January 9, 1920] 



SCIENCE 



31 



case but its family environment and its pliys- 

 ical background. He is constantly striving to 

 find the incipient causes of disease and to 

 deal with those causes before they reach their 

 deadly fruition. He must be much more than 

 a physician in order to fulfil this task; for he 

 must have a knowledge of bacteriology and 

 sanitation, of health administration and sta- 

 tistics, above all of social relationships and 

 social machinery which the curriculum of 

 even the best medical schools can not attempt 

 to supply. 



So the public health nurse must be a 

 trained nurse skilled in the relief of suffering 

 and the bedside care of the sick, but she must 

 be much more. Her work is primarily that of 

 the health teacher, the messenger who carries 

 into the home and interprets to the individual 

 mother the gospel of good health. She must 

 work largely alone, not under the immediate 

 direction of a physician. She must know her 

 bacteriology and her physiology, her sanita- 

 tion and hygiene, well enough to teach their 

 principles to others; and she too must deal 

 with the individual, not merely as an in- 

 dividual, but as an element in a complex social 

 group. 



The bacteriologist in the laboratory and the 

 epidemiologist in the field are two more of the 

 specialists needed, whose work is concerned 

 primarily with the war against the com- 

 munity infections. The former offers aids in 

 early diagnosis and prepares sera and vaccines 

 for the prophylactic and therapeutic treat- 

 ment of these diseases; the latter by his 

 detective work makes it possible to trace out 

 the subtle pathways of infection by which 

 they spread from one person to another 

 through the complex web of community life. 



The public health or sanitary engineer is 

 again an engineer plus. He must have 

 mastered the underlying sciences of physics 

 and chemistry, of structures and hydraulics, 

 and he must also be familiar with the tech- 

 nical applications of his art to the particular 

 problems of sewage disposal and water supply, 

 ventilation, illumination and the like. 



The statistician correlates and analyzes the 

 records of births, deaths and illnesses, keep- 

 ing an expert finger as it were on the pulse of 



the nation's health. His work is the book- 

 keeping of public health, indicating the lines 

 of profitable expansion and furnishing us with 

 the credit balance of lives saved to the com- 

 munity as a result of various public health 

 endeavors. 



In the case of each of these experts, and in 

 the case of the social worker who is operating 

 in the field of public health, there is required 

 sound elementary education in some funda- 

 mental branch of science with the addition of 

 specific training in its applications to the 

 field of public health. For the nurse who 

 desires to become a public health nurse there 

 are offered four-month and eight-month 

 courses of special training in public health 

 nursing. The physician who desires to be- 

 come a public health physician, the engineer 

 who desires to become a sanitarian, the bac- 

 teriologist who desires to become a public 

 health bacteriologist, the social worker who 

 desires to apply a fundamental knowledge of 

 the principles of social readjustment within 

 the field of public health, must similarly 

 undergo a special training, if their services 

 are to be made promptly and fully available. 

 It is for this purpose that our leading univer- 

 sities and technical schools offer the Certifi- 

 cate in Public Health, which like the Master's 

 degree is the equivalent of a year's graduate 

 study. The C.P.H. course gives to the med- 

 ical graduate the special training needed to 

 equip him for the application of medicine in 

 the field of public health, and in the same way 

 enables men and women who have had college 

 training in the fundamentals of bacteriology, 

 engineering, sociology or statistics to fit into 

 their special places in the general scheme of 

 health protection. 



To turn from these special phases of the 

 public health campaign to the organization of 

 the movement as a whole, it seems probable 

 that the ideal public health administrator of 

 the future will be the man or woman who has 

 been first medically trained and has then 

 specialized in a school of public health. If 

 I am right in my belief that the public health 

 movement of the future will go far in the 

 direction of including medical and nursing 

 service within its ample bounds, it is clear 



