There are also maintained 22 hospitals on the seacoasts, lakes and rivers for the care of seamen. During the year closing June 20, 1915, 40,604 seamen were treated at the various stations. Of this number over 14,000 were treated in hospitals owned by the government. The marine hospitals are located at: Mobile, Ala.; San Francisco, Cal.; Delaware Break Water; Key West, Fla.; Cairo, Ill.; Chicago; Evansville, Ind.; Louisville; New Orleans; Portland, Me.; Boston; Vineyard Haven, Mass.; Baltimore; St. Louis; Wilmington, Del.; New York; Memphis; Cape Charles, Va.; Port Townsend, Wash.

Assistant surgeons, whether in quarantine stations, marine hospitals, hygiene laboratory or in field service, work under the direction of their superior officers; and they must accustom themselves to such a rigorous system of routine of work and report as is unknown to the general practitioner. Passed assistant surgeons are more independent, and they may be assigned to special duty in connection with the other departments of the government or in cooperation with the health service of the several states and cities. Whenever they are assigned to special duty with other branches of the government, the medical officers are accorded the honor due to officers of the highest rank.

The rank of surgeon can only be attained by promotion as vacancies occur, and then only by seniority.

CHAPTER XVI.

THE PUBLIC HEALTH SERVICE.

Unlike the well-organized, unified public health and medical service of the Philippines, the machinery for doing this work in the States is not always so well coordinated. This is because the functions which the state and local governments exercise in these fields have grown from the very insignificant beginnings which date back to the organization of our government, when men acknowledged little collective responsibility for the welfare of their fellows. These functions of government deal with the protection of the citizens from infection and contagion, from contaminated food supplies and polluted waters. These functions are exercised by the boards of health of the larger cities within their own areas, and by the state boards of health through local officers in the country districts. The state medical service generally has to do with ministering to the inmates of state institutions, and the county and city medical service take care of the needs of those in institutions under the jurisdiction of the local governments; while in many states there is a separate medical service for the poor which is administered through the boards for poor relief and charity.

This work is as yet very unevenly developed and practices vary in the several states. To convey an idea of the operations of these branches of government and to show the large possibilities in this field, a somewhat de

tailed description is given of the organization and operations of the department of health of the state and city of New York.

The state paid in 1914, to sanitary, medical and scientific officers connected with the board of health and other departments of the state and county governments and to medical officers of institutions, over half a million dollars; and in the one single large city of New York the expenditures of the department of health alone were $3,363,767.85.

The state has a commissioner of public health with an annual salary of $8,000; deputy commissioner, at $5,000 and an advisory council of eight members, each of whom receives $1,000.

There is a department of sanitation and hygiene, which passes upon the plans for water supply systems and sewerage systems of cities and villages, investigates complaints of stream pollution, and looks into the causes of typhoid fever epidemics. This is in charge of a chief sanitary engineer with a corps of trained assistants who cover the state.

The department of laboratories and research has charge of the preparation and distribution of antitoxins. Its medical officers and bacteriologists are at the command of the physicians and health officers of the state.

The division of child hygiene supervises the child welfare agencies of the state and the public and private schools.

The department of vital statistics collects from the county officers of health, statistics relating to births and deaths.

The department of publicity and public health education employs a corps of lecturers, issues bulletins of in

formation for the people and plans and manages exhibits intended to arouse the people to the necessity of sanitation and hygiene.

The division of communicable diseases is constantly on the watch for any outbreaks, and is prepared to check and control the spread of disease, in the same way that a fire department operates or the state militia acts when an enemy threatens the peace and comfort of the people.

Another department regulates and supervises the operation of cold storage plants and the distribution of food from these places.

The psychiatric institute and the institute for the investigation of malignant diseases have their own organization of experts and their own laboratories.

The heads of these several departments are paid $4,000 a year, the assistant directors $3,000, and the members of the scientific forces, whether physicians, bacteriologists, chemists or sanitary experts, are selected by competitive examinations with salaries ranging from $1,200 to $2,500.

The health officer of the port of New York is a state official who is paid $12,500 a year, and has a deputy at $4,000 and three assistants at $3,000. These men have perhaps the most autocratic power of any officials in our system of government.

Outside of the department of health the state has a medical adviser to the workingmen's compensation commission at $4,000 a year, a medical examiner at $3,000 and an assistant at $2,000.

The superintendents of the state insane asylums receive from $4,800 to $6,000 with maintenance, and the physicians from $1,200 to $2,800. The physicians to the school for the blind and the deaf, the homes for

epileptics and feeble-minded, the houses of detention and the prisons of the state, are designated to act as such from among the practising physicians of the communities in which these institutions are located, and they change whenever the political complexion of the state government changes.

Much of the work of the state department is done through physicians who act as local health officers and who are paid according to the amount of time which they give to this service. The county board of health officers usually act as reporters of conditions to the state board of health, and direct the medical service for the relief of the poor.

The most completely developed public health systems are found in our large cities. In the city of New York in 1915 the total number of employees of the department of health was 3,421. Of course, all of these were not medical officers, but a description of the work of this department will show how rapidly this new field for medical men is expanding.

The commissioner of health, the chief of police and the health officer of the port constitute the board of health. There is also an unpaid medical advisory board, and a board of honorary consultants. The head of the administrative force is the commissioner of health ($8,000), a sanitary superintendent ($7,000), and a secretary to the board of health ($5,000). The force in the office of the secretary handles the correspondence, keeps the records, attends to the purchase and distribution of supplies and audits the accounts of the department. It is made up of men and women whose training has been along commercial lines.

The registrar of vital statistics ($5,000) and his 5