and which has received a tremendous impetus through Title VI of the Social Security Act.

When and if we reach the time when we know all that is necessary to know of the secrets of disease, and we apply such knowledge with undiminished force to all individuals and communities, then may public health be said to have reached the level of the super-man or "homo sapientior" in the evolutionary scale.

Since 1900 the medical officer of health has been able to direct his attention to the more technical details of the prevention of disease, which lie wholly within the province of medicine. For the first thirty years of this century he was occupied in introducing and elaborating the school medical, tuberculosis, maternity and child welfare, and venereal disease services. Here again, as these services developed, so their value was more and more appreciated by enlightened opinion, with the result that the Ministry of Health, under the Local Government Act, 1929, were willing to transfer to local authorities much of their own responsibility for the initiation and development of preventive measures, with the sure knowledge that the work would continue to expand. This Act also transferred all poor-law functions to local authorities, and gave the medical officer of health new responsibilities in regard to hospital administration....Good results are already emerging, and there is a growing tendency for municipal hospitals to direct their efforts to the preventive aspects of medicine. --James Fenton, M. D., M. R.C.P., D. P. H. in his Presidential Address to the Society of Medical Officers of Health, Public Health, November 1937.

MEDICAL RELATIONS

of

PUBLIC HEALTH SERVICE AND COAST GUARD

H. MCG. ROBERTSON, M.D.

Medical Director, U.S. P. H. S. and

Chief Medical Officer, U. S. Coast Guard

Broadly speaking, the U. S. Public Health Service alone furnishes medical service to the U. S. Coast Guard. During the fiscal year 1936, the Public Health Service furnished relief as follows: Hospital days, 88,325; outpatient treatments, 130,206; physical examinations, 5,149. This service begins with the physical examination of the prospective cadet or enlisted man and continues until death or dismissal of the officer or enlisted man, either on active duty or retired status.

Physical examinations of applicants for cadetship are held each June. Boards of two medical officers conduct these examinations at Public Health Service stations throughout the United States. Many pass these examinations, but more fail to pass, for the regulations governing the acceptance of applicants are very strict.

Prior to the physical examinations, all applicants for cadetship have passed mental and aptitude examinations. When all of these are at hand, the number to be appointed who have passed highest the mental examination and have passed the preliminary examination, are, in July, ordered to the Coast Guard Academy in New London, Connecticut. There these applicants are reexamined physically and, too often, some of them are found to have disqualifying physical defects which escaped detection at the time of the original examinations. Those rejected are replaced by the highest on the remaining eligible list. During their four years at the Academy the cadets are examined annually and at graduation, and any who have developed disqualifying defects are required to resign. Those graduating are thereafter officers in the Coast Guard and eligible for retirement if at any time disabled by conditions other than those due to vicious habits.

EXAMINATION OF APPLICANTS FOR ENLISTMENT

Applicants for enlistment are examined by medical officers of the Public Health Service. One medical officer usually conducts these physical examinations, which, as in the case of applicants for cadetship, .

include blood pressure readings and Wassermann tests.

An applicant for enlistment having passed the physical examination is enlisted in temporary status for a term of three years. If desiring to reenlist, he must again pass a similar strict physical examination and is again in temporary status for another three-year term. During these six years of temporary, or probationary, status the man is discharged if physically or mentally incapacitated. He does not receive the benefits of retirement for physical disability. This is in accord with the practice of the Army and Navy, which Services have no retirement for enlisted men until after twenty years of service in the Navy and thirty years service in the Army. In the Coast Guard, however, if a man desires to reenlist for a third term, at the end of six years, and if at that time found physically qualified, he is reenlisted in a "regular" status and is then entitled to retirement if disabled from any condition not the result of his own vicious habits. lle may, thereafter, reenlist at three year intervals for as long as he desires to remain in the Coast Guard. No further physical examinations are necessary, if reenlistment is accomplished on the day following discharge. When a "regular" man cannot perform his duties, due to disability not the result of vicious habits, he is retired upon proper procedure.

Thus, insofar as the physical examinations are concerned, are the officers and enlisted men of the Coast Guard secured.

EXAMINATION OF PERSONNEL

All officers of the Service, including Warrant Officers, are required by regulations to have a physical examination during the first quarter of each year. These examinations are made by officers of the Public Health Service, except in a few localities where no officers of that Service are available. In such instances boards of Army or Navy medical officers perform this duty. Nearly all of the annual examinations of flight officers of the Coast Guard--flight physical examinations--are made by flight medical officers of the Navy. All cadets at the Academy are given flight physical examinations while at the Academy by a Public Health Service officer who is qualified to perform these examinations.

Whenever the physical condition of an officer or enlisted man seems to render him unfit to perform full duty, his superior officer, of Head

quarters, acting on his record, may order him to appear for a medical survey at a Public Health Service station. This survey is usually made by a board of two officers who make recommendations after thorough study of the case. The Board of Survey may recommend continuation of treatment with prospect of early recovery; it may recommend change of duty or climate, or both, and it may advise that the condition is such that the person in question should appear before a retiring board, he being considered permanently disabled and unfit for further duty in the Coast Guard. (See General Circular #40, Public Health Service.)

Retiring boards consist of five members who must be commissioned officers--three Coast Guard officers and two medical officers of the Public Health Service. These boards are more or less permanent and are located in the larger cities of the United States--cities in which there are Public Health Service (Marine) Hospitals. They consider only those cases which Coast Guard Headquarters has recommended to come before them. The Retiring Board may or may not recommend retirement in the case of an officer or enlisted man under consideration. If not, return to some sort of duty is recommended, and this is usually approved by Headquarters. If, as is usually the case, retirement is recommended, this must be approved by Headquarters and by the President of the United States--the Secretary of the Treasury usually signing for the President by direction. On the first day of the month following the approval, the man is officially retired. So much for the physical ex

aminations.

In years gone by, all medical papers pertaining to the old Life Saving Service and Revenue Cutter Service were reviewed and acted upon by a medical officer of the Public Health Service located in the Public Health Service Bureau. With the combining of the two Services to form the Coast Guard, and with the expansion of that Service, it became necessary to detail a medical officer of the Public Health Service to exclusive duty at Coast Guard Headquarters. The several officers who have filled the position of Chief Medical Officer to the Coast Guard have, over the years, built up a very efficient supervision of Coast Guard medical affairs coming under their jurisdiction.

ORGANIZATION OF COAST GUARD MEDICAL SECTION

Coast Guard Headquarters now has a "Medical Section." The personnel of this Section embraces the Medical Director, Chief of Section; a Chief Pharmacist of the Coast Guard; one pharmacist's mate, and four civilian

clerks. By them are handled the medical papers pertaining to all Coast Guard personnel throughout the United States and its dependencies.

All records of physical examinations coming to the Medical Section are carefully checked. They may not always be in accord with regulations. If there are on file records of previous examinations, these are considered and discrepancies noted. Usually the recommendations of examining officers in the field must be accepted, but this need not be so in view of information which may be on file at Headquarters. This failure to accept the findings of boards or individual examining officers may extend even to the findings of Retiring Boards. The Chief Medical Officer may recommend to the Commandant such action as in his opinion seems warranted upon a consideration of all the facts bearing upon a case in question. The opinion of the Chief Medical Officer is usually accepted as final, but this need not be so. On rare occasions the Commandant may exercise his privilege of reversing the Chief Medical Officer, accepting a board opinion in lieu thereof.

The Medical Section at Headquarters receives all reports of medical, surgical and dental relief furnished to personnel of the Coast Guard at whatever point the relief may have been rendered. A record card is kept in case of every man and upon this the dates of illness and diagnosis appear. Whether in or out-patient treatment is also recorded.

In the case of syphilis the date and nature of each outpatient treatment is recorded upon a separate report card. In this disease the Medical Section exercises especial control and enforces a compulsory system for receiving necessary treatment. The matter of continuous or intermittent treatment is left to the discretion of the attending medical officer, but the patient is allowed no discretion as regards taking the treatments recommended.

Thus, and through physical examination reports, the Medical Section keeps in intimate touch with the injuries and illnesses of the approximately 10,000 persons in the Coast Guard. If any individual appears to remain unduly long under hospital observation or treatment the Medical Section asks for a report and recommendation in the case.

The Chief Medical Officer must keep the Surgeon General of the Public Health Service advised as to the needs of the Coast Guard for medical officers on Cutters and at shore stations. He must check and transmit to the Surgeon General all requisitions for medical supplies