ventive medicine, and the problems of poverty and of dealing with dependent, defective and delinquent groups will receive increasing attention. This will have a specially important bearing on giving not only the public health point of view but also the attitude toward modern society which is necessary for devoted and loyal public service.

It is to be hoped that some system of fellowship aid may be made. available to encourage promising men and women of limited means to enter the profession. It is possible that, in connection with these schools, endowments may be secured for fellowships of this kind. It is also to be expected that subordinate positions in public health departments will be open to students in schools of public health so that these persons may at the same time support themselves and turn their work to account as a part of the training which they are receiving. In many places, arrangements of this kind have been made. It is reasonable to look forward to an extension of this plan. Fellowships might also be made useful in encouraging small communities to engage full-time health officers. Graduates with stipends for a year might in this way find openings, and after demonstrating convincingly the possibilities of modern health administration, might be given permanent positions, wholly sustained by local appropriations.

The outlook for public health in the United States is encouraging. There is an increasing recognition of its economic and social importance as well as its bearing on individual happiness. The new sense of nationality which is being forced on us will accustom us more and more to taking the general rather than the individual point of view. We shall be driven to co-operate and to undertake public services on a new basis. It is, therefore, a time when the subject of training public health officers is peculiarly significant. It is to be hoped that the work will be developed not through institutional and local ambition, but with the welfare of the whole country in view.

It seems clear that not every university which has a medical schoo! can provide a full course of public health training. It is desirable, therefore, that a few centers be recognized, and that for the higher types of training these centers be given the ample funds which are necessary for the right sort of education. This does not mean that in many places courses for public health nurses and inspectors may not be profitably introduced, or that in still others laboratory men may not be trained at least up to a certain point. Standards and ideals, however, should be set by a few institutions which have the resources which will enable them to establish genuine schools well equipped, properly manned, dominated by authoritative leaders, inspired by the public health point of view, and working in close fruitful relations with the public health agencies of the community, the state and the nation.

The University of Minnesota.

FUMIGATION.*

BY F. ADAMS, M. D., D. P. H.

Acting Director of Laboratories and Epidemiologist, Department of Public Health, Toronto, Canada.

Our knowledge of the contagious diseases has increased, particularly in regard to the ways in which they are spread, and our conceptions of what is genuinely important and what is relatively unimportant in the matter of prevention have undergone radical changes.

1885. Diseases.

SCARLET FEVER, DIPHTHERIA, MUMPS, MEASLES, INFLUENZA, WHOOPING COUGH,

SCARLET FEVER, DIPHTHERIA, MUMPS, MEASLES, INFLUENZA, WHOOPING COUGH,

*This is in part, an article appearing in The Public Health Journal of Toronto, Canada, in March, 1917.

The writer has endeavored to show in chart form public health belief in 1885, as compared with public health belief in 1916. In connection with the 1916 chart it is necessary to explain that the word contact is not restricted to direct personal contact, but is used in the modern public health sense and covers direct personal contact, mouth spray and contact with articles such as public drinking cups recently infected with moist secretions.

Comparison of these charts will indicate clearly why we now believe the high hopes of the health officer of 1885 were inveitably doomed to disappointment. These charts will also make it clear that according to our present day ideas the control of contagious diseases is by no means an easy matter. Sources of infection, such as carriers, mild cases that do not see a doctor, cases not diagnosed and cases not reported are common. Take with this the national daily habit of passing around mouth secretions and you have the conditions to keep contagious diseases fairly prevalent for a good many years at least.

Finally a comparison of these charts will make it clear that the doubt latterly thrown on the efficacy of disinfection as a public health measure is not a fact by itself but is simply part of a general tendency to question and to discard the beliefs of thirty years ago.

Shall We Fumigate?

According to our present day conceptions of the ways in which the contagious diseases are transmitted, the room occupied by a patient recovering from such a disease is not relatively of great importance and consequently whether the room is fumigated or not is not particularly important.

The arguments for and against are somewhat as follows:

The abolitionist will contend that rooms occupied by infectious cases are entirely negligible as compared with other sources of infection. He will point out that such pathogenic bacteria as may be deposited on toilet articles, chairs, bed-steads, door handles, walls, etc., are subject to nature's disinfecting agencies-light, drying, lack of warmth and food supply and not only do not multiply but die out far more rapidly than they do in the human throat where warmth, moisture, food supply and absence of light are all provided. He will point out that Providence, Boston, and New York and many other cities have discontinued lisinfection after contagious diseases and that return cases from such houses are no greater than they always have been. The scientific evidence that he will cite in support of his points will be strong.

His conservative opponent will argue something like this: Even if your theory is correct what health officer would willingly allow his own child to occupy the bed or handle the objects in a room in a case of scarlet fever or diphtheria or tuberculosis, without first applying some effective method of purification? It may be that a good deal of the infection dies out in the course of time. Most of it may die out in a very short time. In any case some of it may certainly remain and the room should be disinfected with formaldehyde to dispose of any danger that is there.

The writer frankly admits his inability to decide the controversy. Disinfection will probably do a little good. It will certainly not do much good. The real question is What is the extent of our public health effort other than fumigation? Disinfection of rooms and objects does not, in the minds of well-informed sanitarians hold the importance that it once did. It is realized that in the sum total of public health effort, the part played by disinfection is small. In towns and cities where a well organized health department is active, no fault can be found if disinfection continues to be practised. The value of the procedure is not overestimated. The health department does a good many other things than the citizens are aware of and the fact that disinfection is practised does not stand in the way of public education on more important subjects. In a good many cities, towns and rural communities the situation, however, is entirely different. The work of the local health officer is often limited to the placarding and quarantining of such infectious cases as are reported to him together with the disinfection of the premises when the quarantine period is over. These are the visible and spectacular activities upon which the laity forms its opinion of what is good and important in the prevention of disease. No one tells them in any accurate way how diseases really spread, no one speaks to them of the protection of water supplies, of the proper disposal of human wastes, of school inspection, of vaccination, of baby feeding, of the prevention of tuberculosis, of the pasteurization of milk, of any of the many subjects that are of real importance.

In such places disinfection stands as a symbol for stagnation and inaction masquerading as genuine public health effort and that state of affairs is most certainly to be condemned.

THE SUCCESSFUL ADMINISTRATION OF MUNICIPAL HEALTH AFFAIRS DEMANDS THAT THE INTERESTS OF THE PUBLIC SHALL BE THE PRIME CONSIDERATION.

To insure the highest degree of efficiency in administrative sanitation it is necessary to first overcome the apathy with which the public receives the work of its health officials during the quiescent periods of smooth sailing and to be assured of its friendship and help when the uncontrollable spread of epidemics rouses a wrathful storm of vituperative scorn.

Experience discloses the fact that commendatory appreciation of the endeavors of individuals to conform with sanitary requirements, which often are irksome and apparently unnecessary, and detailed explanation of the necessity for fulfilling the requirements of the Health ordinances, will accomplish more than pages of threatening invective or even judicial writs of coercion.-Bulletin Saranac Lake Board of Health, Vol. 1, No. 6.

WAR TIME HEALTH MEASURES PROPOSED AT
WASHINGTON CONFERENCE.

The State of Ohio was officially represented at the fifteenth annual conference of State and Territorial Health Authorities with the United States Public Health Service and the thirty-second annual conference of State and Provincial Boards of Health of North America held at Washington, D. C., April 30th-May 3rd, inclusive, by James E. Bauman, Secretary and Executive officer of the Ohio State Board of Health.

Naturally, the subject of most importance presented at the conference with the Surgeon General had to do with the proposed co-relation of federal, state and local health agencies for service in the present emergency. It was unanimously decided that the Federal Public Health Service, under conditions incident to a state of war, should be the agency of the federal government through which correlation, supervision and direction of the various state and local health agencies should be exercised and it was further decided that aside from the hygenic and medical care of the actual military and naval forces, all sanitary and hygienic activities incident to a state of war which require a national policy, should be corelated, supervised and directed by the U. S. Public Health Service. Suggestion was made in resolutions adopted that a National Sanitary reserve corps be created as an auxiliary to the Federal Public Health Service.

The conference of executive officials of the health departments of the various states and territories unanimously adopted a report of a special committee of which Dr. Herman M. Biggs of New York was chairman in which is set forth the various activities and functions that should be exercised by these officials during a state of war. They are as follows:

First. The sanitation of military and naval camps and camp sites.

Second. The exercise of police powers in relation to the sanitation of the environment of military and naval camps.

Third. The provision, when required, of public health laboratory facilities for the diagnosis and sanitary surveillance of infectious diseases occurring among the troops.

Fourth. The provision as far as possible, when required, of hospital accommodations for the care of cases of communicable disease occurring among the troops.

Fifth. The protection of military and naval camps from the introduction of communicable disease (including tuberculosis and venereal diseases) from the civilian population.

Sixth. The sanitation of intrastate transportation facilities.

Seventh. The investigation and exclusion from military and naval camps of disease carriers.

Eighth. The immediate reporting to the Public Health Service of epidemic foci or various infectious diseases (especially poliomyelitis, epidemic cerebro-spinal meningitis, smallpox, typhus, typhoid, and paratyphoid fevers and bacillary dysentery) developing in any of the states or territories. Ninth. The sanitary supervision of refugees and interned aliens.

Tenth. The sanitary supervision of the sources of the water, milk and food supplies of the combatant forces.