health. The Committee found that there were in New York City over one hundred civic, charitable, scientific, social, and religious agencies interested in one way or another in the matter of public health. In order to save effort and to enhance efficiency a plan was put forward to establish a clearing-house of public health activities to include these organizations.

This proposal led to the formation in June, 1913, of a Central Council of Public Health of the city of New York. The purpose of this organization is to deal with those problems requiring civic and public effort for their proper solution.

One of the many subjects which may come within the scope of the Council is the provision of adequate facilities for the care of mental defectives. It has been officially estimated that the number of persons in the State of New York having the taint of mental defect is 200,000, and that there are about 20,000 of the lower grades of mentality, of whom a little over 6,000 are in public and private institutions. With the exception of this small proportion, these mentally deficient individuals are under no restraint and are free to breed a further race of idiots, imbeciles, criminals, prostitutes, and epileptics. In New York City these unfortunates, or such of them as are capable of being taught, receive a certain degree of care and attention between the ages of six or seven and fourteen in the ungraded classes of the public schools established for abnormally backward children. In 1911 the city maintained one hundred and twenty-six such classes, with an enrollment of something over one thousand.

Outside of this provision of school care, which of course is entirely inadequate to deal with the problem of the mentally defective, only the scantiest provision has been made thus far for dealing with this problem.

In

1912 the New York State institutions for the feeble-minded and the epileptic, of whom 98 per cent are estimated to be mentally defective, had a total capacity of 4,155 beds, and their census at the time showed that there were 4,208 inmates. In addition the city of New York maintains at Randall's Island provision for a few hundred of this class of unfortunates. Not only is there a startling lack of physical provision for the care of mental defectives, as shown by the above figures, but there is a lack of adequate laws for dealing with this problem and of a well-defined social policy in relation to it.

CONTROL FOR MENTAL DEFECTIVES

To supply this threefold need the Public Health, Hospital, and Budget Committee of the New York Academy of Medicine has outlined a plan for dealing with this matter. This plan provides for placing the entire charge. of the mental defectives throughout the State in the hands of a Board of Control. Under its supervision the care of feeble-minded children might be left with the parents during their earlier years. During school age means should be provided for teaching as many as possible of them to be self-supporting. Those who attained this position might be allowed later to live outside of institutions, but at all times they should remain under the supervision of the Board of Control in order to make possible their social control and the prevention of propagation. A bureau for the collection of permanent records of all mental defectives in the State, from birth to death, is proposed as one feature of the plan which looks to the careful control of the great army of mental defectives and the gradual reduction of the burden of dependency arising from this cause.

HEALTH SERVICE AT PORTS

One subject which has an important bearing upon the prevention of the spread of disease in these days when commerce between nations has reached such vast proportions is the proper provision of health inspection and quarantine for communicable diseases at the various ports of the country. While the methods of preventing disease from entering the country through its ports are sufficiently well developed as far as technical knowledge is concerned, the possibility of a failure in efficiency through the existence of divided authority is great enough to make the subject one of public concern. This aspect of the case recently has received the attention of the Public Health, Hospital, and Budget Committee of the Academy of Medicine, which has made the recommendation that the health supervision of the port of New York should be transferred to the United States Public Health Service. Because of political considerations action in this direction, however, seems likely to wait until a strong and forceful expression of public opinion demands it.

THE PUBLIC HEALTH SERVICE Since 1893 all maritime and inter-State quarantine powers of the United States have vested in what is now known as the Public

Health Service, which is a branch of the Treasury Department and is directed by a Supervising Surgeon-General. The Public Health Service is empowered to promulgate uniform quarantine regulations for all ports of the United States, and these regulations must be enforced by State and municipal authorities if they retain the administration of port affairs. At the present time the Public Health Service operates forty-eight stations on the Atlantic, Gulf, and Pacific coasts, besides the quarantine systems of Hawaii, Porto Rico, the Philippines, and Alaska. The growth of its control over the various ports was gradual. As cities and States found that their individual efforts to keep out or to stamp out disease were ineffective or too costly, they became ready to transfer the regulation of this matter to the Federal Government of their own accord. Only three ports are not yet under direct Federal controlthose of Boston, Baltimore, and New York.

Of all the ports of the country New York is the one which would seem most certainly to belong under Federal authority. By far the greater part of the ocean-borne trade and travel of the country passes through this gateway. The magnitude of its commerce and its importance as an immigration center make its port business pre-eminently National in character. Yet the financial burden of maintaining at this port the health safeguards which help to protect the whole country rests upon the State of New York alone. The budgetary requests for improvements and administration of the service for 1913 amounted to $2.314.780.

REASONS FOR NATIONAL CONTROL

While the cost of maintaining the New York quarantine service should be an inducement to the State to surrender it to Federal authority, there were numerous other reasons that impelled the Academy of Medicine's Committee to recommend the transfer. Aside from the fact that the service is one that is essentially National, or perhaps it might better be described as international, in its relations and in its bearing upon the public health, there is likely under present conditions to arise a conflict of authority that might seriously endanger the public health under critical conditions. Only last year, at the time of plague prevalence in Cuba, friction between the two authorities developed when a liner from Havana, to which a clean bill of health was refused by the Federal officers at the

port of departure, was admitted to pratique by the State officers of New York on the ground that the violation of the rules on the part of the ship's captain was a matter to be attended to by the Federal Government! Moreover, quarantine is the only service at the port that is not controlled by the National Government. In addition to the customs, immigration, navy and army administration, Federal authority maintains the revenue cutter service and has control over navigable channels, dredging, and lighthouses. It seems only consistent to extend its power to quarantine and to have all port services under the one authority.

There is another reason for the transfer, pointed out by the Committee. As long as quarantine remains under State control and its officers are a part of the spoils of party success, there is constant danger that politics may interfere with the efficiency of its work. The Public Health Service of the United States is outside the domain of partisan politics. Modern quarantine work is essentially scientific, and scientific work cannot be pursued successfully except under the condition of reasonable permanency in office. The positions of chief quarantine officers should not be subject to party vicissitudes and should not be used as a reward for party services. Under Federal control there is continuity of service, uniformity of policy, constant supervision of the acts of all quarantine officers, and abundant opportunities for scientific and administrative training in various ports of the world, such as is not available to the officers of any State.

CO-OPERATION OF LAY PUBLIC AND MEDICAL PROFESSION

While the above sketch of a few of the activities in which the medical profession, through one of its most prominent and influential organizations, is working to promote the cause of public health is necessarily far from comprehensive, and perhaps may be described as fragmentary, it serves to indicate that there is an important field of social endeavor which is not as yet occupied, or at least is only imperfectly occupied. Since the conservation of public health is not wholly a medical question, but is in many cases even more largely a social question, there is abundant need and opportunity here for effective co-operation between the lay public and the medical profession. Do we not need an active National society which shall include

leaders of public thought as well as leaders of achievement in the study and prevention of disease and in the application of medical knowledge to the promotion of public health? Such an organization could do an invaluable work in removing obstacles that exist in the pathway of medical progress and public health advancement. It could help to edu

cate the lay public to the possibility and the advantage of protecting itself by the adoption of reasonable safeguards against the spread of controllable diseases. In many ways it could give a powerful impetus to the great cause of health conservation, which is literally the most vital of all causes claiming our interest and active participation.

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Na recent issue of The Outlook Mr. Edward Bok asks the question,

"6 Is the

College Making Good?" and presents the results of an investigation which leads him to incline toward a negative answer. Mr. Bok's article is interesting, and doubtless will perform a useful service in impelling many teachers to renewed energy in combating the evils he describes. No one appreciates the existence of those evils more fully than does the college teacher, who gains his knowledge of them, not through a single letter written by a given student, but through that student's daily or weekly reports and essays, quiz papers, final examination books, and other compositions which the conscientious teacher must read, correct, and grade.

As a college teacher of physical geography and physiographic geology, I have frequent occasion to mourn the shortcomings of my students in respect to spelling, grammar, and legibility of writing. I have marked examination answers zero because it was simply impossible to decipher them, and have assigned a similar grade to other answers which were unintelligible because of ungrammatical construction. One of my students, a native American, wrote page after page in his examination book without making use of a capital or a punctuation mark, spelled Chicago "chegargo," and other names with equally bewildering originality. His knowledge of elementary physical geography would have

entitled him to a low passing grade, but I gave him an "F" (failure), on the ground of "general illiteracy," a decision which he himself thought eminently just. But while painfully conscious of the evils in question, I have not blamed the college unduly. Perhaps it is because I am a college teacher that I have laid more blame on the elementary and secondary schools, while holding the college entrance authorities responsible for admitting to college standing boys and girls who could neither spell correctly nor write grammatically.

Not in my most gloomy moments, however, have I ever felt that the elementary and secondary schools were not "making good." I have felt that they were not making the best of their opportunities, and have wished that less time were devoted to fads and more to fundamentals. But, in spite of what seem to me serious defects in the present curricula of these schools, I am convinced that he must have but a partial view of a complex subject who would bring a wholesale indictment against elementary and secondary education. In like manner it seems to me that while college graduates as a whole undoubtedly do not spell and write as they should, Mr. Bok's indictment of the colleges is far from convincing.

In the first place, one may question whether the answers to a circular letter form a proper basis for judging the ability of the average student to write legibly and gram

matically. When I reach my desk in the morning, and find some circular which asks me to stop my other work and answer certain questions in which I am not at that moment vitally interested, I may jot down some rather hurried replies, which I would be glad to revise if I learned later that the questioner was really using them for a purpose materially different from the one he professed to have in view. Under the impression that he wants my opinions on the questions raised, I may give them hastily and in rather careless form. If I knew that he really wanted to know what my every-day writing looked like, I would try to write as I do in ordinary correspondence on subjects in which I am interested at the time. It is true that I should not write carelessly in replying to a circular letter. But if I do it is hardly convincing evidence that my college course was a failure. The fact that 1,426 men did not take the time for any reply suggests that some of those who did reply may have done so hastily. Of course many of the mistakes cannot be explained as the result of carelessness; but many others certainly bear the earmarks of haste rather than of ignorance. sometimes write illegibly, and not infrequently transpose the letters of common words when writing hurriedly. On reading my own manuscript later, I have been surprised at the blunders made, as were doubtless many of the students upon seeing their letters in print. But in neither case do I believe that our college courses were necessarily failures.

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A careful investigator will want to be assured that the replies which reached Mr. Bok were fairly representative of college seniors as a whole. Mr. Bok himself, with his characteristic view-point, concludes that those who failed to reply include men who disgrace our colleges more effectually than do those who answer his letter of inquiry. May it not be that the reverse is true? Our best college students are not only busy with routine work, but are active in many other phases of college life, such as literary societies, college papers, oratorical contests, debates, and so on. Such men are apt to push a circular letter to one side until they have "a spare moment"-a moment which does not come. I do not believe that I have been a striking disgrace to my college, but I must confess that had Mr. Bok's circular letter reached me during my senior year it would probably have found its way into the wastebasket, two-cent stamp and all.

This brings us to a question of ethics, which Mr. Bok discusses at some length. One thousand four hundred and twenty-six men failed to answer his circular letter, although they received self-addressed, stamped envelopes. With delightful naïveté Mr. Bok proceeds to condemn these men for having "no conception of the fundamental business rule of courtesy that a business letter calls for an answer, and that a stamped, addressed envelope entails, in a sense, a moral obligation upon the receiver -a moral obligation in this case to write a reply in order that the questioner may publish it and hold its shortcomings up to public ridicule! But, assuming that no unexpected use was to be made of the letters, it would still be difficult to take seriously the contention that the recipient of a stamped, addressed envelope is necessarily under a moral obligation to reply, were Mr. Bok not so evidently in earnest. He does not explain just how a man can, without his knowledge or consent, become morally obliged to expend part of his valuable time on everybody who chooses to mail him a list of questions and a two-cent stamp. Were Mr. Bok's position tenable, it would be a piece of impertinence to send a busy man a stamped envelope, for one would thereby force him into the disagreeable necessity of replying whether he wanted to or not, and whether or not he could afford the time. But a stamped envelope is not a device for putting the other fellow "in a hole" and making him answer. It is rather a courtesy which the sender owes the recipient of the letter, in order that the labor of replying may be made as light as possible. Whether the recipient is under moral obligation to reply depends wholly upon the nature of the letter, not upon the presence of a stamped envelope. If the letter asks if I will act on a committee to consider the proper salaries for college professors, I am under obligation to reply, even if the sender neglected to inclose a stamp. But if I am asked to state how much of my salary I spend for my wife's clothes, I am under no obligation to reply, even though a stamped, addressed envelope accompanies the query.

Business and professional men are constantly receiving circular letters, advertisements, etc., containing stamped, addressed envelopes or cards for reply. I get them from insurance companies, from publishers of various styles of "Who's Who," from mining companies which want to sell stock, and

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from other concerns which believe it good business policy to inclose stamp for reply. To answer all that come in a year would require the expenditure of many dollars' worth of my time, or compel me to pay a stenographer for her time. It is indeed a curious method of reasoning which can evolve the conclusion that I am under moral obligation to spend my time or money in reply ing to these communications simply because the senders inclose stamps. I am sorry to have a man lose his one or two cents. would return his stamp unused if I could do so without expense to myself; but, as this is impossible, I throw letter and inclosure into the waste-basket with a clear conscience. Many letters containing return stamps deserve and receive replies; but the recipient must use his own judgment in deciding which ones he is under obligation to answer. It may be that the 1,426 students used poor judgment in not replying to Mr. Bok's letter. If so, it was because the character of his letter was such as to deserve an answer and not simply because it contained a stamped envelope for the desired reply. I am inclined to believe,. however, that a large number of these men were justified in their decision not to answer the letter, because it would interfere with other more pressing duties, because they could not give an adequate answer without thinking the question over more carefully than they were then prepared to do, because they feared to have their letters quoted, or for other good and sufficient reasons.

In order to ascertain the practice of business men themselves in this matter of the stamped return envelope, I have questioned officials of several large New York concerns, with the following results: A high official in one of the departments of the city administration says he never considers that a stamped envelope entails a moral obligation to reply, and that many letters inclosing such envelopes receive no answer from his office. A member of one of the largest banking houses in New York tells me that it is not his custom to reply to all letters containing stamped envelopes, circular letters in particular being destroyed in considerable numbers every year, together with accompanying stamped envelopes or cards. One of the editorial staff of a big publishing house, after stating that he left many letters accompanied by stamped envelopes unanswered, added, You cannot place a man under an obligation to answer such a

letter, without his consent. If I find fifteen letters in my morning mail, containing return stamped envelopes, it certainly does not mean that I am under obligation to make fifteen replies." A representative of a large and well-known wholesale and retail store said that, it cost his firm from fifteen cents to twenty-five cents to reply to a letter, and that it depended upon the character of the letter whether or not a reply was obligatory. In some cases letter and inclosures were returned in the stamped envelope, without comment, to show that the stamp was not used for other purposes; but large numbers of stamped envelopes and cards were destroyed every year. The secretary of a large university states that he seldom destroys a stamped envelope or card, but returns the empty envelope or blank card to the sender when he does not consider a reply necessary. It is rather curious to note that the college official was the only one of these business men who uniformly sent the stamped envelopes back, whether or not he replied to the communications which they accompanied.

It is certainly true that many of our students are remiss about answering letters which from their very nature demand a reply. Assuredly, it, is a serious breach of etiquette when half the students who receive an invitation to a president's reception fail to reply, although the invitations were marked "R.S.V.P." So, too, there are business letters which demand a prompt response. all means, let us teach our students, in the proper place, the fundamental rules of business courtesy; but neither in the schools nor in the colleges, let us hope, will they ever be taught that they place busy men under moral obligation to reply to a letter by inclosing a stamped return envelope.

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There are several other points in Mr. Bok's investigation which the thorough student of the problem must carefully consider. Are poor penmanship, occasional misspelled words, and ungrammatical construction, individually or collectively, sufficient proof that the guilty party has not profited greatly from his or her college training? In physiography no student can fully comprehend the effects of the forces of erosion upon a mountain unless he first knows what was the original form of the mountain. It seems to me that Mr. Bok is trying to determine the effects of educational forces upon certain persons without paying due attention to the previous condition of those persons. I should