HEALTH

[The widespread flood disaster in Ohio during the last week of March led members of the Pittsburgh Flood Commission to study the situation. Morris Knowles, a member of the Engineering Committee of this commission, has had two assistants in the field for this purpose. One of these, M. R. Scharff, who had previously been employed by Mr. Knowles in making a sanitary survey of the coal-mining camps in Alabama, paid particular attention to the sanitary conditions resulting from the flood. The present article embodies observations made on this trip.—Ed.]

Following in the wake of great disasters which descend from time to time upon our cities, paralyzing the public services that make crowded city conditions possible, is the outcropping of disease that may, if unchecked, prove more disastrous even than the catastrophe itself. This tendency was discernible in the first reports of the floods that have recently devastated Ohio, Indiana and adjoining states, due to the heavy rains of March 24–28. Nearly every flooded city reported that its water works plant had been put out of commission, or the water supply polluted, which with the increased chance of infection, and the general lowering of vitality presented a situation of unusual menace and one demanding complete and immediate handling.

The most serious situation is Dayton, for here every sanitary problem presented at any other point was involved. The complete, immediate and effective organization to handle the situation which was formed there was typical of the effective work now done at such emergency periods.

At Dayton the water works plant was incapacitated by water that reached ten feet above the boiler grates; there was unknown damage to water distribution and sanitary sewerage and drainage systems; storm sewers and catch basins were clogged with filth and debris; dead animals were strewn on every side; the population was at high nervous tension, their vitality lowered by shock, exposure, cold, and lack of food and drink; hundreds of people were crowded for days in single buildings or dwellings; thousands, probably, had been exposed to intestinal infection by drinking the dirty flood water as it swirled through the streets; hundreds had only wet cellars and rooms to return to, if their homes were not altogether destroyed; and everywhere on everything—walls, ceilings, floors, furniture, streets and sidewalks—was a thick coating of the black, sticky, slimy mud left by the retreating waters. This in a measure pictures the situation at Dayton as the flood waters receded. And Dayton knew at once that the toll of the flood would be as nothing compared to the pestilence, unless attention and energy were directed to these problems.

This appreciation of the paramount importance of sanitation was a striking revelation of the success of the campaign of sanitary education that has characterized the last century. In every phase of the work of recovery, in the warning signs and directions on almost every post, in the placards on the automobiles of the sanitary department stating that “This car must not be stopped or delayed day or night,” in the daily exhortations in the free newspapers distributed throughout the city, in a thousand ways, Dayton declared again and again:

“Sanitation first and foremost. Then everything else.”

Such was the spirit of the members of the Dayton Bicycle Club, when they met as the waters receded from their club-house to consider what service they could best render to their stricken city, and volunteered to removethe dead animals strewn it the streets. Such also was the message reiterated by the Ohio State Board of Health, the city health officials, the representatives of the national government, the Red Cross, the Relief Committee, the Ohio National Guard, and every one of the splendid organizations that are working shoulder to shoulder to clean up Dayton and to prevent conditions more costly in toll of life than the deluge itself.

One of the remarkable features of the handling of the relief work at Dayton was the entire absence of red tape, the lack of conflict, and the universal evidence of harmonious co-operation between the various organizations at work, notwithstanding that there was no complete centralization of direction and that some of the organizations were proceeding practically independent of the others. “Results, not credit,” was the watchword, and the results were such as to reflect the most lasting credit upon all engaged in the work.

The Dayton Bicycle Club showed wisdom in volunteering to remove the dead animals from the street. Nearly every horse in the more than seven square miles of the city that was under water—and this area contained all the important livery stables—was drowned, and quick action was needed to remove the bodies to prevent serious results. A sanitary department was organized, and as rapidly as automobile trucks and wagons were volunteered, they were pressed into service. Over 100 vehicles and about 600 men were engaged on this work. A rendering company, which handles all the garbage collected in the city, agreed to take care of the horses and did so as fast as they came for a time. When the carcasses came so rapidly that it was necessary to heap them up on the grounds of the plant, and then on a vacant field nearby, the plant was a grewsome place indeed. Up to the night of March 31, 1,002 had been received. A number were picked up the next two days, so that the final total was probably in the neighborhood of 1,100.

At about the time this work was started, a reconstruction department was organized, under the Citizens Relief Committee, with divisions, each under an engineer, assigned to street cleaning, sewers and drains, streets, and levees. By March 31, the removal of dead animals had been practically completed, and the organization and equipment of the sanitary department were merged with those of the street cleaning division of the reconstruction department. Sanitary notices directed that all mud and rubbish be deposited at the curb, the city was divided into districts and collection progressed rapidly, considering the wagons and trucks available. More wagons could have been put into service, but horses were lacking. All mud and rubbish was hauled to one of the half-dozen city rubbish dumps located in low outlying sections, or was dumped off bridges into the river. The employes of the city water works department were able to get into the pumping station on March 28 and the following day pumping was resumed. Dayton’s water supply comes from a number of deep drilled wells along the Mad River. It is pumped direct into the mains without storage, by means of a Holly vertical, triple-expansion, crank and fly-wheel engine. This pump has given rise to the local name of “Hollywater” applied to the city supply. It was feared at first that the distribution system had been badly damaged, but investigation showed that only three small mains had been broken. Water, at reduced pressure, was therefore possible, except in one or two small sections.

AN IMPROVISED COMFORT STATION

Dayton water is exceptionally pure, but it was feared that there might have been leakage of flood water into the pipes while the pressure was cut off and so notices to “boil all water, even the Hollywater” were posted. Samples were promptly taken for analysis from various portions of the distribution system by the chemist of the National Cash Register Company, the bacteriologist of the city Board of Health, and by the State Board of Health, but the injunction to boil water was continued, even though the first analysis was favorable.

The catch basins and storm sewers throughout the city were badly clogged with wreckage and filth, and early cleaning was imperative. The city was divided into seven drainage districts, and gangs of men and wagons assigned to shoveling out catch basins and hauling the rubbish to the dumps. At the same time systematic inspection of the sanitary sewerage system was begun. It had been expected that the sewers would be clogged, like the storm drains, and the early sanitary notices issued contained these warnings:

IMPORTANTSanitary NoticeFOR YOUR OWN HEALTH(1.) Do not use Sanitary sewers and Closets until notified by the Board of Health. Even if the hollywater system is on, the sewers are full of mud and will clog. Burn or bury all excreta garbage and filth. Add lime and bury deep. Use disinfectant in out-door trenches also.(2.) Thoroughly scrub, clean and dry your cellar. Keep your cellar windows open. Remove and burn or bury all rubbish. Sprinkle lime around cellar, especially in damp places. Sprinkle floor with disinfectant sent herewith (two tablespoons-full to one quart of water.)(3.) Thoroughly clean your in and out door premises.(4.) Place concentrated lye or a tablespoon of disinfectant in each sink or trap in toilet, basement and kitchen. Allow to stand over night. Do this every evening.(5.) Boil all water, even holly water, and thoroughly cook all food. Boil all cooking utensils. Do this for months to come.(6.) Do not enter houses which have been flooded until thoroughly cleaned and dried.(7.) Keep your own self clean.Do these things to avoid pestilence and sickness.Do it for yourself.Do it for Dayton.Take care of yourself and you will take care of Dayton.Maj. L. T. Rhoades,U. S. Army.ONE OF THE EARLY NOTICES

IMPORTANTSanitary NoticeFOR YOUR OWN HEALTH

IMPORTANT

Sanitary Notice

FOR YOUR OWN HEALTH

(1.) Do not use Sanitary sewers and Closets until notified by the Board of Health. Even if the hollywater system is on, the sewers are full of mud and will clog. Burn or bury all excreta garbage and filth. Add lime and bury deep. Use disinfectant in out-door trenches also.

(2.) Thoroughly scrub, clean and dry your cellar. Keep your cellar windows open. Remove and burn or bury all rubbish. Sprinkle lime around cellar, especially in damp places. Sprinkle floor with disinfectant sent herewith (two tablespoons-full to one quart of water.)

(3.) Thoroughly clean your in and out door premises.

(4.) Place concentrated lye or a tablespoon of disinfectant in each sink or trap in toilet, basement and kitchen. Allow to stand over night. Do this every evening.

(5.) Boil all water, even holly water, and thoroughly cook all food. Boil all cooking utensils. Do this for months to come.

(6.) Do not enter houses which have been flooded until thoroughly cleaned and dried.

(7.) Keep your own self clean.

Do these things to avoid pestilence and sickness.

Do it for yourself.

Do it for Dayton.

Take care of yourself and you will take care of Dayton.

Maj. L. T. Rhoades,U. S. Army.

Maj. L. T. Rhoades,

U. S. Army.

ONE OF THE EARLY NOTICES

“Do not use water closets. Contents will reach cellars. Use vessels, disinfect, and bury in back-yards. Disinfectants: carbolic acid, chloride of lime, bichloride of mercury, and creolin.”

“Do not use sanitary sewers and closets until notified by the Board of Health. Even if the “Hollywater” system is on, the sewers are full of mud and will clog. Burn or bury all excreta, garbage and filth. Add lime and bury deep. Use disinfectant in out-door trenches also.”

Inspection showed a much better condition than was anticipated. In all but three districts, the sanitary sewers were running freely and the warnings were replaced by new notices:

“Sewers are open and ready for use. If the water supply is not sufficient for flushing, fill the tank of the closet with a bucketful of water, and flush as usual.”

Wooden public convenience stations were also established over sewer manholes in the business sections and in residential sections without sewer connections.

The three sewer districts that were out of commission were the St. Francis, the North Dayton, and the Riverdale low line. The St. Francis sewer is a gravity line, and a manhole at the lower end was completely choked up. It was necessary finally to dynamite this manhole in order to open the line. The two latter lines are both low, and sewage has to be pumped into the river by pneumatic ejectors. The air lines from the compressor plant in the water works pumping station were laid in the levees which were washed out and at one point about 200 feet of pipe was lost. This was difficult to repair, and these districts had to be left without sewerage until April 2, when a by-pass on each line into the storm drains was opened, and the backed-up sewage lowered sufficiently to clear most of the cellars and to permit the use of water closets.

While this work was proceeding the organizations devoting their energies to control of infectious disease, inspection, and administration had been far from idle. The State Board of Health had three sanitary engineers and two physicians, trained in public health work, in the city before the waters receded. The city Board of Health was one of the first in the field, and the medical corps of the Ohio National Guard promptly took up the work. Co-operating with one another, under the direction of Major L. T. Rhoades of the United States medical corps, who was appointed chief sanitary officer, and with the assistance of local doctors and nurses and those furnished by the Red Cross, these organizations soon established control of the entire city in a comprehensive and effective manner.

The Ohio State Board of Health engineers were assigned to assist in the water works, sewerage, and general cleaning up. Then, in co-operation with the city board and Major Rhoades, the city was divided into sixteen sanitary districts, with a physician in charge of each. These physicians inspected their districts, reported to headquarters, conditions requiring particular attention, instructed people in sanitation and followed up all reported cases of illness to guard against contagion.

The city bacteriologist reestablished his laboratory, which had been inundated, and took up diagnostic and analytical work. The state plumbing inspector and the state inspector of workshops and factories established offices, and joined with the city inspectors in pushing inspection work rapidly. Men were sent out to trace all contagious cases that were on the books at the time of the floods, and the reporting of infectious diseases and deaths were resumed as rapidly as possible.

Four contagious disease wards were established in addition to the tuberculosis and small-pox hospitals, two in the St. Elizabeth and Miami Valley Hospitals in the city and one each in North Dayton and Riverdale. As fast as infectious cases were reported or discovered, they were removed to one of these wards, and the houses placarded and disinfected.

A food inspection office was also opened, and all food arriving on relief cars was inspected before distribution to relief stations, that which had already been distributed being inspected at the stations.

The medical corps of the Ohio National Guard established a base field hospital in the new courthouse, and a supply depot in the probate court room of the old courthouse. In addition, seven relief hospitals were established in Dayton View, Miami City, Edgemont, South Park, the Davis Sewing Machine Company’s plant, North Dayton, and Riverdale, with a surgeon of the medical corps of the National Guard and a corps of civilian physicians and Red Cross nurses in charge of each. These stations had maternity, general, and infectious wards. Hospital and proved infectious cases were promptly forwarded to St. Elizabeth’s or the Miami Valley Hospital. The base hospital received all cases among the companies of the National Guard on duty; those which would obviously not recover in time for useful service were returned to their homes. The supply depot of the field hospital not only furnished the base hospital and the seven field stations, but supplies were also furnished to the sixteen stations of the sanitary committee, at the request of Major Rhoades.

An efficiently manned hospital doing all classes of work was established by the National Cash Register Company and the American Red Cross in the administration building at the National Cash Register Company’s plant, and other medical relief stations were maintained in the city by the Red Cross.

Up to the close of the first week following the flood no unusual prevalence of infectious disease had developed. Some cases of diphtheria, pneumonia, and measles were reported, but the number was not substantially larger than that previous to the flood. When the conditions that prevailed during the first three days after the disaster are considered, with the strain on the entire population during the first days of reconstruction, it seems impossible that Dayton will escape without a considerable number of cases of intestinal and exposure diseases, such as typhoid and pneumonia. But the complete, efficient, and harmonious system of public health organization that has been established gives promise that no epidemic will follow and that the first cases, due to infection before control was established, will be the last.

ALICE HAMILTON, M.D.

As the interest in Dr. Friedrich Franz Friedmann and his tuberculin increases and a large part of the world is anxiously waiting to have its hopes confirmed that at last a real cure for tuberculosis has been discovered, it will be interesting to state what is positively known about this treatment, to what extent it is a new discovery and why the medical profession has shown such hostility to its originator.

In the first place Friedmann’s remedy is not a “serum.” Anti-toxins, such as those used against diphtheria and lock-jaw are sera. An antitoxin is the serum of an animal which has been treated with toxin-forming germs till his blood serum is full of defensive substances against that toxin. An antitoxin, as its name indicates, is an antidote to a poison.

Friedmann’s tuberculin belongs to the class which we have of late begun to call vaccines, a term formerly applied only to the virus of cowpox but now made to cover all forms of virus which are used to stimulate the production of defensive substances. The real difference between an antitoxin and a vaccine is that the first contains an antidote and is an emergency remedy for an acute disease, while the second is a weak form of virus which causes the body of the patient to manufacture its own antidote.

What Friedmann claims as novel in his tuberculin is that it consists of living tubercle bacilli, while those in general use consist of dead bacilli or their extractives. It has long been known that living bacilli would call forth a more rapid production of defensive substances than dead. Dr. Trudeau of Saranac Lake demonstrated this twenty years ago, experimenting on rabbits with bacilli of bird tuberculosis. Later several Americans confirmed his results, using non-virulent strains of human tubercle bacilli. Von Behring’s famous experiments on immunizing calves were made with living bacilli. So far therefore as is yet known, there is nothing new in the principle Friedmann is following. As to the details of his cure, we are in ignorance.

It will be long before any dependable word can be given out as to the results of Friedmann’s work in New York city. Every physician knows that optimism, eagerness to grasp at every hopeful sign, are characteristics of a fair majority of consumptives. We shall need a much longer period of observation before we can be sure that this tuberculin has any superiority to the many previously tested, almost all of which have had initial success followed by more or less disillusionment.

Still greater caution must be used in estimating the immunizing properties of Friedmann’s tuberculin. Friedmann treated over 300 children eighteen months ago and states that during this interval none of them have developed tuberculosis. It will be at least fifteen years before positive statements can be made concerning these children and then only by comparing them with a similar group of non-treated children living in conditions as nearly as possible identical with those of the treated children.

As to the attitude of American physicians to Dr. Friedmann one can hardly accuse them of unfairness and of narrow-minded professional jealousy if one realizes that he has violated three of the fundamental laws of medical ethics and, however impatient the non-medical world may be of much that comes under this head, no one can think that secrecy, exclusivenessor self-advertisement are in accordance with the best traditions of medicine.

A significant contrast could be drawn between the methods pursued by Dr. Friedmann and those pursued by Paul Ehrlich when he announced his new cure for syphilis. No charge of charlatanism or commercialism could ever be brought against Ehrlich. From the first, the medical world knew all about salvarsan, and knew that it would be put into everyone’s hands as soon as Ehrlich thought it safe to give it out for general use. He insisted that it first must be carefully tested, not by himself alone but by approved clinicians, who would agree to use it only on patients that could be kept under constant supervision in hospitals, and who also would agree to make detailed reports of these cases. After this thorough trying out of the new cure, it was given unreservedly to the medical profession the world over. Undoubtedly Ehrlich could have come to America and reaped golden profits by keeping the cure in his own hands, for thousands of cases were eager to have it administered.

The Friedmann tuberculin may be what its discoverer claims it is, but the confidence felt in its promoter can never be the same as that which Ehrlich has won.

JANE R. McCRADYELLIS MEMORIAL CLUB, BOSTON

JANE R. McCRADY

ELLIS MEMORIAL CLUB, BOSTON

Last spring I attended in Boston a course of lectures on sex hygiene given expressly for social workers. The course was given at the request of a number who had been meeting for some time previously to discuss “what women social workers can do now to promote a better knowledge of the meaning of sex in life.”

The course was planned by approaching the subject from various aspects, physiological, psychological, neurological, ideal and simply human. Talks were given by people whose interest in the subject was vastly different—physicians, social workers and mothers, and all showed a spirit of earnestness and willingness to help.

The first few lectures were crowded—overcrowded, in fact—which showed the great need people feel in being aided and enlightened on a subject which touches all to some extent.

When the course was over, there was a feeling of disappointment among some who had attended throughout. Many others had dropped out because they “could not give the time as they were not getting out of it what they hoped for.” What did they hope for? The best answer is that when the opportunity for written questions came, nearly all the inquiries were “What shall I say to so and so when she asks so and so?” “What should be said to a young man under such and such circumstances?” and similar definite demands.

That was the point! People so often want absolute information on subjects in which “circumstances alter cases!” No human being can tell any other human being what he or she “should say” to a third person on any subject at any given time. Each of us has to give of his knowledge which is fed by his experience and modified by his temperament. We give this knowledge (if we are wise) to whomsoever happens to need it in such language as shall appeal to his knowledge, apply to his experience and adapt itself to his temperament. We can not learn how to do that at any lecture or set of lectures, and just as long as we expect it on this or any other subject, we are sure to be disappointed.

The great importance of a right knowledge of sex is borne in upon social workers daily, often hourly, on account of the many people they meet whose lives are exposed to dangers which with either wrong or incomplete knowledge they are not fitted to meet safely. It is frequently the duty of the social worker either to supply the knowledge or help in the situation brought about by lack of it. Often they feel unequal to the task and become morbid over the sorrows brought about by ignorance and their own inability to help matters. Lectures or books on sex hygiene are advertised; to them they turn for assistance. All too often are they disappointed, gaining no concrete knowledge of how to give an answer to problems on their minds at the time. Likewise some people go to a lecture or course given by some one who has been successful in connecting his or her knowledge and experience and giving it out. Afterward they come away thrilled and inspired and proceed to repeat like parrots the words they have heard.

Bitter disappointment at the lack of interest on the part of the audience is the result. I knew of some mothers who attended Laura B. Garrett’s talks in Philadelphia, and came away eager to instruct their children. In each case the result was wholly unsatisfactory. They tried to reproduce Miss Garrett’s words, instead of simply getting knowledge and suggestion from her talks. What they were imparting was not a part of themselves, not their own, therefore not theirs to give.

Miss Garrett has worked out her talks from years of patient, earnest work and hours of thought. She can tell us of her methods and can illustrate, but if we are going to use her methods we have to make them our own first. We must adapt them to our own experience and apply them to the experience of those to whom we are giving them.

The same is true of any other speaker on this subject. There is no fixed method by which a right knowledge of sex in life can be universally taught. We may learn how to teach biology or physiology, or how to adapt the law of life andof coming to life in plants or animals to human laws, but that does not necessarily qualify us to meet the problems of sex in life or to teach others to meet them. There are a few essentials to the proper teaching of the meaning of sex in life and if we possess these we ought to be able to deal with our problems as they come, if we are capable of using our possessions.

First, a real living belief that our bodies are the “temples of the Holy Spirit,” a belief which applies to all parts and functions of the body and makes it a sacred duty to keep them healthy and clean and strong.

Second, an intelligent knowledge of the body as a machine so that we may use it and not abuse it.

Third, a calm, moderate knowledge of the more common perversions of sex and their relations to other forms of nervous troubles, and a belief in human ability to overcome weakness and sin as well as to cure disease.

These things we can learn and keep on learning at lectures, but how to give them out from our personality to other personalities is for each person his or her own individual problem. It must be solved by bringing his or her own experience of life, plus specific knowledge, plus sympathy, plus common sense, to bear on each problem and so to adapt it to the understanding of the person in question that it will help the existing need.

When the Wise Men of Bethlehem presented gifts, each brought his own gifts, not another’s. They were wise men. If we social workers are wise, we shall cease to try to gain from others words in which to express the knowledge of the meaning of sex in life and will bend our energies to gaining high ideals, simple workable knowledge of the use of the body and the evils of its abuse and an understanding heart and common sense.

Then we shall be able to bring our gifts to this subject and present it to those who need it in such forms as to be practical and effective.

RELL M. WOODWARDSurgeon United States Public Health Service

RELL M. WOODWARD

Surgeon United States Public Health Service

Travelers from almost all foreign countries describe the public convenience stations of foreign cities. In London there are many places where crooked streets converge, leaving perhaps an irregular open space or plaza. These are not all occupied by statues, as the city has attempted to provide comfort for the living as well as honor to the dead. Two modest iron stairways with suitable signs lead to two rooms below ground, one for women, the other for men, where toilets and urinals are found.

On the continent the provisions are usually less complete and in many instances in the eyes of Anglo-Saxon observers seem much too public. For instance in Paris urinals for men are located at convenient points, but some of them only cover the user from the breast to the knees. In Antwerp and Brussels urinals are attached to posts at the edge of the narrow sidewalk, and some of them have no screen at all. In Rotterdam at frequent intervals scrolls of sheet iron shaped somewhat like a letter C are located in the gutters of the sidewalks; the open side of the scroll facing the street. They reach from a point above the head to about a foot from the ground. In Italy there are places, notably Naples, where two slabs of slate set in a wall at an angle serve the purpose of a urinal. They are usually at the entrance to a small street or alley, and are not screened. The custom of ages causes the natives to pass by these without a glance, but to use them is embarrassing to the tourist.

It is not the intention to advocate such crude contrivances, but to present a plea for the establishment at frequent intervals of convenience stations designed for the use of both men and women, and with such surroundings that one may enter and leave without feeling the blush of shame.

Many American cities have provided a few such places, for instance in parks, and some of these are admirable in conception and in structure; but one cannot always remain near a park, and in winter when the kidneys are most active, these stations are often closed. One of the most practical stations of this kind that I have seen is in the Boston Common. It is underground in a small hill, with a wide stairway leading to it.

As one approaches it he sees that the room is lighted and is lined with white tiling. There are urinals, closets, washstands, and a shoe-blacking establishment. It has the appearance of a toilet room in a hotel, and the place is well ventilated and kept clean. I do not recall how it is heated, but such places could be heated with steam from adjacent buildings or by stoves.

Cities must of course consider the economic side of any new enterprise. I believe that such stations, outside of the cost of original construction, could be made almost if not quite self-supporting, in the following way. Lease the shoe-blacking privilege to an individual for a good round fee, said individual to be subject to certain rigid rules and regulations, and the place to be subject to periodical inspections. The lessee should be required to keep the place in perfect sanitary condition. In addition to his income from blacking shoes the lessee might be allowed to rent a few closets, ordinarily kept locked, and charge a small prescribed fee. If the patronage of the station in Boston Common is a criterion it would seem to me that the city could demand a fee from the lessee that would cover all ordinary running expenses.

A woman attendant in the ladies’ station could be allowed the privilege of renting closets, and could also be provided with pins, buttons, and other necessaries such as are kept in the ladies’ waiting rooms at department stores.

As a public health measure the subject must be considered from two standpoints, the health of the individual, and the health of the community.

Physiology teaches us that the normal adultbladder, when fully distended, holds twenty ounces, but that a discomfort begins when it contains more than four ounces. As one advances in years prolonged retention of urine causes ammoniacal decomposition, with consequent irritation of the bladder. If the retention is frequent, disease of the kidneys must follow.

At present in most American cities there are few convenience stations available to the public outside of hotels and saloons. In nearly all hotels one finds a sign stating that the toilet facilities are for the exclusive use of the guests. This makes a stranger feel unwelcome.

Saloons are open to the public, but one dislikes to make use of the sanitary privileges offered without purchasing something. To a man of mature age, who is perhaps in the habit of taking an occasional drink, this phase of the subject has little importance; but for a young man in a strange city, driven for lack of comfort stations into a saloon the question assumes a moral side. The only way to avoid the saloon is to make use of an alley or other dark place, thereby breaking a city ordinance and creating a nuisance which gives the offence a public health aspect. The frequency with which this is done is evidenced by the familiar sign “Commit No Nuisance.” In London I saw a sign that to my mind was much less objectionable and equally effective; it read simply “Decency Forbids.”

The establishment of comfort stations at convenient points would I think contribute greatly to public health.

The January Bulletin of the Department of Health in New York city shows that the downward curve of the death rate during 1910 and 1911 was continued in 1912 and that the lowest point ever recorded in the city has been reached. In 1911 the death rate was 15.13 for 1,000, while in 1912 it was 14.11. The difference of 1.02 between the two years means that 5,276 lives were saved in 1912, for, if the rate of 1911 had prevailed last year, New York’s death roll would have been larger by just that number. In analyzing the returns it is found that the decrease has affected those diseases which the Department of Health seeks to control; namely, the acute infectious diseases, tuberculosis of the lungs, and the diarrhoea of children. On the other hand, there is a decided increase in the mortality from those diseases which seem to be peculiar to our modern society and which are not under public health control, organic heart disease and Bright’s disease.

The infant mortality rate is low. Calculated on the basis of reported births the deaths of children under one year number only 105 per thousand born, and in all probability this is a little too high, for New York city does not claim to have more than from 90 to 95 per cent birth registration. The record is encouraging when compared with the figures for Great Britain and Germany. The rate for England and Wales in 1911 was 130; that for Berlin in 1910 was 157.

Only in the last few years has the law required every child attending an elementary school to be physically examined on entering and leaving and, therefore, statistics on the health of school children in England are only now available. About a million and a half children are now examined annually. The report of Sir George Newman, chief medical officer of the Board of Education for 1911, has just been issued. It shows the condition of 186,652 children in thirteen counties and sixteen urban areas and is far from satisfactory. Only in one urban area did the percentage of “good” nutrition reach 45, and from this figure it ranged down as low as 3.8. Of 200,000 children examined in London more than half were found to be defective and over 78,000 were recommended for treatment. According to this report the malnutrition is due in the great majority of cases to ignorance of the relative value of foodstuffs and the means of using them economically, and only in the minority to poverty. About .5 per cent of the children are feeble-minded and of these about one-seventh are of such low grade as to be uneducable.

The preliminary bulletin of the Fourth International Congress for School Hygiene announces a meeting, which is to be held in Buffalo, N. Y., August 23 to 30 next. The three preceding congresses were held in 1904 in Nuremberg; in 1907 in London, and in 1910 in Paris. The president of the congress is Charles W. Eliot, president emeritus of Harvard University; the vice-presidents are: Dr. W. H, Welch, professor of pathology at Johns Hopkins University and Dr. Henry P. Walcott, chairman of the Massachusetts Board of Health. The lists of vice-presidents and members of the international committee includes the names of some of the foremost men of science in Europe and Asia. Buffalo has raised $40,000 to meet the expenses of the Congress and to entertain the delegates.

That the people are coming to favor taxing themselves for public measures to control tuberculosis is indicated by a referendum vote on the establishment of a county tuberculosis hospital in eight towns of St. Lawrence county, New York. The public health committee of the board of supervisors failed to draw up a question to be voted upon in all the towns of the county as instructed by the board. But eight town supervisors took an informal vote on the question. The question carried in all eight towns. The ballots stood more than three to one in the affirmative. This is the first time that this question has been submitted to a vote of the people in New York state. Three of the towns are distinctly rural and only one of the eight communities is a city.

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