sive campaign for the conservation of the child which the most sanguine person can no longer regard as a dream of the social worker, but which is now a national necessity. It is more than ever necessary that we shall spend time, money and strength to bring into the world and to develop therein a race of strong, healthy children. Ohio can respond in a wonderful way if she will, for she has within her boundaries the necessary resources. It is surely fair to expect that in the great national crisis she will do her full share in the preventive work, and the initial impetus in very many of the communities will, in all probability, come from the medical workers.

PLAN TO FEDERALIZE OUR PUBLIC HEALTH MACHINERY. The greatly increased need for sanitary service among the civilian population under war conditions has been brought out by the European war. This service may include such things as the control of non-military concentration and detention camps; co-operative work with army and navy authorities; supervision of medical and surgical supplies and biological and serological products necessary for military purposes; supervision of the health of certain industrial workers; and nursing and medical care of soldiers' families.

The present war situation offers a wonderful opportunity to utilize our state and local health organizations for the benefit of the nation. To this end it has been suggested that at the next meeting of the Conference of State and Provincial Boards of Health of North America, to be held in Washington May 2 and 3, that this proposition be taken up. It is suggested that our state and local health departments might temporarily be federalized much in the same manner as our militia has been federalized,. that is, under certain conditions incidental to a state of war the federal public health service, under direction of the surgeon general, should be able to take executive control of all of our public health machinery insofar as its activities could be brought directly to bear upon the military situation.

PROGRESSIVE EFFECTS OF LEAD AS AN INDUSTRIAL POISON.

On June 20, 1913, one of the occupational disease survey investigators, while inspecting the plant of a carriage works in Columbus, encountered six patients who showed effects of having absorbed lead in varying amounts. The case reports would indicate that all were mild cases. The following excerpt is from the report of one case:

"The man will admit no symptoms which he thinks indicate plumbism, but says he is occasionally constipated, does not enjoy breakfast, and that he gained 18 pounds in two months when away from lead".

The Division of Industrial Hygiene recently received from a Columbus physician a certificate of industrial disease occurring in the same man mentioned above. The diagnosis as given in this certificate was "combined sclerosis of spinal cord-result of anemia and lead poisoning," and the chief symptoms, "atrophy of muscles, slug

gish pupils, absent reflexes, paraplegia, numbness, pyorrhea, and lacinating pains.'

Almost four years were required to incapacitate this man, and although he was warned concerning the dangers of lead and instructed in the prevention of lead poisoning by the investigator, yet because of his failure to heed the advice given, his period of productivity was certainly considerably lessened.

This case illustrates the insidious and slowly progressive action of lead as an industrial poison and shows, also, the need of constant medical supervision for painters and other workers exposed to lead.

THE GARAGE AS A HEALTH MENACE.

In view of the numerous complaints made to the State Health Department, it would seem that too much importance cannot be attached to the garage as a serious health menace.

Recently an investigation was made by the Division of Industrial Hygiene of a two-story building, the second floor of which was occupied by a sign company, a hat factory, a cigar factory and a printing shop. These establishments employed a total of 25 persons, and all complained of headache, weakness, dizziness, impaired vision, insomnia and loss of appetite. These symptoms began about two months previous to the time of the investigation, and it was stated that seven of the nine employes of the sign company had been fitted with glasses, assuming that their eyes needed corrective eye-glasses. The prostration of a stenographer led to a complaint being made to the Health Department.

It was found that gasoline engine exhaust fumes from a poorly ventilated garage which occupied the first floor-, permeated the building in quantities sufficient to produce poisoning. The garage had been occupied only for a period of two months, since which time symptoms had been noticed by persons in the building. The man conducting the garage stated that he himself had been overcome on several different occasions.

With the gradual increase in the number of automobiles, precautions should be taken against locating garages in occupied buildings unless an adequate system of gas removal is provided.

The federal census bureau has just issued its first report concerning the birth rate of this country, and while less than a third of the population is involved, the statistics are highly interesting.

The report covers what is known as the birth registration area, and includes the six New England states, New York, Pennsylvania, Michigan, Minnesota and the Ditsrict of Columbia - about thirtyone million inhabitants in all. It is the area of this country where the statistics are kept in such shape as to comply with the government requirements.

According to the bulletin, the birth rate for last year for the entire area was 24 per thousand of population. This is a higher birth

rate than that of England, France, Belgium and Switzerland, but lower than that of Germany, Austria, Italy or Russia. Russia has the highest birth rate of any nation on earth, the birth running to 44 per thousand of popultion. But she also has the highest infant death rate, a hundred and forty-eight more infants out of every thousand of population dying in Russia than die in the United States.

The highest birth rate was shown in Detroit, Mich, with Niagara Falls, Chicopee, Mass., and New Britain, Conn., just a fraction lower. The lowest rate was in Brookline, Mass., the home of so many millionaires. New York city's birth rate was 25 per thousand of population, which was a little above the average for the entire area.

The foreign born women gave birth to more babies than did the same number of American born women, but the birth rate among the colored people was considerably below that of white people. The mortality among the infants of both blacks and foreigners was greater than among white Americans.

The birth rate for the registration area exceeded the death rate by seventy-five per cent and that is really the most important factor in the report. It shows that even if there were no increase in population from migration the population of the area would increase more than ten to the thousand every year.

These statistics are valuable, of course, but we shall have to have complete records from all sections of the United States before we can tell exactly "where we are at" in comparison with other nations. But we are getting around to the point where we shall soon have such figures. Most of the states are now requiring records to be kept of births and deaths and in time we shall have such correct records we shall be able to make headway in the matter of correcting weaknesses. as they appear as, for instance, the death rate among children. We are not figuring upon correcting any weaknesses in the birth rate, for it has been demonstrated in several nations that governments have no control over such matters.

THE PHILIPPINES HAVE GOT SOMETHING ON OHIO.

One part of the land surface of the globe under the care of the United States has no anti-vaccination society. The reason is that they have had a chance to see what a vast change for the good has been effected by universal vaccination.

In the Philippines under Spanish rule there were about 40,000 smallpox deaths yearly and 6,000 in Manila every year. Although the people were at first bitterly opposed to it, measures for vaccination have been carried out in a most successful manner. So rapid were the results that since 1906 there has not been a single death from smallpox in Manila, and the mortality in all the islands has dropped from 40,000 to 700 per year. Over 10,000,000 Filipinos have been vaccinated without a single death, and where originally they fought the measure viciously, they have now learned to attribute the results to it and seek vaccination with avidity. - Denver Health Bd. Bulletin.

PUBLIC HEALTH ADMINISTRATION.

With Special Reference to Towns and Rural Communities.*

By PAUL PREBLE.

Passed Assistant Surgeon, United States Public Health Service.

Community health must be understood to be an attainable condition and practically every community may have the degree of healthfulness which it desires to secure and with which it is satisfied. Sanitary regulations often interfere temporarily with individual comfort and family management, and the statement often holds that any interference which tends to protect the health of the community is considered unwarranted interference with vested rights.

The old idea that one's health is his own business is based upon false and unfounded premises and has no standing in the sanitary code of today. In the past, individual effort to protect oneself against infection from without has generally proved ineffective and the appearance of epidemics called for more concerted action. Boards. of health were established primarily to control and eradicate prevailing epidemics. The earlier efforts in public health work found expression in local communities before being taken up by the State. However, progress in smaller towns and villages has in many instances remained at a standstill. This lack of progress has often been due to a certain civic pride which has defeated any attempt to change the old order of things or to cooperate with neighboring communities in promoting measures for the betterment of all concerned.

Although theoretically responsible for the health of the communities they represent, local boards of health are today, generally speaking, the weakest elements in the public health machinery we are so slowly building for the physical welfare of the Nation. Aside from certain routine matters, such as the enforcement of old-fashioned quarantine, the placarding of some of the cases of contagious disease that happen to have been reported, and fumigating at the termination of some of them, their activities are too often expended in attempting to abate common nuisances or settling neighborhood disputes over a chicken pen or carting away and burying dead animalsfunctions more fitting for the police department.

The general public has been slow, especially in rural communities, in accepting the simple facts concerned in the causation and spread of preventable diseases. Continued attempts to educate the individual as well as the public at large must be made, because success in public health organization and administration depends upon the cooperation, as well as the moral and financial support, of the community. The same general laws govern health and disease in the city and in the country.

With the development of community life, economic considerations were responsible for the establishment of common water supplies *Public Health Reports March 2, 1917.

and public sewerage systems as well as other measures for the preservation and protection of life and property necessary for civic existence. Protection against communicable disease is as important as protection against larceny or incendiarism.

A glance at the various laws and the regulations adopted by municipal and State health departments during the past few years1 reveals many ill-advised laws and regulations, but the general trend indicates an advance and an improvement in sane sanitary legislation.

The Functions of Federal and State Health Organizations.

To control and diminish effectively and efficiently the prevalence of communicable diseases are proper functions of the Federal, State, and local health authorities.

Briefly, the functions of the Federal health service are as follows: 1. To prevent the importation of communicable diseases from foreign countries and their spread in interstate traffic. (Acts of 1890 and 1893.)

(Act

2. To collect information of the prevalence and geographic distribution of disease and other pertinent sanitary information. of 1893.)

3. To investigate the causes of disease and to determine means for prevention and control. (Acts of 1901 and 1912.)

To cooperate with and render assistance to State and local health authorities in matters pertaining to the public health. (Acts of 1893 and 1902.)

5. To distribute information and literature regarding the prevalence, geographic distribution, causation, and prevention of disease. (Acts of 1893 and 1912.)

are:

The more important functions of the State health organizations

I. To enforce the State health laws.

2. To promulgate and enforce regulations to control the occurrence and spread of disease within the State, including quarantine. 3. To keep informed of the prevalence of disease.

4. To investigate epidemics and instances of unusual prevalence of disease, and to determine the conditions responsible for the epidemics or unusual prevalence.

5. To control the communicable diseases and prevent their spread.

6. To aid and assist local health authorities.

The Rôle of the Local Health Department.

Our early primitive conditions have given place to a really complex civilization, complex because of the more or less close interrelation between the various units through travel and the exchange of commodities. The ease of communication with nearby or distant places, made possible by the increased transportation facilities fur

1See Reprints from Public Health Reports Nos. 200, 264, 279, 338; also Nos. 70, 121, 199, 230, and 273.