in the matter of regular habits and food preferences. These are carried into the home through the mother who is usually most eager to learn why her baby is no longer skinny, pale, and cross. At first when she enters the child in the nursery, the mother is apt to tell the nurse: "Please not put my baby to sleep in the day, she no sleep at night, and baby she no likes milk," and to list other eccentricities of the year-old infant. She is more than pleased when all her shortcomings have been undone and her baby is a natural healthy youngster. The pre-school child perhaps offers the most fertile ground for child-welfare effort. He is unhampered by school duties and at the eager stage where he urgently desires approbation. Principles attractively presented are readily accepted and made his own, either through understanding or through mimicry. This is also the proper period for dentistry, tonsilotomy, and other corrective treatments which prevent more serious conditions in later years. For example, although heart disease rarely appears until between the fifth and tenth year, its foundation is usually laid in the earlier period by constant absorption of toxin from infected tonsils and decayed teeth. So much for the infant and the child of pre-school age. Now what must or can the nursery do for the school child? Here indeed is another and perhaps a bigger task. In the matter of food, corrective and preventive medical attention, the work with the school children differs from that with the pre-school child only in that the school child is older, with habits and prejudices formed. To undo these and develop the right ones while correcting the results of neglect of health principles is an essential and worthwhile but difficult task. There is no distinct line of demarcation between these stages of childhood. The development from the toddler to the adolescent is so gradual that no definite health program can be outlined for any particular age. The school child, however, presents opportunities and responsibilities outside and beyond the general conception of child welfare as interpreted through a health program. In its rôle as substitute home, the day nursery should be responsible for regular school attendance and extend fullest co-operation to the teachers in getting the best results in school work departments. The before-school and the noon hours permit of little beyond the regular meal and preparation for school. The after-school period, however, affords an unusual opportunity for character development. The creative impulse, the spirit of adventure, and the "gang" instinct, present in every normal child, can be translated into constructive channels by intelligent direction. In its role as friend and helper to a family in distress, the day nursery is in a position to secure prompt and complete acceptance of advice as to what is and what is not best for the child. It can have very appreciable effects on family standards where the children are concerned. It can justifiably discontinue care, if full and complete co-operation is refused. Here, then, we have an organization with unrivaled opportunities for child welfare within its enrollment and the family. To make the most of these is the task of the day nursery as we see it today. DIVISION II-DELINQUENTS AND CORRECTION SOCIAL HYGIENE 'A. THE NATURE OF THE INTERDEPENDENCE OF THE PHYSICIAN AND THE SOCIAL WORKER IN A SOUND SOCIAL HYGIENE PROGRAM William A. Evans, M.D., Chairman, Committee on Speakers, Health and Sanitation Society's machinery for the cure of those sick with venereal diseases consists of drugstore or counter prescribing, so-called patent medicines, private physicians including advertising doctors, family practitioners, specialists, dispensaries, venereal disease hospitals, general hospitals, and asylums or hospitals for the insane. At some time or another far more than a majority of those having venereal infections get their treatment from the first two of these. Unfortunately, a very large proportion of those having gonorrhoea depend on counter prescribing for treatment during the earlier stages of the disease. The proportion with chancres and chancroids depending on this line of treatment during the infective stages where they take treatment at all is large. The shortcomings of counter prescribing treatment and patent medicine treatment need not be elaborated. Of those who go to physicians for treatment the vast majority go to family physicians. Candor compels us to say that the treatment by the family physician, especially as regards the treatment of gonorrhoea, is not much better than that by counter prescribing and by patent medicines. The treatment by advertising specialists is neither scientific, thorough, nor honest in its attitude. As a rule treatment by specialists is too expensive for the type of people who contract venereal disease. As our organizations now are, venereal disease hospitals are for women only and practically speaking for professional prostitutes only. The theory of their organization is that the infective prostitute will be compelled to ply her trade in order to live and that forcibly hospitalizing her is necessary for the good of society. Such hospitals receive a few women not of this class, but they constitute the exception. That this theory is correct cannot be denied. I cite some cases to show a parallel need for hospitalizing infective males. There is no reason why general hospitals should not care for infective cases of venereal disease, but as matters now stand they care for gonorrhoeal rheumatisms, neuralgias, neuritis cases, pus tubes, and some other sequelae of venereal disease, including locomotor ataxia, spinal syphilis, and a few out of the ordinary cases of venereal disease. The insane asylums care for the late developments of cerebral syphilis. All in all the two most effective agents for the cure of venereal disease now operating are the specialists and the dispensaries. Both treat ambulatory cases in the 112 113 main. Both do considerable educating and social service. Both give up-to-date treatment. The limitation of the specialist is the infrequency with which he sees cases in the very earliest stages and the expensiveness of his services. The advantages of the good dispensary is the better developed social service, the greater flexibility of the charges for services, and the greater leeway for advertising compatible with the ethics of the profession. In my opinion the outstanding need right now is for improvement in the treatment of gonococcal infections. The control of gonorrhoea is being held back by reason of this shortcoming in treatment. The responsibility for this situation is divided between the laboratory research men and the clinicians. The machinery for social service theoretically is divisible into that for work with infected persons and that for the prevention of infection. The infected are or should be registered with the health department and also with some curative agency where their cure is not undertaken by the health department. Most cases of venereal disease, even in the infective stage, are not hospitalized, neither are they isolated nor quarantined in the home. In a certain sense the social service visitor is a quarantine officer. In addition the social service visitor gathers information as to sources of infection, family relations of those infected, and other cases of infection in the home of the infected person and in the place where he is employed. He or she gives instruction as to the nature of the diseases, how contracted, how spread, how avoided. The opportunities for teaching morality and good citizenship are excellent. Educational and moral literature is distributed by the social worker to good advantage. An important part of his or her duty is to see that treatment is persisted in until a complete rather than a symptomatic cure has been effected. That rule of health departments now rather generally in vogue which requires that all persons who discontinue treatment prior to complete cure shall be reported to the authorities increases the usefulness and the importance of social service. A uniform interpretation of this ruling and a clearer definition of it would make the enforcement of the rule more effective and add still further to the advantages of social service. The machinery for social service in the prevention of venereal disease consists of the church and other institutions for moral instruction, all recreational and wholesome play activities, the schools and other institutions of education, the departments of health and police, and the voluntary associations for the repression of prostitution and sex immorality and for the promotion of social hygiene. The social hygiene worker in this relation gives lectures, shows lantern slides and motion pictures, distributes educational matter, posts placards and warning cards, and teaches and admonishes by personal communication. As medicine becomes less individual and more social the place of social service in the scheme of things becomes increasingly important. The high point in this need is reached in the treatment of venereal disease. The venereal diseases are forms of contagion. Contagion that is not hospitalized is doubly dangerous. Venereal disease is not cared for in hospitals. The fact that active treatment can make both acute syphilis and acute gonorrhoea non-infectious in a very short while, that the diseases are not self-limited, and do not tend to spontaneous recovery-all these considerations increase the importance of both medical care and social service in venereal disease. Wote was yumm wllering from veral diese heads into all sorts of questions A lamwry ide und malinadiya. Tune require vocal service work. In a wel regu Wat vra nytja ditie, every one in reported in conformity with the law, and a hatury a tex Tua tatory vows the source of infection and the danger to others, Wikakver in, ia pasivie to get such information. The patient is furnished with literature routing to his disease in both its medical and its social aspects. By personal Ondara, te vatura relationa of his disease to himself and others is made plain to him. ha tarabully na ponsible the worial service worker visits the home or work place of the infected person where that seems advisable. He studies record sheets, investigates akorian, and by all proper methods strives to learn who is breaking quarantine either wilfully or ignorantly, As a rule health departments only require that physicians, dispensaries, and hospitals treating venereal disease report the cases by number or by name. So long as the case comes regularly for treatment and satisfies the physician that he is obeying such restrictions as the physician has established, the health department takes no action. If the patient breaks treatment or absents himself from the physician's office, the dispensary, or the hospital, that fact is to be reported to the health department, whereupon it will send out notices or inspectors or do other social service work as the circumstances indicate. This method of quarantine, known as “physician's responsibility" method, was in vogue as to scarlet fever, diphtheria, and other forms of contagion up to 1907 in some cities. It was found to be ineffective, because the social service work which the physicians were supposed to do under this law they did not do. In consequence, the plan was very generally abandoned. In all probability it will have to be abandoned also in the case of venereal diseases unless the awakening of the medical profession to its social obligations should be somewhat speedy. For a long time to come there will be need of social service workers to those who have wrong notions as to the seriousness of venereal diseases ar infectivity, to supplement the functions of hospitals, to bring about contin treatment until the possibility of relapse into activity or even until danger lesions has passed, to provide some substitute for quarantine, to stimulat to educate, and to promote educational and moral prophylaxis. Chicago, I imagine, is about as well advanced as any American city in control of venereal diseases. As early as 1909 they began occasionally placarding houses of >rostitution where venereal disease was known to exist and when it was possible to prove that infections had taken place. About that time they began forcible hospitalizing of infected prostitutes, to some small degree. In 1911 they had an official investigation and report on vice conditions. In 1912 the red light districts were abolished. They have the injunction and abatement acts. There is a society for the control of prostitution and one for the control of venereal diseases. The law officers are now interested in vice control. Health Commissioner Robertson has organized a bureau of social hygiene with dispensaries and a hospital. The state issues silver nitrate for use in the eyes of babies in the prevention of gonorrhoeal opthalmia. The social hygiene society and other organizations have venereal disease dispensaries. There is a hospital in which infected prostitutes are kept until they cease to be infective. A great deal of educational work has been done. There has been no neglect either of educational or of moral prophylaxis. And now having established that fact let me cite some cases as furnished me by Dr. Ben L. Reitman, who, as physician for treatment of venereal diseases at the Bridewell, as an official of the health department, as a member of the staff of the Illinois Social Hygiene League, as a practitioner of medicine, and as a practical sociologist, has an unparalleled opportunity to know the attitude of mind and the behavior of several large groups of people infected with venereal diseases. Illustrating lack of self-control sufficient to establish the individual as a social or even anti-social: George W., a sort of clean cut young man owning a grocery store. Married four months. Gonorrhoeal infection. Within ten days after his infection and while taking treatment, he said: "Doc, do you think I could infect my wife?" "Absolutely. Didn't I tell you to be careful not to stay with anybody?" "Well, I was in bed with my wife the other day, got heated up, and forgot all about it." Dr. B., a physician with a venereal practice. After examining a girl he made a positive diagnosis by microscope of gonorrhoea. Was talking confidentially with the girl and before she left the office he had a contact with her. "But didn't you know you were taking a chance?" "Sure, but I got all so was willing to take a chance." Illustrating ignorance sufficient to make the individua Alice, eighteen years old, kept house for her father w night engineer. Contracted syphilis and infected twelve you hood. "Alice, didn't you know you were sick?" "Yes, I knew that if I kept on staying with men I could just pass the infectio system." Illustrating indifference and lawlessness: Babe, born in Tennessee, twentyears old, divided her earni |