nausea, vomiting; weakness in the legs, often described as "caving in"; severe, bursting headache, or coma.

Carbon monoxid poisoning may become chronic, under which condition the patients will become ahemic, irritable and neurasthenic, and complain of headache, anorexia, loss of weight, backache, vertigo, and gastro-intestinal disorders. There will also exist a polycythemia and a leukocytosis of the eosinophil forms.

Carbon monoxid (CO) poisoning should not be confused with carbon dioxid (CO2) poisoning, symptoms of which begin with pressure in the head, vertigo, ringing in the ears, sparks before the eyes, disturbances of respiration, such as air hunger and pain in the chest. and sometimes convulsions. Chronic carbon dioxid poisoning probably does not exist. This gas must be in much greater concentration to be poisonous, about 4 per cent. causing distress symptoms and approximately 10 per cent. causing death. Carbon monoxid is a dangerous poison because of its odorless, colorless and tasteless properties, and its presence should always be suspected in such cases of sudden prostration and death as here related.

IMPORTANCE OF TEETH HYGIENE.

Realizing the importance of better hygienic conditions in the public schools, the health department of Akron has hired a dentist who will attend to all necessary work for pupils of the public schools. A complete dental outfit will be installed.

Close investigation has shown that children having defective teeth. have hard work in keeping up with their classes as well as being more restless than those whose teeth are in perfect condition.

One small cavity in a tooth may lead to typhoid fever and various other diseased conditions and although most people do not appreciate the danger, yet it is important that every child have perfect teeth.

One of the duties of the public dentist will be to thoroughly instruct pupils in proper cleansing and care of their teeth. When pupils care for their teeth as they should, a thousand and one untoward conditions are eliminated.-Marion Tribune.

We find this copied in the February bulletin of the Kansas State Board of Health and we think it's worth repeating.

"If thou will observe

The rule of not too much, by temperance taught,

In what thou eat'st and drink'st, seeking from thence

Due nourishment, not gluttonous delight,

Till many years over thy head return,

So may'st thou live, till, like ripe fruit thou drop

Into thy mother's lap, or be with ease

Gathered, not harshly plucked, for death mature."

Milton.

Rambousek, J.: Industrial Poisoning, London, Edward Arnold, 1913.

PUBLIC HEALTH TRAINING IN UNIVERSITIES.* GEORGE E. VINCENT, PH.D., LL.D.

Minneapolis.

The law of social demand and academic supply is far from an exact formula. Sometimes universities offer a training for careers that depend on other things than institutional preparation. For example, a few years ago several universities announced special courses for candidates for the diplomatic service. When it transpired that political pull, an actual speaking knowledge of foreign languages, or a recognized social status were much more likely to gain one a position than the pursuit of courses in comparative government, international law, the history of diplomacy, and a precarious reading knowledge of French and German, the reasons why these university courses were not patronized became evident. On the other hand, academic institutions are often slow to recognize actual vocational needs, and even when attempts are made to meet authentic demands, the first efforts are too likely to be abstract and speculative, and out of relation to the actual concrete problems involved.

The efforts of universities to meet the needs of organized public health have illustrated both of these tendencies. The first courses to be offered were generally in advance of specific demand. There was little response on the part of prospective public sanitarians. The careers in preventive medicine and public hygiene were not sufficiently attractive, and in the absence of a merit system the causal connection between thorough preparation and appointments and promotions was not convincing. Of late, however, the widespread interest in social medicine, the demand for more efficient service, and the multiplication of administrative and specialized positions, governmental and institutional, have given an impetus to public health training. There is now a possibility that in attempts to meet the growing demand, the universities have rather hastily and with inadequate resources organized curriculums which are not thoroughly adjusted to actual needs. It is only what, in the circumstances, was to be expected. The universities which have taken the lead deserve full credit for the initiative and ambition which they have displayed.

It seems clear that successful public health training must be carried on either by universities or by schools in close affiliation with them Only in a large and well developed institution is it possible economically to provide the various kinds of knowledge and discipline which have a bearing on the preparation of a public sanitarian. Moreover, the university atmosphere of investigation and scientific collaboration offers the most favorable and stimulating environment for the kind of training under discussion. This is not to say that the university can provide all of the necessary conditions. The closest and most sympathetic cooperation with agencies which are carrying on actual public health activities is of fundamental importance. For this no university can in itself provide a substitute. To the universities of the country, however, * Journal American Medical Association, April 7, 1917.

we must look for leadership in developing thorough and progressive schools or departments for training various types of public health functionaries.

As a matter of fact, except for the apprenticeship opportunities in federal, state and city bureaus, the conscious attempts to provide such training have so far been made by the universities. Much has already been accomplished. The lead was taken by the University of Pennsylvania in 1909. This example was followed by Harvard in 1910, Wisconsin in 1911, Tulane in 1912, Colorado, Michigan and the Detroit College of Medicine and Surgery in 1913, Bellevue and California in 1914, and Ohio State in 1915. In October, 1918, Johns Hopkins Uni-. versity, with the aid of the Rockefeller Foundation, will open a school of hygiene and public health under the most favorable conditions which have as yet been realized for the training of specialists in preventive medicine and health administration. The principles, curriculums, standards and ideals embodied in the plans which have been put in force by these institutions offer the general outlines of a system which in the future will gradually be improved and more nicely adjusted to the actual needs of community and nation.

Of the ten institutions, all but two require for admission to the public health course the degree of Doctor of Medicine. Three universities require both the bachelor's degree and the professional medical degree. The obvious implication is that the full preparation of a medical practitioner is desirable, even essential for successful public health work. In come cases this idea is modified to this extent: In the last year of the medical course, students are permitted to substitute, for certain clinical subjects, courses which have a direct bearing on preventive medicine. How far the fact that the initiative in organizing public health training has been taken by the medical schools of the universities influence the requirement of the M. D. degree, and how far this stipulation is necessary for the end in view will be briefly discussed in a later paragraph.

In seven of the institutions under consideration, the training is given in one year; in three, two years of work are required. This variation is correlated with different forms of recognition, varying from the degree of Doctor of Public Health to a certificate of public health or the title of Graduate of Public Health. The lack of uniform practice reflects a variaton in ideals and marks a difference in the types of functionaries and the kinds of training which are required for these officers. Seven institutions give the degree of Doctor of Public Health, namely, Pennsylvania, Harvard, Wisconsin, Tulane, Colorado, Michigan and Bellevue. Of these schools, Michigan, Colorado and Wisconsin offer two year courses; the other four require only

one.

As has already been indicated, the chief recognition takes the form of a degree of Doctor of Public Health, Pennsylvania also confers the degree of Certified Sanitarian after a one year course. Certain graduates of one year courses at Wisconsin and Detroit receive the degree of Master of Public Helath. Four schools, California, Colorado, Michigan and Ohio, confer the degree of Master of Arts in Public

Health and Master of Science in Public Health after one year of residence. Colorado also grants the degree of Master of Science in Sanitary Engineering after a one year course. There is obviously a tendency to assimilate the public health degrees to the graduate school system which has been uniformly adopted by the leading American universities. Thus, Doctor of Public Health corresponds with the degree of Doctor of Philosophy, while the Master's degrees in Public Health take their position as the recognized second degrees in the higher educational system.

The processes of imitation which so quickly tend to conventionalize American education have not had time to produce a fixed type of publice health training. The obvious necessities, the kinds of knowledge, discipline and technic available have inevitably created uniformities. Around these, however, there is a wide field of variation. Laboratory courses in bacteriology, chemistry, protozoology and parasitology are naturally a part of the curriculum in all of the schools. These courses doubtless vary a good deal in content and method of instruction. In only three institutions is special mention made of tropical diseases. The use of different terminology and the grouping of subjects in various forms make it difficult to reach positive conclusions as to precisely what the requirements are. A substratum, however, of laboratory training is prescribed by all the schools.

The next group of courses may be described as specialized public health courses. These are public hygiene, preventive medicine, public health administration, occupational diseases, school inspection, etc. It is not always easy to differentiate these courses from laboratory courses, but in general they seem to be of a more definitely professional character, dealing more concretely with the actual problems of preventive medicine in the field. Although the published programs of three or four of the schools make no explicit mention of teaching of this character, it is fair to assume from the general statements that instruction in courses of this kind is provided.

Five of the ten schools offer courses in sanitary engineering which include water supplies, sewerage, and sewage disposal, street cleaning, and housing and ventilation. Harvard, in co-operation with the Massachusetts Institute of Technology, lays stress on the engineering aspects of its curiculum. As has already been indicated, Colorado confers a special degree, that of Master of Science in Sanitary Engineering. It seems to be recognized that the engineering aspects of public health work must find a place in even a general course for the preparation of public santiarians."

Five out of the ten schools make a place for vital statistics or demography. Santiary legislation, political science and economics are mentioned in the curriculums of two institutions. The first impression is that the social sciences have not been sufficiently recognized in the organizing of these public health training courses. It is altogether likely, however, that in many of the special courses which have been mentioned above the questions of vital statistics, the legal aspects of public health organization and the recent progress of socialized medicine, health insurance, etc., are included. Even when allowance of this

་

sort has been made, it seems probable that the medical school administration which has been chiefly responsible for organizing these courses of study has not sufficiently recognized the need of co-operation of departments of economics, political science, sociology and schools of law.

One of the schools, the Detroit College of Medicine and Surgery, requires a definite period of service in a hospital for contagious diseases. Each student of public health courses is apparently required to serve an internship of twelve weeks in such an institution. Undoubtedly the students of other schools are brought into some relation with hospitals for contagious diseases in connection with the field work which is required in the curriculums of all the schools. There is a valuable sugestion in this plan of requiring a regular internship service in the wards of a hospital for contagious diseases. For students specializing in epidemiology this would be a peculiarly useful experience, under proper supervision, with oportunities for laboratory experience.

It is worth noting that all of the schools provide for practical field work. The need of connecting the experience in the laboratory and the material of the lecture room with the actual concrete problems of the profession is universally recognized. The schools have made close working arrangements with municipal and state departments of public health, with school authorities, and with charitable and correctional institutions, so that students may gain vivid first hand impressions of the conditions to be met, of the technic for dealing with them. of the spirit and methods of public health administration, and of the knowledge of human nature essential to firm and tactful control of individuals and groups.

Eight of the ten schools require as a condition of graduation the presentation of a thesis. This ordinarily takes the form of a piece of practical work, as, for example, a health survey of a given area, a study of an epidemic, or an anlysis of a public health mechanism and its operation. Two or three of the schools explicitly say that the requirements for the degree cannot be stated in terms of class room hours or other conventional credit units. It is the avowed purpose to lay the chief stress on individual power and the ability to deal intelligently and effectively with the subject matter and problems under consideration. The stress laid on the thesis serves to emphasize the research character of this public health training, and the attempt to make it vital and practical rather than what "the man in the street" is wont to call "academic."

A few phases of public health work seem either to have been overlooked or onl yincidentally recognized. For example, the function of public health education and publicity is one which deserves study and for which special types of training should be provided. It has become evident of late that the education of public opinion in a democratic country is necessary for the progress and stability of public health work. A few individuals have shown in a conspicuous way how much can be accomplished through wise methods of education and publicity. Other types of functionaries, such as public health nurses and sanitary inspectors, of whom it is quite impossible to require a full medical