24 



SCIENCE 



[N. S. Vol. LI. No. 1306 



woman to the brilliant head of the instructive 

 District Nursing Association of Boston, " Miss 

 Beard, I want to go into public health. What 

 it it ? " It behooves us to answer this question ; 

 for the greatest of all needs in this field is 

 undoubtedly the need of a personnel, larger in 

 quantity, and better in quality, than that 

 which has been available in the past. 



For these reasons I have determined to de- 

 vote my address as retiring chairman of the 

 Section on Physiology and Experimental 

 Medicine to a tentative, if necessarily im- 

 perfect, formulation of the scope and tend- 

 encies of the modern public health campaign. 



I spoke of the public health movement as 

 protean, and it is indeed true that the em- 

 phasis in this field has shifted with a rapidity 

 almost phantasmagoric. 



To a large section of the public, I fear that 

 the health authorities are still best known as 

 the people to whom one complains of un- 

 pleasant accumulations of rubbish in the back 

 yard of a neighbor — accumulations which 

 possess those offensive characteristics which 

 somehow can only originate in a neighbor's 

 yard and never in one's own. Sanitation, the 

 maintenance of cleanly and healthful environ- 

 mental conditions, does indeed represent the 

 first stage in public health. When Sir John 

 Simon initiated the modern public health 

 movement in London three quarters of a 

 century ago his primary task was the elimina- 

 tion of the masses of accumulated filth which 

 kept alive the pestilences of the Middle Ages. 

 When General Gorgas undertook the task of 

 making safe and feasible the building of the 

 Panama Canal he was in the same way con- 

 fronted with problems that were primarily 

 those of environmental sanitation. The re- 

 moval of excretal wastes, the purification of 

 sewage, the protection of water supplies and 

 the elimination of conditions which permit 

 the breeding of insect carriers of disease — ■ 

 these are always and everywhere the first tasks 

 for the public health expert; and in the early 

 phases of the public health movement in any 

 coimtry it is natural to visualize public health, 

 primarily in terms of sanitation. 



There is stiU much to do in this most funda- 

 mental branch of public health. That terrible 



scourge of the Middle Ages, typhus fever, 

 was only held in control during the war by a 

 systematic and organized attempt to destroy 

 the louse which carries the parasite of this 

 disease; while the infection of bubonic plague, 

 the black death of the Middle Ages, has been 

 spread broadcast throughout the world during 

 the past twenty-five years, and is held in check 

 only by a vigorous campaign against the rats, 

 ground squirrels, and other rodents which 

 harbor the germ of this peculiar pestilence. 

 The control of malaria, which takes a heavy 

 toll of strength and vitality from the popula- 

 tions of our southern states and is estimated 

 to cost the nation over $100,000,000 a year, 

 is one of the mightiest tasks which confronts 

 the sanitarian, but a task which, as the dem- 

 onstrations conducted by the International 

 Health Board have made clear, is easily within 

 the range of practical accomplishment, by 

 systematic drainage and other measures taken 

 against the mosquitoes which carry the germs 

 of this disease. Malaria is with us always, 

 but there are many maladies which like yellow 

 fever arise from endemic foci in certain par- 

 ticular regions of the globe, and thence spread 

 wherever the steamship and the railroad train 

 can carry their inciting causes. Of recent 

 years the bold idea has suggested itself of 

 undertaking an offensive against these pri- 

 mary endemic foci of disease without wait- 

 ing until the invaders cross our own national 

 boundaries. In this way General Gorgas has 

 carried the war against yellow fever into the 

 enemy's own country at Guayaquil, and an 

 organized campaign against such disease on a 

 basis of world cooperation, perhaps through 

 the agency of the International Red Cross, is 

 full of promise of achievement in the future. 

 There is much then to be done in the field 

 of environmental sanitation, yet as the public 

 health movement progresses the tasks of sani- 

 tation in the narrow sense are gradually ac- 

 complished and therefore become relatively 

 less important. Constant attention is of 

 course required to maintain the environment 

 in a healthful condition, but in most civilized 

 communities, in temperate climates, environ- 

 mental sanitation has become a matter of 

 routine, and the pestilences spread by polluted 



