LIST OF CITIES ADOPTING A COMMISSION FORM OF GOVERNMENT IN

develop so that they can be corrected before the plan in general gets discredit, and making plain by analysis the real essential merits of the plan to the end that they may not be overlooked and dropped out as the plan spreads.

The commission plan spread its wings over a 10 per cent increase of population as a result of various elections and referenda on November 7, the total population of the cities under the plan now being 3,894,173.

The following list was prepared by the Editor of the NATIONAL MUNICIPAL REVIEW in cooperation with the officers of the Short Ballot Organization.

ADMINISTRATION WORK

BY SELSKAR M. GUNN1

Assistant Professor of Sanitary Biology and Public Health, Massachusetts Institute

A

of Technology

NY estimate of what constitutes economy and efficiency in health administration work cannot be regarded as satisfactory until the true functions of a health department have been properly defined. Such an understanding has not yet been attained, although the progress of sanitation in the last few years, resulting largely from the wonderful discoveries of bacteriology and the remarkable achievements of epidemiology, is gradually bringing a truer conception of the nature of those conditions which have not imaginary, but real health significance. A study of the annual reports of various health departments of this country reveals great variation, both in the objects pursued and in the detailed. methods of attack.

Health authorities are being relieved gradually of the burdens of garbage and refuse collection and disposal, plumbing inspection, poor relief, and general hospital maintenance-matters of slight if any health significance. Consequently they are becoming more and more able to devote their whole time and energy to questions of real sanitary import, to the solving of problems which will actually result in the decrease of preventable sickness and in conserving human life and happiness. Again, it is generally conceded that at the present time health departments are usually inadequately financed. New funds are not granted for the furtherance of the work of the department, or if so, to only a limited extent. It is doubtful however, if the funds now actually at the disposal of the health authorities are being spent with real economy.

One of the chief causes of inefficiency and lack of true economy is to be found in the lack of proper knowledge as to the comparative importance of the various branches of work which may be pursued. A health commissioner is confronted with the question of what he ought to do to improve the sanitary status of his community. He has limited funds, and consequently cannot do all that he might wish. "Shall I make a special effort to curb tuberculosis, or devote my resources to improving the milk supply?" "Should meat and food inspection be developed before factory inspection?" Questions similar to these are constantly confronting every modern sanitarian in charge of a city health department, and the decisions that have to

1 Selskar M. Gunn is Assistant Professor of Sanitary Biology and Public Health in the Massachusetts Institute of Technology. Formerly he was bacterologist to the Massachusetts State Board of Health and Health Officer at Orange, N. J.