October 23^ 1914] 



SCIENCE 



583 



gives his full time to the towns included in 

 the arrangement. The towns have the ad- 

 vantage of the services of a specialist and the 

 man receives joint compensation connnensu- 

 rate with his services. 



The first step in perfecting our public 

 health organization, therefore is to provide 

 for full time health officers, serving districts 

 large enough to afford an adequate salary for 

 a well-trained man. 



The second step is that of securing stabil- 

 ity of service, by establishing long terms for 

 health officers. To train one's self for this 

 work costs time and money. It requires cap- 

 ital in the shape of education and experi- 

 ence. No man can afford to enter upon this 

 career unless his livelihood is assured. 

 Furthermore, a health officer's success does 

 not depend wholly upon his knowledge of 

 sanitary principles; it depends equally upon 

 his knowledge of the community. He must 

 know his territory geographically and phys- 

 ically, and he must know his people and their 

 habits of life. This knowledge can be acquired 

 only by familiarity. 



The third step is coordination. Lines of 

 authority should be established from the 

 health officials of the smallest communities 

 through the districts to the state departments 

 of health, which in some states are already 

 well organized. Cooperation between the 

 states under the general direction of the fed- 

 eral government will also be necessary. 



But let us come now to the man himself. 

 What shall the health officer be, a doctor, an 

 engineer, a lavyyer, a minister? Yes, any one 

 of these, provided he knows enough about the 

 other three professions and has the proper 

 personality. Instances may be cited where 

 lawyers and where ministers have become 

 public health officers, and in recent years many 

 engineers have proved conspicuously success- 

 ful in this field. It must be admitted, how- 

 ever, that in the majority of cases men have 

 entered this service through the profession of 

 medicine. This was natural and proper as 

 long as disease was regarded as something 

 wholly personal, and it probably will remain 

 true that for many years to come the best 



portal of entry to the public health service will 

 be that of the profession of medicine. By 

 this is meant that the man already learned in 

 medicine will have less to learn of the other 

 sciences than he who is already trained in 

 some other profession will have to learn of 

 matters that are biological and medical. 

 Again, the world has for so long regarded the 

 medical practitioner as the custodian of the 

 public health that the title of doctor carries 

 with it a certain prestige which is of advan- 

 tage from an administrative point of view. 



We have seen, however, that the profes- 

 sion of public health has greatly broadened. 

 Young men starting afresh for this career can 

 not afford in most cases to become a doctor 

 of medicine first and a doctor of public health 

 afterwards, or an engineer first and a doctor 

 of medicine afterwards. Also the training 

 for the degree of M.D. contains many mat- 

 ters which relate to healing and have practi- 

 cally nothing to do with the prevention of dis- 

 ease. The time devoted to them can be spent 

 to better advantage in the study of other sub- 

 jects more directly connected with public 

 health administration, such as sanitary engi- 

 neering and demography. 



It is a fatal mistake, therefore, to make the 

 medical degree a prerequisite to public health 

 positions, as it tends to disbar from the serv- 

 ice young men who are giving themselves the 

 broadest and best possible education for the 

 positions that need to be filled. Some of our 

 best and most recent laws still contain pro- 

 visions for this outgrown and unfortunate 

 limitation. The requirement of an M.D. was 

 doubtless made in order to safeguard the serv- 

 ice from the political appointment of unfit 

 men, but it now needs modification in order 

 to provide for the new conditions and to ad- 

 mit to the service those who are specializing 

 in preventive medicine and the control of the 

 public health. It is true that the harm will 

 come in the future rather than at present, but 

 it is the future of the service to which we 

 should look. Laws which prescribe an M.D. 

 degree should be amended by the addition of 

 some such modifying clause as this — " A doc- 

 tor of medicine or a person trained in public 



