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UNITED STATES OF AMERICA

(FROM AN OCCASIONAL CORRESPONDENT)

FINANCIAL AID FOR PUBLIC HEALTH

THE Congress has at length taken cognisance ofthe present inadequate provision for public healthin large areas of the nation. Only 528 out of 3000counties are served by full time officials, and evenamong these comparatively few have degrees in

public health. The Social Security Act just passedby Congress makes provision for federal aid amount-ing to 8,000,000 dollars to be distributed throughthe public health service, and for a further 6,650,000dollars to be distributed for maternal and childhealth and for crippled children through the children’sbureau. The public health service is in the Treasurydepartment under the special supervision of Miss

Josephine Roche, assistant secretary of the Treasury.The children’s bureau is in the Department of Labour.There will, however, be some attempt to coordinatethe administration of these two funds both intendedfor public health purposes. The fact that the presentassistant chief of the children’s bureau is a physicianwill probably remove some of the antagonismformerly felt by the organised medical profession to .work done by this bureau under the provisions ofthe Sheppard-Towner Act.A meeting of State and territorial health officers

was held in Washington on June 17th and 18th, atwhich agreement was reached with officers of theU.S. Public Health Service regarding standards ofpublic health administration which must be met tojustify reception of federal subsidy, the basis onwhich the 8,000,000 dollars would be allotted tothe several States, and the qualifications of trainingwhich in future are to be required of public healthpersonnel.A qualified full-time State health officer must be

in charge of the State health department receivingsubsidy. The department must give adequateadministrative guidance to local health services,and must include competent divisions of vital

statistics, laboratories, epidemiology, and environ-mental sanitation. No subsidy will be allocated toany local health unit whose staff does not includeat least one. full time health officer, two nurses, onesanitarian (sanitary inspector), and one clerk. Whenmore than one county is included in an administra-tive district there must be at least one public healthnurse in every county.

Health officers in charge of an area having 50,000or more population must have had at least a year’straining in a course of public health which includesspecified courses (including biostatistics and epide-miology), and which corresponds to a modern univer-sity training leading to the certificate in publichealth (C.P.H.). Health officers of smaller unitsmust have specialised in public health work beforethey were 35 years of age. Preference is given tothose who have had one or more years’ experiencein the general practice of medicine. All healthofficers who have not degrees in public health mustbe prepared to take post-graduate training. Pro-vision is made under the Act to assist them in obtain-

ing this training. It is realised however that presentacademic facilities will limit the number that canbe trained in the immediate future. It is clearly

intended that a standard equivalent to the Britishstandard shall be reached as rapidly as the trainingfacilities will permit. Standards are laid down

similarly for the training of public health nurses andof sanitarians.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

EDINBURGH’S HEALTH

SOME interesting statistics are given by Dr. JohnGuy, medical officer of health in the annual report for1934 on the health of the city of Edinburgh. Thebirth-rate for the year was 15’ which shows anincrease over the previous year. Of the total births6’4 per cent. were illegitimate. The death-rate was12’8. The infant mortality-rate was the lowest onrecord for the city, being 62 deaths for 1000 live births.The effect of re-housing tenants from condemnedbuildings is shown by the health figures for the Preston-field re-housing area, to which the tenants in the St.Leonards improvement scheme were transferred enbloc. This has resulted in a reduction of the death.rate for this community from 21’9 in 1927 to 7’7 in1934, a reduction of the death-rate from pulmonarytuberculosis from 1’5 to 0° 3, and a reduction in theepidemic diseases death-rate of from 3-4 to 0’3. Thegreatest improvement was observed in the infantilemortality-rate, which in 1927 was 132 per 1000 birthsin the old area but only 28 per 1000 births in thenew area in 1934. The problem of overcrowdingis still acute, and the new cases of overcrowdingnotified during the year are almost equal in number tothose which were dealt with by providing familieswith larger houses. The pulmonary tuberculosisdeath-rate for the year was 0-66 per 1000, whichmakes a new low record for the city, and is less thanhalf the death-rate 34 years ago. 4530 patients wereadmitted to the City Hospital for infectious diseases.No case of diphtheria or scarlet fever occurred amongthe nursing staff, a feature which Dr. Guy attributesto active methods of immunization. In this connexionDr. Guy emphasises the importance of the campaignfor immunization against diphtheria. An arrangementhas been made whereby all medical practitioners inthe city can give this protection free of charge to allwho apply. The arrangement whereby the professorof bacteriology acts as director of the bacteriologicalservices has proved very satisfactory.The work of the municipal general hospitals con-

tinues to increase, and nearly 6000 patients weretreated during the year. The arrangement wherebythere are resident students in the Western GeneralHospital has proved to be of great value. Dr. Guywent to show that the children now leaving school arephysically and medically fitter than they have everbeen, but that this improvement was not so marked inthe case of those entering school for the first time.There is however a decided reduction in the incidenceof rickets and tuberculosis. In 1907 5’8 per cent. ofthe boys and 7’8 per cent. of the girls entering schoolfor the first time were found to have acquired deform-ities ; the corresponding figures for last year were 0’5and 0’4 respectively. Dr. Guy concluded that theEdinburgh statistics compared favourably with thoseof other large towns, and said that there can be nodoubt that the steps taken to demolish overcrowdedand derelict houses in the city are having a

beneficial effect on the health and well-being of thecommunity.