RULES AND REGULATIONS GOVERNING EXPENDITURES THROUGH THE FUNDS ALLOTTED TO STATES

BY THE U. S. INTERDEPARTMENTAL

SOCIAL HYGIENE BOARD

Chamberlain-Kahn Act. This act constitutes Chapter XV of the "Act making appropriations for the support of the army for the fiscal year ending June thirtieth, nineteen hundred and nineteen.” It reads in part as follows:

That there is hereby created a board to be known as the United States Interdepartmental Social Hygiene Board, to consist of the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury as ex-officio members, and of the Surgeon General of the Army, the Surgeon General of the Navy, and the Surgeon General of the Public Health Service, or of representatives designated by the Secretary of War, the Secretary of the Navy, and the Secretary of the Treasury, respectively.

Appropriation for Fiscal Year 1921. For the fiscal year ending June 30, 1921, Congress provided in the sundry civil bill the following appropriation for the coöperative work with the states:

The duties and powers conferred upon the United States Interdepartmental Social Hygiene Board by Chapter XV of the army appropriation act approved July 9, 1918, with respect to the expenditure of the appropriations made therein are extended and made applicable to the appropriations for similar purposes made in this act.

For allotment to the various states for prevention, treatment, and control of venereal diseases, $450,000; and the unexpended balance on June 30, 1920 (approximately $300,000), of the appropriation heretofore made for this purpose is continued and made available during the fiscal year 1921; provided, that no part of this sum shall be allotted to any state unless such state, in a manner satisfactory to the board, shall have complied with, and shall have given assurance of continued compliance with, the condition and regulations governing such allotments and the expenditures that may be made therefrom.

Reduction in Appropriation for 1921. It will be noted from the above act of Congress that the federal government's appropriation for allotment to the states was reduced from $1,000,000 for 1919 and $1,087,831.41 for 1920, to $450,000 plus the unallotted balance of June 30, 1920.

The 50-50 Plan. Section 3 of the regulations of the Secretary of the Treasury reads:

Funds that may become available from legislative appropriations must not be conserved through the expenditure of funds allotted by Congress.

FEDERAL RULES GOVERNING STATE ALLOTMENTS

The Board has interpreted the above section to mean that a state must not spend the federal allotment before spending the appropriations made by the state, but that it must be a “50-50” plan.

Practice of Other Government Departments. It is a general practice of government departments and independent establishments charged with expending federal appropriations made for state and other activities conditioned upon the matching of dollar for dollar, to require the state first to make the disbursements from its appropriation, submitting the paid vouchers for audit. The government department then pays to the state 50% of such expenditures as may be found to be correct. This procedure serves the double purpose of ascertaining if the disbursements as made are in accordance with the regulations governing the disbursements, and also that the state has complied with the federal law not only by appropriating an equal amount, but by actually expending its proportion.

50-50 Plan Adopted by Board. The United States Interdepartmental Social Hygiene Board has adopted this procedure for disbursing the allotments to states for the fiscal years 1920 and 1921, and it is therefore necessary that the state official making disbursements from these funds forward to the central office at the close of each month, on forms provided by the Board, a statement of such expenditures accompanied by the paid vouchers. A Treasury warrant covering 50% of such ⚫ disbursements, the proportion payable by the federal government, will then be promptly paid to the state treasurer.

REGULATIONS

Promulgated by the Secretary of the Treasury, under which state boards or state departments of health receive the allotment of funds provided in Section 6, Chapter XV, of the act approved July 9, entitled “An act making appropriations for the support of the army for the fiscal year ending June 30, 1919."

The act provides that $1,000,000 shall be distributed to the states for the use of their respective boards or departments of health in the prevention, control, and treatment of venereal diseases, this sum to be allotted to each state, in accordance with rules and regulations prescribed by the Secretary of the Treasury, in the proportion which its population bears to the population of the continental United States, exclusive of Alaska and the Canal Zone, according to the last preceding United States census. State boards or departments of health receiving their respective allotments shall agree to the following cooperative measures under which their appropriation shall be expended:

FEDERAL RULES GOVERNING STATE ALLOTMENTS

1. Put into operation, through a legislative enactment or a state board of health regulation having the effect of law, regulations in conformity with the suggestions approved by the surgeons general of the army, navy, and United States Public Health Service, for the prevention of venereal diseases. The minimum requirements of these rules are:

(a) Venereal diseases must be reported to the local health authorities in accordance with state regulations approved by the United States Public Health Service.

(b) Penalty to be imposed upon physicians or others required to report venereal infections for failure to do so.

(c) Cases to be investigated, so far as practicable, to discover and control sources of infection.

(d) The spread of venereal diseases should be declared unlawful.

(e) Provision to be made for control of infected persons that do not coöperate in protecting others from infection.

(ƒ) The travel of venereally infected persons within the state to be controlled by state boards of health by definite regulations that will conform in general to the interstate regulations to be established.

(g) Patients to be given a printed circular of instructions informing them of the necessity of measures to prevent the spread of infection and of the importance of continuing treatment.

2. An officer of the Public Health Service shall be assigned to each state receiving allotments for the general purpose of coöperating with the state health officer in supervising the venereal-control work in the state. This officer to be selected by the state health authorities and to be approved and recommended for appointment by the surgeon general of the Public Health Service. The salary of this officer will be paid by the state out of the funds made available from the allotment, except a nominal sum of $10 per month, which will be paid by the United States Public Health Service. In those states where a bureau of venereal diseases has already been established, with a full-time medical officer in charge, the present incumbent may be recommended for appointment by the state health officer, and, with the approval of the surgeon general of the United States Public Health Service, he will be appointed as an officer of the Public Health Service. The general plan of work for the state bureau of venereal diseases will be:

(a) Securing reports of venereal infections from physicians and others required to report in accordance with state laws.

(b) Suppressive measures, including the isolation and treatment in detention hospitals of 'infected persons who are unable or unwilling to take measures to prevent themselves becoming a menace to others, the establishment of free clinics for the treatment of venereal diseases, and the elimination of conditions favorable to the spread of venereal infections.

(c) Extension of facilities for early diagnosis and treatment through laboratory facilities for exact diagnosis and scientific determination of conditions before release as non-infectious, in accordance with the standardized procedure that will be prescribed by the United States Public Health Service.

FEDERAL RULES GOVERNING STATE ALLOTMENTS

(d) Educational measures to include informing the general public, as well as infected individuals, in regard to the nature and manner of spread of venereal diseases and the measures that should be taken to combat them.

(e) Coöperation with local civil authorities in their efforts to suppress public and clandestine prostitution. The clinics referred to under (b) will form centers from which the other measures may be conducted by discovering the presence of infections, the securing of data for enforcing the regulations for reporting these diseases, and the institution of educational measures appropriate to particular communities. The immediate reduction in venereal-disease foci resulting from clinic treatment will result in a marked decrease in the prevalence of such diseases in both the military and civil population.

(f) Accurate detailed records must be kept of all the activities of the venereal-disease work. These will include careful records of each case treated, amount of arsphenamine used, final results, and disposition made of patients. Copies of these records must be forwarded to the surgeon general, United States Public Health Service, as a report at such intervals as they may be requested, and in accordance with instructions regarding the form of report.

3. Local funds that may be available, or that may become available from legislative appropriations or any other source of venereal-disease control, shall be used by the state or city health authorities having jurisdiction for the extension of the work, and such local funds must not be conserved through the expenditure of the funds that are allotted by the Congress through the United States Interdepartmental Social Hygiene Board.

4. In extension of the educational measures the state's health authorities and its bureau of venereal diseases shall exert their efforts and influence for the organization of a state venereal-disease committee that will be unofficial in character, but a valuable coöperative agency for furthering the comprehensive plan for nation-wide venereal-disease control.

5. The state health authorities shall take such measures as may be found practicable and decided upon in conference between the Public Health Service and state board of health representatives for the purpose of securing such additional legislation as may be required for the development of control of the spread of venereal infections. Action shall be taken to limit or suppress the activities of advertising "specialists" and quacks by prosecuting them under state laws, or such other measures as may be applicable and effective.

6. In expending the sum allotted a state, the rules and regulations to be promulgated by the United States Interdepartmental Social Hygiene Board for the expenditure of the $1,000,000 civilian quarantine and isolation fund under control of the Secretary of War and Secretary of the Navy shall be given consideration by Public Health Service and state board of health representatives, so that the military necessities of each particular state may receive the consideration due its relative importance, and so that funds from the two sources may be correlated.

7. The state allotment shall be expended along general standard lines for all states and in accordance with an accounting system, to be forwarded by

VENEREAL DISEASES IN THE ARMY

the United States Interdepartmental Social Hygiene Board, approximately as follows:

(a) For treatment of infected persons in hospitals, clinics, and other institutions, including arsphenamine and other drugs, 50% for the allotment. (b) In carrying out educational measures, 20%.

(c) In carrying out repressive measures, 20%.

(d) In general administration and other activities of venereal-disease control work, 10%.

(This distribution is provisional and subject to modification after conference and agreement between each state and the United States Public Health Service to best meet the needs of the particular state.)

8. In carrying out the general government program the administrative organization of the United States Public Health Service will be available at all times to state organizations in coöperative work, and assistance will be given to states whenever possible through the detail of employees, the securing of arsphenamine, providing literature for the educational measures, and in such other ways as may be found practicable as the work develops.

W. G. McADOO,

Washington,
September 4, 1918.

III

Secretary of the Treasury.

VENEREAL DISEASES IN THE ARMY

During 1918, the total number of admissions to sick report for diseases in the entire American army was 2,422,362; for ordinary injuries, 182,789; and for injuries received in battle, 227,855. Diseases, therefore, were nearly six times as great a cause of admission to sick report as battle wounds and all other injuries combined. Which diseases contributed most to this ineffectiveness of our soldiers?

The influenza epidemic occurred during that year, and was the cause of the largest number of admissions for diseases in all branches of the service. In the entire army, 688,869 cases of influenza were reported, nearly 500,000 occurring in camps in this country. One soldier in every four was sick in hospitals or in barracks. The severity of the epidemic is too well known to require description. No one will have forgotten the suffering of soldiers in camps during the late summer and fall of 1918. Recollection of this epidemic may serve as a means of realizing the extent to which venereal diseases also caused suffering.