HE 182 The sphere its relatedness, is emerging at the power and will surely in disease and t hear that or and sometir of this sho medical sc aspects of Pediatric Pediatric schools. of the ti giving part in and sc relate stude health boards in the execution and enforcer federal laws and regulations. The policy o developing state health departments, espec department whose effective operation in the in the spread of disease from one state to another state spread of disease, the Public Health Serv priations will permit, endemic indices of disease officers of the Service and epidemiological aids t order to assist the state health officers in develop reporting. Besides utilizing the state and local prepared by the Surgeon General of the United promulgated by the Secretary of the Treasury whi be observed by all common carriers to prevent the i sources of water supply used in interstate traffic by inspected and either certified to permit their use or co plague in New Orleans, Galveston, Beaumont, and Pe The suppression of epidemics.-There have been these epidemics has been the special task of the Public of the Service work has been the successful confining of th population and prevention of their spread to other localiti Co-operation with state and local boards of health in operative activities take numerous forms, as, for instance: administration and organization, with the view to recomm legislation for meeting state and local conditions, giving assistance in organizing state departments of health or new di ments of health, making sanitary surveys of counties, muni investigating outbreaks of communicable diseases, and aiding tion of disease-producing conditions. In this connection three disease work of the Public Health Service; second, co-operative co-operation with state and local authorities may be mentioned Health Service in rural sanitation; third, co-operation of the Pub st in the prevention and control of malaria. 1. Venereal Disease Work: Under the Chamberlain-Kahn A 1918, there was established in the Public Health Service a Division of for the purpose of enabling the federal government, through the Public to undertake its share of the responsibility of diminishing the rava venereal disease. The general duties of the division, in accordance regulations prescribed by the Secretary of the Treasury, are: "to study an the cause, treatment, and prevention of venereal diseases; to co-operat boards or departments of health for the prevention and control of such dise the states; and to control and prevent the spread of these diseases in traffic." in the union of organizations in the state health departments to deal with The work carried on by the Division has caused the development in ev problems caused by the prevalence of these diseases. The whole effect of th has been to inform the public in a common-sense way of the unnecessary sub death, and damage wrought by the prevalence of these diseases. 154 health boards in the exertion are dederal lawy and regulations. The pr naging state health departmes MENT IN RELATION TO HEALTH-PIERCE 185 tion Work: The importance of this subject has not been fully ess up to the present time. For this reason the Public Health opriation of only $50,000 during the past fiscal year to expend in nitation; yet with this sum work was carried on in 33 counties, ion for health purposes in these counties of about $230,000 was 1 indirect expenditures by private individuals and corporations of was secured. The whole effort of the Service along these lines has le sense of local health responsibility and to encourage the citizens ntain for this purpose adequate local health organizations. rtment whose effective operation in read of disease from one state to anoth rad of disease, the Public E * permit, endemic indios dí the Service and epidemiologia, u st the state health officers in fres des utilizing the state unt .. Surgeon General of the U. the Secretary of the Treas k: Through co-operation with state boards of health, local communternational Health Board, the United States Public Health Service problem of making investigations in malaria, malaria surveys at the health officers, and proposing to malarious communities programs of common carriers to pretion. The expenses of carrying out these programs is met by local ly used in interstate thir, and contributions made by the International Health Board, the plan ertified to permit their use a mapped out and the expert supervision necessary to its proper execution epidemics.-There have the Public Health Service. onference with state health officers.-Under the act of 1902 the Surgeon Galveston, Beaumont k the successful conic health administration and other matters are discussed. an annual conference of the state and territorial officers. At this con he special task of the heir spread to other actions of the diseases of man.-Under the act of August 14, 1912, the s forms, as, for ins influencing the propagation and spread thereof." The extent, therelocal boards of Service is empowered "to study and investigate the diseases of man and ith the view to ch the Public Health Service may carry on this work is limited only to the cal conditions, gons received from Congress. The present urge for economy has prevented ints of health ariation of sums commensurate with the extent of the field. An outstanding eys of courses this work has been the development of what promises to be the successful diseases, and eprosy, at least when the disease is not too far advanced. This latter work is connection is carried on at the Leprosy Investigation Station of the Service at Hawaii. may be metastigative work of the Public Health Service is done at various stations in the ond, coopero at the Hygienic Laboratory in Washington. ration of the bervision of biologic products.—Under the Act of July 1, 1902, the manufaca the United States who produce for shipment in interstate traffic any virus, berlain-Kabutic serum, toxin, anti-toxin, or analogous product applicable to the prevention a Divisiere of disease of man do so under licenses issued by the Secretary of the Treasury gh the Pheir establishments have been inspected by officers of the Public Health Service ing the round to conform to the regulations promulgated by the Secretary of the Treasury, scordafter samples of their products have been found to conform to the standards laid to stata by the Public Health Service for purity and for potency also, where such a codard is practicable. In addition to this all foreign firms who desire to import silar products into the United States must first obtain a license from the Secretary zhe Treasury which is issued to them on the same terms and under the same kind nspection as in the case of manufacturers in this country. Unless these conditions BA met and the samples of their products comply with the standards of the Public ealth Service, they cannot be admitted into this country. Dissemination of health information and public health education.-The scientific ablic is informed by the bulletins prepared by the Hygienic Laboratory and the HEALTH Division of Scientific Research as bulletins of the Hygienic Lab b Health Bulletins. In addition to this, the Service publishes Reports which are eagerly read by those interested in public healt these publications popular bulletins dealing with various health s for the press are prepared and distributed. W fo ORGANIZATION FOR PUBLIC HEALTH ADMINISTRAT surgeon general: W to SOME OF THE ACHIEVEMENTS OF THE PUBLIC HEALTH SERV 900. There was no interruption of business, no stoppage of railroads. Health Service by its conduct of this epidemic this year saved the ma $165,000,000. ACHIEVEMENTS IN SANITARY CONTROL the military forces of the United States in the areas During the war the Public Health Service successfully protected the pla by ide de nat contiguous to the car for possible to co info and canal, has been held up as an example of conspicuous sanitary achievement. the war the Public Health Service performed similar work over an area greater than the Canal Zone, and in sections of country where malaria, typh and other communicable diseases if uncontrolled would have menaced the is o efficiency of the United States to an unprecedented extent. typhoid fever was nearly 300,000. In 1920 the deaths from typhoid feve the best methods for the prevention of this disease. fever," made by the Public Health Service enabled Reid and Carroll of the Army” Pellagra.-The studies of the Public Health Service on disease lay in adopting a proper diet. pellagra have show to be a disease caused by improper diet, and that the prevention and the cure o Beriberi.-This is another dietary disease caused by an improper diet. disease was extremely prevalent and fatal in the Philippine Islands, especially this disease from the prisons and furnished a convincing demonstration, which prisons. By the application of dietary principles the Public Health Service elimin of gra imp Riv suc oth spr tra bee for Research as bulletins, addition to this, the rly read by those inte lar bulletins dealing and distributed. ON FOR PUBLIC HLED OVERNMENT IN RELATION TO HEALTH-PIERCE 187 on throughout the world where this disease is prevalent, of the value of in preventing beriberi. y.-Under the Act of March 3, 1905, the Public Health Service in investisy has developed a method of treatment which promises to cure a disease enerations has been regarded as incurable. ent of syphilis.-Arsphenamine (salvarsan 606) is the most effective remedy tment of syphilis. Unfortunately its administration has been accompanied of Public Heal's stances by sudden death. The causes of sudden death from the adminisfive divisions aarsphenamine (five and six million doses given annually in the United States) arantine and instigated by the Public Health Service, and precautions formulated to make -Sanitary Repersistration of this drug safe. MENTS OF THE PO theria. The preparation and preservation of the standard diphtheria antit. This was an extremely difficult task, owing to a number of considerations necessary to specify here. The task was successfully carried out by the and $170, Lealth Service. 879 the yellow fe me instances cephylaxis.—Officers of the Public Health Service first studied the phenomenon 5 an epideme to scientists as anaphylaxis or hypersensitiveness, which has been found to an that of 18% most important part in the whole question of susceptibility and immunity to mpletely wipe, carby towns sophus fever.—The transmission of typhus fever by lice has been investigated 5, no stoppage Public Health Service, and work of other investigators fully confirmed. The nic this years y of typhus fever to the so-called Brill's disease epidemic in New York City was istrated by the Service. ARY CONTR round squirrel and plague.-That the California ground squirrel could act as a successful pal host of plague was discovered by the Public Health Service. Had it not been as contigo is discovery, it would have been impossible to control plague on the Pacific Coast. hit was Disinfection.-The Public Health Service developed the cyanide method of dissanitary action by which vessels and buildings may be rapidly and effectively rid of rodents work ore vermin. where Measles.-The Public Health Service made the important discovery that measles have maly contagious during the first few days, and placed health officers in the possession :nowledge to handle intelligently measles cases. it. n the Rocky Mountain spotted fever.-A method of controlling this fever by sheepmtzing methods was described and developed by the Public Health Service. ngth Stream pollution.—The Public Health Service first studied and pointed out the ean portant sources of pollution of the waters of the Great Lakes and of the Missouri iver, and made recommendations that are being rapidly adopted for the control of which pollution. These have resulted in enormous reduction in typhoid fever and other water borne diseases in these areas. Cholera.-The Service demonstrated the rôle played by cholera carriers in the spread of cholera in the Philippine Islands. Trachoma.-The Service has developed most effective methods for the cure of trachoma, a chronic disease of the eyes which has blinded many thousands, and has been regarded by some as incurable. Venereal diseases.-The Public Health Service has given great impetus to measures for controlling venereal diseases. Under its leadership every state in the Union has organized a special division in the state health department for the control of these diseases. Hookworm. The identification of the American species of hookworm as a cause of widespread anaemia was first accomplished by an officer of the Service, and has resulted in a notable diminution in the prevalence of this disease. Milk. Studies made by the Service of the relation of milk to public health have resulted in widespread measures for the improvement of milk supplies with corresponding reduction of diseases caused by polluted milk. The milk bulletin issued by the Public Health Service has been adopted as a textbook in universities throughout the United States. ORGANIZATION OF STATE HEALTH DEPARTMENTS The Public Health Service has steadily fostered and aided the organization of state health departments. Through the work of the Public Health Service and through the detail of officers it has contributed directly to the organization and development of state health departments in at least ten states, and has given aid and assistance to developing divisions of health departments in other states. B. THE FEDERAL CHILDREN'S BUREAU Anna E. Rude, M.D., Director, Hygiene Division, Federal Children's Bureau, Washington Modern conditions, the result of social progress, may be considered entirely responsible for the present field of preventive medicine, the object of which is healthful community life. Formerly the doctor's task was that of curing the ills of the individual; now he is required to be able to serve the whole community by preventing illness. The creation of a hygienic conscience in the individuals of a community is the prime factor in assuring the success of preventive work. The health activities of the Federal Children's Bureau have aimed to assist in the creation and molding of this hygienic conscience. Those of you who are familiar with the history of the Bureau know that the first work undertaken by it was an investigation of infant mortality, that subject being the first specified by its organic act in an imposing list of mandatory duties, namely: investigation of "infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents, and diseases of children, employment [and] legislation affecting children in the several States and Territories." This original inquiry-infant mortality-was necessarily restricted to a consideration of social, industrial, and civic factors contributing to the welfare of the child in the home and community, since no medical officer had been provided in the Bureau's staff It was during the second year of the Bureau's existence that the Hygiene Division with a physician as director was established, the work of the previous year, having clearly pointed out the interlocking of the social and medical fields and the advisability of expert direction and co-operation in each field if comprehensive investigation and research were to be attained. To draw an absolute line of demarcation between the two fields was found to be impossible. The series of nine urban infant mortality studies which followed has demonstrated the social and economic problems involved in the high death rate of infancy and also |