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PUBLIC-HEALTH SERVICE.

STATEMENTS OF DR. RUPERT BLUE, SURGEON GENERAL; DR.

W. C. RUCKER AND DR. R. H. CREEL, ASSISTANT SURGEONS
GENERAL

ADDITIONAL COMMISSIONED MEDICAL OFFICERS.

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The CHAIRMAN. You have submitted an estimate for $959,270?
Dr. BLUE. Yes, sir.

The CHAIRMAN. It apears that you are asking for additional commissioned medical officers for the fiscal year 1918, $100,000. You have $745,000.

Dr. Blue. Yes, sir.
The CHAIRMAN. What is the necessity?

Dr. BLUE. The additional commissioned medical officers are needed
in order to carry out the various acts of Congress, which impose cer-
tain duties upon the Public Health Service. The immigration law,
known as the act of February 5, 1917, requires that all aliens shall
be given a double physical and mental examination. That is, each
alien shall be examined by not less than two medical officers. This
includes the alien crews as well as passengers. In order to carry out
the law properly it will require a large number of medical men.
The CHAIRMAN. How many men are now assigned to this work?

Dr. BLUE. There are fully 40 men assigned exclusively to this immigration work, and there are 40 or 50 others that do immigration work in addition to other work. For instance, many of the officers who have charge of the administration of the quarantine stations do also immigration work.

The CHAIRMAN. Is that law mandatory or permissive?

Dr. BLUE. I think it is mandatory. I have been requested by the Commissioner General of Immigration to have officers ready for this work.

The CHAIRMAN. The immigration has dropped from over one million to a quarter of a million, and that materially reduces the volume of work and the number of men required ?

Dr. BLUE. It does, but they have not closed any of their ports of entry.

The CHAIRMAN. No; but the number of officers required to make the examinations must be smaller.

Dr. BLUE. The number has materially diminished at the large stations, such as New York, Boston, and Baltimore, but you will find just as many coming in through the smaller stations on the international borders. There was an increase in Detroit.

The CHAIRMAN. How many additional officers does it provide?
Dr. BLUE. This provides for about 44 additional officers.
The CHAIRMAN. What do they receive?
Dr. Blue. The base pay is $2,000 a year.
The CHAIRMAN. That is what they start at?

Dr. BLUE. Yes, sir. They receive, if serving away from Government reservations, the sum of $360 a year for commutation of quarters, making $2,360 a year. On account of the war we are rapidly losing a number of acting assistant surgeons, who are going into the

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military service. Some of the places at least will be filled by regular officers.

The CHAIRMAN. Why do you ask for commissioned officers rather than an increase in the number of acting assistants ?

Dr. Blue. It is best to have permanent officers, because the training of them is very expensive and we want to retain their services. The acting assistants are only temporary and they leave us. As I say, a number-14, to be exact-have already left us and entered the military service. When we get a medical officer and train him we can keep him for life. Their services are too valuable to be lost.

Under the act approved June 27, 1914, 15 medical officers are now serving on Coast Guard vessels on outside patrol duty. On account of the undue prevalence of cerebrospinal fever, scarlet fever, and diphtheria, in certain States, it became necessary to detail 13 medical officers to the Navy to act as sanitary advisers to the commandants of the 13 naval districts. This was done at the request of the Secretary of the Navy. These men are liable to remain with the Navy until the end of the war.

INTERSTATE QUARANTINE SERVICE-SANITATION AROUND MILITARY

CAMPS.

The CHAIRMAN. You are asking "For cooperation with State and municipal health authorities in the prevention of the spread of contagious and infectious diseases in interstate traffic, $300,000.” You have $15,000?

Dr. RUCKER. Yes, sir. Fifteen thousand dollars is insufficient to run the ordinary work of the prevention of the interstate spread of disease and it has been necessary to cut down very materially the work in all of the interstate sanitary districts in order to keep within the appropriation which you made for us. With the coming of the war the necessity for doing this work has been very greatly increased. The money which we ask for at the present time is intended to be a fund from which to control the interstate spread of disease, particularly as it relates to the change in the sanitary balance which is brought about by the interstate movement of troops and of civilians who inevitably follow in the train of troops.

There are, as you know, 16 cantonments for the National Army and there are 16 cantonments for the National Guard. It is necessary, in order that the health of the civilian population in the areas about these zones be maintained, that the State and local health authorities shall exercise every measure that is possible, and at the same time the Government has a duty in the matter, because these men who are coming into these zones have been brought there by the Government and they have been brought there for governmental purposes. They bring with them in their bodies a great many diseases, and in their movements back through other States they will carry diseases which they have contracted. Unless measures are taken in cooperation with the local health authorities, as required by the act of February 15, 1893, they will carry those diseases back into their home places.

The CHAIRMAN. What precautions can you take?

Dr. RUCKER. Already in the cantonment in Jefferson County, Ky., right near Louisville—there is one at Little Rock, Ark., one at Co

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lumbia, S. C., one at Des Moines, Iowa, and one at Petersburg, Va.an officer has been stationed there to act in cooperation with the State and local health authorities. In the zone, for instance, around Louisville the local authorities have raised $26,000 to be expended in cooperation with and under the direction of our force.

The CHAIRMAN. In what way?

Dr. RUCKER. Not in the zone which is under the military authorities, but in the zone which is under the control of the civil authorities. The town of Highland Park, right in the area of the Louisville zone, has raised $40,000, and they have asked us to assist them in this work, but with no expense to the Government, merely asking us to cooperate with them. In the zone around Little Rock, Ark., and the town of Argenta they have set out to do similar work. At the request of the governor and the mayors of both cities and the Board of Commerce of Little Rock they have raised in that way some $80,000.

At Columbia, S. C., the work is also going on. There is an officer in charge. We are undertaking to assist them in maintaining these zones in such a condition so that the troops coming in there shall not contract disease and so that the troops going away, which is the important thing, will not carry disease back into the civilian community. We know that some of these zones are unfortunately in localities where malaria exists, and men being brought in there are liable to contract malaria and go back to their homes, where the anopheles abound, and will become infected, and we will then have started all over the country malaria, just exactly as following the Civil War we found typhoid fever spread all over the South, and saw it changed from an urban to a rural disease.

The CHAIRMAN. Which one of these camps is in a pest-infected district ?

Dr. RUCKER. I do not know of any that is in a pest-infected district. That is not the question. The question is this

The CHAIRMAN. The suggestion you made is likely to convey the impression that unless extraordinary precautions are taken the men would be subject to malaria or some other disease. From your knowledge, are any of the camps that have been located, located in places that are unhealthy or where the conditions are, from the standpoint of health, unsatisfactory?

Dr. RUCKER. No; I do not think any of the camps have been badly located, nor do I mean to convey the impression that in any of the camps do conditions exist which would not necessarily follow the gathering together of large bodies of men from various portions of the country. I did not mean to convey the impression that any of these camps at all were so situated that they were in diseasebreeding sections, or that the people were unduly neglectful of health conditions, but an extra burden has been placed upon the sanitary balance of these localities by reason of the gathering together in them of large bodies of soldiers and the people who inevitably follow in the train of troops.

The CHAIRMAN. If the sanitary conditions in these camps are proper, would not that eliminate these questions?

Dr. RUCKER. The camp itself might be in a very good sanitary condition, but we must remember that in these zones surrounding the camp the sanitary balance has been very greatly changed and the

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men who come there will bring disease in their bodies. There will be typhoid carriers, there will be malaria carriers, and these men when they are without the military zone will endanger the civil population, and if they infect the civil population the civil population will in turn infect them. The thing works in a vicious circle.

The CHAIRMAN. Is not that true of the movement of people generally, anywhere?

Dr. RUCKER. Yes; it is true of the movement of people generally, and that is why there is an appropriation for the prevention of the interstate spread of disease. But here we have an extraordinary movement. Men will be coming into these camps. They may stay in these camps only a very short time, and then may be rejected for one reason or another, and then they will be returned to their homes. Men will be coming in there who carry in their blood the organism of malaria. We will say there has been no malaria there in a given area for years, but there are anopholes mosquitoes, and when you put a man with the organism of malaria in his blood in the same environment with large numbers of anopholes mosquitoes, you are bound to have planted there malaria and malaria is bound to spread. In the same way, if men come in there who are chronic typhoid carriers and they are careless about the distribution of their discharges, they will infect water supplies and they will place their fecal deposits in such a way that flies have access to them, and then we will find typhoid fever spreading outside of the camp and into an area which is not under the control of the military authorities at all.

Dr. Blue. Mr. Chairman, it is a matter of history that every great war in which this country has been engaged has been followed by epidemic outbreaks among the civil population, and the experts who have investigated this important question have shown that it was due to the concentration and mobilization of large numbers of young men in camps. It is also well established that the movement of sick and wounded or disbanded soldiers has been responsible for wide dissemination of disease in this country; and I simply want to call your attention to the fact that our sanitary forces, provided by Congress up to this time, and that provided by the States, are too small to cope with the serious situation likely to arise as a sequence of the

Mr. Cannon. Doctor, you spoke of typhoid fever. I supposed, while I do not know about it, that typhoid fever was now harmless?

Dr. Blue. Harmless only to those who have been carefully vaccinated against it, and the civil population has not been so vaccinated.

Mr. CANNON. For instance, down on the border, under what I suppose were very objectionable conditions, I understand there was no typhoid fever.

Dr. Blue. Granted there was no typhoid among the soldiers who have been immunized against it by antityphoid vaccination, but there were a great many cases among

the civil population. Mr. Cannon. How could they spread the disease if they were immunized ?

Dr. BLUE. I do not expect the Regular soldiers who have been immunized to spread it, but these men will be assembled from civil life before they are immunized against typhoid.

Mr. Cannon. Are you not going to immunize them at once?

war.

Dr. Blue. Yes, sir; in the camps.
Mr. Canxox. And even before they get to the camps?

Dr. Blue. I presume that will be the very first thing Gen. Gorgas's assistants will do to the men who have been selected by the draft, immunize them against smallpox, typhoid, and paratyphoid fever,

The CHAIRMAN. The first thing they do when they take a man into the service is to vaccinate him and immunize him against typhoid fever.

Dr. Blue. There are probably carriers among these men although they have no symptoms themselves and they are capable of conveying it to other people.

The CHAIRMAN. Even after they have had the treatment!
Dr. BLUE. Yes.

Dr. RUCKER. Vaccination against typhoid fever does not in any way cure a man of being a chronic typhoid carrier. When you go to work and collect a large number of men from all parts of the country in that way you are bound to collect a large number of typhoid carriers among them. Now, a man who is a typhoid carrier does not constantly excrete typhoid bacilli. There may be lapses in between, and he may pass them to-day and may not pass them again for 20 days or perhaps 15 days, so that an examination of this man's feeal contents to-day may not show typhoid bacilli, but in a week or 10 days they might be there. They are intermittent in their discharge of these bacteria, and vaccination does not affect a chronic typhoid carrier at all. It does not cure him and that is where the danger comes in, in spite of the vaccination.

Mr. Cannon. If that is so a man who has not typhoid and is practically immune may through his discharge, spread the disease, is that it?

Dr. RUCKER. Yes. There are people who are chronic typhoid carriers who perhaps have never knowingly had an attack of the disease, and these people spread the disease wherever they go, just liké Typhoid Mary did in New York. The best medical talent in this country tried to cure Typhoid Mary and they were unable to do so, and she will probably continue to be a typhoid carrier as long as she lives. There are many, many such people, and these are the people who create the danger. Now, if sanitary conditions are good and immunization against typhoid is widely practiced—and that is one of the things that is being done at the present time—then we can reasonably hope for control of the disease.

Mr. CANNON. Now, Gen. Gorgas seems to have made the statement that all these places where there has been malaria trouble will be drained and fixed up so as to be comparatively healthy places.

Dr. BLUE. That is true.

Mr. Cannon. Now, if the Army and the Navy, especially the Army, does that work, would you supplement their work?

Dr. BLUE. We would; yes, sir. We propose to work in the areas outside of the camps in cooperation with State and local boards. The Army medical men will look out for the sanitation of the

itself. Mr. Cannon. Now, let us take one place as an illustration. It has been alleged--of course I do not know anything about it--that the Little Rock cantonment is in a mosquito center and swampy, I do not know whether that is true, but that is alleged. Now, how far are you going to make it sanitary. If the medical officers of

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