GENERAL REPORT.

A general review of the progress of State medicine and public hygiene during the past year shows very encouraging results, and presents a very satisfactory outlook for the future. The claims of public hygiene have been more generally recognized by both State and national governments, and more systematic efforts have been made to prevent the introduction and spread of preventable diseases, by measures like the general quarantine act, which includes a well-digested plan for internal quarantine wherever needed. The voluntary sanitary associations that have sprung up all over the land, as the outcome of public necessity in some instances, in others from a recognition of the great benefits to be derived from such concerted action, are an exceedingly interesting feature in the development of sanitary science. The work that they have accomplished in many instances furnishes repeated demonstrations of the power of sanitary measures in preventing epidemic diseases, were such needed. The sanitary council of the Mississippi valley and the auxiliary sanitary association of New Orleans are examples of the first order. Not less valuable, in their respective fields, are the voluntary associations of those that realize the necessity and importance of sanitary work, and are interested in the rapid developments of its scientific aspects. The sanitary associations of Lynn and Newport are examples of this order. An illustration of the important work accomplished by such societies, is given by the recent examination of the water of the different wells in Newport, showing conclusively that almost invariably it was unfit for drinking purposes, being loaded with organic matter, that is, with the products of decay of animal and vegetable substances. The recent ill-health of many of the inhabitants is perhaps thus accounted for. It is seldom considered that a well drains the surface around it often from an area whose diameter is three times the depth of the well, depending upon the nature of the soil and geological formation.

Few wells reach in reality what is called a spring, that is, water collected from a higher level, which thus finds an outlet, but most wells are mere shallow pits, depending entirely upon surface drainage. In a new, sparsely settled country, where the ground receives but little contamination, the water is good enough, unless the well is placed, as is very often the case, too near a privy vault or cesspool. But as the population increases, as a matter of course the amount of filth increases, the soil becomes more or less saturated, and the water of the wells polluted. The time will indeed come when, as in many places in the old world, the garbage and filth of towns and villages will be at least once a day removed, instead of being stored up to pollute earth, air, and water. There is no greater nuisance than this storage of the accumulated filth of years, until the ground is honey-combed with covered pits of corruption. It has been conclusively shown that the germs of disease thus buried retain their vitality for years, and if brought to the surface, or carried into drinking water, are capable of again reproducing the original disease. This is especially true of typhoid fever, as it is now generally conceded that the germs of this disease are actively produced in the body during the continuance of the fever, and are thrown off by the excretions. The formation of these voluntary sanitary associations in cities and towns cannot be too strongly urged. The rural improvement societies might add this department to their work without another separate organization. Although the desirability of shade trees in proper places is cheerfully admitted, the free use of the axe would in very many cases be the first recommendation of the sanitarian. Where trees shut out the sunlight from the house, and are so near it as to induce decay of the outer wood-work from the dampness they cause, they are unmitigated nuisances; and when the shade. is so dense as to exclude the sunlight from the ground, they are so no less. The rays of the sun bring light, heat, and chemical or actinic power, and so are great purifiers.

The past year has also witnessed a great activity in the organization of local boards of health in the country generally, as well as in our own State. The State Board of Health has had more applications for counsel and advice during the past year than previously since its organization. One cause, it is true, has been the appearance of small-pox in many places, but apart from this the interest, zeal, and activity of local Boards has been very marked, contrasted with their former apathy and indifference.

Some have appointed health officers, usually selecting some physician interested in sanitary work, and others have delegated their powers to a more compact committee, of three usually, who report occasionally to the full Board. The progress in this direction has been very encouraging and commendable, and the outlook for the future is promising of better results. One by one towns try the effect of extensive drainage. A fuller account of the action of New Milford in this direction is given elsewhere. Of course it is too soon to expect results as yet, but nevertheless there has been a steady decline in the frequency of malarial diseases.

The progress of State medicine in other States has been exceedingly gratifying, the increased powers given to several State Boards of Health, and the active work of several of the new boards, as that of New York State for instance, is another illustra tion of progress. The action of several State medical societies entirely unsought on the part of the respective State Boards of Health is an indication of how State medicine is regarded by the medical profession generally, as in West Virginia, where the medical society voluntarily contributed a large sum, to increase the appropriation by the State which they regarded as too small; similar action was reported from one or two other States at the last session of the American Public Health Association. The legislature of Minnesota has followed the lead of Michigan and voluntarily increased the salary of the secretary of the State Board of Health, so that he can devote his chief energies to the work.

The cordial endorsement by our own State medical societies of the work of the State Board of Health was exceedingly gratifying. Similar action was taken in all States having State Boards of Health, and the desirability of such an organization was as emphatically asserted in others where the State legislatures have not seen fit as yet to create such boards. Indeed, the universal and emphatic official action of every State medical society in this country is in favor of State Boards of Health, and that very emphatically. It is true that from various motives here and there individuals, even physicians, have virulently attacked such organizations, and have not hesitated to impute unworthy motives, and to decry and belittle their work. But the outspoken verdict of the profession generally throughout this country is in favor of such boards, and against their maligners. It is not expected that no mistakes will be made, nor is just criticism unwelcome. The field is a large one, the problems presented would tax the brain of the

wisest philosopher that ever lived, and an honest, earnest endeavor after the right clue in a most entangling labyrinth is too often the only course open. Sanitary science as a science, is new and generally but little understood. Considering the time of its development, the achievements have been most rapid and wonderful.

It is also gratifying to announce that several States have created State Boards of Health since our last report was issued. West Virginia, Indiana, Arkansas, and New Hampshire have wheeled into line. There are now twenty-seven State Boards of Health, seven of which have been created within the last two years; and in other States the movement for the establishment of such board, is well under way. At the present rate, in a few years every State will have its Board of Health; the progress in this direction in the last few years has indeed been exceedingly rapid. There is, too, a singular misconception or misstatement of the claims of sanitary science. Its principles are clear and involve no other than rational processes. It is a fact too plain to require demonstration, that a large percentage of sickness and death is preventable,—not all, as some of its enemies imply, but a large portion, it is against this that the warfare is waged, and to diminish this percentage is the work of the sanitarian.

There are two elements in the problem: heredity and environ. ment. The personal element is included in the first. Oftentimes a lovely character is developed from two vile parents, so perfect health is sometimes found among the most squalid filth—but in neither case is this the rule. In the fight against preventable sickness and death, when the medium by which disease is conveyed is known, as in the case of typhoid fever, the problem is very much simplified, as our efforts can be directed against the cause. In contagious diseases the problem is again complicated, as we have to contend against those causes that produce the disease de novo, and its introduction and spread by contagion. This is often overlooked in explaining the phenomena of disease. Again, the virus of the disease may be exhaled into the air, or if the case be very malignant, the virus or germs may acquire an intenser activity and exert their influence through unusual distances; all these elements complicate the problem. Still the degree of success obtained in the face of all discouragements is so great that our efforts are more than repaid.

In other instances the endeavor is to remove causes that are somewhat general or universal, and agencies that are obscure,

whose action is more or less theoretical, where the effects produced are the only criteria of action; that is, by the removal of certain materials the general health and longevity is increased, and by their continuance the reverse effect is produced, as in the contest against filth. It is right here that the most common misconceptions arise. Because of our earnest crusade against filth it is often asserted and oftener implied that to the sanitarian the only requisite for the production of disease is filth. This is an error. The fight against filth-using the term in its sanitary sense-is so bitter because experience has shown that it furnishes an essential element for the origin and development of the germs of disease, and the best medium for their dissemination. As these germs of disease have by some been considered as the very quintessence of filth, the confusion may have thus arisen. It is true there are those that hold that germs of disease are produced directly from filth either developed as such at first, or that the organisms inseperably connected with the processes of decay, and developed thereby may be still farther changed into poisonous germs. Others claim that the comparatively inert germs excite a simple inflammation, and in the processes of this inflammation virulent germs are developed.

There is, however, a pretty universal agreement that filth alone does not produce disease except through the intervention of a germ or virus. Here two classes branch; the one holding that the germ of disease must be introduced from without somewhere. No one knows whence these wandering germs come, or by what agency they are brought in at the proper moment. The other, as before stated, believing that under proper circumstances the germs of disease are directly, or indirectly, produced from fiith. There are, of course, those that deny any causative relation of filth to disease. In whichever way the virus or germs of disease originate, it is almost mathematically demonstrated that filth is a link in the chain, and an essential one; removing that, we have then the element of contagion to combat. This, of course, relates to those diseases comprehensively called filth diseases, that is, so far as causation is concerned; but an additional incentive to the removal of filth is the depressing and unfavorable influence exerted upon all types of disease and upon health generally. In fine, then, we fight against filth, because it is a foe to health and life. What its specific action is may be, and no doubt is, an exceedingly interest