condemn every man to tuberculosis because the picture taken for other reasons shows these glands enlarged. It does emphasize the fact that these glands can get into trouble many times from some infection, whether it is from the teeth, throat, or from tonsilitis, or the grippe or measles. And this emphasizes the reason that when we have grippe and measles in our military boys that they develop tuberculosis. Therefore, we should take X-ray pictures more frequently and be a little better forewarned and take a little better care of our post grippe and other infection cases.

DR. HONEIJ (New Haven): The only other point that I wish to emphasize is that I don't believe that a roentgenological examination alone is sufficient. Unless we combine the clinical side we are not getting proper diagnosis.

The Medical Profession and the New Public Health.

EUGENE R. KELLEY, M.D., BOSTON.

(Commissioner of Health, State of Massachusetts.)

In recent years we have seen come into prominence many movements both serious and faddish that have sought to distinguish themselves from their predecessors by prefixing the term "new." We hear much of new verse, new thought, l'art

nouveau.

Of late sanitarians have begun to speak of the new public health. Perhaps in common with most other disciples of "new" cults and movements, we have used the term, just a bit superciliously, with an implied or expressed insinuation that the "old"” public health was a very inferior brand of public health indeed! Yet if pressed for a comprehensive definition of what we mean by the term "new public health" our answers must perforce be a bit faltering. H. W. Hill in his brilliant little work bearing this phrase as a title has attempted to do so in a series of epigrams and illustrations, the central theme of all of them being, "The old public health concerned itself with man's environment for the explanation of disease-the new public health concerns itself with man himself."

However, this does not cover entirely what most of us mean by the "new" public health. The new public health is coming to mean more and more the application of social principles to problems of medicine. In its development we are beginning to hear less and less the word "public" for we are finding it increasingly difficult to say where the line should be drawn in health work between public and private health.

As this distinction fades, the concern of the medical profession as a whole and of the general practitioner in particular in the problem increases. The development of health work constantly encroaches each year upon what was formerly the exclusive territory of the practitioner.

To borrow a trite phrase from the terms of industry, increasing emphasis in health work is being placed upon physical and medical "efficiency." Physical efficiency is being required as never before, and in the attempt to deliver this physical efficiency, public health administration finds itself to-day definitely invading the precincts of medical therapy.

For many decades it has been considered the proper province of the health administrator to concern himself with all those factors bearing upon health in the mass, or with the disease transmitting powers of the individual and to curb them as best he could. But he was not supposed to initiate actual curative or corrective measures for the individual's sole benefit.

He might busy himself as to the water supply and sewerage arrangements of Johnny Smith's school, inspect and correct the school lavatory equipment, insist upon a certain degree of temperature, a certain type of seat, look Johnny over periodically for evidences of parotitis or pediculosis; if found might exclude him from school or might follow him up at home to see that he remained apart from his fellow pupils. Contrary-wise he might convict Johnny of being guilty of such physical misdemeanors as dental caries, adenoids, myopia, scoliosis or what not, but right there the line was drawn.

Under no circumstances could he either insist that the adenoids be removed or provide the expert service to do it, for those steps belonged to the field of private practice of medicine. The most significant thing about the new public health is the rapidly increasing sentiment which insists that Johnny shall be made physically fit to do his full future share in either the industrial or military forces of the country, regardless of tradition, of medical methods, of Johnny's own total indifference, of his parents' poverty, stupidity or religious convictions, or of any other causes which tend to perpetually postpone his treatment.

This sentiment that the Nation owes it to itself to see that all its citizens are physically efficient has increased by leaps and bounds in the past two years. We have not yet begun to realize how strong it is becoming nor to appreciate what far-reaching effects its logical development into a fixed national policy will have upon the future of the medical profession.

Let us say then that the most significant thing about the new, the coming public health for the medical profession, is that the new public health is refusing to stop at the old barrier, refusing to stand aside helplessly when face to face with the problem of the treatment of the individual for the benefit of the common welfare. The new public health will not only point out what should be done for the individual, but will insist that whatever is needed is done. In other words, the new public health will more and more mean socialized medicine. Its keynote will be greater medical efficiency-the constant application of preventive measures on the part of all the medical profession, rather than the application of preventive measures in the mass by a limited number of doctors, called health officials.

It

This means radical changes in the entire field of medicine. means a medical revolution. I am firmly convinced that this revolution is already upon us. We are in the midst of it, but we cannot yet fully comprehend it.

The problem before the medical profession is to see how quickly it can readjust itself to this new era. We were apparently tending towards this fusion of the old conception of the public health function with that of medical practice function before the war. The increasing socializing of medicine was apparent to us all. The differences of medical opinion in regard to it were over the question of how far this socializing tendency would go. That the present methods of institutional and private medical practice were inefficient to a marked degree was recognized on all sides. Broadly speaking, and making due allowance for many striking individual and local exceptions to the rule, it was a truism that only the very rich and the very poor could obtain the maximum benefits of modern medical science in the cities, and the very rich alone, in the country.

The process, however, appeared to all of us a phenomenon of social evolution. To-day the war has laid its rude hand upon our profession as upon so many other cherished institutions of the past and has forced the pace to such an extent that I feel that I am entirely justified in stating that we are passing through a period of medical revolution. Probably the net result

of this revolution will be to a great extent the disappearance of medical practice as previously understood, the transformation of many of our practitioners into civil, salaried officials, the wiping out of many of the distinctions previously existing as to the proper fields of the health official and the private practitioner, a tremendous increase in institutional medical methods and their extension into village and rural medical practice, a great net gain in medical efficiency, an enormous extension of activity in such fields as school hygiene, industrial hygiene, and child hygiene, a standardization of hospital and institutional medical methods, a still greater medical specialization than we have yet had, and a great loss of those qualities which have so endeared the man of medicine to his patients in

the past.

Medicine will become more of a science, but we will lose many of its finest traditional qualities, for we will have lost to a great degree the "art of medicine.”

These are sweeping assertions. It is very possible that they may not all become verified, but before any one denies the fundamental correctness of my thesis, let him consider the facts. When we entered the war the country's medical profession numbered in all about 150,000 members. Excluding those beyond the years of medical activity and those who from one reason or another cannot be reckoned as medically available in any sense, there remained a solid residue of serviceable medical resources of approximately 110,000. Of these, 10,000 at least are women physicians, and as yet not generally classified as available for military duty.

Another 15,000 to 20,000 are already in actual military service and if the war continues for two to three years longer, at least another 25,000, possibly 40,000 medical officers must be supplied. The output of the schools does not greatly exceed the wastage by death and permanent disability in civil life. Therefore, from 33% to 50% of the available medical personnel will probably be drawn into military service. Does any one suppose that this great group after being absent from one to four years from their former lines of medical work, after being a living integral factor