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the necessity of treatment. The annual physical examination of school children will soon, it is to be hoped, become universal. It is said that from twenty to thirty per cent of our school children have defects of vision—which often result in headaches, stomach troubles, or nervousness. A smaller number have defects of hearing, a great many have nose and throat troubles, and perhaps nine out of ten have defective teeth—often the obscure cause of serious ailments which appear in later life.

In addition to these periodic examinations, with the correction of defects revealed, and to the constant watchfulness of the school nurses, the public school children are being trained in personal health-habits and taught the principles of modern hygiene and sanitation. Clean, airy, sunny, well-ventilated schoolhouses are an object-lesson of the first importance. Some States go further and provide for physical training, in the form of supervised exercises, for every pupil. In such ways a new generation is growing up with a keener realization of the importance and the attainability of health. The notable result attained through the teaching of the evils of alcoholism in the schools shows what advances in the general health may be expected to eventuate from this education of the children. They will not be content to endow hospitals to care for the sick; they will see to it that the causes leading to illness are radically diminished.

In addition to the work in the schools, various agencies are engaged in improving the national health. The United States Public Health Service controls the quarantine stations up and down our coasts, and has a splendid record of efficiency in stamping out plagues that might easily have assumed very serious proportions. It also maintains a number of laboratories for the investigation of diseases, and maintains a careful inspection of the private establishments that sell serums, anti-toxins, and vaccines. It has conducted sanitary surveys in several States and secured the passage of many ordinances that regulate the disposal of waste, the safeguarding of the water-supply, the prevention of fly-breeding and other hygienic measures.

Another very efficient organization for the improvement of health, both in this country and in various foreign countries, is the Rockefeller Foundation, whose annual reports show remarkable results. In particular, it is waging a campaign for the eradication of yellow fever and malaria, with the hookworm disease and tuberculosis and infantile paralysis also the object of vigorous onslaughts. It is fostering medical education and research, and in various other ways fighting to lower the death-rate.

The National Tuberculosis Association has demonstrated, especially in its work at Framingham, Massachusetts, that that widespread disease can be almost entirely eradicated. The town of Framingham, by its help, raised its annual per capita expenditure for public health from 39 cents to $1. Before the experiment was made the death-rate in Framingham was about 16 or 17 per thousand, and the infant death-rate about 85 or 90. The first year's attack upon the causes of ill-health reduced these rates to about 12 and 69 respectively. The following year (1918) was the year of the influenza epidemic. But the figures for 1919 show a retention of the gain. Deaths directly due to tuberculosis have entirely ceased.

In these various ways the opportunity for health is being extended to more and more of our citizens, and we may hope to see eventually something approaching a real equality in this respect. In the meantime, health insurance is of great importance in enabling the poor to deal with illness. Even if the present number of something like three million people seriously ill at every given moment in this country is considerably lowered in the near future, there will still be need of provision for those who cannot afford proper doctoring, proper food and care for their sick, and cannot afford the loss of income caused by the illness. Hundreds of thousands are cast into serious financial straits every year through the illness and the death of wage-earners. Most of these people cannot afford the premiums which private companies charge for life and disability insurance. Indeed, these premiums are usually far too highmore than half the money spent on them going, in some cases, to operating expenses and profits, leaving less than half to be paid in insurance.

Whether health and disability insurance should be left in private hands, or managed by the State, or by the several industries, can not be here discussed. But in some way the vicious circle must be broken whereby poverty leads to ill-health and ill-health increases poverty. A wise insurance system will do more than keep the sick and their families from destitution, it will include early diagnosis and advice, the insistence upon proper hygienic precautions, and the education of the community in the prevention of illness.

In such ways, and in ways yet to be devised by the coming generation, we may hope not only to see America made the healthiest nation on earth, but to see health and long life the perquisites of every American, the humblest as well as the most gifted and most highly rewarded. This would be but the logical carrying out of our founders' dreams of Equality, rudely upset by the conditions of a close-compacted industrial society, but secured and made per. manent by the vigorous efforts of our people.


Durant Drake, Problems of Conduct, Chap. XV.
L. H. Gulick, The Efficient Life.
Woods Hutchinson, Handbook of Health.
C. R. Henderson, The Social Spirit in America, Chapters IV,

Lawrence Veiller, Housing Reform.
Jacob Riis, The Battle with the Slums.
R. A. Woods, The City Wilderness.
W. H. Allen, Civics and Health.
T. C. Horsfelt, The Improvement of the Dwellings and Sur-

roundings of the People.
J. S. Gibbon, Infant Welfare Centers.
L. D. Cruikshank, School Clinics at Home and Abroad.
Florence Kelley, Modern Industry, Chap. II.
Charles Zueblin, American Municipal Progress, revised ed.,

Chap. VII.
W. A. Brend, Health and the State.
H. W. Hill, The New Public Health.



ANOTHER corollary of the American ideal of Equality is the demand that every citizen shall be a worker, whether with hand or brain; that neither the possession of wealth or position, or the possession of a roving and vagabond disposition, exempts any one from the duty of contributing his share to the productive work of the nation. In the Old World from which our founders came, there had always been a leisure class, that looked upon labor as menial, debasing, ignoble; a gentleman might be a warrior, showing prowess in killing, he might be an employer, exploiting others' labors, but he must not handle tools himself, or earn his living by the sweat of his brow. Because the life of gentlemen and ladies was a life of leisure and lazy trifling, the Heaven pictured by wistful souls of all classes came to be dreamed of as a place where all work should have an end; and labor was looked upon as the primal curse.

This, however, is not in accordance with the instincts of normal human nature, which finds one of its deepest satisfactions in work. And it is this more normal attitude which has received the stamp of American approval. The late President Harper of Chicago University said on his deathbed that he was looking forward to the world beyond not as a place of rest but a place where he would have more work to

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