himself but upon the city and state health boards as well. For satisfactory results there must be healthful living conditions as well as healthful working conditions.

It is therefore with the idea that our employes and officials should hereafter take a keener interest in such matters, become familiar with disease promoting conditions in their neighborhoods and encourage better sanitary conditions in their communities by co-operating with municipal and state boards of health, that this communication is addressed to you.

The water supply, sewage and garbage disposal, milk inspection, fly and mosquito extermination, overcrowding in the home and like subjects. in every community are matters of vital concern to the individual and public from a health standpoint. No matter to what high degree of sanitary standard an industry or railroad may maintain its properties, if the home environment and community sanitary standards are objectionable from a disease-breeding standpoint, that industry or railroad, in consequence, becomes seriously handicapped in advancing the health interests of its employes.

Health boards generally welcome your interest and support in such matters and your public and personal duty should encourage and enlist your full support, action and constant interest in such matters.

We cannot hope to curtail such diseases as tuberculosis, malaria, typhoid, pneumonia, intestinal diseases, etc., among our employes in the communities along the line of the Baltimore and Ohio unless all such communities, and our own shops, properties and equipment are alike maintained at a high standard of sanitation coupled with the knowledge and practice of personal hygiene on the part of our employes.

Therefore it will be appreciated if you will make it your duty and pleasure to become acquainted with the members of your local and state boards of health, become alive to your opportunities for the protection of your own and your family's health and life.

fever.

Among our employes in your community during the past year there were
cases and
days lost on account of typhoid
Yours very truly,

E. M. PARLETT,
Chief Welfare Bureau.

RELATIVE VALUES IN PUBLIC HEALTH WORK.

Not how many dollars to spend but how to spend the dollars you have for public health activities is the subject of a recently issued pamphlet on "Relative Values in Public Health Work." The author is Franz Schneider, Jr., sanitarian of the Department of Surveys and Exhibits, Russell Sage Foundation, who has conducted public health surveys of Newark, Springfield, Ill., Topeka, Atlanta and other cities.

Given some 1,400,000 deaths annually in continental United States, of which one in four or even one in three are from preventable causes, the problem of the public health officer is to so spend the city's health funds as to prevent these losses as far as possible. The heath officials "must decide what parts of the losses are preventable, and must determine how the greatest return in prevention can be obtained with the money available. This is the problem of relative values in public health work."

The actual situation confronting American health officers is that "with the scanty funds now at their disposal, and the great variation in effectiveness of different activities, the most careful discrimination. must be exercised in making up the departments's program. A bad

distribution of funds means lives lost, and the responsibility, a heavy one, falls on the administrative official." The author quotes Professor George C. Whipple as saying, "this is one of the greatest questions that a sanitarian can consider. It is today the most important of all hygienic problems because it comprehends all others."

The discussion cannot well be condensed from the already concise presentation in this ten-page pamphlet. It is offered as a basis for the discussion of health budgets by officials and citizens who seek the highest returns on the city's investment in terms of deaths prevented. Among the tests applied are the damage done by the preventable diseases, their preventability, cost of prevention, and communicability -small pox, for example, "must be suppressed immediately upon appearance, almost without regard to cost.'

Social workers as well as heavy tax payers and all other citizens will be aided by this pamphlet in studying local health expenditures.

CARBON MONOXIDE AND GAS-HEATED APPLIANCES.

"Are garment workers, particularly pressers and ironers, subject to chronic poisoning by carbon monoxide gas, a poisonous constituent of illuminating gas, which may be discharged into the air of workshops by gas-heated appliances?"

The U. S. Public Health Service in a bulletin which has just been issued answers this question in the affirmative. In 11.8 per cent. of the shops examined in a study of the hygienic conditions surrounding the cloak-and-suit and dress-and-waist industries in New York City the amount of carbon monoxide was excessive. In 38 per cent. of the establishments studied the odor of gas was perceptible. Fifty per cent. of the shops used ordinary gas irons only; 41.8 per cent used irons heated by means of a mixture of gas and air under pressure. Only 2.4 per cent. used electric irons exclusively, and in 8.6 per cent. defective gas irons were found. The study of the gas tubes used showed that none were gas-tight and that most of them were in such a condition as to invite leakage. The constant breathing of carbon monoxide lowers the vital resistance of the body, thus paving the way for the infections of disease.

FELLOWSHIPS FOR PUBLIC HEALTH MEN.

The Harvard Medical School, in co-operation with the Boston. Dispensary, offers a Fellowship to graduates in medicine who desire to pursue a course of study leading to the Certificate of Public Health in the School for Health Officers, or to the degree of Doctor of Public Health in the Department of Preventive Medicine and Hygiene.

Fellows are required to give half their time to the treatment and supervision of the sick in their homes, in a district of the city of Boston, and half their time to study or research at the Harvard

Medical School. Appointments may be made for one or two years. The stipend is $750 per year.

Applications stating previous experience, references, etc., should be made to Dr. Milton J. Rosenau, Professor of Preventive Medicine and Hygiene, Harvard Medical School, Boston, Mass.

WARNING TO HUSBANDS!

A woman from Point Place complained to Edward Kelsey, of the Toledo Railway and Light Company, recently, that her skirt had been ruined by tobacco juice in a car. It was learned that her husband was one of a crowd of workmen who, two hours before, had traveled down town in a car on which he and other passengers smoked and spit.

The following letter, signed by 500 employes, was received by the traction company:

"We, the undersigned, employes of the Toledo Shipbuilding Co., respectfully request that smoking and spitting on the Ironville cars be stopped. We pledge ourselves to do all we can to assist you in enforcing an order of this kind.

"We suggest that you put a sign in the cars calling attention to this matter."-Toledo Blade.

COUNTY TAKES OVER OPEN-AIR SCHOOLS.

Lucas County has taken over the maintenance of the open-air schools for tubercular children.

These schools formerly were on the site of the Cherry street open air school.

The two-story building was taken down and moved to the county infirmary grounds. The shelter building and playground equipment are also to be moved out to the infirmary.

The new arrangement saves the school system about $5,000, Superintendent of Schools Guitteau says. The board of education. still furnishes the teachers. It is saved the expense of one nurse, an assistant and two cooks. The overhead expenses, cost of feeding the children and of heating the building is also saved.

The Legislative Committee on bills of the Indiana Society for the Prevention of Tuberculosis, has embraced under two heads the things for which the Committee will especially ask. The first merely corrects and makes workable the registration law of 1915 for the registration of living cases of tuberculosis.

The second, in form of an amendment to the county tuberculosis hospital law, provides that when two hundred citizens so petition, the people may vote upon the matter of establishing a county tuberculosis hospital. This amendment also encourages county hospital establishment by providing a state subsidy of $5.00 per week for indigent cases of tuberculosis cared for in county hospitals.

A. P. H. A. ESTABLISHES TWO BUREAUS.

The American Public Health Association has recently created a Health Employment Bureau, the chief object of which is to place employers in touch with men and women qualified by experience and training to fill the various kinds of positions connected with modern health activities. We already have a large number of names on file and new ones are received daily and we are prepared to furnish lists of men and women qualified to serve as Health Officers, Laboratory Workers, Statisticians, Public Health Nurses, Sanitary Inspectors, Sanitary Engineers, Epidemiologists, Social Workers, Food and Drug Inspectors, etc.

The Association also announces the establishment of a Health Information Bureau, which will be available free of charge to all members of the Association or subscribers to the American Public Journal.

The Bureau will answer all reasonable queries touching health work, whether questions of policy, ascertained fact, methods, work of others, authorities, or other like subjects. The position of the Association in health work gives it unusually excellent opportunities for the study of health problems, and it is desirous of doing what it can to place its advantages at the disposal of others.

While only men of recognized standing are in the service of the Bureau, it should be understood that the work is solely of an unofficial character. The Association does not bind or commit itself to statements or opinions issued by the Bureau. A. P. H. Journal.

PRINTED WARNING AGAINST SPITTING.

Instead of having a burly brakeman address to passengers a more or less severe admonition against spitting in the cars, several railroads have recently adopted the practice of printing small cards which are either placed in conspicuous places in the train, or handed to persons who are committing the offense. The cards are about the size of a business card, and a good example is the following which is being distributed by the B. & O. railroad:

Spitting is DANGEROUS and ILLEGAL! TUBERCULOSIS is transmitted in this way and kills more people than any other disease.

OVER THREE MILLIONS FOR HEALTH.

The Detroit Board of Health has asked for $3,383,000 to be used during the coming year in the erection of new buildings, the provision of additional equipment and the hiring of many more.

nurses and inspectors. This is more than double the amount appropriated last year. $1,000,000 is asked for an addition to the main tuberculosis hospital to increase the capacity of that institution by 122, and making it possible to care for 366 patients. Few salary increases are sought, but funds are requested for an increased personnel.

The Firestone Company of Akron recently held the first of a series of "health help meetings" in its new club house. The physicians and dentists of the city and county, as well as the employees and the public generally, were invited to hear an address by Dr. Weston A. Price, physician-dentist, of Cleveland. speaker showed the effect of defective teeth on the general health. Other prominent physicians and authorities on health and hygiene will speak at future meetings.

The

The health section of the Federation of Women's Clubs of Mansfield recently organized a public meeting in that city which was addressed by Dr. J. N. Hurty, Secretary of the State Board of Health of Indiana, who spoke on "The Making of a Better Race," dealing mainly with the subject of eugenics.

Health Commissioner, Robert H. Bishop, Jr., of Cleveland, is planning to secure government cooperation in the establishment of at tuberculosis laboratory in connection with the Warrensville Tuberculosis Sanatorium. The U. S. government proposes to expend $1,000,000 on a government laboratory for the study of tuberculosis.

A public health survey is being planned by the civic bodies in Canton to indicate the lines of development which local work should take.