cities have antituberculosis leagues or societies organized for a similar purpose. Besides these there are many local societies whose work consists largely in efforts against the spread of this disease. The main work of these organizations may be summarized as follows: (1) They are teaching the people through printed matter, exhibitions, and lectures that tuberculosis is a contagious disease and that those who are seriously afflicted are menaces to the public health unless they are prevented from mingling with the people in the customary way. They are pointing out the fact that during the process of coughing and spitting great numbers of the bacilli are thrown from the mouth, and that when these are dried and lifted into the air they are liable to infect others, especially those whose physical condition exhibits a low degree of resisting power. As a result of this agitation some States are establishing county tuberculosis sanitariums. Wisconsin is a conspicuous instance.

(2) They are teaching the people that tuberculosis is a curable disease if taken in its early stages. The treatment advocated includes living and sleeping in the open air, cessation from fatiguing toil, and abundance of nourishing food. Many societies and business organizations are going further and in a more or less cooperative way are undertaking to make it possible for patients of slender means to quit work and give their time and energy to overcoming the disease before it is too late. Furthermore, they are teaching the people that the best time to fight is before they are attacked. Hence there has been prepared especially valuable literature on the great need of fresh air and on open-air sleeping apartments for all. Some of these publications contain not only a statement of needs, but specific and detailed information of how to meet them. In this regard they have done better service than the average textbooks on hygiene, and should be in the hands of all teachers, especially rural-school teachers.

(3) They are acquainting the people with the fact that many children suffering with what hitherto has been considered mere skin diseases are in reality tuberculous; and thus they have paved the way for more rational treatment of such children.

(4) Bad housing in congested centers has been a fertile source of contagion, and hence people have to be taught that it is in the long run more economical to prevent illness by living under wholesome conditions than it is to economize on rent at the risk of health. Many organizations are working for legislation which will force the construction of more sanitary apartment and tenement houses and will condemn those now in existence which are insanitary and generally unwholesome. People must be protected not only from their own ignorance but also from the avarice of landlords.

(5) Boards of education have been importuned by these societies to make greater provision for open-air schools into which may be

gathered those children who are anemic, and whose inheritance and home conditions predispose to tuberculous infection. A number of cities owe their open-air schools to the influence these societies have brought to bear in a legitimate way upon the general public.

CLEANLINESS.

A great number of societies, notably the charity organizations, have found it necessary and valuable to direct their work toward teaching the poorer classes of people in a definite way the dangers due to personal uncleanliness and dirty methods of handling food supplies. They have followed up this line of work by inaugurating & movement for public bathing facilities and opportunities for laundry work. Such work has brought to the attention of the general public the utter lack among the very poor of facilities for bathing and the absence of decent opportunities for washing garments and bedclothes. Unless people have the means of keeping clean, it is more or less a waste of time and energy to preach to them the value of cleanliness. If the laws of a State and the ordinances of a city permit families to occupy a single room in a tenement house where not even running water is furnished, not to mention room for a bathtub or a laundry, it is a foregone conclusion that the health of such people and of those with whom they come in contact will be jeopardized. Surely no more fundamental health teaching for such people can be undertaken than to insist that better sanitary conditions be provided in tenements, and then that those who occupy them shall live accordingly. Otherwise, it is a hopeless task to instruct them in wholesome living and the hygienic care of their children. Many poverty-stricken people from foreign lands are willing and ready to hear the gospel of cleanliness, but they can not obey its doctrines for lack of the necessary means.

SEX HYGIENE.

Perhaps no health topic now before the general public has received more attention from the various voluntary societies during the past year than that of sex hygiene. The nature of the subject has unfortunately attracted a good many people to its consideration out of mere curiosity, but in fairness it must be said that the novelty of the subject has been largely due to the general ignorance of the public regarding such matters. In practically every State and city in the country societies have been organized for the prevention of venereal diseases, and most of them have published a large amount of material calling attention to conditions and suggesting various remedies. Perhaps the most extensive method of work used has been that of lectures before organizations of all kinds, such as

women's clubs, men's clubs, churches, Young Men's Christian Associations, Young Women's Christian Associations, civic organizations, teachers' associations, clubs and societies of manufacturing plants, etc. The secretary of one of the State societies organized for the prevention of social diseases states that

as a result of a two years' campaign by this method the whole State has been aroused to the importance of the subject, so that every association and club in the State is undertaking as a part of its work to instruct the people to develop means of eradicating these diseases.

Many societies have secured permission from school boards to present this subject to the high-school children of cities and to the patrons of the school. A number of prominent cities throughout the country are preparing to organize courses of instruction in this subject to be presented to the pupils of the upper grades and to those of the high schools. A large number of books have been written to guide teachers and parents in the instruction of children in the subject, but no thoroughly satisfactory plan has yet been formulated, and possibly it will take a number of years of experience and consideration to develop an acceptable course of study on this subject for the public schools.

A committee has been appointed in connection with the department of school patrons of the National Education Association to prepare a course in sex hygiene for use in normal schools. Mr. W. B. Owen, of the Chicago Teachers' College, is chairman of this committee. A report on this work will be presented at the February meeting of the department of superintendence at Richmond, Va.

One method of general education along the line of sex hygiene which has been used with marked influence during the past year has been that of exhibits. Starting with the remarkable exhibit which was made in connection with the Fifteenth International Congress on Hygiene and Demography in Washington in September, 1912, the use of such exhibits has grown enormously during the past year, and they have invariably attracted a notable amount of attention. A thousand copies of Brieux's play, Damaged Goods, have been scattered throughout the country. Some cities, notably Syracuse, N. Y., have made what they designate "moral surveys" and have published detailed studies of results of their investigations. The Syracuse society for the prevention of social diseases recommended to the bureau of health the advisability of introducing the teaching of sex hygiene in the public schools. Throughout the length and breadth of the country the results of various investigations into the extent of social diseases have been studied and the people have been aroused in an unusual way.

Possibly no topic presented at the Fourth International Congress on School Hygiene at Buffalo, held in August, created so much interest

and attracted so much attention as the addresses on sex hygiene. There has been some fear expressed in various quarters that the general teaching of facts relative to this topic might in many cases be unwise and harmful. If I may judge from the evidence I have gathered from looking through the reports and examining the results of the work of the various organizations throughout the country, I would say that thus far the discussion and agitation of this subject have not passed the bounds of reason and have been, on the whole, conducted in a sane and safe way. Of course any new subject has to be delivered from overzealous enthusiasts who are ready to join in any new movement merely for the sake of self-advertisement. Fortunately, I think these have been few in number and the general movement has been in the hands of well-balanced and morally safe people. It would be impossible to estimate the value of the tremendous amount of teaching, direct or indirect, that has been done on this subject during the past year, but truth presented in an unselfish and unbiased fashion is always powerful. The main precaution now to be taken, if I may be permitted a judgment in this connection, is to limit as far as possible the overstatement and exaggeration of supposed facts. Certain printed documents have been spread broadcast which would tend to lead to the belief that from 30 to 40 per cent of the people of the country have been or are now afflicted with one of the unnamable diseases. What the truth is nobody knows, and it would be much safer and better to leave estimates of the extent of these diseases until far more authoritative information has been collected.

SCHOOL HYGIENE.

A great awakening has taken place in the past few years with regard to school hygiene and school sanitation. This movement has furnished a theme for a very large number of women's clubs, educational associations, medical societies, home and school leagues, and a host of other organizations. All people are interested in the education and development of the children of the Nation and much good has been accomplished by these combined, if not concerted, efforts to make our schoolhouses more sanitary and to furnish larger playgrounds for the children. Medical inspection of school children has grown at a rapid rate, and this growth has been due in no small measure to the public sentiment aroused by these local societies. It would be impossible to state with exactness what particular measures have received the most attention, but among them would be found medical inspection, ventilation, the need of open-air schools, school lunches, playgrounds, and sanitary drinking fountains. Of course a great many other topics have been considered and emphasized, but these topics have doubtless received a larger share of consideration.

The educational work in school hygiene which has been undertaken in this voluntary way has proceeded generally through meetings of mothers and teachers, before whom those who have made a special study of school hygiene have discussed matters in a simple and untechnical way. The movement for school lunches is due largely to the initiative of those home and school leagues and women's clubs which have undertaken to minister to the needs of the anemic children in attendance upon the schools. In connection with openair school work, as well as with the regular classes, this service has been of great value and promises even larger returns. If I may be permitted to suggest one topic which these organizations should study with more care and should bring to the attention of local authorities in a definite way, it is that of the great need for larger school grounds. Despite all that schoolmen can do, city and county boards of education constantly persist in locating school buildings on meager plots of ground and often in congested and noisy centers. Such locations are far more serious blunders than the average community conceives. Dirt and dust, noise and confusion, lack of playgrounds, danger from fire, and more serious danger from moral contamination must be contended with as the result of such blunders. I am persuaded that if the various civic and social clubs of the smaller cities of America were to devote a part of their time and energy to teaching the people the seriousness of locating great school buildings in such places a marked improvement for the betterment of these conditions would be immediately seen. A multitude of topics is considered in this campaign for better health conditions in the school and, generally speaking, the work has been wisely, courageously, and unselfishly done. The evidence shows, however, that the time has come when the societies must depend more upon the guidance of those who have special knowledge in these fields in addition to the desire to be of service to the children. Commendable progress is being made in many cities by introducing departments of hygiene and sanitation which not only have to do with the sanitation of school buildings and school appliances, but with the physical education and development of the child. Many school improvement leagues and similar associations have published leaflets and various sorts of helps designed to serve the rural school-teachers especially. As an example of this, the Alabama School Improvement Association, which is affiliated with the State education association, distributed last year 2,500 health circulars. These were all sent to the teachers of rural schools. When one considers how little these teachers have in the way of helps and suggestions outside of the ordinary textbooks, one can appreciate more fully the real value of such work.

The park and playground movement, which is closely related to the movement for school hygiene, has received a great impetus during