12 



SCIENCE 



[N. S. Vol. XI,II. No. 1070 



Hygiene must therefore always be taugM 

 medical students from the medical point of 

 view by medical men. 



The second great need in this country is 

 for better facilities for the training of pub- 

 lic health officers. The awakening of the pub- 

 lic conscience to the necessity of removing 

 health questions from the domain of polities 

 has resulted in the reorganization of many 

 of our municipal and state departments of 

 health while the excellent achievements of 

 others have given them greater responsi- 

 bilities and increased facilities for carrying 

 out their work. The system of "county, 

 health officers" in which employees of the 

 state department of health are empowered 

 to assume local duties either in cooperation 

 with the local authorities or superseding 

 them has now been adopted in two states 

 and marks a signal advance in health legis- 

 lation. This is an example indeed likely to 

 be followed by a number of states as time 

 goes on. This change in health administra- 

 tion has created a distinct demand for 

 specialists in public health and the medical 

 departments of our universities must now 

 see to it that the men who take up public 

 health as a career are given the opportu- 

 nities of fitting themselves properly in the 

 science of hygiene or public health. This 

 can probably best be accomplished by or- 

 ganizing courses leading up to the Diploma 

 of Public Health or some similar degree, the 

 possession of which will guarantee that the 

 holder has received expert instruction which 

 wiU qualify him to act intelligently as an 

 oiScer of health. Already three of our best 

 medical schools have organized such courses 

 and other universities are contemplating 

 similar enterprises. It is not enough that 

 this or that school shall establish depart- 

 ments for the training of health officials. 

 This movement is one which vitally con- 

 cerns the physicians of this country and is 

 likely to have an important influence upon 



the development of American medicine. 

 The medical profession must demand that 

 our health officers be properly trained, that 

 the Diploma of Public Health shall not be 

 awarded to any sort of individual regard- 

 less of his preliminary training to be used 

 merely as a lever to help him to acquire a 

 position. There must be some sort of stand- 

 ardization of the courses leading up to the 

 degree and particularly must there be some 

 agreement as to their length and the 

 amount of time which must be passed in 

 preparation for the examinations. Above 

 aU American physicians must remember 

 that the health officer, be he county, city or 

 state, has a distinct function, the intelligent 

 exercise of which requires a medical train- 

 ing. It is not enough that our garbage be 

 disposed of, that our drinking water be 

 chlorinated or filtered, the bacteria in milk 

 be counted or the births and deaths of a 

 community be registered, important as these 

 activities may be. It is far more important 

 that the unsuspected and unreported case 

 of typhoid fever or septic sore throat be 

 ferreted out, the typhoid or diphtheria car- 

 rier be recognized, the first ease of small- 

 pox be differentiated from chickenpox and 

 that the correct diagnosis of the obscure 

 eases of meningitis or some of the exanthe- 

 mata be established. It is after all in the 

 great field of the preventable diseases of in- 

 fectious nature that the health officers will 

 do the most work and bear the heaviest 

 responsibilities. Thus while an engineer 

 or a half-trained medical man who has 

 specialized in public health may satisfac- 

 torily perform the functions of a health 

 officer in certain particulars it is difficult 

 to see how he can perform the most impor- 

 tant. This is a particularly grave problem 

 in maritime cities where the danger of 

 bubonic plague is constantly increasing or 

 where a case of yellow fever may slip in 

 almost any time. It is an important ques- 



