eight and one-half hours of work exhausted the workers and was of no value in increasing the output. The experience of employers quoted in the report is to the same effect. The principal Woman Inspector says that where eight-hour shifts have been established "the physical appearance of the workers compares very favorably with that of those in other works, on the longer shifts and highly favorable reports have been made of increased output (in one case to the extent of a third) while need for supervision was decreased."

The Committee of the Health of Munitions Workers point out that long hours do not mean increased output and say "taking the country as a whole the Committee are bound to record their impression that the munitions workers in general have been allowed to reach a state of reduced efficiency and lowered health which might have been avoided without reduction of output by attention to the details of daily and weekly rests."

It is the writer's firm conviction that in shorter hours of work the interests of employer and employee are identical. The well-paid and naturally well-fed mechanic, doing a reasonable day's time, will be healthier and consequently more efficient than the ill-paid, under-fed, long-time worker. The former is bound to take more interest in his work, he will have less tendency to grouch about his condition. Mentally and physically he will be a better man, a better citizen and his work will consequently be of a higher type.

Diphtheria.-Where sudden relief is essential in diphtheria, says Gregory (Med. Fortnightly), the antitoxin should be injected intravenously. Ordinarily the intramuscular method would be almost or quite as efficient.

THE VOCATIONAL RE-EDUCATION OF THE DISABLED SOLDIER.

BY

T. B. KIDNER,

Ottawa, Canada.

The vocational re-education of the disabled soldier involves many considerations. Primarily, it is, of course, a medical problem; but it is equally an educational and a social-economic problem; the factors composing it being interlocked and related. The question of the selection of a suitable vocation is of prime importance and illustrates the many-sidedness of the problem. Clearly, the first consideration is the remaining physical ability of the man; at first, this would appear to be purely a medical question. But how many medical men have a knowledge of the wide ramifications of modern industry and of the qualifications, both physical and mental, of the workers in more than a very few lines with which their practice may have made them familiar? Here, then, is the place and field for the "vocational counsellor." He is a most useful officer whose functions in connection with vocational and industrial training for civil life are becoming increasingly important in modern school systems. This officer must have an expert knowledge of industries and also of the methods of training the workers in them; whether in a special school, in the commercial workshop or office itself, or partly in both. He must also be acquainted with the demand for workers in established industries and, also, in new or projected industries. Again, he must know the liability to seasonal unemployment and occupational disease of workers in a given industry; for disabled men should not be directed towards occupations where there is a strong probability of meeting these draw

backs to a full livelihood. In addition to his technical qualifications, the vocational counsellor must also be very "human," for the objects of his advice are almost always a little out of key with their environment and the utmost sympathy and tact is required in their guidance and training.

There are often general and local considerations to be taken into account in the selection of a suitable vocation for a disabled man-considerations which are neither medical nor technical. Recognizing this, the Military Hospitals Commission has arranged that a third person shall be called in for counsel and advice when the question of a disabled man's new vocation is to be decided. The third member of this little body of three (termed a "Disabled Soldiers' Training Board") is nominated by the local Soldiers' Aid Commission and represents not only the local knowledge, viewpoint and sentiment, but also the unofficial, public side of the question. Fine service is being rendered by these unofficial members, who freely give their time and knowledge to the work. The previous occupation of the man is also to be considered and last, but by no means least, his own desires and wishes for the future; for unless the vocation selected appeals to the man, his successful reeducation is well-nigh impossible.

In considering each case, a careful investigation is made into the man's educational and industrial history. Such significant facts as his place of birth, the nationality of his parents and the occupation of his father, are recorded; also, if the candidate for reeducation was born abroad, the date of his coming to Canada. Then follows a report by the vocational officer (counsellor) as a result of a long personal and intimate interview with the man, in which his appearance, his habits, his recreations, hobbies and

other personal tastes are obtained. The vocational officer also gives his judgment as to the vocations for which the man's ability and aptitude are evident, also the vocational officer's recommendation of a particular vocation and his reasons for the recommendation. The candidate is then examined by a medical officer, who reports on the man's remaining ability and powers, both physical and mental and also names any precautions which should be observed in the choice of a future occupation for the man. In this connection, a definite series of physical and mental tests are applied by the examining medical officer. From the information provided by the investigations of the vocational and medical officers it is possible for the Disabled Soldiers' Training Board (which, as indicated above, is formed of these two officers and a local layman) to make satisfactory recommendations as to the training of the disabled men.

The Military Hospitals Commission is only empowered to provide re-education in new vocations for men whose disabilities, resulting from their service, render them unable to follow their previous occupations. It is already evident, however, that many other men would be glad to undertake vocational training and it is also clear from the records of the industrial history of the large majority of the candidates for re-education, that there is in Canada a great national need for vocational and industrial training in the country at large, apart altogether from the particular aspects of the question as applied

to disabled soldiers.

A reference was made above to the local Soldiers' Aid Commission. In each of the Provinces of Canada, the Provincial Government has appointed a commission of persons, representing all walks of life; the chief

function of these commissions being to provide employment for returned soldiers. They also assist in innumerable other ways in solving "The problem of the returned soldier."

The question is often asked "For what occupations are disabled men being trained?" Such a question does not admit of a categorical answer, for, as may perhaps be inferred from the statement as to the method of selection of an occupation towards which the disabled man may be directed, it is a personal, individual problem in every case. A few broad principles may be stated; the first and most important being that, if at all possible, the man's previous training and experience should not be "scrapped." Thus, a manual worker who is unable to follow his former trade at the bench or lathe, can often be trained to take a leading position in the same industry by an appropriate course of theoretical instruction, mathematics, drafting, etc. Another point is that, wherever physically possible, a disabled man should be directed towards productive work rather than to clerical or distributing lines. While there will be large numbers of men for whom light indoor work will have to be found, it is already apparent that the rigors of service in the field have turned the thoughts and desires of more men towards "indoor jobs" of a clerical nature than is good either for them or for their country. This is true of France as it is for Canada.

Not many of the men who have returned desire to go on the land, but one avenue of promise in that direction is opening up, and may be termed the "Farm Machinery Route." There is a large and growing demand for men who understand the care and use of tractors, gasoline engines, pumps, threshing machines and the hundred and

one other labor-saving appliances of the modern farmer. In the western provinces, training for such work bids fair to be one of the most popular and useful lines which are undertaken for partially disabled men.

The civil service offers another good field for the employment of disabled men, and classes of preparation for the examinations for admission to the service are a feature in most of the re-education centers. Training, leading to clerical and office positions, is also provided for partially disabled men.

During the period of training which is necessary to enable a disabled man to learn a new vocation, provision is made for his maintenance and that of his dependents. The cost of his training, including books and materials is also borne by the Government, so that a man may take his course free from worries. Further, to give him full opportunity, the maintenance allowances are continued for one month after his period of training is complete.

A word must be said about the training which is offered to all men during convalescence in Canadian Military Convalescent Hospitals, irrespective of whether or not they may later be unable to return to their former occupations. A wide range of training is provided and has been proved to be of three-fold value. First, the disciplinary troubles which are always present when a body of men have time hanging heavily on their hands disappear almost entirely when vocational classes are established; second, occupation during illness or convalescence is of undoubted therapeutic value and assists materially in restoring men to health; and, third, many men are enabled to earn more money upon their return to civil life because of their improved capacity from the training they have received. As a pioneer in the

field of occupational therapy on this continent has well put it, "A better job, or a job done better," is the motto for the selfimprovement classes provided during convalescence.

Military Training Camps for Boys.There is no doubt that training, from all points of view, is good for the young. The boy or girl who has been subject to no re- . straint is apt, nay certain, to grow up impatient of control and to some extent, ill balanced in mind. Of course, too much discipline is a fault on the other side. The happy medium should be preserved.

In America, on the whole, children too often are allowed to have their own way to their detriment. While, perhaps, independence is promoted thereby, laxity of control tends to careless habits and even license. In Germany discipline is too rigid.

Therefore, there is no denying that military camps for boys possess various excellent points. They combine a salutary amount of discipline, with a healthy mode of living and clean association. The young are notoriously imitative and take their cue from their leaders. The example set them by their officers in a military camp is an incentive to improvement that will prove of incalculable value in later life.

It goes without saying, that physically the life is in a high degree healthy, just as much as it is mentally stimulating.

The question of feeding boys in a military camp is very important. Growing boys require a great deal of nourishment, and this must be of fitting character. The rations for boys living under such conditions have been laid down, or rather, suggested by First Lieutenant W. E. Fitch, Medical Reserve Corps, U. S. A., in an able article appearing in The Military Surgeon, May, 1917, in which he lays down the daily menu

for a week of what he considers a well balanced ration for a growing boy; a ration which will furnish about 125 grams of protein daily and an average of about 4,300 calories. Lieut. Fitch also emphasizes the fact that unless food contains sufficient vitamine principles, no matter how well balanced the ration may be in the ternary food elements, how large quantities are consumed, or how high the caloric value may be, there will be malnutrition.

Dr. Fitch has shown that not the least of the benefits of military camps for boys come from the opportunity afforded for promoting their health by placing their diet on a sound and scientific basis.

The Question of Salvarsan.-Among the many inconveniences, if so mild a term properly expresses the situation, brought about by the war in Europe has been the more or less complete cutting off of the drug supplies which formerly entered this country from Germany. The great majority of the newer drugs came from that country, in fact, Germany had practically a monopoly of the manufacture of the synthetic products, and of these none was more largely used, or the loss of which was more greatly missed than salvarsan and neosalvarsan. Their value in the various stages of syphilis has been thoroly established and the inability to secure them in adequate quantities from Germany, created, for a considerable time, an exceedingly grave situation. Of course, the attempt to manufacture salvarsan and neosalvarsan here surreptitiously has been made, with how much success it is hard to say, altho there is little doubt that some of the imitations placed upon the market have been comparatively worthless, while the prices have risen by leaps and bounds, until in some instances they were almost prohibitive. From all points of view the salvarsan situation has been, to say the least, disquieting. The products were very expensive and for the most part they could not be relied on, that is, they have not imparted the confidence that was placed in those made in accordance with the Ehrlich processes.

However, in an article published recently in the Medical Times, it is stated that for

mer Congressman H. A. Metz of New York has made an announcement to the effect that he has entered upon the manufacture in Brooklyn of salvarsan and neosalvarsan following the Ehrlich methods. Dr. G. P. Metz, a chemist of repute and a brother of the Congressman, has received thoro instruction at Hoechst in the manufacture of these products, and as a consequence the Ehrlich processes will be carefully and correctly carried out in Brooklyn under the supervision of Dr. Metz.

It is further said to be the intention of Mr. Metz to keep down the price of salvarsan to the lowest possible point, and in this connection it is worthy of remark that unlike many importers who raised their prices enormously after the opening of hostilities, he refused to take advantage of the necessities of the public. Unfortunately, it is more than likely that in the near future there will be a greater call for salvarsan and neosalvarsan than there has been in the past. The collection of large bodies of lusty men in the prime of life in training camps will tend to increase the occurrence and prevalence of the venereal diseases and it is therefore eminently desirable that we should be prepared to meet them with all the weapons at our command. The curative agencies, salvarsan and neosalvarsan hold pre-eminent positions, but in order to be effective these must be properly made. Imitations have been sold within the past few months which were wholly innocent of arsenic and thus it would appear to be in the best interests of all concerned that standard products should be employed, if possible those made after the Ehrlich's processes. The medical profession will welcome the announcement of Congressman Metz and appreciate the spirit he shows in instituting this new enterprise.

The Prophylactic Clinic.-With the advent of summer, renewed efforts will be made to further decrease the wonted mortality of infancy. Experience with infant milk stations most assuredly has demonstrated that the main factor in the control of summer diarrhea consists of the education of mothers in the general hygienic care of infants and particularly in the importance

of maternal nursing or the careful preparation of individualized formulae.

No longer are hospitals and dispensaries overcrowded during the summer months with the little sufferers from gastroenteric disturbances. disturbances. The stress has been removed from the remedial factors to the prophylactic agencies.

Dorwarth in the Archives of Pediatrics, March, 1917, points out that hospitals treating infants and children fail to live up to their obligations if they give care only during illness. He urges that departments of preventive medicine be established as distinct units of children's hospital organization with a view to performing the high type of service necessary to maintain children in a state of health. This suggestion is not entirely new but the fact that so few departments of this character have been organized demonstrates the importance of the constant repetition of an excellent idea to secure its adoption by even a limited number of traditional institutions.

In different cities of the country there have been established prenatal clinics, infant consultations, health centers, health clinics, diagnostic centers, social service departments and similar practical methods for the education of parents, the alleviation of economic distress, and the conservation of child welfare. It is patent that the various functions, implied and involved, are not mutually exclusive but overlap one another in ideals and practice, so that for efficient. service a combination of all of them is essential with a centralized form of organization.

Many years will elapse before the general public will be willing to employ physicians as prophylacticians. There does not appear to be a full realization that health is an asset to be conserved, while disease is a liability that may frequently be avoided, decreased, or postponed. In the constant campaign for human betterment attacks are made first upon one specific disease and then upon another. One group of the community is fighting against tuberculosis; another is profoundly interested in cardiac conditions; a third focuses attention upon venereal diseases. One organization concentrates its efforts upon the production of a supply of pure milk; a second popularizes fly-swatting