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 "consigned" 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 transportation expenses if the transportation is undertaken for the protection of the public health. The war interferred with the selection of a site. and the home at Carville, Louisiana, was not opened until 1920.

Hospital Treatment for Injured Government Employees. Compensation to employees of the government injured in the performance 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, which was organized March 17, 1917, but the actual work of the commission did not begin until April 1, 1917.60 Section nine 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 performance 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

60 U. S. Employees' Compensation Commission, Annual Report, 1918, p. 5.

the fiscal year 1921 this service had grown to 61,811 hospital days relief and 66,793 office treatments.

Medical Inspection of Immigrants, 1917. The present law governing the medical inspection of immigrants was passed February 5, 1917, and became effective May 1, 1917 (39 Stat. L., 874-898). 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 pyscopathic inferiority, persons with chronic alcoholism;

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 being 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 practice 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 board of medical officers of the Public Health Service to be convened 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 seamen 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

there were inspected 6799 immigrants and 16,028 alien sea

men."

61

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.

General War Activities. On April 3, 1917, when it became evident 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: 62

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 times of threatened or actual war, the Secretary 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 puroses as shall promote the public interest in connection with military operations.

Owing to defective health administration in many parts of the country it was felt that the military effectiveness of the country might be seriously handicapped through the spread of disease. It was concluded that this danger could be overcome only by an intensive system of federal health supervision in the zones surrounding military camps and important industrial centers engaged in war work. In the summer of 1917 the Public Health Service was doing sanitary work in twenty-six extra-cantonment zones; by the end of 1918 operations were being conducted in forty-seven such areas.

61 Surg. Gen., Annual Report, 1917, p. 152.

02 Ibid., p. 317.

In this work effective aid was given by sanitary units maintained by the American Red Cross. In many cases the states and local authorities supplied additional funds, but the greater part of the cost was paid by the federal government. 63

The work undertaken included the control of malaria by the establishment of zones free from mosquito-breeding places, the improvement of local water supplies, provision for the disposal of human excreta, vaccination against typhoid fever and smallpox, the collection of morbidity statistics, and general health education. By the end of 1918, there were engaged in this work forty-nine commissioned officers, seventy-two acting assistant surgeons, and approximately four hundred technical employees, in addition to a large force of laborers.64

In order to prevent the interstate spread of disease by either the military forces or the civil population, the Secretary of the Treasury 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.65

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 quarantine laws and regulations to the islands.66

In order to coördinate all activities dealing with public health matters, the President on July 1, 1918, issued the fol

63 Ibid., p. 15.

64 War activities of the Public Health Service, by B. S. Warren and C. S. Bolduan: Reprint 531, from Public Health Reports, 1919, PP. 5-11.

65 Surg. Gen., Annual Report, 1917, p. 251.

66 Ibid., 1918, pp. 227-8.

lowing executive order placing all such work under the Public Health Service:

Whereas, in order to avoid confusion in policies, duplication of effort, and to bring about more effective results, unity of control in the administration of the public health activities of the Federal Government is obviously essential, and has been so recognized 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 propagation and spread thereof" and "to coöperate 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 consolidate executive bureaus; agencies, and offices, and for other purposes, in the interest of economy and the more efficient concentration 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 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."

67

The work taken over as a result of this order included the maintenance 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,

67 Ibid., p. 10.