1908 Journal of the American Medical Association  
service and venture into a field which shows so few signs of promise? And does the profession in general perform its whole duty to the community when it fails to show any concern about who shall be the representatives of preventive medicine? If the great public is to be called on to assist in securing adequate health legislation, it must be taught to recognize the importance of an efficient administration of local interests, of prompt application of all new knowledge relative to preventable
more » ... ase, of the dangers incident to increasing density of population and increasing facilities of communication, and of other matters already touched on; and above all, it should be able to look with respect on those who, being placed in charge of the public health, should be qualified to give to the people intelligent opinions and advice thereon. The creation of educated public interest in the national health is a duty which happily does not belong to any one class or calling. Each in his way can do his part, by precept and example. Of great value, as shown in the agitation for the law relative to foods, and here, there, and everywhere for the establishment of sanatoria and for ordinances against the spitting habit, are popular lectures, magazine articles and the sympathy of the Ipress. Two years ago there was inaugurated at the '.Harvard Medical School a series of free public lectures, given on Saturday evenings and Sunday afternoons for lour months, mainly on preventive medicine. The first Series was a most gratifying success; the second so largely attended that at times more people were turned away than succeeded in securing places. The chief result is a widespread interest in public hygiene and a marked strengthening of the cordial relations which ought to exist everywhere between the profession and the public. The example set in Boston has been followed elsewhere with like results, and the more the habit spreads the sooner will the advocates of a federal health administration see a successful outcome. Whether the proposed service shall take the form of a department represented in the Cabinet or of a division of an existing department with a commissioner for a chief, is of no very great importance, although there are some very obvious objections to the suggestion of a separate department, which can hardly apply to that of a division; but department or division, it could properly have as its nucleus the present Bureau of Public Health and Marine-Hospital Service, to which should be added various existing bureaus scattered about under different departments-some now duplicating the work of others-and additional bureaus to be created. Its head should be charged with advisory powers in relation to other departments and to the states, and with supervisory and executive powers in matters pertaining to his own bureaus. He should not attempt to meddle in local matters not of national concern, nor to encroach upon the duties of other branches of the government. While he should be entrusted with all affairs relating to public health, he should have no control whatever over the medical service of the Army and Navy either in peace or in war, as has sometimes been suggested he should. , He should not be restricted in the selection of those to whom he would entrust the investigation of large problems of sanitary importance, but should as occasion requires draw on the whole scientific world, if necessary, to secure experts who would not accept permanent government employment or be on regular salary. Without such freedom he could hardly expect to compete in ex-perimental research with educational institutions and the various scientific foundations. He should be empowered to call on other departments for statistical data and to cooperate with the states in carrying on inquiries of interest to any or all of them. He should give attention to the hygiene of occupation, to questions of woman and child labor, to the hygiene of infants, to the hygiene of schools, and to many other problems of general interest. He should collect the vital statistics of the entire country, enforce the laws relative to quarantine, food and drugs and meat inspection, and perform such other duties as properly belong to a great national health organization. Inasmuch as no one man could be expected to conduet so great an establishment with only the advice of his bureau chiefs, and inasmuch as the cordial cooperation of all the states would be absolutely essential to satisfactory achievement, he should have a national council consisting of one delegate from each state, appointed by the governors or state boards of health for a term of years. Such a council should be composed of men of recognized standing in medicine, engineering or other branch of learning which would be of assistance. It should be called together at least once each year and as much oftener as might appear to be necessary, and the expenses of each such meeting should be borne by the government rather than, as now is the case with the annual conference of the state boards of health with the surgeon general of the Public Health and Marine-Hospital service, at the expense of the states or of the delegates themselves. At each meeting the subject of the national health should be discussed and proposals for future work should be made and considered. Even though at times the meetings might not appear to be of great scientific value, at least they would serve to promote the cordial feeling that the individual states form a part of the administration and exercise a proper influence.
doi:10.1001/jama.1908.25310500007001a fatcat:uuwtefawofdbvcp3kriiyxq5na