which is run for cash only, and which does not maintain an efficiency record, so no comparison with previous years is possible. They can not tell whether an individual department is going ahead or falling behind, or whether the business is succeeding or failing; such is the situation in the average city of today.

Plumbing inspection is usually imposed upon the health department; this should be turned over to the building department.

Nuisance abatement should be under the control of the police department, and garbage disposal should be taken care of by the department of public works.

Passed Assistant Surgeon Paul Preble, of the United States Public Health Service, last year completed a survey of 330 cities in the United States. He found that the average city of from 25,000 to 50,000 inhabitants spent an average of 24.6 cents per capita per year on public health and that the health officer received an average of $100 per month.

"Public Health Is Purchasable"

Public health is as purchasable as any other commodity. For example, in the construction of the Panama Canal, it was necessary to pay a very high price for public health-$3.65 per capita per annum. Consensus of opinion of those competent to discuss the matter gives 50 cents per capita per annum as the amount necessary to maintain an efficient health control of a city from 20,000 to 35,000. That would mean an expenditure of $17,500 per annum for health protection. This, of course, bars unforeseen emergencies, and does not include such activities as gar

bage collection, plumbing inspection, maintenance of city pound, etc., but it relates only to expenditures on public health activities which have been outlined.

Where a city has been spending from $8,000 to $9,000 per annum and securing a department that is probably 50 to 70 per cent efficient, and they are asked to spend $17,ooo, they would either ignore the request, or raise an awful storm of protest. How can we demonstrate such expenditure to be warranted? For example, examine the death records of your city for deaths from typhoid fever; remember the death rate of typhoid is under 10 per cent; that is, for every ten reported deaths from this disease there must have been over 100 cases; more than likely less than one-half of these were ever reported. Ascertain the expenses incurred for nurse, medicine, hospital, and funeral expenses for these cases that have died. Ascertain or determine the expenses incurred for the cases that have recovered, and as I have said before, we have nine times as many recoveries as we have deaths. Determine the financial loss in wages during illness and long convalduring illness and long convalescence of those that have recovhave been only two or three deaths from typhoid in your community, you will find that enough money has been lost to pay for health department several times over.

your

Seriousness of Whooping Cough

Or again, consider the so-called minor diseases, say whooping cough. Possibly no actual money was spent or time lost while baby had whooping cough, still I know of a family where many hundreds

of dollars were spent on hospital, physicians, nurses and medicines during the eight or ten years following an attack of whooping cough in a small child, which was contracted in a small town where no control was exercised over this disease; this case is not unique. In figuring the expense from whooping cough, the medical expense and funeral bills in deaths from whooping cough should be included. Whooping cough in children under two kills more than all other communicable diseases put together.

Again, if some article be purchased in a foreign land, a large freight bill paid, and after the article has been received, it is unfortunately broken while being adapted to the purpose for which it was purchased the purchase price, the freight bill, to say nothing of the time and disappointment, would all be considered an irrevo

cable loss. The same is true in all deaths from communicable disease in childhood. For all money spent during the life of each fatal case, all money spent for the mother's care during her pregnancy and at the time of her child's birth, should be included, because it represents something just as irrevocably lost as the article purchased in the foreign land. Many other examples could be mentioned, the items of which could be easily enumerated, but considerable work would be required to determine the actual money expended.

If your citizen is willing, and does actually spend $1.50 per capita per annum for fire protection, and $1.00 for police protection for mere property, surely he should be willing to spend 50 cents per capita for life and health protection.

Effect of War Sanitation

Today many, many thousands of and in army cantonments. They our young men are "over there" are receiving instruction not only in the arts of war, but also in the arts of peace. Sanitation plays a greater part in the present war than world, and the sanitation of camps ever before in the history of the today is the most efficient the world has ever known. The greater number of these men will in time return home, and when they do so, they will demand that typhoid be eliminated, that better sanitary conveniences be supplied; in short, they will demand that the sanitary efficiency of the army camp of today be maintained in their civilian homes of tomorrow. Speed the day they return!

How shall we organize our health departments to do all of these things which we have outlined, and at the same time keep within the estimated 50 cents? First, by employing a health officer trained and experienced in public health, and one who devotes his entire time to the duties of his office; $2,400 per year should secure such a person for a city the size we have in mind. He should be supported by a corps of experienced or trained public health nurses. A city of 35,000 gives a population of about 7,000 children of school age. In the organization of Health District No. I in New York City, three nurses were assigned to an estimated school population of 7,000. Besides school inspection and visits, these nurses do a great deal of district nursing work, taking up baby welfare work and prenatal guidance, control of communicable diseases, and sanitary supervision; therefore I would suggest that a minimum number of three nurses

be employed in our suggested department at a salary not less than $100 per month. To have control of meat and milk inspection, a veterinarian should be employed on full time at a salary not less than $1,200 per year. A housing inspector, trained in housing, sanitation and social problems, at the same salary. An office force of secretary and stenographer at a minimum salary of $75 and $64 per month, respectively.

Compensation for Skilled
Workers

Laboratory. It is difficult to obtain a person trained in chemistry and bacteriology of public health without offering adequate pay; $150 per month would be a minimum rate. There would not be enough work in a city of this size to keep such a person busy all the time, so he could devote part of his time to foodstuffs and to food establishments; for the laboratory he would receive $100 per month, and for the food inspection $50. An untrained laboratory assistant at $50 per month would be found necessary to make media, wash glassware and other menial work.

Field workers should be supplied with automobiles of the Ford type; this would increase their efficiency fully 50 per cent. With the upkeep of automobiles, laboratory supplies, maintenance items, such as office supplies, printing and other sundry items, the health officer would be compelled to figure very closely in order to come within the suggested appropriation.

With such an organization it would be possible to reduce communicable disease to the minimum; to secure the reporting of all births; to maintain close supervision of child life from before birth to the

end of the school period; to build up a first-class milk inspection service; to supervise the production of meat and other foodstuffs; to have a laboratory that would be of inestimable value to the physicians of the community; to carry on a continuous campaign of education; and finally, to have a system of public health bookkeeping, from which at all times could be determined the health situation of the community, as well as the efficiency of the public health work in all departments.

ARMY LOWERS DEATH

RATE FROM DISEASE Annual rates for deaths in battle and deaths from disease among the American American Expeditionary Forces were exactly equal for the first ten months of American participation in the war, according to figures compiled by the War Department. Both rates stood at 8 per 1,000 per year.

In previous wars of the United States the deaths from disease have far exceeded the deaths in battle. In the Mexican War 15 per 1,000 died annually in battle and 110 from disease. In the Civil War the

rates were: 33 in battle, 65 from disease; in the Spanish War: 5 in battle, 26 from disease.

Statistics of the French and British armies for four years of the war, as given out in a statement from the American chief of staff, show that only fewer than one in twenty wounded men sent to hospitals die. The average of British and French statistics is as follows: Returned to service, 810 per 1,000 wounded; discharged from service because of physical disability or other cause, 145 per 1,000; died from wounds, 45 per

1,000.