Man is just as much capital as is a machine or a horse, of which the cost price.and the probable output must be considered. His output depends upon his health, and upon his physical, intellectual and moral value.

During the active period of his existence, a healthy man produces normally more than he consumes from birth till death. During illness or disability he produces less or ceases entirely to produce, becoming a burden to collectivity. Healthy adults must produce for the non-producers, i.e. children, old people, the sick and the infirm.

General prosperity depends, therefore, upon the proportion of producers to non-producers. It grows as the number of the former increases and the number of the latter decreases. Industrial medicine aims at increasing the number and value of producers and the length of their period of productivity, and at reducing as far as possible the number of nonproducers (the sick and infirm) by fighting the causes of sickness.

Medicine and Public Health, by preventing avoidable illness and premature deaths and by reducing unproductivity caused by illness or infirmity, lessen the social burden and unproductive expenditure and increase production by increasing the number and value of workers.

The net cost (N) of a man varies and can be calculated at any period of his life; it corresponds to the total expenditure which has been made for him up to that time :

(1) At birth: maternity expenses (b)

(2) Care during infancy and childhood (c) (3) Education (e)

(1) H. Spencer: On Education, p. 233.

+e+ a + m.

At death N = b + c + e + a + m + p + 1. If the total output of the individual during his active period is represented by T, his social value or usefulness may be measured by the formula T

(3) T must be greater than N + SO. If T is smaller than N + SO, there is a deficit or loss: TN + SO.

If T is greater than N + SO, there is a profit (P) or gain: T > N + SO.

It should be noted that T depends upon N, except in the case of illness and pensions. N can, therefore, only be reduced by reducing these latter. All other expenditure is, on the contrary, productive expenditure.

Everything which increases T increases P.

Everything which decreases SO increases P. and, inversely,

Everything which increases SO decreases P. Everything which increases T, everything which increases the active period of production, good health, physical, intellectual and moral vigour, increases P. Everything which decreases man's social obligations (SO) increases P.

The social obligations (SO) include all unproductive expenditure involved by premature deaths and relief to the sick and disabled.

Death and illness destroy human capital, especially death and disablement coming before output has compensated for the expenditure which constitutes the cost price of the producer.

Swiss statistics show that of 100 boys born in one year 40 alone are fit for military service at 20 years of age. The wastage through death, sickness and disablement is 60 per cent.

In 1894, 436,000 boys were born in France. 118,000 of these were dead by 1914. Out of the 318,000 survivors, 19,000 were definitely rejected for military service and 77,000 were sent back temporarily, so that only one-half of a generation attains the age of 20 in in a normal state of health (death has claimed a quarter).

These premature deaths represent a loss to the nation equal to all the expenditure made for birth, upbringing, education and apprenticeship, without any compensation whatever. This means an enormous waste and a sad decrease in national strength and group production. The social value of a third of the young men who reach the age for military service has already diminished more or less.

Add to this the loss in workers caused by tuberculosis, syphilis, alcoholism and other preventable diseases, through death and disablement, through loss of productive power and through expenditure for poor relief (for the sick, the disabled and the insane). It is easy to understand, if not to calculate, the enormous saving which can be effected by industrial hygiene. The first calculations of this kind were made by Jules Rochard in his opening address to the Hygiene Congress at the Hague on August 23, 1884, on The economic value of human life ".

"

equals the sum the interest of which is represented by the output of this same work. It increases from birth until the age when man is at full productive strength. It remains stationary for a time, because, as the worker's strength and skill increase, the number of years during which he can enjoy this productive activity decrease. Finally, it begins to decrease, like all perishable capital, to disappear altogether in old age, when man can no longer render any service to society and when he becomes valueless, like the sick, the infirm, the insane, and the idle, who are only burdens to society. >

Landouzy, in a lecture at the Sorbonne on March 5, 1905, on "Tuberculosis as a Social Disease ", and in his address on September 30, 1908, to the International Tuberculosis Congress in Washington, reckoned up the economic consequences of this scourge, and Calmette and others have recently continued these calculations. According to economists, each human life before the war represented a capital of 25,000 francs, and the value of an adult worker between 20 and 40 years of age is to-day at least 50,000 francs. The social capital wiped out annually by tuberculosis in France exceeds five thousand million francs.

Similar calculations may be made for other diseases such as syphilis, for example. It is reckoned that syphilis costs France each year 140,000 human

lives (miscarriages, stillbirths, infantile mortality, etc.), that 40 per cent of patients under treatment for chronic diseases owe the origin of their illness to syphilis, and that syphilis causes France an annual loss of several thousand million francs through death, illness, disablement, loss of working hours, expenses of treatment and relief, and diminished output. These calculations are naturally only approximate, since the true value of each individual varies according to his age, position, productive power, technical training, and moral development, and also according to economic conditions at the time the calculation is made.

Besides the cost of death and disease, there is also the low output of the man in ill-health to be considered. The industrial experiments quoted by Dr. René Sand in his interesting book prove this. (1) Output depends upon the health of the workers and the conditions of work; production is more economical when the workers are " in good form ". From the point of view of profit and the good conduct of a business concern, the personnel requires as much consideration as the machinery. That human capital be cared for and respected is a condition essential to social prosperity.

(1) René Sand: Organisation industrielle, médecine sociale et 'ducation civique en Angleterre et aux EtatsUnis. 1920.

A recent outbreak of enteric fever in Yorkshire, England, illustrates the fact that a village pump may be as dangerous a contrivance as a bombing aeroplane, if the water supply is not submitted to periodic tests. In this case the source of the outbreak was traced to contaminated water from the village pump. A propos of the occurence, Sir George Newman. Chief Medical Officer of the British Ministry of Health, wrote:

This outbreak of widespread and fatal illness following the acidental contamination of a public

water supply warns us against being lulled into a false sense of security. For quite apart from the occurence of typhoid or other endemic disease transmissible by drinking water, cholera has, at the present time, assumed epidemic proportions in Russia and in Poland, and the possible introduction of the infection of this disease into England is a fact that has to be realized. It, therefore, behoves all public authorities who are responsible for our water undertakings to use every endeavour to ensure the purity and safety of their supplies.

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It is with the idea of meeting this need that I have the honour to submit to you this decree, which has been drawn up by the Department of Public Relief. It is based on the experience already obtained, incompletely but very successfully, by several public and private organizations, and, while respecting existing institutions, it offers very real advantages to those professional schools which will benefit by the new statute. The sick and the general public will find in it guarantees that will raise in the public opinion a profession which has a right to state protection, since the manner in which it is practised deeply affects preventive medicine and social hygiene.

of the nursing profession in France at the outbreak of war in 1914. A rapid historical résumé may not be out of place here.

HISTORY OF NURSING IN FRANCE.

France has always been the home of charity. The archives of its religious orders contain many excellent documents on the subject of hospitals, asylums and charitable homes; every form of relief to the sick and needy appears, century by century, throughout its history.

The revolution of 1789, like all revolutions, swept away the good with the bad, and the hospitals of the religious orders disappeared in large numbers. Their disappearance was for many of them only a change of costume, and when, under the Consulate and the Empire, the government officials again sought to set up relief throughout the country, they found the forgotten nuns at their posts ready openly to take up their charitable work once more. During the greater part of the XIXth century, the female religious orders retained the management of the majority of hospitals and homes. They looked after the sick according to the methods of the times, that is, with the conscientious devotion which was second nature to them, under the supervision of doctors and surgeons who only required of nursing sisters, besides the above moral qualities, strict cleanliness and perfect docility.

But the day came in France, as elsewhere, when the new doctrine concerning microbes came, with its vast consequences, to cause another revolution,

The programme shall be the same for all examinations dealing with the same subjects. Examinations shall be held only in towns in which there is a Faculty of Medicine or a University to which a School of Nursing in full activity is attached.

Each Examination Committee shall include a delegate appointed by the Minister of Health and Social Welfare with the approval of the Prefect of the Department concerned. Its composition shall be determined after consultation with the competent section of the Advisory Council; at least half the membership of the committee shall consist of the following: one or more doctors, surgeons or chemists representing the Corps of University Professors, one or more representatives of the local medical corps, one