1938: Public Health Services

The origin of official public health services of today can, with an acceptable degree of accuracy, be traced to ancient Babylonia and Assyria where, available records indicate, there were developed certain basic sanitary measures, such as cesspools, crude sewerage systems, and provision for securing potable water supplies from distant sources. We still marvel at the wonderful aqueducts and sewage drains of ancient Rome, some of which are still standing and even being used. The famous Cloaca Maxima, the main sewer and drain of ancient Rome, constructed approximately 2,600 years ago, is still in use, and several of the Roman aqueducts may be seen today standing in Italy and in some of the former Roman colonies.

During the 15th century of the Christian era Venice and other Italian cities in the Mediterranean adopted detention measures to prevent the importation of disease by vessels coming from infected ports. The period of detention was forty days, called 'quarantine' from the Latin word meaning 'forty.'

In the 19th century the deplorable sanitary conditions in certain sections of London and a severe epidemic of cholera focused attention sharply on health matters which crystallized in the construction of water and sewerage systems in that city.

All of these early measures, directed at mass or group protection from disease, constitute the elementary phase of the public health movement and are retained today as important basic functions of public health services.

It may be noted that, while in the beginning of public health activities, the cities and religious groups took the initiative, it later became evident that the state itself should assume the responsibility for the health of the people. In Europe, after the dissolution of the monasteries, the state made itself responsible for the care and health of the destitute; while in the United States the nationalization of the public health service was largely initiated by the taking over of quarantine activities from the states and cities. In the last 150 years practically all of the nations of the world have developed well organized public health services; in some of them these activities are lodged in a separate department with Cabinet portfolio.

Health Service in the United States.

The difference between the Federal Public Health Service in the United States and the national health services of most European countries is found in the differences in the forms of government. Highly centralized governments have highly centralized health organizations. Under the Constitution of the United States, most health matters remain under the police power of the states. The Federal Government, however, administers health laws and regulations of national concern, such as quarantine laws and regulations regarding foreign and interstate commerce, enters into treaties with foreign nations regarding matters of international health, acts to suppress epidemics that threaten to spread from state to state, protects the health of the people in interstate traffic, and supervises and controls the manufacture and sale, in interstate traffic, of biologics used in the prevention and treatment of disease.

The official health services of the United States consist of the United States Public Health Service, the state departments of health, and the health departments of cities, towns, incorporated villages, counties and rural districts.

Federal Public Health Service.

The United States Public Health Service was created by an Act of Congress signed in 1798 by John Adams, the second President of the United States, to provide medical care and hospitalization for seamen of the young American merchant marine. It still conducts hospitals and relief stations for the care of American merchant seamen and other beneficiaries, but from time to time Congress has extended its functions to include strictly public health activities, such as the study of the cause and prevention of disease, administration of quarantine measures, epidemiological studies, surveys of disease prevalence, studies of health administration, and cooperation with the states in all health matters.

State Public Health Service.

The first state health department was established in Massachusetts in 1869. By 1900 similar health departments had been created in 38 other states, and at the present time all states have boards or departments of health. While only three states had established health departments by 1873, in that year 134 cities of the United States had some form of official health organization.

Rural Health Service.

The development of full-time rural health services dates from 1908. Although the states, cities, and towns had developed health services prior to that year, no advance had been made in providing such services for rural areas. By 1911 the county health movement had been initiated in three widely separated states. During the following 10-year period it had spread to 186 counties in 23 states, and in 1938, full-time health services were available in 1,166 counties in 41 states and in the rural areas of the Territory of Hawaii.

Recent Trends.

The most important recent development in public health services generally is the broadening of the concept of 'public health service' and the extension of public health functions not only to include the benefits of mass preventive measures but to secure medical service and medical guidance for all persons from before birth to old age. Whether or not the direction of medical service requires systematized public action is yet controversial; but there can be no doubt that the conception of the responsibility of government to society is here undergoing a change.

Probably the most important developments in the United States Public Health Service in 1937 and 1938 are the passage of the Act (Aug. 5, 1937) establishing the National Cancer Institute, authorizing an appropriation of $750,000 (subsequently appropriated) for the building and $700,000 ($400,000 subsequently appropriated) annually for conducting cancer investigations; and the Venereal Disease Control Act (May 24, 1938), expanding the activities in connection with the fight against the venereal diseases. An important public health development was the proved efficacy of specific therapeutic serums in certain types of pneumonia, and the initiation of special activities directed to enlightenment of physicians and the public regarding the importance of prompt action in their use in combating pneumonia.

Improvement in state health departments is marked by the increase in and improved qualifications of public health personnel (stimulated by annual Federal grants-in-aid of $8,000,000 under the Social Security Act) and the increase in the number of states having separate industrial hygiene, venereal disease, and communicable disease control units; while rural health services showed an increase from 946 counties with full-time services to 1,166 counties.

During the year, France made diphtheria immunization compulsory for all children; Germany had 744 health departments, employing 22,265 (48 per cent full-time); and in 13 Latin American counties the health department was headed by a Cabinet officer, while practically all of these countries had national health services.