THE RESERVE OF THE UNITED STATES PUBLIC HEALTH SERVICE. The Reserve of the Public Health Service is for use in time of national emergency. Its membership consists of physicians, sanitary engineers, epidemiologists, pathologists, zoologists, pharmacologists, bacteriologists, chemists, sanitarians, and others whose qualifications, training, and experience are such as would enable them to perform the duties of the Public Health Service. The President alone is authorized to appoint and commission as officers in the Reserve such citizens as, upon examination prescribed by the President, shall be found physically, mentally, and morally qualified to hold such commissions; and the commissions remain in force for a period of five years, unless sooner terminated in the discretion of the President. Commissions in the Reserve do not exempt the holder from military or naval service. Officers are commissioned in the Reserve in the grades of Assistant Surgeon, Passed Assistant Surgeon, Surgeon, Senior Surgeon, and Assistant Surgeon General. They are distributed in the several grades in the same proportion as now obtains among the commissioned personnel of the United States Public Health Service, but it should be stated that the proportion in the grades of Senior Surgeon and Assistant Surgeon General is very small. Officers are at all times subject to call to active duty, and are required to serve whereever ordered. The duties which Reserve officers may be required to perform are those of the Public Health Service, and are broad and varied in character. They include the care of patients in hospitals under the control of the service, the examination of arriving alien immigrants at ports of entry, service at sea on board coast guard cutters, work in connection with the conduct of national quarantine stations, the prosecution of campaigns against epidemic diseases, the carrying out of research work in the Hygienic Laboratory and in the field, the study of various factors in the protection of the public health in all parts of the nation, and cooperation with State and local health authorities. As members of the Reserve are not called to active duty except in the existence of an emergency when their services are needed to supplement the work of the regular personnel of the service, and as they do not receive pay while on inactive duty, commissions in the Reserve can not be considered as affording regular or permanent employment in the Public Health Service. The right to be recommended for appointment and commission in the Reserve of the Public Health Service is determined by a thorough examination by a board of medical officers. In order to receive this examination an applicant must make an application to the Surgeon General of the service in his own handwriting, requesting permission to be considered by the board of examiners. He must state the date and place of his birth, present legal residence, whether he is a citizen of the United States; give the names of the schools or colleges of which he is a graduate; furnish testimonials from at least two persons as to his professional and moral character; and submit a recent photograph of himself. An applicant of foreign birth must furnish proof of American citizenship. If the application is favorably considered, the candidate will then be provided with information in regard to the details of the examination. The grades in which officers are appointed in the Reserve are determined by the qualifications, training, and experience in their special lines of work which they reveal in the examination. The pay of Reserve officers when on active duty is that of regular commissioned officers of the Public Health Service. Assistant surgeons receive pay at the rate of $2,090 per annum; passed assistant surgeons, $2,400; surgeons, $3,000; senior surgeons, $3,500; assistant surgeons general, $4,000. In addition officers receive commutation for quarters and prescribed allowances for heat and light in accordance with their grade. Recommendations for promotion are based solely on the record for fitness and capacity, without regard to seniority, except that selections are ordinarily made from the next lower grade. For the purpose of recommending officers for promotion, a board of three or more commissioned officers is convened from time to time by the Surgeon General. Vacancies in the higher grades may be filled by original appointment to the Reserve, but are ordinarily filled by selection from officers in the Reserve. As regards the expenses incident to the service, it may be stated that stations are supplied with medical books and periodicals, and there is no necessity for the officer purchasing these or the instruments of his profession. He is, however, expected to own and keep in good condition the uniform prescribed for field duty. When traveling on official business, actual and necessary expenses are paid by the Government. In order that Reserve officers may receive training which will familiarize them with the work of the Public Health Service and prepare them for the duties to which they may be assigned in time of emergency, it is contemplated, in so far as practicable, to order them as on active duty, for a period not exceeding one month each year, to a school of training in an approved institution or station. located convenient to the districts in which they reside. The train ing thus gained will also prove of great value to the officers in their regular work. By holding a commission in the Reserve of the Public Health Service an officer renders himself liable to considerable personal sacrifice, but gains the opportunity to perform a patriotic duty by holding himself in readiness to serve whenever and wherever called. The experience acquired while on active duty and the association with other officers, many of whom are experts in their special lines of work, are advantages which compensate in some degree for the temporary character of the duty. THE PHYSICIAN'S RESPONSIBILITY IN DIPHTHERIA. 1 In a study of 1,000 deaths from diphtheria recently made by the Massachusetts State Board of Health evidence is presented which shows that for various reasons the abundant fund of useful knowledge which medical science has at its disposal for dealing with diphtheria is still utilized far too little. Especially discouraging, after the many years of exhortation to call a doctor at once, is the fact that in over 23 per cent of the cases the patient had been ill a week before the physician was called. In 4.2 per cent the patients had been ill from one to two weeks before they received medical attention. It is also surprising to find that in a populous State like Massachusetts, where laboratory facilities as well as antitoxin and Schick outfits are conveniently available, 7.6 per cent of the deaths should have occurred in "unrecognized" cases. Apparently this denotes carelessness on the part of the medical profession. It is certain, as the Massachusetts State health authorities point out, that health authorities have a right to expect that the diagnostic and therapeutic facilities which they furnish be utilized by the practicing physicians to effect a diminution of the morbidity and mortality of diphtheria. Inquiries as to the dosage and use of diphtheria antitoxin also indicated that physicians were not utilizing this remedy in accordance with the best experience. In a number of the fatal cases studied the physician had delayed antitoxin treatment by waiting for a laboratory confirmation of the diagnosis. In not a single instance was the antitoxin given intravenously, and this despite the fact that in several cases antitoxin was administered every four hours until death occurred, in one instance a total of 80,000 units being given in this way. That the complaint of the Massachusetts State health authorities is not only well justified, but that it probably voices a legitimate indictment of a part of the medical profession generally, is indicated by the fact that a very similar complaint was 1 Boston M. and S. Journal, Jan. 16, 1919. made by the New York City health authorities a year or two ago. With a diagnostic laboratory service unsurpassed, and with Schick test outfits, antitoxin serum, and active immunization outfits practically at their elbow, the physicians of New York were charged with insufficient or delayed utilization of these aids, and with responsibility in the continued prevalence of fatal cases of diphtheria. It is possible that a thorough investigation of every fatal case of diphtheria, with a request for an explanation by attending physician, might serve to make those who are now negligent in their management of cases of diphtheria exercise greater care and thus lead to a saving of life. In any event the analysis here presented indicates strikingly the need for more extended and thoroughgoing education, not only of the medical profession, but also of the general public. After all, this is the final solution of so many of our health problems, and it should be encouraged and urged by health administrators everywhere. THE NOTIFIABLE DISEASES. DISEASES AND CONDITIONS REQUIRED TO BE REPORTED IN THE SEVERAL STATES. Owing to the demand for the publication of the data given in the accompanying table showing the diseases required to be reported in the several States, it is reprinted at this time. The table has been brought up to date as to the States requiring the reporting of venereal diseases, but it has not been revised since January 1, 1917, as to other diseases. It is not believed, however, that there have been any great changes since then, except with regard to influenza. Information received by the Public Health Service indicates that this disease has been made reportable in most of the States. The table on page 238 shows the methods of reporting venereal diseases in the several States. It will be noted that only six States require that the names of venereally infected persons be reported at once by the physicians. The usual method is by serial number only unless the patient discontinues treatment prior to reaching the noninfectious stage or the patient willfully or carelessly fails to observe the precautions necessary to prevent the spread of infection to other persons. Thirteen States have a bureau or division of venereal-disease control as a part of their State health organization. In others the work is carried on as a part of the division of communicable-disease control or in some other manner. |