Among educational authorities there are many advanced minds who realize the shortcomings of present methods. They labor under great difficulties in trying to overcome the prejudices of self-perpetuating pedagogy, and the indifference of a body of school teachers of whom so large a proportion regard their jobs as mere stop-gaps rather than life professions. Under these circumstances it is not strange that the product of the schools is not prepared in its mental outlook to become interested in, or to have convictions concerning, a subject apparently so remote as public health.

Much could be accomplished if really adequate courses in physical sciences and public and personal health topics could be introduced into the normal schools. A teacher convinced by personal demonstration in the laboratory and on field excursions, would be a more inspiring instructor than one who mechanically follows a textbook in which he or she has no real interest.

Legislation is no function of health authorities per se, but they have a duty in bringing to the attention of legislators matters so important to the public welfare as those pertaining to the public health, and furthermore in advising wisely as to the ends to be striven for and the means of accomplishing them.

The Public Health Outlook. Students and practitioners of public health have different outlooks, just as specialists in any other line of human activity. It is too much to expect that all of them would endorse what is said here; and in attempting to present the subject to readers presumably relatively unfamiliar with it, the best one can do is to give what is believed to represent the general attitude of the profession.

It has been deemed necessary to run the risk of wearying the reader with what is, after all, a very brief survey of public health work before attempting to summarize its outlook.

First, the public health official feels the confidence which is born of very real accomplishment in the past. Most of the great pestilences which formerly menaced mankind have been swept away, so far as civilized countries are concerned. We shall have no more devastating epidemics of bubonic plague, Asiatic cholera, or yellow fever in the United States. These diseases have yielded to science as they never would have yielded to any other attack. Many of the minor epidemic diseases are definitely in process of disappearance. Typhoid fever, for example, has been reduced by scientific attack within some twenty years in the proportion of from about seven to one. The paradox remains with regard to a number of other diseases that the means of getting rid of them are known, if we only had the means. Their persistence, in other words, is a social and economic, rather than a scientific, reproach. To this category, so far as this country is concerned, belongs malaria, stated on high authority to be the only disease capable of making a geographic area uninhabitable for the human race.

There remains, however, a long list of disease conditions against which little or no headway has been made. There is at present no answer to the problem of influenza, the last of the great scourges to menace civilized populations. Of the minor epidemics, poliomyelitis and meningitis may be mentioned as examples which are little amenable to public health control. Meningitis is an example of a disease whose microbial cause has been known for many years, and offers a refutation of the common dictum that once the cause is known, the cure is in sight. This is due, of course, to the fact that every phenomenon has multiple causes. The one essential causative agent in meningitis is the meningococcus, but the contributory causes of epidemics have not yet been envisaged. As the health official surveys his public, he finds only a small percentage who, at any given time, can be described as in perfect health. On the average, each individual spends a week or more out of the year completely incapacitated on account of acute illness, and, in addition, a large proportion drag themselves around for much of the time in a state of reduced efficiency and well-being. The field for work is thus practically illimitable.

The health man has now no hesitation in turning to science for the solution of his problems. If he knows his history, he sees centuries of complete failure to control any disease on a non-scientific basis followed by the spectacular disappearance of a number of the worst scourges after the introduction of scientific control. The conquest of the remainder is to him merely a question of more science. Possibly this will have to be directed along lines as yet little explored, and, likely enough, progress will be held up pending the discovery of new methods of attack; but the major conclusion is clear - disease is conquerable by scientific means.

For this reason research has the hearty support, in theory at least, of all health workers. Though many of them are submerged in the day's task so deeply that they can seldom come up to take breath and look around, at least on these occasions they realize acutely how needful is more knowledge and how scanty, all told, is the provision for securing it. This research must be conducted not only in the laboratory, but also at the bedside and in the field. It must embrace not only immediate pressing problems but must probe deeper into general laws of nature. It must enter and cultivate fields at first sight apparently remote from health subjects. Existing research institutions of the governments - municipal, state, and Federal - should be encouraged and supported, as should those of educational and voluntary health organizations.

The health official cannot fail to feel the need of a greater knowledge and understanding of the public whom he is striving to protect against disease and help toward a more healthful life. Perhaps this is especially difficult to come by in America, where populations are so often heterogeneous as regards race, social and economic status, tradition, and other pertinent factors. He should also be keen to make known to his public what he is doing and planning to do in their behalf. He will often find, however, that the greater part of the population is unprepared, by reason of its lack of training and experience, to comprehend just what he is driving at. He will look forward to the time when popular education has habituated a considerable portion of the people to a scientifically oriented manner of thought, so that what he has to propound will be readily and convincingly assimilated.

A health worker of long experience will remember almost with wonder the expansion in the scope of health work within the period of his service, and be prepared for a similar broadening of conception in the future. To this end he will appreciate the need for the perfection and expansion of organization in order to deal effectively with new problems. He will realize the need for increasing support of his efforts, both financial and moral, and will cultivate more assiduously than ever the opportunities for cooperation with his co-workers in the public health field, and with all legitimate agencies which may need or offer a helping hand.

And yet, he will sometimes look into the future with a hope mingled with misgivings. His hope is based upon the demonstrated efficacy of the method of attack upon disease to which he has definitely committed himself. His misgivings may arise chiefly from doubts as to the direction in which his public is going. If it be upward further into the light which reason and science are shedding upon human affairs, he feels that his profession can make relatively short work of the worst features of disease prevalence. If the race is preparing for a retreat back into the unprofitable realms of outworn tradition, bigotry, unreasoning emotionalism, and mysticism, from which it had begun to emerge, the health worker may well feel that his efforts are not worth the trouble which they undoubtedly cost him.

When one recalls the wonderful advances which have been made within our own generation, there is every reason for an optimistic outlook for the future. In my opinion the progress of public health along logical lines depends largely upon the intelligent assistance and guidance to the movement from the medical and allied professions.