treatments to correct iodine deficiency in 4022 persons in 
endemic goiter districts. 
7. Forty-three thousand three hundred and ninety-one visits to 
homes of cases of communicable disease to advise and show the 
afflicted households how to prevent spread of the infections. 
8. Six thousand five hundred and twenty-four visits by health 
nurses to prenatal cases to advise and assist expectant mothers 
in carrying out hygienic and physiological measures making for 
healthy mothers and healthy babies. 
9. Instruction of 2205 midwives in cleanly and careful methods. 
10. Twenty-three thousand six hundred and forty-three infants 
and children of pre-school age examined and over 39,800 home 
visits by health nurses or health officers to demonstrate hygienic 
measures for the promotion of the health and the protection of 
the lives of infants. 
11. Seventy-one thousand one hundred and fifty-six persons 
inoculated for protection against typhoid fever. 
12. Forty-seven thousand four hundred and eighty-eight per- 
sons vaccinated against smallpox. 
13. Nineteen thousand and eighty-nine children inoculated with 
toxin-antitoxin mixture for immunization against diphtheria. 
14. Forty-two thousand and seventeen cows tuberculin tested, 
with elimination of reactors from herds to prevent communica- 
tion of bovine tuberculosis to persons through the medium of milk. 
15. Four thousand six hundred and fifty-four persons treated 
effectively for relief from hookworm disease and for the preven- 
tion of the spread of the infection. 130 
NATIONAL GOVERNMENT AND HEALTH 
i6. Marked reduction in the spread of malaria in hundreds of 
localities, with an aggregate population of several hundred thou- 
sand. 
17. Twenty-nine thousand two hundred and fifty-one treatments 
to rid persons of venereal disease infection and prevent the spread 
of the infection. 
18. Special examination of 3660 persons for tuberculosis, of 
whom 1108 were found with an active tubercular process and were 
advised to place themselves in the care of their private physicians 
and to carry out hygienic measures. Three hundred and forty-two 
of the positive cases were sent to institutions maintained in whole 
or in part for the treatment of tuberculosis. 
19. Eleven thousand seven hundred and sixty cases of dangerous 
communicable diseases quarantined to prevent the spread of infec- 
tion in the local community, the state, and throughout the country. 
20. The installation of 17,415 sanitary privies and 1256 septic 
tanks at dwellings where previously there had been either grossly 
insanitary privies or no toilets of any sort. 
21. Twelve thousand three hundred and seventy-five privies 
repaired so as again to be of sanitary type. 
22. Six thousand eight hundred and thirty-nine homes con- 
nected for the first time with sanitary sewers. 
23. Six thousand seven hundred and eighty homes provided with 
safe water supplies in place of contaminated water supplies. 
24. Radical improvement of 409 public milk supplies, the milk 
from which was being distributed to a considerable extent through 
the channels of interstate commerce, to prevent the spread, through 
milk and milk products, of such infections as typhoid fever, scarlet 
fever, diphtheria, tuberculosis, septic sore throat, and infant 
diarrhea. 
25. Twenty-three thousand six hundred and twenty-two adult 
persons (most of them over 40 years of age) examined and advised 
about measures to conserve their health and prolong their lives. 
Such activities and results indicate that the plan of the work is 
both comprehensive and effective. They mean prevention of pre- 
mature human death, prevention of human illness, promotion of 
human health, conservation of economic resources. The total 
result of such work stands in importance to our national welfare 
second to none other obtainable from equivalent investment of 
public fund's. 
Foreign Quarantine. The quarantine work of the Public Health 
Service begins in the foreign port from which the ship sails, as 
every vessel departing for the United States must obtain a bill of 
health from the consular officer or the medical officers detailed 
to that port. This bill of health contains information regarding the 
sanitary condition of the vessel and the port, a statement of pre- DEPARTMENT OF THE TREASURY 
131 
vailing diseases at the port, and information regarding cases and 
deaths from certain infectious diseases. At a foreign port where a 
medical officer is stationed and where cholera, yellow fever, plague 
in men or rodents, smallpox, or typhus fever prevail, all vessels 
must be inspected before the bill of health is issued. At other ports 
the inspection is limited to vessels carrying steerage passengers, 
and if the ports are healthful, the inspection may be limited to the 
steerage passengers and their quarters on the ship. 
The regulations provide that vessels must be mechanically clean 
in all parts, that any part exposed to communicable disease must 
be disinfected, that air space, ventilation, food and water supply, 
and hospital accommodations are in accordance with law, and that 
infected articles must be disinfected. 
The United States has, of course, no direct authority to inspect 
vessels in foreign ports, but this end is accomplished by providing 
that no vessel from a foreign port shall be allowed to enter a United 
States port unless it has obtained a bill of health from the proper 
United States officer. 
On arrival of a vessel in an American port, the bill of health 
is examined by the quarantine officer, who also makes an inspec- 
tion of the vessel, the passengers, and the crew. If a contagious 
disease exists on the vessel, the quarantine officer detains the vessel 
or requires the fumigation or disinfection of the ship, passengers, 
crew, or cargo as the circumstance may warrant. At border 
stations the same procedure is carried out as regards passengers 
and baggage. The fumigation of the forecastles of American mer- 
chant ships is also under the direction of the Public Health Service, 
under authority conferred by the Seamen's Act of March 4, 1915 
(38 Stat. L., 1116). 
During the fiscal year 1925, officers of the Public Health Service 
were stationed at forty-three ports abroad and at 101 stations in 
this country. There were inspected 19,731 vessels and 1,715,936 
passengers and members of crews at the continental maritime sta- 
tions, and 2867 vessels and 369,701 individuals at insular stations. 
At foreign ports 7212 vessels and 821,019 passengers and mem- 
bers of crews were examined. At the border quarantine stations 
49,694 travelers were inspected. 
Medical Inspection of Aliens. The medical inspection of immi- 
grants was begun by the Service in the early part of 1890, when 132 
NATIONAL GOVERNMENT AND HEALTH 
this work was undertaken at New York, by direction of the Secre- 
tary of the Treasury under the provisions of the act of August 3, 
1882 (20 Stat. L., 214). The act of March 3, 1891, made more 
specific provision for the medical examination of aliens, and placed 
this duty definitely on the Marine Hospital Service. The inspec- 
tion of immigrants at foreign ports was begun in 1889. A second 
act providing for the medical examination of aliens was passed on 
March 3, 1903 (32 Stat. L., 1213). The authority for this work 
at the present time is contained in Sections 3 and 16 of the act of 
February 5, 1917 (39 Stat. L., 875). The classes denied admission 
by Section 3 are " idiots, imbeciles, feeble-minded persons, epi- 
leptics, insane persons, persons who have had one or more attacks 
of insanity at any time previously, persons of constitutional psy- 
chopathic inferiority, persons with chronic alcoholism, . . . per- 
sons afflicted with tuberculosis in any form or with a loathsome or 
dangerous contagious disease, [and] persons not comprehended 
within any of the foregoing classes who are found to be and are cer- 
tified by the examining surgeon as being mentally or physically 
defective, such physical defect being of a nature which may affect 
the ability of such alien to earn a living." This work includes the 
medical examination of all alien seamen, regardless of whether 
they desire to land or not. 
Section 16 requires the physical and mental examination of 
arriving aliens to be made by medical officers of the Public Health 
Service, who have had two years' experience in the practice of 
their profession since receiving the degree of doctor of medicine. 
If, however, medical officers of the Public Health Service are not 
available, civil surgeons may be employed by the Commissioner 
General of Immigration, who has general supervision over the 
admission of immigrants and has direct charge of all examina- 
tions that are not physical or mental. 
It is the function of the proper immigration officers of the 
Department of Labor " to determine whether an alien may belong 
to any one or more than one of the excluded classes.84 It is the 
duty of medical officers of the Public Health Service to submit to 
the immigration officers evidence of two kinds: (1) Certification 
as to findings of fact, and (2) testimony in the form of profes- 
84 Regulations governing the Medical Inspection of Aliens, Public Health 
Service, Miscellaneous Publication No. 5, 1917, p. 6. DEPARTMENT OF THE TREASURY 
133 
sional opinions. For instance, the question whether an alien has 
a particular defect or disease " is purely medical and is therefore 
for the medical officer to determine; the question of the effect of 
such a disease on the alien's earning capacity is a practical one, 
and therefore for the immigration officer to determine, although 
such immigration officer may desire, and having obtained, may 
consider an expression of opinion by the medical officer on the 
practical phase of the matter." 86 
The specific duties of the medical officers are defined in the 
regulations of the service as follows:86 
9. To conduct physical and mental examinations of all arriving 
aliens, including alien seamen subject thereto, and to certify for 
the information of the immigration officers and boards of special 
inquiry any and all physical and mental defects and diseases. 
[Secs. 16 and 35, act Feb. 5, 1917.] 
10. To furnish the required information in such form as to 
enable the proper immigration officers to determine whether the 
alien concerned belongs to one of the excluded classes. [Secs. 3 
and 17, act Feb. 5, 1917.] 
11. To convene medical boards for the consideration of appeals 
made in the cases of aliens certified for insanity or mental defect; 
also in other cases as provided for by these regulations. 
12. To submit such opinions as may be necessary to assist the 
Secretary of Labor in determining whether certain penalties 
shall be imposed in connection with the certification for certain 
classes of physical and mental diseases and defects in cases of 
arriving aliens. [Secs. 9 and 35, act Feb. 5, 1917.] 
13. To certify, when requested and when the facts so justify, 
that an arriving alien who has been excluded is helpless from 
sickness, mental or physical disability or infancy, in order that the 
deportation of an accompanying alien may be effected. [Sec. 18, 
act Feb. 5, 1917.] 
14. To certify, when the facts so justify, that an excluded or 
deportable alien is in need of special care and attention or of the 
services of a special attendant. 
15. When requested by the proper immigration officers to submit 
in writing for the information of the Secretary of Labor esti- 
mates as to the probable length of time medical treatment may be 
necessary to effect a cure in cases of arriving aliens who may be 
adjudged to have come to the United States in violation of law. 
[Sec. 18, act Feb. 5, 1917.] 
16. To render when necessary a certificate in regard to the con- 
dition of insane aliens which will enable them to be held for treat- 
85 Ibid., p. 8. 
Ibid., p. 10-12. 134 
NATIONAL GOVERNMENT AND HEALTH 
ment at the expense of the United States until they may be safely 
deported. [Sec. 18, act Feb. 5, 1917.] 
17. To render opinions when requested by the proper immigra- 
tion officers as to the curability of a " contagious disorder " affect- 
ing the wife or minor children of a domiciled alien or certain minor 
children of a citizen. [Sec. 22, act. Feb. 5, 1917.] 
18. To give an opinion as to the age of an alien, when requested 
to do so by the proper immigration officers. [Sec. 3, act Feb. 5, 
IW-] 
19. To render opinions, when requested to do so by the proper 
immigration officers, as to whether an alien may be " physically 
capable of reading." 
20. To designate to the proper immigration officers such aliens 
as may be in need of hospital care and treatment, as provided 
under the law and these instructions, and to recommend their trans- 
fer to hospital or other suitable place and there supervise or con- 
duct such care and treatment as may be necessary. [Sec. 18, act 
Feb. 5, 1917.] 
21. To designate to the proper immigration officers such arriving 
aliens as it may be necessary to transfer to hospitals for the purpose 
of completing their medical examination. [Sec. 16, act Feb. 5, 
I9I7-] 
22. Upon the request of the proper immigration officers, and in 
accordance with such special departmental authority as may be 
necessary, to determine the physical and mental condition of aliens 
charged with being unlawfully in the United States, and who have 
been taken into custody by the immigration officers under depart- 
mental warrants of arrest. Also, when requested, to submit in 
writing for the information of the Secretary of Labor estimates 
as to the length of time that medical treatment may be needed in 
such cases. [U. S. Immigration Regulations.] 
23. To conduct the physical and mental examination of aliens 
along the borders of Canada and Mexico, subject to such special 
rules and arrangements as the Commissioner General of Immigra- 
tion, with the approval of the Secretary of Labor, may prescribe. 
[Secs. 10 and 23, act of Feb. 5, 1917-] 
The number of alien passengers examined by officers of the 
Public Health Service during the past five years (fiscal) is as 
follows: 
1921 1,137,682 
1922 586,228 
1923 745,515 
1924 938,928 
1925 545,472 
In addition to the passengers, 874,962 alien seamen were ex- 
amined in 1924 and 854,915 in 1925. DEPARTMENT OF THE TREASURY 
135 
Control of Venereal Diseases. The interest of the Public Health 
Service in the control of venereal diseases has been said by officers 
of the Service to date back a good many years. The 1875 annual 
report of the Surgeon General of the Marine Health Hospital 
Service, for instance, contains pertinent information on the subject. 
The Public Health Service has also prepared the medical regula- 
tions for the inspection of arriving aliens and the government's 
interest in venereal disease control in this respect is reflected in 
provisions in these regulations which were in effect for years be- 
fore the commencement of the late war. The fuller participation 
of the Federal Government in the control of venereal diseases was, 
however, promoted, by the revelations of the World War. 
Early in 1918 the Public Health Service urged the state boards 
of health to make specific provision for the control of persons 
afflicted with venereal diseases. By June 30, 1918, twenty-four 
states had made arrangements with the Public Health Service to 
have a Service officer take charge of venereal-disease control in 
cooperation with the state health department. 
In order to perfect organization and to supply additional funds, 
a bill was drafted and introduced into the Senate as Senate 
Bill 4608. This bill, with some changes, was incorporated in 
Chapter XV of the army appropriation act for the fiscal year 1919, 
approved July 9, 1918 (40 Stat. L., 1886).87 
Section 3 of this act provided for the creation of a Division of 
Venereal Diseases of the Public Health Service, while Section 4 
described the duties of this division to be 
(1) to study and investigate the cause, treatment, and preven- 
tion of venereal diseases; (2) to cooperate with state boards or 
departments of health for the prevention and control of such 
diseases within the states; and (3) to control and prevent the 
spread of these diseases in interstate traffic: Provided, That noth- 
ing in this chapter shall be construed as limiting the functions and 
activities of other departments or bureaus in the prevention, con- 
trol, and treatment of venereal diseases and in the expenditure of 
moneys therefor. 
Section 7 provided $200,000 for the establishment and mainte- 
nance of the division during the fiscal year 1919. The same amount 
87 For more detailed review of history of this legislation see pages 110-114. 136 
NATIONAL GOVERNMENT AND HEALTH 
was appropriated in subsequent sundry civil appropriation acts for 
the fiscal years 1920, 1921, and 1922, but in 1923 this sum was 
reduced to $175,000, in 1924 to $127,353, in 1925 to $124,000, and 
in 1926 to $75,000. 
Section 6 of the act of July 9, 1918, appropriated $1,000,000 for 
each of the fiscal years 1919 and 1920 to be paid to states for the 
use of boards or departments of health in the prevention, control, 
and treatment to venereal diseases. This sum was to be allotted to 
each state, in accordance with rules and regulations to be pre- 
scribed by the Secretary of the Treasury, in proportion to the 
population. For the fiscal year 1920 it was provided that each 
state should specifically appropriate or set aside for the prevention, 
control, and treatment of venereal diseases, an amount equal to 
the money allotted by the United States. In a later act $450,000 
was appropriated for the fiscal year 1921 (41 Stat. L., 888) in 
addition to the unexpended balance for the fiscal year 1920. No 
appropriation was made for the fiscal year 1922, but for the fiscal 
year 1923 the sum of $250,000 was appropriated to the Public 
Health Service for allotment to the states in cooperative work in 
the prevention and control of venereal diseases, and for 1924, 
$100,000 was appropriated. In 1925 only $25,000 was allowed for 
state aid, and no appropriation was made for this purpose in 1926. 
The act of July 9, 1918, created also the Interdepartmental Social 
Hygiene Board, consisting of 
The Secretary of War, the Secretary of the Navy, and the Secre- 
tary of the Treasury as ex officio members, and of the Surgeon 
General of the Army, the Surgeon General of the Navy, and the 
Surgeon General of the Public Health Service, or of representa- 
tives designated by the Secretary of War, the Secretary of the 
Navy, and the Secretary of the Treasury, respectively. 
An appropriation of $100,000 for each of the fiscal years 1919 
and 1920 was made to the Board to be paid to scientific institutions 
for discovering more effective medical measures in the prevention 
and treatment of venereal diseases. The Board also received an 
appropriation of $300,000 for each of the years 1919 and 1920, to 
be paid to suitable institutions for the purpose of discovering and 
developing more effective educational measures in the prevention 
of venereal diseases and for the purpose of sociological and psy- DEPARTMENT OF THE TREASURY 
137 
chological research related thereto. A later act (41 Stat. L., 888) 
appropriated $85,000 for medical research and $250,000 for educa- 
tional research for the fiscal year 1921, with the limitation that 
the institutions receiving the grants must set aside a similar amount 
for the same purpose. No appropriation for medical or educational 
research was provided for the fiscal year 1922. 
Section 5 of the act of July 9, 1918, appropriated $1,000,000 for 
the fiscal year 1919 to be expended under the joint direction of the 
Secretary of War and the Secretary of the Navy " for the purpose 
of assisting the various states in caring for civilian persons whose 
detention, isolation, quarantine or commitment to institutions may 
be found necessary for the protection of the military and naval 
forces of the United States against venereal disease." The admin- 
istration of this fund was placed in the hands of the Interdepart- 
mental Social Hygiene Board by these two secretaries. The bal- 
ance of this appropriation unexpended on June 30, 1919, was by 
a later act (41 Stat. L., 178) reappropriated for the fiscal year 
1920. The sundry civil appropriation act for the fiscal year 1921 
appropriated the unexpended balance and $150,000 additional for 
similar purposes during that year (41 Stat. L., 888). 
For the fiscal year 1922 there was appropriated, $200,000 for 
assisting the states in protecting the military and naval forces 
against venereal diseases, and $25,000 for the expenses of the 
Board.88 No appropriation has been made for the Interdepart- 
mental Social Hygiene Board since. On June 20, 1923, the Presi- 
dent issued the following Executive Order, though whether he 
had the power to do so has been queried by supporters of the 
Board: 
It is hereby ordered and directed that the Chairman of the 
United States Interdepartmental Social Hygiene Board, effective 
July 1, 1923, relinquish and transfer to the United States Public 
Health Service, Treasury Department, all files and records, to- 
gether with the filing cabinets in which said files and records are 
now contained, and that upon such relinquishment and transfer 
the United States Interdepartmental Social Hygiene Board shall 
cease and be at an end. 
88 For account of the work of this Board see Manual for the various 
agents of the Interdepartmental Social Hygiene Board, 1920, and Annual 
Report. 138 
NATIONAL GOVERNMENT AND HEALTH 
To sum up, it may be stated that the Interdepartmental Social 
Hygiene Board made grants of money to universities and associa- 
tions for carrying on medical and educational researches concern- 
ing the venereal diseases, and exercised supervision over the 
work resulting from the appropriation for assisting the states in 
caring for civilian persons whose detention, isolation, or quaran- 
tine, or commitment to institutions might be found necessary to 
protect the military and naval forces against venereal diseases; 
the Division of Venereal Diseases of the Public Health Service 
was authorized by law to study and investigate the cause, treat- 
ment and prevention of venereal diseases, to cooperate with 
state departments of health in the control of these diseases, and 
to control and prevent the spread of these diseases in interstate 
traffic.89 The activities of the Interdepartmental Board, aside from 
making grants of money to colleges, institutions, and organizations 
for medical and educational research, consisted chiefly in the pro- 
motion of so called social-protective measures in the interest of 
the military and naval forces. The funds appropriated under Sec- 
tion 5 of the act of July 9, 1918, to be expended under the joint 
direction of the Secretary of War and the Secretary of the Navy, 
were used to defray the expenses of this vice-repressive program. 
Scientific Research. Scientific research is one of the most 
important activities of the Public Health Service and is conducted 
under the general supervision of the Division of Scientific Re- 
search. The subjects investigated include " at least some phase of 
all or nearly all of the major public health problems which confront 
the Nation and in which further research has been required for 
their practical solution." 90 
During 1924 studies were made of cancer, clonorchiasis, food 
poisoning, goiter, influenza, malaria, pellagra, Rocky Mountain 
spotted fever, and typhus fever. Research has also been carried on 
in industrial hygiene and sanitation, public health administration, 
milk control, child hygiene, mental hygiene, stream pollution, 
excreta-disposal, and leprosy. A statistical office is maintained in 
the Division and the Hygienic Laboratory conducts much additional 
noteworthy research. 
89 For detailed outline of activities of Division of Venereal Diseases, 
Public Health Service, see page 135. 
90 Surg. Gen., Annual Report, 1924, p. n. DEPARTMENT OF THE TREASURY 
139 
A report on the cancer studies was issued in 1925. This con- 
sisted of an analysis of the cancer mortality in the ten states which 
formed the original registration area for deaths in 1900, and 
showed that there has been a real increase since that year of the 
cancer mortality in those states. Studies of cell growth and cancer 
are also under way. The goiter study has included a survey of 
thyroid deficiency in about 50,000 school children in Cincinnati. 
The investigation of the epidemiological aspects of influenza has 
included the collection of data regarding respiratory affections 
from about 12,000 students in universities, and 900 families of 
medical officers of the Army, Navy, and Public Health Service. 
The Rocky Mountain spotted fever work was performed at Hamil- 
ton, Montana, and also at the Hygienic Laboratory. 
Studies of malaria have been conducted by the Public Health 
Service for the last ten years, the objective being the control of 
this incapacitating disease in the United States. Headquarters for 
the work, which includes the epidemiology of the disease, rural 
malaria control, control of man-made malaria, fish control of 
malaria, life habits of malaria mosquitoes, and mosquito control, 
are at Memphis, Tennessee. The prevalence and distribution of 
the malady, its engineering control, drainage problems, habits of 
mosquitoes and other entomological features, and fish control have 
all been considered. 
Studies on pellagra, a disease shown by the investigations to be 
due to a deficiency in dietary factors, have been carried on con- 
sistently for nearly two decades, and original and important data 
have been developed. Field investigations have recently been made 
in Georgia, and laboratory studies have been conducted at the 
Hygienic Laboratory. 
Industrial Hygiene and Sanitation. The study of occupational 
diseases and industrial hygiene was first undertaken during the 
fiscal year 1914 under the general authority conferred by the act 
of August 14, IQ12 (37 Stat. L., 309), providing for the study 
and investigation of the " diseases of man and conditions influenc- 
ing the propagation and spread thereof." The scope of this work 
has varied somewhat from year to year, investigations being made 
where the need was considered greatest. During the World War 
attention was concentrated on the industries directly related to the 
successful prosecution of the war, and the work included sanitary 140 
NATIONAL GOVERNMENT AND HEALTH 
surveys of navy yards and of plants making war material, sanita- 
tion at shipyards, malaria relief and sanitation at the government 
explosive plant at Nitro, West Virginia, and a study of poisoning 
in the manufacture of trinitrotoluol. The following investigations 
made at various times indicate the general character of this activity: 
Hygiene of the garment-workers industry in New York City, 
including inspection of places of employment, physical examination 
of employees, and special studies of light and ventilation, with the 
approval of the city health commissioner and at the request of the 
joint board of control of the garment trade. 
Tuberculosis in Cincinnati industries, at the request of the Anti- 
Tuberculosis League and the state and city health authorities. 
Sanitary survey of Indiana industries employing women, at the 
request of a commission appointed by the legislature. 
Trachoma among steel mill workers at Youngstown, Ohio, at the 
request of the Secretary of the Ohio State Board of Health. 
Mine sanitation, diseases of miners, health conditions in blast 
furnace plants and steel mills in Pittsburgh district, in cooperation 
with the Bureau of Mines. 
Health conditions surrounding employment of women and 
hygienic conditions of shop lighting in Wisconsin at the request of 
the Industrial Commission of Wisconsin. 
Health of steel workers. 
Medical and surgical care of industrial workers. 
Industrial fatigue. 
Effect of pneumatic stone cutting tools on health. 
Health conditions in electro-chemical and abrasive plants at 
Niagara Falls with special reference to the employment of women, 
at the request of the Women in Industry Service of the Depart- 
ment of Labor. 
Industrial hygiene at plants at East Chicago, Indiana Harbor, 
and Kalamazoo. 
Occupational hazards in Perth Amboy district, New Jersey, at 
the request of the Department of Labor of New Jersey. 
Survey of health insurance in relation to public health and co- 
ordination of health insurance systems with local agencies. 
Health hazards of the chemical industry and health of the work- 
ers, at the request of a chemical company. 
Health hazards in connection with the manufacture and distribu- 
tion of illuminating gas, at the request of the Bureau of Standards. 
Health hazards of the textile industry, at the request of the 
Department of Labor and Industry of Pennsylvania. 
Visual condition of workers engaged in occupations likely to 
cause eye strain. DEPARTMENT OF THE TREASURY 
141 
Lead poisoning in the pottery industry, at the request of the 
National Brotherhood of Operative Potters. 
Ventilation studies of dusty industries. 
Industrial cross section of New York Harbor industries, at the 
request of the Department of Labor of New Jersey. 
Health hazards in the foundry trades. 
Skin diseases from oil and ink. 
Tellurium as an industrial poison. 
Recent investigations have included (I) Studies of occupational 
health hazards, (2) studies of occupational diseases, (3) studies of 
the causes of industrial absenteeism, (4) studies of the use of 
cyanogen chloride as a new fumigation gas, (5) statistical studies, 
(6) studies of tetra-ethyl lead in gasoline, and (7) cooperation 
with other government departments and industrial agencies. These 
have included ventilation, illumination, and dust investigations, 
fatigue and poisoning studies, posture surveys, and various other 
activities. 
Public Health Administration. In 1921 a committee of the 
American Public Health Association undertook to have made 
surveys of the public health practice of the eighty-three largest 
cities of the United States. The Public Health Service cooperated 
in this work and in 1923 set up an office of administrative health 
practice, office space having been provided at the School of Hy- 
giene and Public Health of Johns Hopkins University. In 1923, 
fifty medical officers and sanitary engineers were assigned to make 
surveys of the one hundred largest cities of the country. This 
work was completed by the end of the fiscal year 1924, and the 
results were being prepared for publication in 1925. 
A demonstration in county health work has been conducted in 
Washington County, Maryland, for several years. 
Milk Investigations. Investigations of milk control, which are 
said to have given a remarkable impetus to the cause of more and 
better milk, have been carried on for several years under the super- 
vision of a sanitary engineer of the Service, with headquarters at 
Montgomery, Alabama. The work has included the following: 
A continuation of the assistance given the State Board of Health 
of Alabama in executing the state-wide milk sanitation program 
previously formulated cooperatively with the Public Health 
Service. 142 
NATIONAL GOVERNMENT AND HEALTH 
Assistance to other states in a consulting capacity relative to 
the problem of state-wide milk sanitation. 
Assistance to individual cities in organizing their milk sanitation 
work. 
s Further studies of the best method of securing the enactment of 
milk legislation. 
Further studies of the best method of insuring the enforcement 
of milk legislation. 
The continuation of studies for the determination of a plan for 
rating the milk sanitation status of municipalities. 
Study of the occurrence of milk-borne outbreaks. 
Studies to determine proper specifications for the design of 
pasteurization machinery. 
Child-Hygiene. The special work of the United States Public 
Health Service for mothers and children is restricted, by reason of 
statutory limitations, to research and education. The Service 
claims, that because of the inter-relation of all health problems, the 
exercise of the general sanitary and other vested functions of the 
Service has not been without beneficial effect on the health of this 
population group. The bearing of the general sanitary work of the 
Service on child health is, in fact, particularly in evidence when 
viewed in connection with epidemiological investigations, and the 
work of the Hygienic Laboratory. 
The special child hygiene activities have been largely confined 
to education and to field studies of conditions subject to improve- 
ment by general health protective measures. In general, field 
investigations have included such studies as the value of dried 
milk in infant feeding, child health administration, school hygiene, 
mouth hygiene, physical development, nutritional status, school 
vision, daylight illumination of class-rooms, the physical and 
mental status of negro school children in urban and rural districts, 
and other problems and measures relating to child health promo- 
tion and protection. The results of these special studies and inves- 
tigations are available in the form of official reports and special 
bulletins. 
Mental Hygiene. Investigations relating to mental health have 
dealt chiefly with the subject of immigration and have been carried 
on for several years by an officer of the Service specially trained 
in this subject. DEPARTMENT OF THE TREASURY 
143 
Statistical Research. In addition to the Division of Sanitary 
Reports and Statistics, which collects morbidity and other data, 
there is a statistical office in the Division of Scientific Research, 
which conducts studies and investigations of special scope. These 
have included studies on the morbidity among industrial workers; 
morbidity in the general population made at the Washington 
County demonstration ; the trend of mortality in the United States; 
and various mortality studies. 
Stream Pollution. Authority to investigate the pollution of 
navigable streams and lakes was conferred expressly on the Public 
Health Service by the act of August 14, 1912 (37 Stat. L., 309). 
This activity was started in 1913, but was temporarily discontinued 
in 1917 owing to the necessity of carrying on work directly con- 
nected with the war. It was again taken up in the summer of 1919. 
Prior to 1917 these operations were carried on in three distinct 
lines: (1) Studies of the pollution of coastal waters, with special 
reference to the contamination of oyster beds; (2) studies of the 
biochemistry and treatment of sewage and industrial wastes; and 
(3) a study of the pollution and natural purification of typical 
rivers. Preliminary studies were made on the Missouri and Poto- 
mac rivers, but the most thorough study has been given to the 
Ohio. This stream was selected because it presents a fair compos- 
ite of the problems encountered in the study of stream pollution 
and purification. This river, like most of the large watercourses, is 
used for two conflicting purposes: as a convenient and cheap 
means for the disposal of sewage and industrial wastes, and as a 
readily available source for domestic water supplies. The repre- 
sentative character of the stream yields results that will be of 
general as well as of local application. 
Laboratory studies are being made of the fundamental factors 
in stream pollution and natural purification, at an especially 
equipped laboratory at Cincinnati, and field surveys are being con- 
ducted of the municipal sewage disposal plants in order to obtain 
detailed data regarding the efficiency of these plants and the cost 
of operation. A collective study of municipal water purification 
is under way, and a study is also being made of the fundamental 
factors involved in the pollution and natural purification of the 
Illinois River. The work on the Ohio River resulted in the estab- 144 
NATIONAL GOVERNMENT AND HEALTH 
lishment of definite quantitative relations between the pollution of 
the stream and the basic factors: population, industrial wastes, 
stream flow, and temperature. The work on the Illinois River has 
been undertaken in order to test, and, if necessary to modify, the 
conclusion drawn from the Ohio River investigation. A study of 
the waters of lower Lake Michigan has likewise been completed. 
Hygienic Laboratory Work. The Hygienic Laboratory of the 
Public Health Service is housed in its own building in Washington, 
D. C. An annual appropriation of about $44,000 is made for the 
purposes of this laboratory and, with these limited funds, much 
valuable research is carried on. 
A laboratory for the making of researches and tests in connec- 
tion with the medical service at the marine hospitals was estab- 
lished in 1887, but general laboratory work was not specifically 
authorized until the passage of the sundry civil appropriation act 
of March 3, 1901 (31 Stat. L., 1137), which made an appropria- 
tion for the erection of a laboratory " for the investigation of 
infectious diseases and matters pertaining to the public health." 
The act of July 1, 1902 (32 Stat. L., 712), provided definitely for 
the organization and management of the Hygienic Laboratory. 
The Hygienic Laboratory is organized into divisions of Pathol- 
ogy and Bacteriology, Zoology, Chemistry, and Pharmacology. 
The scope of this work can be defined only in general terms, and 
an enumeration of some of the completed and current studies will 
best indicate its character. Work in pathology and bacteriology has 
included tuberculosis research studies of specific immunity and the 
treatment of experimental tuberculosis in guinea pigs by means of 
compounds derived from chaulmoogra oil. Studies of pneumonia 
vaccines have been made to determine the efficiency of the agents 
now in use and to increase the protective value of these products. 
Meningitis investigations have comprised technical studies of the 
bacteria and attempts to improve methods of testing the potency 
of commercial serums. Anti-rabic vaccine virus for one thousand 
seven hundred and two treatments was manufactured in one year 
and sent to state health organizations. In addition thirty-one 
patients were given the Pasteur treatment. 
In the field of pharmacology special attention has been paid to 
the chemotherapy of syphilis and related diseases. This work DEPARTMENT OF THE TREASURY 
145 
has followed four distinct lines : (i) Biological standardization of 
commercial arsphenamine and neoarsphenamine, the standard reme- 
dies for syphilis ; (2) a study of the causes of arsphenamine intoxi- 
cation and methods of prevention; (3) investigation of the mode 
of action of the remedies on the parasites; and (4) a study of 
methods of treating syphilis in the central nervous system. Other 
work included studies of hookworm remedies, of the food value 
of dried milk, and of poisoning by trinitrotoluol, and the compila- 
tion of comments of the United States Pharmacopoeia. 
Chemical researches include work on the disposal of chemical 
wastes, the use of ultra-violet rays in water purification, the use of 
ozone in ventilation, the composition of reconstructed milk, the 
detection and estimation of poisonous nitro compounds, the detec- 
tion and estimation of impurities in arsphenamine and neoarsphena- 
mine, and the determination of the preservatives used in therapeu- 
tic serums. A fundamental research into the role of oxidation- 
reduction phenomena in the biology of public health is in progress. 
In the field of zoology the work has included studies of human 
excreta, the continuance of the preparation of the index to medical 
and veterinary zoology, and examinations for intestinal parasites. 
Among special investigations of the last five years have been 
studies of tularaemia, tuberculosis, pneumonia, malta fever, tra- 
choma, and narcotic drug addiction. Students sent by the health 
section of the League of Nations and from other sources have been 
stationed at the Laboratory at various times. 
Control of Biologic Products. The tests of biologic products 
applicable to the diseases of man and the licensing of manufacturers 
are carried on under authority of the act of July 1, 1902 (32 Stat. 
L., 728). This act provided for a board composed of the Surgeon 
General of the Army, the Surgeon General of the Navy, and the 
Supervising Surgeon General of the Marine Hospital [Public 
Health] Service, which was given authority, subject to the approval 
of the Secretary of the Treasury, to promulgate regulations gov- 
erning the licensing of establishments engaged in the " propagation 
and preparation of viruses, serums, toxins, antitoxins, and analo- 
gous products, applicable to the prevention and cure of diseases of 
man, intended for sale in the District of Columbia," or to be 
carried or sold in interstate or foreign commerce. The act makes 146 
NATIONAL GOVERNMENT AND HEALTH 
it unlawful to transport or sell in interstate or foreign commerce 
any such preparation unless it has been prepared at an establish- 
ment licensed by the Secretary of the Treasury, and unless each 
package is marked with the name and license number of the manu- 
facturer and the date beyond which the contents can not be 
expected to yield " their specific results." The execution of the act 
was placed in the hands of the Secretary of the Treasury, whose 
agents were given power to inspect the premises of any establish- 
ment manufacturing these products. All of the tests and inspec- 
tions have been made by the Public Health Service, which in 
recent years has had specific appropriations for this1 work. 
The first regulations under this act were promulgated February 
21, 1903, and asi the law required an interval of six months before 
the regulations became effective, they were not in force until 
August 21, 1903. Since that time this work has been carried on 
continuously in the Hygienic Laboratory of the Service. 
Before a license is granted, a medical officer detailed as inspector 
visits the establishment manufacturing the product and reports on 
the sanitary and technical conditions observed. In case application 
is made for a license for a new product, laboratory or clinical tests 
are made when practicable to determine whether the agent has any 
therapeutic or prophylactic value. A report is made to the Surgeon 
General, and if the conditions in the manufacturing plant are satis- 
factory, if the product passes certain tests, and in some cases the 
Service believes that the product has prophylactic or therapeutic 
value, a recommendation is made to the Secretary of the Treasury 
that a license be issued. This license is effective for one year unless 
revoked for faulty methods of preparation, faulty construction or 
administration of the establishment, or impurities or lack of po- 
tency, where a potency test is feasible, or products which may be 
disclosed by laboratory examination. Samples of the various prod- 
ucts are purchased from time to time in the open market and 
examined in the Hygienic Laboratory for both purity and potency. 
The examinations of biologic products are made with the view 
of determining their purity and, in some cases, their potency. The 
determination of purity is a comparatively simple technical process, 
but considerable original work was necessary to establish stand- 
ards by which to measure potency. One of the first steps taken by DEPARTMENT OF THE TREASURY 
147 
the Hygienic Laboratory after the passage of the act of July I, 
1902, was to duplicate the unit for measuring the strength of 
diphtheria antitoxin established and made by Ehrlich at his labora- 
tory at Frankfort-on-the-Main.01 
The necessity for a similar standard for measuring the dosage of 
tetanus antitoxin was early recognized, and after much highly 
technical work a satisfactory standard was prepared. Prior to the 
adoption of this unit there were as many standards as there were 
manufacturers. The variation in the units is shown by the fact 
that one serum claiming six million units per cubic centimeter 
showed only ninety units according to the Service standard, while 
another serum claiming only seventy-five units per cubic centimeter 
showed seven hundred and sixty-nine units to the new standard.02 
Standards of potency have been developed for certain other 
products of this character, and this work is being continued. 
Since November 30, 1917, the Service has paid particular atten- 
tion to the control of the remedy for syphilis previously known 
under the trade name " Salvarsan," " 606," " arsenobenzol," and 
" arseminal." This was a German product which was protected by 
patents and which had been manufactured to only a small extent 
in this country under license from German owners of the patent. 
The Trading with the Enemy Act, approved October 12, 1917 
(40 Stat. L., 420), gave the President power to authorize the use 
of patents owned by enemy subjects, and on the same date the 
President issued an executive order vesting in the Federal Trade 
Commission, the power to grant licenses for the manufacture of 
products covered by enemy owned patents. In accordance with 
this authority the Federal Trade Commission gave the name 
" arsphenamine " to these products, and all licenses for their manu- 
facture required compliance with such rules and standards as 
might be established by the Public Health Service. In addition to 
routine tests, studies were made of methods of manufacture in 
order to overcome some of the difficulties. As a result the manu- 
facturers were able to increase their output and produce a drug 
of a higher quality. 
Regulations governing the manufacture and sale of arsphena- 
mine, neoarsphenamine, and sodium arsphenamine, were approved 
91 Surg. Gen., Annual Report, 1920, p. 375. 
92 Ibid., pp. 26-52. 148 
NATIONAL GOVERNMENT AND HEALTH 
by the Secretary of the Treasury June 21, 1920, under the authority 
of the act of July 1, 1902. The importance of the regulation of 
arsphenamine is evidenced by the fact that six million doses are used 
in this country each year.93 
In 1925 licenses were issued to thirty-six establishments making 
biological products in this country and eleven in foreign coun- 
tries.94 During 1924 sterility tests were made on 1315 specimens, 
and potency tests on 967. 
Statistics and Reports. The collection and publication of statis- 
tical information was first authorized by the act of April 29, 1878 
(20 Stat. L., 37), which provided that consular officers should make 
reports on sanitary conditions and that the Surgeon General of the 
Marine Hospital Service should transmit to medical officers of the 
Service, to collectors of customs, and to state and municipal health 
authorities, weekly abstracts of the consular sanitary reports and 
other pertinent information. The act related to quarantine, and the 
evident purpose was to disseminate information regarding condi- 
tions in foreign countries. Bulletins were issued weekly from July 
13, 1878, to May 24, 1879. These were published by a manifold 
process and were not printed until 1881. The act of March 3, 
1879 (20 Stat. L., 484), created the National Board of Health to 
which was assigned the duties pertaining to quarantine and collect- 
ing and disseminating information relating to sanitary conditions, 
the grant of authority to the Marine Hospital Service being re- 
pealed. From July 5, 1879, to July 1, 1883, statistical information 
was published by the National Board of Health. 
The provisions of the act of March 3, 1879, were limited to four 
years, so that the duties of distributing statistical information 
automatically devolved upon the Marine Hospital Service on March 
4, 1883, but the publication of statistics was not resumed until 
January 27, 1887. This statistical work has been carried on con- 
tinuously since that time. The weekly publication containing 
current statistics was known as the Weekly Abstract of Sanitary 
Reports from 1887 to 1895 ; since 1895 it has been known as Public 
Health Reports. 
The quarantine act of February 15, 1893 (27 Stat. L., 449), 
reestablished the earlier authority to obtain and publish informa- 
83 House Committee on Appropriations, Hearings on sundry civil appro- 
priations bill for 1922, p. 392. 
84 List given in Public Health Reports for May 29, 1925. DEPARTMENT OF THE TREASURY 
149 
tion on the sanitary conditions in foreign countries and in addi- 
tion directed the Secretary of the Treasury to obtain weekly reports 
on the sanitary conditions at ports and places within the United 
States. Both foreign and domestic mortality statistics have been 
published for some years, but the collection of domestic morbidity 
statistics was not started until 1906, the first publication of these 
statistics being on October 19. 
At present the statistical material in the Public Health Reports 
consists of weekly mortality statistics for principal cities (collected 
by the Bureau of the Census) ; weekly morbidity reports for com- 
municable diseases for cities, received by mail; weekly morbidity 
reports for communicable diseases for states, received by telegraph ; 
monthly morbidity reports for states, received by mail; and reports 
on communicable diseases in foreign countries, received by mail or 
cable. The telegraphic reports by states are published within one 
week, and the mail reports by cities within three weeks. At the end 
of the fiscal year, 1924, weekly telegraphic reports were received 
from thirty-seven states and monthly mail reports from forty-five 
states, the District of Columbia, and Hawaii. The state reports 
contain statistics on the prevalence of the following diseases: 
anthrax, cerebrospinal meningitis, dengue, diphtheria, influenza, 
pneumonia, leprosy, measles, poliomyelitis (infantile paralysis), 
rabies in man, Rocky Mountain spotted (or tick) fever, scarlet 
fever, smallpox, typhoid fever, and typhus fever. 
In the field of morbidity statistics an endeavor is made to obtain 
weekly reports by mail from all cities which have a population of 
10,000 or over. During the fiscal year 1924, reports were received 
from 564 cities. An endeavor is made to obtain reports of deaths 
from all causes and of new cases and of deaths from the following 
diseases: Anthrax, chancroid, gonorrhea, influenza, leprosy, ma- 
laria, cerebrospinal meningitis, pellagra, pneumonia, poliomye- 
litis (infantile paralysis), rabies (in animals), smallpox, syphilis, 
tetanus, typhoid fever, diphtheria, measles, scarlet fever, tubercu- 
losis, and typhus fever. Weekly statistics are published for all these 
with the exception of the venereal diseases. 
Statistics on foreign countries are published as soon as received 
or compiled. These are obtained from Public Health Service 
officers, from American consuls, and from official reports of foreign 
countries and municipalities. 150 
NATIONAL GOVERNMENT AND HEALTH 
In addition to the publication of current statistics for use of 
health officers, the Service also undertakes to analyze available sta- 
tistics in order to obtain information regarding the incidence of 
certain diseases and to aid in defining fields in which intensive 
studies might be made to advantage. 
In connection with the morbidity report, studies are made of the 
following: (i) The report forms actually in use for the purpose 
of developing a standardized set, (2) the report forms used for 
certain acute infectious diseases from the point of view of health 
administration and the collection of epidemiological data, and (3) 
the possibilities of the statistical use of the data so collected. 
In the field of mortality, studies are made of specific mortality 
rates from certain causes and the trend of mortality from certain 
important causes. 
Current statistics of disease prevalence among sample groups of 
industrial establishments and employee sick-benefit associations 
are secured through the cooperation of the plants and associations. 
The data are compiled, analyzed, and published currently. 
In 1925 a morbidity registration area was proposed.86 More than 
four thousand collaborating and assistant collaborating epidemiolo- 
gists in the states are authorized by law to use government " pen- 
alty " envelopes in collecting morbidity data. Congress has not 
as yet seen fit to make a definite appropriation for these statistics. 
In addition to its work in collecting data, the Division of Sanitary 
Reports and Statistics issues annual compilations of new state health 
legislation, edits the weekly Public Health Reports, sends out health 
information, and gives radio talks. The Scientific Research Divi- 
sion edits the pamphlets and bulletins of the Service. 
Organization. The head of the Public Health Service is the 
Surgeon General, who, under the direction of Secretary of the 
Treasury and an Assistant Secretary, is responsible for the super- 
vision of all matters connected with the administration of the 
affairs of the Service. He is directly assisted by an executive officer, 
who acts on behalf and by order of the Surgeon General in all 
matters of routine administration. The detailed work of the Service 
9S See Lloyd, B. J., Plan to establish in the United States a morbidity 
registration area, Public Health Reports, July 24, 1925. DEPARTMENT OF THE TREASURY 
151 
is carried on by means of the following administrative units, which 
report directly to the Surgeon General: 
Office of Chief Clerk 
Inspection Service 
Division of Personnel and Accounts 
Hospital Division 
Division of Venereal Diseases 
Division of Domestic (Interstate) Quarantine 
Division of Foreign and Insular Quarantine and Immigration 
Division of Sanitary Reports and Statistics 
Division of Scientific Research 
The Office of the Chief Clerk, the Inspection Service, and the 
Division of Personnel and Accounts are institutional units, as 
they are concerned entirely with matters relating to the operation 
of the Service, and do not carry on any of the activities for which 
the Service exists. These units assist the other units in carrying 
on their work. The other seven units are functional, as they are 
concerned with the administration of specific laws or the direc- 
tion of investigations undertaken by authority of law. 
Office of the Chief Clerk. The Office of the Chief Clerk has 
general supervision over the routine matters connected with the 
administration of the business of the Service of the bureau or- 
ganization in Washington. On the personnel side this work in- 
cludes, for the clerical, messenger, and labor force, the making of 
appointments, promotions, and demotions, the assignment of 
employees, granting leaves of absence, enforcing discipline, keep- 
ing records of attendance and leaves of absence, and preparation 
of pay-rolls. Other duties are the administration of a library 
containing over 10,000 volumes, the furnishing of supplies of all 
kinds for the bureau in Washington, the care of buildings, the 
supervising of telephone and motor car service, the custody of the 
files and archives, the furnishing of stationery and printed forms 
to both the Washington office and the field stations, the prepara- 
tion and transmittal of requisitions for printing publications, 
the execution of multigraph and mimeograph work, and the prep- 
aration and custody of mailing lists. It should be noted that the 
Chief Clerk has no supervision over the Hygienic Laboratory, 
which is a field station. 
During 1924 the number of employees on duty at the Bureau 
was 261. 152 
NATIONAL GOVERNMENT AND HEALTH 
Inspection Service. The Inspection Service as an adminis- 
trative unit was created as a result of the increase in the hospital 
work during 1919 and 1920, and also because of the very apparent 
necessity for closer supervision of all of the lines of activity pur- 
sued by the Public Health Service. Formerly all charges and 
complaints were investigated by an officer specially detailed for 
that purpose, but the increase in number of complaints resulting 
from the rapid growth of the hospital service led to the creation 
of an inspection section in the Hospital Division during the early 
part of the fiscal year 1920. Under this arrangement the Hospital 
Division had charge of the investigation of all matters relating to 
hospitals, while officers were specially detailed to make needed in- 
vestigations of other branches of the Service. The Hospital Divi- 
sion was thus investigating its own operations. It was felt that 
more satisfactory results would be obtained if an independent 
agency, reporting directly to the Surgeon General, were estab- 
lished for inspection purposes, and accordingly the Inspection 
Section was created on February 16, 1920. This was changed to 
the General Inspection Service by the regulations approved 
August 29, 1920. 
The Inspection Service makes routine inspections of hospitals 
operated by the Service and other stations and establishments 
pertaining to the other divisions. In addition to these routine 
examinations the Inspection Service investigates complaints 
against any division, establishment, or branch of the Service. The 
inspector is authorized to take testimony under oath in order to 
ascertain the truth of the charges. Annual inspections of property 
reported unserviceable are made by the Inspection Service in order 
to provide for its disposal. 
The Inspection Service is in the charge of an assistant surgeon 
general, assisted by an executive officer. The Washington office 
of the Inspection Service is divided into the Section of Records 
and Correspondence and the Section of Reviews and Reports. The 
Section of Records and Correspondence has charge of the files 
of the Service and looks after the clerical details relating to the 
correspondence. The Section of Reviews and Reports examines 
the findings of the field inspector in order to determine whether 
the inspection fully covers the ground and makes recommenda- 
tions regarding the action to be taken. The work of the field in- DEPARTMENT OF THE TREASURY 
153 
Spectors is generally confined to the determination of facts, but the 
Section of Reviews and Reports drafts recommendations to the 
Surgeon General regarding the remedial action, disciplinary or 
other, that should be taken. 
There are now two inspection areas, the Eastern and the West- 
ern. During 1924, twenty-five marine hospitals, 109 second-, third-, 
or fourth-class stations; and 165 contract hospitals were under 
inspection by four officers detailed for the purpose. 
Division of Personnel and Accounts. The Division of Per- 
sonnel and Accounts has charge of the payment of all vouchers, 
the record of disbursements from various appropriations, and all 
matters relating to the appointment, promotion, and discipline of 
commissioned officers, personnel of every character in the field, 
and the technical and scientific personnel in Washington. In the 
field, special disbursing officers are stationed at the large centers 
in order to avoid the delay incident to transmitting vouchers to 
Washington for payment. 
The activity of this Division in the work of personnel adminis- 
tration consists in arranging for the appointment and all changes 
of status of commissioned officers, employees of every character 
in the field, and technical and scientific employees in Washington. 
It also, by direction of the Surgeon General, convenes boards for 
the examination of applicants for appointment, for the examina- 
tion of employees entitled to promotion, for the investigation of 
commissioned officers, and for other purposes. 
The Division is in the charge of an assistant surgeon general 
the organization being as follows: 
1. Office of Chief of Division 
2. Personnel Section 
1. Medical and Scientific Personnel Unit 
2. General and Technical Personnel Unit 
3. Travel Unit 
3. Finance and Accounts Section 
1. Transportation Audit Unit 
2. Voucher Auditing Unit 
3. Payroll Audit Unit 
4. Bookkeeping Unit 
4. Property Section 
Hospital Division. The Hospital Division has charge of all 
medical relief except that furnished by the trachoma hospitals and  NATIONAL GOVERNMENT AND HEALTH 
154 
clinics and the leper hospital at Kalihi, Hawaii. Its work includes 
the maintenance and operation of Service hospitals, the furnish- 
ing of medical relief at other stations of the Service, the placing 
of patients in contract hospitals, and the making of physical 
examinations. 
The marine hospitals are known as relief stations of the first 
class. Each hospital reports directly to the Hospital Division. 
Each hospital is in the charge of a medical officer, who is assisted 
by a professional and administrative staff. 
Marine hospitals are located as follows: 
Number and location 
Year in 
which relief 
activities 
were begun 
Date 
present 
hospital was 
built or acquired 
Capacity 
i. Baltimore, Md 
1802 
1887 
167 
2. Boston, Mass 
1798 
i860 
170 
3. Buffalo, N. Y 
1873 
I909 
60 
5. Chicago, Ill 
1852 
1873 
125 
6. Cleveland, Ohio 
1852 
1852 
83 
7. Detroit, Mich 
l8S7 
1857 
80 
8. Evansville, Ind 
1856 
1892 
48 
9. Ft. Stanton, N. Mex 
1899 
1899 
261 
10. Key West, Fla 
1840 
1845 
40 
11. Louisville, Ky 
1847 
1856 
60 
12. Memphis, Tenn 
1870 
1884 
50 
13. Mobile, Ala 
1834 
1840 
80 
14. New Orleans, La 
1802 
1885 
250 
15. Pittsburgh, Pa 
1851 
1910 
60 
16. Portland, Me 
1802 
1859 
42 
17. Port Townsend, Wash 
1855 
1895 
102 
18. St. Louis, Mo 
1840 
1882 
70 
19. San Francisco, Calif 
1849 
1875 
320 
20. Savannah, Ga 
1873 
1906 
85 
21. Stapleton, N. Y 
1802 
1883 
288 
22. Vineyard Haven, M'ass 
1798 
1895 
24 
43. Ellis Island, N. Y 
1802 
1919 
340 
66. Carville, La 
1921 
1921 
213 
70. New York City 
I§02 
1919 
23 
82. Norfolk, Va 
1798 
1919 
217 
The Fort Stanton hospital is for the tuberculous and the Car- 
ville hospital is for lepers. All the others are for general medical 
and surgical patients. 
Dentistry has been introduced in all the marine hospitals and is 
also available at twenty-one other relief stations. The Service 
now has twenty-five full-time dental officers and twenty-nine part- 
time contract dentists. There is also a nursing section in the Divi- 
sion of Hospitals and Relief, in the charge of a Superintendent of DEPARTMENT OF THE TREASURY 
155 
Nurses, who is likewise in charge of all reconstruction aides, 
dietitians, librarians, and social service workers. Of four hundred 
women engaged in these activities, 360 are nurses. 
Division of Venereal Diseases. The functions and duties of 
the Division of Venereal Diseases as imposed by the act of July 9, 
1918, are (1) To study and investigate the cause, treatment, and 
prevention of venereal diseases ; (2) to cooperate with state boards 
or departments of health for the prevention and control of such 
diseases within the states; and (3) to control and prevent the 
spread of these diseases in interstate traffic. 
The general scope of these duties comprise the following 
activities: 
1. Cooperation with state departments of health for the preven- 
tion and control of venereal diseases within the states. 
a. Detailing personnel to promote community interest by 
conferences with local authorities, civic organizations, editors, 
other public-spirited citizens, nurses, midwives, social and pro- 
bation workers, for the purpose of ameliorating conditions 
which facilitate the spread of venereal diseases. Examples of 
such conditions are: lack of examination and treatment 
facilities for indigent men, women and children; lack of legal 
authority and organization of the health department; commu- 
nity, newspaper and institutional disinterestedness ; lack of 
venereal disease publicity; inertia in tracing sources of infec- 
tion and in cooperating with other communities and states in 
controlling the travel of infected itinerants. 
b. Promoting home and school instruction in fitness and in 
sex education as an aid in the prevention of venereal diseases. 
c. Delivering venereal disease lectures to selected groups, 
such as industrial, commercial, and domestic employees. 
d. Making available to health authorities and, through them, 
to others, literature, films, exhibits and slides relating to the 
medical, legal, administrative and socio-economic aspects, for 
the prevention and control of venereal disease within the states. 
2. Studies and investigations of the cause, treatment, and pre- 
vention of venereal diseases. 
The cooperative work with the states affords concurrent 
opportunities for the practical study and investigation of the 
various conditions encountered, and results are utilized by 
the division in preparing educational facilities and literature 
for use in its cooperative work. 
The division also studies and investigates the literature, 
laws, reports and conditions in this and other countries relat- 156 
NATIONAL GOVERNMENT AND HEALTH 
ing to the cause, treatment and prevention of venereal diseases, 
and it disseminates this information by publications, news 
releases and by correspondence in special cases. 
Clinical studies and investigations are made at the Hot 
Springs Clinic, and all patients treated there are given special 
instruction in the necessity for the early detection of the dis- 
eases and their prompt and adequate treatment. Such patients 
are also instructed in the regulations controlling the interstate 
travel of infected persons, and they are enlisted as venereal 
disease educators in their respective communities. Sociologi- 
cal studies of this pilgrimage group are carried on, and efforts 
are made to induce them to continue treatment at their own 
homes. Reports are made to the health officers and physicians 
at the patients' homes in order to vouchsafe the continuance 
of treatment as well as to secure the examination and neces- 
sary treatment of members of their families. 
3 . Control of venereally infected persons in interstate traffic. 
Regulations defining conditions under which venereally 
infected persons may engage in interstate travel are promul- 
gated by the Secretary of the Treasury under authority of the 
Quarantine Act of 1893. Efforts are made to promote obser- 
vance of these regulations by cooperation with state and local 
health authorities, with hospitals frequented by interstate 
travelers, and with agencies procuring laborers for work in 
other states. 
The Division distributes printed information and instruc- 
tions concerning procedural methods required in connection 
with this undertaking. 
Division of Domestic (Interstate) Quarantine. The work of 
the Division of Domestic Quarantine is directed mainly toward 
the control of the spread of communicable diseases. When a dis- 
ease is epidemic in any section it is the function of this Division to 
take such steps as may be necessary to prevent its spread into 
other states. With the view of preventing the spread of epidemic 
diseases this division formulates the interstate quarantine regula- 
tions which govern the movement of infected persons in interstate 
travel and looks after their enforcement. Much of the work look- 
ing to the sanitation of railroad cars has been taken up in coopera- 
tion with the American Railway Association, which has given 
warm support to all suggestions looking to improved sanitary con- 
ditions on railroads. The greater part of the work of this division 
is devoted to building up and improving divisions of communicable DEPARTMENT OF THE TREASURY 
157 
diseases and sanitary engineering in state health departments. In 
order to accomplish this purpose, investigations of outbreaks of 
communicable disease are made at the request of state health 
authorities by medical officers or sanitary engineers of the Service. 
The work of this division is entirely in the field of control and' the 
stimulation of the health activities of the states. It does not make 
any investigations of the causes of and remedies for diseases. 
Studies of the causes of disease are made by the Division of 
Scientific Research, the practical application of the preventive mea- 
sures falling properly within the scope of activity and operations 
of the Division of Domestic Quarantine. 
This division has charge of the trachoma hospitals, clinics, and 
demonstration work, of the special work for the suppression of 
plague, of the certification of water supplies for use by interstate 
carriers, and of the sanitary inspection of certain national parks. 
An assistant surgeon general is in charge. 
Division of Foreign and Insular Quarantine and Immigration. 
The Division of Foreign and Insular Quarantine and Immigration 
has charge of quarantine administration and the inspection of 
immigrants at ports and border stations. In connection with both 
these activities, medical officers are stationed at foreign ports. 
Information regarding the prevalence of disease in foreign ports 
is also furnished by consular officers. 
Quarantine officers for the examination of vessels and passen- 
gers are stationed at sixty-eight places in the Continental United 
States, two in Alaska, seven in Hawaii, ten in Porto Rico, three in 
the Virgin Islands, seven in the Philippines, and thirty in foreign 
countries. In addition one medical officer is detailed for duty under 
the Governor of the Panama Canal as chief quarantine officer of 
the Canal Zone. All officers in charge of quarantine stations report 
directly to the Chief of the Division of Foreign and Insular Quar- 
antine and Immigration. The equipment and personnel at these 
stations vary considerably. Important stations have several medi- 
cal officers, a corps of attendants, and an extensive plant for the 
detention of passengers and the fumigation of vessels and cargo. 
At others only a single medical officer is available to make the 
examination, and to remand the vessel to one of the larger stations 
if detention or fumigation is necessary.  NATIONAL GOVERNMENT AND HEALTH 
158 
The fumigation of forecastles on American ships, as required 
by the act of March 4, 1915 (38 Stat. L., 1166), is under the 
supervision of this Division. 
The medical inspection of immigrants and of alien seamen is 
carried on at one hundred and ten stations in the Continental 
United States, at eight in Canada, one in Alaska, and at several in 
the insular possessions. At some stations where there are few 
immigrants, the inspection is made by the officer in charge of the 
quarantine station. At the more important points for the entry of 
immigrants there is a staff of inspectors. Medical officers engaged 
in the inspection of immigrants certify their finding to the local 
commissioners of immigration or to local boards of inquiry. In 
their reports to the Public Health Service, they correspond directly 
with the Chief of the Division of Foreign Quarantine and Immi- 
gration. 
An alien certified for mental defects may appeal to a board of 
medical officers appointed by the Surgeon General. 
The Division of Foreign Quarantine and Immigration is in the 
charge of an assistant surgeon general. Its work is carried on 
almost entirely in the field, only seven persons in addition to the 
assistant surgeon general being employed in the Washington office. 
Division of Sanitary Reports and Statistics. The Division of 
Sanitary Reports and Statistics has charge of the collection of 
morbidity statistics and the publication of Public Health Reports. 
The statistics published in Public Health Reports are compiled by 
this division, but that publication contains also short articles on 
the cause, prevention, or control of disease, information regarding 
sanitation and the public health, changes in regulations, and other 
matters of interest to health officers and physicians. The general 
articles are contributed by all the other divisions of the Service. 
This division receives weekly telegraphic and monthly mail re- 
ports of communicable diseases from state boards of health, weekly 
mail reports on communicable diseases from city health authorities, 
and mail and cable reports from Service officers and American con- 
suls in foreign countries. Each agency reporting is supplied with 
cards or forms on which to insert the statistics desired. The reports 
are reviewed in the Division of Sanitary Reports and Statistics and 
prepared for publication. In addition to the periodic reports, state 
health officers and service officers report by telegraph any unusual DEPARTMENT OF THE TREASURY 
159 
occurrence of diseases which may be spread through interstate 
traffic. 
In order to stimulate the collection of accurate statistics, collab- 
orating epidemiologists and assistant collaborating epidemiologists 
are appointed for states and minor subdivisions respectively. These 
officers serve at the nominal salary of one dollar a year. Collaborat- 
ing epidemiologists are state health officers designated by the state 
health department. 
The processes involved in the scheme of collecting morbidity 
data through collaborating epidemiologists and assistant collaborat- 
ing epidemiologists are indicated in the following outline: 
i. Reports of the occurrence and location of individual cases of 
communicable diseases by practicing physicians to the assistant col- 
laborating epidemiologists on duty at the local health office, where 
all the information becomes available for primary use by the local 
health officer for the control of disease within his jurisdiction. 
2. Reports of cases of communicable disease and local health 
status by the assistant collaborating epidemiologists to the collab- 
orating epidemiologist on duty at the state health office, where the 
information may be used, in turn, by the state health officer. 
3. Reports of cases of disease and general health conditions 
within states by the collaborating epidemiologists to the Public 
Health Service.30 
Statistics and statements on the prevalence of communicable 
diseases in foreign countries are received by mail and cable from 
Public Health Service officers and American consuls. These re- 
ports go first to the Division of Foreign Quarantine and Immigra- 
tion, which makes note of any facts that may be of value in con- 
nection with the quarantine work or the medical inspection of 
immigrants. They are then sent to the Division of Sanitary Reports 
and Statistics, which prepares the material for publication in the 
Public Health Reports. Data of this character are obtained also 
from the official publications of foreign countries and munici- 
palities. 
The compilation of laws, ordinances, and judicial decisions 
relating to public health is made in this Division. These items are 
published in Public Flealth Reports as received, and later state 
laws, municipal ordinances, and judicial decisions are brought 
together in separate compilations. 
96 Surg. Gen., Annual Report, 1920, p. 205. 160 
NATIONAL GOVERNMENT AND HEALTH 
The Section of Public Health Education of the Division of 
Sanitary Reports and Statistics distributes the publications of the 
Service, particularly those designed for the use of the general 
public. Requests for specific publications are answered by this 
section, which also supplies information in reply to inquiries in the 
field of general medicine, sanitation, and hygiene. Technical inqui- 
ries on special subjects not covered by the publications of the 
Service are answered by the division having supervision over the 
particular class of work. 
This section also prepares bulletins for popular use, and dis- 
seminates public health information by means of articles given to 
the press and question and answer columns in newspapers. 
The Division is organized as follows: 
I. Office of Chief of Division 
2. Administrative Section 
3. Editorial Section 
4. Morbidity Reports Section 
1. United States 
a. Collaborating and Assisting Collaborating Epide- 
miologists at various places 
2. Foreign 
5. Legal Section 
6. Section on Public Health Education 
7. General Statistical Office 
The Division of Sanitary Reports and Statistics is in charge of 
an assistant surgeon general. 
Division of Scientific Research. The Division of Scientific Re- 
search has a more elaborate organization than any other division 
in the Public Health Service, as its work is not confined to one or 
two specific purposes like that of the other units. Its duties are 
primarily to investigate the causes of disease and methods of 
treatment, while the work of the other divisions is primarily to 
apply the principles developed, as well as those of general medi- 
cine and hygiene, to the specific work committed to their care. The 
work of this division includes the indefinite field described in the 
act of August 14, 1912 (37 Stat. L., 309), namely, of the "dis- 
eases of man and conditions influencing the propagation and spread 
thereof, including sanitation and sewage and the pollution either 161 
DEPARTMENT OF THE TREASURY 
directly or indirectly of the navigable streams and lakes of the 
United States." 
With such a wide range of potential activity, the work and 
organization of the Division vary considerably from time to time, 
as problems are disposed of and new ones taken up. The outline 
below shows the organization of the work in progress at present. 
i. Office of Chief of Division 
2. Hygienic Laboratory 
i. Division of Zoology 
2. Division of Pathology and Bacteriology 
3. Division of Pharmacology 
4. Division of Chemistry 
3. Control of Biologic Products 
4. Malaria 
5. Child Hygiene 
6. Industrial Hygiene and Sanitation 
7. Nutrition 
8. Stream Pollution 
9. Mental Hygiene 
10. Leprosy Investigation Station 
11. Studies of Public Health Administration 
12. Morbidity statistics 
13. Rocky Mountain spotted fever 
14. Cancer 
15. Influenza and pneumonia 
16. Clonorchiasis 
17. Goiter 
18. Milk 
19. Housing 
This division is in charge of an assistant surgeon general, and 
the general direction of all field investigations is from the Wash- 
ington office, but in many studies headquarters are established in 
the field and the details of the work are directed from field head- 
quarters. The Hygienic Laboratory is located at Washington. The 
laboratories of marine hospitals and quarantine stations are uti- 
lized for field investigations, but the Division of Scientific Research 
does not exercise any control over the routine work of these 
laboratories undertaken in connection with medical treatment. 
This division also assists other divisions of the Service in the 
preparation of statistical material needed in connection with gen- 162 
NATIONAL GOVERNMENT AND HEALTH 
eral studies of the diseases of man. In this connection it operates 
a general statistical office which was established for the following 
purposes: 
1. To furnish, in connection with many other lines of service 
activities, the technical advice required in planning their statistical 
work and in the analyses of the results. 
2. To conduct certain statistical studies independently but closely 
coordinated with other field and epidemiological studies carried on 
by the Public Health Service. 
3. To provide a central plant, with experienced personnel and 
necessary mechanical equipment, for the tabulation of material 
collected in previous studies and reports of disease prevalence. 
Public Health Districts. In 1923 the Continental United States 
was divided into seven Public Health Districts and an experienced 
officer of the Public Health Service was placed in charge of each, 
with the object of bringing about closer coordination of the various 
activities of the service. The boundaries of the Interstate Sani- 
tary Districts were changed at the same time to correspond to these 
districts. In January, 1925, a rearrangement of districts was 
effected, as follows: 
Public Health District No. 1.... 
(District of the North 
Atlantic) 
Comprising the States of Maine, 
New Hampshire, Vermont, 
Massachusetts, Rhode Island, 
Connecticut, New York and 
New Jersey. District Direc- 
tor, Assistant Surgeon Gen- 
eral Rupert Blue. 
Public Health District No. 2.. .. 
(District of the Middle 
Atlantic) 
Comprising the States of Penn- 
sylvania, Delaware, Maryland, 
District of Columbia, West 
Virginia, Virginia, North Caro- 
lina, South Carolina, Kentucky, 
and Tennessee. District Direc- 
tor, Surgeon B. S. Warren. 
Public Health District No. 3.. .. 
(District of the Great Lakes 
and the Missouri) 
Comprising the States of Ohio, 
Indiana, Illinois, Wisconsin, 
Michigan, Missouri, Iowa, 
Minnesota, North Dakota, 
South Dakota, Nebraska and 
Kansas. District Director, 
Senior Surgeon C. C. Pierce. DEPARTMENT OF THE TREASURY 
163 
Public Health District No. 4.... 
(District of the Gulf) 
Comprising the States of Flori- 
da, Georgia, Alabama, Missis- 
sippi, Louisiana, Texas, Okla- 
homa, and Arkansas. District 
Director, Surgeon John Mc- 
Mullen. 
Public Health District No. 5.. .. 
(District of the South 
Pacific) 
Comprising the States of Cali- 
fornia, Nevada, Utah, Ari- 
zona, New Mexico, and Colo- 
rado. District Director, Senior 
Surgeon J. C. Perry 
Public Health District No. 6.. .. 
(District of the North 
Pacific) 
Comprising the States of Wash- 
ington, Oregon, Idaho, Mon- 
tana, and Wyoming. District 
Director, Senior Surgeon 
G. M. Magruder. 
The duties assigned to the district directors are, in general, to : 
1. Make inspections of service stations and activities. 
2. Study and report upon standardization of methods and facili- 
ties, including personnel. 
3. Coordinate service activities by means of conferences with 
service officers in the district. 
4. Investigate and adjust controversies on instructions from the 
Surgeon General. 
5. Service on boards convened by the Surgeon General. 
6. Report on matters affecting service and public health policies. 
7. Promote cordial relations with state and local sanitary 
authorities and other public health organizations. 
8. Maintain an office which will serve as a general center for 
Public Health Service matters. 
9. Carry out additional instructions issued from time to time 
by the bureau. 
In the discharge of these functions it was made clear that the 
work of the directors was to be of an investigational character, 
and was not to include authority over the internal affairs of sta- 
tions or disciplinary powers over their personnel, such matters to 
be taken up in reports to the bureau. 
Personnel. While the President in time of war may utilize 
the Public Health Service in any manner that will promote the 
public interest,97 and while during the war with Germany he made 
"7 Act of July I, 1902 (32 Stat. L., 712). 164 
NATIONAL GOVERNMENT AND HEALTH 
it a part of the military forces of the United States,98 it is essen- 
tially a civil organization. Nevertheless, ever since the reorganiza- 
tion of the Marine Hospital Service in 1870 the commissioned 
medical personnel has been in uniform and has had an organization 
analogous to that of the Medical Corps of the Army and Navy. 
Provision is made for promotion in certain grades after a specific 
period of service, longevity pay, allowance for quarters, discipline 
through boards of investigation, and retirement. There is a defi- 
nite distinction as to appointment and conditions of service between 
the commissioned medical personnel on the one hand and the 
scientific personnel, subordinates, and clerks on the other. The 
members of the commissioned medical corps are appointed by the 
President, by and with the advice and consent of the Senate, and 
their salary is fixed by law. The regulations affecting these officers 
differ materially from those affecting all other employees, who are 
appointed by the Secretary of the Treasury in accordance with 
Civil Service Regulations. They are subject to duty and changes 
of stations whenever required; all others are local appointments. 
The regular commissioned personnel system is particularly 
interesting, as it provides for periodic promotion, longevity pay, 
the elimination of the unfit through examination, and retirement 
for disability or age. Periodic promotion and the elimination of the 
unfit are also provided for certain of the scientific personnel." 
Commissioned Personnel. The commissioned personnel con- 
sists of the regular commissioned officers and the commissioned 
officers of the reserve corps. The grades in the regular commis- 
sioned medical corps are fixed by statute as those of surgeon gen- 
eral, assistant surgeons general, senior surgeons, surgeons, passed 
assistant surgeons, and assistant surgeons (37 Stat. L., 309). 
The act of January 4, 1889, requires original appointments in the 
Service to be made only to the lowest grade-that of assistant 
surgeon-and after the applicant has passed a satisfactory exam- 
ination in medicine, surgery, and hygiene before a board of medical 
officers of the service (25 Stat. L., 639). The regulations require 
that the applicant must be between 23 and 32 years of age, 
a graduate of some reputable medical college, and have had one 
year's hospital experience or two' years in professional practice. 
98 Executive Order of April 3, 1917. 
99 See page 165. DEPARTMENT OF THE TREASURY 
165 
Acting assistant surgeons whose compensation is more than $300 
and who have served five years continuously preceding the exam- 
ination, and reserve officers who have had five years' service, may 
take the examination for assistant surgeon, provided they are less 
than 45 years old.10* All applicants must be examined for physical 
defects.101 
In order to train the newly appointed officers in the technique 
of the various branches of the service, they are detailed, when prac- 
ticable, for the following service: Marine hospital, three months ; 
quarantine station, four months; immigration station, five months ; 
Hygienic Laboratory, six months. The number of assistant sur- 
geons is not specifically fixed, being determined by the amount of 
money appropriated for the work of the service. On June 30, 
1925, the number of assistant surgeons was twenty-three. 
An assistant surgeon can be promoted to the rank of passed 
assistant surgeon only after four years' service. The regulations 
provide that not less than thirty days prior to the expiration of 
four years' service, an assistant surgeon shall be given a physical 
and professional examination for promotion to the grade of 
passed assistant surgeon. If he fails in the first examination for 
promotion, he is given a second examination after the expiration 
of one year. If he fails in the second examination, he is reported 
to the Secretary of the Treasury as not qualified for promotion 
and is requested by the Secretary to tender his resignation.102 The 
number of passed assistant surgeons is determined automatically 
by the number of promotions from the grade of assistant surgeon. 
On June 30, 1925, the number of passed assistant surgeons, includ- 
ing three on waiting orders, was twenty. 
The law specifies that a passed assistant surgeon shall not be 
promoted to the rank of surgeon without examination (25 Stat. 
L., 639). The regulations provide that after twelve years' service 
from the date of his original commission (or eight years after 
promotion from rank of assistant surgeon if he passed the first 
examination) a passed assistant surgeon shall be entitled to pro- 
motion to the grade of surgeon after passing the required written 
and physical examination. If he fails in the first examination, he 
100 Regulations 1920, Par. 25-27. 
101 Ibid., Par. 65. 
103 Ibid., Par. 65. 166 
NATIONAL GOVERNMENT AND HEALTH 
is given a second one at the expiration of a year; if he fails in the 
second examination he is reported to the Secretary of the Treasury 
as not qualified for promotion, and is requested by the Secretary 
to tender his resignation.103 The number of surgeons is not limited 
by law, but is determined by the promotion from the next lower 
grade. On June 30, 1925, the number of surgeons, including four 
on waiting orders was 132. 
The law does not specify how promotions shall be made to the 
grades above that of surgeon, but the regulations provide that a 
vacancy in the grade of senior surgeon shall be filled on the recom- 
mendation of a board of regular commissioned medical officers by 
promotion of an officer of the regular commissioned medical corps 
according to seniority, subject to a physical examination and a 
review by the board of the officer's record as to fitness. The regu- 
lations specify that no officer over 64 years old shall be promoted 
to the grade of senior surgeon.104 If a surgeon is not recommended 
for promotion, he is reported to the Secretary of the Treasury as 
not qualified for promotion, and is " placed in the official register 
of the service as ' not in line for promotion.' " 106 The act of August 
14, 1912 (37 Stat. L., 39), limits the number of senior surgeons 
on active duty to ten. On June 30, 1925, the number of senior 
surgeons was twenty-one, there being eleven on active duty, nine 
on waiting orders, and one on leave. 
Regular commissioned officers may be temporarily promoted 
during an emergency when ordered to assume charge of important 
work by transferring them to the reserve corps at a higher grade. 
While doing such work they are given such rank in the reserve as 
in the direction of the Secretary of the Treasury the importance 
of the work may require. Unless sooner terminated by direction 
of the President, the commission in the reserve terminates when 
the emergency ceases. The temporary transfer of officers from 
the regular corps to the reserve does not create a vacancy in the 
grade from which the officer is transferred. At the termination of 
a temporary commission in the reserve the officer returns to the 
grade and number he would have occupied if not transferred.108 
103 Ibid., Par. 68-69. 
1M Ibid., Par. 70. 
105 Ibid., Par. 73- 
Ibid,, Par. 77-78. DEPARTMENT OF THE TREASURY 
167 
The act of July I, 1902 (32 Stat. L., 712), provides that com- 
missioned medical officers detailed by the surgeon general for 
duty in charge of the administrative divisions shall be assistant 
surgeons general. By this act no officer below the rank of passed 
assistant surgeon may be detailed for this duty. The regulations 
provide that after the expiration of the detail, an assistant surgeon 
general may be reassigned for an additional period of four years, 
but after the expiration of the second detail, he is not eligible for 
a third detail unless he shall have served at least four years at 
some other duty. The regulations are silent regarding the length 
of the first detail, but in practice the period has been four years. 
The temporary assignment for duty as assistant surgeon general 
does not create a vacancy in the grade occupied by the officer; at 
the end of the detail he returns to the grade and number he would 
have held if he had not been assigned as chief of division.107 
Assistant surgeons general at large were first provided for by 
the sundry civil appropriation act for the fiscal year of 1920 (41 
Stat. L., 174), which did not specify their qualifications or meth- 
ods of selection, but simply made money available for pay, allow- 
ance, and commutation of quarters of " assistant surgeons general 
at large not exceeding three in number." This authority has been 
carried in similar form in subsequent appropriation acts. The 
regulations provide that a vacancy in the grade of assistant sur- 
geon general at large shall be filled on the recommendation of a 
board of regular commissioned officers by the promotion of an offi- 
cer who has served as surgeon general or of an officer of the regular 
corps according to seniority. The officer promoted is examined 
physically and his record is reviewed by the board. No officer 
over 64 years of age is eligible for promotion to such a vacancy.10' 
On June 30, 1924, there were four such officers, two of whom 
were on waiting orders. 
The Surgeon General is appointed by the President, by and with 
the advice and consent of the Senate (Act of March 3, 1875; 18 
Stat. L., 377). The regulations of 1889, 1897, 1902, 1913, and 1920 
provided that the Surgeon General should be selected from the 
medical officers of the service above the grade of passed assistant 
surgeon. In 1911, however, the Acting Attorney General gave an 
107 Ibid., Par, 16-17. 
108 Ibid., Par. 71. 168 
NATIONAL GOVERNMENT AND HEALTH 
opinion that the " law does not restrict the President in selecting 
a surgeon general of the Public Health and Marine Hospital Ser- 
vice to the list of commissioned officers in the medical corps of the 
service." 109 The act of August 14, 1912 (37 Stat. L., 309), did not 
make any change in the methods of appointment, merely stating 
that " all laws pertaining to the Public Health and Marine Hospital 
Service of the United States shall hereafter apply to the Public 
Health Service, and all regulations now in force, made in accor- 
dance with law for the Public Health and Marine Hospital Service, 
shall apply to and remain in force as regulations of and for the 
Public Health Service until changed or rescinded." Notwithstand- 
ing the opinion of the Acting Attorney General, the regulations of 
1913 and 1920 require the Surgeon General to be selected from the 
commissioned medical personnel. This provision, however, evi- 
dently does not bind the President in his selection. The President 
prescribes the regulations of the Service (32 Stat. L., 712, sec. 9), 
and he can amend this regulation or ignore it at any time he desires 
to do so. 
As a matter of fact, all surgeons general except the first one 
have been appointed from the officers of the Service. The first 
Surgeon General, Dr. J. B. Woodworth, served eight years, from 
1871 to 1879, and died in office. His successor, Dr. J. B. Hamilton, 
served twelve years, from 1879 to 1891, and was relieved at his 
own request and commissioned as a surgeon in the Service. The 
third officer to hold this position, Dr. Walter Wyman, served 
twenty years from 1891 to 1911 and died in office. After the death 
of Dr. Wyman, President Taft appointed the new Surgeon Gen- 
eral for a term of four years. Dr. Rupert Blue was appointed in 
1912 and was reappointed in 1916, being succeeded in 1920, on 
the expiration of his second term, by Dr. Hugh S. Cumming, who 
was reappointed for another four years in 1923. 
The present regulations fix the term of office of the Surgeon 
General at four years; they provide also that the Surgeon General 
shall be selected from the commissioned medical officers of the 
regular corps above the grade of passed assistant surgeon.110 As 
the President has fixed the term of office at four years, there is 
109 29 Op. Att. Gen. 287. 
110 Regulations 1920, Par. 10-U. DEPARTMENT OF THE TREASURY 
169 
nothing to prevent him from changing the length of the term or 
making it indefinite. 
The regulations provide that upon the expiration of his term the 
Surgeon General shall return to the grade and number he would 
have occupied if he had not been appointed Surgeon General. He 
may be appointed assistant surgeon general at large on the recom- 
mendation of a board of regular commissioned medical officers.111 
At the expiration of his term he may also be appointed an assis- 
tant surgeon general in the reserve for duty in an advisory capacity 
in the direction of training schools and stations, with pay and 
allowances of an assistant surgeon general on active duty. This 
appointment does not create a vacancy in the grade from which he 
was appointed surgeon general, and at any time on his own request 
he may be transferred back to the grade and number which he 
would have occupied in the regular corps if he had not been ap- 
pointed Surgeon General and commissioned in the reserve.112 
Commissioned officers and pharmacists are not permanently 
assigned to any particular hospital or station, but are appointed to 
the Service at large and are moved from station to station. The 
tour of duty is ordinarily four years, except at quarantine stations 
where it is three years. The regulations provide that service out- 
side the geographical limits of the United States shall not exceed 
three years unless the officer makes application for an extension 
of such service.113 
The annual salaries of regular commissioned officers are now 
fixed by the act of June 10, 1922,114 prescribing the pay and allow- 
ances of the commissioned personnel of the Public Health Service, 
Army, Navy, Marine Corps, Coast Guard, and Coast and Geodetic 
Survey. This act fixes the base pay according to rank and period 
of service and in addition provides longevity pay, allowance for 
quarters when these are not furnished, and allowance for subsis- 
tence. The base pay and the number of allowances are given on 
page 170. 
The longevity pay is 5 per cent of the base salary for each three 
years service up to thirty years, but it is provided that the base 
pay plus longevity for officers below the grade of assistant surgeon 
111 Ibid., Par. 71. 
112 Ibid., Par. 11-12. 
113 Ibid., Par. 193. 
114 42 Stat. L., 625. 170 
NATIONAL GOVERNMENT AND HEALTH 
general shall not exceed $5750. It is also provided that the total 
of the base pay, longevity pay, and allowances for subsistence and 
quarters shall not exceed $7200. 
Each subsistence allowance is fixed at sixty cents a day for the 
fiscal year 1923, and it is provided that the value for subsequent 
years shall be fixed by the President in accordance with a certifi- 
Period 
Officers receiving base 
rate at each period 
Base 
rate 
of 
pay 
Subsistence 
allowances 
for officers with 
dependents a 
Allowance when 
quarters are not 
furnished 
Officers 
with 
dependents 
Officers 
without 
dependents 
Sixth 
'Assistant surgeons general with'' 
26 years service. 
Senior surgeons with 30 years 
>- 
$4,000 
U nits 
2 
Rooms 
6 
Rooms 
4 
Fifth 
- 
service. 
Assistant surgeons general not 
entitled to pay of sixth period. 
Senior surgeons with 20 years 
3,500 
3 
6 
4 
Fourth 
■ 
service. 
Surgeons with 23 years service. 
Senior surgeons not entitled to 
pay of fifth or sixth periods. 
Surgeons with 14 years service. 
3,ooo 
3 
5 
3 
Third 
- 
Passed assistant surgeons with 
17 years service. 
Surgeons not entitled to pay of' 
fourth or fifth periods. 
Passed assistant surgeons with 
7 years service. 
2,400 
2 
4 
3 
Second 
Assistant surgeons with 10 
years service. 
Passed assistant surgeons not 
entitled to pay of third or 
fourth periods. 
2,000 
2 
3 
2 
First 
Assistant surgeons not entitled 
to pay of the third period. 
None in Public Health Service. 
1,500 
Base Pay and Allowances of Commissioned Officers 
a An officer without dependents receives only one subsistence allowance regardless of 
period of service. DEPARTMENT OF THE TREASURY 
171 
cate furnished by the Secretary of Labor showing the comparative 
retail cost of food as compared with the calendar year 1922. 
The value of the allowance for one room is fixed at twenty 
dollars a month for the fiscal year 1923, and its value for future 
years is to be determined by the President in the same manner as 
the allowance for subsistence. 
It will be noted that the allowances for subsistence and quarters 
are higher for officers with dependents, which includes the wife, 
unmarried children under 21 years of age, and the mother of the 
officer if she is in fact dependent on him for support. The subsis- 
tence allowances for the highest grade is smaller than for the two 
next lower, as it is presumed that by the time an officer reaches 
this rank his children will have been educated and will be self 
supporting. 
It will be of interest to apply these principles to a surgeon of 
sixteen years service to whom quarters are not furnished. As his 
service has been more than fourteen and less than twenty-three 
years, he draws the pay and allowances of the fourth period which 
are as follows: 
With 
dependents 
Without 
dependents 
Base pay $3,000 
$3,000 
Longevity, 5% for each of five 3-year periods. . 750 
Subsistence allowance (three at 60 cents a day for 
officers with dependents; one at 60 cents a day 
750 
for officers without dependents) 657 
Allowance for quarters (5 rooms at $20 a month for 
officers with dependents, 3 rooms at same rate for 
219 
officers without dependents) 1,200 
720 
$5,607 
$4,689 
The base pay of the Surgeon General is fixed at $6000. He does 
not receive longevity pay, but he is entitled to two subsistence 
allowances if he has dependents and one such allowance if he has 
no dependents; if quarters are not furnished, he receives an allow- 
ance of six rooms if he has dependents and of four rooms if he 
has no dependents. The maximum of base pay plus allowances 
for subsistence and quarters is fixed at $7500. The act of June 10, 
1922, does not change the method of promotion in rank. 
The salaries of all commissioned medical officers are paid from 
lump sum appropriation for salaries or for specific lines of work. 172 
NATIONAL GOVERNMENT AND HEALTH 
Officers of the Public Health Service are permitted to purchase 
quartermaster supplies from the Army, Navy, and Marine Corps 
at the price charged officers of those services.115 
Officers detailed for duty at leprosaria receive in addition to the 
pay and allowances of the grade, one-half the pay of the grade 
and such allowances as may be provided by the Surgeon General, 
with the approval of the Secretary of the Treasury.118 
The retirement of regular commissioned officers who are unfit 
to perform duties by reason of disease or injury or who have 
reached the age of 64 years is accomplished by placing them on 
waiting orders.111 Officers on waiting orders for a period longer 
than two months receive 75 per cent of the pay of their rank. 
There has been no specific legislation governing the retirement of 
officers or authorizing that they be placed permanently under wait- 
ing orders, but the regulations effecting this have been given the 
force of law by the act of July 1, 1902 (32 Stat. L., 712). Waiting 
orders are referred to in the regulations of the Service for the first 
time in 1889.119 These regulations provided that officers placed on 
" Waiting orders " for more than two months should receive 75 
per cent of the pay of their grade, but prescribed no method by 
which officers were to be placed in this status. The regulations of 
1897 provided definite procedure for placing under waiting orders 
officers unfit to perform their duties by reason of disease, injury, 
or age. The compensation under waiting orders was fixed as before 
at 75 per cent of the salary of the grade.120 These regulations were 
evidently based on the act of June 29, 1870 (16 Stat. L., 169), 
which provided that the duty of the supervising surgeon should 
be, "under the direction of the Secretary [of the Treasury], to 
supervise all matters connected with the Marine Hospital Service, 
and with the disbursement of the fund provided by this act." The 
act of July 1, 1902 (32 Stat. L., 712), provided that " the salaries 
and allowances of the commissioned medical officers of said ser- 
115 Act of March 6, 1920 (41 Stat. L., 507). 
116 Act of March 3, 1905 (33 Stat. L., 1010) ; act of March 4, 1911 (36 
Stat. L., 1394) ; act of February 3, 1917 (39 Stat. L., 873). 
117 Regulations 1920, Par. 74. 
118 Ibid., Par. 113. 
110 Regulations 1889, Par. 24. 
120 Regulations 1897, Par. 195-96. DEPARTMENT OF THE TREASURY 
173 
vice shall be the same as now provided by regulations of the Marine 
Hospital Service." This regulation therefore " legalized the regu- 
lation of 1897 providing pay under waiting orders and made 
it law." 121 
No method is provided by law for placing officers under " wait- 
ing orders," but Section 9 of the act of July 1, 1902, states that 
" the President shall from time to time prescribe rules for the con- 
duct of the Public Health and Marine Hospital Service. He shall 
also prescribe regulations respecting its internal administration 
and discipline and the uniforms of its officers and employees." 
The existing regulations of the service provide that when any 
commissioned medical officer reports himself or is reported unfit 
to perform his official duties by reason of disease or injury, or 
when he has reached the age of 64 years, he shall be ordered by 
the Secretary of the Treasury to appear before a board of com- 
missioned officers, who shall recommend the officer for " waiting 
orders " if the disability was received in line of duty. If the Secre- 
tary of the Treasury approves the finding of the board, the officer 
is placed on waiting orders by direction of the President.122 At the 
end of the fiscal year 1925, nineteen officers were under " waiting 
orders." 123 
Leave of absence to commissioned medical officers is governed 
by the act of February 19, 1897 (29 Stat. L., 554), which provides 
that leaves of absence without deduction of pay is authorized, in 
the discretion of the Secretary of the Treasury " for the same 
periods of time and in the same manner as is now authorized to be 
granted to officers of the Army by the Secretary of War." Leaves 
of absence in the Army are governed by Section 1265 of the Re- 
vised Statutes and the act of July 29, 1876 (19 Stat. L., 102), 
which provide that officers absent on account of sickness shall 
receive full pay, no time limit being specified. Officers absent on 
leave for other causes shall receive full pay for not exceeding 
thirty days in any one year and half pay for absence exceeding 
thirty days. However, the leave may be extended to sixty days if 
taken only once in two years, to three months if taken only once 
in three years, and to four months if taken only once in four 
13X19 Comp. Dec. 512. 
123 Regulations 1920, Par. 74. 
123 Surg. Gen., Annual Report, 1921, p. 347. 174 
NATIONAL GOVERNMENT AND HEALTH 
years. The regulations of the Service further provide that " an 
officer who has four months' leave credits may get five months on 
full pay by going between February and May 20.121 
Serious infractions of discipline and charges against commis- 
sioned officers are tried before boards of investigation, composed 
of not less than three commissioned medical officers of the Service. 
Boards of investigation are ordered only by the President or the 
Secretary of the Treasury, and make, in addition to a report of its 
findings, recommendations as to punishment if the accused officer 
is found guilty.125 In organization and procedure these boards are 
analogous to courts martial in the Army and Navy. The Surgeon 
General may detail an officer to act as prosecutor, and the accused 
may be represented by council. All proceedings are under oath. 
The punishments that may be recommended by a board are sum- 
mary dismissal from the service, or one or more of the following: 
suspension from duty without pay; suspension from duty on half 
pay, reduction of rank in his own grade, retention of his present 
number on register for a specified time or until a specified number 
of officers shall have been promoted over him, or official repri- 
mand by letter.126 The board transmits its report to the Surgeon 
General, who reviews the proceedings and findings and forwards 
them to the Secretary of the Treasury with his recommendations. 
A commissioned officer can not be dismissed from the Service 
without a hearing before a board of investigation, and no finding 
of such a board recommending the dismissal of a commissioned 
officer can be carried into execution until it has been approved by 
the President.127 
A reserve corps in the Public Health Service similar to the 
reserve corps in the Army and Navy was authorized by the joint 
resolution of October 27, 1918 (40 Stat. L., 1017). The President 
is authorized to appoint and commission in the reserve persons 
who, after examination prescribed by the President, are found 
physically, mentally, and morally qualified. Commissions are 
issued for a period of five years unless sooner terminated in the 
124 Regulations 1920, Par. 224. 
125 Ibid., Par. 294-95. 
™ Ibid., Par. 345. 
m Ibid., Par. 347-48. DEPARTMENT OF THE TREASURY 
175 
discretion of the President. The officers commissioned are to be 
distributed in the several grades in the same proportion as the 
regular commissioned officers. The reserve officers are subject to 
call to active duty at all times, and when on duty receive the same 
pay and allowances as the commissioned officers in the regular 
corps. 
Applicants for appointment as reserve officers are examined by 
a board of commissioned officers, which makes recommendations 
for appointment.328 A board of three or more commissioned officers 
is convened from time to time for the purpose of recommending 
reserve officers for promotion. Vacancies in the higher grades 
are ordinarily filled by promotion from the lower grades, but they 
may be filled by original appointment.329 
Non-Commissioned Personnel. All non-commissioned em- 
ployees are appointed by the Secretary of the Treasury or under 
authority granted by him, and in most cases certification by the 
Civil Service Commission is necessary. Internes are appointed 
after an examination by a board of officers of the Service. The 
positions that are not subject to examination are the minor places 
that are generally excepted from the classified civil service and 
places which require only temporary appointments. The salaries 
of the scientific personnel, pharmacists, administrative assistants, 
nurses, dietitians, and reconstruction aides are fixed by the regu- 
lations. As the regulations are promulgated by the President the 
salaries fixed by regulations may be changed at any time. In a 
matter of this kind the President is generally guided by the recom- 
mendations of the chief of the bureau and department concerned. 
The salaries of other employees are fixed by the Secretary of the 
Treasury. 
Non-commissioned employees are granted the same leave of 
absence as employees in other branches of the Federal service, 
namely, thirty days annual leave and a maximum of thirty days sick 
leave. Neither sick nor annual leave is cumulative. Non-commis- 
sioned employees receive allowances only as specifically indicated 
below. 
128 Ibid., Par. 46-56. 
129 Ibid., Par. 76. 176 
NATIONAL GOVERNMENT AND HEALTH 
The scientific personnel, in the technical sense used here and in 
the regulations of the Service, includes all persons engaged in scien- 
tific work, with the exception of commissioned officers and the per- 
sonnel of the Hygienic Laboratory. Both of these excepted classes 
are engaged in scientific work, but methods of appointment and 
promotion are provided for separately in the regulations and are 
discussed elsewhere.130 
Employees engaged in scientific investigation are designated 
according to the character* of the work for which they are quali- 
fied, such as sanitary engineers, chemists, bacteriologists, zoolo- 
gists, etc. Each main designation is divided into six coordinate 
classes, with appropriate prefixes to designate the class. The classes 
for sanitary engineers are given below, the chemists, zoologists, 
etc., being similarly graded: 
I. Directing sanitary engineer. 
II. Senior sanitary engineer. 
III. Sanitary engineer. 
IV. Associate sanitary engineer. 
V. Assistant sanitary engineer. 
VI. Junior assistant sanitary engineer. 
Original appointments are ordinarily made to the lowest grade, 
but if an applicant has special qualifications and has had previous 
experience adapting him to the work, he may be appointed to any 
class below Class I. After two years' service in Class VI and three 
years' service in Class V, a member of the scientific personnel is 
entitled to promotion to the next highest grade, provided he passes 
a satisfactory technical and physical examination and has had a 
good record for efficiency, honesty, and sobriety. If he fails in 
his first examination, he may be given a second one at the expira- 
tion of a year, but if he fails the second time he is separated from 
the service, the report of the board of examiners being used as 
the basis for charges. 
An appointee of Class IV is entitled to promotion to Class III 
in order of seniority after twelve years' service from date of 
original appointment. Those who had honorable service in the 
Public Health Service at any time between April 6, 1917, and 
November 11, 1918, are entitled to promotion at the expiration of 
130 See pages 164, 177. DEPARTMENT OF THE TREASURY 
177 
eight years from date of their original appointment; however, they 
must pass a satisfactory physical and technical examination. As in 
the case of Classes VI and V, an appointee is separated if he fails to 
pass the second examination after the expiration of one year. The 
number in Class II is limited to five, and vacancies are filled on the 
recommendation of a board of regular commissioned medical 
officers by promotion to an appointee of Class III according to 
seniority, subject to a physical examination and a review of his 
fitness. No appointee who is over 64 years of age or who is not 
physically fit or whose record does not show meritorious service 
may be promoted to this grade. In exceptional cases original 
appointments may be made to this grade. 
The number in Class I is limited to four, and vacancies are filled 
on the recommendation of a board of regular commissioned medical 
officers by the promotion of an appointee from Classes II and III 
according to seniority, subject to a physical examination and a 
review of his fitness. No one over 64 years of age, or who is not 
physically fit and whose record does not show meritorious service, 
may be promoted to this grade. 
Scientific personnel on permanent change of station are entitled 
to ship not exceeding 7200 pound's of baggage at government ex- 
pense. They are also reimbursed for packing and drayage at a rate 
not exceeding two dollars per hundred pounds of freight?31 
The director, assistant director, and the Chief of the Division of 
Pathology and Bacteriology of the Hygienic Laboratory are com- 
missioned medical officers of the Service detailed by the Surgeon 
General. The act of July 1, 1902 (32 Stat. L., 712), provides that 
the director must be a commissioned medical officer, but the detail 
of officers to the positions of assistant director and Chief of the 
Division of Pathology and Bacteriology is provided for by the 
regulations of the Service.132 The act of July 1, 1902, also provides 
that the chiefs of the Divisions of Chemistry, Zoology, and Phar- 
macology shall be appointed by the Secretary of the Treasury when 
commissioned medical officers are not available. Commissioned 
medical officers in the Service above the rank of assistant surgeon 
are eligible for detail for duty in charge of these divisions. 
131 Regulations 1920, Par. 79-86. 
Ibid., Par. 520, 522. 178 
NATIONAL GOVERNMENT AND HEALTH 
The pay of the Director of the Laboratory is fixed by the act of 
March 4, 1913 (37 Stat. L., 915), as that of a senior surgeon. The 
pay of the Assistant Director and the Chief of the Division of 
Pathology and Bacteriology is that of their rank. The regulations 
of 1920, as amended, provide that thereafter the chiefs of the Divi- 
sions of Chemistry, Pharmacology, and Zoology, shall be known as 
professors of chemistry, pharmacology, and zoology. 
If commissioned medical officers are detailed as chiefs of divi- 
sion, they receive the pay and emoluments of their rank.133 
The regulations approved August 29, 1920, as amended March 
31, 1922, provide that pharmacists in the Service shall be divided 
into three classes, but that no further appointments shall be made 
to this class of employees. After three years' service, pharmacists 
of the third class are promoted to the grade of pharmacist of the 
second class after passing a physical and professional examina- 
tion. If they fail to pass the examination, they are allowed a 
second one at the expiration of one year, and if they fail the second 
time they are separated from the service. 
After ten years' service from the time of their original appoint- 
ment, pharmacists of the second class are examined for promotion 
to the grade of pharmacists of the first class. If they fail they are 
allowed a second examination at the end of a year, but if they 
again fail they are separated from the Service. 
The regulations approved August 29, 1920, as amended March 
31, 1922, provide that administrative assistants shall be divided into 
four classes. Administrative assistants of Class 1 are employed 
only in hospitals with a capacity of more than two hundred beds, 
or at a field station where the duties are of equal importance to 
those at a hospital of similar size. Administrative assistants are 
placed in Classes 2, 3, and 4 in accordance with the responsibility 
and difficulty of the work, and the efficiency of the individual. 
Nurses, dietitians, reconstruction aides, internes, and attendants 
are entitled to quarters, heat and light, subsistence, and laundry, 
but when these cannot be supplied by the Service, these employees 
may be reimbursed in a sum not exceeding $25 a month for quar- 
ters, heat and light, $5 for laundry, and $35 for subsistence. 
Acting assistant surgeons are appointed for temporary work, 
for work requiring only part time, or for general or hospital duty 
133 Act of July i, 1902 (32 Stat. L., 728). DEPARTMENT OF THE TREASURY 
179 
when the personnel of the Service is not sufficient. Officers of this 
class receiving more than $480 a year are appointed after certifica- 
tion by the Civil Service Commission; those receiving less than 
$480 a year are appointed by the Secretary of the Treasury on the 
recommendation of the Surgeon General. Their salary is fixed 
by the Secretary of the Treasury, and as they are not commissioned 
officers they are not entitled to quarters or to allowances if quarters 
are not furnished. 
Acting assistant dental surgeons are appointed in the same 
manner and have the same status as acting assistant surgeons. 
Prior to 1923, salaries of the scientific personnel and of all other 
employees in Washington were determined by the regulations of 
the Service. On March 4, 1923, however, there was passed the 
Classification Act (42 Stat. L., 1448), which governs all positions 
in the departments and establishments in Washington, with the 
exception of the commissioned corps and certain other positions. 
It was designed to classify positions and fix their compensation on 
the basis of the duties and responsibilities of those positions. A 
number of grades are established, such as the professional and 
scientific service; the subprofessional; the clerical, administrative, 
and fiscal service; the custodial; and the clerical-mechanical. Stand- 
ard rates of compensation are to be paid in each grade, the person- 
nel being allocated in the various grades by heads of departments in 
a manner prescribed by the Personnel Classification Board, which 
reviews and revises the allocations. Advancement from rate to 
rate within a grade is dependent on efficiency and is controlled 
through an efficiency rating system and the provisions of the appro- 
priation acts. 
The grades and ranges of annual salaries are as follows: 
Professional and Scientific 
i. Junior professional, from $1860 to $2400 
2. Assistant professional, from $2400 to $3000 
3. Associate professional, from $3000 to $3600 
4. Full professional, from $3800 to $5000 
5. Senior professional, from $5200 to $6000 
6. Chief professional, from $6000 to $7000 
7. Special professional, $7500 
In these grades come all the scientific workers of the Service 
who are not part of the medical corps. 180 
NATIONAL GOVERNMENT AND HEALTH 
Subprofessional 
1. Minor subprofessional, from $900 to $1260 
2. Under subprofessional, from $1140 to $1500 
3. Junior subprofessional, from $1320 to $1680 
4. Assistant subprofessional, from $1500 to $1860 
5. Main subprofessional, from $1680 to $2040 
6. Senior subprofessional, from $1860 to $2400 
7. Principal subprofessional, from $2100 to $2700 
8. Chief subprofessional, from $2400 to $3000 
The nurses of the service have been placed by the Personnel 
Classification Board in this subprofessional group, though against 
the protest of the Surgeon General and contrary to the desires of 
the nursing organizations of the country. The Army and Navy 
have nurse corps with commissioned rank for the members. 
The salaries of the other groups need not be given in detail. 
There are fourteen grades in the clerical, administrative, and fiscal 
service, with salaries ranging from $1140 to $7500 per annum. 
The number in the various groups are given in detail in the Budget 
for the fiscal year 1927, including field workers, who have also been 
classified. 
Appropriations. The following is a statement of appropria- 
tions for the Public Health Service for the fiscal year 1925, as 
given in the 1925 report of the Surgeon General: 
Appropriation Amount 
Salaries, office of Surgeon General $ 104,405.00 
Books 500.00 
Freight, transportation, etc 30,000.00 
Maintenance, Hygienic Laboratory 44,600.00 
Pay, etc., commissioned officers and pharmacists 1,135.000.00 
Pay of acting assistant surgeons 322,228.00 
Pay of other employees 1,027,827.00 
Preparation and transportation of remains of officers 3,000.00 
Pay of personnel and maintenance of hospitals "5,748,884.46 
Medical and hospital services, Veterans' Bureau (transfer to 
Public Health Service, act June 7, 1924) 384,960.00 
Salaries and expenses, Veterans' Bureau (transfer to Public 
Health Service, act June 7, 1924) 18,580.00 
Quarantine Service 479,000.00 
Preventing the spread of epidemic diseases 363,482.00 
Preventing the spread of epidemic diseases, 1925 and 1926.... 275,000.00 
Field investigations of public health 299,356.00 
Interstate quarantine service 22,530.00 
a Includes $330,135.46 reimbursements for care and treatment of Veterans' Bureau 
patients. DEPARTMENT OF THE TREASURY 
181 
Appropriation Amount 
Interstate quarantine service, 1925 and 1926 $ 57,600.00 
Studies of rural sanitation 75,760.00 
Control of biologic products 45,020.00 
Expenses, Division of Venereal Diseases 149,040.00 
Marine hospitals: 
Baltimore, Md "387.12 
Savannah, Ga "10,128.07 
Boston, Mass " 16,462.26 
Cleveland, Ohio "474.95 
New Orleans, La "887.67 
San Francisco, Calif b88o.O2 
Quarantine stations: 
Boca Grande, Fla b 500.00 
Boston, Mass "3,835.72 
Brunswick, Ga "4,279.37 
Cape Charles, Va b 1,358.05 
Charleston, S. C "634.46 
Chesapeake Bay (site) "6,935.00 
Columbia River "4,146.66 
Columbia River (boarding vessel) b5>750.90 
Delaware Breakwater "857.00 
Gulf "868.39 
Honolulu, T. FI "390.52 
Key West and Mullet Key, Fla "19,996.83 
Mobile, Ala " 10,000.00 
New Orleans, La "5,750.90 
Pensacola, Fla "919.52 
Port Townsend, Wash "20,806.53 
San Diego, Calif "760.37 
San Francisco, Calif " 6,393.70 
San Juan and Ponce, P. R "3,414.42 
Savannah, Ga " 12,063.65 
South Atlantic "2,729.90 
Leprosy Hospital, Honolulu, Hawaii "16,969.43 
$10,745,353.87 
b Balance available as of June 30, 1924. 
The Bureau of Internal Revenue.114 The Bureau of Internal 
Revenue, the most important fiscal agency of the government, was 
established in the Treasury Department in 1862 (12 Stat. L., 432), 
though collectors of internal revenue had been authorized in 1798 
(1 Stat. L., 599). The duties of this service are to collect all 
Federal taxes other than those levied on imports, and to enforce 
134 See Schmeckebier and Eble, The Bureau of Internal Revenue. Insti- 
tute for Government Research, Service Monograph No. 25. 182 
NATIONAL GOVERNMENT AND HEALTH 
certain regulatory laws, such as those pertaining to the sale of 
alcoholic liquors, narcotic drugs, and white phosphorus matches. 
Many of these have a direct bearing on the public health. 
Taxation and Public Health. The first important piece of 
internal revenue legislation relating to the public health was the tax 
on oleomargarine, imposed by the act of August 2, 1886 (24 Stat. 
L., 209). Congress quite frankly passed this law as a regulatory, as 
well as revenue raising measure, and it was designed primarily to 
assist the dairy interests.135 The act has been upheld by the courts.136 
In order to conduct the necessary analytical work entailed by this 
law, an Analytical and Chemical Division was set up in the Bureau 
in 1886. An act of 1888 (25 Stat. L., 549), to prevent the manu- 
facture and sale of adulterated foods in the District of Columbia, 
increased the activities of this Division, as the health authorities 
were authorized to submit samples to the Bureau of Internal 
Revenue for analysis.137 With the passage of the Pure Food and 
Drug Act of 1906 (34 Stat. L., 768), the analytical activities of the 
Division of Chemistry, as it was then called, were transferred to 
the Bureau of Chemistry of the Department of Agriculture. 
Duties in connection with the Prohibition and Narcotic Acts have, 
however, developed the present Industrial Alcohol and Chemical 
Division of the Bureau into an important service. Branch labora- 
tories are operated in New York, Columbus, Chicago, Little Rock, 
and San Francisco, and a cooperative arrangement has been effected 
with the Department of Agriculture whereby internal revenue 
chemists are stationed in certain food and drug laboratories, where 
it is not advisable for economic reasons to maintain separate estab- 
lishments. Under this arrangement the chemists work in the food 
laboratories at Buffalo, Minneapolis, and Denver. 
Several other tax laws which are regulatory or prohibitory have 
been passed by Congress, and their collection and enforcement en- 
trusted to the Bureau of Internal Revenue. These include a tax on 
135 The report of the House Committee on Agriculture said, " That there 
are from four to five million American citizens engaged in the dairy busi- 
ness and that they must all abandon it and be driven into some other already 
overworked branch of industry unless they can be relieved from the present 
ruinous competition with cheap imitations of butter and cheese." 
138 See page 56. 
u7 This law of 1888 was practically repealed by a later act, that of Febru- 
ary 17, 1918 (30 Stat. L., 246). DEPARTMENT OF THE TREASURY 
183 
" filled cheese " (Act of June 26, 1896; 29 Stat. L., 253), a tax on 
mixed flour (Act of June 13, 1898; 30 Stat. L., 448), and a tax on 
white phosphorus matches (Act of April 9, 1912; 37 Stat. L., 81). 
None of these have been productive of much revenue, but have been 
successful as prohibitory measures, as manufacturers have found 
it expedient to discontinue making those articles. Child labor 
products were taxed by the act of February 24, 1919 (40 Stat. L., 
1138), but this law was declared unconstitutional on May 15, 1922. 
While in operation it was enforced by the Child Labor Tax Divi- 
sion of the Bureau. 
Narcotic Law Enforcement. The so-called Harrison Anti- 
narcotic Act went into effect on December 17, 1914 (38 Stat. L., 
785), and was amended on February 24, 1919. Previous legisla- 
tion concerning opium had been passed as early as October 1, 1890 
(26 Stat. L., 620), imposing a tax of ten dollars a pound on all 
opium manufactured in the United States for smoking purposes. 
This sum was increased to $300 per pound by the act of January 
17, 1914 (38 Stat. L., 277). An act of February 9, 1909 (35 Stat. 
L., 614), had prohibited the importation of opium except for 
medicinal use, while provisions of another act of January 17, 1914 
(38 Stat. L., 275), regulated importation still further, absolutely 
prohibited exportation of smoking opium and allowed exportation 
of opium and cocaine and their derivatives only to countries regulat- 
ing their entry, in accordance with the regulations of the several 
countries. The act of February 9, 1909, was amended again by the 
act of May 26, 1922 (42 Stat. L., 596). A Federal Narcotics Con- 
trol Board, consisting of the Secretary of State, the Secretary of 
the Treasury, and the Secretary of Commerce, was created and 
empowered to make regulations for the importation of narcotics 
for medicinal uses only, all other importations being illegal, by the 
terms of the act. The administration of this last named law is 
given over to the Secretary of the Treasury, and is actually carried 
out by the Customs Service, the law clerk of which acts as secre- 
tary for the board. 
Domestic control of narcotics under the Harrison Act which was 
reenacted in 1924 (43 Stat. L., 328) requires the registration of all 
persons, such as physicians, who dispense or deal with drugs, and 
the control of certain of their activities. The law is not only a 
source of revenue, amounting to over a million dollars annually, 184 
NATIONAL GOVERNMENT AND HEALTH 
but is also regulatory and has been so recognized by the United 
States Supreme Court.138 There is, of course, much illicit traffic in 
drugs. 
Organization. The organization in charge of enforcement 
of the narcotic laws comprises a Narcotic Division in the Prohi- 
bition Unit. This Division is composed of the Office of the Head of 
the Division and has three sections : Field, Legal, and Returns. The 
Field Section is in charge of the work of the field divisions, of 
which there are thirteen, each under a narcotic agent, the total force 
on this work in 1925 numbering 164 persons in the field. These 
field divisions endeavor to apprehend and prosecute violators of 
the law, whether registered parties, or illicit peddlers, and they 
also check up records and returns. 
The work of the Legal Section consists of handling the officers' 
reports of law violations, the verification of taxes for assessment, 
consideration of claims for abatement or refund of taxes erro- 
neously assessed or paid, consideration of offers in compromise 
covering violations, and miscellaneous matters concerning pre- 
scribing and dispensing of narcotic drugs and drug addiction. 
The Returns Section audits the returns of importers, manufac- 
turers and wholesale dealers, compiles statistical matter concerning 
operations in narcotics by registered persons, maintains a central 
index of such registered persons in this country and conducts mis- 
cellaneous correspondence along these lines. 
The enforcement of the Prohibition Act has some bearing on 
public health and is, of course, now one of the major activities of the 
Internal Revenue office. Of a total appropriation of approximately 
$45,000,000 to the Bureau in 1925, somewhat over $10,000,000 
was for the enforcement of the prohibition and narcotics acts. 
The Customs Service.139 The Customs Service was created in 
July, 1789, and in the following September placed in the newly 
organized Treasury Department, where it has been ever since. 
This Service collects duties on imports, enforces laws restricting 
imports and exports, collects taxes and enforces certain laws relat- 
ing to vessels and navigation, and enforces other laws governing the 
"s United States vs. Jin Fuey Moy, 241 U. S. 394. 
See Schmeckebier, The Customs Service. Institute for Government 
Research, Service Monograph No. 33. DEPARTMENT OF THE TREASURY 
185 
departure of persons. While its major activity is not in the field 
of public health, some of its duties have a bearing on that sub- 
ject and in the past it has conducted certain definite health work. 
In 1798 an act, that of July 16 (1 Stat. L., 605), directed col- 
lectors of customs to collect dues of twenty cents per seaman from 
the masters of merchant vessels, in order that medical and hospital 
relief might be furnished to members of the crews needing aid. 
While this law was the foundation for the development of the 
Marine Hospital Service,140 the collectors of customs acted in the 
early days as ex-officio directors of the hospitals and, in fact, were 
authorized by Secretary Gallatin in 1809 to make all rules for 
government hospitals. The collectors remained in charge of the 
hospitals until 1870, when the Marine Hospital Service was defi- 
nitely organized to take them over, and they continued to collect 
the tax until 1884, when it was abolished. To-day they collect the 
quarantine charges on vessels and the charges on foreign seamen 
treated in marine hospitals. These charges are determined by the 
Public Health Service. 
In affording medical relief to American seamen at certain ports 
customs officers also act as agents of the Public Health Service. 
In 1924 there were fourteen such ports, the number having gradu- 
ally decreased, through the appointment of acting assistant sur- 
geons by the Public Health Service. The customs officers' duties 
in this connection consist merely in having a physician make the 
necessary examination. 
The passenger act of August 2, 1882 (22 Stat. L., 186), as 
amended on December 19, 1908 (35 Stat. L., 583), contains a 
number of provisions to safeguard health, which the customs offi- 
cers must enforce. These relate to size of quarters, ventilation, 
sanitary facilities, hospital facilities, and kind and quality of food. 
Collectors must ascertain the number of deaths, prevalence of un- 
usual sickness or mortality, and its cause. Reports along these lines 
are sent to the Secretary of Commerce, as the Steamboat Inspection 
Service, under his jurisdiction, is also interested in such matters 
and charged with enforcing provisions for safety and welfare of 
passengers and crews. 
14<l See page 76. 186 
NATIONAL GOVERNMENT AND HEALTH 
The importation of certain articles is forbidden unless they are 
of a definite standard of purity, and here again customs officers 
are charged with investigatory powers. Tea standards were set up 
in 1897 (29 Stat. L., 604), for instance, though now the detailed 
analytical work in this connection is entrusted to the Bureau of 
Chemistry in the Department of Agriculture, but the Customs 
Service is responsible until the tea is passed by the examiners of 
the Department of Agriculture. So, too, viruses, serums, and other 
biological products can be denied entry by customs officers, unless 
manufactured in accordance with regulations of the Public Health 
Service. The importation of narcotic drugs is permitted for medici- 
nal purposes only. Meat products can be imported or exported 
only if passed by inspectors of the Bureau of Animal Industry of 
the Department of Agriculture. In a few places the customs officer 
acts as immigration inspector on behalf of the Bureau of Immigra- 
tion of the Labor Department. CHAPTER VIII 
THE DEPARTMENT OF AGRICULTURE 
In the Department of Agriculture there arc eleven bureaus which 
are sufficiently concerned with public health to merit a description 
here of their functions and activities. The major duties of two of 
these agencies, the Bureau of Chemistry and the Bureau of Animal 
Industry, are in the field of public health. With two others, the 
health work is important, though only part of the general scope 
of the bureau. These are the Bureaus of Home Economics and of 
Dairying, both of which were elevated to the status of bureaus 
only within very recent years. The Extension Service also conducts 
important health activities. The other bureaus have only a more or 
less incidental interest in the subject. The Department of Agricul- 
ture has in all sixteen bureaus or offices and a number of boards 
under its jurisdiction. 
The Bureau of Chemistry. The Bureau of Chemistry pro- 
motes agriculture and the industries that make use of agricultural 
products by chemical research and by the application of the results 
of such research to the solution of problems involved in the 
production, the preservation, and the more profitable utilization 
of farm crops. It carries on analytical and investigational work 
under the Food and Drugs Act, the Tea Inspection Act, and the 
Naval Stores Act, and makes chemical investigations for other 
branches of the government service. 
History and Development. When the Department of Agri- 
culture was organized as an independent department in 1862, a 
Division of Chemistry was set up. The organic act establishing the 
department (12 Stat. L., 387) had, in fact, authorized the Com- 
missioner of Agriculture to employ chemists, botanists, entomolo- 
gists, and other persons skilled in the natural sciences pertaining 
to agriculture. As originally conceived, the Division was to per- 
form all the chemical work of the government,1 but as the need 
1 Annual Report, 1924. 
187 188 
NATIONAL GOVERNMENT AND HEALTH 
for chemists in other branches increased, they set up their own 
chemical services, so that now chemical work on soils, road mate- 
rials, forestry, dairy products, meat, fish, supplies, commercial 
products, and various other materials is carried on in many differ- 
ent bureaus.2 
As early as 1848 Congress passed a law (9 Stat. L., 237) pre- 
venting the importation of adulterated and spurious drugs and 
medicines, the enforcement of which devolved upon the Treasury 
Department. In 1890 investigations of the adulteration of foods 
were authorized (26 Stat. L., 285), and a law was also passed for 
the inspection of imported foods (26 Stat. L., 414). The Tea 
Inspection Act was adopted in 1897 (29 Stat. L., 604), and in 
1900 an investigation of adulterated foods (31 Stat. L., 196) was 
authorized. In that year the Division had only twenty employees 
and received an appropriation of only $29,500. A small building 
of nine rooms, a converted residence, was occupied as an office. 
The Chief Chemist at that time was Dr. Harvey W. Wiley, who 
had been appointed in 1883 and who served until 1912. In 1901 
the Division was raised to the status of a bureau, this change having 
been accorded recognition in the appropriation act of that year 
(31 Stat. L., 922). The act also authorized another investigation 
of adulterated foods. 
In 1903 there was inaugurated a study of the methods of making 
better table syrup from the ordinary sugar producing plants, such 
as the maple tree, sorghum, and sugar cane. A model syrup factory 
was erected at Waycross, Georgia, and various manufacturing prob- 
lems were taken up, with the result that many economies in pro- 
duction were achieved. In the same year a contracts laboratory was 
organized to test supplies furnished by contractors to the Govern- 
ment. Another laboratory was set up in 1903 for the purpose of 
examining drugs and chemicals. Many remedies and fake cures 
were investigated for the Post Office Department, a duty which is 
still undertaken. 
The appropriation bill for 1903 (32 Stat. L., 296) authorized 
the Secretary of Agriculture " in collaboration with the Association 
of Official Agricultural Chemists and such other experts as he may 
2 See mimeographed report on chemical work in Department of Agricul- 
ture, issued by the Bureau of Chemistry. DEPARTMENT OF AGRICULTURE 
189 
deem necessary, to establish standards of purity for food products 
and to determine what are regarded as adulterations therein." 
This work was, accordingly, undertaken, though the authority was 
repealed after having been continued for several years. Investi- 
gations of adulterated foods and their relation to health were also 
authorized in these years, the Bureau then receiving an appropria- 
tion of about $150,000 a year. 
The Pure Food and Drugs Act was approved on June 30, 1906 
(34 Stat. L., 768), and became effective on January 1, 1907, when 
the actual work of enforcement began. Inspectors to collect sam- 
ples and procure information, chemists to analyze these samples 
and conduct necessary investigations, and a Board of Food and 
Drug Inspection were added to the personnel of the Bureau. 
Branch laboratories were established at a score of localities, such 
as the principal ports of entry and commercial centers, and analyses 
were made either there or at the central office in Washington. 
For the six months ended June 30, 1907, a deficiency appropriation 
of $250,000 was made to carry out the act (34 Stat. L., 841) and 
in the next fiscal year the total appropriation to the Bureau aggre- 
gated nearly $700,000. 
An exhaustive study of the various feeding stuffs on the market 
was completed in 1908. In addition to supplying data to pur- 
chasers and laying the basis for further studies of the nutritive 
value of stock food materials, this study was useful in the enforce- 
ment of the Food and Drugs Act. In the same year investigations 
of denatured alcohol were begun at a model distillery, which was 
erected for the purpose. Various farm products were also investi- 
gated and work on insecticides and fungicides was begun.3 
The Bureau was reorganized in 1913 by Dr. C. L. Alsberg, who 
succeeded Dr. Wiley as Chief. Laboratories for protein, phyto- 
chemical, microbiological, and pharmacognological investigations 
were established, and an Office of Development, manned largely 
by engineers, was also set up. Regulation and research were 
separated as administrative functions, and as much of the regula- 
tory work as possible was relegated to the field. The effectiveness 
of this new system was demonstrated in the following years by 
greater results from research and by an increase in the number of 
court actions under the Food and Drugs Act. Another notable 
3 Yearbook, 1912, p. 196 ff. 190 
NATIONAL GOVERNMENT AND HEALTH 
step in 1913 was the creation in the Bureau of an Office of State 
Cooperation. 
By 1917 the Bureau was receiving an appropriation well in 
excess of a million dollars, more than $600,000 of which was 
devoted to the enforcement of the Food and Drugs Act. The pub- 
lished program of work for the Bureau during that year was 
ambitious and included many researches in agricultural chemistry, 
poultry and egg investigations, fish and shellfish investigations, 
biological studies of food and food products, color investigations, 
citrus by-products studies, investigations of naval stores and 
demonstration of methods of production, as well as the enforce- 
ment of the Food and Drugs Act. 
Dr. Alsberg resigned as Chief of the Bureau in 1921, and was 
succeeded by the present chief, Dr. C. A. Browne, who was ap- 
pointed on October 1, 1923. 
Current Activities.4 The major activity of the Bureau of 
Chemistry is the enforcement of the Food and Drugs Act of 1906, 
as subsequently amended. 
Food and Drugs Act Enforcement.11 The Food and Drugs Act, 
popularly known as the Pure Food Law, prohibits the manufac- 
ture or sale within any territory or the District of Columbia, or 
the importation, or shipment in interstate commerce of foods and 
drugs which are adulterated or misbranded. A fine of not more 
than five hundred dollars, or a year's imprisonment, or both, is the 
penalty for the first violation of the manufacturing clause, and a 
fine not to exceed two hundred dollars is imposed for the first 
violation of the interstate and foreign shipment clause. Penalties 
for subsequent violations are greater. 
The Secretaries of the Treasury, Agriculture, and Commerce 
are charged with making uniform rules and regulations to enforce 
the law,8 and the enforcement of the regulations has indubitably 
improved the foods and drugs of the nation. The act requires the 
Bureau of Chemistry to perform the analytical work necessary 
and requires district attorneys to prosecute in the proper courts 
4 See Bureau of Chemistry, Department Circular No. 137 (1924). 
5 See Department of Agriculture, Circular 21. Also Laws applicable to 
the United States Department of Agriculture (1923). 
6 Given in Circular 21. See also Linton, F. B. Protecting the consumer 
from food and drug frauds, The Nation's Health, October, 1925. DEPARTMENT OF AGRICULTURE 
191 
when evidence has been presented. " Drugs " is defined as includ- 
ing any medicine or preparation recognized in the United States 
Pharmacopoeia or National Formulary for internal or external 
use, and any substance or mixture of substances intended to be 
used for the cure, mitigation, or prevention of disease of man or 
other animals. " Food " is defined as including all articles, whether 
simple, mixed, or compound, used for food, drink, confectionery, 
or condiment by man or other animals. 
The act further outlines specifically what are to be considered 
adulterations, in both the foods and drugs, and it expressly defines 
misbranding. Thus, adulteration applies to foodstuffs which are 
(1) Composed of filthy or decomposed materials, (2) cheapened 
by the substitution in whole or in part of another substance, (3) 
rendered injurious to health by any added deleterious ingredient, 
and (4) those from which valuable components have been removed. 
Misbranding of food consists of the use of an untruthful or mis- 
leading label, including omissions as well as direct falsification. 
Labeling which is truthful but deceptive on account of arrange- 
ment of type comes under this classification. 
Patent medicines 7 come within the drug classification, and it is 
the duty of enforcing officers to see that their labels " hold out to 
the public no promise of benefit that is not fully justified by the 
composition of the preparation.'"8 The law requires the quantities 
of certain dangerous and habit-forming substances contained in 
such patent medicines to be made known on the label. 
The steps necessary in prosecutions under the law may be sum- 
marized as follows: 
(1) An inspector collects samples of the suspected article and 
forwards them to the proper station for analysis. 
(2) The station makes the analysis and reports on the samples 
to the station chief, who in turn reports with recommendation to 
the district chief. 
(3) The district chief, if he approves a recommendation that 
the goods are in violation of the act, instructs the station to hold 
a hearing. 
(4) The manufacturer appears or sends a statement about his 
product, following which the station chief again reports to the 
district chief. 
7 See section on the Patent Office, page 305. 
8 Bureau of Chemistry, Department Circular No. 137, p. 8. 192 
NATIONAL GOVERNMENT AND HEALTH 
(5) The district chief may then transmit the papers, with his 
recommendation, to the Chief of the Bureau. 
(6) Here the case is reviewed, usually with the assistance of 
the laboratory specializing in the particular type of product. 
(7) If, upon a review of the facts, the reviewing officer deter- 
mines that prosecution is warranted, the case is referred to the 
Solicitor of the Department. 
(8) If prosecution is found to be legally justified, the neces- 
sary records are prepared by the Solicitor and referred to the 
Department of Justice. 
(9) The Department of Justice transmits the records for trial to 
the appropriate district attorney who conducts the case in court. 
(10) The court hears the case and issues judgment. 
(11) A notice of judgment is prepared by the Solicitor and 
published by the Bureau, which terminates the case. 
Since the law was passed, more than twelve thousand seizures 
and prosecutions have been completed and the results published. 
During the fiscal year 1925, there were 746 prosecutions and 910 
seizures. Goods may either be seized and removed from the chan- 
nels of trade pending a court decision, or a criminal prosecution 
may be brought against the alleged violator of the law, or both 
actions may be taken. District attorneys may act directly, but most 
cases are referred to them through the Department of Justice. 
Imported foods and drugs are denied entry to this country if they 
do not conform to the legal requirements. Foreign merchants must 
certify regarding the content of their wares before consular officers. 
Bureau of Chemistry inspectors examine the invoices of imported 
foods and drugs, bearing such certificates, and, if deemed desirable, 
take samples for analysis. If the goods do not comply with the 
requirements they will not be admitted, although a hearing will be 
granted to the manufacturer. Sometimes they may be relabeled, 
reconditioned, or denatured to meet the rules. In this work the 
Bureau has the cooperation of the Customs Service.8 As it is not 
possible, with the force at hand, to inspect adequately all imported 
articles, only those thought to be adulterated or misbranded are 
examined. 
Factory and Local Investigations. In order to reach goods at 
their source and aid manufacturers in remedying possible defects 
in making foods or drugs which are intended for shipment in 
9 See page 184. DEPARTMENT OF AGRICULTURE 
193 
interstate commerce, a systematic investigation of manufacturing 
plants is conducted. 
The control of the purity of mineral waters shipped in interstate 
commerce is achieved largely by inspection of the sources of sup- 
ply. Much educational work must be done to prevent contamina- 
tion of such supplies. About one hundred wells and springs are 
inspected annually for this purpose. 
Cooperation with States and Cities. Practically all the states 
have pure food and drug laws, in many instances modeled after 
the federal act. The Bureau of Chemistry, of course, exercises 
supervision only over such foods and drugs as are the subjects of 
interstate commerce. It maintains, however, an Office of Coopera- 
tion, which keeps in close touch with all state food, drug, feeding- 
stuff, and health authorities. It informs them of changes in the 
law or regulations and other administrative matters, acts as a 
clearing house for the interchange of information, and brings about 
a harmonious cooperation in the enforcement of the federal and 
state laws. According to the Food and Drugs Act, state health, 
food, or drug officers may collect and submit for examination to 
the bureau any product within the scope of the law. 
The Office of Cooperation has also' attempted to work out uni- 
form methods of procedure for local officers. 
Tea Inspection. Tea is subject to the provisions of the Food 
and Drugs Act and also of the Tea Inspection Act, as amended. 
The Tea Act provides for actual standards of quality of imported 
teas. The enforcement of this law was originally placed with the 
Secretary of the Treasury, but transferred to the Bureau of 
Chemistry in 1920. During the fiscal year 1925, 92,925,470 pounds 
of tea were examined and 84,137 pounds were rejected. 
Naval Stores Act Enforcement. The enforcement of the Naval 
Stores Act (42 Stat. L., 1435), which was signed by the President 
on March 3, 1923, and went into effect June 1, 1923, has been 
assigned to the Bureau of Chemistry by the Secretary of 
Agriculture. 
The act defines and establishes classes and grades for the several 
kinds of turpentine and of rosin, makes the rosin types prepared 
by the Bureau of Chemistry the United States official standards 
for rosin, authorizes the Secretary of Agriculture to revise or make 
new standards, requires the sale in interstate and foreign com- 194 
NATIONAL GOVERNMENT AND HEALTH 
merce of all turpentine and rosin under the standards provided, 
makes unlawful the use of words, parts, or derivatives of words 
resembling " turpentine " or " rosin," or of any misleading or 
false word or words in advertising, offering for sale, shipping, or 
selling anything which is not naval stores of the standards pro- 
vided in the act. The law also authorizes the Secretary of Agri- 
culture, upon request of interested persons, to examine and grade 
naval stores and to issue a certificate showing the analysis, classi- 
fication, or grade, which certificate shall be prima facie evidence in 
any court. For this service the Secretary is authorized to make a 
charge to cover the cost of such work. 
Research. Agricultural chemistry studies, the original func- 
tion of the Bureau, have been extended in recent years. The pre- 
vention of losses by deterioration of fruits, vegetables, grains, 
sugars, syrups, and other foods, and the prevention of spontaneous 
combustion of agricultural products, are problems which have had 
special attention. The improvement of the quality of crops by 
increasing their protein and mineral content is another problem 
which has been considered. Protein investigations of food are 
made, and the vitamins are studied. The tanning of leather is 
studied in order that farmers may receive practical instructions 
for preparing hides and selecting and caring for their shoes, har- 
ness, driving belts, and other leather articles. 
The chemistry of plant constituents and the vegetable fats and 
oils are studied. The more profitable use of cull and surplus fruits 
and vegetables is the aim of other work of the Bureau. Much 
experimental work has been done on the dehydration of foods.10 
The waterproofing, mildewproofing, and fireproofing of farm 
fabrics, and the use of wrappers for fruits and vegetables are 
studied. The Bureau makes biological investigations of food and 
drug products and the physiological effects of such products on the 
human organism. It develops methods for the manufacture of 
table syrups and sugar. It investigates chemical problems relating 
to the composition, manufacture, action, and application of insec- 
ticides and fungicides. It conducts experimental work in the 
utilization, for coloring, medicinal, and technical purposes, of raw 
materials grown or produced in the United States. It investigates 
10 See Commercial dehydration of fruits and vegetables. Department 
Bulletin 1335 (1925). DEPARTMENT OF AGRICULTURE 
195 
and develops methods for the prevention of grain dust, smut dust, 
and other plant dust explosions and fires, including fires in cotton 
gins and cotton-oil mills. It investigates and demonstrates improved 
processes for preparing, weighing, handling, transporting, and uses 
of rosin and turpentine. It collaborates with other departments 
of the government desiring chemical investigations whose heads 
request the Secretary of Agriculture for such assistance. 
The investigatory activities of the Bureau of Chemistry include 
those pertaining to' food control or drug control, a necessary sup- 
plement to the enforcement of the Food and Drugs Act, the Tea 
Inspection Act, and the Naval Stores Act, studies in agricultural 
chemistry, and chemical investigations for other bureaus and 
departments. 
In order to determine when a food or drug is adulterated or mis- 
branded, it is necessary to have standards for comparison. Thus, 
much of the research work has been devoted to investigations of 
products, so that such standards may be formulated. Critical 
studies of methods of analysis have also been made for various 
products. Supplementary to these studies have been investigations 
of commercial methods, whereby an attempt is made to evolve and 
perfect processes for the preparation of foods and drugs and the 
practical utilization of their by-products. Microbiological, micro- 
chemical and pharmacological investigations are conducted along 
all of these lines. Studies of cattle feeds are likewise under way. 
Drug control studies are concentrated on (1) Medicinal tablets 
containing important therapeutic agents ; (2) galenicals ; (3) crude 
drugs, including herbs, leaves, barks, roots, flowers, seeds, etc.; 
(4) medicines offered for the treatment or prevention of serious 
diseases; (5) methods of analysis of drugs.11 Under certain condi- 
tions, fraudulent medicines can be dealt with more advantageously 
under the postal laws than under the Food and Drugs Act. There- 
fore, many analyses are made for the Post Office Department.12 
Expert testimony is furnished in these cases at hearings and in 
court. 
Publications. More than a hundred bulletins and circulars 
have been prepared and issued by the Bureau since 1913.13 Many 
of these have a direct interest to sanitarians, and nearly all are of 
11 Annual Report, 1924, p. 20. 
13 See page 310. 
13 See mimeographed list of Bureau publications, 1913-1925. 196 
NATIONAL GOVERNMENT AND HEALTH 
indirect interest. In the early years, for instance, studies were 
made, in cooperation with the Bureau of Entomology on the 
destruction of fly larvse in manure, and three bulletins were pub- 
lished on this subject (Nos. 118, 245 and 408). Department of 
Agriculture Bulletin 585, "A Guide for Formulating a Milk 
Ordinance," in which the Bureau of Animal Industry cooperated, 
and numerous bulletins and circulars on eggs, oysters, olives, dairy 
products, fish, bread, flour, fruits, poultry and cereals are of par- 
ticular interest to health officers. 
Organization. The Bureau of Chemistry maintains head- 
quarters at Washington and branch offices and laboratories in the 
field. At the head of the organization are the Chief, an Assistant 
Chief, and an Administrative Assistant, who exercise general super- 
vision over all work. Twenty laboratories and three offices in 
Washington develop facts upon which the decisions and policies 
are based, recommend methods for attacking regulatory problems, 
and conduct scientific investigations.14 
The Bureau is further organized into an Office of Cooperation,15 
Office of Development Work, an Office of Imports, and a Tea 
Inspection Service. There are special technical administrative 
assistants, assistants to the chief, a librarian, and an editor. 
Laboratories. The laboratories are as follows: 
Analytical Reagent Investigations 
Carbohydrate 
Color Investigations 
Crop Chemistry 
Drug Control 
Food Control 
Fruit and Vegetable Chemical 
Leather and Paper 
Microbiological 
Microchemical 
Miscellaneous Division (including Cattle Feed and Insecticide 
and Fungicide) 
Oil, Fat, and Wax 
Pharmacological 
Phytochemical 
Protein Investigations 
Special Collaborative Investigations 
Water and Beverage 
14 Department Circular 137, p. 5. 
18 See p. 193. DEPARTMENT OF AGRICULTURE 
197 
Field Service. In order to enforce the Food and Drugs Act, 
the United States has been divided into three inspection districts: 
The Eastern, with headquarters at New York; the Central, with 
headquarters in Chicago; and the Western, the office of which is 
at San Francisco. 
The Eastern District has stations at Baltimore, Boston, Buffalo, 
New York, Philadelphia, San Juan, and Savannah; the Central 
District has stations at Chicago, Cincinnati, Kansas City, Minne- 
apolis, New Orleans, and St. Louis; and the Western District has 
stations at Denver, Los Angeles, San Francisco, and Seattle. 
The work at these stations is for the most part regulatory, but 
some research is carried on. Each station serves a group of states. 
Personnel. The total personnel is about six hundred, of 
whom approximately half are in the field. Of the total number, 
about half are technically trained, including chemists, bacteriolo- 
gists, microscopists, engineers, and inspectors. Somewhat more 
than half of the personnel is employed directly in the enforcement 
of the Food and Drugs Act. 
Appropriations. The total annual appropriation to the bu- 
reau is about one and a half million dollars. For the fiscal year 
1925, $1,387,230 was appropriated, though an increase was esti- 
mated as necessary for 1926. 
The appropriations for 192618 give a good indication of the 
relative fiscal importance of the various activities of the Bureau 
and so may be cited: 
Salaries $ 363,208 
Agricultural chemical investigations 123,400 
Collaboration with other government departments.. 14,090 
Raw materials studies 54,805 
Syrup and sugar studies 28,000 
Enforcement of Pure Food and Drugs Act 788,860 
Enforcement of Tea Act 40,690 
Insecticide and fungicide studies 27,580 
Dust explosion studies 26,555 
Naval Stores Act 35,000 
Total $1,502,188 
16 43 Stat. L., 822. 198 
NATIONAL GOVERNMENT AND HEALTH 
The Bureau of Animal Industry.17 The Bureau of Animal 
Industry of the Department of Agriculture is concerned with the 
promotion of the livestock, meat, and poultry industry of the 
country, and the protection of the health of animals and man. 
It deals with the investigation, control, and eradication of diseases 
of animals, many of which are communicable to man; the inspec- 
tion and quarantine of livestock; the inspection of meat and meat 
products; and with animal husbandry. It is the largest bureau in 
the Department, and with the exception of the Weather Bureau 
and the Bureau of Dairying, the only one formally created by 
statute, though others have been recognized by Congress in appro- 
priation acts. It is also the oldest bureau in the Department, though 
much of its work is of recent origin. 
History and Development.13 The Federal government con- 
cerned itself with the animal diseases as early as i860, when the 
Agriculture Division of the U. S. Patent Office issued a report 
on hog cholera. Two years later there was created a Department 
of Agriculture, though the head of this new department did not 
become a cabinet officer until 1889. During the twenty years 
following the establishment of the Department of Agriculture fre- 
quent recommendations were made that a veterinary division 
be created, but it was not until 1883 that such a division was author- 
ized. At that time a seven acre farm in the District of Columbia 
was acquired as an experiment station. 
On May 29, 1884, the President approved an act of Congress 
(22 Stat. L., 603), which established the Bureau of Animal In- 
dustry in the Department of Agriculture. The first important work 
of the Bureau was the eradication of contagious pleuro-pneumonia 
from the cattle of this country. The complete extirpation of this 
disease was accomplished in 1893 and its conquest was the first 
great achievement of the Bureau of Animal Industry. 
The Bureau was organized into four divisions in 1891. They 
included the Inspection Division, the Division of Animal Path- 
ology, the Division of Field Investigations and Miscellaneous 
Works, and the Division of Quarantine. The Division of Animal 
17 See Powell, The Bureau of Animal Industry. Institute for Govern- 
ment Research, Service Monograph No. 41. 
18 See Houck, U. G., The Bureau of Animal Industry. Published by the 
author, Washington, D. C. (1924). DEPARTMENT OF AGRICULTURE 
199 
Pathology had been previously the Bureau Laboratory and was in 
charge of Dr. Theobald Smith after 1884. Dr. Smith continued 
with the Bureau as chief of the Pathological Division until he 
resigned in 1895, to be succeeded by Dr. V. A. Moore. During the 
decade in which Dr. Smith conducted his experiments, many 
important discoveries of interest to public health were made. The 
transmission of disease by insects was proven, the diagnosis of 
glanders developed, the effect of bovine tuberculosis on human 
beings was exhaustively studied and the tuberculin test studied and 
applied. Dr. Smith was assisted in many of his experiments by 
Dr. E. A. de Schweinitz, who was appointed chemist of the Divi- 
sion in 1890, and who became chief of the Biochemic Division, 
when it was organized in 1896. Trichinosis was demonstrated in 
the early days, much work on rabies was done from! 1899 on> 
and foot-and-mouth disease studied in the field in 1902 and 1908. 
The bacteriological study of milk was begun in 1898, while 
anthrax and botulism were investigated in 1916 and' 1920, respec- 
tively. Many investigations were made of animal diseases, with 
notable accomplishments against Texas fever, hog cholera, dourine, 
necrobacilosis, blackleg, and the like. 
As an aid to bringing about improvements in the dairy industry 
of the country, the Dairy Division of the Bureau of Animal In- 
dustry was formed in 1895. The first work consisted of a survey 
in the industry, while later, in 1900, a study of dairy sanitation was 
made. From 1902 the scope of this Division greatly broadened. 
Dairy research laboratories were organized in that year, and in 
1905 a dairy farming section and a market milk section were added. 
An experiment farm at Beltsville, Maryland, was acquired in 1910, 
and breeding experiments were started in 1911. One of the accom- 
plishments of this Division was the score-card system of dairy 
inspection, used by many health officers. Much other work on 
sanitation and food value of milk and milk products has been 
carried on. This Division became a bureau in the Department in 
1924" 
Investigations in animal husbandry were begun in 1901, and this 
work, dealing largely with animal genetics and breeding, was or- 
ganized into the Animal Husbandry Division in 1910. In 1906, 
Congress passed broad legislation (34 Stat. L., 679), covering meat 
19 See page 211. 200 
NATIONAL GOVERNMENT AND HEALTH 
inspection to supersede earlier acts of 1890, 1891, and 1895. This 
new act greatly enlarged the scope of this work. Regulations for 
meat inspection were issued in 1908, after having been passed on by 
a committee of sanitarians, including Dr. W. H. Welch, Dr. L. 
Hektoen, Dr. Joseph Hughes, Dr. V. A. Moore, Dr. L. Pearson, 
Dr. M. J. Rosenau, and Prof. Charles W. Stiles. Six years 
later, in 1912, the old Inspection Division was separated into the 
Meat Inspection and Field Inspection divisions. In 1913, a com- 
mittee of sanitary experts, including Dr. V. A. Moore, Dr. M. P. 
Ravenel, and Prof. W. T. Sedgwick, studied and reported on the 
efficiency of the Federal meat inspection. The Field Inspection 
Division has coped with the extensive epizootics of foot-and- 
mouth disease in 1902, 1908, 1914-1915, and 1924, and has also 
done much work in the eradication of sheep and cattle scabies. 
Although the study and eradication of tuberculosis in animals 
has been a function of the Bureau from early times, the Tuber- 
culosis Eradication Division was not created until 1917. This Divi- 
sion has conducted campaigns for tuberculin testing and has carried 
on much propaganda for tuberculosis-free herds and areas. The 
importance of this work in relation to human health is shown by 
the investigations of Park and Krumwiede in New York, of 
Novick, Ravenel and others, who have demonstrated the trans- 
missibility of bovine tuberculosis to children. 
The relation of the cattle tick to Texas fever was one of the 
early discoveries of the Bureau, and the systematic eradication 
of the tick by cattle dipping was undertaken in 1906. Since that 
time more than 72 per cent of the originally infected area in the 
South has been freed of ticks. 
Current Activities. The current activities of the Bureau 
consist of regulation in the interests of public health of various 
products which enter into interstate commerce; of scientific re- 
search ; of extension work; and of the promotion of the livestock, 
meat, and poultry industry of the United States. 
Regulatory Work. Regulation is the most conspicuous activity 
of the Bureau. It includes inspection of all meat intended for 
shipment in interstate commerce; the enforcement of laws govern- 
ing the importation and interstate shipment of viruses, serums, and 
other biological products used for the prevention or treatment of 
animal diseases; examination of livestock presented for entry into DEPARTMENT OF AGRICULTURE 
201 
this country or shipped in interstate commerce; certification of 
imported breeding animals; prevention of cruelty to animals in 
interstate commerce; inspection and testing of animals and meats 
for export; and inspection and disinfection of animal by-products. 
Meat inspection consists of an inspection of all cattle, sheep, 
goats, and swine before they are slaughtered in an official estab- 
lishment, and examination of the carcass immediately after 
slaughter. All products passed are stamped by inspectors. Animals 
condemned before slaughter are disposed of so as to prevent their 
use as food, and those suspected are slaughtered separately from 
those which have been passed. This meat inspection is performed 
in nearly a thousand establishments in as many cities and towns." 
In addition, market inspection is conducted in twenty-four cities. 
In 1924, nearly 80,000,000 ante mortem inspections and a slightly 
smaller number of post mortem examinations were made. Nearly 
350,000 animals or carcasses were condemned, and about 1,360,000 
parts were rejected as unfit for use.21 
Sanitary supervision plays an important part in the meat inspec- 
tion work. Standards have been prescribed by the Bureau and are 
enforced in the various establishments by the inspectors. Plans 
and specifications of all meat plants are submitted to the Bureau 
and must be approved before the product is permitted to go into 
interstate commerce. Operating methods and cleanliness of em- 
ployees are also regulated and watched. 
Extension Work. In cooperation with all the states much work 
has been undertaken in the eradication of animal diseases. Tuber- 
culosis is the most significant of these, as it is responsible for three- 
quarters of the condemnations of carcasses. It is most common 
among dairy cattle, which constitute about one-third of all 
cattle in this country. Tuberculin for testing has been prepared 
by the Bureau since 1892 and furnished to Federal, state, and local 
inspectors. A nation-wide drive to extirpate tuberculosis in cattle 
has been conducted for several years. There are now more than 
ten million cattle under supervision and nearly seven million which 
have successfully passed the first test. Somewhat over a million 
are in fully accredited herds. The eradication of bovine tubercu- 
20 See Directory of the Bureau of Animal Industry (1925). 
21 See Lippman, W. H., Meat inspection as a public health measure. 
Journal of the American Medical Association, October 31, 1925, p. 1392. 202 
NATIONAL GOVERNMENT AND HEALTH 
losis is, of course, of importance in the campaign against the disease 
in man. 
Other extension work involves such diseases as hog cholera, foot 
and mouth disease, tick fever, scabies, glanders, etc. During 1924, 
nearly forty million cattle were inspected or dipped for ticks in 
nearly a thousand counties. About thirty thousand farms were 
visited in that year in the interests of hog-cholera control. Much 
educational and demonstration work is carried on locally. 
Research. Among the many studies and investigations which 
are made, there should be mentioned those on breeding and animal 
genetics; on feeding and care of cattle; on soft-pork problems; on 
management and handling of cattle; on methods of killing and 
dressing; and on farm work. The nutritive value of meat and meat 
products has been the subject of research and a comprehensive 
study of the content of vitamin A in beef, pork, and lamb was 
begun in 1923 and completed in 1924. A number of investigations 
are associated with the meat inspection service, such as the reason 
for unusual pathological conditions noted in such examinations, or 
the cause of parasitic conditions. 
Publications. During its existence, the Bureau of Animal 
Industry has issued more than two thousand different publications, 
including reports of original scientific research, popular treatises, 
regulatory orders, circulars of information, administrative re- 
ports, and various miscellaneous pamphlets. The number of copies 
of individual publications furnished on request has frequently 
exceeded half a million, and the aggregate editions of all the pub- 
lications are believed to have been a large factor in the successful 
development of the livestock industry. 
Organization. The Bureau of Animal Industry is now or- 
ganized into eleven divisions as follows : 
Animal Husbandry Division 
Biochemic Division 
Division of Hog-Cholera Control 
Division of Virus-Serum Control 
Experiment Station 
Field Inspection Division 
Meat Inspection Division 
Pathological Division 
Tick Eradication Division 
Tuberculosis Eradication Division 
Zoological Division DEPARTMENT OF AGRICULTURE 
203 
In addition to the divisions, there are offices of Accounts, Chief 
Clerk, Personnel, Property Clerk, Editor, Exhibits, and Legal 
Advisor. 
The Chief of the Bureau is Dr. John R. Mohler, who' was ap- 
pointed in 1917. The first chief of the Bureau was Dr. D. E. 
Salmon, who served from 1884 to 1905. The second chief was Dr. 
A. D. Melvin whose term of office was from 1905 to 1917. Dr. 
Mohler, the third chief, had previously been chief of the Pathologi- 
cal Division. 
Animal Husbandry Division. This division conducts investiga- 
tions and experiments in feeding, breeding, and management of 
live-stock and poultry. 
Biochemic Division. This division is concerned with biochemi- 
cal and bacteriological research affecting animal diseases, meat 
products, disinfectants, the production of tuberculin and mallein, 
and the analysis of dips and disinfectants. 
Division of Hog-Cholera Control. This division carries on the 
field work against hog cholera. It directs field forces in various 
states, engaged in the investigation, suppression, and control of 
outbreaks of hog cholera and' other infectious diseases of swine. 
Division of Virus-Serum Control. This division has charge of 
regulatory work in the enforcement of the virus-serum toxin law, 
aimed to insure a high quality of commercial viruses, serums, 
toxins, and similar products for combating animal diseases. 
Experiment Station. A veterinary experiment station is main- 
tained at Bethesda, Maryland, for conducting necessary investiga- 
tions. Its facilities are used by the various divisions. The scope of 
work includes investigations of animal diseases, such as tuber- 
culosis, contagious abortion, and anthrax, and the production of 
serums, and various experimental studies. 
Field Inspection Division, This division has charge of eradi- 
cation of sheep scabies, cattle scabies, horse scabies, dourine, an- 
thrax, influenza, etc. It supervises the interstate transportation of 
livestock. Its work is largely instrumental in locating and stamping 
out sources of disease by tracing infection to the locality from 
which animals were shipped. This division also directs work relat- 
ing to importation and exportation of livestock, and importation 
of hides, skins, wool, hair, and similar products, especially with 204 
NATIONAL GOVERNMENT AND HEALTH 
regard to danger of transmitting infection through these com- 
modities. 
Meat Inspection Division. This division conducts meat inspec- 
tion at slaughtering and processing establishments engaged in in- 
terstate and foreign commerce, supervises the transportation of 
meats, and inspects imported meats. It is organized into Western 
and Eastern divisions and also into sections of exports and imports ; 
transportation, exemptions; laboratories sanitation and construc- 
tion; labels; and records. 
Pathological Division. This division conducts laboratory work 
relating to animal diseases, their control and suppression, including 
bacteriological and pathological investigations into causes of disease. 
Tick Eradication Division. This division, in cooperation with 
authorities of various Southern states, conducts work of eradicating 
the cattle tick. 
Tuberculosis Eradication Division. This division supervises the 
eradication of tuberculosis from cattle and swine in cooperation 
with state authorities and individual owners. During the fiscal 
year 1921 more than 75,000 herds of cattle were under supervision. 
Of these, 8201 herds comprising 193,620 cattle were fully accred- 
ited as free from tuberculosis. In all, 1,366,358 cattle were tested 
with tuberculin by veterinarians. 
Zoological Division. The duty of this division is to conduct 
laboratory and field investigations of animal parasites. 
Editorial Office. This office edits and distributes the publica- 
tions of the bureau. It also prepares special articles on news mate- 
rial, plans motion pictures, does translating, conducts general 
correspondence relating to printed matter of the bureau, compiles 
statistics, issues a weekly summary concerning livestock matters 
and does other editorial work. 
Exhibit Office. This office consults with the various officers of 
the bureau and prepares exhibit material for use at state fair cir- 
cuits and at special shows. 
Office of Personnel. This office keeps records of the bureau 
personnel; supervises veterinary colleges under the department's 
regulations, and performs duties of varied character. 
Field Service. The field service is distributed among 146 sta- 
tions, with a veterinary inspector usually in charge of each. The 
staff varies with local demands and is more or less mobile, being DEPARTMENT OF AGRICULTURE 
205 
shifted as exigencies arise. In 1924, for instance, an outbreak of 
foot-and-mouth disease occurred in California. Inspectors were 
hurried to the scene of the epizootic, and federal and state forces 
united under the direction of an officer from the Bureau of Animal 
Industry.22 
Personnel. The total personnel of the bureau is about 4200, 
of whom some 3500 are engaged in meat inspection activities. Tick 
eradication and tuberculosis eradication come next, with about 
three hundred persons regularly engaged in each of these efforts. 
Appropriations. The total appropriation to the Bureau of 
Animal Industry for the fiscal year 1926 was $11,385,156. This 
was allotted as follows: 
Animal husbandry $ 348,225 
Inspection and quarantine 610,000 
Hog cholera 431,363 
Disease investigations 125,860 
Tuberculosis eradication 982,000 
Tuberculosis indemnities 2,578,000 
Tick eradication 699,451 
Dourine study 40,520 
Meat inspection 4,896,110 
General 673,627 
There is a permanent specific annual appropriation of $3,000,000 
for meat inspection, which is supplemented by a million dollars or 
more, according to the needs of the service. Of the sum for tuber- 
culosis eradication, about two and a half million is for the payment 
of indemnities. 
The Bureau of Home Economics. The Bureau of Home 
Economics of the Department of Agriculture has charge of investi- 
gations, connected with the home, such as food's and nutrition, eco- 
nomic problems, textiles and clothing, and housing and equipment. 
The bureau was established as such in 1923, though it had been in 
operation as a division of other bureaus in the Department for a 
number of years. 
History and Development. The first distinct Federal ap- 
propriation for a study of nutrition was made in 1894 when, on 
recommendation of the Secretary of Agriculture, Congress appro- 
priated $10,000 to " enable the Secretary of Agriculture to inves- 
22 See Annual Report, 1924. 206 
NATIONAL GOVERNMENT AND HEALTH 
tigate and report upon the nutritive value of the various articles 
and commodities used in human food, with special suggestion of 
full, wholesome, and edible rations less wasteful and more eco- 
nomical than those in common use." (Act of August 8, 1894; 28 
Stat. L., 271). The agricultural experiment stations were author- 
ized by the act to cooperate with the Secretary in carrying out these 
investigations " in such manner and to such extent as may be 
warranted by a due regard to the varying conditions and needs of 
the respective states or territories, and as may be mutually agreed 
upon." 
The supervision of these investigations was, accordingly, turned 
over to the Office of Experiment Stations,23 of which Dr. W. O. 
Atwater was director, and a headquarters for the study was estab- 
lished at Middletown, Connecticut. The work of the first year 
included: studies of the cost and nutritive value of food material 
in every section of the country in order to determine what kinds of 
food the people actually buy; studies of actual dietaries, of the 
digestibility of foods, of the laws of nutrition of man, including 
experiments regarding ways in which food is actually used in the 
body; compilation of the results of researches conducted in various 
countries; and the publication of technical and popular bulletins. 
These investigations were in subsequent years expanded to include 
studies of food supply and food consumption in this country, ex- 
periments to compare the nutritive value and economical use of 
various combinations of food materials, investigations of the effect 
of cooking upon nutritive values, studies of the heat of combustion 
of food materials, experiments with the respiration calorimeter, and 
metabolism experiments. 
Between 1896 and 1900 the annual appropriations for these nutri- 
tional studies were $15,000. In 1901 it was $17,500, and from 1902 
to 1907, $20,000, yearly. The work was then discontinued for two 
years to be resumed in 1910 under a new law (35 Stat. L., 1056), 
which changed the scope of the work to include investigation of 
" the nutritive value of agricultural products used for human food, 
with special suggestions of plans and methods for the more effective 
utilization of such products for this purpose, with the cooperation 
23 See Conover, The Office of Experiment Stations. Institute for Govern- 
ment Research, Service Monograph No. 32 (1924). DEPARTMENT OF AGRICULTURE 
207 
of other bureaus of the department . . . ." This arrangement con- 
tinued with appropriations varying from $10,000 to $16,000 a year 
until 1915, when the functions were broadened to include investiga- 
tions of " the relative utility and economy of agricultural products 
for food, clothing, and other uses in the home, with special sugges- 
tions of plans and methods for the more effective utilization of such 
products for these purposes, with the cooperation of other bureaus 
of the department . . . ." (38 Stat. L., 438). 
The appropriation act of March 4, 1915, enabled the Secretary of 
Agriculture to reorganize the work in agricultural education into 
a States Relations Service, and the nutritional and home economics 
studies were conducted thereafter in the Office of Home Economics 
in this Service. Appropriations were larger, increasing from 
$25,760 for the fiscal year 1915 to $50,000 for the year 1923. Pur- 
suant to the terms of the annual Appropriation Act of February 26, 
1923 (42 Stat. L., 1315), the Office of Home Economics became a 
separate Bureau in the Department of Agriculture and Dr. Louise 
Stanley was appointed as Chief. For the fiscal year 1924, the Bu- 
reau received an appropriation of $71,760, which was increased 
to $107,024 for 1925. 
Under the States Relations Service, the Office of Home Eco- 
nomics conducted technical research on subjects pertaining to 
food, clothing, household equipment, and household labor, and 
disseminated much popular information through many bulletins. 
The information derived from regular research was also sent to 
the county agents and other extension workers of the Department 
in order that they in turn might transmit it to the people. An 
endeavor was made to interpret all technical studies in a popular 
way, so that they would be understandable and useful to all house- 
wives and others interested. Many requests for information also 
came from foreign countries and much of the data developed 
was published in foreign journals. Prior to the year 1916, the 
Office had available 132 publications on nutrition, sixty-two of 
which were of a technical nature. 
A laboratory kitchen was early established by the Office in 
order to study the chemistry and physics of cooking processes, 
tests methods of cooking, work out standard recipes, and provide 
data for publications to answer numerous inquiries. Some of the 208 
NATIONAL GOVERNMENT AND HEALTH 
investigations undertaken included: a determination of the causes 
of the differences in the culinary quality of granulated and smooth 
fats ; tests of the cooking qualities of soft pork products from hogs 
fed on peanuts as compared with the cooking qualities of the usual 
grades of pork; studies of relative economy and flavor of grades 
of meat cooked by standardized methods, made at the request of 
the Bureau of Animal Industry and the Bureau of Markets. Other 
studies were made of home canned vegetables, data being compiled 
to indicate the percentage of spoilage of thousands of cans of 
vegetables when all the several home methods of processing had 
been employed. Digestibility of animal fats and vegetable fats was 
investigated, as was also that of very young veal and of the hard 
palates of cattle. The use of starch in potatoes was studied and 
experiments were conducted with maize, feterita meal, and Kaffir 
corn. Research on various uses of honey was likewise conducted. 
Cold storage problems and methods for the transportation of 
perishable fruit were worked out with the aid of the respiration 
calorimeter. Studies on the digestibility of fish were made in co- 
operation with the Bureau of Fisheries. 
Among the subjects pertaining to domestic science and home 
economics which have been studied are: attempts to discover 
the amount of human energy expended in the performance of 
household tasks; investigations of textiles and their care; improve- 
ments in labor saving devices in the home; development of home- 
made fireless cookers; care of floors and floor coverings; and 
various other household matters. 
Current Activities. The investigations of the Bureau of 
Home Economics endeavor to set up standards which will guide 
the housewife in her home demands, especially those which pro- 
mote health, efficiency, and general well-being. Studies are, 
therefore, made on foods and nutrition, on economic factors, on 
textiles and clothing, and on housing and equipment. 
The food and nutrition work, to which more attention has been 
devoted than to any other function of the Bureau, was curtailed 
slightly during 1925 in order to permit expansion in other home 
economics studies. Food studies which were carried on consisted 
of research on soft flour; on home canning, including color 
changes in fruit preserves, and meat canning processes ; and on the DEPARTMENT OF AGRICULTURE 
209 
chemical composition of American food materials, an earlier 
bulletin on this subject having been revised. A dietary manual 
for diabetics was prepared in 1925 and sent out in mimeographed 
form in order to get suggestions for changes to improve its useful- 
ness. This pamphlet was prepared with the cooperation of a 
number of dietitians and physicians. Special studies of institu- 
tional diets for children and of general expenditures for foods 
have also been undertaken. At the request of the General Federa- 
tion of Women's Clubs, a program on nutrition has been drawn 
up for club women. 
Of particular interest in the field of child hygiene is a study of 
the psychology of child feeding. Believing that mothers are in 
need of facts and practical suggestions for the solution of beha- 
vior problems associated with food refusals of children, the 
bureau has undertaken to ascertain the causes and remedies of 
food likes and dislikes of children. Facts were collected by a 
questionnaire circulated through the Merrill-Palmer Nursery 
School of Detroit, and the American Association of University 
Women. The bureau feels that the data obtained will be of value 
not only to mothers, but also to pediatricians, nutrition workers, 
public health nurses, and others concerned with the solution of 
child welfare problems. 
Economic studies consist of the inquiries into food costs and 
expenditures already mentioned, and studies of standards of 
living on farms, this investigation being made with the cooperation 
of the Bureau of Agricultural Economics. A study of clothing 
expenditures is under way, as is also one on the handling of 
family finances. The use of time by the homemaker has been the 
subject of research. 
The laundry problem is looked into by the textile and clothing 
division, home sewing practices are investigated, and a study of 
the designs used in children's clothing and their relation to habit 
formation was recently initiated. Other work on fabrics has like- 
wise been undertaken. 
During the fiscal year 1925 the personnel of the Bureau con- 
sisted of forty persons, of whom twenty were professional workers 
and twenty were clerical. 
Publications. Reports of the results of research activities 
are issued in popular and technical form in the regular series of 210 
NATIONAL GOVERNMENT AND HEALTH 
bulletins of the Department of Agriculture. The following list of 
some of the more important pamphlets which are still available 
will give a good indication of the kind of work conducted by this 
Bureau: 
Food for Young Children. By Caroline L. Hunt. Farmers' 
Bulletin No. 717. 21 pp. Issued March 4, 1916; Revised June, 
1920. 
Food for Farm Families. By Helen W. Atwater. Separate No. 
858 from Yearbook, 1920. 13 pp. 
Floors and Floor Coverings. Farmers' Bulletin No. 1219. 29 pp. 
September, 1921. 
Rice as Food. Farmers' Bulletin No. 1195. 21 pp. December, 
1921. 
How to Select Foods. 1922. 
I. What the Body Needs. Farmers' Bulletin No. 808. 
II. Cereal Foods. Farmers' Bulletin No. 817. 
III. Foods rich in Protein. Farmers' Bulletin No. 824. 
Good Proportions in the Diet. By Caroline L. Hunt. Farmers' 
Bulletin No. 1313. 22 pp. March, 1923. 
Lamb and Mutton and Their Use in the Diet. Farmers' Bulle- 
tin No. 1324. 13 pp. June, 1923. 
Food Values and Body Needs Shown Graphically. By Emma 
A. Winslow. Farmers' Bulletin No. 1383. 35 pp. November, 
T923: 
Milk and Its Uses in the Home. (Prepared in cooperation with 
the Dairy Division of the Department of Agriculture.) Farmers' 
Bulletin No. 1359. 18 pp. Issued July, 1923; Revised January, 
T924- 
Family Living in Farm Homes. By E. L. Kirkpatrick, of the 
Bureau of Agriculture Economics ; Helen W. Atwater and Ilena M. 
Bailey of the Bureau of Home Economics. Department Bulletin 
No. 1214. 35 pp. January, 1924. 
Digestibility of Raw Starches and Carbohydrates. By C. F. 
Langworthy and Alice Thompson. Department Bulletin No. 1213. 
15 pp. February 28, 1924. 
Time-Tables for Home Canning of Fruits and Vegetables. Mis- 
cellaneous Circular No. 24. May, 1924. 
School Lunches. By Caroline L. Hunt. Farmers' Bulletin No. 
712. 21 pp. Issued March, 1916; Revised June, 1922, and May, 
1924. 
Corn and Its Uses as Food. Farmers' Bulletin No. 1236. 24 
pp. Issued February, 1923; Revised July, 1924. 
Housecleaning Made Easier. By Sarah J. MacLeod. Farmers' 
Bulletin No. 1180. 18 pp. Issued January, 1921; Reissued 
September, 1924. DEPARTMENT OF AGRICULTURE 
211 
Selected List of Government Publications on Foods and Nutri- 
tion (mimeographed). Compiled by Ruth Van Deman. Revised 
January, 1925. 
Selected List of Government Publications on Textiles and Cloth- 
ing (mimeographed). Compiled by Ruth Van Deman. February, 
I925- 
Organization. The Bureau of Home Economics was in 1925 
organized into four divisions, dealing respectively with: Foods 
and nutrition; economic studies; textiles and clothing; and hous- 
ing and equipment. The functions of each of these divisions have 
been outlined by the Bureau as shown on page 212. 
The Bureau of Dairy Industry. The Bureau of Dairy Indus- 
try of the Department of Agriculture investigates problems re- 
lating to all phases of the dairy industry. Projects undertaken 
include studies of: bacteriology and chemistry of milk; breeding 
and nutrition of dairy cattle; management of dairy cattle; dairy 
sanitation; dairy plant management; market milk; manufacture 
of dairy products and by-products; and the introduction of new 
principles and methods of dairying. 
This Bureau was established as the Bureau of Dairying by an 
act of May 29, 1924 (43 Stat. L., 243), though the work had 
previously been conducted for many years by a division in the 
Bureau of Animal Industry. The change of name was made in 
1926. 
History and Development. In order to bring about improve- 
ments in the American dairy industry, a Dairy Division was or- 
ganized in the Bureau of Animal Industry of the Department of 
Agriculture on July 1, 1895, although this organization was not 
legally recognized until 1897, when Congress in the agricultural 
appropriation act (Act of April 25, 1896; 29 Stat. L., 99) pro- 
vided for several divisions in the Bureau, including the Dairy 
Division. The early work consisted of the collection of informa- 
tion of value to the industry and the dissemination of information. 
A survey of the dairy industry was made and several bulletins 
were issued. Experimental exports of butter were begun in 1897 
and continued during 1898, and in the following year the possi- 
bilities of developing an export trade were studied. 
Dairy sanitation first occupied the attention of the division in 
1900. At that time a report on the milk supplies of two hundred 
cities was issued. In 1901 dairy products intended for exporta- NATIONAL GOVERNMENT AND HEALTH 
212 
Foods and nutrition 
Economic studies 
Textiles and clothing 
Housing and equipment 
Food selection and meal plan- 
ning from the standpoint of 
health and economy. 
Dietary studies. 
Chemical composition of food 
materials. 
Home methods of food preser- 
vation. 
Utilization of new food prod- 
ucts. 
Comparative cooking qualities, 
grades, and varieties of 
foods. 
Utilization of soft wheat flour 
in home baking. 
Vitamin content of foods. 
Economics of consumption. 
Standards of living. 
Costs of living. 
Consumption statistics. 
Family budgets and ac- 
counts. 
Economics of housekeeping. 
Time studies. 
Economic value of house- 
work. 
Evaluation of housekeeping 
services (family, com- 
mercial, and cooperative). 
Economic relationships with- 
in the family. 
Textile composition and con- 
struction from the stand- 
point of the consumer. 
Simplified methods of clothing 
construction. 
Costume design and other re- 
lated art problems. 
Hygiene of clothing. 
Renovation and care. 
General aspects of the housing 
situation. 
House planning for health and 
convenience. 
Kitchen arrangement and 
equipment. DEPARTMENT OF AGRICULTURE 
213 
tion were made subject to the terms of the Meat Inspection Act 
of 1891 (Act of March 2, 1901; 31 Stat. L., 922, 926). Market 
milk investigations were started in 1905, and the collection of 
information on bacteria found in milk and methods of studying 
them was begun. One of the notable developments along this line 
was the dairy score card for use in sanitary inspections. This 
card is now employed by health officials all over the country. 
Milk and cream contests were inaugurated in 1906 in cooperation 
with state and municipal health authorities. Dairy manufacturing 
investigations commenced in this same year and field work with 
individual creameries was begun the following year. 
Funds for the promotion of the dairy industry in the Southern 
states " by conducting experiments, holding institutes, and giving 
object lessons in cooperation with individual dairymen and state 
experimental stations " were authorized by the agricultural appro- 
priation act for 1907 (Act of June 30, 1906; 34 Stat. L., 669, 
674), though this type of activity had been in operation since 1905. 
By 1920 this work had been so well developed that it was assumed 
entirely by state agricultural colleges and the department with- 
drew from this field. Other cooperative experiments included 
those on dairy and livestock production, carried on in the semi- 
arid and irrigated districts of the West since 1917 (by Act of 
August 11, 1916; 39 Stat. L., 446, 491), extension work in Pacific 
Coast and Rocky Mountain states, begun in 1910, livestock demon- 
strations in the cane-sugar area of Louisiana, dating from 1914; 
and various other activities with local groups. 
An experimental farm was acquired at Beltsville, Maryland, in 
1910 (Act of March 4, 1909; 35 Stat. L., 1039, 1043), and in the 
same year a model dairy was set up at the United States Naval 
Academy at Annapolis. Since 1902 the Division (Bureau) has 
supervised the manufacture of from 50,000 to 100,000 pounds of 
butter each year for the Navy Department. Renovated butter has 
been inspected since 1902. 
The use of cottage cheese as a food, in order to eliminate 
waste of skim milk, was encouraged by a national campaign in 
1918 and stimulation of the consumption of milk was under- 
taken in 1919 as an after-the-war measure. Campaigns to this 
end were directed in cooperation with the States Relations 214 
NATIONAL GOVERNMENT AND HEALTH 
Service, local health officials and voluntary dairy organizations. 
Milk transportation studies were also conducted in this year and 
the care of milking machines came in for attention. In 1920 
much of the dairy extension work had to be discontinued on 
account of the curtailment of funds. 
Current Activities. A large part of the current activities of 
the Bureau is concerned with public health, though most of it 
also has an economic aspect. Many studies are conducted on 
milk handling and dairy sanitation. Cow testing work is carried 
on in cooperation with state extension forces or other state 
agencies, and bull associations are likewise organized. The pur- 
pose of this work is to improve the breeding of dairy cattle 
and increase the quality and quantity of milk production. 
In connection with the milk production investigations, the 
additional expense attributable to the use of modern methods and 
equipment is determined. In the milk distribution studies, atten- 
tion is given to the factors influencing the commercial quality of 
milk and to the devising of better methods of preparation and 
handling; and cost figures are obtained for each of the various 
operations. " Milk-for-health " campaigns, promoted by state ag- 
ricultural colleges and other extension agencies, are encouraged 
and given practical assistance in movements to increase the con- 
sumption of milk. 
A series of milk studies has to do with condensing methods and 
with the preparation of a product that will maintain its quality. 
A series of butter studies is concerned with the factors that con- 
trol flavor, including methods of handling cream, pasteurization, 
ripening of cream, storage, and renovation. Information is gath- 
ered as to the conditions under which milk and cream are handled, 
the qualitative effect of cream-grading, and the dififerent opera- 
tions involved in the manufacture of butter, with particular refer- 
ence to costs and other factors in the efficient management of 
creameries. Cheese factory methods and equipment are subjects 
of investigation as well as the factors producing the peculiar 
flavors and physical characters of various types of cheese and the 
possibility of producing in this country the types now imported. 
An attempt is made to determine localities where cheese might 
be produced and to stimulate local interest in the establishment 
of cheese factories. Studies are made of the methods of utiliza- DEPARTMENT OF AGRICULTURE 
215 
tion of the by-products of creameries and cheese factories by 
converting them into products useful in the arts or available as 
food for man or animals. Attention is also given to the methods 
and conditions necessary for the manufacture of condensed and 
evaporated milk and ice cream. 
Laboratory studies are made to obtain definite information as 
to the physiology of milk secretion and nutrition of dairy cows, 
and as to the net energy produced by different feeds and the 
distribution thereof between fattening and milk secretion. These 
studies are related fundamentally to the experiments in feeding, 
which are designed to determine the effects of the various feeds 
and constituents of feeds upon the animal body, upon growth, and 
upon the yield and composition of milk. 
Milch cows are kept under different stabling conditions and 
the results measured by the milk and butter fat produced and 
economy of feed and labor. Experiments are made to determine 
the effects of watering at different intervals and in different 
quantities. Studies are made of actual dairy farm practice to 
secure data on milk production, including costs under average 
and under improved conditions. This work, of course, has im- 
portant hygienic aspects. 
One of the fundamental projects relating to milk has for its 
purpose the securing of complete and detailed information as 
to the bacteria occurring in milk and the development of methods 
of preventing contamination and of destroying harmful groups of 
bacteria in milk. Sanitary considerations are, in fact, prominent 
throughout all of the work of the bureau relating to milk. In 
connection with the milk production studies, the additional cost 
attributable to modern sanitary methods is determined. In con- 
nection with the work on housing and care of dairy cattle, the 
results of clean cows, clean stables, and properly sterilized utensils 
are shown in terms of bacterial count. Attention is also given to 
the sanitation of city milk supplies, in cooperation with state and 
local boards of health and dairymen. 
Publications. Among the many bulletins and pamphlets 
issued by the Bureau, or under its auspices as a division in rhe 
Bureau of Animal Industry, the following may be mentioned 
as of special interest to sanitarians and health officials: 216 
NATIONAL GOVERNMENT AND HEALTH 
The Four Essential Factors in the Production of Milk of Low 
Bacterial Content. By S. FI. Ayers, L. B. Cook, and P. W. 
Clemmer. Bulletin No. 642. April 30, 1918. 
Straining Milk. By E. Kelly and J. A. Gamble. Farmers' 
Bulletin No. 1019. Jan. 1919. 
Cooling Milk and Storing and Shipping it at Low Tempera- 
tures. By J. A. Gamble and J. T. Bowen. Bulletin No. 744. 
Jan. 17, 1919. 
The Present Status of the Pasteurization of Milk. By S. H. 
Ayers. Bulletin No. 342. Issued 1916, revised Oct. 10, 1922. 
Milk Plant Operation. By C. E. Clement. Bulletin No. 973. 
June 5, 1923. 
Cleaning Milking Machines. By L. H. Burgwald.. Farmers' 
Bulletin No. 1315. March, 1923. 
Inspection of Milk Supplies. By E. Kelly and C. S. Leete. 
Department Circular No. 276. July, 1923. 
Production of Clean Milk. By E. Kelly. Farmers' Bulletin 
No. 602. Issued 1914, revised Nov. 1923. 
Posters Prepared by School Children in Milk-For-Health Pro- 
grams. By Jessie M. Hoover. Miscellaneous Circular No. 21. 
August, 1924. 
Milk and its Uses in the Home. (In cooperation with Bureau 
of Home Economics.) Farmers' Bulletin No. 1359. Issued 1923, 
revised Jan. 1924. 
Organization and Personnel. The Bureau of Dairy Industry 
is now organized into eight divisions, as follows: 
Dairy Extension 
Dairy Introduction 
Market Milk Investigations 
Dairy Manufacturing 
Dairy Cattle Breeding Investigations 
Research Laboratories 
Dairy Engineering 
Dairy Statistics 
Much work is done in the field at stations at Huntley, Montana; 
Ardmore, South Dakota; Woodward, Oklahoma; and New Iberia, 
Louisiana. The research laboratories are in Washington. 
The personnel authorized for 1925 was about 150 of which 
about half were scientists and technical experts. 
The appropriation for the fiscal year ending June 30, 1925, 
amounted to about $400,000. DEPARTMENT OF AGRICULTURE 
217 
The Extension Service. Agricultural extension, as carried on 
by the Department of Agriculture, consists of aid to the people 
of the rural sections by giving them practical instruction in farm- 
ing, home economics, and other useful matters. In cooperation 
with the states, county agents are employed, farm bureaus and 
other farmers' organizations encouraged, home demonstration 
agents supported, and boys' and girls' clubs maintained. All of 
these activities have both a direct and indirect bearing on the 
public health. The home demonstration agent, for instance, is 
frequently the only social service worker in a rural region, and 
it seems always to have been considered that her duties properly 
included instruction and advice regarding sanitation, home nurs- 
ing, and the preparation, care, and use of food. The boys' and girls' 
clubs are also known as the 4-H clubs, one of the H's standing 
for health. The extension service is, in fact, a potent force in 
rural hygiene. 
History and Development. Extension work had its inception 
in 1904 when the Department attempted to show the farmers 
of Texas how to cope with the Mexican cotton boll weevil. In 
1906 the first county agent was employed, and in 1911 the first 
farm bureau was organized. Home demonstration began in 1910, 
when a tomato club for girls was started in Aiken County, South 
Carolina. The scope of this work was broadened and it grew 
rapidly in the early years with the financial assistance of the 
General Education Board of the Rockefeller Foundation. Finally, 
in 1914 the Smith-Lever act (38 Stat. L., 372) was passed by 
Congress, under the terms of which $10,000 a year is permanently 
appropriated to each state, and, to quote the statute, " There is 
also appropriated an additional sum of $600,000 for the fiscal 
year following that in which the foregoing appropriation first 
becomes available, and for each year thereafter for seven years 
a sum exceeding by $500,000 the sum appropriated for each 
preceding year, and for each year thereafter there is permanently 
appropriated for each year the sum of $4,100,000 in addition to 
the sum of $480,000 hereinbefore provided." 
These sums are allotted to the states in the proportion that the 
rural population of the state bears to the total rural population of 
all the states. 218 
NATIONAL GOVERNMENT AND HEALTFI 
In order to administer this act, a States Relations Service was 
created in the Department of Agriculture in 1915. It had four 
divisions, the Office of Extension Work in the South, the Office 
of Extension Work in the North and West, the Office of Home 
Economics, and the Office of Experiment Stations, the last named 
having previously been a separate unit in the department since 
1888. A reorganization occurred in 1923, when the Extension 
Service was made a branch of the immediate office of the Secre- 
tary, and the Bureau of Home Economics, and the Office of Ex- 
periment Stations were set up as separate units in the department. 
To the Extension Service were transferred the Office of Exhibits 
and the Office of Motion Pictures of the Division of Publications. 
The Extension Service is not exactly coordinate with the bureaus 
of the department, but serves as the clearing house and means of 
contact for all extension work of the department. 
The growth of the home demonstration work since 1910 is 
shown by the following table, giving for each year the number of 
counties having home demonstration agents :24 
Year Counties 
1910 4 
I9H 21 
1912 149 
1913 199 
1914 279 
Year Counties 
1915 350 
1916 430 
1917 537 
1918 1715 
1919 1049 
1920 784 
Year Counties 
1921 699 
1922 8oi 
1923 874 
1924 930 
1925 929 
Financial support from 1910 to date is given in the following 
table, which indicates the total allotment of funds from all sources 
for home demonstration agents and also home economics 
specialists: 
Home 
economics 
specialists 
work 
$332,415.00 
300,147.00 
386,979.00 
538,887.00 
601,548.00 
582,710.00 
Fiscal Home 
year demonstration 
1911 $5,000.00 
1912 39,939-77 
1913 61,628.69 
1914 I3i,574.29 
1915 319,823.00 
1916 519,867.00 
1917 741,680.00 
1918 2,226,228.00 
Fiscal Home 
year demonstration 
I919 $2,889,210.00 
1920 2,177,024.00 
1921 2,388.473.00 
1922 2,980,741.00 
1923 3,012,303.00 
1924 3,099,464.00 
1925 3,172,354-00 
24 Frysinger, Grace E., Demonstration work, 1922. Department Circular 
No. 314. DEPARTMENT OF AGRICULTURE 
219 
Current Activities. The types of work conducted by the 
home demonstration agents, as listed in the reports issued by the 
Department of Agriculture, are illuminating in their display of an 
interest in public health. Of a total number of " improved prac- 
tices " reported in 1923,25 amounting to over five million, result- 
ing from over a million demonstrations in about six hundred 
counties in forty-four states, there are listed 112,463 of these 
" improved practices," as related to health and sanitation, includ- 
ing such items as child care, home nursing, sanitation, and un- 
classified. " Improved practices " in nutrition, comprising food 
selection, food preparation, school lunches, child feeding, milk 
feeding, and unclassified, number 439,794-26 Other items include 
food production, food preservation, clothing and textiles, home 
management and furnishings, and community activities. 
Work for farm homes in counties without home demonstration 
agents was also reported 27 by county agricultural agents cooperat- 
ing with state home economics specialists and, among other things, 
comprised encouragement of hot school lunches, home water sys- 
tems, milk for children, septic tanks, and food supplies. Among 
accomplishments listed for these county agents in 1922 were: 
Water systems planned and installed 2,447 
Sewage disposal systems planned and installed 2,107 
Lighting systems planned and installed 5,883 
Farms homes constructed or remodeled according to plans 
furnished 10,063 
Home grounds improved according to plans furnished... 17,737 
Homes modifying practice relative to gardening 58,575 
The responsibilities of the home demonstration agent are ex- 
tremely broad in scope. According to the 1922 report, " The 
county home demonstration agent contributes through educational 
methods to the progress of the rural people of the county in 
which she is working along lines affecting the home. Practically 
no limitations have been placed as to the manner of develop- 
ing the work, thus leaving to agents every opportunity for ex- 
25 See Cooperative Extension Work, 1923. U. S. Dept, of Agriculture, 
Washington, D. C. 
28 See Birdseye, M., Extension work in foods and nutrition, 1923. Depart- 
ment Circular 349. 
27 Hochbaum, H. W., Methods and results of cooperative extension work, 
1922. Department Circular 316; also Ervin, G., Extension work in agricul- 
tural engineering, 1923. Department Circular 344. 220 
NATIONAL GOVERNMENT AND HEALTH 
pressing their ingenuity and resourcefulness, as well as their abil- 
ity to cooperate with individuals^ and organizations." Programs 
of work are based on specific local problems. Methods of exten- 
sion teaching have included demonstrations, tours, use of the 
press, exhibits, campaigns, score cards, contests, use of motion 
pictures, bulletins, short courses, camps, plays and pageants, and 
various miscellaneous procedures. 
Results in health activities were outlined in the 1922 report as 
follows: 
The outstanding work in the health project has been the visuali- 
zation to rural people of positive standards of health for adults 
and children, which inspired them to desire to attain health in- 
dividually and to obtain community sanitary conditions tending 
to promote health. The health project was carried on as a separate 
project in seventeen states, with the result that more than thirteen 
thousand houses were screened, and nine hundred septic tanks 
were installed. Since in many rural communities the services of 
doctors and nurses are difficult to obtain, and sometimes at such 
expense as to be almost prohibitive, the information from the 
Extension Service as to preventive and simple curative measures 
and the proper care of the patient until the doctor arrives has 
been of distinct help to the rural people receiving such informa- 
tion. One health measure which has been an outgrowth of the 
nutrition work is the dental clinic. Such clinics have met a real 
need in rural sections where dentists are not readily accessible. 
Many states emphasized the health phase of the work in the 
development of every project. 
In 1923, 16,075 demonstrations in home health and sanitation 
were reported, and 674 county agents said that 112,463 home 
makers had adopted better sanitary practices during the year. 
Boys' and girls' club work, or junior extension service, has 
shown its development by an increase in project enrolment from 
115,291 in 1912 to 600,957 in 1922. In 1923, 722,508 projects 
were undertaken by the 459,074 different boys and girls enrolled. 
Reports for 1925 show an even greater increase, exceeding the 
growth for 1924, which in turn was larger by 51,000 members 
than in 1923. In 1922 there were reported28 28,194 organized 
clubs, " of which 8072 were standard," " whereas in 1924 there 
28 Hobson, Q. L., and Warren, G. L., Boys' and girls' club work, 1922. 
Department Circular No. 312. DEPARTMENT OF AGRICULTURE 
221 
were 38,120 clubs. The purpose of these clubs is to encourage 
boys and girls to become interested in assuming more responsi- 
bility in the work of the farm and home.29 Food, hot school 
lunches, clothing, crops and livestock are some of the subjects 
considered. During 1924, for instance, 2077 clubs were stated39 
to have studied home health and sanitation measures. 
Organization and Personnel.81 The personnel of the Extension 
Service comprises nearly four thousand workers, of whom about 
3800 are in the field. In addition, about one thousand other per- 
sons, not in the employ of the national government, are engaged 
in this type of activity. Of the federal employees, about 950 are 
home demonstration agents, over two thousand are in county agent 
work, 130 or more in boys' and girls' club work, and nearly three 
hundred engaged in extension work for negroes. 
The Service has an Office of Cooperative Extension Work, 
and Offices of Motion Pictures and Exhibits. The cooperative 
extension office has divisions of visual instruction and publica- 
tions, reports and efficiency studies, and subject matter specialists. 
In addition, there are regional subdivisions in the Northeastern 
states, the Southern states, the North Central states, and the 
Western states. There is a state director in each state. 
The total annual appropriation to the Service amounts to about 
seven and a half million dollars, of which $4,5.80,000 represents 
the permanent specific appropriation under the Smith-Lever Act. 
Total funds available from all sources during the fiscal year 1924 
amount to nearly twenty million dollars, about 37 per cent coming 
from the Federal Government. 
The Bureau of Entomology. The Bureau of Entomology 
studies insects in their economic relation to agriculture and agri- 
cultural products and to the health of man and animals; experi- 
ments with the introduction of beneficial insects; makes tests with 
insecticides and insecticide machinery; and identifies insects sent 
in by inquirers. Of an appropriation for 1925 of nearly two 
million dollars, $64,630 was for the study of insects affecting the 
health of man and animals. Of this sum, however, the greater 
29 See Tisdale, E. S., and Tobey, J. A., Health in the hills of West Virginia, 
The Nation's Health, July, 1923. A description of a local 4-H project. 
30 Official Record, Aug. 19, 1925. 
31 See Cooperative extension work, 1923. Department of Agriculture. 222 
NATIONAL GOVERNMENT AND HEALTH 
part goes into work relating to the influence of insects on the health 
of animals. 
Active entomological work by the government dates from 1877 
when an Entomological Commission, consisting of three skilled 
entomologists was appointed by the Secretary of the Interior in 
accordance with an act of March 3, 1877 (19 Stat. L., 357). The 
duties of this Commission were to report upon the depredations 
of the Rocky Mountain locusts in the Western states and Terri- 
tories and the best method of coping with them. The Commis- 
sion was transferred to the Department of Agriculture by acts of 
June 16, 1880 (19 Stat. L., 344), and March 3, 1881 (21 Stat. L., 
259). The Division of Entomology became a Bureau in the De- 
partment of Agriculture by the appropriation act of April 23, 1904 
(33 Stat. L., 289). At that time it received an appropriation of 
$82,450. 
During its whole existence the Bureau of Entomology has 
had but one chief, Dr. L. O. Howard, who was appointed assis- 
tant entomologist in 1878, and became Chief of the Division in 
1894. In 1904 he was also appointed consulting entomologist 
for the Public Health Service, though the number of consulta- 
tions he has been called upon for have not been great. Due to 
Dr. Howard's medical training, he became interested late in the 
nineteenth century in the subject of mosquitoes and other insects 
in their relation to the health of man, and thus the Bureau 
undertook a number of studies along these lines and Dr. Howard 
was one of the first to publish books on mosquitoes 32 and flies.33 
The fact that malaria is carried by a certain genus of mosqui- 
toes, Anopheles, was discovered by Dr. (later Sir) Ronald Ross 
in 1897, and was immediately confirmed by other investigators. 
Several years later, after the somewhat unfortunate experiences 
of our Army with disease in the War with Spain, an American 
army commission demonstrated that yellow fever was also 
spread by mosquitoes of a genus now called the EEdes calopus. 
This discovery was made in Cuba in 1900 by Dr. Walter Reed, 
with the cooperation of Drs. James Carroll, Jesse W. Lazear. 
and Aristides Agramonte, and during the course of the ex- 
32 Mosquitoes, how they live, how they carry disease, and how they may be 
destroyed (1901). 
83 The house fly (ign). DEPARTMENT OF AGRICULTURE 
223 
periments, Dr. Lazear was himself accidentally bitten by an in- 
fected mosquito and died of yellow fever.34 Enlisted men of the 
United States Army volunteered, with the sanction of General 
Leonard Wood, to assist in the experiments. The practical re- 
sults of this work were the riddance in Havana of yellow fever 
by Colonel Gorgas and the later construction of the Panama Canal, 
made possible by sanitary measures freeing the region from this 
scourge. In 1905 when yellow fever broke out in New Orleans, 
vigorous anti-mosquito measures under direction of officers of 
the Public Health Service successfully prevented a severe epi- 
demic, such as that seaport had often seen in the past. 
With all of this work Dr. Howard was closely in touch. In 
1911 the Bureau issued pamphlets on malaria and on remedies and 
preventives against mosquitoes. Other early bulletins included 
those on flies, fleas, and ticks, by means of which various diseases 
may be spread. The magnitude of the problem of insects and 
health is shown by the fact that more than two hundred diseases 
have been shown to be carried by insects, though many of these 
are tropical.33 Among the more important, in addition to the 
mosquito-borne infections, are: typhus fever, spread by body 
lice; bubonic plague, carried by fleas; Rocky Mountain spotted 
fever, spread by ticks; typhoid fever, disseminated by flies; and 
sleeping sickness, by tsetse-flies. 
At the time of the American military expedition into Mexico 
in 1916, the Bureau issued a pamphlet entitled " Important insects 
which may affect the health of men or animals engaged in military 
operations." In 1922 it made an incursion into sanitary engi- 
neering and published a bulletin on " Impounding water in a bayou 
to control breeding of malaria mosquitoes." The bulletins on the 
yellow fever mosquito and the house fly were reissued in 1923 and 
1924, respectively. Experiments were conducted during 1923 to 
determine the possibilities of controlling the breeding of the 
anopheles mosquitoes, which carry malaria, in extensive swamp 
areas by means of dry insecticides distributed by aeroplanes. An 
investigation was also begun on the chemotropism of the anoph- 
eles, with a view to finding substances which were attractive 
34 Howard, A fifty year sketch history of medical entomology and its rela- 
tion to public health, in A half century of public health (1921). 
35 Pierce, W. D., Sanitary entomology (1921). 224 
NATIONAL GOVERNMENT AND HEALTH 
or repellent to them. A study of the host preference of these 
mosquitoes has been carried on for some years in cooperation 
with the School of Hygiene and Public Health of the Johns 
Hopkins University. 
Much of the other work of the Bureau also has an indirect 
effect on human health, as the endeavors to prevent devastation 
of food plants or fruits by various types of insects. The bureau 
receives appropriations to investigate the Hessian fly, grasshopper, 
alfalfa weevil, chinch bug, wireworm, and to take measures against 
gypsy and brown-tail moths, European corn borer, Mexican bean 
beetle, and Japanese beetle, and other insect pests. As previously 
stated, only a small proportion of its work is directly concerned 
with insects affecting the health of man. 
The bureau has a permanent personnel of about six hundred, 
of whom, however, more than 350 are in the field. There are also 
on the average about eight hundred per diem employees. The 
personnel authorized for 1926 under the appropriation for iden- 
tification and classification of insects, including investigations of 
insects affecting the health of man and animals, and the importa- 
tion and exchange of useful insects, consists of nine persons of 
professional and subprofessional grade and twelve field workers. 
The Bureau of Biological Survey. The Bureau of Biological 
Survey studies the distribution and habits of native wild life, 
makes biological surveys of areas, and maps the natural life zones 
of the country; investigates the relation of wild birds and animals 
to agriculture and stock raising, with a view to the control of the 
harmful and the conservation of the useful species; conducts 
campaigns for the extermination of predatory wild animals, de- 
structive rodents, and other injurious forms; experiments in fur 
farming and studies the diseases to which fur-bearers are subject 
in captivity; investigates Alaskan reindeer management, and ad- 
ministers big game and bird reservations, and Federal laws relat- 
ing to migratory game, non-game, and insectivorous birds, impor- 
tations of foreign wild birds and animals, interstate commerce in 
wild birds and game, and Alabama land fur-bearing animals. 
The work of the Bureau which pertains to public health con- 
sists of activities against rats and ground squirrels, the fleas of 
which are carriers of bubonic plague; activities against the spread DEPARTMENT OF AGRICULTURE 
225 
of rabies, a disease of animals, also transmissible to humans; and 
a number of other less important items. In the report of the Chief 
for 1924, it is stated that, " The bureau continued to cooperate 
with the United States Public Health Service of the Treasury 
Department, and with state, county, and municipal health organi- 
zations in lines of work where rodents are important agents in the 
dissemination of such diseases as bubonic and pneumonic plague, 
Rocky Mountain spotted fever, and tularaemia." The work in 
behalf of the conservation of food animals and prevention of 
destruction of crops also, of course, has an indirect health, as well 
as economic, aspect. 
Prior to 1896 the Biological Survey had been known as the 
Division of Ornithology and Mammalogy. It became a Bureau 
in 1905 in accordance with the authority contained in an act of 
March 3 (33 Stat. L., 877). At that time it received an appropria- 
tion of $52,000. Up to 1916 its activities against rodents had 
been largely in the nature of investigation, though there had been 
some field work in the national forests. During 1916, however, 
actual operations against rodents were undertaken in cooperation 
with the states, and 208,950 acres were treated in that year for the 
destruction of ground squirrels. By 1920 the total acreage treated 
for all rodents amounted to approximately twenty million acres, 
mostly in the West.36 
In 1916 Congress made an emergency appropriation of $75,000 
for operations against rabies. As an example of the extent of such 
work in 1920, the fact that the Bureau employed from three hun- 
dred to four hundred skilled hunters may be of interest.37 
Activities against house rats have also occupied much of the 
attention of the Bureau. Publications and information regarding 
them have been furnished.38 Demonstrations on their eradication 
were conducted in nineteen states in 1924, and local control cam- 
paigns have been organized, usually in county units. A motion 
picture, called " The Modern Pied Piper," and a poster (No. Bi- 
733) have been issued as part of the educational campaign. In its 
86 Bell, W. B., Death to the rodents, Yearbook, 1920. 
87 Bell, Hunting down stock killers. Yearbook, 1920. 
88 Lantz, D. E., The house rat: the most destructive animal in the world. 
Yearbook, 1917. House rats and mice, Farmers' Bulletin No. 896; How to 
get rid of rats, Farmers' Bulletin No. 1301. 226 
NATIONAL GOVERNMENT AND HEALTH 
investigations to improve methods of combating rats, the Bureau 
has had the cooperation of the Bureaus of Animal Industry, 
Chemistry, and Plant Industry, and the Hygienic Laboratory of 
the Public Health Service.80 
The Bureau of Biological Survey is organized in six divisions: 
Economic Investigations; Food Habits Research; Biological In- 
vestigations ; Alaska Investigations; Game and Bird Refugees; 
Migratory Bird Treaty and Lacey Acts. For 1926 there was 
authorized a personnel of about eleven hundred,, nearly one 
thousand of whom are field workers. The appropriation for 1925 
was nearly a million dollars and for 1926 considerably in excess of 
that sum. 
The Bureau of Public Roads.40 The principal functions of the 
Bureau of Public Roads of the Department of Agriculture are 
to administer the Federal Aid Road Act, under the terms of 
which the national government cooperates with the states in the 
improvement of post and national forest roads; and to conduct 
investigations in various phases of highway construction, and to 
disseminate knowledge thereon. These duties are, of course, only 
very remotely connected with the public health. The bureau, 
however, receives a special appropriation for certain sanitary 
engineering work. 
Agricultural engineering work was begun in the Department 
of Agriculture as early as 1887, when the Office of Experiment 
Stations inaugurated investigations in irrigation and drainage. 
These studies developed considerably in the following years, receiv- 
ing statutory authority and congressional appropriations from 
time to time.41 In fact, rural engineering became a major activity 
of the Office of Experiment Stations, with a considerable field 
force and wide cooperative activities with the states. In 1902 the 
Director of the Office recommended that the scope of the ag- 
30 Annual Report, 1924, p. 15. 
The Public Health Service also carries on extensive operations against 
rats in the far West and elsewhere when plague occurs or threatens. During 
1924 this disease was prevalent in California and the Public Health Service 
conducted much work against rats and ground squirrels in that state. 
40 Holt, The Bureau of Public Roads. Institute for Government Research, 
Service Monograph No. 26 (1924). 
41 Acts of July 5, 1892 (27 Stat. L., 74) ; August 18, 1894 (28 Stat. L., 422) ; 
March 22, 1898 (30 Stat. L., 335) ; and April 23, 1904 (33 Stat. L., 294). DEPARTMENT OF AGRICULTURE 
227 
ricultural engineering be broadened to include such matters as 
laying out of farms, water supply, sewage disposal, and use of farm 
machinery. 
In 1915 all of the engineering work of the Department of 
Agriculture was transferred by the Secretary to the Office of 
Public Roads. The transfer was further effected by the appro- 
priation act for 1916 (38 Stat. L., 1086, mi), which also changed 
the name of the Office of Public Roads to Bureau of Public Roads 
and Rural Engineering. The name was changed to Bureau of 
Public Roads in 1919. Beginning in 1916 special appropriations 
have been made " for investigating farm domestic water supply 
and drainage disposal, the construction of farm buildings, and 
other rural engineering problems involving mechanical problems." 
These annual appropriations for this purpose have been as follows: 
1916 $12,805.00 
IQI7 20,000.00 
1918 25,000.00 
1919 25,000.00 
1920 25,000.00 
1921 25,000.00 
1922 25,000.00 
1923 33,000.00 
1924 33,000.00 
1925 35,300.00 
Only a small part of this, perhaps one-fifth, goes into the 
sanitary engineering work. 
For 1925 the total appropriation to the Bureau for all purposes 
was $474,175.00. 
In January, 1922, the Bureau issued a pamphlet (Farmers' 
Bulletin No. 1227) on " Sewage and sewerage of farm homes," 
written by George M. Warren, Hydraulic Engineer. Other pam- 
phlets on sanitary engineering subjects, issued by the Department 
of Agriculture, include: "The sanitary privy" (Farmers' Bul- 
letin 463, superseded by 1227) ; " Clean water and how to get it 
on the farm" (Yearbook, 1914) ; " Water supply, plumbing, and 
sewage disposal for country homes " (Department Bulletin 57) ; 
"Sewage disposal on the farm" (Yearbook, 1916); "Securing 
a dry cellar " (Yearbook, 1919) ; " Farm plumbing " (Farmers' 
Bulletin No. 1426, 1924) ; " Farmstead water supply " (Farmers' 
Bulletin No. 1448, 1925) ; and " Simple plumbing repairs in the 
home" (Farmers' Bulletin No. 1460, 1925). 228 
NATIONAL GOVERNMENT AND HEALTH 
These pamphlets are popular, and that on sewage disposal has 
been distributed to the number of approximately one hundred 
thousand. 
This sanitary engineering work is conducted by two full-time 
engineers of the Division of Agricultural Engineering. One of 
these engineers is at the Washington headquarters, while the 
other is in charge of experiments on sewage irrigation at Vineland, 
New Jersey. Other activities of the engineers of the Division on 
irrigation, drainage, refrigeration, and ventilation have an in- 
direct bearing on public health. The Division has a force of about 
fifty engineers, architects, and other technical personnel. 
Bureau of Agricultural Economics. The Bureau of Agricul- 
tural Economics was created in 1922 (41 Stat. L., 1315, 1341) 
by consolidating the Office of Farm Management and Farm Eco- 
nomics with the Bureau of Markets and Crop Estimates. It is 
concerned with all of the economic questions involved in the 
production, marketing, and distribution of farm products. It 
is also interested in farm financial relations, farm labor, agricul- 
tural history and geography, land economics, and problems of 
rural life. Besides the compilation, interpretation, and dissemina- 
tion of information, it performs regulatory work in connection 
with enforcement of the Cotton Futures Act, the Grain Standards 
Act, the Standard Container Act, and it has charge of the ad- 
ministration of the Warehouse Act. 
Duties of the Bureau which have an indirect bearing on the 
public health include a market inspection service on fruits and 
vegetables at many of the principal producing and receiving 
centers, and on butter at five of the chief terminal markets. There 
are also other dairy inspection services and a meat grading service. 
During the fiscal year 1924, 130,959 cars of fruits and vegetables 
were inspected at shipping points as compared with 72,466 42 in- 
spected the previous year. At receiving markets, 29,283 inspec- 
tions were made. A total of 7334 inspections of butter were made, 
of which 5948 were commercial and 1386 were governmental. 
An egg standardization program was carried out and nearly five 
thousand cases of eggs were inspected during the fiscal year 1924. 
Center Market in the District of Columbia is administered by the 
42 Annual Report 1924, p. 33. DEPARTMENT OF AGRICULTURE 
229 
Bureau, and persistent efforts are made to improve and maintain 
sanitary conditions there. 
For several years the Bureau has been gathering data on the 
retail marketing of meats, including information on sanitary prac- 
tices. A special report on pushcart methods in New York declares 
that the sale of fish as carried on by that system is a menace to 
public health. An economic study on the use of milk in metro- 
politan Boston was issued in 1925. The Division of Farm Popu- 
lation and Rural Life conducted a survey of rural hospitals in 
1925, though from the sociological, rather than the medical angle. 
Before publication this was sent to the Public Health Service for 
comment. 
The annual appropriation to the Bureau amounts to over four 
million dollars a year, being $4,504,764 in 1925. Of this sum about 
$350,000 was for the investigation and certification of the class, 
quality and condition of cotton, fruits, vegetables, poultry, butter, 
hay, and other perishable farm products offered for interstate 
commerce. The personnel engaged on this work is about one 
hundred, the total personnel of the Bureau amounting to over 
one thousand six hundred. 
The Office of Experiment Stations?3 The Office of Experi- 
ment Stations of the Department of Agriculture exercises the 
supervision provided by law over the work and the expenditures 
of the state agricultural experiment stations, serving as a general 
clearing house for the national system and assisting in various 
ways to promote its efficiency; it supervises the work and ex- 
penditures of the agricultural experiment stations maintained by 
the Department in Alaska, Hawaii, Porto Rico, Guam, and the 
Virgin Islands; and compiles and disseminates information re- 
garding the progress of agricultural research through the Experi- 
ment Station Record and other publications. Many of these ac- 
tivities now have a direct or an indirect bearing on the public 
health. Studies on the nutrition of men have been made (at 
fourteen stations in 1923), studies of dairying and the chemistry 
and bacteriology of milk have been conducted, and many experi- 
ments on production and use of food have been undertaken. 
43 See Conover, The Office of Experiment Stations, Institute for Govern- 
ment Research, Service Monograph No. 32 (1924). 230 
NATIONAL GOVERNMENT AND HEALTH 
The Office of Experiment Stations was created by the act of 
March 2, 1887 (24 Stat. L., 440), though there had been experi- 
ment stations in the states for some years previously. In 1915 
it became a part of the States Relations Service, but was rees- 
tablished on its original basis in 1923. The Office of Experiment 
Stations lias a personnel of about eighty, of whom about half 
are in Washington and the remainder in the field. It deals with 
about seventy agricultural experiment stations in the states. 
Appropriations to this Office increased from $15,000 in 1890 
to $95,000 in 1900 and $339,220 in 1910. In 1916 they dropped 
to $168,610, due to the reorganization in the Department, but have 
increased ever since. In 1920 the Office received $256,580, and 
for 1925 it was granted $528,368. Rural engineering, including 
sanitary work, nutrition, and home economics studies were all 
carried on under the auspices of the Office until 1915, when these 
activities were transferred to other branches of the Department. 
The Bureau of Plant Industry. The Bureau of Plant Industry 
conducts researches into all problems of plant life, including 
such items as soils, seeds, cuttings, plant breeding and acclimatiza- 
tion, cultural methods, marketing and utilization of products, 
plant diseases, and similar matters. Its principal activities are 
not in the field of public health, but one or two of its functions 
have an indirect relationship to this subject. 
The Bureau was created in 1901 through the consolidation of 
existing Divisions of Agrostology, Botany, Gardens and Grounds, 
Pomology, Seeds, and Vegetable Physiology and Pathology. This 
action was confirmed by Congress in the agricultural appropria- 
tion act for 1902 (31 Stat. L., 922). One of the present project 
groups of the Bureau is an Office of Drug, Poisonous, and Oil 
Plant Investigations, which receives an annual appropriation of 
$40,000 for its work. A notable achievement of this Office was 
the successful search a few years ago for the seeds of the trees 
which produce chaulmoogra oil, a remedy used to cure or alle- 
viate leprosy.44 These trees grew only in the dense jungles of 
Siam, Burma, Assam, and Bengal, and an agricultural explorer 
was able in 1922 to secure a quantity for the seeds, so that these 
important trees could be cultivated in Hawaii. 
44 Rock, J. F., The Chaulmoogra Tree and Some Related Species. Bulletin 
No. 1057 (1922). U. S. Department of Agriculture. DEPARTMENT OF AGRICULTURE 
231 
The Bureau is also attempting to improve strains of medicinal 
and essential oil plants by breeding, and to promote the produc- 
tion of such plants on a commercial basis in this country. Studies 
on cancer of plants have been made, the data being of value for 
comparative purposes in investigations of the disease in man. Pro- 
motion of improved cereal cultural methods and the development 
of other food plants is likewise being undertaken. Other studies 
include those on fruits, especially from the standpoint of handling 
and storing; and investigations of poisonous plants. 
The total appropriation to the Bureau is nearly $4,000,000 
annually, and the personnel is about eighteen hundred. 
The Forest Service. The Forest Service of the Department of 
Agriculture administers the national forests, of which there are 
over 150 with a total acreage of more than 157,000,000. They are 
scattered throughout the country, usually in mountainous regions. 
Since they are visited annually by more than 10,000,000 persons, 
the sanitary problem is an important one. In fact, all that is asked 
of the visitor to the national forests, according to publications of 
the Forest Service, " is that he look to the proper sanitation of his 
camp and be careful with fire." 
The sanitary problem in the national forests is, in fact, similar 
to that in the national parks, administered by the Department of the 
Interior, and is essentially one in rural hygiene. An annual appro- 
priation of $25,000 for sanitation and fire protection has been made 
to the Service for several years. There are some 1500 public camps 
to which this money has been devoted, the total cost over a period 
of years having been $403,000, or on the average about $235 a 
camp. 
Local water supplies often have their sources in forest lands and 
the rangers cooperate in keeping them protected from con- 
tamination. CHAPTER IX 
THE DEPARTMENT OF LABOR 
Four of the six bureaus of the Department of Labor are con- 
cerned with the public health. One of these agencies, the Chil- 
dren's Bureau, is interested primarily in this subject, though also 
doing other work, but with the other three, the interest in public 
health is secondary to the general scope of the Bureau. These are 
the Women's Bureau, the Bureau of Labor Statistics, and the 
Bureau of Immigration. The Bureau of Immigration is con- 
cerned directly with the duty of excluding immigrants who are 
undesirable on account of physical or mental conditions, though 
the actual examinations for this purpose are made by officers of 
the Public Health Service, detailed for this duty. 
The Children's Bureau.1 
History and Development. The Children's Bureau was cre- 
ated to promote the general welfare of children in the United 
States and the several territories. It was established by an act 
of Congress approved April 9, 1912 (37 Stat. L., 79), and its 
duties declared to be to 
investigate and report . . . upon all matters pertaining to the 
welfare of children and child life among all classes of our people, 
and . . . especially [to] investigate the questions of infant mor- 
tality, the birth rate, orphanage, juvenile courts, desertion, dan- 
gerous occupations, accidents and diseases of children, employ- 
ment [and] legislation affecting children in the several states and 
territories. 
The original suggestion for a Federal Children's Bureau is 
attributed to Miss Lillian D. Wald, head of the House on Henry 
Street in New York City. Mrs. Florence Kelley of the National 
Consumer's League, to whom Miss Wald communicated her idea, 
1 Tobey, The Children's Bureau. Institute for Government Research, 
Service Monograph No. 21 (1925). 
232 DEPARTMENT OF LABOR 
233 
formulated the plan, which was supported by officials of the 
National Child Labor Committee, and by other well-known 
sociologists. 
Six years elapsed after the first introduction of bills to this end 
before Congress passed a measure creating the Children's Bureau. 
Final action was taken on April 5, 1912, and the bill was signed by 
the President on April 9 (37 Stat. L., 79). The first chief of the 
Bureau was appointed June 4, 1912, and the legislative bill carry- 
ing the first appropriation for the new bureau was approved 
August 23, 1912. 
At that time the Children's Bureau became the twelfth bureau 
of the Department of Commerce and Labor, where it remained 
until 1913, when it was transferred to the newly created Depart- 
ment of Labor (Act of March 4, 1913; 37 Stat. L., 736). 
The First Work: Infant Mortality Studies. The Bureau began 
operations on August 23, 1912, when its first appropriation of 
$25,640 became available. The staff authorized for the first year 
comprised only fifteen persons, though this number was not reached 
until March, 1913. The initial work undertaken was experimental, 
and as infant mortality seemed to present the most strategic point 
at which the Bureau could begin investigations with its limited 
forces, a study of the family, social, industrial, and economic 
factors concerned in infant mortality was conducted in the City 
of Johnstown, Pennsylvania. At this time the Bureau had no 
medical staff, and so " The inquiry was necessarily restricted to a 
consideration of social, industrial and civic factors." 2 Although 
the general plan of the series of reports on infant mortality which 
followed was unchanged, later studies, after a child hygiene divi- 
sion was established, discuss in some detail the incidence of medi- 
cal causes of death. The infant mortality studies have never been 
the responsibility of any one division. Up to the present time 
studies have been conducted in Johnstown, Pa.; Montclair, N. J.; 
Manchester, N. H.; Brockton, Mass.; New Bedford, Mass.; 
Saginaw, Mich.; Waterbury, Conn.; Akron, Ohio; Pittsburgh, 
Pa.; Baltimore, Md.; and Gary, Indiana. In Gary a study of the 
pre-school child, from 2 to 6 years of age, was made, and the infant 
mortality aspect was somewhat simplified. Recently a statistical 
1 Annual Report, 1914, p. 7. 234 
NATIONAL GOVERNMENT AND HEALTH 
analysis of causal factors in infant mortality based on the combined 
figures of eight of these cities has been published. 
Other Early Activities. Other activities during the early 
years of the Bureau's existence included the preparation of a pam- 
phlet on prenatal care; a review of child labor legislation; studies 
on the employment certificate system; and campaigns to increase 
birth registration, carried on in cooperation with the United States 
Bureau of the Census and with the assistance of the General 
Federation of Women's Clubs. The Bureau also assembled and 
interpreted figures previously published by the Bureau of the 
Census relative to children of the United States. 
In the fiscal year 1915 the staff was increased from fifteen to 
seventy-six and an appropriation of $164,640 was obtained. Five 
divisions were set up in the Bureau, as follows : 
1. Statistical. 
2. Library. 
3. Industrial. 
4. Hygiene. 
5. Social Service. 
Later, the library was incorporated in the Department of Labor 
Library. In 1916 the Bureau initiated the national observance of 
Baby Week, in which 2083 communities participated. 
On April 1, 1925, the personnel numbered 161, on the average, 
and the appropriation for the fiscal year 1915 was $375,900, ex- 
clusive of the $1,190,000 available for allotment to the states under 
the Maternity and Infancy Act passed in 1921. 
Administration of the First Federal Child Labor Law. A 
Child Labor Division was organized in the Bureau in May, 1917, 
in order to administer the act of September 1, 1916 (39 Stat. L., 
675), which prohibited interstate commerce in the products of 
child labor. The act became effective on September 1, 1917, but 
was held unconstitutional by the United States Supreme Court 
on June 3, 1918.3 The Child Labor Division continued in existence, 
however, in order to make general investigations and to secure 
enforcement of the child labor cause inserted in government war 
contracts.4 The work of the Division was finally discontinued 
8 Hammar vs. Dagenhart, 247 U. S. 251. 
4 See Administration of the first federal child labor law, Bureau Publica- 
tion No. 78, 1921. DEPARTMENT OF LABOR 
235 
when the federal child labor tax went into effect on April 25, 1919 
(40 Stat. L., 1138), to be administered by the Bureau of Internal 
Revenue of the Treasury Department.5 
Special War Work; Children's Year. At the time the United 
States entered the World War, in April of 1917, the Bureau had 
assembled information with reference to the special problems 
which had developed and the dangers which the children of the 
warring countries had met. This was promptly made available in 
reports describing the provisions made for the care of the children 
and other dependents of enlisted men in various countries, the 
increase in delinquency, and the ill-advised increase in child labor. 
During the war, as occasion developed, the bureau studied special 
problems growing out of the increase in the employment of married 
women, nursery care for the children of working mothers, and the 
use of milk in families having young children. 
The second year of our participation in the war was designated 
as " Children's Year," and a Children's Year campaign was for- 
mally launched on April 6, 1918, with the approval and support of 
President Wilson, who allotted $150,000 from the National Se- 
curity and Defense appropriation for carrying on this work. The 
President also turned over at the same time $100,000 to the Bu- 
reau in order that it might have funds to administer through its 
Child Labor Division the child labor clause in Government war 
contracts. The program for Children's Year, which had the co- 
operation of the Women's Committee of the Council of National 
Defense, through its Child Welfare Department (later known 
as the Child Conservation Section of the Field Division), com- 
prised these four main parts :8 
1. Public protection of maternity and infancy. 
2. Mother's care for older children. 
3. Enforcement of child labor laws and free schooling for all 
children of school age. 
4. Recreation for children and youth, abundant, decent, pro- 
tected from any form of exploitation. 
5 This law was declared unconstitutional, in 1922, in Bailey vs. Drexel 
Furniture Company, 259 U. S. 20. 
6 See Children's year (Bureau Publication No. 67, 1920). 236 
NATIONAL GOVERNMENT AND HEALTH 
In. order to carry out this program, committees were organized 
in the states, to the number of about seventeen thousand, with a 
total estimated enrolment of some eleven million women. All but 
two states participated, and the weighing and measuring test of 
infants and children, with which the Children's Year drive was 
opened, was conducted in 16,811 cities and towns. The weighing 
and measuring of apparently well children, for which purpose the 
bureau distributed over seven and a half million cards, was fol- 
lowed by an effort to secure adequate recreational facilities, and 
by a " Back-to-School " movement. 
As a concluding activity of Children's Year, a conference on 
child welfare standards was held in Washington during May, 
1919, with a number of distinguished child welfare experts from 
foreign countries in attendance. Following eight Washington 
meetings, beginning on May 5, regional conferences were held 
at New York, Cleveland, Boston, Chicago, Denver, Minneapolis, 
San Francisco, and Seattle. At the Washington conference mini- 
mum standards on child welfare were formulated and these were 
later revised and approved by a special committee. 
The results of the Children's Year were followed up in subse- 
quent years by tabulating 200,000 of the weighing and measuring 
cards; by putting into operation the Child-Welfare Special, a 
specially equipped travelling unit to promote child hygiene work 
in rural communities; and by publishing a series of Children's 
Year Follow-Up pamphlets. A program for communities was 
also suggested. The Child-Welfare Special consisted of a motor- 
truck, fully equipped for making physical examinations of chil- 
dren and carried a staff consisting of a physician, a nurse, a 
clerk, and a chauffeur. It was sent into a state only on request of 
the state health authorities. After being in operation four years, 
during which it made surveys in six states, its operation by the 
bureau staff was discontinued in September, 1923, because a 
number of the states had signified their willingness to supply the 
staff and operate the Special without expense to the Children's 
Bureau. 
The Maternity and Infancy Act. In her annual report for 1917, 
Miss Julia C. Lathrop, then Chief of the Bureau, recommended 
that there be adopted in this country a plan for federal aid to the 
states for the public protection of maternity and infancy. Some DEPARTMENT OF LABOR 
237 
four years later, after having had the matter before it in the mean- 
time during the Sixty-Fifth, Sixty-Sixth, and Sixty-Seventh con- 
gresses, this last Congress passed such a measure and it was 
signed by the President on November 23, 1921. 
This law (42 Stat. L., 224) authorized an annual Federal appro- 
priation for five years, amounting to $1,240,000 a year, to be 
allotted to those states which accepted the terms of the act and 
designated a state agency to administer it. Except for an initial 
sum of $5000, which is given outright, the federal grant can be 
obtained only if matched by a state appropriation. The state 
agency is required to submit for approval detailed plans to a 
Federal Board of Maternity and Infant Hygiene, composed of the 
Surgeon General of the Public Health Service, the Chief of the 
Children's Bureau, and the Commissioner of Education, and make 
such reports to the Children's Bureau concerning its operations 
and expenditures for the purposes of the act as shall be prescribed 
or requested by the bureau. The Children's Bureau was designated 
as the agency to administer this law, by cooperating with the states, 
by making necessary studies and investigations, by certifying to 
the Secretary of the Treasury and to the states the amounts allotted 
to each state, and by other general administration. A special 
Maternity and Infant Hygiene Division was created in 1921 to 
perform the duties required.7 
Although the Federal Maternity and Infancy Act passed Con- 
gress by a large majority and by June 30, 1922, had been accepted 
by forty-two states, a considerable amount of opposition to it 
also developed. The Commonwealth of Massachusetts refused to 
accept the act, and, believing that its rights as a state were in- 
fringed, brought suit in the United States Supreme Court against 
the federal officers charged with the administration of the act, in 
order to restrain them from carrying out what was alleged to be 
an unconstitutional law. About the same time a Massachusetts 
taxpayer brought a similar suit in the courts of the District of 
Columbia. Both the Supreme Court of the District of Columbia 
and the Court of Appeals of the District upheld the law, however, 
and an appeal was taken to the United States Supreme Court. Here 
both cases were decided together. The decision, given by an 
7 See The promotion of the welfare and hygiene of maternity and infancy 
(Bureau Publication No. 146, 1925. No. 137, 1924). 238 
NATIONAL GOVERNMENT AND HEALTH 
unanimous court in 1923, was to the effect that the cases must be 
dismissed for want of jurisdiction, neither the state nor the tax- 
payer having a status sufficient to bring court action. The con- 
stitutionality of the law was not actually passed upon. 
An act approved March 10, 1924, extended the provisions of 
the Maternity and Infancy Law to the Territory of Hawaii upon 
the same terms as to the states, and beginning with the fiscal year 
1925, for which period an appropriation of $12,079.96 was made. 
The administration of the law, which by May, 1925, had been 
accepted by the legislatures of forty-three states, is discussed later.8 
Current Activities. In putting into effect its organic act, 
the bureau has gone on the theory that its proper sphere en- 
compasses all of the problems of childhood, including hygienic, 
social, industrial, civic, and economic questions. It endeavors to 
deal with the child as a whole and childhood as a unit. To this 
end, activities undertaken have been and are concerned with all 
classes of American children and the factors which directly or 
indirectly affect their welfare. Not only have children themselves 
been the subject of investigation and report, but an attempt has 
been made to achieve effective working relationships with all the 
agencies, official and voluntary, and with the great groups of 
people in the country who are concerned with the community 
problems of child care, and the still larger numbers of individual 
parents who have been asking for assistance in problems con- 
nected with their own children.9 
Activities, therefore, include not only studies and surveys of 
maternal and infant mortality and the myriad of cognate matters, 
but also research into health problems of the pre-school or runa- 
bout period, investigations and reports on child labor laws and 
their administration, juvenile courts, mothers' pensions, illegiti- 
macy, exploitation of children, school attendance, and all matters 
pertaining to neglected, dependent, delinquent, defective, and un- 
derprivileged children. 
Actual administrative duties have consisted only of the enforce- 
ment of the first Federal Child Labor Law during the nine months 
of 1917 and 1918 that it was in operation and of the administra- 
8 See page 242. 
9 See Abbott, Grace, Ten years' work for children, North American 
Review, August, 1923. DEPARTMENT OF LABOR 
239 
tion of the Federal Maternity and Infancy Act since it went into 
effect on November 23, 1921, though the funds authorized were 
not available until March, 1922. 
Except for its activities under these two laws the bureau has 
had no administrative duties, and, therefore, its attention has been 
devoted to research along the lines indicated by the portion of the 
organic act quoted above and to promoting the welfare of 
children. 
Infant and Maternal Mortality; Child Hygiene. The early 
studies of infant mortality, with which the Bureau began opera- 
tions, reversed the usual process of investigation. Instead of 
deriving the information from death record's, they began with 
birth records and followed each child through the first year of 
life, or such part of the year as had been lived. Between 1915 and 
1923 reports on investigations of this nature in eleven cities were 
published. The rates were found to vary widely in different states 
and in different parts of the same state, these variations being 
probably due to many racial, social, economic and educational fac- 
tors. In order to obtain a group large enough to warrant statis- 
tical analysis, the figures for eight of the cities were combined, 
and the statistical discussion of the 23,000 babies included was 
issued in May, 1925, under the title, " Causal Factors in Infant 
Mortality." A high infant mortality rate (that is, the number of 
deaths under one year of age per thousand live births) was found 
to be associated with: poor physical condition of the mother; 
births occurring within a year after the preceding births to the 
same mothers; artificial feeding; unfavorable economic condi- 
tions such as housing congestion and low earnings; and employ- 
ment of the mother away from home. 
In 1925, at the request of the Tennessee Department of Public 
Health, a study of birth and death records was made in six coun- 
ties of the state to ascertain to what extent, if at all, the neonatal 
and maternal mortality rates are affected by the type of attendant 
at birth. 
In 1916 a comprehensive survey was made of statistics relating 
to maternal mortality from all conditions relating to childbirth, 
both in the United States and in certain foreign countries. A 
new report on this subject, based on the most recent statistics 
available, was prepared in the Statistical Division in 1925 and was 240 
NATIONAL GOVERNMENT AND HEALTH 
then in press. Although the infant mortality rate in this country 
has declined in recent years, the maternal mortality has remained 
among the highest of all nations for which recent statistics are 
obtainable. 
New Zealand has been so successful in handling the infant mor- 
tality problem that the bureau has issued two publications dis- 
cussing the methods used and results achieved in that dominion: 
" New Zealand Society for the Health of Women and Children: 
An example of the methods of baby-saving work in small towns 
and rural districts," and a more comprehensive report in 1922 
entitled " Infant mortality and preventive work in New Zealand." 
Along with the first studies of infant mortality, popular pam- 
phlets on prenatal care, infant care, and child care were pub- 
lished. The tremendous circulation of these bulletins is shown by 
the fact that to date about 3,000,000 copies of one of them, that 
on " Infant care," have been distributed. Other popular bulletins 
have been issued from time to time, but none has reached the 
demand of these three, which is not only continuous, but increases 
annually. The most recent bulletin of this character is " Child 
management," of which 15,000 copies were distributed within 
six weeks after its publication in March, 1925. 
In order to stimulate the registration of births, the Bureau 
cooperated with the United States Bureau of the Census, the 
General Federation of Women's Clubs, the Mother's Congress, the 
Association of Collegiate Alumnae, and other organizations in 
trying to popularize knowledge of the value of birth registration. 
In cooperation with the Bureau, local committees of women can- 
vassed small districts and filled out the standard birth certificate 
furnished by the Census Bureau. These certificates were then 
compared with the local records and the returns made to the 
Census Bureau in order to determine the accuracy of birth regis- 
tration. 
In some states such tests were made to help the passage of a 
uniform vital-statistics law. In 1915 committee members made a 
house-to-house canvass in thirty cities of Florida and arranged 
with the state health officer to have recorded the unregistered 
births found by the canvass. These birth-registration tests were 
continued for several years in twenty-four states, and the impor- 
tance of birth registration has also been emphasized by the bu- DEPARTMENT OF LABOR 
241 
reau in connection with Children's Year, Baby Week campaigns, 
and other movements. In 1923, at the request of the state health 
officer, the Children's Bureau made a test of birth registration 
in Alabama to assist the state in bringing its registration up to 
the standard required for admission to the birth-registration area. 
The discussion and passage of the Maternity and Infancy Act 
have given fresh impetus to birth registration in many states. Of 
the seventeen states cooperating under the Maternity and Infancy 
Act which were not in the birth-registration area in 1924, eleven 
have instituted special work to secure more complete registration. 
" National Baby Week " was first observed in March, 1916, at 
the joint suggestion of the Children's Bureau and the General 
Federation of Women's Clubs. The purpose was to stimulate 
interest in the proper care of infants and by means of exhibits and 
conferences to bring to the attention of parents the standards of 
infant welfare which had been developed by experts who had 
studied the subject. In order to promote the success of this work 
the bureau prepared a pamphlet entitled Baby Week campaigns, 
describing the methods used in the earlier urban baby-week ob- 
servances whose success had encouraged the belief that a nation- 
wide observance would be practicable. This pamphlet was revised 
to include the best original ideas and devices developed during the 
campaign of 1916. A similar movement was carried on in 1917, 
and the work begun in these campaigns was developed even more 
extensively in 1918 in connection with Children's Year activities. 
In response to public demand the bureau has recently prepared 
and published a directory of child-health agencies in the United 
States. A study has been made and a report was issued in 1924 
on methods of conducting nutrition work for pre-school children 
in nine urban and three rural communities in which some defi- 
nitely organized work in this field is being done. Another impor- 
tant piece of work in progress in 1925 was a study of the status 
of knowledge in the field of the physical fitness of children. In 
connection with this study an annotated bibliography of all the 
available literature on the subject of the growth and develop- 
ment of children was being prepared. Another part of the physical- 
fitness survey was an investigation conducted during 1924 and 
1925, in cooperation with the public schools of Chelsea, Mass., 
and the Boston Community Health Service, on how posture train- 242 
NATIONAL GOVERNMENT AND HEALTH 
ing can be used to promote general physical fitness and how pos- 
ture affects weight, height, vital capacity, power of concentration, 
and scholastic attainment. A report, based on the results of this 
investigation, on the organization of posture work for children, 
was planned for 1925. A study of the prevalence and conditions 
of development of rickets among young children in the District of 
Columbia was made by the Children's Bureau in 1922 and 1923; 
and in 1925 nearly two years had been completed of a three-year 
demonstration in New Haven, in conjunction with the Department 
of Pediatrics of the Yale School of Medicine, to show that rickets 
is a preventable disease and subject to community control. A bulle- 
tin was issued in 1924 on the work of habit clinics for children of 
pre-school age, and a report was in preparation in 1925 on the 
health supervision of department children. 
Welfare problems of the rural child have been the subject of 
numerous investigations and reports by the Bureau. In making 
these surveys the agents of the Bureau have used different methods 
of approach. Sometimes a local study was started with a children's 
health conference to which parents were encouraged to bring their 
children. Here they were shown a small exhibit and advised as to 
the care, feeding, and general condition of the children. No medical 
service was given and if physical impairments were discovered, 
the parent was advised to secure competent medical attention for 
the child. In the Kentucky nutritional survey physical examina- 
tions of over half the children were made by a Children's Bureau 
physician and the environmental factors affecting the health of the 
child were ascertained by visiting the home and interviewing the 
mother. Recently a survey of health conditions affecting maternity 
and infancy in two counties in New Mexico has been conducted. 
The act, effective November 23, 1921, known as the Maternity 
and Infancy Act, authorizes an annual appropriation of $1,240,000 
for a five-year period, of which not more than $50,000 may be 
expended by the Children's Bureau each year for administrative 
purposes and for " such studies, investigations, and reports as will 
promote the efficient administration of the act," the balance being 
divided among the states accepting the act as follows: $5000 
unmatched to each state and an additional $5000 to each state if 
matched; the balance to be allotted among the several states on the 
basis of population and granted if matched. All the states had DEPARTMENT OF LABOR 
243 
accepted the act in 1925 except Maine, Massachusetts, Connecticut, 
Illinois, and Kansas. The state activities include: (1) An increase 
in the number of public-health nurses in state or county positions, 
or both; (2) the establishment of maternal and infant health 
centers; (3) stimulation of better birth registration; (4) improve- 
ment in milk supplies; (5) surveys of maternity homes and infant 
homes; (6) studies of the midwife problem; (7) general educa- 
tional activities through literature, exhibits, lectures, demonstra- 
tions, mothers' classes, and correspondence courses. The admin- 
istrative work of the Children's Bureau in connection with the 
act, in addition to cooperating with the states through correspon- 
dence, includes visits to the states to discuss plans of work and 
activities; conducting of nurses' institutes on maternal and infant 
care when requested by authorities; accounting for federal and 
state funds and checking of state books by the bureau accountant. 
A survey has been made of maternity homes in Pennsylvania and 
in Minnesota, and a study is being made of the teaching of obstetrics 
in the United States. With the cooperation of local physicians, 
investigations are in progress to determine the causes of stillbirths, 
neonatal mortality, and maternal mortality. A survey of health 
conditions affecting maternity and infancy was conducted in two 
counties in New Mexico in 1925. 
In response to the request of state divisions of child hygiene 
for statements of standards of prenatal care and standards for 
conducting child-health conferences, for the use of physicians 
engaged in maternity and infancy work in the states, a confer- 
ence of physicians was held at the Children's Bureau in May, 1925, 
to assist in formulating such standards. The standards drawn 
up at this meeting have been reviewed by the Bureau's advisory 
committee of pediatrists and submitted to other physicians who 
were unable to attend the conference. 
By the law extending the Maternity and Infancy Act to Hawaii, 
an appropriation of $12,000 was authorized for the fiscal year 1925. 
Hawaii has accepted the provisions of the act. 
Child Labor and Industrial Conditions Affecting Child Felfare. 
The first study undertaken by the bureau on the subject of child 
labor was a review of the legislation affecting child labor in the 
different states. This review contains a summary of child labor 
legislation in this country by states, covering such points as the 244 
NATIONAL GOVERNMENT AND HEALTH 
minimum age, hours of labor, night work, prohibited employments, 
and the text of the child labor laws. Reports have been published 
also on the administration of the employment-certificate laws of 
Connecticut, New York, Maryland, and Wisconsin, and a report 
has been published on methods of enforcing child labor laws, par- 
ticularly employment certificate systems. Other studies of child 
labor laws made by the bureau are a study of the administration 
of street trades laws and of the administration of state laws requir- 
ing children to obtain permits for work in their own homes or in 
domestic service outside the home. 
A study of employment-certificate records in Connecticut has 
been issued in a report entitled " Industrial Instability of Child 
Workers; a study of employment certificate records in Connec- 
ticut," and a comprehensive report on child labor in Boston, based 
on employment-certificate records and interviews with working 
children, was issued in 1922. 
Studies made by the bureau in the industrial field, as it relates 
to children, have included a survey of child welfare in coal mining 
areas in Pennsylvania and West Virginia, both anthracite and 
bituminous; investigations of the employment of children in can- 
neries of the Gulf Coast and the State of Washington, industrial 
home work in Rhode Island, and agricultural activities, particularly 
in the beet fields of Michigan and Colorado, in the cotton field's of 
Texas and in the truck gardens of Maryland, Virginia, and New 
Jersey, on the tobacco farms of Kentucky, South Carolina, Vir- 
ginia, Massachusetts, and Connecticut, in the fruit and hop growing 
districts of Washington and Oregon, and in selected areas of rural 
North Dakota and Illinois. Other studies of employed children 
relate to street trades and to child labor in Atlanta, made at the 
request of the Children's Code Commission of Georgia and at 
Columbus, Omaha, and Wilkes-Barre. As part of an inquiry into 
conditions under which children are directed into industrial life, 
a study of organized vocational guidance and juvenile placement 
activities was conducted in cooperation with the United States 
Employment Service in a number of cities. An inquiry into occu- 
pations for minors in metal manufacturing industries in Michigan, 
a second into opportunities for minors in the printing industry in 
New York City, and a third into types of occupations entered by 
children of subnormal mentality as well as studies of minimum DEPARTMENT OF LABOR 
245 
wage and industrial accidents to minors, have also been made. 
Somewhat similar are an investigation of the types of occupations 
entered by children of subnormal mentality in seven cities and a 
study of the work histories of continuation school children in 
Milwaukee. Reports on industrial accidents to minors in Wiscon- 
sin, Massachusetts, and New Jersey and on the effects on minors 
of minimum-wage rulings in Minnesota, Wisconsin, California, and 
the District of Columbia are in press. 
The Bureau receives periodical reports giving statistics of chil- 
dren between 14 and 16 years of age obtaining permits to go to 
work in a number of cities and states (the only source of current 
information between census years indicating the general trend in 
the employment of children of legal working age) and from time 
to time publishes analyses of these statistics. 
Measures to stimulate public interest in working children and 
their needs formed a part of the Children's Year program. A 
Back-to-School Drive was inaugurated in the fall of 1918 with the 
object of encouraging children, especially those who had been 
tempted to leave school for war work, to return to school. This 
was followed in February, 1919, by a Stay-in-School campaign. 
In connection with the Back-to-School Drive a number of popular 
pamphlets dealing with several phases of child labor were issued. 
The most recent pamphlet of this character, " Child Labor in the 
United States: ten questions answered," originally published in 
1922 and revised in 1924, was issued in response to a popular 
demand for information regarding the extent and legal regulation 
of child labor in the states. Charts showing the state child-labor 
standards and the state compulsory school attendance standards 
affecting the employment of minors were issued in 1921, and a 
pamphlet giving the legal provisions of the various states regulating 
the employment of minors 16 years of age and over, was published 
in 1924. A pamphlet giving outlines for the study of child labor 
was issued in 1924 in cooperation with the Federal Board for Voca- 
tional Education. A report on physical standards for working chil- 
dren with a record form for the use of physicians examining chil- 
dren who apply for certificates to work was prepared in 1921 by a 
committee of physicians appointed by the bureau. The Director 
of the Industrial Division served as Secretary of the committee, 
whose report was issued by the Bureau. The appendix giving the 246 
NATIONAL GOVERNMENT AND HEALTH 
legislative requirements of the states on this topic was later revised 
to include laws of 1924. All of the publications on legal subjects 
are revised from time to time to embody changes in state 
legislation. 
A bibliography on child labor was issued in 1916 and a supple- 
mentary list of references covering the years of 1916 to 1924 came 
out late in 1925. 
The surveys and reports of the Industrial Division of the Bureau 
have, in general, been concerned not only with the employment 
of children, but also with that of mothers of young children and 
with the industrial status of the father as it affects the welfare of 
his children. 
Dependency, Mothers Pensions, Delinquency, Juvenile Courts, 
and Mental Defects. Studies and reports relating to dependency, 
delinquency, mothers' pensions, juvenile courts, and mental defect 
have been made under the auspices of the Social Service Division. 
A study of mentally defective children in the District of Columbia 
was undertaken and completed in 1914 at the request of a local 
citizens' committee. Following this, at the request of a state com- 
mittee, two studies-one urban and one rural-were made in Dela- 
ware in collaboration with the United States Public Health Service. 
A brief study of the relation between juvenile delinquency and 
mental defect was made in cooperation with the Georgia Com- 
mission on the Feeble-Minded in 1919, and during the same year 
the Bureau entered into a joint inquiry with the Public Health 
Service in one of its series of psychiatric studies of delinquent 
girls. 
The mothers' pension laws of the various states and of Denmark 
and New Zealand were collated and published in 1914; a revised 
edition including the mothers' pension laws of Canada was issued 
in 1919, and a bulletin containing the text of such laws passed in 
the United States from 1920 to 1923 was issued in 1924. A report 
on the administration of the aid-to-mothers law in Illinois was 
published by the bureau in 1921. In 1922 a conference on mothers' 
pensions was held under the auspices of the Mothers' Pension 
Committee, Family Division of the National Conference of Social 
Work, and the Children's Bureau, which published the proceedings 
of the conference. A report on this subject, entitled " Standards 
of Public Aid to Children in Their Own Homes," is based on in- DEPARTMENT OF LABOR 
247 
vestigations in nine communities chosen as examples of different 
types of administration and deals primarily with the standards of 
living of the families receiving aid. This earlier study has been 
followed by a recent investigation undertaken by the bureau at 
the request of the Family Division of the National Conference of 
Social Work and including counties in eight states and the Province 
of Manitoba, Canada. The inquiry was directed especially towards 
the analysis of prevailing standard's of housing, health, sanitation, 
and recreation. State laws in effect November I, 1922, concerned 
with public aid to children in their own homes were summarized 
in a chart which was later revised to include 1924 legislation 
and the texts of the laws of certain states. 
Contributory to the dependency problem is that of children born 
out of wedlock, and the bureau's studies of illegitimacy have had 
special reference to the burden of dependency resulting from illegi- 
timacy, and the need for enforcing parental responsibility and im- 
proving the legal status of these children. Two reports have been 
issued dealing with legislation, and two studies on illegitimacy as 
a child-welfare problem, one of them being a field inquiry in 
Massachusetts. The third in this series, issued in 1924, deals with 
the treatment of the problem by the social agencies of several dif- 
ferent communities. In 1920 two regional conferences were held 
and proceedings were issued on the subject of standards of legal 
protection for children born out of wedlock; this material formed 
the basis for the work of a committee of the National Conference 
of Commissioners on Uniform State Laws, appointed to consider 
a model law on status and support. This law was approved by the 
Commissioners in 1922 and has been adopted, with slight modifi- 
cations, in four states. In 1925 the bureau published a study show- 
ing that the infant mortality among illegitimate babies in Baltimore 
had increased 50 per cent between 1915 and 1921, apparently as 
the result of the increase in breast feeding made possible by the 
Maryland law of 1916 forbidding separation from their mothers, 
except under specified conditions, of babies under six months old. 
In the general field of dependency, a report has been issued 
relating to children deprived of parental care. Considerable legal 
and other research material has been prepared for limited distribu- 
tion in temporary form, especially in connection with the bureau's 
cooperation in the work of state commissions for the study and 248 
NATIONAL GOVERNMENT AND HEALTH 
revision of child-welfare laws, on which a bulletin was issued early 
in 1924. A study of county boards of child welfare or public 
welfare in Minnesota, North Carolina, California, New Jersey, 
and New York was published in 1922. During 1923 a field study 
was made of the organization and methods of work of child- 
caring agencies in ten localities chosen as presenting .examples of 
some of the best work in child placing in different parts of the 
country. The bureau had in preparation in 1925 a handbook of 
instructions, standards, and information for boards of directors, 
superintendents, and workers in institutions for dependent children. 
A collection of papers on the subject of foster-home care for 
dependent children, contributed by eleven of the leading authori- 
ties in that field, was also issued in 1924. A study of dependent 
children in the District of Columbia, which covers the work of the 
Board of Children's Guardians and, in less detail, that of private 
institutions, came out in the same year, and a report has been 
written of a field study of children indentured by the Wisconsin 
State Public School for dependent children. In cooperation with 
The Children's Code Commission and The Department of Public 
Welfare of Georgia an investigation was made in 1924 of depen- 
dency, delinquency, and child protection in that state. Adoption 
laws have likewise been summarized. 
The methods of juvenile courts and the problems of juvenile 
delinquency have been studied extensively and many publications 
on these subjects have been issued. A field study has been made and 
a report was issued in 1925 on the procedure, organization, and 
methods of work of ten courts in different parts of the country. 
In 1921, in cooperation with the National Probation Association, 
a conference was held on Juvenile-Court Standards. The final 
report of a committee on standards appointed at that time was 
approved by the third conference, in 1923, and has been published 
under the title " Juvenile-Court Standards." An investigation of 
domestic-relations courts was in progress in 1925, to include: 
(1) An analysis of the laws of the forty-eight states with reference 
to jurisdiction, procedure, and provision for probation service; 
(2) a statistical study of about 12,000 families in Cincinnati and 
Philadelphia, showing the extent to which the same family is 
dealt with in different types of cases and the inter-relationships of 
courts and social agencies in such cases; and (3) studies of the DEPARTMENT OF LABOR 
249 
organization and case-work method's of courts in those cities which 
have attempted special court organization for dealing with family 
problems. 
The Child Welfare Commission movement has come in for 
special attention from the Social Service Division and much mate- 
rial has been supplied for use in the work of the various state com- 
missions for the study and revision of child welfare laws. In 
1924 a pamphlet on this subject (Publication No. 131) was issued. 
At that time there were twenty-nine such commissions in existence 
and the Children's Bureau was in active cooperation with those 
in Georgia, as previously stated ; in Kentucky, where assistance was 
given in preparing legislative recommendations; and in Pennsyl- 
vania, where the Bureau was making a study of dependency and 
delinquency in selected counties, the findings of which the commis- 
sion planned to use in preparing recommendations to the 1925 
session of the legislature. 
Miscellaneous Studies and Investigations. The bureau has un- 
dertaken various other studies and investigations on the subject of 
the general welfare of children, one of the early ones being con- 
cerned with recreation facilities for children in the District of 
Columbia, made at the request of the President of the Board of 
District Commissioners. A campaign for wider recreational oppor- 
tunities was a feature of the Children's Year program. 
During the fiscal year 1923, a specialist in recreation was added 
to the bureau staff, in order that in the future this part of the 
bureau's work may be greatly extended. " A brief manual of games 
for organized play adapted from standard sources " was prepared 
in connection with the Porto Rican survey, and a handbook of 
games for blind children was in preparation in 1925. A study of 
public amusements for children was underway in 1925. 
The first of a projected series of studies of the welfare of chil- 
dren in the insular possessions of the United States has recently 
been made in Porto Rico, where it took the form of a Children's 
Year Survey in 1922, with follow-up work in 1923. In addition to 
investigating conditions on the island the representatives sent by the 
bureau to Porto Rico assisted in developing activities to improve 
the health and well-being of children. An insular division of child 
health was established, health teaching was introduced in the 
schools, child-welfare activities were stimulated through " baby 250 
NATIONAL GOVERNMENT AND HEALTH 
weeks," and games and athletics for school children were devel- 
oped. A report on the Porto Rico Survey was issued in 1923. 
For several years the bureau has been obtaining from state 
officials, current information on legislation relating to child wel- 
fare which was pending before the various state legislatures. This 
information, data on bills before Congress pertaining to child 
welfare, reviews of current books, and items from English and 
foreign language periodicals dealing with child welfare have been 
given in the weekly News Summary, issued in mimeographed 
form by the bureau and distributed to organizations interested in 
these subjects. Action taken on state child welfare legislation has 
been summarized in the annual reports of the chief of the bureau 
for the fiscal years 1923 and 1924. 
Publications. More than 150 different bulletins and pam- 
phlets have been prepared and issued by the Children's Bureau. 
They include both technical and popular publications, and cover 
such general subjects as child welfare, infant and maternal mor- 
tality, hygiene of maternity and infancy, child hygiene, industrial 
problems of child welfare; dependent, defective, and delinquent 
children, and recreation. 
Organization. The work of the Children's Bureau is carried 
on through the following administrative units: 
Office of the Chief 
Office of the Assistant to the Chief 
Social Service Division 
Child Hygiene Division 
Industrial Division 
Editorial Division 
Statistical Division 
Maternity and Infant Hygine Division 
Each division is supervised by a director and an associate 
director. 
Office of the Chief. The Chief of the Bureau, with the help 
of the assistant to the chief and the directors of the division, 
plans the work and decides the policies to be followed. 
Office of the Assistant to the Chief. Under the Assistant to 
the Chief come the general administration of the Bureau, the 
correspondence section, the filing section, and general assistance 
to the Chief in planning and executing the work of the Bureau. DEPARTMENT OF LABOR 
251 
Special surveys or investigations of a general character which 
do not come under any single division are under the direct 
supervision of the Chief or the Assistant to the Chief. 
Social Service Division. The Social Service Division was 
organized in November, 1914. The work relates to children in 
need of special care-the dependent, the delinquent, and the men- 
tally or physically handicapped. The activities of the division 
include research and investigation of problems relating to de- 
pendent, defective, and delinquent children; methods in use by 
institutions and agencies; the problems and methods of work of 
courts dealing with children; legislation needed for the protection 
of children; the work of state and other governmental agencies 
for children in need of special care. There are maintained a 
current index of references to articles and reports within the 
scope of the division's work, an index of agencies and institutions 
and compilations and digests of legislation. The personnel varies 
with the work undertaken. 
Child Hygiene Division. The Child Hygiene Division was 
established in October, 1914. It consists of a Director who is 
a physician, an Associate Director and a research assistant (also 
physicians), a field staff of doctors and public health nurses, and 
a clerical force. 
The Child Hygiene Division serves in an advisory capacity 
to the other divisions on all matters pertaining to hygiene. It 
has cooperated with the other divisions of the bureau in studying 
the social, economic, and hygienic factors in infant mortality. 
It makes investigations into the prevalence and methods of con- 
trol of physical conditions affecting children's health and effici- 
ency; for example, rickets and bad posture. Through research it 
assembles material relating to the physical and mental health and 
the physical development of children. The division prepares 
popular bulletins and leaflets on child hygiene, physical and men- 
tal, and conducts the correspondence with the very large number 
of mothers seeking advice regarding the general hygienic care 
of themselves and of their children, and with others interested 
in the health and care of children. 
Industrial Division. The function of the Industrial Division, 
organized in July, 1914, is to collect and disseminate information 
regarding the various ways in which industry affects the welfare 252 
NATIONAL GOVERNMENT AND HEALTH 
of children and child life and to cooperate with other divisions 
in matters involving industrial or economic problems. 
Studies relating to the employment of children necessarily con- 
stitute the greater part of the work of the Division. These fall 
into three main fields, namely: 
i. The extent, conditions, causes, and effects of child labor. 
2. Methods of regulating child labor, including laws affecting 
child labor and their administration. 
3. The transition of the child from school to work, including 
his preparation for industrial life, the requirements for his ad- 
mission to the various trades, and supervising his entrance into 
industry. 
In addition, the division inquires into the relation of industry 
to child welfare in its broader aspects, as in the studies regarding 
children in mining and agricultural communities in which the re- 
lation of the economic and occupational status of the parents to 
the development of the child is perhaps the most significant aspect. 
As in the other divisions of the bureau, the work of investiga- 
tion is carried on by means of field studies and library research, 
and the data collected are given out informally through corres- 
pondence and conferences, as well as through technical and popu- 
lar reports. 
The work is performed by a Director and Associate Director 
and a permanent staff of specialists, research and field agents and 
clerks, assisted by temporary field workers according to the extent 
of the field investigation under way. 
Maternity and Infant Hygiene Division. With the passage 
of the federal act for the promotion of the welfare and hygiene 
of maternity and infancy in November, 1921, the bureau added to 
its other six major divisions a new Division of Maternity and 
Infant Hygiene. It is in charge of a Medical Director, assisted 
by an Associate Medical Director, and there is also a public health 
nurse, an accountant, and such clerical and field force as neces- 
sary. The division acts as a clearing house for plans with re- 
gard to organization, activities, publications, exhibits, and other 
details of the state program; renders assistance and advice to the 
states through visits by the Director, Associate Director, and the 
consulting nurse, by conducting institutes for public health nurses, DEPARTMENT OF LABOR 
253 
and by issuing news letters and other bulletins; conducts research 
on appropriate topics; supervises financial accounting of the 
Federal funds allotted to the states; and receives reports of state 
activities. An annual report is issued on the administration of 
the Maternity and Infancy Act. 
Statistical Division. The functions of the Statistical Division, 
established in August, 1914, include assistance in the planning 
of schedules and instructions, examining and editing schedules; 
coding, card-punching, and tabulation; the writing of reports; 
statistical criticism and statistical editing of all reports issued by 
the bureau; and the conduct of special statistical investigations. 
The Director has general charge of the division, and is respon- 
sible for the statistical criticism of all reports. A considerable 
amount of his time is devoted to writing reports. 
Most of the administrative work of the division falls upon the 
Associate Director, in particular the organization and planning 
of the work. Part of the Associate Director's time is also devoted 
to the writing of reports. A statistical expert assists in planning 
symbol sheets and in drawing up tables. 
The work of the division is organized according to the re- 
quirements of the study under way at any particular time, into 
separate sections, each section dealing with a single piece of work. 
Thus the sections vary from time to time in accordance with the 
number of separate pieces of work on hand, and as additional 
temporary clerks are employed, or clerks are detailed from other 
divisions. Each section is under a section head, who is directly 
responsible for the progress of the work of the section. 
Editorial Division. The work of the Editorial Division in- 
cludes: (1) Editing, revising, and proof-reading of the Bureau's 
publications; (2) issuance of a weekly child-welfare News Sum- 
mary (mimeographed) ; and (3) press releases, special articles, 
and exhibits. 
The News Summary contains abstracts of important articles 
on child welfare, book reviews, notices of meetings, and notes 
on national and state chi Id-welfare legislation. The leading period- 
icals in English and foreign languages are digested for this 
purpose. 
As a part of the bureau's effort to inform parents of the child- 
welfare standards worked out by specialists there has been as- 254 
NATIONAL GOVERNMENT AND HEALTH 
sembled a collection of exhibit material which is loaned to or- 
ganizations desiring to make use of it. It includes three models- 
a playground, an institution on the cottage plan, and a child-health 
center; two motion-picture films; slides on infant and child care; 
and posters, panels, and charts. A film demonstrating posture 
exercises was completed and released early in 1926. 
The Director of the division is assisted by an associate director 
in charge of reports and a specialist in public information in 
charge of the News Summary, the distribution of information, 
and exhibits; and there are also editors, a checker, an indexer, 
research workers, exhibits assistants, a secretary, and clerical 
workers. 
Personnel. On April 1, 1925, the total personnel numbered 
136, of whom somewhat less than half were of professional 
grade. There were also a score or more of temporary employees 
on various duties, chiefly in the field. 
Appropriations. The Bureau began in 1913 with an appro- 
priation of about $25,000, but now receives somewhat over a 
million and a half dollars, though of this sum a million or more is 
under the Maternity and Infancy Act and is allotted to the states 
which have accepted that law. 
Annual appropriations have been as follows: 
1913 $25,640 
1914 25,640 
1915 164,640 
1916 164,640 
1917 214,640 
1918 380,542 
1919 658,499 
1920 310,308 
1921 291,273 
1922 769,135 
1923 1,526,272 
i924 1,528,652 
1925 1,332,993 
The Women's Bureau.10 The Women's Bureau formulates 
standards and policies to promote the welfare of wage-earning 
women, to improve their working conditions, and advance their 
opportunities for profitable employment. To this end the Bureau 
conducts investigations and publishes the results of its research. 
10 Weber, The Women's Bureau. Institute for Government Research, 
Service Monograph No. 22 (1923). DEPARTMENT OF LABOR 
255 
As the welfare of women obviously includes their health and 
physical condition, the bureau is interested in this phase of the 
problem. 
History and Development. The Women's Bureau was 
originally established as the "Women in Industry Service" in 
the Department of Labor on July 16, 1918 (40 Stat. L., 634), 
as a war emergency measure. Its scope was stated by the Secre- 
tary of Labor to be to " develop in the industries of the country, 
policies and methods which will result in the most effective use 
of women's services in production for the war, while at the same 
time preventing their employment under injurious conditions." 
Thus the primary functions of this bureau were recruiting 
women workers and safeguarding their health and efficiency while 
at work. 
The first work of the Women in Industry Service consisted of 
a survey of occupations hazardous tO' health. A study was made 
of the proposed employment of women during the war in the 
chemical industries at Niagara Falls, N. Y. Cooperating with 
the Women in Industry Service in this study was a committee, 
the membership of which represented the Surgeon General's Office 
(Army), the Ordnance Department, Chemical Warfare Service, 
Navy, Public Health Service, National Research Council, Bureau 
of Standards, Bureau of Labor Statistics, Working Conditions 
Service, and the New York Industrial Commission. Recom- 
mendations for dust removal, sanitation, and safety, and other 
precautions against occupational hazards were worked out by 
physicians, engineers, and women investigators, acting for the 
committee. 
Another early activity was a study of the problem of night 
work for women. A series of conferences to consider this prop- 
osition was called in Washington during August, 1919. Repre- 
sentatives of the Women's Committee, the Committee on Women 
in Industry, the National Consumers' League, the National 
Women's Trade Union League, the American Association for 
Labor Legislation, American Federation of Labor, and state in- 
dustrial commissions and departments of labor were present. 
Plans for the control of night work and the consequent protec- 
tion of public health were formulated, but were not put into 
effect, due to the armistice. 256 
NATIONAL GOVERNMENT AND HEALTH 
Other subjects which received attention during the war in- 
cluded cooperation in the enforcement of state labor laws, and 
equal wages for men and women doing the same work. 
After the armistice was signed (November n, 1918) the 
Women in Industry Service was continued for the fiscal year 
1920. On December 12, 1918, there were issued standards for 
the employment of women in industry. Included in them were 
provisions regarding hours of labor, wages, working conditions, 
home work, employment management, cooperation of workers in 
establishing standards, and cooperation with official agencies. 
Other post-war operations during the first year included studies 
on labor legislation, wages after the war, negro women in in- 
dustry, displacement of women workers, and home work. 
The Women's Bureau was made a permanent peace time or- 
ganization under the act of June 5, 1920 (41 Stat. L., 987). Its 
purpose was stated to be the same as the former Women in In- 
dustry Service. 
Current Activities. The functions of the bureau have been 
threefold: (1) To secure information which was not already 
available, but which was needed to throw light on special women in 
industry problems urgently in need of consideration; (2) to search 
out and arrange such other material as was already available but 
which was not in such form as to' make its significance readily 
appreciated or to permit of its full use; and (3) with the 
results of the information thus gained, to cooperate with other 
agencies in the recommendation and establishment of certain 
standards which had been shown to be necessary for the protec- 
tion and advancement of women in industry. 
In September, 1919, the bureau studied the opportunities for 
women in the federal service. Other studies were made on 
women's part in American industries during the World War and 
industrial training for women and girls. The effect of laws regulat- 
ing the hours of work on the employment of women and the 
responsibility of wage-earning women for the support of others 
were investigated, as were also general industrial conditions. 
An increased appropriation was given the Women's Bureau 
for the fiscal year 1921. It received $75,000 for this period, so 
that its field of work could be somewhat broadened. The previous 
appropriations had been $40,000 for each year. DEPARTMENT OF LABOR 
257 
During its third year, investigations of hours, wages, and 
working conditions for women in industry in the various states 
were among the most important activities. This work has been 
done at the request of the states and in cooperation with them. 
Special studies were made in Kansas, Iowa, Rhode Island, Georgia, 
and Maryland; also one on wages of shoe workers in Manchester, 
New Hampshire, and one on family responsibilities of women as 
compared with those of men. A pamphlet entitled " A physio- 
logical basis for the shorter working day for women " by Dr. 
G. W. Webster was issued.11 Another publication of the bureau 
in this year was one entitled " Health problems of women in 
industry." 12 
An outstanding activity in 1923 was the calling of a Women's 
Industrial Conference in January. Among the numerous papers 
read before the 326 women who attended as delegates was one 
by Dr. R. A. Spaeth on " Health standards for women in in- 
dustry." At a similar conference held in January, 1926, one after- 
noon was devoted to a discussion of health problems. 
Another notable event in 1923 was a decision13 of the United 
States Supreme Court holding unconstitutional the minimum wage 
law for the District of Columbia.14 The Bureau has studied and 
advocated such laws in the states, and has prepared a comprehen- 
sive bibliography on the subject. 
In 1923 a study of industrial accidents among women was 
begun in cooperation with the Department of Labor of New 
Jersey, and was later extended to Ohio and Wisconsin. This was 
completed in 1924. There was also undertaken an investigation 
of absenteeism among women in textile mills in eighteen states, 
in which it was found that 23 per cent of all the 2215 women 
interviewed were absent because of personal illness. 
Other recent studies have included the collection of data on 
standard and scheduled hours of work, conditions in the canning 
and preserving industry in the State of Washington (in coopera- 
tion with the Children's Bureau), and on state laws affecting 
working women. 
11 Bulletin 14. 
12 Bulletin 18. 
13 Adkins vs. Children's Hospital, 261 U. S. 525. 
14 40 Stat. L., 960. 258 
NATIONAL GOVERNMENT AND HEALTH 
The Bureau has contributed a permanent exhibit on industrial 
hygiene to the Hall of Health at the Smithsonian Institution. A 
motion picture film " When Women Work " is also in circulation, 
having been prepared under the auspices of the Bureau. A new 
two reel film containing material on industrial women, including 
their health, was under way in 1925. A number of posters and 
charts have also been issued. 
Organization and Personnel. During 1925 there were forty- 
six employees in the Bureau, of whom nineteen were of profes- 
sional grade. There was no medical personnel. The bureau con- 
tains four divisions, each directly under the supervision of the 
Director. The present director is Miss Mary Anderson, who was 
appointed August 16, 1919, succeeding Miss Mary Van Kleeck, 
who had been Director since the Women in Industry Service was 
established. The Director has general supervision of the work of 
the bureau. She is aided by an assistant director. 
The Division of Investigations, under the assistant director, 
investigates actual conditions in the field which affect women in 
industry. 
The Division of Statistics prepares the statistical tables on 
which the reports of the bureau are based. 
The Division of Reports and Exhibits prepares and edits the re- 
ports of the bureau. To date about fifty bulletins have been issued. 
The Division of Research searches out material relating to 
various investigations and studies undertaken by the bureau and 
does the research work necessary to answer requests made by 
individuals and organizations. It prepares and keeps up to date, 
maps and charts showing state legislation for women workers. It 
classifies and indexes reference material in the office. It also 
prepares a monthly news letter that reports the activities in the 
various states and foreign countries that concern women workers. 
Appropriations. In recent years the annual appropriation to 
the bureau has been about $100,000. Appropriations have been as 
follows: 
1919 $40,000 
1920 4i,2OO 
1921 75,600 
1922 75,000 
1923 100,000 
1924 105,000 
1925 107,380 DEPARTMENT OF LABOR 
259 
The Bureau of Labor Statistics.15 The Bureau of Labor Sta- 
tistics is charged with the duty of acquiring and diffusing among 
the people of the United States useful information on subjects 
connected with labor in the most general and comprehensive sense 
of that word, and especially upon its relations to capital, the hours 
of labor, the earnings of laboring men and women, and the means 
of promoting their material, social, intellectual, and moral pros- 
perity. From the beginning of its existence, this range of func- 
tion has evidentally been interpreted to include studies on indus- 
trial hygiene, as bulletins, chapters in bureau reports, and special 
articles in the Monthly Labor Review have frequently been de- 
voted to this subject. Workmen's insurance, occupational diseases, 
accidents, vocational education, and other topics related to the 
public health have also been investigated by the bureau from time 
to time. 
History and Development. The Bureau of Labor Statistics 
is an outgrowth of the original labor organization in the National 
Government. It was first created by Congress by an act of June 
27, 1884 (23 Stat. L., 60), as a Bureau of Labor in the Department 
of the Interior. Four years later, by an act of June 13, 1888 (25 
Stat. L., 182), it was made an independent establishment, as 
the Department of Labor. When, in 1903, the Department of 
Commerce and Labor was created (32 Stat. L., 825), this "De- 
partment " became the Bureau of Labor in the new department. 
Finally in 1913 it became the Bureau of Labor Statistics in the 
new Department of Labor (37 Stat. L., 736). Throughout these 
changes the work was carried on without variation. 
Except for a brief period from May 30, 1908, to September 7, 
1916, when the bureau enforced certain aspects of a law (35 Stat. 
L., 556), granting government employees the right to receive 
compensation for injuries sustained in the course of employment, 
all of its functions have been educational. One of its earliest in- 
vestigations was concerned with working women in large cities,18 
while another early one dealt with marriage and divorce.17 Special 
" Weber, The Bureau of Labor Statistics. Prepared as a Service Mono- 
graph for the Institute for Government Research and published (1922) as 
Bulletin No. 319 by the Bureau of Labor Statistics. 
18 Annual Report, 1888. 
17 First Special Report, 1889. 260 
NATIONAL GOVERNMENT AND HEALTH 
reports were issued in 1895 and 1904 on housing, and in the 
latter year, a bulletin on public baths was published. On January 
29, 1907, Congress directed the bureau (34 Stat. L., 866) to in- 
vestigate industrial, social, moral, educational, and physical con- 
ditions of women and child wage earners in the United States. 
The results of this study were subsequently (1910-1912) issued 
in nineteen volumes.18 Volume XIII of this series pertained to 
infant mortality and mothers' employment; Volume XIV, to 
causes of death among female cotton-mill operatives; and Volume 
XVII, to hookworm disease among cotton-mill workers. 
Up to July 1, 1912, one hundred bi-monthly bulletins had been 
issued on various labor topics. The system thereafter was changed, 
these regular bi-monthly bulletins and the annual and special 
reports being supplanted by a number of series of bulletins, which 
were published as occasion demanded. The designations of these 
series were: Wholesale prices; Retail prices and cost of living; 
Wages and hours of labor; Women in industry;1' Workmen's 
compensation and insurance; Industrial accidents and hygiene; 
Conciliation and arbitration; Labor laws of the United States 
(including court decisions) ; Foreign labor laws; and Miscel- 
laneous series. 
Studies in industrial hygiene have been undertaken and re- 
ported upon frequently since 1912. Among subjects dealt with 
have been lead poisoning, anthrax, hygiene of the printing trades, 
industrial efficiency in munition works, mortality from dusty 
trades, carbon monoxide, and various other aspects of occupa- 
tional hazards. 
The complete list of the bulletins on industrial accidents and 
hygiene is as follows (items starred being out of print) : 
No. 75. Industrial hygiene, by George M. Kober, M. D. 
(1908). . 
No. 79. The mortality from consumption in dusty trades, by 
Frederick L. Hoffman (1908). 
No. 82. Mortality from consumption in occupations exposing 
to municipal and general organic dust, by Frederick 
L. Hoffman (1909). 
18 61 Cong. 2 sess., S. doc. 645. 
19 This series was discontinued in 1918 when the Women in Industry Ser- 
vice, now the Women's Bureau, was organized. DEPARTMENT OF LABOR 
261 
No. 86. Phosphorus poisoning in the match industry in the 
United States, by John B. Andrews; List of indus- 
trial poisons, by Dr. Th. Sommerfield in collabora- 
tion with Sir Thomas Oliver and Dr. Felix Putzeys 
No. 95. Industrial lead poisoning, with descriptions of lead 
processes in certain industries in Great Britain and 
the western states of Europe, by Sir Thomas Oliver; 
The white-lead industry in the United States, with 
an appendix on the lead-oxide industry, by Alice 
Hamilton, M. D.; Deaths from industrial lead 
poisoning (actually reported) in New York State 
in 1909 and 1910, by John B. Andrews; Laws 
enacted during 1911 requiring the report of occu- 
pational diseases (1911). 
No. 100. List of industrial poisons and other substances injuri- 
ous to health found in industrial processes; Act 
providing for a tax on white phosphorus matches 
and for prohibiting their import or export (1912). 
*No. 104. Lead poisoning in potteries, tile works, and porcelain 
enameled sanitary ware factories, by Alice Hamil- 
ton, M. D. (1912). 
No. 120. Hygiene of the painters' trade, by Alice Hamilton, 
M. A., M. D. (1913). 
*No. 127. Dangers to workers from dusts and fumes and methods 
of protection, by William C. Hanson, M. D. (1913). 
*No. 141. Lead poisoning in the smelting and refining of lead, 
by Alice Hamilton, M. D. (1914). 
*No. 157. Industrial accident statistics, by Frederick L. Hoffman 
(I9I5)- 
No. 165. Lead poisoning in the manufacture of storage batteries 
by Alice Hamilton, M. D. (1914). 
*No. 179. Industrial poisons used in the rubber industry, by 
Alice Hamilton, M. D. (1915). 
No. 188. Report of British departmental committee on the dan- 
ger in the use of lead in the painting of buildings 
(1916). 
*No. 201. Report of the Committee on Statistics and Compen- 
sation Insurance Costs of the International Asso- 
ciation of Industrial Accident Boards and Com- 
missions (1916). 
No. 205. Anthrax as an occupational disease, by John B. 
Andrews (1917). 
No. 207. Causes of death, by occupation, by Louis I. Dublin 
(I9U). 
No. 209. Hygiene of the printing trades, by Alice Hamilton, 
M. A., M. D., and Charles H. Verrill (1917). 262 
NATIONAL GOVERNMENT AND HEALTH 
*No. 216. Accidents and accident prevention in machine build- 
ing, by Lucian W. Chaney and Hugh S. Hanna 
(1917). 
No. 219. Industrial poisons used or produced in the manufac- 
ture of explosives, by Alice Hamilton, M. D. (1917). 
No. 221. Hours, fatigue, and health in British munition fac- 
tories (1917). 
No. 230. Industrial efficiency and fatigue in British munition 
factories (1917). 
No. 231. Mortality from respiratory diseases in dusty trades 
(inorganic dusts), by Frederick L. Hoffman (1918). 
*No. 234. The safety movement in the iron and steel industry, 
1907 to 1917, by Lucian W. Chaney and Hugh S. 
Hanna (1918). 
No. 236. Effects of the air hammer on the hands of stonecutters 
(1918). 
No. 251. Preventable death in the cotton manufacturing indus- 
try, by Arthur Reed Perry, M. D. (1919). 
*No. 253. Women in the lead industries, by Alice Hamilton, 
M. A., M. D. (1919). 
No. 256. Accidents and accident prevention in machine building, 
by Lucian W. Chaney. Revision of Bulletin 216 
(I9I9)- 
No. 267. Anthrax as an occupational disease, by John B. 
Andrews; Revised edition (1920). 
No. 276. Standardization of industrial accident statistics. Re- 
ports of the committee on statistics and compensa- 
tion insurance cost of the International Association 
of Industrial Accident Boards and Commissions, 
1915-1919.(1920).. 
No. 280. Industrial poisoning in making coal-tar dyes and dye 
intermediates, by Alice Hamilton, M. D. (1921). 
No. 291. Carbon monoxide poisoning, by Alice Hamilton, M. D. 
(I92J). 
No. 293. The problem of dust phthisis in the granite stone in- 
dustry, by Frederick L. Hoffman (1922). 
No. 298. Causes and prevention of accidents in the iron and 
steel industry, 1910 to 1919. 
No. 306. Occupational hazards and diagnostic signs, by Louis I. 
Dublin and Philip Leiboff (1922). 
No. 339. Statistics of industrial accidents in the United States, 
by Lucian W. Chaney (1923). 
No. 392. Survey of hygienic conditions in the printing trades, 
by S. Kjaer (1925). 
No. . Phosphorus necrosis in the manufacture of fireworks 
and the preparation of phosphorus, by Emma F. 
Ward. (In press.) DEPARTMENT OF LABOR 
263 
A completed study, not yet ready for print, on the effects of 
radio-active substances on the health of workers. 
Articles on industrial hygiene are also given in the Monthly 
Labor Review, published by the bureau. 
Statistics on industrial accidents have been collected and ana- 
lyzed by the Bureau since 1910.20 Efforts have been made to stand- 
ardize accident statistics and occupational disease data through- 
out the country, so that comparable information, by industries 
and occupations, by states and localities, and by causes and results, 
may be available. The Bureau is represented on the statistics and 
compensation insurance cost committee of the International Asso- 
ciation of Industrial Accident Boards and Commissions, and has 
also been closely identified with the efforts of the American Engi- 
neering Standards Committee to develop standard safety codes 
for this country. The Bureau of Standards has likewise been 
prominent in this work and the Public Health Service has pre- 
pared an industrial hygiene code for the committee. 
Organization and Personnel. For the fiscal year 1926, the 
personnel estimated for the Bureau totaled 112, of whom twenty- 
two were in the professional and scientific class. Studies of indus- 
trial hygiene have in the past been made sometimes by the bureau 
personnel, and sometimes by experts specially employed. Among 
persons in the latter category, who have made special studies, have 
been Dr. Alice Hamilton, F. L. Hoffman, Louis I. Dublin, and 
John B. Andrews. The permanent staff is shifted as the demands 
of work require, though the Bureau is divided into the Office of 
the Commissioner, the Office of the Chief Statistician, a Statis- 
tical Division, an Editorial and Research Division, and a Law 
Division. A library was maintained until 1916, when the libraries 
of the different bureaus of the Department were combined in a 
departmental library. 
The appropriation to the bureau for the fiscal year 1926 is 
$285,300. Since 1907 the annual appropriations have been between 
$170,000 and $300,000. Just what proportion of these sums 
has been used for industrial hygiene studies is difficult to say. 
20 See Methods of Procuring and Computing Statistical Information. 
Bureau of Labor Statistics, Bulletin No. 326 (1923). 264 
NATIONAL GOVERNMENT AND HEALTH 
The Bureau of Immigration.21 The Bureau of Immigration is 
concerned with the enforcement of all federal laws relating to the 
admission, exclusion, and deportation of aliens. This means 
that the bureau must (1) determine the eligibility for entry of 
the alien, (2) prevent the entry of those who are ineligible, (3) 
deport those who have gained entrance and remain in violation 
of law, and (4) admit those who are entitled to admission. 
Physical and mental examinations of applicants, in order to pre- 
vent the entry of diseased persons, that is, the socially and men- 
tally unfit, form one of the most important functions of the 
bureau. These examinations are actually made by medical offi- 
cers of the Public Health Service, assigned for the purpose 
by the Surgeon General, and the regulations governing these medi- 
cal inspections are made by the Public Health Service, though 
carried out under the general supervision of the Bureau of Im- 
migration. 
History and Development. During the century following the 
adoption of the Constitution in 1789 the control of immigration 
by the federal government was unorganized and received slight 
and only intermittent attention. Although the encouragement, 
rather than repression, of immigration was considered desirable 
in the early days of the nation, it became apparent in the late 
thirties that some form of regulation to exclude the unfit was 
needed. In 1838, about the time when steam was making trans- 
atlantic travel more simple, a bill was introduced in Congress to 
penalize masters of vessels who transported idiots, lunatics, per- 
sons afflicted with incurable diseases, and criminals, but the bill 
was not even considered.22 
Reporting of immigrants to Congress by the Secretary of State 
had been authorized as early as 1819 (3 Stat. L., 488) and con- 
tinued until 1870. Provisions for sanitary facilities for passengers 
on merchant vessels had been contained in legislation in 1847 (9 
Stat. L., 149) and 1848 (9 Stat. L., 223). In 1864 an act (13 
Stat. L., 385) was passed creating a Commissioner of Immigra- 
tion, but this law was repealed in 1868 (15 Stat. L., 56)- Not 
21 See Smith and Herring, The Bureau of Immigration. Institute for 
Government Research, Service Monograph No. 30 (1924). 
22 Treadway, W. L., Our immigration policy and the nation's mental 
health, Scientific Monthly, October, 1925. DEPARTMENT OF LABOR 
265 
until 1882 was the first comprehensive immigration law enacted 
(22 Stat. L., 214). Up to this time, most of the aliens had come 
from the British Isles and from Germany, though subsequently 
there has been a great influx of immigrants from Southern and 
Eastern Europe. 
The law of 1882 provided for the exclusion of convicts, luna- 
tics, idiots, and persons likely to become public charges. Other 
laws followed in quick succession, the most notable being the act 
of March 3, 1891 (26 Stat. L., 1084). This law created the 
office of Superintendent of Immigration in the Treasury Depart- 
ment, where it remained until 1903, when it was transferred to 
the new Department of Commerce and Labor. When this Depart- 
ment was split in 1913, the Bureau went to the Department of 
Labor. The law of 1891, which, among other things, provided for 
medical examinations of immigrants by officers of the Public 
Health Service, was elaborated by later acts. In 1893 a law (27 
Stat. L., 449) permitted the President to suspend immigration 
with countries where dangerous contagious diseases existed. 
The most comprehensive statute came in 1917 (39 Stat. L., 
874), following an intensive study of immigration made by a 
special commission. This law excluded the insane, idiots, imbe- 
ciles, feebleminded, chronic alcoholics, mentally defective per- 
sons, persons with loathsome or dangerous contagious diseases, 
and persons over sixteen unable to read. Except for minor 
amendments and a new act in 1924 (43 Stat. L., 153) which fixes 
quotas from the various countries, and increases penalties for 
bringing in excludable aliens, this 1917 law is still in effect. 
Current Activities. The Public Health Service, as previously 
stated, is primarily responsible for the physical and mental ex- 
amination of immigrants. During the fiscal year 1924, there were 
examined by medical officers of the Service,2' 938,928 alien pas- 
sengers, as compared with 745,515 for the fiscal year 1923, 586,228 
for the fiscal year 1922, and 1,137,682 for the fiscal year 1921. 
In addition to passengers, 874,962 alien seamen were examined 
in 1924. These examinations were conducted at nearly one hun- 
dred ports and places in the United States and its dependencies 
and in Canada. At some of the stations, immigration and quaran- 
23 Surgeon General, Annual Report, 1924, p. 166. 266 
NATIONAL GOVERNMENT AND HEALTH 
tine inspections are conducted jointly by the officers of the Public 
Health Service. About half of the arriving immigrants came 
through the port of New York. 
The grounds for excluding or deporting aliens for physical or 
mental reasons are thus set forth in the law (39 Stat. L., 874) : 
. . . All idiots, imbeciles, feeble-minded persons, epileptics, 
insane persons; persons who have had one or more attacks of 
insanity at any time previously; persons of constitutional psycho- 
pathic inferiority; persons with chronic alcoholism; . . . per- 
sons afflicted with tuberculosis in any form or with a loathsome 
or dangerous contagious disease; persons not comprehended 
within any of the foregoing excluded classes who are found to be 
and are certified by the examining surgeon as being mentally or 
physically defective, such physical defect being of a nature which 
may affect the ability of such alien to earn a living. 
Discovery of a disease dangerous to the public health is suffi- 
cient to warrant exclusion or deportation without recourse, but 
in the case of certification of mental defect, the alien may appeal 
to a board of medical officers of the Public Health Service, and he 
may introduce before this board at his own expense one expert 
witness. He is also entitled to reexamination by order of the immi- 
gration authorities. 
Hospitalization for aliens when required is accomplished only 
on an order by an immigration officer, though it may result from 
the report of a medical officer. According to law, hospitalization 
may be given where " the dictates of humanity require that . . . 
[the alien] be given immediate hospital treatment." The law also 
requires the refusal of entry to a hospital of an alien " certified 
to be suffering from tuberculosis in any form or from a loath- 
some or dangerous contagious disease other than one of quaran- 
tinable nature . . . unless the Secretary of Labor is satisfied that 
to refuse treatment would be inhumane or cause unusual hardship 
or suffering, in which case the alien shall be treated in the hospi- 
tal under the supervision of the immigration officials at the ex- 
pense of the vessel transporting him." Alien seamen may also be 
admitted to hospitals in accordance with similar procedure. The 
hospitals are generally conducted under the supervision of the 
medical officers of the Public Health Service. DEPARTMENT OF LABOR 
267 
In 1925 a plan was put into operation whereby immigrants 
about to proceed to the United States are examined abroad. 
Officers of the Consular Service, the Bureau of Immigration, 
and the Public Health Service make the necessary inspections, and 
thus enable the selection of more desirable aliens for admission 
to this country. The steamship companies also examine the immi- 
grant, as they are liable to a fine, as well as having to bear the 
expense of a return trip, if the alien is rejected on arrival. He 
may be so rejected for cause whether he has a visa from the con- 
sul on the other side or not. 
Organization and Personnel. The Bureau of Immigration 
consists of the central headquarters in Washington and the field 
force outside, known as the Immigration Service at Large. There 
are about fifty employees in Washington and over two thousand in 
the field, not including medical officers from the Public Health 
Service. Of the latter, 167 were in 1925 assigned to this work in 
eighty-five ports and stations in this country and twelve ports in 
Europe. Seventy-four of the 155 medical officers on immigration 
duty in the United States and its insular possessions, and four 
of the twelve in Europe are engaged exclusively in the medical 
inspection of aliens. The remainder combine this work with other 
duties. In addition to the medical officers, the Public Flealth Ser- 
vice has 2400 employees on immigration and all hospital work. 
Appropriations. For the fiscal year 1925, the amount appro- 
priated to the Bureau of Immigration was $4,691,840, while the 
sum for 1926 is over $5,000,000. Since 1909 the appropriations 
for medical examinations have been included in those of the 
Public Health Service. In 1925 the amount was $4,900,000,24 or 
more than half of the total for the entire Public Health Service. 
24 This includes some other medical examinations and all hospital work, 
but not quarantine service. CHAPTER X 
THE DEPARTMENT OF THE INTERIOR. 
The Department of the Interior has seven bureaus, several 
other establishments, and a number of boards and commissioners 
under its jurisdiction. Among them, two of the bureaus are directly 
concerned with health problems, two of the other establishments 
are hospitals, two other bureaus have an indirect interest in the 
public health, and one has certain medical problems. The Office 
of Indian Affairs has supervision over the health of the Indian 
wards of the government, while the Bureau of Education is in- 
trusted with the administration of medical relief for the natives 
of Alaska. This latter Bureau is also interested in school hygiene 
and physical education. St. Elizabeth's and Freedmen's hospi- 
tals are attached to the department. The Geological Survey is 
indirectly concerned with sanitary engineering through its work 
on water resources, while the National Park Service has certain 
health problems, and the Pension Office has the duty of making 
certain medical examinations. 
The Office of Indian Affairs. The Medical Division of the Office 
of Indian Affairs in the Department of the Interior is charged 
with the care of the health and the furnishing of medical relief 
to the Indian wards of the government. This Division was created 
in 1924, though there had been a health section in the Division 
of Education since 1909. 
History and Development. Since the original inhabitants of 
this country were the Indians, our government has been con- 
cerned with Indian affairs from its beginning. Laws regulating 
trade with the Indians were passed in the early days of the Repub- 
lic and the Office of Superintendent of Indian Trade was created 
in 1806, and continued until 1822. In 1824 a Bureau of Indian 
Affairs was established in the War Department by the Secre- 
tary of War. In 1832 Congress passed a law which created the 
268 DEPARTMENT OF THE INTERIOR 
269 
Office of Commissioner of Indian Affairs and continued it in 
the War Department. When the Department of the Interior was 
formed in 1849 the Office of Indian Affairs was transferred to 
it, where it has been ever since. 
The only order on record dealing with health while the Indians 
were under the jurisdiction of the War Department seems to have 
been one concerning the moving of Indians from one country 
to another. In this order, it was stipulated that care should be 
taken that the best sanitary conditions should prevail and that 
the health of the Indians should be carefully guarded. Physi- 
cians were employed during those days, though more for the 
benefit of the government agents than for the Indians. Army 
surgeons were generally accessible and were frequently called 
upon to render medical care. The change from the early nomadic 
existence of the Indian to the more sedentary life on the reserva- 
tion accentuated the health problems of the race and caused the 
increase of many disease conditions. 
The first recognition by Congress of the medical needs of the 
Indian was contained in an act of May 5, 1832 (4 Stat. L., 515), 
which appropriated. $12,000 for the purpose of purchasing " genu- 
ine vaccine matter " and employing physicians to administer it. 
The treaty of 1836 with the Ottawas and the Chippewas provided 
for the payment by the government of $300 a year " for vaccine 
matter, medicines, and the services of physicians, to be continued 
while the Indians remain on their reservations." Later treaties 
with other tribes also provided for physicians and in a few cases 
for hospitals. 
In 1873 the first organized effort was made to deal with the 
health of the Indians. In that year a Division of Medicine and 
Education was established and was continued until 1877. There 
was great need for such work, as disease had been a potent factor 
in decreasing the Indian population. As early as 1865 a Senatorial 
committee had stressed this rapid decrease and had attributed 
no small part of it to contact with civilization and the consequent 
ravages of disease. In spite of this fact, the Division of Medicine 
was discontinued in 1877, not to be revived until 1909 by a de- 
partmental order, although there was always a certain amount of 
medical service in the field. 270 
NATIONAL GOVERNMENT AND HEALTH 
The first hospital for Indians was established in 1882. The 
growth in the number of hospitals is shown below: 
1888 4 
1900 5 
1911 5o 
1912 «... 53 
1913 48 
1914 5i 
1915 74 
1916 81 
1917 8i 
1918 87 
1919 87 
1920 87 
1921 85 
1922 73 
1923 77 
1924 79 
The reduction in 1922 is clue to increased cost of maintenance 
and to a decrease in appropriations. 
Hospitals are classed as insane, sanatoria, general, agency, 
school, and emergency. The one hospital for the insane is at Can- 
ton, South Dakota. Eight tuberculosis sanatoria are now main- 
tained, with a capacity for 624 persons, and these draw their 
patients from all the reservations. General hospitals draw their 
patients from a larger area than do' agency hospitals, but other- 
wise are the same. School hospitals are primarily for the treat- 
ment of the pupils in the boarding schools, although relief is ex- 
tended to other persons when necessary. 
Current Activities. There are at present approximately 
347,000 Indians in the United States, including the Five Civilized 
Tribes. While they are citizens by recent enactment, and while 
some have become entirely independent of the control of the 
national government, many of them are in greater or in less degree 
wards of the government. While the Indians are scattered through- 
out the country, Oklahoma has the largest number, 119,255. In 
general, the majority are in the states of the Southwest and West, 
Arizona, New Mexico, South Dakota, etc. In 1924 there were 
210 widely scattered reservations, with ninety-five agencies, each 
under a superintendent. Practically all of the agencies have day 
or boarding schools, in connection with which there is usually 
a hospital, though there is sometimes an agency hospital. 
The employees of the Medical Division treat diseases among the 
Indians, and to a slight extent do some preventive work. The 
Service has in the past prepared pamphlets on tuberculosis 1 and 
1 Murphy, J. A., Manual of tuberculosis (1910); Tuberculosis among 
Indians (1917). DEPARTMENT OF THE INTERIOR 
271 
Indian babies,2 which have been fairly well distributed, and use has 
been made of the many other government publications on health. 
The Indian race has been considered for many years to be a 
dying one. The Medical Division cites figures to show, however, 
that this is no longer the case. In 1913 the general death rate among 
the Indians was 32.24 per thousand population. In 1918 it had 
been reduced to 29.42 per thousand population, while in 1920 it 
was 22.33. The birth rate in 1918 was 29.42 per thousand popu- 
lation and in 1920 was 31.67. These figures include the entire 
Indian population, except the Five Civilized Tribes, where normal 
birth and death rates are said to exist. 
Trachoma studies and efforts among Indians in the Southwest 
were undertaken by the Public Health Service in 1925 at the 
request of the Secretary of the Interior. During the influenza 
epidemic of 1918 the Public Health Service detailed 362 tem- 
porary physicians for work among Indians. 
Organization. The Medical Division3 operates directly 
under the Commissioner of Indian Affairs, who is assisted by an 
Assistant Commissioner. There is also a nursing unit, consisting 
of three nurses, which was formed at the same time that the 
Medical Division was created in 1924. 
In that year the Division had the following personnel: 
Position 
Number employed 
Salary 
Chief Medical Supervisor 
I 
4 $5200 
Medical Supervisor 
I 
4 3800 
Special Physicians 
6 
6 3000 
Traveling Nurses 
6 
5 1500 
Field Dentists 
6 
i860 
Agency and School Nurses 
TOO 
Agency and School Physicians.. 
160 
Contract Physicians 
50 
Field Matrons 
90 
Total of Health Personnel.. 
420 
2 Indian Babies; how to keep them well (1916). 
3 Stevens, W. S., Indian service doctor replaces the medicine man, Nation's 
Health, June, 1925. 
4 Allowed transportation expenses and a per diem of $3.50 in lieu of sub- 
sistence when in the field in addition to salary. 
5 Allowed transportation expenses and actual subsistence expenses, not to 
exceed $3-50 a day when on duty, in addition to salary. 272 
NATIONAL GOVERNMENT AND HEALTH 
The administrative duties of the Medical Division include the 
approval of changes in health personnel, construction and repair 
of hospitals, purchase of medical and hospital supplies, and all 
other expenditures for health work, together with the allotment 
of funds for such purposes. Instructions are issued through the 
superintendents to the field personnel and directly to the travel- 
ing physicians and dentists. Forms for reports are prescribed 
and examinations are made and action taken upon such reports 
of special physicians, field dentists, regular physicians, field ma- 
trons, and hospitals. 
The Chief Medical Supervisor is Dr. R. E. L. Newberne, who 
was appointed in 1918 after four years' service with the Indian 
Office and thirteen years' in the Philippine Health Service, then 
controlled by the United States Public Health Service. The 
Chief Medical Supervisor directs the employees and facilities of 
the health service at large, and makes recommendations for the 
improvement of the service to the Commissioner of Indian 
Affairs. In addition to his other duties, he acts as principal epi- 
demiologist for the Office of Indian Affairs. 
The duties of the Medical Supervisor are of the same general 
character, though somewhat more restricted in scope. 
The special physicians of the Indian Service are primarily 
specialists in the diseases of the eye, ear, nose, and throat. They 
also take charge of epidemics, fill special assignments, and make 
district and local inspection reports to the Commissioner. The 
service is divided into six special physician districts. 
Traveling nurses accompany special physicians, assisting them 
in the work and taking care of all patients operated on or treated 
by the special physicians. 
Field dentists travel from jurisdiction to jurisdiction in the 
respective districts, and perform dental work for the pupils of 
the schools and for the reservation Indians. The service is 
divided into seven dental districts. 
The difference between agency and school nurses is in most 
instances a difference of funds from which they are paid. An 
agency nurse is paid from agency funds, and a school nurse 
from school funds. The duties are practically the same when 
they are employed in an agency hospital or a school hospital. DEPARTMENT OF THE INTERIOR 
273 
The Field Nurse is the public health nurse of the reservation. 
This name differentiates her from the hospital or school nurse. 
Her duties and the demands on her time are comparable to those 
of any county public health nurse. It is hoped in the future to be 
able to increase this service materially, with much emphasis on 
health education? 
Field Matrons are employed in order to bring about the im- 
provement of home, educational, moral, sanitary, environmental, 
and social conditions for the advancement of the Indian people. 
The Field Matron comes into the closest relationship with the 
family and has the best opportunity to influence the home circle, 
especially the mother and the girls; therefore, she is particularly 
charged with the duty and responsibility of developing the higher 
standards of living, of inculcating a desire for progress, and of 
evolving plans to make the home more attractive. According 
to a statement of the Commissioner: " The duties of the Field 
Matron are too varied and extensive for brief enumeration. 
Many of the helpful things that she may do are not subject to 
schedule classification and her influence for good can be measured 
only in terms of human destinies." 
Personnel. The growth in the number of positions author- 
ized for health service is shown in the following table. During the 
war, and since, the Office of Indian Affairs has not been able to 
keep all of the positions filled. Of the physicians, about seventy 
are contract physicians, and the remainder on full time. 
Year 
Physicians 
Nurses 
Hospital 
employees 
Field 
matrons 
1895 
74 
8 
7 
3 
1897 
84 
24 
21 
16 
1898 
83 
32 
32 
30 
1899 
87 
30 
19 
29 
1900 
83 
25 
15 
21 
1905 
96 
33 
IO 
40 
1918 
151 
88 
158 
82 
1919 
154 
9i 
158 
82 
1920 
160 
98 
158 
78 
1921 
168 
99 
155 
75 
1922 
172 
102 
150 
75 
1923 
177 
106 
154 
63 
1924 
184 
IIO 
156 
63 
Letter from the Assistant Commissioner, January 28, 1925. 274 
NATIONAL GOVERNMENT AND HEALTH 
The principal diseases with which the medical service has had 
to cope have been tuberculosis 7 and trachoma. It is estimated that 
in 1920 there were nearly 25,000 cases of tuberculosis and over 
30,000 cases of trachoma, among some 200,000 Indians, not in- 
cluding the Five Civilized Tribes. In that year, there were 1230 
deaths from tuberculosis. 
Appropriations. In 1909 a special appropriation was made 
by Congress (35 Stat. L., 642) to investigate, treat, and prevent 
the spread of trachoma. In the same year a medical supervisor 
was appointed for the entire service and the systematic organiza- 
tion of medical work dates from this time. In 1911 began the first 
of the annual appropriations for " the prevention and treatment 
of tuberculosis, trachoma, smallpox, and other contagious and 
infectious diseases" (36 Stat. L., 271). A sum of $40,000 at the 
beginning has gradually increased to $700,000 for the fiscal year 
1926, as shown in the following table: 
1911 $ 40,000 
1912 60,000 
1913 90,000 
1914 200,000 
1915 300,000 
1916 300,000 
1917 35o,ooo 
1918 350,000 
1919 $375,ooo 
1920 350,000 
1921 355,ooo 
1922 370,000 
1923 370,000 
1924 370,000 
1925 500,000 
1926 700,000 
The foregoing appropriations do not include all that is spent 
for health purposes, but simply the specific appropriations made 
for " Relieving distress and preventing disease among Indians." 
In 1912 the Public Health Service was authorized (37 Stat. L., 
519) to make a survey of contagious and infectious diseases among 
the Indians. The report8 revealed much disease and many insani- 
tary conditions. The Bureau of American Ethnology of the Smith- 
sonian Institution had collected data on tuberculosis in previous 
years which it had reported at the Sixth International Conference 
on Tuberculosis in 1908. 
7 See Report of Committee of National Tuberculosis Association: Tuber- 
culosis among the North American Indians (1923) ; Senate Committee 
print (67 Cong., 4 sess.). 
3 62 Cong., 3 sess., S. doc. 1038 (1913). DEPARTMENT OF THE INTERIOR 
275 
The Bureau of Education. Two of the divisions of the Bureau 
of Education are concerned with public health. These are the 
Division of School Hygiene and the Alaska Division. The Bureau 
of Education was created by the act of July 12, 1870 (16 Stat. L., 
230), though there had previously been an Office of Education 
(15 Stat. L., 92), which had succeeded the Department of Edu- 
cation, formed by the act of July 20, 1867 (14 Stat. L., 434). 
The Division of School Hygiene. A Division of School 
Hygiene and Physical Education was created in the Bureau of 
Education of the Interior Department by an order of the then 
Commissioner of Education, P. P. Claxton, October 23, 1911. 
This order was made possible by the provision in the appropria- 
tion act for 1912 for " Investigation of rural education, industrial 
education and school hygiene." 
The scope and purposes of the Division of School Hygiene were 
outlined by the Commissioner in his annual report for 1912, as 
follows: 
1. To furnish to all who seek it, information regarding the sani- 
tary construction of school buildings. 
2. To bring together at the Bureau information relating to school 
hygiene and sanitation and to render this information acces- 
sible to school authorities and all others interested. 
3. To gather and prepare for publication information concerning 
the hygienic condition of school buildings and grounds 
throughout the country. 
4. To conduct all correspondence referred to it wherein advice 
and information are sought on matters of school hygiene 
and school sanitation. 
5. To prepare bulletins on such special topics as the commissioner 
may from time to time direct. 
6. To direct such cooperative investigations as shall be made in 
connection with the Bureau on matters relating to the hygiene 
of the school children. 
7. To compile and send out bibliographies on special topics in 
school hygiene, school sanitation, and medical inspection. 
8. To assist in any work connected with the Bureau which the 
commissioner may see fit to assign to the Division. 
History and Development. During the first three years of 
the existence of the division, in which time there was a full time 
specialist in charge for one year only, the work undertaken con- 
sisted of answering correspondence, giving out information, com- 276 
NATIONAL GOVERNMENT AND HEALTH 
pilation of bibliographies, preparation of exhibits on school hygiene 
for the Fifteenth International Congress on Hygiene and Demog- 
raphy and the Fourth International Congress on School Hygiene, 
a survey of hygienic conditions of rural school houses, and the 
preparation for lending purposes, of cardboard models and three 
types of school houses. 
In the following three years (1915-1917) the division had the 
part-time services of two special agents, one in Washington and the 
other in Nashville. The former conducted correspondence, edited 
bulletins, and prepared annual surveys of progress in educational 
hygiene. The latter did much work throughout the country on 
school architecture and in helping in surveys of rural schools. A 
bulletin on open air schools was prepared by the division in col- 
laboration with Sherman C. Kingsley of the Elizabeth McCormick 
Memorial Fund. Other bulletins on Medical Inspection in England, 
Physical Growth and School Progress, School House Sanitation, 
and Physical Education in Secondary Schools were also issued. 
In 1918 the Division again had a full-time specialist in charge 
for the first time since 1912. In addition to continuing its routine 
duties as outlined above, it did much work on physical education. 
On February 26, 1918, a conference was held in Atlantic City 
under the auspices of the Bureau of Education for the purpose 
of discussing ways and means of promoting a nation-wide move- 
ment to establish physical education, including health instruction 
and training as a part of the education of all children. As a 
result of this and subsequent conferences, the Playground and 
Recreation Association of America created a National Physical 
Education Service, with an office in Washington, for the specific 
purpose of promoting state and federal legislation for physical 
education. Through the help of this service, thirty-three states 
now have laws making physical education and other health activi- 
ties an essential part of the school program. The Washington office 
of this service was closed in 1924, and the work is continued from 
the Association headquarters, 315 Fourth Avenue, New York City. 
Other activities by the Division during this year included co- 
operation with a number of war-time committees. In cooperation 
with the Medical Section of the Council of National Defense, a 
pamphlet on sex education for high school boys entitled " Keeping DEPARTMENT OF THE INTERIOR 
277 
fit " was prepared and issued. An analytical summary of state 
laws on physical education was also issued. 
In 1919, besides the full-time specialist in charge, and a part- 
time state agent on schoolhouse construction and sanitation, there 
was added a full-time assistant in health education. Temporarily, 
there was some field assistance. Among studies and surveys made 
or participated in during that year and the following year, were 
the surveys of the school system of the state of Alabama and the 
city of Memphis, and studies of physical education in normal 
schools, school health supervision, and janitor service in city 
schools. 
For several years, beginning in the late fall of 1918, the bureau 
had the active assistance of the Child Health Organization of 
America. This association was formed in the spring of 1918 as a 
branch of the National Child Labor Committee, primarily for the 
purpose of studying malnutrition among school children. It later 
became independent and, at the request of the Secretary of the 
Interior, gave assistance to the Bureau of Education. Until 
July, 1919, the director of the Child Health Organization acted as 
special collaborator, and office assistance was supplied by the Child 
Health Organization.9 Five publications in editions of nearly a 
million were issued during the first year. The special appropria- 
tion for printing was made from the President's War Emergency 
Fund. These formed the beginning of the Health Education Series. 
In 1922 the name of the Division was lengthened to that of 
School Hygiene and Physical Education. 
The appropriations for this division for salaries, travel, and 
publications have not been large and have never reached much over 
$20,000 a year. 
Present Organization and Activities. In 1922 W. S. Small, 
Ph. D., resigned as Chief of the Division, and was succeeded by 
James F. Rogers, M. D., Dr. P. H. The personnel in 1925 consisted 
of three full-time specialists in School Hygiene and Physical Edu- 
cation, one part-time specialist in School House Construction and 
Sanitation and one full-time secretary and clerk. 
9 In 1922 this agency was merged with the American Child Hygiene 
Association to form the American Child Health Association (370 Seventh 
Ave., New York). 278 
NATIONAL GOVERNMENT AND HEALTH 
The work of the division consists in furnishing information 
on all features of school health work through bulletins and by 
correspondence in reply to special letters of inquiry from all over 
the country. Its publications on school housing, medical inspection, 
school feeding, health education, physical training, playground 
management, legislation for physical and health education, etc., 
now number about fifty. The demand has far exceeded that for 
other publications of the bureau, a fact which indicates the actual 
interest and progress in health work in the schools of the country. 
The division has still further stimulated such work by the articles 
which it contributes to " School Life," the monthly publication of 
the bureau. 
The Division, has, each year, arranged a number of important 
conferences of workers in school health. It also furnishes speakers 
for various meetings of teachers, and school nurses, parents and 
others interested in school health work. 
The division takes part in the surveys of schools carried on by 
the bureau in many cities, and it offers advice not only as to school 
sanitation, the organization and planning of courses, etc., but also 
in the construction and remodeling of school buildings, gymnasia, 
swimming pools, etc. 
Publications. Pamphlets prepared by the Division have included 
the Health Education Series, a Physical Education Series, and 
School Health Studies. In addition, cards, posters, and classroom 
weight records have been issued. The list is as follows: 
Health Education Series 
No. i. Wanted, teachers to enlist for child health service. 
No. 2. Diet for the school child. 
No. 3. Summer health and play school. 
No. 4. Teaching health. By Lucy Oppen. 
No. 5. Child health program for parent-teacher associations and 
women's clubs. By Lucy W. Collier. 
No. 6. Further steps in teaching health. 
No. 7. The lunch hour at school. By Katharine A. Fisher. 
No. 8. Health training for teachers. By Robert G. Leavitt. 
No. 9. Your opportunity in the schools. By L. Emmett Holt. 
No. 10. Suggestion for a program of health teaching in elemen- 
tary schools. By J. Mace Andress and Mabel C. Bragg. 
No. 11. Milk and our school children. By Bernice C. Reaney. DEPARTMENT OF THE INTERIOR 
279 
No. 12. Sleep. By Harriet Wedgwood. 
No. 13. Dramatics for health teaching. By Harriet Wedgwood. 
No. 14. The kindergarten and health. By Arnold Gesell and 
Julia Wade Abbot. 
No. 15. Suggestions for a program for health teaching in the high 
school. By Dorothy Hutchinson. 
No. 16. The continuing need for teachers of child health. By 
Dorothy Hutchinson and Harriet Wedgwood. 
Physical Education Series 
No. 1. Preparation of school grounds for play fields and athletic 
events. By Dorothy Hutchinson. 
No. 2. Athletic badge tests for boys and girls. 
No. 3. Suggestions for a physical education program for small 
secondary schools. By Walter F. Cobb and Dorothy 
Hutchinson. 
No. 4. Athletics for women. By J. F. Rogers. 
School Health Studies 
No. i. Health for school children. 
No. 2. The child health school. By Lydia J. Roberts. 
No. 3. Who's who in Healthland. By Anne Whitney. 
No. 4. Growing healthy children. A study of health supervision 
in the Trenton, N. J., schools. By Mrs. Ina J. N. 
Perkins 
No. 5. Health promotion in a continuation school. By Harriet 
Wedgwood. 
No. 6. Municipal and school playgrounds and their management. 
By J. F. Rogers. 
The Alaska Division. Among the administrative duties of 
the Bureau of Education is the care of the natives of Alaska. This 
territory was purchased from Russia in 1867 and was given a civil 
government in 1884 (Act of May 17; 23 Stat. L., 27). At that 
time the duty of providing education for the children of Alaska 
was placed upon the Secretary of the Interior, who delegated the 
duty to the Commissioner of Education on March 2, 1885. From 
the first, the teachers in these various outposts of civilization had to 
cope with diseases and epidemics and with household conditions 
and sanitation. There are few professional facilities for medical 
and sanitary care, and so teachers have been and are given elemen- 
tary instruction in medical aid and furnished with supplies for 280 
NATIONAL GOVERNMENT AND HEALTH 
emergency cases. By 1909, however, the division had arranged for 
nine physicians, and from then on, has had from fifteen to twenty- 
five physicians and nurses on duty each year in Alaska. Hospitals 
are likewise maintained at five centers, Juneau, Kanakanak, Akiak, 
Nulato, and Noorvick, the first having established at Juneau in 
1910. 
A survey of health and sanitary conditions in southern Alaska 
was made in 1911 by an officer of the Public Health Service, who 
was detailed at the request of the Commissioner of Education. 
Tuberculosis, pneumonia, rheumatism, and venereal diseases were 
found to prevail to an alarming extent. As a result of this report 
the Public Health Service detailed an officer for an indefinite term 
to supervise all measures for medical and surgical relief, to instruct 
the teachers in sanitary subjects, and to act in an advisory ca- 
pacity to the Superintendent of Education of Natives of Alaska. 
The first separate appropriation for medical relief in Alaska was 
made in 1915 (38 Stat. L., 822) and consisted of $25,000. This 
amount was doubled in 1916 and has been increased somewhat for 
each succeeding year, until in 1925, $110,000 was authorized. The 
appropriation acts granting these sums to the Bureau of Education 
require that they shall be utilized with the advice and cooperation 
of the Public Health Service. 
The population of Alaska is now about 55.000 of whom 27,000 
are natives. The work of the Bureau of Education extends over 
eighty-five widely scattered settlements. It is in charge of the 
Chief of the Division, with an office in Seattle. The total number 
of employees authorized under the appropriation of $122,320 for 
medical relief for the fiscal year 1926 is forty-three. 
Medical relief in isolated stations along the coast of Alaska is 
also often given by the Coast Guard of the Treasury Department. 
Certain activities relating to food, tubercular cattle, and home 
economics in Alaska are carried on under the auspices of the 
experiment stations of the Department of Agriculture and are 
described elsewhere. 
St. Elizabeth's Hospital. St. Elizabeth's Hospital is the gov- 
ernment institution for the insane. Legislation authorizing its 
organization was passed in 1855 (Act of March 3, 10 Stat. L., 
682), although an appropriation of $100,000 for the purpose had DEPARTMENT OF THE INTERIOR 
281 
been granted three years previously. The object of the institution 
was stated to be " the most humane care and enlightened curative 
treatment of the insane of the Army and Navy of the United States 
and of the District of Columbia." The name " St. Elizabeth's " 
was given to it in 1916 (39 Stat. L., 309). From the beginning 
the Hospital has been under the general jurisdiction of the Secre- 
tary of the Interior, who appoints the Superintendent. There is a 
Board of Visitors, consisting of nine citizens of the District of 
Columbia, appointed by the President, whose duties are to make 
necessary by-laws to govern the hospital. The Surgeons General 
of the Army, Navy, and Public Health Service were members of 
this Board in 1925. 
The patients admissible to the Hospital, according to the law, 
are as follows:10 
1. Insane persons belonging to the Army, Navy, Marine Corps, 
and Coast Guard. 
2. Civilians employed in the Quartermaster's, Pay, and Subsis- 
tence Departments of the Army, who may be, or may hereafter 
become insane while in such employment. 
3. Men who, while in the service of the United States, in the 
Army, Navy, or Marine Corps, have been admitted to the Hospital, 
and have been thereafter discharged from it on the supposition 
that they have recovered their reason, and have, within three years 
after such discharge, again become insane from causes existing at 
the time of such discharge, and have no adequate means of support. 
4. Indigent insane persons who have been in either of the said 
services and have been discharged therefrom on account of 
disability arising from such insanity. 
5. Indigent insane persons who have become insane within three 
years after their discharge from such service, from causes which 
arose during and were produced by said service (12 Stat. L., 23 ; 14 
Stat. L., 93; 31 Stat. L., 7; 37 Stat. L., 591; 38 Stat. L., 800). 
6. Insane patients of the Public Health Service (18 Stat. L., 
486; 32 Stat. L., 712; 37 Stat. L., 309; 39 Stat. L., 309; 40 Stat. 
L., 644). 
7. Inmates of the Soldier's Home who become insane (23 Stat. 
L., 213 ; 39 Stat. L., 309). 
8. Inmates of National Home for Disabled Soldiers who become 
insane (22 Stat. L., 330; 33 Stat. L., 731 ; 39 Stat. L., 309). 
10 See, Laws governing the admission of patients to St. Elizabeth's 
Hospital. Department of the Interior (1925). 282 
NATIONAL GOVERNMENT AND HEALTH 
9. Interned persons under jurisdiction of War or Navy depart- 
ments who become insane (39 Stat. L., 309; 39 Stat. L., 558; 
40 Stat. L., 373). 
10. American citizens adjudged insane in the Canal Zone (40 
Stat. L., 179). 
11. Insane persons of the District of Columbia, including per- 
sons charged with crime, or prisoners (10 Stat. L., 683; 22 Stat. 
L.,251). 
12. Indigent insane non-residents of the District of Columbia, 
upon the order of the Board of Commissioners of the District 
(33 Stat. L., 316). 
13. Insane persons accused of crime, or persons becoming insane 
while serving sentence in the United States penitentiary (11 Stat. 
L., 158). 
14. Beneficiaries of the United States Veterans' Bureau (40 
Stat. L., 1302; 42 Stat. L., 147). 
15. Beneficiaries of the Employees' Compensation Commission 
(18 Stat. L., 486; 39 Stat. L., 742). 
On November 1, 1925, there were 4430 patients in the Hospital. 
The number of physicians and scientists on that staff at that time 
numbered fifty-seven, and there were about twelve hundred addi- 
tional employees. The appropriation for maintenance during the 
fiscal year 1925 was $900,000, although reimbursements from other 
sources for the care of patients amounted to about $2,000,000 
additional. 
The administration of the Hospital, under the Superintendent, is 
divided into two parts. One, under an Administrative Assistant, 
is concerned with business and financial affairs; the other, under 
the First Assistant Physician, deals with medical and scientific 
matters. Medical administration is further subdivided into several 
services. There are, for instance, two Clinical Directors, one male 
and one female, who, with the aid of senior assistant physicians, 
have charge of respective (male or female) parts of the institution. 
There are also divisions of Clinical Psychiatry, Internal Medicine, 
and laboratories. An Out-Patient Department, with headquarters 
in the city, looks after patients on parole, or for whom parole is 
contemplated, and does other sociological work. A training school 
for nurses is also maintained at the Hospital, and there is a special 
department for Veteran's Bureau patients. There is, in addition, 
a medical library.11 
11 White, W. A., St. Elizabeth's Hospital, Medical Journal and Record, 
April 16, 1924. DEPARTMENT OF THE INTERIOR 
283 
Freedmen's Hospital. Freedmen's Hospital, under the juris- 
diction of the Department of the Interior, is a hospital for colored 
patients. It is located in the District of Columbia and receives the 
majority of its patients from that area, though in 1924 indigent 
patients represented thirty-three states, and pay patients, twenty- 
eight states. The Hospital cares for about four thousand patients 
a year. 
The Freedmen's Hospital was established in 1871 (16 Stat. L., 
506), and placed under the supervision of the Secretary of War, 
where it continued until 1874, when it was transferred to the Secre- 
tary of the Interior (18 Stat. L., 223). The number of patients 
has grown from 190 in 1875 to 2427 in 1900, and to 4121 in 1924. 
The hospital has a staff of six physicians, six nurses, about a dozen 
internes, and a visiting staff of some fifty physicians. It maintains 
a school for nurses, which has graduated about four hundred 
students. In 1924 thirteen received diplomas. 
The appropriation to the Hospital under the Interior Department 
was $174,700 in 1925, though $42,500 more is carried in the District 
of Columbia appropriation act for care and treatment of indigent 
patients. Receipts from pay patients amounted to nearly $30,000 
in 1924. 
The Geological Survey.12 The Geological Survey of the Depart- 
ment of the Interior is engaged in making topographic, geologic, 
and water-resource surveys of the United States, and in publishing 
the results of these surveys. Its work in regard to water resources, 
which is done by the Water Resources Branch, furnishes informa- 
tion of fundamental importance in the field of sanitary engineering, 
especially in developing and improving the public water supplies 
of cities throughout the country. Some of this work is done in 
formal cooperation with state boards of health. 
The Geological Survey was established in the Interior Depart- 
ment in 1879 (20 Stat. L., 394), although previously geological 
and geographic surveys had been made by the National Govern- 
ment. In 1888 it was directed to investigate irrigation in arid lands. 
This authority was repealed two years later, but in 1894 an appro- 
priation of $12,500 was made for " gauging the streams and 
12 The Geological Survey. Institute for Government Research, Service 
Monograph No. i (1918). 284 
NATIONAL GOVERNMENT AND HEALTH 
determining the water supply of the United States, including the 
investigation of underground currents and artesian wells in arid 
and semiarid sections." This appropriation was doubled in 1896, 
quadrupled in 1897, remaining at $50,000 until 1899. Then it 
was increased to $70,000 in 1900, and to $100,000 for 1901. In 
1902 the Reclamation Act was passed, its administration being 
entrusted to a division of the Hydrographic Branch of the Geo- 
logical Survey until 1907, when the Reclamation Service was set 
up as an independent bureau in the Interior Department. 
Since 1888 the Geological Survey has carried on important 
surveys of water resources, and since 1894 it has been engaged 
in the project of surveying all of the surface waters of the 
country, a tremendous task and one of great value. An attempt is 
also being made to locate all ground waters throughout the United 
States, a matter having a sanitary as well as an economic aspect. 
The main work of the Water Resources Branch, therefore, is 
the gauging of streams to determine the quantity of water which 
they carry. Daily records of stream discharge are at present 
obtained at more than 1700 gauging stations. When results have 
been obtained for a stream over a period of ten to twenty years, 
it is possible to make a fairly close estimate of the maximum, 
minimum, and average future yield of that stream and of others 
where conditions that affect stream flow are similar. Systematic 
surveys and investigations of the ground-water conditions in 
different parts of the country are carried on, to determine the 
occurrence, quantity, head, quality, and availability of the water 
that exists below the surface and is recovered through wells. The 
work of the branch on the quality of water is confined to a con- 
sideration of the physical characteristics of water and the chemical 
composition of its dissolved mineral matter. The results of this 
work have no direct bearing on health problems, but are always 
to be considered among the factors involved in selecting the 
source of a public or private supply. 
The Water Resources Branch maintains two small but well 
equipped laboratories, one for making chemical analyses of both 
surface and ground waters, and one for making tests of porosity, 
permeability, and other physical properties of water-bearing 
materials. The results of these laboratory tests are extensively 
utilized by sanitary engineers. DEPARTMENT OF THE INTERIOR 
285 
Recently the Water Resources Branch has cooperated with the 
United States Public Health Service in an intensive study by 
that Service of the pollution of ground waters by human excreta. 
In this cooperation the work of the Water Resources Branch is 
restricted to the hydrologic phases of the problem. 
A series of reports, known as Water-Supply Papers, has been 
published by the Geological Survey since 1896, nearly six hun- 
dred of these papers having been issued to date. Most of them 
relate to stream measurements, but there are also many papers 
relating to ground water, quality of water, and water power in 
different areas. Some of the earlier pamphlets in this series 
dealt with stream pollution by industrial wastes and sewage, but 
this subject has not been under investigation by the Geological 
Survey since 1909, when this line of work was transferred to the 
Public Health Service. 
The National Park Service. The National Park Service was 
established as a bureau in the Department of the Interior in 1917, 
having been created by the act of August 25, 1916 (39 Stat. L., 
535)- National parks had, however, been in existence since 1872, 
when the Yellowstone National Park was established. To-day 
there are nineteen of them, with a total area of 11,387 square 
miles. In addition, there are thirty-five " national monuments," 
usually consisting of small areas created by executive order to 
conserve objects and areas of historic or scientific importance. 
A few of these national monuments are, however, under the 
jurisdiction of the War or Agriculture department, the former 
having nine and the latter fourteen. 
Aside from their value as recreation centers and places for out- 
door life, the national parks are concerned in public health by 
virtue of the sanitary problems created by the influx of large num- 
bers of persons. Stream pollution must be prevented and pure 
water supplies maintained for human consumption. Sewage and 
waste must be properly disposed of, insects which may spread 
disease must be eliminated, and medical service must be provided 
for tourists. In other words, the public health problem is similar 
to that encountered in any rural area within a state. 
For a number of years sanitary and medical assistance has been 
rendered to the national parks by the Public Health Service at 286 
NATIONAL GOVERNMENT AND HEALTH 
the direct request of the Secretary of the Interior. In fact, in a 
statement of policy on national parks issued on March n, 1925, 
by Secretary Hubert Work, occur these sentences, " In the solu- 
tion of administrative problems in the parks and monuments 
relating both to their protection and use, the scientific bureaus of 
the government are called upon for assistance. For instance, in 
the protection of the public health, the Public Health Service of 
the Treasury Department cooperates; in the destruction of insect 
pests in the forests, the Bureau of Entomology in the Department 
of Agriculture is called upon and in the propagation and distribu- 
tion of fish, the Bureau of Fisheries in the Department of Com- 
merce gives its hearty cooperation." 
The assistance rendered by the Public Health Service consists 
of the assignment of sanitary engineers during the park season, 
which is approximately from May to October, and the detail of 
one or more medical officers throughout the year. In order to 
show the type of service performed, for it is an important illus- 
tration of what may be called " contract " health service provided 
by one bureau for another, the outline of activities, as given in 
the annual report of the Public Health Service for the fiscal year 
1924, will be quoted in full: 
Yellowstone. A complete sewerage system with treatment 
plant designed by this district was installed at the Lake Junction. 
This plant receives the sewage from all the buildings and camps 
at the junction. The treatment plant consists of a settling tank 
with separate sterilization chamber and a small concrete building 
for housing the chlorine machine. At the Canyon Junction a 
sewerage system, settling tank, and sterilizing equipment were 
installed to take care of the sewage from the Canyon Hotel, and 
similar designs were prepared at the canyon for sewers, tank, and 
sterilizing apparatus for taking care of the sewage from the 
Government automobile camp, ranger stations, and the stores. At 
the Fishing Bridge, West Thumb, and Lewis Lake, plans were 
made for disposing of sewage from comfort stations. These 
works will be constructed during the next fiscal year. At the 
eastern entrance to the park a sewerage system and treatment 
plant were laid out and the detailed plans will be prepared by an 
assistant engineer of the Park Service. 
Complete surveys of all the water supplies of the park were 
made and samples taken for bacteriological analysis. A special 
report on the supply at Mammoth Hot Springs was made, which 
included recommendations for improving the physical properties DEPARTMENT OF THE INTERIOR 
287 
of the water. The water supplies of the park are satisfactory 
from a bacteriological standpoint, but in many places there is 
a shortage of water that must be met within the next few years. 
This is particularly true at the canyon, and surveys were made 
to locate a single supply that will be sufficient for all consumers at 
this junction. 
The dairies supplying milk were inspected, and the reports 
indicate that the milk supplied to the park was of high quality 
throughout the year. 
The disposal of garbage has always been a serious problem in 
the park, and beginning this year a clean-up program was started 
at all the old dumps, and new burial pits were located at each junc- 
tion. Bear feeding platforms were installed at the pits, and each 
day garbage that has been worked over is thrown into the pits and 
covered. 
Mosquito-control work was carried out again this spring along 
the lines worked out last year. It was stated by the superintendent 
of the park that there was a very material reduction last year as 
compared with former years. With a more efficient organization 
each year and more funds available for drainage, it is believed that 
the mosquito nuisance can be practically eradicated at the more 
important junctions in the park. 
Yosemite. The work in Yosemite during the year included the 
following activities: (i) Inspections of the sanitary conditions of 
all places handling, storing, and serving foods and soft drinks; 
(2) preparation of plans for remodeling bathhouses and inclo- 
sures around the two swimming pools ; (3) design of an incinerator 
for burning garbage; (4) cooperating with the park civil engineer 
in the operation of the sewage-treatment plant; (5) bacteriological 
examination of water and milk supplies and water flowing in 
Merced River above and below the sewage-treatment plant; and 
(6) the examination and report on two cases of typhoid fever that 
occurred at the same time among employees of the Government. 
Grand Canyon. On account of extensive improvements, prob- 
ably amounting to more than two million dollars, that the Santa Fe 
Railroad and Fred Harvey Companies expect to make at the south 
rim of the Grand Canyon during the next few years, considerable 
time was spent at the Canyon during the last year. The work in 
which this district has an interest is as follows: (1) The design 
of a sewerage system and a treatment plant to be built by the 
Government at an estimated cost of $72,000 that will produce an 
effluent that can be used for boiler and irrigation purposes and for 
flushing toilets; (2) the construction of a new water-supply 
system by the Santa Fe Railroad at an estimated cost of $300,000; 
(3) the disposal of garbage by incineration or feeding to hogs ; (4) 
the design of a swimming pool; and (5) the problems of general 
sanitation. 288 
NATIONAL GOVERNMENT AND HEALTH 
At the north rim of the Grand Canyon a thorough survey was 
made of the water supplies, and recommendations ^yere given as 
to the developments that can be made with the water supply 
available. 
Sequoia. A new and complete water-supply system was installed 
during the year under the general supervision of this district, and 
a sewerage system and treatment plant were designed in coopera- 
tion with an engineer of the Park Service and construction work 
started the 1st of June. General inspections of the sanitary condi- 
tions of the park were made. A garbage incinerator was designed 
and partially constructed at the close of the fiscal year. 
General Grant. A new water-supply system and a sewerage 
system and treatment plant were installed during the year and have 
proven successful in operation. Inspections of the sanitary con- 
dition of the concessions and Government automobile camps were 
made. 
Crater Lake. A complete sewerage system and treatment plant 
were designed to take care of the sewerage from Crater Lake Lodge 
and the regular inspections of the sanitary conditions in the park 
were made. Analyses of the public water supply were made and 
recommendations given for increasing the amount of water de- 
livered to the camp grounds and the Lodge. 
Mount Rainier. The work done in Rainier consisted of the 
regular inspection of the sanitary conditions of the automobile 
camping grounds and the places handling and selling food, milk, 
soft drinks, and other food products. Recommendations were also 
made in regard to the development of a new and adequate water 
supply for all interests at Longmire and this district laid out a new 
water-supply line for the automobile camp. 
Glacier. A general survey was made of the sanitary conditions 
of all automobile camps and chalets in the park. Estimates were 
prepared for the cost of a sewerage system and treatment plant 
for the Government headquarters at Belton and the money was 
appropriated in June. 
Zion. The Union Pacific Railroad is anticipating an expenditure 
of about $600,000 in this park for constructing a large hotel and 
camps. During the past year considerable time was spent in con- 
ference with Union Pacific Railroad engineers and Park Service 
officials regarding plans for sewerage system, treatment plant, a 
new water supply, and garbage disposal. 
Bryce Canyon. The last Congress passed legislation which, 
under certain conditions, will change this canyon into a national 
park under the name of Utah National Park. In anticipation of 
this law being carried out, a visit was made to the Canyon in June 
to inspect the plans for sewage and garbage disposal which were 
being worked out at the time for the building program then under 
way. DEPARTMENT OF THE INTERIOR 
289 
Muir Woods. A general inspection of the sanitary conditions 
was made and recommendations given for improving the water 
supply and disposing of garbage and refuse. 
Park Rangers, in charge of policing, also supervise sanitary 
measures in the areas under their jurisdiction. 
The Bureau of Pensions.13 The Bureau of Pensions of the 
Department of the Interior executes the laws granting pensions on 
account of military or naval service to the United States, and the 
laws making provision for retirement of civil service employees. It 
is not, of course, a public health agency, but it maintains a Medical 
Division, and so deserves brief mention for this reason. 
Pensions have been granted by the United States since Revolu- 
tionary days. They were administered under the jurisdiction of 
the Secretary of War and the Secretary of the Navy, respectively, 
until 1849, when the Interior Department was created and the 
Pension Office became a bureau of that department. 
At the head of the Bureau is a Commissioner, who is assisted 
by a Deputy Commissioner and a chief clerk. There are eleven, 
divisions, as follows: Law, Record, Invalid, Widow, Board of 
Review, Retirement, Medical, Special Examination, Certificate, 
Finance, and Disbursing. 
The Medical Division is in the charge of a Medical Referee, who 
has the aid of an Assistant Medical Referee. The Medical Referee 
supervises the examination and revision of the reports of examin- 
ing surgeons, and such other duties concerning medical and surgical 
questions as the interests of the service demand. He issues orders 
for medical examinations and keeps records of them; examines 
and audits the accounts of examining surgeons; appoints surgeons 
in the field; and determines all medical questions which arise. 
The division has about one hundred employees, of whom twenty- 
six are medical officers. There are about four thousand examining 
surgeons in the field, employed on a contract basis. About half a 
million dollars is appropriated annually for fees and expenses of 
these examining surgeons. The total appropriation to the bureau 
is about two hundred million dollars a year. In 1925 it was 
$224,616,000. 
" See Weber, The Bureau of Pensions. Institute for Government Re- 
search, Service Monograph No. 24 (1923). CHAPTER XI 
THE DEPARTMENT OF COMMERCE 
Of the ten bureaus of the Department of Commerce, a division 
of one, the Division of Vital Statistics of the Bureau of the Cen- 
sus, has a major interest in public health; another, the Bureau of 
Mines, has an important interest in this subject; while four others 
are only casually interested in public health. These four are the 
Bureau of Fisheries, which studies the nutrition of sea foods, and 
cooperates in developing fish for anti-mosquito work; the Bureau 
of Standards, which develops industrial safety codes; the Patent 
Office, which issues patents and trade-marks for drugs and medi- 
cines ; and the Steamboat Inspection Service, charged with the 
oversight of sanitary conditions on all steamers licensed by the 
United States. 
The Bureau of the Census.1 The Bureau of the Census of the 
Department of Commerce takes the decennial census of the United 
States and regularly compiles statistics on many different sub- 
jects. Data on the dependent, defective, and delinquent classes in 
institutions; on national fiscal affairs; and other matters are com- 
piled every tenth year between decennial censuses. An agricultural 
census is taken the fifth year after the decennial census, and manu- 
facturing statistics are collected biennially. Financial statistics of 
cities are compiled annually, as are also vital statistics and divorce 
figures. 
The Division of Vital Statistics. Vital statistics include 
births, stillbirths, and deaths, and they have been aptly called the 
bookkeeping of public health. In the Bureau of the Census, the 
collection and compilation of these national vital statistics is the 
duty of the Division of Vital Statistics, one of the seven divisions 
of the Bureau, the others being Agriculture, Manufacturing, Sta- 
1 See Schmeckebier, The Statistical Work of the National Government 
(1925). Institute for Government Research. 
290 DEPARTMENT OF COMMERCE 
291 
tistics of Cities and States, Surveys of Current Business, Cotton 
and Tobacco, and Geography. 
Section 8 of an act approved March 6, 1902 (32 Stat. L., 51, 
52) entitled "An act to provide for a permanent Census Office," 
authorized the collection of both birth and death statistics. The 
act provided that such statistics should be obtained only from the 
registration records of such states and municipalities as, in the 
judgment of the Director of the Census, possessed records afford- 
ing satisfactory data in necessary detail. 
An act of July 1 of the same year (32 Stat. L., 714) states 
that, to secure uniformity in the registration of mortality, mor- 
bidity, and vital statistics, it shall be the duty of the Surgeon 
General of the Public Health and Marine Hospital Service to pre- 
pare and distribute suitable and necessary forms for the collec- 
tion and compilation of such statistics and to issue them as part 
of the reports of the Service. In view of the collection of the data 
by the Census Bureau, the Public Health Service has never 
attempted to assemble birth and death statistics, though it has 
collected morbidity reports for years and has recently inaugurated 
a plan for a morbidity registration area.2 
History and Development. The first annual mortality report 
related to the year 1900 and was published in 1906 as part of a 
report covering the five years, 1900 to 1904. Previous to that 
time, mortality reports based on enumerators' returns had been 
published as early as 1850 and again in i860 and 1870. Data from 
such returns and from registration records were published in 1880, 
1890, and 1900 (census year). The registration area was recog- 
nized as early as 1880, and it was enlarged in 1890 and again in 
1900, so that it included in 1900 the New England States, Indiana, 
Michigan, New Jersey, New York, and the District of Columbia. 
Since 1900 the following states have been admitted to the death 
registration area: 1906, California, Colorado, Maryland, South 
Dakota, and Pennsylvania; 1908, Washington and Wisconsin; 
1909, Ohio; 1910, Minnesota, Montana, North Carolina (munici- 
palities of 100 and over), and Utah; 1911, Kentucky and Missouri: 
1913, Virginia; 1914, Kansas; 1916, North Carolina (remainder 
of state) and South Carolina; 1917, Tennessee; 1918, Illinois, 
2 Lloyd, B. J., A plan to establish a morbidity registration area, Public 
Health Reports, July 24, 1924. 292 
NATIONAL GOVERNMENT AND HEALTH 
Louisiana, and Oregon; 1919, Delaware, Florida, and Mississippi; 
1920, Nebraska; 1922, Georgia, Idaho and Wyoming; 1923. 
Iowa; 1924, North Dakota; 1925, West Virginia. There are also 
seventeen registration cities in non-registration states, making 
a total of forty states, the District of Columbia, and the seven- 
teen cities before mentioned, or over 80 per cent of the total 
estimated population of the United States. Only three states 
remain with unsatisfactory registration laws-South Dakota which 
had been admitted, but was later dropped, Nevada, and Arizona. 
This leaves five states with satisfactory laws which will be ready 
for admission as soon as they can show that the laws are ade- 
quately observed. 
The first annual report on birth statistics related to the year 1915, 
though prior to that time, reports of births had been made in the 
decennial census reports. In 1915 a birth registration area was 
recognized, including Connecticut, Maine, Massachusetts, Mich- 
igan, Minnesota, New Hampshire, New York, Pennsylvania, 
Rhode Island, Vermont, and the District of Columbia. In 1916 
Maryland was added; in 1917, Indiana, Kansas, Kentucky, North 
Carolina, Ohio, Utah, Virginia, Washington, and Wisconsin were 
added. None were added in 1918, and in 1919 Rhode Island was 
dropped because of failure to send in all transcripts of birth cer- 
tificates for the year. California, Oregon, and South Carolina were 
added in 1919 ; Nebraska in 1920; Delaware, Mississippi, New Jer- 
sey, and Rhode Island (readmitted) in 1921; Illinois, Montana, 
and Wyoming in 1922; Florida, Iowa, and North Dakota in 1924; 
and West Virginia in 1925. Thus, thirty-four states and the Dis- 
trict of Columbia, or over 60 per cent of the total population of 
the United States, comprise the birth registration area. 
Maps showing the birth and death registration areas have been 
issued by the Bureau of the Census. 
Current Activities. As already indicated, the principal work 
of the Division of Vital Statistics is the compilation of birth and 
death statistics. In addition, the Division compiles life tables, 
encourages and promotes uniformity in the local registration laws 
for births and deaths, issues weekly reports of deaths occurring 
in sixty of the larger cities, makes special studies of various sub- 
jects relating to vital statistics, and cooperates in the statistical DEPARTMENT OF COMMERCE 
293 
work of other government departments and with extra-govern- 
ment agencies interested in vital statistics. 
The birth and death statistics are gathered only from the regis- 
tration area. A state or city is admitted to the birth or death 
registration area if, on investigation, it is found that 90 per cent 
of the actual births or 90 per cent of the actual deaths have been 
reported. 
The statistics are based upon the local records. Certificates of 
birth and death are made by physicians, midwives, and under- 
takers, for the city or county records. For several years the 
Bureau of the Census has been urging upon local governments 
the adoption of standard forms for these certificates, and its efforts 
have met with considerable success. Agents are employed by the 
Bureau of the Census to make transcripts of certificates for trans- 
mission to the bureau in Washington. They receive, as a rule, 
compensation at the rate of three cents for each certificate tran- 
scribed. Upon receipt in the bureau, the transcripts are edited, 
and the data tabulated by the punched card system and assembled 
in report form. 
Reports of birth and death statistics are published annually, 
by calendar years; they are supposed to appear about the end of 
the year following that to which they relate. Birth statistics are 
presented in one volume, death statistics (mortality statistics) in 
another. 
In order to extend the registration area, the Bureau of the 
Census directs a considerable part of the effort of the Division of 
Vital Statistics to promoting adequate registration in localities 
outside the present area. In fact, one of the great accomplish- 
ments of the division has been the building up of the registration 
area from practically nothing to its present nearly complete status. 
This promotion work consists in educating committees, societies, 
state legislatures, and the public generally, through publications 
and press notices, as to the importance of complete registration. 
It also includes a system of testing the completeness of registra- 
tion of births and deaths in the various states, which is done by 
means of form letters addressed to clergymen, postmasters, rural 
carriers, and others, calling for information regarding recent 
births and deaths. The replies are compared with the registered 294 
NATIONAL GOVERNMENT AND HEALTH 
births and' deaths in the same localities, and serve as a test of the 
accuracy and adequacy of the registration. 
Another important activity is the publication and distribution 
of the American edition of the " Manual of the international list 
of causes of death," which is the standard authority. More than 
148,000 copies of this twenty-eight page pamphlet were distributed 
by the division during the fiscal year 1919. The sixth edition was 
issued in revised form in 1923. The Chief Statistician represented 
the division at the International Conferences held in Paris in 1909 
and 1920 for the revision of the list. The division also publishes 
the " Index of joint causes of death," and the " Physicians' pocket 
reference." 
The Division of Vital Statistics constructs life tables, which 
show the rate of mortality and the number of years of expectation 
of life of various age groups. The geographical field covered by 
these statistics is limited in the case of the most of the tables to the 
states that have had for a long time an adequate registration of 
deaths. These states are New York, New Jersey, Indiana, 
Michigan, and the New England States. The District of Columbia 
is also included. 
The first publication of life tables was issued in 1916, the statis- 
tics referring to the year 1910. This publication, which was en- 
titled "United States life tables, 1910," gave in its preliminary 
pages a complete explanation of the tables, with illustrative ex- 
amples of their use. A more complete publication was issued in 
1921, entitled "United States life tables, 1890, 1901, 1910 and 
1901-1910." Abridged life tables for 1919-1920 were issued in 
1923. There was also published in this year " Mortality rates, 1919- 
1920," in which the tables are considered by the division to be the 
best of this nature ever put out by the organization. 
The Division of Vital Statistics receives weekly telegraphic 
reports of deaths from sixty of the largest cities. The figures are 
issued within seventy-two hours after the close of the week to 
which they relate. These multigraphed statements show, in addi- 
tion to the number of deaths occuring: (1) The numbers of 
deaths in corresponding prior periods of time, (2) the estimated 
populations, (3) the death rate per year, (4) the number of 
deaths of infants under one year old, and (5) the estimated infant 
mortality rate. DEPARTMENT OF COMMERCE 
295 
Monographs are issued from time to time on subjects related 
to vital statistics. Among these monographs may be mentioned 
for purposes of illustration those relating to cancer and other 
malignant tumors, influenza mortality, and the standard nomen- 
clature of diseases and pathological conditions, and of injuries 
and poisonings. 
Organization. The Division is under the direction of a Chief 
Statistician, W. H. Davis, M. D. There was in 1925 a personnel 
of sixty-nine including the staff in Washington and in the field. 
In 1922 the personnel was 124. 
The Chief Statistician is assisted by an Expert Chief of Division, 
who is in immediate charge of the clerical force and of the pro- 
duction of the work. The Division is a complete unit in itself and 
is related to the rest of the Bureau of the Census only in that it 
obtains from the Division of Population and from the Geographer, 
facts of population for census and intercensal years for purposes 
of calculating rates. The division had its own mechanical equip- 
ment until 1923, when it was transferred to a central mechanical 
section. 
Appropriations. Appropriations for the division have come 
out of the lump sums of the bureau. For the fiscal year 1924, 
the division received $188,038.54. For the three years consti- 
tuting the decennial census period, the first year of which ended 
June 30, 1920, the division had an allotment of $825,000, of 
which $75,000 was for printing and $250,000 for each year's 
expenses. 
The Bureau of Mines. The Bureau of Mines was established 
in the United States Department of the Interior by an act of 
Congress, approved May 16, 1910 (36 Stat. L., 369), and was 
transferred to the Department of Commerce by Executive Order in 
1925. Authority for publishing the reports of the Bureau was 
given in a joint resolution approved June 25, 1910 (30 Stat. L., 
883). A new organic act of the Bureau of Mines was signed by 
the President on February 25, 1913 (37 Stat. L., 681). The estab- 
lishment and maintenance of mining-experiment and mine-safety 
stations under the bureau was authorized by an act approved 
March 3, 1915 (40 Stat. L., 969). 296 
NATIONAL GOVERNMENT AND HEALTH 
Section 2 of the Act of 1913 provides as follows: 
That it shall be the province and duty of the Bureau of Mines, 
subject to the approval of the Secretary of the Interior, to con- 
duct inquiries and scientific and technologic investigations concern- 
ing mining, and the preparation, treatment, and utilization of 
mineral substances with a view to improving health conditions and 
increasing safety, efficiency, economic development, and conserv- 
ing resources through the prevention of waste in the mining, 
quarrying, metallurgical, and other mineral industries; to inquire 
into the economic conditions affecting these industries; to investi- 
gate explosives and peat; and on behalf of the Government to 
investigate the mineral fuels and unfinished mineral products 
belonging to, or for the use of, the United States, with a view to 
their most efficient mining, preparation, treatment and use; and to 
disseminate information concerning these subjects in such manner 
as will best carry out the purposes of this act. 
History and Development. The precursor of the present 
Bureau of Mines was the Technologic Branch of the Geological 
Survey which was established by an order of the Secretary of the 
Interior, April 2, 1907, for the purpose of testing fuels and struc- 
tural materials. Such work had been started in 1904 under the 
supervision of the Geological Survey. In May, 1908, Congress 
authorized an investigation (effective July 1, 1908) of the causes 
of mine explosions, and this work was assigned to the Technologic 
Branch. An old arsenal at Pittsburgh was used as an experiment 
station. During 1908 and 1909, stations equipped with mine-rescue 
and first-aid apparatus were established at Urbana, Knoxville, 
and Seattle. 
The high mortality among miners, the necessity for intensive 
effort to prevent needless deaths, and the widespread demand for 
a separate government bureau to cope with these problems, re- 
sulted in 1910 in the formation of the Bureau of Mines. The 
investigation of structural materials was transferred to the Bureau 
of Standards of the Department of Commerce and Labor and the 
new Bureau of Mines was charged with increasing health, safety, 
economy, and efficiency in the mining, quarrying, metallurgical, 
and miscellaneous mineral industries of the country. 
The bureau began operations on July 1, 1910. Its first work 
consisted in a continuance, with renewed vigor, of investigations DEPARTMENT OF COMMERCE 
297 
of accidents in mines. Seven mine-safety cars were operated 
for this purpose and for rescue work. A compilation of mine- 
safety laws was begun. The fuel investigations were also carried 
on. In 1911, in cooperation with the Public Health Service, a 
study was begun of certain miners' diseases, especially tuber- 
culosis (miners' phthisis) and hookworm. In that year the first 
national mine safety demonstration was held at Pittsburgh on 
October 30, 1911.8 
In the second year of its existence the bureau was organized 
into five divisions. The Administrative and Miscellaneous Minerals 
divisions had headquarters in Washington, while the Mining, 
Mechanical, and Chemical divisions were located at Pittsburgh. 
The scope of the bureau was considerably broadened in 1913 when 
the new organic act, part of which is quoted above, went into effect. 
Cooperation with the states was inaugurated with the assignment 
of a mining engineer for full-time inspection work in California. 
In addition to much rescue and first-aid work, investigations of 
metal mine ventilation and studies of the injurious physiological 
effects of rock dust were commenced.4 A sanitary engineer of the 
bureau visited mining communities, made investigations, and 
delivered lectures. Pamphlets on health subjects were prepared.6 
The work on fuel and metallurgical matters was also continued 
An important study of pulmonary diseases in the Joplin, Mis- 
souri, district was begun in 1914, and continued for several years 
with the aid of an officer of the Public Health Service.8 The 
bureau had now five technical divisions: Mining, Metallurgy, 
Mineral-Technology, Fuels (and Mechanical Equipment), and 
Petroleum and Natural Gas. The Mining Division, in addition 
to a staff of mining engineers, included a Safety Commissioner, a 
Mine Surgeon, and a Sanitary Engineer. Among other accomplish- 
ments of that year may be mentioned the production of radium at 
a cost of one-third of that by previous commercial methods. Forty- 
3 See Bureau of Mines, Bulletin 44, for complete description. 
4 Bulletin 132. 
5 Houses for mining towns, by J. H. White, Bulletin 87; Miners' wash 
and change houses, by J. H. White, Technical Paper 116. 
6 Pulmonary Disease in the Joplin District, Mo., and its relation to rock 
dust in the mines, by A. J. Lanza and Edward Higgins, Technical Paper 
105. 298 
NATIONAL GOVERNMENT AND HEALTH 
seven mine-rescue and first-aid contests were held at different 
places. An improved type of breathing apparatus was developed, 
and a committee of consulting engineers issued a comprehensive 
report on prevention of accidents. 
When this country entered the World War, in 1917, the activi- 
ties of the bureau were concentrated as far as possible on military 
problems. Investigations of gas and gas masks formed an impor- 
tant part of this activity, and much work on minerals was carried 
on. In addition a study of pulmonary disease in the Butte, Mon- 
tana, district was made.7 Several new experiment stations were 
opened in 1917 and 1918. In the latter year surgeons attached to 
mine-rescue cars inspected many mines for sanitary conditions. 
Extensive studies of the effects of exhaust gases from gasoline 
engines in tunnels and mines have been made during the past 
two years. These studies set forth the physiological principles 
applicable to ventilation of any mine, tunnel, chamber, fire room, 
or other space in which the air is contaminated with carbon mon- 
oxide and, particularly, the application of these principles to 
tunnels for motor vehicles. 
The early investigations pertaining to health were made by the 
personnel of the Bureau of Mines, but later congressional authority 
was granted to obtain surgeons from the Public Health Service. 
This developed into a close cooperation between the two services 
for the study and recommendation of all matters pertaining to 
health in and around mines and the mineral industries. The rela- 
tionship led to the establishment of the office of Chief Surgeon 
in the bureau, with headquarters in Washington. The medical 
personnel now consists of the Chief Surgeon and six surgeons, 
detailed from the Public Health Service. 
During recent years as the bureau has been enlarged, it has 
increased its technical investigations, and its safety and health 
activities have also increased in technical aspects as well as in 
service. Work being done under the direction of the Chief Surgeon 
is as follows: sanitary surveys of mining camps of various states, 
as Illinois, Kentucky, California, Utah, Alabama, New Mexico, 
7 Miners' consumption in the mines of Butte, Montana, by Daniel Har- 
rington and A. J. Lanza, Technical Paper 260. DEPARTMENT OF COMMERCE 
299 
and Arizona; studies of carbon monoxide poisoning;8 physiological 
effects of high temperatures, humidities, and other ventilation con- 
ditions ; ' lead poisoning in mines in Utah; lead poisoning from the 
use of ethyl gasoline in gasoline-burning engines;10 surveys of 
medical organizations and sanitary facilities;11 standardization of 
first-aid methods for the mining and allied industries; safety and 
health campaigns; caisson disease, and the use of synthetic atmos- 
pheres 12 in its prevention; and hydrogen sulphide poisoning.13 
Since its organization, the bureau has trained about 115,000 
miners in first-aid and rescue work. 
Effective July I, 1925, the bureau, except for its oil-leasing and 
mineral leasing activities, was transferred to the Department of 
Commerce, by Executive Order, dated June 4, 1925. 
8 Physiological effects of exposure to low concentrations of carbon mo- 
noxide, by R. R. Sayers, F. V. Meriwether, and W. P. Yant. Public Health 
Reports, May 12, 1922, pp. 1127-1142, Reprint No. 748. 
The elimination of carbon monoxide from blood, by treatment with air, 
with oxygen, and with a mixture of carbon dioxide and oxygen, by R. R. 
Sayers and W. P. Yant. Public Health Reports, September 7, 1923, pp. 
2o53-74, Reprint No. 865. 
The pyro-tannic acid method for the quantitative determination of car- 
bon monoxide in blood and air, by R. R. Sayers, W. P. Yant, and G. W. 
Jones. Public Health Reports, October 5, 1923, pp. 2311-2320, Reprint 
No. 872. 
9 Physiological effects of high temperatures and humidities with and 
without air movement, by R. R. Sayers and D. Harrington. Public Health 
Reports, July 20, 1923, pp. 1616-1637, Reprint No. 854. 
Effective temperatures for still air conditions and their application to 
mining, by F. C. Houghton, C. P. Yagloglou, and R. R. Sayers. Bureau 
of Mines, Reports of Investigations, Serial 2563, January, 1924. 10 pp. 
Some effects on man of high temperatures, by W. J. McConnell and R. R. 
Sayers. Bureau of Mines, Reports of Investigations. Serial 2584, March, 
1924. 13 pp. 
10 Exhaust gases from engines using ethyl gasoline, by R. R. Sayers, A. C. 
Fieldner, B. G. H. Thomas, and W. J. McConnell. Bureau of Mines, Re- 
ports of Investigations, Serial 2661, December, 1924. 24 pp. 
11 Change houses in the Lake Superior Region, by Cleve E. Kindall, 
Bureau of Mines, Technical Paper 289, 1923. 31 pp. 
12 Possibilities in the use of helium-oxygen mixtures as a mitigation of 
caisson disease, by R. R. Sayers, W. P. Yant, and J. H. Hildebrand. Bureau 
of Mines, Reports of Investigations, Serial 2670, February, 1925. 
13 Investigation of toxic gases from Mexican and other high-sulphur 
petroleums and products, by R. R. Sayers, A. C. Fieldner, N. A. C. Smith, 
et al., Bureau of Mines, Bulletin 231, 1924. 108 pp. 300 
NATIONAL GOVERNMENT AND HEALTH 
The bureau works in active cooperation with the War and Navy 
departments, the Bureau of Standards, and other branches of the 
government. The cooperation with the Public Health Service has 
already been described. It also works with numerous state and 
private organizations, such as the First Aid division of the 
American Red Cross, the National Radium Institute, National 
Research Council, and many universities. 
Organization and Personnel. The Bureau of Mines, as now 
organized, includes twelve Divisions, as follows: 
Fuels Division 
Petroleum Division 
Division of Mining Experiment Stations 
Division of Metallurgy- 
Division of Mineral Technology 
Mining Research Division 
Safety Service 
Chief Surgeon 
Chief Explosives Chemist 
Division of Office Administration 
Information Service 
There are now twenty-one mine-safety stations, eleven of which 
are movable cars. The headquarters for these activities is Pitts- 
burgh, Pennsylvania. 
The present Director of the Bureau is Scott Turner, appointed 
in 1925 to succeed H. Foster Bain, who was appointed on January 
1, 1921, succeeding F. G. Cottrell, who had served from June 7, 
1920, up to that time. The first Director of the Bureau was 
Dr. Joseph A. Holmes, appointed July 1, 1910, after previously 
having had charge of the work under the Geological Survey. On 
his death, on July 3, 1915, he was succeeded by Van H. Manning, 
who resigned on June 7, 1920. 
The present Chief Surgeon is Dr. R. R. Sayers, who was detailed 
to the Bureau of Mines by the Public Health Service on February 
4, 1920, and has served since that date. The Safety Service Direc- 
tor is T. T. Read. DEPARTMENT OF COMMERCE 
301 
The personnel of the Bureau is shown by year below: 
1911 298 
1912 304 
1913 39i 
1914 426 
1915 4i8 
1916 430 
1917 550 
1918 648 
1919 785 
1920 738 
1921 772 
1922 667 
1923 7°9 
1924 767 
Of the number employed in 1925, one hundred were concerned 
directly and three hundred indirectly with health and safety work. 
Some of the personnel detailed from other departments or 
from cooperating agencies are also employed upon health and 
safety work. 
Publications. The publications of the Bureau consist of Bul- 
letins, Technical Papers, Miners' Circulars, and various miscel- 
laneous types of pamphlets. Most of the twenty-seven Miners' 
Circulars are on the subject of accident prevention or health con- 
servation, and many of the bulletins and technical papers also 
deal with these subjects. In addition to the references given in this 
report, the following selected pamphlets of the bureau may be 
mentioned: 
Bulletin 132. Siliceous dust in relation to pulmonary disease among 
miners in the Joplin District, Missouri. By Edwin Higgins, 
A. J. Lanza, F. B. Laney, and George S. Rice. 
Bulletin 139. Control of hookworm infection at the deep gold mines 
of the Mother Lode, California. By J. G. Cumming and J. H. 
White. 
Bulletin 204. Underground ventilation at Butte. By D. Harrington. 
Bulletin 225. Stone dusting or rock dusting to prevent coal-dust 
explosions, as practiced'in Great Britain and France. By G. S. 
Rice. 
Technical Paper 260. Miners' consumption in the mines of Butte, 
Montana. By D. Flarrington and A. J. Lanza. 
Technical Paper 285. Compressed-air illness and its engineering 
importance. By E. Levy. 
Technical Paper 324. The sanitation of oil-shale camps. By A. L. 
Murray. 
Technical Paper 372. Silicosis among miners. By R. R. Sayers. 
Technical Paper 375. Safety and Health in the Mines of Butte, 
Montana. By G. S. Rice and R. R. Sayers (in Press). 
Miners' Circular 20. How a miner can avoid some dangerous 
diseases. By A. J. Lanza and J. H. White. 302 
NATIONAL GOVERNMENT AND HEALTH 
Miners' Circular 28. Sanitation in mines. By R. R. Sayers. 
Manual of First Aid Instruction for Miners (Revised). By R. R. 
Sayers. 
Appropriations. Appropriations for all purposes of the Bu- 
reau have been as follows: 
1911 $ 502,200 
1912 475,500 
1913 585,100 
1914 662,293 
1915 730,500 
1916 757,300 
1917 981,060 
1918 1,467,070 
1919 $3,245,285 
1920 1,216,897 
1921 1,362,642 
1922 1,439,300 
1923 1,580,900 
1924 1,900,468 
1925 1,900,468 
1926 1,971,560 
About $50,000 is spent on health work and about $400,000 is 
spent on health and safety work combined. 
The Bureau of Fisheries. The Bureau of Fisheries of the 
Department of Commerce is concerned chiefly with the economic 
aspects of fisheries, though some of its activities have an indirect 
bearing on public health. The functions of the Bureau comprise: 
(1) The propagation of useful food fishes and their distribution 
to suitable waters; (2) inquiry into causes of decrease of food 
fishes in lakes, rivers, and coastal waters, studies of fish culture, 
and determination of food resources; (3) investigations of meth- 
ods of fisheries and the preservation and utilization of fisheries 
products ; (4) administration of the salmon fisheries in Alaska, the 
fur-seal herd on the Pribilof Islands, and the care of the natives of 
those islands; and (5) administration, of the law for the protec- 
tion of the sponges off the coast of Florida, in cooperation with the 
Coast Guard. 
The total appropriation to the Bureau for the fiscal year 1925 was 
$i,3i9,335- Of this sum, $386,250 was for the propagation of food 
fishes, $38,170' for an inquiry respecting food fishes, and $10,000 
for a reserve supply of food, medicines and clothing for the people 
of the Pribilof Islands. 
The importance of fish in human nutrition is indicated by the 
following quotation from a recent report of the Secretary of Com- 
merce : 14 " Marine foods have certain health properties of impor- 
14 Secretary of Commerce, 1924, p. 159, Annual Report. DEPARTMENT OF COMMERCE 
303 
tance and interest to the dietitian and the general public when 
accurately determined and adequately understood. For example, 
investigations conducted in the fishery products laboratory of the 
Bureau have proven that sea foods are unusually rich in iodine, 
some shellfish having two hundred times as much iodine and most 
marine fish fifty times as much iodine as ordinary foods. Marine 
animals and the oils of fish have certain constituents, such as vita- 
mins, which are of unusual advantage in promoting good health. 
For example, cod-liver oil contains an abundance of the anti- 
rachitic vitamin and oysters of the antiscurvy vitamin. The Bu- 
reau is cooperating with investigators in examining these questions 
more closely." 
Many investigations of oysters 15 and other shellfish have been 
made, including studies of their pollution. The digestibility of fish 
has been investigated, in cooperation with the Office (now Bureau) 
of Home Economics of the Department of Agriculture,18 and 
various bulletins have been issued by the Bureau of Fisheries on 
fish as food.17 
Experiments on the use of fish in the control of mosquitoes 
have been conducted by the bureau for several years at Augusta, 
Georgia, in cooperation with the Public Health Service and the 
local board of health.18 
Fisheries activities by the National Government date from 1871, 
when a Fish commission was created by a joint resolution of Con- 
gress. The supervision of Alaskan fisheries had been conferred 
upon the Secretary of the Treasury in 1868. In 1903 the Fish 
Commission was transferred to the Department of Commerce 
15 See Oysters, a little of their history and how to cook them. By H. F. 
Moore. Economic Circular 18. Revised 1918. 
" Experiments on the digestibility of fish. By A. D. Holmes. Department 
of Agriculture, Bulletin 649 (1918). 
17 See Selected list of government publications on food and nutrition. 
Bureau of Home Economics (1925). 
See especially: Oysters, an important food. By Lewis Radcliffe. Eco- 
nomic Circular 58 (1925). 
18 Use of fishes for control of mosquitoes in Northern fresh waters of 
the United States. By J. Percy Moore. 62 pp. Doc. 923 (1922). 
Fishes in relation to mosquito control in ponds. By Samuel F. Hilde- 
brand. Doc. 874 (1918). 
Fishes destructive to eggs and larvae of mosquitoes. By Lewis Radcliffe. 
Economic Circular 17 (1915). 304 
NATIONAL GOVERNMENT AND HEALTH 
and Labor, where it became a bureau. The work of the Alaskan 
Fisheries Division also was taken over into this new department 
in 1903, and in 1905 its duties were assumed by the Bureau of 
Fisheries. 
The Bureau of Standards.19 The Bureau of Standards of the 
Department of Commerce may be characterized as the great physi- 
cal, chemical, mechanical, metallurgical, and general laboratory 
of the government. Its functions, in the words of its Director, 
" comprise the development, construction, custody, and mainte- 
nance of reference and working standards, and their inter-com- 
parison, improvement, and application in science, engineering, in- 
dustry, and commerce." Among the vast and varied activities of 
the bureau are several which have some bearing on the public 
health. They represent, of course, only a very small fraction of 
the total work of this Bureau, which was established only twenty- 
five years ago (in 1901), but has grown so rapidly in scope and 
function that it is to-day one of the most important branches 
of the government. 
Current Activities. For over ten years the Bureau has been 
concerned with problems of accident prevention. " It is endeavor- 
ing to promote safe, efficient, and economical practice in the opera- 
tion of utility companies, and reasonable uniformity in the tech- 
nical requirements of state and local commissions which control 
such companies. This work, which has very greatly expanded 
since its beginning, consists of the preparation and revision of 
safety standards; study of technical problems in traffic control; 
investigation of accidents and of conditions and practices in in- 
dustry; and preparation of publications bearing on the application 
of safety standards." 20 
The bureau has assisted and, in fact, been responsible for the 
preparation of a number of standard safety codes. These codes 
are presented to the American Engineering Standards Committee, 
through the Safety Code Correlating Committee, upon which the 
bureau is represented. The bureau has sponsored the following: 
electrical safety code; gas safety code (with American Gas Asso- 
10 Weber, The Bureau of Standards. Institute for Government Research, 
Service Monograph No. 35 (1925). 
w Ibid., p. in. DEPARTMENT OF COMMERCE 
305 
ciation) ; code for the protection of the heads and eyes of industrial 
workers; combined electrical fire and safety code; code for pro- 
tection against lightning (with American Institute of Electrical 
Engineers) ; safety code for logging and sawmill operations ; safety 
code for aeronautics (with the Society of Automotive Engineers) ; 
code for the colors of traffic signals (with National Safety Coun- 
cil) ; and safety code for elevators (with American Society of 
Mechanical Engineers and American Institute of Architects). 
The Bureau of Labor Statistics of the Department of Labor has 
also been concerned with certain other safety codes under similar 
auspices,21 while the Public Health Service was in 1925 working 
on an industrial hygiene code for presentation to the American 
Engineering Standards Committee. 
In the field of radiometry, the bureau has made an investigation 
for the Public Health Service on the radiation characteristics of 
quartz mercury vapor lamps used for therapeutic purposes; it has 
also cooperated with the research department of the Public Health 
Service in determining the kind and extent of the effects of the 
radiation from radioactive materials on members of the staff of 
the Bureau who handle them. Studies on the X-ray have likewise 
been made. 
In connection with its Building and Housing Service, the bu- 
reau has had a committee at work on a standard plumbing code. 
This committee, comprised of sanitary engineers and plumbing 
experts, issued a comprehensive report in 1924.22 A zoning com- 
mittee formulated in 1923 a standard state zoning enabling act. 
Organization. The Bureau of Standards has a personnel of 
over seven hundred persons, who are employed in fourteen divi- 
sions, organized into sixty-six sections. The annual appropria- 
tions are now nearly two million dollars. In 1925 the sum was 
$1,775,760. 
The Patent Office.23 The administration of the Federal laws 
dealing with patents, trademarks, prints, and labels is entrusted 
21 See page 263. 
22 Recommended minimum requirements for plumbing in dwellings and 
similar buildings. Bureau of Standards. 1924. 
23 See Weber, The Patent Office. Institute for Government Research, 
Service Monograph No. 31 (1924). 306 
NATIONAL GOVERNMENT AND HEALTH 
to the Commissioner of Patents, who is chief executive of the 
Patent Office of the Department of Commerce, to which it was 
transferred from the Department of the Interior by Executive 
Order in 1925. The only way in which the Patent Office touches 
upon the subject of public health is in its issuance of patents or 
trademarks for drugs, chemicals, and other preparations used as 
medicines, cosmetics, or for similar purposes. This, however, 
has been in the past, and still is, a matter of some importance. 
The Constitution mentions the granting of patents as one of the 
functions of the national government. Soon after the First 
Congress assembled, a bill to enact a patent law was introduced, 
and an act to this effect was finally passed on April 10, 1790 
(1 Stat. L., 109). Since that time numerous other laws on the 
subject have been enacted. Patent laws were administered by 
the Secretary of State until 1836, when a separate Patent Office 
was created within the State Department. It was transferred to 
the Department of the Interior in 1849, when that Department 
was created, and in 1925, it became a part of the Department of 
Commerce. 
At the present time nearly one hundred thousand applications for 
patents and trademarks are received annually. In 1923, 56,021 
patents and registrations were granted. The business of the Patent 
Office is further augmented by litigated cases and miscellaneous 
transactions, such as supplying copies of records, etc. About a 
million and a half patents have been granted in this country since 
1790. 
The work of examining applications for mechanical patents 
is distributed among forty-nine divisions, each in charge of a 
principal examiner, who is assisted by a corps of assistant ex- 
aminers and clerks. Each division has jurisdiction over a group 
of supposedly related subjects. Those which touch directly or 
indirectly upon the field of public health include the following 
divisions: 
6. Chemicals, dyeing, explosives, paints, plastic compositions. 
20. Closure fasteners, undertaking, artificial body members, 
locks and latches, dentistry. 
31. Industrial chemistry, fuel. 
35. Buckles, buttons, cards, signs, signals, toilet. 
43. Sanitary engineering, surgery, fire extinguishers. DEPARTMENT OF COMMERCE 
307 
Before a patent is issued, it must be proven that: 
i. The alleged invention is in fact new. 
2. It is useful. 
3. It is an invention. 
4. It has not been known or used by others in this country 
before the date of the alleged invention. 
5. The invention has not been abandoned. 
6. It has not been patented or described in any printed publi- 
cation in this or any foreign country before the date of the alleged 
invention or more than two years prior to the date of the domestic 
application. 
7. It has not been in public use or on sale in this country more 
than two years prior to the domestic application. 
8. There is a complete and accurate disclosure of the alleged 
invention and a distinct definition of the subject matter claimed to 
have been invented. 
Patents, except for design, are granted for a term of seventeen 
years. 
In past years many patents have been issued for medicines. The 
patent, of course, is no guarantee of the efficacy of the remedy. 
At present the procedure of manufacturers of medical products 
is usually to register the name as a trade-mark, which is a " dis- 
tinctive word, emblem, symbol, or device, or a combination of 
these, used on goods actually sold in commerce to indicate or 
identify the manufacturers or seller of the goods." Prints and 
labels may also be registered. The Department of Agriculture 
has an arrangement with the Patent Office to the effect that no 
application for registration of a trade-mark for a meat product will 
be favorably acted upon by the Patent Office unless stamped 
" approved " by the Bureau of Animal Industry. There is no 
reason why there should not be a similar arrangement between 
the Patent Office, on the one hand, and the Bureau of Chemistry 
and the Public Health Service, on the other, with respect to 
medical preparations. 
The Commissioner of Patents has established a number of 
classes of merchandise for the purpose of registration. Among 
them are: 
6. Chemicals, medicines, and pharmaceutical preparations. 
44. Dental, medical and surgical appliances. 
46. Foods and ingredients of foods. 308 
NATIONAL GOVERNMENT AND HEALTH 
The Steamboat Inspection Service.24 The Steamboat Inspection 
Service of the Department of Commerce is charged with the duty 
of administering the laws enacted for safeguarding the lives of 
passengers and crews of vessels engaged in marine transportation. 
It inspects hulls, machinery, and equipment of vessels of the 
merchant marine of the United States ; licenses officers and certi- 
fies crews of such vessels; and conducts investigations to ascer- 
tain violations of rules and regulations. These activities date 
from 1838, when the first act (5 Stat. L., 304) for the security 
of passengers was passed, though the Service itself was not or- 
ganized until 1852 (10 Stat. L., 61), when it was attached to the 
Treasury Department. A Supervising Inspector-General was pro- 
vided for in 1871 (16 Stat. L., 440), and in 1903, the Service 
was transferred to the Department of Commerce and Labor (32 
Stat. L., 825). Much other legislation regarding marine safety 
was also passed from time to time. 
Since most of the work of the service is concerned with life and 
safety, it obviously has some bearing on the public health, though 
by no means would this bureau be classed as a health agency. 
Besides inspections to insure general safety, the service, under 
the Seaman's Act of 1915 (38 Stat. L., 1164), sees to it that 
vessels provide suitable sleeping quarters, toilets, washing places, 
and hospital facilities for their crews. It also regulates the trans- 
portation of dangerous articles, such as explosives and acids, on 
vessels. 
The Public Health Service cooperates with the Steamboat In- 
spection Service by making physical examinations of applicants 
for licenses as master, mate, pilot, or engineer, and also conducts 
classes in first-aid for officers and crews of vessels. Sanitary engi- 
neers of the Public Health Service have likewise been active in 
securing pure water supplies for vessels.23 Customs officers are 
charged with inspection of sanitary conditions of vessels entering 
ports with steerage passengers (22 Stat. L., 186, as amended, 
33 Stat. L., 711, and 35 Stat. L., 583), reporting on such conditions 
to the Secretary of Commerce. 
24 See Short, The Steamboat Inspection Service. Institute for Govern- 
ment Research, Service Monograph No. 8 (1922). 
25 See Connelly, J. I., The supplying of drinking water to vessels in the 
United States. Public Health Service, Public Health Reports, May 22, 1925. CHAPTER XII 
THE DEPARTMENTS OF STATE, JUSTICE, AND THE 
POST OFFICE 
Each of the Departments of State, Justice, and the Post Office 
carry on some work which is of indirect importance to national 
vitality. The Consular Service of the State Department has 
certain duties with respect to foreign quarantine, though the con- 
suls are often assisted by officers of the Public Health Service 
detailed for the purpose. The Department of Justice conducts the 
prosecutions for violations of the Pure Food and Drugs Act and 
other Federal laws pertaining to health, while the Superintendent 
of Prisons of this Department is charged with giving proper 
medical care to Federal prisoners. The Post Office Department 
issues fraud orders against deleterious and fraudulent drugs or 
medicines using the mails. The Service Relations Division of this 
Department endeavors to improve the physical welfare of postal 
employees. 
The Consular Service. The Consular officers, under the juris- 
diction of the Department of State, are required to issue bills of 
health to1 vessels clearing for ports in this country, after satis- 
fying themselves that such vessels are in proper sanitary condi- 
tion, and they must also report weekly to the Secretary of the 
Treasury regarding the sanitary conditions of the ports at which 
they are stationed. The first legislation on this subject was the 
act of April 29, 1878 (20 Stat. L., 37), which provided that con- 
sular officers in foreign countries should advise the Supervising 
Surgeon General of the Marine Hospital Service of the preva- 
lence of contagious diseases in any foreign port or the departure 
of any vessel from such a port for the United States. Subsequent 
legislation to the same or similar effect was passed in 1879 (21 
Stat. L., 5) and in 1893 (27 Stat. L., 449), the latter law being 
still in operation. The act of 1893 authorized the President to 
detail medical officers to serve in the office of any consul to assist 
in this work. Accordingly, officers of the Public Health Service 
309 310 
NATIONAL GOVERNMENT AND HEALTH 
have been assigned to about forty foreign ports. Regulations 
governing sanitary conditions of vessels are made under the super- 
vision of the Secretary of the Treasury, and the President is given 
the power to " prohibit, in whole or in part, the introduction of 
persons and property from such countries or places as he shall 
designate and for such period of time as he may deem necessary." 
The inspection of immigrants at foreign ports was actually com- 
menced in 1899, when an assistant surgeon was sent to Naples. 
During the fiscal year 1924, about a half a million passengers were 
inspected in Europe on more than two thousand vessels. The 
medical officers were also called upon by consuls to examine sick 
American seamen, to make physical examinations of war veterans, 
pensioners, and seamen, and to advise the consuls on all medical 
and public health questions. 
The Superintendent of Prisons. The Superintendent of 
Prisons, attached to the Division of Taxation, Prohibition, and 
Prisons of the Department of Justice, has charge of the health and 
medical care of all Federal prisoners. On June 30, 1925, there were 
8518 such prisoners confined in the United States penitentiaries at 
Atlanta, Georgia; Leavenworth, Kansas; McNeill Island, Wash- 
ington ; the National Training School for Boys, the National Train- 
ing School for Girls, and in state institutions other than county 
jails. Physicians, nurses, and dentists are employed at all of these 
institutions. Flospitals are maintained at Leavenworth and Atlanta, 
and construction of a hospital was begun in 1925 at McNeill 
Island. 
The Post Office Department. The Post Office Department is 
charged with the enforcement and administration of the postal 
laws, a duty which since 1775 has been under the supervision of a 
Postmaster General. 
The postal laws prohibit, among other things, the transmission 
through the mails, of poisons, explosives, disease germs, and other 
dangerous articles (35 Stat. L., 1131), except under such rules 
and regulations as may be made by the Postmaster General. Ob- 
scene matters, articles used for abortion, and contraceptive ma- 
terial and information are also debarred. Fraudulent and spurious 
articles are unmailable; and advertising for such purposes is pro- 
hibited through the mails. STATE, JUSTICE, AND THE POST OFFICE 
311 
These offenses against the postal service include the transmission 
through the mails, of patent medicines and other drugs and prepara- 
tions which are fraudulent or dangerous to health.1 It is some- 
times more practical to deal with such articles under the postal laws 
than under the Pure Food and Drugs Act.2 When evidence is 
collected by inspectors showing that an organization or person is 
using the mails to promote improper medical schemes the Post- 
master General, after a hearing, may issue a fraud order denying 
the use of the mails, or the firm or person responsible may be 
prosecuted under the penal laws. A fraud order is not always 
issued; for an opportunity is sometimes given to the offender to 
discontinue or amend his practices. The Bureau of Chemistry 
makes many analyses for the Post Office Department. 
The Division of Service Relations. The Division of Service 
Relations endeavors, through the medium of national, county, 
local, and departmental councils, to improve the working conditions 
of the postal employees and to bring about closer cooperation and 
better understanding among the public, the officers, and the em- 
ployees. One of its objectives is the promotion of measures for 
physical health. 
History and Development. A Welfare Division was organized 
by Postmaster General Hays in June, 1921, and Dr. Lee K. Frankel 
was appointed as Director, without salary. A national council, 
consisting of two representatives of each of the ten postal em- 
ployees' organizations, was immediately formed and has held 
monthly meetings ever since. A departmental council was also cre- 
ated and a plan of constitution for local councils was adopted in 
October, 1921, and one for county councils, in May, 1922. The 
plan of constitution was slightly changed in April, 1923. 
A survey of post office buildings in Washington, D. C., was made 
in 1921, and the Director also made a personal inspection of the 
larger post offices throughout the country. A questionnaire, con- 
taining more than two hundred questions relating to working 
conditions, was sent to all first and second-class post offices, and 
the information was tabulated in December of 1921 and thereafter. 
This study indicated nearly six thousand complaints of conditions 
1 See Kebler, L. F., Public health conserved through postal laws, Ameri- 
can Journal of Public Health, August, 1922. 
2 See page 190. 312 
NATIONAL GOVERNMENT AND HEALTFI 
in about 3500 buildings, nearly one thousand of which were owned 
by the United States and the remainder leased. More than two 
thirds of these cases have now been remedied, according to the 
Division. 
Physical examinations of one hundred employees were made 
by the Life Extension Institute in 1921, and in the following year 
the Public Health Service made examinations of one thousand 
employees in the New York and Chicago offices. Since 1923 the 
Public Health Service, and since January, 1925, other Federal agen- 
cies, have offered such physical examinations at seventy-eight 
stations throughout the Service. To September 30, 1925, 8267 
postal employees had availed themselves of the privilege, which 
is entirely voluntary. Free vaccination against smallpox, typhoid 
fever, and para-typhoid is also extended at all their stations by 
the Public Health Service. 
The Public Health Service has further cooperated with the divi- 
sion by making an intensive survey of lighting and illumination 
in the post office in New York City and also at the City Hall 
Station,3 and in testing the eyes of 2500 persons. The information 
contained in this survey was to serve as a basis for new lighting 
and for correcting the lighting systems in the different post office 
buildings throughout the country, in so far as appropriations would 
permit. A summary of the survey report was published in pam- 
phlet form and forwarded, with a letter from the Postmaster 
General, to all first, second, and third-class post offices, and to all 
post office inspectors. As a consequence of the findings of this 
investigation and the recommendations contained in the report, 
and of further studies made by lighting experts of the Post Office 
Department, Treasury Department, and the Public Health Service, 
the most modern standard of lighting affecting post office work 
was adopted, and is now being stipulated by the Department 
when new leases are executed. The Treasury Department is instal- 
ling modern lighting in new construction work and where additions 
and alterations are being made. 
First-aid instructions have been prepared in pamphlet form by 
the Public Health Service and made available to all postal em- 
ployees. First-aid kits have been furnished all post offices, stations, 
3 Studies in illumination. Public Health Service, Public Health Bulle- 
tin No. 140. STATE, JUSTICE, AND THE POST OFFICE 
313 
and terminals having twenty-five or more employees. Large chests 
were sent to 115 of the largest offices, and a complete unit was sent 
to 1800 smaller offices. These kits are replenished as needed. The 
kits, chests, and supplies for replenishment were obtained from the 
surplus war material, without expense to the Department. There 
was available in 1925, sufficient stock, with a few exceptions, for 
two years' replenishment. 
At the suggestion of the Postmaster General, the Public Health 
Service placed a dispensary in the main post office in New York 
City, and located its principal dispensary in Washington in the 
Post Office Department building. 
Dr. Frankel was succeeded as Director by Mr. Henry S. Denni- 
son, whose appointment was announced on April 1, 1922. The 
name of the Division was changed from " Welfare " to Service 
Relations on January 1, 1923. 
Current Activities. In its efforts to improve the health, comfort, 
and working conditions of postal employees, the Service Relations 
Division engages in many activities. Much of the work is educa- 
tional, and bulletin letters are sent out to be posted conspicuously. 
To the local councils they have been sent monthly since 1923, while 
to county service councils quarterly since 1924. 
Among the accomplishments and current activities of the divi- 
sion and through the councils may be cited: the betterment of 
" swing room " conditions, the movement for rest rooms for 
women, which the Department has provided in most of the larger 
post offices ; cooperation with postal officers in proper mailing, mail- 
early campaigns, and other improvements in postal service. 
The need of rest bars for distributing clerks, who stand four or 
more hours a day, was studied and considered. Under the direc- 
tion of the First Assistant Postmaster General, investigations and 
tests were made in ten of the larger offices to determine the advan- 
tages and disadvantages and the best general type. Based on these 
tests the First Assistant Postmaster General decided to initiate 
an improved program, and a standard type was adopted for leased 
buildings and the same standard was recommended to the Trea- 
sury Department for adoption for use in Federal buildings. Such 
bars under certain regulations have been installed in leased build- 
ings and in most of the Federal buildings, and further installations 314 
NATIONAL GOVERNMENT AND HEALTH 
are being made when needs are brought to the attention of the De- 
partment, in so far as appropriations will permit. 
In cooperation with the National Association of Letter Carriers, 
a large shoe manufacturer was interested in constructing a shoe 
specially adapted to the needs of the letter carriers. This shoe 
was approved by the Public Health Service as to shape, fit, and 
comfort; by the Bureau of Standards as to quality of material; 
and by the National Boot and Shoe Manufacturers Association as 
to workmanship, and can now be secured at a reasonable cost. 
Among other activities may be mentioned: a study of the dust 
hazards in handling quantities of mail bags, made with the coopera- 
tion of the Public Health Service; study of a new type of shoulder 
strap for letter carriers; survey of congestion in work rooms of 
post offices ; study of carbon monoxide poison in post office garages, 
again with the cooperation of the Public Llealth Service; promotion 
of cooperative cafeterias; and various activities concerned with 
the improvement of the economic conditions of employees. 
Organisation. The Service Relations Division consists of a 
part-time Director, a full-time associate, an assistant, and a clerk. 
The division comes under the direct supervision of the Postmaster 
General. 
In addition to the national service relations council, and the De- 
partmental council, the latter representing the 2600 postal employees 
in the departmental service in Washington, there are 807 active 
local councils and 330 active county councils. These various coun- 
cils represent approximately 150,000 employees. CHAPTER XIII 
THE DEPARTMENTS OF WAR AND THE NAVY 
The Army and Navy each has its medical establishment, which is, 
of course, concerned primarily with caring for the health of its 
own personnel, or of providing soldiers and sailors with medical 
relief when necessary. Although such services are of special scope, 
and naturally would not be considered as elements in any plan for 
correlation of federal health agencies, a description of each is 
desirable. Much of the work of these medical agencies has a dis- 
tinct influence on civilian health. 
Besides its operations through the medical establishment, the 
War Department does certain other work of interest to public 
health. The Chemical Warfare Service, for instance, has studied 
the possibility of utilizing chlorine in the cure or alleviation of 
respiratory diseases-investigations which have been made by an 
officer detailed from the Medical Department. 
The Secretary of War, who has jurisdiction over navigable 
waters of the United States, is charged with the enforcement of the 
Oil Pollution Act of 1924 (43 Stat. L., 604), which prohibits pol- 
lution by oil of the coastal navigation of the United States. The 
Secretary also controls the withdrawal of water from navigable 
streams or lakes for purposes of sewage disposal or water supply. 
This right was emphasized in a recent decision of the United States 
Supreme Court in which the Sanitary District of Chicago was 
enjoined from using more water from the Great Lakes than the 
Secretary would permit.1 These duties are usually exercised 
through the Chief of Engineers.2 
The Quartermaster General has charge of the construction of 
water supplies and waste disposal systems for military use. 
1 Sanitary District of Chicago vs. U. S., 266 U. S. 405 (1925). 
2 See Holt, The Office of Chief of Engineers. Institute for Government 
Research, Service Monograph No. 27 (1923). 
315 316 
NATIONAL GOVERNMENT AND HEALTH 
The Medical Department of the Army. The Medical Depart- 
ment is charged with the prevention of disease and care of the 
health of the United States Army and other persons under military 
control; the making of physical examinations of officers and en- 
listed men; the care and transportation of the sick and wounded; 
the administration of military hospitals ; and the supervision of the 
component organizations, the Medical Corps, the Army Nurse 
Corps, the Veterinary Corps, and the Medical Administrative 
Corps. The Surgeon General is the adviser of the War Department 
upon all medical and sanitary affairs of the Army. 
History and Development. The medical history of the United 
States Army is a subject upon which many volumes could be and, 
in fact, have been written. Five volumes, for instance, are devoted 
to the War of the Rebellion, while fifteen are estimated as necessary 
for the World War. Ten of the latter have already been prepared, 
the work having been progressing steadily since the close of the 
war in 1918. It will require several years yet for it to be completed. 
Naturally, therefore, nothing can be presented here except the 
barest outline of some of the historical aspects of the development 
of administrative features of the Medical Department. 
The establishment of an army hospital was agreed upon as early 
as July 27, 1775, by the Continental Congress. An act of May 28, 
1798 (1 Stat. L., 559), authorized the President to appoint a physi- 
cian general for the Army, though he was never called into service. 
In 1799 Congress passed a law (1 Stat. L., 721) to regulate the 
medical establishment, which provided for a physician general, 
an apothecary general, a purveyor, and other personnel. The office 
of Surgeon General was not created until 1818 (3 Stat. L., 426), 
this law repealing the earlier one, and giving the Medical Depart- 
ment a permanent chief. The office of Apothecary General was 
omitted in 1821 (3 Stat. L., 615), this act also reducing the per- 
sonnel of the entire service. 
The Medical Department served with distinction during the war 
with Mexico from 1846 to 1848. At the beginning of the Civil War 
in 1861, the corps consisted of 115 medical officers, twenty-four of 
whom resigned to join the Confederate cause. During this war 
the medical service cared for more than a million sick, though, of 
course, the size of the corps had been greatly increased. One of the 
notable steps was the establishment in 1862 of the Army Medical DEPARTMENTS OF WAR AND THE NAVY 
317 
Museum, which, together with the Surgeon General's Library, has 
increased' in scope to the present day. 
The Army Medical School was organized in 1893 at Washington, 
D. C. From this school and the office of the Surgeon General, was 
organized in 1898 the famous Yellow Fever Commission. The rest 
of that story is well known in history, as is the narrative of the 
practical application of the scientific facts developed by Walter 
Reed and his associates, in the conquest of yellow fever in Havana 
and Panama under the direction of William C. Gorgas. At the 
outset of the war with Spain, the medical establishment consisted 
of 177 officers and 750 enlisted men. Disease played a conspicuous 
part in this war, and the sanitary experiences were extremely 
instructive. One of the achievements was the epidemiological study 
by Walter Reed, V. C. Vaughan, and E. O. Shakespeare on 
typhoid fever, which demonstrated the modes of infections of this 
disease. Preventive inoculation against typhoid was developed in 
1907 and succeeding years by F. F. Russell, with the result that 
today typhoid in the military establishment is practically extinct. 
A Nurse Corps was created in 1901 (31 Stat. L., 753), a Dental 
Corps in 1901 (31 Stat. L., 752), and the Veterinary Service was 
incorporated in the Medical Department in 1916 (39 Stat. L., 176). 
The World War, in which the United States first participated in 
1917, brought with it a tremendous increase in the duties and scope 
of the Department. More than three and a half million men be- 
tween the ages of 18 and 30 were examined for military service 
by draft boards. The results of these examinations, which were 
summarized in 1920 by officers of the Medical Department, revealed 
a surprisingly large amount of physical deficiency in the male popu- 
lation of the country. 
One of the outstanding events since the war has been the estab- 
lishment and progressive development of the Army Medical Center 
at Washington. This center was created on September 1, 1923, in 
accordance with General Orders No. 33, W. D. In this year, and 
about the same time, the Army Medical School moved to the cen- 
ter and occupied its own home for the first time in its existence. 
Current Activities. The United States Army has an author- 
ized enlisted strength of 125,000, though the actual strength is 
several thousand less. The soldiers are distributed in nine corps 
areas in the United States, and at foreign stations in the Philippines, 318 
NATIONAL GOVERNMENT AND HEALTH 
Hawaii, Panama, Alaska, China, and Porto Rico. In addition there 
are about 12,000 commissioned officers. 
It is the function of the Medical Department to maintain the 
health of these military forces. " This is accomplished by the selec- 
tion and enrolment for military service, through properly con- 
ducted physical examinations, of only those men physically fit for 
the performance of the duties to devolve upon them, by keeping 
such personnel in good physical condition through the application 
of modem principles of preventive medicine, and in furnishing 
those who do become disabled with such aid in the form of evacua- 
tion and hospitalization facilities as will speedily restore them to 
health and fighting efficiency."3 
Organization. At the head of the Medical Department is a 
Surgeon General with the rank of Major General. The present 
incumbent is Major General M. W. Ireland, who succeeded Major 
General W. C. Gorgas in this position. The Surgeon General's 
office at the War Department has the following divisions: Pro- 
fessional Division; Administrative Division; Dental Division; 
Veterinary Division ; Personnel Division; Vital Statistics Division ; 
Finance and Supply Division; Library; and Plans and Training 
Division. For administrative purposes the Army is divided into 
nine corps areas, with headquarters at Boston; Governor's Island, 
N. Y.; Baltimore; Washington; Atlanta; Fort Hayes, Ohio; 
Chicago; Omaha; Fort Sam Houston; and the Presidio at San 
Francisco. At each of these headquarters a corps area surgeon is 
stationed. 
The Army Medical Library, commonly known as the library of 
the Surgeon General's office, is the largest medical library in the 
world, comprising nearly a million books and pamphlets. It is lo- 
cated in the same building as the Army Medical Museum near the 
Smithsonian Institution, and is consulted by many physicians and 
sanitarians not members of the Army. 
In addition to the officers and enlisted men, the Medical Depart- 
ment has over 1600 civilian employees. 
The Medical Corps. The authorized strength of the Medical 
Corps, consisting exclusively of medical officers, is 985, though 
there were about fifty vacancies in 1924. Shortly after a newly 
3 Army regulations, No. 40-5 (1924). DEPARTMENTS OF WAR AND THE NAVY 
319 
appointed officer in the Corps receives his commission, he is sent to 
the Army Medical School at Washington, and to the Medical 
Field Service School at Carlisle, Pennsylvania, for special training. 
The subjects taught at these schools are bacteriology, pathology, 
hygiene and preventive medicine, Medical Department administra- 
tion, military surgery, clinical medicine, sanitary chemistry, 
ophthalmology, roentgenology, sanitary tactics, tropical medicine, 
psychiatry, military law, and equitation.4 
The duties of a medical officer are: (i) Professional, those 
incidental to the practice of medicine including the making of physi- 
cal examinations; (2) advisory, those pertaining to a medical offi- 
cer as a staff officer; and (3) administrative, those pertaining to a 
commander of Medical Department personnel and establishments 
and the patients therein. A medical staff officer is normally assigned 
to each command larger than a company. A medical officer who 
has had special training in the School of Aviation Medicine and is 
properly qualified, is known as a flight surgeon and is assigned to 
the air service. This school was recognized by the War Depart- 
ment as a special service school in 1921. 
The Dental Corps. The authorized strength of the Dental Corps 
is 158 officers, being in the relation of one to one thousand total 
strength of the Army, a ratio which is considered inadequate. An 
Army Dental School has been maintained since. 1921, and is now 
located at the Army Medical Center in Washington. 
The Army Nurse Corps. The strength of the Army Nurse Corps 
on June 30, 1924, included 468 regular and 207 reserves. The 
nurses rank as commissioned officers. An Army School of Nursing 
was created in 1918 and now forms part of the Army Medical 
Center. 
The Veterinary Corps. The authorized commissioned personnel 
of the Veterinary Corps is 126. This Corps also has a school of 
instruction, known as the Army Veterinary School, which was 
moved from Chicago to Washington in 1923, and forms part of 
the Army Medical Center. The Corps not only has charge of the 
health of animals, but it is also responsible for meat and dairy 
hygiene. 
4 See Circular of Information for Appointment, Form 132 (1925), Sur 
geon General's Office. 320 
NATIONAL GOVERNMENT AND HEALTH 
Enlisted Personnel. There are nearly seven thousand enlisted 
men in the Medical Department, holding grades from private to 
master sergeant. 
Reserves. The number of officers in the Medical Reserve Corps 
in 1924 was 7459. In addition, there were 3055 dentists, 865 veteri- 
narians, 416 officers in the Sanitary Reserve Corps, and 880 in the 
Medical Administrative Reserve Corps. Reserve officers training 
corps units are in operation at twenty-four medical, eight dental, 
and four veterinary institutions. 
Medical Administrative Corps. The Medical Administrative 
Corps, with an authorized strength of seventy-two officers, is made 
up of non-medical personnel, who are assigned to various admin- 
istrative duties. 
The National Guard. The National Guard of the various states 
has a federal status by virtue of official recognition from the gov- 
ernment. In 1924 there were 950 commissioned medical officers in 
the National Guard, and 8459 enlisted men. 
Hospitals. The number of patients admitted to army hospitals 
during 1924, was 84,976, including 6324 beneficiaries of the Vet- 
erans' Bureau.6 General hospitals are maintained as follows: 
Walter Reed, Washington; Letterman, Presidio, San Francisco; 
Fitzsimmons, Denver; Army and Navy General, Hot Springs, 
Arkansas; William Beaumont, El Paso; Sternberg, Manila; and 
Tripier, Hawaii. There are also 108 station hospitals throughout 
the country and six in the Insular possessions. 
Appropriations. The annual appropriation to the Medical De- 
partment is nearly a million and a half dollars. For 1925, 
$1,272,914 was appropriated, though the sum estimated for 1926 
was somewhat greater. 
The Bureau of Medicine and Surgery of the Navy. The Bu- 
reau of Medicine and Surgery of the Navy has charge of all matters 
pertaining to the health of the personnel of the United States Navy. 
The Navy consists not only of ships, but of navy yards, training 
stations, and hospitals, and the Department of the Navy acts as the 
governing agent for certain of the island possessions, such as Guam, 
Samoa, and the Virgin Islands. The Bureau of Medicine and Sur- 
gery has charge of the upkeep and operation of all hospitals; 
B Surgeon General, Annual Report, 1924, p. 14. DEPARTMENTS OF WAR AND THE NAVY 
321 
advises with respect to all matters of hygiene and sanitation ; makes 
physical examinations of officers and enlisted men; has jurisdiction 
over all the personnel of the Medical Corps, Dental Corps, Hos- 
pital Corps, and Nurse Corps ; and cares for the sick and wounded 
in time of battle. 
History and Development. To outline in detail the medical 
history of the Navy would obviously require much space, and only 
certain significant events will be mentioned. As early as 1799 
Congress passed a law extending relief for sick and disabled sea- 
men of the Navy (i Stat. L., 729). Naval hospitals were placed 
under the supervision of a board of commissioners in 1811 (2 Stat. 
L., 650), but transferred to the Secretary of the Navy in 1832 (4 
Stat. L., 572). An act for the better organization of the medical 
department of the Navy, passed in 1828 (4 Stat. L., 313), author- 
ized the appointment of assistant surgeons, although the Bureau 
of Medicine and Surgery itself was not created until 1842 (5 Stat. 
L., 579). Various other laws relating to the medical service of 
the Navy have been passed since that time.8 The Hospital Corps 
was established in 1898 (30 Stat. L., 474), the Nurse Corps in 
1908 (35 Stat. L., 146), and the Dental Corps in 1912 (37 Stat. L., 
903). The Naval Medical School was organized by General Order 
No. 89 of the Navy Department in 1902. 
Current Activities. The average daily strength of the Navy 
is somewhat over 116,000, including commissioned officers, war- 
rant officers, enlisted men, midshipmen, and nurses. Of this number 
about 19,500 make up the Marine Corps. The average daily num- 
ber on the sick list for the entire Navy is about four thousand. The 
force afloat, or the United States Fleet, with a strength of about 
sixty thousand, consists of the Battle Fleet in the Pacific, the Scout- 
ing Fleet in the Atlantic, the Asiatic Fleet, the naval forces in Eu- 
rope, the special-service squadron, the naval transportation service, 
and ships on special duty. A modern battleship, with a complement 
of over one thousand officers and men, is a community in itself, 
presenting health problems involving sanitation, hygiene, disease 
control, food, ventilation, and many other matters. 
The Bureau of Medicine and Surgery is charged with inspecting 
the sanitary condition of the Navy and making recommendations 
8 See Manual of the Medical Department of the United States Navy. 322 
NATIONAL GOVERNMENT AND HEALTH 
concerning it; with advising the Department and other bureaus 
with reference to the sanitary features of ships under construc- 
tion and in commission; and with caring for the health of the 
entire personnel. Its jurisdiction in this regard includes the 
ships of war and the shore stations, which comprise navy yards at 
Portsmouth, New Hampshire; Boston; New York; Philadelphia; 
Washington; Norfolk; Charleston; Key West; New Orleans; 
Mare Island, California; and Puget Sound. There are also subma- 
rine bases, naval air stations, marine barracks, and receiving ships 
in different parts of the country, which is divided into thirteen 
naval districts for administrative purposes. 
Various educational courses are given by the bureau to officers 
of the Medical Department and also to the hospital corps. In 1924, 
some four hundred members received instruction, not including 
hospital corpsmen who were trained at various stations. These 
courses have been given chiefly at the Naval Medical School, where 
there are laboratories and other facilities. A Dental School is also 
maintained there. 
The bureau publishes monthly the Naval Medical Bulletin, a 
professional magazine first issued in 1907. Many of the articles are 
of interest to sanitarians as well as to practitioners of medicine. 
No person may be appointed to the navy or marine corps until 
he has passed a rigid physical examination, which is made by offi- 
cers of the Medical Corps.7 In addition, annual physical or health 
examinations are made of officers, nearly nine thousand having 
been examined in January, 1924. Of this number, 1127, or 12.6 per 
cent, were found to have physical defects worth mention in the 
reports. Compared with findings from examinations made in civil 
life, this is a remarkably good record. Physical examinations are 
also given prior to promotions. 
Organization. At the head of the Bureau of Medicine and 
Surgery is a Surgeon General with the rank of Rear Admiral. The 
present incumbent is Dr. E. R. Stitt. 
The Medical Corps. The Medical Corps has an authorized 
strength of 0.65 per cent of the total personnel of the Navy. In 
1925 the number of medical officers averaged 785. Practice of 
medicine in the Navy does not differ materially from practice in 
T See Physical Examinations and Requirements. Reprint of Chapter li 
of the Manual of the Medical Department (1922). DEPARTMENTS OF WAR AND THE NAVY 
323 
civil life,8 except, perhaps, that the Navy medical officer acquires 
more knowledge of preventive medicine than the average practi- 
tioner. Recently the plan has been adopted of accepting qualified 
graduates of Class A medical schools, giving them commissions as 
lieutenant, junior grade, and placing them as internes in the large 
naval hospitals. Thus, they receive pay while serving their interne- 
ship, whereas in civil life interneship carries no remuneration 
with it. After completion of this interneship, or following the 
appointment from civil life of licensed physicians, and after a tour 
of hospital duty, new medical officers receive special instructions at 
the Naval Medical School at Washington. They are then ordered 
to sea duty, or sometimes to a foreign station. After this comes a 
tour of shore duty at one of the naval hospitals. 
Hospitals. The naval hospitals are located at Portsmouth, New 
Hampshire; Boston; Newport; New York; Philadelphia; Wash- 
ington; Annapolis; Norfolk; Charleston; Parris Island, South 
Carolina; Key West; Great Lakes, Illinois; St. Thomas, Virgin 
Islands ; San Diego, California; Mare Island, California; Bremer- 
ton, Washington; Pearl Harbor, Hawaii; Guam; and Caracao, 
Philippine Islands. Besides caring for their own personnel, these 
hospitals have furnished medical and surgical aid to Veterans' Bu- 
reau patients, 3225 beds in sixteen hospitals having been assigned 
for this purpose during 1924. The American Red Cross supple- 
ments recreational and occupational therapy facilities at the 
hospitals. 
Two hospital ships, the Relief and the Mercy, are maintained by 
the bureau. To these ships, which are manned by medical special- 
ists, are sent the critically ill of the fleet, and those whose ailments 
requiring a long time for cure. 
A naval dispensary is maintained at Washington, and there are 
also dispensaries at all navy yards and stations. 
The Hospital Corps? The Hospital Corps consists of about four 
thousand persons, including pharmacists of various grades, hos- 
pital apprentices, and various other enlisted personnel who assist in 
medical work. 
8 See The Navy as a special field for medical work. By the Surgeon 
General (1923). 
9 See Hospital Corps Handbook of the United States Navy (1923). 324 
NATIONAL GOVERNMENT AND HEALTH 
The Nurse Corps. The strength of the nurse corps is about 
five hundred. Nurses have the rank of commissioned officers, 
and also retirement privileges. Their duties are those of gradu- 
ate nurses in caring for the sick in hospitals and on board hospital- 
ships and transports, but they are not assigned to the fleet. The 
nurse corps has been active in training civilian native nurses in 
Guam, Samoa, the Virgin Islands, and Haiti, work which has had a 
significant effect on maternal and infant mortality in these 
possessions. 
The Dental Corps. The Dental Corps has somewhat over 150 offi- 
cers, although this number is considered inadequate for the naval 
force. Their duties are to give dental service to the entire personnel. 
Bureau Divisions. The bureau has divisions as follows : Admin- 
istration ; Personnel; Rehabilitation and Morale; Physical Quali- 
fications and Medical Records; Preventive Medicine; Finance and 
Supplies; Planning and Publications; and Dental. 
Of particular interest to public health are the activities of the 
Division of Preventive Medicine. These include:10 Collection and 
editing of morbidity and mortality reports, and the compilation and 
presentation of vital statistics; study of annual, monthly, and 
special sanitary reports, and epidemiological data; recommenda- 
tions regarding hygiene and sanitation, especially housing, ventila- 
tion, heating and lighting, toilet and bathing facilities, drainage, 
water supplies, sewage and refuse disposal, insects and vermin 
extermination, food, ship hygiene, industrial hygiene, personal 
hygiene, and, clothing; study of health conditions in civilian com- 
munities constituting the environment of naval stations and ports 
visited by naval vessels, and study of the health reports of the 
Public Health Service and those of state and local health authori- 
ties ; dissemination of information relating to preventive medicine 
for the use of medical officers of the Navy; provision for a course 
of instruction at the Naval Medical School in naval hygiene, epi- 
demiology, sanitation, and the prevention and control of communi- 
cable diseases. 
The description of the health of the Navy, as given in the 1924 
report of the Surgeon General, is an excellent treatise in public 
health. The discussion on the control of the venereal diseases is 
"Surgeon General, Annual Report, 1924, p. 11. DEPARTMENTS OF WAR AND THE NAVY 
325 
especially noteworthy and has been highly praised by experts in 
social hygiene. These diseases appear among the six leading causes 
of sickness and disability in the Navy, and gonorrhea led all dis- 
eases in 1923. The control of the venereal diseases among the Navy 
personnel obviously has a direct influence upon the spread of those 
diseases among the civil population. Health conditions in the Navy 
are on the whole very favorable. The death rate in 1923 was 4.05 
deaths per one thousand personnel, considerably less than half that 
of the registration area of the United States, though, of course the 
personnel of the Navy represents a special age group and also a 
selected group from the general population. The morbidity admis- 
sion rate for the Navy in 1923 was 608 per one thousand personnel, 
including all causes. 
Appropriations. The annual appropriations to the Bureau of 
Medicine and Surgery are about $3,000,000. CHAPTER XIV 
INDEPENDENT ESTABLISHMENTS 
In addition to the ten executive departments, there are about 
twenty-five independent establishments which operate directly 
under the President or Congress. A number of these are interested 
in public health or medical activities. The most notable instance is 
the United States Veterans' Bureau, which is charged with giving 
medical relief and vocational training to ex-service men. 
The Employees' Compensation Commission provides medical 
services for civil employees of the national government injured in 
the course of their employment. The Federal Board for Vocational 
Education, in administering the expenditure of subsidies to the 
states for vocational education and industrial rehabilitation, carries 
on some activities of indirect influence on the public health. 
There are several other independent establishments which 
should be mentioned as having a more or less indirect interest in 
public health. The Smithsonian Institution has a Hall of Health 
containing a health exhibit and also a medical and pharmacological 
exhibit in its Arts and Industries Building; the Bureau of Eth- 
nology of the Smithsonian Institution has made anthropological 
studies and investigations of diseases. The Interstate Commerce 
Commission has a Bureau of Safety, which conducts the activities 
of the Commission relating to the safety of passengers, employees, 
and property, except locomotive inspection, and the regulation of 
the transportation of explosives.1 The Federal Narcotics Control 
Board makes regulations regarding the import and export of cer- 
tain narcotics. An Interdepartmental Social Hygiene Board was 
created in 1918 by Chapter 15 of the Army appropriation act (40 
Stat. L., 886). This Board, consisting of the Secretaries of War, 
Navy, and the Treasury, respectively, and representatives of the 
Public Health Service and the medical services of the Army and 
Navy, with an executive secretary and a staff of workers, continued 
1 See Bernhardt, The Interstate Commerce Commission. Institute for 
Government Research, Service Monograph No. 18 (1923). 
326 INDEPENDENT ESTABLISHMENTS 
327 
in operation until June 30, 1922, after which time Congress made 
no further appropriations for the work of the Board.2 
The United States Veterans' Bureau. The United States 
Veterans' Bureau, an independent establishment, directly under 
the President, is the agency charged with the administration of all 
relief for disabled veterans of the World War and hospitalization 
for the veterans of all other wars, military expeditions and occupa- 
tions subsequent to 1897. This bureau administers all laws relating 
to compensation, insurance, rehabilitation, and medical care and 
treatment of all veterans entitled to such service. It is, of course, 
chiefly with the medical aspects of the work that we are concerned 
here, activities which have been so tremendous in scope and rami- 
fications that only a summary of their development, present activi- 
ties, and organization can be given. 
History and Development.3 The United States Veterans' 
Bureau was not created until 1921, though relief for disabled vet- 
erans of the World War dates from October 6, 1917. At that time 
Congress passed an act (40 Stat. L., 406) granting compensation 
to disabled soldiers through the Bureau of War Risk Insurance, 
which had been created in the Treasury Department in 1914 (38 
Stat. L., 711) to insure vessels, cargoes, seamen, and personal prop- 
erty of officers and seamen against war risk. This act further pro- 
vided (Section 302) that, in addition to compensation, the injured 
person should be furnished by the United States such reasonable 
medical, surgical, and hospital services as necessary. In order to 
perform this work, a Medical Division was organized in the bu- 
reau, by detail of officers from the Public Health Service. Physi- 
cal examinations of men in the field and provisions for hospital 
facilities were duties delegated to the Public Health Service. In 
fact, the medical care of veterans for the four years or so follow- 
ing 1917 belongs to the history of the Public Health Service, 
though it will be described here. During this period the activities 
for veterans grew to such an extent that they overshadowed the 
regular functions of the Public Health Service. 
Early in 1918 the Director of the Bureau of War Risk Insurance 
requested the Public Elealth Service to give hospital relief to dis- 
2 See annual reports of the Board for activities. 
3 See Schmeckebier, The Public Health Service. Institute for Govern- 
ment Research, Service Monograph No. io (1923), pp. 55-75. 328 
NATIONAL GOVERNMENT AND HEALTH 
abled soldiers, although there were available at that time only 
between five hundred and six hundred beds in the Marine Hospitals. 
In July of that year the Service was asked to provide accommo- 
dation for fourteen thousand tuberculous soldiers, and in September 
a medical committee prophesied that twenty thousand men suffer- 
ing from tuberculosis and needing care would be rejected in the 
years 1918 and 1919. Congress then had no hospital program, had 
supplied no funds for that purpose, and did not do so until March 3, 
1919, when an act was passed (40 Stat. L., 1302) appropriating 
$9,050,000 to provide hospital facilities. This law also transferred 
a number of army hospitals to the Public Health Service and 
authorized the transfer of others. A sum of $785,333 was appro- 
priated for operation and maintenance of hospitals during the 
remainder of the fiscal year 1919, while the regular maintenance 
appropriation for 1920 amounted to $4,000,000. Several defi- 
ciency acts for the same year made additional appropriations of 
$20,413,963.95. 
The three months following the passage of the act of March 3, 
1919, saw an enormous increase in the hospital work of the Public 
Health Service. During the fiscal year 1918, the Service had cared 
for 12,797 patients, but in 1919, as many as 26,991 were furnished 
in-patient treatment under its supervision. Over two hundred re- 
serve medical officers were assigned to active duty, and the number 
of acting assistant surgeons was increased from 578 on June 30, 
1918, to 2296 on June 30, 1919. 
In spite of this increase, 7200 beds being available by December 
of 1919, sufficient hospital facilities were still lacking, and contracts 
had to be made with private institutions. On June 30, 1920, there 
were in operation fifty hospitals; a year later the number had 
increased to sixty-two. The number of patients treated in 1920 was 
68,791, while in 1921 it was 113,496. By the end of the fiscal year 
1921, 485 reserve officers were on duty and 1511 acting assistant 
surgeons were employed. From October 6, 1917, to June 30, 1920, 
all hospital treatment for veterans was under the control of the 
Public Health Service, but after the latter date, Army and Navy 
hospitals, and those of the National Homes for Disabled Volunteer 
Soldiers were also available, and these were supervised by medical 
officers of the respective services. Up to April 19, 1921, district 
supervisors of the Public Flealth Service, in the fourteen districts INDEPENDENT ESTABLISHMENTS 
329 
which had been established, had charge of the assignment of 
patients to hospitals. On that date, however, the Secretary of the 
Treasury transferred to the Bureau of War Risk Insurance this 
work of assignment and also the supervision of all private hospitals 
with which the bureau had contracts. As an example of the amount 
of this contract service, the efficacy of which has been severely 
criticized, out of 9769 neuro-psychiatric patients treated between 
March 3, 1919, and June 30, 1920, more than half, or 5641, were 
in contract institutions. 
In order to remedy the deficiency in the number of hospitals, 
Congress on March 4, 1921 (41 Stat. L., 1364), appropriated 
$18,600,000 for additional facilities. At that time there were three 
government organizations interested in the relief of disabled sol- 
diers-the Bureau of War Risk Insurance and the Public Health 
Service, both in the Treasury Department; and the Federal Board 
for Vocational Education, an independent establishment which had 
been charged by Congress with the vocational education of veterans 
and the determination of the amount of allowances for men in train- 
ing. In medical matters the Public Health Service was also acting 
as agent for the Federal Board for Vocational Education. There 
was much dissatisfaction with this division of authority, and con- 
siderable complaint arose regarding delay in obtaining hospital 
treatment, the Public Health Service coming in for much of this 
criticism. 
An independent establishment known as the Veterans' Bureau 
(the name later being changed to United States Veterans' Bureau) 
was created by the act of August 9, 1921 (42 Stat. L., 147). To 
it were transferred the entire work of the Bureau of War Risk 
Insurance, the activities of the Federal Board for Vocational Edu- 
cation pertaining to ex-service men, and certain of the hospital 
work, though the Public Health Service hospitals were not trans- 
ferred. The Director of the Bureau was authorized, however, to 
utilize the facilities of the Public Plealth Service, and he was made 
responsible for the " proper examination, medical care, hospitaliza- 
tion, and convalescent care " of discharged soldiers. The Presi- 
dent was authorized to transfer to the Veterans' Bureau specifi- 
cally designated hospitals, and this he did by executive order on 
April 29, 1922.' This left the Public Health Service in control only 
4 See Surgeon General of the Public Health Service, Annual Report, 
1922, p. 228. 330 
NATIONAL GOVERNMENT AND HEALTH 
of its Marine Hospitals, though many veterans were receiving 
treatment in those institutions. Of the fifty-five hospitals trans- 
ferred to the Veterans' Bureau, forty-six had a total of 12,069 
patients and 11,006 employees, 755 of whom were commissioned 
officers of the Public Health Service detailed to the Veterans' Bu- 
reau for duty. Dispensaries and out-patient clinics had been trans- 
ferred from the Public Health Service to the Veterans' Bureau on 
February 1, 1922. 
On May 11, 1922 (42 Stat. L., 507), Congress appropriated 
another $12,000,000 for hospital construction, and also authorized 
the Director of the Veterans' Bureau to incur obligations for the 
same purpose to the extent of $5,000,000. The peak of the load in 
hospitalization occurred in March of 1922, when nearly thirty-one 
thousand patients were being cared for. From that time to the 
passage of the World War Veterans' Act, on June 7, 1924, there 
was a steady decrease in the number of patients under treatment, 
so that at the expiration of the fiscal year 1923, there were but 
approximately 23,500 cases. Most of this decrease was in general 
medical and surgical cases, although, some reduction also occurred 
among tuberculous patients. The number of neuro-psychiatric 
patients, nevertheless, increased consistently during this period, and 
apparently has not yet reached its peak. Upon the passage of the 
World War Veterans' Act, there were but 22,457 patients under 
treatment in all hospitals. The liberalizing features of this act, 
however, resulted in such an increase in patients that on February 
26, 1925, or approximately eight months later, there were 30,753 
cases in all hospitals, a figure but slightly below that of the peak 
load of March, 1922. This increase, representing the greatest 
ever experienced over a similar period of time, was not confined to 
any one type of patient, but fairly well distributed over the three 
major classifications of diseases. The total number of patients 
under treatment on June 30, 1925, was 26,631, an appreciable 
decrease since February, but due in part to the customary seasonal 
reduction at that time of the year. 
The act of August 9, 1921, broadened the scope of medical 
treatment to include all disabilities of service origin not due to will- 
ful misconduct whether compensatable or otherwise. In order the 
better to handle medical problems, the Medical Service was decen- 
tralized during 1922 and the bulk of operation placed in the INDEPENDENT ESTABLISHMENTS 
331 
district offices. During the fiscal year 1923 there were 82,814 
admissions to hospitals, and there were furnished 8,952,021 in- 
patient days of treatment. In addition, 2,099,424 out-patient treat- 
ments were given. At the close of that fiscal year there were ninety- 
one government hospitals available in whole or in part for benefici- 
aries of the Bureau to the extent of 25,714 beds. There were also 
1009 civil hospitals being used, caring for 6738 patients. On June 
30, 1924, there were eighty-three government hospitals in use, fur- 
nishing 24,877 beds, and but 405 contract hospitals in use, caring 
for 4803 patients, whereas on June 30, 1925, ninety-two government 
hospitals were in use furnishing 30,328 beds, and 327 civil hospitals, 
caring for 4172 patients. Admissions in 1924 totaled 64,053 and in 
1925, 77,981, with in-patient days of treatment rendered totaling 
8,087,771 and 10,018,125, respectively. Out-patient treatments 
given during 1924 and 1925 totaled 1,703,316 and 1,257,967, respec- 
tively. For these two years the cost of operation of veterans' hos- 
pitals was approximately $19,500,000 and $23,350,000, respectively. 
A Senate investigation of the activities of the Bureau was con- 
ducted during 1923 and 1924, and a somewhat voluminous report 
filed in the latter year. On June 7, 1924, an act known as the World 
War Veterans' Act was passed (43 Stat. L., 607) to codify the 
many laws previously enacted. Among other provisions, this law 
extended the hospital facilities of the bureau to every honorably 
discharged veteran of the Spanish-American War, the Philippine 
Insurrection, and the Boxer Rebellion, as well as the World War, 
suffering from neuro-psychiatric or tubercular ailments and dis- 
eases, paralysis agitans, encephalitis lethargica, or amoebic dysen- 
tery, or the loss of sight of both eyes, regardless whether such ail- 
ments or diseases are due to military service or otherwise (Title 
II, Section 202, Par. 10). This same section also authorized hos- 
pitalization to the extent of available government facilities for 
veterans in any military occupation or military expedition since 
1897 not dishonorably discharged, without regard to the nature or 
origin of disability. Another important beneficial feature of this 
legislation was the extension of the presumption of service origin 
to January 1, 1925, up to which date, if certain diseases, namely, 
neuro-psychiatric, tuberculosis, paralysis agitans, encephalitis lith- 
argica or amoebic dysentery, are considered to have developed to 
a 10 per cent degree or more of disability, service connection is pre- 332 
NATIONAL GOVERNMENT AND HEALTH 
sumed and the claimant's right to disability compensation estab- 
lished. This provision and the above provisions for general hospi- 
talization were directly responsible for an immediate increase in 
active disability awards and for a material increase in patient popu- 
lation, since it was necessary to admit many cases to hospitals for 
observation for the determination of diagnosis, and because many 
other cases became eligible for treatment. 
For the purpose of carrying out the policy to replace leased 
facilities or government-owned temporary facilities by modern 
hospital structures, and to eliminate, in so far as possible, civil and 
state hospitalization, further appropriations were made for hos- 
pital construction through the passage of an act of June 5, 1924 
(43 Stat. L., 389), authorizing an appropriation of $6,850,000, 
and through an act approved March 3, 1925 (43 Stat. L., 1212), 
authorizing the appropriation of $10,000,000. 
Current Activities. The current activities of the Medical 
Service include the administrative control over the operation of 
hospitals and dispensaries, the furnishing of medical and dental 
relief to claimants entitled thereto, the physical examination of 
claimants to determine their rights to benefits under existing law 
and need for hospital or out-patient treatment, the rating of disa- 
bilities, and the standardization of hospitals and dispensaries, as 
well as the methods and materials employed in treating and exam- 
ining claimants. These represent the major responsibilities of the 
Medical Service, although their performance involves many other 
kindred matters. 
Disability Ratings. One of the functions of the Medical Service 
is to assist in the determination of disability ratings. At the present 
time disability ratings are made in the regional offices by claims and 
rating boards, which are composed of claim examiners, vocational 
specialists, medical examiners and specialists in the major disability 
from which the claimant is suffering. A claimant whose case is to 
be rated is first referred to a general medical examiner who is a 
member of the Claims and Rating Board, and then to specialists 
for any necessary special examination. After all examinations are 
completed they are attached to the claimant's folder and are re- 
viewed by the board. The claimant is then called for a personal 
appearance, and the disability from which he is suffering is rated 
in accordance with the authorized schedule of ratings. Before the INDEPENDENT ESTABLISHMENTS 
333 
claimant leaves he is advised of his rating, and is allowed to dis- 
cuss his case with the board. 
In cases of dissatisfaction an explanation is given as to the reason 
why the particular rating in that case was decided upon. This 
method has eliminated the former procedure of rating upon a 
report of physical examination without contact with the claimant 
or beneficiary, has brought about a greater satisfaction among 
claimants, and has resulted in fewer appeals to the Central Board 
of Appeals. During the fiscal year 1925, 457,987 ratings were made, 
and there were reported some 34,875 appeals, as contrasted with 
57,055 in 1924. 
Schedule Disability Ratings. The former provisions of the War 
Risk Insurance Act as amended, which call for the preparation of a 
schedule for disability ratings based upon the average impairments 
of earning capacity resulting from injuries in civil occupations, 
etc., were amended by Section 202, Sub-Section 4, Par. 2, of the 
World War Veterans' Act to require preparation of a schedule 
based " as far as practicable upon the average impairments of earn- 
ing capacity resulting from such injuries in civil occupations similar 
to the occupation of the injured man at the time of enlistment," 
etc. This feature of the new legislation imposed upon the bureau 
one of the heaviest constructive tasks that ever confronted it, not 
only because of the inherent magnitude and difficulties of the task, 
but also because of the lack of adequate precedents. A new schedule 
of disability ratings was being prepared in November, 1925. 
Vocational Rehabilitation. After the Claims and Medical Rating 
Groups had examined and certified applicants, they were entitled 
to vocational training under certain conditions. This work has been 
administered by the rehabilitation Division of the bureau. At 
the end of the fiscal year 1924 about 45,000 trainees were receiving 
this vocation service while at the end of the fiscal year 1925 there 
were some 21,803. At one time in April of 1922, there were 
nearly 110,000 such beneficiaries. A total of 179,747 disabled 
soldiers entered upon this training, and more than 106,608 
completed it. In accordance with the present law, no applica- 
tions can be received subsequent to June 30, 1924, no original induc- 
tions into training made subsequent to June 30, 1925, and all train- 
ing must close by June 30, 1926. 
Certain of the training given is of special interest from the 
standpoint of public health. Among the employment objectives  NATIONAL GOVERNMENT AND HEALTH 
334 
of trainees on June 30, 1925, it is interesting to note that the 
bureau classed as "medical," those of 731 persons. This group ac- 
tually includes only 151 persons studying to be physicians, how- 
ever, while 198 were taking dental courses, and' 148 instruction in 
mechanical dentistry. Other training included that for chiropractic, 
embalming, laboratory work, optical work, osteopathy, pharmacy, 
and veterinary medicine. It is stated that " training in medicine, 
dentistry, pharmacy, and all courses affecting the public health 
was given in class A institutions only, though medical authorities 
assert that such a rating is impossible in the case of other than cer- 
tain of those teaching regular medicine. 
Organization of the Medical Service.' The Medical Service 
of the Veterans' Bureau was reorganized in June, 1924, when the 
present Medical Director, Dr. E. O. Crossman, was appointed. 
For six months previous to that date the medical and rehabilita- 
tion divisions had been operated as separate divisions of this same 
service, but this arrangement was dissolved on June 9. The 
functions of the Medical Service have been stated to be,* " to serve 
the bureau in all medical matters relative to the administration of 
the laws under which the bureau operates ; to carry out the policies 
of the director as set forth in regulations and orders governing the 
provisions of medical, surgical, and hospital care, dental treatment, 
prosthetic appliances, physical examination of claimants, and rating 
of claims ; and the administration of bureau hospitals, dispensaries, 
and other relief facilities." 
The Medical Director is assisted in the administration of the 
Medical Service by an executive office which supervises miscella- 
neous medical services, and he also has the advice of a Medical 
Council, composed of eminent members of the profession. Dr. 
Ray Lyman Wilbur is permanent chairman of this Council and 
Dr. Kennon Dunham is Vice-Chairman. The Council is divided 
into a group of hospitals, dispensaries, and general medical wel- 
fare ; a committee on general medicine and surgery; a group on 
neuro-psychiatry; a group on tuberculosis ; and a group on investi- 
gation and research. 
Three main divisions have been set up within the Medical Ser- 
vice. These are the General Medical Division, the Tuberculosis 
6 See U. S. Veterans' Bureau, Medical Bulletin, July, 1925. 
8 Annual Report, 1924, p. 31. INDEPENDENT ESTABLISHMENTS 
335 
Division, and the Neuro-psychiatric Division, each of which has 
assigned to it two chief administrative officers, one in charge of the 
hospitals conducted by the division and the other of all the medical 
work pertaining to that division in the district or regional offices, 
including the examination and treatment of patients in dispen- 
saries, their hospitalization, and after-care. In addition to the three 
main divisions, there are subdivisions of dentistry, prosthetics, oc- 
cupational therapy and physiotherapy, and insular and foreign af- 
fairs. Finally, there is a nurses' section, a dietetic section, and a 
section devoted to psychiatric social work. The fourteen districts 
into which the work was formerly divided have been abolished, and 
in their place fifty-four regional offices have been established in 
accordance with the authority of the law of 1924 in the important 
centers in each state. The organization in the regional offices is 
along the same general lines as in the central office in Washington. 
On June 30, 1925, the number of physicians and dentists in the 
service of the Bureau was 2125, out of a total of 27,622 employees. 
On June 7, 1924, an executive order was issued placing all of the 
commissioned officers formerly detailed by the Public Health Ser- 
vice, 649 in number, on the regular rolls of the Veterans' Bureau. 
The bureau has never had a medical corps, similar to those of the 
Army, Navy, and Public Health Service, though such a corps has 
been repeatedly urged. Nurses in the employ of the bureau num- 
bered 1660 on June 30, 1925, and there were on this date 138 dieti- 
tians, 206 physiotherapy experts, and 366 occupational therapy 
employees. 
Ratings. Prior to the fiscal year 1925 there was in each of the 
then existing fourteen district offices a Rating Section composed 
of medical referees who were specialists in the various branches 
of medicine. These medical referees interpreted reports of physical 
examinations and determined the degree of disability, as well as 
service connection, based upon military records, in conjunction 
with the history of the case since discharge. Boards of appeal 
were set up in the several district offices, which considered cases 
appealed from the decisions of the medical referees, and in addi- 
tion a Central Board of Appeals was established in the central 
office to consider appeals on decisions by the district boards. 
Commencing with the fiscal year 1925, however, a change of 
system was effected, coincident with the establishment of the fifty- 
four regional offices. 336 
NATIONAL GOVERNMENT AND HEALTH 
Central Board of Appeals. Commencing with January, 1925, 
the Central Board of Appeals, formerly located in Washington, 
was decentralized and is now functioning as five separate sections 
under the general supervision of the Chairman of the Board of 
Appeals at the central office. These sections of the board are 
located at Area Headquarters in Boston, New York, New Orleans, 
Chicago, and San Francisco. Final action is taken on appeal cases 
by these sections of the board exactly as if the cases had been 
sent to the central office. Appeal cases coming to the personal 
attention of the Director are handled by an Advisory Group on 
Appeals. This group is located in the central office, and is directly 
responsible to the Director. 
Medical Statistics. Medical statistical work is carried on in 
one of the other Services, the Coordination Service, where there 
are compiled, maintained, and interpreted all records pertaining 
to the medical, regional, and hospital activities of the bureau, and 
where charts and reports are prepared. This service has on file 
493,875 cards representing total admissions to hospitals to June 30, 
1925, though this does not indicate the number of patients, as 
113,271 patients have had more than one hospital period. The 
total number of separate individuals hospitalized amounts to 
296,898. In addition, there has been established within the 
Medical Service itself a. Medical Research Section. 
Hospitals. The administration of the hospitals of the Veterans' 
Bureau is under the jurisdiction of the Medical Service at Wash- 
ington. The fifty hospitals are divided into three groups as 
follows: 
General Medical and Surgical (17) 
No. 32 Washington, D. C. 
No. 48 Atlanta, Ga. 
No. 52 Boise, Idaho. 
No. 53 Dwight, Ill. 
No. 59 Tacoma, Wash. 
No. 63 Lake City, Fla. 
No. 65 St. Paul, Minn. 
No. 67 Kansas City, Mo. 
No. 69 Ft. Thomas, Ky. 
Edward Hines Jr. Hospital. 
Maywood, Ill. 
No. 77 Portland, Ore. 
No. 84 Algiers, La. 
No. 88 Memphis, Tenn. 
No. 90 Muskogee, Okla. 
No. 91 Tuskegee, Ala. 
No. 92 Jefferson Barracks, 
Mo. 
No. 99 Excelsior Springs, 
Mo. INDEPENDENT ESTABLISHMENTS 
337 
Tuberculosis (17) 
No. 27 Alexandria, La. 
No. 41 New Haven, Conn. 
No. 50 Whipple, Ariz. 
No. 51 Tucson, Ariz. 
No. 55 Ft. Bayard, N. M. 
No. 60 Oteen, N. C. 
No. 64 Camp Kearny, Calif. 
No. 68 Minneapolis, Minn. 
No. 72 Helena, Mont. 
No. 79 Dawson Springs, Ky. 
No. 80 Las Animas, Colo. 
No. 85 Walla Walla, Wash. 
No. 89 Rutland, Mass. 
No. 93 Legion, Texas. 
No. 96 Tupper Lake, N. Y. 
No. 98 Castle Point, N. Y. 
No. 102 Livermore, Calif. 
Neuro-Psychiatric (16) 
No. 24 Palo Alto, Calif. 
No. 37 Waukesha, Wise. 
No. 42 Perry Point, Md. 
No. 44 West Roxbury, Mass. 
No. 49 Philadelphia, Pa. 
No. 57 Knoxville, Iowa. 
No. 62 Augusta, Ga. 
No. 74 Gulfport, Miss. 
No. 78 North Little Rock, 
Ark. 
No. 81 Bronx, N. Y. 
No. 86 Sheridan, Wyo. 
No. 94 American Lake, 
Wash. 
No. 95 Northampton, Mass. 
No. 100 Camp Custer, Mich. 
No. 101 St. Cloud, Minn. 
New hospitals are planned and their construction supervised by 
the Construction Division of the bureau, which consults the 
Medical Service as to the requirements of the institution. The 
average cost of a hospital has been about $3700 per bed. 
The Bureau in General. Besides (1) the Medical Service and 
(2) the Rehabilitation Division, already mentioned, the Bureau 
has (3) a Claims and Insurance Service, (4) a Finance Service, 
(5) Office of General Counsel, (6) a Guardianship Service, (7) 
a Coordination Service, including the Standardization Division, 
the Evaluation Division, the Investigation Division, and the Budget 
Office, and (8) certain independent divisions, such as the Supply 
Division, the Construction Division, the Personnel Division, the 
Mails and Records Division, and the Information and Cooperation 
Division. Disbursements by the Bureau during the fiscal year 
1925 amounted to $393,755,857.18. So far, the Veterans' Bureau 
and the activities undertaken in behalf of ex-service men have cost 
about three billions of dollars. Of the disbursements for 1925, 
only 8.39 per cent were for medical and hospital expenses, and 
0.99 per cent for hospital facilities and services, these figures, how- 338 
NATIONAL GOVERNMENT AND HEALTH 
ever, not including the salaries, allowances, and travel of medical 
personnel in regional offices, nor any personnel in hospitals. For 
the fiscal year 1925, the total amount appropriated was $406,713,- 
559.21. On June 30, 1925, active disability compensation awards 
totalled 211,644, active death compensation awards totalled 65,391, 
and 171,319 claims for term and United States Government Life 
Insurance had been awarded. 
The Federal Board for Vocational Education.7 The func- 
tions of the Federal Board for Vocational Education are to admin- 
ister the acts of Congress providing for the promotion of voca- 
tional education in cooperation with the states, and for the voca- 
tional rehabilitation of persons disabled in industry. The board 
also investigates vocational matters and issues reports thereon, 
and studies agriculture, trade, commerce, home management and 
domestic science, and allied topics. Some of its work has a distinct 
bearing on public health. 
History and Development. The Federal Board for Voca- 
tional Education was created by an act of Congress approved' 
February 23, 1917 (39 Stat. L., 929). This law, which is gener- 
ally known as the Smith-Hughes Act, or the national vocational 
education act, provided for a continuing federal appropriation for 
the purpose of cooperating with the states in establishing and main- 
taining programs for vocational education of less than college 
grade, and for the preparation of teachers to carry out such pro- 
grams. The federal government had previously made grants to 
aid vocational education, notably by means of the Morrill Land 
Grant Act of 1862 (12 Stat. L., 503), the Hatch Act of 1887 (24 
Stat. L., 440), the second Morrill Act of 1890 (26 Stat. L., 417), 
and the Smith-Lever Act8 of 1914 (38 Stat. L., 372), but all of 
these laws were concerned with vocational education of college 
grade. In 1914 Congress, yielding to pressure from industrial 
groups, created (38 Stat. L., 767) a Federal Commission on 
National Aid to Vocational Education, which investigated the 
T See Holt, The Federal Board for Vocational Education. Institute for 
Government Research, Service Monograph No. 6 (1922). 
8 See page 217. INDEPENDENT ESTABLISHMENTS 
339 
subject and reported at length, with the result that the Smith- 
Hughes Act was passed. 
The states were quick to avail themselves of the act, and by 
December 31, 1917, all had accepted its terms. The Federal subsi- 
dies were arranged in three parts: (1) For teacher training, (2) 
for industrial education, and (3) for agricultural education. By the 
terms of the law, each of these sums began at $500,000 a year and 
increased annually until 1926, when a maximum of $3,000,000 
is reached for agricultural education and also for industrial edu- 
cation, and $1,000,000 for teacher training. The total federal 
vocational education funds have increased from $1,655,586.72 in 
1918 to $7,154,901.51 in 1926. 
The scope of the activities of the board was enlarged during 
the World War, when Congress by an act of June 27, 1918 (40 
Stat. L., 617), charged it with the duty of giving vocational 
rehabilitation to disabled soldiers. The Bureau of War Risk In- 
surance was to determine whether the soldier was entitled to com- 
pensation, and only an ex-service man who had been awarded such 
compensation could receive vocational training. By an act of July 
11, 1919 (41 Stat. L., 158), however, the board was made sole 
judge of the need for vocational education. This duty called 
for many medical examinations, and a medical staff had to be built 
up. In order to' assist in carrying out the work, the Public Health 
Service assigned medical officers to the board and also arranged 
for physical examinations to be made at the stations of the Service. 
When, on August 9, 1921, the Veterans' Bureau was created, all 
of the vocational rehabilitation for soldiers was transferred to it.9 
At that time there were nearly ninety thousand men in train- 
ing in about three thousand schools and colleges throughout the 
country. 
Vocational education for civilians injured in industries was pro- 
vided by an act of June 2, 1920 (41 Stat. L., 735), and the Federal 
Board was charged with the administration of the law, beginning 
June 30, 1921. This law followed the terms of the national voca- 
tional education act., and had' for its purpose the restoration to 
useful working ability of any citizen who might, through injury or 
disease, become so handicapped that he could not continue to work 
9 See page 333. 340 
NATIONAL GOVERNMENT AND HEALTH 
at his job efficiently. The law provided for an appropriation to 
the states of $750,000 for the fiscal year 1921, and $1,000,000 
annually for the next three years. By the end of the fiscal year 
1924, thirty-six states had accepted the act. On June 5, 1925, the 
law was amended (43 Stat. L., 430), and annual appropriations 
of $1,000,000 authorized through the fiscal year 1930. In addition, 
a sum of $75,000 annually was provided for a three-year period 
in order that the board might conduct research. 
Current Activities. The board has three general functions: 
First, the administration of those federal funds allotted to the 
various states to encourage and assist them in developing programs 
of vocational education of less than college grade and in develop- 
ing corresponding programs for civilian rehabilitation in the states 
which have accepted the civilian vocational rehabilitation act; 
second, the conducting of research and studies for the purpose of 
promoting and improving vocational education and civilian voca- 
tional rehabilitation; and, third, assisting the states in the promo- 
tion and development of their programs along these lines.10 
In 1924 there was an enrollment of 652,994 persons in federally 
aided schools. Of this number, 85,984 were interested in agricul- 
tural studies, 409,843 in trade or industrial work, and 157,167 
in home economics subjects. The number of schools receiving aid 
in 1924 was nearly seven thousand and there were also about 130 
teacher-training institutions. 
Of special interest from the standpoint of public health are the 
activities in home economics and in civilian rehabilitation. Train- 
ing in home-making is construed by the board to include the deter- 
mination of the expenditure of income, the direction and perform- 
ance of labor involved in home management, and the information 
and skill necessary to carry out the various tasks connected 
with feeding and clothing the family, the care of the house and 
its equipment, the care of family health, and the care and rearing 
of children. 
In order to promote interest in these subjects, the Home Eco- 
nomics Education Service of the board has conducted certain re- 
10 Annual Report, 1924. INDEPENDENT ESTABLISHMENTS 
341 
search and has published a number of bulletins as a result. These 
are as follows: 
No. 23. Clothing for the family (1918). 
No. 28. Home economics education; organization and adminis- 
tration (Revised, 1924). 
No. 35. Use and preparation of foods (1919). 
No. 37. Survey of the Needs in the Field of Vocational Home 
Economics Education (1919). 
No. 65. Child care and child welfare (1919). 
No. 71. The home project; its use in home-making education 
(1921). 
No. 79. A study of home economics education in teacher-train- 
ing institutions for negroes (1923). 
No. 86. The health of the family; a program for the study of 
personal, home, and community problems (1923). 
In its Employment Management Series, the board has a bulle- 
tin (No. 47, 1919) on " Industrial accidents and their prevention." 
Civilian rehabilitation had in 1924 reached over 13,000 persons 
in thirty-six states. The average cost of rehabilitating a disabled 
individual was computed to be $221.01, a reduction from a figure 
of $262 in 1923. This cost is borne partially by federal and par- 
tially by state funds. In developing vocational training for those 
" disabled in industry or any legitimate occupation," as the law 
states, the physical restoration of the individual has been recog- 
nized as a necessary foundation. According to the annual report 
of the board for 1924, rehabilitation clinics have been organized 
in a number of states in order to provide diagnosis and medical 
and surgical treatment for persons eligible for vocational rehabili- 
tation. 
Out of 628 types of jobs at which six thousand rehabilitated per- 
sons are working, those of interest to the public health which are 
named include chiropractor, dental mechanic, dentist, embalmer, 
bacteriologist, masseur, nurse, hospital orderly, pharmacist, phy- 
sician, safety supervisor, social worker, cow tester, milk tester, 
veterinary, X-ray technician. 
Organization and Personnel. The Federal Board for Voca- 
tional Education consists of the Secretaries of Labor, Commerce, 
and Agriculture, respectively; the Commissioner of Education; 
and three persons appointed by the President, subject to approval 
by the Senate, to represent labor, agriculture, and manufacture 342 
NATIONAL GOVERNMENT AND HEALTH 
and commerce. The board employs a Director, who is assisted 
by a secretary and chief clerk, and an editor and educational con- 
sultant. There are two divisions, Vocational Education, and 
Civilian Vocational Rehabilitation. The former is subdivided 
into a trade and industrial education service, an agricultural edu- 
cation service, the home economics education service, and a com- 
mercial education service. Each service in turn has supervisors in 
charge of four regions of the country. 
In 1925 the board had a personnel of fifty-two, of whom 
twenty-three were of professional grade. 
The United States Employees' Compensation Commission.11 
The United States Employees' Compensation Commission admin- 
isters the Federal Compensation Act of September 7, 1916 (39 
Stat. L., 742). This law had been preceded by an act of 1908 
(35 Stat. L., 556), which charged the Secretary of Commerce and 
Labor with the duty of providing compensation to certain govern- 
ment employees injured in the course of their duties. The 1908 
law was administered by the Bureau of Labor (now Labor Statis- 
tics). Because of the inadequacy of this act, it was superseded in 
1916 by the present statute. 
Current Activities. The law provides that the United States 
shall pay compensation for the disability or death of any employee 
resulting from a personal injury sustained while in the perform- 
ance of his duty, but no compensation shall be paid if the injury 
or death is caused by wilful misconduct. For total disability, a 
monthly compensation equal to 66| per cent of the employee's 
salary shall be paid up to a maximum of $66.67, and for partial 
disability, a monthly sum equal to two-thirds of the difference 
between his monthly pay and his earning capacity. Immediately 
after the injury and for a reasonable time thereafter, the United 
States shall furnish the injured employee, reasonable medical, 
surgical, and hospital services and supplies unless he refuses to 
receive them. An amendment to the law, approved June 5, 1924 
(43 Stat. L., 389), defines injury to include " in addition to injury 
by accident, any disease proximately caused by the employment." 
This amendment also provides that the finding of facts and the 
decisions of the commission shall be final. 
11 See Weber, The Employees' Compensation Commission. Institute for 
Government Research, Service Monograph No. 12 (1922). INDEPENDENT ESTABLISHMENTS 
343 
The compensation law provides that medical services to injured 
employees shall, wherever possible, be supplied by medical officers 
of the United States. Accordingly, arrangements have been made 
with the Public Health Service, whereby the marine hospitals and 
other relief stations are utilized. That service has also detailed 
medical officers to serve with the commission. During the fiscal 
year, 1924, nearly one-quarter of all patients in Public Health Ser- 
vice hospitals were from the Employees' Compensation Commis- 
sion. The cost of such hospitalization and out-patient service comes 
out of the appropriation of the Public Health Service and' not that 
of the commission. Dispensaries of the Army and Navy are also 
used for first-aid and out-patient work and the hospitals of these 
services might be, but rarely are, employed. 
In order to provide medical service in cities and towns where 
facilities of the Public Health Service are not available, the com- 
mission has designated 3588 physicians, of whom, 199 are ophthal- 
mologists, seventy-two specialists in orthopedic surgery, and seven 
neuropsychiatrists. The Public Health Service has only two gen- 
eral hospitals west of the Mississippi, so that these private con- 
tract physicians are needed there and also elsewhere. In cases of 
emergency, the nearest physician or hospital may be called upon 
for aid. 
The total number of federal employees on June 30, 1925, was 
557757, of whom 63,756 were in the District of Columbia, and 
the remainder in other parts of the country. Every month, about 
fifteen hundred of these employees are injured. From September 
7, 1916, to the close of the calendar year 1923, there had occurred 
13,233 injuries upon which action had been taken by the com- 
mission.2 Of these, 236 were deaths, 34 permanent total disabili- 
ties, and 434 permanent partial disabilities. During the year 1924 
the largest number of injuries (4891) occurred among employees 
of the Post Office Department, with the War Department second 
(3585), and the Navy third (1449). It should be remarked, 
however, that the Post Office Department had in 1924 some 
300,000 employees, whereas the Army and Navy Departments had 
only about 50,000 each. Statistics compiled by the Employees' 
Compensation Commission seem to show numbers and not rates. 
"Annual Report, 1924. 344 
NATIONAL GOVERNMENT AND HEALTH 
When a federal employee is injured, the procedure is, in general, 
something like this: within forty-eight hours, written notice 
must be given by the employee to his immediate superior. If the 
injury results in any medical charge or in loss of time other than the 
remainder of the day or shift, the superior reports to the com- 
mission. A claim for compensation must be made on the proper 
form, which includes a medical statement, and must be filed 
within sixty days with the superior, who transmits it to the com- 
mission. Here it is received in the Assembly Division and trans- 
mitted from there to the Claims Division. Claims requiring inter- 
pretation of medical questions are referred to the Medical Divi- 
sion. Every claimant must submit to a medical examination and 
if disagreement occurs between the individual's own physician 
and a federal medical officer, provision is made for the appoint- 
ment of a medical referee by the commission. The commission 
itself finally passes on all claims. Payments are, however, subject 
to check by the Comptroller of the Treasury. 
In addition to paying compensation and providing necessary 
medical relief, the commission compiles statistics and attempts to 
analyze them, distributes pamphlets explaining the law to govern- 
ment employees, and directs and conducts damage suits where the 
injury or death has been caused by a third party. No attempt 
is made to do preventive work, that is, to undertake safety and 
industrial hygiene activities in government departments, so as to 
reduce accidents and injuries. Such efforts along this important 
line are, if at all, conducted by the various departments themselves. 
Organization. The Employees' Compensation Commission 
consists of three commissioners appointed by the President, wtih 
the consent of the Senate. Each receives a salary of $4000 
a year. Each has a separate office. There is also a secretary, and 
there are seven divisions: Assembly, Claims, Medical, Medical 
Claims, Legal, Statistical, and Disbursing. The personnel author- 
ized for 1925 was seventy-four. The annual appropriation aggre- 
gates about $2,500,000, of which about half a million goes for 
medical treatment and supplies, though, as previously stated, this 
does not include service rendered by the marine hospitals of the 
Public Health Service, which the commission estimates is worth 
about $700,000 a year. INDEPENDENT ESTABLISHMENTS 
345 
The Federal Narcotics Control Board. The Federal Narcotics 
Control Board consists of the Secretary of State, the Secretary of 
Commerce and the Secretary of the Treasury. The board was 
created by an act approved May 26, 1922 (42 Stat. L., 596), known 
as the Narcotic Drugs Import and Export Act, the purpose of 
which was to prohibit the importation or exportation of certain nar- 
cotic drugs (opium, coca leaves, cocaine, and their derivatives) ex- 
cept for legitimate medicinal purposes. The administration of the 
act is vested in the Treasury Department, and the only function of 
the board is to make regulations for carrying it out. Such regula- 
tions were made on October 15, 1922, and revised in January, 1925. 
The head of the narcotic division of the Bureau of Internal Reve- 
nue, Treasury Department, acts as secretary of the board. CHAPTER XV 
SUMMARY AND COMMENT 
The Bureaus Involved. In the preceding pages there have been 
described some forty bureaus or other administrative units of the 
national government which are concerned directly or indirectly 
with some phase of the public health. These bureaus may be classi- 
fied under four headings: (1) Those in which the public health 
activities constitute the major work and primary purpose of the 
bureau or other unit; (2) those in which public health work is an 
important activity, but secondary to the general scope of the bureau 
or other unit; (3) those which undertake purely medical work or 
public health activities of a special and somewhat limited char- 
acter; and (4) those in which the public health or medical work 
is of a minor or more or less insignificant or casual importance. 
In accordance with this classification, the Federal agencies described 
may be grouped as follows : 
i. Major Interest in Public Health 
Public Health Service (Treasury) 
Bureau of Chemistry (Agriculture) 
Children's Bureau (Labor) 
Division of Vital Statistics, Bureau of the Census (Commerce) 
Medical Division, Office of Indian Affairs (Interior) 
Division of School Hygiene, Bureau of Education (Interior) 
Bureau of Animal Industry (Agriculture) 
2. Interest in Public Health Important, but Secondary 
Bureau of Home Economics (Agriculture) 
Bureau of Mines (Commerce) 
Bureau of Dairying (Agriculture) 
Extension Service (Agriculture) 
Bureau of Immigration (Labor) 
Women's Bureau (Labor) 
Bureau of Labor Statistics (Labor) 
3. Medical Service or Relief, or Public Health of Restricted or 
Special Scope. 
Medical Department (Army) 
Bureau of Medicine and Surgery (Navy) 
United States Veterans' Bureau 
St. Elizabeth's Hospital (Interior) 
346 SUMMARY AND COMMENT 
347 
Freedmen's Hospital (Interior) 
Alaska Division, Bureau of Education (Interior) 
United States Employees' Compensation Commission 
Service Relations Division (Post Office) 
4. Public Health or Medical Work Incidental Only 
Bureau of Internal Revenue (Treasury) 
Customs Service (Treasury) 
Consular Service (State) 
Bureau of Entomology (Agriculture) 
Bureau of Public Roads (Agriculture) 
Bureau of Agricultural Economics (Agriculture) 
Bureau of Biological Survey (Agriculture) 
Bureau of Plant Industry (Agriculture) 
Office of Experiment Stations (Agriculture) 
Forest Service (Agriculture) 
Bureau of Fisheries (Commerce) 
Bureau of Standards (Commerce) 
Steamboat Inspection Service (Commerce) 
Patent Office (Commerce) 
Geological Survey (Interior) 
National Park Service (Interior) 
Bureau of Pensions (Interior) 
Federal Board for Vocational Education. 
It will be seen from this summation that there are seven bureaus 
or divisions in which public health is more or less the major 
activity and primary purpose of the particular agency of the 
government. Any plan for centralizing federal health work should 
consider these agencies first and provide for bringing all of them, 
or essential parts of them, together in one department, under uni- 
fied direction, or else for effecting some form of practical liaison 
or cooperation between them. In 1926 these seven agencies were 
scattered through five different departments and, as a rule, carried 
on their activities independently. 
The second group of agencies, those in which the public health 
interest is important but secondary to the general scope of the 
bureau, also numbers seven administrative units, representing 
three different executive departments. If there were a central 
health administration in the federal government, all other public 
health work, not directed by it, should be effectively coordinated 
with it. This might be accomplished by a system of liaison, or by 
contract service supplied' from the central agency. The desira- 
bility for the latter arrangement has already been recognized, and 
Congress has authorized, or cabinet officers and bureau chiefs have 348 
NATIONAL GOVERNMENT AND HEALTH 
requested, the assignment of medical officers of the Public Health 
Service to assist in the public health work of other departments. 
This form of contract or cooperative service was in 1925 in 
operation in the following instances, Public Health Service officers 
being detailed in each case: 
1. Bureau of Immigration (Labor) 
By an act of March 3, 1891 (26 Stat. L., 1084), surgeons of the 
Marine Hospital Service (now the Public Health Service) were 
directed to make the medical examinations of immigrants. The act 
of February 5, 1917 (39 Stat. L., 885), provides for detail of such 
officers. In 1925 there were 167 medical officers assigned to this 
duty. 
2. Consular Service (State) 
The act of February 15, 1893 (27 Stat. L., 450), authorized the 
President to detail medical officers to serve in the office of any 
consul in a foreign port. During 1925 officers of the Public Health 
Service were stationed in consular offices at thirty ports in 
Europe. 
3. Office of Indian Affairs (Interior) 
In 1912 the Public Health Service was authorized (37 Stat. L., 
519) to make a survey of contagious and infectious diseases among 
the Indians. In 1918 physicians of the Service were assigned to 
combat influenza among the Indians. In 1925 a trachoma survey 
was being undertaken among the Indians by the Public Health 
Service at the request of the Secretary of the Interior. In 1926 
the Secretary of the Interior requested the Public Health Service 
to aid in reorganizing the Indian Medical Service. 
4. Alaska Division, Bureau of Education (Interior) 
Since 1915 annual appropriation acts for medical relief in Alaska 
have directed the Secretary of the Interior to provide such relief 
" with the advice and cooperation of the Public Health Service " 
(38 Stat. L., 862). 
5. United States Employees' Compensation Commission 
The act of September 7, 1916 (39 Stat. L., 743), directed 
medical services for injured civil employees of the government to 
be furnished by United States medical officers and hospitals 
wherever possible. An officer of the Public Health Service has 
acted as medical director of the Commission. 
6. Bureau of Mines (Commerce) 
By an act of June 12, 1917 (40 Stat. L., 146), the Secretary of 
the Treasury is authorized to detail medical officers of the Public 
Health Service to the Bureau of Mines for cooperative health, 
safety, or sanitation work. In 1925, seven officers were so detailed. SUMMARY AND COMMENT 
349 
7. Bureau of Chemistry (Agriculture) 
An act of October I, 1918 (40 Stat. L., 992), authorized the 
Secretary of the Treasury to detail medical officers of the Public 
Health Service to assist in the administration of the Pure Food 
and Drugs Act. 
8. Post Office Department 
At the request of the Postmaster General, the Public Health 
Service has since 1921 cooperated with officers of the postal service 
in studying sanitary conditions in postal establishments. 
9. National Park Service (Interior) 
At the request of the Secretary of the Interior, the Public 
Health Service has for several years assigned sanitary engineers 
and medical officers to assist in supervising public health in the 
national parks. 
10. Miscellaneous 
Since 1914 the Public Health Service has supplied medical offi- 
cers for the Coast Guard (38 Stat. L., 387). 
From October 6, 1917, to August 9, 1921, Public Health Service 
officers cared for ex-service men, and from the latter date to June 
7, 1924, detailed officers to the United States Veterans' Bureau. 
Officers were also supplied to the Federal Board for Vocational 
Education. 
The third class of bureaus listed above are those which are 
concerned only with the giving of medical relief, such as the 
Veterans' Bureau, which is by no means a health agency, or else 
carry on health work of limited, instead of general scope. Cura- 
tive medicine and preventive medicine are, of course, quite differ- 
ent matters, and it is only with the latter that plans for coordina- 
tion of public health work should deal. These eight medical relief 
bureaus should not, therefore, be considered for transfer, although 
it would be desirable to maintain close cooperative relations 
between them and any central federal health agency. The prin- 
ciple of contract service would also apply in some cases here. 
The fourth class of bureaus are those whose major functions 
are in some field other than public health, but which carry on 
some activities of indirect or incidental interest to public health 
Thus, the Bureau of Entomology does a small amount of work 
on mosquitoes and other insects affecting the health of man. The 
Bureau of Public Roads has designed sanitary conveniences for 
farm homes. The question arises whether such activities or some 
of them should not be discontinued by the agencies with whom 
the work is only incidental, and assumed by the Public Health 350 
NATIONAL GOVERNMENT AND HEALTH 
Service or by a central federal health agency. This would be 
more economical and more effective. At any rate, promiscuous 
public health work conducted by federal bureaus which have 
entirely different functions should be directed by scientific per- 
sonnel detailed from such a central health agency, or should be 
closely coordinated with the work of this agency. Otherwise, 
there is likely to be waste motion and even cross-purposes. 
Appropriations and Personnel. In the following pages will 
be outlined and tabulated for purposes of comparison various items 
concerning the many bureaus which do public health work. A 
summary of appropriations and of personnel will be given, and 
actual duplication in activities or functions will be described. This 
summary is intended to point out further the need for coordina- 
tion, though additional arguments or reasons for such an admit- 
tedly essential step in federal progress are almost superfluous. 
Federal Appropriations for Public Health. The following 
appropriation figures are taken from the appropriation acts for 
the fiscal years 1925 and 1926. The figures have been given in 
considerable detail, in order to indicate the relative amounts for 
different purposes, and to show the comparative value placed on 
these activities by Congress. Everything relating directly or in- 
directly to public health or medical affairs has been included. 
Treasury Department 
Public Health Service 
Salaries, Office of Surgeon General.... 
Pay of commissioned officers 
Acting assistant surgeons 
Pay, all other employees 
Travel and transportation 
Hygienic Laboratory 
Medical examinations 
Quarantine service 
Prevention of epidemics 
Deficiency appropriation 
Field investigations 
Interstate quarantine 
Deficiency for study of oyster pollution. 
Rural sanitation 
Biologic products 
Venereal Disease 
Miscellaneous 
1925 
.$ 104,405 
. 1,135,000 
300,000 
840,000 
30,000 
44,600 
. 4,900,000 
479,000 
332,9io 
275,086 
21,900 
74,300 
41,320 
149,000 
3,500 
1926 
$ 101,560 
1,110,000 
3i5,ooo 
1,020,000 
25,000 
43,400 
5,211,285 
470,000 
328,772 
275,000 
282,054 
22,530 
57,6oo 
75,ooo 
45,ooo 
75,ooo 
3,5oo 
Total, Public Health Service 
.$ 8,731,021 
$ 9,460,701 SUMMARY AND COMMENT 
351 
Supervising Architect 
1925 
1926 
National Leper Home (completion).., 
, 150,000 
Marine hospitals (work) 
87,000 
$122,350 
Quarantine stations (work on) 
34,350 
255,000 
Internal Revenue 
Prohibition and narcotics 
. 10,629,770 
11,000,000 
Navy Department 
Care of lepers, Guam 
30,000 
30,000 
Bureau of Medicine and Surgery 
. 2,347,620 
2,078,400 
New naval hospitals 
. 2,257,500 
7i5,5oo 
State Department 
International Sanitary Bureau 
IIJ54 
IIJ54 
International Office of Public Health... 
3,86o 
3,860 
Cape Town Hospital 
50 
50 
Conference on oil pollution 
42,000 
Department of Justice 
Medical care of prisoners 
22,000 
22,000 
Department of Commerce 
Bureau of the Census; vital statistics 
Salaries 
133,000 
i35,ooo 
Field 
107,000 
102,000 
Travel 
2,556 
4,000 
Total, Vital Statistics 
.$ 242,556 
$ 241,000 
Bureau of Fisheries 
Health on Pribiloff Islands 
10,000 
10,000 
Department of Labor 
Children's Bureau 
Salaries 
117,820 
110,000 
Child Welfare studies 
136,080 
I35,ooo 
Travel and publications 
72,000 
68,000 
Maternity and Infancy 
. 1,007,092 
1,000,000 
Total, Children's Bureau 
.$ 1,332,992 
$ 1,313,000 
Women's Bureau 
107,380 
105,000 
Department of the Interior 
Office of Indian Affairs 
Conservation of health 
500,000 
700,000 
Geological Survey 
Water supply investigations 
170,000 
165,000 
Pension Office 
Fees for examining surgeons 
450,000 
500,000 
Deficiency appropriation for same.... 
90,000 
Bureau of Mines 1 
General expenses 
88,000 
86,000 
Safety of miners 
359,768 
400,000 
Same in Alaska 
35,ooo 
33,ooo 
Mine rescue work 
262,300 
281,840 
Mine rescue equipment 
40,000 
Total, Mines 
$ 785,068 
$ 800,840 
1 Transferred to the Department of Commerce in 1925. 352 
NATIONAL GOVERNMENT AND HEALTH 
Bureau of Education 
1925 
1926 
School hygiene ; 
about $ 15,000 
$ 15,000 
Medical relief, Alaska 
110,000 
122,320 
Insane of Alaska 
150,000 
157,757 
St. Elizabeth's Hospital 
General appropriation 
900,000 
910,000 
Construction 
320,400 
113,000 
D. C. appropriation 
850,000 
900,000 
Deficiency appropriation, same... 
236,000 
Freedmen's Hospital 
174,700 
202,950 
Department of Agriculture 
Bureau of Animal Industry 
Salaries 
670,000 
649,401 
Inspection and quarantine 
573,ooo 
610,000 
Tuberculosis eradication 
850,000 
982,000 
Tuberculosis indemnities 
2,427,600 
2,578,000 
Tick eradication 
660,000 
699,451 
Dairy investigations2 
386,600 
484,340 ' 
Animal husbandry 
295,440 
348,225 
Animal diseases 
118,000 
125,860 
Hog cholera 
404,000 
431,363 
Dourine studies 
40,240 
40,520 
General 
27,886 
24,226 
Meat inspection, extra 
1,071,150 
1,896,110 
Total, Animal Industry 
$ 7,523,9i6 
$ 8,385,156 
Meat inspection, permanent 
3,000,000 
3,000,000 
Forest Service 
Sanitation and fire prevention 
25,000 
25,000 
Bureau of Chemistry 
Salaries 
340,000 
363,208 
Agricultural chemistry 
120,600 
123,400 
Work for other departments 
14,090 
14,090 
Raw materials 
55,805 
54,805 
Syrup studies 
28,370 
28,000 
Pure food and drugs law 
716,260 
788,860 
Tea act 
36,110 
40,690 
Insecticides and fungicides 
29,440 
27,580 
Dust explosions 
26,555 
26,555 
Naval stores 
20,000 
35,ooo 
Total, Chemistry 
$ 1,387,230 
$ 1,502,188 
Bureau of Entomology 
Insects affecting health of man or 
animals 
64,630 
66,560 
Bureau of Public Roads 
Water supply, drainage, and rural 
engi- 
neering 
35,300 
? 
Bureau of Home Economics 
Salaries 
27,244 
27,244 
Investigations 
79,244 
90,000 
107,024 
H7,244 
2 In 1926 this appropriation is to the Bureau of Dairying. SUMMARY AND COMMENT 
353 
War Department 
1925 
1926 
Water and sewers at posts 
.$2,109,950 
$ 2,450,000 
Hospital construction 
489,500 
440,000 
Medical department 
942,610 
1,033,633 
Hospital care, Canal Zone 
Army Medical Museum 
3'5,000 
40,000 
7,500 
7,500 
Library, Surgeon General 
20,000 
20,000 
Salaries, Office of Surgeon General 
267,804 
268,284 
Insane Filipinos 
1,900 
900 
Insane in Porto Rico 
50 
50 
Citizens Military Training Camp 
2,330,000 
2,807,471 
Medical history, World War 
National Homes for Disabled Volunteer 
16,600 
19,700 
Soldiers, hospitals 
1,755,500 
2,132,300 
Sanitation, Canal Zone 
Independent Establishments 
Employees' Compensation Commission 
580,000 
653,216 
Salaries 
136,600 
138,000 
General 
14,000 
10,000 
Compensation and medical relief 
2,500,000 
2,150,000 
United States Veterans' Bureau 
$ 2,550,600 
$ 2,298,000 
General 
46,790,000 
45,500,000 
Medical and hospital 
42,000,000 
35,000,000 
Vocational rehabilitation 
Federal Board for Vocational Education 
89,000,000 
38,000,000 
Salaries 
200,000 
200,000 
Industrial rehabilitation 
2,556,000 
Summary of Appropriations for 1926 
All purposes, including public health, sanitation, 
medical relief, rehabilitation, care of in- 
sane, hospital construction, narcotic control, 
etc about $131,000,000 
Medical relief and hospital service only about $ 48,000,000 
Public health work about $ 16,000,000 
Public health work, exclusive of meat inspec- 
tion about $ 11,600,000 
Annual federal budget about $3,267,000,000 
Per cent expended on public health about 0.5 per cent. 
Per cent expended on medical relief about 1.5 per cent. 
The Bureau of the Budget estimates that $12,593,341.29 is the 
amount of federal appropriation for the promotion of public 354 
NATIONAL GOVERNMENT AND HEALTH 
health for the fiscal year 1926.3 This figure differs from the 
estimate of the author due to the fact that the Bureau of the 
Budget has considered only part of the activities which are con- 
cerned with national public health and also because it has mixed 
medical relief with preventive work. The items included for health 
in its functional classification are: 
Interdepartmental Social Hygiene Board 
International Sanitary Bureau 
International Office of Public Health 
International Congress against Alcoholism 
Bureau of the Public Health Service 
St. Elizabeth's Hospital 
Freedmen's Hospital 
Enforcement of Pure Food and Drugs Laws 
Meat Inspection 
Division of Vital Statistics, Bureau of Census 
Children's Bureau 
This, is obviously an incomplete and in some respects erroneous 
classification; as far as the promotion of health is concerned. 
Federal Personnel on Health Work. The following figures 
show the number of Federal workers engaged on medical and 
public health activities. The data are in some cases, approximate, 
as personnel changes radically from time to time, and in certain 
instances the number is estimated. 
Treasury Department 
Public Health Service 
Commissioned medical officers 
203 
Acting assistant surgeons 
477 
Other medical personnel 
291 
Other scientific personnel 
582 
Other employees 
2,925 
Total 
4,478 
Bureau of Internal Revenue 
Narcotic agents 
164 
Department of Agriculture 
Bureau of Chemistry 
Scientific (chemists, engineers, bacteriologists, microscopists, and 
inspectors) 
300 
Other employees 
300 
3 Message of the President transmitting the Budget for the fiscal year 
1926, page A54. SUMMARY AND COMMENT 
355 
Bureau of Animal Industry 
Scientific (veterinarians, microscopists, inspectors, etc.).... 
.... 3,000 
Other employees 
Bureau of Home Economics 
... . 1,000 
Scientific personnel 
.... 20 
Other employees 
Bureau of Dairying 
.. . . 20 
Scientific personnel 
.. . . 120 
Other employees 
Bureau of Entomology 
50 
Scientific personnel 
.... 6 
Other employees 
15 
Department of Labor 
Children's Bureau 
Physicians 
5 
Other scientific personnel 
55 
Other employees 
76 
136 
Women's Bureau 
Scientific personnel 
19 
Other employees 
27 
Bureau of Labor Statistics 
3 
Department of the Interior 
Office of Indian Affairs, Medical Division 
Physicians 
42l8 
Other scientific personnel 
202 
Division of School Hygiene, Bureau of Education 
Physician 
I 
Other personnel 
5 
St. Elizabeth's Hospital 
Physicians 
57 
Other employees 
1,200 
Alaska Division, Bureau of Education 
Physicians 
8 
Other personnel 
35 
Department of Commerce 
Division of Vital Statistics, Bureau of the Census 
Total personnel (mostly clerical) 
69 
Bureau of Mines 
Safety and sanitation work 
100 
Department of War 
Medical Department 
Medical Corps 
935 
Dental Corps 
158 
Army Nurse Corps 
675 
Veterinary Corps 
126 
Medical Administrative Corps 
72 
Enlisted men 
7,000 
Other employees 
1,600 
4 Including fifty contract physicians. 356 
NATIONAL GOVERNMENT AND HEALTH 
Department of the Navy 
Medical Corps 
800 
Dental Corps 
ISO 
Nurse Corps 
500 
Hospital Corps 
5,ooo 
Other employees 
Miscellaneous 
45 
U. S. Veterans' Bureau 
Physicians and dentists 
2,125 
Nurses 
1,660 
Dietitians 
138 
Physiotherapy experts 
206 
Occupational therapy 
366 
4,495 
Total physicians in Government Service5 about 4,500 
Physicians actually doing public health work about 350 
Scientific (non-medical) personnel engaged directly or in- 
directly upon health and medical work about 10,000 
Scientific (non-medical) personnel, exclusive of Army, 
Navy, Veterans' Bureau about 6,000 
M'edical and Scientific personnel on federal health and 
medical work about 15,000 
Non-professional employees on health or medical 
work about 14,500 
Non-professional employees, exclusive of Army, Navy, and 
St. Elizabeth's about 2,000 
Grand total, medical, scientific and non-professional. .about 30,000 
Grand total actually concerned with public 
health estimated about 5,000 
Summary 
8 Not including contract physicians with the Bureau of Pensions, Employees' 
Compensation Commission, and other bureaus. CHAPTER XVI 
DUPLICATION IN FEDERAL HEALTH WORK 
When it is considered that there are some forty different Fed- 
eral bureaus which are directly or indirectly interested in some 
phase of public health, some duplication of functions and activities 
is naturally to be expected. Such duplication is not particularly 
extensive, however, nor, as a rule, is it serious where it does occur. 
The field is so vast and there is so much to be done, that the more 
accomplished to promote national vitality, the better. On the other 
hand, there is considerable overlapping, and, what is of equal 
significance, there are some gaps. Efficiency would be promoted if 
there could be concentration, with the use of greater resources, 
by several bureaus on one particular problem, instead of inde- 
pendent activities on different propositions. 
The actual overlapping' of certain functions will be briefly des- 
cribed in the following pages. 
Maternal and Child Hygiene. Maternal and child hygiene 
activities, that is, efforts to conserve and promote the health of 
mothers before, during, and after confinement, and of infants and 
children up to school age, are now conducted directly by the 
Public Health Service (Treasury), the Children's Bureau (Labor), 
the Bureau of Home Economics (Agriculture), the Extension 
Service (Agriculture), and the Federal Board for Vocational Edu- 
cation, and indirectly by a number of other bureaus. Statistics on 
births, infant mortality, and other subjects of significance to child 
hygiene are collected and compiled by the Division of Vital Sta- 
tistics of the Bureau of the Census (Commerce). 
In his admirable historical account of child welfare in the 
United States,1 Dr. Philip Van Ingen lists seven events as mile- 
stones in the development of this type of work. They are: 
1 In a half century of public health, p. 290. American Public Health 
Association (1921). 
357 358 
NATIONAL GOVERNMENT AND HEALTH 
1. The publication, in 1906, by the Census Bureau, of the Mor- 
tality Statistics for the five years 1900-1904. . . . " It was these 
accurate and systematic statistics from the Census Bureau which 
first called the attention of the country at large to the appalling loss 
of human life during infancy and childhood." 
2. Establishment in New York City, in 1908, of the Division of 
Child Hygiene. 
3. The Conference on Prevention of Infant Mortality, called 
by the American Academy of Medicine in New Haven in 1909. 
4. The formation of the Federal Children's Bureau in 1912. 
" This was the recognition by the Federal Government of the rights 
of the child and the advisability of special machinery to study and 
protect him. It was more than that, for it was an important step 
in arousing the interest and activity of the lay public in meeting 
a situation which had been considered to be the function and 
responsibility of the medical profession." 
5. The establishment of the Division of Child Hygiene in the 
New York State Department of Health. 
6. The establishment of the Birth Registration Area and the 
publication of birth statistics for 1916 (by the United States Bu- 
reau of the Census). " For the first time birth statistics, on which 
are based all infant mortality rates, were available for a consider- 
able area and were compiled in a uniform manner." 
7. The formation, in March, 1920, of the National Child Health 
Council and, in December of the same year, of the National Health 
Council. 
In 1908 the Public Health Service conducted studies of milk 
in relation to public health and published the results in a mono- 
graph of 750 pages,2 much of which was devoted to the place in 
milk in the health of children. In 1912 the service made exten- 
sive surveys of trachoma among children, and since 1915 it has 
done much school hygiene work.3 The service has had a section on 
child hygiene in its Division of Scientific Research for some years, 
in the charge of a surgeon of the medical corps. About $60,000 
a year is allotted to this work. In 1918 a program of child conser- 
vation was formulated by the service,4 and in 1924 child hygiene 
activities) were being conducted in twenty-one states and the Dis- 
2 Hygienic Laboratory Bulletin No. 41. 
3 See Clark, T., Child hygiene activities of the Public Health Service. 
Public Health Service, Reprint No. 723 (1922). 
4 Clark, T., The plans of the United States Public Health Service. 
American Association for Study and Prevention of Infant Mortality, 
Transactions, 1918. DUPLICATION IN FEDERAL HEALTH WORK 
359 
trict of Columbia,8 though much of it pertained to school hygiene 
rather than to infant welfare. Many pamphlets and bulletins on 
the subject have been issued by the Service.8 
Both the Public Health Service and the Children's Bureau are 
in close touch with state departments of health regarding child 
hygiene work. The latter bureau is charged with the administration 
of the Federal Maternity and Infancy Act, though the Surgeon 
General of the Public Health Service is one of the three members 
of the Federal Maternity and Infancy Board.7 When hearings were 
held in July of 1921, on this proposed law, representatives of the 
Public Health Service and other witnesses advocated that the ad- 
ministration of the law should be under the Public Health Service. 
Although testimony at congressional hearings is often of doubtful 
value, one quotation may be of interest, as it comes from one of 
the then Assistant Surgeons General of the Public Health Service, 
Dr. J. W. Schereschewsky. He said:8 
The- Public Health Service and the Children's Bureau are doing 
identical work. In other words, I know the Children's Bureau has 
relations with the State departments in child hygiene and so have 
we. Both of us try to help them out. We are Government servants 
here and the Government serves the public. 
He was asked, " Should we, if we could eliminate that duplica- 
tion, put it all into the hands of one service?" and answered: 
"If you want to be logical, I would say that all health matters 
should be under the direct charge of one Government agency; in 
the interests of efficiency no other answer is possible. Of course, 
Congress in its wisdom will do- exactly as it wants to in regards to 
that matter." 
Congress in its wisdom did not see fit, shortly thereafter, to1 en- 
trust the administration of the maternity and infancy act of No- 
vember 23, 1921 (42 Stat. L., 224), to the Public Health Service.' 
6 Surgeon General, Annual Report, 1924, p. 37. 
8 See Child hygiene and related publications issued by the Public Health 
Service, Reprint No. 960 (1924). Lists eighty-six pamphlets or bulletins. 
7 See page 242. 
8 House Committee on Interstate and Foreign Commerce. Hearing on 
public protection of maternity and infancy. 67 Cong., p. 199 (1921). 
8 See page 242. 360 
NATIONAL GOVERNMENT AND HEALTH 
The work of the Department of Agriculture on child hygiene has 
consisted in the conduct of a number of studies on nutritional 
problems,10 and the extension work done by home demonstration 
agents in rural regions.11 The Federal Board for Vocational Edu- 
cation, with the cooperation of the Children's Bureau, has issued 
a bulletin on " Child care and child welfare," 12 and through its 
home economics education service has stimulated interest in this 
subject. At one time (1913) the Home Education Division of the 
Bureau of Education was advising mothers on the care of babies, 
but this service seems to have been discontinued. 
" From being a neglected, almost friendless member of society 
fifty years ago," writes Dr. Van Ingen, " the child today occupies 
the center of the stage. Every period of his existence is being 
studied and the best intelligence in the world is busy in trying to 
secure for him conditions and opportunities which will render him 
an efficient, healthy, full grown member of society." This seems 
to be true with respect to the federal government. 
Child hygiene is an integral part of the whole public health 
movement. It cannot be separate from public health as a whole 
The child may be a unit, but public health is a more important unit. 
The infant mortality rate has declined with the general death 
rate and partly as a result of that decrease. Maternal and child 
hygiene activities should form a part of a central, unified program 
of federal health work. 
School Hygiene. Activities in the interest of the health of the 
child of school age are now conducted by the Public Health Service 
(Treasury), the Bureau, of Education (Interior), and the Bureau 
of Home Economics (Agriculture). Between the first two agencies 
named, there is considerable overlapping of functions, if not, per- 
haps, of actual operation. The Division of School Hygiene of the 
Bureau of Education, created in 1911, has conducted studies and 
issued pamphlets on many phases of school health work. The Pub- 
lic Health Service began epidemiological studies in schools in 1912, 
"As, Food for young children, Farmer's Bulletin No. 717 (1920). 
11 See Stanley, L., The contribution of the home demonstration agent to 
health, support and education for mothers, babies, and younger children in 
rural communities. American Child Health Association, Transactions, 1924. 
" No. 65 (1919). DUPLICATION IN FEDERAL HEALTH WORK 
361 
and has been making investigations of school hygiene ever since. 
Each of these agencies has published about fifty pamphlets on 
school hygiene or sanitation. Thus we find: 
Nutrition and Education. Reprint No. 798 of the Public Health 
Service; 
School Lunches. Farmer's Bulletin No. 712, prepared by the Bu- 
reau of Home Economics; 
Diet for the School Child. Health Education Series No. 2, of the 
Bureau of Education. 
Apropos of these bulletins on school lunches, the late H. C. 
Wallace, Secretary of Agriculture, told the Joint Committee on 
Reorganization that " Often what seems to be duplication is not 
duplication at all. I can give you an illustration of that in this way. 
We put out a bulletin on school lunches for country children. The 
question was raised as to whether that was not a duplication of a 
bulletin put out by another department on school lunches, and we 
had a great time discussing as to whether one of them should not 
be eliminated. As a matter of fact, it is not a duplication at all. 
One is directed to city children and the other to country children. 
One has circulation in the country and the other has circulation 
in the city. Yet there are people who hold up these two bulletins 
and say that duplication is going on in the service and that is a 
waste of the Government's money. There may be a duplication in 
the printing even and yet not a duplication in the circulation." 
In spite of Mr. Wallace's attempt to justify this duplication, it 
is still a duplication. The overlapping occurred in the preparation. 
One agency could have prepared one pamphlet applicable to school 
lunches. They are the same and have the same fundamental re- 
quirements whether eaten in rural or urban environments. One 
pamphlet could be circulated in both city and country schools. 
There is actual duplication here and it is the kind of thing which 
could be avoided by more effective correlation of health interests. 
The difference between the school hygiene work of the Public 
Health Service and the Division of School Hygiene of the Bureau 
of Education is that the former makes field investigations of phys- 
ical development, oral hygiene, and similar matters among school 
children, while the latter develops instructive material for the gui- 
dance of health promotion among children in school. A bill pro- 
posed in 1921 for federal aid to physical education in the states con- 362 
NATIONAL GOVERNMENT AND HEALTH 
tained a clause establishing a Division of Child Hygiene in the 
Public Health Service, but Congress did not pass this measure. 
Foods and Nutrition. Studies of human nutrition are conducted 
by the Bureau of Home Economics (Agriculture), the Bureau 
of Chemistry (Agriculture), the Bureau of Animal Industry 
(Agriculture), the Bureau of Fisheries (Commerce), and the Pub- 
lic Health Service (Treasury). All these agencies issue pamphlets 
regarding the care and use of food, and additional material is put 
out by the Children's Bureau (Labor), the Bureau of Education 
(Interior), the Bureau of Dairying (Agriculture), and the Fed- 
eral Board for Vocational Education. The Bureaus of Chemistry, 
Animal Industry, and Agricultural Economics of the Department 
of Agriculture do' regulatory work on foods shipped in interstate 
commerce, while the Customs Service (Treasury) cooperates in the 
regulation of food offered for entry into this country. 
A selected list of government publications on foods and nutri- 
tion, compiled at the Bureau of Home Economics, contains refer- 
ences to nearly two hundred publications on subjects pertaining to 
nutrition.13 About a dozen bureaus, divisions, offices, boards, or 
commissions are responsible for the production of these useful 
bulletins. The list of government publications on foods and cook- 
ing, issued by the Superintendent of Documents, contains over 
three hundred titles. 
Milk control offers a good example of duplication of effort. 
Both the Public Health Service and the Bureau of Dairying are 
conducting activities for the sanitation of milk.14 Several bureaus 
have issued educational pamphlets on the use of milk, as, for 
instance: 
Milk: The indispensable food for children (1918). Bur. Publ. 
35. Children's Bureau. 
Milk and our school children. Health Educ. Series No. 11 (1922). 
Bureau of Education. 
Safe milk, an important food problem. Supp. No. 31 (1917). 
Public Health Service. 
Milk and its uses in the home. Farmer's Bulletin No. 1359 (1923). 
Department of Agriculture. 
13 Van Deman, R., Selected list of government publications on foods and 
nutrition (January, 1925). 
14 See Frank, L. C., A statewide milk sanitation program. Public Health 
Service, Reprint No. 971 (1924); also: Kelly, E., Production of clean 
milk. Department of Agriculture, Farmer's Bulletin No. 602 (1923). DUPLICATION IN FEDERAL HEALTH WORK 
363 
The list of Government publications on animal industry issued 
by the Superintendent of Documents enumerates fifty different 
pamphlets or bulletins regarding milk, and this list is not a com- 
plete one. 
A few years ago, the Committee on Milk Supply of the Sanitary 
Engineering Section of the American Public Health Association 
wrote to four different departments of the Government asking 
whether they had officially defined pasteurization of milk. Three, 
the Public Health Service, the Department of Agriculture, and the 
Navy Department, replied, and the remarkable fact appeared that 
all of the definitions were different. Why should this be ? 
In this various food work, there is some line of demarcation. 
Thus, the Bureau of Fisheries is concerned only with sea food, the 
Bureau of Animal Industry only with meat, the Bureau of Dairy- 
ing only with dairy products, the Public Health Service with food 
in relation to health and disease, the Children's Bureau with the 
nutrition of children, the Bureau of Home Economics with food 
and nutrition in relation to home economics, and the Bureau of 
Chemistry with food research corollary to the enforcement of the 
pure food and drugs law. Yet it all has to do with the improve- 
ment of human health. 
The importance of food control to the public health is well 
brought out in an article on the extent of federal rural sanitation 
efforts, written by an officer of the Public Health Service. In 
Public Health Reports for October 23, 1925 (page 2255), he says, 
" The sanitary quality of the tremendous volume of raw foods 
now shipped daily through interstate traffic from our rural dis- 
tricts to our cities has an obviously important bearing on urban 
health, and, in view of the interstate feature, is a matter with which 
our federal government is to some extent concerned." It is not 
unreasonable to suppose that a correlation of these several gov- 
ernment nutritional interests might conduce to more effective 
results in the production of scientific information on nutritional 
hygiene. 
Industrial Hygiene. Industrial hygiene activities are conducted 
by the Public Health Service (Treasury), Bureau of Mines (Com- 
merce), Bureau of Labor Statistics (Labor), Children's Bureau 
(Labor), Women's Bureau (Labor), Bureau of Standards (Com- 364 
NATIONAL GOVERNMENT AND HEALTH 
merce), and the War, Navy, and Post Office Departments." The 
Public Health Service, using about $100,000 a year for the pur- 
pose, studies physical conditions in commercial plants, and also 
the factors influencing morbidity among industrial workers gener- 
ally. The Bureau of Mines studies methods for improving the 
health and safety of miners. The Bureau of Labor Statistics was 
the pioneer among the federal bureaus in making investigations of 
occupational diseases and still continues such studies. The Chil- 
dren's Bureau and the Women's Bureau are interested in the 
health of working children and women, respectively. The Bureau 
of Standards is working on safety codes to prevent accidents, while 
the War, Navy, and Post Office Departments, as the largest em- 
ployers of skilled labor in the Government, endeavor to provide 
safe working conditions for their employees. The Post Office 
Department has the cooperation of the Public Health Service in 
this regard. 
Although the functions of each of these bureaus seem to be 
well delimited, there is some overlapping. Thus studies have been 
made and publications produced on carbon monoxide poisoning 
by the Public Health Service, the Bureau of Mines, and the Bureau 
of Labor Statistics, as follows: 
Carbon monoxide poisoning in closed garages. Reprint No. 694 
(1921). Public Health Service. 
Vitiation of garage air by automobile exhaust gases. Tech. Paper 
216 (1919). Bureau of Mines. 
Carbon monoxide poisoning. Bulletin 291 (1921). Bureau of 
Labor Statistics. 
More recently such studies as have been made on carbon mon- 
oxide and allied problems by the Bureau of Mines have been 
under the direction of the officer detailed from the Public Health 
Service. The Public Llealth Service has recently been making 
studies on the effect of radioactive substances on workers at the 
Bureau of Standards. In 1925 the Bureau of Labor Statistics had 
a completed study, not yet ready for print, on the effects of radio- 
active substances on the health of workers. The value of having 
as much information as possible, from as many sources as possible 
18 See Bean, W. S., The Role of the Federal Government in Promoting 
Industrial Hygiene. American Journal of Public Health, July, 1925. DUPLICATION IN FEDERAL HEALTH WORK 
365 
on this and other industrial hygiene topics is apparent. Coordina- 
tion of efforts might, however, be a means of enhancing the value 
of these investigations. 
Sanitary Engineering. Sanitary engineering is conducted by 
the Public Health Service (Treasury), the Geological Survey (In- 
terior), the Bureau of Public Roads (Agriculture), the Army, the 
Bureau of Entomology (Agriculture), and by various other bu- 
reaus, the extent depending upon what is considered to be the do- 
main of sanitary engineering. It encompasses, in fact, all engineer- 
ing activities which affect human health by the control of environ- 
mental conditions. 
The Public Health Service, with a personnel of about thirty 
well-trained, graduate sanitary engineers, is the chief agency con- 
cerned with this essential branch of public health. All other sani- 
tary engineering of the government should be performed by, 
directed by, or coordinated with that of the Public Health Service. 
Dairy sanitation, for instance, is more of an engineering problem 
that a veterinary or a chemical one. 
The Geological Survey is concerned only with water resources 
in a general engineering way, and so there is no conflict here. The 
Bureau of Public Roads is the engineering office of the Depart- 
ment of Agriculture, and has designed sanitary conveniences for 
farm homes, a subject frequently considered by the Public Health 
Service. This is one example of an entirely unnecessary duplica- 
tion. The Bureau of Entomology is conducting experiments on 
mosquito control, and the Bureau of Biological Survey, on rodent 
control, both subjects being also covered by the Public Health Ser- 
vice, though the duplication here is not serious and is one of func- 
tion and not operation.16 The chief of the Bureau of Entomology 
is supposed to be consulting entomologist for the Public Health 
Service, though the consultations are said to have been extremely 
rare. 
Rural Hygiene. Health promotion in rural areas is sponsored 
by the Children's Bureau (Labor), the Public Health Service 
10 Out of about one hundred government publications on malaria, the 
majority come from the Public Health Service. See, Some facts about 
malaria, Farmer's Bulletin 450 (1911, revised 1924) ; and What the farmer 
can do to prevent malaria, Public Health Service, Supp. 11 (1914. 
See also, Insects, Price List 41, and Price List 39, Birds and wild animals. 
Superintendent of Documents. 366 
NATIONAL GOVERNMENT AND HEALTH 
(Treasury), the Extension Service (Agriculture), and the Federal 
Board for Vocational Education. The Children's Bureau, under 
the Federal Maternity and Infancy Act, is endeavoring to see that 
mothers and infants in rural districts get the same health advan- 
tages that those in the cities have. The Public Health Service 
received for 1926, an appropriation of $75,000 for rural sanita- 
tion, which cannot be used for demonstration purposes in the 
states unless the state, county, or municipality agrees to pay half 
the expense of such work (43 Stat. L., 775). In the fiscal year 
1925 the Service cooperated in demonstration projects in seventy- 
nine counties, or districts comparable to counties, in nineteen 
states.17 
The Extension Service of the Department of Agriculture has 
nearly one thousand home demonstration agents and about two 
thousand persons engaged in county agent work. Promotion of 
rural health is considered one of the many proper functions of 
these workers, and all reports are replete with data as to improved 
sanitary practices brought about by these agents.18 The Federal 
Board for Vocational Education administers the expenditure of 
large Federal subsidies for agricultural education. 
Rural hygiene is an important element in public health and there 
is a vast amount of effort needed along these lines. More effective 
results would, nevertheless, be achieved by coordinated activities. 
Tuberculosis. Tuberculosis control work, either actual operation 
or study, is undertaken by the Public Health Service (Treasury), 
the Bureau of Animal Industry (Agriculture), the United States 
Veterans' Bureau, the Office of Indian Affairs (Interior), the 
Bureau of Labor Statistics (Labor), the Bureau of Mines (Com- 
merce), the Army and the Navy, the Bureau of Chemistry (Agri- 
culture), the Post Office Department, and a few other organiza- 
tions. With the Army, Navy, Veterans' Bureau, and Office of In- 
dian Affairs, this work is concerned with the persons coming under 
the special jurisdiction of these departments. Likewise, the studies 
of the Bureau of Mines have been concerned with miners' phthisis. 
The investigations of the Bureau of Labor Statistics have had to 
do with the effects of dust on workers. The Bureau of Animal 
17 See Lumsden, L. L., Cooperative rural health work of the Public Health 
Service in the Fiscal Year 1925. Public Health Reports, October 23, 1925. 
18 See Department of Agriculture, Cooperative extension work, 1923. DUPLICATION IN FEDERAL HEALTH WORK 
367 
Industry gets an annual appropriation of nearly a million dollars 
for eradication of tuberculosis in animals, and another two and a 
half million for indemnities. The Bureau of Chemistry analyzes 
so-called consumption cures and either that bureau or the Post 
Office Department sets in motion prosecuting machinery against 
frauds. Tuberculosis cures are also analyzed and tested by the 
Hygienic Laboratory of the Public Health Service, and the Ser- 
vice is interested in the general problems of the disease. There 
is, as a matter of fact, not much duplication here, although coopera- 
tive efforts would be desirable. 
Mental Hygiene. Mental hygiene work, psychiatry, and other 
analogous subjects are considered by the Children's Bureau (La- 
bor), Public Health Service (Treasury), St. Elizabeth's, the Gov- 
ernment Hospital for the Insane (Interior), the United States 
Veterans' Bureau, and more or less indirectly by some other bu- 
reaus. The Bureau of Home Economics, for instance, is making a 
study of the psychology of child feeding.19 St. Elizabeth's is not 
only a relief institution, but also a valuable laboratory for mental 
hygiene studies. The only instance of direct collaboration between 
the Children's Bureau and the Public Health Service was on studies 
of mentally defective children in the District of Columbia (1914) 
and in Delaware, and on psychiatric studies of delinquent girls 
(1919). The Public Health Service has made a number of other 
studies and issued several pamphlets on mental deficiency. The 
service also makes the mental examinations of arriving immi- 
grants. 
Statistics.20 Statistics relating to various phases of public health 
are collected, compiled, and analyzed by a number of different bu- 
reaus. Thus, birth and mortality data for the United States are 
obtained by the Division of Vital Statistics of the Bureau of the 
Census (Commerce) ; morbidity reports are collected and published 
by the Public Health Service (Treasury), which has also issued a 
reprint annually since 1912, giving the mortality from certain com- 
municable diseases; statistics on infant mortality and children are 
assembled by the Children's Bureau (Labor) ; industrial accident 
19 Department of Agriculture, Official Record. November 4, 1925. 
20 See Schmeckebier, Statistical work of the National Government (1925). 
Institute for Government Research. 368 
NATIONAL GOVERNMENT AND HEALTH 
data are gathered by the Bureau of Labor Statistics (Labor), ex- 
cept in the case of mine and quarry accidents, data for which are 
compiled by the Bureau of Mines (Commerce) ; and railroad acci- 
dents, by the Interstate Commerce Commission. The Bureau of 
the Census has also collected and published statistics on the insane 
and feeble-minded, and on hospitals. The Army, Navy and Vet- 
erans' Bureau have their own statistical services, as do a number of 
other agencies interested in public health. The Army's report on 
the results of the draft examinations constitutes the only national 
data on physical defects of the male population. 
Statistics are ancillary to the work of any bureau, no matter what 
its particular function may be. Thus it is entirely proper and logi- 
cal that the Children's Bureau should be concerned with statistics 
on infant mortality, so long as the bureau is charged by law with 
the duty of investigating that subject. Vital statistics, however, are 
the bookkeeping of public health. Because the data are so essential 
to an adequate conception of general conditions of national vitality, 
they should be collected by a central federal health agency. 
If any further argument were needed for such a transfer, it can 
be found in the annual report of the Director of the Census for the 
fiscal year 1925. On page 11 of this report occurs the following 
significant statement (italics ours) : 
The annual mortality statistics give the number of deaths from 
each cause in each locality, and thus make it possible to measure 
the toll exacted by each cause of death from year to year. Such 
■figures Serve as the foundation of public health work. They indi- 
cate to the public health officer the most promising direction for 
the expenditure of funds appropriated for such work, and they 
clearly show what degrees of success have attended the campaigns 
for better health in former years. 
No better reason for the collection of vital statistics by a central 
health agency could be given than this dictum from the Director 
of the bureau now responsible for such collection. 
Drug Control. The control or investigation of various kind's of 
drugs is the concern of the Bureau of Chemistry (Agriculture), the 
Public Health Service (Treasury), the Internal Revenue Office 
(Treasury), the Federal Narcotics Control Board, and the Bureau 
of Plant Industry (Agriculture). In addition, the Patent Office DUPLICATION IN FEDERAL HEALTH WORK 
369 
(Commerce) issues patents and trade-marks for medicines and 
drugs, and the Customs Service (Treasury) cooperates in the 
control of drugs and narcotics. The last named drugs are regulated 
by the Internal Revenue Office, though the Public Health Service 
has conducted a number of studies on narcotics. The Bureau of 
Plant Industry, as a more or less incidental activity, explores for 
and studies medicinal plants. 
Publications..21 Every federal agency interested in any way with 
the public health has issued pamphlets and bulletins on some aspect 
of the subject. Many of these have been indicated in various 
places in this book. The total number of government health publi- 
cations is somewhat astounding. The latest list of publications 23 
on health, diseases, drugs, and sanitation, issued by the Superin- 
tendent of Documents, contains the titles of over 1200 different 
pamphlets and this is not all that there are. There are forty differ- 
ent classes of pamphlets included, that is, such series as the Far- 
mer's Bulletins, Reprints from the Public Health Reports, Health 
Education Series, etc. 
The quantity of different classes of pamphlets on health is 
summarized below though this tabulation is not complete, as addi- 
tional bulletins have appeared and are constantly appearing subse- 
quent to the dates of the catalogs consulted. Not all the different 
bureaus are included in this tabulation, but only the more prominent 
ones. 
Federal Publications on Health 
I. Public Health Service23 
Public health bulletins I42 
Venereal disease bulletins 74 
Bulletins of the Hygienic Laboratory 138 
Yellow-fever Institute bulletins 17 
Reprints from the Public Health Reports 897 
Supplements to the Public Health Reports 44 
Keep Well Series 13 
Miscellaneous publications 28 
1,353 
31 See Schmeckebier, The Government Printing Office. Institute for 
Government Research, Service Monograph No. 36 (1925). 
33 Price List No. 51. 
33 List of May, 1924. 370 
NATIONAL GOVERNMENT AND HEALTH 
2. Children's Bureau24, 
General child welfare 21 
Bulletins for mothers 6 
Child hygiene 28 
Maternal and infant hygiene 39 
Maternal and infant mortality 18 
Rural child welfare 17 
Mental defect 8 
Total of 167, less 91 on non-health and duplications 76 
3. Bureau of Labor Statistics25 
Bulletins on industrial hygiene 50 
4. Women's Bureau26 
Bulletins on health of working women 2 
5. Department of Agriculture25 
Department bulletins 34 
Department circulars 14 
Farmer's bulletins 35 
Year book separates 5 
88 
6. Bureau of Education22 
Bulletins 11 
Health Education Series 16 
School health studies 6 
Miscellaneous 4 
37 
7. Bureau of Mines23 
Bulletins 5 
Technical papers 21 
Miners' circulars 6 
Miscellaneous 4 
36 
8. Office of Indian Affairs 
Health pamphlets 5 
9. Geological Survey 
Water-supply papers on sanitary engineering 17 
10. Bureau of the Census 
Vital statistics 13 
Miscellaneous 18 
3i 
24 List of April 15, 1925. 
25 List of December 1, 1924 
28 List of October, 1924. 
27 List of September, 1924. 
23 List of July, 1924. DUPLICATION IN FEDERAL HEALTH WORK 
371 
ii. Bureau of Standards 
Miscellaneous, safety, etc 4 
Total about 1,700 
The distribution of these health pamphlets is tremendous. Over 
three million copies of one pamphlet alone, " Infant care," issued 
by the Children's Bureau, have been sent out. During 1924, the 
Children's Bureau distributed 1,345,862 copies of all its publi- 
cations, of which nearly half were on the care of children. The 
Health Education Series of the Bureau of Education has also 
been popular, and has been printed in the past in editions of a 
million each. The Public Health Service distributes annually about 
half a million copies of its general publications (527,614 in 1924) 
and about a million (1,230,811 in 1924) on venereal diseases. The 
Public Health Service adds about one hundred new pamphlets or 
reprints each year to its available supply. The Farmer's Bulletins 
and other publications of the Department of Agriculture are also 
in great demand. 
During the fiscal year 1924 government publications sold num- 
bered 7,244,727, while those distributed free by various depart- 
ments amounted to 48,528,418, a grand total of 55,773,145- Just 
what proportion of these were on the subject of health, is difficult to 
state, though the Children's Bureau and the Public Health Ser- 
vice together distributed about three million, so that five million 
Federal health pamphlets a year is a conservative estimate of pres- 
ent distribution. The number has been much greater in the past. 
In 1920, for instance, the Public Health Service alone distributed 
about eighteen million pamphlets, half of them on the venereal 
diseases. 
The question has been raised as to whether a more efficient con- 
centration of effort regarding government health pamphlets might 
not be conducive to better quality and more effective distribution.29 
There are many people to be reached, however, and different bu- 
reaus often have different clienteles. A reasonable coordination in 
the matter of production of these health pamphlets would unde- 
niably be somewhat worthwhile, and undoubtedly it would also be 
economical. 
29 See editorial, Pamphleteering and public health, American Journal of 
Public Health, February, 1922, p. 148. 372 
NATIONAL GOVERNMENT AND HEALTH 
Periodicals. A number of bureaus issue periodicals which are 
concerned entirely with public health or medicine, or else carry 
articles on health subjects. The most valuable of these to sanita- 
rians is Public Health Reports, issued weekly by the Public Health 
Service. It contains technical articles, statistics, and other useful 
and essential information. The principal current publications are 
as follows: 
Public Health Reports. Weekly. Public Health Service. 
Naval Medical Bulletin. Monthly. Bureau of Medicine and Sur- 
gery, Navy Department. 
United States Veterans' Bureau Medical Bulletin. Monthly. 
Monthly Labor Review. Bureau of Labor Statistics. 
Weekly News Summary. Mimeographed. Children's Bureau. 
Official Record. Weekly. Department of Agriculture. 
School Life. Monthly. Bureau of Education. 
Experiment Station Record. Monthly. Department of Agriculture. 
Weekly reports. Mimeographed. Division of Vital Statistics, Bu- 
reau of the Census. 
Service and regulatory announcements (food and drugs). Depart- 
ment of Agriculture. 
General Comment. In the preceding pages there have been set 
forth a number of instances of actual or apparent duplication of 
effort in federal public health activities. Many other specific ex- 
amples of overlapping could be cited, though most of them would 
be of minor importance. The descriptions of each bureau given 
in the preceding part of this book indicate in greater detail the 
instances of overlapping. It is worth repeating that the field of 
public health is vast, that the need for many efforts is great, and 
that even with the activities now undertaken, the whole field is 
inadequately covered. Duplication is, therefore, not particularly 
serious, but the elimination of such as there is would, nevertheless, 
add something to the efficacy of national public health endeavor. 
If Congress should suddenly see fit to grant ten times as much 
financial assistance to Federal health activities as is now the case, 
duplication would be more apparent and more troublesome and 
there would be no question of the advisability of unification of 
health work. Coordination under present conditions would mean 
more and better production for every dollar spent. Efficiency in 
production is to be desired under any circumstances, but especially 
when budgets are restricted. PART III 
THE CORRELATION OF FEDERAL HEALTH 
ACTIVITIES 
CHAPTER XVII 
PREVIOUS ATTEMPTS 
As federal health activities have increased in importance and 
scope during the last century or so, suggestions have frequently 
been made that they should be correlated. Such expressions began 
some fifty years ago and have been growing in intensity ever since. 
Every President from Cleveland on has advocated a better arrange- 
ment of national health work, and many proposals to this end 
have been made. Several definite campaigns for a national bureau 
of health have been undertaken, though without achieving the 
results sought. The story of these attempts and the narrative of 
the consideration given to the subject in the past are essential to 
the present discussion of this important matter, for the experi- 
ence and lessons of the past often have a significant influence on the 
movements and programs of the present. 
The National Board of Health.1 The first serious endeavor to 
unify federal health work was the creation in 1879 °£ a National 
Board of Health. This board, however, was brought into being 
not so much in order to centralize health activities as to provide an 
effective administrative organization for dealing with a disastrous 
epidemic of yellow fever prevalent at the time. Sanitary legis- 
lation of national scope was, in fact, usually the result of the panics 
caused by epidemics. The early quarantine legislation was always 
induced by1 the inability of the states to cope with the devastation 
of disease, though Congress hesitated for many years before pass- 
1 See Part I, Chapter IV, page 33, for a more complete description of this 
board and its work. 
373 374 
NATIONAL GOVERNMENT AND HEALTH 
ing a really comprehensive national quarantine act. It did not do 
so until 1893/ though there had been a partially effective law in 
1878. 
The National Board of Health was created by an act of March 
3, 1879 (20 Stat. L., 484), but this law merely charged the board 
with obtaining information on all matters affecting the public 
health and giving advice regarding national vitality. The board 
was also directed to report to Congress at its next session, a plan 
for a national public health organization, to be prepared after a 
consultation with the principal sanitary organizations and the sani- 
tarians of the several states. The duties of the board were greatly 
enlarged on June 2, 1879, by an act (21 Stat. L., 5) to prevent 
the introduction of contagious or infectious diseases into the 
United States. This law authorized the board to cooperate with 
and SO' far as it lawfully could, to aid state and municipal boards 
of health in the execution and enforcement of quarantine; and 
also to make such rules and regulations as were permitted by fed- 
eral laws for the enforcement of maritime quarantine. 
Various other duties were given to the board, chiefly of an 
investigatory nature, and little opportunity for administrative ef- 
fort was offered. The board began operations in 1879, and during 
the next few years conducted a number of useful investigations. 
Its quarantine activities brought it into conflict with some state 
authorities and with those whose commercial interests ran counter 
to activities for the public health. In 1882, when the danger from 
epidemics had somewhat subsided, Congress restricted the duties 
of the board to the investigation of yellow fever, cholera, and 
smallpox (22 Stat. L., 315). The board held no meetings after 
1884, and received no appropriations after that time. In 1893 the 
law which had created it was repealed (27 Stat. L., 452), and a 
new and extensive national quarantine act (27 Stat. L., 449) was 
passed, charging the Marine Hospital (now the Public Health) 
Service with its enforcement. An unsuccessful attempt was made 
in 1899 to' revive the National Board of Health. 
President Cleveland's Recommendation. In 1884 Grover 
Cleveland, who was serving his first term as President, urged Con- 
gress to create a national board of health or similar instrumental- 
ity,8 but Congress did not act on the recommendation. 
3 See page 90. 
3 See Chapter III, page 24. PREVIOUS ATTEMPTS AT CORRELATION 
375 
Federal health activities continued to be scattered throughout 
several departments of the government. The diversity of interests 
was well brought out in a paper written by Professor James W. 
Garner in 1905.4 In describing these activities of twenty years ago, 
the author said: 
There is hardly a department of the government which does not 
exercise functions either directly or indirectly in aid of the pub- 
lic health, mainly by contributing to our knowledge of sanitary 
science, but sometimes by other means. Thus, the Interior Depart- 
ment, through the Hydrographic office, studies the question of 
a wholesome water supply, and through the Bureau of Education 
it publishes reports on schools, hygiene, and similar subjects. The 
Department of Commerce and Labor through the Bureau of Labor 
conducts investigations into the condition of slums, housing of 
the working people, the factory system, etc., and sends broadcast 
printed reports of such investigations. The Navy Department 
through its Bureau of Medicine and Surgery maintains a medical 
school of research and instruction for its officers. The War De- 
partment maintains a somewhat similar school, and through its 
corps of sanitary engineers render valuable service towards the 
sanitary rehabilitation of communities governed by the military 
authorities. Its work in Havana at the close of the war with 
Spain and its services in Panama, at the present time are notable 
examples. The work of the State Department in requiring consuls 
to furnish bills of health and make reports on the sanitary condi- 
tions of the ports at which they reside, as well as that of the Trea- 
sury Department through the Marine Hospital Service, has al- 
ready been described. The Agricultural Department, through 
the Bureau of Chemistry, the Bureau of Animal Industry, and the 
Weather Bureau, renders valuable service in the interest of the pub- 
lic health. Through the Division of Foods in the former bureau the 
pure food legislation is enforced, and investigations into the char- 
acter of food preservatives and adulterations are conducted, while 
through the Bureau of Animal Industry, with its more than 1400 
employees, the meat inspection laws are executed, and investiga- 
tions into the existence of contagious diseases in animals used for 
human food are carried on. With the possible exception, therefore, 
of the Postoffice Department and the Department of Justice, all 
of the departments of the national government are at present con- 
ducting lines of activity which relate directly or indirectly to the 
promotion of the public health. 
4 Garner, Federal activity in the interest of the public health, Yale Review, 
August, 1905. 376 
NATIONAL GOVERNMENT AND HEALTH 
The Committee of One Hundred. A proposal that these exist- 
ing Federal health agencies should be brought together to form, a 
central health department was contained in a notable paper in 
1906, read by J. Pease Norton, Ph. D„ before the Economic Section 
of the American Association for the Advancement of Science. The 
paper met with enthusiastic approval in the Association, and as a 
result there was appointed a Committee of One Hundred on Na- 
tional Health, comprising sociologists, economists, philanthropists, 
sanitarians, educators, clergymen, city health officers, state health 
officers, and members of the medical profession.6 This committee 
worked out a plan for the construction of a national health depart- 
ment, and for several years carried on a, very active campaign to 
this end. 
In 1908 President Roosevelt called a White House conference to 
consider national conservation. One of the many results of this 
conference was the development of a remarkable report on national 
vitality,* prepared for the National Conservation Commission by 
Professor Irving Fisher, one of its members, who was also chair- 
man of the Committee of One Hundred. In this report of 
130 pages were summarized and explained data for the United 
States on the existing span of life, the prevalence of disease and 
physical deficiency, the conservation of life, and its prolongation. 
The report recommended, among other things, that " the existing 
health agencies of the Government should be concentrated in one 
department, better coordinated, and given more powers and ap- 
propriations." 
Both of the major political parties took cognizance of this 
movement in 1908, and included planks regarding it in their plat- 
forms. The Republican platform said, "We commend the efforts 
designed to secure greater efficiency in national public-health agen- 
cies and favor such legislation as will effect this purpose." The 
Democratic platform, with the approval of the late William J. 
Bryan, went even further, saying, "We advocate the organization 
of all existing national public-health agencies into a national bureau 
of public health, with such power over sanitary conditions con- 
nected with factories, mines, tenements, child labor, and other such 
6 Memorial relating to the conservation of human life. 62 Cong., S. doc. 
493, P- 43 (1912). 
6 Report on national vitality (1909). (Now out of print.) PREVIOUS ATTEMPTS AT CORRELATION 
377 
subjects as are properly within the jurisdiction of the Federal 
Government and do not interfere with the power of the states con- 
trolling public-health agencies." The Independence League party 
of 1908 adopted an even broader plank on this subject. 
In 1908 President Roosevelt appointed a commission consisting 
of Charles D. Walcott, J. R. Garfield, W. L. Capps, William Cro- 
zier, and Gifford Pinchot to study the organization of the scientific 
work of the government. On November 13, 1908, this commission 
made a report to the President recommending that all bureaus 
relating to public health be transferred to the Department of the 
Interior.7 In his last annual message to Congress on December 8, 
1908, Mr. Roosevelt urged Congress to coordinate federal health 
activities, saying, " . . . The first legislative step to be taken is 
that for the concentration of the proper bureaus into one of 
the existing departments. I, therefore, urgently recommend the 
passage of a bill which shall authorize a redistribution of the bu- 
reaus which shall best accomplish this end." 
Efforts During the Taft Administration. President William H. 
Taft, in his first annual message to Congress, on December 7, 1909, 
made a strong plea for a national bureau of health,8 a matter which 
he had espoused while Secretary of War. In March, 1910, a bill 
to this end was introduced in Congress. This bill, in suggesting the 
transfer to a new Department of Public Health of " all departments 
and bureaus belonging to any department, excepting the Depart- 
ment of War and the Department of the Navy, affecting the medi- 
cal, surgical, biological, or sanitary service, or any question rela- 
tive thereto," proposed to take over the Public Health and Marine 
Hospital Service; the medical officers of the Revenue Cutter Ser- 
vice, of the Pension Office, of the Indian Service, and of the Sol- 
dier's Homes; all hospitals ; the Bureaus of Chemistry, Entomology, 
and Animal Industry of the Department of Agriculture; and the 
emergency relief service of the Government Printing Office. 
Hearings were held on this bill by both Senate and House Com- 
mittees. About thirty proponents and a dozen opponents appeared. 
The chief fault of the proponents seemed to be the lack of agree- 
ments on a definite, well considered plan. All these witnesses had 
general ideas, but no specific suggestions, and several of them con- 
7 Schmeckebier, The Public Health Service, p. 33. 
8 See page 27. 378 
NATIONAL GOVERNMENT AND HEALTH 
tradicted one another. The opponents represented various healing 
cults and leagues for medical freedom, so called. Their attorney 
was ex-Governor John L. Bates of Massachusetts. No action was 
taken by this Congress. The gist of these hearings was ably sum- 
med up in an article in the Journal of the American Medical Asso- 
ciation by Dr. George B. Young, who' also proposed a plan of his 
own as a substitute.9 
In his second annual message to Congress, on December 6, 1910. 
President Taft decried the opposition which had arisen to the pro- 
posed national health department and again recommended adop- 
tion of the plan. Another and somewhat modified bill was intro- 
duced in 1912, and again a determined effort was made to induce 
Congress to pass it. In May of that year the President transmitted 
to Congress a report of the Commission on Economy and Effici- 
ency which recommended coordination of health activities. This 
report specifically urged the transfer to a new Public Health Ser- 
vice of the Public Health and Marine Elospital Service, the Bureau 
of Chemistry, and the Division of Vital Statistics of the Census 
Bureau. It further proposed the granting of authority to the 
President to transfer to the new establishment, the whole or a part 
of any existing government organization engaged in public health 
work, except the medical departments of the Army and Navy. 
Once again, opposition arose. Ex-Governor Bates had appeared 
at the hearings on March 30, 1912, and contended that the legisla- 
tion was not needed, not wanted except by a few " political doc- 
tors," and that it was generally illegal and unconstitutional.10 His 
argument is by no means convincing. The legal basis for federal 
health activities has been presented earlier in this book,11 and clear- 
ly shows under what constitutional sanction such work may be 
exercised by the federal government. 
Congress again took no action on the matter, although a law was 
passed changing the name of the Marine Hospital and Public 
Health Service to the Public Health Service (37 Stat. L., 309). 
9 Young, The proposed enlarged national public health organization, 
Journal of the American Medical Association, September 17, 1910, Vol. LV, 
pp. 979-89 (1910). See also National public health. 61 Cong., S. doc. 637 
(1910). 
19 Bates, Public health bureau or service, 62 Cong., S. doc. 560 (1912). 
Contra, see Memorial relating to the conservation of human life. S. doc. 493. 
11 See pages 48, 61. PREVIOUS ATTEMPTS AT CORRELATION 
379 
This law did little else except authorize extensive investigations by 
the service and increase the salaries of the commissioned officers.13 
After this lack of positive success, the Committee of One Hundred 
became inactive. Senator Owen, who was the author of the bill, has 
introduced a similar one at every session of Congress since. 
Coordination During the World War. No further attempt to 
achieve correlation of federal health activities was made until 1918. 
In order to coordinate all these activities in the interests of effici- 
ency during the war with Germany, President Woodrow Wilson, 
on July 1, 1918, issued an executive order placing practically 
all health work of the government under the Public Health Ser- 
vice.13 This order read as follows : 
Whereas, in order to avoid confusion in policies, duplication 
of effort, and to bring about more effective results, unity of con- 
trol in the administration of the public health activities of the 
Federal Government is obviously essential, and has been so recog- 
nized by Acts of Congress creating in the Treasury Department a 
Public Health Service, and especially authorizing such Service " to 
study the diseases of men and the conditions influencing the propa- 
gation and spread thereof " and " to cooperate with and aid 
state and municipal boards of health "; 
Now, therefore, I, Woodrow Wilson, President of the United 
States, by virtue of the authority vested in me as Chief Executive, 
and by the Act " authorizing the President to coordinate or consoli- 
date executive bureaus, agencies, and offices, and for other pur- 
poses, in the interest of economy and more efficient concentration 
of the Government," approved May 20, 1918, do hereby order 
that all sanitary or public health activities carried on by any execu- 
tive bureau, agency, or office, especially created for or concerned 
in the prosecution of the existing war, shall be exercised under the 
supervision and control of the Secretary of the Treasury. 
This order shall not be construed as affecting the jurisdiction 
exercised under authority of existing law by the Surgeon General 
of the Army, the Surgeon General of the Navy, and the Provost 
Marshal General in the performance of health functions which are 
military in character as distinguished from civil public health 
duties, or as prohibiting investigations by the Bureau of Labor 
Statistics of vocational diseases, shop sanitation, and hygiene. 
12 The development and status of the Public Health Service in 1913 was 
well set forth in Kerr, J. W., Federal public health administration. Pub- 
lic Health Service, Reprint No. 112 (1913). 
13 See Warren, B. S., and Bolduan, C. S., War activities of the Public 
Health Service. 380 
NATIONAL GOVERNMENT AND HEALTH 
At the request of a confidential adviser of President Wilson, a 
group of prominent sanitarians drafted, in 1918, a plan for a na- 
tional health policy. This plan, which has never been published, 
recommended that to carry out the policies formulated, there be a 
Secretary of Health and that there be grouped under his direc- 
tion the Public Flealth Service, the Children's Bureau, the Divi- 
sion of Vital Statistics of the Census Bureau, and the Bureau 
of Chemistry. No definite action was ever taken on this matter. 
Late in 1918, Dr. F. L. Hoffman, of the Prudential Life Insurance 
Company, presented an elaborate plan for a United States Health 
Administration as an independent federal department, respon- 
sible directly to the President.14 The pamphlet issued on this sub- 
ject by him was a consolidation of two papers, one presented at the 
American Public Health Association Convention in 1918, the other, 
to the Commonwealth Club of California about the same time. 
Proposed Reorganization of the Executive Departments. 
Shortly after Warren G. Harding was elected to the presidency, 
there was considerable renewed agitation for the general reorgani- 
zation of the federal executive departments. On December 17, 
1920, Congress passed a joint resolution creating a Joint Commit- 
tee on Reorganization to study and report on this problem. On 
May 5, 1921, another resolution was passed, adding to this commit- 
tee a representative of the President. With the President's de- 
signee as chairman, this committee proceeded to work out a plan 
for reorganization. 
In the meantime, the President's personal physician, Brigadier 
General C. E. Sawyer, had been asked by Mr. Harding to consider 
how to improve the administration of the health and welfare agen- 
cies of the government. In fact, Dr. Sawyer asserted at hearings 
before Senate committees that he came to Washington to help the 
President develop a plan for a department of welfare.10 Senator 
Kenyon introduced a bill for a Department of Social Welfare in 
1921, at the first session of the Sixty-seventh Congress. This bill 
was later revised and the name of the proposed department changed 
to Public Welfare. It provided for a Secretary in the Cabinet, 
14 Hoffman, A plan for a more effective Federal and state health adminis- 
tration (1918). 
15 Senate hearings on S. 408, April 21, 1921. PREVIOUS ATTEMPTS AT CORRELATION 
381 
with assistant secretaries for Education, Public Health, Social 
Service, and Veteran Service, and would have transferred to the 
proposed department various bureaus concerned with the subjects 
mentioned. No action was taken on this matter by the Sixty- 
seventh Congress, which adjourned on March 3, 1923, after having 
been in almost continuous session since April 1, 1921. Just before 
Congress adjourned, President Harding submitted a plan for 
reorganization of the executive departments, including a new 
Department of Education and Welfare, though no bill was intro- 
duced at this time. This plan for the department mentioned was 
more or less similar to the previous ones.18 
Federal Board of Hospitalization. A Federal Board of Hospi- 
talization was created on November 1, 1921, by the Director of the 
Bureau of the Budget (Mr. Charles G. Dawes) by direction of the 
President.17 The purpose of this board was to coordinate the sepa- 
rate hospitalization activities of the Medical Department of the 
Army, the Bureau of Medicine and Surgery of the Navy, the 
Public Health Service, St. Elizabeth's Hospital, the National Home 
for Disabled Volunteer Soldiers, the Office of the Commissioner 
of Indian Affairs, and the United States Veterans' Bureau. 
Brigadier General C. E. Sawyer was appointed Chief Coordi- 
nator and served as President of the board until late in 1924, when 
he was succceeded by the Director of the United States Veterans' 
Bureau. The other members have consisted of the three Surgeons 
General, the Superintendent of St. Elizabeth's Hospital, the Presi- 
dent of the Board of Managers of the National Home for Dis- 
abled Soldiers, and the Commissioner of Indian Affairs. The board 
has held regular meetings on the first and third Mondays of every 
month. 
The duties of the board were set forth as follows: 
To consider all questions relative to the coordination of hospitali- 
zation of the departments represented. 
To standardize requirements, to expedite the interdepartment 
use of existing Government facilities to eliminate duplication in 
the purchase of supplies and the erection of buildings. 
To formulate plans designed to knit together in proper coordi- 
nation the activities of the several departments and establishments, 
18 67 Cong., S. doc. 302 (1923). 
17 Treasury Department, Circular No. 44. 382 
NATIONAL GOVERNMENT AND HEALTH 
with a view to safeguarding the interests of the Government and 
to increasing the usefulness and efficiency of the several organi- 
zations, and to report to the President thereon. 
The board has no appropriation. 
Sundry Proposals. A comprehensive scheme for reorganiza- 
tion of the administrative branch of the National Government was 
issued in 1923 by the Institute for Government Research. This 
plan, which had been evolved after many years' study, contained as 
one of its major recommendations a proposal for a new depart- 
ment of public health. It would take over the Public Health Ser- 
vice; the Division of Vital Statistics of the Census Bureau; the 
enforcement of the Pure Food and Drugs Law, as performed by the 
Bureau of Chemistry; the inspection of meat, as done by the Bu- 
reau of Animal Industry; St. Elizabeth's Hospital; the Columbia 
Institution for the Deaf ; and it suggested consideration for the pos- 
sible transfer of certain other institutional services, such as the Of- 
fice of Superintendent of Prisons, and the Bureau of Immigration. 
Studies made in 1922 under the auspices of the National Health 
Council had shown that there were at that time thirty-four differ- 
ent federal bureaus directly or indirectly interested in public 
health. The Washington office of the National Health Council pre- 
pared mimeographed reports on a number of these bureaus,18 which 
were widely circulated and aroused much comment. An endeavor 
was made to bring the data to the attention of General Sawyer and 
Mr. W. F. Brown, Chairman of the Joint Committee on Reorgani- 
zation, but the plans proposed by them took little cognizance of 
the relative importance of the various federal health agencies. 
Hearings on the plan submitted by the President in the closing 
days of the Sixty-seventh Congress were begun shortly after the 
Sixty-eighth Congress convened. They were held from January 
7 to 31, 1924, and have been printed in a volume of nearly eight 
hundred pages.19 During the course of the hearings it was sug- 
gested by Dr. Hubert Work, Secretary of the Interior, that, in the 
18 Bureau of Mines; Division of Vital Statistics; Children's Bureau; 
Women's Bureau; Division of School Hygiene of the Bureau of Education; 
General Report on U. S. Government health activities; Health Section, 
Office of Indian Affairs; Division of Welfare, Post Office Department; 
Bureau of Animal Industry. 
19 Reorganization of Executive Departments. Hearings before the Joint 
Committee (1924). PREVIOUS ATTEMPTS AT CORRELATION 
383 
event of the failure to establish the proposed Department of Educa- 
tion and Welfare, public health might well be transferred to the 
Interior Department. The Secretary of the Treasury, Mr. Mellon, 
and Secretary Hoover agreed that the Public Health Service did not 
belong in the Treasury Department, and the latter suggested that 
all public health activities should be put in one group. 
A bill for a Department of Education and Relief was introduced 
in the Sixty-eighth Congress, following the report of the Joint 
Committee on Reorganization, which was made on June 3, 1924. 
The only health agency included in this plan was the Public Health 
Service, though St. Elizabeth's Hospital, a medical institution, 
would also have been transferred. This plan, like former ones, pro- 
vided for inclusion of the Veterans' Bureau and the Bureau of Pen- 
sions. These agencies would have comprised about ninety-eight 
per cent of the new department, and for this reason and others, the 
plan was opposed by the sanitarians of the country and by the 
organized medical profession. It was also said to be unsatisfactory 
to the educators and to veterans' organizations. The American 
Journal of Public Health and the Journal of the American Medi- 
cal Association each carried editorials condemning the proposition.20 
Although scheduled to pass by steering committees in each house, 
the bill did not pass and was not brought to a vote in either the 
Senate or House before this Congress adjourned on March 3, 1925. 
20 Federal health reorganization, American Journal of Public Health, 
February, 1925, p. 143. See also editorials in the Journal of the American 
Medical Association, May, 1923; December 20, 1924; January 10, 1925; and 
February 7, 1925. CHAPTER XVIII 
PROPOSAL FOR BETTER CORRELATION 
The foregoing survey of the public health activities of the na- 
tional government has revealed the fact that there are in 1926 seven 
distinct bureaus or divisions located in five different executive de- 
partments, which carry on public health work of such importance 
as to justify its classification as the major activity of the particular 
bureau or division. In addition, there are seven other bureaus which 
have an important but secondary interest in public health. Besides 
these fourteen administrative units which are directly concerned 
with public health duties, there are about twenty-five other fed- 
eral agencies which are incidentally interested in public health, 
or carry on work of a purely medical character. 
No one can study this situation without being convinced that 
it is, in general, an unsatisfactory one. These several services have 
been created, and they have had imposed upon them or have as- 
sumed their public health activities, in accordance with no carefully 
thought out plan. The result has been a diffusion of responsibility 
for the care of the public health, a failure in many cases to have an 
activity performed by that service which can perform it most effi- 
ciently and economically, and a duplication of activities, at least to 
the extent of a number of services doing work of precisely the same 
character. 
The correction of this situation lies: first, in the assembling 
under a common direction of those services whose sole or major 
function is that of promoting the public health; and second, in 
providing that such united services shall, as far as practical admin- 
istrative conditions will permit, act as a central agency for the 
performance of the public health activities of all other branches 
of the national government. Those two ends are sought and, it 
is believed, provided for in the plan set forth below. In formulating 
this plan the following considerations have been kept in mind: 
1. That it is not desirable at this time to advocate any expansion 
of existing public health activities, such expansion, if any, being 
a matter that should receive independent consideration; 
384 PROPOSAL FOR BETTER CORRELATION 
385 
2. That the action proposed shall be of a character that will pro- 
duce increased economy and efficiency in the performance of the 
work being done, and: 
3. That this plan shall be one representing not merely a theoreti- 
cally desirable proposal, but one that is feasible, especially with 
regard to the attitude likely to be taken by the services whose 
status and activities are affected by it. Though it is not possible 
to devise a plan that will meet with the full approval of all ser- 
vices affected, it is nevertheless desirable to give as much consid- 
eration as possible to conflicting interests and to seek to formu- 
late a proposal that will meet the most strenuous opposition to be 
anticipated. 
Assembling Under a Common Direction of Services Whose 
Major Activity is in the Field of Public Health. The first fea- 
ture of the plan proposed is that all federal services whose major 
activity lies in the field of public health shall be brought together 
under the common direction of an Assistant Secretary in one of the 
departments. .From a theoretical standpoint, a strong argument 
might be made in favor of the establishment of a separate Depart- 
ment of Public Health. In view of the fact that there is strong op- 
position to the creation of new departments, it is believed that the 
wiser course at the present time would be to limit the proposal to 
one which, while providing for the bringing together of the major 
public health services, will not involve adding to the number of 
existing departments. If at a later time it is thought best to- have a 
separate Department of Public Health, this can be more easily ac- 
complished when the grouping proposed has been made than could 
be effected when the public health services are scattered, as at pres- 
ent, among a number of departments. This is in line with the action 
taken when the Department of Commerce and Labor was created, 
with its subsequent division into two separate departments. 
No definite recommendation is made here as to the particular 
department in which this group of public health services should 
be located. Such location should be determined in accordance with 
action that may be taken for the general reorganization of the 
administrative branch of the national governrrient. If, for 
instance, a decision is reached to effect a grouping of all the services 
having tO' do with public education, the two groups might con- 
ceivably be joined in a Department of Public Health and Educa- 
tion. The important thing is to bring together under a common 386 
NATIONAL GOVERNMENT AND HEALTH 
direction the services whose major activities have to do with the 
same general function. Whether this shall take the form of a 
separate department or of a major subdivision of a department of 
broader scope, is a secondary consideration. 
The report of the Congressional Joint Committee on Reorgani- 
zation recommends a new Department of Education and Relief, 
with a Secretary. This department would have assistant secre- 
taries for education, health, and veterans' relief. The only health 
agency involved in the plan as proposed is the Public Health Ser- 
vice, though, of course, there are others which ought to have been 
included. In the opinion of sanitarians and physicians, this plan 
is impractical. The suggested department would obviously consist 
mostly of veterans' relief, and health and education would be 
subordinated and submerged. The educators and veterans' organ- 
izations are said to be opposed to this plan, as are members of the 
public health profession. It is indubitably unsound. 
The federal health services that it is believed should be grouped 
and given organic connection with each other through being sub- 
ject to the same general overhead direction and control are the 
following: 
i. Bureau of the Public Health Service (Treasury Department) 
2. Division of Vital Statistics (Bureau of the Census, Department 
of Commerce) 
3. Children's Bureau (Department of Labor) 
4. Nutritional Research Work (Bureau of Chemistry, Department 
of Agriculture) 
5. Division of Foods and Nutrition (Bureau of Home Economics, 
Department of Agriculture) 
6. Medical Division (Office of Indian Affairs, Department of the 
Interior) 
7. St. Elizabeth's Hospital (Department of the Interior) 
A brief statement of the reasons for including each of these 
services in the proposed grouping follows: 
Public Health Service. The Public Health Service should 
obviously be transferred to the grouping of public health services, 
and be made the nucleus of such grouping. Not only is this bureau 
the most important of all the public health services of the govern- 
ment, but its present location in the Treasury Department is mani- 
festly illogical; the transfer would improve the organization 
of that Department by relieving it of a responsibility having noth- 
ing to do with its primary functions. PROPOSAL FOR BETTER CORRELATION 
387 
Division of Vital Statistics. Vital statistics form the founda- 
tion data for the consideration of public health. Such statistics 
have often been termed the bookkeeping of public health admin- 
istration. They furnish the information through which needs for 
action are revealed, and they supply the means for determining 
the results of action. If such statistics are to be properly 
compiled and interpreted, they must be collected, compiled, and 
analyzed by the service having in charge the subject to which 
they relate. This is generally recognized in almost all governments 
other than the national government. In every state, except one, 
vital statistics are collected by the state health authorities. In that 
one state, Massachusetts, this activity comes under the jurisdiction 
of the Secretary of State, which is as illogical as having it in a com- 
merce department. The present federal work in the collection of 
vital statistics has no direct relation to the other activities of the 
Bureau of the Census, and detaching it would disrupt no duty of 
that Bureau. As the handmaiden of public health, vital statistics 
should be compiled by the principal federal health agency The 
Public Health Service at the present time concerns itself with vital 
statistics in foreign countries and to a certain extent with vital sta- 
tistics in the individual states and cities, and publishes in the Public 
Health Reports much material of a vital statistical character. It is 
illogical and improper to have two services performing work in this 
field. Furthermore, the proposed transfer would simplify relations 
between the federal government and the vital statistics services of 
the states, by having one instead of two federal services maintain- 
ing such relations. 
The argument in favor of this transfer, as given by Mr. W. F. 
Willoughby in his volume dealing with the reorganization of the 
federal administrative services generally, will bear repetition here. 
Fie says:1 
It would seem to be almost equally evident that the Division of 
Vital Statistics of the Bureau of the Census, Department of Com- 
merce, should likewise find a place in that organization. There was 
a time, shortly after the creation of the Bureau of the Census, when 
there was a strong movement to concentrate in this bureau all of 
the statistical work of the government. It is now recognized that 
1 Willoughby, The Reorganization of the administrative branch of the 
National Government, pp. 245-47. Institute for Government Research, 
Studies in Administration (1923). 388 
NATIONAL GOVERNMENT AND HEALTH 
this was a move in the wrong direction. Statistical work is under- 
taken, not as an end in itself, but for the purpose of assisting in 
the solution of definite problems. If this work is to serve this pur- 
pose it is necessary that it shall be planned and its results analyzed 
and interpreted by the service having to do with the subject mat- 
ter of the inquiry. The most competent body, for example, to de- 
termine the character of information that shall be sought regarding 
the operation of railroads and to interpret and otherwise utilize 
the data secured is manifestly the Interstate Commerce Commis- 
sion. In precisely the same way the Department of Public Health 
is the service that can best determine the nature of the information 
that it is desirable to have regarding births, deaths, and morbidity, 
and to make the most effective use of the data that are secured. If 
vital statistics are to serve their maximum usefulness it is essential 
that many facts regarding births and deaths shall be secured ; such, 
for example, as the age, color, nativity, occupation, etc., of the 
parents of children in the case of births and the same data together 
with the causes of death in the case of deaths. The securing of 
these facts involves many technical questions of classification, 
which only persons of medical training are competent to solve. 
Only persons with a professional medical training, moreover, can 
interpret to the best advantage the returns after they are compiled. 
One of the most important duties of a Department of Health is to 
keep in touch with the movement of births, deaths, and morbidity, 
to determine what diseases or casualties are on the increase, or the 
reverse, and, by comparison with other facts, to discover, if possible, 
the causes of the changes taking place. Vital statistics constitute by 
far the most effective means for doing this. It is thus of the highest 
importance that the service responsible for the care of the public 
health shall have immediate charge of work of this kind. 
In further support of this position, two additional facts may be 
noted. The first is that the work of the Division of Vital Statistics 
has little or no relation to the other work of the Bureau of the Cen- 
sus. Detaching it from that bureau would thus in no way disrupt 
the organization of that service or interfere with its other work. 
The second is that that division now exploits only a part of the field 
of vital statistics-births and deaths in the United States; the 
securing for comparative purposes of data regarding births and 
deaths in other countries and regarding morbidity in this and other 
countries, in so far as such data are secured at all, is performed 
by the Public Health Service. This division of responsibilities is 
unfortunate. The transfer of the Division of Vital Statistics from 
the Bureau of the Census to the proposed Department of Public 
Health will correct this and insure one service having full respon- 
sibility for the collection, compilation, and exploitation of data 
bearing upon the matter of public health. PROPOSAL FOR BETTER CORRELATION 
389 
Children's Bureau. The claim has been made that the child 
is a unit, and that all work for the welfare of children, whether 
social, sanitary, medical, industrial, or general, should be kept 
intact, though Congress, incidentally, places educational activities 
for the child in a department other than that concerned with his 
general welfare. The fact that the child is a unit has been recog- 
nized in the proposed plan for federal health correlation by recom- 
mending that the entire Children's Bureau, now in the Department 
of Labor, should be transferred to the new arrangement. Child 
hygiene and maternal hygiene comprise extremely significant fea- 
tures of the work of this bureau. Child and maternal hygiene are 
integral parts of public health. They cannot be set apart from the 
general health problem. They are not labor questions, nor do activi- 
ties in their behalf apply only to the industrial classes. The or- 
ganic act of the Children's Bureau states that its duties shall be to 
" investigate and report . . . upon all matters pertaining to the wel- 
fare of children and child life among all classes of our people. . . 
When hearings on the general plan for reorganization of the 
executive departments were held in January of 1924, the Secretary 
of Labor, James J. Davis, had placed in the record a letter which 
he had submitted to the chairman of the Joint Committee of the 
Reorganization of the Administrative Branch of the Government. 
In giving a brief outline of the similarity of some of the services 
rendered by bureaus of his department and outside agencies, he 
stated in this letter: 
Another relationship, somewhat along the same line, exists 
with reference to the parallel activities of the Public Health Ser- 
vice and the Children's Bureau. The nature of this overlapping 
is of such character that there is practically no limit to the dupli- 
cation and resultant likelihood of confusion unless there is complete 
and harmonious adjustment of the respective activities. 
No better argument could be used than this, from a most 
authoritative source, for the effective centralization of control of 
the child hygiene activities of these two bureaus. The unity of 
child hygiene with general public health has been recognized in 
the states, where bureaus or divisions of child hygiene are invari- 
ably in the state departments of health. According to a report of 
3 Hearings on S. J. Res. 282, p. 630. 390 
NATIONAL GOVERNMENT AND HEALTH 
the Children's Bureau itself,3 the administration of maternity and 
infancy hygiene activities was in 1924 under the jurisdiction of 
state health authorities in every state, except three. In one instance, 
Colorado, it was under the Department of Public Instruction, and 
in two others, New Mexico and Idaho, under the Board or Depart- 
ment of Public Welfare, which also has supervision of all state 
health work. If the states, which have the primary responsibility 
over the protection and promotion of public health, recognize this 
unity, it should likewise be acknowledged by the federal govern- 
ment. The Children's Bureau should, therefore, be part of this 
central federal health agency, and all child hygiene work of the 
government should be properly correlated. 
Nutritional Research: Bureau of Chemistry and Bureau of 
Home Economics. The most important activity of the Bureau of 
Chemistry of the Department of Agriculture is that of the adminis- 
tration of the Pure Food and Drugs Act. Due to the fact that 
the protection of the public against impure and adulterated 
foods and drugs has distinctly for one of its purposes the protection 
of the public health, there is much to be said in favor of this bureau 
being made one of the group of public health agencies. This trans- 
fer was in fact suggested in 1912 at the time of the agitation for a 
national bureau of health, and the proposal had the endorsement of 
the then Secretary of Agriculture, James Wilson.4 Against this pro- 
posal the fact is pointed out that the problems dealt with by the 
bureau are as much economic as sanitary. This is partially true, 
for this pure food and drugs activity has two main purposes: one 
is the protection of the public health; the other is the protection of 
the consumer from fraud. Just what proportion these two func- 
tions take is a moot point. A study of the operation of the law 
indicates, however, that they are approximately equal, though per- 
haps with a slight inclination toward the economic phase. 
Due to this dual character of the service, it is probably a matter 
of expediency that the proposal for the coordination of the health 
services of the government should not, at this time at least, call for 
3 The promotion of the welfare and hygiene of maternity and infancy, 
p. 52. Bur. Publ. No. 146 (1924). 
4 Letter to the Chairman of the Senate Committee on Public Health and 
National Quarantine, dated February 16, 1912. PROPOSAL FOR BETTER CORRELATION 
391 
the transfer of this entire bureau from the Department of Agri- 
culture to the health service group. The bureau, however, en- 
gages in a special activity which, it is believed, more properly 
belongs to a public health service and can be more advantageously 
prosecuted by such a service. Reference is had to the research 
work in the field of human nutrition. It is desirable, therefore, to 
transfer this activity to a central health agency. 
What has been said regarding the nutritional studies of the 
Bureau of Chemistry applies with equal force to the work of the 
Division of Foods and Nutrition of the Bureau of Home Econom- 
ics of the Department of Agriculture. That division now con- 
ducts important investigations into the basic sciences underlying 
human nutrition. The nutritional activities of these two bureaus 
would more than justify their combination to form a bureau of 
foods and drugs in a central federal health agency, in order that 
their correlated nutritional studies might be available to all the 
people for their physiological advantage. This activity of the 
service is, to be sure, concerned with agricultural products, and its 
results reach farmers and rural dwellers, but the scope of the work 
is of national and not sectional interest. Public health knows no 
age, sectarian, or geographical limitations. 
A bureau or division of foods and drugs in a central federal 
health agency could use the excellent extension facilities of the 
Department of Agriculture, just as they are used now. One of 
the much needed reforms in government operation is, in fact, 
better liaison between production in one department and operation 
or field service in another, to replace the all too frequent aloof- 
ness, which is now unduly prevalent between departments. 
James Wilson, who- held the office of Secretary of Agriculture 
longer than any other incumbent (1897-1913), and who was admit- 
tedly one of the great secretaries, wrote in 1912, " All the agen- 
cies of the Federal Government that contribute to the maintenance 
of the public health should be grouped together." The reason for 
assembling food and drug work as a part of public health are as 
cogent today as they were then. 
In the states the administrative control of foods and drugs is 
about equally divided between public health authorities and agri- 
cultural departments, although in about a dozen instances there is 392 
NATIONAL GOVERNMENT AND HEALTH 
apparently an entirely separate department devoted to this subject.5 
Thus, out of the forty-eight states, only twenty have placed food 
and drug control under the Department of Agriculture. 
Medical Division, Office of Indian Affairs. Health conser- 
vation for Indians has in recent years received considerable 
attention from the government. The Health Section of the Edu- 
cation Division of the Office of Indian Affairs was in 1923 raised 
to the status of a division called the Medical Division. A super- 
visor of public health nurses was attached to the office at the same 
time. Salaries of physicians: in the Indian Office, which had been 
pitifully inadequate for many years, were increased by the Re- 
classification Act of March 4, 1923 (42 Stat. L., 1488). Appropria- 
tions for preventing diseases and giving medical care to Indians 
were increased from $370,000 for the fiscal year 1924 to $500,000 
for 1925 (with a deficiency appropriation of $104,590), and to 
$700,000 for 1926. These increases, while raising the morale of 
the employees, and providing more and better facilities, have not 
altered the scientific attainments or the efficiency of the physicians 
of the Indian Office. 
In order to do this, it is proposed that the physicians of the 
Indian Medical Service be attached to the Public Health Service 
for purposes of recruitment, training, and scientific direction, and 
then detailed to the Commissioner of Indian Affairs for adminis- 
trative direction. This is entirely feasible, and would be some- 
what similar to the present arrangement between the Public 
Health Service and the Bureau of Immigration, as now authorized 
by law. In medical and public health matters, the Indian physician 
would be responsible to a public health agency and not to a local 
superintendent of a reservation or agency, whose conception of 
medical matters is likely to be erroneous, as experience has too 
often proved. Such a proposed arrangement would result in better 
medical and health service to the Indian wards of the government. 
The promotion of their health is important not only for the benefit 
of the Indians, but has a definite influence on that of the civil popu- 
lation in the vicinity of the agency< State health authorities have 
for years been much concerned with the Indian health problem, and 
6 See Bureau of Chemistry, Directors of state offices charged with the 
enforcement of food, drugs, dairy products and feeding stuffs laws. 
(Mimeographed.) PROPOSAL FOR BETTER CORRELATION 
393 
are desirous that improvements in its administration should be con- 
summated. 
The proposal that health work for Indians should be done by 
the Public Health Service has been made before. It was opposed 
on the grounds that the Indian is a unit and that his entire welfare, 
social, hygienic, and educational, is so interrelated that one and 
only one agency could deal with the problem as a whole. This fact 
is recognized and given due weight in the proposed plan. In the 
interests of the public health the arrangement proposed is desir- 
able and essential. 
The transfer would not cause any large additional appropria- 
tions. Physicians in the Indian Medical Service now receive 
$1860 or $2100 a year, depending upon whether there is a hospital 
or not, the latter sum being paid where there is. In addition they 
get certain allowances. As assistant surgeons, passed assistant 
surgeons, or surgeons of the Public Health Service, they would 
receive from $2000 to $2400 a year base pay, with commutation 
allowances and retirement privileges. 
St. Elizabeth's Hospital. The reason why it is recommended 
that St. Elizabeth's, the Government Hospital for the Insane, 
should be transferred is because a central federal health agency, 
if there were one, would be a more logical place for this medical 
institution than would the Department of the Interior, which now 
has control over it. Dr. Hubert Work, Secretary of the Interior, 
in testifying before the Joint Committee on the Reorganization 
of the Administrative Branch of the Government in January, 1924, 
said that St. Elizabeth's ought to be administered under the Public 
Health Service. At any rate, as an important laboratory of psy- 
chiatry and mental hygiene, subjects which are now conceded to be 
part of the general public health problem, this hospital belongs with 
the unified health activities of the government. 
United States Veterans' Bureau. Having given the argu- 
ments in favor of the transfer to the public health services group 
of the agencies and work indicated, the reasons should be given 
why such a transfer is not recommended in the case of the United 
States Veterans' Bureau, which does so much in the way of the 
medical care of a certain class of our population. First, and pri- 
marily, the Veterans' Bureau is not a public health agency. Its 
work lies in the curative and not the preventive field. Secondly, the 394 
NATIONAL GOVERNMENT AND HEALTH 
size of this bureau is such that if joined with the public health 
agencies it would dominate that group, a result that would be 
highly injurious. There should, of course, be cooperation between 
the hospital work of all federal agencies. 
Public Health Services as Agencies for the Performance of 
Health Work for Other Services. At one time it was thought 
that efforts looking to the improvement of the organization of the 
administrative branch of the government should take the form of 
seeking to concentrate in one service or department all activities of 
the same character. It is now recognized that this would be a great 
mistake. Examination shows that a clear distinction should be 
made between those activities which have as their purpose the per- 
formance of the function which is made the basis of the grouping 
and those which have as their purpose to aid in the accomplishment 
of some other function. The first class of activities are undertaken 
as an end in themselves ; the second, merely as means to the accom- 
plishment of some other end. To illustrate, the public health activ- 
ities engaged in by the Public Health Service have for their direct 
purpose the promotion of the public health; those engaged in under 
the auspices of the Immigration Service in the way of the physical 
examination of immigrants have for their primary purpose the 
proper enforcement of the immigration laws. All activities of the 
first character, that is, the accomplishment of one definite aim, 
should, as a general principle, be concentrated in a single 
service or group of services under a common direction. Those of 
the second character should remain under the administrative direc- 
tion of the services in which they are located. To attempt to 
remove them might disrupt such services and place them in a 
position where they would have entire control over the activities 
necessary for the performance of their function. 
In providing for the performance of this second class of activi- 
ties, the services concerned can pursue one of two policies; they 
can organize special divisions with their own personnel and equip- 
ment for the performance of such work; or they can have such 
work done for them by the central technical service whose major 
function is the performance of work of the character in question. 
Of these two policies, the second is undoubtedly the desirable one 
in all cases except where the work to be done is on a large scale 
and requires special equipment and personnel. It is impossible PROPOSAL FOR BETTER CORRELATION 
395 
for the services which need technical work of an incidental nature 
to secure, without undue expense, a personnel of the same compe- 
tence and equipment of the same excellence as that possessed by the 
service having as its primary function the performance of such 
work. It is to the advantage of the former services, therefore, to 
make use of the facilities of the latter service wherever possible. It 
is also to the advantage of the latter service to do this work, since 
it increases its scope and thus broadens its personnel system from 
the career standpoint. 
With respect to no class of technical activities is the foregoing 
policy any more sound than in public health or medical work. The 
government has in the Public Health Service a technical agency ex- 
ceptionally well equipped as regards personnel and plant to perform 
all kinds of medical and health work. Its facilities should, there- 
fore, be availed of by other services to the largest extent practi- 
cable. The desirability of this policy is now recognized and acted 
upon in a number of instances. Existing laws already authorize 
the detail of medical officers of the Public Health Service to the 
following bureaus: 
Consular Service (27 Stat. L., 450). 
Bureau of Immigration (39 Stat. L., 885). 
Coast Guard (38 Stat. L., 387). 
Alaska Division, Bureau of Education (38 Stat. L., 862). 
Bureau of Mines (40 Stat. L., 146). 
Bureau of Chemistry (40 Stat. L., 992). 
It is recommended that this policy be extended to other services 
and especially to the Division of School Hygiene of the Bureau of 
Education, to the Bureau of Animal Industry, the Bureau of Dairy- 
ing, and the Extension Service, all of the Department of Agricul- 
ture, and to the Bureau of Labor Statistics of the Department of 
Labor. All of these bureaus are doing public health work, though it 
is secondary to their general scope. It is further recommended that 
the President be authorized to direct in other cases that health and 
medical work required by services as activities incidental to their 
major function be performed by officers or scientific personnel of 
the Public Health Service detailed for that purpose. 
If the two foregoing recommendations are put into effect, those, 
namely, of bringing together under a common direction all those 396 
NATIONAL GOVERNMENT AND HEALTH 
services which have as their prime function the promotion and pro- 
tection of the public health, and then having such services act as 
executing agencies for the performance of the health and medical 
work of other services, there will result that concentration of work 
in this field which is highly desirable. Such a scheme would not and 
need not disrupt or interfere in any way with the integrity of the 
other services. 
Proposed Grouping of Public Health Services as Exemplified 
by Other Governments. It is of interest to note that the proposal 
here made for the grouping of public health services under a com- 
mon direction is supported by action that has been taken by most 
other governments of first rank. Indeed, many such governments 
have carried this tendency to the extent of setting up independent 
departments of Public Health. Such ministries, with cabinet 
officers at their heads, now exist in:0 Great Britain, France, Ger- 
many, Canada, New Zealand, Poland, Jugo-Slavia, Czecho- 
slovakia, Brazil and Hungary. 
Most of these ministries have been established within the last 
decade, usually about 1918 or 1919. That of Great Britain came 
into being in 1919 and by its creation brought about a coordination 
of health activities in that country.7 In other nations, where there 
are no separate ministries, national activities are usually conducted 
under the supervision of a single minister. Such countries often 
have national departments of health under a secretary of a depart- 
ment corresponding to our Interior Department. 
Method of Achieving Coordination. Congress might see fit to 
adopt specific legislation providing for the transfer and coordina- 
tion of federal health activities, or authority might be given to the 
President to effect by executive order such changes as would be 
desirable. There is some precedent for the latter procedure, for 
in the act of February 14, 1903 (32 Stat. L., 825), which estab- 
lished the Department of Commerce and Labor, the President was 
authorized to transfer other bureaus to the new department. This 
section of the law (32 Stat. L., 830) read as follows : 
Sec. 12. That the President be, and he is hereby, authorized, by 
order in writing, to transfer at any time the whole or any part of 
6 See Cal ver, H. N., and Tobey, J. A., National health departments in 
review, Nation's Health, July, 1921. Also reports of the League of Nations. 
7 See Newsholme, A., The Ministry of Health (1925). PROPOSAL FOR BETTER CORRELATION 
397 
any office, bureau, division or other branch of the public service 
engaged in statistical or scientific work, from the Department of 
State, the Department of the Treasury, the Department of War, 
the Department of Justice, the Post Office Department, the Depart- 
ment of the Navy, or the Department of the Interior, to the Depart- 
ment of Commerce and Labor; and in every such case the duties 
and authority performed by and conferred by law upon such office, 
bureau, division or other- branch of the public service, or the part 
thereof so- transferred, shall be thereby transferred with such office, 
bureau, division or other branch of the public service, or the part 
thereof which is so transferred. And all power and authority con- 
ferred by law, both supervisory and appellate, upon the department 
from which such transfer is made, or the Secretary thereof, in 
relation to the said office, bureau, division, or other branch of the 
public service, or the part thereof so transferred, shall immediately, 
when such transfer is so ordered by the President, be fully con- 
ferred upon and vested in the Department of Commerce and Labor, 
or the Secretary thereof, as the case may be, as to the whole or part 
of such office, bureau, division, or other branch of the public service 
so- transferred. 
When the Department of Labor was created in 1913 (37 Stat. 
L., 736) the above law remained in force with respect to the De- 
partment of Commerce. In accordance with its provisions the 
President in 1925 by executive order transferred the Bureau of 
Mines and the Patent Office from the Department of the Interior 
to the Department of Commerce. He could, under this law, trans- 
fer federal health activities from certain departments to the De- 
partment of Commerce, though that is hardly the place for them. 
Such activities of the Departments of Agriculture and of Labor 
could not, moreover, be included under the terms of this law, nor 
could the Public Health Service, for a law was passed in 1904 (33 
Stat. L., 104) providing that that bureau should remain under the 
Treasury Department until otherwise specifically provided by law. 
A bill has been introduced in the Sixty-ninth Congress pro- 
posing to give the President authority to make transfers of bureaus, 
in accordance with the recommendations of a joint reorganization 
committee of five, consisting of two senators, two members of the 
House of Representatives, and a representative of the President. 
This bill, if passed, would permit the federal health reorganization 
in accordance with the recommendations of this committee, to 
whose attention could be brought the desirability of the scientific 
plan worked out. 398 
NATIONAL GOVERNMENT AND HEALTH 
Coordination of the Group of Public Health Services. If 
the decision is made to bring together, under the direction of an 
assistant secretary, the services indicated, the problem will then 
be presented of determining the extent to which each of those ser- 
vices shall maintain its separate integrity or be merged with some 
one of the other services, or a new distribution of activities among 
the several services be effected. It cannot be made too clear that 
the mere grouping of services under a common overhead direction 
does not necessarily carry with it the consolidation of such services 
or the effecting of any organic change in respect to the field or 
character of their activities. Neither does it necessitate any merg- 
ing of the personnel of those services. At the same time, one 
of the prime advantages of the grouping of services engaged in 
the same field is that it lays the basis for a better coordination of 
such organization, a better allocation of activities among the ser- 
vices, and a more effective assignment of personnel according to 
capacities. 
It would be a mistake at this time to attempt to determine in too 
great detail just what should be done in this way. Certainly it 
would be unwise for an act providing for the grouping of the ser- 
vice to attempt to handle all of these administrative problems by 
legislative provisions. The desirable method is that such an act, 
after setting forth certain fundamental considerations, should 
authorize the secretary of the department in which the group is lo- 
cated, with the approval of the President, to make such further 
changes in organization and distribution of activities as in his 
opinion are desirable. A number of provisions which are of im- 
portance in any plan for correlation, and which should be incorpo- 
rated in any legislation to that end are, however, suggested. 
To the Public Health Service, now the principal federal health 
agency, and almost of departmental size itself, there should be 
added the Division of Vital Statistics of the Census Bureau, the 
Medical Service from the Office of Indian Affairs, St. Elizabeth's 
Hospital, and the nutritional research of the Department of Agri- 
culture, as mentioned above. 
The divisions of the Hygienic Laboratory, the chief medium for 
the research of the Public Health Service, should be utilized to 
provide agencies for the solution of public health problems, facili- 
ties for the coordination of research of health authorities and PROPOSAL FOR BETTER CORRELATION 
399 
scientists engaged on special problems, and demonstrations of 
sanitary methods and appliances. Such facilities should be ex- 
tended for stated periods to health officers and scientists engaged 
in special investigations, and officers should be detailed to educa- 
tional and research institutions for special studies of scientific prob- 
lems and for the dissemination of information relating to the 
science of public health. Thus would legislative sanction be given 
to a procedure of much importance, now often done informally. 
The Children's Bureau has been coordinate with the Public 
Health Service since 1912. It is expedient to continue it so. Since 
the major function of this Bureau is in the field of public health, it 
belongs under the same direction as other federal health activities. 
Furthermore, the application of the technique of sociology to pub- 
lic health and a harmonious adjustment between the sociological, 
the medical, and the other phases of the modern science of public 
health, is eminently desirable. The Children's Bureau was created 
at the behest of social workers, and is manned largely by them, 
though it has of necessity a medical personnel. The Children's Bu- 
reau at present considers the child only up to the school age; the 
health of the school child coming within the purview of the Bureau 
of Education. 
An assistant secretary in charge of public health activities, 
should there be one, should be selected solely with reference to the 
qualifications for the discharge of his duties. He need not be, and 
perhaps should not be, a physician, but he ought to be a person 
familiar with public health. By no means should he be appointed 
purely for political reasons, and with no previous experience in, or 
conception of, the science of public health. It has been suggested 
that the Surgeon General of the Public Health Service might be 
ex officio the assistant secretary for public health. 
In connection with this suggestion for an assistant secretary for 
public health, it is interesting to note that the report of the Presi- 
dent's Committee on Air Service, made public in December, 1925, 
recommended assistant secretaries for air service in the Depart- 
ments of War, Navy, and Commerce. Air Service development, 
important as it is, is no more significant to the welfare of the United 
States than is the development and promotion of national vitality. 
If a plan for correlation of federal health agencies should be 
adopted and a central federal health agency established, considera- 400 
NATIONAL GOVERNMENT AND HEALTH 
tion should be given to the eventual central housing of such an 
agency. At present the offices and laboratories of the various 
bureaus concerned with public health are widely scattered through- 
out the City of Washington. The Public Health Service itself oc- 
cupies quarters in three different places, several miles apart, and 
two of these offices are of a temporary nature. The Hygienic 
Laboratory has its own building and is surrounded by some seven- 
teen areas of vacant ground owned by the government. This 
site would be an appropriate one for the eventual central housing 
of all those federal health activities involved in the plan for 
coordination. This is a matter for the future, however, and while 
a desirable step, is not urgent. 
Reorganization of the Personnel System. It is likely that 
the bringing together under a common direction of the public 
health services indicated will also raise certain questions in. respect 
to the personnel systems of the several services so grouped; and 
especially in respect to the desirability of bringing such systems 
more in harmony with each other, and even of establishing a single 
personnel system for all the services. 
At present there is a commissioned medical corps in the Public 
Health Service. All other scientific personnel of this bureau and 
of other bureaus doing health work have a civil service status, sub- 
ject to the Reclassification Act of 1923 (42 Stat. L., 1488). It is 
desirable that in the future, all properly qualified scientific per- 
sonnel, whether medical or non-medical, should have an identical 
status. 
The method of appointment of dental officers, sanitary engineers, 
and other scientific personnel in the Public Health Service, selected 
for general service and subject to changes of stations, could, there- 
fore, be the same as already provided by law for the appointment 
of commissioned medical officers; provided, that applicants for 
appointment should have had the training and experience equiva- 
lent to that required of commissioned medical officers in the 
regular service prior to original appointment and should be ex- 
amined in the phase of public health in which they are specialists. 
Any sanitary engineer, medical, dental or other scientific officer 
already in the Public Health Service or in any other service trans- 
ferred to the Public Llealth Service, after examination in the sev- 
eral branches of his profession before a board of officers convened PROPOSAL FOR BETTER CORRELATION 
401 
by the Surgeon General, might be commissioned by the President, 
in any of the several grades, corresponding to: assistant surgeon, 
passed assistant surgeon, surgeon, senior surgeon, and assistant sur- 
geon general, as determined by the President on the recom- 
mendation of an examining board. The actual designations of 
these officers could comprise the name of the professions under 
which they have qualified, with prefixes according to grades to 
determine their equivalent rank. 
Although essentially a civil organization, the Public Health Ser- 
vice has had this quasi-military personnel system since 1870. There 
are now about 200 commissioned miedical officers in the service. It 
is claimed that the present methods of appointment and promotion 
of the professional workers, assuring security of tenure at a reason- 
able compensation, and providing a mobile corps of experts, are 
essential to the efficiency of the service. It is further stated that the 
Public Health Service would be disrupted if the system were 
abolished, and that the morale of the personnel would be destroyed. 
Some students of government, on the other hand, have questioned 
whether any bureau should be singled out for a special personnel 
system, especially when it is made somewhat comparable to that 
of the Army and Navy. The services which have had such special 
systems are the Public Health Service, the Coast Guard, and the 
Coast and Geodetic Survey. In 1924 Congress passed a law reor- 
ganizing the Foreign Service (43 Stat. L., 140) and provided for 
foreign service " officers," divided into nine classes, with appoint- 
ments and promotions a matter of merit, and the whole foreign 
service established on a career basis. This act provides, further- 
more, for very liberal retirement privileges. The personnel system 
for the public health services of the government might to advantage 
be made somewhat less military in character, to conform with the 
principles of this law regarding the foreign service. 
An Advisory Council. It is highly advisable that the govern- 
ment services having to do with matters of public welfare should 
have the means of maintaining close connection with all other 
agencies operating in the same field. Intimate working relations 
between public and private agencies is essential if the best results 
are to be obtained. Especially is it desirable that such relations 
should be maintained between agencies of the national govern- 402 
NATIONAL GOVERNMENT AND HEALTH 
ment and those of the state and local governments performing 
the same functions. To this end it is proposed that provision be 
made by law for the creation of a national advisory health council, 
upon which should be represented the public health services of the 
national, state, and local governments, of private health organiza- 
tions and of the public health, medical, and sanitary engineering 
professions of the country. 
The Public Health Service already has an advisory committee 
for the Hygienic Laboratory. It was created by the act of July I, 
1902 (32 Stat. L., 728), and consists of three competent experts, 
to be " detailed from the Army, the Navy, and the Bureau of 
Animal Industry, by the Surgeon General of the Army, the Surgeon 
General of the Navy, and the Secretary of Agriculture, respec- 
tively, and five other members appointed by the Surgeon General 
of the Public Health Service, with the approval of the Secretary 
of the Treasury." The present members of this board are Lieuten- 
ant Colonel J. F. Siler, U. S. A., Lieutenant Commander J. R. 
Phelps, U. S. N., Dr. J. R. Mohler of the Bureau of Animal Indus- 
try, Dr. Simon Flexner, Dr. Reid Hunt, Dr. M. P. Ravenel, 
Dr. V. C. Vaughan, and Dr. W. H. Welch. Surgeon G. W. 
McCoy, Director of the Laboratory, is ex officio a member. 
The Surgeon General of the Public Health Service, by the terms 
of this same law, is directed to call an annual conference of state 
health officers, or to call such a conference upon the application of 
not less than five state or territorial health officers. He may also in- 
vite some of the state health authorities to a conference whenever 
the interests of public health would be promoted by such a confer- 
ence. The law does not say whether these state health officers are to 
advise the Surgeon General, or whether he is to advise them. Such 
conferences are held annually, however, and much of mutual 
benefit enures from them. Perhaps they would be even more 
valuable if the health officers were in conference with representa- 
tives of all the federal health agencies. 
This proposed new advisory council would not be a national 
board of health. It would have purely advisory functions. Its pur- 
pose would be to keep the public health profession closely in touch 
with federal health work, to provide for a group of eminent sup- 
porters for a central federal health service, and to provide expert PROPOSAL FOR BETTER CORRELATION 
403 
advice on health matters. This might be accomplished by author- 
izing the increase of the present advisory board of the Hygienic 
Laboratory from eight to fifteen members, to become such a 
National Advisory Health Council. The Surgeon General of the 
Public Health Service should be one member and ex officio chair- 
man, and he should appoint the others, with the approval of the 
Secretary. APPENDICES 
APPENDIX 1 
RESOLUTIONS IN FAVOR OF CORRELATION OF 
FEDERAL HEALTH ACTIVITIES 
Herewith are presented three recent resolutions advocating cen- 
tralization and coordination of Federal health activities. They 
were passed separately by the American Public Health Associa- 
tion, the Conference of State and Provincial Boards of Health of 
North America, and the National Tuberculosis Association. These 
three associations, which are the most important extra-govern- 
mental agencies in the field of public health, have in the past adopted 
many other resolutions on this subject, all of the same general 
tenor: 
American Public Health Association.1 Resolution adopted at the 
fifty-fourth annual meeting held in St. Louis, October 22, 1925: 
Whereas; Public Health activities are now undertaken by a 
number of different departments of the Federal Government, in 
accordance with existing law; and 
Whereas; The correlation and centralization of these activities 
would conduce to efficiency, economy, and the enhancement of 
national vitality; and 
Whereas; Public Health is an essential feature of govern- 
ment and as important to national progress as the development of 
agriculture, commerce, labor, fiscal affairs, public works, the com- 
mon defence, justice, or any other branch of public service ; 
Be It Resolved, that the American Public Health Association 
urges the more effective centralization of Federal health work 
under the direction of a competent, trained official, who shall have 
the rank at least of an Assistant Secretary. 
That such a central, unified department or arrangement shall 
include as many as practicable of the bureaus engaged in public 
*The American Public Health Association is the professional society 
of the sanitarians of North America, Its five thousand or so members con- 
sists of health officials and other professional health workers. 
405 406 
NATIONAL GOVERNMENT AND HEALTH 
health and preventive medicine, but shall not include the United 
States Veterans' Bureau, which is a relief agency. 
That the President of the American Public Health Association 
is hereby authorized to appoint a committee of five to bring these 
resolutions and sentiments to the attention of President Coolidge 
and appropriate committees of Congress, and co-operate with other 
groups who are studying or promoting Federal Health correlation. 
Conference of State and Provincial Health Authorities of North 
America? Resolution adopted at its annual meeting, Montreal, 
June 5, 1925. 
Be it Resolved, That it is the sense of this Conference that the 
now scattered health activities of the United States government 
should be more effectively coordinated and placed under the direc- 
tion of a competent central authority, and that the Executive Com- 
mittee of the Conference should act in an advisory capacity to the 
sanitarians and experts in political science now engaged in study- 
ing this important matter. 
National Tuberculosis Association.5 Resolution adopted at its 
twenty-first annual meeting,, Minneapolis, June, 1925. 
Whereas, The health activities of the Federal Government are 
now scattered through a number of different departments and 
independent establishments; and 
Whereas, The President of the United States has repeatedly 
recommended the reorganization of all the Federal executive de- 
partments ; and 
Whereas, Studies are now under way to* determine exactly what 
are the present activities and functions of the United States 
Government in the field of public health; therefore be it 
Resolved, That it is the sense of this Association that the now 
dispersed public health activities of the Federal Government should 
be more effectively coordinated and placed under the central direc- 
tion of a properly trained sanitarian; and furthermore 
Be it Resolved, That this Association commends the efforts of 
President Coolidge to bring about an efficient reorganization of the 
executive departments and pledges its support to this movement 
to the end that national health may be promoted by a more effica- 
ciously organized central Federal health agency. 
2 This conference consists of all the State, Territorial, and Provincial 
Health officers of the United States, Canada, and Mexico. 
3 This association has branches in every state, and also some 1200 local 
affiliated societies throughout the country. APPENDIX 
407 
National Health Council. On April 27, 1921, the National 
Health Council, which was then comprised of representatives of the 
following national health organizations: American Public Health 
Association, American Red Cross, American Social Hygiene Asso- 
ciation, American Society for the Control of Cancer, Conference 
of State and Provincial Health Authorities of North America, 
Council on Health and Public Instruction of the American Medi- 
cal Association, National Child Health Council, National Commit- 
tee for Mental Hygiene, National Organization for Public Health 
Nursing, and National Tuberculosis Association, met in Washing- 
ton, D. C., and passed the following resolution: 
The National Health Council has learned with the greatest plea- 
sure and interest of the desire of the President of the United 
States, as expressed in public utterances, to improve the health 
functions of the Federal Government through a better coordina- 
tion of the health activities now distributed through various de- 
partments. 
While the National Health Council is not authorized under its 
plan of organization to advocate or oppose specific legislative 
propositions, all of the constituent organizations represented in 
the Council have at some time positively endorsed the principle of 
uniting Federal health activities in one department. 
In securing this object, the National Health Council pledges 
itself to transmit to its constituent organizations the views of the 
President and committees of Congress and to obtain prompt con- 
sideration thereof for such action as the individual societies might 
find practicable. APPENDIX 2 
SOME PERTINENT QUOTATIONS REGARDING 
FEDERAL HEALTH CORRELATION 
Grover Cleveland 
" I earnestly recommend the inauguration of a national board 
of health or similar national instrumentality, believing the same 
to be a needed precaution against contagious disease and in the 
interest of the safety and health of our people." 1 
Theodore Roosevelt 
" The work of the state and city boards of health should be 
supplemented by a constantly increasing interest on the part of 
the National Government. . . . This whole branch of the Govern- 
ment should be strengthened and aided in every way." 2 
William Howard Taft 
" But there seems no reason why all the other [except from Army 
and Navy] bureaus and offices in the General Government which 
have to do with the public health or subjects akin thereto should 
not be united in a bureau to be called the ' Bureau of Public 
Health.' "s 
" I renew this recommendation."4 
Woodrow Wilson 
" . . . unity of control in the administration of the public health 
activities of the Federal Government is obviously essential. . . . " " 
Warren G. Harding 
"To bring these various activities (welfare) together in a sin- 
gle department . . . would make for increased effectiveness, econ- 
omy, and intelligence of direction." 6 
1 Second annual message, December 3, 1894. 
2 Seventh annual message, December 3, 1907. 
3 First annual message, December 7, 1909. 
4 Second annual message, December 10, 1910. 
5 Executive Order, July 1, 1918. 
6 Special message, April 12, 1921. 
408 APPENDIX 
409 
Andrew W. Mellon, Secretary of the Treasury 
" The Public Health Service could be under the Secretary of 
the Interior about as well as where it is. What I mean is, it is not 
especially related to the Treasury in its work." 7 
Hubert Work, Secretary of the Interior 
". . . I suggest that the Bureau of Public Health come into 
the Interior Department and that the Surgeon General be ex officio 
the assistant secretary." 8 
" . . . the Public Health Service is one of the most vital organ- 
ized responsibilities of the Government." 0 
Herbert Hoover, Secretary of Commerce 
" Public health should also be put into a single group." 10 
" I think it (the Public Health Service) is an entire anomaly in 
the Treasury Department. . . . Normally that would go to the 
Interior. . . . "11 
James J. Davis, Secretary of Labor 
" The functions and scope of authority of the Public Health 
Service relate to labor and its conditions in several respects; and 
as to some of them the field of operations comes in contact with 
or overlaps certain functions of those bureaus which are at present 
under the jurisdiction of the Department of Labor." [Occupa- 
tional disease studies cited.] 
" Another relationship, somewhat along the same line, exists 
with reference to the parallel activities of the Public Health Ser- 
vice and the Children's Bureau. The nature of this overlapping 
in the same fields of endeavor is of such a character that there is 
practically no limit to the duplication and resultant likelihood of 
confusion unless there is complete and harmonious adjustment of 
the respective activities." " 
'Testimony (p. 204) before Joint Committee on Reorganization, Janu- 
ary 16, 1924. 
8 Testimony (p. 220) before Joint Committee on Reorganization, Janu- 
ary 17, 1924. 
9 Same (p. 224). 
10 Testimony (p. 347) before Joint Committee on Reorganization, Janu- 
ary 22, 1924. 
"Same (p. 348). 
13 Letter to Walter F. Brown, January 26, 1924. Reproduced in the Hear- 
ings on Federal Reorganization (p. 631). 410 
NATIONAL GOVERNMENT AND HEALTH 
H. S. Citmming, Surgeon General, Public Health Service 
" . . . several bureaus and divisions in several executive de- 
partments have been authorized by Congress to perform limited 
functions in certain specific fields. . . . The logical conclusion 
recahed when one studies this question is to bring these several 
bureaus together and coordinate them under one administrative 
head. Obviously the several branches of public health work are 
so intimately related that the bureaus cannot work to the best 
advantage in different departments. . . . Without question one 
administrative head should have supervision over all the civil and 
Federal health activities." 13 
J. W. Schereschewsky, Former Assistant Surgeon General, Pub- 
lic Health Service 
" The Public Health Service and the Children's Bureau are 
doing identical work. 
"If you want to be logical, I would say that all health matters 
should be under the direct charge of one Government agency; in 
the interests of efficiency no other answer is possible." 14 
Julia C. Lathrop, Former Chief, Children's Bureau 
" I think the most important point at present ... is the ques- 
tion of whether there is a kind of cooperation between these bu- 
reaus in the Government which is scientific, effective, and eco- 
nomical, or whether it is better for us to go our separate ways. I 
am satisfied by the experience of the Children's Bureau that we 
cannot go our separate ways without steadily encroaching upon 
each other's fields."18 
B. S. Warren, Former Assistant Surgeon General, Public Health 
Service 
" Without question one administrative head should have super- 
vision over all the civil Federal health activities. ... If all health 
activities are to be coordinated under one administrative head, 
the creation of a department of health with a Cabinet officer in 
charge, together with a transfer to it of all bureaus or parts of bu- 
13 Testimony (pp. 156, 157), Joint Hearings on a Department of Public 
Welfare, May 20, 1921. 
14 Testimony (p. 199) before Hearings on public protection of maternity 
and infancy, July 22, 1921. 
"Testimony (p. 238) before Hearings on public protection of maternity 
and infancy, July 23, 1921. APPENDIX 
411 
reaus and divisions of the Government now engaged in such activi- 
ties, is very generally considered the ideal method. Whether or 
not this is practicable at this time is a serious question."10 
William M. Steuart, Director of the Census 
" Such figures [annual mortality statistics] serve as the founda- 
tion of public health work." w 
Charles H. Burke, Commissioner of Indian Affairs 
" In its health work the Indian Service is not aiming merely to 
care for and cure the sick. This is one object, but not the only one. 
The main issue is to build up the vitality of the Indian people and 
to establish for them a new standard of living. Such an under- 
taking presents a formidable problem, involving a school-health 
program, an industrial program, and a great amount of preventive 
work and systematic attention to the physical welfare of children, 
in order that a stronger race may be developed."18 
Charles W'. Eliot, President Emeritus, Harvard University 
" It seems to me highly desirable to attempt to develop a na- 
tional movement, the purpose of which shall be to work out a 
better correlation of Federal health activities." 10 
W. F. Willoughby, Director, Institute for Government Research 
"The fundamental reasons actuating this recommendation (for 
a department of public health) are that the promotion of the public 
health is now one of the recognized functions, that the Govern- 
ment is now maintaining a number of distinct services, the activities 
of which have no direct relation to the functions of the depart- 
ments to which they are now attached ; that in the interests of these 
departments it is desirable that they should be relieved of responsi- 
bilities and work in no way pertaining to their primary duties ; and 
that only by grouping of these services in a separate department 
is it possible to adhere to the principle of having a strictly unifunc- 
tional character." 20 
16 Reprint No. 575 from the Public Health Reports (p. 5), December 5, 
1919. 
1T Annual Report, 1925 (p. 11). 
"Annual Report, 1925 (p. 1). 
19 Letter to the author, dated June 16, 1924. 
20 Reorganization of the administrative branch of the national government. 
Institute for Government Research (1923). (p. 239.) 412 
NATIONAL GOVERNMENT AND HEALTH 
W. C. Braisted, Late Surgeon General, U. S. Navy; President, 
American Medical Association 
" As a general proposition, I am firmly opposed to the disposi- 
tion to saddle every public and semi-public enterprise on the gov- 
ernment, a tendency arising from a profound misconception of 
government and its legitimate function, and often associated with 
a disinclination on the art of those displaying it to perform their 
own individual duty. But I am unqualifiedly in favor of a national 
department of health with a cabinet officer at its head, which 
shall by its very creation give a great object lesson to1 our people 
and shall correlate and vastly expand all the efforts now put 
forth for the improvement of the race, the prolongation of life, 
and the full development of physical capacity for work and 
production. . . . " 21 
Excerpts from Books on Public Health in which Federal 
Health Correlation is Advocated 
The following quotations were assembled after this book had 
been completed. They are presented as interesting examples of the 
trend of opinion of writers on public health administration. In- 
clusion of these excerpts does not mean, however, that all of the 
sentiments in them are indorsed: 
" Five economic reasons are assigned for establishing a national 
department of health: 
i. To enable society to increase the percentage of exceptional 
men of each degree, many of whom are now lost through prevent- 
able accidents, and also to increase the total population. 
2. To lessen the burden of unproductive years by increasing the 
average age at death. 
3. To decrease the burden of death on the productive years by 
increasing the age at death. 
4. To lessen the cost of sickness. It is estimated that if illness in 
the United States could be reduced one third, nearly $500,000,000 
would be saved annually. 
5. To decrease the amounts spent on criminality that can be 
traced to overcrowded, unwholesome, and unhygienic envi- 
ronment." 
W. H. Allen, Civics and health (1909). 
21 Journal of the American Medical Association, May I, 1920 (p. 1209). 
Presidential address. APPENDIX 
413 
A. C. Burnham, M. D., The community health problem (1920). 
" In the first place there would be required a United States De- 
partment of Health, with a Secretary of Public Health. This 
department would include the present United States Public Health 
Service, now under the Treasury Department, the Board for Child 
Welfare now under the Department of Labor, the Indian Medical 
Service now under the Department of the Interior anl the various 
other medical activities under the Federal Government." 
E. L. Fisk, M. D., Health building and life extension (1923), 
" It is logically a function of the State powerfully to aid in 
controlling and increasing the physical vigor of the Nation. 
" The first essential, therefore, is a federal department of health 
with a secretary in the cabinet. 
" The health of the Nation should be the first consideration of 
a member of the Cabinet, devoting all his energies to the subject." 
H. B. Hemenway, M.D., American public health protection 
(1916). 
" It is the opinion of most sanitarians that several of these 
National bureaus should be combined into one department, under 
the leadership of a member of the Cabinet who should be, not a phy- 
sician, but a sanitarian of broad experience, and with constructive 
ability. Such a head to' the department should be permanent, in 
fact, though not by enactment. Such a department is far more 
important to the people of the land than two or three of the pres- 
ent departments . . . . " 
" From that time (1884) to the present there have been proposals 
for the establishment of a National public health service in the 
broadest sense, to embrace all of the present agencies, correlate 
them and enlarge their scope. ... In the present agitation the 
true question relates not so much to the nature of the activities 
now carried on as to their coordination. The demand for a Na- 
tional health department should not be taken to mean that we have 
not, aside from questions of organization, a good National health 
service, for a very brief survey proves the reverse. . . . But the 
efforts to obtain such re-organization are evidently based on 
sound arguments, and, when questions as to the particular form 
of re-organization shall have been settled, will doubtless gain the 
desired end." 
J. Scott MacNutt, A manual for health officers (1915). 414 
NATIONAL GOVERNMENT AND HEALTH 
H. H. Moore, Public Health in the United States (1923). 
" The time has now come when health officers must consider 
whether it is not practicable to devise some plan for centralized 
leadership which will not result in the usurpation of the powers 
assured the states by the federal Constitution. . . . Although 
our form of government recognizes the supremacy of the state in 
the control of sanitation within its borders, the growth of inter- 
state commerce, increased speed in travel, war, and other forces 
have tended to unify the Nation. This nationalization of interests 
has seemed to bring about a new consciousness of a need for a 
coordination of health activities under a central head." 
G. M. Price, M. D., Hygiene and public health (3 ed. 1924). 
" National health being the greatest National asset, the preven- 
tion of National life waste and the conservation of National 
health becomes one of the most important problems and duties, and 
there is no reason why the appalling infant mortality, the unneces- 
sarily great death-rate, and the loss of life by preventable diseases 
should not be a federal function, and not left to the politicians 
of various states and small hamlets and towns." 
William H. Welch, M. D., Papers and addresses (1920). 
" Dr. Billings was vice-president of the short-lived National 
Board of Health, established by the government in 1879. The 
withdrawal by Congress of support of this promising service of 
the government set back, we believe, for many years the advance- 
ment of the public health interests of this country." 
G. C. Whipple, State sanitation, Vol. I (1917). 
" There are good reasons for the assembling of some of these 
activities in a National Department of Health, and some time this 
will probably be done. On the other hand there are objections to the 
multiplication of cabinet positions. Meantime the Public Health 
Service is growing in power and efficiency, and is more and more 
coming to perform the functions of a Federal Department of 
Health." INDEX 
Accidents, industrial, 263. 
Adams, John, 21. 
Adulteration, 191. 
Advisory health council, federal, 
401. 
Aediles, 8. 
Agramonte, Aristides, 222. 
Agricultural Chemists, Association 
of, 188. 
Agricultural Economics, Bureau of, 
209, 228. 
Agriculture, Department of, 187, 
352, 354, 370. 
Akron, 233. 
Alabama, 141, 241, 277, 298. 
Alaska, 40, 65, 102, 157, 229, 279, 302. 
Alaska Division, 279, 348. 
Aliens. See Immigrants. 
Allen, W. H., 412. 
Alsberg, Dr. C. A., 189, 190. 
American Association for Advance- 
ment of Science, 376. 
Association for Labor Legisla- 
tion, 255. 
Association of University Wo- 
men, 209. 
Engineering Standards Com- 
mittee, 304. 
Federation of Labor, 255. 
Gas Association, 305. 
Institute of Architects, 305. 
Institute of Electrical Engi- 
neers, 305. 
Public Health Association, 17, 
36, 141, 363, 380, 405. 
Railway Association, 156. 
Red Cross, 108, no, 300. 
Society of Mechanical Engi- 
neers, 305. 
Anderson, Mary, 258. 
Andrews, John B, 263. 
Animal diseases, 33, 54, 199. 
Animal Industry, Bureau of, 198, 
208, 226; activities, 200; appro- 
priations, 205; history, 198; or- 
ganization, 202; patents on meat 
products, 307; personnel, 205; pub- 
lications, 202. 
Anthrax, 199, 260. 
Appius, Claudius, 7. 
Appropriations, federal, for public 
health, 350. 
Aqueducts, ancient, 7. 
Ardmore, S. D., 216. 
Aristotle, 7. 
Arizona, 292, 299. 
Arkansas, 38, 123. 
Army, Medical Department of, 32, 
316. 
Arsphenamine, 146. 
Arthur, Chester A., 23. 
Assistant Secretary for health, 399. 
Assistant surgeons, 165. 
Assistant surgeons general, 167. 
Assyrian empire, 5. 
Atlanta, 244. 
Atwater, W. O., 206. 
Augusta, Ga., 303. 
Australia, 19. 
Babylon, 6. 
Bacteriology, development of, 13. 
Bailhache, Preston H., 35. 
Bain, H. F., 300. 
Baltimore, 101, 233, 247. 
Bates, John L., 378. 
Bedloes Island, 95. 
Beltsville, Md., 199, 213. 
Bemis, Samuel M., 35. 
Beriberi, 104. 
Biggs, H. M., 15. 
Bill of health, 91, 131. 
Billings, John S., 35. 
Biological products, 40, 98, 106, 145. 
Biological Survey, Bureau of, 224. 
Blue, Rupert, 168. 
Board of Health, the first state, 11. 
Boston, 12, 78, 101, 229, 241. 
Botulism, 199. 
Bowditch, Henry I., 35. 
Braisted, W. C., 412. 
Brazil, 396. 
Broad Knossus, palace of, 6. 
Brockton, Mass., 233. 
Brown, John M., 35. 
Brown, W. F., 382. 
415 416 
INDEX 
Browne, Dr. C. A., 190. 
Bryan, W. J., 376. 
Budget, Bureau of, 353. 
Burke, C. H., 411. 
Burnham, A. C., 413. 
Cabell, James L., 35. 
California, no, 205, 245, 248, 291, 
292, 298. 
Canada, 246, 265, 396. 
Canal Zone, 157. See Panama Canal. 
Cancer, 138, 139. 
Canton, S. D., 270. 
Capps, W. L., 377. 
Carbon monoxide, 364. 
Carriers, interstate, 125. 
Carroll, Dr. James, 222. 
Carthage, 7. 
Carville, 121, 122, 154. 
Census, Bureau of, 234, 240, 290, 
370. 
Chadwick, Edwin, 10. 
Chailie, Dr. S. E., 36. 
Chaldean-Babylonian empire, 5. 
Chapin, C. V., 15. 
Charleston, 78. 
Chaulmoogra oil, 230. 
Chelsea, Mass., 241. 
Chemical Warfare Service, 315. 
Chemistry, Bureau of, 187, 348; 
activities, 190; appropriations, 
197; history, 187; organization, 
196; personnel, 197; publications, 
195; scheme for correlation, 390. 
Chicago, 13; sanitary district of, 53, 
315- 
Child Health Organization, 277. 
Child hygiene, 142, 239, 357. 
Child labor, 58, 63, 64, 234, 243, 245. 
Child welfare standards, 236. 
Children's Bureau, 41, 72, 102, 232; 
activities, 238; appropriations, 254, 
351; child hygiene, 240; child labor, 
234, 243; delinquency, 246; de- 
pendency, 246; history, 232; infant 
mortality, 239; juvenile courts, 
248; maternity, 236, 239, 252; 
mothers' pensions, 246; organiza- 
tion, 250; personnel, 254; publica- 
tions, 370; scheme for correlation, 
389. 
Children's Year, 235. 
Cholera, 22, 24, 34, 84, 86, 88, 123, 
131. 
Cincinnati, 104, 143, 248. 
Claxton, P. P., 275. 
Cleveland, 80. 
Cleveland, Grover, 24, 374, 408. 
Cloaca Maxima, 7. 
Clonorchiasis, 138. 
Colorado, 244, 291. 
Columbus, 244. 
Commerce, Department of, 290, 351, 
355- 
Committee of One Hundred, 27, 376, 
379- 
Conference of State Health Officers, 
406. 
Connecticut, 13, 72, 77, 243, 244, 292. 
Constitution, Federal and public 
health, 48, 62. 
Consular Service, 267, 309, 348. 
Consuls, reports of, 39, 85, 92. 
Contract service, principle of, 394. 
Coolidge, Calvin, 406. 
Cooperation, office of, 193. 
Correlation of federal health activi- 
ties, 373; proposed, 384; resolu- 
tions on, 405. 
Cottrell, F. G., 300. 
County agents, 219. 
Crete, 6. 
Crossman, Dr. E. O., 334. 
Crozier, W., 377. 
Crusades, the, 8. 
Cuba, 93. 
Cumming, Dr. H. S., 168, 410. 
Customs Service, 184, 191. 
Cyrus the Great, 6. 
Czecho-Slovakia, 396. 
Dairy Industry, Bureau of, 42, 211; 
activities, 214; appropriation, 216; 
history, 211; organization, 216; 
personnel, 216; publications, 215. 
Dark Ages, 8. 
Davis, J. J., 389, 409. 
Davis, Dr. W. H., 295. 
Dawes, C. G., 381. 
Death rates, 18. See Vital Statistics. 
Delaware, 246, 292. 
Demosthenes, 7. 
Denmark, 19, 246. 
Dennison, H. S., 313. 
Dentistry, 154. INDEX 
417 
Department of Public Health, dis- 
cussed, 385. 
Derby, Earl of, 16. 
Diabetic manual, 209. 
Diphtheria, 104. 
Disability ratings, 332, 333. 
Diseases, interstate control of, 88, 
123 ; investigations of, 101; of In- 
dians, 104; reports of, 149, 159. 
See Specific diseases. 
Disraeli, quoted, 19. 
District of Columbia, 20, 22, 65, 245, 
246, 248, 249, 291, 292. 
Districts, public health, 162. 
Domestic quarantine, Division of, 
155- 
Drugs, definition of, 191; duplication 
in control of, 368. 
Dublin, L. I., 263. 
Dunham, Dr. K., 334. 
Dunwoody, W. P., 35. 
Duplication in federal health work, 
357- 
Dysentery, amebic, 31. 
Education and Relief, Department 
proposed, 383. 
Education, Bureau of, 275, 370. 
Edward III, 9. 
Edwards, Dr. T. O., 79. 
Egypt, 6. 
Eliot, Charles W., 411. 
Elizabeth McCormick Memorial 
Fund, 276. 
Employee's Compensation Commis- 
sion, 41, 342, 348. 
Encephalitis lethargica, 331. 
Engineers, Chief of, 315. 
Engineers, sanitary, 126, 176, 227, 
286, 297. 
England, 2, 9; first board of health, 
10; 15, 17. 
Entomology, Bureau of, 221, 286, 
349- 
Epaminondas, 7. 
Epidemiologists, collaborating, 159. 
Experiment Stations, office of, 206, 
226, 229. 
Extension Service, 217; activities, 
219; history, 217; organization, 
221. 
Federal Board for Vocational Edu- 
cation, 41, 245, 329, 338. 
Federal health; appropriations, 350; 
correlation of, 373, 384; legisla- 
tion, 42; periodicals, 372; person- 
nel, 354, 400; publications, 71, 369; 
resolutions on, 405; research, 65; 
states and, 69. 
Federal Narcotics Control Board, 
42, 183, 345. 
Filled cheese, tax, 183. 
Fisher, Irving, 376. 
Fisheries, Bureau of, 208, 286, 302. 
Fisk, E. L, 413. 
Flexner, Dr. Simon, 402. 
Florida, 240, 292, 302. 
Folger, Charles J., 35. 
Folsom, Charles F., 35. 
Food, definition of, 191; purity of, 
56; studies of, 208, 229, 303, 362. 
Foot and mouth disease, 201, 202. 
Forecastles, fumigation of, 105, 131, 
158. 
Foreign quarantine, Division of, 157. 
Forest Service, 231. 
Fort Stanton, 121, 154. 
France, 9, 396. 
Frankel, Dr. L. K., 311. 
Freedmen's hospital, 32, 283. 
Fumigation, of forecastles, 105, 131, 
158. 
Gaffky, 14. 
Galveston, 101. 
Garfield, J. R., 377. 
Garner, J. W., 375. 
Gary, Ind., 233. 
General Education Board, 217. 
General Federation of Women's 
Clubs, 209, 234, 240, 241. 
"General Welfare," 62. 
Geological Survey, 283, 370. 
Georgia, 139, 244, 248, 249, 257, 292. 
Germany, 396. 
Glanders, 199, 202. 
Goitre, 104, 138. 
Gorgas, W. C., 15, 223, 317, 318. 
Grant, U. S., 22. 
Great Britain, 10, 396. 
Greece, the golden age of, 6; per- 
sonal hygiene in, 7. 
Gregory the Great, 8. 
Egypt, 6. 
Gaffky, 14. 418 
INDEX 
Guam, 229, 320, 324. 
Guiteras, John, 36. 
Haiti, 324. 
Hamilton, Dr. Alice, 263. 
Hamilton, Dr. J. B., 85, 90, 168. 
Hardie, T. S., 36. 
Harding, Warren G., 30, 380, 381, 
408. 
Harris, Elisha, 37. 
Harrison Act, 183. 
Harrison, Benjamin, 24. 
Havana, 15, 86, 223. 
Hawaii, 94, 100, 157, 229, 230, 238, 
243- 
Hayes, Rutherford B., 22, 33. 
Hays, Will H., 311. 
Hebrews, the ancient, 6. 
Hektoen, Dr. L., 200. 
Hemenway, H. B., 413. 
Herodotus, 6. 
Hippocrates, 7. 
History, public health in, 5. 
Hoffman, F. L., 263, 380. 
Flog cholera, 198, 202. 
Holland, 19. 
Holmes, J. A., 300. 
Home demonstration, 217. 
Home Economics, Bureau of, 42, 
205; activities, 208; history, 205; 
organization, 211; publications, 
209; scheme for coordination, 390. 
Hookworm disease, 104, 260. 
Hoover, Herbert, 383, 409. 
Hospitalization, Federal Board of, 
381. 
Hospitals 
Alaska, 280. 
Aliens, 266. 
Freedmen's, 283. 
Indians, 270. 
Insane, 281. 
Marine, 77, 154. 
Naval, 77. 
Rural, 229. 
St. Elizabeth's, 32, 280. 
Veterans', 328, 336. 
Hours of labor, 57. 
Howard, Dr. L. O., 222, 223. 
Hughes, Dr. Joseph, 200. 
Hungary, 396. 
Hunt, Dr. Reid, 402. 
Huntley, Mont., 216. 
Hygienic Laboratory, 95, 98, 99, 100, 
402; advisory board, 97, 402; de- 
scription of, 144; director's pay, 
104, 177. 
Idaho, 69, 292. 
Illinois, 38, 53, 72, 243, 244, 246, 291, 
292, 298. 
Immigrants, medical inspection of, 
39, 89, 99, 101, 107, 131, 158, 264, 
265. 
Immigration, Bureau of, 264, 348. 
Independent establishments, 326, 353. 
India, 19. 
Indian Affairs, Office of, 268, 348, 
370, 392. 
Indiana, 38, 104, 291, 292, 294. 
Indians, health of, 33; diseases of, 
104, 269. 
Industrial conditions and health, 57, 
139, 260, 305, 363. 
Infant mortality, 233, 239. 
Influenza, epidemic of, 115, 138, 139. 
Information, collection of, 70. 
Insane, Government hospital for, 32, 
280. 
Insanity, in aliens, 107, 132, 265. 
Inspection Service, Public Health 
Service, 152. 
Interdepartmental Social Hygiene 
Board, 41, 112, 136, 137, 326. 
Interior, Department of, 268, 351, 
355- 
Internal Revenue, Bureau of, 181. 
International Health Board, 71. 
Interstate commerce, 49, 50, 64, 73. 
Interstate Commerce Commission, 
326. 
Iowa, 38, 257, 292. 
Ireland, M. W., 318. 
Jefferson, Thomas, 9, 21. 
Jerusalem, 6. 
John II, King, 9. 
Johns Hopkins University, 141, 224. 
Johnson, Andrew, 22. 
Johnson, Hosmer A., 35. 
Johnstown, Penn., 233. 
Joplin, 297. 
Jugo-Slavia, 396. 
Justice, Department of, 309, 351. 
Juvenile courts, 248. INDEX 
419 
Kalihi, 121, 154. 
Kansas, 72, 243, 257, 291, 292. 
Kelley, Florence, 232. 
Kentucky, 38, 242, 244, 249, 291, 292, 
298; trachoma in, 122. 
Key West, 87. 
Kingsley, S. C., 276. 
Knoxville, 296. 
Koch, Robert, 14. 
Labor, Department of, 232, 351, 355. 
Labor Statistics, Bureau of, 259, 370. 
Laissez-faire policy, 9. 
Lateran Council, 8. 
Lathrop, Julia C., 236, 410. 
Lazear, Dr. Jesse W., 222, 223. 
Legislation, federal health, 42; first 
sanitary, 12. 
Lepers, 6, 8, 66, 94, 100, 106, 122, 154, 
35i- 
Leprosy, 94, 100, 104, 121, 138, 230. 
Life Extension Institute 312. 
Life, length of, 17; tables, 294. 
Liverpool, 10, 86. 
London, 6, 9, 10, 86. 
Loring, Dr. G. B., 79- 
Louisiana, II, 37, 38, 5L 53, 213, 292. 
Lyons, Council of, 8. 
MacNutt, J. S., 413. 
Maine, 72, 243, 292. 
Malaria, 15, 104, 138, 139, 222. 
Manchester, N. H., 233, 257. 
Manning, Van. H., 300. 
Marine Hospital Service, 76; name 
changed, 96; the organized, 81; 
quarantine, 83; the unorganized, 
76. See Public Health Service. 
Marine hospitals, the first, 77, 78; list 
of, 154- 
Markets, Bureau of, 208; 228. 
Marseilles, 9. 
Marshall, John, 49. 
Maryland, 244, 257, 291, 292. 
Massachusetts, 11, 12, 14, 22, 50, 51, 
72, 77, 78, no, 237, 247, 292, 387. 
Massachusetts Institute of Technol- 
ogy, 14. 
Massachusetts Sanitary Commission, 
7, ii- 
Matches, white phosphorus, 63, 103. 
Maternal mortality, 239. 
Maternity and infancy act, 58, 63, 72, 
234, 236, 359. 
McCoy, G. W., 402. 
Meat Inspection, 73, 201. 
Medical Department of Army, 32, 
316. 
Medical relief, of U. S. P. H. S., 
119; persons entitled to, 119; sea- 
men, 32, 185. 
Medicine, practice of, 59; state, 17. 
Medieval period, 8. 
Mellon, A. W., 383, 409. 
Melvin, Dr. A. D., 203. 
Memphis, 37, 139, 277. 
Mental hygiene, 142, 367, 393. 
Merchant seamen, medical relief of, 
76. 
Merrill-Palmer Nursery School of 
Detroit, 209. 
Mesopotamia, 5. 
Michigan, 38, 244, 291, 292, 294. 
Middletown, Conn., 206. 
Milk, 56, 141, 199, 211, 229, 362. 
Mines, Bureau of, 40, 72, 101, 105. 
295, 348, 370. 
Minimum wage decision, 58. 
Ministries of Health, 396. 
Minnesota, 243, 248, 291, 292. 
Mississippi, 38, 292. 
Missouri, 38, 53, 123, 291. 
Mitchell, Robert W., 35. 
Mobile, 101. 
Mohler, Dr. John R., 203, 402. 
Monroe, James, 22. 
Montana, 139, 291, 292. 
Montclair, N. J., 233. 
Montgomery, 141. 
Monthly Labor Review, 259, 263. 
Moore, H. H., 414. 
Moore, Dr. V. A., 199, 200. 
Morbidity; reports, 149, 159; regis- 
tration area, 150. 
Moses, 6. 
Mosquitoes, 15, 222, 303, 349. 
Naples, 93, 94. 
Narcotic law, 183. 
National Association of Letter 
Carriers, 314. 
Boot and Shoe Manufacturers 
Association, 314. 
Child Labor Committee, 233, 
277. 420 
INDEX 
Conference of Commissioners 
on Uniform State Laws, 247. 
Conference of Social Work, 
246, 247. 
Consumer's League, 232, 255. 
Health Council, 382, 407. 
Homes for Disabled Volunteer 
Soldiers, 328. 
Probation Association, 248. 
Radium Institute, 300. 
Research Council, 300. 
Safety Council, 305. 
Tuberculosis Association, 406. 
National Board of Health, 23; de- 
scription of, 33; 59, 85, 373. 
National Bureau of Plealth, pro- 
posed, 27, 378. 
National Park Service, 285, 349. 
National parks, sanitation in, 127, 
285. 
Naval hospitals, 77. 
Naval stores, 193. 
Navy, Bureau of Medicine and Sur- 
gery of, 320. 
Nebraska, 69, 292. 
Neoarsphenamine, 146. 
Nevada, 292. 
New Bedford, Mass., 233. 
Newberne, Dr. R. E. L., 272. 
New Hampshire, 50, 77, 292. 
New Haven, 242. 
New Iberia, La., 216. 
New Jersey, ^4, 245, 248, 257, 291, 
292, 294. 
New Mexico, 69, 242, 243, 298. 
New Orleans, 33, 37, 53, 78, 101, 223. 
Newport, 78. 
New York, 51, 91, 244, 248, 291, 292, 
294. 
New York City, 13, 15, 39, 89, 95, 
101, 132, 228, 244, 312. 
New Zealand, 19, 240, 246, 396. 
Niagara Falls, 255. 
Nineveh, 6. 
Norfolk, 78. 
North Carolina, 248, 291, 292. 
North Dakota, 123, 244, 292. 
Norton, J. Pease, 376. 
Norway, 19. 
Nuisances, early regulation of, 13; 
15; police power and, 51. 
Nutrition studies, 208, 219, 229, 303, 
362, 390. 
Ohio, 38, 257, 291, 292. 
Oil pollution, 315. 
Oleomargarine, 56, 63, 182. 
Opium, 183. 
Oregon, 244, 292. 
Organic diseases, 18. 
Oysters, 303. 
Pamphlets, government, 71. 
Panama Canal, 223. 
Paralysis agitans, 331. 
Paratyphoid fever, 109. 
Passed assistant surgeon, grade 
created, 86. 
Pasteur, 13, 36. 
Patent medicines, 191, 306. 
Patent office, 305. 
Pearson, Dr. L., 200. 
Pellagra, 104, 138, 139. 
Pennsylvania, 13, 243, 244, 249, 291, 
292. 
Pensions, Bureau of, 289. 
Periodicals, federal, 372. 
Personnel, federal on health work, 
354; reorganization of, 400. 
Pharmacists, 178. 
Phelps, J. R., 402. 
Philadelphia, 13, 248. 
Philippines, 94, 157. 
Phillips, Samuel F., 35. 
Phoenicians, 6. 
Physical education, 276. 
Pierce, Franklin, 22. 
Pinchot, Gifford, 377. 
Pittsburg, 233, 297. 
Plague, bubonic, 9, 88, 123, 131, 225. 
Plant Industry, Bureau of, 230. 
Plato, 7. 
Playground and Recreation Associa- 
tion, 276. 
Plumbing code, standard, 305. 
Plutarch, 7. 
Plymouth, 12. 
Poland, 396. 
Police power, 48, 49, 61; delegation 
of, 68; limitations on, 67. 
Poor laws, 10. 
Portland, Me., 80. 
Porto Rico, 93, 94, 157, 229, 249, 250. 
Port Townsend, 87. 
Post Office Department, 310, 349. 
Presidents, public health in messages 
of, 20. INDEX 
421 
Pribiloff Islands, 302. 
Price, G. M., 414. 
Prisons, superintendent of, 310. 
Providence, R. I., 15. 
Prussia, 9. 
Public health; defined, 16; depart- 
ment of discussed, 385; evolution 
of, 15; expenditures for, 69; 
federal appropriations, 350; history 
of, 5; modern, 16; needs of, 19; 
periods of, 15; police power and, 
49; results of, 17; studies of ad- 
ministration, 141; taxation and, 
182; U. S. Supreme Court and, 48. 
Public Health Reports, 85, 158. 
Public Health Service; activities, 
119; appointments to, 164; appro- 
priations, 180, 350; biologic prod- 
ucts, 145; Bureau of Mines and, 
298; chief clerk, 151; child hy- 
giene, 142; correlation of, 386; de- 
scription of, 75; details of officers 
to other bureaus, 348; districts, 
162; Domestic Quarantine Divi- 
sion, 155; Employees Compensation 
Commission and, 344; foreign 
quarantine, 130; Foreign Quar- 
antine Division, 157; functions, 
76; history, 76; Hospital Division, 
153; Hygienic Laboratory, 144; in- 
dustrial hygiene, 139, 305; Inspec- 
tion Service, 152; medical inspec- 
tion of aliens, 131; medical relief 
by, 119; mental hygiene, 142; milk 
investigations, 141; non-commis- 
sioned personnel, 175; organization 
of, 150; personnel, 163, 175; Per- 
sonnel and Accounts Division, 153; 
pharmacists, 178; post offices and, 
312; promotions in, 165; publica- 
tions, 369; public health adminis- 
tration, 141; reserves, 115, 174; 
retirement, 172; rural sanitation, 
127; salaries, 118, 169; sanitary 
engineering, 126; Sanitary Reports 
and Statistics Division, 158; scien- 
tific research, 138, 160; statistical 
research, 143, 148; stream pollu- 
tion, 143; supervising surgeon, 
81; surgeon general, 96, 150, 167, 
168, 237; venereal diseases, 135; 
Venereal Disease Division, 155; 
veterans' work, 327; World War 
and, 108. 
Public Roads, Bureau of, 226, 349. 
Publications, federal, on health, 369. 
Pueblo, 102. 
Pumpelly, Raphael, 37. 
Pure Food and Drugs Act, 40, 73, 
189, 311; enforcement of, 190. 
Quarantine; court decisions on, 54; 
Domestic, 156; first, 9; foreign, 
130, 157; law of 1878, 83; law of 
1893, 90; national, 21, 37, 100, 117; 
Public Health Service and foreign, 
130. 
Quartermaster General, 315. 
Rabies, 199, 225. 
Radium, 297, 305. 
Ragusa, 9. 
Rats, 224. 
Ravenel, Dr. M. P., 200, 402. 
Read, T. T., 300. 
Reed, Walter, 222, 317. 
Registration area, 291. 
Remsen, Ira, 36, 37. 
Reserve Corps, U. S. P. H. S., 115. 
Revere, Paul, 13. 
Rhode Island, 50, 77, 244, 257, 292. 
Rickets, 242. 
Rocky Mountain spotted fever, 138, 
223, 225. 
Rogers, Dr. J. F., 277. 
Rome, sanitation in ancient, 7. 
Roosevelt, 19, 25, 100, 376, 377, 408. 
Rosenau, Dr. M. J., 200. 
Ross, Sir Ronald, 222. 
Rural sanitation, 105; duplication in, 
365; by public health service, 127; 
results of, 128. 
Russell, F. F., 317. 
Russia, 279. 
Saginaw, Mich., 233. 
St. Elizabeth's Hospital, 280, 393. 
St. Thomas, 109. 
Salaries, Public Health Service, 168. 
Salem, 12. 
Salmon, Dr. D. E., 203. 
Samoa, 320, 324. 
San Diego, 87. 422 
INDEX 
Sanitary Engineering; ancient, 8; 
duplication in, 365; Bureau of 
Mines, 297; Bureau of Public 
Roads, 227; Public Health Ser- 
vice, 126, 177, 286. 
Sawyer, C. E., 380, 381, 382. 
Sayers, Dr. R. R., 300. 
Scabies, 202. 
Schereschewsky, Dr. J. W., 359, 410. 
School hygiene, 360. 
School Hygiene, Division of, 40, 275. 
School lunches, 361. 
de Schweinitz, Dr. E. A., 199. 
Scientific research, of Public Health 
Service, 138, 160. 
Seamen, medical relief for, 32, 185. 
Seattle, 296. 
Sedgwick, W. T., 14, 200. 
Segovia, 8. 
Senior Surgeon, 103. 
Service Relations, Division of, 311. 
Shakespeare, E. O., 24, 317. 
Shattuck, Lemuel, 11. 
Shipyards sanitation, 109. 
Siler, J. F., 402. 
Simon, John, 10. 
Simons, Thomas, 35. 
Sleeping sickness, 223. 
Small, W. S., 277. 
Smallpox, 12, 37, 88, 105, 109, 123, 
I3L 213. 
Smart, Charles, 35. 
Smith, Stephen, 35, 37. 
Smith, Dr. Theobald, 199. 
Smithsonian, 258, 274, 326. 
Society of Automotive Engineers, 
305- 
South Carolina, 13, 101, 217, 244, 291, 
292. 
South Dakota, 291, 292. 
Spaeth, Dr. R. A., 257. 
Spanish War, 93, 317. 
Spencer, Herbert, quoted, 5. 
Standards, Bureau of, 263, 304, 371. 
Stanley, Louise, 207. 
State Board of Health, the first, 11; 
chronology of, in U. S., 12. 
State Department, 309, 351. 
State health, federal recognition of, 
66; federal government and, 69; 
organization of, 68. 
State health officers, conference, 66, 
97, 402. 
State medicine, 17. 
States Relations Service, 207, 213, 
218. 
Statistics; duplication, 367; research, 
143; and reports, 148. 
Steamboat Inspection Service, 308. 
Sternberg, G. M., 24, 36, 37. 
Steuart, W. M., 411. 
Stiles, C. W., 200. 
Stitt, Dr. E. R., 322. 
Stream pollution, 143. 
Subsidies, federal, 63, 338. 
Summary and comment, 346. 
Superintendent of Documents, 369. 
Supervising Surgeon, Public Health 
Service, 81. 
Supreme Court, public health and the 
United States, 48. 
Sweden, 19. 
Syphilis, 146. 
Taft, W. H., 27, 102, 377, 378, 408. 
Taney, Roger, 50. 
Tax; filled cheese, 183; marine hos- 
pital, 77, 79, 83, 87; white phos- 
phorus matches, 103, 183. 
Taxing power, federal, 62. 
Tea inspection, 193. 
Tennessee, 38, 122, 123, 239, 291. 
Texas, 53, 101, 217, 244. 
Tiber, 7. 
Tick fever, 200, 202. 
Trachoma, 104, 271, 274; hospitals, 
122. 
Trademarks, 306. 
Treasury, Department of, 75. 
Treaties, 65. 
Trichinosis, 199. 
Tuberculin, 201. 
Tuberculosis, 18, 26, 28, 94, 104, 107, 
121, 132, 200, 270, 274, 280, 297, 
328 331, 334, 366. 
Tularaemia, 225. 
Turner, Scott, 300. 
Turner, Thomas J., 35. 
Tyler, John, 22. 
Typhoid fever, 18, 104, 105, 109, 127, 
223, 312, 317. 
Typhus fever, 104, 131, 138, 223. 
United States Supreme Court, public 
health and, 48. 
Urbana, 296. 
Utah, 291, 292, 298. INDEX 
423 
Vaccination; 109, 270, 312; court de- 
cision on, 55. 
Van Buren, Martin, 22. 
Van Ingen, Dr. P., 357. 
Van Kleeck, Mary, 258. 
Vaughan, V. C., 317, 402. 
Venereal diseases; Alaska, 280; con- 
trol of, no, 135; Division of, 66, 
112, 155; Navy, 324. 
Venice, 9. 
Ventilation studies, 298. 
Vera Cruz, 86. 
Verdi, Tullio S., 35. 
Vermont, 292. 
Veterans' Bureau, 41, 327, 393. 
Veterans, medical care of, 117. 
Victoria, Queen, 10. 
Virgin Islands, 109, 157, 229, 320, 324. 
Virginia, 122, 244, 291, 292. 
Virus, serum tests, 98. See Biolog- 
ical products. 
Vital statistics, 40, 97, 290. 
Vital Statistics, Division of, 290, 387. 
Vitamins, 194, 202, 303. 
Vocational rehabilitation, 333, 339, 
341. 
Waiting orders, 172. 
Walcott, C. D., 377. 
Wald, Lillian D., 232. 
Wallace, H. C„ 361. 
War Department, 315, 353, 355. 
War Risk Insurance, Bureau of, 327, 
329. 
Waring, George E., 15, 36, 37. 
Warren, B. S., 410. 
Washington, State, 244, 257, 291, 292. 
Water; mineral, 193; on railroads, 
126; supplies, 231; resources sur- 
veys, 283; vessels, 308. 
Waterbury, Conn., 233. 
Waycross, Ga., 188. 
Webster, Dr. G. W., 257. 
Welch, Dr. W. H., 200, 402, 414. 
Welfare, department of, 30, 380. 
West Virginia, 101, 122, 140, 244, 
292. 
Wiley, Dr. Harvey W., 188, 189. 
Whipple, G. C., 414. 
White slave laws, 59. 
Wilbur, Dr. R. L., 334. 
Willoughby, W. F., 387, 411. 
Wilson, James, 390, 391. 
Wilson, Woodrow, 29, 109, 235, 379, 
408. 
Winslow, C-E. A., quoted, 9, 11. 
Wisconsin, 38, 244, 248, 257, 291, 292. 
Women's Bureau, 41, 254; activities, 
256; appropriations, 258; history, 
255; organization, 258; publica- 
tions, 370. 
Women in Industry Service, 41, 255. 
Wood, Leonard, 223. 
Woodward, Okla., 216. 
Woodworth, Dr. J. M., 81, 85, 168. 
Work, Hubert, 286, 382, 393, 409. 
Wyman, Surgeon General Walter, 
22, 90, 168. 
Wyoming, 292. 
Yale School of Medicine, 242. 
Yellow fever, 11, 12, 13, 15, 21, 22, 
33, 36, 53, 86, 88, 96, 123, 131, 222, 
373, 374- 
Yellow fever institute, 96, 99. 
Yellowstone, 285, 286. 
Young, George B., 378.