APPENDIX G

TABLE A.-Some major amendments of the Public Health Service Act since 19441

Public Law 80-755, June 24, 1948 (62 Stat.
598).
Public Law 81-380, Oct. 25, 1949 (63 Stat.
898).

Public Law 81-692, Aug. 15, 1950 (64 Stat.
443).

Public Law 83-482, July 12, 1954 (68 Stat.
461).

Public Law 84-652, July 3, 1956 (70 Stat. 489).

Public Law 84-830, July 28 1956 (70 Stat.
709).

Public Law 84-835, July 30, 1956 (70 Stat. 717).

Public Law 84-941, Aug. 3, 1956 (70 Stat.
960).

Public Law 84-911, Aug. 2, 1956 (70 Stat.
923).

Public Law 86-415, Apr. 8, 1960 (74 Stat. 32).

Public Law 86-610, July 12, 1960 (74 Stat. 364).

Purpose of the act 4

To amend the PHS Act to provide for research relating to psychiatric disorders
and to aid in the development of more effective methods of prevention, diag-
nosis, and treatment of such disorders, and for other purposes.

To amend the PHS Act to authorize grants to the States for surveying their
hospitals and public health centers and for planning construction of addi-
tional facilities, and to authorize grants to assist in such construction.
To amend PHS Act to support research and training in diseases of the heart and
circulation, and to aid the States in the development of community programs
for the control of these diseases, and for other purposes.

To amend the PHS Act to provide for, foster, and aid in coordinating research
relating to dental diseases and conditions, and for other purposes.

To amend the Hospital Survey and Construction Act (title VI of the PHS Act),
to extend its duration and provide greater financial assistance in the construc-
tion of hospitals, and for other purposes.

To amend the PHS Act to support research and training in matters relating to
arthritis and rheumatism, multiple sclerosis, cerebral palsy, epilepsy, polio-
myelitis, blindness, leprosy, and other diseases.

To amend the hospital survey and construction provisions of the PHS Act to
provide assistance to the States for surveying the need for diagnostic or treat-
ment centers, for hospitals for the chronically ill and impaired, for rehabilita-
tion facilities, and for nursing homes, and to provide assistance in the con-
struction of such facilities through grants to public and nonprofit agencies,
and for other purposes.

To provide for a continuing survey and special studies of sickness and disability
in the United States, and for periodic reports of the results thereof, and for
other purposes.

To confer upon Alaska autonomy in the field of mental health, transfer from the
Federal Government to the territory the fiscal and functional responsibilities
for the hospitalization of committed mental patients, and for other purposes.
(Includes PHS grants to Alaska for mental health program.)

To amend the PHS Act so as to provide for grants-in-aid to non-Federal public
and nonprofit institutions for the constructing and equipping of facilities for
research in the sciences related to health.
To amend title III of the PHS Act, and for other purposes. (Establishes in the
PHS the National Library of Medicine.)
To improve the health of the people by assisting in increasing the number of
adequately trained professional and practical nurses and professional public
health personnel, assisting in the development of improved methods of care
and treatment in the field of mental health, and for other purposes.
To strengthen the Commissioned Corps of the Public Health Service through
revision and extension of some of the provisions relating to retirement, ap-
pointment of personnel, and other related personnel matters, and for other
purposes.

to provide for international cooperation in health research, research
training, and research planning, and for other purposes. (NOTE: By error
there was left in the purpose clause the phrase "to establish a National
Institute for International Health and Medical Research" although, as

head asterisks in Hen

1 This table includes only major amendments which have made significant or extensive
changes in the PHS Act. It does not purport to be a comprehensive listing of all amend-
ments of that act.

2 As authorized in the act, except where noted.

3 Since the 85th Cong., each public law has carried a prefix which is the number of the Congress in which it was enacted. Thus, Public Law 85-480 is Public Law 480 of the

To assist in expanding and improving community facilities and services for the health care of aged and other persons, and for other purposes.

To amend title III of the PHS Act to authorize grants for family clinics for domestic agricultural migratory workers, and for other purposes.

To amend the PHS Act to provide for the establishment of an Institute of
Child Health and Human Development, to extend for 3 additional years the
authorization for grants for the construction of facilities for research in the
sciences related to health, and for other purposes.

To assist States and communities to carry out intensive vaccination programs
designed to protect their populations, particularly all preschool children,
against poliomyelitis, diphtheria, whooping cough, and tetanus.

To increase the opportunities for training of physicians, dentists, and pro-
fessional public health personnel, and for other purposes.

To provide centers for research on mental retardation and related aspects of
human development.

To improve the public health through revising, consolidating, and improving
the hospital and other medical facilities provisions of the Public Health
Service Act.
To amend the Public Health Service Act to increase the opportunities for
training professional nursing personnel, and for other purposes.

To extend and otherwise amend certain expiring provisions of the Public
Health Service Act relating to community health services, and for other
purposes.

To amend the Public Health Service Act provisions for construction of health
research facilities by extending the expiration date thereof and providing
increased support for the program, to authorize additional Assistant Secre-
taries in the Department of Health, Education, and Welfare, and for other
purposes.
To assist in combating heart disease, cancer, stroke, and related diseases.
To improve the educational quality of schools of medicine, dentistry, and
osteopathy, to authorize grants under that act to such schools for the award-
ing of scholarships to needy students, and to extend expiring provisions of
that act for student loans and for aid in construction of teaching facilities for
students in such schools and schools for other health professions, and for other
purposes.

To provide for a program of grants to assist in meeting the need for adequate
medical library services and facilities.

85th Cong. For convenience, the references to public laws contained herein have been
conformed to this new practice. The dates cited herein are the dates of Presidential
approval of the act, and are not necessarily the dates of effectiveness of specific provisions
of law. The parenthetical citations are to the U.S. Statutes at Large.

4 Quoted from the purpose clause of the public law.

APPENDIX H

MEMORANDUM

APRIL 18, 1966.

To: Secretary.

From: Surgeon General William H. Stewart.

Subject: Reorganization of the Public Health Service.

On January 18 I submitted to you a preliminary statement of the goals toward which the American health partnership should be moving, the role of the Public Health Service in achieving these goals, and the pattern of organization which can best equip us to discharge our responsibilities.

Since that time I have had the benefit of the final report of the Corson Committee and further discussions with thoughtful and competent people both within and outside the Service. I feel that the time is now ripe for a definitive statement of our aims and the organizational structure which will, in my judgment, serve them best. This memorandum is designed to constitute such a statement. My fundamental thesis is that the health of the American people, in its totality. shall be the overriding concern of the Public Health Service and the measure of our success or failure. Our ultimate commitment is not to agencies or insituations but to people. In this context the Surgeon General should be the individual to whom the public may turn when their expectations for health care are not being fulfilled.

The Service would welcome this assumption of central responsibility for health on behalf of the people. I believe it is capable of exercising a form of leadership in health that is now impossible because responsibilities are diffused among many agencies at the Federal level-a diffusion which is reflected throughout state and community programs. There is, in medicine and its allied sciences, a leading edge of research and development which is piercing the frontiers of existing knowledge. This advance requires support and guidance in directing its efforts toward those needs which are greatest. Also required is a strong movement that will convert science into practice and channel new developments into the mainstream of medicine. Both of these are logical functions of the Public Health Service stemming from the stature of leadership to which we aspire.

Clearly, such responsibility cannot be pre-empted. It must be earned. It can only be earned by an agency that is oriented toward the future and organized so as to make the most effective use of its resources.

In the organization plan which follows, each major component will be characterized by commonality of purpose, achieved through the harnessing of complementary skills. I believe that such an organization can attract and retain the number and quality of personnel it needs to fulfill its mission, and that it can furnish the full measure of leadership, stimulation, and guidance required from the Federal government in advancing the Nation's health.

ORGANIZATION OF THE PUBLIC HEALTH SERVICE

The organization plan which I consider essential for these purposes would consist of eight major components, as follows:

A. Five operating Bureaus: Bureau of Health Services, Bureau of Health Manpower, Bureau of Disease and Injury Prevention and Control, National Institutes of Health, and a National Institute of Mental Health;

B. Two major activities reporting directly to the Surgeon General: The National Library of Medicine and National Center for Health Statistics; C. The Office of the Surgeon General.

The composition of the eight major components of the reorganized Public Health Service has been agreed upon in substance by the Bureau Chiefs and other top staff. The following descriptions and the appended chart, showing program elements may therefore be considered as firm and final recommendations.

The plan is ready for immediate implementation. Certain aspects of it will involve highly complex inter-relationships. Although certain steps are proposed for immediate action, full development will require additional steps over a longer period of time. Two of these complex areas, described in the appropriate sections of the following text, are (1) the relationships between the proposed National Institute of Environmental Health Sciences and the categorical programs responsible for control of environmental hazards to health; and (2) the de

velopment of a system of grants management that will enable each echelon and component of the Service to derive full benefit from and make its maximum contribution to the extramural effort.

A. Bureau of Health Services

The new Bureau of Health Services is designed as a central resource for improving the quality and accessibility of health care for the American people. It will have the primary responsibility to develop and maintain effective working relationships with private medicine, public and private institutions and organizations and official agencies in the health care field, and to stimulate and support innovations in the delivery of health care.

The new Bureau will contain all PHS activities which take part in establishing quality standards for health services. It will contain all our programs which provide medical care to legal beneficiaries—the general hospitals and clinics, the Indian program and the health care provied to Federal employees, the Coast Guard and prisons. The Bureau will also discharge the PHS responsibilities in meeting health needs in national emergencies.

By combining our direct medical care activities with programs which support the planning and construction of health facilities and the development of new and improved personal health services, the Bureau of Health Services will enable the Public Health Service to undertake, for the first time, a fully coordinated effort to improve the quality and accessibility of health care for the nation as a whole.

The Bureau of Health Services will be made up of the present Divisions of Medical Care Administration, Hospital and Medical Facilities, Indian Health, Hospitals, and Health Mobilization, plus our Bureau of Prisons and Peace Corps medical programs and portions of the Divisions of Community Health Services 3 and Chronic Diseases.

B. Bureau of Health Manpower

The Bureau of Health Manpower will concentrate the rapidly growing Federal support of programs designed to provide additional and better qualified manpower for health. The Bureau will serve as a central point of contact for educators and others involved in planning and carrying out education and training programs for health professional and subprofessional personnel. It will also constitute a national source of reliable information and projections as to manpower needs and programs designed to meet them.

The Bureau will carry out our present and anticipated programs in the manpower field, except for research training activities which will continue to be administered by NIH and certain specialized training activities which will be retained by the programs to which they are closely related. The new Bureau will administer programs of school construction, student assistance and educational support. It will be involved in every stage of professional and paramedical training, including the continuing education of health personnel inn practice. The Bureau of Health Manpower will include the present Divisions of Dental Health and Nursing, plus those activities of the Divisions of Hospital and Medical Facilities and Community Health Services which relate to the development of health manpower.

C. Bureau of Disease and Injury Prevention and Control

The new Bureau of Disease and Injury Prevention and Control will consolidate the activiteis of the Service in preventing or controlling infectious diseases, chronic illness and disability, and accidental injury, and in controlling environmental contamination.

It will maintain surveillance of illness and deaths associated with specific diseases and conditions. It will monitor contaminants in the environment which may be harmful to health and study their relationships with morbidity and mortality. It will establish human tolerance levels for environmental contaminants and advise when such tolerances are exceeded.

The Bureau will conduct and support research directed toward improved methods for preventing and controlling disease and accidental injury. It will spearhead eradication programs and support prevention and control studies. demonstrations and programs in states and communities. It will provide technical specialists and other assistance activities for special consultant assignments to states, communities and institutions. The Bureau will develop and apply the most effective means for preventing the importation and exportation of disease and maintaining effective interstate quarantine.