Vol. 1 No. 2 such persons, In this publication, the wide difference between sterilization and "birth control" by contraception is stressed. "Eugenic sterilization is applied by the state to persons who would be likely to produce defective children. It protects persons, their potential children, the state and posterity. Such persons may not have the intelligence, the foresight, or the self-control to handle contraceptives successfully, nor the ability to care for children intelligently. Sterilization is practically irreversible -permanent -- and 100% effective. It is the only reliable method of birth control which many defectives can use. Birth control by contraceptive methods is voluntary and applied by the individual for his own purposes. care, intelligence, and a practical biological understanding the problem. Both sterilization and contraception have a place in modern society." It requires extreme The work of the Human Betterment Foundation during the past year included the distribution of more than 40,000 pamphlets through 136 college instructors. These publications were sent for class work at the request of the professors. Among the different departments of colleges using these pamphlets are the departments of Animal Husbandry, Biology, Economics, Education, Genetics, Physiolgy, Psychology, Sociology, and Zoology.. Other educational activities of the Foundation included an exhibit at the San Diego Exposition and lectures to selected groups in schools and colleges. The San Diego Exhibit was made in collaboration with the California division of the American Eugenics Society and the Los Angeles Institute of Family Relations. In 1935, Mr. Harry Chandler, publisher of the Los Angeles Times, introduced a department on Social Eugenics, published in each issue of the paper's Sunday Magazine. It is believed that the Times is the only newspaper in the United States at the present time carrying a permanent feature dealing with eugenics.. The most important project of the Human Betterment Foundation for 1935 was the Case Study of Sterilization in California, which has been underway since 1932 in collaboration with the California Bureau of Juvenile Research. the Some 8,000 case studies of sterilization in the insane and feebleminded in California were carefully analyzed. Results of the study have not yet been completely analyzed and published. However, a preliminary report on the survey was published by Dr. Norman Fenton, Director of The California Bureau of Juvenile Research, and Paul Popenoe, Secretary of Human Betterment Foundation, in the Journal of Juvenile Research (October, 1935). A number of interesting things in general facts of sterilization practice are noted. "First, both sexes are almost equally represented in the sterilization statistics in California. Again, about three-fourths of the patients sterilized have been in the state hospitals for mental disease and only one-fourth in state homes for the feebleminded. This difference does not mean that sterilization is more frequently indicated for the mentally diseased. It simply reflects the condition existing in every state, namely, many more of the mentally diseased are cared for in state institutions than of the feebleminded........The California experience, viewed scientifically, should give an unbiased and accurate picture of what sterilization may or may not be ex pected to accomplish in such (feeble minded cases." Sterilization statistics collected by the Human Betterment Foundation report a total of 20,063 eugenic sterilizations performed in the United States in State institutions, under State laws, up to January 1, 1935. This total does not include voluntary eugenic sterilizations nor ther apeutic operations performed in State institutions lacking State laws. Dr. L. L. Stanley, prison physician at San Quentin, reported during the past year that he had performed vasectomies on more than 150 prisoners who voluntarily sought sterilization. Further study of eugenic sterilization was made by the American Neurological Association. A committee to investigate sterilization was appointed by this society, and the report, edited by Dr. Abraham Myerson of Boston, was published in the Summer of 1935. The B-1339a committee reviewed the whole subject, and while not endorsing compulsory operations, urged that voluntary sterilization laws be not confined to inmates of state institutions, but that they be applied also to patients in private institutions and to those who are at large in the community. PUBLIC HEALTH AND MEDICAL CARE PROBLEMS OF THE RESETTLEMENT ADMINISTRATION. Robert Oleson, M.D. Medical Director, U.S. P. H.S. and Medical Director, Public Health Section, Resettlement Administration this of and of af The peculiar needs of the Resettlement Administration in the fields of public health and medical care can better be understood by a brief consideration the conditions which have necessitated rehabilitation efforts. It will be recalled that during the darkest years of the depression more than a million farm families were on direct relief. This meant that between four and one-half and five million persons in agricultural areas were dependent upon Federal, State local agencies. In seeking an explanation for distressing condition fairs, it became apparent that, apparent that, insofar as agriculture was concerned, the causes were not of recent making but extended to mistaken policies during the past one hundred years. Especially was Especially was this true when homesteading was attempted upon marginal lands incapable of yielding a decent standard standard of living. of living. Other potent factors in bringing about the distress in agricultural areas were the mistaken policies of over-farming and over-grazing, especially aggravated by war conditions. Later came the struggle to produce more commidities to offset low prices. Damage from erosion, as well as exhaustion of lumber, mine and oil areas have all contributed to the increase of waste lands. Associated with the agricultural catastrophe there has been the inevitable human tragedy in which poverty, miserable housing, undernourishment and disease have played prominent parts. Rural and urban slums are only too widely distributed. It is to the task of rehabilitating the victims of this cumulative disease that the Resettlement Administration is June, 1936 some cases dedicating its efforts. In families of achieving success in agricultural or other pursuits is more promising. In other instances, without moving the families, assistance is afforded by so improving living conditions, farm equipment and methods that a new start in life is provided. Approximately 500,000 persons scattered throughout the United States fall in this rehabilitation category. The Resettlement Administration also has under development 93 community projects in which 10,475 persons are already living. The supervision of so large a number of clients demands unusual social planning, including public health measures and provisions for adequate medical care. For some time prior to the establishment of the Public Health Section of January 2, 1936, it was apparent that matters of sanitation, public health and medical care in the Resettlement Administration required the attention of personnel familiar with these specialized subjects. This group, headed by a medical officer detailed from the U. S. Public Health Service, has expanded with deliberation, as the need for additional skilled service has been noted. The present staff, which has been authorized but not fully assembled, comprises in addition to the medical director and one office assistant the following: 1 public health public health engineer, 1 supervisory public health nurse and 1 med ical economist. The functions of the the Public Health Section are quite apparent from the nature of its personnel, However, quite aside from customary duties, all members of the Section are important are charged with the functions of correlating the activities the Resettlement Administration with the regulations and requirements of the several states. An Administrative Order now requires that all matters of sanitation and public health be cleared through State or local departments of Health before receiving consideration in Washington. It may be said that the Resettlement Administration has been diligent and likewise largely successful in providing for its clients certain fundamental facilities for comfortable and healthy living. Among Vol. 1 No. 2 these may be mentioned decent housing, safe drinking water, effect disposal of human waste and malaria control. the aim of the Public Health Section to see that these advantages are maintained and suitably supplemented. This is being done through field inspections, visits to and correspondence with State and local health officers having knowledge of the conditions and education of Resettlement Administration employees in desirable standards of sanitation and public health. Complying with numerous similar requests from State health officers the Pub-lic Health Section advocates as minimum provision, the employment, by the Administration, of of a competent public health nurse at each large project. An opinion favorable to the possible employment of such nurses has been received from the general counsel. In the event that public health nurses are employed, it would be the policy to negotiate for their attachment to existing county health organizations. When there is no organized local health service the presence of the nurse from the Resettlement Administration should serve as the incentive for the formation of a full-time county or district health unit. The most urgent and perplexing problem confronting the Resettlement Administration is that of providing adequate medical, dental and hospital care with fees the people can afford to pay. Whether a full-time resident physician should be employed or the services of qualified local practioners obtained on a fee basis is a matter depending upon local conditions, needs and desires. The services which can be secured through cooperative medical associations appear to be promising. Several such organizations have been formed by resettlement clients with funds loaned by the Administration. These efforts, while commendable, are still far from satisfactory or adequate. However, the experience derived from these experi-. mental efforts will point the way to better, more successful and more permanent methods. Movements designed to provide satisfactory medical care deserve thoughtful encouragement, for it is only by having adequate medical care that the secur ity so essential to the success of the Resettlement experiment can be realized. It is hoped that this short article will convey to health officers and others the desire of the Resettlement Administration for their cordial cooperation in promoting the success of an unique experiment in human relationships. Although there are acknowledged shortcomings in the public health affairs of the Administration considerable progress has already been made in correcting the defects and more definite achievements may be expected in the future. THE PAN AMERICAN SANITARY BUREAU Its Genesis, Functions, Relationships and Activities Bolivar J. Lloyd, M. D. Medical Director, U.S. P. H. S. and Asst. to the Director, Pan American Sanitary Bureau There are 21 American republics. In 1889, representatives of the State Departments of all the American republics met in Washington as the First International Conference of American States. Permanent organization was effected by providing for subsequent conferences, and for a permanent executive organ, the Bureau of American Republics, now the Pan American Union. The Pan American Sanitary Bureau is not, as many suppose, a part of the Pan American Union. It is a separate, autonomous body, as we shall see. The Second International Conference of American States, which met in Mexico City in January, 1902, authorized the creation of a series of sanitary conferences, this series also to have its executive organ. The first of these met in Washington in November, 1902, under the Presidency of Surgeon General Walter Wyman, and was known as the First International Sanitary Conference of the American Republics. Permanent organization was cffected by providing for subsequent conferences and electing members of a Directing Council, called collectively the International Sanitary Bureau. These bodies are now called Pan American Sanitary Conferences and Pan American Sanitary Bu B-1339a reau, to distinguish them from the International Office of Public Health of Paris. The members of the Pan American Sanitary Bureau (Directing Council) reside in different countries, and meet once in two years or oftener. The Bureau did not function until reorganized in Montevideo by the Sixth Sanitary Conference in 1920. Delegates to the Pan American Sanitary Conferences possess treaty-making powers. The Washington Convention of 1905, and the Pan American Sanitary Code of 1924, are examples of the use of these powers. The Bureau is supported by quotas aggregating $50,000 annually contributed by all the American republics on a per capita basis. It is authorized to accept donations at the discretion of the Directing Council. There is a third series of conferences known as the Pan American Conferences of National Directors of Health. These conferences were authorized by the Fifth International Conference of American States in Santiago, Chile, in 1923. Delegates to these conferences do not have treaty-making powers. Nine Pan American Sanitary Conferences and three Fan American Conferences of National Directors of Health have been held to date. The Tenth Pan American Sanitary Conference is scheduled to meet in Bogota, Colombia, in 1938. The Pan American Conferences of National Directors of Health meet every five years in Washington under the auspices of the Pan American Sanitary Bureau. The Director of the Pan American Sanitary Bureau is elected at each Pan American Sanitary Conference. Surgeon General Walter Wyman was the first to occupy this position, followed by Surgeon General Rupert Blue, and later by Surgeon General Hugh S. Cumming, who will hold office until his successor is elected by the Tenth Pan American Sanitary Conference. The resolutions creating the Pan American Sanitary Conferences and the Pan American Sanitary Bureau granted these bodies unusually broad general powers. These powers have been augmented by subsequent conferences and by the Pan American Sanitary Code to a degree never yet June, 1936 of utilized.. The solution of almost any health or sanitary problem in any American republic may be undertaken provided the Government requests the services the Bureau and accepts its cooperation. Research is authorized. Almost unlimited opportunities exist exist now which cannot be taken advantage of for lack of funds and lack of trained personnel who can speak the language of the countries countries to which they might be assigned--Spanish, Portuguese, and French. Among the many objectives of the Pan American Sanitary Bureau may be mentioned the following: 1. By cooperative measures to prevent the introduction of communicable diseases from other countries into America, and from one American republic into anoth 8. To intervene and aid in the execution of international sanitary treaties. 9. In cooperation with the health departments of the American republics, the Bureau is authorized to name as Traveling Representatives, Epidemiologists, etc., any officer or employee of the health de partment of any country. In such cases, the Government detailing the officer.or employee pays his salary, and the Pan American Sanitary Bureau pays his traveling expenses. In 1928, Medical Director John D. Long was named Traveling Representative of the Pan American Sanitary Bureau, which position he has filled ever since. In the course of his work he has visited practically all South American countries, aiding them in their sanitary problems, Vol. 1 No. 2 Hanson. assisting them in drafting legislation, and in some of them actively engaging in combating bubonic plague. Intensive campaigns against plague have been carried on in Ecquador since September 18, 1929, and in Peru since October 13, 1930. The following were detailed at different times to assist Dr. Long in his work: Dr. E. Savino and Dr. A. Sordelli, of Argentina; Dr. A. Macchiavello, of Chile; Dr. J. I11ingworth Icaza and Dr. C. A. Mino, of Ecquador; Dr. B. Mostajo, of Peru; and acting Assistant Surgeon Henry Dr. Long and Dr. Hanson are now on duty. Passed Assistant Surgeon M. A. Roe recently been detailed as Traveling Representative of the Pan American Sanitary Bureau in Cuba; his detail is in addition to his other duties. On two occasions, the Vice Director of the Bureau, Dr. Mario G. Lebredo, a distinguished Cuban physician and sanitarian, was detailed for duty with the Bureau at Washington. At the present time, Dr. Solon Nunez, Minister of Ilealth of Costa Rica, is OCcupying a similar detail. 10. To publish and distribute has to health authorities and to others concern-ed information pertaining to health and sanitation, research, reports of communicable diseases, vital statistics, and related subjects. Such data are collected and published in the form of a monthly bulletin, Boletin de la Oficina Sanitaria Panamericana. The present circulation of the Boletin is 7,000 copies. Its mailing list is carefully revised annually, and its circulation is constantly increasing and constantly expanding territorially. 11. To act as liaison among the National Directors of Health of the American republics, and between these collectively and other international bodies. A more detailed account of the activities of the Pan American Sanitary Bureau will be found in Public Health Reports of August 30, 1935. A limited number of reprints of this article are available. In conclusion it may be said that the Pan American Sanitary Bureau is a perma nent international body, whose usefulness is limited only by its resources, by the powers granted it, by willingness on the part of affiliated governments to accept McKinley's book is the first attempt to draw a world picture of the incidence, the geographic distribution and the public health importance of tropical and certain other communicable diseases. This survey which required two and a half years. to complete, was made possible by a grant from the American Leprosy Foundation to the Division of Medical Sciences of the National Research Council. The author, as director of the survey, was fortunate in having the distinguished names of Frederick P. Gay, Richard P. Strong, and the late Theobald Smith on his advisory committee. As an initial effort, remarkable success was obtained in eliciting the cooperation of the health agencies of the various tropical and sub tropical countries in all parts of the world. The data are presented in tabular form and report whether or not the eighty tropical and thirty-two diseases usually considered as of temperate climates are present or absent now, or were present or absent previously. The distribution, the number of cases, the presence of the intermedicate host (if any), and the public health importance of each condition are also given. A resume of the social, economic, racial, and climatic complexion of each book |