December 8, 1916] 



SCIENCE 



803 



of medical education, to define the require- 

 ments of admission to medical schools, to 

 submit those who wish to practise within 

 its borders to certain intellectual and moral 

 tests in order to pass upon their profes- 

 sional fitness and to revoke the licenses of 

 the unworthy. The federal government 

 has its public health service which passes 

 upon immigrants, controls national quar- 

 antine, maintains a research laboratory, 

 supervises the manufacture and sale of vac- 

 cines and antitoxins, and stands ready to 

 aid any state in combating epidemics. 

 Each state has its board of health, the pow- 

 ers, functions and efficiency of which vary 

 widely. Our great municipalities have their 

 boards of health and commissioners of 

 health which for the most part are efficient, 

 but in some instances are parts of a polit- 

 ical machine. Our smaller cities and rural 

 communities have their boards and health 

 officers, which with some notable exceptions, 

 fortunately in increasing numbers, are 

 cheap, ignorant and inefficient. 



By means of these organizations, imper- 

 fect as many of them are, the death rate 

 in the registered area of the United States 

 has been reduced in the past thirty years 

 from twenty to fourteen per thousand, the 

 average life has been increased more than 

 ten years, and the mortality from tubercu- 

 losis and other infectious diseases has been 

 reduced about fifty per cent. On account 

 of the greater efficiency of the health serv- 

 ice in our larger cities, the reduction in the 

 death rate has been more marked in these 

 than in smaller cities and rural communi- 

 ties. The greatest reduction in mortality 

 has been secured in our cities of one hun- 

 dred thousand or more. Our metropolis, 

 New York, has a municipal health service 

 which is second to none in the world. It 

 supports a research laboratory in which 

 the highest grade of scientific investigation 

 is done, diagnostic laboratories in which 



diphtheria cultures, suspected sputum, 

 blood examination and other tests essential 

 to scientific medicine are made and labora- 

 tories in which water and food supplies are 

 carefully guarded. It has a corps of ex- 

 pert diagnosticians ready to aid the prac- 

 titioner in all suspected cases, free of 

 charge to either the medical man or the pa- 

 tient. It provides medical-school inspectors 

 who detect infection in its earliest stages,, 

 excellent hospitals in which the sick have 

 the best care and treatment and nurses 

 who patrol the tenements and other homes 

 of the poor and give instruction in sanita- 

 tion. It examines cooks and waiters to see 

 that none of these may distribute typhoid 

 fever, tuberculosis, syphilis or other infec- 

 tions. It inspects meat markets, bakeries, 

 milk stations and other places of food 

 supply and has the authority to close these 

 when unsanitary conditions are found. 



The last legislature of Michigan made an 

 appropriation of one hundred thousand 

 dollars and directed the state board of 

 health to expend it in attempts to re- 

 strict tuberculosis. Several thousand citi- 

 zens have already been examined free 

 of charge in order that this disease may be 

 detected in its early stages when it is 

 amenable to hygienic treatment. These 

 people are not only examined but those 

 found infected are instructed how to live 

 in order to avert the progress of the dis- 

 ease. 



I have chosen to bring these matters be- 

 fore you in order to impress upon you the 

 relation which the profession, which you 

 have selected, bears to the. public. Even 

 the physician who devotes himself wholly 

 to what is known as private practise does 

 not escape his duties to the public. He is 

 morally bound not only to do his full duty 

 to the individual who employs him, but to 

 protect the community. You have chosen 

 to come to a school supported by the state. 



