The readers of this Bulletin will have noted that the major health problems of fifty years ago have been almost completely solved. The epidemic diseases, diphtheria, scarlet fever, typhoid fever, diarrheal diseases have disappeared as i mportant factors in the death rate. New Haven has finished with them, providing that the present progress is maintained.

Twenty-five years ago, the outstanding health problems were tuberculosis and infant mortality. These, too, have been in large measure conquered, but not yet completely. We still had 93 deaths in 1930 from tuberculosis (as compared with 213 in 1905) and 126 deaths of infants under one year of age (as compared with 430 in 1905). A definite program for the continuation of the campaign against these two diseases has been mapped out by the Health Department. In the case of tuberculosis, the next step is the extension of the program for the tuberculin-testing and X-raying of school children, so well begun in the Prince Street School last year, -since the early detection of incipient tuberculosis in children is the only sure defense against th is disease. In the field of infant hygiene the Department has for several years asked for a full-time Director of Child Hygiene to coordinate and guide the entire community program so that the splendid work of the official agencies, the Visiting Nurse Ass ociation, the Junior League, the Community Center, the Crippled Children's Aid Society, the Dispensary and the Hospitals may be made fully effective. The projects are eminently sound and essential for the safety of the community. If they are supported in the future as we hope they will be, the program should go steadily onward so that in 1981 deaths from tuberculosis and deaths of infants will be as rare as deaths from diphtheria and typhoid were in 1931.

What then are the next problems,-the large and significant problems for solution during the next half century? Clearly they are three in number: pneumonia, which caused 162 deaths in 1930; cancer, which caused 202 deaths in the same yea r; and diseases of the heart, arteries and kidneys (a closely inter-related group) which caused 665 deaths.

The control of these three groups of diseases will present very much greater difficulties than those which have been overcome in the case of diphtheria or tuberculosis. They are diseases in which the inevitable processes of old age play a large part; and against old age there is no defense. It is possible, however, to prevent premature old age, to postpone death, to reduce invalidism and disability to a notable degree. Thirty years ago the writer published a paper in which it was urged that a typhoid rate which would correspond to 60 deaths a year in New Haven was too high but that a rate corresponding to 30 deaths per year was normal and to be expected! This was true in 1900. It is not true today. We may change our present standards a lmost as radically in the case of pneumonia, cancer and heart disease.

It is wholly probable that during the next half century medical science will give us new weapons as yet undreamed of for our warfare against these maladies. Even with the weapons in hand, however, we can accomplish much. We can in the f irst place reduce diseases of the heart, arteries and kidneys by with certain basic causes, with disease of the tonsils for example, and with venereal disease. This latter problem is perhaps "the next step" for New Haven after we have our Director of Chi ld Hygiene. Recent evidence suggests that these communicable diseases are more easily controllable than we had realized, and that substantial gains may be accomplished by vigorous action. We have no effective machinery for dealing with this problem- very few cities have. It is a clear challenge to us for the future.

In main, however, the problems of heart disease and cancer must be the dealt with by early medical diagnosis and prompt preventive treatment. The excellent work of the New Haven Cancer Committee is blazing a new trail in this field. It must be clearly recognized, however, that in the war against these diseases the Health Department can furnish only leadership and coordination. The really vital factor in these new phases of public health is the practicing physician. If he is to perform his task, he must be prepared to render the fullest modern medical service- an end which will be attained only as the profession so organizes itself that the general practitioner, the specialist and the laboratory can all focus on the individual case. Fur thermore, the physician cannot function properly if the patient does not come to him in time;- and this condition can probably be attained by the development of new systems of payment for medical care on an annual basis. The problems of the organization o f the profession to deliver the best preventive service and the problem of facilitating payment for such service- these are perhaps the outstanding health problems of the coming fifty years.

[Previous page | Next page]