THE OUTLOOK OF PUBLIC HEALTH WORK 



to have originated in social reform. The abuses in working 

 conditions and housing, arising from rapid and uncon- 

 trolled industrial changes, aroused the nation to the passage 

 of legislation which, although aimed at the abuses, 

 actually had the effect of public health acts. Typhus fever 

 in New York, erroneously believed to be due to filth as 

 such, led to the establishment of a health department and 

 a campaign of sanitation. In Panama public health work 

 was undertaken as an essential preliminary to building the 

 canal. Elsewhere the work has been the outgrowth of 

 hospital activities, of charitable efforts, of missionary 

 endeavor, or of business enterprise. Sooner or later, how- 

 ever, it tends to become a function of government, the 

 reasons for this being chiefly that in some of its aspects 

 the exercise of police powers becomes necessary, and that 

 the fixing of responsibility cannot be satisfactorily secured 

 under other auspices. 



In the United States the general order of establishment 

 of governmental agencies for carrying out public health 

 work has been: first, the large cities; second, the states; 

 third, the small cities; fourth, the counties; lastly, the 

 villages. The Federal Government under our Constitution 

 can function only in international and interstate activities, 

 but in these it finds a large and useful field. Public health 

 duties have been assigned to it for only about half a century, 

 but in one way or another it has contributed to the cause 

 of public health for a much longer time. 



The systems of organization which have been developed 

 in different parts of the world for carrying out public health 

 work still vary widely. In some countries the national 

 government exerts a strong influence through its repre- 

 sentatives, even down to the smallest communities. In 

 others the central health office is little more than a super- 

 vising and recording device and a purveyor of safe water; 

 the measures are carried out largely by private physicians 



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