drug laws of the Federal Government and may not conflict with the requirements of the latter. In McDermott v. Wisconsin, 228 U. S. 115; 1913, the State claimed that its regulations governing the wholesale and retail sale of goods and the labels which must be placed upon them were valid, even when they did not coincide with the Federal regulation. It was claimed that while Congress had the control of interstate trade and original packages, this control did not extend to the goods after the original package was broken, and the products displayed for sale at retail. The Supreme Court, however, upheld the Federal regulation and declared that the State rules for labelling were invalid when they conflicted with the former. The power of Congress to prevent the circulation in interstate trade of goods which were misbranded or injurious, was complete and absolute. The very purpose for which it was exerted would be defeated if a State could make other and different rules for the labelling of the packages. The purpose of Congress was to protect the consumer. Only the retail package and its label came under the consumer's eye. In order to make the Federal protection effective the method of labelling prescribed by Congress must be carried out, even on the retail package. This decision, while it establishes the supremacy of Federal regulation over articles brought in from other States, in no wise interferes with the proper authority of the State to control local manufacturers. Nor does it relax the standard of regulation since the Federal laws are far above the average standard of State legislation on this subject.

Pure Food Laws.-The second class of laws, those directed towards the suppression of harmful adulterants and preservatives, is more important. The extension of the vegetable and fruit canning industries has been in the main beneficial but has brought with it the wholesale use of certain conserving compounds which are considered harmful by medical authorities. The use of these drugs, notably salicylic and boric acid, is now forbidden by several of the commonwealths, as are also certain coloring extracts because of their injurious effects.

The executive force employed to administer these laws is organized under various authorities in different States. In Massachusetts the State Board of Health has been chosen, in Pennsylvania the Dairy and Food Commissioner of the Agricultural Department, in New York the Commissioner of Agriculture, in Illinois a special Food Department under its own Commissioner, with an additional Commission which fixes food standards. At the office of the central authority, in each case, there are located the necessary chemical laboratories, with a staff of expert analytical chemists, for the purpose of testing all products suspected of being manufactured or sold in violation of the law. In addition, a corps of inspectors is employed to traverse different sections of the State, particularly the manufacturing districts, and secure samples of food for analysis. These inspectors, acting as ordinary customers,

purchase from wholesalers or retailers the products towards which suspicion has been directed. The products are then carefully labelled and shipped to the State laboratories and tested, the results are notified to the inspectors and in case the law has been violated a criminal prosecution is commenced against the offending merchants and manufacturers.

The heads of the State food bureaus and of the national bureau have formed a league known as the Association of State and National Food and Dairy Departments. They hold an annual meeting which has become a clearing house for the exchange of experiences and improved methods. At this meeting the results of chemical analyses are talked over, new forms of adulteration are brought to notice, proposed changes in national and State laws are considered and the ever-present problem of cheap substitutes is viewed from the practical standpoint of the administrator.

Three important obstacles are encountered in the struggle for a firm administration of the law. The first is the difficulty of securing direct evidence against manufacturers. The purchase of a package of adulterated food stamped or marked with the name of the manufacturer is not conclusive legal proof that he is guilty of such adulteration. On the other hand, the dealers will not voluntarily testify that the manufacturer produces adulterated articles. It has therefore been found necessary to prosecute the dealer first, and after obtaining a conviction, proceed against the manufacturer. This is especially true also of bottled soft drinks which are extensively adulterated. A second difficulty is presented by the large profits gained by adulteration. In oleomargarine for example, the manufacturing interests have naturally aided in the defence of retail dealers when the latter were prosecuted for violation of the law, and have quite frequently paid the fines of dealers who were convicted. The prosecution of food frauds must be carried on carefully, with the utmost vigor and upon a large scale, in order to make violations of the law unprofitable.

Finally in certain manufacturing sections the support given the administration by the people themselves is only lukewarm. The ever-present demand for cheap food has already been mentioned; among the foreign-born population the lower standard of diet makes this a strong factor. In manufacturing districts like Massachusetts and Western Pennsylvania large numbers of the people prefer adulterated products on account of the price. In some sections it is even difficult to secure the conviction of offenders, in a jury trial, because of the popular demand for adulterated foods or food substitutes. None of these obstacles has proved insuperable, however, and both the standard of law making and the execution of the laws have steadily risen in the last few years. The prominence given to the pure food crusade has been enhanced by the general revival of interest in matters of both individual and public health. How widespread and genuinely national is the question of food

standards, may be seen from the fact that each new improvement in one State rapidly spreads to the others, that thirty-five States have already adopted the National Food and Drugs Act of 1906 in their legislation, that the State commissioners support each other with eagerness, and that each is constantly urged to renewed activity by pure food associations, local clubs and societies and even pure food journals, of which several have already sprung into existence. We are in the full flood tide of a national movement which promises to subside only after the entire food standards of the country have been permanently lifted to a higher level. The State might well extend its work in two different directions, first a further and more rigid suppression of dishonest practices, especially by the plainer marking of ingredients upon each package, and by a large increase in the inspecting force so that many provisions of the law which are now dormant might be strictly enforced; and second, the State might help the people by showing the amount and kind of nourishment contained in various classes of foods; it should conduct a general chemical study of food products or it should encourage such studies in University laboratories; above all it should publish and distribute a series of free pamphlets showing in a popular style the practical results of these studies. With every increase in the demand for cheap food and with every rise in food prices the importance of State action along this line becomes plainer.1

(c) The Tuberculosis Campaign. It is in the fight against the chief cause of death that the State's usefulness shows the greatest possibilities. Consumption is curable and preventable. In both cure and prevention it is peculiarly subject to environment. The efforts of medical experts are accordingly aimed to cure those already afflicted by placing them in open air camps and sanatoria, and if this is impossible, then by inducing them to change their diet to simple flesh-producing foods and securing as much fresh air as they can; while to prevent the spread of the disease the specialists urge the separation of those who have it, wherever possible, and the most widespread, universal dissemination of knowledge as to ventilation, exercise, foods and cleanliness. This maps out the work of the State. By a combination with the public forestry reserves there have been established State camps where at a low charge patients may take the out-door cure for several months, while for those who are unable to leave their own localities special hospitals, dispensaries and educational measures are provided. Many State and city boards of health issue pamphlets of instruction free to the people and furnish to the newspapers material which is spread broadcast, so that a constant agitation among all classes is beginning to produce its results in the local mortality tables. But the greatest work remains to be done; emi

1 Some of the States regulate cold storage by requiring that food products must not be so kept for longer than a fixed period, and must be marked when offered for sale.

nent workers in the campaign are convinced that unless some specific medical cure is found for the malady, it would pay the State to offer free treatment in a large series of mountain and highland camps and to defray the cost of transportation to and from these camps for those who are unable to do so. By no other means can the ravages of this persistent and insidious disease be completely rooted out.

(d) The Powers of the State Board.-Two widely differing solutions of this general problem have been evolved; the first or early Massachusetts plan is to make the central State board chiefly a bureau of information for the education of the people at large and for the assistance and encouragement of the local boards; under this system the State board has no control over the local bodies and its only direct executive powers of importance lie in the suppression of epidemics, care of the water supply and the food laws. The reasons for this are so typical of the whole Massachusetts plan of administration as to deserve comment. The fundamental idea is to spread information and then rely upon the natural capacity of the people and of the local bodies to adopt the results of the investigations made by the central board. The latter issues popular leaflets, circulars and reports, and acts generally as a clearing house for information desired by officials or individuals. Public health requires a continuous campaign of advertisement and education in order to insure a strong, active and enlightened popular opinion. While this is true of all branches of administration in a democracy, it applies with special force to sanitation because of the rapid scientific advances which are being made in hygiene and medicine. Another cause has favored an informative, educational, rather than a strong executive authority; the Massachusetts board was the first in the United States, it was called forth by a series of violent epidemics of contagious disease which raged over the country in the late sixties of the last century. These virulent outbreaks caused such great loss of life that public attention was centered upon the problem and the State board of 1869 was established, largely as an emergency measure to cope with the situation. But when the emergency had passed it was not considered necessary to confer upon the central board any authority over the local officials and the State board to this day therefore possesses little control except in case of epidemic or similar crisis.

The Indiana Plan.-With the passage of time it has transpired that the original Massachusetts system does not meet the conditions of other States. It frequently occurs that the local township and city boards are, to put it mildly, not qualified for their work. In some cases where dangerous diseases were in question, a policy of concealment has been followed, out of a mistaken idea of local patriotism and the protection of local business interests. In others the measures prescribed by the State board to combat epidemics have not been followed or have been wilfully opposed and defeated, while often the returns of vital statistics which should be made by

the local to the central board, have been omitted for no apparent reason whatever. The local bodies have been able to defy the central authority in this way because of their complete legal independence and the lamentable weakness of the State board. To cope with this situation the State of Indiana, by its health laws of 1899 and succeeding years, explicitly provided that the local bodies, besides the usual functions mentioned in the law, shall "perform such other duties as may from time to time be required of them by the State Board of Health, pertaining to the health of the people." It is further provided that the local boards shall appoint executive health officers and, in order to establish firmly the authority of the central board of the State over these local officials, it is provided that, "The State Board of Health shall have power to remove at any time, any county, city or town health officer for intemperance, failure to collect vital statistics, obey rules and by-laws, keep records, make reports or answer letters of inquiry of said State board concerning the health of the people." Another section provides that, "The State Board of Health shall have supervision of the system of registration of births, deaths, and marriages." By these three important sections of the law the central board is placed in firm control of the sanitary administration of the entire State. Nor has this power been regarded as merely nominal; the board has exercised its full prerogatives and its activity has been welcomed by the local boards in many cases, because the latter have thereby been relieved of responsibility in matters which had become involved in political agitation or dispute. Indiana has also adopted the plan in vogue in some other States of holding an annual conference of all the local health officers for the exchange of ideas and for instruction in the latest advances in public hygiene. This conference lasts for two days, and is held in June for the officers from counties, cities and large towns and in December for those from smaller towns. Attendance is compulsory and the expenses of officers are paid by the localities. The Indiana plan of establishing a more adequate control by the central over the local authorities has thus far proved successful and seems well adapted to the needs of most of the States.

How Shall the Central Authority be Organized?-Much of the effectiveness of health administration has been lost because most of the States have adopted the board plan. In New York, instead of a board, there is a Department presided over by a single Commissioner of Health who must be a physician of at least ten years' actual practice, appointed by the Governor. Under his direction are the Secretary, Medical Expert, Registrar of Vital Statistics, Director of the Bureau of Pathology and Bacteriology, Director of Chemistry, Director of Cancer Laboratory, Consulting Engineer, Consulting Ophthalmologist, Director of Anti-Toxin Laboratory, etc. The powers of the Commissioner are to make inquiries and investigations concerning causes of disease, especially epidemics,