28 



SCIENCE 



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



beginning to deyelop in connection even witli 

 diseases of the heart and arteries and cancer. 

 If it is sound economy to provide for the early 

 diagnosis and sanatorium treatment of tuber- 

 culosis, it is just as sound to provide for the 

 early diagnosis and surgical treatment of 

 cancer. The two diseases are equally danger- 

 ous, and equally burdensome to the commun- 

 ity; they are equally preventable, if the right 

 educational and clinical procedures are organ- 

 ized for their control. 



From both sides of the artificial boundary 

 line between public health and private medi- 

 cine comes the appeal for a closer correlation. 

 The public health worker needs the physician 

 because in so many diseases education depends 

 on diagnosis and demands the application of 

 medical skill. The far-sighted physician is 

 equally eager to link up his science with the 

 public health program, because on his side he 

 realizes that medicine can never attain its full 

 potentialities of service unless it is made really 

 preventive through some type of effective pro- 

 fessional and social coordination. It is a 

 striking fact that in spite of the great advances 

 in medical science diseases like heart disease 

 and nephritis and cancer, which have been 

 handled in the past along strictly medical lines, 

 have shown no decrease comparable to that 

 which has been manifested in the group of 

 maladies with which the sanitarian has dealt. 

 This is not because medical science is helpless 

 but it is because medical knowledge has gen- 

 erally been applied only when disease has gone 

 so far that the damage is irremediable. Med- 

 ical knowledge will be highly effective only 

 when applied in the incipient stages of disease. 

 When this comes to pass " preventive medi- 

 cine " will become a reality and not merely a 

 catch word. 



It is not for us to say to-day in just what 

 fashion the reorganization of medical service 

 which will make it effective for prevention can 

 best be brought about. In the working out of 

 such a schenie there must be first of all, within 

 the profession itself, effective coordination of 

 specialties in clinical and laboratory lines to 

 provide the type of expert service which is fur- 

 nished by our best hospitals and which no in- 



dividual private practitioner can possibly 

 supply. In the second place such organized 

 medical care must be made available not 

 merely for the very poor and very rich but for 

 the entire community, for those who can afford 

 to pay the whole or a part of the cost of the 

 service they require, and for those who can 

 not pay at all. Finally, if medical care is to 

 be made reaUy preventive in its ajyplication 

 its cost must be so distributed as to encour- 

 age systematic recourse to the physician as an 

 agent for the detection and control of incip- 

 ierit disease, rather than as a last resort when 

 illness has become too grievous to be borne. 



There are those who believe that these ends 

 may be attained through group medicine and 

 it is interesting to notice that very similar ends 

 have actually been reached in the nursing field 

 through private initiative as manifested in our 

 best visiting nurse organizations. There are 

 others who claim that medical and nursing 

 service can best be provided in connection with 

 a plan for sickness insurance and there are 

 still others who urge that the insurance prob- 

 lem should be handled as a distinct and sepa- 

 rate one, and that the early diagnosis and pre- 

 ventive care of incipient disease should be at- 

 tained through a definite system of state medi- 

 cine. 



The working out of the best plan for secur- 

 ing such ends as these is a fascinating task for 

 the publicist of the future, and it is quite pos- 

 sible that the problem may be solved in true 

 Anglo-'Saxon fashion by no single logical pro- 

 cedure but by diverse methods, suited to local 

 ends and local circumstances. The remarkable 

 developments during the past ten years in the 

 field of industrial medicine may have a wide 

 bearing on the general solution of our problem 

 as a whole. Some 900 different industrial es- 

 tablishments employ at this time 1,500 indus- 

 trial physicians, and the plant hospitals under 

 their chaise, from first-aid dressing stations, 

 are developing into educational centers and 

 diagnostic clinics and laboratories for the 

 study of industrial physiology and vocational 

 guidance and rehabilitation. 



We have seen the emphasis of the public- 

 health campaign move steadily inward from 



