The third era of public health which was just emerging in 1928 as a definite new phase, out of that of public information or health education, had its inception in the World War experience from which the conviction developed that only by the systematic use of the periodic health examination could all the potential benefits of preventive medicine be made effective for the indi vidual.
With the common action of the American Medical Association and the unofficial and official health agencies through the Na tional Health Council in 1922 an agreement was reached which has been followed with much success. The objective of the pres ent era of public health is to obtain from the prenatal stage until old age for each individual the benefits of personal medical guidance in a healthy way of life, in addition to medical services for the care of sickness. The supervision of the expectant mother, the guidance of the infant's growth, the supervision of the devel opment of the runabout child of two to five. the protection of the health of young people and adults of middle age until their years of work are over in old age all depend for their effective ness upon individual application of the principles of personal hygiene according to the requirements of age, sex, work, personal ity and the limitations of inheritance and of economic and social status.
The policy has been to inform the public through official and volunteer health agencies of the benefits to be obtained from a periodic medical examination and to train physicians to carry out the technical service required. Personal interest in and responsi bility for individual health is essential if the present knowledge is to be effectively applied through the mechanism of medical examinations and health conferences.
In all health matters pertaining to interstate and foreign com merce the responsibility rests with the Federal Government through the United States Public Health Service of the Treasury Department. In addition to large functions in medical relief, par ticularly for merchant seamen, the Public Health Service main tains active consulting and co-operative relations with State and local health authorities, carries on widespread attack upon the ve nereal diseases through a variety of channels, supervises and con trols the standards and production of biological products used for diagnosis and treatment of disease, maintains an effective informa tion and education service of national scope, and carries on re searches in sanitation, preventable diseases and vital statistics.
Health activities of various kinds are carried out under six other Cabinet departments and many more independent estab lishments of the executive branch of the Government.
Local health organizations may not set up standards or enforce local ordinances inconsistent with those established by the com petent State authority.
Not only cities, towns and incorporated villages, but counties and rural districts to an increasing degree maintain self-contained health departments adequately performing the essential functions.
A minimum provision for any unit of population of so,000 persons or over as conceived by the professional public health workers of the United States is as follows: a full time health officer, qualified by training and experience, free from partisan political interference in tenure of office, and paid a salary in proportion to the responsibility of the position ; a board of health or advisory health council; trained personnel, including public health nurses to the number of one to every 3,000 of the population, capable of carrying on the seven functions previously described, and a budget based upon an appropriation from public funds of $1.00 to $2.00 per capita for health purposes.
Adequate provision for the organized care of sickness in any community of 50,00o persons or more includes at least: A general hospital with a capacity of five beds for each i,000 of the population for the use of general medical and surgical patients, and for maternity cases, and space for the cubicle isola tion of acute communicable diseases (one bed for each 2,000 of the population). Beds for diagnosis and observation of tuber culosis, venereal disease and mental patients should be included. A tuberculosis sanatorium with accommodations for one pa tient for every i,000 of the population.
Hospital facilities for three mental patients for each 1,000 of the population. Institutional provision for chronic invalids and convalescent patients according to the social, economic and indus trial status of the people.
While all local health departments do not have direct responsi bility for the care of the indigent and other sick of the commu nity, the hospital care of the acute communicable diseases and often of tuberculosis and venereal diseases is commonly under the health officer and in a number of large cities, e.g., Philadelphia and Detroit, public hospitals for general medical, surgical and maternity care and district or city physicians to visit the sick poor are under the health department.
Interest in treatment and prevention of all sickness is within the proper province of the health officer and unless the institu tional and private physician facilities for the diagnosis and care of sickness are adequate, a community cannot have a wholly sat isfactory service for health.