fully plausible from the observations made on the Hartford and the practice on well-managed ships. It was further observed that, as stated in the writer's report mentioned above, efficiency of ventilators as inlets and outlets, respectively, diminishes materially and rapidly as the horizontal axis of the cowl departs from the direction of the wind, or, in other words, as the angle formed by the horizontal axis. of the ventilator cowl and the direction of the wind is increased.

In view of the foregoing, the writer recommends that special attention be given to the facing of ventilator cowls, and that: (a) Ventilators at windward side of a hold be faced away from the wind, and ventilators at leeward side of a hold be faced toward the wind; (b) the horizontal axis of cowls of such ventilators be made coincident, as nearly as possible, with the direction of the wind, and that adjustment of cowls be corrected accordingly as changes in direction of wind or position of ship occur during ventilation after fumigation.

The considerations prompting the foregoing apply also largely to spaces other than holds, such as lockers, storerooms, etc., where the phenomena involved occur, but are less distinguishable because of greater irregularity of shape as compared with cargo holds.

It has been noted that shut-in spaces, with little or even almost no provision for ventilation, exist on most ships. Often such spaces are difficult of access. It has occurred that from known and, at times, unknown causes, gas remained or accumulated in certain spaces below. It may be that the gas was not properly eliminated because of lack of ventilating facilities, or that it condensed in contact with cool objects and diffused after the time when the hold was believed to be clear; and there may have been instances when the gas was absorbed by the cargo, or by the bilge water, and subsequently liberated.

The writer finds that on some ships plying in tropical waters, where noxious odors and gases quite readily form from decomposition of highly perishable cargo (such as bananas, mangoes, etc.), the bilge pumps are called into action to relieve the situation. This is done not only to remove bilge water (which would, under the conditions referred to, be especially foul) but also to induce air currents in spaces insufficiently or not at all reached by the regular ventilating apparatus. Thus it was found that operation of the bilge pumps is of value even after the bilges are dry. The writer learned from one ship's captain that he usually operates the bilge pumps for some time after the ship has been fumigated and cleared at quarantine, finding that he has then less trouble from gas that is still noticeable below or that makes its appearance later. The writer observed on a recent steamship trip that operation of the bilge pumps dry (sucking air) will set up air currents and induce ventilation in most of the places that are especially difficult to free from gas.

In view of the somewhat obscure properties of concentration and condensation of some gases, and the certainty that it is desirable to empty the bilges (a) for sanitary reasons in general, (b) because of possible gas condensation and absorption by the bilge water, and (c) to improve ventilation of remote spaces, which latter point in itself is of commanding importance, the writer recommends that consideration be given to the issuance of new instructions ordering the operation of the bilge pumps until the bilges are fully drained, and continued thereafter for a period of not less than 20 minutes, and preferably longer, such operation to be commenced as soon after fumigation as the ship's crew may safely be allowed access to the pumps.

THE NATIONAL HEALTH COUNCIL AS AN AID TO ORGANIZED HEALTH AGENCIES.

The following report was prepared by the National Health Council committee on programs and budgets and presented before the annual conference of State and Provincial health authorities at its meeting in May, 1923, by Dr. S. J. Crumbine, the representative of the conference on the council, secretary of the Kansas State Board of Health. This report furnishes a comprehensive statement in regard to the National Health Council as an aid to organized health agencies.

A. INTRODUCTION.

By the national unofficial health agencies associated in the National Health Council two main obligations are universally recognized:

1. The support of official health department work and of other governmental agencies interested in various types of preventive medicine, the encouragement of their development, and the handing over of voluntary activities to official groups after adequate experiment and demonstration when such activities have been initiated under private auspices.

2. The education of the public to the general support of official health activities and the advocacy of active cooperation with the public health officials by voting funds, by observing sanitary laws, and by practicing personal hygiene.

This report will deal primarily with those organizations having an extensive program, organized field service, and definite contacts with local or State groups. An effort will be made to present the types of field and central office services that may be placed at the command of the State health officials. Of course, it should be understood that the total number of individuals available for service is limited. Demands are great, and requests for service have always to be considered in relation to commitments already made.

B. GENERAL RELATIONS OF VOLUNTARY AGENCIES TO PUBLIC HEALTH OFFICIALS; GENERAL SERVICES ALL MAY PERFORM.

A primary purpose of nonofficial agencies is the encouragement of the organization

or extension of official health activities in one or more ways:

1. Experiment, demonstration, and research in unestablished fields.

2. The promotion of legislation and appropriations.

3. The development of standards-educational, statistical, medical, nursing, etc. 4. The encouragement of adequate institutional provisions.

5. The recruiting and training of personnel and the continued education of workers. 6. The development of State and local private organizations to support and cooperate with official activities.

7. The education of the public along health lines by means of journals, literature, films, exhibits, lectures, etc.

8. Information, consultation, and advisory service on official procedure in cooperation with the United States Public Health Service and the State health departments (especially as projected by the American Public Health Association).

C. SPECIAL ACTIVITIES OF PARTICLUAR AGENCIES CONSIDERED IN THE LIGHT OF THE USUAL DIVISIONS OF STATE HEALTH DEPARTMENT ORGANIZATIONS.

In this and the following section there are presented summaries of the more important services of certain of the agencies in the National Health Council. The more specialized organizations are carrying on particular services referred to in the present section. In the following section reference is made to one or two organizations whose services are for the most part general in character. It must be understood that certain organizations have functions which fall in each group.

I. Maternity, Infancy, and Child Health:

Coinciding to a large degree with the work ordinarily carried out in this division of State health departments are the services offered by the American Child Health Association-the organization recently formed by the amalgamation of the American Child Hygiene Association and the Child Health Organization of America. Particular mention should be made of

(a) Health supervision and education for (1) parents, infants, young children; (2) school age groups.

(b) Development of methods and procedures for health education and supervision. (c) Stimulation of training of professional workers; scholarships.

(d) Preparation of scientific and popular literature relating to child and maternal health.

(e) Publication of magazine, "Mother and Child.”

(f) A service of information, consultation, and assistance to State and local groups. (g) Bureau of research and statistics in child health problems. II. Public Health Nursing:

While many of the agencies in the council are directly concerned with this field, agencies such as the American Child Health Association, the National Tuberculosis Association, and the American Red Cross, yet particular mention should be made here of the services of the National Organization for Public Health Nursing.

(a) Through the vocational department, fitting "the right nurse to the right work," and developing uniformity in public health nursing:

(b) Through the National Health Library, offering services in the preparation of bibliographies, the distribution of loan package libraries, advice on health literature,

etc.

(c) Through the field service, assisting in the organization of State and local nursing groups.

(d) Through the educational department, offering services in studying problems of the education of nurses for public health nursing.

(e) Through the eligibility department, the establishment and maintenance of standards of nursing education.

(f) Through the membership and publicity department, supplying material for nurses' recruiting campaigns, publicity campaigns, etc.

(g) Publishes a monthly magazine, "The Public Health Nurse."

III. Tuberculosis:

Special mention should be made here of the work of the National Tuberculosis Association:

(a) The medical service, offering consultation on surveys of tuberculosis institutions, advice on occupational therapy, sanatorium and home treatment, industrial rehabilitation, etc.

(b) A crusade service, promoting the modern health crusade in the schools-a service which also has a bearing upon the interests of the division of maternity, infancy, and child health.

(e) A field service, giving special attention to organization problems, programs and budgets of State and local tuberculosis associations, interrelations between voluntary and official groups, etc.

d Publicity and publications service, making available newspaper and special articles, motion pictures, and other educational material.

Statistical service, offering assistance in health surveys, consultation on morbidity and mortality statistics, etc.

f) Library service on tuberculosis and general health through the National Health Library.

(g) Publishes "The Review of Tuberculosis" and "The Journal of Outdoor Life.” The training of personnel through the Tuberculosis Institute.

IV. Venereal Diseases:

Special mention should be made here of the services offered by the American Social Hygiene Association:

(a) The general promotion of public opinion in support of the venereal disease programs of State and local health departments.

b) The making and distribution of films desired by health authorities; placing the program before physicians, social workers, officers of courts, and police departments, and other important groups.

e Similarly, the making and distribution of exhibits, pamphlets, and other publicity.

The provision of full or part time personnel when voluntary aid is desired for surveys of clinics, lectures, conferences, vice investigations, etc.

In addition the association carries on its general activities, which are not usually considered as within the public health field, but which indirectly have a bearing upon reduction of the total number of exposures to the venereal diseases:

1. The publication of the monthly Journal of Social Hygiene, devoted to articles and discussions on social hygiene research and activities.

2. The promotion of education in social hygiene with particular reference to accurate, wholesome instraction for youth.

3. The promotion of protective measures.

4. The promotion of legal measures.

5. Other activities in the general field of social hygiene.

f General sex education and home and child hygiene promotion-an activity also bearing on the division of child hygiene.

g) Library service through the National Health Library.

V. Division of Mental Hygiene:

Obviously there should be mentioned here the services of the National Committee for Mental Hygiene:

ia, A statistical research and advisory service on mental hygiene and insanity problems.

by Public education through lectures, literature, exhibits, monthly and quarterly bulletins, etc.

(c) Institutional and other surveys and promotion of adequate facilities.

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(d) Delinquency and other child health and welfare contacts.

(e) Information and expert advice on general mental hygiene problems.

(f) Library service through the National Health Library.

VI. A Division of Public Health Education:

Many of the agencies devote a major portion of their resources to health education, including the American Child Health Association, the American Social Hygiene Association, the National Committee for Mental Hygiene, the National Tuberculosis Association, the American Society for the Control of Cancer, and the National Organization for Public Health Nursing.

In addition, one agency, the American Red Cross, considers that public health education constitutes one of the first factors in its future health program, through the health study class, lectures, exhibits, classes in first aid, life saving, home hygiene, nutrition, etc. Through the Junior Red Cross, the American Red Cross also offers facilities of interest to child health divisions; and, through its public health nursing service, it is in close touch with the corresponding division of State health departments. VII. Division of Vital Statistics:

Most of the agencies have some facilities for service in this field and could be called upon by State health departments more extensively than is the case at present. The following agencies provide practically full-time statistical personnel, either directly or through purchases of service from the National Health Council, or in both

ways:

1. The National Tuberculosis Association.

2. The National Committee for Mental Hygiene.

3. The American Social Hygiene Association.

4. The National Organization for Public Health Nursing.

5. The American Child Health Association.

D. SPECIAL ORGANIZATIONS TOUCHING DISTINCT FIELDS OF STATE HEALTH DEPARTMENT INTEREST, BUT NOT ORGANIZED PRIMARILY ALONG RECOGNIZED AND ESTABLISHED DIVISIONAL LINES.

I. The American Society for the Control of Cancer:

The particular services of this organization include

(a) Publications of three types: Pamphlets for the profession, for nurses, and for the general public.

(b) Exhibits a number of sets being in constant circulation.

(c) Films-the society possesses one popular dramatized cancer film in two reels. (d) The organization of cancer committees and cancer weeks in cooperation with State and local health authorities.

(e) The promotion of medical standards of diagnosis and treatment.

II. The American Public Health Association:

Last, but by no means least, this organization, composed primarily of official health workers, is in a position to offer valuable and extensive service to public health officials, State and local, along the following lines:

(a) A clearing house, through its sections and annual meetings, for questions of general administrative interests, organization procedure, etc.

(b) Through its committees standards are set as to laboratory, statistical, sanitary engineering, and other procedures.

(e) Through the committee on municipal health department practice, in cooperation with the United States Public Health Service, information about official health organization in general is kept current, and a consulting advisory service offered at the present time to municipalities, and perhaps, subsequently, to States. (d) Through the Journal, general information, employment service, etc.