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The medical members of this service are all commissioned by the President
and are entirely unaffected by political upsets. They rank as officers in both the
Army and the Navy. The chief is the Surgeon-General, and under him are assistant
surgeon-generals in charge of divisions; senior surgeons; surgeons; passed
assistant surgeons ; and assistant surgeons. The department has nothing to do
with the administration of the food laws, this being in the hands of the Bureau
of Animal Industry and the Bureau of Chemistry; the second is not fully staffed,
and the supervision of manufacturers is far from complete. The officers admit
this. On this point I should like to say, that I have been greatly impressed at the
manner in which every door has been thrown open to us. There has been, so far
as I can see, no attempt either to conceal anything or to exaggerate the value and
importance of what is done. This is, of course, because the men we have met are
highly scientific and probably the pick of the American medical profession. As a
fact, they are in many respects like the health people one meets at the Ministry of
Health and in the bigger districts at home, their aims and motives and attitude
towards their work being exactly the same.
We have had a great deal of kindness shown to us. The Assistant Secretary
of the Treasury (the Health Department is under the Treasury for some reason)
invited us to lunch one day, and we have been given the freedom of all the chief
clubs. Prohibition is greatly favoured by all the people I have spoken to—a selected
class, of course—and all hope that the old arrangements will never come back
again.
THE STATE OF VIRGINIA.
The last time I wrote to you was after my stay in Washington. To-day we
finish up the time allotted to the study of conditions in Virginia and sail for
Baltimore, where we are to spend two days in examining the course of study in
Public Health provided at the Johns Hopkins University.
Altogether we have been just over three weeks in this State, and in that time
have covered a tremendous amount of ground and seen specimens of the work done
in a large number of representative areas.
Virginia is largely rural and what we have seen has been mainly rural work.
The great problems have been the filth diseases, typhoid fever, and "hook-worm
disease," and malaria. To get rid of the first two the chief necessity has been to
abolish insanitary methods of disposing of filth and to improve the water supply.
Before anything could be done it was essential to educate the people, who were
extraordinarily ignorant and bigoted. Even to-day, so far as education is concerned,
the people who live in the more remote parts are very far behind, and even when
they can be got at—the roads generally being very bad—resent any attempt to teach
them, quite commonly showing a tendency to use a gun to make clear their point
of view. The life of a health officer, since the introduction of prohibition, in outof-the-way
places particularly, has been far from pleasant, more especially if he
should find himself in the neighbourhood of a "moonshine" factory.
In the State there are in all 100 counties, varying in size from 250 to GOO or
700 square miles. Up to the present only in 34 has any health organization been
set up, and in many places this is represented by a man only more or less qualified
as a sanitary inspector. The number of county health officers who are medically
qualified is not great, partly because the "Board of Supervisors" will not make
the necessary appropriations, despite the fact that the State Board of Health and
the International Health Commission (operating with Rockefeller funds) are
prepared to share the cost of the work done.
Though the counties are quite large it should be noted that the populations
are in general small, going down as low as 12,000, e.g., in Nansemonde county in
the neighbourhood of which the first English colony was set up by Captain John