success. When the disease appeared in Honduras, Salvador and Nicaragua, the Foundation offered its assistance, which was welcomed by the various Governments. Each country provided a part of the cost of the campaign, while the Foundation contributed the services of its experts also making large appropriations toward the Commission budgets. These various commissions co-operated in an international programme for the protection of all the areas concerned, and the plan was carried out so energetically and thoroughly that by the middle of October Yellow Fever had been practically banished from Central America.

Plans for the near future include the sending of a Commission to Peru, where Yellow Fever appeared in 1919, and, with the co-operation of the British Government, to the suspected areas on the West Coast of Africa. It is also hoped that a way will be found to banish Yellow Fever from Southern Mexico.

Malaria.

While the Yellow Fever campaign was being conducted in Ecuador and Central America, a Malaria campaign was undertaken in Mississippi and Arkansas. In the four Arkansas towns in which experiments were carried on during 1919, anti-mosquito measures were the chief arm employed, resulting in a 67 % reduction in the prevalence of Malaria at a per capita cost of 60 cents exclusive of the overhead expenses of supervision.

The object of these demonstrations was to show that methods of control, which have succeeded in large towns are applicable to villages at an expense which the communities can all well assume. The results have fully confirmed the expectations of the Board. As a result of these demonstrations public funds for Malaria control are now being appropriated faster than sanitarians can be found to supervise the work. A significant feature of the 1919 campaign was the use of top minnows to consume the eggs of the anopheles mosquito, which proved a cheap and effective measure.

From the outset of its Health work the Foundation's International Health Board has entered an area only on the invitation of the Government concerned. All its work has been based on three primary considerations: 1) Co-operation with the authorities, 2) the community's assumption of some part of the expenses, and, 3) an agreement that, if the experiment be successful, the Government will take over the enterprise as a part of its official machinery.

In June, 1919, a Conference was held to plan a concerted campaign against Malaria in the Southern States, representatives of the United States Public Health Service, of the State Departments of Health and of the International Health Board of the Rockefeller Foundation being present. This Conference worked out a programme which has been adopted in ten States. It is proposed to carry on simultaneously in at least four communities in each of these States a systematic anti-Malaria campaign, the object being

to test the efficacity of various measures of control by applying them under a wide range of varying conditions, and to educate a larger public in order to stimulate public sentiment to support a comprehensive effort for the elimination of malaria from the whole South.

Hook Worm.

Hook Worm disease, which was the first disease to be dealt with by the International Health Board, still remains its chief concern as far as areas covered, personnel employed and funds expended are concerned. The disease is widely prevalent throughout the world in tropical and semi-tropical regions. In parts of Porto Rico, in the low-lying districts of Colombia, on many of the plantations of Ceylon and Dutch Guiana and in the mines of China, an infection rate of about go % is found. The Hook Worms, lodged in the intestinal tract, impoverish the victim's blood and produce anemia which impairs bodily and mental vigour. The malady is easily curable, but the campaigns are not of permanent value unless proper sanitation is introduced to protect the soil from polution and the population from reinfection. For this reason the Board is declining more and more to undertake control measures until Governments have actually seen fit to enforce the necessary sanitary provisions.

In 1919 Hook Worm control measures were conducted in 25 different States and countries, surveys or campaigns were inaugurated in 8 new areas, and work was suspended in two countries. While varying degrees of success were attained in different fields, the general tendency has been toward a steady reduction in the prevalence and intensity of the infection. Hook Worm control has proved a most successful means of convincing communities that health is a purchasable thing. Brazil and Australia afford striking examples of the way in which Hook Worm campaigns widen into comprehensive Public Health programmes. In the former country, chiefly as a result of the Hook Worm work, one million dollars has been appropriated for rural sanitation.

A feature of the Hook Worm work of the Board has been the preparation of a bibliography which deals with this disease.

Tuberculosis.

Only in France - and there as a war measure- has the International Health Board undertaken to aid in combating Tuberculosis. A campaign begun there in the summer of 1917 had as its chief objects the following: 1) the setting up in typical urban and provincial areas of standard demonstrations in systematic methods of control; 2) the training of Public Health nurses, clinicians, lecturers and organisers; 3) the arousing of communities to the need of creating local antituberculosis agencies, governmental

and voluntary; 4) the educating of the public in the causes, treatment and prevention of Tuberculosis; 5) the gradual transfer of responsibility to French agencies and the organisation of these agencies on a national basis.

Appreciable progress toward each of these goals was made during 1919. Demonstrations in the 19th arrondissement of Paris and in the department of Eure-et-Loir were made by the extension and the consolidation of dispensary service in the urban district and by the establishment of 22 dispensaries scattered throughout towns, and villages in the rural districts. In six schools for training nurses under French administration, 205 women holding medical scholarships were registered; 51 graduated and 76 nurses were assigned to various departments. A graduate course on the theory and practice of treating Tuberculosis was worked out in co-operation with the Paris Faculty of Medicine and with physicians of the various hospitals. In addition to this, a six weeks course for physicians on the diagnosis and treatment of Tuberculosis was organised and was attended by a group of French doctors, 22 of whom received scholarships from the Com

mission.

Dispensaries were opened in three departments in the devastated regions and preliminary surveys undertaken in five others; new committees were organised in 14 departments and preliminary work undertaken in 12 others; 41 new dispensaries were built, 36 were in process of construction and plans for 52 more have been made.

The process of transferring responsibility to French communities and agencies has continued steadily, the personnel in charge of dispensaries being now almost entirely French. The hospital and sanatorium facilities for the tuberculous provided on a large scale by the American Red Cross during the war have been taken over and extended by municipalities and departments.

The French Government has passed a law under which each department will be compelled within five years either to supply a sanatorium of its own or to send its patients to that of another department. The cost of construction is to be shared by the Government and the departmental authorities. In addition to departmental committees throughout France, a National Committee, which originally concerned itself only with tuberculous soldiers, has been re-organised and will henceforth be known as a National Committee of Defence against Tuberculosis. This organisation has agreed to supervise and direct the entire National AntiTuberculosis Campaign.

In order to overcome the reluctance of people in France to go to dispensaries, due to the fear of being declared tuberculous, the Foundation organised exhibits and groups of lecturers which visited many towns and villages. Mass meetings with addresses, slides and motion pictures were organised and attractive illustrated pamphlets widely distributed. Other forms of publicity such as posters,

series of articles in the press, simple text books for school children, ingenious health games and amusing picture post-cards were likewise employed. One of the most successful innovations has been a special Punch and Judy theatre for teaching children simple truths about hygiene.

Other Activities.

During the year 1919 the Commission's exhibits visited 28 departments, 293 towns, with a combined population of three million, over 1400 addresses were given in public schools and three million pieces of literature distributed.

In order to supply the existing lack of trained men and women for Public Health work, the Foundation offered in 1916 to establish at Johns Hopkins Hospital University a School of Hygiene and Public Health. Two years later the School opened with a Faculty of thirty and with eighteen students. In 1919 these numbers increased to thirty-six and eighty-two. The courses vary in length from two years for a degree of Doctor of Public Health to a period of six weeks for officials in active service and for physicians who expect to enter part-time Public Health work. The new School has already made considerable progress in its three chosen fields of professional training, scientific research and popular education.

The China Medical Board of the Foundation endeavours to aid agencies which represent Western Medicine in China toward higher standards and greater efficiency. In introducing the theory and practice of modern medicine among the Chinese, Japanese influence has been a leading factor, the Government and professional medical schools being mostly staffed by Japanese-trained Chinese, together with numbers of Japanese teachers. The majority of native physicians professing to practice Western medicine. have also likewise been trained in Japan. On the other hand the influence of Chinese physicians who have been trained in the medical schools of the United States and Europe is continually gaining in importance. Missionary societies have also played a leading part in introducing a knowledge of modern medicine into many communities scattered throughout the country. In many cases dispensaries begun as adjuncts to Evangelistic work have developed into small hospitals, and, in some instances, into institutions comparable with the average hospital in the West. In 1919 Protestant Missions in China were conducting 317 hospitals, while Catholic orders and societies maintained hospitals and dispensaries in large ports such as Shanghai and Hankow.

The chief agency by which it is hoped to further the aims of the China Medical Board is the Peking Union Medical College, which has recently been opened in the Chinese capital. Controlled by a Board of Trustees chosen by the Rockefeller Foundation and by six co-operating Missionary societies, American and British, the Peking Institution is being built and maintained by Foundation