should be one of interest, sane criticism, careful observation and thoughtful comparative judgments. The results of radium therapy will improve with the improvement of technic and knowledge concerning its better and safer employment. If the surgeons and radio-therapists will work in closer harmony, the benefits to suffering mankind will be achieved more quickly.

Visiting Teachers.-The problem of visiting teachers, on first thought, does not appear to be intimately related with medical service. The brief report on "The Visiting Teacher in the United States," issued by the Public Education of the City of New York, should indicate the helpfulness of this type of public servant, whose services have already been recognized in fifteen states of the Union. The visiting teacher is a home and school coordinator and a clearing house for information and effort in the better adjustment of school children. Her work requires an understanding of all the types of special classes, from those for mental defectives and neurotics, to the special classes for the deaf and blind, the crippled, the cardiacs and epileptics, as well as the other special auxiliary classes of a hygienic and therapeutic nature.

Her problems arise from maladjustments and poor scholarships, adverse home conditions, misconduct and impaired physical condition. She is as interested in mental precocity as in mental subnormality. Irregular attendance, with its underlying reasons is no more important than misconduct in or out of the school. The physical and mental examinations are part of her corrective measures. In her general educational and social training, there is required considerable specialization in psy

chology, sociology, dietetics, biology, mental hygiene, mental abnormalities and mental testing, general physical hygiene and a reasonable acquaintance with the practical phases of medicine.

There is every reason to believe that this new type of school worker will be of considerable assistance, and will require the aid of physicians and psychiatrists in the accomplishment of the adjustment of many who are at present school failures for one or more of various reasons.

The educational system has become more conscious of the need of guidance in the constructive aid of school children. It is doubtful whether the medical profession is adequately alive to the advantages to be derived thru practical cooperation with trained teachers, particularly those who have specialized in the management of abnormal and pathologic types of children. There is little question but that the teacher may be utilized advantageously as a therapeutic agent in many instances, and on a still larger number of occasions as a factor in the prevention of serious deviations from normal conduct and mental maladjustment.

Ventilation and Colds.-The increase of respiratory affections during the cold season is not thoroly understood. The part played by actual climatic conditions, as opposed to indoor temperature and humidity, has not been demonstrated with any degree of conviction. G. T. Palmer, in the September and October numbers of the Journal of Laboratory and Clinical Medicine, has presented "A Study of Ventilation, Weather and the Common Cold." His studies are based upon the prevalence of respiratory diseases among school children and their association with different forms of school ventilation and seasonal changes in weather.

New York City schools were the subjects of the investigation. The general types of ventilation included window and gravity exhaust, plenum and exhaust fans, and plenum fan and gravity exhaust.

It is rather significant that schools located in congested districts and "attended by pupils of inferior economic and sanitary status had less illness than those located in the better class neighborhoods." The question naturally arises as to whether the extra care that follows as a result of family prosperity tends to undermine the health of potentials of the school children with homes possessing unusual environmental and social conditions. This, of course, might be interpreted as meaning that such children are subjected to abnormal conditions of temperature and humidity in their homes, and hence lack the "hardening" that results from varying degrees of exposure to cold and, therefore, more sensitive to environmental

are

changes.

More significant among the conclusions. is the statement that "there appears to be something inherent in the indirect method of ventilating school rooms by means of forced draught and gravity exhaust that is productive of respiratory affections, something which is not present in rooms ventilated with windows and gravity exhaust." These elements have not been determined satisfactorily. Temperature, humidity, rate of air flow and stability of room atmosphere conditions may all serve as individual varying factors affecting health favorably or adversely. With the millions of dollars that have been spent upon ventilating equipment, there is an economic note in the fact that window ventilation has competed most favorably from a health standpoint with the most elaborate ventilation systems requiring fan and duct equipment. This statement refers entirely to the problem of ven

tilating school rooms. Obviously, natural ventilation has its limitation, and thus is not applicable nor practicable for rooms that seat several hundred persons at one time. This condition, however, does not obtain in the school room.

Coolness and air motion are vital factors in promoting the comfort, health and efficiency of school children and their teachers. Further, in the general distribution of respiratory disease among school children, the school ventilation is of less moment than the external weather condition. In so far as the alteration of the indoor atmosphere may serve to conserve the vitality of school children, the problem assumes considerable importance. If natural ventilation accomplishes as favorable results as the costly installation of ventilating apparatus, there has been a tremendous waste of public moneys which might better have been devoted to other methods of caring for the health of school children. There is insufficient evidence at the present time to indicate what future school policies should be; and sanitarians are by no means agreed as to the full values of the various types of ventilation in their actual effect upon the vital capacity and reserves of school children. The open air classes have indicated their tremendous advantages for certain types of children who require the stimulation of fresh air, lower temperatures and air in motion without the existence of draughts. If, as appears reasonable, natural ventilation suffices to promote the health of school children, there is no further excuse for impairing the atmosphere of school rooms thru the unnecessary expenditure of funds for useless ventilating systems.

Further study is required by public health investigators to secure more complete and accurate data to determine in how far

the unfavorable effects of outdoor weather conditions may be offset or mitigated by the control of the indoor atmosphere. This is a particularly important problem that calls for solution in view of the tremendous morbidity from respiratory diseases.

Hesitation and Progress.-The tendency of medical organizations to cast aside. opportunities for constructive efforts frequently is discouraging. Special committees work for long periods of time and formulate excellent reports which are then presented to the house of delegates or the general membership. After an interval of discussion, during which individual physicians present their views, which may or may not be the result of thoughtful study, the report of the committee is amended beyond recognition, referred back to the committee, or laid upon the table. The usual report of a committee dealing with problems that involve no questionable facts is accepted without serious discussion.

In Minnesota Medicine, October, 1921, one notes an excellent illustration in the handling of the Report of a Committee on Social Insurance. A brief but constructive report, was offered which urged that "Thought and study be given by the profession to the problem of social and industrial medicine." Three specific recommendations were made with the following preamble:

"As the problem is one for study and one in which the entire profession is concerned and should be informed, and as the Medical School of the University of Minnesota is the teaching and research medical institution of the state, we recommend and strongly urge:

"(1) That the Minnesota Medical Association urge its members to give the subject of social insurance thought and study,

as we believe some form of social or industrial insurance is inevitably to be widely tried thruout the country. We believe that such study is necessary as a foundation for the settlement of these problems when they present themselves before the legislative bodies.

"(2) We urge that the Association recommend to the Board of Regents of the University of Minnesota that a course of courses on industrial medicine be added to the curriculum of the school. We believe that the medical student of today will have an important part in the solution of these problems and deem it just that he be taught concerning the phases of industrial medicine as it exists today and thus be better prepared to meet the problems as they arise. "(3) We recommend that a copy of this report be sent to the President of the University of Minnesota, to the Board of Regents and to the Dean of the Medical

School."

It must be admitted that these three items are constructive in character. After the motion to accept the report, there was an amendment to strike out the portion of the report which recommends the teaching of industrial insurance in the university. The amendment was accepted. Then followed a discussion by one man who presented his own opinions upon the subject of social insurance and pronounced "This sort of legislation absolutely pernicious, but we will have to meet it in the near future." posed the recommendations that "The University of Minnesota should be requested to take up the subject of social insurance or investigate it." After a re-reading of the recommendations, the committee was thanked for its valuable report and it was then laid upon the table.

He op

This situation is not peculiar to Minnesota nor to any particular state medical society. It is a more or less characteristic attitude of approach to problems of public policy that constantly leaves the profession behind, rather than among the leaders in thought,

concerning large public questions dealing with their own welfare. In this instance especially, a forward step was proposed, an intelligent investigation and a form of education that would serve as a background for thoughtful opinions. Nevertheless, the report was laid upon the table.

Constant shutting of the door to the entrance of new ideas is not the means of controlling them. Welcoming, guiding, accepting and directing modern opinion is far more efficacious than rejection, irrational opposition and unalterative refusal to view more than one side of the question. The entire history of social legislation in this country indicates that laying reports upon the table is a blind and hazardous method of approach and must give way to one in which intellectual understanding replaces emotional reactions. It is impossible, of course, to divorce sentiment and professional feeling from participation in the consideration of our problems dealing with professional welfare and progress. On the other hand, a full knowledge is to be encouraged, and dispassionate judgment carries greater conviction than rage or impassioned resentment. It is time that the laying of reports upon the table gave way to a deeper study and investigation of their merits with a final recording of opinion upon the acceptability of the report in the light of the information available for those voting upon the report.

Tuberculosis and Quackery.-The Framingham Community Health and Tuberculosis Demonstration was designed primarily to indicate how tuberculosis might be controlled thru adequate medical and social organization. The basis of the plan lies in

the examination of all persons in order to discover the presence of the disease. By careful cooperation with the physicians of the city, a comparatively large number of cases of arrested tuberculosis were discovered. The size of the community and the small number of cases of tuberculosis make general conclusions rather difficult.

In the Journal of the American Medical Association, August 21, 1921, appeared an article detailing some of the medical results of the experiment. It points out in its summary some cogent facts which merit reflection. "The chief factors that seem to be responsible for the late discovery of tuberculosis cases which give to the community every year advanced and dying patients that have not been known or treated for tuberculosis in the early stages of the disease are: The recluse type, which seems to be the main type, never receiving any medical attention; failure of patients to seek medical advice early, or if they do, not to give the physician sufficient time to make a diagnosis; occasional failure of physicians to detect disease early; failure of both physician and patient to use all of the services at their command for early diagnosis of tuberculous disease; lack of complete annual medical examination, and lack of annual factory and school examinations." This brief summary represents conditions that exist in all communities and represent a serious part of the tuberculosis problem. From a practical standpoint, it is doubtful whether any machinery can be devised to meet all these situations until communal education is on such a plane that the tuberculosis problem is recognized by all individuals as a real peril.

The difficulties, however, are complicated by the existence of the rapidly growing group of religious and pseudo-scientific cults

which deny the existence of disease or attribute its causation to variations in structural anatomy. All efforts of the medical profession for the complete control of communicable diseases, including tuberculosis, are hampered by the counter-opinions of the charlatans and quacks, who deny the existence of the scientific facts which the long history of scientific investigation has established. It would seem as tho health departments and organizations for the control of tuberculosis would take more active steps to eliminate the activities of the various cults which are endangering public health. While it is true that educational propaganda and medico-social organization will continue to decrease the morbidity and mortality from tuberculosis, the irreducible minimum cannot be reached while there continues to exist a group in the population which is insidiously and indirectly undermining the confidence of considerable proportions of the public in the benefits of complete medical examinations, bacteriologic diagnoses and rational therapeutics.

A recent advertisement is headed, "Tuberculosis! Get well at home in 10 days." Why the publication of an advertisement of this character is countenanced or permitted is beyond understanding. It appears in a paper of wide circulation and certainly is fraudulent in character. Knowledge concerning the Framingham Experiment has reached certain small groups of medical men whose opinions concerning its general results and advantages have not reached as large a group of persons as would read the single advertisement, which in spirit counteracts much that the experiment would convey to intelligent persons. Warfare against tuberculosis must include the prevention of dishonest advertisement and the exploitation of the public thru heinous

promises of unscrupulous purveyors of alleged cures.

The results of constant attacks upon the tuberculosis problem are gratifying and there is every evidence that another decade will bring with it a greater decline in the morbidity rate. It is incumbent upon the medical profession to attack more vigorously the disreputable elements in the community that utilize fraudulent methods at every opportunity. The truth eventually. will prevail, but constant vigilance is requisite to overcome and destroy the inimical forces that seek to take advantage of those afflicted with the disease or those who believe themselves to be suffering from symptoms of an indefinite character, but resembling the advertised descriptions of incipient tuberculosis. The National Committee for the Prevention of Tuberculosis, working in harmony with medical organizations, should prove powerful enough to wage war successfully upon the common enemy. Public health demands a more assertive policy against those who present obstacles to modern methods of combating tuberculosis.

Minimum Wage Laws. Minimum wage laws are considered part of the legal and economic organization of society. As a matter of fact, the upholding of minimum wage laws by courts has been a declaration of their validity as an exercise of the police power of the state, that is to say, a provision to promote general welfare.

In Bulletin 285 of the United States Bureau of Labor Statistics, one learns that "The commissions charged with the administration of the laws are designated as welfare commissions in five states; and the maintenance of health and welfare is said