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The training of the candidate for the public health qualification
1914.
PUBLIC
THE TRAINING OF THE CANDIDATE FOR THE PUBLIC HEALTH QUALIFICATION. BY WILLIAM ROBERTSON, M.D., D.P.H., Medical Officer of Health, Leith.
time to time attention has been F ROM directed to the special training required by the candidate aspiring to a qualification in public health. And as each governing body has taken the subject in hand some improvement in the course of study has been effected. T h e t i m e has now come, however, when special consideration must be given to the whole question. This is specially felt by those who undertake to train candidates for the various public health qualifications. In many instances pupils present themselves for tuition obviously expecting that a minimum of attendances and a maximum of reading will enable them to pass the necessary examination. Many of these aspirants can set themselves the task to read up the theory of public health within a given time. The knowledge thus absorbed may, and frequently does, secure pass marks in such subjects as sanitation, epidemiology, sanitary law and vital statistics. Indeed it is sometimes cause for surprise that so many fail in that part of the examination which offers the " r e a d e r " a favourable opportunity to distinguish himself; his failure to reach the pass marks suggesting that slip-shod and scant studies have been expected to carry the candidate through. In making this observation I do not overlook the well-recognised fact that a man may make a very poor appearance before a board of examiners, but may nevertheless have the germs of a successful administrator in him. That anomaly is one of the inherent weaknesses of the examination system as presently conducted. In short a pass is not a necessary corollary to tuture administrative brilliance. Nevertheless, it is generally true that the candidate who does well at the examination table has the makings of success in him. But, t h e s e are generalities. Let me pass to the examination itself. At present the standard of the various qualifying bodies is unequal. There is no uniformity. A pupil may be advised to go to A because the qualification given there is believed to place its possessor in a more favourable position for securing quick promotion. On the other hand if he goes to B he may be specially coached for an examination which he is told can be passed with considerable ease. Or, again, he is
HEALTH.
401
warned that if he goes to C he will require to display a higher proficiency in bacteriology than in chemistry, because at this particular place they wonder that so much time is spent upon chemical analysis in other schools. Lastly, the pupil who has studied in the laboratory at X may find himself handicapped when he presents himself for examination at E school. At E they belittle the methods taught at D, and only the teaching followed at E will be accepted at that centre. This sort of thing can only be described as most unsatisfactory. The pupil is placed at a disadvantage, and the examination test is rendered misleading and unreliable. If the results secured by the candidate by known methods are accurate, the examiner has no right to pose as an arbiter in technique. Unfortunately such tendency of " rival " teachers to obtrude their own ideas too commonly prevails. This is a very delicate question, but I have approached it fearlessly, because the grounds for complaint are many and oft repeated. So much so indeed that pupils may refrain from going to be examined at E since the methods learned by them at D are liable to be called in question. Coming, however, to more direct criticism I would favour a curtailment of the period given over to the stady of chemistry. The training a pupil receives at present at the chemical laboratory almost fits him to become a public analyst. This is not necessary. Able chemists already exist and the Sale of Food and Drugs Act makes special provision for the appointment of public analysts. With few exceptions such officials, independent men that is, are appointed by city and county councils. If a sanitary authority desires to get t h e best work and most attention from its medical adviser the on¢,~ous duties of a public analyst should not b e placed upon his shoulders. It stands to reason that he cannot do his public health work satisfactorily if he is to devote the time required for examining foods and drugs. The significance of various adulterants, their quantities and limitations can be readily taught. W h y then spend so many valuable hours in the detailed examination of milk, butter, coffee, pepper and such like substances ? T h e time so spent might be more profitably utilised in another place and in other branches of study.
402
PUBLIC HEALTH.
The chemical examination of water certainly points in the right direction of practical teaching, as does that of sewage and air. But apart from these mentioned features in chemistry, the candidate should not be expected to profess the detail and technique of the specialist. In a legal case, for example, the evidence of the expert who is devoting his life's work to chemical investigations would far outweigh that of the medical officer of health who might chance to hold the dual appointment. Our Local Government Boards should do all that lies in their power to discourage the appointment of medical officers of health to the posts of public analysts, and those governing bodies which control the examinations in public health should aid the reform by limiting the course of chemical study within practical requirements. When one comes to the consideration of bacteriology the course of study becomes more serious. The time deducted from the present day teaching of chemistry might, as has been said, be profitably given over to bacteriological
work. It is in this laboratory that the budding medical officer of health finds himself embracing a science, the thorough grasp of which must be one of his best accomplishments. Every candidate should be called upon to display an intimate knowledge of bacteriology in its relation and application to preventive medicine. The bacteriology of soil, sewage, air and disease should be so accurately known as to enable the future medical officer of health not only to map out a line of research or study for others, but also to put his own hand to the incubator, and if need be the test animal. At present the bacteriology professed is of sufficient extent to enable the candidate to name specimens, to make slides or answer general questions. More than that is required, and no one recognises this more than the present day public health official. Vaccine therapy is still in its infancy and must be included in the foregoing course; because we still have much to learn regarding its value. All this entails time it may be argued. But that is not denied. Think of the days now being unnecessarily devoted to chemistry. A medical officer of health cannot know his bacteriology too well. He may very soon forget his chemistry. If it does not actually pass out of his mind, he certainly has no
SEPTEMBER,
further concern for the major part of what he has been taught when he becomes involved in active administrative work. I speak regretfully, because my own meagre training in bacteriology often finds me unprepared to delve into the fascinating labyrinths of original research. The opportunities for the study of this branch of preventive work twenty odd years ago were very scanty. I therefore not only envy those who have the present opportunities for learning; but regret to observe that so many fail to embrace the grand chances presented by well-known teachers and elaborately equipped laboratories. A man holding the health qualifications and, literally speaking, armed to the teeth with a full training has a splendid outlook before him. His worth will force him to the front. And when he does become a medical officer of health he will be tempted to follow side paths of research; since it will be only when he is brought face to face with present day problems that he can appreciate how much yet remains to be done in the domain of epidemiology alone. It is not necessary that the future administrator shall shut himself up in a laboratory. But the fact that he is an administrator will empower him to map out schemes of research for those qualified to complete them. Original research h a s brought many an obscure individual to the front. Such work will continue to mark for high distinction those who have the capacity for taking pains and are gifted with that unique attribute, fecundity of ideas. Therefore I can conceive no better grounding for the public health student than that which demands a prolonged and assiduous study of bacteriology. The fact that he has gone through the searching work demanded by this course will fit him to meet an examiner with every confidence. W h e n we come to the second part of the examination we find that a good deal of reading and memorising can be depended upon to command success, as far as examination purposes are concerned. Sanitary law of a very extensive nature must be professed. The student usually knows this part of his work fairly well. But at the examination table he is amazed to find himself confronted by two solitary questions, and these, after weeks and weeks of strenuous work upon
1914.
PUBLIC HEALTH.
a dreary subject. The oral may fill up this inefficient test of knowledge, but half of the oral is occupied, as is the paper, with questions upon vital statistics. The examiner may never have had any experience in the administration of sanitary law. He is, therefore, quite unable to bring out what his candidate really knows. An examiner has been known to have a list of questions written down. A departure from his parrot-like catechism would have found the gentleman quite at a loss to cross-question the candidate. That is not the way to conduct a serious examination. Sanitation can be professed from b o o k s - that is to say, the theoretical side of the subject. But what of the practical aspect, which, in after life, is to be the foundation of the health official's success. Little or no practical knowledge is demanded at the examination. The present certificate of proficiency granted by the medical officer of health is sufficient, because the pupil is asked little beyond elementary questions. Nevertheless, the present certificate is inadequate. The examination should attach greater importance to the work actually done under the medical officer o f health. And it is really at this point that one is faced with difficulties in making recommendations towards improving the present scheme of examination. As long as pupils present themselves in batches of eight, nine, or it may be a dozen at a time, the medical officer of health who undertakes the pupilage system will find it difficult to perform the work in a way that is either satisfactory to himself or to his students. Under the existing system the men present themselves at the Public Health Office on two or three days a week for six months. The medical officer of health has council meetings to attend, and his other duties may compel him to hand the pupils over to a deputy. Once a week a sanitary inspector conducts the students about, showing them drains, cowsheds, bakehouses, offensive trades, and so on. Some pupils attend regularly, others do not, and so on the time is passed. Six months have been spent in out-door work, and the certificate of attendance is duly filled in. As the examination is presently conducted the knowledge acquired is quite sufficient for the student'g purpose. Practical sanitation presently consists in writing a report upon a house inspection. This is a farce, and nothing else.
403
But how can matters be improved ? The medical officer of health cannot give up every day of the week to teaching, nor dare he be seen marching a band of students day after day round his district. Councils are now so constituted that certain members unhesitatingly complain when a medical officer of health takes pupils. The council appoints a medical officer of health " to devote his whole time to the duties of his office," and nothing outside that is permitted. The medical officer of health may accordingly take the pupils " in his own t i m e " to give them a theoretical conception of public health. Something must be done to overcome this obstacle to teaching. An understanding will have to be arrived at at teaching centres whereby the controlling sanitary authorities may be persuaded to permit their medical officer of health to afford pupils the necessary educational facilities. Three months must be so spent, and the attendances must be daily and uninterrupted. Each day of the week should be devoted to a particular inspector-say, Monday with the drain inspector, Tuesday with the food inspector, Wednesday at the slaughter-house, Thursday with a district inspector, Friday with the epidemic officer, and Saturday in the office. But to make this work real each pupil should be provided with an " a u t h o r i s e d note b o o k " (authorised that is by the teaching or qualifying body). In this book a detailed diary of the week's work will have to be written up, together with the plans of defects inspected and the alterations required by the Public Health Department. The writing up of this book might be done on Saturday forenoon. This record of work must then be corrected, criticised and sub-edited, as the case may be, by the medical officer of health, who will sign each week's work. Further, this book should form the basis of practical proficiency at the final examination ; each volume being presented to the examiner in sanitation a week or more before the written examination takes place. A practical man can quickly tell whether or not the pupil has been actually comprehending the meaning of his " o u t - d o o r " work. If need be the candidate can be taken over his records in a vivd voce examination. The possibility that such may be done will compel the pupil to study his diary so that he may be able to explain his notes and observations. So much for practical sanitation.
4,04
PUBLIC
More particular knowledge is required from pupils as regards fever hospitals and tuberculosis schemes. In fact every aspiring medical officer of health should provide himself with the qualification of residency in a fever hospital and attendance at a tuberculosis dispensary. Architects can work out the details of sanatoria, dispensaries, and isolation hospitals; but the architect looks to the medical officer of health to supply the data for the actual requirements. The scheme above outlined implies that each pupil must make up his mind to devote his whole time for a complete year to the study of the ~¢arious branches required for this examination. At present there are men who become pupils with a medical officer of health merely for the sake of securing a qualification which may command promotion in one or other direction. In these days when wire pulling and other influences are depended upon for the securing of appointments the casual student, provided with a qualification in hygiene, is placed in unfair competition with him who has really given" serious and prolonged attention to the study of public health. F o r the individuals who merely want a health qualification there should be a distinct certificate granted. Their qualification would only convey with it the information that the possessor was proficient in elementary hygiene. Perhaps it would be well to make this certificate include those who are going to become medical,inspectors of schools and school children. If so, a special training would be required by compulsory attendance for three months at a school clinic. Such certificate might be called the Sch. Hy. (Certificate in School Hygiene). In conclusion, I would suggest that at every university or teaching school there should be a complete curriculum for studying the various branches required for the public health qualification of the future. The subjects taught should include chemistry, bacteriology, applied public health (including sanitary law and vital statistics), epidemiology (including tuberculosis), sanitary engineering and drawing. Fever hospitals, sanatoria, tuberculosis dispensaries, meat, and perhaps fish markets, are all available in large teaching centres, so that the pupil would command a wide field of practical work.
SL~PTEMBER,
HEALTH.
My point is that the course (excepting outdoor work) should be given in a systematic way in a recognised medical school which is empowered to grant degrees. W e might have fewer pupils, but we should get a better class of men who would make public health a serious study. SYLLABUS SUGGESTED. Chemistry. Physics.
One
Summer Session.
Three months, one day weekly ; three hours each attendance.
Bacteriology,
Three months, four days we kly; five hours each day.
Epidemiology and Tuberculosis.
Twenty-five Lectures, to include visits to Hospitals and Dispensaries.
Sanitary Law and Vital Statistics.
~Vinter Session.
Twenty-Five Lectures including atten dance at Court Cases.
Year
THE
Sanitary Engineering and Drawing.
Twenty-Five Lectures, and Demonstration s.
Applied Public j Health.
Twenty-Five Lectures.
Pupilage with I Summer Medical Officer Session. of Health, )
Three months, daily attendance. Also visits to Sewage and other works controlled by Public Heahb or Cleansing Depattments.
THERAPEUTIC USE OF T U B E R C U L I N . - - I n
the number of PUBLIC HEALTH of May of last year appeared a paper by Dr. Cecil Wall on the therapeutic use of tuberculin. In this paper Dr. Wall writes that "the type of case from which the best results are claimed is that in which a certain number of recoveries may be expected with other forms of treatment." The risk attending the use of tuberculin is pointed out by him. Opinion as to its value is obviously divided at the present time, but the fact that bad results may attend tuberculin treatment cannot be denied. In a letter to the Lancet of July 25th of the present year, the results in a particular case are given by Dr. Charles Miller. There is evidently much need for watchfulness in connection with the use of tuberculin. SALE OF I-IYPODERMIC SYRINGES P R O H I B I T E D . T h e "Boylan Law," which came into force in New
York State in July of this year has amended the public health law in relation to the sale of habitforming drugs, which are prohibited as well as hypodermic syringes, unless prescribed by a physician.
PUBLIC
THE TRAINING OF THE CANDIDATE FOR THE PUBLIC HEALTH QUALIFICATION. BY WILLIAM ROBERTSON, M.D., D.P.H., Medical Officer of Health, Leith.
time to time attention has been F ROM directed to the special training required by the candidate aspiring to a qualification in public health. And as each governing body has taken the subject in hand some improvement in the course of study has been effected. T h e t i m e has now come, however, when special consideration must be given to the whole question. This is specially felt by those who undertake to train candidates for the various public health qualifications. In many instances pupils present themselves for tuition obviously expecting that a minimum of attendances and a maximum of reading will enable them to pass the necessary examination. Many of these aspirants can set themselves the task to read up the theory of public health within a given time. The knowledge thus absorbed may, and frequently does, secure pass marks in such subjects as sanitation, epidemiology, sanitary law and vital statistics. Indeed it is sometimes cause for surprise that so many fail in that part of the examination which offers the " r e a d e r " a favourable opportunity to distinguish himself; his failure to reach the pass marks suggesting that slip-shod and scant studies have been expected to carry the candidate through. In making this observation I do not overlook the well-recognised fact that a man may make a very poor appearance before a board of examiners, but may nevertheless have the germs of a successful administrator in him. That anomaly is one of the inherent weaknesses of the examination system as presently conducted. In short a pass is not a necessary corollary to tuture administrative brilliance. Nevertheless, it is generally true that the candidate who does well at the examination table has the makings of success in him. But, t h e s e are generalities. Let me pass to the examination itself. At present the standard of the various qualifying bodies is unequal. There is no uniformity. A pupil may be advised to go to A because the qualification given there is believed to place its possessor in a more favourable position for securing quick promotion. On the other hand if he goes to B he may be specially coached for an examination which he is told can be passed with considerable ease. Or, again, he is
HEALTH.
401
warned that if he goes to C he will require to display a higher proficiency in bacteriology than in chemistry, because at this particular place they wonder that so much time is spent upon chemical analysis in other schools. Lastly, the pupil who has studied in the laboratory at X may find himself handicapped when he presents himself for examination at E school. At E they belittle the methods taught at D, and only the teaching followed at E will be accepted at that centre. This sort of thing can only be described as most unsatisfactory. The pupil is placed at a disadvantage, and the examination test is rendered misleading and unreliable. If the results secured by the candidate by known methods are accurate, the examiner has no right to pose as an arbiter in technique. Unfortunately such tendency of " rival " teachers to obtrude their own ideas too commonly prevails. This is a very delicate question, but I have approached it fearlessly, because the grounds for complaint are many and oft repeated. So much so indeed that pupils may refrain from going to be examined at E since the methods learned by them at D are liable to be called in question. Coming, however, to more direct criticism I would favour a curtailment of the period given over to the stady of chemistry. The training a pupil receives at present at the chemical laboratory almost fits him to become a public analyst. This is not necessary. Able chemists already exist and the Sale of Food and Drugs Act makes special provision for the appointment of public analysts. With few exceptions such officials, independent men that is, are appointed by city and county councils. If a sanitary authority desires to get t h e best work and most attention from its medical adviser the on¢,~ous duties of a public analyst should not b e placed upon his shoulders. It stands to reason that he cannot do his public health work satisfactorily if he is to devote the time required for examining foods and drugs. The significance of various adulterants, their quantities and limitations can be readily taught. W h y then spend so many valuable hours in the detailed examination of milk, butter, coffee, pepper and such like substances ? T h e time so spent might be more profitably utilised in another place and in other branches of study.
402
PUBLIC HEALTH.
The chemical examination of water certainly points in the right direction of practical teaching, as does that of sewage and air. But apart from these mentioned features in chemistry, the candidate should not be expected to profess the detail and technique of the specialist. In a legal case, for example, the evidence of the expert who is devoting his life's work to chemical investigations would far outweigh that of the medical officer of health who might chance to hold the dual appointment. Our Local Government Boards should do all that lies in their power to discourage the appointment of medical officers of health to the posts of public analysts, and those governing bodies which control the examinations in public health should aid the reform by limiting the course of chemical study within practical requirements. When one comes to the consideration of bacteriology the course of study becomes more serious. The time deducted from the present day teaching of chemistry might, as has been said, be profitably given over to bacteriological
work. It is in this laboratory that the budding medical officer of health finds himself embracing a science, the thorough grasp of which must be one of his best accomplishments. Every candidate should be called upon to display an intimate knowledge of bacteriology in its relation and application to preventive medicine. The bacteriology of soil, sewage, air and disease should be so accurately known as to enable the future medical officer of health not only to map out a line of research or study for others, but also to put his own hand to the incubator, and if need be the test animal. At present the bacteriology professed is of sufficient extent to enable the candidate to name specimens, to make slides or answer general questions. More than that is required, and no one recognises this more than the present day public health official. Vaccine therapy is still in its infancy and must be included in the foregoing course; because we still have much to learn regarding its value. All this entails time it may be argued. But that is not denied. Think of the days now being unnecessarily devoted to chemistry. A medical officer of health cannot know his bacteriology too well. He may very soon forget his chemistry. If it does not actually pass out of his mind, he certainly has no
SEPTEMBER,
further concern for the major part of what he has been taught when he becomes involved in active administrative work. I speak regretfully, because my own meagre training in bacteriology often finds me unprepared to delve into the fascinating labyrinths of original research. The opportunities for the study of this branch of preventive work twenty odd years ago were very scanty. I therefore not only envy those who have the present opportunities for learning; but regret to observe that so many fail to embrace the grand chances presented by well-known teachers and elaborately equipped laboratories. A man holding the health qualifications and, literally speaking, armed to the teeth with a full training has a splendid outlook before him. His worth will force him to the front. And when he does become a medical officer of health he will be tempted to follow side paths of research; since it will be only when he is brought face to face with present day problems that he can appreciate how much yet remains to be done in the domain of epidemiology alone. It is not necessary that the future administrator shall shut himself up in a laboratory. But the fact that he is an administrator will empower him to map out schemes of research for those qualified to complete them. Original research h a s brought many an obscure individual to the front. Such work will continue to mark for high distinction those who have the capacity for taking pains and are gifted with that unique attribute, fecundity of ideas. Therefore I can conceive no better grounding for the public health student than that which demands a prolonged and assiduous study of bacteriology. The fact that he has gone through the searching work demanded by this course will fit him to meet an examiner with every confidence. W h e n we come to the second part of the examination we find that a good deal of reading and memorising can be depended upon to command success, as far as examination purposes are concerned. Sanitary law of a very extensive nature must be professed. The student usually knows this part of his work fairly well. But at the examination table he is amazed to find himself confronted by two solitary questions, and these, after weeks and weeks of strenuous work upon
1914.
PUBLIC HEALTH.
a dreary subject. The oral may fill up this inefficient test of knowledge, but half of the oral is occupied, as is the paper, with questions upon vital statistics. The examiner may never have had any experience in the administration of sanitary law. He is, therefore, quite unable to bring out what his candidate really knows. An examiner has been known to have a list of questions written down. A departure from his parrot-like catechism would have found the gentleman quite at a loss to cross-question the candidate. That is not the way to conduct a serious examination. Sanitation can be professed from b o o k s - that is to say, the theoretical side of the subject. But what of the practical aspect, which, in after life, is to be the foundation of the health official's success. Little or no practical knowledge is demanded at the examination. The present certificate of proficiency granted by the medical officer of health is sufficient, because the pupil is asked little beyond elementary questions. Nevertheless, the present certificate is inadequate. The examination should attach greater importance to the work actually done under the medical officer o f health. And it is really at this point that one is faced with difficulties in making recommendations towards improving the present scheme of examination. As long as pupils present themselves in batches of eight, nine, or it may be a dozen at a time, the medical officer of health who undertakes the pupilage system will find it difficult to perform the work in a way that is either satisfactory to himself or to his students. Under the existing system the men present themselves at the Public Health Office on two or three days a week for six months. The medical officer of health has council meetings to attend, and his other duties may compel him to hand the pupils over to a deputy. Once a week a sanitary inspector conducts the students about, showing them drains, cowsheds, bakehouses, offensive trades, and so on. Some pupils attend regularly, others do not, and so on the time is passed. Six months have been spent in out-door work, and the certificate of attendance is duly filled in. As the examination is presently conducted the knowledge acquired is quite sufficient for the student'g purpose. Practical sanitation presently consists in writing a report upon a house inspection. This is a farce, and nothing else.
403
But how can matters be improved ? The medical officer of health cannot give up every day of the week to teaching, nor dare he be seen marching a band of students day after day round his district. Councils are now so constituted that certain members unhesitatingly complain when a medical officer of health takes pupils. The council appoints a medical officer of health " to devote his whole time to the duties of his office," and nothing outside that is permitted. The medical officer of health may accordingly take the pupils " in his own t i m e " to give them a theoretical conception of public health. Something must be done to overcome this obstacle to teaching. An understanding will have to be arrived at at teaching centres whereby the controlling sanitary authorities may be persuaded to permit their medical officer of health to afford pupils the necessary educational facilities. Three months must be so spent, and the attendances must be daily and uninterrupted. Each day of the week should be devoted to a particular inspector-say, Monday with the drain inspector, Tuesday with the food inspector, Wednesday at the slaughter-house, Thursday with a district inspector, Friday with the epidemic officer, and Saturday in the office. But to make this work real each pupil should be provided with an " a u t h o r i s e d note b o o k " (authorised that is by the teaching or qualifying body). In this book a detailed diary of the week's work will have to be written up, together with the plans of defects inspected and the alterations required by the Public Health Department. The writing up of this book might be done on Saturday forenoon. This record of work must then be corrected, criticised and sub-edited, as the case may be, by the medical officer of health, who will sign each week's work. Further, this book should form the basis of practical proficiency at the final examination ; each volume being presented to the examiner in sanitation a week or more before the written examination takes place. A practical man can quickly tell whether or not the pupil has been actually comprehending the meaning of his " o u t - d o o r " work. If need be the candidate can be taken over his records in a vivd voce examination. The possibility that such may be done will compel the pupil to study his diary so that he may be able to explain his notes and observations. So much for practical sanitation.
4,04
PUBLIC
More particular knowledge is required from pupils as regards fever hospitals and tuberculosis schemes. In fact every aspiring medical officer of health should provide himself with the qualification of residency in a fever hospital and attendance at a tuberculosis dispensary. Architects can work out the details of sanatoria, dispensaries, and isolation hospitals; but the architect looks to the medical officer of health to supply the data for the actual requirements. The scheme above outlined implies that each pupil must make up his mind to devote his whole time for a complete year to the study of the ~¢arious branches required for this examination. At present there are men who become pupils with a medical officer of health merely for the sake of securing a qualification which may command promotion in one or other direction. In these days when wire pulling and other influences are depended upon for the securing of appointments the casual student, provided with a qualification in hygiene, is placed in unfair competition with him who has really given" serious and prolonged attention to the study of public health. F o r the individuals who merely want a health qualification there should be a distinct certificate granted. Their qualification would only convey with it the information that the possessor was proficient in elementary hygiene. Perhaps it would be well to make this certificate include those who are going to become medical,inspectors of schools and school children. If so, a special training would be required by compulsory attendance for three months at a school clinic. Such certificate might be called the Sch. Hy. (Certificate in School Hygiene). In conclusion, I would suggest that at every university or teaching school there should be a complete curriculum for studying the various branches required for the public health qualification of the future. The subjects taught should include chemistry, bacteriology, applied public health (including sanitary law and vital statistics), epidemiology (including tuberculosis), sanitary engineering and drawing. Fever hospitals, sanatoria, tuberculosis dispensaries, meat, and perhaps fish markets, are all available in large teaching centres, so that the pupil would command a wide field of practical work.
SL~PTEMBER,
HEALTH.
My point is that the course (excepting outdoor work) should be given in a systematic way in a recognised medical school which is empowered to grant degrees. W e might have fewer pupils, but we should get a better class of men who would make public health a serious study. SYLLABUS SUGGESTED. Chemistry. Physics.
One
Summer Session.
Three months, one day weekly ; three hours each attendance.
Bacteriology,
Three months, four days we kly; five hours each day.
Epidemiology and Tuberculosis.
Twenty-five Lectures, to include visits to Hospitals and Dispensaries.
Sanitary Law and Vital Statistics.
~Vinter Session.
Twenty-Five Lectures including atten dance at Court Cases.
Year
THE
Sanitary Engineering and Drawing.
Twenty-Five Lectures, and Demonstration s.
Applied Public j Health.
Twenty-Five Lectures.
Pupilage with I Summer Medical Officer Session. of Health, )
Three months, daily attendance. Also visits to Sewage and other works controlled by Public Heahb or Cleansing Depattments.
THERAPEUTIC USE OF T U B E R C U L I N . - - I n
the number of PUBLIC HEALTH of May of last year appeared a paper by Dr. Cecil Wall on the therapeutic use of tuberculin. In this paper Dr. Wall writes that "the type of case from which the best results are claimed is that in which a certain number of recoveries may be expected with other forms of treatment." The risk attending the use of tuberculin is pointed out by him. Opinion as to its value is obviously divided at the present time, but the fact that bad results may attend tuberculin treatment cannot be denied. In a letter to the Lancet of July 25th of the present year, the results in a particular case are given by Dr. Charles Miller. There is evidently much need for watchfulness in connection with the use of tuberculin. SALE OF I-IYPODERMIC SYRINGES P R O H I B I T E D . T h e "Boylan Law," which came into force in New
York State in July of this year has amended the public health law in relation to the sale of habitforming drugs, which are prohibited as well as hypodermic syringes, unless prescribed by a physician.