BIOLOGY IN HUMAN AFFAIRS 



matters. The states have also delegated powers to cities 

 within their respective boundaries by charter. In the case 

 of some large cities the terms of the charters are so liberal 

 that the local health authorities have become practically- 

 autonomous, subject only to the provisions of state law. 

 The conditions in the counties and villages are neither so 

 uniform nor so well defined in many states. In a good many 

 of them the county health organization is practically an 

 extension of that of the state, under the supervision, if not 

 the administration, of a deputy official. In others the 

 delegated powers of the county government enable them 

 to maintain a health unit under the commissioners. 



Considering, from this point on, only the official health 

 agencies, it is necessary first to inquire to what extent they 

 have been established and are being maintained proportion- 

 ately to the need for their services. On this point there 

 would be unanimity of opinion among students and practi- 

 tioners of public health. Provision is still lamentably 

 inadequate in the United States. On the other hand, the 

 trend of the past twenty years has been most encouraging. 

 Within this period the remaining states and important cities 

 have provided themselves with at least the framework of a 

 health organization, which might be filled out in succeed- 

 ing years. A beginning also has been made during this time 

 in provision for rural health service. Since nearly half of 

 the population still lives in the country, the neglect of the 

 rural dweller has been a serious oversight in public health 

 administration. There has been an increasing interest in 

 this phase of health work which has already borne fruit 

 in the establishment of county health organizations in 

 many of the states. This, however, has been a slow process, 

 so that only a fifth of the counties in the country are pro- 

 vided with official health service, except such as may be 

 secured in emergency from the state organization. This 

 means that a vast number of American citizens are born and 



[258] 



