structions were given to the anesthetist to watch for facial twitchings.

The wound was packed as usual with iodoform strip and at the end of 36 hours there was a marked facial paralysis of the right side. The packing was removed immediately, but the paralysis continued for three weeks and then disappeared entirely.

I might say that although the patient was found on the second morning with the index finger of the right hand deep in the mastoid wound, the patient was discharged on the nineteenth day.

Wasserman examination of the mother was negative. X-ray report was also negative.

There is probably one important thing in connection with this case and that is the role which the Eustachian tube plays in middle ear infections.

A search of medical literature on the subject of microtia with suppurative mastoid involvement has been made, but to no avail. Perhaps I shall have the pleasure of hearing from some one who has had the good fortune of having had a similar case.

FUTURE PUBLIC HEALTH INTER-
ESTS AND ACTIVITIES.
III-OBJECTIVES IN FUTURE PUB-
LIC HEALTH

JOHN SUNDWALL, Ph. D., M. D. Professor of Hygiene and Director of the Department of Hygiene and Public Health. University of Michigan, Ann Arbor, Mich.

In the previous articles, the following points were emphasized: Our past public health interests and activities were concerned chiefly with the control of the environment-sanitation. Our future public health efforts are going to be focused more and more on the person. Indeed, ninety per cent or more of future public health work will deal directly with people. For we have learned that man himself is the source of practically all of our common infectious diseases, that the infectious agents-germs-leave his body in his disrchagesand that these germs are "passed on" to the next person through close social contact. The prevention of disease then becomes a problem of "cleaning up" the sources of diseases an dof blocking the routes taken by them in their spread.

But the prevention of disease will be only a fraction of the future public health's concern.

What America needs today is strong, active and vigorous men and women. Preventing communicable diseases alone will not produce this want. The dismaying revealtions of the draft examinations wherein one-third of our young men failed to pass the tests for physical fitness and the deplorable findings of numerous physical examinations of groups in all ages of life, assuredly point

out the fact that we must concentrate our efforts more and more on building up sound, active, vigorous and harmoniously developed bodies. Not only is such a procedure essential to the happiness and success of the individual, but it is of serious economic, social and national concern.

Let us see what will happen forty years hence to one hundred physically sound young men at the age of twenty-five. Bear in mind that this group includes only those who can pass the tests for physical fitness. It does not include the third that failed to pass. At the age of sixty-five-forty years hence-sixty-four will be living. It is possible to prognosticate the economic conditions of these sixty-four living men as follows:

One will be rich.

Four will be well to do.

Five will be supporting themselves through their own efforts, salary or wages.

Fifty-four will be dependent, wholly or in part on relatives, friends or charity for life's sustenance.

These figures are furnished by Dryden after extensive analysis of morbidity and mortality reports. While perhaps the discouraging economic conditions of the vast majority of those who will be alive at the age of sixty-five cannot be laid entirely at the door of health, still health plays an enormous role in the economic affairs of our people.

At any rate this table shows the stupendous wastage of human lives during that span of life when communicable diseases play a minor role as a cause of life's devastation. Ignorance of the fundamental laws of right living and neglect of the

body and its functions are in the very largest measure responsible for life's failures.

"Seeing to it" that each individual making up our social units is given every opportunity, is encouraged and is even compelled to build up a sound body and maintain the highest physical efficiency possible, is a broad, comprehensive and difficult program indeed., In order to achieve this newer and widespread objective in future public health interests and activities, many parallel roads must be traveled. There is no single short cut route. Many highways lead to Hygea and all must be traveled.

Future public health must, therefore, be interested in eugenics, better maternity hygiene, furtherance of infant welfare, development of school hygiene, including physical education. It must be concerned with the conservation of the health of adults, for they are of most value to society. Already industry has learned that human conservation is even better business than machine conservation. To all of these age periods-infant, school and adult, the fundamentals of health promotion and disease prevention must be applied.

Indeed, one may define future public health as all those interests and activities concerned with the saving of human beings from death, illness and incapacity through the prevention of diseases and the preclusion, in so far as it is possible, of the various hazards of life; the building up and maintaining of sound, active, vigorous and harmoniously developed bodies whereby the individual may carry on his economic burdens and social duties with enjoyment to himself and entire satisfaction to the society in which he lives. That he may make the proper social adjustment, and serve society to the utmost of his capabilities, public health interests must include a mental hygiene program whereby people will be taught to think better, act better and live better than they do now.

"THE THREE ERAS"*

"In the development of the modern public health movement it will greatly aid our comprehension if we conceive it to have developed in three fairly definite eras or periods, always bearing in mind that by the use of these terms we simply indicate the shift of emphasis, not that all the problems of the earliest era in point of time were solved before the others began to grow in significance.

"I will call these three periods

"(1) The Era of Sanitation. Roughly, from 1850 to 1880.

"This era was principally concerned with environment. Its keyword was 'environment.' Its typical exponent in the public health ranks was the sanitary engineer.

"(2) The Era of Infectious Disease Work. It began roughly about 1870 and was in full sway largely overshadowing all other public health concepts for about thirty years.

"This era was principally concerned with bacteriology. Its keyword was the 'the germ.' Its typical exponent was the laboratory research

worker.

"(3) The third era is just beginning. It may be called the Era of Hygiene. It marks a return to first principles.

"This era is principally' concerned with the human machine, the person. Its keyword is 'education.' Its typical exponent is perhaps the public health nurse.

"It greatly helps us to comprehend the present status of public health development to realize that

both the earlier of these eras accomplished great things; that at the height of their vogue many of their most eminent exponents seem to have largely confused their special and limited possibilities with those of the entire field of public health; and that they have fixed certain definite misconceptions upon the public mind that very greatly hamper the development of an intelligent concept of the significance of the health problem as a whole by millions of public-spirited people.

"To the wonderfully beneficent results of modern water supply and sewage and waste disposal methods may partially be traced the persistence of the idea that filth in and of itself can create disease, especially communicable disease, with all the handicap this imposed upon the second era in getting a fair show to demonstrate what can be accomplished by the control of the germ."

From "The Modern Health Movement," by Eugene R. Kelley, M. D., State Commissioner of Public Health, Massachusetts. The Common Health, Nov.- Dec., 1921, page 260-261.

MEDICAL MISFITS

There are two classes of medical men who are not helpful and are hard to assimilate. They will not co-operate and are an absolute hindrance to progressive medicine. These are the medical broker and the medical croaker. The first is one who is out for gain at any cost, regardless of hardships and inconveniences to fellow-beings. He takes much but gives little. He cares nothing for public opinion in matters of equity and community welfare, or professional advancement; cares nothing for what you think of his methods. He is aggressive domineering, hypocritical, pretentious and strutty; a friend to your face, a traitor to your back. Meet him in consultation, he is the chief actor, working well up-stage. When you depart, he will remain or return and take advantage of your absence. Meet him alone and he is suspicious. Crowd him into a corner, you will behold a frightened, trembling, apologetic, cowardly crook. Better get him then, or he will try to get you later. He belongs to most of the medical societies, but never attends; does not permit his dues to become delinquent for reasons quite obvious. Avoid him. His selfish ambition has hardened his heart. You are better than he and he knows it.

The medical croaker-he neither hinders nor helps. He would not be missed, yet you wish him no harm. What the majority are for, he is against. You are in the wrong, he is always in the right; never succeeds well and admits it, but it is not his fault; takes no part in discussions at society meetings, but does a lot of barking and criticism in private; makes a great fuss and flurry about weak medical laws and wonders what is the matter with the profession, but does nothing himself but rant.

He is strong on the laymen, but weak on the medical brethren. Belongs to no medical societies the A. M. A. is a trust; prefers proprietary medical literature to standard medical journals; profane against quackery, but will sign a death certificate for a chiropractor.

Don't be a broker. Don't be a croaker. -Hollis, Journal Indiana State Medical Society.

necessary parts used in the manufacture of carriages.

The manufacture of automobiles was inaugurated in 1910 by the Buick Motor Company. The growth of this industry has steadily increased until at the present time Flint is the second largest automobile center in the world, being the home of the Buick, Chevrolet, Dort, and Paterson. In addition there are many accessory plants such as the nationally known Champion Ignition Company, Marvel Carbureter, Imperial Wheel, Flint Motor Axle, Flint Varnish and Color Works, and the W. F. Stewart Body Company, with a new diversification in the Perkins Structural Steel Co., and the Arnold Automatic Gauge Co. As a result of the phenomenal industrial development Flint has increased in population 138 per cent in the last ten years.

Two trunk railroad lines and electric interurban systems connect the city with other communities in the state. The right of way for an eight and one-half mile cut off on the Pere Marquette has been secured and work of construction began last June. This extension opens up for industrial development 1,000 acres on the east side of the city, insuring future industrial expansion.

During 1920, Flint made remarkable progress in comparison with other cities in meeting the building and housing situation. In the matter of one-family dwellings, Flint occupies fourth place with a total of 2,000 dwellings, being passed only by Los Angeles, New York City and Detroit.