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So much has been written on the prophylactic inoculation against typhoid fever in the last few years that it seems almost like an act of supererogation to -make a further report on this same subject. However, this work has been largely limited to military life, and as our inoculations have been given to inmates of institutions and to civilians, we feel that this is sufficient apology for adding to the literature upon the subject. Again, it is more with the hope of stimulating others to use antityphoid vaccine in private life than with the intention of proving the efficacy of this method of reducing the attack rate from typhoid fever, that we present our results. Indeed, no further proof of the .,efficiency of vaccination against enteric fever need be adduced than citing the brilliant results obtained at the encampment of the M-aneuver Division at San Antonio, -Texas. Nelson and Hall' state that of approximately 12,000 men at this camp only two became infected with typhoid fever. Of these one was a teamster who had -never been inoculated, the other a private of the hospital corps who had received two doses of the vaccine. These writers are of the opinion that with these cases ,of typhoid and with typhoid carriers present in the command, an epidemic of -enteric fever could not have been prevented had the troops not been immunized. We were led to take up this work by the report of Major Russell in the Johns Hopkins Hospital Bulletin for March, 1910, and by a knowledge of the -excessive attack rate from typhoid fever among physicians, nurses and attendants in hospitals. Thus Joslin and Overlander2 found that in the years 19021906 inclusive the morbidity rate for the nurses in six Boston hospitals was 161 -per 10,000, as compared with 20 per 10,000, which was the approximate attack Tate for the whole population of Massachusetts. These writers conclude that 4'the hospital nurse in Massachusetts is about eight times as liable to contract typhoid fever as the ordinary citizen." At the time this paper was presented our statistics from the local hospitals were very incomplete and showed at that time an attack rate of 1.4 per cent. or of 140 per 10,000 among nurses and -hospital attendants. Since then more nearly complete figures show the morrbidity rate for the five years preceding the inoculations to average about 500 per 10,000 among nurses. Since in the city at large the attack rate has -ranged from 24.5 to 42.2 per 10,000,* in these hospitals the nurses and attendants appear to be from about 12 to 20 times more likely to become infected than the citizens' of Baltimore.

In my paper read last year before this Section, I divided the Chemical Disinfectants which are most commonly used in sanitary practice, into six distinct classes, but owing to limited time, was not able to describe more specifically the chemical nature of each individual group. I feel that Health Officers, Laboratory men and others in charge of sanitary work, to whom the proper selection of a disinfectant is entrusted, should be as familiar with the chemical, phvsical, bacteriological and physiological properties of the available products, as the analytical chemist must be with the purity of his reagents, or the synthetical chemist with the nature of the chemicals he uses in his research. I will briefly recapitulate the six classes into which disinfectants should be divided, namely: i. Reducing agenits. 2. Oxydizing Agents. 3. Absorbents and Deodorants. 4. Toxic Agents and Precipitants. 5. Producing Chemical Compounds. 6. Coal-Tar Products. I will also give you what should be considered the Ten Commandments of a Disinfectant, namely: i. High Germicidal Power. 2. Stability in Presence of Organic Matter. 3. Homogenous Composition. 4. Ready Solubility in All Proportions. 5. Non-Poisonous to Man or Higher Animals. 6. Non-Corrosive to Skin or Metals. 7. Power of Penetration. 8. Economy in Cost. 9. Power to Deodorize. io. Power to Remove Dirt or Grease. If we submit the six classes of Disinfectants mentioned above to the scrutiny .of these Ten Commandments our clhoice must fall invariably on Coal-Tar Disinfectants. However, during the last year I had occasion to examine the Bulletins of nearly all our State Boards of Health, and they all, with few exceptions, religiously recommend, under approved disinfectants: Fire, Water, Chloride of Tron, Milk of Lime, Bi-Chloride of Mercury, Formaldehyde and Carbolic Acid. These bulletins further call attenition to the great danger in the use of some of these approved disinfectants, such as toxicity, corrosioin and irritation to those

There is no more interesting chapter in the history of sanitary science than that devoted to the development of our ideas regarding the cause and transmission of typhoid fever. Confused as the disease was until about the middle of the hast century with typhus fever, the differentiation of the two left the cause of typhoid fever still unknown. Real work in connection with its transmission thus began with the recognition of the disease as a clinical entity. It was early evident in the study of typhoid fever that filth, particularly filth from human bodies had a large share in the causation of outbreaks. It was likewise recognized that water and milk polluted with human filth sometimes caused widespread epidemics of the disease. These facts seem to have been accepted by most of the early students of typhoid, but most of the sanitarians of the middle of the last century denied the contagiousness of the disease. Murchison formulated a theory of the causation of typhoid to fit these beliefs. He taught that the disease was pythogenic, or bred in filth, that the virus was spontaneously generated in decomposing organic matter and was given off in an effluvium of malaria. He later modified this theory by ackowledging the contagious element in the disease, but still contended that the contagion from a case had to develop or breed in filth before infecting others. Murchison's ideas were generally accepted by the sanitary world and prevailed until the year 1873 when Budd* published his wonderful series of observations on the spread of the disease and his conclusions from them. Budd's work, begun long before the days of the germ theory or even Listerism, was continued with the publication of occasional papers on the subject, from 1850 to the time of the publication of his complete monograph in 1873. In many respects this monograph on typhoid fever is the most remarkable document ever produced on the subject. Working as a practitioner in the rural districts of England, with only his own personal observations and reason to guide him, he produced a work which lacks but little of telling the whole story of the transmission of typhoid fever even today. Budd's conclusions, which he supports by full and complete epidemiological evidence, are as follows: 1. That typhoid fever is, in its essence, a contagious, or self-propagating

Since public opinion has been sufficiently aroused to demand the distributors in many cities to furnish milk under a certain bacterial count, it is becoming more and more necessary for even the small dairyman to supply himself with the apparatus necessary to assist him in securing these prescribed standards. One of the problems which confronts both the producer and likewise the distributor of milk is the sterilization of utensils used in collecting and distributing the product. Undoubtedly the ideal method of rendering these utensils free from bacteria is by steam sterilization. This method, however, necessitates the installation of expensive apparatus and the cost of operating a steam sterilizing plant even for the requirements of a small dairy farm is correspondingly great. In other words, the small producer can scarcely afford such apparatus, and as a result the utensils add to the bacterial count of the milk from day to day. In the investigation of small dairy plants the application of hypochlorite to the sterilization of milk apparatus suggested itself to the writers as a method of sterilization simple in its application with a possible field of merit. The investigations of this paper have been confined to a determination of the relative efficiency of various solutions of calcium hypochlorite in the sterlization of milk bottles. A number of dairies were visited and the work was done on the spot with the apparatus actually in use by the dairymen at that time. In this way it was possible to determine the relative efficiency of this chemical under a variety of conditions. The exact procedure of the work was carried out as follows: The dairy selected for investigation was visited with sufficient apparatus to do immediate plating for the bacterial count before and after treatment. The milk bottles used in the experiments were selected from those already cleaned and ready for refilling with milk for distribution. A solution of calcuim hypochlorite of known strength was carried so that a definite amount could be added to the local water used in the process of treatment. The treatment was done in a tub or tank of sufficient size to permit the submerging of the bottles used. The technique of obtaining the count on bottles before and after treatment consisted in rinsing the inside of the bottle as thoroughly as possible with a definite amount of sterile, distilled

The purpose of my paper is to make known to those who are honoring us with their presence; and those who may not be acquainted with the systems employed by our Sanitary Department, the manner in which our Yellow Fever Service works in the inspection of non-immune febrile patients, and the studies which we have been making in connection with the house-tohouse inspection of passengers arriving from Mediterranean ports, where cholera has made its appearar,ce. The Department of Health and Charities, to which I have the honor to belong, is proud to be able to say that it exercises a real control over yellow fever, but with regard to cholera, fortunately our services have not as yet been put to a test. I can assure you, however, that the lives of all here are perfectly safeguarded, and that when you depart satisfied of having faithfully complied with the sacred duty that brought you here, you will enjoy perfect health. No one could have dared to make this prediction ten years ago! And that satisfaction which we feel, necessarily must be felt among you, because it is also your work. Side by side with the name of our immortal Finlay we shall engrave with characters of gold the names of others, whom I shall not mention, fearful as I am of hurting their modesty; who are among my hearers and because their names are too well fixed in the minds of all; men to whose genius Cuba owes so much. Not only my beloved country, for it is Humanity that has been their beneficiary.

Chemical analysis has long played an important part in the determination of the degree of pollution of natural waters, and in the measurement of the results of sewage purification. The methods employed for this purpose have been inherited from the older methods of water analysis almost without change. The latter were designed primarily to determine the purity of drinking waters but they have been adhered to in sewage work despite the fact that sanitarians have long since abandoned the idea of maintaining streams at a drinking water standard and in disregard of the present day aspects of sewage disposal. Sewage purification is essentially oxidation of organic matter. In the wellnigh perfect work of the slow sand filter the oxidation was so complete that it was conveniently measured in terms of nitrification. This is not a true quantitative measure of the whole work of the filter, but appears to be an end-point reaction indicating the completion of the process. With the introduction of rapid methods of purification designed for partial oxidation only, the test of nitrification and the whole scheme of chemical analysis fail utterly to meet the requirements of the situation. Hence the recent development and general use of putrescibility determinations. From a stream pollution aspect the older analytical procedure not only fails to define the quality of an effluent, but is actually misleading. Lederer' has shown that the removal by sedimentation of 63 per cent. of suspended solids results in an improvetnent iIl stability of only 31 per cent. In dealing with oxidation processes and employing as criteria of improvement the decrease of albuminoid ammonia and of oxygen consumed, the opposite effect is noted. A complete removal of the putrescibility of the sewage may be accompanied by an improvement in these analytical values of not over 50 per cent. In stream pollution studies the condition is, if possible, a more serious one. Here there is no " per cent. removal " with which to cover the uncertainty of the result. We are given a definite statement that the stream in question contains so many parts per million of free and albuminoid ammonia or of organic nitrogen or oxygen consumed. We are expected from his information to draw a conclusion as to the present condition of the stream in question and the possible effect upon it of the discharge of additional sewage either untreated or partially purified. If these analvtical determinations do not enable one to distingulish betweein organic matter in

At the meeting of the American Public Health Association held in Richmond in 1909, the subject of my paper was "Utilization in Connection with Incineration." In the course of the paper it was predicted that we would be doing street lighting and furnishing electric power for general purposes. Minneapolis has since developed the plan as outlined at that time and something of the process of evolution may be of interest. Beginning in 1908 the incinerator furnished sufficient power to generate electricity for the lighting of Hopewell Hospital and the workhouse buildings. Later in the same year the heating of the same buildings was taken over. This service has continued up to the present time. In May, 1912, we began the systematic lighting of public streets. At first this light was extended to include twenty-two miles of the city's streets. This has been gradually extended until now the street lighting includes thirty-one miles of streets. At the time the crematory began to do street lighting, the city was paying to the Minneapolis General Electric company $70 per arc light per year. The crematory furnished the service from the start fqr $60. As a result of this competition, the rates of the General Electric were cut first to $65 and since to $62.50. t

In connection with the examination of a series of samples of ice cream by the Health Department Laboratory of Chicago, in the course of which the presence of foreign fats was demonstrated in a few instances, the contention was raised by scientific counsel representing one of the ice cream manufacturers that reprocessed butter often yields a low Reichert Meissl number and saponification value; that, judging from the data furnished by these tests, it is often impossible to distinguish renovated butter from mixtures of butter and foreign fat. As a basis for this contention it was stated that the alleged lowering of the findings of these two tests was due to a loss of volatile acids occurring during the process of renovation, as a result of the heating and washing. The assertion was confidently made that the aforementioned loss of volatile fatty acids may represent as much as one third of the volatile fatty acid content, as determined by the Reichert Meissl method. It was the opinion of the city's experts that the loss of volatile acids occasioned by the process of renovation would be slight, and would not in any case be sufficient to invalidate the test as a means of distinguishing genuine butter from other fats. The firm in question admitted that renovated butter had been purchased for the preparation of homogenized cream, used in the manufacture of ice cream, but disclaimed any knowledge of the use of oleomargarin or other foreign fats for this purpose. The purchase of supplies, however, had not been controlled by laboratory tests. As very little definite data could be found upon the point in question, however, it was decided to undertake the series of tests here reported. The procedure adopted was as follows: Samples of butter purchased in the open market were subjected to tests for the determination of the Reichert Meissl number and saponification value. They were then placed in an incubator, at 37°C., for from three to five weeks, until an extreme degree of rancidity developed. The samples were then reprocessed by blowing steam through them for two

Sulphate of alumina as a coagulant and decolorizer is in use on many waters in the United States, and is recognized as one of the most effectual means of reducing an objectionable color in the water prior to filtration. The river water as applied to the West Parish filters of the Springfield water supply is naturally a water of few objectionable features. No large population is resident upon the water-shed and the sanitary conditions are excellent so that there is not a large danger of serious contamination of the supply at any time. By filtration a water free from practically all objections is produced, except that at times, the remaining color is noticeable, and the present systeni of coagulation is the result of a study of the means of correcting this one objection to the water. This water was first used as a supply in December, 1909, and sulphate of alumina was used for the reduction of color in the manner in which it is usually applied. The accompanying cut showing the use of coagulant during 1910 illustrates the amount of sulphate of alumina which was necessary for this reduction. Its application during this year was in accordance with the usual practice, that is, in amounts sufficient to secure a clear-cut reaction and the coagulant was applied continuously. The present method is illustrated by the chart showing the amounts and the color of the raw and filtered water during 1912 and 1913. As at present practised, excellent color reduction is secured by the use of 0.2 grain of sulphate of alumina per gallon of water during a larger portion of the time.

Not for many years in the history of the American Continent-or indeed of Europe-has the subject of this paper seemed to be more appropriate for discussion than at the present time. Dr. Max Nordau in his work on "Degeneration" written twenty years ago, in comparing conditions existing about 1840 and at the time when he wrote, says, " It is about that date when that generation was born which has witnessed the irruption of new discoveries in every relation of life and thus personally experienced those transformations which are the consequences." Since that time another generation has grown to manhood in the United States and in Canada and urban populations have continued ever to increase as illustrated in the following table

IN CONSIDERING the effect of occupations upon the health, it is necessary to study the average physical status of workers in the occupations under consideration. The Public Health Service is now engaged in making studies of this character, an investigation having already been completed by the Service during the past summer under the writer's direction, as to the physical condition of workers engaged in one of the typical industries, that of garment-making. This investigation was undertaken at the solicitation of the Joint Board of Sanitary Control of the cloak and suit, dress and shirt-waist trades of New York. The object of the investigation was to examine into the condition of the health of male and female workers in this occupation, as well as into lighting and ventilating conditions in shops of the trade, with a view to making any necessary recommendations for the sanitary improvement of the industry. During the course of the investigation, over 2,000 male and 1,000 female garment-workers were physically examined. It has not been practicable, for lack of time, to tabulate as yet the results of the physical examinations of female garment-workers. These results, however, in regard to the males, have been tabulated. I have been requested by the Secretary of the Section on Vital Statistics to present a paper on some of the results of the

In this paper Mr. Routsong outlines a comprehensive program for workshop education and hygiene. Mr. Routsong's experience in this matter makes his statement extremely valuable to industrial hygiene workers.

Professor Winslow has collected in this paper some very interesting comparative statistics with regard to state health laboratories. The progress of public health laboratories in the United States has indeed been remarkable in the last few years. While we may congratulate ourselves on our advance, it is obvious that in many instances much may yet be done to make laboratory of greater value to the citizens of the state.

Doctor Chesley has worked out with great care and detail a system which works very well in Minnesota. His paper explains that system and tells exactly how it was applied in one epidemic.

The title of this paper well describes the scope of an important contribution to our rapidly advancing knowledge of sewage disposal.

Doctor Mann's paper not only presents the specific problem indicated in the title, but also deals with some problems which are sure to command an increasing amount of attention on the part of health administrators, particularly the relationship between wages and health.

Doctor Farnum points out the value of coöperation between medical and safety departments with an object of fitting the man to the job for which he is physically fit, a means of reducing accidents. This paper tells what one company has done.

In this rather brief paper, Doctor Rankin outlines the problem which was the subject of an interesting and important session of the meetings at Rochester.

We can scarcely understand why certain sections of the lay mind still look with horror upon inoculation, in spite of the many proofs of its efficacy. This excellent paper, in which is discussed the attack-rate among inoculated persons, adds to the proof, if proof be needed, a convincing argument.

The authors in this paper discuss the methods employed and the results obtained in the bacteriological analysis of the water about St. Louis, with the view ultimately establishing definite modes of procedure for such analysis.

In this paper a man not professionally engaged in public health work but familiar with the difficulties of rendering vital statistics useful in that work and technically trained to cope with such difficulties, discusses some of the important features of “The Book-keeping of Public Health.”

Doctor Caverly is in charge of the public health in a state of small cities, but nevertheless a state in which public health work is conducted along very advanced lines. In this paper he reviews the present situation and points out some of the advantages of the isolation hospital and suggests how rural communities can best proceed to secure one.

As announced in the papers and elsewhere, the Framingham Community Health and Tuberculosis Demonstration is being conducted under the supervision of a committee organized by the National Association for the Study and Prevention of Tuberculosis. On this committee 1 are represented the National Tuberculosis Association, the Massachusetts State Department of Health, the United States Public Health Service, private antituberculosis organizations in Massachusetts, Connecticut, New York and Pennsylvania, and the Metropolitan Life Insurance Company, the donors of the $100,000 to be devoted to the work. The selection of Framingham was made after several months' study of numerous communities of similar size in various parts of the United States, but particularly in Massachusetts and New York State. Framingham recommended itself to the committee because it possessed certain average qualities, being an industrial community, with mixed industries, varied racial groups, a good local health organization, backed up by an excellent state department of

Doctor Perkins tells how one feature of health department routine is carried out in one of our large cities. This is a well written paper which will prove of particular interest to laboratory workers and communicable disease men.

C ERTAIN communities in our population make a practice of drinking milk permitted to undergo souring spontaneously. The question arose whether it is necessary to subject the raw milk used for souring purposes to preliminary pasteurization in order to insure the destruction of the typhoid-paratyphoid group of bacilli, or whether any of those bacteria which might be-present would not be destroyed by the acids developed in the souring process. In order to answer this question a series of tests was arranged, the results of which are given in the tabulations of this paper. The subject of investigation is not wholly a new one, although the practical point of departure of this study may be peculiar. A brief survey of the earlier literature on the subject includes the following: Cautley (1) found that typhoid bacilli which had been added in large amount to milk could be demonstrated in the living state for several days, and that the viability of these organisms depended on the number and character of the contaminating bacteria. In sterilized milk the typhoid bacilli were found to survive as long as four months, according to Bolley and Field (2). Fraenkel and Kister (3) added an enormous dose (2, and loops) to 10 cc. of buttermilk. At room temperature the typhoid bacilli remained alive for three days, while at incubator temperature they died out after twentyfour hours. Bruck (4) endeavored to approximate natural conditions and recovered the bacilli from sour cream for ten days after its separation from artificially infected milk. He also isolated them from buttermilk for the same period of time and from butter, prepared from infected cream, for twentyseven days. Bassenge (5) states that the typhoid bacilli are killed when the acid production reaches 0.3 per cent to 0.4 per cent and is maintained there for twentyfour hours. This opinion is not shared, however, by many other workers. Krumwiede and Noble (6) say that "the typhoid bacillus is gradually killed in sour cream by the acids produced, the rate of destruction being proportional to the degree of acidity and the number of typhoid, bacilli present." They find that typhoid bacilli are killed in about four days in a moderately contaminated cream, but that they will live longer if initial multiplication has occurred. Lactic acid in varying amounts was added to milk containing typhoid bacilli by Trillat and Fouassier (7), and its inhibitive effect demonstrated. They also made a comparative study of the rate of multiplication of typhoid bacilli in broth and milk. In milk multiplication began at once, but in broth no development was noticed for twenty-four hours.

Dr. Bishop here takes up the discussion of one of the greatest problems of the day. This is one of two sterling papers presented at Chicago, for the publication of which the Journal has had a good many requests. It is the intention to follow this by Dr. Bishop's second address to make the story the more complete.

Prohibition has boomed soft drinks so that more than ever there is need of rigid inspection. Dr. Stokes finds beverages with five-figure counts and empty “sterile” bottles always with some bacteria, sometimes with millions. This paper should attract the attention of health officers to their soft drink problems.

Beet sugar is an industry yearly attaining greater and greater importance. Likewise the disposal of the wastes is a problem of increasing consequence in various sections of the country. This paper and the discussions constitute an unusual assembling of the facts, valuable to local authorities and those commercially interested, alike.

This communication proves to be a good argument in favor of the outside paper cap that covers the whole top of the bottle and is held on by a ring, although no mention is made of it. Possibilities for contamination of milk bottle lips under current methods of handling are set forth quantitatively as a help to the education of the public.

In view of the controversies over the closing of theatres and halls during the influenza epidemic this paper is illuminating. Such places seem, even under good conditions, to be clearing houses for oral organisms. Contamination of the atmosphere in them apparently relates itself to local epidemics. Here is food for thought for health officers.

Health officers have known something of the early plague situation in California, but never before has the story been related in such stirring fashion as in this paper. It is an experience that, fortunately, seldom goes to such lengths. The necessity for strenuous extermination activities now against plague carriers is patent.

Much that has been written about botulism is not true and truths have been so distorted as to convey false impressions. This paper presents truths plainly and without bias. Two things are important—canned foods that show any signs of spoilage must be destroyed, so that neither animals nor man can eat them, and boiling “ready to serve” canned foods will always make them safe.

More and more it becomes evident that carelessly washed dishes and utensils in eating places and at soda fountains are potential disseminators of infections. Principles like this, however, need to be confirmed by observation. This paper furnishes practical facts that point to the health value of machine dish washing.

The anaërobic spore test for manurial pollution of milk has certain definite advantages. Total bacterial count is at best an indefinite warning, visible dirt gives no clue to manure in solution, while B. coli depends on temperature and may give false indications. The anaërobic spore test is simple and meets requirements.

All parts of modern swimming pools must be maintained in sanitary fashion or they may be public health risks. This paper outlines some of the problems and tells how a pool in Florida has tried to solve them. Here are scientific observations of pool conditions not often secured and more rarely at the service of officials.

Swabs and cultures prove to be of equal value for diphtheria diagnosis while swabs may give evidence of other infections. This paper tells of an experiment in routine work lasting a year. It shows swabs to be less costly, never dry through storage, and better for surveys. The paper emphasizes the need of rural branch laboratories.

Rats are a civic reproach and a sanitary menace of the first magnitude, not merely an unavoidable economic burden. Health officers everywhere must be active because civilization demands the coöperation of all forces in the removal of the rat menace to health and well-being. This paper outlines well-digested plans for efficient warfare on the rat.

Failure to locate papers in an office is a symptom of careless thinking, states this writer. If, as a health officer, you have not established efficient office methods and trained the personnel to see that these methods “carry on,” perhaps such failure is due to the kind of thinking you have been doing.

ONE of the many perplexing problems in state health administration has been the proper co6rdination of the work performed by public-health nurses. Their field of service is so new, so constantly enlarging in its scope, and so rapidly undergoing changes in emphasis, that any discussion of the problem, to say nothing of a solution, has been well-nigh fruitless. Are we beginning to see a solution of the problem? It is perhaps significant that the subject recently received attention simultaneously in two journals of national authority within the same month. Dr. Allen W. Freeman, lecturer on public-health administration at Johns Hopkins University, and formerly commissioner of health of Ohio, set forth the "Organization of Public Health Nursing in the State Board of Health" in the March, 1922 issue of The Public Health Nurse. Miss Rose M. Ehrenfeld, R. N., director of the bureau of public-health nursing and infant hygiene in the State Board of Health of North Carolina, had a paper on "The Relation of Public Health Nursing to other Phases of Work of the State Board of Health with Special Reference to That of the Division of Child Hygiene" in the March, 1922 issue of the AMERICAN JOURNAL OF PUBLIC HEALTH. Thus, we have the problem discussed by two public-health workers possessing intimate first-hand knowledge of the subject. The one approaches the problem from the medical (for want of a better term) point of view; the other from the nursing (again for want of a better term) point of view. Recognizing the administrative problem involved, each endeavors to reach a solution from a different standpoint. Both agree upon the orgapization of the public-healthnursing service as an independent bureau or division in the state department of health. Both insist upon the necessity of having a well-trained, experienced public-health nurse in charge of such bureau or division, reporting directly to the chief executive officer of the state department of health. Their agreement does not seem to be so clear about the detail content of the work to be performed by the publichealth nurse. This lack of agreement appears to center around the difficulties in harmonizing the program of publichealth nursing and child hygiene. In this connection, an earlier attempt to lharmonize the functions of a state department of health was made by Miss Jessie L. Marriner* in a very suggestive analysis of the work of the various bureaus established by a state department of health. Here the approach to the problem is upon the basis of function. Other attempts have been made to analyze the problem on the basis of organizing the type of workers. If the organization of a division of public-health nursing is to be justified upon the basis of function or type of worker, we believe it would be difficult to sustain the justification in the face of severe competition. However, the establishment of a division of public-health nursing can be easily justified on the basis of method of work. We believe the phenomenal growth in public-health nursing is to be attributed not to the functions performed nor the particular type of worker, but to the method of work employed in the functions performed by the particular type of worker.