ily traced through various down hill grades, to the alms houses, jails, and penitentiaries. The civil and political aspects of the question, are so intimately involved in the brief considerations above, that they need no separate discussion.

By these statements we find the State a great loser by reason of sickness and death. Suffering financially, suffering socially and morally. The foundations of public and private virtue sapped, its future prosperity and existence endangered. What then? Can anything be done to stay the moral and physical death? The laws of nature are beneficent, rightly observed, but violated, are a two-edged sword. Though absolute, they are not tyrannical, they recognize the sacredness of human life, and the blessedness of human health. The great fear of human mortals should be less the servile fear of human authority and human opinion, and more the fear of Divine authority, as declared and administered through the laws of nature. But when natural laws are recklessly or ignorantly violated by masses of citizens, it is the duty as well as the right of the State to interpose, and while seeking diligently to enlighten its people, should also affix a just penalty for violation of its own laws, enacted for the better observance of the laws of nature. It does seem as if the time has come when the State cannot justifiably withhold its authority in the devising and maintaining of proper measures for the protection of life and health, by instituting such inquiries in regard to the influence of locations, occupations, habits, customs and indulgences, as humanity requires, and by such interference in the removal of causes of sickness and death as common justice demands.

ECONOMY OF EARLY SANITARY ACTION.

The towns of Rhode Island are, with very few exceptions, in process of steady growth in population. Within some of them are conditions limited to small areas which, if allowed to remain, will, at no very distant day, become sources of disease, entailing great pecuniary loss, private and public. In most of them, these sources of future danger can be removed or remedied at very small cost, during these earlier periods of their growth, and thus stamped out, much suffering and expense prevented. But, by reason of delay, may be so hidden by the so-called march of improvement, that their existence is lost sight of and forgotten, until the outburst of some terrible epidemic, reveals the perilous and portentous fact. And also, by reason of delay, some of these fountains of death may become so incorporated

with large pecuniary investments, and thereby acquire the title of "vested rights" of individuals, that, though the right of eminent domain should be unlimited in the interests of public health, there would still remain the probability of costly litigation, and heavy damages. The attention of the general public, under direction of recognized authority, would readily detect many of these future sources of disease, and so be easily and cheaply preëmpted in the interests of humanity and public health.

For the purposes suggested above, of the prevention of disease and the protection of life, and thereby the enhancing of the interests of individuals and the State, it cannot be reasonably denied that

A STATE BOARD OF HEALTH IS NEEDED.

Because there is no other agency to effect the desired objects, or put in operation the desired measures. It is true that all intelligent and well educated physicians are regarded as the established conservators of the public health, and it is their duty to observe and study diseases in all their relations, to collect facts in regard to circumstances surrounding, as well as conditions personal to, and inhering in, the suffering individual, but they cannot, without going outside the daily routine of professional work, and at pecuniary loss, enter upon the wider labor of a comprehensive survey of the entire broad field of morbid phenomena, as affecting a large area of communities. This work, it is the policy as well as the duty of the State to put in operation. The question may be asked, how can a board of health accomplish the desired objects?

BY POPULARIZING A KNOWLEDGE

OF THE MEANS OF AVOIDING

DISEASES.

The dissemination among the masses of the people, of information in regard to the prevention of disease, emanating from acknowledged authority, would without question be respected, and its suggestions be largely observed. Such information, widely diffused, need not necessarily be attended with much expense. Tracts of one, two, or more pages of printed matter, at insignificant cost, can be scattered among the families of the State where they would be of value. Such distribution might be easily accomplished through town superintendents of public schools, and many other agencies. Then again, doubtless, the public press, at intervals, would admit short articles of

a half column or so, without any expense to the State, on the policy of furnishing to its readers matter of public interest and value. In this way great numbers of the people, otherwise ignorant, thoughtless or indifferent, would have their attention effectively called to sources of danger and the means of defence. Notwithstanding the fact, that so many

"Know the right and approve it too,

But know the wrong, and yet the wrong pursue,"

and the known perversity and carelessness, characteristic of human kind, it must be admitted that popular hygienic information and instruction, so diffused, must inevitably largely influence the public mind and perceptibly decrease the percentage of sickness and the death rate. Among the common causes of preventable disease, about which the masses of the people need more positive knowledge, may be mentioned vitiated air, absence of light, morbific emanations from cess-pools, sink drains, decomposing garbage; haze and dusts holding animal, vegetable or inorganic irritants and poisons, special morbid products derived from diseased bodies of men or animals, exhaustion of physical and mental vitality, by too prolonged or excessive labor of body or mind, loss of sleep; violent anger, grief or joy, and long immersion in cold and humid atmospheres. It will be seen that a State board is needed

TO GIVE UNITY OF PURPOSE AND EFFECTIVENESS

to diffusion of sanitary knowledge, and to direct investigation in a systematic manner:

1. The first, and the continued leading object of a State board of health should be (a) the general enlightenment of the people in sanitary knowledge, (b) so that they may have a clear understanding of the rights, duties and responsibilities of all persons in relation to public as well as to personal health; and (c) to perceive the necessity of the earnest observance and enforcement of good sanitary laws and regulations, as the foundation of success, in the promotion of health and longevity.

2. To act as a central board in giving enlightened direction to all labors of a sanitary character, that may be instituted in different sections of the State; first, by suggesting systematic and uniform methods of inquiry and investigation; second, by suggesting the best modes of applying general sanitary laws to special or local circum

stances; and third, by suggesting to local authorities the presumably best means of securing popular support to local sanitary administration; and fourth, by encouragement and promotion of formation of village health clubs, who will look after the performance of the sanitary duties of their respective localities, under the superintendence of the central board.

3. In reference to above remarks, it need hardly be observed that the inference is clear that every person, family, community, town and city, have each certain individual and local, as well as general, duties and responsibilities in regard to the prevention of disease and loss of life, and while more widely spread and general causes of peril to life and health exist, requiring a central sanitary organization, such central organization can most fully accomplish its purpose by giving unity of purpose, counsel and aid to local organizations.

4. Such local organizations, by observation and inquiry, can collect a mass of facts, not otherwise so well attainable. These facts singly, may seem and be of little value; but, reported from many points, over a considerable extent of territory, and under a great variety of circumstances, will, when properly arranged and classified, and subjected to a reasonably inductive method of study, become a valuable basis for generalizations and logical conclusions, and also valuable as affording great aid in the observation and detection of new facts. Sanitary observations must necessarily extend over a considerable territorial area, comprising cities, towns and villages, neither of which alone can furnish all the facts absolutely needed for full generalization. What is true of a city, may not be true of a country town or village, any more in sanitary matters than in morals, habits or customs. Consequently, the jurisdiction of the central board, should comprise supervision, not only of important, but also such as at first thought might be regarded as unimportant localities.

There has been in contemplation, for a number of years, the establishment at the national capital of a national health bureau, or a public health commission for the United States. Such a bureau like the signal service office, must be in regular correspondence with responsible bodies in all the several States; bodies having defined duties and authorities, such as are conferred on State boards of health. time there are three departments of the national government doing all their limited authority will allow, in the way of collecting an accurate knowledge of, and in the restriction and prevention of diseases, mostly of an epidemic character. They are the surgeon general's

bureau of the army, the medical department of the navy, and the marine hospital service. Compared with what might be accomplished by a bureau established for the specific purpose of promoting the national health, their work is very limited. When all the States, or nearly all, (and the time is near at hand, nearly one half already) have established boards of health, then the knowledge acquired in the several States can be utilized by a national board, to the great advantage of the nation. Without question, in a majority of cases, the inception and development of pestilences can be detected at the outset, the course of the epidemics, and the spread of the contagion arrested, and their existence stamped out.

A bill is now pending in the Senate of the United States, having passed the House of Representatives with such unanimity as to give good assurance of its becoming a national statute, to aid State and municipal authorities in excluding from the country contagious and infectious diseases. It requires weekly reports from Consuls of the sanitary condition of foreign ports, and oftener by telegraph if at hand, if needful to announce the departure of suspected vessels or persons, and requires all needful information to be distributed to the local State and municipal authorities, by the Surgeon-General of the Marine Hospital Service. It alludes to State organization of Boards of Health in such a way as to lead to the inevitable inference that the general government expects that State Boards of Health will be soon. universally established throughout the country.

The limited time allotted me forbids a more extended consideration of the subject at the present time; but such suggestions as have been made are simply skirmishing on legitimate ground, for the more the field of sanitary observation, presenting prospective benefits from systematic legal supervision, is surveyed, the wider its borders extend. There is to-day in all the broad world no material agency of any kind whatsoever, that is working out so many, promisingly beneficent results to mankind, as that which is involved in the universal application of the laws of sanitary science. They are demonstrating that health and longevity are the natural inheritance of mankind; that disease is abnormal, and death accidental, except from natural decline of age; and that both are largely preventable by human agencies.

CHARLES H. FISHER,

For the Committee on Executive Communications.