torture which life has brought to them: the life which they did not ask to have given to them."

When we think of the thousands of mothers in rural communities and isolated places and even in large cities in every State, who get along without a semblance. of skilled care in child-birth, of the thousands more unmarried mothers whose children are handled as above described, we see more clearly the need for the Children's Bureau Campaign in behalf of babies, and we long for the time to come when the American nurse, mid-wife-the nurse who has specialized in mid-wifery, will assume a larger share of responsibility in making the corner of the world she lives in a really safe place for babies to arrive in and to pass their baby life in. We are yet a long way from the ideal condition in this respect, and the dwindling supply of doctors does not offer much hope for widespread improve

ment.

The Present Smallpox Menace

The people of America in recent years have become careless with regard to the dangers from smallpox. There has been a long period of comparative freedom from severe forms of the disease. The cases which have occurred have been few and mild. The public is indifferent to the serious smallpox situation at the present time. Since the world war, there has been a world-wide increase in the number of cases. During the war, people from all parts of the globe were brought together in large numbers, and some came from countries where there was much smallpox. The lack of adequate medical and sanitary service in all of the fighting countries of Europe, the unfavorable living conditions arising out of the war, and the marked falling off in universal vaccination have resulted in an increased prevalence of the disease. In a number of instances it has occurred in severe form. At the present time, smallpox is a real menace

to the health and welfare of the people of the United States and Canada.

It is entirely within the power of the people to erect a barrier against the disease. Vaccination is the one measure which has proven its effectiveness as a means of smallpox control. The evidence shows conclusively that in those countries where vaccination is faithfully carried out, hardly any deaths from smallpox occur; and in those areas where there is public and private indifference to this simple procedure, there is always more or less mild, and, at times, virulent smallpox.

The experience of the people of Cuba is one of the most important facts we have on smallpox prevention. In 1896 and in 1897 there were over one thousand deaths each year from smallpox in the city of Havana alone. With the beginning of American occupation of the island, vaccination was enforced, children were compelled to be vaccinated, as were also all persons who could not produce satisfactory evidence of previous vaccination. The beneficent effect of this common sense procedure was observed almost at once. Between 1901 and 1917, there was only one death from smallpox in the city of Havana. In Japan, a similar condition was observed. Before the practice of vaccination was effectively carried out, Japan had thousands of cases and deaths each year. Epidemics of the disease were especially severe. In 1909, a law was passed requiring vaccination of each infant within three months after birth. This measure alone apparently had the effect of greatly reducing the number of cases and deaths. There have been no serious epidemics from smallpox in Japan since vaccination was generally introduced.

In the United States and in Canada, there are no centers of smallpox infection where vaccination has been thoroughly tried out. Some cases are brought in from other countries, or from other areas where the practice of vaccination is lax, but no epidemics have commenced in these protected cen

ters. On the other hand, in cities where there is great laxity in the enforcement of vaccination laws, or where there are no laws to be enforced, many cases occur each year. In the Province of Ontario, where there has been persistent opposition to vaccination, a very severe outbreak with thousands of cases occurred early this year and the United States sanitary authorities declared a quarantine on all travelers from that Province into the United States. California reported more than two thousand cases in 1919, and reports from several States in the South show that smallpox has been widely prevalent recently. In every State where the disease is seriously prevalent, vaccination is not enforced.

Health officers, publicists and others interested in the public safety should arouse their communities immediately to this menace and inaugurate campaigns to liven public interest in the passing of vaccination laws where none now exist, or in the thoroughgoing enforcement of such laws and ordinances as now appear on the statute books. -Metropolitan Life Insurance Company Bulletin.

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Clinical Thermometers At a meeting of the Board of Health of the Department of Health of the City of New York, held in the said city on the 29th day of July, 1920, the following resolution was adopted:

Resolved, That Article 12 of the Sanitary Code be amended by adding thereto a new section to be numbered Section 226, to read as follows:

Sec. 226. Clinical Thermometers; Sale Regulated. No person shall sell, offer for sale, deal in or supply or have in his possession with intent to sell, offer for sale, deal in or supply, any inaccurate clinical thermometer. Every manufacturer of clinical thermometers shall, before offering any such clinical thermometers for sale in the city of New York, test the same or cause the same to be tested in accordance

with the regulations of the Board of Health. The term "clinical thermometer" as herein used, shall be taken to mean and include every thermometer intended for taking the temperature of human beings and animals. The term "standard clinical thermometer" as herein used, shall be taken to mean and include a clinical thermometer certified by the Department of Health as correct after having been tested and compared with the official clinical thermometer maintained by the Department of Health and certified to and corrected by the United States Department of Commerce and Labor, Bureau of Standards.

A clinical thermometer, as herein defined, shall be inaccurate:

(1) If, when tested with a standard clinical thermometer, the mercury fails to register within plus or minus two-tenths (0.2) of a degree Fahrenheit, or its equivalent on the centigrade scale, of the mercury in a standard clinical thermometer when compared at ninety-six (96), one hundred (100), one hundred and four (104) and one hundred and six (106) degrees Fahrenheit, respectively, or their equivalents on the centigrade scale, or if, when so tested, a variance is found to exist in excess of threetenths (0.3) of a degree Fahrenheit, or its equivalent on the centigrade scale, between any of the points compared;

(2) If the mercury column, by reason of its own weight, or for any reason other than through the application of force, retreats in the tube at any point in the scale;

(3) If its scale fails to show accurately, clearly and legibly, graduation lines and numbers from ninety-six (96) to one hundred and six (106) degrees Fahrenheit, or their equivalents on the centigrade scale;

(4) If the maker's name or trade-mark is not clearly and legibly engraved thereon, or where the trade-mark appears thereon, such trade-mark has not been filed with the Department of Health.

The provisions of this section shall take effect on the 1st day of October, 1920.

The refusal of various groups of workmen in factories to contribute in the community campaign for funds because hospitals were included, and the criticism that arose of hospitals during the campaign led to the introduction of the hospital hostess as a "smoother-out" of small difficulties. The burdens of superintendents in this age have so increased that they no longer have the time or strength to go around with the oil-can pouring oil on petty troubles all over a big, busy institution. Yet the person with the oil-can is needed in every institution. The hospital hostess meets patients and friends on arrival and establishes cordial relations with them in the beginning. She represents neither the medical nor the business side, but is there for the patient's benefit. This is explained when the patient enters. She asks especially that anything of an unpleasant nature be referred to her. She keeps friends of out-of-town patients informed of the patient's condition, finds board and lodging near the hospital if they desire it; meets families of patients who are undergoing operation; devotes herself to friends of patients for whom there is likely to be no recovery; writes letters; sends telephone messages; receives flowers and sends them where they belong or are most needed, and in hundreds of ways she finds opportunity every day to smooth out misunderstandings and helps to keep both patient and friends happy and satisfied with the hospital service.

Some Practical Points in Hospital Social Service

Just what is the purpose of a hospital social service department asks Etelka Weiss, in the Hospital Social Service Quarterly. Occasionally, she remarks, one hears it stated that a social service department should reduce the actual expenses per capita in a hospital. This is a great fallacy, as even the most efficient and most success

ful social service department is an expense just like any other important and essential part of the hospital. Hence the economic phase of the question from this point of view must be laid aside. Is its purpose the increasing of dispensary attendance or the soliciting of interesting cases?? Not where the giving of true service is intended. We are living in an age which is clamoring for efficiency, and no efficiency can be a onesided affair.

Answering her own question as to the purpose she writes "First, to enable the physicians to give more intelligent service to the individual patient by bringing such social facts about the patient to his attention, and have a direct influence on his physical or mental condition; second, to supplement the physician's treatment by such services as the patient needs but the doctor cannot give; third, to co-ordinate all medical care needed by the patient and which cannot be obtained in the same department of the hospital; fourth, to make it as little humiliating as possible for the self-respecting poor who need the free services of the doctor and the hospital, and at the same time eliminating little by little the abusers of free hospital and dispensary care; fifth, to act as an educational agency in the community."

Discussing some of the complex problems which confront the social service worker, she says that "Many times the constructive work in a family may be arrested for the lack of a few dollars with which to buy some articles of infinite value to a member of the family, but for which no organization seems to have a fund, and which consequently no one supplies. This is wasteful. For instance is it not foolish to spend time and effort to cure a man of a certain kind of stomach trouble when he has pyorrhea and what he needs is treatment by a dentist, which we can get free of charge, followed by a set of teeth, for which, alas, we must pay. Positively, with the cost of medicines so high, one can buy

a set of teeth for such a patient for the price of the medicines which are wasted on him, aside from the waste of time and energy and the important fact that no results are obtained."

Concluding her paper she calls attention to the fact that the "results obtained by an efficient social service department manifest themselves not only by the actual number of cases handled, or by its helpfulness to other agencies doing social work, but by the successful termination of efforts when dealing with individual cases. One mother saved for her children, one father saved for his family, one crippled child made whole, one human wreck made a real man, and one pre-natal death prevented—just five short items-but they show good work better than indefinite statistics dealing with figures in the thousands."

Things Worth Remembering Plans to use discarded X-ray plates instead of new glass is expected to effect a saving of $30,000 in the new Municipal Tuberculosis Hospital of Detroit now under construction at Northville, Michigan. It is claimed that when cleaned, they will serve the purpose as well as ordinary window glass.

When purchasing mattresses for hospital beds, plan for enough extra mattress covers, so that frequent washing of such covers can be made. This makes it possible for each patient to occupy a bed that not only is clean but looks clean. It adds to the good reputation of the hospital.

The waste from old X-ray tubes, discarded glass and "hypo" apparatus, has been turned into a source of profit by the London Hospital. Discarded radiographs are put aside for six months, and then sold at the current price for glass.

That vocational training will help to solve a good many of the problems that arise when large numbers of females afflicted with venereal diseases are confined in a hospital

is shown by the experience of Harper Hospital, Detroit, where at the request of the State Board of Health fifty beds were set apart for female venereal cases who were interned there for treatment. By co-operation with one of the large industrial concerns and at the expense of the factory a workshop was installed, the necessary equipment for sixteen workers and an instructor provided. The work is optional. Each girl who cares to work is put on the payroll of the factory. The money earned is deposited to her credit and given to her when she leaves the hospital. The money earned was sufficient to provide neat suitable shoes and other clothing and to leave a substantial sum in the girl's purse on her release.

Rug-weaving, basketry, toy-making, wood-carving were also taught. These occupations had much to do with changing the spirit of this new group of patients who were not really ill, and who were restless and discontented under their enforced confine

ment.

In the new Fifth Avenue Hospital an experiment in reducing the amount of clerical work in the keeping of bedside records is to

be made. be made. Specially prepared chart forms. are to be used on which nurses will enter only the abnormal findings, simply placing a check against normal conditions to indicate that the required observations have been made. As the nurses change, the head nurse will collect the charts, replacing them with fresh ones and record the findings of her own chart for each patient. It is believed that this will save time and labor and reduce the size of the bedside records by at least one-half.

Cooperating with the Health Department in Toronto

Eight hospitals through their training school department this past year entered into a plan of cooperation with the City Health Department by which fourteen pupil nurses at a time were detailed to