duced in Virginia from approximately 14,500 cases to 5,200 a year, and in many communities the reduction has been 100 per cent. Summer complaints among infants, which have annually reaped a large harvest of deaths, are now classed among the preventable diseases. In one large city where sanitary measures and instructive work of the public health nurse were carried out, the death rate among infants has been reduced 50 per cent in five years' time. Hookworm disease, that numbers its victims by the hundreds of thousands, and which does not take its toll directly in deaths, but by blighting the physical and mental growth of the child and reducing his working power and usefulness, is being steadily eradicated.

VALUE OF PUBLIC HEALTH WORK

I would cite one instance to show the value of public health work as an aid to industry and to compensate for the shortage of labor. The superintendent of a lumber and manufacturing plant two years ago appealed to the State Board of Health for assistance, saying that on account of sickness the work of his plant was seriously interfered with. Some machines were always idle on account of the sickness of the employes, and he had great difficulty in securing sufficient labor. A special better health campaign was conducted, directed specially against malaria and the filth-borne diseases. Last fall the superintendent wrote that since the health work was instituted, no machine had been idle on account of sickness among the employes; that malaria had been reduced 99 per cent; that the employes and their families were healthy, happy and contented; and that his company had no difficulty in getting all the labor it wanted, notwithstanding the greatly disturbed condition of the labor markets resulting from the war and the government building activities going on in the state. The superintendent added that his company had not made a better investment than that spent for protecting the health of the employes.

These instances are cited to show what is being done and the possibility of what may be done to increase the man power of our country and develop our national efficiency by promoting the public health. To accomplish this result the health authorities must have the coöperation and assistance of all the people. We can then make America as safe for health as for democracy.

We can conquer

disease as surely as we can conquer the enemy. It is purely a question of means and of effort.

WASTE CAUSED BY PREVENTABLE DISEASE OF IN

TESTINAL ORIGIN

BY VICTOR G. HEISER, M.D.,

Director for the East, International Health Board of Rockefeller Foundation.

In a general way much has been said about the waste caused by disease, but not enough emphasis has been placed upon the enormous amount of pain, misery, unhappiness, sickness and death, that is caused by preventable intestinal disease. It is well within the bounds of conservatism to state that over 127,000 persons in the United States die annually from causes acting in and through the intestines, in other words, from swallowing something unclean which might easily be avoided. To this must be added the hundreds of thousands who are made ill and incapacitated.

The economic losses are estimated at enormous totals. For instance, Doctor Allen Smith, of the University of Pennsylvania, states that hookworm disease in the South causes between $250,000,000 and $500,000,000 damage per annum. Stiles states that the very conservative estimate of 50 cents loss per week for each person suffering from hookworm disease gives a total of $50,000,000 per annum. Ellis estimates that typhoid fever costs the United States $350,000,000 annually. For instance, before the city of Pittsburgh had a safe water supply, typhoid fever in one year was estimated to have cost $3,142,000. Ellis also estimates that in the state of South Carolina alone the hookworm losses are $30,000,000 per annum. The State Board of Health of Louisiana estimates an annual loss of $3,000,000 from hookworm disease in that state. Gunn estimates that the loss from hookworm disease in one mine in California which employs 300 men was $20,000 per year. The construction of the St. Gotthard tunnel through the Alps was almost completely stopped by disease among the laborers until it was discovered that the illness was caused by the lack of proper disposal of human excrement. Again, Stiles estimates that 30 per cent of the education in the southern states is wasted owing to the backward mentality caused by hookworm infection. Clayton Lane has just published a statement showing that the entire war debt of India could be paid by wages which are lost by Indian hookworm victims,

and yet we know that wages in India are a mere pittance compared to American standards. So far we have mentioned only typhoid and hookworm infection. To these must be added the losses caused by diarrhoea, dysentery, cholera, and a host of other diseases, which are caused by swallowing something unclean.

Then there is also an enormous indirect loss. Hazen, for instance, showed that each death from typhoid fever avoided caused the prevention of two or three other deaths from other diseases. This theory has frequently received confirmation. For example, in Manila, in periods during which water from an uninhabited watershed was used there were 3,000 less deaths per annum than when the water supply was taken from an inhabited watershed. The deaths from practically all causes were decreased by changing the source of the drinking water. For instance, there was a reduction in the number of deaths from pneumonia, tuberculosis, nephritis, and other affections not ordinarily associated with intestinal disease.

THE REMEDY

It may be well to ask what can be done to prevent this enormous waste. The answer is simple. It is only necessary to provide for the safe disposal of the excrement of the entire population. In most of our cities the problem has been largely solved through the water carriage of sewage. Yet even in Philadelphia there are thousands of open privies which may be a menace to health through the agency of flies and other sources of contact which may cause contamination of human food and drink. The great bulk of the trouble, however, is in rural communities. It has been the popular belief that the health of those who live in the country is much better than the health of those who live in the city. This could probably be made so by the observance of ordinary hygienic precautions.

But let us look at the actual conditions. In a survey of more than 200,000 school children in New York City compared with 200,000 school children in rural Pennsylvania, it was shown that disease was at least four times more prevalent in rural Pennsylvania. Death rates in the country are higher. A large percentage of the ill health in the country districts is due to primitive latrine conditions. There are many areas in this country in which there is no latrine whatsoever. By careful surveys it has been demonstrated in many sections of the United States that only 50 per cent of the

houses have latrines of any kind. The remedy is very simple and easy of application. No great engineering works are necessary, and the method of prevention can be demonstrated to the most ignorant. There is no community in this country which does not have sufficient resources to carry out the safe disposal of body discharges, and when that is done, typhoid, dysentery, hookworm and a host of other diseases will disappear.

The meagre evidence here presented shows that the loss caused by only a few of the intestinal diseases will total to more than a billion dollars per year. Efficiency is the watchword of the day. The struggle for existence after the war will probably be greater than ever. Shall we enter the contest with this handicap, or shall we strike it from us?

NATIONAL EFFECTIVENESS AND HEALTH INSURANCE

BY JOHN B. ANDREWS, PH.D.

Secretary, American Association for Labor Legislation.

"When the workers return from the trenches they will not he satisfied with flowers or brass bands." This sentiment, recently expressed by one of our loyal and most influential leaders of organized labor, may be welcomed as a "healthy indication" or opposed as a "seething menace," according to one's point of view. It conforms rather conservatively to the reported pronouncement of Mr. Schwab that "within two years the workers will be running this country." Mr. Schwab for this declaration was publicly denounced as a threatening Bolshevik, but presently he was placed in charge of the nation's shipbuilding, the most urgent and critical job in our war preparations. Politically the sentiment is in harmony with the expression of the official historian of the British army in France, who recently said: "I predict that our next Parliament will be a labor Parliament." And it is most effectively and eloquently reënforced in a recent letter by President Wilson who declares:

Every man with any vision must see that the real test of justice and right action is presently to come as it never came before. The men in the trenches, who have been freed from the economic serfdom to which some of them have been accustomed, will, it is likely, return to their homes with a new view and a new im

patience of all mere political phrases, and will demand real thinking and sincere action.

The foregoing sentiment may therefore be regarded as the wellconsidered political expression of some of the keenest and most practical of our forward-looking representative men who are earnestly seeking national effectiveness in a period of supreme national responsibility.

THE PUBLIC HEALTH PROBLEM

What national problems are of such supreme importance as to challenge our chief attention in this reconstruction period?

Aside from measures for the development and protection of labor organizations in their campaign for higher wages, shorter hours, and increased control of industry, it is probable that no single factor in industrial betterment will be so widely accepted as vital to the welfare of the masses of the people in this country as the assurance of reasonably healthful working and living conditions. Certainly no other problem of equal importance to wage-earners, to employers, and to the state, has been longer understood and more persistently neglected.

As a problem in political and social science national health as a factor in national efficiency thus assumes interesting proportions. "Health is wealth," says the proverb, and surely in this country there has been abundant expert testimony as to the importance of national health. The famous Shattuck Sanitary Commission in Massachusetts in 1850 reported the following:

That the average length of human life may be very much extended, and its physical power greatly augmented; that in every year, within this Commonwealth, thousands of lives are lost which might have been saved; that tens of thousands of cases of sickness occur, which might have been prevented; that a vast amount of unnecessary impaired health and physical disability exists among those not actually confined by sickness; that these preventable evils require an enormous expenditure and loss of money, and impose upon the people unnumbered and unmeasurable calamities pecuniary, social, physical, mental, and moral which might be avoided; that means exist, within our reach, for their mitigation or removal; and that measures for prevention will effect infinitely more than remedies for the cure of disease.

We have since had repeated official reminders that within reasonable limits public health is purchasable. And a conservation commission of the Roosevelt administration declared that the aver