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In one example the organization cited, Flexner says that aspiring Black doctors should pursue more menial roles: “A well-taught negro sanitarian will be immensely useful; an essentially untrained negro wearing an M.D. degree is dangerous.”

Those cases and others in the region have served as a wake-up call, said Megan Spry, whose job as district sanitarian involves enforcing a state mask requirement at businesses in counties with more than four active cases.

As a result, the county won’t be able to fill the sanitarian positions or hire an intern this summer to help trap mosquitoes and apply pesticides.

Kollar-Kotelly called it “critical” for jail facilities to strengthen environmental health and safety conditions by hiring a registered sanitarian, overseeing new training for inmates and workers on use of cleaning tools and protective gear, and supporting security staff members’ enforcement of social distancing “on a unit-by-unit basis.”

“The craze for paving streets with flagstones was largely driven by sanitarian logic and a desire to seal in the earth’s poisonous gases.”