Janttaet 9, 1920] 



SCIENCE 



27 



necessary for tbe saving of a maximum number 

 of lives at a minimum cost. 

 I Education in personal hygiene is in part a 

 general propaganda applicable to all alike. 

 There are certain fundamental principles as to 

 food, fresh air, exercise and rest, -which every 

 one should know in order to manage wisely the 

 delicate physical machine entrusted to his 

 charge. Unfortunately, however, each living 

 machine is in some respects different from 

 every other living machine, and in many cases 

 deviations from the normal are so marked that 

 they demand fundamental modifications in the 

 regimen of daily life. The man with the weak 

 heart needs less exercise, the man with weak 

 lungs more air and more rest, the man with 

 diabetes a special kind of food. In addition to 

 the hygiene for the normal, which we may 

 teach to all, there is a hygiene for the abnormal 

 which requires an adaptation to each specific 

 case. But it is obvious that the teaching of 

 this kind of hygiene demands first of all an 

 individual diagnosis. We are here face to face 

 with the problem of the relation of the physi- 

 cian to the modern public health campaign. 



In the past a sharp line was drawn between 

 the measures taken by pulblic health authori- 

 ties to check the spread of epidemic disease 

 and the daily routine of the practitioner in the 

 treatment of the individual case. The first was 

 public health, the second private medicine. 

 With the passing of every year it becomes 

 harder to draw such a sharp line, more difficult 

 to say where public health should end and pri- 

 vate medicine begin. The history of medical 

 school inspection offers an excellent example of 

 the tendency to obliterate such arbitrary lines. 

 The physician was first sent into the schools in 

 Boston in 1894 to perform a definite police 

 function, to detect cases of communicable dis- 

 ease and by so doing to protect one child 

 against the danger from another. If it had 

 been proposed at that time to organize clinics 

 for free treatment of disease among school 

 children, the proposal would probably have 

 been denounced as socialism of the most dan- 

 gerous kind. Just so soon, however, as the 

 physicians began actual work in the classroom 

 they found that acute infections passing from 



one individual to another played but a smaU 

 part in the total burden of preventable disease 

 borne by the children in the schools. They 

 found defects of teeth, defects of vision, defects 

 of hearing, enlarged glands. Nine tenths of 

 the time of the school inspector of to-day is 

 devoted to problems of this kind. He is no 

 longer protecting one child against another. 

 He is helping each child to attain its maxi- 

 mum possibilities of health and efficiency. 



The discovery of non-contagious physical 

 defects was the first step in bringing the pub- 

 lic health movement into intimate contact with 

 the individual child. Very soon, however, it 

 became evident that the detection of remedi- 

 able defects was of little value unless some- 

 thing was done to remedy them, and the school 

 nurse was drafted into service to follow the 

 child into the home and to persuade the par- 

 ents to take the measures indicated by the med- 

 ical examiner's report. The development of a 

 school nursing service as an educational 

 agency of this sort resulted in New York City 

 in increasing the proportion of defects actu- 

 ally treated from 6 to 80 per cent. In a cer- 

 tain number of cases, however, a new difficulty 

 arose. Remediable defects were present and 

 the parents were willing and anxious to have 

 them treated, but they were without funds to 

 pay for the special medical care that was 

 needed. The next step was as logical as the 

 preceding ones. It involved the establishment 

 of school clinics for the treatment of children 

 unable to obtain the necessary care in any 

 other way. So, with the establishment of nose 

 and throat clinics, eye and ear clinics, dental 

 clinics, for the school child the obliteration of 

 the line between public health and private 

 medicine was well-nigh complete. 



If it is good public policy to provide for the 

 school child whatever machinery is necessary 

 to make possible the attainment of a reasonable 

 standard of physical health, it is difficult to see 

 why the same arguments do not apply to the 

 adult as well. As a matter of fact exactly the 

 same tendencies to provide (a) diagnosis, (fi) 

 hygienic advice, (c) treatment when necessary, 

 are already manifest in our tuberculosis clin- 

 ics and our venereal disease clinics, and are 



