In view of the great need for more of these institutions in Ohio, we present herewith and recommend a careful reading of The Optimist's editorial:

In the issue of August 10, 1916, an editorial appeared in the Columbus Dispatch, headed "Prevention Better than Cure." The heading of the editorial explains the editor's stand. The editor is unquestionably correct. Prevention is better than Cure. An ounce of prevention is worth many, many pounds of cure. The last paragraph of his article is especially significant. It follows: "The prevention of tuberculosis is the essential thing. On that it is hardly possible to spend too much money or effort. But sanatoria as they are conducted are rather hopeless institutions, of value chiefly in letting the victim gently down to the grave."

We are in hearty accord with the editor of the Columbus Dispatch when he says that the prevention of tuberculosis is the essential thing and that it is hardly possible to spend too much money or effort along the lines of prevention. But we most decidedly disagree with him and feel that he is taking an untenable stand when he says that "sanatoria as they are conducted are rather hopeless institutions, of value chiefly in letting the victim gently down to the grave." The impression conveyed in that sentence is misleading, harmful, and not supported by the facts and by experience.

The value of the sanatorium has been studied and stated by men to whom the prevention and cure of tuberculosis is a life work, and who are fitted by many years of experience to study and authoritatively discuss this question. Prof. Irving Fisher of Yale, an authority on all matters relating to public health, discusses the value of the sanatorium in his article on the "Economic Cost of Tuberculosis," read at the 8th Annual Meeting of the National Association for the Study and Prevention of Tuberculosis at Washington in May 1912.

He takes as his example the Gaylord Farm Sanatorium of Wallingford, Conn. and quotes Dr. David Russell Lyman, the superintendent who has carefully gathered statistics on all the patients discharged from his sanatorium. Dr. Lyman's records are probably the most complete in the world. Prof. Fisher shows that "for each dollar invested in the Sanatorium there is a return of about $9.00, of which about $4.00 is presumably enjoyed by others than the consumptives themselves. The $4.00 is returned on the wages within six years and on the average in about three years. From the point of view therefore of mere commercial gain the fight against tuberculosis through sanatoria pays a profit by the side of which any ordinary bonanza is a poor investment."

"But the possible return is really far greater even than fourfold in three years. This calculation takes no account of what is probably really the most important return from sanatorium treatment, viz., the prevention of tuberculosis in the home and neighborhood of the patient who returns from his stay at the sanatorium to spread the gospel of fresh air and prevention."

Prof. Fisher speaks of a man who returned to his home after a course of treatment at the sanatorium, who "visited the old concern where he had contracted this disease, a brass mill, and talked to the men in such a way as to reform totally the customs so far as spitting on the floor was concerned. He also changed the habits of living in his own immediate neighborhood. This is typical of what many patients accomplish.”

The value of the sanatorium must be judged by the number of patients who are restored to earning capacity. The earnings of all the discharged patients of the Gaylord Farm Sanatorium from 1904 to 1912 inclusive, totaled $1,020.713.00.

Far from letting the victim gently down to the grave, the results of observation in sanatoria throughout the country-and this is as true of Ohio as it is of Connecticut or Massachusetts show that between 80 percent and 85 percent of incipient cases return to work: about 45 percent of moderately advanced cases, and between 10 percent and 15 percent of advanced cases.

The records of the Ohio State Sanatorium are in accord with those given above. The Ohio State Sanatorium is doing what the Connecticut Sanatoria and the Massachusetts and Pennsylvania Sanatoria are doing.

We regret that the circulation of THE OPTIMIST is quite small compared to that of the Columbus Dispatch, and that we are unable to give publicity to our views to the same extent as our contemporary. We regret this exceedingly because we feel that many consumptives who might possibly derive benefit from sanatorium treatment will accept as correct the statement in the editorial under consideration, and will stay at home, progressing unfavorably themselves, and remaining a prolific source of infection, rather than go to a place where the victims are "let gently down to the grave."

In the crusade against tuberculosis there are numerous factors to contend with. It is a wee bit discouraging to have unnecessary factors such as destructive newspaper criticism.

* * **

FINANCING OF SEWAGE DISPOSAL IMPROVEMENTS.

In Ohio it is customary to meet the cost incurred in the installation of trunk sewers and sewage disposal works by the sale of bonds on the municipality making the improvement. Rarely, if ever, are improvements paid for by assessments upon the properties benefited. In a recent opinion, January 2, 1917, the Attorney General of Ohio. has held "that the cost and expense of constructing the necessary main sewers and a sewage disposal plant outside of a municipal corporation may be assessed by the council upon the specially benefited lots or lands in the corporation or sewer district therein, in proportion to the benefits which result from such improvement, subject only to the limits upon such assessment for improvements constructed wholly within the corporate limits." This method of financing such improvements will, in many cases, render possible the execution of the improvements, whereas the issuance of bonds on the municipality as a whole may be rendered impossible by statutory limitations on municipal indebtedness.

Smallpox was recently discovered in Steubenville. The local board of health promptly ordered the vaccination of all school children and of adults who had been exposed.

Vaccination is the only recognized means of controlling smallpox and is advocated and practiced by public health officials and physicians in civilized communities the world over. Its value is firmly established and generally accepted.

Nevertheless a small group of anti-vaccinationists gathered at once to oppose the order of the Steubenville health board and form an anti-vaccination league.

And where did they hold their meetings?

Why, in the mayor's office!

What of that?

Only this, that the mayor, in Ohio cities, is ex officio president of the city board of health. True, a president pro tem. is elected by the board and a mayor is not, in most cases, closely in touch with his board of health and its activities.

Still this does not absolve him from the responsibility of consulting his board in times of emergency or at any time when matters of policy are involved and for a mayor to give aid and comfort to the

opponents of his health board to the extent that has been done apparently in this case, shows poor judgment, to say the least.

His honor may not be entirely in sympathy with the anti-vacs. If he isn't, all the more should he have considered the effect that lending his office for such a purpose may have in aiding a propaganda dangerous to the health of the community and which seeks to nullify the efforts of the city health department.

If he is in sympathy with the anti-vaccinationists his fitness for his official position may properly be called in question.

THE IMPORTANCE OF BIRTH REGISTRATION.

Why has the United States lagged behind other civlized countries in the care and completeness with which births are registered? All the States fail to provide for some of their children the official record which may become to any citizen at any time essential for the protection of his property rights, or even of his life.

The Children's Bureau of the U. S. Department of Labor has taken up the question because the recording of births affects children immediately and in various ways. Complete registration is indispensable to any comprehensive work for the welfare of babies. Without it, regulations for the prevention of blindness in babies can not be enforced; the public-health nurse can not be sure of reaching every baby in the congested districts; and the death rate among babies - that most sensitive index of social well-being- can not be reckoned either for the community as a whole or for districts within the community.

The Children's Bureau, in cooperation with the Census Bureau, has therefore devised an informal test which is carried out by local committees and which brings home to the parents of young babies the importance of accurate and complete birth registration, for, after all, it is upon the interest and understanding of parents that an absolutely complete record must, in this country, depend.

Of course a good State law is necessary to provide the machinery for registering births in each community and forwarding records to the State Registrar. A good law is necessary to give authority for the fining of physicians and midwives who habitually fail to report the births they attend, and such fining has proved essential for securing registration in some communities. But even with a good law and officials who honestly try to enforce it, there will always be some unregistered babies unless parents insist upon having their children's births recorded.

Interest n birth registration is constantly growing. Many State and city health departments are systematically working for better registration in their respective districts. Volunteer committees in 282 communities in 27 States have already reported to the Children's Bureau on local tests, and over 250 communities are now at work. And Baby-Week campaigns usually include a birth-registration day or some other special publicity for the subject.

THE RELATION OF INDUSTRY TO THE HEALTH
DEPARTMENT.*

C. D. SELBY, M. D.,
Health Officer, Toledo.

There is not a man in attendance at this conference whose heart has not ached for the community he represents, its suffering and its loss from preventable sickness. And there is not a community represented at this conference that sustains its health officer to the extent the value of the human life within its corporate limits would justify.

It is the opinion of health officers that human life is the most valuable of all the sources of wealth and prosperity, and that its conservation should be first in the minds of the people. But it is not; and it is not because of the fact that the people have not been brought to realize that every life in a community is of physical, intellectual, economic and moral value to that community.

The basis of value in this age is wealth. The ability to produce wealth, and that which goes with it-prosperity, determines value. If human life is the greatest producer of wealth it is the most valuable and should come first in the program of conservation.

There are three sources of wealth:

I.

Land-because of its location, what it produces, what stands on it, or the number of people who pass it every twenty hours.

2. Capital-represented in money, bonds, mines, machinery, or materials, finished or raw.

3. Labor-by virtue of its ability to handle land and capital and turn them to account.

Land, existing in the form of real estate, is known to be an exceedingly safe investment and frequently a source of tremendous big profits. It needs no argument to support its claim as a source of wealth and prosperity. Its value is well understood and recognized. It is conserved.

Capital is receiving due recognition as a factor in commerce and business life. Thousands in dollars and years in time are being spent in the study and installation of systems, highly organized and efficient, to the sole end that capital may produce more at less cost. It is being conserved.

Labor, which is human life, is regarded as a purchasable commodity; a thing to be hired, used as long as useful, then fired. It is not regarded as having permanent tangible value. Its productiveness is increased temporarily by speeding, a process that destroys its productiveness. The employer gets what he can out of labor, with

* Read at Conference of Municipal Health Officers, Columbus, January 18-19, 1917.

out attempting to prolong its usefulness, and when its ability to produce falls off, he casts it aside.

The world talks of conserving its natural resources, which are land and those products that come from it, in order that those who dwell upon the land may become wealthy. The world exerts itself to the utmost to conserve capital, in order that there may be greater prosperity. The world drains labor of its vitality, and when its productiveness ceases supports it in charity-on poor farm, in hospital, home for the aged or state institution, or buries it in poverty.

About a year ago Mr. Victor T. Noonan, Director of Safety of the Industrial Commission of Ohio, said "Certain statistics show that at least 25,000 men lose their lives in industrial accidents in this country; that 300,000 more are seriously injured each year and that 1,000,000 sustain minor hurts to the extent of at least one day's labor lost."

In Ohio, an average of almost two industrial workers are killed each day the year around by the industries they serve. Half of the vast number who are seriously injured but not killed are permanently maimed.

The foregoing facts, appalling as they are, do not take cognizance of the thousands and thousands in the employed classes whose health is impaired or whose lives are sacrificed as the result of diseases that are fostered by unfavorable working conditions.

Speed, efficiency and production are the requirements of modern industry. Labor must work at high tension, must make every move count, that the production may be up to the demand for the product. Long hours result, monotonous and fatiguing, spent under insanitary conditions, with the worker exposed to dust, darkness, dampness, extremes of cold and heat, vibrations, poisons, fumes and gases, overcrowding and immorality.

There can be but one result to this-an early death. And industry goes on and on. Labor comes, stays for a spell and goes. And we conserve-we conserve land and capital.

It is incongruous that labor, the one source of wealth which represents human life, should be considered the least valuable and held in the least esteem. Can it be possible that human life possesses less worth than the other sources of wealth and prosperity? Can it be that human life is not a thing of real value?

We point with pride to the wonderful progress our nation has made, to the marvelous inventions our people have conceived and to the wonderful structures our toilers have reared. The steam engine, the cotton gin, the printing press, the telephone, the aeroplane, the submarine, the wireless telegraph, the automobile, the typewriter and the many, many other amazing conceptions of man's mind stand forth as stars of the first magnitude in the firmament of history and progress.

Which is the greater, the mind of the man who conceives a marvelous invention, or the invention that marvelous mind conceives? Which is the greater, the hand of the man who constructs a wonderful machine, or the machine that wonderful hand con