66 the character. Doctor Elwood Worcester says of the nervous affections to which such morbid thoughts usually lead: The curse of neurasthenia and allied nervous weaknesses is their egotistic and anti-social character. The neurasthenic is afraid of his own shadow, worries himself to death over trifles, magnifies real troubles out of all proportion to their intrinsic significance, is self-centred, looks at everything from the point of view of its bearing upon his petty fortunes." In all these troubles there is a gradual degeneration of self-control which affects the altruistic and social feelings and to this extent the character of the person involved. Unreasonable dislikes, undue self-esteem, and an abnormal sensitiveness of self are apt to develop and color every decision and act that infringes upon the self-erected standards and views. "The curse of neuroticism is its egotism." This is why a morbidly nervous teacher or an overwrought mother is so apt to be totally unfit to deal with young people. If we would exert a wholesome influence upon others, especially upon children, we ourselves must have only healthy thoughts and a hopeful attitude toward life. Some of the important things that influence the mental attitude and therefore the health of the pupil are: 1. Environment.-A sunny, neatly decorated schoolroom, with suitable pictures on the walls, growing plants in the windows, and a happy, buoyant teacher in charge, will breed wholesome, health-giving thoughts, even though never a word is spoken on the subject of health. But a harsh or irritable teacher or parent will make the most admirable surroundings and health teachings of little avail. Business men know that a grouchy foreman or manager will almost inevitably foster ill health among their more sensitive employees. And a grouchy teacher or parent is all the worse because of the more sensitive natures that must live in the unwholesome mental atmosphere which they create. 2. Suggestion.-Children are far more open to suggestion than adults. In all matters pertaining to their own health or the health of others suggestion plays an important part. Observation has shown that children are apt to contract such nervous disorders as chorea, hysteria, undue excitability, and even epilepsy, from seeing others in these conditions. Wherever children are congregated this im portant fact needs to be kept in mind. There is a psychic contagion which spreads even more rapidly than physical contagion. Fortunately, proper conditions can use the psychic contagion as well as the improper conditions can, and all who have to deal with the young can minimize the influence of the unwholesome and, by due care, suggest only the more healthful things of life. Health instruction for the young should dwell almost entirely upon lines that suggest health and a hopeful outlook upon life. Even the courage of the child should be fostered for this reason. The teacher or parent who in any way suggests to a child that it lacks ability, or is hopelessly bad, may not only repel it from further efforts to improve but also start it on the way toward morbid views that will darken its entire life. 3. Self-control.-Any system of education that is worth while is founded on the idea of developing self-control. No amount of instruction, whether it be in matters of practice or in matters of knowledge, is worth while unless it is under the leash of self-restraint. There is a deplorable tendency, under certain conditions of American life, to slacken up on desirable restraints and to permit the following of inclinations for the sake of "freedom." No health teaching can bear its best results where this kind of freedom prevails. But there is an even more serious threatening of our health as a people. This is the high pressure at which we are working and involving ourselves in a burdensome multitude of duties and pleasures. Biologists warn us that such highpressure work will inevitably result in a race of high-strung, nervous people who will lack the poise and self-control so necessary to effective living. And there are already entirely too many individual instances of the lack of these qualities, without which the maximum amount of work cannot be accomplished with the minimum amount of effort and friction, and with the steadiness of judgment and reliability of temperament that go so far toward permanency of success. Parents, but especially teachers, need poise and self-control as a foundation for the confidence they must inspire in the young before they can accomplish much in the way of building up these essential things in the life of the child. No one can control others who is not himself or herself self-controlled. No one can build up self-control in others who is not well poised in his or her methods of approach and influence. 4. Work. One of the best agencies for securing healthful mental habits is work. Recreation liberally interspersed with the work is also necessary. But recreation alone can never fully satisfy the natural instincts which demand the accomplishment of something useful. Without work-serious, solid work-the life soon becomes empty and the mind diseased. Work is a condition of mental health. It is useful employment which builds up strength and endurance, as well as joy in living, in our entire mental and physical existence. In fact, the work-cure, especially where it takes the patient out of doors and into touch with nature, has been found to be most effective in the forms of mental disorder which arise from too much leisure, bad habits of work, or the hallucinations that develop from having too much opportunity to think of self. Work usually draws us outside of ourselves and frees us from the danger of morbid introspection. A boy or girl who is not taught to perform useful work and to look forward to a life of active usefulness will inevitably feel the lash of violated mental hygiene. The mind of youth is active. And when this activity is not directed into channels of usefulness it flows into the ways suggested by caprice, by the passions, by the temperament, or by any other mentally dangerous agency. 5. But work must not be centred upon self. It must be for the purpose of accomplishing that which is beyond, higher, and better than self. It must be for service-service to others rather than for self. One of the most unwholesome mental attitudes that can arise is that of feeling that one is of no use in the world. Such feelings may arise temporarily as a result of disappointment or failure and be only fleeting in their influence. But, where it becomes a habit of thought, the feeling becomes a serious menace to the mental health. For this reason young people need much consideration and encouragement in their failures. All of them need the bracing, invigorating feeling of at least occasional success. No task should be so far beyond the efforts of the child that he cannot succeed. It is therefore manifestly unwise, and a serious menace to the attitude toward work, to push a developing child beyond his understanding or strength. Both mental age and physiological age must be taken into account in arranging the course of study, the daily program, the daily responsibilities and tasks. But with all of these, and in all of these, the child should be led into the ways of service. Usually the child is pleased with the dignity of being permitted to serve of demonstrating his ability to do things that are useful. Usually he is so pleased with responsibility that from these first stages of service for those he loves or in whom he has confidence he can be led out into the wholesome, safeguarding, developing influences of social and civil service. And when this end is accomplished, another physically, mentally, and morally healthy citizen has been developed for the State. Doctor of Public Health. The work that boards of health and medical inspectors have been called upon to do in the schools has called attention to the need of a wider training, on the part of the physicians who undertake such work, than that which is necessary in the ordinary medical practice. Two things occurring within recent years have greatly emphasized the need for this broader training. One was the discovery of the fact that the mosquito is largely responsible for epidemics of yellow fever and the resulting improvement made in the sanitary conditions in Cuba. The other was the work of sanitation so effectively done and maintained by Colonel Gorgas and his medical staff in the Canal Zone. This work made possible the digging of the Panama Canal, and has transformed a region, which for centuries was regarded as one of the plague spots of the earth, into a place with a death-rate lower than is to be found in many of the large cities of more northern climes. The work of Doctor Oscar Dowling in fighting filth and disease in the State of Louisiana has also called attention to this same need of type of health expert. new The training for this new profession should be based upon a thorough medical education and should include, in addition to this training, careful preparation in public hygiene, sanitation, food and water testing and analysis, and advanced skill in bacteriology. The preparation in public hygiene should include a knowledge of the best methods of securing the results and habits that make for health. And the sanitary training should impart a good engineering knowledge of the problems of heating, ventilation, and drainage. For the work of successful medical inspection in the schools, these doctors of public health might also well have a knowledge of criminology, mental pathology and hygiene that would prove of great service in the recognition and treatment of mental and moral defectives. Because of the high degree of training required, competent persons for this broader health work should be paid attractive salaries and should be employed continuously. Only in this way can the school, the community, or the State hope to receive the full benefit of their work as their experience in it grows and they thus become more valuable in the service. In the Canal Zone the work of the sanitary experts included getting rid of malaria and yellow fever and the difficult task of furnishing uncontaminated water and food supplies, as well as proper incentives to secure more healthful habits of living. These tasks demanded expert knowledge and executive ability far beyond that possessed or ordinarily demanded of the physician. The yellow fever mosquitoes, fortunately, do not fly far, and the sanitary measures pertained to such things as segregating patients, screening hospitals and houses to prevent their access to patients, and to the covering or removal of all their possible breeding places. In the case of malaria, however, the problem involved far more. The germs of this disease are also carried by a mosquito; but it is of comparatively strong flight, and becomes a menace to regions probably even as far as a mile and a half from its breeding place. To get rid of its dangers, therefore, involved not only screening the houses, but the filling in of water holes and marshes and, in some cases, the creation of new and better channels for streams. During the eight years that the work has been going on, the engineers and the physicians have spent over $12,000,000. But they have made it possible for the Caucasian to remain healthy and vigorous in this torrid climate, and to accomplish the most stupendous engineering feat ever attempted without unnecessarily sacrificing either lives or health. The extent of the safety from yellow fever is shown by the fact |