is made in Table I, which follows, showing the total deaths among the colored in each of the two-year periods, the principal causes of death among Negroes, listed by number of deaths and by the mortality rates based on 100,000 Negro population, together with data showing the percentage of increase or decrease in these mortality rates in 1920-24 as compared with 1910-14. A second table is also submitted (Table II) which gives the estimated 5-year mortality rates for the period 1920-24 for the white and colored population in these principal causes of death among the colored listed in the table comparing the two 5-year periods. Table II also shows the total or combined mortality rates for the city of Cleveland for the 5-year period 1920-24 in the same principal causes of death among Negroes. A study of the data furnished in these tables will give most of the detail regarding the effect of Negro migration upon community life in so far as fatal diseases are concerned. As regards morbidity rates but little information is available beyond a general conclusion that among the migratory colored people coming to Cleveland there exist very few diseases not often fatal which have an effect upon the community life beyond that which would be considered a normal condition of affairs. In fact, among the colored school children a recent investigation has shown that absenteeism on account of illness among colored children in the public schools is relatively less frequent than among white children. In venereal diseases, however, there has been noted a definite increase in the proportion of colored attending the out-patient departments of hospitals maintaining such clinics during recent years, and investigation over a considerable period of time seems to indicate that 40 per cent of patients attending such venereal disease clinics are colored at the present time. Returning to the consideration of the fatal diseases and those which cause the greatest effect upon community health, a consideration of the tables submitted leads to the following conclusions: First, the total mortality rates among Negroes have not increased as a result of Negro migration. Second, among diseases prevalent or predominant in the wage-earning group and among young adults, a marked increase among the colored population has occurred during the past five years in some instances, and in other instances, such as tuberculosis, while no great increase has occurred, there has been no decrease among Negroes in these diseases, as has been generally the case in the total population. Third, the chief immediate effect upon the public health of Negro migration has been to increase the health hazards of the entire population to such communicable diseases as tuberculosis because of the much higher rate of incidence of this disease among the colored population. It is generally agreed that tuberculosis is largely spread by infectious material from those already infected. Tuberculosis is also a disease which requires a long period of invalidism for cure or for its fatal termination in the great majority of cases. The effect of the Negro migration has been to bring into Cleveland a 360 per cent increase in a population group which, both before and after the migration, shows mortality rates from tuberculosis over 300 per cent greater than similar rates among the entire population. Among the entire population tuberculosis deaths, during the 5-year *Total mortality by principal causes of death among Negroes, Cleveland, Ohio, in the two 5-year periods, 1910-14, inclusive, and 1920-24, inclusive, with estimated mortality rates for each period and the percentage of increase or decrease in rates for 1920-24, inclusive, for each principal cause. period 1920-24, numbered 4,115, of which 883 were among the colored. This is 21 per cent of all tuberculosis deaths occurring in the city. In the years 1924 and 1925 over 28 per cent of all tuberculosis deaths have been among Negroes. Nevertheless, in the comparison of mortality rates of the two 5-year periods, 1910-14, inclusive, before migration began, and 1920-24, inclusive, the increase of mortality rates in tuberculosis for the second period among Negroes has not * Estimated 5-year mortality rates, 1920-24, inclusive, Cleveland, Ohio, for white and colored population by principal causes of death among the colored population. exceeded 1 per cent. The same increase of health hazards for the entire community arises, of course, in connection with any other communicable disease which has a greater incidence among the migratory group. Fourth, another marked immediate effect upon the public health has been the increase in deaths due to external violence, excluding suicides and acute poisoning. In deaths due to external violence, the mortality rate per 100,000 among the colored is nearly twice that among the white. In such types of external violence as homicides this disparity is marked. In both 1924 and 1925 in Cleveland over 35 per cent of all homicides were among the colored population. In 1925, in a total of 127 homicides in the entire city, 48 were colored. Fifth, another immediate effect upon the community health of Negro migration refers to the death-rate among infants and maternity cases. During the 5-year period 1910-14, inclusive, there were but 572 births of colored children registered in Cleveland. During the same period there were 918 deaths among the Negroes. The birth-rate was far less than the death-rate. During the 5-year period 1920-24, however, and since migration has occurred, there has been a marked increase in the number of colored births, as might be expected, due to the fact that the migratory group is composed largely of young adults of the wage-earning and child-bearing ages. The total number of colored births in the latter 5-year period was 5,540 as compared with 4,234 colored deaths during the same period. With this increase of births there has been, naturally, an increase of maternal deaths due to puerperal diseases, and also an increase in the deaths of infants under one year of age. The sixty-four deaths due to puerperal diseases for the 5-year period 1920-24 among colored mothers with 5,540 births during the same period indicates a maternal mortality rate in excess of I per 100 births. Sixth, a remote effect of Negro migration upon the public health lies in the increasing number of deaths, and cases requiring medical relief, caused by the degenerative diseases, such as cerebral hemorrhage, cardiac and circulatory diseases, and nephritis. While in none of these diseases at the present time does the migratory group of Negroes show an increase of mortality rates from those obtaining among the colored group previously, nevertheless the general incidence of such diseases among the entire population, regardless of color, is extremely high, and higher among the colored than among the whites. It must be expected, therefore, that increasing demands will be made upon the relief agencies, both public and private, as a result of the influx of large numbers of a group which, on account of financial restrictions, is unable to provide for itself the necessary relief which these conditions demand. Finally, as evidenced by mortality statistics, the Negro population, here as elsewhere, has a much higher annual death-rate than the white population. The average annual death-rate among Negroes was 20 per 1,000 in both the 5-year period 1910-14, before migration, and the 5-year period 1920-24, since migration has been going on. During the same period the average annual death-rate among whites fell from 13.5 per 1,000 to 9.6, a decrease of nearly 30 per cent. This decrease has largely been accomplished by the practical application of accepted methods of preventing diseases. While there are many instances where the Negro population has also shown decreased mortality rates in preventable causes of death, there has been a sufficient increase in mortality, due to certain causes, to keep the Negro death-rate stationary. These causes have been largely those commonly most affecting a group of such age composition as the migratory Negroes have been. Due to the extremely high rate of increase of death due to acute respiratory diseases among the Negroes in 1920-24, there is some reason to believe that the climatic change from the South to the North plays some part in the health problems of the Negro migrants, but overcrowding and poverty are factors as well. The obvious result of Negro migration emphasizes the need for increased efforts on the part of all health agencies to lower the unnecessarily high mortality among the colored population. THE HEALTH COUNCIL IDEA Bleecker Marquette, Executive Secretary, Public Just as the rapid increase in the number and type of social agencies has given rise to the necessity of councils of social agencies, so too the development of numerous organizations to meet various health problems has given rise to the health council idea in cities. Health councils and federations have been organized so recently, and new ones are being formed so rapidly, that it is difficult to state with accuracy how many there are at the present time. Our best information would indicate that there are the following such organizations in existence, either well organized or in the process of development: Health Council, Cleveland; Health Division, Council of Social Agencies, San Francisco; Health Conservation Association, Kansas City; Tuberculosis and Health Council, Denver; Hennepin County Public Health Association, Minneapolis; Health League, Boston; Health Division of Community Council, St. Louis; Health Council of Community Chest, Louisville; Public Health Association, Toledo; Public Health Federation, Cincinnati. These councils are organized and operated on plans that differ widely. It is not the purpose of this paper to discuss the different methods of organization and work being pursued by these various federations, but rather to outline briefly the plan of organization of the Cincinnati Federation and some of the things it has been able to accomplish, and then to discuss specific problems involved in the federation of health activities. Dr. Haven Emerson, after careful studies of the public health resources of several cities, has advocated the federation of health activities as essential to the best results. Dr. Emerson's recommendations led to the organization of the Cleveland Health Council, and later, the Louisville Health Council. The goal of public health work is to foster the best possible facilities for the care of the sick, to reduce preventable disease to the minimum, to promote vigorous, positive health, and to prolong life. It is difficult to accomplish this purpose to the best advantage as long as a variety of specialized health agencies pursue particu |