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 has demonstrated that the problems of no two communities are identical, so that any remedial efforts require individual consideration governed by local conditions. The Children's Bureau early recognized that infant mortality rates in rural areas were less favorable than had generally been taken for granted, and consequently required special investigation; the need for practical remedial measures was found to be even greater in rural than in urban communities since many of the larger cities were already taking measures for the prevention of infant mortality. Analyses of the causative factors in the high infant death rate found in these investigations readily showed the interdependence of maternal and infant welfare, so that the rural studies were concerned with conditions affecting both maternity and infancy. These rural investigations have been popularized by children's health conferences, held in connection with them, and thousands of children have been given physical examinations by physicians, and individual mothers have been given advice as to the care of their children. Such studies have been made in nine different States-North Carolina, Virginia, South Carolina, Georgia, Mississippi, Kansas, Wisconsin, Montana, and Wyoming-thus revealing local conditions in areas differing widely in remoteness and civic and social development. More recently the Children's Health Conferences have been conducted largely in remote areas by means of a motorized health center. Thousands of children have been examined in out-of-the-way places, and the popularity and success of this type of educational propaganda may be measured by the long list of applications on file from state boards of health for this type of service. The educational value of simple but authoritative literature on the care of mothers and children seems little questioned in this country, though its entire absence in England's child welfare movement is very noticeable and has led to our being termed "good advertisers." This method of reaching large numbers of people is, to say the least, practical and economical in our country of vast distances and inaccessible localities. Public demand was responsible for the Children's Bureau's early adoption of this method. Before the Children's Bureau had formally opened its doors or had begun specific investigations, letters of personal inquiry from mothers regarding the care of themselves and their children determined the need and nature of the Bureau's early publications, namely, Prenatal Care, Infant Care, and Child Care. Many hundreds of thousands of copies of these bulletin been distributed and are designed to present in simple text for the use of indiv information on matters of hygiene and home care of y As a direct corollary to the infant mortality studies, mortality based on figures of the United States Census B Grace Meigs Crowder. This original contribution has been besides directing attention to the fact that material mortality wa the United States, has undoubtedly as breast feeding was possibly the single factor most needing stress in preventive pediatrics, suggested that a breast feeding campaign be undertaken by the Children's Bureau. The bulletin, written by a staff physician, is intended for circularizing the entire medical and nursing professions, while a less technical presentation of the subject will be prepared for the laity. The object of the Bureau's campaigns and propaganda has been to create or increase interest in preventive pediatrics in every home in the United States, but particularly in those homes where government reports never have been read. Birth Registration.—An Aid in Protecting the Lives and Rights of Children; Necessity of Extending the Registration Area, was the first bulletin issued by the Bureau and was used in a birth registration campaign in co-operation with the Census Bureau, the Federation of Women's Clubs, the Mothers' Congress and Association of Collegiate Alumnae, and other women's organizations. In the Baby weeks of 1916 and 1917 and the weighing and measuring tests of 1918 the Bureau has co-operated with state and city health departments and with many millions of women represented by the General Federation of Women's Clubs and the State Councils of Defense. That all child welfare movements received great impetus from these popular methods cannot be questioned. This is particularly true of the Children's Year campaign, which interested millions and helped to awaken the public as to the need for better care and a sense of its responsibility for the welfare of the children. Permanent results are now to be seen in an increased number of centers for prenatal and infant care, more public health nurses, and more state and municipal child hygiene divisions. A child hygiene division of a federal bureau which has no power to impose authority has unique opportunities for service in the child welfare field and falls far short of its possibilities if its co-operation with governmental or voluntary child welfare or nursing agencies fails to be stimulating. Such co-operation has been attempted by the detailing, upon request, of expert physicians or public health nurses to assist in the development or reorganization of child health activities in many places; by direct correspondence, not only with organizations, but with individual mothers regarding the general hygienic care of themselves and their children; and by serving as a clearing house on child hygiene activities, especially through quarterly news letters to state child hygiene divisions. In fact, this field of general unsefuless seems limited only by very meager appropriations and a small staff. While responsible for initiating and conducting studies pertaining to hygiene, perhaps the most important function of the Hygiene Division of the Children's Bureau is its relation and service in an advisory capacity to other divisions of the Bureau in all matters pertaining to health, and its co-operation with other divisions in conducting investigations concerning such subjects as dangerous and injurious occupations, social factors responsible for high infant mortality, and the studies involvin among all classes of children. Let me here emphasize again the educati popularizing value of health conference conducted in co-operation with of investigations. This educational propaganda in no way minimiz scientific research. The Industrial Division of the Children's Bureau, while primarily industrial conditions affecting child welfare, has always recognized t standards are necessary in order to protect the health of adolescent childre th |