provided individual
courses. It is possible for a man to graduate with honors from our
leading medical colleges without knowing what "vital statistics" means.
Even boards of health, their duties and their educational
opportunities, are not understood by graduates; it is an accident if
the "social and economic aspects of medical practice," "statistical
fallacies," "hospital administration," "infant mortality," are familiar
terms. It is for this reason, rather than because physicians are
selfish, that indispensable and beneficent legislation is so generally
opposed by them when the prerogatives of their profession seem in
danger. Practically every important sanitary advance of the past
century has been fought at the outset by those whose life work should
have made them see the need. Physicians bitterly attacked compulsory
vaccination, medical inspection of schools, compulsory notification of
communicable diseases. What is perhaps more significant of the
physician's indifference to preventive hygiene is the fact that most of
the sanitary movements that have revolutionized hygienic conditions in
America owe their inception and their success to laymen, for example,
tenement-house reform, anti-child labor and anti-tuberculosis crusades,
welfare work in factories, campaigns for safety appliances, movement
for a national board of health, prison, almshouse, and insane-asylum
reform, schools for mothers, and milk committees. The first hospital
for infectious diseases, the first board of health, the first
out-of-door sea-air treatment of bone tuberculosis in the United
States, were the result of lay initiative.

Dr. Hermann M. Biggs says that in America the greatest need of the
medical profession and of health administration is training that will
enable physicians and lay inspectors to use their knowledge of
preventive hygiene for the removal of living and working conditions
that cause preventable sickness. A physician without knowledge of
preventive hygiene is simply doing a "general repair" business.

For a few months in 1907 New York City had a highly efficient
commissioner of street cleaning, who, in spite of the unanimous
protests and appeals of the press, refused to give up the practice of
medicine. Hitherto the board of health of that city has been unable to
obtain the full time of its physicians because professional standards
give greater credit to the retail application of remedies than to the
wholesale application of