Labour Law

Infant Mortality. While 5o years ago one out of every four babies born alive died within the first year of life, now only one in 20 is so sacrificed. This saving in child life has occurred wherever education of the mother has been provided by doctors and nurses, and water and milk supplies have been safeguarded. It is common to find infant mortality rates lower in the cities than in rural The shift in proportion of deaths occurring in the various decades of life is a striking evidence of the effective control of the communicable diseases of childhood and early maturity.

Drop in the Birth Rate.

With the reduction in loss of in fant life has come a lowering of the birth rate in the United States as a whole and for each State and racial group. Within the past 5o years the birth rate has dropped from approximately 4o per ,000 population per annum to 16.7. From 1921-25 the birth rate was 22.5 in the birth registration area and in 1936 it was 16.7.

The Three Eras of Public Health.

For the first 125 years of the life of the nation, public health work was limited to con trol or improvement of man's physical environment and enforce ment of quarantine by the exercise of the authority of the official health agencies, the boards and departments of health acting under the police powers which are reserved to the States under the federal constitution. This may be called the era of sanita tion, the great accomplishment of which was the reduction of communicable diseases transmitted largely, if not exclusively, through drinking water polluted by human wastes. Sanitary dis posal of sewage, the protection and purification of water sup plies, the control of nuisances and the improvement of housing constituted the first effective attack on environmental hygiene and saved the cities from destruction. At the beginning of this era death rates in the large cities equalled or exceeded the birth rates. The health officer relied upon legal rather than scientific authority, upon the force of police powers rather than the power of education and authority, upon his individual or departmental services rather than upon the technical assistance and popular influence of volunteer co-operating agencies and associate profes sional groups.

Not until Lemuel Shattuck in Massachusetts in 1848 and Dr. Stephen Smith and his associates in New York city in 1865 had disclosed by careful surveys of the health of the population the true extent of preventable disease and death, and the fact that the death rates in the cities were higher than the birth rates did the public demand something approaching qualified direction and consistent scientific operation of a well-organized department of health. The first State department of health was organized in Louisiana in 1853.

In 1900 there began the movement for public education in health which has been a factor of tremendous importance ever since, not only in the widespread dissemination of popular in formation about preventable disease, but in bringing to the sup port of the official health department or health officer interest, knowledge, financial assistance and public opinion through the influence of volunteer or unofficial health agencies.

The initial movement of this educational or public informa tional era of public health was that of the tuberculosis commit tees and societies and national, State, and local associations, now operating with undiminished vigour and sustained interest and financial strength as the National Tuberculosis Association. The three simple facts with which the public was approached were the communicability, curability and preventability of tuberculo sis. Once accepted, it was inevitable that knowledge of these facts should lead to appropriate communal action. The National Tu berculosis Association, its 48 State societies and 1,300 other local societies have been the exciting, if not the driving, force which has brought 600 tuberculosis clinics, 6o,000 sanatorium beds for tuberculous patients (1922), a tuberculosis division in all im portant State and local health departments and a scientific pro gram of prevention uniformly accepted as an essential part of the work of the public health officer and department of every community.

The most important features of the program of the Na tional, State and local tuberculosis associations since the begin ning of the movement in 1904, have been those measures which have brought about "notification and supervision of persons af flicted with tuberculosis; the construction and maintenance by cities, counties and States, of institutions for the care and treat ment of tuberculous patients of all types ; institutions for the prevention of tuberculosis, such as preventoria, open-air schools and camps; the instruction of the public in the methods of avoid ing and curing tuberculosis; and finally the intensive scientific study of methods to be used in the prevention and treatment of tuberculosis." Following the leadership and example of the tuberculosis asso ciations, there were developed similar private health agencies first as local societies and later on a national scale to carry a lesson of prevention and of health on the subject of infant mortality and child hygiene, on pre-natal care of the expectant mother, on social hygiene, a synonym in the United States for venereal dis ease control, on mental hygiene, cancer, blindness, heart diseases, etc., until the country was swept with successive waves of spe cialist health propaganda to stimulate appropriate public and official action. It is not unusual to find that twice as much money is spent for public health through the private agencies as is in vested by the taxpayers in their official health department.