CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER— Continued.

Reports Received from Dec. 28, 1918, to Feb. 14, 1919-Continued.

CHOLERA, PLAGUE, SMALLPOX, TYPHUS FEVER, AND YELLOW FEVER

Continued.

Reports Received from Dec. 28, 1918, to Feb. 14, 1919—Continued.

PUBLIC HEALTH REPORTS

VOL. 34

FEBRUARY 28, 1919

JOINT INFLUENZA COMMITTEE.

No. 9

The Surgeon General of the Army, the Surgeon General of the Navy, the Surgeon General of the Public Health Service, and the Director of the Census have designated officers from their respective departments to form a joint influenza committee. The members of the committee are as follows:

Bureau of the Census.-Dr. William H. Davis (chairman), Mr. C. S. Sloane.

Public Health Service.-Dr. Wade H. Frost, Mr. Edgar Sydenstricker.

United States Navy.-Lieut. Commander J. R. Phelps, Surg. Carroll Fox.

United States Army.-Col. D. C. Howard, Col. F. F. Russell, Lieut. Col. A. G. Love.

The functions of the committee are to study the epidemic and to make comparable, so far as possible, the influenza data gathered by the Government departments.

A UNIFIED HEALTH SERVICE.1

By B. S. WARREN, Assistant Surgeon General, United States Public Health Service.

Within certain limitations a people can have such hygienic conditions as they choose to buy. In other words, "hygienic conditions" are purchasable, and they are safe-paying investments. No State government should delay making such investments on account of the cost. It is now well known from many demonstrations that even under the worst conditions a reasonable expenditure of public funds will afford such protection against disease as to pay large dividends, not only in the saving in human life and suffering but also in dollars and cents.

It is hardly necessary to tell an Alabama audience that Gorgas, Carter, and their assistants made the Panama Canal possible. This demonstration was a wonderful achievement and of itself should be sufficient to cause Gorgas's native State to profit by the example and invest in health work which, beginning at the capital, would reach into the remotest community of the State.

1 Read before the Birmingham (Ala.) Civic League, Jan. 13, 1919. 101769-19-1

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Of more recent date, and nearer home, is the health work which protected the soldiers in the camps of this country during the mobilization of the millions of men. By the cooperation of the military and civil health authorities there were established in the camps and zones about the camps, health organizations which controlled the communicable diseases in a record-breaking degree for armies in the field.

Within the boundaries of the camps themselves the Army health authorities were responsible for proper hygienic conditions. In the extra-cantonment zones the Public Health Service, in cooperation with State and local health authorities, was responsible. But all worked together and the results may well be called a "unified health service." Aided by funds from the American Red Cross and local authorities, the Public Health Service established complete health organizations in 51 extra-cantonment zones. In all, the Public Health Service expended $1,201,909, the American Red Cross $507,000, and the States and local authorities, $650,000. The civil population protected by these organizations was approximately three and three-quarter million persons, in addition to the military population. It is not possible here to enumerate all of the work done, but to illustrate: Two thousand five hundred miles of ditches were dug and 1,200 square miles of swampy territory drained, and an antimosquito zone-1 mile in width--was established around each camp. It is a well-known fact that malaria, which was a serious potential disability factor about many of these camps, was prac tically eliminated from the soldier population, and only 3,160 cases were reported to the Public Health Service during the malarial season of 1918 among the civil population of three and three-quarter million, a rate of 83 per 100,000. From such data as were obtainable for previous years this was a tremendous reduction in the malarial rate in these communities. These results may well be compared with those in Panama, especially since they were obtained not under military conditions, but through the voluntary work of a civil population.

In considering whether or not an adequate health machine is worth while it is well to examine the health records and weigh the value of the results to be expected according to the following standards:

1. The human standard of sorrow and suffering caused by preventable diseases;

2. The actual cost in money of preventable sickness; and

3. The saving to the State of the economic values lost in preventable sickness and death.

One can not place a money value on the sorrow endured by a mother over her baby dead from a preventable cause, nor on the sorrow caused by a defective or blighted child, due to preventable

causes. Still, we know that annually over 16 per cent of all deaths in the United States are in infants under 1 year of age, most of which are preventable, and, further, we know that over 30 per cent of the boys in the draft age, 21 to 31, were rejected on account of physical or mental defects, a large proportion of which could have been prevented by proper attention in infancy and childhood. Over 4,000 infants under 1 year died in Alabama in 1916. Half of these deaths could have been prevented by a reasonably adequate pre and post natal health care. I wonder whether each one of those mothers would have been willing to have paid $100 to save those babies. If so, I am sure your State health officer would be glad to have had the $200,000 in order to make effective his plans to save the babies.

As to actual cost in money of preventable sickness, consider one item: The death rate in Alabama for the year 1917 from typhoid fever was 38 per 100,000 population, or a toll of 898 deaths and at least 8,980 cases of the disease. At a cost for the doctor's bill and time lost from sickness of $100 per case of the disease, the total cost was $898,000. A proper support of your State and local health administration with funds and personnel could be expected to reduce the rate to five per 100,000 and save $780,000 per annum. That item alone would pay the cost.

Concerning the economic values which would accrue to the State by preventing a reasonable amount of the preventable sickness and death, it may be safely stated that if Alabama would free itself from malaria the increase in the taxable values of the State would meet all the expense.

In the matter of health organization some analysis of the responsibilities and relations of the several governmental agencies is necessary in order to determine the character of organization which would result in a "unified health service." With our form of government, the Federal, State, and local political subdivisions have certain responsibilities. Within each of the governmental administrations there are several departments, bureaus, or divisions which have definite relations to health. Furthermore, the legislative branches. (Federal, State, and local) have definite relations and responsibilities. In framing any health legislation all of these must be considered and worked out so that the proposed organization will function harmoniously, and result in a "unified health service."

In the beginning of this discussion it may be well to realize that a perfect health machine is not to be expected, but it should be planned so that it will be elastic and easily adjusted, as changing conditions or experience of operation may indicate. It would therefore seem relevant to discuss (1) the Federal, State, and local governmental responsibilities, and (2) the relations to the departments, bureaus, or