one of the diseases. There is nothing manifest to show duplications of reports any more than there are signs of the co-existence of the diseases in the same individual. This incomplete summary of a two years' experience of some of the state carries with it a lesson of fundamental importance. Regardless of the efforts of education, or the institution of legal restrictions for the control of prostitution, the most effective work in the control of venereal diseases does not become possible until there is established an effective system of registration of those infected with the venereal disease. Posters, exhibits, and lantern slides may have decided values for the prevention of venereal disease, but their use to the community is by no means as valuable as the prompt treatment of syphilitics with arsphenamine. The establishment of clinics, and the treatment of patients by physicians, dispensaries, and hospitals are limited by the failure of the cooperation of the patient, unless there is some system evolved to require the individual patient to submit to treatment, until he is no longer a source of danger to the community. For such a type of venereal disease control, there must be a more complete cooperation on the part of physicians, and a restriction of counterprescription for the venereally diseased. Until states and municipalities insist upon the reporting of syphilis and gonorrhea. there can be no satisfactory program for the control of venereal diseases. Apparently, at the present time more stress must be placed upon the contagiousness of gonorrhea, as well as the importance of filing a record card for each person presenting himself with the disease, as the basis for organizing proper regulations for the control of such disease carriers. In a work of this character it is exceed ingly important that the organized medical profession should not merely comply with the existing laws but should urge the adoption of such rules and regulations as may be required to safeguard the public. The benefits of a system of registration have been manifest in the control of tuberculosis, and the advantages that have accrued from this procedure will be even more evident in the registration of the victims of venereal diseases. A Uniform Licensure Certificate.-The necessity for a national board of medical examiners has long been recognized. The importance of a single standard test for medical practice that would be acceptable to the responsible boards of various states in this country, and the licensing powers abroad is undeniable. Fitness to practice medicine should not be determined by geographic divisions, but by proven competence. The National Board of Medical Examiners, after five years of existence, has been successful in having its certificate recognized by twenty states of the Union, the Conjoint Board of England, the Triple Qualification Board of Scotland, the American College of Surgeons, and the Army, Navy and Public Health Service Medical Corps. This represents a tremendous advance in the system of medical licensure. In order to extend the opportunities for securing its certificate the Board proposes to conduct two written examinations covering the theoretical phases of medicine, including diagnosis, prognosis, and therapeusis in class A medical schools. A third examination of a practical character covering the clinical branches will be given by subsidiary boards to be appointed in fifteen. cities of the country, with wide geographic distribution so as to be convenient for applicants in all sections of the country. Fees of twenty-five dollars each for the written examination, and fifty dollars for the practical examination will be charged. State medical societies should urge upon the Board of Regents of their respective states, that the certificate from the National Board of Medical Examiners be accepted in lieu of the special state examination now demanded. From all indications, the types of examination afforded are thoro, searching, and sufficiently complete to demonstrate the fitness of candidates for the practice of medicine. It may be urged that there is too great rigidity demanded in the examinations thus far provided, and in consequence of future general adoption capable men might be denied the privilege of medical practice, if state examinations were to be discontinued. It is more likely that state examinations have been less thoro-going, and thus there have been admitted to practice some individuals not fully qualified to assume the responsibilities involved in medical practice. Certainly, New York State would not be desirous of admitting to practice those licensed in other states with lower qualifications for medical practice. The general public is protected best when the exclusions from practice result from a high standard of examination, recognized to be fair and determinative by the consensus of medical opinion thruout the country. Ability to practice medicine in Idaho should be recognized as of the same worth as ability of practicing in Massachusetts or California. The needs for meeting the problems of specific diseases are certainly the same in the three states. The effect of a uniform national practice act, as manifest in the uniform examination, would be to elevate the teaching in medical colleges, and would, undoubtedly, result in the exclusion of all institutions failing to meet the qualifications of the grade A medical college. The elimination of sub-standard medical colleges is to be desired. It is unfair that students of medicine should have their future imperiled by the failure of a few medical institutions to present the highest type of training and experience. The plea for the unfortunates who might be prevented from entering medical practice is more than counteracted by the plea of the public for the best trained type of physician. Public health demands that there be the one standard of medical practice, and that, the highest attainable in the light of our present knowledge. It likewise requires confidence in the licensing agent which is to determine the fitness of practitioners. In these particulars no organization possesses a higher claim for recognition than the National Board of Medical Examiners. Eugenics. The recent International Conference on Eugenics brought together many leaders in eugenic investigation from America, England, France, Mexico, Italy, Norway, Sweden, Bohemia and Scotland. A particularly active part was taken by numerous representatives of the Carnegie Institution of Washington, possibly better known as the Eugenics Record Office. This institution is designed to serve as an authoritative director of studies of the biologic and social forces which affect the welfare of mankind. While probably only one-tenth of mankind consists of a stock dysgenic in character, the dilution of racial power thru unfortunate matings demands an increasing familiarity with the hereditary defects for which this portion of the population may be responsible. For constructive processes it is essential to establish systems of control and elimination of this part of the community. Obviously, this is not a simple matter. Eugenics is charged with the responsibility of determining what matings are fittest for society. There is no criticism implied in the admission of a lack of sufficient understanding of the social, economic, and biologic factors that govern marriage, or fecundity any more than there are sufficient data on the nature and method of inheritance of the multiplicity of human traits. It is essential, therefore, that as rapidly as the facts of inheritance are ascertained they should be disseminated. This demands, naturally, an investigation of genealogy in relation to character, temperament, physical well-being, and social characteristics which can only be properly achieved thru the cooperation of the public at large. The negative phase of eliminating dysgenic factors in the population is by no means as consequential as the improvement and conservation of effective parents thru encouraging the reproduction of the better racial stock. It is vitally important that the positive phases of eugenics should be thoroly appreciated by society if progress is to be secured. The interest of the state cannot be aroused unless a sufficient group of citizens exerts its influence in order to promote necessary legislation. While eugenics is primarily a biologic science, its roots dip deeply into the social structure and involve sociology, economics, history, philanthropy, and medicine as well as various other sciences. The basis of study is the family, and the physical, mental, and moral traits of families must be studied in extenso in order to discover any underlying laws of heredity for the purpose of securing suggestive information regarding potential lines of education for offspring, and particularly for giving some basis for the intelligent determination as to the biologic possibilities of contemplated matings. Predictability of the outcome of the fusion of various strains of stock would be highly desirable. To bring this about, however, there must be accumulated and analyzed a vast number of heredity charts. A biologic genealogy is of tremendous importance. Unfortunately, it requires an intelligent type of person to complete the elaborate records that are of most value. Nevertheless, the gain from the study of the biology of families would be of more value to the race than the mere collection of genealogic data for the purpose of finding out familial relationships to ancient or mediæval royalties, courtiers, or ladies-inwaiting. The interest of physicians in the physical reformation of society must certainly involve an appreciation of the value of facilitating the study of eugenics. Those of an inquiring trend of mind may perform a valuable service in compiling heredity charts in relation to the definite physical conditions. Others may wish to investigate their own ancestry with a view to gaining knowledge concerning the potentials of their own children. While still others may find pleasure in studying the origin of their own characteristics. To all those who believe in the value of improving the human character, but who lack an adequate background of eugenic ideas and ideals, we would recommend that they get in communication with the Eugenics Record Office which invites consultation and offers its large experience in explaining methods, and interpreting data, compiling schedules, and in giving effective cooperation. Eugenics is a comparatively young science, but its promise to humanity constitutes the hope of the future. Employment Certificates.-The establishment of physical standards for working children is recognized, tho there is a vast difference in the practice in various states and communities. Bureau Publication No. 79 of the Children's Bureau deals with the report of a committee appointed by the Bureau to formulate standards of normal development and sound health for the use of physicians in examining children entering employment and children at work. It is obvious that the child who goes to work between the age of 14 and 18 years requires some special protection, if it is desired that he reach maturity in health and with undiminished vigor and vitality. It is for this reason that there is a large amount of public opinion tending to keep children out of industry until they are at least 16 years of age. The purpose also includes raising the standards of education by demanding school attendance until this period. If, however, children are obliged, for one reason or another, to enter industry there should be some mandatory provision for a physical examination before securing an employment certificate. already exists in eighteen states. This Something more, however, is required. than the physical examination on entrance. to employment: namely, more provision for the regular re-examination of working children, particularly during those first industrial years when the strains of industry are most likely to work to his physical disadvantage. The object of a physical examination is to prevent children entering unsuitable occupations, or to make it impossible for them to enter any industry for which they are unfitted without jeopardizing their physical well-being. The first examination on entrance to industry is an inadequate safeguard against the brevity of periods in employment and the frequent changes of jobs that result. A child may be well fitted for one type of employment, but completely unfitted for another. Hence, certificates for employment should be specific in character and with each change of occupation there should be readjustment of the certification in order to secure the maximum protection. An initial examination can only safeguard from those hazards which are known to exist in the particular occupation for which the child is being certified; and new physical examinations or at least new certifications should be required when a change of employment occurs. The Committee that has carefully studied the situation urges also the necessity for the provision of adequate facilities for the medical examination of all children of school and pre-school age. The reasons for this are obvious; namely, to prepare children for their occupational life by correcting all existent handicaps in so far as may be possible, and to give such directions and regimen for health as will prevent the development of weaknesses in their physical organization. That there is much wisdom in the certification and examination of school children is patent in the light of our war experience. Industry, in a sense, is a part of the struggle for existence for which one should be as well fitted as for bearing arms against a hostile foe. The physical standards for working children are no different than those that should be demanded for all children, the only difference being that periodical re-examination is more essential in order to obviate the handicaps that may arise from some. inherent hazards of occupations or from the stresses of work beyond the strength of the the enthusiastic and willing, youthful worker. In order to have efficient, mature workers in a community it is essential to safeguard the health of those who enter industry before their physical body has achieved maturity. Society protects itself in protecting its children. Success. It's doing your job the best you can |