1939: Public Health Services

The official public health services of the United States consist of the United States Public Health Service, the state departments of health, and the local health organizations in cities, towns, incorporated villages, counties and other rural civil subdivisions.

National Public Health Services.

The United States Public Health Service administers health laws and regulations of national import, such as those relating to maritime quarantine and the prevention of the introduction of disease from abroad; it observes the international sanitary conventions; acts to protect the health of the people in interstate traffic, to prevent the spread of disease from state to state, and to suppress epidemics; and cooperates with the states, through Federal grants-in-aid, in the improvement of their health services and in other health matters. Under the Federal Constitution, the states retain control over local health matters and have jurisdiction over sanitary affairs within their borders such as the control of communicable diseases, collection of vital statistics, maintenance of diagnostic laboratories, the enactment of sanitary legislation for their jurisdictions, and similar health matters. The states, however, delegate certain health powers to local civil divisions, whose ordinances and regulations must not, of course, be inconsistent with state or Federal laws.

In the United States, as well as in foreign countries, the most important advance in public health and expansion of the activities of the public health services is probably represented by attempts to secure wider and more effective application of known preventive measures, improvement in the qualifications of public health service personnel by providing training facilities, more intensified attacks on specific diseases, such as the venereal diseases, tuberculosis, and pneumonia, the reduction in which has not been commensurate with the available preventive measures, the shift in emphasis from the communicable diseases, already so successfully attacked, to the chronic diseases, the inclusion of nutrition in public health programs, and the securing of a wider dispersion of health facilities and medical care.

State and Local Health Services.

State and local health services in the United States are being improved and expanded by Federal grants-in-aid under the provisions of the Social Security Act and the Venereal Disease Control Act. During the fiscal year 1939, a total of approximately $10,500,000 of Federal funds were allocated to the states for these purposes. Since this Federal subvention was begun in 1935, many state departments of health have added specialized divisions of industrial hygiene and venereal disease control, accredited public health training has been provided from some 5,400 personnel of state and local health departments, and the number of full-time rural health services has increased more than 130 per cent. Federal funds supplement, but do not supplant, state and local funds, and have actually increased them by more than $13,000,000.

Under the stimulus afforded by the passage of the Venereal Disease Control Act approved May 24, 1938, adequate treatment has been brought within the reach of more patients and clinical facilities have been expanded, resulting in an increase in the number of patients brought under treatment. Through improved case-finding methods, an increasing number of syphilitic patients are being given treatment in the early stage of the disease, when the outlook for cure is most favorable.

Industrial Hygiene.

Greater attention is being paid by health services to industrial hygiene and the reduction of industrial hazards. Through financial aid and technical assistance of the United States Public Health Service, industrial hygiene units, confined to 4 state departments of health in 1936, have now been established in 34 states.

National Institute of Health.

Under the provisions of the Social Security Act, an appropriation of $1,600,000 was made available to the Public Health Service during the fiscal year 1939 for the investigation of disease and problems of sanitation, most of which was allotted to the National Institute of Health. The new National Institute of Health is located at Bethesda, Md., near Washington, D. C. Three of the five buildings comprising the Institute and the National Cancer Institute building, part of the National Health Institute and located on the same site, were occupied during 1939.

Research and Recent Results.

The principal research of the Public Health Service during 1939 related to studies of infections and virus diseases, heart disease, cancer, epidemiology, chemotherapy, pharmacology, nutrition, industrial hazards, public health administration methods, and similar public health problems. New foci of spotted fever were discovered in some of the eastern states, endemic typhus fever was shown to have lost its urban limitations, and the tick was demonstrated to be a carrier of three other acute febrile diseases besides spotted fever. In a study of the dietary deficiency diseases, Public Health Service investigators discovered the existence of a new vitamin (riboflavin) deficiency disease in man which has probably existed in this country for many years. The term 'ariboflavinosis' was given as a name for the condition.

Fundamental investigations are being conducted on the etiology and treatment of cancer. Under the National Cancer Institute Act of 1937, 13 grants totaling nearly $90,000, were recommended for use in furthering cancer research in other institutions, and 29 trainees were appointed during 1939 to receive instruction in the diagnosis and treatment of the disease. Nine and a half grams of radium, valued at $200,000, were procured by purchase, of which 8 grams are being lent to hospitals properly equipped to treat cancer patients, the remainder to be used for research at the National Cancer Institute.

As the result of increased knowledge regarding the constitution of an adequate diet and the importance of proper nutrition from a health standpoint, greater attention is being given to the subject of nutrition by public health services. Nutrition education programs have been instituted by many state and local health services, and the United States Public Health Service is conducting research and serving the state health departments in an advisory capacity in developing this new public health activity.

The public health services of many foreign countries are undertaking surveys to determine whether the intake of vitamins and minerals in the dietary of certain groups of their populations is sufficient to meet physiological requirements. Symptoms of dietary deficiency disease have been reported frequently among the rural population in different parts of Europe, especially cases of night blindness and skin affections attributable to vitamin A deficiency.

Great success has been achieved in public health in the control of many of the important communicable diseases, and, as a result, chronic diseases are assuming greater relative importance. Greater public health effort is therefore being directed to these diseases. An increase in these conditions was to be expected, with the older age groups, among whom they are most prevalent, forming an increasingly larger proportion of the population. The magnitude of this problem in the United States was revealed by the report of the National Health Survey conducted by the Public Health Service, which indicated that the enormous total of over 800,000,000 days of disability are lost annually in this country from chronic diseases.

Expansion of Scope.

The fundamental purposes of public health services are the prevention of disease and the promotion of health through the fullest application possible of known protective measures and research to obtain greater knowledge of the cause and prevention of disease and to improve health administration methods. The older basic public health functions of quarantine, environmental sanitation, and immunization are being continued; but new battle fronts are being drawn as a result of the widening concept of public health service and the assumption of increasing responsibility of the government in matters of health and social welfare.

In 1938 the Interdepartmental Committee to Coordinate Health and Welfare Activities submitted an outline of national health needs, and a National Health Conference called during that year made specific recommendations on a national health program. It was the sense of the Conference that national requirements for health and medical services are being met inadequately. In January 1939, the President submitted to Congress and recommended consideration of the report of the Interdepartmental Committee outlining a health program that would provide adequate services for the prevention of disease and treatment of the sick; insure adequacy and accessibility of the necessary adjuncts to modern diagnosis and treatment, such as laboratories, health centers, and hospitals; protect wage earners against the hazards of unemployment; and bring adequate medical care within the reach of everyone. Legislation has been introduced in Congress designed to bring the recommendations of the Interdepartmental Committee and the National Health Program into a practical reality.

On July 1, 1939, the United States Public Health Service was transferred to the newly created Federal Security Agency from the Treasury Department, under which it had developed and functioned since 1798, when it was first established by an Act of Congress creating the marine hospitals. See also ROCKEFELLER FOUNDATION.

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.