of opinion, because new discoveries may invalidate previous conclusions.

The annual meeting of the Commission, because of its scientific spirit, the integrity of its members, and its group honesty of opinion, has established it as one of the most reliable and dependable sources of judgment and information upon the numerous problems relating to milk and milk products. Its contribution to the practical solution of rural and municipal regulation of milk supplies bears witness to the value of its services and the importance of its sane leadership. As a National Commission it has functioned successfully even tho without power to issue mandates or to coerce food administrators. Its strength lies in its membership and the vital nature of the subject with which it is concerned in the interests of public health and particularly infant welfare.

Problems in Medical Progress.-The entire report of the Cleveland Hospital and Health Survey, to which reference was made in AMERICAN MEDICINE, December, 1920, has appeared. Each small volume is filled with highly informative and suggest ive material of general and special interest to those interested in public health administration, and the methods of determining facts concerning communities upon which to base constructive operations for the conservation and protection of communal health.

In as much as rigid standardization of methods of treatment for community ailments is undesirable, the diagnosis of Cleveland's ills does not afford a complete basis for undertaking to cure the defects of other communities. There are certain fundamen

tal conditions concerning curative and preventive medicine, however, which should obtain thruout the country. In this connection Part Eight, which deals with the Education and Practice in Medicine, Dentistry and Pharmacy, is especially valuable.

Cleveland boasts of a Class A medical institution in Western Reserve University, which is responsible for the preparation, the guidance and the inspiration of physicians, dentists and pharmacists. This creates a larger responsibility for medical standards in Cleveland than would exist naturally in cities not thus provided with educational resources in this direction. One criticism of this institution merits attention, because it is undoubtedly applicable to many other institutions where the faculty and trustees do not meet upon a satisfactory basis.

"Little exact knowledge was found to be possessed concerning many of the important problems of medical and dental education by those in responsible positions as trustees and executives."

Similarly, other medical colleges may take to heart the implied suggestion concerning the curriculum of this institution. "Systematic instruction in public health problems and methods is now an obligation of every medical school, which can no longer be escaped on the plea of an overcrowded curriculum." It is important for medical schools to realize their responsibility to their students that they may give them adequate training to serve as quasi health officers, as well as private practitioners. With the growth of public medicine there is reason for the introduction of industrial hygiene, and an elaboration of the work in connection with psychiatry. In the form of instruction it is noteworthy that the types of medicosocial activity at

present receiving greatest attention are not given much consideration in the general plan of training medical students in this particular institution, but this difficulty is less marked in many other of the Class A medical institutions.

The report calls attention to the fact that practically 29.4 per cent. of all the practicing physicians of Cleveland "control the opportunities of education and personal advancement afforded by 80 per cent. of the hospital beds of the city." According to Dr. Haven Emerson, who wrote the report, "In Boston about 42 per cent. of the practicing physicians enjoy hospital opportunities. In New York it was learned from a recent study that 51 per cent. of the registered physicians have hospital or dispensary affiliations (12.6 per cent. only dispensary affiliations, 12.8 per cent. both hospital and dispensary affiliations and 26.2 per cent. only hospital affiliations)." This, obviously, brings up the question of opened or closed hospitals as agencies in promoting the welfare of the community and in advancing the standards of the medical profession. It is obvious that under a closed system recent graduates who represent the best products of present-day medical teaching should be given an opportunity to utilize their enthusiasms and interests in connection with hospital and dispensary service. Their capabilities should not be retarded, nor their development handicapped by the feeling that hospitals are controlled by a small group of men in the community who utilize their affiliations for personal advancement, commercial benefit and an enhanced reputation. After all, hospital and dispensary services are designed to benefit the community and should not be considered as the property of the attending staff nor

established for their particular benefit. The larger the number of physicians utilizing hospitals and dispensaries the greater safety there is for the community, and the more numerous are the opportunities for raising the standards of private medical practice thruout the section served by the particular institution.

This fact of control of opportunities is undoubtedly responsible for a lack of harmony among physicians in many cities and districts. Only thru the recognition of a just distribution of all opportunities and the generous support, encouragement and advancement of young physicians by their seniors will bring about that mutual trust and confidence which is so essential for the advancement of the ideals of the medical

profession. The need of developing among recent graduates fields of activity for which they have received the training that was not available for their elders in medicine is patent, and every effort should be made to take advantage of the ambitious willingness of young physicians to participate in advancing the technic of medical practice and in attempting research work that may be of benefit to particular institutions or, indeed, to humanity as a whole.

The general tone of the pamphlet dealing with education is constructive and free from harsh criticisms. All recommendations made are based upon adequate data, and are born of a broad conception of medical education. It recognizes the relations of trustees, teachers, hospital affiliations, departmentalization, clinical research and specialized phases of modern medicine. The reading of this report, together with the remaining ten numbers, will give an excellent idea of the purpose and value of health surveys as a means of improving all phases of private and public agencies and insti

Freudian Fraud.-Among the resolutions adopted by the All-American Conference on Venereal Diseases, held in Washington, D. C., December 6-11, was the following statement:

"Resolved that: Altho there is danger that a superficial and erroneous interpretation of the Freudian psychology in regard to the repression of the sex instinct may be detrimental to the successful development of the program for the control of venereal disease, a more thorogoing, complete and scientific interpretation, however, tends to aid such a program in that it places the emphasis upon the practical means for guiding the sex instinct into social usefulness and constructive activities."

The importance of this resolution lies not merely in its timeliness, but in its recognition of an inherent danger of the Freudian psychology as very generally interpreted.

The resolution recognizes that much of what parades as true Freudian psychology is superficially and erroneously interpreted. It is unfortunate that at the present time. modern psychology has been adopted as a fad by large groups of so-called intellectuals almost entirely lacking in either the scientific preparation or the educational background for discriminating between fact and fallacy. Too many individuals who perchance have felt the necessity of submitting to psychanalysis, regard themselves as competent to practice it and, furthermore, offer themselves to the general public as thoroly capable psychologists of the dynamic Freudian school. Books dealing with Freudian psychology have been written by numerous similar individuals of variable literary skill, who appreciate the

moment, or seek relief from a cerebral priapism.

Writing in a psuedoscientific and mystical vein they expose their lack of psychologic perspective and their superficial acquaintanceship with the valuable contributions that have been made by Freud, Jung, Adler and others of this group. Sensational volumes dealing with education, hygiene and ethics in terms of erotic symbolisms, and many books on the application of psychology to industry, art, literature and biography have followed rapidly so that a certain uncertain group of the population is arriving at the saturation point in terms. of sex psychology as related to instinct, sentiments, habits, vocation, religion and what not.

No objection can be urged against the scientific elucidation of all psychologic theories in so far as they are accurate expositions and reliable interpretations. Unfortunately, more stress has been placed upon the inherent hazards of repressing the sex instinct into useful service. The communal dangers that arise from the release of the sex instinct from normal control are of immense importance. In the program for controlling venereal diseases it is obvious that any form of psychology that countenances the individualistic conception of emotional unrestraint is pragmatically unsound and contrary to public policy. The advocacy of sexual freedom on the physical plane is opposed to the best interests of society, and is certainly detrimental to any program that seeks to lessen the disease problems that arise from promiscuous sex relations.

The sound thinker recognizing the influence of the herd instinct appreciates the importance of sublimation as a useful fac

tor in preserving the group. Violations of the rules and regulations, promising the greatest benefits to the mass, carry with them a varying degree of punishment. In the sexual sphere, however, venereal disease does not merely punish the individual, but penalizes the race, and all doctrines which tend to promote individual freedom in sexual activity threaten the integrity, health and progress of society.

Those who misinterpret Freudian psychology are distinctly antagonistic to the welfare of the community. Their pernicious views, eagerly sought and acclaimed by the unthinking, call for the rational opposition of the scientific and moral elements of the community. The disciples are seeking to out-Freud Freud, and in this process constitute a menace.

It is time that the general public received a warning against the misstatements, false interpretations and degenerate ideas which tend to reduce many honest persons to the level of phallus worshipers. The problem is more serious than is generally recognized, and to no small extent is responsible to some degree for the moral upheaval which is evident in the adolescent generation. The resolution, suggesting the dangers in Freudian psychology, is adequately worded to make clear the idea requiring most emphasis. Social usefulness and personal adequacy develop thru the sublimation of instincts and not thru the unleashing of primitive impulses for personal gratifications.

Popular Health Letters.-The necessity for education as part of every healthconserving program has been adequately emphasized. There has been a great need, however, for the development of a type of literature that would actually serve the

public. Too much stress, as a rule, has been placed upon the individual disease problems with a view to developing a personal interest of individuals in their specific complaints or symptoms. As a matter of fact, comparatively few organized efforts have been made to arouse public interest in general health, and to familiarize the reading public with the methods and purposes of health administration with a view to eliciting their personal cooperation thru the practice of what is popularly known as personal hygiene.

The Framingham experiment has been productive of a most excellent compilation of health letters which have appeared in the Framingham Evening News every Saturday night for the last three years (Framingham Monograph No. 8). As properly indicated in the introduction, "Educational work must aim at the promotion of public hygiene by community. action, and at the encouragement of personal hygiene by individual action." With this aim, a practical educational program was worked out, laying stress upon the necessity and value of thoro, regular, annual, medical examinations, supplemented by the advice to take advantage of all the facilities afforded by the community. In order to test the success of the educational program, recently seven or eight hundred individuals were canvassed and it was ascertained that 29 per cent. of them, without any specific urging, had consulted their own physicians during the previous six months "for advice with reference to hygiene and its prevention and for a medical or health examination." This is indicative of a fair degree of success of the educational campaign.

While the Framingham experiment primarily was designed as a demonstration of the ability of a community to attack

the problems of tuberculosis, it was early recognized that this involved a complete program for raising health standards in the community. The prevention of tuberculosis is not an isolated problem, but involves a complete program for protecting public health. The educational material, therefore, was designed to cover not merely tuberculosis, but the hygiene of childhood and of the worker, the especial phases of food work; seasons were adequately considered, and due attention was paid to special diseases that lower communal vitality. The simplicity of the articles, their directness, variety in presentation and optimism, together with their scientific accuracy and logical development, make them a most acceptable pattern for those engaged in public health education. There is no evidence of writing down to a lower mental level of readers, nor is there evidence of pedantry in discussion. The series published indicates that there has been a careful adaptation of subject matter and method of presentation to the community of Framingham.

As evidence of a constructive and systematic effort at health education, the health letters merit commendation and should prove suggestive to the writers of popular medical stories for newspaper service. There has been so little work of this type developed in an orderly manner, with a unity of purpose and a more or less fixed group of readers, that it is desirable that the subject matter prepared and published be carefully considered by all who contemplate advancing health thru publishing for educational propaganda.

The Prevention of Diabetes.-An abnormal appetite and thirst are characteristic

symptoms of diabetes mellitus. Evidence is accumulating to indicate that the same conditions are probably pronounced factors in its causation. E. P. Joslin, in discussing "The Prevention of Diabetes Mellitus", Journal of the American Medical Association (January 8, 1921), indicates that the prevention of obesity would probably result in a marked lessening of the incidence of diabetes. The association of obesity and diabetes has been recognized for many years, and the fact that there are probably more than half a million diabetics in the United States would suggest the opportunity for acquiring information leading to a more intelligent appreciation of this relation.

Joslin has made a study of one thousand successive cases of diabetes, paying particular attention to the items of age, weight and height at the time of the incidence of the disease. His published table shows that "among 1,000 diabetic persons there was no instance in which diabetes occurred when the maximum weight was 31 or more per cent. below the normal zone, whereas there were 273 persons who developed the disease among those who were 30 or more per cent. above it." Furthermore, in his series with persons who are 21 or more per cent. overweight, diabetes occurred 79 times as frequently as when in the corresponding degree of underweight. Among the entire number, the maximum weights of only 10 per cent. were below the standard weight zone, which varied from five pounds below to five pounds above the average weight for height and age, while 15 per cent. came in that zone and 75 per cent. were above it.

In Joslin's words, "Diabetes, therefore, is largely a penalty of obesity and the greater the obesity, the more likely is Nature to enforce it." He formulates this