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SCIENCE 



[N. S. Vol. XL. No. 1034 



paign, the health officers of the country, must 

 base their work upon all four of the great 

 professions, upon medicine, engineering, law 

 and social service. It is for this ideal that the 

 new School for Health Officers of Harvard 

 University and the Massachusetts Institute of 

 Technology stands and it is about this ideal 

 that I wish to speak to you to-day. 



The movement for fostering health and 

 preventing premature death from accident and 

 disease is world wide in its range, and has 

 attained a magnificent popular momentum, 

 thanks to thousands of earnest men and wo- 

 men who have approached the subject from 

 many different angles. It is a mighty stream, 

 and like a mighty stream has power for good 

 and power for harm. It needs to be controlled. 

 The movement needs to be organized through 

 regularly constituted governmental agencies. 

 The mechanism for this already exists in crude 

 and diversified forms. We have departments 

 ■ of health in most states and cities, local boards 

 of health in small communities, occasional 

 county or district organizations, voluntary 

 associations, philanthropic agencies, and last 

 but not least our ambitious and constantly 

 improving national Public Health Service. 

 Without in any way belittling what is being 

 done, on the contrary with a just pride in 

 what has been accomplished, we must all 

 admit that, take it the country through, the 

 public health service is ineffectively organized 

 and insufficiently supported. The need of the 

 hour is for official leadership and for the pub- 

 lic recognition of this need for official leader- 

 ship. 



We are all familiar with the term " captains 

 of industry." We know that the men so called 

 are leaders in the industrial world. But we 

 also know that industrial organization would 

 go to smash were it not for the sergeants of 

 industry and for the corporals of industry, for 

 those who come into actual contact with the 

 rank and file of business men. Similarly we 

 have our " captains of health." Their great 

 names are known to us all. We recognize 

 their ability. When they speak the world 

 listens and takes heed. But as an organization 



we lack the sergeants of health and the cor- 

 porals of health, we lack the local leaders. 



Our present local health officers have risen 

 from the ranks, generally from the medical 

 profession. All honor to those who have 

 served so faithfully and so well. Those who 

 have succeeded and have become not only 

 sergeants, but captains of health, have done 

 so only by long service, individual study and 

 personal sacrifice. Individuals here and there 

 have succeeded, yet the method is wrong. 



Our present service is unequal in efficiency. 

 The large city, with a large problem, can af- 

 ford to pay a large salary to a large man. 

 The small town with a small problem has 

 likewise been obliged to pay a small salary 

 to a small man, or, to put it less harshly, to 

 pay a small salary to some man who, because 

 of the small salary, can not give all of his 

 time or thought to the public health service. 

 We also have local boards of health where 

 no one is paid, and where the service is con- 

 sequently irresponsible. A great fault is that 

 the ultimate unit has been too small. The 

 problem of caring for a people's health is so 

 complicated that the man who attempts it 

 should not try to do anything else. He can 

 not do so in justice to himself and to his 

 work. 



In order that he may give his whole time 

 to his job he must be paid a living wage. 

 And in order that he may be paid a living 

 wage he must serve a district large enough 

 to afford such payment. Hence the ultimate 

 unit must be made larger than it has been in 

 the past. Improvements in transportation 

 and the communication of thought make this 

 possible to-day to a much greater extent than 

 formerly. The town, or the borough, or the 

 village, or the small city will not ordinarily 

 prove adequate, and one of the signs of the 

 times is the establishment of public health 

 districts presided over by a district health 

 officer. The state of New York has adopted 

 this system and Massachusetts is following 

 her example. 



We also have in Massachusetts examples of 

 voluntary combinations of neighboring towns 

 to secure the services of a health officer who 



