The great world war with its many lessons is gradually reconstructing our ideas of life to such an extent that every phase of existence is subject to enormous changes. Amidst the shifting opinions of the relative value of things, one great paradox is being developed. While men are being sacrificed on the battlefields, as if the supply were inexhaustable, one of the first lessons which is being impressed upon those who remain behind is the relative value of human life. Before the actual emergency occurred, there was probably a majority of people in this country who thought that an army of physically fit young men could be raised with very little trouble, but when the draft came and we found that only 50 per cent, were accepted as fit for the army, we then began to realize that something must be radically wrong with the young manhood of our country. Then, as the men were subjected to one special examination after another and such a comparatively small number showed the perfection which we had fondly imagined all our young men would attain, we have become impressed with the humiliating fact that many of the present generation have been allowed to "just grow up" with little thought of the perfect manhood which is only gained by attention, first of all, to the physical health of the child.

The lesson, then, of all this is the great importance of public health and public health service. In this emergency, public health must be considered in its broadest sense, comprising not only the prevention of communicable diseases, but rather looking toward the training and development of the rising generation so that our young manhood may regain that which it has evidently lost, and our race be regenerated. By the same process of reasoning, public health service cannot be restricted to boards of health, but must become a part of the every day life of every person, particularly those who come in contact with children. It is the plain duty of those who compose the membership of charitable and religious associations to acquaint themselves with the conditions which have been shown to exist and to so conduct themselves that by example, as well as by precept, they may help to bring about a better state of affairs.

Of all the conditions which reduce the efficiency of men, there are none of greater menace than the twin vices, alcoholism and immorality. Public opinion has now reached a stage where the liquor traffic will probably be dealt with according to its just deserts, but the people in general are not yet sufficiently well informed as to the results of immorality, and the prevalence of venereal diseases. Medical men have known for many years that venereal diseases were at the foundation of much of the suffering and inefficiency of humanity, but up to the present, there has been no way of obtaining accurate statistics as to the actual prevalence of these diseases, syphilis and gonorrhea. The gathering of the National Army has been the means of obtaining such statistics and has also furnished a cross sectional view of the conditions existing among the young men of the draft age in civil life. Some idea of the extent of these diseases may be gained by the following statement from the Council of National Defense:

"During the twelve weeks ending December 7, 1917, there were reported from 31 cantonments, 21,742 new cases of venereal diseases. The incapacitation of these men involves not only loss of time; in addition it has cost the Government to keep them during the period of hospital confinement (which varies from one to eight weeks) more money than is required to maintain the entire command at Camp Dix (the cantonment in New Jersey with 20,859 men) plus an additional sum for medical treatment."

The Surgeon‐General believes that venereal diseases in the army are due to conditions existing in civil life, infection being received at home towns of the men, or the towns through which they pass on the way to camp. In some cantonments, nearly 40 per cent of the National Army men were found to be affected with syphilis or gonorrhea during the first two weeks of mobilization. Inasmuch as these men were drawn from all conditions and classes, no other inference is possible than that venereal disease has permeated society from top to bottom. The truth of such a statement would not be denied by any physician of large experience.

Vermont conditions, at least numerically, are not as bad as the Surgeon‐General's report would indicate for the country at large, but even under the most conservative estimates, the problem is an exceedingly large one. Last year (1917), there were reported to the State Board of Health 491 cases of gonorrhea and 191 cases of syphilis. Taken together, these figures would show a prevalence of venereal diseases of about two cases per thousand population, but these are only the acute cases, newly under treatment, and it is generally estimated that these represent approximately 10 per cent of the total. On this basis, which is undoubtedly conservative, we have in this State 20 cases of venereal disease per 1,000 population, or something over 7,000 infective cases. What this really means will be better understood when it is compared with the problem of tuberculosis. On the basis of 300 deaths per year from tuberculosis, there are in Vermont 2,500 to 3,000 cases of that disease. In other words, cases of venereal disease are two or three times as numerous as cases of tuberculosis. Tuberculosis has heretofore been considered our big problem. Here is one of the places where our ideas must be reconstructed.

We cannot find in the vital statistics any considerable number of deaths attributed to venereal diseases, but their effects are often worse than death. About 90 per cent, of all cases of locomotor ataxia are due to syphilis and a large proportion of the cases of general paresis and spinal trouble. Syphilis is responsible for 42 per cent of abortions and miscarriages, and statistics show that from 60 to 80 per cent, of the offspring of syphilitics die before or shortly after birth and those who survive are subjects of degenerative and organic defects which are transmitted to future generations. This disease swells the number of inmates of almshouses, asylums for the insane and homes for incurables.

Gonorrhea, aside from its effect on the man who contracts it, is probably responsible for fully 80 per cent, of all surgical operations for inflammatory diseases peculiar to women. This disease tends to produce sterility in both the male and the female and it is said that 45 per cent, of the involuntary childless marriages are due to this cause. Even with our present means of preventing ophthalmia neonatorum, it is probable that from 10 to 20 per cent, of all blindness is due to gonorrheal infection.

The nature of these diseases makes it impossible to attack them as we do tuberculosis or infantile paralysis, but this only makes the solution of the problem more urgent. First of all, doctors must be made to do their duty, not only in reporting cases, but in giving instruction to persons under their care. The churches and clergymen must aid in this fight. They must be made to see that this is a cancer at the very vitals of civilization, and that many a man can be saved through his moral beliefs. Pastors of churches are often loath to allow this subject to be brought to their men. They must learn to what extent the secret sin and its consequences has already invaded their congregations. The press is already being used to a larger extent than ever in connection with this subject, and all these agencies are gradually molding public opinion so as to make it possible to speak of its curse openly and not in whispers, as formerly. It is the duty of every right‐minded citizen, man or woman, to believe in and practice the single standard of morality, to refrain from suggestive conversation, to learn the symptoms and dangers of these diseases and the methods of their transmission, and to instruct the youth under their charge when the proper opportunity occurs.

The first selective draft called for a quota of 1,049 men from Vermont. In order to supply this number, it was necessary to examine 5,658 men and of these 2,862 or over 50 per cent were rejected as physically deficient. The largest number of rejections were on account of defective teeth, being 482 or 16.8 per cent. Defects of the feet were next, numbering 442 or 15.4 per cent, while 420 or 14.6 per cent, were found to be deficient in height, weight or development. Defects of the circulation, mostly trouble with the heart or veins, were found in 358 cases, or 12 per cent; eye defects in 322 cases, or 11.2 per cent, and hernia in 285 cases or 10 per cent. Other causes for rejection were trouble with the nervous system, 4 per cent; chest difficulties, 3.4 per cent; rectal, 1.9 per cent; nose and throat, 1.5 per cent; deafness, 1.9 per cent.

It will thus be seen that over 90 per cent of the rejections were due to causes which could have been prevented by proper care and treatment. This is certainly a sad commentary on the American way of bringing up children. Never before have we had the opportunity to see ourselves as we are and to realize how we are actually wasting human lives and fostering a generation of defectives who could be brought up to the full standard of man‐hood by the proper methods of instruction and treatment. The lesson is so obvious that it should not be allowed to go unheeded. In fact, we have already begun in a small way to rectify some of the most glaring defects.

In the matter of venereal diseases, we have speeded up the campaign which, in a smaller way, has been waged in this State since 1913. Stress is being laid upon the educational side of the problem and the cooperation of civil authorities is being enlisted to a greater extent than ever before. The great amount of publicity now being given to these diseases is a most encouraging sign.

Through private beneficence, a rural dental clinic has been established in Vermont, this being the first of its kind in the country. Under the combined auspices of the Department of Education, State Board of Health and State Dental Society, a thoroughly equipped dentist has been secured and provided with a portable outfit which can be quickly set up in the school room or in some convenient place in or near the building. The present plan is to operate only in districts far removed from the large centers, so that no regular practicing dentist will be interfered with. Only children between the ages of six and twelve are treated, these ages being considered the crucial ones in the care of the teeth. The actual operative work is supplemented by lectures and school room instruction, with the institution of toothbrush drills, each child being provided with a toothbrush and a tube of toothpowder.

This work has been in progress only two months, but something of its importance may be understood from the report of the dentist, Dr. E. E. Johnson. Up to January 1, he had treated 80 patients in seven schools, giving prophylactic treatment to all. He had done 577 fillings, an average of over seven for each patient, and 142 extractions. The cooperation of the teachers and parents in this work has been practically perfect, only one parent refusing treatment for his child. The attitude of the children has been a source of surprise even to the most sanguine promoters of this work. No trouble has been experienced in any way and the children have entered into the scheme with an enthusiasm which is a joy to behold. This experience is sufficient to demonstrate the practicability of corrective work applied directly to the school children during school hours. Here and there in the State, a few public spirited dentists are giving free treatments to school children in their offices, and it seems altogether likely that there will be a great awakening among the general public in regard to the value of sound teeth and the dangers from neglected mouths. The signs of the times are certainly encouraging in this regard.

I doubt if any one outside of the actual work realizes what. is being done in Vermont to remedy the disastrous results of infantile paralysis. This disease has proven to be one of the greatest problems with which we have to deal. Since 1910, when this disease became reportable, there have been 726 known cases in the State of whom 126 died. Thus we have at least 600 potential cripples with defects ranging all the way from weakness of a single muscle of the hand or eye to almost complete paralysis of the entire body with most distressing deformities. Moreover, as time goes on, we are continually finding new cases who have developed some paralysis after a sickness which was not recognized at the time as poliomyelitis.

Our problem is, first of all, to prevent the spread of the infection and, second, to care for the patients after their recovery from the acute attack and try to make them as nearly perfect as the degree of paralysis will permit. Here, again, we are aided by private benefaction and the extensive work which has made Vermont a living example to every other State in the country has been done without expense to the State.

In pursuance of the first object, a research laboratory was established in Burlington at the time of the 1914 epidemic and work on poliomyelitis has been conducted since then in connection with the Rockefeller Institute of New York. Some of the most important discoveries in connection with this disease have been made in our laboratory. Expert diagnosticians are at the call of any physician in the State at short notice and thus consultation which would be a heavy expense to the family of the patient is to be had free. Along with the diagnostic service, we have been able to furnish immune, human serum in cases where its administration proved to be applicable. This serum had been secured by our own expert and prepared for use in our own laboratory. The results of this work in the saving of lives and prevention of paralysis cannot, of course, be computed in figures, but we firmly believe that in connection with the rigid quarantine, great good has been accomplished.

The working out of the second part of the problem, the aftercare of patients, has developed into what is known as the "Vermont Plan," now being followed in New York City, New York State, Massachusetts, Virginia and Minnesota. This consists in the employment of specially trained women, who regularly visit the patients in their own homes or see them at hospitals or clinics, for advice, instruction and aid in performing the exercises which are designed to strengthen the weak muscles or train certain muscles to do the work of others which are paralyzed. This whole system is called "muscle training."

This service has been constantly under the direction of Dr. R. W. Lovett of Boston who, with his assistants, has held four series of clinics for the purpose of prescribing treatment for the new cases, and giving advice to the ones already under the care of the muscle trainers. From one to three women have been continuously on duty in this capacity since 1914 and, at the present time, one is giving intensive treatment to the cases in Montpelier, Barre and Waitsfield, while another travels constantly about the State, supervising the treatment of other cases.

Still another feature of this work is the furnishing of braces and other apparatus to crippled children and providing hospital care and surgical treatment to indigent cases. By these means, many children who would have been handicapped for life have been brought up to good physical condition and started on the road to useful citizenship.

The tuberculosis problem is now being efficiently handled and, with proper support, the outcome of the work now in progress should go a long way toward improving the health conditions of our people by the elimination or, at least, the reduction of the Great White Plague.

But what shall we say in regard to work along other lines indicated by the draft figures? Our law provides for an examination of the eyes and ears of school children by the teachers once in two years. As the system stands at present, the teachers dislike to do the work and the children take little interest in having it done and, altogether, it has become a more or less perfunctory procedure. But, strange as it may seem, this meager attention has accomplished surprisingly good results, for at least the glaring defects have been recognized and, in many cases, followed by treatment. The last available statistics on this subject show that about 30 per cent, of the children examined were found to be deficient in either sight or hearing.

There are a few district nursing associations in the State whose workers are securing medical and surgical service for the children under their care, and some private agencies are doing good work along these same lines. In addition to these efforts the usual propaganda of the State and local boards of health in the matter of prevention of communicable diseases and education of the public is being regularly carried forward. In total, all this constitutes a comparatively large amount of work, and we are able to say without fear of dispute that Vermont is a leader among the states in public health service, although we cannot show the number of organized agencies which are considered necessary in some commonwealths. On the other hand, compared with the need as it is shown to exist, our efforts are indeed small.

To my mind, there is one line of work provided for by the laws of the State, which should be developed to a much larger extent than has heretofore been done. This is the medical inspection of school children. The 1916 report of the Commissioner of Education shows that 17 towns had availed themselves of this service according to the statute, although something had been done in 27 towns, for which varying amounts had been paid, ranging from 75 cents to $821.05. The total amount spent for medical inspection of schools in the State in 1916 was $3,348.87, an average of $13.60 for all towns in the State. In some of the towns where this is in vogue, the inspection and follow‐up work are being done conscientiously and with good results. In others, it is a mere perfunctory thing which apparently interests no one, and is, therefore, without effect except to bring the system into ill repute.

There is certainly a great opportunity for good in this work among school children. Here is the fountain‐head. Here defects may be discovered and the remedy applied in time to save the child from a life of misfortune and dependence. Here the educational benefits may be applied with their fullest results. Here the future generation may be reached and started in a way of living which will save the nation from a repetition of the embarrassing situation which the present draft has shown to exist. It is a work for those who are interested in the upbuilding of the race, and is, I believe, the only logical starting point.

There is, however, one more point of attack which might well be developed, and that is the education of the girls and young women who are to be the future mothers. Not enough is done along the line which might be called prenatal education, and too many young people who become parents are in dense ignorance of even the elementary principles of the duties and privileges of their station. Child welfare leagues and similar organizations should be fostered for the accomplishment of this object.

At least a part of the lesson of the draft army is squarely up to the medical profession and it is encouraging to note that the subject is being considered in medical societies throughout the country. The greater lesson is for the public generally and it should be the duty and desire of every citizen to study the figures which have been published, by the Provost Marshal‐General and the Surgeon‐General and try to find out what part he should take in public or private life to make conditions better. Patriotic duty does not consist entirely in wearing the uniform of the army or navy. Every man, woman and child should be, in some degree, a public health worker, at least to the extent to seeing to It that the home city or town embraces the opportunities which are open to all. This must be an individual service in which the ones who know the conditions must be the first to lend their aid toward the accomplishment of better things. The great need has been shown and every good citizen must respond to the stimulus which this call to duty affords.