August 26, 1921] 



SCIENCE 



161 



in at least physiology, biochemistry and bac- 

 teriology. Anatomy is required at Hopkins 

 and Harvard and the latter school also requires 

 introductory pathology. It is evident that we 

 are approaching the curriculum recently advo- 

 cated by Sedgwick (5), who advised identical 

 training for medicine and public health stu- 

 dents for two years with divergent paths for 

 two years more. Public health further re- 

 quires somewhat more elaborate training of its 

 students in certain branches of zoology, notably 

 in parasitology, protozoology, helminthology 

 and entomology, than is usually required of 

 medical students. 



Then come the medical and pre-medical 

 sciences specifically applied to public health 

 problems. Advanced physiology particularly 

 of fatigue, respiration, climatology and ven- 

 tilation ; chemistry as applied to nutrition and 

 metabolism, food, food adulteration and sani- 

 tation ; bacteriology as applied in public health 

 laboratories and to sanitary engineering. 



And lastly are the public health sciences 

 properly speaking: vital statistics, public 

 health administration, sanitary law, sanitary 

 engineering, epidemiology, school inspection, 

 control of contagious diseases, and the like. 



The total curriculum is certainly medical 

 enough in aspect, which accounts for the very 

 natural supposition in the minds of the gen- 

 eral public and of many of the medical pro- 

 fession that public health is simply another 

 specialty of medicine. How far wrong this 

 conception is I shall hope to bring out a little 

 later. Let it suffice here to note that the 

 medical bulk of public health as outlined in 

 schools of public health is preventive medi- 

 cine and not curative medicine, medical sci- 

 ence and not medical art. This is clearly 

 brought out by the almost complete absence in 

 all these curricula of the medical clinic. The 

 hospital is not a necessary adjunct in public 

 health training. 



In finally considering the scope of public 

 health we may glance at it as mirrored in cur- 

 rent textbooks. Here at least no practical con- 

 sideration of money or men need limit the 

 field to be covered.^ Again the main emphasis 



iRosenau (6), Park (7), and Abel (8) were 

 consulted in this connection. 



very properly lies in disease prevention with 

 rather more emphasis than in the course out- 

 lines on certain correlated branches of per- 

 sonal hygiene and community welfare; the 

 construction of dwellings; the question of 

 clothing; the group care of infants and school 

 children; health measures as applied to pris- 

 ons, to armies, to transportation, and the 

 tropics. A wider field is suggested by mention 

 at least of such deeply specialized fields as 

 mental hygiene (Park) and eugenics (Rose- 

 nau). 



It is evident then from these summaries that 

 public health is primarily concerned and prop- 

 erly so with the abolition of disease and in 

 this campaign has enlisted the cooperation of 

 many specialists outside the field of medi- 

 cine. We suggest again that its future lies 

 in the further assumption of the burden of 

 combating ignorance, vice, crime, and pov- 

 erty. What then is the actual and prospective 

 personnel of the army of public health work- 

 ers? Since disease is and will probably re- 

 main its most serious, tangible and defeatable 

 enemy the man with a medical training is the 

 most considerable figure in the scheme. Un- 

 doubtedly a full medical training remains 

 the best foundation on which to base a fur- 

 ther training in the broader field of public 

 health. As an entire training medicine alone 

 is inadequate, and to the type of mind that 

 remains satisfied with accomplishment of the 

 diagnosis and cure of an individual case of 

 disease, it may even be detrimental. This is 

 no place for the guild-consciousness of the 

 practitioner of medicine. As a matter of fact 

 the graduate in medicine is no longer of neces- 

 sity the forwarder of those very sciences on 

 which the art of medicine depends. If it be 

 true that physiology, bacteriology, biochem- 

 istry and anatomy are progressing in the 

 hands of non-medical specialists to the ulti- 

 mate advantage of medical practise, this is 

 even more true of the field of public health. 

 No one would dream of asserting that one 

 must have a medical training to be a good 

 sanitary engineer, social worker, or crimi- 

 nologist. In this connection it is of interest 

 to note that less than half the faculties of 



