(b) Development of clinical pathological methods applicable to industrial environmental exposure, such as special methods for detecting the early effects of lead on blood. (c) Establishment of a register of human industrial pathological material received from clinical research hospitals for occupational diseases. 8. Analytical chemistry.—(a) Development of chemical methods of analysis with specific reference to the new compounds as they are introduced into industry. (b) Modification of known methods of analysis for field use. (c) Investigation of the chemical behavior of substances to be studied toxicologically, particularly new chemicals. B. Field research A necessary fulfillment of a research program affecting the health of workers is the study of the individual in his environment. This is an extension of the fundamental knowledge gained in laboratory research. In addition, clinical studies of workers in their environment may lead to new trends for further laboratory study. This field research would necessarily require the specialized personnel and facilities enumerated under "A", and would not require any new personnel or facilities. C. Hospital research This is primarily an extension of laboratory research on animals to man. The hospitalization of workers suffering from occupational diseases for intensive study and treatment with new therapeutic agents or procedures discovered in the laboratory. The medical appraisal, treatment, and rehabilitation of United States Employees' compensation cases. The following services will be required: 1. Occupational diseases.—Clinical study of workers suffering from industrial poisoning, with special reference to the study of organ function and treatment and clinical tests for the recognition of such poisoning. 2. Occupational infections.-Clinical study of workers suffering from occupational infections and parasitic infestations, such as cotton sickness, anthrax, brucellosis, and hookworm infestation. 3. Occupational deformities.-Clinical study of workers suffering from occupational deformities such as injuries of the peripheral nerves from use of pneumatic tools; deformities of the bones due to improper posture; injuries of the musculature due to overexertion. This would include the development of procedures for rehabilitation. 4. Occupational injuries of female workers.-Study of the effects of certain occupations on women, with special reference to the organs of reproduction. 5. Occupational physiological stress.-Study of fatigue, causes of accident proneness, and the relation of comfort of the worker to efficiency and health. 6. Occupational age of the worker.—Definition of types of employment suitable for young and old workers. OTHER SCIENTIFIC RESEARCH BROAD SCOPE OF RESEARCH ACTIVITIES The scientific work of the National Institute of Health covers an ever-widening range of laoboratory activities in specific fields, such as cancer and industrial hygiene, in the basic sciences, and in cooperative studies requiring group work. After the war, when chemical studies are undertaken in the new medical research hospital, there will be increasing demands on the several laboratoris in the institute. THE CHEMISTRY LABORATORY Chemical analyses are made in the chemistry laboratory to aid investigation of infectious diseases, dental caries, the processes of digestion, and other conditions. After the war the laboratory will expand to carry on studies of digestive enzymes. These chemical ferments are formed by living cells and accompany good health when they act normally; their improper functioning gives rise to digestive and metabolic disorders of the most deep-seated significance. More knowledge is needed of the ways in which these vitally important substances act. The promising lines for their study are now known to be in the chemical and biochemical fields. THE PATHOLOGY LABORATORY The evolution of disease processes in experimental animals is studied in the pathology laboratory where original investigations are initiated and where studies are conducted in cooperation with other divisions of the institute. Additional work in the human pathology of the infectious diseases as well as their effects in experimental animals is needed, particularly in reference to those relatively less known infectious diseases occurring in tropical climates. At this time the pathology of the malarial fevers, the dysenteries, the leishmaniases (tropical parasitic diseases transmitted by species of sand flies), yellow fever, and the typhus-like fevers are of importance. Further work is likewise needed on the relation of toxic substances and dietary deficiencies to such conditions as arteriosclerosis and cirrhosis of the liver. BIOLOGIES CONTROL LABORATORY This division of the institute is concerned with the legal control of the manu facture and sale of products used in the prevention and treatment of human diseases, such as serums, vaccines, viruses, and the like. Diphtheria antitoxin, vac cine virus, and antitetanus serum are a few of the products that have been tested and standardized by the Service. Years of research have been required for this work, but as a result the public has been protected from contaminated or subpotency products. An expansion of postwar research will be needed in this work of controlling biologic products. Adequate methods of control are lacking in the case of some products present knowledge is insufficient. In developing new controls there must be preliminary study and trial and sometimes this requires years of work. Standards now in use should be reviewed; where necessary they should be improved and new standards should be developed This laboratory for years has performed a most important public service. It will require increased personnel after the war to carry on its regular functions and to expand research activities. The Service issues licenses to some 50 manufac turing firms, covering over 150 different biologic products, every one of which must be subjected to periodic bacteriological or serological tests. BUREAU OF MEDICAL SERVICES 1. Office of Chief of Bureau: (a) Emergency Medical Section (b) Office of Nursing 2. Hospital Division: (a) Marine hospitals and medical relief stations (b) Sheepshead Bay Hospital (c) Freedmen's Hospital 3. Mental Hygiene Division: (a) Lexington Hospital (b) Fort Worth Hospital 4. Foreign Quarantine Division: (c) Immigration 5. Medical care services for other governmental agencies: (a) War Shipping Administration (b) Office of Indian Affairs (c) Bureau of Prisons (d) United States Employees Compensation Commission (f) Farm Security Administration (g) Office of Vocational Rehabilitation (h) Medical Division, Office of Civilian Defense (i) Detention centers (j) Public Roads Administration EXHIBIT J.-Postwar budget and personnel requirements of the Bureau of Medical · Services, fiscal year 1946, and first, sixth, and tenth postwar fiscal years The Marine Hospital Service is one of the oldest functions of the Federal Govermnent, dating back to 1798. Originally established to give medical relief to seamen of the merchant marine, this service for many years consisted of a few hospitals administered from a central office in the Treasury Department. As public health services developed in this country and additional authority was given to the Marine Hospital Service by Congress, the original name lost its appropriateness and was changed in 1902 to "Public Health and Marine Serv ice." In 1912 the name was shortened to Public Health Service. The Marine Hospital Service is now a part of the Hospital Division, Bureau of Medical Services, of the Public Health Services. It operates through 26 hospitals, including the national leprosarium at Carville, La., and Freedmen's Hospital in the District of Columbia. These hospitals furnish medical services to Aemrican merchant seamen, Coast Guard personnel and their dependents, Coast and Geodetic Survey personnel and their dependents. Federal beneficiaries of the Employees' Compensation Commission, officers and employees of the Public Health Services, and other legally designated beneficiaries. Over 1,000,000 patients were treated in the marine hospitals in 1943 and nearly 2,500,000 days of care were furnished. RESEARCH ACTIVITIES Staff members of the marine hospitals have made many valuable contributions leading to improvements in clinical techniques. Continuous caudal analgesia in obstetrics was developed by two members of the staff at the Staten Island marine hospital. By this method trained physicians were able to accomplish safe and painless childbirth in about 90 percent of hospitalized deliveries. This method of analgesia has been found to be applicable to other fields of medicine and surgery, and its use has been demonstrated to many civilian practitioners and hospital staffs. At the United States Marine Hospital, Ellis Island, N. Y., a neuropsychiatric service was developed. Organized and staffed by competent psychiatrists and neurologists, it has proved invaluable to patients suffering from mental and neurologic conditions. POSTWAR EXPANSION The marine hospitals are badly crowded and many need repairs and improvements. It is recommended that 5 new hospitals be built and that replacement or extension of existing facilities be undertaken at 21 marine hospitals and at Freedmen's Hospital. Quarantine stations at San Diego and San Francisco, Calif., Galveston, Tex., and Honolulu, T. H., should be replaced, and the stations ot Baltimore, Md., and Tampa, Fla., should be replaced or the existing facilities should be extended. This construction program will cost approximately $61,000,000, and it might appropriately be extended over a 5-year period. The additional facilities are urgently needed, for the number of statutory beneficiaries has greatly increased and postwar needs for services are expected to rise. The situation in Philadelphia may be cited as an illustration. The nearest marine hospitals to this city are located in Baltimore, Md., and Ellis Island, N. Y. Four separate hospitals in Philadelphia are now under contract with the Government for the furnishing of in-patient care to Service beneficiaries. Patients from this area requiring long-time care must be shipped to the nearest marine hospital. This situation could be corrected if a 400-bed marine hospital were erected in Philadelphia to care for the Service beneficiaries of this important commercial and maritime center. (Detailed estimates for each project have been prepared.) FOREIGN QUARANTINE CURRENT ACTIVITIES The Division of Foreign and Insular Quarantine and Immigration engages in numerous activities in all parts of the world. It inspects new vessels for foreign trade to assure their sanitary and ratproof construction; it clears vessels from foreign ports and fumigates them when necessary; through quarantine stations at seaports and, more recently, at airports, it protects this country from the invasion of epidemic diseases from other parts of the world. Working with the Government of Mexico, this Division examines agricultural laborers before they leave their native towns so as to avoid rejections at the border. Similarly, medical officers of the Public Health Service are detailed to Jamaica and other islands to examine laborers imported therefrom. Finally, all applicants for immigration visas are medically examined and certified by the medical officers of the Division. During the war this last function has been confined to Cuba, Canada, Great Britain, and the Irish Free State. POSTWAR ACTIVITIES When hostilities end the activities of the Division will expand as a result of the opening of quarantine activities in Europe, China, and Honolulu. There will be a budget increase of about 10 percent during the first five postwar years, and thereafter expenditures will level off. BUREAU OF STATE SERVICES 1. Office of Chief of Bureau: (a) Allotments (b) Audits (c) Merit system (d) Liaison officers (e) Office of Public Health Nursing 2. States Relations Division: (a) Interstate quarantine (b) Plague control (c) Malaria control, war areas (d) Typhus control (e) Emergency health and sanitation (f) Lanham Act activities (g) Public health dentistry 3. Venereal Disease Division: (a) Control methods and procedures (c) Hot Springs Training Center 4. Industrial Hygiene Division: (b) Consultation service to States (c) Inspection teams, Government plants 5. Tuberculosis Control Division: (a) Office of the Chief (b) State Aid Control Section (c) Radiology Section (d) Field Studies Section |