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aroused organization after organization has developed, each concentrating on its own program.

We are now confronted with the problem, therefore, of providing proper machinery for bringing these health activities more closely in touch with each other, preventing duplication, developing broad health programs, and meeting new needs without allowing overhead costs of health work to mount beyond the point where they can be financed. It will be my task to discuss methods of accomplishing this co-ordination in municipalities.

Health federations past and present.-There are, so far as I know, only four municipal or county health federations-the Cuyahoga County Health Association, the Boston Health League, the Hennepin County Health Association and the Cincinnati Public Health Federation. New York City some time ago through the New York Academy of Medicine initiated a plan for co-ordinating its health activities. I understand that there is a possibility that the New York Federation may be revived.

Mr. Curtis E. Lakeman, secretary of the New York State Department of Health, in an article in the Survey of February 4, 1922, entitled “Three City Health Federations" presents an interesting view of the federations in Cleveland, Boston, and Cincinnati. The Cleveland and the Cincinnati federations, he points out, are similar in their aims. They are made up of representatives of the health agencies of the community, are directed by a governing committee; their aims are in general to tie more closely together the work of all health agencies in the community, to prevent duplication, to meet new health needs as they may arise. The Boston League is organized differently. There twenty-five health organizations have pooled their resources of nursing and field service in a selected district of the city where they have concentrated on determining what careful study of the district's needs and a united effort to meet them can accomplish.

The chief difference between the Cleveland Association and the Cincinnati Federation is that the former includes only voluntary health agencies and does not include the health officials, the schools, the medical profession or the hospitals. It brings these four forces into contact with its own association of voluntary agencies by means of an advisory committee on which all five groups are represented. There are other differences of less importance.

The Cincinnati Federation was the first health federation, having been organized in January of 1918. The Boston Health League was established in 1919. The Cleveland Association was a direct outgrowth of the Cleveland Hospital and Health Survey conducted under the direction of Dr. Haven Emerson in 1920.

This paper will be confined principally to the organization and activities of the Cincinnati Federation. A group of interested health workers in Cincinnati came to feel that the city's health activities were not sufficiently cohesive, that there was need for a getting together to put an end to waste motion and to attack health problems in the broadest possible way. This small group developed the idea to the point that they were ready to launch the Federation, and then called a meeting of representatives of all of Cincinnati's health agencies. To this group they presented the plan for a health federation. Their proposal met with the approval of the delegates of the forty-two organizations represented and a permanent federation was organized in January of 1918. The original plan has continued in most of its essentials. Any organization doing health work may become a member of the Federation subject to the approval of the co-ordinating committee. Each member organization is entitled to two delegates.

These delegates elect the officers of the Federation consisting of president, first vicepresident, second vice-president, honorary secretary and treasurer; receive periodical reports on the work of the Federation, make changes in the constitution and in general are free to offer any criticisms or suggestions they wish as to the work of the Federation. The Federation functions by means of councils on special phases of health work. Each council is made up of delegates from the agencies interested in that particular problem. They elect their own chairman who becomes a member of the co-ordinating committee. The co-ordinating committee consists of the officers of the Federation, the chairmen of these Divisional councils and more recently of ten members at large. It determines the general policies of the Federation, selects the executive, and passes upon the programs of the councils.

The Cincinnati Federation is the Health Branch of the Community Chest and works closely in co-operation with the director of the Chest.

Since the Federation was originally organized certain fundamental changes have been made: first, the constitution has been changed to permit the Federation to function in meeting needs not logically within the province of any constituent agency; second, certain councils instead of being made up of delegates from groups of organizations now consist of a single constituent agency, i.e., the council on housing is the Better Housing League; the council on tuberculosis is the Anti-Tuberculosis League; the council on social hygiene is the Social Hygiene Society; third, ten members at large (elected by the delegates to the Federation) have been added to the co-ordinating committee in order to bring in a group of business men whose counsel would be of value, and who would be of assistance in legislative and other campaigns requiring strong backing in the community.

The Federation has at present ten councils as follows: cancer control, child hygiene, hospitals, housing, industrial health, mental hygiene, mouth hygiene, nursing, social hygiene, and tuberculosis. It will be possible in this brief paper only to sketch the work of the individual councils and then to summarize what the Federation has accomplished independently of the councils.

The councils on housing, tuberculosis, and social hygiene being respectively the Better Housing League, the Anti-Tuberculosis League and the Social Hygiene Society, have a close co-operative relationship with the Federation, but are entirely independent in their operations. Their respective presidents serve on the co-ordinating committee. They report on their work at the annual meeting of the Federation. They are free to call on the Federation for assistance or for advice at any time. On the other hand the Federation turns over to them any problems in their respective fields coming before the Federation.

Cancer control.-The council on cancer control was organized at a time when several groups were urging the formation of a society for the control of cancer. It has filled the need in this field without the necessity for forming a new organization with additional overhead. This work being a phase of the Federation's activities was immediately tied up with the rest of the health work of the city. The chief activity of this council has been a vigorous educational campaign carried on in co-operation with the American Society for the Control of Cancer.

Child hygiene. The two outstanding accomplishments of the child hygiene council have been the initiation of a demonstration in diphtheria immunization and the formation of a special day nursery section. The demonstration of diphtheria immunization

was carried on in two public schools and in four child-caring institutions. It was initiated and financed by this council which organized a committee of the city's leading pediatrists who supervised the demonstration and assumed complete responsibility for its success. The actual work of Shick testing and immunizing was done by the staff of the City Health Department. The demonstration was a complete success.

The Day Nursery Section has brought together all of the nurseries in the city in regular meetings. Definite rules for the admission of children have been agreed upon, regular medical examinations are being given, standard record forms are being used. The entire day nursery work has been put on a better plane.

Hospitals. A preliminary survey has been made of hospital facilities for both adults and children with a view to determining as to the need for additional children's hospital facilities in Cincinnati.

Mental hygiene.-In this field again the formation of the council forestalled the establishment of a separate mental hygiene society with an additional overhead. The mental hygiene council has been one of the most worth while in the Federation. It initiated and helped to pass a law providing for a new state institution for the feebleminded. It took the lead in the formation of a State Mental Hygiene Committee.

At its request the National Committee for Mental Hygiene made a complete study of mental hygiene problems of Cincinnati and outlined a comprehensive program, the chief recommendation being the establishment of a central psychiatric clinic. The council prepared and distributed a sixteen-page summary of the survey in popular form, has published the complete survey, a volume of 130 pages, and is making every possible effort to carry out the recommendations of the survey beginning with the most important-the central psychiatric clinic.

Mouth hygiene council.-The mouth hygiene council has just been organized to bring together the many groups interested in this subject. Its chief work at present is to find a way of meeting the needs of the county as there is now no organization dealing with the pressing need for dental service for the county children.

Nursing. The nursing council has presented a series of demonstrations and lectures for public health nurses in Cincinnati and has conducted a series of nursing tours for girls graduating from high school, the aim being to give them an opportunity to see nursing problems at first hand and to interest them in this field. The council is now at work on the very complex problem of formulating a comprehensive program for nursing activity in the city.

Industrial health.-Due principally to the industrial depression of the past two years which has made health work in factories unwelcome and extremely difficult, the industrial health council has not been active.

Aside from the work of the councils the Federation itself carries on several activities. It conducts a speaker's bureau, supplying speakers on any health subject. It publishes a monthly bulletin on the work of its councils and affiliated organizations. It conducts an information service on current publications for the benefit of constituent organizations, carrying in its bulletin references to important articles published each month. It initiated Negro Health Week in Cincinnati, and succeeded in co-operation with the Board of Health and the Negro Civic Welfare Committee in stimulating greater interest in periodical examinations among the colored people. It follows city, state, and national health legislation, keeping constituent agencies informed on matters in which they are interested. In 1920 it led Cincinnati's health organizations in a

vigorous fight in co-operation with other organizations in the state against the state Reorganization Code which broke down the safeguards of the State Health Department and drew it into the the whirlpool of politics.

Unquestionably the outstanding achievement of the Federation was the great Cincinnati Health Exposition conducted in October of last year. Practically every organization doing any kind of health work in Cincinnati took part, some eighty in all, as well as a half-dozen state and a dozen national organizations. It was the second great health exposition held in this country, Chicago's being the first. It presented the health work being done in Cincinnati in graphic form, practically every exhibit being marked by life, motion, and interest. It attracted between 150,000 and 200,000 people. For the first time in the history of the hall in which it was held the doors had to be closed on next to the last night of the exposition, with literally thousands of people turned away.

In addition to the two exhibit halls filled with graphic displays, the huge auditorium seating 3,600 people was the scene of a constant program of addresses by the nation's leading health authorities interspersed with attractive entertainment features, such as a beautiful health pageant, a nursing masque, a demonstration in military athletics and many others.

The exposition cost over $40,000.00. It paid all expenses and turned over a surplus of nearly $3,000 to the Community Chest. Perhaps the fairest view of success of the exposition is that of out of town visitors who saw it. I quote the opinion of Dr. Woods Hutchinson: "I have visited quite a number of health expositions in my time on both sides of the Atlantic and can frankly say that I have never seen one which was more clear cut and educational in its aims and none which succeeded in rousing so thoroughly, and by legitimate, scientific means, the overwhelming interest of the community."

The federation of health activities in cities is a logical common-sense step which if properly carried out should promote efficiency and produce results with less expense than is involved in the old plan of numerous agencies working entirely independent of each other.

We do not claim that the Cincinnati plan is anything like perfect. In fact it has been materially changed and improved since it was first worked out and will no doubt be changed from time to time in the future. There is no question, however, that it has been thoroughly workable and has accomplished sufficiently definite results to justify its existence.

THE ART OF LIVING

THE HEALTHFUL HOME

Ira S. Wile, M.D., New York

When Roger Williams fled from Massachusetts he carried with him the memories of the happy homes of Pilgrims and Puritans. Truly American b

of the Indians, but the colonists built habitations of logs, filled and mud, and thatched the roofs with reeds. Oiled paper fo The substantial stone chimney led up from the friendly broa

ere the tepees Araw

knots crackled and blazed to yield warmth, good cheer, and the hospitable hearth of the early days. Within a twenty-foot inclosure human beings ate, worked, and slept, along with their domestic pets, ever endeavoring to resist the ravages of disease and the attacks of the unfriendly Redmen. Such were the healthful homes when Providence was founded.

Times have changed, and the log cabin is a relic of a courageous past. Whether homes of today are more healthful is a matter that merits consideration. It is as impossible to compare the apartment house dwelling to the private house with any great assurance or dogmatism as it is to contrast the abodes of the cliff dwellers with the chateaux of France. The needs and requirements of each age and generation help to determine the general character of their habitation. Their ideas, education, and ideals are closely related to their expression in manner and methods of living. Indeed, the healthfulness of homes must be regarded in the light of the existent knowledge concerning the laws of hygiene and right living.

The healthfulness of homes during the Middle Ages, in the days of open sewers and barred streets, when cattle and human beings dwelt together, reflects different standards from those which it is fair to expect today in the light of our knowledge concerning the importance of sanitation, ventilation, lighting, heating, water supplies, garbage disposal, and the relation of insect life to family welfare. It is patent that the healthful home for the rural dweller is not identical with that requisite for the promotion of safety and comfort for the urban citizen.

A home is the fixed abode of a person and his family, a congenial abiding place in which should be found affection, peace, and rest. Bearing this concept in mind, one recognizes at once the variations in home organization. As humanity is ordinarily placed in social and economic strata, it is natural to find a differentiation in the homes, from the degraded and degrading levels deemed satisfactory for the poorest to those considered ultra-comfortable for the millionaires. It need not be assumed that the alleged superior dwellings of the rich are therefore infinitely more healthful than those available for the poor. The health needs of the artisan, the artist, the laborer, and the banker do not vary greatly in so far as physiologic and hygienic standards are concerned. A healthful home contributes to physical wholeness, mental soundness, and moral stability. It is a positive cause as well as a definite result of the interaction of human values found in physical, mental, and moral law. The home is more than a physical shelter, it is the product of the combined efforts of home-makers.

A reasonably healthful home for a man and his wife may be converted into an unhealthful home when five children are living in the surroundings whose air, light, and bathing facilities are inadequate. A well-ventilated modern apartment may be converted into an unhealthful abiding place for children by reason of the presence of an ignorant, slovenly mother, or the coarse and disgusting habits of mental dements, or diseased beings who do not know how, or are unwilling, to take proper care of their secretions and excretions. The segregation of the sick may alter conditions so as to transform an unhygienic home to one that is more healthful. The emotional instability of a parent may destroy the mental balance of a home, regardless of its pretentiousness. Standards of healthful living do not depend essentially upon the gratification of aesthetic desires. Practical aesthetics are conducive to health and may raise the standard of living. Beauty may influence emotional states and add to the joyfulness of homes, thus reacting upon the general well-being. The architecture in itself, and