October 20, 1911] 



SCIENCE 



505 



demonstrated that mere advice counts for 

 little unless it comes from one whose ability 

 to do commands respect. The hygienic 

 talks given to individual students by the 

 medical adviser and his assistants are far 

 more effective than any public lectures on 

 hygiene could be, because the staff com- 

 mands the respect of the students by its 

 ability to diagnose and treat disease. This, 

 I believe, will be found generally to be the 

 case in all institutional medicine. 



In the diagnosis and treatment of dis- 

 ease etiology plays an important part, but 

 the great triumph of etiologic medicine lies 

 in the possibilities for preventive and social 

 medicine which it has opened up. In pre- 

 ventive medicine the state through educa- 

 tion, legislation, inspection and regulation 

 plays an essential part. Preventive medi- 

 cine can only be made effective where the 

 state employs highly trained men to look 

 after sanitation and hygiene. Nearly all 

 diseases at bottom are social and can be 

 properly repressed only by social coopera- 

 tion. 



Indeed even the most individualistic dis- 

 eases, congenital defects of various sorts, 

 may be frequently traced either to bad or 

 vicious surroundings of the parents or to a 

 bad ancestral line on one or both sides. 

 Eugenics, the new science which seeks to 

 determine the laws necessary for propaga- 

 tion of an improving species, will have to 

 be studied both by the family physician 

 who is to be a wise councilor and by public 

 health officers who aim to be good teachers 

 and guides. Sociological medicine begins 

 not only before birth, but even before con- 

 ception. The life of young women must be 

 made healthful, young men must be made 

 to understand the lasting effects to the 

 third and fourth generation of drink and 

 the social vices. 



At birth again sociologic medicine has its 

 important part to play. When* the clean 



hospital with its specialists comes to be 

 substituted for the dirty midwife and the 

 so frequently bungling general practitioner 

 years of ill health and suffering will be 

 saved the larger share of our married 

 women and our blind asylums will become 

 one fourth too large. Havelock Ellis esti- 

 mates that in England in 1891 midwives 

 were responsible for the deaths of three 

 thousand women. They were doubtless re- 

 sponsible for the lifelong suffering of many 

 more. It is estimated that about a fourth 

 of the blindness in our blind asylums is due 

 to lack of proper care of eyes at birth. 



During infancy the death rate is fright- 

 ful. "While doubtless the fittest survive, 

 they do not survive in the fittest way. An 

 abundance of well-trained district nurses 

 under careful medical supervision could 

 do untold good in this field of sociologic 

 medicine. 



A fifth of the population are in the pub- 

 lie schools. Here sociologic medicine has 

 already made a good start. In most of the 

 large cities moderately efficient medical 

 supervision has already been established 

 and in the smaller towns it is beginning. 

 Massachusetts has a state law making it 

 compulsory in the public schools to provide 

 a medical adviser and several states have 

 permissive laws. It is the duty of the 

 medical inspector to see that children suf- 

 fering from contagious diseases are ex- 

 cluded from the school during the infec- 

 tious period, to examine for defects in the 

 eyes, ears, nose, teeth and throat, to advise 

 treatment when necessary, and in general 

 to look after school hygiene and sanitation. 

 As already twice pointed out, the school 

 medical inspector has his efficiency greatly 

 increased when school nurses are attached 

 to his staff. It has been suggested, quite 

 wisely, I think, that there be an abundance 

 of school nurses who can not only follow 

 the children to their homes and see that 



