tary of the Navy, and 1 commissioned medical officer to the Army, upon request of the Secretary of War.

These trained medical officers are acting as sanitary advisers at military cantonments and shore stations.

In accordance with the act of June 27, 1914, 16 commissioned medical officers are serving upon Coast Guard cutters in the Navy on outside patrol duty, and 1 officer, under the approval of the President, was detailed to the hospital relief ship Surf.

The joint resolution of July 9, 1917, while it gave pensions to these officers serving with the military forces on shore or at distant stations in case of death or disability, failed to give them the equal status and protection given other officers in the military service. This subject should receive serious consideration, because commissioned medical officers are liable to military service should the necessity arise.

Commissioned and other officers.-The commissioned medical officers at the close of the fiscal year numbered 212, as follows: The Surgeon General, 1 assistant surgeon general at large, 14 senior surgeons, 70 surgeons, 44 passed assistant surgeons, and 82 assistant surgeons. The acting assistant surgeons numbered 258, and physicians are also employed for the medical relief of superintendents, keepers, and surfmen near life-saving stations and at places where the services of medical officers of the service are not available, to the number of 76, making all told 546 medical officers. The total personnel of the service, including 50 pharmacists, 1,259 attendants, and 189 other employees, numbered 2,044.

Expenditures. The appropriations for the ordinary maintenance of the Public Health Service were $2,154,156. The receipts from all sources, repayments for care of foreign seamen, etc., were $33,596.46. The expenditures, including outstanding liabilities, were $2,059,457.90, leaving an estimated balance of $128,294.56.

The appropriation for prevention of the introduction and spread of epidemic diseases was $400,000. The expenditures, including outstanding liabilities, were $384,376.39, leaving an estimated balance of $15,623.61.

The appropriation for the maintenance of the quarantine service was $185,000. The amount of repayments was $2,841.86. The expenditures were $187,837.35, including outstanding liabilities, leaving an estimated balance of $4.51.

The appropriation for field investigations of public health was $250,000. The repayments were $117.09. The expenditures, including estimated outstanding liabilities, were $238,513.45, leaving an estimated balance of $11,603.64.

The appropriation for interstate quarantine service was $100,000. The expenditures were $85,763.86, including outstanding liabilities, leaving an estimated balance of $14,236.14.

The appropriation for special studies of pellagra was $40,000. The expenditures were $27,789.66, including outstanding liabilities, leaving an estimated balance of $12,210.34.

The appropriation for studies of rural sanitation was $25,000. The expenditures were $24,984.80, including outstanding liabilities, leaving an estimated balance of $15.20.

The appropriation for control of biologic products was $10,000. The expenditures were $9,929.86, including outstanding liabilities, leaving an estimated balance of $70.14.

Miscellaneous Division.

Publications. During the fiscal year 1917 the service issued 2,891,050 copies of documents dealing with various phases of public health and sanitation. These figures represent an increase of 649,825 copies over that reported last year. During the latter part of the fiscal year just ended the bureau was compelled to cease all printing on account of a shortage in the printing appropriation, so that the above figures do not fairly indicate the demand made on the bureau for literature, but rather the best results possible to obtain with a limited appropriation.

Because of this limitation of funds for printing the bureau was forced to refer many requests for literature to the Public Printer, from whom copies could be purchased.

Library. The library of the bureau continued to expand during the past fiscal year by the purchase and donation of many new and valuable works on medicine, public health, and kindred subjects. In addition to the acquisition of these volumes the bureau kept acquainted with the progress of the medical sciences by subscribing to 49 journals.

Recommendations.

National quarantine.-As in previous years, a recommendation is renewed as to the importance of making the national quarantine system complete by the acquisition of the few remaining quarantine stations under State or local control. During the past year the State Legislature of New York indicated its desire by legislative enactment that the National Government should take over the quarantine station at the port of New York, stipulating, however, that reasonable reimbursement should be made therefor to the State. The city authorities of Baltimore likewise passed an ordinance expressive of

their desire to transfer the Baltimore quarantine station to the Federal Government at a reasonable rate of reimbursement to the city. The inclusion of these two quarantine stations, the sole remaining stations not under Federal control, therefore awaits congressional action in appropriating the sums of money necessary for reimbursement for the stations, as provided for in the act of 1893, namely, "that whenever the proper authorities of the State shall surrender to the United States the use of buildings and disinfecting apparatus at a State quarantine station the Secretary of the Treasury shall be authorized to receive them and to pay a reasonable compensation to the State for their use * *" It is believed that a very substantial interest to the National Government will have been served by these transfers.

Quarantine procedure at ports of entry is closely interwoven with cther Federal activities, such as customs and immigration, and uniformity of quarantine procedure is essential in the interest of commerce, for the protection of the country as a whole, and for the adjustment of international questions involving quarantine methods.

During the past three years more serious epidemics of typhus fever, smallpox, and cholera have occurred in continental Europe than have been recorded in the history of modern sanitation in those countries. The disturbance of established trade channels has been one of the factors in causing a very considerable prevalence of rodent plague in Great Britain. Four or five of the largest English ports reported rodent plague at varying periods throughout the year.

The condition of our commercial relations after the war, through resumption of traffic with continental Europe, may well constitute a serious menace to the health of this country, furnishing an additional reason why local quarantines should be taken over by the National Government.

Additional commissioned officers.-Estimates have been submitted to Congress for increases in appropriations which will permit of additions to the force of commissioned medical officers of the Public Health Service in the entrance grade of assistant surgeon. The need of additional trained officers has been one that has been felt at all times in the development and expansion of the Public Health Service during the past few years. It is to the commissioned officers who enter the service under permanent appointment as a life work that the service must look for its most thoroughly trained sanitarians and publichealth experts. The experience gained by officers who are subject to change of station, and who can therefore be assigned to duty on sanitary and health problems of varying character, is cumulative, and their value to the Government is increased with their years of service. Recent legislation has largely increased the amount of work

13034°-FI 1917— 15

which the Public Health Service has to perform. Aside from increased appropriations for extending the work which was already its function, the new immigration law, the Government employees' compensation law, the seamen's law, and other acts of Congress have imposed additional duties, necessitating additional medical officers. Under the immigration act, examination of arriving aliens by two medical officers is specifically required at many immigration stations where the work has heretofore been performed by a single officer. This act also requires the examination of all alien sailors on vessels arriving at American ports. The hospitals and relief stations of the service have also been opened to employees of the Government suffering injuries in the course of their employment. All sailors who apply for rating as able seamen are now required to pass a physical examination by Public Health Service officers. It is believed to be distinctly in the public interest that the enlargement of the permanent corps of the service should keep pace with its increasing duties, and favorable consideration of this matter is earnestly recommended to Congress.

Proposed sanitary reserve corps.-Legislation is pending in Congress for the establishment of a sanitary reserve corps in the Public Health Service. The purpose of this proposed corps is to provide an organization of experienced health officers and sanitary experts to which the service can turn for assistance in times of emergency. The need of such a body has been acutely felt in the work of studying and remedying sanitary conditions in the areas surrounding military camps and cantonments-work of vital importance which was suddenly thrust upon the service with the entrance of this country into the war. The pending bill provides for appointment by the President of State and local health officers and others skilled in sanitary science in a reserve corps, which could be called into service whenever outbreaks of epidemic disease or other emergency situations affecting the public health make such action necessary. Such appointees would have grades and rates of pay corresponding to those of the regular medical officers of the service, but would receive compensation only when and for such periods as they might be called upon for active duty. The legislation has the approval of the Council of National Defense and the Conference of State and Territorial Health Officers, and it is sincerely hoped that it will receive favorable consideration by Congress.

Information of disease prevalence.-In public-health work and the control of disease there is nothing of such fundamental importance as having dependable information of the localities where preventable diseases are present, their relative presence in such localities, and

the conditions under which cases are occurring. Knowledge of the distribution of diseases is a matter of paramount importance in connection with its control. In carrying on its public-health functions the Public Health Service must at all times have information of the prevalence of communicable diseases throughout the country. The need at present is especially acute because the more complete the information at hand of the occurrence of communicable diseases in the civil population the more effectively can the spread of these diseases to the troops be prevented. To secure better and more complete information of disease prevalence an appropriation of $25,000 is being asked for in the annual estimates.

Publications.-The advance of the service into new fields of pubiic health and sanitation has stimulated the demand for its publications. It is believed that in no other way does the service so directly benefit the public at large as by the distribution of literature giving the results of its work and disseminating practical information on health subjects. Although showing a considerable increase over the preceding year, the number of publications distributed during the fiscal year just closed was of necessity very much curtailed, owing to limited appropriations for printing. It is respectfully urged that additional funds for the widespread circulation of service publications be provided.

Bureau personnel. The clerical force of the bureau has not been enlarged in proportion to the activities of the service. New and varied activities in the field, with steady growth in the volume of its operations along established lines, have greatly increased the administrative work of the bureau. In the estimates which have been submitted for the fiscal year 1919 several increases in the bureau personnel have been requested, and an earnest endeavor has been made to hold these estimates to a minimum consistent with efficient administration. It is hoped that provision for additional assistance will be made.

COAST GUARD.

The Captain Commandant summarizes the operations of the service as follows:

The act of January 28, 1915, provides that the Coast Guard

Shall operate under the Treasury Department in time of peace, and operate as a part of the Navy, subject to the orders of the Secretary of the Navy, in time of war or when the President shall so direct.

Upon the declaration of war on April 6, 1917, the Coast Guard accordingly passed from the Treasury to the Navy Department, and for obvious reasons the following summary does not include those