We find in the average city that we have a part-time health officer who is usually engaged in active practice. He can not enforce health measures without creating antagonism amongst his professional brethren, and amongst his own patients to the detriment of his practice; therefore we find him doing as little as possible.

In the control of communicable diseases we find lax reporting, and more lax supervision. The quarantinable diseases are placarded, but the complaints of the public are depended upon to secure observance of the quarantine regulations. No epidemiological investigation is undertaken, and the unnecessary expense of fumigation is indulged in. The quarantining and fumigating are very frequently done by the plumbing inspector, or sanitary inspector, as a side issue to his regular duties.

The health officer usually makes no examination for release from quarantine or isolation. He invariably neglects the minor diseases, makes no tabulations other than those required by the state board, and is unable to work out a morbidity rate; in fact, I doubt if he knows what such a thing is.

In the conservation of child life, with possibly the exception of medical inspection in schools, practically nothing is being done in the average city. We frequently find. baby week campaigns have been held; these are usually fostered by mothers' clubs of the city, but this very good work is not followed up by the health department. No. supervision of midwives, maternity homes, or homes for children is undertaken, except possibly the registration of midwives. (Under the present laws of California anybody can be a midwife.)

Birth registration is not actively enforced, so no determination can be made of infant mortality rates. Nothing is done about child labor.

Under food supervision we very frequently find more activity shown than in any other department. A milk inspector, and frequently a food inspector, will be found, and occasionally stock is inspected at the time of killing.

Sanitary supervision is usually reduced to the abatement of nuisances, and is a very secondary part of the work of the plumbing inspector.

A laboratory is usually maintained for the examination of swabs for diphtheria and sputum for tuberculosis for diagnoses.

Bacterial and chemical examination of milk is also done, but we find as little as possible is done where the pay is part time and there is no incentive to increase the amount of work.

Public Health Bookkeeping

Under office detail we usually find a clerk whose duties are about equally divided between receiving reports of cases of communicable diseases from physicians, ordering quarantines and fumigations, receiving and registering birth certificates, death certificates, issuing burial permits, answering 'phone kicks, issuing permits for milk, meat, and other vendors, and making reports to the State Board. No bookkeeping of public health is done, therefore no information is available which would show the health situation of the city. An annual report is usually not prepared. "Bookkeeping of Public Health" is a very good term borrowed from Irving Fisher. A city which does not do such bookkeeping is on a par with the business