not well poised in his or her methods of approach and influence. 4. Work. One of the best agencies for securing healthful mental habits is work. Recreation liberally interspersed with the work is also necessary. But recreation alone can never fully satisfy the natural instincts which demand the accomplishment of something useful. Without work-serious, solid work—the life soon becomes empty and the mind diseased. Work is a condition of mental health. It is useful employment which builds up strength and endurance, as well as joy in living, in our entire mental and physical existence. In fact, the work-cure, especially where it takes the patient out of doors and into touch with nature, has been found to be most effective in the forms of mental disorder which arise from too much leisure, bad habits of work, or the hallucinations that develop from having too much opportunity to think of self. Work usually draws us outside of ourselves and frees us from the danger of morbid introspection. A boy or girl who is not taught to perform useful work and to look forward to a life of active usefulness will inevitably feel the lash of violated mental hygiene. The mind of youth is active. And when this activity is not directed into channels of usefulness it flows into the ways suggested by caprice, by the passions, by the temperament, or by any other mentally dangerous agency. 5. But work must not be centred upon self. It must be for the purpose of accomplishing that which is beyond, higher, and better than self. It must be for service-service to others rather than for self. One of the most unwholesome mental attitudes that can arise is that of feeling that one is of no use in the world. Such feelings may arise temporarily as a result of disappointment or failure and be only fleeting in their influence. But, where it becomes a habit of thought, the feeling becomes a serious menace to the mental health. For this reason young people need much consideration and encouragement in their failures. All of them need the bracing, invigorating feeling of at least occasional suc cess. No task should be so far beyond the efforts of the child that he cannot succeed. It is therefore manifestly unwise, and a serious menace to the attitude toward work, to push a developing child beyond his understanding or strength. Both mental age and physiological age must be taken into account in arranging the course of study, the daily program, the daily responsibilities and tasks. But with all of these, and in all of these, the child should be led into the ways of service. Usually the child is pleased with the dignity of being permitted to serve of demonstrating his ability to do things that are useful. Usually he is so pleased with responsibility that from these first stages of service for those he loves or in whom he has confidence he can be led out into the wholesome, safeguarding, developing influences of social and civil service. And when this end is accomplished, another physically, mentally, and morally healthy citizen has been developed for the State. Doctor of Public Health. The work that boards of health and medical inspectors have been called upon to do in the schools has called attention to the need of a wider training, on the part of the physicians who undertake such work, than that which is necessary in the ordinary medical practice. Two things occurring within recent years have greatly emphasized the need for this broader training. One was the discovery of the fact that the mosquito is largely responsible for epidemics of yellow fever and the resulting improvement made in the sanitary conditions in Cuba. The other was the work of sanitation so effectively done and maintained by Colonel Gorgas and his medical staff in the Canal Zone. This work made possible the digging of the Panama Canal, and has transformed a region, which for centuries was regarded as one of the plague spots of the earth, into a place with a death-rate lower than is to be found in many of the large cities of more northern climes. The work of Doctor Oscar Dowling in fighting filth and disease in the State of Louisiana has also called attention to this same need of a new type of health expert. The training for this new profession should be based upon a thorough medical education and should include, in addition to this training, careful preparation in public hygiene, sanitation, food and water testing and analysis, and advanced skill in bacteriology. The preparation in public hygiene should include a knowledge of the best methods of securing the results and habits that make for health. And the sanitary training should impart a good engineering knowledge of the problems of heating, ventilation, and drainage. For the work of successful medical inspection in the schools, these doctors of public health might also well have a knowledge of criminology, mental pathology and hygiene that would prove of great service in the recognition and treatment of mental and moral defectives. Because of the high degree of training required, competent persons for this broader health work should be paid attractive salaries and should be employed continuously. Only in this way can the school, the community, or the State hope to receive the full benefit of their work as their experience in it grows and they thus become more valuable in the service. In the Canal Zone the work of the sanitary experts included getting rid of malaria and yellow fever and the difficult task of furnishing uncontaminated water and food supplies, as well as proper incentives to secure more healthful habits of living. These tasks demanded expert knowledge and executive ability far beyond that possessed or ordinarily demanded of the physician. The yellow fever mosquitoes, fortunately, do not fly far, and the sanitary measures pertained to such things as segregating patients, screening hospitals and houses to prevent their access to patients, and to the covering or removal of all their possible breeding places. In the case of malaria, however, the problem involved far more. The germs of this disease are also carried by a mosquito; but it is of comparatively strong flight, and becomes menace to regions probably even as far as a mile and a half from its breeding place. To get rid of its dangers, therefore, involved not only screening the houses, but the filling in of water holes and marshes and, in some cases, the creation of new and better channels for streams. During the eight years that the work has been going on, the engineers and the physicians have spent over $12,000,000. But they have made it possible for the Caucasian to remain healthy and vigorous in this torrid climate, and to accomplish the most stupendous engineering feat ever attempted without unnecessarily sacrificing either lives or health. The extent of the safety from yellow fever is shown by the fact that during the year 1911 there was not a single case of yellow fever within the entire Canal Zone. Doctor Dowling's work in Louisiana illustrates the more usual forms which public health work must assume and for which the doctor of public health must prepare. Soon after becoming president of the Board of Health of his State, he saw the necessity of carrying his health message and his personal inspection out among the people. To do so he had equipped a health exhibit train by means of which he visited every town of 250 inhabitants or over in the entire State. Through this "gospel of health on wheels" he was able to convince the people of the need of proper sanitation; of the necessity of protecting food supplies from dust, flies, and other insects; of the value of clean, rich milk, produced by healthy, well-fed, well-bred cattle; of the importance of exercising care in the slaughtering and handling of meats; of the danger of drinking contaminated water; of the disease germs lurking in the drinking-cup used by everybody and in the public roller towel; that dirty houses and streets and bad drainage are the fertile means of breeding and communicating disease; and that the drug habit arising from the use of patent medicines is often as dangerous as disease itself. During his tour practically every school-house, jail, asylum, and other public building was visited and inspected, as were also most of the stores, restaurants, barber-shops, and hotels. While the inspection was going on in a town, Doctor Dowling's assistants lectured to the people on health conditions, with a view not only of imparting knowledge but also of reforming the habits of individuals in the hope of making of each one of them an enthusiastic agent and inspector for public health. As it always is difficult to arouse adults to a saving sense of conditions to which they have become accustomed, Doctor Dowling soon realized the importance of carrying his health work into the schools of the State. By bringing about proper instruction in matters of health in the schools, the Louisiana Board of Health expects that the coming generation will be trained in better ways of living and in a proper interest in the general public health. For, in the interest and intelligence in such matters which can be awakened and maintained among young people, lies, no doubt, the greatest hope for the health of the future. Experts in social statistics have placed an economic valuation upon human life at every period from infancy to old age. This valuation increases steadily from $90 for the newborn infant to $4100 for the matured adult, and then declines slowly as the expectation of life decreases with advancing years. Taking Professor Irving Fisher's estimate of $2900 as representing the average value of the lives of Americans, we find the vital assets of our nation to be approximately $300,000,000,000, or nearly 21⁄2 times the value of its other wealth. This helps to emphasize the importance of conserving the health of the nation as its most valuable asset. Doctor Earl Mayo, in an article in The Outlook for December 7, estimates the number of deaths in the United States each year as 1,500,000, and says that it is not this tremendous total which is the big fact, but rather that " It is the undeniable truth that a very large proportion of them are preventable,—that is, postponable for longer or shorter periods." Even if a knowledge of the preventive measures that are already known could be spread and acted upon, in his judgment 40 per cent, or 600,000 lives, could be spared each year. This represents, without considering at all the incomputable suffering and sorrow accompanying it, an economic waste that calls for prompt remedy. And in applying the necessary remedies there would also be a distinct gain in general health. "The methods required for the prevention of unnecessary deaths would at the same time do away with much preventable illness. The conclusion of the most widely recognized authority on the relative extent of sickness and mortality is that for each death there is a little more than two years of invalidity." While most of the invalidity is among the very young and the very old, there is still at least one-third of it among persons in the productive periods of life. Averaging earning capacity at $1.50 per day or $450 per year, the loss from sickness each year of probably a million persons involved represents a loss of about $450,000,000 per year. "The cost of medical care, medicines, and nursing average at least a dollar a day additional, or a yearly total (for approximately 3,000,000 persons who represent the average number sick) of over $1,000,000,000." Altogether Doctor Mayo feels that the elimination of preventable sickness would add at least $1,500,000,000 to our |