recognize, however, the tremendous efforts that have been made and are being continued to enhance the health and safety of the employees in accordance with the definite principles of modern methods of accident prevention. The breadth of its program is sufficiently indicated to place it among the foremost of American corporations seeking to conserve the most vital assets of industry, the human beings, whose labor makes possible the success of industry.

To Dr. Thomas Darlington, one of the best Health Commissioners New York City ever had, this splendid showing is largely due. He became head of the medical department of the U. S. Steel Corporation. soon after the expiration of his term as Health Commissioner, and as a result of his ability as an organizer and executive, as well as a physician, the medical service was straightway put on an efficient basis. Many new and original ideas were evolved, and in a very short time the medical department of the U. S. Steel Corporation became one of the best exemplifications of what industrial medicine can accomplish when properly conducted, not only for the workers, but for every community within its sphere of influence. The men at the head of the Steel Corporation have fortunately been big enough, with sufficiently broad vision, to see what a well equipped, well organized, and thoroly efficient medical department would mean from economic, as well as from social and humanitarian standpoints.

The above results are an eloquent tribute to their common sense and judgment.

Control of Doctors or Drug Addicts?— Rules and regulations promulgated Decem

ber 27, 1920, by Walter R. Herrick, Commissioner of Narcotic Drug Addiction of New York State, caused another change in the matter of dispensing cocaine, opium and their derivatives. Regulation 12 reads as follows: "A physician or physicians of any institutions issuing a prescription for, administering or dispensing cocaine, opium or their derivatives in any quantity whatsoever, whether for a drug addict or any other patient, shall only do so upon the official duplicate dispensing blank. An apothecary must not dispense cocaine, opium or their derivatives on any prescription unless it is written on the official triplicate prescription blank. All provisions of law and all regulations applying to the filling of official prescription blanks and official dispensing blanks shall apply to such blanks used pursuant to this regulation.”

The attention, of the profession is called to the fact that New York State has now taken complete control over the method of prescribing narcotic drugs. It is no longer possible for a physician to write for paregoric, Brown mixture, or to administer the smallest quantities of opium, cocaine or their derivatives unless use is made of the official blank made out in triplicate or in duplicate if dispensed by the physician.

While the purpose of this regulation is designed to secure more effective control of the narcotic addicts, its results will be disadvantageous to physicians who are called upon to be careful in the use of official prescription blanks, and in the maintenance of adequate records. It is doubtful whether this record will in any way benefit the general public that is ill and requires medicaments of the type indicated for the relief of pain or for the sedation. of harassing coughs or distresses tending to shatter the circulatory function. Its un

fairness is manifested by the fact that the layman can secure remedies containing small amounts of codeine without the use of a prescription. Ammonium chloride, too, with Brown mixture can be secured over the druggist's counter upon request. An occasional request for paregoric will be honored, but the physician can only write non-refillable prescriptions for such substances and on an official blank to be made out in triplicate. It is easier to tell the patient to procure the drug than it is to write the prescription, and in consequence there undoubtedly will be greater familiarity on the part of the general public with the facility for getting these therapeutic agents without recourse to a physician.

It is doubtful whether the state inspection of drug stores is sufficiently careful or thoro to secure information from their records whereby the real check upon prescriptions can be maintained, and hence the value of the scheme is materially decreased.

It is unfortunate that physicians practicing in good faith are no longer permitted to take advantage of the second paragraph of subdivision 5 of Section 427 of, Article XXII, Chapter 639 of the Public Health Law which reads: "He may upon an unofficial prescription blank issue a prescription which does not contain more than five grains of cocaine or more than thirty grains of opium or more than six grains of codeine or more than four grains of morphine or more than two grains of heroin. He may also on an unofficial prescription blank issue a prescription for such quantity of any such drugs in excess of such respective quantities as may reasonably be required in the treatment of a surgical case or a disease other than drug addiction, provided such fact be stated upon the prescription. Each other prescription for

any such drugs shall be written upon a serially numbered official prescription blank in triplicate, to be procured from the department, signed by him and containing in legible English or Latin the name and the amount of the drug prescribed, the name, age and address of the person for whom and the date when the prescription is issued. He shall issue the original and one other of such triplicate prescriptions for delivery to an apothecary and shall retain the other copy on file for a period of two years." This paragraph is manifestly fair and does not provide any privilege which contravenes public welfare.

The New Regulation Should be Tested by Friendly Court Action.—It is exceedingly desirable that the constitutionality of the new regulation be tested, and some plan should be devised whereby regulations of this character can receive legal interpretation thru a friendly court action under the auspices, let us say, of the State Health Commissioner or the State Medical Society. At the present time it is necessary that the law be violated even by agreement, and that action be brought, before its constitutionality can be passed upon by the courts. It would seem preferable, however, to effect some means whereby court action could be secured without jeopardizing the interest or welfare of any individual physician because of the stigma which might attach to him in event of the regulation being sustained. Under the law, a violation of any of the provisions constitutes a misdemeanor and is punishable as such. The State Medical Society would be conferring a benefit upon the profession of the state if it were to take definite action leading to a test of the constitutionality of Regulation 12, which practically discriminates against the

physician, and in favor of the layman in the matter of administering cocaine, opium or their derivatives in quantities smaller than those actually provided for in Article XXII of Chapter 639, dealing with narcotic drug control. It is true that under paragraph 421 of Article XXII the Commissioner is empowered to make all regulations, rules and decisions "which in his judgment may be necessary or proper to supplement or effectuate the purposes and intent of this article or to interpret or clarify its provisions or to provide the procedure or detail requisite in his judgment to effectually secure the proper enforcement of its provisions, which rules, regulations, rulings and decisions, when made and promulgated by the Commissioner, shall become rules, regulations, rulings, decisions of the department and until modified or rescinded shall have all the force and effect of statute."

The question arises: Has the Commissioner promulgated a regulation that will properly supplement the efforts at narcotic drug control as previously outlined in Article XXII of Chapter 639 of the Public Health Law?

We want it distinctly understood that the foregoing is not offered in any way as an unfriendly criticism of the Commissioner. We have no doubt whatsoever that these new regulations, as viewed from his standpoint, are entirely justified. But we do feel that the situation is so serious, and offers such a handicap to legitimate medical practice, that a free discussion is called for. To a large extent the earnest medical journals are the spokesmen of the medical profession. It is our aim, therefore, simply to express the views of a considerable proportion of the doctors of New York,

with the object of presenting all phases of a most important problem, and of arriving, if possible, at a solution that not only will correct any existing abuses, but will be fair and just to the great bulk of the profession, who are practicing medicine honorably and honestly, and conforming in every way to the narcotic laws and regulations. In the last analysis, we feel that the function of medicine is too important and essential in the community, to handicap and penalize the many decent physicians for the misdeeds of the few.

In concluding, we wish to leave this thought, the narcotic laws and regulations will never accomplish their greatest good

until there is full accord between those who execute them and those who are affected by them. In other words, a law to be successful requires more than mere conformity to its letter; those who are subject to it, must believe in its necessity and justice. Is it not desirable that common ground be reached, if possible, on which the medical profession and the Narcotic Commission can meet with full sympathy in each other's purposes and acts?

Syphilis and Insanity.-"Syphilis as a Cause of Insanity" is discussed by E. Donaldson in Public Health Reports, January 21, 1921. The statistics presented are based upon the experience of 88 state hospitals for the insane scattered thru 39 states of the Union.

Percentages varied considerably for inmates and for admissions. This is obvious in view of the fact that those whose insanities are due to syphilis are comparatively short lived, wherefore the percentage among admissions would naturally be higher than it is among the inmates.

The results of the inquiry may be summarized as follows:

Percentage of male inmates whose in

sanity is due to syphilis Percentage of female inmates whose in

....

6.9

.. 2.2

sanity is due to syphilis Percentage of inmates (M. and F.) whose insanity is due to syphilis... 3.9 Percentage of male admissions whose

insanity is due to syphilis ........15.5 Percentage of female admissions whose insanity is due to syphilis ......... 6.1 Percentage of admissions (M. and F.) whose insanity is due to syphilis...10.4

It is manifest that these figures do not represent the true rate of incidence of syphilis among the insane or the number of those possessing a positive Wassermann reaction. As the author wisely notes, "Some insane persons have contracted syphilis after becoming insane; others contracted syphilis before becoming insane, their insanity being due, however, to other causes."

A study of the occupations of the inmates indicates, as might have been expected, that syphilitic insanities are not confined to any one class of the community, but are drawn from all classes and occupations of the general community.

From an economic standpoint, it is unfortunate that figures were not secured to indicate the duration of stay after admission to state hospitals, and the length of time that the syphilitic insanity incapacitates from labor in order that the economic loss and the financial liability of the state might be properly determined.

The fact that 10 per cent. of the admissions of men and women in state hospitals are due to insanity of luetic origin is sufficient indication of the costliness of this par

ticular manifestation of syphilis to taxpayers; and it similarly provides an effective argument for greater efforts at the control of syphilis and a wider education of the public concerning its effects upon mentality and length of life.

manac.

Why a Health Department?-The January issue of Public Health, published by the Michigan Department of Health, again takes the form of the popular alThe popularity of almanacs continues, particularly in rural communities. There is considerable advantage, therefore, for educational departments of states to recognize their usefulness for getting messages over to the general citizenry. While the date of sunrise and sunset and the phases of the moon are of practical importance and they far transcend in value a knowledge concerning birth stones and flowers, the brief statements of fact concerning contagious and infectious diseases, personal hygiene, diets, the part that insects and pets play in the transmission of disease are of greater value to individuals. The intermingling of historical statements, fast days and feast days with popularized advice, more or less provides for a reading of the almanac.

Especially commendable are the brief and simply written articles concerning vaccination, pneumonia, whooping-cough, diphtheria, breast feeding, typhoid fever, scarlet fever, tuberculosis and syphilis with succinct statements of the regulations relating to them.

There could be little reason for ignorance concerning the laws of the state under such circumstances if the almanac could reach every home. Unfortunately, this valuable edition is limited to 13,000 copies.

A more expressive exposition of the value of the Michigan Department of Health is evident in a résumé of some of the ways in which the Department of Health is trying to live up to its responsibilities to the people. While the list of functions is far from complete, it bears witness to the modernness of the viewpoint of the Michigan Department of Health, and is quoted for the benefit of states and municipalities which have thus far not instituted some of the health facilities provided by progressive Michigan.

The Michigan Department of Health issues its monthly bulletin, Public Health, to 13,000 readers; distributes public health

literature; assists in the inspections of

school children; maintains laboratories for milk and water analyses; conducts Wassermann tests for the service of health officers and physicians; furnishes lecturers on public health topics; assists in arranging "health weeks" for any community; loans exhibits for health campaigns; maintains traveling health clinic; gives expert assistance in establishing baby clinics; assists in establishing county nursing systems; offers you the privilege of a loan library on public health subjects; sends prenatal instruction letters, on request, to expectant mothers; makes confirmatory laboratory diagnoses on all types; offers treatment for venereal disease in all clinics; sends material to health officers for the swabbing of children's throats; uses six educational moving picture films and 1,000 health slides; conducts

investigations in stream and lake pollution; advises on water purification and sewage disposal; keeps the 6,500 physicians and health officers informed of health conditions thruout the state; distributes arsphenamine at cost; hospitalizes infectious cases. of venereal diseases; aids communities in

Schick testing school children; has corps of physician inspectors to aid communities in control of epidemics.

This rather incomplete list of a part of a state's health activities shows the altered viewpoint of health administration. No longer is the maximum attention fixed upon filth and nuisances. Diagnosis and education, particularly the latter, occupy the center of present-day tendencies. Treatment by the state is beginning to manifest itself as a phase of preventive work on the theory that the control of disease carriers is an essential part of the complete scheme of prevention. To this factor of public health

administration there has been considerable

objection on the grounds of interference with the liberty of conscience of the patients, and an unwarranted interference with the methods of private practitioners. The discussion of this phase of state activity is by no means closed, and considerable opposition has developed in various countries. None the less, there is a very distinct tendency to establish treatment as part of the necessary work of health protection and disease prevention.

It is generally acknowledged that in its ultimate analysis, the maintenance of public health becomes an individual problem. The necessity of reaching the maximum number of the population is paramount. This can only be done, however, thru community efforts, and the end to be achieved is relatively unattainable without the extensive and continuous cooperation of the community thru its accepted public agencies

and the individuals who are at once the support and the wards of these institutions.

Physicians and Legislation.—The special commission of Massachusetts appointed to investigate maternity benefits, whose re