CHAPTER XV.

THE FEDERAL PUBLIC HEALTH SERVICE.

Under the provisions of the constitution of the United States empowering the federal government to regulate the admission of immigrants and to promote the general welfare of the people, from the beginning of our national existence, officers were stationed at the chief points of entry to prevent incoming vessels from landing plague-stricken passengers or members of crews, and gradually, under the supervision of the Department of the Treasury, the United States Public Health Service has been developed. Few people have any conception of the extensive work which is being carried on by this department, which is just as active in protecting the people of the country as is the army and navy.

The work of the department is organized under the following divisions: scientific research and sanitation; foreign and insular quarantine and immigration; interstate quarantine; sanitary reports and statistics; marine hospitals and relief; personnell and accounts; miscellaneous.

Each of these divisions is in charge of a medical officer who is responsible for its operations to the surgeon-general of the service.

The staff of the department at the close of the year ending June 30, 1915, consisted of the following:

Medical inspector

1

Quarantine inspector

1

.1,429

Passed assistant surg's. 39

Hospital and quarantine nurses and attendants

This service must be attractive, because during the year considered there were no resignations from the service, although during the year five officers were placed under "waiting orders" on account of illness, which means that they were relieved from duty on full or half pay.

The rate of pay is as follows: assistant surgeons receive $2,000; passed assistant surgeons, $2,400; surgeons, $3,000; senior surgeons, $3,500; and assistant surgeon-generals, $4,000 a year. When quarters are not provided, commutation at the rate of $30, $40 and $50 a month, according to the grade, is allowed.

After four years' service, assistant surgeons are entitled to examination for promotion to the grade of passed assistant surgeon.

All grades receive longevity pay, 10 per cent. in addition to the regular salary for every five years' service up to 40 per cent. after twenty years.

The tenure of office is permanent. Officers travelling under orders are allowed actual expenses.

Admission to the service is governed by the following regulations contained in a circular letter which is sent. to applicants:

Boards of commissioned medical officers will be convened to meet at the Bureau of Public Health Service, 3 B Street, S.E., Washington, D. C., for the purpose of examining candidates for admission to the grade of

assistant surgeon on the Public Health Service, when applications for examination at these stations are reIceived in the Bureau.

Candidates must be between 23 and 32 years of age, graduates of reputable medical colleges, and must furnish testimonials from two responsible persons as to their professional and moral character. Service in hospitals for the insane, or experience in the detection of mental diseases will be considered, and credit given in the examination. Candidates must have had one years' hospital experience or two years' professional work. They must be not less than 5 feet, 4 inches, nor more than 6 feet, 2 inches in height.

The following is the usual order of the examination: physical, oral, written, clinical. In addition to the physical examination, candidates are required to certify that they believe themselves free from any ailment which would disqualify them for service in any climate, and that they will serve wherever assigned to duty.

The examinations are chiefly in writing, and begin with a short autobiography of the candidate. The remainder of the written exercise consists of examination in the various branches of medicine, surgery and hygiene. The oral examination includes subjects of preliminary education: history, literature and natural sciences. The clinical examination is conducted at a hospital. The examination usually covers a period of about ten days.

The officers of the medical corps examine the papers of all incoming vessels. The medical officer of all ships upon arriving at a port must state the health condition of the port from which the ship comes as well as the conditions of the ports at which the ship touched during

the voyage, and enumerate any cases of sickness which occurred during the voyage. The medical inspectors may examine all the passengers and crew and require the fumigation of the cargo; and in suspected cases they may cause the vessel or passengers who were exposed to contagion or infection to be detained in quarantine sufficiently long to give any suspected diseases the full period of time to develop.

The department may also send inspectors to suspected foreign ports to scrutinize cargo, crew and passengers of vessels destined for American ports, to prevent the spread of communicable diseases.

Officers are stationed as sanitary guards at Santiago, Chile; Callao, Peru; Guayaquil, Ecuador; Rio de Janeiro, Brazil; La Guaira, Venezuela; Calcutta, India; Naples, Italy; Libau, Russia and in several Cuban and Mexican ports, and in such other foreign ports as deemed necessary.

One can hardly appreciate the value of the service which the government is rendering to its people through this department. Although Asiatic ports from which vessels sail are often infected with bubonic plague, cholera, smallpox or other diseases, yet these diseases have only on a few occasions been introduced into this country. Several years ago bubonic plague did develop upon the Pacific coast, and but for the persistent, thorough work of these medical officers, the whole country from coast to coast might have been infected.

This work at the ports of entry is not by any means all the work that is done in disease prevention by this department, but investigations of disease epidemics are carried on continually. During 1914, important investigations of typhoid fever, cholera, plague, smallpox,

typhus fever, tuberculosis, trachoma, pellagra, poliomyelitis, malaria, dengue, hookworm disease, water pollutions and milk hygiene have been conducted.

The officer detailed to investigate the disease among the mountain whites in Tennessee, and among the natives of Porto Rico, known as the "lazy" disease, because all the inhabitants afflicted with the disease became lazy, indolent and sleepy, found the cause of the disease to be a hookworm. The officer detailed to this investigation also developed a treatment for the cure of these afflicted mountain whites.

Another officer was detailed to investigate the Rocky Mountain spotted fever, and found the cause to be a microorganism disseminated by a tick. The name of Surgeon T. B. McClintic, who sacrificed his life to the cause of science in order that this fever might be eradicated, belongs with those heroes who have given up their lives for the common good of mankind.

Until recent years, there was possibly no familiar disease that was as little understood by the public and physicians as rabies. The public health service detailed an officer to investigate this disease, its cause, localities and treatment. His report clears up the mysteries of the disease, and will eventually aid in its complete eradication.

The department maintains a hygienic laboratory where much of the work in connection with these investigations is carried on. In this laboratory the trained men of the service also determine the merits of the new medical discoveries which are announced from time to time, and valuable service has been rendered to the public in exposing frauds.