and the creation of child hygiene divisions in city and State depart-
ments of health. Within five years of the close of the first World War,
43 States had public, tax-supported divisions of child hygiene.

The special efforts in behalf of babies and children were only a part
of the huge ground swell of public health action which has steadily
been gaining force and volume during the interval between the two
wars. From year to year physicians and public health officials have
been able to say: ‘““We know more and are in a position to do more
than at any period in the past.”

Vigorous and increasingly successful attacks have been made on
communicable diseases, particularly the acute childhood infections, the
venereal diseases, tuberculosis, and pneumonia. Of the “four grim
horsemen of contagion,” diphtheria, measles, scarlet fever, and whooping
cough, one—diphtheria—has been conquered in some localities by
immunization, and could be conquered everywhere. The other three
are far better controlled than formerly by preventive and therapeutic
measures and consequently take fewer lives and leave fewer serious
aftereffects. The incidence of rheumatic fever, which is responsible
for most of the heart disease in early adult life, has appreciably declined
during the past two decades, with a consequent reduction in the heart
defects caused by it. With the advent of the “sulfa drugs’’, puerperal
fever, pneumonia, gonorrhea, wound infections, and a number of other
acute diseases and conditions are losing ground as causes of death.

Tuberculosis, the first disease to be called the ““Foe of Youth” and the
“Captain of the Men of Death,” has had directed against it an educa-
tional campaign unparalleled in public-health history. Partly, at least,
as a result of this effort there has been a steady decline in the tuber-
culosis death rate. In the interval between the two drafts, this decline
for white males at all ages has been 80 percent and for men at the
selective service ages nearly 90 percent.

The so-called water-borne and milk-borne diseases including typhoid
fever, dysentery, and the intestinal diseases of infancy, referred to
variously as infant diarrhea, summer complaint, and cholera morbus,
are on the way to practical extinction. Except in certain rural areas,
experts in public health engineering have been able to accomplish this
feat by measures taken to improve the healthfulness of the environment,
including the protection of water supplies, the safeguarding of milk and
other perishable foods, the inspection of food-handling establishments,
the control of insects, and the sanitary disposal of sewage.

Furthermore, in the fields of public health action concerned with the
improvement of living and working conditions, extraordinary progress
has been made. Housing, one of the knottiest of all public health
problems, has at last been given special attention. Revolutionary
improvements have been made in working conditions in industrial
plants, and sound health and safety conservation programs for workers
have been inaugurated. Research in nutrition has gone on at a rapid
pace, and serious attempts have been made to educate the public con-

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