This gloomy picture may seem overdrawn to those city dwellers who visualize the country as a blessed spot where happiness and health flourish. The picture may be overdrawn for some rural areas still unprovided with local health service, but especially favored by climate, natural resources, and economic conditions which enable the inhabitants, by reason of their prosperity, to avoid some of the menaces of ill health through their own efforts and through the medical attention which they are able to secure. The picture is not beyond the facts, however, as regards a significant proportion of some thirty or forty million rural inhabitants of this country.

Returning now to the city health organizations and those of the states, it is to be noted that the actual financial provision for their activities is everywhere but a small fraction of that for other civic activities fundamentally no more important, such as school maintenance, fire protection, police, etc. Everywhere health protection, as reflected in city and state appropriations, appears to have been an afterthought. This condition is due to two considerations: first, that considering the returns, official health work is not nearly so expensive as the other forms of service mentioned; and, second, that health work actually is still somewhat of an afterthought on the part of the average appropriating body. This is apparently a matter of individual psychology reflecting itself in concerted thought. The average man who is or believes himself to be in good health finds it irksome to think about ill health or its prevention. Only when he actually becomes recognizably sick does he develop an interest in health, and then it is of course too late for prevention.

The maximum effect of health work is thus never realized, because nowhere is financial provision made for maximum effort. Every health official can furnish, at a moment's notice, a list of additional health activities beyond those in which he is engaged, upon which he could guarantee a more than 100 per cent return in service, if only the funds were forthcoming for carrying them out.

This condition in counties, cities, and states extends also to the Federal Government. The provisions for health activities on the part of the Public Health Service have never approached those made for other useful but no more necessary activities of government.

This leads up to the pronouncement of an outlook which, it may be taken for granted, is shared by students and practitioners of public health work everywhere. Health is the birthright of every citizen. In so far as he has been deprived of health by the neglect of his community and his government to provide public health service (as distinguished from purely medical service) he has been cheated of his birthright. No one questions the right of every child to an education and to the protection of the law. Relatively few, however, have visualized the importance of starting out in life with healthy bodies and minds, and the responsibility of civilization in securing them for every citizen, in so far as may be possible.

It has already been stated that the conception of the scope of public health work has constantly been extended. At first, people were concerned chiefly with dangers which presumably threatened them at the borders of their domains - strange terrifying scourges which must be kept out at all hazards. We still quarantine against smallpox and typhus fever from Europe, and properly so, although we have much more indigenous smallpox among us than do many of the countries against which we quarantine, and in spite of the fact that we have an apparently ail-American brand of typhus fever at home which nobody gets excited about for long. But interest in our home-made disease products has now been established for many years, and it extends throughout almost innumerable ramifications.

Public health work is still in process of discovering its material. It is not so many years since it perceived that children were an important part of the public. Before that they seem to have been neither seen nor heard. Nowadays they loom large in the vision and the activities of the average health office. Then someone discovered the mothers of the children, and presently the industrial worker was unearthed and shown to be worthy of consideration from a health standpoint. And so, as regards the conception of what constitutes the public, a continual broadening and shifting of viewpoint has been necessary. Perhaps the most recent class to be recognized as presenting special health problems which will have to be dealt with is the touring public, that very considerable portion of the population which is here to-day and several hundred miles away to-morrow, exposed, on the way, to a variety of give-and-take episodes with roadside brooks, refreshment stands, and other hazards.

It has been pointed out also how the primary interest was fortunately with the infectious diseases - those which are due to parasitism with microorganisms - but that diseases due to improper diet, to poisonous influences in the environment, to the rush of modern life, to psychic disturbances, to social maladjustments, and to heredity, have forced themselves upon the attention of health officials and students, and have demanded action for their relief.

To meet all of these varied demands calls for a great number of separate but coordinated activities, and it may be profitable to attempt a brief review and classification of them. Roughly, then, the activities of public health work may be divided into (1) research, (2) control, (3) education, (4) legislation.

Research in the past forms the basis of present-day practice. Present-day research is laying the groundwork of future progress. It is, or should be, a part of the program of every public health organization. Unfortunately, because of the inadequate financial support of many such organizations, actual research comes in for what little attention it can get after the imperative work has been done. Some of the state and city health organizations, however, have made notable contributions, through research, to the armamentarium of the public health worker. The Federal Government also, through the Public Health Service which maintains a personnel of some three hundred research employees, has contributed much valuable data. In addition we must remember the notable achievements of other branches of the government, of the universities, and of voluntary organizations devoted to health research or related activities. Moreover, as has been pointed out, new facts in any branch of physical science may prove to have immediate practical bearing on health work, so that such work anywhere throughout the world must be counted as a potential asset in health research.