his home and the railway depot at one end and his office and the railway depot at the other. Proximity to a depot is an allurement, often a fatal allurement, to the sedentary worker. It shortens the time needed to reach the office but it also reduces the amount of outdoor exercise taken and, as Doctor Hill points out, lessens mental vigor. The habit, indeed, of plunging, as it were, straight from the breakfast table into the subway and straight out of the subway into the office is a pernicious one and it would be of benefit physically and mentally to many who live near a station if they eliminated that station from the day's programme. In order to obtain the six mile ration of outdoor exercise a beginning might be made by starting earlier in the morning and walking to the next station; then, perhaps, starting yet earlier and walking to another station further on, and soon, if the office is not too far away, walking the entire distance. There is no doubt that sedentary workers do not have enough exercise. The remark is possibly more applicable to the sedentary workers of America than to those of any other nation, assuredly than to those of Great Britain. Americans are not great walkers and the distaste for walking has been more noticeable since the advent of the automobile. The business American is likely to think that walking is a waste of valuable time, and he does not pause to consider that by such means he keeps the human machine in good working order, a far more important matter than that of making money in a hurry. A daily walk is infinitely superior in its health-giving effects than the daily aperient and is also more beneficial than working for some time at high tension and then playing for some time at high tension or than even taking a long rest. Working in spurts and playing or resting in spurts as the American usually does is not good practice. Business men and women should ration their outdoor exercise and the exercise could take the form of walking.

THE STATE AND PUBLIC HEALTH

In an address on this subject which appeared in the New York Medical Journal, Dr. Wm. A. Groat of Syracuse says: The development of State medicine has been largely along a line perfectly sound, but of secondary status-that of public

safety. It has developed defences against epidemic disease as a method of protection superficially of the individual, but deeper of business; and deeper still, the development of the State and the conservation of defenders. It has developed along charitable lines. The State assumes care of the indigent sick, theoretically, at least, as a charity. It assumes almost wholly the care of the mentally incompetent. It looks to the health welfare of its citizens in a variety of ways not ordinarily associated in our minds with State medicine; child labor, strect cleaning, garbage removal, sewage, and the like, are all touched by, or touch upon, public health principles.

How should State medicine be expanded? Should it invade the field of medical practice, do general or special diag nostic work, or treat all the sick as a matter of public safety? If this would be for the public good, I would say yes; but I do not for one moment believe it would be. I do believe that there is a distinct tendency in that direction and that that tendency should be opposed. The reason for objection is not a selfish one. It is a practical one, a scientific one.

Let us have a national department of health for the principal reason that the nation's welfare demands it. Let the activities be along the broad educational lines of preventive medicine. Let it co-operate with the States and let them win back and take over the indirect and secondary health activities now scattered among bureaus, commissions, and boards which have no true scientific interest therein. Let it teach how to breed, feed and develop the child at least as well as the agricultural department teaches animal husbandry, and show the cash values so created. Let it show from its seat in equality the value of health counsel to every other department of gov ernment. Let it teach the employer that unhealthy surroundings and improper requirements breed sickness, and sickness and the resulting labor turnover mean economic loss; and show him the cost, to him, in dollars and cents.

Teach the worker, he who labors with brain or hand, that his health is his greatest asset; that properly directed work is beneficial and brings prosperity, and prosperity happiness.

Teach that the human machine, like any other, requires frequent inspection, proper care, and lasts longest when kept at work under normal load.

Let it support medical education and medical investigation, and openly fight quackery. Let it carefully avoid undermining a people by relieving individual responsibility or antag onizing family ideals.

Let it direct its charities along broad lines, but on business principles; charity should give strength rather than breed weakness.

And, finally, let the medical profession measure and judge departments of health by what they accomplish for preventive medicine and public health, not by what they do for the profession. It will gain in the end.

DENTAL CARIES

A contemporary says that dental caries is undoubtedly an extremely serious problem in all civilized countries, for it is only when primitive people receive the perhaps doubtful blessings of civilizations that dental caries is introduced. A writer in this same journal says that dental caries and diseases of the gingiva are as truly scourges of civilization as either cancer or tuberculosis. This writer considers pyorrhea alveolaris as a progressive disease, and almost invariably associated with gastrointestinal disturbances, and personal neglect of mouth hygiene.

He has noted that athletic children and those whose food is cooked in vegetable oil (rather than animal fats with their fatty acids) have the best teeth. This he attributes to athletics and the free bowel movement due to the lubrication by oil. Children of the poor have bad teeth, due to malnutrition.

The contributor quoted says that the "family tooth brush" is a menace, as well as the over-worked and too-long-used personal brush. These cause disease of the gums by re-infection. The Japanese use their fingers to masage their gums and teeth, and sell us their tooth brushes.

Fruit acids are ideal cleansers of the mouth and teeth. The canned tomato is a splendid stimulant to the mucous membrane and salivary glands of the mouth, and likewise is a good anti-scorbuter. According to some opinions, pyorrhea is a mild symptom of scurvy.

Book Reviews

Lectures on Dietetics, by Max Einhorn, M.D., Emeritus Proffessor of Medicine at the New York Postgraduate Medical School and Hospital; Visiting Physician to the Lenox Hill Hospital, New York. Illustrated. Philadelphia and Lendon: The W. B. Saunders Company. Canadian Agents: The J. F. Hartz, Co., Limited, Toronto, 1922. Price, cloth, $2.25 net.

This excellent little book discusses diet in a very practical way. After a short summary of the essentials of diet and the chemistry of food, the diet of healthy persons is considered and then several chapters follow on diet in digestive, metabolic and excretory disorders. Useful chapters on duodenal alimentation, subcutaneous and rectal alimentations and preparation of food for invalids are added.

The book is essentially common sense and the mind of the faddist is absent. It is specially to be recommended for general practitioners and students.

Hygeia. A Journal of Individual and Community Health. Published by the American Medical Association, Chicago. This publication is one of which any association may be proud. It is freely illustrated in half tone and printed on fine coated paper. As the title states, Hygeia is a journal devoted to "Individual and Community Health." It is without an exception one of the best Journals on any subject that reaches our editorial sanctum, both scientifically and mechanically.

The September number includes such subjects as "Health Education in School Children," "Summing and Airing for Health," "Your Opportunity for Health," "The Relation of Air to Health," The Canoe Trail to Health," and "How Colds Travel."

In the October issue we find some most interesting contributions, including an article by Charles Zucblin entitled "A Pilgrim in the Hospital;" "The Future of Preventive Medicine," by John E. Elinendorf; "What do we Measure by the

Intelligence Test?" by L. L. Thurstone; and other material that cannot but interest not only the rank and file of the profession, but, particularly, Medical Officers of Health and those devoting their time to community work.

Hygeia costs but thirty cents a month to Canadians, and is worth a great deal more.

Walter Reed and Yellow Fever, by Howard A. Kelly, M.D. Third edition revised. The Norman, Remington Company, Baltimore, Md. Price, $2.50.

Any book bearing on its title page the name of Howard Kelly, who is so well known to Canadians, at once attracts attention. During the past sixteen years, which have elapsed since this most interesting volume was first published, a great deal of work has been done along sanitary lines by such men as General W. C. Gorgas and his associates, and of later years through the magnificent work accomplished by The Rockefeller Foundation. The third edition is, in part, devoted to a life of General G. M. Sternberg, Dr. Reed's predecessor-also a life of Gorgas, who did so much to put Reed's work forward. It is a most interesting and instructive volume, and we consider it a privilege to have reviewed it.

International Clinics. A Quarterly of Illustrated Clinical Lectures and especially prepared articles on Treatment, Medicine, Surgery, Neurology, Pediatrics, Obstetrics, Gynecology, Orthopedics, Pathology, Rhinology, Laryngology, Hygiene and other topics of interest to students and practitioners by leading members of the medical profession throughout the world. Edited by Henry W. Cattell, A.M., M.D., Philadelphia. Vol. II, 33rd series, 1923. Philadelphia. London and Montreal: The J. B. Lippincott Company. 1923. Price $2.50 per volume, or $10.00 for set of four.

Four papers are given to Insulin. Canadians will be especially interested in this number; for the initial article is by Dr. Alexander McPhedran and Dr. F. G. Banting on "Insulin in the Treatment of Severe Diabetes." The contribution is based on remarks before the Association of American