30 



SCIENCE 



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



of mankind repudiates the rigorous applica- 

 tion of the principle of unhindered natural 

 selection. We can let the combination of de- 

 fective protoplasm and crippling environment 

 accomplish the major portion of its work and 

 then salvage what we can from the wreck by 

 some form of institutional relief. Or we can 

 apply our social energy and our community 

 fimds to make good the deficiencies in the 

 beginning. I have little doubt as to which 

 will be found in the long run the cheaper way, 

 and I am quite certain that the preventive 

 method will prove more conducive to a high 

 national morale. 



If the foregoing outline of the problems of 

 public health be accepted as correct, it will be 

 obvious that the field as thus visualized is no 

 small and restricted one. The claim to so 

 large a province will be denied by many, 

 within, as well as without, the public health 

 profession. The logic of the situation and 

 the tendencies of social development are, how- 

 ever, sweeping the public health movement 

 forward to a future of wider possibilities than 

 those dreamed of by its own protagonists. If 

 we are looking to the future we must conceive 

 our subject in terms no smaller than those of 

 the following definition: 



Public health is the science and the art of 

 preventing disease, prolonging life, and pro- 

 moting physical health and efficiency through 

 organized community efforts for the sanita- 

 tion of the environment, the control of com- 

 mimity infections, the education of the indi- 

 vidual in principles of personal hygiene, the 

 organization of medical and nursing service 

 for the early diagnosis and preventive treat- 

 ment of disease, and the development of the 

 social machinery which will ensure to every 

 individual in the community a standard of 

 living adequate for the maintenance of health. 



Public health conceived in these terms will 

 be something vastly different from the exer- 

 cise of the purely police power which has been 

 its principal manifestation in the past. 



Even to-day it is still possible to make an 

 effective argument for increasing health de- 

 partment budgets by showing that appropria- 

 tions for the protection of health are in most 

 cities far less than those which are made for 



police and fire protection, matters of far leas 

 moment in actual possibilities of community 

 service. As a matter of fact the police de- 

 partment and the fire department furnish 

 criteria much too modest for the public health 

 department of the futxire. It is rather to edu- 

 cation that the possibilities of public health 

 should be compared. I look to see om- health 

 departments in the coming years organizing 

 diverse forms of sanitary and medical and 

 nursing and social service in such fashion as 

 to enable every citizen to realize his birthright 

 of health and longevity. I look to see health 

 centers, local district foci for the coordination 

 of every form of health activity, scattered 

 through our cities, as numerous as the school 

 houses of today and as lavishly equipped; 

 while the public health services of the city 

 and state will constitute a corps of experts 

 comparable in size and infiuence to the great 

 educational organizations of the present day. 

 In the development of the public health 

 campaign of the future along such lines as 

 these it is obvious that many different experts, 

 of fundamentally distinct training, must con- 

 tribute their special resources to the common 

 task. Ignoring all minor specialties there 

 must be at least the following seven types of 

 highly qualified persons in this field: 

 The physician The epidemiologist 



The nurse The engineer 



The bacteriologist The statistician 



The social worker 

 In addition there must be inspectors to 

 supervise sanitary conditions, housing condi- 

 tions, food stores and the like, for whom no 

 special training is provided anywhere in this 

 country, but who should be offered brief prac- 

 tical courses to fit them for the relatively 

 modest duties which their task entails. 

 Finally there is the administrator who organ- 

 izes and develops the work of all the rest. 

 The physician in the public health field 

 practises medicine but with a difference, in 

 that the goal before his eyes is prevention as 

 well as cure, and that he has always in view 

 not merely the individual but the community 

 as well. In the infant welfare station and 

 the school clinic and the tuberculosis dispen- 

 sary he visualizes not merely the individual 



