Public Health Association. On April 18, 1872, was held the primary meeting whence has sprung the very important associ- Public Health ation entitled the American Public Health Association. Association. Its first meeting was held in New York, Sept. 13, 1872. Three have been held annually since; viz., at Cincinnati, Baltimore, and Boston. The volumes containing the records of its reports and papers are very valuable, as showing opinions on various sanitary questions; i.e., on the mode of transmission and prevention of various diseases, quarantine, &c., longevity, hospital hygiene, climatology, sanitary architecture and administration, water-supply, &c.1 American Medical Association. Among the more strictly professional institutions which have had some weight in helping forAmerican ward the cause of State Preventive Medicine Medical Association. may be named the American Medical Association. In 1847 this Association was instituted; and, from its inception, it has almost annually published papers relating to epidemics, climatology, &c. Still more recently, definite efforts have been made by its members in furtherance of Preventive Medicine. The intermingling of men from all quarters of the Union, at its annual meeting, has also contributed to the same end. But it must be confessed that, judging from the numbers usually attendant on the section devoted to that subject, Public Hygiene seems to afford less interest to the profession than almost any other topic. 1 Reports and Papers presented at the meetings of the American Public Health Association, in the years 1873, 1874, 1875. New York: Hurd & Houghton. Riverside Press, Cambridge, 1875–76. than for cen Public Interest in Sanitary Work. Notwithstanding the apparent indifference at times still displayed by our profession and by the public at large in reference to Public Hygiene, I may safely assert that during the past three or four years there has sprung up, wherever European civilization holds sway, a thoughtfulness about the necessity and value of hygienic measures. Almost all persons in their various spheres have become more accessible to the protests of the sanitarian. Still further, I think it may be said with truth that during this last epoch, short as it is, More sanitary more practical work has been done among the work lately people tending to crush out disease and preturies. vent its appearance, and more valuable papers have been written illustrating the subject of public hygiene, the world over, than since the opening of the Christian era. Among the subjects discussed in all societies, and in the public journals which all classes of people read, sanitary discussion seems to interest many persons as much as the pages of the novel attract others. A physician said to me the other day, "There seems to be arising among the citizens a kind of panic relative to the drains of their own houses, and they have a great horror of the least odor of sewer gases." I take courage from the remark. The workers are all around us. A popular writer sits beside the "Autocrat of societies dis- the Breakfast Table," and discusses sewerage in the "Atlantic Monthly" with infinite gusto, and apparently to the satisfaction of all readers of this popular monthly. In every State there are active and earnest co-laborers. It would be impossible to name them all. Some of the States, in their corporate capacity, have sustained these laborers for the pub Journals and cuss them. lic weal. But I regret to say that a large majority of the States and Territories of this Union are not as yet sufficiently enlightened to appreciate the duty devolving upon them, to be careful of the health of their people. With these preliminary statements, I pass to the present status of the country on this important subject. THE PRESENT CONDITION OF STATE PREVENTIVE MEDICINE IN THE VARIOUS STATES, TERRITORIES, AND THE NATION. Circulars to Some months ago I sent out a circular, containing several questions bearing upon the above subject, and tending to elucidate it quite as far States and I thought as I could do so, with the means at my command. Territories. Doubtless, to a critical eye, many imperfections and omissions will be observed in the small number, the character, and relevancy of the questions proposed. I thought a few interrogatories, all or most of them answered, even mono-syllabically, from all quarters of the country, would enable me to get at least a glance at the present condition of Public Hygiene and Preventive Medicine better than a larger number, or even a few, requiring elaborate replies, very many of which, I was satisfied, from my experience in similar undertakings, would not be answered at all, if much labor were required of my correspondents. The paper was sent to two hundred and sixty-three2 medical men living in the 1 See Appendix I. 2 The main propositions of my circular came before twenty-one more individuals, who answered more or less in detail; making the whole number two hundred and eighty-four instead of two hundred and sixtythree, as mentioned in the text. thirty-eight States, nine Territories, and the District of Columbia, making, in all, forty-eight different governments. These embrace an area of twenty-five degrees of latitude, — viz., from Maine to Florida, - and fifty-seven of longitude; spanning, in fact, the continent, from the Atlantic to the Pacific Oceans. In the South, some lie almost within the tropics; while, in the North, others are close to the coldest inhabited regions of the earth. Of the character and ability of these correspondents, I would remark that I endeavored to select the ablest I could get; as far as possible, those known or supposed to be interested in Character of my correspondents. Public Hygiene, -representative men, in fact, in the various States and Territories. I may not always have succeeded in my effort, and may have omitted many, who would have been willing and most valuable correspondents. But I trust that you will admit that their various reports will, together, constitute as full and as accurate an account of the whole matter as it is possible for any one man, without governmental influence, to obtain; that is, so far as my questions cover the object sought for. Replies have been obtained from one hundred and seventy-nine correspondents, many of whom have not been satisfied by mono-syllabically answering each question. Some have entered cordially, and oftentimes very fully, into detail. Many of these details will be found in the Appendix II. The writers are residents in all the various States and Territories, except Alaska, our newly acquired Russian territory in the North, and the socalled Indian Territory in the South, just north of Texas. The former, we know, is chiefly occupied by Indians. The latter, as its name indicates, is really "an unorganized portion of the Replies from every State and Territory. Except the 66 United States." It contains an immense congregation of Indians of the various tribes, collected there, and living separately, each according to its own method, under the protection of the Union; some, like the Camanches, being still in a wild state, while others, as the Cherokees, are comparatively civilized.1 ANALYSIS OF CORRESPONDENCE. FIRST QUESTION. Does your State, by its Legislation, show a Due Appreciation of the Duty devolving upon a State to be careful of the Health of its People? I considered this an important, nay, a fundamental, question. That it would cause unpleasant feelings in the minds of most of my correspondents, when called upon to answer it truly and categorically, I was well aware, because I believed that few could Correspondreply affirmatively. The loyalty to truth ents loyal to truth. evinced by them, even while oftentimes regretting to be obliged to write what seems derogatory to the character of their native States, has been most honorable. It evinces, likewise, their interest in the cause we all now have at heart. It enhances a hundred-fold the value of their courtesy to me. The answers to the question are as follows, viz.: 1 Vide Appleton's New American Cyclopædia, 1874. 2 Under each question, I shall give similar returns for the forty-eight States and Territories of which this Union is composed. The terms |