PRESENT PROBLEMS 69 



of the sanitarian, in order to have the aid of specialists in hygiene 

 in solving the problems of disease. 



Modern public hygiene, in fact, has passed the point where the 

 overcrowding of population has made prompt solution of sanitary 

 problems imperative, there are many questions of administration 

 and policy to be solved, and for these the physician ordinarily has 

 little aptitude. His experience and training are rarely, if ever, of 

 the sort to make him a successful administrator. I do not by any 

 means seek to maintain that this function resides wholly in the 

 sanitarian, so called; far from it. But in the adaptation of means 

 to ends, in the countless circumstances of administrative duty 

 which public service entails, a layman, with skilled medical advice 

 upon purely medical questions, seems to me better fitted to accom- 

 plish results than the physician alone. 



This leads me to a statement of what I believe to be the best 

 possible organization of a sanitary service, municipal, state, or 

 national, and one which I hope some day will be adopted not only 

 in cities and states, but by our Federal Government. At its head 

 should be a board of administration, consisting of a physician of 

 the first rank, skilled in the application of bacteriological and gen- 

 eral medical research to the problems of hygiene; a trained sani- 

 tary engineer; and third, if you like, as a balance-wheel to prevent 

 the eccentrics of the specialists from disturbing the workings of the 

 machine, a man of affairs in the broader sense of the word, who 

 should be versed in sanitary practice and, at the same time, chosen 

 mainly for administrative skill and for a certain practical common 

 sense which might guide such an organization wisely, and, per- 

 chance, prevent misuse of the great powers with which it ought to 

 be endowed. In the service of such a department of our government, 

 there should be a staff of specialists in every branch of medical and 

 sanitary science, laboratories equipped for research and diagnosis, 

 and all other adjuncts which make for efficiency in public hygiene. 

 One may question how such a body would be regarded by the 

 existing sanitary authorities of cities and states; but, to my mind, 

 it would be entirely feasible to coordinate all the minor divisions 

 of sanitary service into one comprehensive whole, in which the 

 central body, though maintaining its position of leadership, should 

 exercise police powers with extreme caution while developing its 

 advisory function to a degree of usefulness beyond any yet attained. 



Those who see in such a plan an unwarranted extension of federal 

 power might profitably study the workings of such organizations 

 as the Kaiserliches Gesundheitsamt in Germany and the union of 

 British medical officers of health. Particularly in the former are the 

 beneficial effects of centralized authority evident. Our own gov- 

 ernment's centralized activity along such lines as that pursued by 



