the problem. "A sanitary service, subsidized by the State, will alone render efficient relief in the backward districts without generally demoralizing the profession."

6. The newer medical education is making more and more provisions each year for post-graduate work. Such post-graduate work aims not so much to be helpful to the person interested in research work, which is intensive and original in character, as to give practical assistance and a wider outlook: (a) To the busy urban physician and surgeon who are in constant danger of losing touch with progressive developments; (b) to those lacking the broadening and stimulating effects of connection with a public clinic; and (c) to those who dwell so far from the centres of activity as to be in danger of stagnation. "How much post-graduate instruction can accomplish for any one person is largely dependent upon the quality of his original medical training." Such medical courses are usually brief and recur for most individual practitioners only at somewhat lengthy intervals. "If a man has been poorly trained what he carries away is apt to be superficial, mechanical, and may be perilous; but if he has been trained in the scientific spirit he may gain much by an occasional dip into these waters." What Doctor Flexner, who wrote the main part of the Report, has in mind in this post-graduate work is brief courses, each a few weeks in length, in such things as new methods in physical diagnosis, serology, or vaccine therapy. The best forms that the post-graduate work can take are in his judgment: (a) To organize the local medical talent and material and on occasion to import for their instruction the more prominent men within reach; (b) extension or vacation courses in the laboratories or clinics of the universities; and (c) selected hospitals that are made the centre of more or less regular instruction.

7. The admission of women to the full medical courses is rapidly extending. Access to the medical schools on the terms enjoyed by men was granted to women by the Swiss universities as early as 1876. Despite deeply rooted domestic traditions, the German universities are now also opening their doors to women. Prussia did so at the beginning of the winter semester of 1908. Economic necessity and social awakening," Doctor Flexner says,

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"have overborne the conservative traditions that sought to confine women to the nursery, the kitchen, and the church.” Until quite recently women in Germany had difficulty in being able to present the certificate of the nine-year preliminary education that is required for matriculation. This was because they had to procure the required secondary training chiefly through private study and tuition, the cost of which was for many prohibitive. Prussia, however, has since 1908 thrown open its secondary schools to girls.

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Co-education is the general practice in medical education on the Continent. Three hundred women mingle on even terms with three thousand men students in the hospitals of Paris; in Rome, Geneva, Brussels, Upsala, Copenhagen, and the Swiss universities, no distinction whatever is made between the sexes." A long contest in Great Britain has now resulted "in the opening to women all qualifications except those of the ancient universities of Oxford and Cambridge, neither of which will examine women medical students, though Cambridge is willing to teach them." On the other hand, the University of Edinburgh will examine but not at present teach women in medicine, owing to the claim that its present facilities do not suffice for its male students alone. The other Scotch universities, however, provide equal facilities for men and women medical students, and in most of them they work side by side excepting in anatomy. Doctor Flexner says, "It is interesting to observe, as doubtless significant of the quality of the material of which this body of women practitioners (in Great Britain) is composed, that women complete their studies in shorter time than the men." On the contrary, however, the proportion of women medical students who subsequently engage in practice is, at least as far as Swiss experience goes, not large. This is due to marriage and the usual lack of the incentive of necessity.

Health and the Schools.

The new attitude toward disease, which is placing emphasis upon preventing it (a) by discovering and removing the causes of ill health, (b) by discovering and promoting the conditions of good health, and (c) by fostering

the influences that bring about the physical vigor which is the most successful agency in warding off disease, places a great responsibility upon the school. This is true, partly because the child at its most susceptible age spends so many hours of the day in the school-room under all the physically trying conditions that are apt to be presented by the free intermingling and grouping of numbers, but even more largely because the possibilities of instilling helpful knowledge and habit are so much greater in youth than in adult life. The responsibility for providing the conditions and agencies for good health in the schools rests in part upon the school board and in part upon the school executives and the teachers. The school board is pledged to the duty of providing the more or less helpless and physically ignorant child with a safe and sanitary school building, with proper facilities for healthful exercise and play, and with the medical inspection that safeguards against contagion and other menaces to health. The executives and teachers are responsible for such use of these agencies, and of the formal instruction which gives them meaning and purpose, as will tend to lead the pupil into intelligent habits of health. Of course, without intelligent help from the home and sympathetic coöperation from the community much of the benefit of these provisions will be lost. But it still remains true that a properly equipped and properly conducted school will make impressions that, even under the most unfavorable conditions, never entirely disappear. And this is more true of the work of the school than it is of any other single agency; hence, society makes no better investment for public health than through the money it expends for this purpose on its schools.

SCHOOL SITES AND BUILDINGS IN THEIR RELATION TO HEALTH. It has been estimated that approximately $70,000,000 are now spent annually in this country for the erection of school buildings; and this does not include the buildings erected for the use of the higher institutions of learning. It follows without the saying that this money should be spent only for buildings that are safe, sanitary, and suitable to the highest possible degree. Anything less than this is a menace to the welfare of the child, an economic and social waste, and a more or less blameworthy

violation of trust on the part of those who have the spending of such public money. The erection of a proper school building involves such matters as: (1) The selection of a site; (2) meeting the various purposes and needs of the school in the best possible way in the building plans; (3) constructing it in a safe and substantial manner; (4) exercising due care in regard to its furnishings and equipment; and (5) giving especial attention to such important matters as lighting, heating, ventilation, and water-closets.

1. The Selection of a Proper Site for the School Building. This is a more important matter than the practice of the past would seem to indicate. Aside from such questions as convenience of access to the greatest number and meeting the modern need for large grounds as far removed as possible from all disturbing influences, arises the important question of the nature of the ground. All authorities now agree that school buildings should be located on soil as free from moisture as possible. The interstices of the soil are filled with air which is subject to motion under the influence of heat and cold just as is the air above the ground. While this movement is slow, it does not prevent cold air from the surface from sinking down and displacing the warmer air of the soil, which then rises above the surface, bearing with it the impurities of the soil with which it has been in contact. The damper the soil the more rapid and the greater the amount of decomposition going on within it, especially under the influence of summer heat. While a loose soil will after a time get rid of many of its impurities, a close and heavy soil will pollute the air with its pestilential effects for a long time. And any soil, whether loose or heavy, which is kept constantly more or less wet by surface water will continually throw off more impurities than a dry soil. These things receive additional emphasis in the fact that the ground beneath a building is usually drier than the surrounding soil; hence, there is a constant tendency, especially in rainy weather, for the ground air to move toward this place of least resistance and there to emerge with its contaminations. This is why there is nearly always a "cellar-like air" to be noticed in unventilated basements and cellars. This is especially noticeable in large cities, where it sometimes seems impossible to avoid

erecting a school building upon "made ground." As this made ground is usually the site of a dump where all sorts of material have been thrown, it is advisable to clear away the made part, especially where the building itself is to be erected. The irrigated regions of the United States experience such a great difference in temperature between day and night, often as much as 30° F., that they have an exceptionally cold heavy air at night, which rapidly drives out the warm air of the soil, with whatever impurities it has gathered up, and fills basements or uncellared ground rooms in a way that demands thorough ventilation before the opening of school in the morning. Great care in the construction of cellars and the means of ventilating them needs to be exercised in such regions.

A matter of great importance in selecting school sites in cities and large towns is to avoid the proximity of noisy factories and railroads, with the additional injurious effects upon children of breathing in their smoke, coal dust, and poisonous fumes. Even vegetation suffers under such

conditions. Leaves soon become coated with dust and soot which the rains cannot remove, and the plants languish and the trees die. The leaves are the lungs which in these cases become clogged and fail to perform their functions well. How much greater the injury to the delicate tissue-cells of the lungs of the growing child! It is a matter of surprise that effective protests have not long before this been made against the general violation of cleanliness and the menace to health created by the smoke nuisance. And this is equally true of the annoyance and injury to others that is so often caused by the fumes from certain types of factories. In these days of smoke-consuming devices and possible chemical treatment for destroying odors, there certainly can be no valid excuse for the continuance of these things. At least there is no excuse for erecting school buildings on sites that are certain to be subjected to these annoyances and dangers. Disregard of such matters can only arise from ignorance of the possible injury involved, from the blindness of favoritism, or from a more blameworthy selfish greed. Any attempt of a school board to save money on a school site at the expense of children's health is highly reprehensible. Disregard of their interests