above. On September 4, the Secretary of the Treasury issued the regulations under which the state boards could obtain their shares of the million dollar fund; 74 and on November 19, 1918, regulations governing the interstate travel of persons infected with venereal diseases were issued. 75 Additional clinics were established, the aid of physicians and druggists was enlisted, the state and city authorities were urged to suppress prostitution, and an extensive educational campaign was carried on by means of pamphlets, lectures, and motion pic

tures.

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 fiscal year 1919, the Army and Navy relief amounted to 46,197 hospital days out of a total of 757,018 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 beneficiaries 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 the 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 distributed. On September 26 the state health officer of Massachusetts requested immediate aid from the Public Health Service, as not enough doctors and nurses were available. There was a shortage of doctors and nurses in other places, and by the first of October the situation had 74 Public Health Reports, September 13, 1918. 75 Surg. Gen., Annual Report, 1919, p. 238.

become so serious that Congress appropriated 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 nursing 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 appointing 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.76

Organization of Reserve Corps. On October 27, 1918, Congress 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 receive the pay and allowances of the grade in which they hold commissions.

Organization of New Administrative Units. In order to extend and coördinate the educational work of the service a section of Public Health Education was organized on April

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 administra

76 Surg. Gen., Annual Report, 1919, pp. 81-5.

77 Ibid. p. 213.

tive unit for the investigation 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 that of General Inspection Service. 78 Another administrative unit resulting from the growth of the work was the Purveying Service, organized April 9, 1920. Formerly 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 seperate unit reporting directly to the Surgeon General was created. 79

Increased Compensation for Commissioned Officers, 1920. Increased 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., 601-605). The increases granted to officers of the Public Health Service were $600 for Assistant Surgeons General and Senior Surgeons, $840 for Surgeons, $720 for Passed Assistant Surgeons, and $600 for Assistant Surgeons. The increased pay was to continue until June 30, 1922. A special committee consisting of five members of the Senate and five members of the House of Representatives was provided in order to make an investigation and report recommendations relative to the readjustment of the pay and allowances of the officers in these organizations. Section 12 of this act provided also that the government should furnish transportation for the wife and dependent children of officers of the organizations 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

78 Ibid., 1920, pp. 13-14:

79 The Purveying Service was discontinued in 1922, when a general supply bureau for the entire Treasury Department was organized.

civil 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. etc. A discussion of the activities of the Public Health Service in giving medical and hospital relief to discharged soldiers 80 and sailors has been deferred to this point in order that all of this legislation may be considered together. Section 302 of the act of October 6, 1917 (40 Stat. L., 406), granting compensation to disabled soldiers through the Bureau of War Risk Insurance provides that in addition to compensation the "injured person shall be furnished by the United States such reasonable governmental medical, surgical, and hospital services and with such supplies, including artificial limbs, trusses, and similar appliances, as the director [of the Bureau of War Risk Insurance] may determine to be useful and reasonably necessary.' Section 303 of the same act provided that persons applying for compensation should be examined by a "medical officer of the United States or by a duly qualified physician designated or approved by the director." Section 304 provided for vocational training, but this section was repealed by the act of June 27, 1918 (40. Stat. L., 617-620), which conferred this duty on the Federal Board for Vocational Education.

81

Prior to the passage of the act of October 6, 1917, the functions of the Bureau of War Risk Insurance were con

80 The term discharged soldiers as used in this discussion includes discharged sick and disabled soldiers, sailors, and marines, and Army and Navy nurses (male and female) entitled to compensation under the War Risk Insurance act.

81 For discussion of the compensation features of this and later acts and the activities of the Veterans' Bureau, see Monograph on Veterans' Bureau to be published by Institute for Government Research.

fined solely to the insurance of vessels, cargoes, seamen, and personal property of officers and seamen against war risk. This work did not require a medical staff, but the act of October 6, 1917, which granted compensation to disabled soldiers, required an extensive medical organization in order to make the necessary physical examinations and to determine the degree of disability. In order to carry on this work the Medical Division of the Bureau of War Risk Insurance was organized by the detail of medical officers of the Public Health Service. The Bureau of War Risk Insurance also delegated to the Public Health Service the physical examination of men in the field and the task of providing hospital facilities and treatment. Section 302 of the act of October 6, 1917, did not specify the agency that should furnish hospital treatment, and there was some doubt whether the Marine Hospitals maintained by the Public Health Service and the private hospitals under contract with that organization were available for this class of patients. This question was settled on March 28, 1918, by a decision of the Acting Comptroller of the Treasury, who reached the conclusion that by reason of the executive order of April 3, 1917, making the stations of the Public Health Service available for sick and wounded officers and men, and by reason of the general authority conferred on the Director of the Bureau of War Risk Insurance, the question as to the availability of any particular class of hospitals did not come within his jurisdiction, this matter being entirely one to be decided by the Director of the Bureau of War Risk Insurance, under the general direction of the Secretary of the Treasury. He decided, however, that where it was deemed necessary to utilize Marine Hospitals or contract relief stations the expenses were properly chargeable to appropriations made to the Bureau of War Risk Insurance.82

It should be borne in mind that the mere fact of military service did not entitle a person to treatment by the Public Health Service. To obtain medical treatment at a Public 82 24 Comp. Dec., 556.