men cannot work without just and fair compensation. This compensation should be fixed by the State.

Appointments of health officers, whether federal, state or local, should depend entirely upon professional qualifications, and tenure of office be based absolutely upon efficiency. Such servants should not be permitted to engage in any duties other than their regular official ones. Surely the services of the guardians of the public health are as important as those of county sheriff or attorney.

When such provisions are recognized and enforced by law, organizations which care for the public health will become more highly standardized and win a higher respect from the people at large. Their next step in attractiveness will be that regular physicians will prepare for and desire to be appointed to the many positions which now are dubbed civil ones, but will gradually evolute until they are held absolutely by professional physicians, carefully educated and especially trained.

Stop talking-stop criticising the health organizations of your State and pull together until you have forced a more satisfactory state of affairs. You have more power than you have any knowledge of. I am appealing to your self-interest, you see. You have the power to demand and enforce wise legislation. You can raise efficiency to a high level and standardize it. You can keep health legislation and health administration out of politics. To accomplish these Utopian conditions, you must co-operate with, and stand by, the health officers the State now supports, if you desire to lend a hand in advancing the health work and health organization of the State you call your own.

The organization of the public health of a State must not neglect providing for the training of workers it requires for its own service. Outside institutions may train men for the higher positions but the masses of workers in any State system must be trained in the State where they later expect to be employed. As long as the State neglects to provide for this training it will be weak in one of the most vital links in the chain it is endeavoring to forge.

This training can be obtained nowhere so well as in the uni

versities which are maintained by the State. In Germany, all universities are under State control, and nearly all medical instruction gained in such universities; therefore the State has recognized its duty in educating the physicians who later save the lives of its people. In Austria, Hungary and Switzerland all the universities are State ones, and in Holland with but one exception. In Great Britain originally all its universities were private ones, but they have gradually passed to those of State control except Oxford, Cambridge, and a few others.

When our physicians are trained in universities supported by the State, it will seem but one step forward for them to be placed in hospitals and institutions for caring for the sick and dependent. classes. All such institutions, including insane asylums, should be in conjunction with State universities whose graduates, upon completing their courses, should find their way into State institutions where they will receive a fair compensation for their services, and thus more closely cement the bonds between public health and the medical profession.

How may such reform be obtained? In a democracy, where people govern themselves, there is one way and one only. By legislation which should voice the desires and the needs of those who are most intimately concerned. In all medical legislation the interest of the physician has been singularly, and almost hopelessly, disregarded. It is due to this fact that the question is being asked, "What is the matter with the medical profession?" It remains for the doctors themselves to cure such conditions. How may they do it? By associating themselves with the medical societies of their State and by organization, co-operation and determined efforts, force their rights before the public, which, after all, is fair-minded and remembering the great debt of gratitude it owes to the physician, will exercise all the power it has to insist that doctors receive fair treatment at the hands of the legislators. This the public will do when once it understands the true conditions under which we suffer.

To facilitate the bringing about of such a desired improvement, bills relating to public health must be carefully drawn by men with practical knowledge of the legislative needs as far as public

health is concerned. This has not been so in the past. Out of one thousand bills upon health matters, introduced into 42 legislatures last year, most of them came under the head of fads. We need fewer laws carefully framed, and so critically considered before adoption, as to avoid the trouble and confusion that careless legislation entails.

While many of these laws introduced were unimportant, yet several were passed and enforced which have done much to advance the medical health of the nation. It is not too optimistic to hope that when physicians have roused themselves to an appreciation of their power, they will enforce legislation, which will raise their economic status, so that they may reap a fair reward for their arduous and oft-unrequited labors in behalf of humanity. With civil positions offering legitimate compensation open to physicians, with an assurance of his continuance in same as long as he makes good-with reasonable chance of promotionwith services in hospitals, dispensaries and institutions open to the graduate of our medical colleges, fair salaries being attached thereto; with the years of his unrepaid labor lessened by the two or three he was expected to serve as an unpaid interne before he dare hang out his shingle-with the cost of his medical education reduced from $10,000 to $1,000-his charity work paid for by the State which directly benefits by it-then I dare to hope that my profession and yours may retain the high ideals for which it has always stood, and for which it will ever fight instead of being allowed to sink to the depths of sordid commercialism.

SOCIAL INSURANCE AGAINST ACCIDENTS (WORK

MEN'S COMPENSATION LAWS).

By FREDERICK L. VAN SICKLE, M.D., Olyphant, Pa.

"THE FAITHFUL LABORER IS WORTHY OF HIS HIRE."

Workmen's Compensation.

In studying the evolution of incomes and of means whereby the people of the world are supported, either by hand or brain, it is well to make some investigation as to the changes which have taken place in the past twenty years, whereby a gradual evolution of wages, salaries and earnings has been granted to the working and middle classes of the people of this and foreign countries, which is evidenced by the present state of wages with their increase, as compared to those paid in times gone by.

It is very difficult to get a table of comparisons from which each section of a country as large as the United States can be workt out, because there enters into such estimates many factors that deal with local conditions, with the sale of commodities and with the general standing of prices of all things entering into the cost of living; but it is well known from statistics gathered by industrial organizations, that in cases where the wages of a

daily laborer twenty years ago ranged from $1.10 to $1.25 per day of ten hours, the present wage would not be less than $1.95 to $2.25 per day of eight hours for similar labor.

Again, comparing the wages of a higher grade, for instancemechanics, carpenters, bricklayers and masons, the wages of twenty years ago would run from $2.00 to $2.25 per day of ten hours, whereas in 1916 the earnings of most of the states would give us an average of from $3.00 to $4.00 per day of eight to nine hours, for the same grade of labor.

Again, taking a higher class, a more skilled workman or men in salaried offices, we find that whereas $50 to $75 per month was a fair income some years ago, the same work to-day brings from $100 to $150 per month.

It is unnecessary for us to go into detail regarding the reasons for giving these advances, as they are too well known for discussion.

A most vital reason, however, is the greater consideration for labor by capital, as a necessary part of its equipment and a greater coming together of the two units, thru which greater concessions are granted in time of working hours, in vacation periods, and furnishing means which afford not only the necessities of life, but aiding in supplying the comforts and pleasures which up until the present decade were almost deprived to a large class of the working people of the nation.

In considering this feature of the workmen of the world, we must realize what has entered into this problem from the various influences which have cemented the closer relationship with labor and capital and that another means of rendering aid has been brought about by the passage of various laws in foreign countries and in the United States, whereby in time of injury compensation was granted, making the path of the injured more easy, the trials and hardships of the family more tenable, the pain and suffering-while not abolisht-rendered more bearable, with the thought that the wage earner was not without means of sustenance for himself and family in the dark hour of trouble. For the most part these liberal laws have been termed "Work