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chew tobacco during school hours-the blue gums and lips of the tobacco-chewer are frequently seen among the little tots.

There has never been any intelligent public attempt to educate the illiterate adult, and in North Carolina, South Carolina, and Georgia about twenty-one out of every hundred people can neither read nor write, while in Iowa there are fewer than two illiterates to the hundred. (These figures are for individuals ten years of age and upward.) Consider, too, that the population is practically entirely native-born, Americans for generations. In the same period of time the State of Washington received 13,093 immigrants, while South Carolina, of greater population, received 132. (The figures are for the year ending June 30, 1915.)

To reach these illiterate adults night schools were established in many of the villages on two nights in every week, the mill owners making up the expense of tuition out of their own pockets. Liberal prizes were provided also for the greatest progress among men and women in reading, writing, and arithmetic; and every encouragement was afforded the grown people to take advantage of the opportunity offered.

THE “T. I. I." PLAN

It

With the realization of this desperate need for adult education came the question of providing some system by which education might be made attractive and attainable. was manifestly absurd to expect that grown men and women would enter the graded schools and undertake the mastery of their A B C's in company with children in pinafores, even had they the means to do so.

But with a happy spontaneity there came the project of the Textile Industrial Institute, the idea of a Methodist parson who was conversant with mill village conditions.

He suggested that it would be possible to provide a school which the mill operative, of whatever age, might attend every other week. In alternate weeks his labor in the mill could provide the small amount of money necessary for his board in the school, tuition and all other expense to be provided for by public contribution.

The theory was put into effect, and five years ago the Institute began. As the enrollment grew, public interest awakened; the people of Spartanburg, South Carolina, got behind the work, and a fine stone building was erected on the rolling plains of the Pied

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mont just outside the town. One hundred and twenty men and women, averaging twentytwo years of age, were enrolled this year, and the single building is almost outgrown.

For a week these men and women, many of whom are just learning to read and write, work in the mill near by, sleeping and eating in the Institute. Then for a week they devote themselves entirely to study.

Youngsters of fifteen to whom the Institute offers the only opportunity of securing an education while earning a living, and mature men who have risen to the rank of overseer only to see further progress blocked by lack of education, are in classes together studying multiplication and the "Fourth Reader." Women whose years of toil at the loomsseveral of the girls of the Institute entered the mill when seven or eight years old--have made the future seem hopeless are preparing themselves for teaching, missionary work, or marriage, upon a higher plane than they could ever have known.

WHAT A MILL GIRL BELIEVES

And, after all, education and marriage are not incompatible, are they? Irma Wade thinks not, though previous to entering the mill at the age of eleven she had had but three years' elementary schooling. She has been in the mill thirteen years, and expects to stay in the mill; but every other week she is able to study at the Institute.

She writes:

Many of the mill girls marry at an early age, and become the wives and mothers of our mill villages. Having spent most of their lives earning their living, they have had little time to learn the business of home-making. Many homes are made unhappy because the wife does not know how to spend and take care of the husband's hard-earned money. He becomes discouraged and has little heart to try. . . The mill girls of to-day need an education because they are to be the mothers of our next generation. If the mother is narrow and has low ideals, her children are more than likely to be like her. If she is uneducated, she will not try to educate her children.

The Textile Industrial Institute is an experiment. So far it has prospered and has done on a small scale a great amount of good. It is only one school; but that there is one is a significant sign.

So far this has been a story of work-of work under more happy conditions than the past knew, but still of a hard, toilsome grind. Men, women, and children labor with their

hands, are learning to labor with their heads. But of play, of the enjoyment of leisure, of sheer careless happiness, they have known little or nothing.

"They uns sets on the steps an' whittles," says the mill father who is careful of the upbringing of his four small boys. "No, ma'am, they don't run in the street." And that was all of healthy amusement these children or thousands of others ever knew until there appeared in the streets of a certain mill village a young stranger from Connecticut.

A RED-HEADED YANKEE GIRL

She was not the first of the community. workers to come to the South. She was in no way a pioneer. But in her own community she was typical, and may well serve as an illustration.

"A red-headed Yankee girl," they called her; slight, timid, and quite unused to the ways of the South, and homesick. "Why, when I went to see The Birth of a Nation,' she says, "and General Grant came on the screen, I just had to clap, though I did it 'way down in my lap where nobody could hear me."

But, in a strange environment as she was, she realized that she had a real opportunity to make good, and set about her task sturdily. Of course she was in a "good" mill, for the mill-owners who are willing to back community and welfare work and to pay the salaries of the professional workers are more than casually interested in their operatives. The chief difficulty that confronted the redheaded Yankee girl was, therefore, not in getting such improvements made as she wished made, but in getting the people of the village to take advantage of their chance.

To this end she set about learning the names of the seven hundred odd people living in the village, so that she might approach them on terms of friendship. That in itself was no easy task, and before it had been accomplished the community building which the owner had caused to be built was ready for occupancy. The first floor of this building was given over to the use of the regular district school; about a quarter of the second floor served as a lodge-room for the men, and the remainder was divided into a big common room, library and reading-room, and kitchen. About the building a large tract was reserved for the planting of a demonstration garden, each youngster having his own plot where he may experiment under

the eyes of the girl, whose training, incidentally, extends to the rudiments of farming.

Cooking, sewing, home sanitation, are now taught daily in the community house; the children are initiated into the mysteries of the almost unknown toothbrush and are shown the value of regular bathing. The little tots are told stories and are taught how to play simple games.

On Saturday nights the common room is thrown open to the whole village, and the fact that it is no uncommon sight to see a hundred grown men and women playing "cat and rat" or "Who's got the button?" is sufficient indication of the eagerness with which the people have "caught on."

Back of the community house a large space has been cleared and leveled'Only a red-headed Yankee girl could get houses moved to make space for playgrounds," says the Methodist minister-and already several swings, giant strides, and two tennis courts are installed. Basketball has become popular among the men, and the Girl herself, at the cost of numerous bumps and bruises, showed the mill boys the excitement of field hockey. The girls too have their volley ball, and have even gone so far as to adopt bloomers,

But one of the most interesting occasions perhaps was the staging of a "better babies" contest. Sixty children under five years of age were examined according to the standard table of the American Medical Association. Of these nine made a score of over ninety-nine per cent. One of these children was the son of the superintendent, the other eight were the children of ordinary operatives. And both of the two children making the highest score were born of fathers and mothers who had worked in the mill since childhood.

Still more remarkable is the fact that the mothers of both prize babies had suffered with pellagra and had been cured.

So much for the "other side of the cotton mill," the side that is not seen save by him who lives with the people of the cotton mill.

From a dozen investigations I draw the conclusion that the insanitary, desolate, cheerless mill village is already the exception. Illiteracy is rapidly on the decrease. In few States may a child under fourteen be employed. Tuberculosis, typhoid, and pellagra are fast disappearing.

Is the cotton mill, then, so black? Or are conditions that were once a serious social menace solving themselves?

T

HE complete disappearance of teeth from the human mouth is the condition towards which the most highly cultivated classes of humanity are drifting. We have already gone far on a course that leads to the coming of a toothless age in future generations. Only by the immediate adoption of the most active and widespread measures of prevention can the human tooth be saved from the fate that has befallen the leg of the whale.

Posterity may be saved from the necessity of falling back on a diet of liquids and tabloid foods if we to-day recognize the fact that the welfare of the teeth depends largely on the welfare of the body as a whole, and that, conversely, the welfare of the whole body depends largely on the welfare of the teeth.

Happily, the medical profession has at last come to realize that the field of dentistry is not isolated or independent, but touches at many points the field of general medicine and surgery. It has been found imperative for physicians and surgeons to possess at least a theoretic knowledge of disease-breeding conditions met with in the teeth and jaws, but it is even more important for the dentist to appreciate the close relationship between his profession and that of the physician, surgeon, bacteriologist, chemist, and public health official.

In all of the larger dental colleges a thorough training in bacteriology is now required. of the candidate for a degree. He must also take other courses formerly regarded as essential only to the professional equipment of physicians. Gradually dentists are beginning to have a just appreciation of the relation of morbid conditions met with in the mouth to that of abnormal conditions in other parts of the body. Thus, by mutual co-operation between the dentist and the medical practitioner, real progress is being made in the diagnosis and treatment of a number of heretofore obscure maladies which have their origin in the teeth.

For some time now we have known that civilized man's teeth were deteriorating, despite his efforts to care for these important organs, although primitive man and the lower animals continue to enjoy good teeth without any conscious effort on their part to care for

their dental equipments. We have also come to know that many conditions, tendencies, and habits of modern life are responsible for this racial degeneration. Among such causes are the artificial feeding of infants; the prevalence of chronic nasal obstruction in the young by adenoids and enlarged tonsils, causing mouth breathing, which in turn produces constantly dry, and therefore unhealthy.gums; an improperly balanced dietary, which contains an undue proportion of soft and partly digested food, thereby eliminating the healthful necessity for thorough mastication; and the bolting of food which should be thoroughly chewed for its complete digestion.

TWO INSIDIOUS DISEASES

Only very recently have we begun to appreciate the very serious danger to the health, and even to life itself; which lurks in bad teeth. Two diseases of the teeth in particular have been engaging the especial attention of bacteriologists, dentists, and physicians during the past few years, because they have learned that these two maladies frequently undermine the general health and even endanger the lives of persons afflicted.

These are Riggs's disease (pyorrhoea alveolaris) and root abscess.

The first stage of Riggs's disease is characterized by a weakening of the resistance to infection, and later by a retraction of the gums. These changes are caused by constitutional conditions which have not yet been definitely determined, although there seems to be some reason for believing that one of the causative factors may be gout. Where there is a deposit of tartar along the gum margins, it must unquestionably be held responsible as a local contributing cause. The rich blood, lymph, and nerve supply of the healthy teeth and gums serves as a strong protection against the entrance into the tissues of disease germs; a weakening of the gums by disease turns what has been a source of protection into a menace to the general health.

When the bacteria have entered the gums and worked down between these and the teeth, the delicate structure called the peridental membrane, which attaches the root of the tooth to the socket, is destroyed. Then the tooth becomes loosened in the abscess

cavity thus formed, and from this cavity pus and myriads of bacteria escape into the mouth and are swallowed or are taken up by the neighboring tissues.

As a result of much study, it was announced a few years ago that the cause of Riggs's disease had been discovered to be endamæbæ — a low form of animal organisms found quite generally in small numbers in the human mouth, but in very large numbers about diseased gums.

Later the theory was advanced

that the endamæbe fed on the great host of bacteria by which they were surrounded, and by digesting those set free certain poisons from the bodies of the bacteria which, taken into the circulatory system, produced symptoms of illness with which Riggs's disease has been observed to be associated. The truth of this interesting theory remains to be established, as well as the actual rôle played by the endamabæ in causing Riggs's disease.

Assistant Surgeon John S. Ruoff, of the United States Public Health Service, has recently published a report of the effect of emetin given hypodermatically in combination with local treatment with ipecac used on the toothbrush. Notwithstanding the decided effect of this treatment in driving amabæ from the mouth, he found that the discontinuance of the treatment for a few weeks or months was followed by the reappearance of the amabæ in as great numbers as before, and that, furthermore, there was at no time a marked improvement in the Riggs's disease. He concludes that "emetin is an amoebacide, but alone will not cure pyorrhoea alveolaris.”

To sum up, we know a good deal of the conditions under which this disease flourishes, of the symptoms by which it is marked, and of the effect which it has on the human body, but we have not yet discovered a specific treatment for it.

Root abscess is a specially insidious foe of the teeth, for it is generally well under way before it is discovered. Moreover, it is known to be associated with a very malignant form of blood-poisoning which nearly always proves fatal within a few weeks or months of its inception.

This deadly malady begins with the destruction of the enamel of the teeth. This is followed by the formation of cavities in the teeth, which permit the entrance of various bacteria into the dental canals, where they cause destruction of the tooth pulp and the formation of a focus of infection at the apex of the tooth. There is little or no warning

pain and no external discharge of pus to call attention to it, and it is only by the modern means of the use of the X-ray in diagnosis that the general prevalence of this condition has come to be recognized.

The organisms which are most frequently the cause of general blood-poisoning are called Streptococci. Dr. Thomas B. Hartzell, of the University of Minnesota, has made cultures from 162 cases of abscess of the root, and found Streptococci in 150 cases. Other observers have obtained similar results. The Streptococcus viridans, which is the one found in the blood of patients suffering from malignant heart disease, is that one most frequently found in cases of root abscess.

THE TEETH AS A SOURCE OF GENERAL
DISEASE

In the old days dentists resorted to the extraction forceps as an infallible cure for all ailments of the teeth, and doubtless many teeth which might have been saved were ruthlessly sacrificed. To-day forceps have been largely relegated to the scrap-heap. Moreover, the up-to-date dentist is alive to the dangers of bridges and caps, which are often but ornamental coverings of imperfectly filled and unsterilized cavities, containing millions of bacteria whose poisonous products are being constantly absorbed or which are themselves actually migrating throughout the body and setting up distant foci of disease.

There is little doubt that a good many morbid physical conditions whose starting-points were until recently totally obscure do, in fact, originate in the teeth and surrounding structures. These unhealthy conditions are aggravated and spread by the absorption into the tissues of bacterial products by swallowing or by way of the blood and lymph stream.

It cannot be too strongly emphasized that if a tooth cavity cannot be made sterile and filled to the very bottom no permanent covering of any kind should be placed over it or within it. It is far better to sacrifice a tooth than health and possibly life.

PREVENTING AND CURING DENTAL TROUBLEPUBLIC MEASURES

There is just one moment in your life when your mouth is bacteriologically clean. That is the moment of your birth. During all the remaining years your mouth is a veritable botanic garden of bacteria. Most of these bacteria are harmless. Some are harmless in a healthy mouth, but harmful in varying

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degrees when concentrated in damaged or dead tissues. Some are the well-known germs of the communicable diseases—pneumonia, diphtheria, tuberculosis, and bloodpoisoning.

Within the last few years the public interest in oral hygiene has spread rapidly throughout all enlightened countries. In the United States the progress has been amazing.

New York City, through its Health Department, has taken a leading part in this work, and set an example for other communities to follow. The number of pupils in New York City showing defective teeth was found to be so large, namely, nine children in every ten, that in 1913 the Department of Health decided to direct its energies towards prevention of dental defects rather than cure. For this purpose it now employs a supervising dentist and nine operating dentists in seven clinics, to each of which also a nurse is assigned. Only children from six to eight years are kept under supervision. These all report at the clinics, where the teeth are thoroughly cleaned, defects repaired, and, when absolutely necessary, extractions are made. At six months' intervals throughout their entire school life they are required to return. From time to time they are visited at their homes by the nurse, and taught the proper use of the toothbrush and the importance of clean mouths.

The results have been most encouraging. and it is confidently expected that future generations of school-children will show a much smaller proportion of oral defects than the present generation, which has unfortunately been deprived of this intelligent service.

Other American cities are pursuing the sane kind of dental surveys, inspections, and clinics among the school-children. Among such cities there may be mentioned Los Angeles, California; Philadelphia: Muscatine, Iowa; St. Paul, Minnesota; Boise, Idaho; Cincinnati; Chicago; Taunton, Massachusetts; Hallock, Minnesota; Ann Arbor, Michigan; Kansas City, Missouri; East

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Liverpool, Ohio; Elgin, Illinois; Jerseyville, Illinois; Keokuk, Iowa. Several of these cities have organized a "Toothbrush Week" to stimulate interest in the care of the teeth..

If anything is certain in medicine, it is that clean teeth are safer than dirty ones. The care of the teeth should begin at birth. If the infant cannot be breast-fed, the diet should be supervised by an expert on infant feeding. If cow's milk is pasteurized, fresh orange juice should be given daily, beginning with the third to the sixth month. Thumbsucking should be prohibited; it tends to deform the jaws. Later, if adenoids and enlarged tonsils are suspected, a physician should be consulted as to the advisability of removing them. From the sixth year of life on a dentist should be consulted every six months throughout life.

The habit of using a toothbrush should be acquired as soon as a child can wield it, and the habit should never be abandoned. The teeth should be brushed at least twice a day. Not only the teeth but the gums and the back of the tongue should be cleansed. The usual sawing movement of the brush across the teeth is far less efficacious than a rotary movement directed from the gum downward. A thorough rinsing of the mouth and forcing the water between the teeth is of great importance.

A diet should be adhered to throughout life which requires a good deal of mastication.

The use of fruit acids, especially that of the apple, orange, and grapefruit, tends to clean the teeth and, theoretically at least, prevents the deposit of tartar.

Finally, the sufferer from bad teeth and unhealthy gums should by preference consult those dentists whose reputation is based not merely on manual skill, but primarily on a knowledge and appreciation of the necessity of asepsis (that is to say, surgical cleanliness, or freedom from disease-breeding germs) and the importance of getting rid of sources of infection in the teeth and mouth.