244 



SCIENCE 



[N. S. Vol. XLII. No. 1077 



" The Present Status and Future of Hygiene 

 or Public Healtli in America," read at the 

 May, 1915, meeting of the Association of 

 American Physicians, and published in 

 Science, July 2, 1915. His presentation of the 

 subject is an interesting exposition of the 

 medical viewpoint and bias in public health, 

 but many of his statements are dogmatic as- 

 sertions, and are highly debatable; others are 

 inconsistent with each other. For example, 

 compare (page 11, column 1) 

 . . . every medical school in this country should 

 have its department or institute of hygiene. . . . 

 It makes little difference whether the head of this 

 department is a chemist, a bacteriologist or a 

 physicist, since the problems of hygiene must be 

 approached from various angles . . ., 



and (page 11, column 2) : 



It is essential that hygiene be presented as a 

 distinct and independent science and not as a 

 phase of bacteriology, or of chemistry, or of 

 physics, 

 with (page 11, foot of column 2), 



Above all it must be remembered that hygiene 

 is a medical subject and a part of medicine. Its 

 methods are the methods of medicine . . ., 



and with (page 12, column 2), 



. . . the health officer, be he city, county or state, 

 has a distinct function, the intelligent exercise of 

 which requires a medical training. 



Surely if chemists, bacteriologists and 

 physicists are competent to teach hygiene or 

 public health (which is debatable), they 

 should be competent to practise it; obviously 

 if public health or hygiene is admitted to be 

 a distinct and independent science, it can not 

 be in the same breath a mere subsidiary of 

 medicine. 



Some of the main points in Dr. Ford's ar- 

 ticle must here go unchallenged for lack of 

 space, but before proceeding to my main 

 statement I wish to take up one minor point. 

 He states (page 10, near bottom of column 2) : 



The indifference to hygiene as a science lies in 

 our universities and in our medical schools, and 

 the responsibility for the failure of its develop- 

 ment rests squarely upon them. 



This is at least partly true, unless we wish 

 to quibble as to whether public health is a science 

 or the application of facts and principles of sci- 

 ence. But the failure of the practise of public 

 health rests squarely upon the medical pro- 

 fession. Led astray by idealism and zeal for 

 the public welfare (some of the finest traits of 

 the profession as a whole), they have oifered 

 their services as health officers in this country 

 too often either without compensation or with 

 very inadequate compensation. This has had 

 a bad effect upon the public mind. Rightly or 

 wrongly, the public tends to value things or 

 services in proportion to the price they pay. 

 This unselfishness by the profession will re- 

 tard the development of public health in the 

 future, as it has in the past, by making the 

 public unwilling, until educated, to pay well 

 for full-time technically trained health oificers 

 when they are able to get part of the time of 

 an untrained practitioner-health-officer at 

 nothing or next to nothing. 



As has been well said before, we have here- 

 tofore chosen practitioners of medicine as our 

 health officers because they came nearest of 

 any class in the community to having the 

 qualifications necessary for the work. As a 

 matter for argument, I submit that practi- 

 tioners of medicine lack much of the funda- 

 mental training and knowledge required for 

 public health work, and some of their train- 

 ing and qualifications, except in unusual men, 

 actually unfits them for true public health 

 work, in part for the following reasons : 



1. Public health is a function of govern- 

 ment, not an appendage to the practise of 

 medicine. 



2. Public health is a distinct entity, an 

 application of the facts and principles of 

 various fundamental sciences to the mainte- 

 nance of health and the prevention of disease. 



3. Public health must be based on the facts 

 of health and disease in the mass (in numbers, 

 space and duration of time) ; the practise of 

 medicine mainly upon individual cases. 



4. The practise of medicine is an individ- 

 ual endeavor for private gain derived from 

 individuals in a community; the practise of 

 public health is a public endeavor by and for 



