Bringing Order into the Administration of Health Services *

More than a century has passed since Edwin Chadwick in England (1842) made some of the first studies of public health services to bear fruit in new methods. Lemuel Shattuck in this country studied the State of Massachusetts in 1848 and we shall soon mark the centenary of his publication. Since these early beginnings very significant progress has been made in our means for conserving health, and it has not been progress by blind evolution. It is well that the record should show how this has been achieved. In the United States, Shattuck's Report of the Sanitary Commission in Massachusetts (1850) represents a notable mile-stone of progress.4 This report is still a source of wise guidance and inspiration, representing one of the very first serious proposals to bring the scientific method to bear on public administration. The Report of the New York Citizens Association on Sanitary Condition of the City (1865) 5 followed the Shattuck report on Massachusetts and was published shortly before the appointment in 1874 of a committee of 24 "to prepare schedules for the purpose of collecting information with regard to the present condition of public hygiene in the principal towns and cities of the United States, and the laws and regulations, state and municipal, relating to the same period." This was an early activity of the American Public Health Association which, in 1947, will mark 75 years of existence. This sur6vey schedule was developed by Dr. John S. Billings,l a man of many talents, and it represents perhaps the first comprehensive document for recording all phases of public health practice as it then existed. The schedule included sections on the sanitary condition of the community and on the laws, the personnel, and the procedure for the control of illness and death. This was a wonderful germinal idea, but it did not come to immediate fruition. Indeed, it was 41 ye-ars before the publication, in 1915, of the epoch-making report on American state health departments by Dr. Charles V. Chapin of Providence.2