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1248 BRISTOL AND WESTERN COUNTIES. ".throughout the States. In their efforts they had been greatly aided by the press. But the most useful ally was the moving picture, for they had to reach people who would ’neither read nor listen. Dr. Farrand concluded his address by protesting against exaggeration. The facts were big enough. Sanitary Engineering. Continuing the discussion on the best means of teaching - and on what should be taught in regard to the laws of ’hygiene, Professor GEORGE C. WHIPPLE, of Harvard University, insisted on the importance of sanitary - engineering. From simple plumbing and the potter’s work ,to the most scientific civil engineering one and all sought to adapt the forces of nature to the preservation of public health. But engineers must be broad-minded, for they had to assimilate many other sciences than their own. They, of course, had to be good mathematicians, but they must also have knowledge of practical mechanics. Geology, zoology, bacteriology, chemistry, vital.statistics; had all to be studied, understood, and applied. But the sanitary engineer must , primarily be trained in engineering-the other sciences only taught what should be done and not how it should be done. In some cases a good deal of laboratory work was needed, .-and, of course, there must be a thorough knowledge of - hydraulic. Then when the model sanitary engineer had been brought into existence, a model sanitary executive was necessary to sanction the work the engineer would wish to ’undertake. What Health Officers should Kn07/J. Dr. FRANK F. WESBROOK, professor of pathology and ’bacteriology at the Minnesota University, and President of .Section VI., pointed out that training in hygiene needed at least one year and more, probably three years, of special study after qualification. Dr. Wesbrook showed the practical impossibility of any one man really knowing all a health officer should know. Nor was there in existence any one hygienist capable of teaching all these different branches of -sanitary science. Then much of this could not be taught in shocks and school. It needed practical experience, object- !lessons, not theories, and, above all, a great knowledge of mankind. The public health officer had to deal with men ;and women. He had to inspire them with respect for him- self and belief in the usefulness of his functions. If the public did not second his efforts his mission was a failure. Dr. WILLIAM F. SNOW, State Board of Health, California, insisted on the presentation of documentary evidence in support of points raised or taught. Then in each centre there should be at least the nucleus of a museum. The health bulletins issued to the public should be drawn up by capable writers, who knew how to present facts in a readable manner, and distributed in sufficiently large numbers. They had better abandon popular doggerels on killing flies in order to print matter likely to be useful to teachers. But, after all, what were they going to teach ? 7 In one locality it was relieved that with a wholesale slaughter of cows bovine ’tuberculosis could be stamped out. Elsewhere they were ’told the cows might be left alone if the patients were at once - snatched away from their homes and isolated. Others were - content with more frequent and rigorous disinfection, and yet a fourth party maintained that the housing problem was .at the root of all the evil. When these points were brought forward the section was crowded : men of all nationalities were present. How ’useful, how interesting it would have been to obtain an - expression of opinion i By a vote, Section VI., after hearing these arguments and papers, might have given some guidance by indicating which of all these measures it thought was the most urgent. But absolutely nothing was - done. Able papers were read. but no one has the slightest idea of what effect they produced. Physical Training. Professor DUDLEY A. SARGENT, of Harvard University, spoke on applied physiology, describing the great improve- ’ment in health and physique which had followed systematic training. Of 136 colleges and universities 94 per cent. had regular instruction in gymnastics. What athletic training had accomplished in America was not realised abroad. Popnlarising Hygiene. Miss ROSALIE SLAUGHTER MORTON, honorary chairman of the American Medical Association Committee on Public Health Education, New York, described the propaganda work done ramong the people. Their lectures were very successful. Each member of the audience was made to feel he was part of a great movement. All classes of the community attended, and there were overflow meetings. Forty-two subjects covered the whole field of preventive medicine. They first of all properly ventilated the hall. Then they frequently changed the speakers, since people soon tired of hearing the same voice. Also they avoided fatiguing the eye by a prolonged lantern show. They strove to encourage the audience to ask questions and state what subjects they would like to hear explained at the next lecture. The Independence of Medical Officers. The section now reverted again to the question of the education of sanitary officers and their position. Sir GEORGE MCCRAE, Vice-President of the Local Government Board of Scotland, insisted that even the sanitary inspector as well as the medical officer of health should not be subject to dis- missal at the hands of the local authority. The difficulty was in rural districts where there was not enough money to pay such functionaries adequate salaries. In some cases they had to drive as far as 40 miles ; but as the work they did was of use to the entire nation as well as to their imme- diate locality the State should help financially exceptionally poor districts. Dr. SANDWITH, of Alabama, insisted that health boards must consist of qualified practitioners only, must be divorced from party politics, and freed from the domination of com- mercial men. At present, in American experience, if a board of health proposed some reform it was treated as a party measure and opposed as such. The education authority should be absolutely uninterested in party politics, so that sanitary measures might be brought forward and discussed solely on their technical merits. (To be continued.) BRISTOL AND WESTERN COUNTIES. (FROM OUR OWN CORRESPONDENTS.) Administration of Sanatorium Benefit in Bristol. THE scheme drawn up by the Provisional Medical Com- mittee of the Bristol area, the Insurance Committee, and the Municipal Health Committee for the temporary adminis- tration of sanatorium benefit under the Insurance Act has now received the approval of the Commissioners and will forthwith be put into effect. The mechanism is briefly as follows. The patient entering upon the receipt of benefit has the form known as "Med. 2," provided by the Local Government Board, filled up by his own medical man, who states his opinion as to the kind of treatment required, whether domiciliary or institutional. This form is taken to the medical officer of health, who is acting as chief tuberculosis officer for the time being. He may accept the diagnosis and recommendations set forth therein, or he may consider a second opinion necessary. If he takes the latter view, or if the patient himself gives reasons for particularly desiring a consultation, the medical officer of health will refer the case to one of the local consultants, whose names will presumably appear on a list from which the patient may choose. For such consultations a fee of 1 guinea will be paid. If the patient’s medical man recommends him for special dispensary treatment, he may be referred to the Redcliff Tuberculosis Dispensary, which is under the control of a whole-time officer. Otherwise the patient may be recommended for sanatorium treatment or for domiciliary treatment by his own medical man. If the latter course is adopted, periodical reports to the medical officer of health will be furnished by the medical attendant of the patient. Payment to medical men undertaking domiciliary visit will be made on a basis of 2s. 6d. per visit, with certain extras. This scheme is only temporary, but no doubt it will be placed on a permanent footing if it works satisfactorily. The medical men of the district are urged, in a letter from the secretaries of the Provisional Medical Committee published in the local press, to work the plan as economically as is consistent with efficiency. Much p wise is due to the Insurance and Health Committees for the reasonable and courteous spirit in which they have con ducted the necessary negotiations.
