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PROCEEDINGS
QUARTER-CENTENNIAL  CELEBRATION
ESTABLISHMENT
/
MICHIGAN. STATE BOARD OF  HEALTH
DETROIT, MICHIGAN, AUGUST 9,1898.
1873.
1898.
mmsmi wm wmw mmvA
[Supplement to the Annual Report of the Michigan State Board of Health.]





           [Reprint No. 53S ]
40 
VIA
N\U4P
   $<j8
    c. I
NATIONAL LIBRARY OF MEBICINE

 •-  BETHESDA 14, MD. 
MEMBERSHIP  OF  MICHIGAN  STATE  BOARD
                    HEALTH,  1873-1898.
                       Ex-members of the Board.

 Homer Owen Hitchcock, A. M., M. D., Kalamazoo.
    Robert Clark Kedzie, A. M., M. D., Sc. D., Agricultural College.
        Zenas Emory Bliss, M. D., Grand Rapids.
            Rev. Charles Henry Brigham, A. B., Ann_Arbor.
                Henry Francis Lyster, A. M., M.  D./Detroit.
                     Rev. John S. Goodman, Saginaw.

 Arthur Hazlewood, M. D., Grand Rapids.
    Rev. Daniel Cook Jacokes, A. M.,  D. D., Pontiac.
        Hon. LeRoy Parker,  Flint.
            John Harvey Kellogg, M. D., Battle Creek.
                Edwin Atson Strong, A. B., A. M., Grand Rapids.

 Hon. John Avery, M.  D., Greenville.
    Victor C. Vaughan, M.  D., Sc. D., Ph. D., Ann Arbor.
        Columbus V.  Tyler, M. D., Bay City.
            Mason Wilbur Gray, B. S., M. D., Pontiac.
                Hon. George H. Granger, M. D.,  Bay City.

                    Members of the  Board in 1898.

Hon. Frank  Wells, President, Lansing.
    Prof.  Delos Fall, Sc. D., Albion.
        Samuel George Milner, M.  D., Grand Rapids.
            Judge Aaron Vance McAlvay, A. B., LL. B., Manistee.

Fred Rice  Belknap, B. S., M. D., Xiles.
    Frederick George Novy, B. S., Sc.  D., M. D., Ann Arbor.
        Henry Brooks Baker, A. M., M. D.,
                      Secretary and  Executive Officer, Lansing. 
 
CONTENTS.
                                                                          PAGES.
Introduction, Committees, etc_________.....___________________________ 9-10
JNameB of persons registered as present at  sessions________________________10-11
Letters of regret_________.....___________________.....______________    12
Opening Address, by Hon. Prank Wells, president Michigan State Board of Health 13-16
Address of Welcome, by Hon. William 0.  Maybury, Mayor of Detroit_________16-20
Address of Welcome, by Heneage Gibbee, M. D.,  Detroit___________________20-21
A Quarter Century of Sanitary Work,  1873-1898, etc., by A. N.  Bell, M. D„
    Brooklyn, N. Y_________________________________________________22-36
Public-Health Work in Michigan,  by Arthur R. Reynolds, M. D., Health Com-
    missioner, Chicago, 111_____________________________________.....__. 36-41
Sanitary Work Twenty-five Years Ago, by Robert C. Kedzie, M. D., Michigan
    State Agricultural College_______________________________________ 41-46
Educational Work of the Michigan State Board of Health, including the work
    of the  State  Laboratory of Hygiene, by Charles Lindsley, M.  D., professor
    Emeritus  in Yale College________________________________________46-51
State Sanitary Conventions, by Benjamin Lee, A. M.,  M. D,  Ph. D., Secretary
    Pennsylvania State Board of Health---____________________________51-58
Annual Conferences of Local  Health Officers, by C. O. Probst, M. D., Secretary
    Ohio State Board of Health.______________________________________58-62
State Work for the Restriction and Prevention of  Diseases, by John  S. Pulton,
    M. D., Secretary Maryland State Board of Health_____________________62-71
Municipal  Restriction  of  Diseases, by Ernest Wende, M.  D., Health Commis-
    sioner, Buffalo, N. Y______________________.....___________________ 72-82
Address, by Felix Pormento, M. D., New  Orleans, La----------------------83-85
Address, by Hon. LeRoy Parker, Buffalo,  N.  Y....._______________________ 85-87
Letters from Walter Wyroan, M. D.,  Washington, D. C_________.....______    87
Extract from letter from Hon. John Avery, M.  D., Greenville, Mich__________    88
Address, by Peter H. Bryce, M. A.,  M. D., Secretary Provincial  Board  of Health,
    Ontario___________________________________________________.....88-90
Address, by D.E. Salmon, D. V.  M., Washington, D. C---.....____________90-93
Address, by William Bailey, M. D., President State Board of Health,  Louisville,
    Ky__________________________________________________....._____    94
Address, by Cressy L. Wilbur, M. D., Superintendent of Vital Statistics, Lansing,
    Michigan______________________________________________________95-96
Address, by J. N. Hurty, M. D., Secretary Indiana State Board of Health_____96-98
Reception_________________________________________________________    98
After-dinner Speaking...........-------------------------------------    98
Remarks, by Leartus Connor, A. M.,  M. D., Detroit, Michigan--------------    99
Visit to Parke, Davis & Co., and  Ride on Detroit River...:-----------------   i00
Vote of Thanks of State Board of  Health to Local Committees________......   100 
 
QUARTER-CENTENNIAL  CELEBRATION  OF  THE   ESTABLISHMENT   OF

               THE  MICHIGAN  STATE BOARD  OF HEALTH.


       Concurrent Resolutions Adopted by the Michigan Legislature of 1897-

  Whereas, On the thirtieth  day of July,  1898, the Michigan State Board of Health
will have been  established twenty-five years, and the appropriate celebration of the
event may be made to promote those interests of the people of Michigan for which
that board was established,
  Resolved by the Mouse (the Senate concurring), That  the State Board  of Health is
hereby authorized and requested  to prepare accurate comparative statements of
the conditions affecting the public health, and of the actual conditions of health in
Michigan before and since the establishment  of the board,  especially exhibiting,
if it be true, that there has been a very marked improvement in the healthfulness
of Michigan in recent years, and statements of the principal dangers to life and
health at the present time, also an  appropriate  program for a public meeting for
the discussion of measures for the further promotion of the public health in Michi-
gan, the  meeting to occur on or about the time of the completion of the twenty-five
years of  the existence of the board.
  Resolved further, That the Governor is hereby  authorized and requested  to send
to the National Conference of State Boards of  Health, at its  coming meeting  iu
1897, which is to be held in Nashville, Tennessee, during the centennial exposition, an
invitation for the  National  Conference of State Boards of Health, to hold its next
annual meeting in Michigan in the summer of 1898 to aid in celebrating the quarter
centennial of the establishment of the Michigan State Board of Health.
  Resolved further, That the Governor  is hereby authorized and requested  to invite
to this quarter-centennial meeting, Surgeon-General  Sternberg of the United States
Army, Surgeon-General Tryon of the Navy,  Surgeon-General  Wyman of the Marine
Hospital  Service,  D.  E. Salmon, M. D., of  the Bureau of Animal Industry, U.  S.
Department  of Agriculture, the officers and members of other State boards of
health, and of  the boards  of health of the principal  cities  in the United States,
and other distinguished sanitarians  in this and  neighboring  countries.
  Resolved further, That, in case the  invitations are accepted, the Railroad  Commis-
sioner  and the  State  Board of  Health are requested to act,  and to cooperate with
interested citizens so far as practicable, for facilitating the attendance of repre-
sentative excursionists from other States, and for placing before those who may  visit
Michigan on that occasion, the beauties of the  numerous delightful summer re-
sorts around the shores of the Great Lakes, and at the numerous inland lakes and
other sanitaria, the  general healthfulness of the State, and the unparalleled ad-
vantages  of Michigan as a summer resort  State.
  Resolved further,  That the  local boards  of health in Michigan be requested to send
delegates to this proposed quarter-centennial meeting, in order that they may con-
tribute, for the general welfare of the State, and that they may gain any  informa-
tion which they can for the use and benefit of the public  health in their respective
localities.
  Approved June  2,  1897.
                                                 WILLIAM D. GORDON,
     H.  S.  PINGREE,                  Speaker of the House of Representatives.
                Governor.
                                                THOMAS B. DUNSTAN,
                                                       President of the Senate. 
 
PROCEEDINGS  AND ADDRESSES  AT  THE QUARTER-CENTENNIAL
         CELEBRATION  OF  THE ESTABLISHMENT  OF  THE
              MICHIGAN  STATE BOARD OF HEALTH.
                   DETROIT,  MICHIGAN, AUGUST 9, 1898.

  [Supplement to the Annual Report of the Michigan State Board of Health for the year 1899.]

   The Quarter-Centennial Celebration of the Establishment of the Michi-
 gan State Board of Health was held in accordance with Concurrent Reso-
 lutions of  the  Michigan Legislature for  1897.  A  copy of these resolu-
 tions will be found printed on the opposite page.
   Arrangements for the Celebration were made through the organization
 of general  committee of citizens of Detroit, as follows:—

                  THE CITIZENS* GENERAL COMMITTEE.

   Chairman—Henry A. Haigh, Hammond Building, Detroit.
   Secretary—Dr.  E. S. Sherrill, 270 Woodward Ave., Detroit.
   Members—George H. Russell, Dr. H. O. Walker, Levi L. Barbour, Dr.
 Leartus Connor, Dr. J. E. Emerson, Dr. Heneage Gibbes, George H. Bar-
 bour, Dr. J. H. Carstens, Dr. H. W. Longyear, Howard M. Holmes, Dr.
 C. W. Hitchcock, O. A. Bierce, A. A. Schantz.
   The Citizens' General  Committee  appointed  the  following sub-com-
 mittees :—

                        RECEPTION COMMITTEE.

  Hon. Hazen S. Pingree, Hon. William C. Maybury, Dr. and Mrs. Leartus
 Connor,  Dr.  and Mrs. J. E. Emerson, Charles  Buncher,  Mr.  and Mrs.
 George A. Steele, Dr. and Mrs.  H. W. Longyear, Dr. and Mrs. W. P. Man-
 ton, Dr. Ben B. Brodie, Dr. and Mrs. E. T. Tappey, Dr. C. T. McClintock,
 Dr. and Mrs. Geo. E. Frothingham, Dr. and Mrs. J.  K. Gailey, Mr. and
 Mrs. H. C. Parke, Mr. and Mrs. F. K. Stearns, Mr. and Mrs.  L. L. Barbour,
 Mr.  and  Mrs. R. H. Fyfe.

                         FINANCE COMMITTEE.

  George H. Russell, Dr. H. O. Walker, C. B. Hubbard, Dr. J. H. Carstens,
Bryant Walker.

                     ENTERTAINMENT COMMITTEE.

  Dr. Leartus Connor, George H. Barbour, Dr. H. 0. Walker, Howard M.
Holmes,  Walter E.  Campbell.
         2 
10              QUARTER-CENTENNIAL CELEBRATION
                      TRANSPORTATION COMMITTEE.


  Col. R. G. Butler, A. A. Schantz, E. C. Brown, Blaine Gavett, J. S. Hall,
0. A. Bierce, J. C. Hutchins.

                          PRINTING COMMITTEE.


  Dr. C. W. Hitchcock, Dr. J. K. Gailey, Dr. A. H. Steinbrecher.


  Those who attended the Quarter-Centennial from without the  State of
Michigan and  those from within the  State, and especially the Michigan
State Board of Health have to thank the members of the various com-
mittees for the energv displaved in making the celebration  the success
that it  turned out to be; a success from the beginning to the end,  was
the expression of those  in attendance.
  There were  present:   Representatives from the Provinces of Ontario,
Quebec, and  Manitoba, delegates  from  many of  the State  Boards  of
Health in the  United States, the Health Commissioners of several of the
leading cities  of the  U.  S., a representative of the U. S. Government, a
representative of the  State Department of Michigan, presidents and mem-
bers  of local boards  of  health  in Michigan, health officers in Michigan,
phvsicians and citizens  of Detroit,  and members and ex-members of the
Michigan State Board of Health.  Each one in attendance was supposed
to  write  his  name, postoffice  address,  and  official title in the official
register for the meeting.  The following is a list of those registering:—

  John  M. Arnold.  Sec. Board of Health, Monitor  Tp., West Bay City, Michigan;
Dr. F. B. Adams, Health Officer. Plymouth. Michigan; Dr. William Bailey, Presi-
dent State Board of Health, Louisviile,  Ky.; Mrs. William Bailey, Louisville,  Ky.;
Dr. Henry B. Baker, Secretary State Board of Health, Lansing, Mich.; Mrs. Henry
B. Baker, Lansing, Mich.; Dr. Fred R. Belknap, Member of State Board of Health,
Niles, Mich.; C.  B. Blubaugh, Pres.  State Board of Health, Parkersburg, West Va.;
Dr. H,  M. Bracken, Sec. State Board of  Health, Minneapolis. Minn.;  Dr.  Alonzo
Bryan, Detroit.  Mich.; Hon. Daniel Briggs, Ex-Supt. of Public Instruction, Lansing,
Mich.; William  B. Bremer, Sanitary Inspector, Buffalo, N. Y.; J.  Bishop, attorney,
Milwaukee, Wis.; Ann Brown, teacher,  Milwaukee, Wis.; J.  H. Brown, member of
State Live Stock Commission, Climax, Mich.; Dr. D. D. Crowley, member of  State
Board of Health. Oakland, Cat; Mrs. D. D. Crowley. Oakland, Cal.; C. J.  Chaddock,
Muskegon, Mich.;  Dr. Leartus Connor, member  of Local Committee of Arrange-
ments. Detroit, Mich.; Dr. George H. Cattermole, State Contagious-Disease Inspector.
 Lansing, Mich.; Mrs. George H. Cattermole. Lansing, Mich.; H. M. Cunningham,
 Health  Officer,  Detour Tp., Detour, Mich.; Charles W. Calkins. President of Board
of Health. Grand Rapids,  Mich.; George H. Carlisle, Detroit, Mich.: C. L.  Case.
Health  Officer  of Thetford Tp.. Clio. Mich.;  Dr. J. C.  Crossland. member  State
 Board of Health, Zanesville, O.; Dr. E. W. Cooper,  Pres. State Board  of Health,
Camden. Del.; Dr. Henry W. Oadieux, Health Officer, Grosse Point,  Mich.: Dr. W.
R. Chittick, Professor Detroit College of Medicine, Detroit, Mich.; M. Coad. Teacher,
Milwaukee, Wis.; Mrs. C. R. Cross, Milwaukee, Wis.; Dr. C. J. Dove Health Officer
Muskegon, Mich.: Dr. J.  S.  Dohany. Health Officer of  Tp.,  Greenfield  Mich •
J. Eisehmeir.  Professor, Milwaukee. Wis.: Dr. Robert G. Ellegood Member  State
Board of Health, Concord, Del.; Dr. J. E. Emerson. Member of Local  Committee
of Arrangements  Detroit,  Mich.;  Dr.  J. A. Egan.  Sec.  State  Board of Health.
Springfield. 111.; Dr.  .Tames Evans. Sec. State Board of  Health,  Florence  S  C ■
George H. Emmons. Detroit, Mich.: Mrs. Ann Emmons. Detroit. Mich •  Dr  J H
Forest,  Yice-Pres. State Board of Health, Marion, Ind.; Prof. Delos Fall, Member
2f  ,Ate^oard  0f Health-  Albion,  Mich.;  Dr. John S. Fulton. Sec. State Board of
Health  Baltimore. Md.; Dr. Felix Formento. Ex-President American Public-Health
Association, and Ex-Member State Board of Health, New Orleans La • Dr  H F 
MICHIGAN  STATE  BOARD  OF  HEALTH
11
 Foster,  Health Officer of Nankin Tp.,  Wayne,  Mich.;  Dr.  H. Z. Gill, Sec.  State
 Board of Health, Topeka, Kan.; Dr. R. S. Goodwin, Member State Board of Health,
 Thomaston, Conn.; Dr. Heneage Gibbes, Health Officer, Detroit, Mich.;  Hon. Frank
 Wells, Pres. State Board of Health, Lansing,  Mich.; S. Case Jones,  Commissioner
 State Board of Health, Rochester, N. Y.; H. A. Gilmartin,  Newspaper Reporter,
 Detroit, Mich.; Dr. C. W.  T.  Goodman, Prof. Sanitary Science, Saginaw,  Mich.;
 Dr. A. E. Gourdeau,  Health Officer, Ishpeming, Mich.;  Dr. E. A. Guilbert, Member
 of State Board of Health,  Dubuque,  Iowa.; C. A. Foss, Newspaper  Reporter, De-
 troit, Mich.; Dr.  Mason W. Gray, Ex-Member State  Board  of Health,  Pontiac,
 Mich.;  Henry  Goldmark,  Asst. Eng. U.  S. Board of  Deep Waterways,  Detroit,
 Mich.;  Pauline Gnacke, Teacher,  Milwaukee, Wis.;  J. C.  Harter,  Sanitary  In-
 spector, Jackson,  Mich.; Dr. Charles  W. Hitchcock, Member  of  Local Committee
 of Arrangements, Detroit,  Mich.; Roberts P.  Hudson,  Time-Clerk State Board of
 Health  Office,  Lansing, Mich.; Dr. J. N. Hurty,  Sec.  State Board  of Health of
 Indiana, and  Secretary Conf. State  and Prov.  Boards of Health. Indianapolis,
 Ind.; F. E.  Janette,  Newspaper  Reporter, Detroit, Mich.;  Dr. AY.  K.  Jacques,
 Expert Health Depart.. Chicago,  111.: Dr. PI.  D. Jenks, Physician, Detroit,  Mich.;
 Dr. Charles B. Johnson, Member  of State Board of Health, Champaign, 111.; Mrs.
 L. C. Gower,  Milwaukee.  Wis.; Dr. R.  C. Kedzie, Ex-President  American Public
 Health Assoc,  Michigan, Ex-President Michigan State Board of Health, etc., Agricul-
 tural College, Mich.; Dr. R. D. Kahle, Yice-Pres. State Board of Health,  Lima, Ohio;
 Mrs. R. D. Kahle, Lima,  Ohio;  E. G.  Kehr,  Milwaukee, AYis.; Dr.  S. A. Knopf,
 Physician to Lung Department N.  Y. Nose and Throat Hospital, New York City;
 Mrs. S.  A. Knopf, New York  City; Dr. C. A. Lindsley, Dean of Medical Faculty
 Yale College,  New  Haven,  Conn.;  Dr.  Benjamin Lee, Secretary State Board of
 Health,  Health Commissioner  of Philadelphia. Pres. Con. of State and Provincial
 Boards of Health, Philadelphia, Penn.; D. C. Chuenins,  Professor, Milwaukee, Wis.;
 G. N. Lawrence, Lapeer, Mich.; C. E. Rinabury.  Lapeer, Mich.; Dr. John J. Castel-
 lanos, Yice-Pres. State Board of Health, New  Orleans,  La.; E. J.  Mealley,  Supt. of
 City Schools.   Hastings, Mich.; Dr. H. Matthey,  Member State Board of Health,
 Davenport, Iowa; Dr. J. A.  McKelveen, Member State Board of Health, Chariton,
 Iowa; Hon. William  C. Maybury,  Mayor of  City of  Detroit,  Mich.;  Hon. J.  H.
 Morrow, Ex-State Senator, Lansing, Mich.; Dr. Samuel G. Milner. Member of State
 Board of  Health, Grand  Rapids,  Mich.;  Dr. Hugh  McColl,  Ex-Health  Officer,
 Lapeer,  Mich.; J. J.  Manners, Health Officer  Tp., Port Sanilac,  Mich.; Dr. H. R.
 Mills, Health Officer,  Port Huron,  Mich.;  R. J. Morrison. Detroit, Mich.; Theo. R.
 MacClure, Chief Clerk State Board of Health, Lansing, Mich.; Rev. John McCarroll,.
 Detroit,  Mich.;  Hon. Aaron Y.  McAlvav. Member State Board of Health, Manistee,
 Mich.; Dr. A.  J.  McKillop, Health Officer of Tp., Wolverine,  Mich.; Dr. F.  G.
 Novy, Member State Board  of Health, Ann Arbor, Mich.; G. A. Nettleton, Special
 Agent of Railroads. Detroit, Mich.; Dr.  S. D.  O'Brien,  Health Officer.  Kalamazoo,
 Mich.; Dr. C. O. Probst, Sec. State Board  of Health. Columbus,  Ohio; Hon. LeRoy
 Parker,  Ex-President  State Board of  Health of Michigan, Vice-Dean Buffalo Law
 School, Buffalo, N. Y.; Dr. James  Patterson, Chairman of Board of Health, Winni-
 peg,  Manitoba; Jarvis C.   Phillips, Milwaukee, Wis.;  Dr.  Elzear  Pelletier. Sec.
 Prov. Board of Health, Treas. Con. of State and Prov. Boards of Health, Montreal,
 Quebec; Mrs.   M.  A.  C. Patterson,  Sec.  Hancock School Mothers'  Club,  Detroit,
 Mich.; Dr. Arthur R. Reynolds,  Health Commissioner, Chicago, 111.;  A.  G.  Rice,
 Local Health Officer. Woodstock, Canada; Dr. George E. Ranney. Lansing, Mich.;
 Dr.  Byron Stanton, Member State  Board of Health, Cincinnati, Ohio; Dr. Q. O.
 Sutherland, member  State  Board  of Health, Janesville, Wis.; Dr.  Gardner  T.
 Swarfs.  Sec. State Board  of Health, Providence,  R.  I.; Dr. Theo.  Schmalzriedt,
 Health  Officer  Springwells  Tp., Woodmere. Mich.; Dr.  D. E. Salmon, Y. S., Chief
 of Bureau of  Animal  Industry,  Washington,  D. C; T. B.  Scott, Health Officer,
 Vernon,  Mich.: Dr. M. C.  Sinclair. Member  of  Local Board of Health, Grand
 Rapids,  Mich.;  Louis A Safford, Representative  Associated  Press, Detroit, Mich.;
 Dr.  E. B.  Smith.  Professor Michigan Medical College. Detroit, Mich.; Dr. B. R.
 Hoyt, Detroit.  Mich.; Dr.  J. S. Shoemaker, Health Officer,  New Lathrop,  Mich.;
 B. F. Schellberg. Detroit, Mich.; E.  H. Sellers, Detroit.  Mich.: Mrs. E.  H.  Sellers,
 Detroit.  Mich.: Miss  M. Sellers. Detroit.  Mich.:  Dr.  Edwin S. Sherrill.  Member
 of Local Committee of  Arrangements. Detroit.  Mich.; Dr. Mary Thompson  Stevens,
 Detroit.  Mich.; Dr.  Rollin  Stevens.  Detroit,  Mich.; Dr. U. O.  B. Wingate, Sec.
State Board of  Health.  Milwaukee, Wis.: Dr. Ernest Wende.  Health Commissioner,
 Buffalo.  N.  Y.; Dr. C. L. Wilbur,  Chief of  Division of Vital Statistics, Lansing,
Mich.: Dr. Bion Whelan, Health  Officer,  Hillsdale, Mich.;  Dr.  Frank B. Wynn,
Indianapolis,  Ind. 
12               QUARTER-CENTENNIAL  CELEBRATION
                         LETTERS  OF  REGRET.

                            The Johns Hopkins Hospital, North Broadway, £
                                   Baltimore, Maryland, July 29, 1898.        )

Henry M. Hurd, M.  D., Superintendent.
Hon Hazen S. Pingree, Governor of Michigan, Lansing, Michigan:
  Deae Sib--I write to acknowledge with thanks the reception of your invitation
to be present at the quarter centennial  celebration of the establishment of the
Michigan State Board of Health.  I  regret exceedingly that my duties and othei
engaSments 'vill not permit me to be present.  Until my removal from Michigan
nlSe yeTrs ago I knew the members  of the State Board of Health personally  and
had a deep appreciation of the value of their unrequited services to the  State.
Shice I came to Maryland I have been constantly  impressed with the recognition
which the work in Michigan receives  from other  States.   The  sanitary  work in
Michigan has served as a model in many respects for other States   The personnel
of  the State Board  of Health has always been admirable,  and the work or tne
Secretary deserves great praise.  I  congratulate the State of Michigan  through you
upon its quarter century of efficient work.
                                         Very respectfully,
                                                        HENRY M. HURD.


   Letters similar to the foregoing, addressed either to His Excellency the
Governor or to the Secretary of the State Board of Health, were received
from the following named  persons:—

   William Abbott, Sec.  City Board of Health, Binghampton, N. Y.; Dr. L.  Adels-
 berger,  Pres. State  Board  of Health,  Waterloo, 111.; Hon.  John  Avery,  M. D.,
 Ex-Pres. State Board of  Health,  Greenville,  Mich.; Dr. William Curtiss Bailey,
 Las Vegas, New Mexico; Dr. Preston H. Bailhache, Surgeon U. S.  Marine Hospital
 Service, Washington, D. C; Dr. A. N.  Bell, Editor of "The Sanitarian", Brooklyn,
 N. Y.; Dr. John S. Billings, Deputy Surgeon-General U. S. A., (Retired), New York;
 Edwin Farnham, Sec. City Board  of Health, Cambridge, Mass.; Dr.  A. L.  Gihon,
 Ex-Surgeon  U. S. Navy (retired), New  York City; Paul Gerhard, C. E., New York
 City;  Edmond Godschaux, Sec. City Board  of Health, San Francisco, Cal.;  Dr.
 Arthur Hazelwood.  Ex-Member  State Board  of Health, Grand Rapids, Mich.; Dr,
 Frederick L. Hoffman, Newark, N. J.;  Dr.  J. L. Hess, Health Officer of Cleveland,
 Ohio; Dr. M. D. Hoge,  Jr., Richmond, Va.; Dr. Walter Kemster,  Health  Commis-
 sioner,  Milwaukee,  Wis.;  Dr.  E.  P. Lachapelle,  Pres.  Prov.  Board of  Health,
 Montreal, Quebec; Dr. J. N. McCormack, Sec. State Board of Health, Bowling Green,
 Ky.;  Dr.  J.  E. Monjaris,  San  Luis Potosi,  Mexico; Dr. F.  Montizambert. Supt.
 Canadian Quarantines,  Toronto, Ont; John McCay,  Chief Clerk Board of Health,
 Philadelphia, Penn.; Dr.  Joseph Porter, State Health Officer, Jacksonville, Fla.;
 Estelle Reel, Sec. State Board Corrections and Reform. Cheyenne,  Wy.; Prof. F. C.
 Robinson, Pres. State Board of Health. Brunswick, Me.;  Salem Board of Health,
 Salem, Mass.; Dr.  Baxter T. Smelzer.  Sec. State Board of Health, Albany, N. Y.;
 Dr. Stephen  Smith, New York City; Dr. H.  K. Snow, Sec.  City Board of Health,
 Oakland. Cal.; Dr.  E. L. Standlee. Pres. Board of Health, St. Louis. Mo.; Dr. Max
 C. Starkloff, Health Commissioner,  St. Louis, Mo.; Hon.  Frank  Sternberg,  Gov-
 ernor, Boise City, Idaho; Dr. George M.  Sternberg. Surgeon-General  U  S  Army
 Washington, D.  G;  Prof. E. A.  Strong.  Ex-Member of State Board of Health!
 Ypsilanti. Mich.; Dr. E. Liceaga, President Superior Board of Health.  Mexico City
 Mexico; Dr. W. K.  Van Reypen, Surgeon  General U. S. Navv, Washington  D  C '
 Dr.  H. P. Walcott,  Pres. State Board  of Health,  Boston.  Mass • Dr  Irvin^ \'
 ^rat,S°,n,^e- State Boarcl of Health-  Concord. N. H.; Dr. William C. Woodward'
 Health Officer, Washington. D. G;  Dr. Walter Wyman, Supervising  Surgeon Gen-
 eral IT. S. Marine Hospital Service, Washington, D. C; Dr. A. G  Young Sec  State
 Board of Health, Augusta, Maine; Franklin Staples. M. D.. Health Office, Winona
 Minn.:  Dr. Tobias  Nunez, Medical Inspector. Mexico Citv, Mexico; Dr. Henrv Mit'
 chell, Secretary State Board of Health, Asburv Park, N. J. 
MICHIGAN  STATE  BOARD  OF  HEALTH             13
            Morning Session,  Tuesday, August 9, at 9:30.

 The morning session was called to order by the chairman of the meeting, Hon. Frank Wells,
President of the State Board of Health, and. after prayer by Rev. John McCarroll, M. D., Mr.
Wells read the following address:—
                        OPENING ADDRESS.

 BY  HON. FRANK  WELLS, PRESIDENT OF  THE STATE  BOARD OF  HEALTH,
                         LANSING, MICHIGAN.

   The Michigan State Board of Health greets most cordially today all
 who are here to celebrate the twenty-fifth anniversary of its birth, and to
 rejoice with it over the achievements  of  Sanitary  Science  during the
 period of its existence.  You have come from near and from far, at the
 invitation of the State, which, twenty-five years ago called  into existence
 this Board and  whose people have since that time sustained it  in its
 efforts to  save human life and prevent human  suffering.  Engaged, as
 nearly all  of you are in labors similar to these, the Michigan State Board
 of  Health feels assured of your sympathy,  and that you will today re-
 joice with it at any success which may have crowned its efforts* during
 the quarter of a Century which has witnessed its activities.
  Nature divides time into days and years.  We order our lives to accord
 with these divisions  in the ordinary  routine  of  their progress,  while
 recognizing that it  is the events with which they are filled, instead of
 the number of days and years which  mark their existence, that exhibit
 what these lives have been, and  what they express.  This is not alone
 true of individuals.  It is equally true of society and of  every organiza-
 tion of human beings, for whatever purpose it may have  been  created.
 Mankind does  not estimate the value of a period  by the number  of its
 years, but by the importance of the events with which these years have
 been filled.  Measured by this standard, the century just closing  must
 be  regarded as of more value than any equal number of years within
 the experience of the race.  It is a  Century which lias revealed  to  man-
 kind secrets concerning nature and her laws, of the greatest interest and
 importance.  The Centuries immediately  preceding  this witnessed the
 growth of new political ideas and theories of government, and the emanci-
 pation of mankind from conditions of vassalage and priestly thraldom,
 to independence and civil and religious liberty.  Important and far reach-
 ing in their practical effects as were these steps in human progress, yet
 it is doubtful if their influence in the promotion of the happiness and
 well being of the race,  can equal the achievements of  our own Century.
  It is a Century which has enlightened mankind  concerning  myster-
 ies  which  previous ages have vainly sought  to  solve.   It  is a Century
 during which inventive skill has most  wonderfully  utilized the forces
of nature for man's convenience and  comfort, and has perfected  those
marvelous  instruments which have  enabled  us not only  to contemplate
the myriads  of  worlds which surround us,  but have revealed to  us a 
14
QUARTER-CENTENNIAL CELEBRATION
kingdom of nature within our own world, of which before we had no
conception.  It is a Century which has given to the world investigators
in every realm of scientific inquiry, whose ability, industry, and success
have never been equaled.  Their labors have led to generalizations ana
doctrines  which have profoundly  affected our conceptions of  natural
phenomena, and influenced philosophies and views in  nearly  every  de-
partment of human thought.
  The last quarter of this greatest of all the centuries,  contemporaneous
as it is with the period during which the Michigan State Board of Health
has had an existence, is notable for the development  of two  sciences,
biology  and sanitation.  Had the entire century nothing more  to offer
than those two coordinate branches of knowledge, it might still retain its
rank in the world's march of progress.
  The application of this knowledge to the saving of human life and the
prevention  of human suffering, has kept misery and despair from enter-
ing countless homes.   It has dictated methods of treating the wounded
upon the battle  field so successful that, in the camps  and hospitals of
our soldiers, very much  of the loss of life has been prevented, and the
horror of war dispelled.  It is a quarter-century filled with victories over
humanity's most relentless foes, and of knowledge concerning their char-
acter and methods of warfare.
  You have been invited, gentlemen,  by the Legislature of the State of
Michigan,  through its  Governor,  to  celebrate today  the twenty-fifth
anniversary of an event, the creation of the Michigan State  Board of
Health.  It will be difficult for you who are so familiar with the sanitary
achievements of the  last twenty-five  years to commemorate this event
without having in your thoughts those remarkable  developments which,
during this brief period, have evolved the  science  of sanitation.  With
the day will necessarily  be  associated in your minds an era of  progress
in sanitary knowledge of far greater value than were all the ages which
preceded it. It is well on this day to celebrate such an era, and to recall
the accomplishments of those men whose genius and labors have in such
large measure made them the saviors  of their race.
  Every true American  heart thrills  today at the  achievements of our
soldiers upon the field of battle,  and of our sailors  upon the sea. Their
names become- household words,  and every lip  speaks their praise.
   Our pride is heightened by the knowledge that it is the cause of  hu-
manity  which inspires these  heroes to deeds of valor  and courage.  It
is to save human lives,  and to relieve human suffering, that they have
taken up arms,  and  are offering their own  lives upon the altar of  hu-
manity. As we rejoice at their successes, and admire their heroism, let us
not forget those  who in  other ways have labored to save life, and to pre-
vent suffering.   The honor and  applause  which everywhere  greets  the
warrior who is moved by patriotism  and duty to noble deeds, is justly
due to Dewey, to Shatter,  to Sampson, to  Schley  and to Hobson.  A
grateful people is placing their names high  up  upon the scroll of glory
and of fame.  Shall we  not place side by side with these, to  be equally
remembered with gratitude, the names of Pasteur, of Lister, of Koch and
of Roux?
  Achievement in any field is exalted by high purpose, and, while man-
kind will always honor the true  soldier,  it will never cease to  remember
with gratitude the good  Samaritan. 
MICHIGAN STATE -BOARD  OF  HEALTH
15
   The Michigan State Board of  Health is one of the pioneer  organiza-
 tions of its kind in the United  States.  The friends of the law which
 created it, must have been inspired by hope, rather than faith, in making
 investigations concerning the causes of  epidemics, one of its duties.  The
 mystery surrounding these causes twenty-five years ago was well  nigh
 as impenetrable as it always had been.  Knowledge concerning epidemics
 was then almost entirely empirical.  It was known that many diseases
 were communicated by contact,  and that one attack of either of these
 diseases usually secured immunity from subsequent attacks.  Vaccina-
 tion for Small-pox had been proved to be efficacious, and that disease had
 therefore largely ceased to menace the  world with its horrors.  Author-
 ities had scarcely taken a step in the direction of stamping out  any of
 the  other communicable diseases, nor had science revealed their  causes,
 or taught  us what diseases properly  belonged to this class.  Scarcely a
 glimmer of the light which was  to illumine these problems, and create
 the twin sciences, biology and sanitation, was then visible.
   The Michigan State Board of Health  entered upon its existence before
 the  sanitary knowledge now regarded as elementary had been  revealed.
   It was five years after this  event that Pasteur announced to the world
 his discoveries concerning Anthrax, and  it is from this date only, 1877,
 that wThat was afterwards styled the  germ theory of disease, may  be
 said to have had an existence. From then, until now,  a  vast expanse of
 knowledge concerning the cause and prevention of a large portion of the
 diseases which  afflict humanity,  has been opened to our view.  Others
 will today remind you  of  its  extent, and of  the full significance  of this
 epoch of sanitary learning and achievement.
   In inviting prominent sanitarians  from abroad to come to Michigan,
 the  Legislature  expressed  a  desire  that  they  be shown  some  of  the
 numerous  and beautiful  summer and health resorts of the State, and
 learn of their value in the restoration  of health, and the promotion of
 comfort and pleasure.
   Michigan is rapidly becoming famed  for these resorts, and thousands
 annually visit her shores from other States  and  countries, to enjoy her
 charming and varied scenery, to  be stimulated by her pure  and invigor-
 ating breezes, or to be restored to health by her waters of absolute purity,
 or by those whose medicinal value have long been unquestioned.
   Michigan's peculiar insular position gives  her  a coast line of remark-
 able extent.  It equals in distance the entire length of the United  States,
 from the most  northern  point in Minnesota, to the most  southern in
 Texas.  The Great Lakes which  form nearly her entire  boundaries, are
 the theatre of a commerce which  rivals  that of the ocean. The  spectator
 upon these waters, or upon her shores, beholds a  never-ending panorama
 of marine  architecture.   The lordly  passenger steamer,  the  freight
 steamer with its line of consorts, the private yacht with its dainty ap-
 pointments, the screeching tug, and the white-winged sailing vessels, of
 every size, and  for  every  purpose, are never absent from  view.  They
 lend to these vast inland seas that touch of life, and man's supremacy,
 which complements nature, and gives to each picture an ideal perfection.
 Innumerable islands arise from the bosom of these waters, and  add to
their charm  the picturesqueness of beautiful and varied foliage, or of
towering rocks, eroded by time and the elements, into varied  and fan-
tastic forms. 
16             QUARTER-CENTENNIAL CELEBRATION
  The shores of the mainland present great variety of vegetation  ana
rocky cliff.   Cities,  villages and  farms,  diversify  the  landscape,  and
exhibit the homes of a people whose intelligence, thrift, and hospitality,
are nowhere excelled.  Wherever  upon these  shores  nature presents
unusual attractions, will be found the cottage of the seeker for  health,
recreation,  or enjoyment.
  Men  filling all the  professions, and those representing every  depart-
ment of business activity,  students  and teachers in every  realm,  with
their families, crowd  our steamers and railroad cars, to occupy,  during
the months when the heat  of summer is elsewhere so depressing, these
novel and attractive homes.  Here they find tonic in the dustless air sent
freshly from the northland over Superior's vast expanse.  The ills  and
worries of life are forgotten, the steps of age or infirmity become  elastic,
the eye brightens,  the pulses thrill, and the  heart responds  to  the
laughter of childhood, as it gambols in the waters upon the shelving
sands.
  The inland lakes present their  own peculiar  scenes  of beauty,  and
the beholder finds it difficult to decide, often, whether the larger or the
smaller lakes offer the greater attraction.
  To the State which nature has so lavishly endowed with these health
and pleasure giving attractions, and to this beautiful city which is the
gateway to them all,  you are to be welcomed by distinguished citizens
of the commonwealth.
  The welcome of the State Board of Health, to the many distinguished
sanitarians who honor it by their  presence today, is  most earnest.
  It hopes  your visit  to the State  will be agreeable and profitable,  and
that you will remain  within our borders long enough to appreciate the
truth of the motto  on Michigan's crest:  "If a beautiful peninsula  you
would behold, look about you"!

  Chairman  Wells—Your welcome to Detroit, ladies and  gentlemen,  will be  ex-
pressed by one of its most distinguished and popular citizens.  I take great  nleasure
in introducing Hon. William C.  Maybury, mayor of the citv
                    ADDRESS  OF  WELCOME.

     BY HON. WILLIAM  0. MAYBURY, MAYOR OF DETROIT, MICHIGAN.

Mr. Chairman, Ladies and Gentlemen:
  It affords me very great pleasure to welcome to Michigan and to Detroit
 h£ ItVZ  TI  Wlt\ ltS j>hilanthr°Pfc  Purposes.  I  can but  believe
that the legislature  showed great wisdom when it designated Detroit
as the meeting place for the sanitary  scientists, and as the most proper
Bo^rd oftSth. ^^ ** Q^er-centennidal of the MiZfan^e

u^fl  iS+ a b^utliful cit*Y> and to this is  added the fact that it is a
Ent  heir SF"  We hT * ?" qU°ta °f P^iaiw all eminent in  skill*
but their labors are not confined to ministering to disease, for the condi
t ons of life are such here that they are more largely engaged in maTimr
 he strong stronger and the healthy healthier.  II"is welf record tnat
there are only two principal causes of death  in Detroit-one is unavoW 
MICHIGAN  STATE BOARD  OF  HEALTH
17
able accident, and the other extreme old age.  If there were a,ny anti-
dotes against these it might be truly said that immortality characterizes
life in Detroit.
  At present there is no contagious disease of any kind in our city.  Our
health officer, who will address you later, will give you every assurance
that your environment  is  one absolutely foreign  to  disease.   There is
another element essential  to healthy conditions, and that is fresh air.
This we have in abundance, and to cap the climax, we have passing in
vast volume in  front of our  city  one of the most beautiful of  rivers,
whose waters are conservative of both health and cleanliness.
  A few days ago there assembled in our city the official representatives
of many cities. One  of the questions most discussed by their assemblage
was that relating to the disposition of garbage.  When the convention
realized that through our system  of public and lateral sewers all  the
fears of the effects of night soil and the absence of sewage was dissipated,
and in the careful collection of the garbage of the city, and its inciner-
ation a few miles  therefrom was the full solution of all our difficulties
and dangers, there  was  manifested great  surprise.  As we listened to
the discussion of representatives of other cities as to the great difficulties
they had in sew7age, in many cases surface, and the difficulties of properly
collecting and disposing of garbage, we in Detroit could but  feel  that
we were peculiarly  blessed.   There was one  suggestion  which I made
officially and which I renew, and that is my unalterable opposition to the
farming out to any  private individual of anything which relates to the
health of  the people.  The taxes of the individual are paid in part to
secure immunity from disease, and the strong arm of the government
should never relax its power or vigilance in this most important matter.
It is hardly  a sufficient answer to one who has suffered through  foul
drainage or the  putrifying of garbage, that some individual contractor
has not done his duty.  This duty is too important to be farmed out, and
the individual very properly looks to the city for relief.
  I welcome you to  this city  individually and collectively, and because
we are all deeply interested in the purpose of your coming.  It  has been
my pleasure in the past to welcome many  organizations of men coming
here for  the accomplishment of various purposes.  Indeed, the  confer-
ences have been most varying.  Some have come  for political  purposes
only, others have come here in the interest of finance, and we have had
conventions here of those who are  met to discuss the best way  of caring
for those who are to be prepared for sepulchre. Our welcome  to you is
especially hearty because your coming  is wholly humanitarian, and we
know that as a  result of your conference we  will all have gained more
knowledge of the best means and methods for the preservation and pro-
tection of public as  well as individual  health.
  In the quarter-century of life of Michigan's State Board of  Health
how wTonderful  have been the changes witnessed.  How primitive in
those early days were the means  provided and plans adopted for the
conservation of public health in the State and in its several cities. Then
we  had the omnipresent marsh, the primeval forest, and malaria and
ague as a  natural  consequent.  Under present conditions these  have
largely disappeared,  and Michigan has come to be known  as a  most de-
sirable State for one who is seeking health and its attendant blessings.
The ratio of deaths has diminished  very largely since that day, and multi-
         3 
18
QUARTER-CENTENNIAL  CELEBRATION
tudes of lives have been prolonged through the splendid achievements
of modern sanitation.   That the Michigan State Board of Health has
participated in these successes cannot be gainsaid;  and so we assemble
here today for the purpose of giving proper credit to the valuable work
accomplished, and to express the debt of gratitude  which we owe  to
those who have been and are now foremost in the work of the board.
  In all the world's ongoing in the past, men  have known too little  of
each other.  There was a  spirit  of  selfishness existing that obliterated
every other consideration.  Men  passed  each other  as ships pass in the
night.  If I may be permitted to borrow this simile from a most excel-
lent sermon preached  by our reverend friend present  (Dr. John McCar-
roll), and which left a deep impress upon my mind, "The ship that passes
in the night shows but  a flash of light,  and then she  disappears in the
darkness.  She may be laden with the richest blessings, but she showers
none  of them upon those whom she passes.   She  makes no  exchange
of cargo to a passing  ship.  Those from the  shore who  see her for a
moment may be both hungry and thirsty, and she may carry that which
may be of inestimable blessing  to  them, but  she goes silently on her
disappearing way."  So men  in the past  carried  the rich  secrets  of
health, and of experience, and of happiness  in the generations that have
gone.  The Edisons, the Teslas and  the Humboldts of the early world
passed in the night.  They never dipped  their colors to one another, nor
exchanged their secrets.  Today  these ships pass as ships pass by day.
They exchange their rich cargoes; they  show the port of  their destina-
tion;  they  realize that although both are  going by different passages
they are all aiming to arrive at  that one great port known as the port
of the world's ongoing—the port  of the world's  common prosperity. The
day of selfishness as allied with success in life has passed.  The measure
of individual success today is in the ratio  of  unselfish labors done for
others.  It is the day when no man can rejoice  in his wealth if gained  at
the expense of another's poverty or pain.  It  is the day  of reciprocity
and of exchange.  It is this purpose that has brought you together.  Here
there will be an exchange of ideas and an exchange  of experience—each
to be benefited by the wisdom  of the other.  You come to  give, and you
come to receive, and in this reciprocal spirit the noble cause you repre-
sent will be advanced and  elevated.
  In this age it is the aim of municipal government particularly to reach
with benefit all classes and conditions; and to see that all,  both rich and
poor, fortunate and unfortunate,  enjoy their  share  of  the  privileges
which wise government  confers.  No blessing or benefit is conferred  by
government if we have not that which protects health and stands sentinel
against disease, both moral and physical.  In this generation municipal
government has become so far paternal that it  is exerting itself in every
direction to alleviate  the  conditions of poverty and  suffering   Many
cities of the old world, such as Glasgow, Birmingham,  London and Vienna
have extended  the powers of government  even to the extent  of wil-
fully destroying filthy abodes, and erecting  upon their foundations com-
fortable and cleanly homes.  These homes, humble though they are in all
their appointments  are built under the best sanitary  conditions known
to the times  New lork city has completely cleaned out that crime and
disease-breeding spot known as  "The Five Points".  Tenement houses
plainly but substantially built,  more especially respecting the health
of the community, stand on this  fateful  spot.   Schools of  manual train 
MICHIGAN STATE  BOARD OP HEALTH            19
 ing,  which include a practical course in the modes and means of keep-
 ing cleanly in person, have been established. Children are inspired with
 the thought that there is sweetness in life—that there is beauty  and
 dignity in cleanly living which they never experienced before.
   A  criminal who had sojourned for years at Sing Sing prison returned
 to his home at Five Points, and was astonished to see the changes that
 had taken place  in his absence.  With the change in material  things in
 and about his favorite haunt there  was a notable change for the better
 in the people that inhabited it.  A  light dawned upon his soul, and he
 turned away from  these changed conditions, determined to make a  like
 change in his own life, to  forget the prison and the prison garb, and to
 plant his feet in the paths that lead to duty and righteousness.
   The lessons of history and experience teach us, that material prosperity
 is not all that contributes  to the better life of the community and of its
 people.  They may enjoy great commercial prosperity and yet be upon
 the verge of ruin.  If the  moral well-being of the community is not ad-
 vanced side by side with the material, moral disease will insidiously sap
 the city's life.  The  free cities of  Greece  were never so prosperous as
 when they fell an  easy prey to the sword of Philip of Macedon; Rome
 was never so beautiful, nor was she blessed with a better water supply
 — great  military roads leading out into all  the nations of the earth—as
 when C;esar crossed the  Rubicon  and crowned  himself Emperor.   It
 often happens, also, that communities become a prey to diseases whose
 course cannot be interrupted.  The eloquence of Demosthenes could not
 save  Greece; the valor  of Hannibal could not save Carthage;  all  the
 statecraft of Marcus Antonius could not prevent the dissolution of the
 Roman  Republic, while there is no picture in  all history so deeply
 pathetic  as that which  shows one  who,  Himself the Saviour  of Man-
 kind, would not and could not save a city dying from moral and spiritual
 indifference. The aged Apostle St. John, when permitted a vision of the
 Heavenly City, describes its symmetry and completeness in these words:
 "And the  length of it,  and the hight of it, and the breadth of it wTere
 equal".  So in every city that would be perfect there must be a  coordina-
 tion between its  commercial, moral  and spiritual forces.
   To this city of our affection I again bid you a hearty welcome.  You
 will travel far to find a city that manifests greater thrift or more that is
 homelike, than the city  in which  you are  now  assembled.  There is no
 city of its size in the world where a larger proportion of the land belongs
 to the people.  The houses are in every sense homes. This statement is
 true,  whether it applies to the palace or the cottage home owner.  You
 will not fail to note the evidence of ownership in the garden planted with
 vegetables for the  table; in  the vines that clamber over the doors; in
 the flowers that trail above the window; in  everything and everywhere
 there is that which is significant of ownership, of thrift, and of home.
  Wefnay well ask the question—why should not Detroit be a magnifi-
 cent city?  Consider all her natural  advantages—the beautiful river and
 the island park both creations of nature with all that is ideal in natural
 beauty!  Nature  has done so much for us  that we can only claim  the
wisdom of making fair use  of that which she has so abundantly provided.
  Let me,  by an incident that occurred at one  of our early  missionary
stations, emphasize the spirit of your welcome.  It is said that one of the
early Jesuit Missionaries, worn out from his labors, stood under  a spread-
ing oak on a hot June Sabbath morning, preaching the gospel  of peace 
20             QUARTER-CENTENNIAL  CELEBRATION
to the half-naked children of the forest as they sat upon the ground, en-
circled around him.  It was manifest that the minister was ill, and stood
erect  with difficulty.  Suddenly  out of the naked savages rose the form
of a strong warrior wrho had learned, through many acts of kindness and
sacrifice, to love the black  robed father.   The warrior stole  silently
around  and placed his shoulder against the back of the preacher, and
as the preacher turned and looked  inquiringly at him, not knowing what
his movement meant, the Indian said to him, "If you love me lean hard".
And so  wre say to you today, if you would know the strength of our hos-
pitable  greeting; if you would know how much we appreciate your com-
ing, lean with confidence—lean hard upon the  kindly hospitality which
we offer.

  Chairman Wells—Perhaps many who are here today from abroad know compara-
tively  little about Michigan, but you have all doubtless heard  of Michigan's Gov-
ernor.  His name and fame are not  confined to the  limits  of his own  State.
Realizing how gratifying it would be to you all to see and hear Governor Pingree
on this occasion and have him welcome  you to Michigan in person, I greatly regret
that I  must announce that ill health prevents his being present. He has requested
Doctor Uibbes to extend this welcome in his name, and I introduce  to you Doctor
Heneage  Gibbes, Health Officer of the City  of Detroit.
                    ADDRESS  OF  WELCOME.

  BY HENEAGE GIBBES, M. D., HEALTH  OFFICER  OF DETROIT, MICHIGAN.

  Ladies and Gentlemen :—I find myself in an unexpected position, hav-
ing been requested by Governor  Pingree last evening to represent him
this morning and give an address of welcome to you, as a sudden  indis-
position prevents his attendance.   I am very sorry His Excellency is not
able to be present this morning.  It is a disappointment to you. You will
miss the many practical suggestions he would  give you.
  In welcoming you to the  beautiful City of Detroit, I wish  you to un-
derstand I do not make any invidious comparisons, as  I am not familiar
with many of the larger cities of the  United States.  Although I have
lived m Michigan for ten years I am better acquainted with the larger
cities of other countries.  I am not a native-born citizen, but one by adop-

  Detroit is a healthy as well  as a beautiful city to live in   Her sewer-
age system is almost perfect.  Her garbage is disposed of satisfactorily.
Her food supply is in quantity and quality all that can be desired   She
is built on one  of  the  most beautiful rivers I  have  ever  seen  ' More
tonnage passes daily than in any  other place.  Only one thing is needed
to make this the most beautiful  city in the world,  that is a River-side
park, which would  enable the citizen to enjoy the beauties of ihe ever-
hlW1tn? iTer a,nd  m5mflcent ™*els  Passing  up and down, with  the
beautiful Canadian  shore in  the distance.  Her numerous parks scattered
throughout and around  the  city and  the beautiful Belle Isle a veritable
2PlanfV"d °/her Island parks within the easy reach of aH, give the
vS If Detr°\t.a1n  opportunity for  rest  and recreation; giving  that
vital stamina which ,s nature's  immunizer.  This  is expressed in  thl

Z*^ &]?£"*are placardea ,or srar,et *™ "=-" 
               MICHIGAN STATE BOARD  OF  HEALTH             21

   Turning from the City of Detroit to the State  of Michigan, we have in
our State everything that conduces to health and happiness here below.
We have,  within reach of the city,  quail and grouse shooting, farther
north as good  deer shooting as found anywhere.  The bass fishing is too
well known to need describing.   Farther  north we have trout fishing
which cannot be excelled anywhere.   What can  a man want better than
to  find in  a day's journey a  river which he can wade  comfortably and
catch  during  the day western trout, European brown trout, and  the
native  grayling, and in addition to  this the rainbow7 trout, one of  the
gamiest fish found  in the world.  They  have  been caught over seven
pounds in  weight.  When a man has landed one of  these rainbow trout
with a fly,  he has enjoyed one of the pleasantest experiences in the world,
excelled only by the capture  of a salmon in a Scotch river.  So far as I
myself am concerned I have only one more move to make, and that is to
heaven.
   With all due deference to the important work of the Convention, I
would advise you if possible  to take a portion of your  time and run up
to  the "Flats" and  do a little bass  fishing and visit the places I have
mentioned around the city.   Then, when you leave  I feel  sure you will
exonerate me from any charge of exaggeration.
   New  Sanitary problems are imposed upon  us by the present war.  I am
not very familiar with the conditions in Cuba,  but I have traveled ex-
tensively through all the other parts of the West Indies, Spanish Main,
and the Brazils, and can easily understand the terrible fatality of yellow
fever in those  countries.  Any one can hardly understand  their ideas of
sanitation  without seeing the conditions.
   Passing  to Asia,  India and China are well worthy of consideration;
you can calculate very well the Sanitary condition of those countries  by
the number of victims dying annually from their ever-present plagues.
This is the condition of these countries when I sawT them, but that is some
years ago,  and I hope their ideas  of Sanitation have  advanced since that
time.
   Again extending to  you a hearty welcome to our beautiful  city, I trust
your stay  among us will be  both pleasant  and  profitable.

  Chairman  Wells—To those engaged in public-health work  no subject can have a
deeper interest, or possess greater practical value than that of the Sanitary work
of the last quarter of a century.  The one whose occupation has been to observe.
to chronicle and to criticise such labors is especially qualified to  speak of the
results of a  quarter century of public health work.  Dr. A. N. Bell, editor of the
"Sanitarian", who has  had long experience in recording the achievements of sani-
tary science, has prepared a paper upon  this subject  to be read at  this meeting.
He expected to read this paper to you in  person, but, because of an unfortunate
accident to Mrs. Bell, he has found it impossible to be present.  By Doctor Bell's re-
ouest. Doctor Henry B. Baker, Secretary  of the  State  Board of Health, will read
the paper. 
22             QUARTER-CENTENNIAL  CELEBRATION
   A  QUARTER-CENTURY  OF  SANITARY  WORK,  1873-1898,
       TOGETHER WITH  A  SKETCH OF  ITS PRELUDES.

  BY A. N. BELL, M. D., EDITOR  OF THE "SANITARIAN," BROOKLYN, N.  Y.

  Mr. Chairman, Ladies and Gentlemen:—If your appreciation of sani-
tary work during the quarter-century for which you have invited me to
speak  corresponds with my estimate of it, you  will, I  am confident,.
shortly perceive that  the  honor of your invitation has been most  un-
worthily bestowed.  For, while I concur with the general belief that of
all  the quarter-centuries since the first  one of the  Christian era, there
has been greater progress  in civilization in the present one than in any
other, I venture to think, and shall  endeavor to show7, that  of all the  pur-
suits of knowledge that have contributed to human welfare,  preventive
medicine excels; and the more because it has been the chief means by
which  the art of medicine has  been transformed into a science.  Hence,
while I have the courage to state this  proposition, I  shrink from  the
pretension of capability to adequately express a just appreciation of it.
  Feebly as I may, I shall  endeavor to show the  culmination' of  this
quarter-century of sanitary work, with wmich the State Board of Health
of Michigan has been closely identified, by a brief summary  of the  pre-
ludes and forces which have  contributed to  it, and by particularizing
some of its achievements.
  The advent of cholera to England in 1831, despite the quarantine regu-
ations  wiiich at that time obtained,  gave Edwin  Chadwick occasion to
observe that wiiatever infectious property there might be in the disease,
it was particularly prone to prevail under filthy conditions.
  "In  Poor Law administration,"  he said,  "it appeared to me and my
colleagues, on examination,  that the great impending visitation  would
probably advance as to places chiefly on the  lines and on local condi-
tions  on which  ordinary epidemics  proceed.   I  had been prepared by
medical officers to take business out  of its turn, because, from the state
of the  weather,  they had a confident expectation  that  they would have
some visitation  of one of the ordinary epidemics  to deal with.  Asking
one of them, the medical officer, what was the specific  disease he appre-
hended, he stated that when he arose in  the morning and found the at-
mosphere warm, moist, and stagnant, he  always found that there would
be an increase of some foul air disease—it might be typhoid, it might be
scarlatina, it might be measles, it might be small-pox', but one species or
another of eruptive disease he was sure to have in  such weather in the
low-lying and ill-drained districts.  I asked a relieving officer of a large
•district—to test his knowledge of the habitat  of such disease—whether
if I gave him some half-dozen cabs, he  knew where,  without previous
knowledge, he could go and fill them with fever cases and  he said he
could,  just as a gamekeeper  misrht  go and net a bag of  game—he said he
certainly could; the cases might not be all of  tvohus, but fever cases of
one sort or  another; he knew where he could'find them. It  appeared
that smnll-pox  follows on much the same  lines  as  tvohus, and so  does
scarlatina, but with wider deviations as to classes of cases  and condi 
MICHIGAN  STATE BOARD  OF  HEALTH
23
 tions of persons.  On passing through a low district I observed, 'Surely
 this must be a fever nest,' when out came some children with the marks
 of recent  small-pox upon them.  I remember that I was once consulted
 by  Dr. Lyon Playfair as  to the readiest mode  of making a sanitary in-
 spection of an urban district, without the medical officer's or the Regis-
 trar-General's returns, which there was no time to get out.  I advised
 him to go into-one of the primary schools, and select a group of the most
 squalid children, get their addresses,  and go there. He told me that he
 had acted on this suggestion; and that, in the first school, there were
 two boys  with particularly blotched  faces, and he had  found that their
 habitations were at the confluence of  some putrid sewage.  On ill-paved,
 ill-cleansed and  filthy streets the attacks are heavy, especially amongst
 children."
   This citation is made  for  a two-fold purpose: its appropriateness as
 showing the receptive conditions of localities common to infectious dis-
 eases everywhere, and the mistaken contention  of Mr. Chad wick and his
 colleagues, and their successors for thirty years or more, against local
 filth only  as sufficient protection from foreign as well as domestic in-
 fectious diseases.
   It was no new thing that dirt propagated disease, but why? had never
 been searched for. And the good results of the energy displayed by Mr.
 Chadwick  and his co-workers  appears for the time to have stifled scientific
 inquiry.   In  two reports—1849  and 1852,  respectively—the  General
 Board of Health, following the lead  of Mr.  Chadwick, "sought  to dis-
 parage the contagionistic medical opinions which  were represented in
 systems of quarantine and to substitute for them a doctrine that epi-
 demic diseases have their primary and essential condition in an epidemic
 atmosphere, which (irrespective of traffic) may exist over thousands of
 square miles, and yet affect only particular (unwholesomely kept) locali-
 ties.   Contending on the strength of that hypothesis  that  quarantine
 could not give any but a  false security for the purpose it pretended to
 accomplish, and adducing illustrations of the futility and oppressiveness
 of quarantine as commonly administered, the Board proposed, as prac-
 tical conclusion,  that the  country should entirely set aside the existing
 quarantine establishments, and should rely  exclusively on the protec-
 tion jt could derive from a system of local sanitary improvements."*
  It is especially noteworthy  with reference to  this pronouncement that
 the General Board of Health did not then have, and had not had hitherto,
 a medical man among its members or officers.  And that it did not have a
 medical member until bv virtue of its charge  of the "Interment Act,"
 in 1850.
  Dr. Rumsey, referring to this subject some years later in the  preface
 of his Essays on State Medicine, speaks of it in the following terms:  "Who
 would have thought that in  the  last decade of advancing  civilization,
 and in a nation boasting of its intellectual and material  resources, of its
 administrative energy and efficiency,  the whimsical  experiment should
 have  been  actually tried  of appointing three non-medical authorities—
 two  Lords and a  Barrister—to preserve the  health of  the  living; and
 then, after a year or so of doubtful  success, calling in  a physician to
bury the dead?"f
* English Sanitary Institutions. John Simon, p. 219.
tOp. cit., p. 211. 
24
QUARTER-CENTENNIAL CELEBRATION
   Nevertheless the public  acts, 1848-1S58, authorizing  the war on filth,
 and prosecuted as it was by Mr. Chadwick and his co-workers and suc-
 cessors,  secured  a  world-wide reputation for  the life-saving  effects  of
 cleanliness.
   It was at an early period under its auspices that, in 1839, in order that
 the Registrar-General might be enabled to turn to scientific use the vast
 quantities of detailed information flowing into  his hands, and  especially
 the facts medically certified to him as to the causes of registered deaths,
 William Farr, at  the instance of Mr. Chadwick, had been appointed Com-
 piler of Abstracts in his office.  "Eminently," says Sir  John Simon, "he
 was the man to bring into  statistical relief, and to make intelligible and
 instructive to the common mind, whatever broad  lessons were latent  in
 the life and death ledgers  of the great counting-house.   Eminently, too,
 not a man to forget the practical human interest of such mathematics."*
 Mr. Fair's first annual report  was made in 1841.   He continued in office
 until 1879, and to him more than to any one else the nation is indebted
 for creating the  demand for sanitary work:   The Registration of Vital
 Statistics.
   The particularly  important  events of this decennium were Dr.  Farr's
 statistical reports of the cholera invasion  and dissemination, and Dr.
 John Snow's first utterance, in 1849, of his theory as to the propagation
 of cholera by means of the intestinal discharges of  the sick.
   The first Medical Officers of Health in England  were in virtue of acts
 procured by the Town Councils, of Liverpool, in 1847, when Dr. William
 Henry Duncan, the earliest of the medical profession  to hold  any such
 office, was appointed Medical Officer of Health of that city; and, in 1848,
 when the corporation of the city of London obtained  like powers and
 appointed Dr. John Simon  Medical Health Officer  of that citv.  By him
 appointments of local medical officerships were  initiated and the acquire-
 ment of  exact knowledge as to the local distribution of diseases under-
 taken.  In 1855 Dr. Simon's office was made the Central Medical Officer-
 ship. At that time there were no statutory functions of a medical kind,
 except as to special occasions when cholera or some other such danger
 might require the Disease-Prevention Act to be in force. The laws werein-
 congruous and sanitary work  unsystematic.  Sundry investigations fol-
 lowed and many  important facts were elicited contributing  to the con-
 solidation and comprehensive acts of 1871-72, changing the status  of the
 Central authority and giving it full general powers of control and direc-
 tion over all local health authorities, so that it should be able to give the
 public connected  information on the matters in question, and making  it
 obligatory on every local authority to have at least one Officer of Health
 ouaMc'a ion  1^.^ah,fied1medical Practitioner,  or possessing  such othei
 qualifications  in  medical science as shall be  declared bv the Central
authority to be satisfactorv.f                           *      <-en™ai

 GenUa^Bonrd3^10^^^1^ PrCV T" t0 1871' When the Powers of the
 general Board of Health  were enlarged, there had been no sanitary
organization in England that would compare favorably with ?he Meti^
pohtan Board of Health of  New York, organized in iSfiO
nir^T' Va,S duriD£ this same interval, while quarantine was sus
ff hnrtf  J ^ that ln  1MGfl>the he*lth authorities and comme?-
cal bodies orrhis^country  formulated quarantine  regulations thatTave
 *Op. cit., p. 214.              '      "-------------------
 tOp. cit., pp. 329, 346.                          • 
MICHIGAN  STATE BOARD  OF  HEALTH  .
25
 constituted the basis of our quarantine laws since, and with which recent
 port sanitary regulations of England agree.  Among the important inci-
 dents of the  period, in England, was the introduction of yellow fever at
 Swansea, in 1805, by the return trip of the bark Eecla, a Swansea vessel,
 that had left Cuba July 26 with a cargo of copper and arrived at Swansea
 September 2d.   She had a clean bill of health and was  not subjected to
 a  critical examination.  Within an  hour of her arrival two  passengers
 landed with  their baggage and several of the crew had left and distrib-
 uted themselves about the towm, and yisitors were admitted on board
 without  restraint.  Within  three hours  from the time of arrival  the
 hatches wTere removed and the discharge of the cargo began.  Three of
 the men who were permitted to land were sick, two of whom—the cap-
 tain said—were  convalescent from fever, and the other  one had  the
 dropsy.  The one who had the "dropsy" died the next  day in the town
 with unequivocal signs of yellow fever.   An uncertain  number of cases
 occurred among the people of the town, fifteen of which* were  fatal.  But
 all of the cases reported upon were traced to communication  with the
 vessel.
   Whether this misadventure had anything to  do with the revival of
 port regulations for the prevention of the introduction  of infectious dis-
 eases which  had been superseded  by the  Chadwick  regime does  not
 appear.  But the Act  of 1872, under the head of Port Sanitation, pro-
 vides:
   Hospital accommodations for  infectious diseases; means of transport-
 ing cases to hospital and officers from ship to ship; apparatus for disin-
 fection, together with  needful provision  against the landing of rags or
 other things liable to  infection from infected ports.   And the Medical
 Officer of Health is required to take such steps as may appear to him to
 be necessary  for the prevention of the spread of infection.
   But  still  more explicitly with regard to cholera, yellow fever and
 plague,  in virtue of the public  health acts of 1875 and 1896, the port
 sanitary regulations, by order of the Local  Government Board, are, ex-
 cepting that  in some respects they are more rigid,  quite in line with the
 quarantine regulations of the United States.
   They are in substance as follows:   Every  port sanitary authority, and
 every other sanitary authority within whose  district persons are likely
 to be landed from ships coming from foreign ports, shall, with the ap-
 proval of the chief officer of customs of the port,  fix some place where
 any ship may be moored or anchored, and such ship shall remain there
 until the requirements  of this order have been duly fulfilled; and shall
 make provision for the reception of  patients and persons suffering from
 cholera, yellow fever and plague; and no person so removed  shall leave
 such hospital or place until the Medical Officer of Health shall have  cer-
 tified that such person is free from said disease.
   If any person so certified to be suffering from cholera, yellow fever or
 plague cannot  be removed,  the  ship shall remain subject, for the pur-
 poses of  this order, to  the control of the Medical Officer of Health; and
such person shall not be removed from or leave the ship, except with the
consent in writing of the Medical Officer  of Health.
   Any person certified by the Medical Officer of Health to be  suffering
from any illness which such officer  suspects may  prove to  be cholera,
yellow fever  or plague, may either  be detained on board ship for any
          4 
26
.   QUARTER-CENTENNIAL CELEBRATION
 period not exceeding twTo days, or be taken to some hospital or other suit-
 able place appointed for that purpose  by the sanitary authority,  and
 detained there for a like period, in order that  it  may be  ascertained
 whether the illness  is or is not cholera,  yellow  fever  or  plague.   The
 Medical Officer of  Health, if he  have reason to suspect any ship coming
 or being within the jurisdiction or  district of the  sanitary authority,
 whether examined by officer of customs or not, is infected, shall, or if he
 have reason to suspect  that the ship has  come from an infected  place,
 may visit and examine such ship for the purpose of ascertaining whether
 such ship is infected; and may  make the  like  visit  and examination in
 the case of any ship coining or being within the jurisdiction of the sani-
 tary authority which has come from an infected place. *  *  * And here
 follow directions for disposal of the dead from  those diseases in such
 manner as to be without danger to  any one; the disinfection  or destruc-
 tion of  merchandise  and clothing, and  the disinfection  of  the vessel.
   The master of e'very ship infected with cholera, yellow fever or plague
 shall,  when  within three miles of the coast of any  part of England or
 Wales, cause to be hoisted at the masthead, or where best  seen, a large
 flag of yellow and black, borne  quarterly, and shall  keep the same dis-
 played during the whole  of the time between sunrise and sunset, and
 no person (other than an officer of the customs or a person acting in  the
 execution of this order)  shall leave  such ship until after such visit.
   Moreover, it is made the duty of Medical Officers of Health, in respect
 of the  port  sanitary districts for which they are appointed,  to inform
 themselves as far  as practicable respecting all influences  affecting or
 threatening to affect injuriously the health of  crews and other persons
 on shipboard within their respective districts.  To inquire into and ascer-
 tain by such means as are at their disposal the causes, origin  and distri-
 bution  of diseases  in the ships and other vessels  within their districts,
 and ascertain to what  extent the  same  have depended on  conditions
 capable of removal or mitigation.
   By inspection of the shipping  in  their districts, respectively, to keep
 themselves informed of the conditions injurious to health existing therein
 and be prepared to give advice  on  all sanitary points involved to the
 port sanitary authority.
   Regulations requiring notification of  infectious  diseases  isolation of
 persons affected with such diseases, closing of schools for the prevention
 of their spread, infectious-disease hospitals, under recent laws  excel ours
 in  strictness.  Besides,  special  regulations are provided for  "for the
 treatment of cholera, or any other epidemic, endemic, or infectious dis-
 eases, and for the prevention of  the  spread of such diseases as  well  on
 the seas, rivers and waters of the United Kingdom, and on the hi-h Las









years ago, at themeetino- of ivj\,        £\,?andler- Just twent.v-five
             me meeting of the American Public Health Association in 
MICHIGAN  STATE BOARD  OF  HEALTH
27
 New York, of which the following is an abstract—on the testimony of a
 large number of the most  celebrated physicians and chemists:  "The
 commission declared themselves satisfied  with  both the quantity and
 quality of the water supplied by the Thames."  But Dr. Frankland, Pro-
 fessor  of Chemistry at the Royal Institution, dissented, and made some
 criticisms.   To these Dr. H. Letheby, the Medical Officer of Health for
 the city of London, addressed the committee in reply:   "I have to state
 that I  cannot agree with  Dr. Frankland that the water  of the Thames,
 after receiving defecated  sewage water, is  unfit  for domestic use; for,
 after a large practical acquaintance with the subject  as it is observed
 in the principal streams and rivers of England, I  have  arrived at a very
 decided conclusion that sewage, when it is mixed with twenty times its
 volume of  running water and  has fiowed a distance  of  ten or  twelve
 miles, is absolutely destroyed; the agents of destruction being infusorial
 animals, aquatic plants and fish and chemical oxidization."
   At a subsequent investigation, on the evidence of Dr. Parkes, Professor
 of Military Hygiene at Netley;  Sir Benjamin Brodie;  Dr. Odling, Pro-
 fessor  of  Chemistry at the Royal Institute; Dr. Miller,  Professor  of
 Chemistry  at Kings College; Dr. Letheby again,  and others, the Royal
 Commission again reported at  great length, endorsed the previous re-
 ports, and  concluded that for  these reasons—the evidence as given—■
 "We believe that  the organic contamination of the Thames is much less
 than is commonly imagined; still it would be sufficient to do great mis-
 chief, were it not for a most beneficial provision  of nature for effecting
 spontaneously the purification of the streams."
   This  report, made in 1869, appears  to have been abundantly  satis-
 factory to Prof. Chandler, for he adds:  "It has been before the British
 public in an accessible form, in all its details, nearly five years, and its
 conclusions have  been generally accepted."
   He gives as his reason for selecting the Thames as the chief basis  of
 comparison with  American water supplies,  because it had been more
 carefully studied  than any other source of city  supply and because  it
 may be considered an extreme case. But he also  cites the sources  of
 supply to a  number of other foreign cities whose death rates from cholera
 and typhoid fever had been notoriously large; and  "that there is gen-
 erally no fear on the part of engineers and those having charge of water
 supplies in  American cities is fully shown by the fact that many of our
 largesl  cities take water from  rivers.   *   *  *   Jersey City,  from the
 Passaic; Philadelphia, from the Schuylkill; Washington, from the Poto-
 mac; Cincinnati and Louisville, from the Ohio,"  and some other deadly
 examples which still obtain.
   The report  then proceeds to give the chemical  analyses of a number
 of such  river supplies, and  concludes:  *  *   * "For the supply of cities,
 lakes or rivers must be selected, and  although rivers are  the  great
 natural sewers, and receive the drainage of towns  and cities, the natural
 process of purification  in  most cases destroys the offensive bodies de-
 rived from sewage and renders  them harmless.  In very  rare cases will
 organic matters be derived from swamps and peaty deposits, and except
that these bodies may sometimes discolor the water, there is no sanitary
objection to them."*
  My purpose in citing this report of Prof.  Chandler at such length  is
to show7 the  concensus  of medical opinion  and  the  sum of  chemical
 ♦ Public Health. Vol. I, p. 533-563. 
28
QUARTER-CENTENNIAL  CELEBRATION
knowledge of what was considered healthful drinking water at the be-
ginning of the era of our special  consideration, and  because this report
was a sustaining  force of one of the chief obstacles against which sani-
tarians have had to contend.  There were sanitarians at that time fully
alive to the dangers of  water pollution with sewage, and especially with
reference to typhoid fever, as well as cholera, as indicated by the results,
but biological researches had not yet sufficiently advanced to verify those
results.  Indeed, it appears that what Lord Bacon said of  the medicine
of his day, that it stood for judgment on quite different merits than did
other learned pursuits, was scarcely less true at the beginning of this
quarter-century than at the time of his  utterance.
  "Other arts and sciences," he said, "are judged of  by the power and
ability exhibited in the conduct of them by their professors, and not by
success or events.  The lawyer is judged by the skill of his  pleading,  not
by the issue of the trial; the pilot  by his skill in directing  the course of
his ship, not by the fortune of the voyage.  But the physician can form
no particular act by which his ability can be directly demonstrated, and
therefore he is  principally judged by the  result, winch is very unjust.
For wiio shall decide,  if a patient die  or recover, whether the good or
the evil is brought about by art or by  accident?  Whence imposture is
frequently extolled and virtue decried.  Nay, the weakness and credulity
of men is such that they often prefer a mountebank or a cunning woman
to a  learned physician. So the accidents made ^Esculapius and Circe
brother and sister and  both children of Apollo.   Hence," he adds, "phy-
sicians say to themselves,  in the words of  Solomon:   'if it befall to me
as befalleth fools, why should I  labor to become more wise?' And there-
fore  one  cannot wonder that they commonly study some  other art  or
science more than their profession, because they find the mediocrity and
excellency in their own art makes no difference  in profit or reputation,
for man's  impatience of diseases, the solicitude of friends, the sweetness
of life, and the inducements of hope, make them depend upon physicians
with all their defects."
  With a  few exceptions,  this estimate of the art of medicine by Lord
Bacon obtained until the  eve of  the quarter-century of our particular
consideration.  Omitting the rest,  one exception is pre-eminently worthy
of mention—Jenner's discovery  of  vaccination—for never wTas discovery
more thoroughly demonstrated on  a scientific basis than this, based on a
considerable period of observation and repeated experiments before it
was announced.  It was a contribution toward, though not to the science
of medicine.  It stood alone for half a century.  Though Jenner  in his
lifetime, in answer to  the question whether vaccination  might 'not  be
a means of controlling other diseases besides small-pox, said-
  "The vaccine  disease, in my opinion,  is not a prevention  of the small-
pox,  but the small-pox itself; that is, the horrible form under which it
appears in its contagious  state is (as I conceive) a malignant variety.
Now, if it  should ever be discovered that the plague is a variety of some
milder disease, generated in a way that may even elude our researches
and the source  should  be discovered whence it sprang, this mav be aS
phed to a great  and grand purpose.  The phenomena of the  cow pox open

plored "      °P SPedal aCti°n'  eYGrV °ne °f Which  J h°Pe maybe^
  Yet there was  no  attempt made to  attenuate  other diseases besides 
MICHIGAN STATE BOARD  OF  HEALTH
29
 small-pox, as suggested by Jenner, until it was brought about  by Pas-
 teur's researches into the  causes of  certain forms of disease in French
 vineyards.  There were earlier discoveries  of bacteria by Leeuwenhceck
 and others, in almost every kind of organic matter in process of decom-
 position, but the part they^played in disease was not even hinted at.
   In 1840  Henle announced that the cause of miasmatic  infective con-
 tagious diseases must be looked for in  similar minute living organisms. He
 was unable to offer any satisfactory experimental  proof of his theory.
 But his  argument in favor  of it created a profound impression, and from
 that time forwrard greatly increased attention was given by medical and
 other microscopists to all infective diseases.  In 1S13 Mitscherlich pointed
 out that as yeasts gave rise to fermentation, so vibrios in like manner must
 be the cause of putrefaction; and Helmholtz showed that by the use of
 a membrane it was possible to separate from a putrefying liquid a fluid
 which, under suitable  conditions,  would  remain  sterile  without  the
 application of heat or chemicals.  In 1849 Pollender discovered microbes
 in the blood of the spleens of cows that had died of splenic fever; this
 discovery recalled attention to what Henle had suggested,  that  these
 organisms  were  in some way etiologically  connected with the outbreak
 of anthrax. Six years later he gave a more detailed description of his
 discovery, but meanwhile Davaine and Rayer described bacteria taken
 from the blood of animals affected with splenic fever.
   In 1857 Pasteur described a new fermenting organism which he showed
 had the power of  forming  lactic acid from sugar.   For this, however,
 the presence of  nitrogenous matter.was essential, not because  the ele-
 ments were required for the composition of the lactic acid, but  because
 they were necessary for the nutrition of the organism winch  produces it,
 thus throwing a new light upon  the relation  between cause and effect
 in fermentation.   In  1862  Pasteur  published  his paper  on organized
 corpuscles  existing in the  atmosphere,  and by a series of experiments
 showed that unless organisms  w7ere introduced into the organic fluids
 from without, by some means or other, no putrefaction could take place
 —that is, until  some organisms  were  present which could grow  and
 multiply in the fluid, no evidence of organic life would make its  appear-
 ance.
   In this year, too, Traube  showed that ammoniacal fermentation of the
 urine in  the bladder wTould not take place  if the  access of vibrios from
 without were prevented; and Pasteur, after  insisting upon the same fact,
 indicated that this fermentation might be prevented by the  presence  of
 boracic acid, and he proposed that in cases  of operations on the  bladder
 the parts should be kept irrigated as  far as  possible with a three or four
 per cent  solution of that substance.
   This lucid paper of Pasteur on "Organized Corpuscles in the Air" was
 the  prelude to Professor Lister's experiments  on the antiseptic treat-
 ment of wounds,  first undertaken three years after Pasteur's paper.  His
 experiments at the first were crude and difficult of application, but with
 a  persistence commensurate with his  nobleness  of  purpose, after  two
 years perseverance he had rendered them so facile and so successful in
 his hands that, in 1867, he insisted  upon the importance of excluding
special bacterial  organisms  from wounds.
   It is no disparagement of the  brilliancy of the results of following
 Professor Lister's practice  in  the application  of  knowledge  of  disease
v 
30
QUARTER-CENTENNIAL  CELEBRATION
germs and germicides, drawn from the store of facts developed In  san
tarv work, to surgical procedure, to invite attention to the even  moie
brilliant results that have followed the like recourse to Professor V\>\^  N
by medical practitioners.  The brilliancy of the surgical results is  inoie
apparent  because  it is more  easily demonstrated than the  results 01
medical practice.                                       .      ,   .,,
  In 1872 Bollinger demonstrated the presence of spores in the  Dacuius
anthracis. He also showed that if blood from a cow affected with *Plenic
fever were kept for some time, the rods disappeared, but the  blood still
retained its  virulence.  This virulence he attributed to the presence ot
spores, which, though remaining inactive under conditions unfavorable to
the existence of the anthrax bacillus, still retained their vitality; and by
the recurrence of  conditions  favorable  to their development they as-
sumed the form of the bacillus and  were then capable of setting up the
disease.  He pointed out the important bearing of this  retained vitality
of germ spores on the question of infection of the  soil; and, by indicating
that the so-called epidemic  diseases were due to the fact that the condi-
tions were  favorable or  otherwise—perhaps intermittently—for the
growth and  development of anthrax organisms, he not  only  discovered
the etiology of those diseases,  but, by pointing out the conditions under
which  the vitality of their germs  were maintained,  he displayed the
feasibility of preventing or  stamping out  such diseases by sanitary work.
  Closely  related in substance to  Bollinger's discovery  were Dr. George
M. Sternberg's observations on the  soil in  New Orleans, as reported by
him to the  National Board of Health in 1,881.   "The fact observed by
myself," he  says, "that during the summer months the mud in the gut-
ters of  New Orleans  possesses an  extraordinary degree  of virulence,
shows that  pathogenic varieties of bacteria are not alone bred in the
bodies of living animals. The more I study this  subject the more  prob-
able it seems to me that in this direction  lies the explanation of  many
problems  which have puzzled the epidemiologists, and that the sanitari-
ans are right in fighting against filth as a prime factor in the production
of epidemics—a factor of  which the role is  easily understood, if this
view is correct.  The presence of septic organisms possessing different
degrees of virulence, depending upon the abundance and kind of papnlum
furnished them,  and upon meteorological conditions more  or  less favor-
able, proves, in my opinion, the epidemic constitution of the atmosphere,
which wise  men were wont to speak of  a  few years ago as a cloak for
ignorance.  It must be remembered  that the gutter mud of today, with
its deadly septic organisms, is the dust of tomorrow, which in respiration
is deposited upon  the  mucous membrane of the respiratory passages  of
those who breathe the air loaded with it."
  Moreover, foremost in sanitary work for the time being, in the quarter-
century of our contention, was that as a whole, which the paragraph just
above quoted brings to mind, the work of the National Board of Health
during the  period of its active existence,  1879-81.  How  earnestly and
successfully it battled with and stamped  out the yellow  fever in Memphis
and New  Orleans  is popular history.  But this was but a mere  item of
its work.  It'promptly revised the situation and appointments of the
quarantines of the Southern  Atlantic and Gulf Coast harbors;  estab-
lished refuge stations  for infected vessels; instituted sanitary inspection
of vessels, raihvay coaches and persons  at infected ports and places of 
MICHIGAN  STATE BOARD  OF  HEALTH
31
   departure; established a sanitary police of the lower Mississippi in time
   of yellow fever at any port or landing thereon; required thorough cleans-
   ing, disinfection and aeration of all houses, river vessels and boats, in
   which there had been cases of yellow  fever.  To notice in detail the in-
   vestigations made by Drs. Chaille" and Sternberg on fevers; Drs. Wood
   and Formand on diphtheria; Professors Remsen and Smyth on  the dan-
   gers of carbonic oxide and  soil gases; Professors  Mallet, Martin  and
   Pumpelly, on the organic matter in potable water; Col. Waring and Mr.
   Bowditch's report on sewerage and drainage  in the United States; Mr.
   Rudolph Hening's report upon sewerage  works in Europe, and many
  other scientific investigations conducted under the auspices of the Board,
  and their practical results, would  require  much more space than this
  occasion affords.
    In 1875 Klebs first  described the  bacillus of typhoid fever, and again,
  with Eberth,  more accurately, in 1880; in  1884 Koch demonstrated the
  bacillus of cholera, and Loefrter  that of diphtheria; but it is needless to
  pursue this category,  literature  with which we are all familiar is filled
  with it.  Equally important  to  our contention  is the relation of these
  discoveries to  measures for their prevention  or destruction.   Hitherto
  the  use of disinfectants  had been an art only  and empyrical.  Certainty
  of their utility  awaited their application to disease germs as a test of
  their efficiency,  and thus disinfection has become a scientific procedure.
  Steam had been  used to a limited extent and had won the confidence of
  all who  used it by its recognized result as  an efficient disinfectant, for
  many years, but it was not until 1884, when Dr. Sternberg reported that
  by  actual  experiment it wTas  fatal  to  all  of  the pathogenic  and  non-
  pathogenic organisms tested, in the absence of  spores (with the single
  exception of sarcina lutea), at a temperature of 143.6°, which placed its
  use on a scientific basis, that it  has since that time been generally ac-
  cepted.  Nevertheless,  the first ship disinfection undertaken on a strictly
  scientific  basis was with  mercuric  bichloride, in virtue  of its known
  germicidal properties, by  Dr.  Joseph  Holt  in  the same year that Dr.
  Sternberg declared the efficiency of  steam.   Two years afterward, how-
  ever, Dr. Holt "became fully convinced of  the entire sufficiency of the
 moist high temperature, as in itself a  potential agent of the most de-
 cisive kind."*  And the use of steam has since become one of the most
 efficient agents in sanitary work in  the destruction  of disease germs.
   Antitoxins were the  outcome of sanitary  work by  Salmon and Smith
 in 1886, who showed that the products  of active or virulent bacilli were
 capable of inducing very severe symptoms  or septic poisoning, so the
 products of attenuated  bacilli, if injected into an animal, confers a degree
 of protection against the actions  of virulent bacilli almost, if not quite,
 as great as that obtained wiien the attenuated  bacilli are themselves in-
 jected.   This discovery, together  with Sewall's observations on the im-
 munity produced  by gradually increasing doses of cobra poison, and the
 observations of Von Fodor and Nuttall  on the  bacterial action of blood
 and  blood serum, opened up the way  for the production of antitoxin
 serum by Behring, Kitasato, Ogata and others in 1889-90, and the anti-
toxin treatment of diphtheria and tetanus, which began in  1891 and has
been  the means of prolonging many thousands  of lives.
  Efforts for the  protection and purification of water supplies seem to
have awaited conditions somewhat analogous to the use of  disinfectants
* Sanitarian Vol, XVII, p. 331. 
32             QUARTER-CENTENNIAL  CELEBRATION
 —the discovery of disease germs in polluted water.   At any rate,  it is
 only since the discoveries of Eberth  and Koch that  chemists and engi-
 neers have become convinced  that sewage is unwholesome, no matter
 how much diluted.
   The benefit of purification methods is aptly shown by the reduction of
 the death rates from typhoid fever.
   Death rates from typhoid fever per 100,000 population for seven years
 ending December, 1896:
   Cities using lake water—Chicago,  71;  Milwaukee, 29;  Detroit,  30;
 Cleveland, 46; Buffalo, 34.  Average, 42.
   Cities using  river water—Pittsburg, 84; Philadelphia, 45; Cincinnati,
 49; Louisville, 74; St. Louis, 39.  Average, 58.
   Cities using filtered water—London, 14.4; Berlin, 7.1; Rotterdam, 5.7;
 Hamburg (filters put in service May, 1893), 9.7.  Average, 9.1.
   But there are no more striking  examples than those of Lawrence and
 Lowell, Massachusetts:
   "The city of Lawrence, with a  population of 55,000, draws its water
 supply from the Merrimac River,  after it has received the sewage  from
 Lowell, nine miles above.  The city of Lowell,  with a population of 85,-
 700, draws its water supply partly from the Merrimac River and partly
 from a system of driven wells.   Lawrence, however, has filtered its water
 since September, 1893, while Lowell uses such water as is drawn  from
 the river in its natural state.
   "The typhoid fever death rates per 100,000  of  population living,  for *
 these two cities since 1890, have been:

      Year.            1890  1891  1892   1893   1894 1895 1896
    Lowell ...........   158    98    90    61    55    39    42
    Lawrence  ........   123   115   102    93    48    31    15

  "The average death rates for the years 1890  to 1892, inclusive, before
 filtered water was used in Lawrence, were,  for Lowell, 115, and for Law-
 rence, 113, or  quite the same;  while for the three years, 1894 to 1896,
 inclusive, during  which time filtered water was  used in Lawrence, the
 average rates were, for  Lowell, 45, and for Lawrence, 31.  The percent-
 age of reduction in the  rates for Lowell was 40, and for Lawrence over
 72, leaving a net  reduction of 32 per  cent  to be credited to the filtered
 water of the latter city."*
  Unfortunately, the protection of our water supplies, excepting in Massa-
 chusetts, is not under the direction of the sanitary authorities.  The  ex-
 cellent results in  this exceptional  case, as  just cited, should not fail of
 influence on the legislative authorities to confer like power on all of the
 State Boards of Health.
  Allied to the protection of the water supplies, however, is the protec-
tion of milk and  other food supplies,  which has  been a signal illustra-
tion of sanitary work, State and local,  so extensive and so generally  ac-
knowledged as to require no details.
  Of the sanitary work in the  public service, Army,  Navy and Marine
Hospital Services, now in such  prominent evidence/the co-operation  en-
 tered upon at the beginning of  the war is worthy of the highest  nraise
and  unqualified confidence in the joint effort to prevent  the spread of
yellow fever,  even though it may, from time to time, under the extra-
 ♦Public Water Supplies.  Hill,  p. 36. 
MICHIGAN  STATE BOARD  OF  HEALTH
33
  ordinary circumstances of the occasion, find entrance.   The exceptional
  promptitude with which the disease was stamped out after its discovery
  at McHenry, Miss., May 20, is an encouraging example of energetic work.
   And what may now be said of the crusade that has but just now begun,
  as it were, against tuberculosis, omitting  any attempts to discuss  that
  phase of it which has been in progress for several years in the destruction
  of cattle—further than to rivet attention,  if possible, to the liability of
  children to intestinal tuberculosis, and since children are the great milk
  consumers—to insist upon this fact as a sufficient  justification of  the
  destruction of tuberculous cows, and for the most  rigid supervision of
  the milk supply by the sanitary authorities.
   Every sanitarian readily recalls to mind  the discovery of the fostering
  influence  of tuberculosis by  a damp soil,  in 1862, by our always-to-be-
  remembered pioneer in sanitary work, the late Henry I. Bowditch, and
  recognizes the immense  benefit of that discovery in the  promotion of
  soil drainage.   But our present reference is more particularly to Koch's
  discovery of the tubercle bacillus fifteen years ago.  And since the recog-
  nition of  the  communicability of the disease by the inhalation of  the
  bacilli from the dried dust of the sputum of consumptives, the question
  of hoir to prevent this  danger with  the least possible inconvenience  to
  the afflicted is  one of the most important problems of practical sanitation.
  That  there are various  means adaptable to the  different  conditions  of
 exposure and the proper care of consumptives, subject to sanitary super-
  vision, every sanitarian  knows.  And the  salutary  results are  proven
  by the diminishing death rate from consumption wherever it  has  been
 imposed.  Moreover, the  restrictive measures of  sanitary authorities  in
 this regard have been  an educational force among the people at large.
 And  no persons have become  more keenly  alive to the danger of tuber-
 culosis sputum than consumptives themselves,  who  would be the  last
 to afflict in like manner those who  are dear to them or other persons.
 While, therefore, their  sensitiveness in this regard should  always be re-
 spected, the day has gone by—even with them—wiien such sensitive-
 ness  should be an obstacle to the protection of human  life.  Consump-
 tion is no longer regarded as a family disease—much less  a community
 disease—but a  personal one: a disease  that is  ordinarily contracted by
 inhaling the dust of dried  sputum, and above all by persons whose re-
 sisting powers are belowT par from any cause, though no person, however
 well,  can be considered absolutely exempt  from the danger of such ex-
 posure.
   The tendency to consumption is constitutional weakness  from any cause,
 no more likely to be "inherited" from  consumptive parents than from
 dyspeptic parents, and not  as  likely from either as from the stifling air
 and physical restraints of  some schools.  Besides, the tendency  to  dis-
 ease from these sources extends to other diseases  as well as to consump-
 tion.   Disease  germs are beyond question  the  chief antagonizing force
 to human  existence upon the  earth.   They belong to a great family of
 vegetable organisms whose office in the role of living things is, in  gen-
 eral,  beneficent, but, as  in the  higher  orders  of vegetable organisms,
some  are poisonous, and  these are the  "pathogenic microbes"—disease
germs.  Of their life-history there is nothing known  beyond their pres-
ent aspect.  No evolutionist has yet instituted inquiry into their primitive
form—if they  were ever  of any other than as  now  observed—or  ven- 
34
QUARTER-CENTENNIAL  CELEBRATION
tured to anticipate their development in  the  future.  Nor, indeed,  has
there ever been described any division of their  bodies into special organs
or anv  function beyond their self-multiplication by  "fission";  that is,
by division of each unit into two,  and so  on, ad infinitum, resulting by
geometrical progression in such an enormous  increase of numbers in a
very  short space of time—under  favorable circumstances—as  to  defy
the power of imagination to comprehend.
  When we consider that an impure atmosphere is one of the most favor-
able conditions for their propagation, and reflect upon the facility of their
reproduction and marvelous distribution, we may well wonder how is it
possible to escape them. Indeed, it is impossible.  But from the scientific
basis on which Preventive Medicine rests, we can fight them, and though
we may not be able to wholly subdue and conquer them, we can so culti-
vate our powers of resistance to them as to measurably  defy them.
  Stamina' is an educational force of primary  importance to both body
and  mind.   All  understand that a pure atmosphere is essential to  the
maintenance  of health.  But, owing to the wonderful facility which the
human  body  possesses  of accommodating itself to circumstances, it  fre-
quently happens that  school assemblies breathe a  most unwholesome
atmosphere  day after  day,  or perhaps for weeks, without apparently
suffering from it,  while one after another of  the pupils is continually
dropping out—overtaken by some  epidemic disease.   English  statistics,
which are more complete than any others accessible to us, show that the
death rate of elementary school teachers is  20  per 1,000—more than
double that of soldiers on home  service and four times as great as that
of the police, or of seamen.  It is  from five  to six times greater than that
of criminals who have no specific  disease among them in prison. And
of school children,  the best results obtained are from half-time schools—
schools  in which but half the time is devoted to mental  study and  the
other half to physical exercise.   Indeed,  education  without sanitation
must be, cr necessitate rei, always unsatisfactory.
  Sanitary work has been not only eminently successful in the promo-
tion  of  school hygiene  in the United  States during the era of our con-
sideration, so evident that he who runs may read, but it  has concerned
itself with eminent success in the promotion of  medical education.
  With  but one single exception,  that of North Carolina, all of our State
laws for the prevention of quackery, commonly designated Medical Prac-
tice  Acts, are chiefly, if not wholly, due  to the influence of  our State
Boards  of Health.   With special reference to  the leading spirit in  the
promotion of the Medical Practice Acts,  the  late John  H. Rauch, we
know of no better description of the relation  of such Acts to sanitary
work than the summary prefacing the Sixth  (1883) Annual Report of
the Illinois State Board of Health:
  "Boards of Health are created  and maintained for the conservation of
the interests  of health and life.  Ordinarily their functions are limited
to dealing with  sanitary questions; with  the  removal of the  causes of
preventable disease and premature death.   This Board, however  is also
charged with the execution of the  Act to regulate the practice of medi-
cine  in the State; and thus the medical profession, one of the most im-
portant  agencies which is concerned with the interests of health and life
is brought within the scope of sanitary legislation. To improve the status
of the individual practitioner, and to develop a well-trained  and thor- 
                MICHIGAN  STATE  BOARD  OF  HEALTH             35

 oughly educated medical profession, must result in increasing the value
 of this force in sanitary science and public hygiene; a force, which in the
 nature of things must  always exist so long as there are physicians and
 patients; and the character and influence of which must always  hold a
 direct relation to the tone, attainments, and the competency  of those  by
 whom it is exerted."
   In an address Dr. Rauch delivered as Chairman of the Section of State
 Medicine,  at  the session  of the American  Medical Association in 1886,
 he submitted certain propositions which he considered germane to need-
 ful action of  that body in the promotion of the highest attainable stand-
 ard of medical education, and  in order to give practical effect to them
 he specifically suggested:
   "That the American Medical Association should put itself upon record
 at that session as recommending the extension of the period  of study to
 four years, and of attendance  upon lectures  to three full  terms, with
 ample hospital  practice  and clinical  instruction, as the requirements
 for graduation in medicine."
   The Association did not so put itself upon record until six years after-
 ward.  But Dr. Rauch ceased not to so urge to the day of his  death.  At
 the recent meeting  of the Association  in Denver, Dr. Rauch's  suggestion
 was unanimously adopted by special resolutions, as hereto appended.*
   Well did Tyndall observe, as a physicist twrenty-three  years ago:  "If
 recent theories on the propagation of disease by germs  were proved  to
 be correct, and if the laws which govern the propagation or  destruction
 of those germs were known, the art  of the physician would  be raised
 from dependence on empirical observation into  the position of an exact
 science.   *  *  *   Yov never before," he said, "was medicine manned
 and officered  as it is now.  * *  *  On the old  Baconian lines of obser-
 vation and experiment the work is carried on.   The inter-communication
 of scientific thought plays here a most important part.   * *   *   While
 physiologists  and physicians in  England and elsewhere were drawing
 copiously from the store of facts  furnished by the researches  of Pasteur,
 that admirable investigator long kept himself  clear of  physiology and
 medicine.  *   *  *  The  union of scientific minds is,  or ought  to  be,
 organic.  They are parts of the same body, in wiiich every member, under
 penalty of  atrophy and  decay, must discharge its  due  share of duty
 imposed  upon the'whole.   *  *  *  In observational medicine one fine
 piece  of  wTork may be here referred  to—the  masterly  inquiry  of Dr.
 Thorne into the outbreak  of typhoid  fever  at Caterham and Redhill.
 Hundreds were smitten by this epidemic and  many died.  The qualities
 of mind  illustrated  in  Dr. Thome's inquiry match those displayed by

                         ♦AMERICAN MEDICAL ASSOCIATION.
                                                     Philadelphia, June 30,1898.
 Dear Sir • At the recent meeting of this Association the following was unanimously adopted:
 Whereas' The American Medical Association did,'at Detroit in 1892, unanimously resolve to demand
of all the medical colleges of the United States the adoption and observance of a standard of require-
ments of all candidates for the degree of doctor of medicine which should in no manner fall below the
minimum standard of the Association of American Medial Colleges ; and
 Whereas This demand was sent officially by the Permanent Secretary to the deans of every medical
rolWe in the United States, now, therefore, the American Medical Association gives notice  that here-
after no Drofessor or other teacher in, nor graduate of, any medical college in the United States which
shall  after January 1, 1899,  confer the degree of doctor of medicine or roceive such degree on any con-
HiH™,rhelow the published standard of the Association of American Medical Colleges, be allowed to
register as either delegate or permanent member of this Association.
 Resolved That the Permanent Secretary shall within thirty days after this meeting send a certified
copy of these resolutions to  the dean of each medical college in the United States and to each medical
iournal in the United States.
journal m                                              WlLLUM B. ATKINSON,
                                                         Permanent Secretary. 
36
QUARTER-CENTENNIAL  CELEBRATION
William Budd in his memorable investigation of a similar outbreak in
Devonshire.  Dr. Budd's process was centrifugal—tracing from a  single
case in the village  of  Xorth Lawton the  ravages of  the fever far  and
wide.  Dr. Thome's  process was centripetal—tracing the epidemic back-
ward from the multitude of cases first presented to the single individual
whose infected excreta,  poured into the  well  at Caterham, were the
cause of all.
  Finally,  my friends,  the good time a-coming, announced by Tyndall
twenty  years  ago, has  arrived!  The sanitary wTork of the quarter-cen-
tury of our contention in correlation with  the facts  it has evoked in
conjunction with collateral  delvers  into the foul  soil it has cleansed,
into the impure waters it has clarified, into the marshes it has drained,
the air  that it has screened from malignant organisms are the notes of
its triumphant song in  praise of sanitary methods.
  Chairman Wells—"Public Health Work in Michigan"—The gentleman who is to
address you on this subject is a native of Michigan, and one of the products of our
State to  whom we can point with pride.  Though he  left  Michigan before its
systematic public-health work had fairly  begun, yet he has watched its develop-
ment with interest. Our loss was Chicago's gain,  and the work of Doctor Reynolds
during the exposition and  the terrible outbreak of  small-pox which followed it is
known to most  if not all of you.  Though interrupted  for a time in his efforts to
perfect the sanitary systems of a great city, he is now rapidly bringing  to bear
upon the problems which this work  presents a degree of knowledge and executive
ability which are rapidly placing Chicago in the front rank of cities in our own land
whose inhabitants are  protected in  their lives and health by every means which
modern science and skill can dictate.  I introduce to you Doctor Arthur R. Reynolds,
Health Commissioner of Chicago.
             PUBLIC-HEALTH WORK  IN  MICHIGAN.

  BY ARTHUR R. REYNOLDS, 31. D.,  HEALTH COMMISSIONER OF CHICAGO.

  When I first received an invitation to address this assembly my im-
pulse was to decline, knowing full well that I had not time at my com-
mand  in  which to prepare anything adequate for such  a noteworthy
occasion.   I finally yielded, however, to  an urgent repetition of the invi-
tation, largely because I recalled that it was in this State, at the village
of Orion, just forty miles from Detroit, twenty-four  years ago, that I
began  my medical career.  That was in the office of an older brother
then of Orion, later of this city, but now of tender  memory.
  It was  then I received my first lesson in preventive medicine through
pamphlets of instructions on  the  limitation of the spread of the con-
tagious diseases, the disinfection of premises, etc., prepared and  sent me
 Lt r\?TP' B- -Baker- then as now the faithful and  efficient Secretary
of the Michigan State Board of Health.
  In the few desultory remarks which I shall  offer I need not  refer to
the ongin of the  State Board of Health of Michigan, for  this Conven-
tion is held in commemoration of  the fact that it  was established iust
twenty-five years ago.                                             J
  Looking back to that date, I think it will be admitted that the sponsors
of the  Board builded more wisely than they knew  in  selecting its natal
year.   Sanitary science' was then in  its swaddling clothes;  an infant—
histy it is true and full of the promise  of potencies then undreamed of- 
MICHIGAN  STATE  BOARD  OF  HEALTH            37
  The germ-theory of disease  was yet struggling for  recognition,  and
there were, probably, in July,  187:5,"when the  Michigan State Board of
Health Act  took effect, more believers  in the  theory  of  spontaneous
generation than  in the doctrine of a living contagion as the cause of
disease.
  The culture-tube, the bacteriologic  microscope, the  instruments of
precision  familiar to the present day, were then known only to  a  few
isolated students.
  Disinfection, now an exact  science—its practice subject to the  con-
trol  tests of the  laboratory—was then a rule-o'-thumb art, whose best
results were obtained by disengaging a  smell so foul  and irrespirable
that it compelled doors and windows to be opened for the  access of
nature's  potent disinfectant—fresh air.
  The modes of the spread of the contagia of the communicable diseases
were only vaguely guessed at—indeed, some of the most prevalent  and
deadly of the preventable  diseases, tuberculosis, for  example, were not
even recognized as communicable, still less were their causes known or
their ways  and  means of propagation  understood;  while  induced im-
munity against the infective diseases of the human family was limited
to the empiric practice of vaccination.
  And so in almost every  branch of what may now  justly claim to be
an exact science  there was incertitude, vagueness, speculation and pri-
meval ignorance.
  It was in this  field that the  Michigan State Board of Health entered
twenty-five years  ago and a record of its labors and achievements during
the intervening period would be a history of the development of sanitary
science to its present well-nigh  perfect proportions.
  I will not  here attempt even to summarize these labors and achieve-
ments.  Their story is well and fully set  forth in the pages of Mr. Mac-
Clure's volume,  "A Quarter of a  Century of Public-Health  Work in
Michigan", to which you all have access.
  What God hath wrought through this Board is therein tersely  told in
the statement that between 1890 and 1896, nearly one hundred and fifty
thousand cases of sickness were prevented and more than seven thousand
lives were saved  from premature death through the advice, instructions
and  supervision of the Board.
  It is not too much to say that the State Board of Health of Michigan
has,  in the  language of our great classic in  hygiene, Edmund Parkes,
made growth more perfect, decay less  rapid, life more  vigorous, death
more remote for every citizen within the boundaries of this fair State.
  And now, what of the future of the Board?
  At first blush it may seem that the field of usefulness of a State Board
of Health  is  a narrow one.   On  reflection, however, we will discover
that its function  is as broad  as civilization itself. It  follows the citizen
in all his dealings through* all his days.  It begins at  his birth and even
before; it has him under observation whatever his occupation or wherever
his mission through all  his life to its close, and it keeps careful vigil at
his grave until the last  vestige of his remains is crumbled into the dust
from whence it  came.  There is  no situation  in life  that escapes its
scrutiny.  Every incident  that lowers the vitality,  that depraves the
mind or that  whets  an abnormal appetite calls for its  interference.  It
holds no despot's sway to club mankind  along paths that are hard.  It 
3.s
QUARTER-CENTENNIAL  CELEBRATION
only asks that he be normal.  It teaches no abstruse philosophy,  but
offers hope and regeneration to the weak.
  In this work of sanitation there is nothing of the spectacular,  mere
is none of the inspiration and the glory that reckon with a nation sa\ eci
or a foe repulsed bv feats of arms.  Nevertheless, those who study under-
stand that the proper appreciation of sanitary science defeats man s most
relentless foes and  that neglect  or defiance  of her  laws has  brought
destruction to nations  in all  time.
  And right  here let me say that, if unhappy Spain  had no other sin
than  that of  having maintained  at our doors a  preventable breeding
place for  yellow fever she richly deserves  the wrath  that has been
visited upon her.,
  Wonderful as has  been the improvement of the  public health in your
State and in your mortality rate during these twenty-five years, a glance
at the diseases that cause the greatest number of deaths,  keeping in
view the increasing  and broadening effect of education and  the  multi-
plying avenues for the spread of information, reveals the promise of a
still greater reduction in the death  rates of the future.
  The greatest number of deaths in the centers  of population is caused
by diseases of the nervous  system—the irorry diseases.  The  number is
steadily increasing year by  year and this increase is due to the keenness
of commercial competition  and the fierceness of the struggle, not alone
for  existence, but for wealth.
  As we grow in wisdom we may learn how utterly futile is this struggle
and how utterly foolish it is to bring on a premature demise when, under
the  present conditions of our  civilization, riches are and must be con-
fined  to the few.  The only thing needful for all  is a competence for
declining years.  It  is folly to struggle a life-time for  the  purpose of
leaving a fortune behind, with the hope that one's name and fame may
live after he is gone.
  The only  rational wray to perpetuate a name and an example  is through
a robust posterity.
  It is an almost universal rule that those who have labored and wor-
ried beyond their endurance leave a generation of weaklings to fritter
away their substance and ultimately to pass from history forever.
  The lesson to be learned and the lesson that must be learned is to stop
fretting and stewing one's self into the grave to leave a pitiful physical
and mental inheritance to one's children.
  It is difficult to trace the  full benefit  of sanitary work, but the cumula-
tive force and momentum developed by twenty-five years of  intelligent
and well-directed education in the prevention of disease has saved to your
State hundreds of lives and made it the equal of the best as  a place of
abode. This is seen  in its present mortality rate,—now among the low-
est  in the land.  A low rate of mortality means that death is  here more
remote, that  here it is possible for  man to reach  his highest physical
perfection, to enjoy his greatest immunity from disease and to postpone
to the uttermost his day of dissolution.
  It needs no argument to prove that such conditions enhance the value
of property, make investments more secure and attract those of other
places looking for the  most favorable environment for living out their
days in peace and plenty. As an evidence of this truth you will recall the
great migration of those that are frail who seek vour ports, your rivers
and your wooded dells  in the summer time.  Thev come from the  north 
MICHIGAN  STATE BOARD  OF  HEALTH
39
 the south, the east and the west to regale and refresh their weary bodies
 within your borders.  Many of these visitors have in the years gone by
 remained  as permanent  citizens.  The State has grown in population,
 in wealth, in learning, in men of wisdom  and distinction until it is the
 peer of any Stale in the Union.
   That this has been possible is due in no small measure to the fact that
 the State  has been wise1 enough to maintain at its capital this bureau
 known as the State Board of Health.  This Board has collected a wealth
 of information concerning the diseases and occupations and  habits of
 the people that  are inimical to human  growth and longevity,  and has
 poured forth each year a steady stream of information for the education
 and guidance of the people in the  ways of health and  lengthened days.
   And all this the Board does without emolument or profit—only the
 executive force receiving moderate salaries.
   That the people  of  the  State are alive to their best interests and to
 the importance of  the good  accomplished  is  evidenced  by the  fact that
 the founder of the  Board, who was  appointed its Secretary and  executive
 officer at the beginning, has  been continued through the quarter century
 just ended and is still on  guard.
   A striking feature of the work of the State Board of Health of Michi-
 gan is its method of placing in the hands  of each citizen the knowledge
 with wiiich he can ward off  disease.
   By its conventions in cities and towns and  even in villages; by its pro-
 motion of local health organizations; by lectures and institutes; and by
 innumerable leaflets and circulars and  pamphlets and  reports—spread
 broadcast  over the State, its citizens are  educated in sanitary matters
 beyond those of any other commonwealth with which  I am familiar.
   The Board has sent the sanitary schoolmaster abroad in the land—
 teaching, expounding, illustrating; line  upon line, precept upon pre-
 cept; here a little  and there a  little.  And his first and most valuable
 assistant is the daily  press—a fact which the astute Secretary of your
 Board has  not been slow to appreciate.
   As a matter of personal and official experience I have found no other
 one agency capable of affecting so much in sanitary matters as  the daily
 paper.   Unfortunately we cannot always command  its assistance  as
 fully as we would  like.  The absence of the sensational and  the spec-
 tacular in our work limits the space given in the newspaper columns—
 especially when events of great popular interest are occurring.
   The effect  of this limitation has been so seriously impressed  upon my
 mind during the past  few weeks, and the  lesson is one  of such import-
 ance from the sanitary standpoint,  that I venture to trespass upon your
 time with its brief recital.
   Unusually frequent  pollutions of the Chicago water supply, which, as
 you know,  is drawn from  Lake Michigan, finally led to the cutting off
 of the supply from the 230-odd public schools of the city in the fall of
 1896. During the winter of that year and well into the  summer of 1897,
 the character of  the water supply,  the question of filters, the action of
 the Board of Education  and of the Department of Health  furnished
 columns upon columns of matter in the daily press and were thus made
 the common themes of discussion in every household.  Space was freely
given to the regular bulletins of the Department announcing the sanitary
 quality of the water and to warnings against its use unless thoroughly
 boiled or properly  filtered.  Careful investigation warrants the belief 
40
QUARTER-CENTENNIAL  CELEBRATION
that, during this period of active newspaper discussion, between 60> and
70 per cent of the population of Chicago, including upwards of -uu>"u"
school children, absolutely abandoned the use of  the raw,  untreated
hydrant water for drinking purposes.                               .
  In 1896 the deaths from typhoid fever—the typical impure water dis-
ease—were 751.  In 1897 they numbered only 437, or more than 40 per
cent less than in 1896.
  The sanitary  quality of the water was substantially the same during
the two years", and this forty-odd per cent reduction I regard as attrib-
utable solely to the  newspaper agitation and its salutary  warning effect
upon the public mind.
  During the earlv  part of the present year a fair share of space and
attention was given to the bulletins of the Department, and the warning
to "boil the water",  issued from time to time, was given due prominence
and editorial emphasis,  with  a gratifying effect upon the typhoid-fever
death rate.
  Since the destruction of the Maine, however,  the all-engrossing war
news has monopolized the columns of the papers and, as was said in one
of our recent bulletins, "the repeated warnings of the Department against
the use of the raw  hydrant water  in its present condition do not seem
to be taken seriously "by the public."  These warnings lack the force and
effect that were given to them by  editorial comment a year ago and to
this I consider is due the recent increase of typhoid deaths.
  Up to March  12 there had been only 79 deaths from typhoid fever this
year as against  108 during the same period last year.  Since that date
up to the close of last month there were 279 typhoid  deaths as against
112 last year.  And yet the quality of the water supply during  the first
six months last year was  distinctly worse than this year.
   In this excess of  deaths from a purely preventable disease, which  ex-
cess in all human probability, might  have been avoided by giving the
same publicity to the character of  the water supply as was done a year
ago, sanitarians may see another illustration of the value of the press
as a potent auxiliary in their labors, while Chicago  has in  it another
cause to "Remember the Maine."
   I will detain you with only one more thought which seems to me worthy
of present consideration.
   Natural law  intends that man shall live and be useful and not that
he shall be degenerate  or  dependent  or that he  shall prematurely die.
The world is  for man  and his up-building,  for  the  developing  of  his
mental, moral and physical stature. The future sanitarian will broaden
out upon this basis. He must educate the masses upon the known laws
of reproduction and  enable  human beings to improve  their breeding
as the farmer improves all domestic animals by proper mating.
   The remedy for the social  evil that leaves such human wrecks in its
wake—that causes such loathsome  diseases and which modern knowledge
has shown indirectly furnishes so much of the surgeon's practice for  the
remedy of disease, particularly of women, must come through a thorough
dissemination among the public of knowledge now  chiefly held  by those
of the medical profession.  Let parents and  their daughters once fully
understand the jeopardy girls are placed in by marriage with men who
have lived reckless  and impure lives and there will be less need for sur-
geons to practice their divine art upon women in the future
   Let all understand that much of this danger and disease has its in- 
MICHIGAN  STATE  BOARD  OF  HEALTH
11
centive in the semi-delirium caused by intoxicating drinks.  When this
is generally understood  the young man who is known to be a rounder
will not be hailed as a jolly good fellow, but as an evil thing to be shunned
as was the leper in the  days of old.
  But neither the sanitary millenium, nor the social and  economic inil-
lenium, nor the millenium of peace, has yet arrived.  Hellish war is still
waged by civilized people and, in the name of both God and the law, men
are still  legally marshalled out for slaughter.
  Sanitary science believes in war; but its warfare does not tend either
to brutalize or to destroy life, but to save it and to elevate it.  Sanitarians
believe in the war that  regenerates and refines; the  war for the  defeat
of Satan and the enthronement of Immanuel; a war whose weapons are
reason, sweetness and light.
  To all  who serve in such warfare in this State, both past and present,
and to those who have brought sanitary work to its present perfection,
I offer my most respectful homage.  It  is the Master's work and  I bid
you God speed.

  Chairman Wells—Probably few persons  in the country, and certainly none  in
Michigan, are so competent to speak of sanitary work twenty-five years ago  as
Doctor Kedzie.  Much of this work in Michigan he was identified with as a mem-
ber of the first State Board of Health, and soon afterwards as its president.  He
has been  a member of most of the national organizations  for the promotion  of
public-health work, and president  of several of them.  Many of you have long
known Doctor Kedzie and probably  all of you know of his  scientific labors in many
fields.   I introduce to you with great pleasure Prof. R. C. Kedzie, of the Michi
gan State Agricultural College.
         SANITARY  WORK TWENTY-FIVE  YEARS  AGO.

BY  ROBERT  C. KEDZIE,  M. D.,  EX-PRESIDENT  MICHIGAN STATE BOARD OF
             HEALTH, AGRICULTURAL COLLEGE, MICHIGAN.

  In assigning to me this topic the committee doubtless expected me to
confine my discussion to work done in this State, else they would hardly
limit my time to twenty minutes.  A preliminary glance at the men, the
times and conditions of that period may not be out of place.

               Physicians and the Sanitary Movement.

  The  physicians of Michigan always took a deep interest in sanitary
matters, and were ready with voice and pen to  help  on the good work.
Dr.  Palmer,  of  our University, Dr. Beech, of Coldwater, Dr.  Pratt, of
Kalamazoo, Dr.  Jerome, of Saginaw, Dr. Jenks, of Detroit,  Dr. Bar-
tholomew, of Lansing, and others by the score did good service  in this
cause; but Dr. Hitchcock, of Kalamazoo, was  a most  efficient worker in
promoting the public health by organizing sanitary work.
  A few years previous the cause had received a powerful impulse from
Massachusetts—that grand old commonwealth—wiien  for the common
weal she inaugurated a State Board of Health.  In the face of a  strong
plea for strict economy and diminished expenditure because of the hard
times,  she demanded a large expenditure for  the public health,  on  the
ground—suggested by a woman—that nothing is  so economical as health,
          6 
42             QUARTER-CENTENNIAL  CELEBRATION

and nothing so wasteful as sickness.  Here was faith  to remove moun-
tains, and true economy won the day.
  The leaven of this logic began to work among our best people, but the
fermentation became especially active at the meeting of our State Medical
Society  in LS72,  when Dr. Hitchcock in his presidential address recom-
mended the appointment of a "special committee  to carefully consider
and report upon the  laws  of hygiene in  their relations to  our public
schools."  The suggestion was heartily approved, for the welfare of our
schools  lies very close to the heart of our people. The committee ap-
pointed, with Dr. Hitchcock  as chairman, divided  up and  assigned the
topics as follows:  "Light  in the school room," "The  kind of type for
school books," "The hygiene  of the ey<\" etc.. Dr.  Noyes.   "Methods of
study, grading, rewards, Idntergarten," etc.. Dr. McGraw.   "School gov-
ernment, hours of study, recess," etc., Dr. Hitchcock.  "Physical condi-
tion of school rooms, warming and ventilation," Dr. Kedzie.
  On  account of the  pressure  of professional duties, Drs.  XoVes and
McCraw could not  find  time  to prepare papers, but Dr. Hitchcock pre-
pared a valuable paper  on his topic, and the paper on the warming and
ventilation of school rooms presented the results of analysis  of air, and
the distribution of temperature in a large number of school rooms during
school hours.  Both papers were read at  a subsequent meeting of the
Society, wlien the newspapers took up these subjects and ventilated them
thoroughly, and  thus did much to create a demand for sanitary reform.
The Society appointed a committee  to wait upon the  out-going  and the
in-coming Governors to urge the importance of sanitary legislation by
creating a State  Board of Health.  Gov. Baldwin  gave the committee a
cordial reception.  When the subject was laid before Gov.  Bagley his
big heart beat responsive to the call. These influences and  a  score more
paved the way for the State Board of Health.
  Perhaps I dwell too long on this subject and have  widely wandered
into discursive fields, but the best "sanitary work done twenty-five years
ago" was in establishing the State Board of Health,  and for this w7ork the
State  Medical Society is entitled to a measure of credit.

                        Need  of Knowledge.

  Before speaking of  sanitary work done twTenty-five  years ago, let me
call your attention to  the conditions calling for such work  at that time.
It was before the world had availed itself of the labors of Pasteur, Lister
and Koch; when the terms  tubercle bacillus, antitoxine, asepsis and
antiseptic wTere unknown, or without meaning.  "The great white plague"
was the creature of heredity  and nourished by environment;  in  popular
thought "the visitation  of God." Then typhoid and cholera were in the
air and flew  with the wind—inhaled, not  ingested; if  you would  only
clasp your nose and hold your breath in the presence of the pestilence,
you would be safe no  matter what you swallowed.  The infectious prin-
ciple could be combatted by  burning a  few grains of  coffee or a linen
rag, the prophylactic power of a strong smell was  popularly  recognized.
Not thirty years  ago in an interior city a doctor calmly went from small-
pox patients to visit other patients,  without ablution or change of cloth-
ing, and in reply to expostulation said, "there is no danger  of mv «nvin<»
the small-pox because I always carry  a lump of  camphor in inv vest 
MICHIGAN  STATE BOARD  OF  HEALTH           43
 pocket."  The sanitarian might well take up the wail of the old Hebrew
 prophet, "My people are destroyed for lack of knowledge."

                           Potable Water.

   In former years the ideal of water for domestic and potable use was

               "Sparkling and  bright in  its liquid light
                Is the water in our glasses."

   If this was secured nothing more w7as required.  In popular estimation
 char water was  clean water.  It seemed impossible that bright, sparkling
 water could become a vehicle of disease1.
   Early in my medical practice I  had the care of a family that had a
 singular aptitude to get sick, and  recovery was slow and uncertain.  So
 far as the  family was concerned the cause was not obvious.  Temperate,
 moral, regular in their habits, they had no good excuse to be sick.  After
 weighing several possible causes of this valetudinarianism, my suspicions
 finally fastened  upon the family well, and I  suggested to the father my
 suspicions.  He took up a glass  of the water, tasted, smelled and critically
 examined  with  his eye and said,  "Clear  as crystal, and transparent as
 air!  Here is no cause for sickness."  The family went lingeringly down
 to death.   The place was sold and came into possession of a family noted
 for vigorous health,  when the  old scenes of mysterious sickness came
 again on the stage.  The wrell was condemned absolutely, closed up and
 a  new one dug.   With the  new well the  family got well and remained
 well.
   Once the inquiry was how to cleanse water already soiled and make it
 fit for potable use; wTe asked for some Elisha to cast a cruse of salt into
 the spring  to heal the water of  bitterness and death. How slow wTe  were
 to learn that germs of disease  may clothe themselves with  garments of
 light.  The new  demand for domestic and potable water is innocence not
 repentance—not  healing, but health.

                        Drainage of Swamps.

  It is a pleasing thought that  many operations begun for a specific pur-
 pose  introduce,   incidentally,  benefits outweighing the good  directly
 sought.  A good illustration is  furnished  in the legislation to secure the
 drainage of swamps, "to reclaim waste lands for agricultural purposes."
 The government surveys  of the lower peninsula  reported one-ninth of
 the area as swamp. An exaggeration undoubtedly.  If the surveyors told  '
 the truth, they told more than  the truth.  But there was enough swamp
 land to give a bad name to our State, and impress a decided malarial
 character upon our autumnal fevers.
  The summer and autumn  of 1850 was very dry,  and the fall fires that
 usually burn only the fallen leaves of the forests, burned out the muck
 swamps, burning off the roots of the marshy shrubs and trees and filling
 the burned-out basins of the swamps with fallen timber.  The season of
 lsr>7 was very rainy and the bark  and branches of the fallen timber rot-
 ting in the pools of stagnant water caused a  fearful amount of malarial
disease in the State; in many neighborhoods there were not enough wTell
persons to  give a cup of cold water to the sick. The mortality was not
oTcai  but the suffering was very general. 
44             QUARTER-CENTENNIAL  CELEBRATION
  The unsold swamp lands were finally donated to the State by the gen-
eral  government  for purposes  of reclamation and improvement,   .tor
these purposes the State  passed a  County Drainage Law,  and then a
Township Drainage Law, by which it was provided that where drains are
necessary for reclaiming land,  the expense shall be equitably  assessed
according to the  property benefited, and right of way for a drain was
secured so that no churl could stop such improvement because the outlet
must pass through his land.  The benefit to  agriculture was  great.
Noisome swamps  were changed  to waving meadows  and flocks of cattle;
but the change in public health was greater still.  Instead  of an  ague-
smitten district we have become one  of the healthiest states in the union.
So marked has been their  benefit to the public health, that  in Howell's
Compiled Laws, the  County  and Township Drainage Laws, instead of
being placed under "Public Lands," are placed under the "Public Health."
For both agriculture and sanitation, no more beneficent laws are on our
public  statutes.

                    School-house  Architecture.

  The  needs  of the school room—nure air, properly distributed  heat,.
floor-space, etc.—were early considered by the Board of Health, but on
one topic it spoke with emphasis, viz.: The evils of too lofty school build-
ings  and  too  much  stair-climbing.   Observation  and  inquiry showed
that  the evil was real  and growing.  A certain village had erected a
beautiful four-story brick house for its excellent school.  Its  fine propor-
tions and lofty walls caught the public  eye, and the high reputation of
its school made other villages anxious to rival its house and fame, and
school  houses were going up all over the State.   Against this tendency
the Board  lifted  its voice in no uncertain tones, pointing  out its evil
effects  on the girls while in school and the entailments that follow, last-
ing through life.  A critic objected to "low and  squatty school  houses,"
and pointed to "the beauty of  the Grecian temples with their lofty pillars
and stately forms." The reply was that Grecian temples were one-story,
and neither Gods nor Godesses  would occupy a room on the  fourth floor
when they had to climb stairs.

                       The  Kerosene  Battle.

  The petroleum products  for artificial light had come into  general use
25 years ago, and  the kerosene lamp  was found in every home.  The elec-
tric light was waiting for  Edison.  Even in homes of wealth where gas
was in use, in kitchen or garret the unsafe oil lamp was still to be found.
Not  only was  its use  very  general but very  unsafe.  The head-line
"Another Kerosene Horror" was seen in nearly  every daily  paper, with
sickening details of some poor woman roasted like a martv'r at the stake,
set on fire by a "lamp explosion."  To accentuate the danger, the cheap
and inflammable benzine was sold for an illuminant under catch names,
"Sunlight Oil," "French Burning Oil,"  etc.,  with preposterous recipes
to make the material non-explosive.  Packages of common  salt colored
with aniline, sold to "kill the gas," etc.. filled the homes with danger and
hearts  with dread. These special sources of danger confronted the State
Board  of Health at the  very threshold  of their  duties.  The oil was  im-
properly refined, too much of  the volatile materials retained in the kero- 
              MICHIGAN  STATE  BOARD  OF  HEALTH            45

 sene, and no certain method of inspection was in use, the testing of the
 oil being too largely within the personal control of the operator.  When
 the Micnigan Oil Tester adopted by the Board, with closed  cup inspec-
 tion and the flashing point as the line of danger,  were made  the legal
 method of  testing, and a State Oil Inspector to have charge of  this busi-
 ness, then  the people found a safe light.
   The battle, however, went on for nearly  twenty  years in  newspapers
 and in legislative halls, often with great bitterness and frequent changes
 of the law, but two legislative sessions have passed without  a serious
 effort to change the law, and people are forgetting the dangers  of former
 years.
   I have thus briefly  brought before you  some of the  "sanitary wrork
 done 25 years ago."  How- meager the resume".  But the best sanitary
 work is not that which may be pronounced  "done"—ready to be labeled
 and filed awaj' on the  dusty shelves of history.  It is rather the kind of
 work which is self-perpetuating, a stream that grows broader and deeper
 as it flows, bearing life and healing to eveiy  plain it touches.
   There are two ways by which we may attack sanitary evil; by light, or
 by lightning. Among a free people the surest if hot the quickest way to
 remove any great evil is to clearly point out the  evil  itself, its extent
 and its effect; many interests injured or at  least threatened  by the evil,
 without concert silently place themselves in opposition; a thousand eyes
 are at once turned to the examination of this evil and its tendencies; that
 wonderful  and complex phenomenon  which we call "a change  in public
 opinion" ensues, and the evil finds it must take itself out of  the way, for
 it has no home amid a hostile people. In this wTay the wrongs which
 threaten society in mass, right themselves  when brought to the bar of
 enlightened public opinion.  Such rectifications are the more permanent
 and abiding because they take place by the action of natural laws and not
 by the exercise of arbitrary authority.  The silent forces are the most pow-
 erful; the noisy and loudmouthed forces dissipate half their energy in the
 very noise itself.  The boom of the cannon is brag, but the hurtling shell
 is pow7er. The best work of the sanitary reformer is by light  rather than
 by lightning where  rending forces with  deafening noise and choking
 dust lay low the ramparts of wrong.  Let in the blessed sunlight, silent
 but potent, which renews  the face of nature, and  morning  by morning
 reveals a new world.
   In this line of work—advisory,  not mandatory—the  State  board in-
 augurated

                        Sanitary Conventions.

   The  prime object was  to  diffuse  information  on sanitary subjects
 among the  people, and to secure the co-operation of  all classes in promot-
 ing public  health.
   In entering upon sanitary  work the Board had high aims—too high—
 for we shot over the heads of common people.  This is  the  fault of all
 raw troops, and we had yet to learn and follow the precept of experience,
 "shoot low."  To bring our work down to the breast level and thus reach
 the heart of the people, the Board in 1878 inaugurated Sanitary Con-
 ventions to reach the laity,  and secure  the  co-operation of  men and
women of all ranks with the experts in sanitation. Dr. Lee is  to speak on
this subject and I  will  trench  upon his ground  only  to say  that  the 
46             QUARTER-CENTENNIAL  CELEBRATfON
work already accomplished in practical Sanitation in this State through
these Sanitary Conventions is incalculable, and the future opens  a wiue
door of usefulness  along this line.
          Afternoon Session, Tuesday, August  9, at 2 P. M.

  Chairman Wells-The meeting will come to order.  The  various lines of  vrovk.
which have engaged the attention of the Michigan State Board of Hea"& ^mJ?0"
cupv most of our time this afternoon.  Distinguished sanitarians from abioau. wno
have had practical experience in these various lines, have been  asked to Pieseiu
their views upon them at this time.  "Educational Work  of the Miclngan _Mate
Board of Health, including the work of the State Laboratory of Hygiene , is tne-
first subject upon the program.  This will  be considered by Prof. C. A.  Linasiey,
M. D., Dean of the Medical  Faculty of Yale College,  ex-President of the Conteiv
ence  of  State and Provincial Boards of Health,  and  President  of  the American
Public Health Association.  I introduce to  you Prof. Lindsley:—
EDUCATIONAL  WORK OE THE MICHIGAN STATE  BOARD OF
       HEALTH, INCLUDING THE  WORK OF THE STATE
                   LABORATORY OF  HYGIENE.

BY  CHARLES  A.  LINDSLEY, M.  D.,  PROFESSOR  EMERITUS IN  YALE  COL-
                       LEGE,  NEW HAVEN, CONN"'.

  A pleasant duty has been assigned to me today, to outline  for you the
work which  your State Board of Health  has accomplished  during the
twenty-five years  of its interesting and illustrious career.  It is always
pleasant to repeat the story  of  success and progress.   Because  success
implies efforts put forth,  difficulties conquered, and achievements won.
And that pleasure in this instance is enhanced by the consciousness that
the victorious  conflicts of the past have been so  steadily  progressive
towards the  object sought, and have been  so rich in  fruitful  experiences
as to give assurances of still  future victories, of still better success, and
of an onwrard progress in the great work of humanity which has been
undertaken.
  The State Board of Health of Michigan is among  the  oldest  in the
Union.   Not only because of  its early  establishment, but much  more by
its  judicious and  energetic action,  it has been a conspicuous symbol  of
the intelligence, the well-directed enterprise, and wisdom  of the people
of Michigan.  It has been a  pioneer, in what was at the time of its or-
ganization almost a new field of work in this country.
  Under the skillful leadership of  its  able and accomplished Secretary,
it has proved a guiding  star, to illumine  the  way and encourage other
and younger organizations in the same work.
  Before, howrever, we make any direct reference to the many and im-
portant results which it has achieved, let us briefly  considei- what wTe
ought reasonably to expect a State Board of Health to do.
  What is its mission? What are its functions?  Its  mission  is to preach
the gospel of public health to all the  people.  And  to  that  end  its first
and foremost  requisite is, to be well informed in sanitary science;  to 
MICHIGAN  STATE  BOARD  OF  HEALTH
47
 chief functions will be to teach the people the laws which concern the
 maintain an up-to-date acquaintance with the science of sanitation; for
 that is the foundation upon which its public utility will largely depend.
   In that capacity, as a fountain and source of information,  one of the
 health of communities, and especially, how to apply them.
   Sanitary laws are discovered and recognized by the careful and intel-
 ligent observation of  facts.  (A single fact by  itself is of little value.)
 But the accurate observation  of a large number  of facts, admitting of
 classification and  comparison, and corroborated  when  possible by ex-
 periment, are the means by which a knowledge of the laws of nature is
 acquired.  When such laws are tested and verified and  found to be un-
 changeable,  we call such knowledge, Science.
   The knowledge of natural law is science.  Sanitary Science  is a knowl-
 edge of the laws which govern in any way the physical development, the
 functional activity, the  mental growth, and even the moral  character,
 of the citizen, from his ante-natal existence  even to the celebration of his
 funereal rites.
   The laws of sanitation with  which a State Board  of Health is mostly
 concerned are those which point to the dangers, the whirlpools and the
 perils, that beset the ship of life throughout its  course, and so chart out
 the voyage that it may escape the tempests of disease and avoid the rocks
 of hostile casualties and thus be piloted in safety to the haven of a good
 old age.
   Some of the best-known sanitary laws wore very slow of recognition.
 For instance, nothing is better established than that certain  disease's
 are contagious, and yet that law was not self evident, nor generally ac-
 cepted until after generations  of experience and inaccurate observation.
  It is within the memory of the speaker that men standing high in repu-
 tation, for intelligence and learning, both in and out of the medical pro-
 fession, denied the law of contagion, and vigorously disputed the facts
 upon which  it is based.
  And,  on the other hand, the recognition of a sanitary law does not
 always  depend upon  the man  of  science,  but is sometimes  discovered
 and utilized by the common people.
  In a large old book in  my library, written more than 150 years ago, by
 Richard Mead, M. I)., the most noted medical man of his  day,  Court Phy-
 sician to  George II., I find the following account of the discovery of a
 most important contribution to sanitary science:—viz:—that innoculat-
 ing small-pox modifies the severity and duration of the disease.
  Dr. Mead writes:—"As far as I have been able to  find out by enquiry,
 innoculation was the invention of the Circassians, the  women of which
 country are said to excel in beauty; upon which account, it is very com-
 mon, especially among the poorer  sort, to sell young girls for slaves to
 be carried away into the neighboring parts.
  "When  therefore it was observed, that they, who were  seized with this
 distemper, were in loss danger both of  their beauty and  their life, the
vounger they were, they contrived this way of infecting the body, that the
merchandise might bring the greater profit." From this discovery the prac-
tice of innoculation for small-pox  became common throughout  civilized
Europe, and about 100 years ago was introduced in this country and very
generally  adopted, until superseded by the safer method  discovered  by
the immortal Jenner, viz:—Vaccination.  And even  that,  was the  prior
discovery  of the English milk-maids, who told the Doctor, that they were 
18
QUARTER-CENTENNIAL CEL E15 R ATION
not afraid of small-pox, because they had had the cow pox.  And Jenner
took 20 years of careful enquiry before he ventured to announce the pro-
tective power of vaccination.
  The laws of sanitary science are many and varied. The subject covers
a very wide field  of investigation.   It includes legitimately  within its
scope, the habitations  of men,  their modes  of living, their occupations,
their water, air, and food supplies; even their social relations, in  short
whatever  influences the longevity  of the human race,  or  concerns its
vitality and health. It is also a progressive science, and its  progress
is as ever before, dependent upon  the accurate observation, classification
and  comparison of facts, in their relation to man's physical health.
  Hence it is that the basis of the  science is Vital Statistics:  An accurate
and full knowledge of the length  of life in a given community, the birth-
rate, the marriage-rate, the death-rate, and  the causes of death.  Here
permit me to congratulate the people of Michigan, that your State Board
has carried the education of your legislature so  far, that at its last ses-
sion it enacted a law for the more perfect registration of deaths through-
out the State, by requiring a certified statement of the fact with certain
particulars and a permit to be issued, before the burial or removal of the
body.  It was a most important step in the cause of sanitary science.  It
will speedily  demonstrate its  usefulness, and  lead inevitably to  other
desirable reforms in registration.  It is a consummation which your State
Board has long been striving for, and which they long  ago would have
realized, if  legislators had fully appreciated,  that the  administration
of public  sanitation is founded  on a rock-bottom of  science, of which
vital statistics is the chief corner-stone.  The idea has prevailed too much
in the  popular mind that public-health laws were a sort of fad of indi-
viduals, an impracticable hobby of  a few  enthusiastic and visionary
people, generally doctors, who must have some scheme in it for their own
interest. The populace has made  the tremendous jump from the premises
to that conclusion, by the simple logic involved in the  question, "Why
else should doctors before all others  be so persistent in advocating them?"
As if the measure of every effort for the public good  were grounded in
selfishness, as it so often is with politicians!
  The most essential element of  success in the administration of Public
Hygiene is  public cooperation; an  intelligent appreciation on the part
of the people that the work of State and local boards of health is simply
applied sanitary science. It is merely the employment of what the people
call business  principles and  common sense, to  the observance of  those
conditions and that environment  which by the ordinances of the Supreme
Ruler of the Universe  are most conducive to the health of communities.
The State Board of Michigan recognized the necessity of such cooperation,
and has strenuously  and  persistently sought to secure it by its unre-
mitting efforts to educate the people.  Its work in that direction has been
characterized by  a practical directness and efficiency  unsurpassed  by
any organization in the country.  It has not been satisfied with the pub-
lication of an annual  report, which although replete with valuable  in-
formation, reaches but a small portion of the people.  But it has secured
their attention  and interest  far more successfully and effectively  by
other means.
   Your Board was among the first to recognize  in its plan of instruction
that men took most interest in irhat concerns them  personally.  Hence the
Board seized the opportunity on  every occasion of an outbreak of  a con- 
MICHIGAN  STATE BOARD  OP  HEALTH
49
 tagious  disease to circulate in the families so afflicted and among  the
 neighbors, full printed instruction for the restriction and prevention of
 the disease; Avell assured that the wraste basket at such a time will  not
 receive them until they have been studiously considered, and their coun-
 sels put in practice.  In short, your State Board of Health, with a wisdom
 that is beyond criticism, has  taken the  people  into'its confidence,  has
 frankly  told them what it wished  to do for the public good; has told
 them just how it is to be done, and how much  they can help in  its ac-
 complishment.  It has not arbitrarily undertaken the work alone, but,
 with commendable judgment,  has  not only sought the aid so  necessary
 to success but has adopted the wisest methods to secure it cheerfully
 and even zealously.   By such wise measures, the administration of pub-
 lic sanitation has been established  in your State upon a basis of organic
 unity,  in which not only the State and local boards are joined,  but every
 reputable and intelligent citizen and householder in the State, feels also
 the responsibility of being a health officer to his own domicil.
  Your board has not only told the people what to do, but it has justified
 its  course, and confirmed its teaching, by keeping in the public eye  the
 results of its work, by means of those graphic  illustrations, showing the
 diminished prevalence of contagious diseases, which although covering
 only a page, are conspicuous across the room, and which are so familiar
 not only to you, but to every reader of sanitary literature throughout the
 United States.
  With a  boldness, born of experience, and an assurance of  the confi-
 dence  of the public in its discretion and judgment, it ventured,  before
 any other  State Board, to include consumption in the list of  communi-
 cable diseases that must be reported to the health officer, as soon as it
 is recognized.   Consumption  having now  found its  legitimate  place
 among the infectious  diseases, the Board could  not logically avoid tak-
 ing some direct supervision of it, as it does of other diseases of the class.
 Nevertheless there are reasons why the act required a courage,  that most
 other Boards of Health have failed to exhibit.
  It is significant of  the respect in which the  State Board of  Health of
 Michigan is held by the people.
  Numerous and varied fields  of service, requiring skill and learning in
 the administration of public  hygiene, are yet to be developed by  the
 conditions which progressive civilization is constantly producing*   In no
 department of human activity is there  afforded better opportunity for
 philanthropic effort, with promise of rich results than in those  undertak-
 ings for the protection and improvement of the public health  so  wisely
 inaugurated  and  auspiciously  pursued by the Michigan State Board of
 Health.
  Politics.  There is no party politics in  sanitary organizations, or there
 ought  not  to be,  because it is as  destructive to their usefulness  as  the
 typhoid bacillus is to the human subject.  Hence it follows, as the night
 follows day, that public sanitation has  no attractions for the ordinary
 legislator." He is never a leader  in sanitary legislation.  The approval
 of all such legislation is forced from him by the enlightened sentiments
 of his  constituents.   Any instance of a  sanitary law, originating in a
 legislature, would be 'justly quoted in  support of the theory of spon-
taneous generation.  Therefore, that your legislature has enacted so many
excellent laws through the instrumentality of your State Board of Health,
          7 
.")()
QUARTER-CENTENNIAL  CELEBRATION
is to be  taken as the highest proof of the advanced education of the
people of Michigan in sanitary science.  v
  The motto of your Board is evidently "Excelsior"; for not content with
what  it  has achieved, it  has recently taken a  step, in  advance  of all
other  State Boards, in the dissemination of practical knowledge relating
to health, by  beginning instruction, wleue  all rudimentary  instruction
should begin,  with the children.   Your legislature, instigated  by your
State  Board, and quite assured that it is not preceding,  by any danger-
ous distance,  the  sentiments of the voters, has enacted a  law,  "That
there  shall be taught in every year in every public school in Michigan,
the principal modes by which each of the dangerous  communicable dis-
eases is spread, and the best methods for the  restriction and prevention of
each such disease."  (Act  No. 146,  Laws of IS!).").)  It  is a master stroke
of policy. The children of today, will direct the sanitary administration
of Michigan twenty years hence, on the principles taught them now.
  Sanitary Conventions.  Your State Board has ever kept prominently in
view the duty imposed upon it, "to disseminate among the people, all
useful  information on the subject  of hygiene.'"  No more practical  and
effective  method has  ever been devised, than the holding of local sani-
tary conventions  in the smaller towns in various parts  of the  State: a
method which  originated with 3*0111* Board and has been successfully car-
ried on for nearly twenty* years.  It has long been known that tracts and
bibles  without the presence and personal efforts of missionaries, would
never convert  the heathen.  Hence the wisdom of these  missionary con-
ventions.
  Of their utility as  a means of diffusing a knowledge of the laws of
health; of their power in stimulating an interest in the principles of
sanitary  science; and of their agency in  enlisting new  recruits in the
army  of  workers, and of the practical local reforms  and improvements
which have been suggested and  acomplished through them, it is  unneces-
sary for  me to dwell.  You are already familiar with these results.
  1 pass to another subject—

                  STATE  LABORATORY OF HYGIENE.

  I have  said  Sanitary Science  is progressive.  So also is the work of a
State  Board of Health.  It was  simply the result of natural growth that
when it had reached a certain stage in its development, it should feel the
need of and provide  for a Laboratory of Practical Hygiene/
  The time always comes to every well-organized and active State Board,
when  an  institution  of that kind is an  indispensible necessity  to  its
highest usefulness.  No better evidence of this  can be offered than the
very valuable  work which has been done by your own Laboratory.  Its
detection of frauds in medicine; its discovery of poisonous ptomaines in
common  articles of food; its examinations of water supplies; its investi-
gations into the sources of epidemics; its bacteriological work, and, in
many ways beside these,  it has proved its  abounding usefulness  as an
essential  adjunct to the outfit of a  well-equipped working State Board of
Health.  It is  not only directly valuable in  affording the means of solv-
ing the hundred and one problems that from time to  time present them-
selves, but it  is indirectly of great educational influence by  illustrating
in a very practical way.  how*  closely the  lives and the health  of the
people are connected with purely  scientific  investigations. 
MICHIGAN  STATE  BOARD  OF  HEALTH
51
   It is to be kept ever in mind that, although the State Board of Health
 is an executive body, it is not clothed with mandatory powers, its func-
 tions are wholly advisory.   The great  work which it has accomplished
 it has achieved almost  entirely  by educational means, and this Labor-
 atory  will stand, as it has stood ever since its establishment, an object
 lesson, extending, illustrating  and emphasizing the  teachings of  the
 Board.
   The great future of  public sanitation it is  difficult—aye, impossible
 to predict.  Some writer, gifted  with a prophetic mind,  whose words I
 can only quote from memory, has said:   "I saw* a vision, a civic proces-
 sion of great pomp and elaborate display, in which appeared in person
 all the high dignitaries  of State, surrounded by their respective staffs,
 emblazoned with the full official insignia of their rank.  These were  on
 foot, marching in  stately measure to the grandest music; and there was
 still  another officer, apparently  one of  still higher rank, wearing  his
 official robes, and seated in a chariot of most costly structure, to wiiom
 all seemed to render obeisance  and honor.  I  asked who is  this?  The
 reply was, 'That is his High  Excellency—the Commissioner of Health.'"

  Chairman Wells—Will Judge McAlvay take the chair for a short time?
  Acting Chairman McAlray—-The next subject this afternoon is Sanitary Conven-
tions, by Benjamin Lee, M. D., President of the Conference of State and Provincial
Boards of Health of  North America, and I take pleasure in  introducing Doctor
Lee:—
                 STATE  SANITARY CONVENTIONS.

 BY BENJAMIN  LEE, A.  M., M. D., PH. D.,  SECRETARY OF THE STATE  BOARD
         OF HEALTH OF PENNSYLVANIA, AND  HEALTH  OFFICER OF
                      THE  CITY OF PHILADELPHIA.

   The proverbial unwisdom, not to say, presumption, of the merchant
 "who carried  coals to  New  Castle," was both sagacity and modesty com-
 pared with the audacity of one who  dares  to appear before the  Board
 of Health, now* grown to adolescence and maturity,  of this great  State,
 and make pretense of saying anything  new and interesting, or conveA*-
 ing information to its members, on the topic on which I am announced
 to speak.  I can only  say in self-defense, that the subject is not one of
 my own selection.  I  deem it indeed an  unusual compliment that the
 Secretary of your Board, himself a veteran  in management of meetings
 of this character, should have requested me  to speak to 3*ou with regard
 to this valuable means for  disseminating information among the people
 in reference to the preservation of life and health, not the least import-
 ant among  the  manifold duties assigned to your Board and mine, and
 probably to all  State and Provincial Boards of Health.   Let us consider
 for a moment the  history of this movement:
  The first State Sanitary Convention of which we have authentic records,
was held on November 1, of the year before Christ 1451, in the midst of a
large plain  about equidistant from five considerable towns lying  on  or
near the river Jordan.  The sessions lasted more than a week, and were
attended by immense audiences.  The principal address on this occasion
was  delivered by a Hebrew7 savant  named Mesu or Moses,  the most 
52             QUARTER-CENTENNIAL  CELEBRATION
learned and accomplished scientist of his day.  His early life was passed
in the court of the most magnificent empire of the times.  His education
was confided to private tutors, and no pains was spared to make it com-
plete and thorough.- His were the secrets of the heavens above and of
the earth beneath and  of the waters under the  earth.  This  training in-
cluded not only the cultivation of his mind and furnishing it  with all the
lore of the schools, but scrupulous attention  to the development of his
bodily  powers, and the acquirement of proficiency in athletic sports and
military exercises.  His great bodily strength  was unfortunately evinced
soon after reaching manhood by his killing, with a blow of his fist, a man
with whom he had an altercation.  This led to his banishment from the
court and his flight from the country.   Then  followed a period of close
communion with  Nature, during which he had an opportunity to digest
and formulate the knowledge he had  received from his princely tutors,
and to  cultivate the spiritual  side of his  nature, while, at the same time,
in the  simple, hardy life of a shepherd,  passed  entirely in the open air,
he still further developed his physical powers,  and laid the foundation
for a robustness of constitution rarely paralleled.  Needless  to  dwell on
the magnificent achievements of his maturer years; his heroic efforts for
the release from  slavery of a long-oppressed race, writhing under the
tyranny of a proud, avaricious and blood-thirsty dominant  nation; his
magnificent militar3* enterprises; his marches and counter-marches; his
battles and surprises;  his wise  statesmanship  and  his wonderful  con-
trol of a turbulent and self-willed people.  He appears before us now,
at the close of his stormy and eventful life, having more than passed the
century mark, and yet in the full possession of the vigor of his early man-
hood, with his keenness of vision and his  natural forces unabated. Surely
such a man, if any, had a right to call a  State Sanitary Convention,  The
program  on this  occasion was comprehensive and  varied.   Among the
topics treated were:—
  The  Importance  of the Inspection of Animals intended  for Use as
Food.
  The  dangers resulting from the Use of the Meat of Animals which are
unclean Feeders.
  The  Proper Method of slaughtering Animals  to be used as Food, and
of the  Preparation of the Meat.
  The  Danger of  using Meat  which has  begun to putrefy.
  The  Value of a combined Animal and  Vegetable Diet.
  The  Dangers arising  from the Use of the Meat of Animals which have
died a  Natural Death, or have been killed by Dogs or other Animals.
  The  Diagnosis of Leprosy.
  The  Differential Diagnosis between  Leprosy  and  other Cutaneous
Affections.
  Leprosy both a Contagious and an Infectious  Disease.
  The  Necessity for the absolute Isolation of  Lepers.
  The  Importance of Quarantining  those  w*ho are suspected  of  being
affected with Leprosy or other Contagious  Cutaneous Affections.
  The  Necessity  for the Destruction'by Fire of infected Clothing and
Bedding.
  The  Importance of scraping and replastering the Walls of infected
Apartments.
  The  Hair and Beard  considered as a nidus  for the Development of the
Germs of Disease.
\ 
MICHIGAN STATE  BOARD OF HEALTH
53
   The Occasional Necessity for the Destruction of infected Houses.
   The Dangers arising from the Use of a Polluted Water-supply.
   The Importance of Washing the Hands before Eating, and of scrupul-
 ous Cleanliness in the Preparation of Food, of Cooking Utensils and of
 Articles of Table Furniture.
   The  Unwholesome Character of  Meat which has  been  bruised or
 crushed during Life.
   The Dangerous Deterioration of Yeast in hot Climates.
   The Cremation of  Offal and Garbage.
   The Purification of the Atmosphere by burning Aromatics.
   The Cultivation of a high Standard of Morality essential to the Main-
 tenance of Public Health.
   The Importance of Personal  Cleanliness  and frequent Ablutions.
   The Sanitary Relations of the Sexes.
   The Dry-Earth Treatment of  Human Excreta.
   No better evidence could be desired as regards the value of Sanitary
 Conventions than the results which followed this memorable gathering.
 Its proceedings, formulated into a Code, were preserved with the greatest
 care,  a night  and a day watch being kept over them, and  the  entire
 people  were constantly instructed as to their contents. As a result of
 strict adherence to these sanitary laws a race of the greatest vigor was
 developed. Prosperous in peace, invincible in war, they were the terror
 of their enemies  and the envy of all surrounding nations.  At length,
 however,  they grew lax  in  the  observance of  hygienic  requirements.
 Disease, luxury  and licentiousness  sapped  their strength, and they be-
 came the prey  of those over whom they had formerly triumphed.  Finally,
 a condition was reached of the most absolute degradation, in which the
 very existence of a written Code seems to have been forgotten.  At this
 time,  about eight hundred years after the Convention referred to, a second
 Convention was called.
   The occasion of this assemblage was the somewhat remarkable dis-
 covery, after  so great an elapse of  time, of the original  Code, hidden
 away under rubbish in the ruins of an old temple. The King then on the
 throne, profoundly  impressed  with the  importance  of this  discovery,
 immediately ordered a convocation for the purpose of again making the
 people familiar with the requirements of the Code.   This meeting was
 held in the month of March in the year before Christ  02.1.  Like the for-
 mer it was attended  by immense throngs, men, women and children, and
 lasted over a  period of several days. With the return of a better and
 simpler mode  of living, and the strict observance of the precautions of
 the Code, prosperity again returned to the race,  and for centuries again
 thev acquired  a wonderful preeminence.
  History is dumb as  to any future assemblages of this  kind until we
 come  down to  the present century, during which, from time to time,  those
 who were intrusted with the management of seaboard quarantines, met
 too-ether in Europe to discuss topics more especially connected with the
 performance of their own specific duties.  These,  however,  could scarcely
 be called State Sanitary  Conventions.
  The last war in which our country was engaged was the  starting  point
 of manv new movements in this country of a most beneficent character,
 and among those we are probably safe in classing State  Sanitary Con-
 ventions.  Out of the furnace of that war  came a second Moses.  Like
the first, educated not only in the sciences, but having had also the train- 
51             QUARTER-CENTENNIAL CELEBRATION
ing of a military experience, he had not failed to note, when in the ai'1113,
that the number of deaths which  take place in battle is  comparatively
small compared with those which result from disease, and that the chief
duty of the army  surgeon who  has  any just comprehension of  his  re-
sponsibilities is, not the administration of drugs or the amputation of
limbs, but the insistence on the observation  by the soldier of every pos-
sible precaution for the  preservation of health,  and  by his superior
officers  of such measures as will enable the soldier to carry out these
precautions.  In other words  the  hygiene of  the camp and the march
were of infinitely greater importance than the treatment of disease and
the curing  of wounds.   It did not take him long on returning to civil
life to adapt his newly-acquired knowledge to the ordinary conditions
of existence, and he at*once set on foot a propaganda with the object of
arousing interest in this question  among the people  of his State, Michi-
gan.  In language almost prophetic  of his future career,  he declared
that, "Grander victories, of greater importance to the people remain to
be  achieved than  any  which have  heretofore resulted  from warlike
methods.  To  the  peaceful  hero,  who shall  call  forth and so marshal
facts and generalize the scattered forces of knowiedge as to lead to a
victory  over am* one of  the prominent causes of death which now an-
nually destroy our citizens by  hundreds or by thousands, humanity may
well accord a higher praise than to the most  successful of warlike gen-
erals."  Owing to his persistent  and  energetic efforts, the inertia  which
possessed the  legislature of that  State, in common with all others, in
regard to movements of a scientific character looking to the general good
of the people, w*as gradually overcome.
  As I dictate these words I am reminded that it is the exact anniversary
of the  day  on  which the first  meeting of the  State Board of Health of
Michigan, the result of these earnest and conscientious labors,  was held.
It was not,  however, until five years later that the veteran Kedzie, w*hose
name is held in reverence by all sanitarians in the United States, in his
Presidential Address before the Board, stated the proposition that  one
means,  and a most important means,  of disseminating  knowiedge  re-
specting diseases and useful information on the subject of In-giene among
the people as required I13* law, wrould be to assemble  the people in differ-
ent parts of the State, and to talk to them face to  face, instead of  de-
pending on printed documents alone for the conve3*ance of  information.
This suggestion w*as immediately acted upon, and the first  State Sanitary
Convention of Michigan was held in this city in the month of April, 187!).
We are told that "all who  were in attendance at this Convention w*ere
well pleased, and regarded  the work done as  equal to the anticipations
of its  most enthusiastic friends."  That these meetings  have gone  on
increasing in interest and usefulness we may fairly conclude from the
fact that up to the present time forty-five have been held; the next to the
last having also taken place in this city at the close of last year.  Con
siderably more than two conventions a year have therefore been held
since the inauguration  of the movement.
   The  Pennsylvania Board, coming  into existence  twelve  .years later
than your own, naturally attempted to gain, from the experience of that
and other older boards, hints  as to the best methods of carrying on its
important work. It was deeply impressed with what seemed to be almost
a  specialty  of  the Michigan Board,  the frequent  occasions  on which
like Moses  of old.  it called the people together to hear the words of the 
MICHIGAN  STATE BOARD  OF  HEALTH
55
 sanitary law.  The method  commended itself to the judgment of our
 members, and we initiated the movement  by a Convention in Philadel-
 phia, the metropolis  of our State.  With a program on which appeared
 the  names of the most distinguished sanitarians  of the entire country,
 and which was probabh* richer in papers of sterling scientific value than
 that of  any sanitary meeting ever held in the United  States, except
 possibly those of the American Public Health Association, after months
 of advertising, both in medical journals and in daily papers, and with a
 conspicuous  placard posted  mam* weeks  in advance1 in the  most fre-
 quented center of the city, we found ourselves at the opening session,
 with the Governor of the State and other high dignitaries  representing
 all professions on the platform, confronted  by an arra3* of  emptA* benches
 as chilling in their effects as the Plasmodium malaria'.  We found to our
 disimy also  that a considerable portion of this  meagre audience was
 composed of our  friends from a distance who were to read papers.  It is
 true, the rains descended and the winds blew and beat upon that house—
 the  weather  did its worst—but although we sleuth* maintained to each
 other that this was the cause of the scant\  attendance, we none of us, in
 the  slightest degree, believed the assertion.  No, we were compelled  re-
 luctantly to admit that the one million people who inhabited the city of
 Philadelphia didn't care a ------, well, didn't care whether the Con-
 vention "kept" or not.  The  city went on  its way rejoicing, and recked
 not of our efforts or our disappointment.
  What then had been our mistake?  Why did not the thronging  multi-
 tudes, whoni our rosy dreams had  pictured as crowding the audience
 room, which indeed we had feared would not contain them, materialize
 in response to our call?  Our mistake consisted in having the Convention
 in Philadelphia at all.  The cares, the distractions,  the business, the
 amusements of the great city were too engrossing and overpowering to al-
 low  our puny efforts on behalf of the good of the people to make any im-
 pression on them. A great city is not the place for a State Sanitaiy Con-
 vention. This was the first lesson we learned, and in the main w*e have
 profited by it, as I advise any Board which contemplates inaugurating
 this  work "to do.  The second lesson was that it is unwise to attempt to
 get the largest hall in a town in  which to hold your Convention. The
 local committee will always make this mistake if not warned against it.
  The most fruitful fields for such efforts are small towns, in which for
 the time being the Convention will be the great and controlling interest,
 the one grand attraction.  To reduce the  statement  to a mathematical
 proposition  I would  say, the size of the audience at a State Sanitary
 Convention will be inversely as the square  of the population of the place
 in which it is held.  Of course 1 am not saying that, even in a country
 village, it can compete with a circus or a minstrel show.  It is well, there-
 fore, if possible, to avoid coming in competition with  any first-class  at-
 traction of this kind.  The best possible places are educational centers,
 university towns, and Normal School villages.  In such places the pace
 is sei bv" people of intelligence, the  outside diversions are few, and  ar-
rangements can also often be made by which the older students will  be
present, not only to fill up the benches,  but to constitute an audience at
once appreciative and valuable. I can imagine no more inspiring sight
than  the thousand eager,  intelligent faces of  the pupils of one of our
Normal Schools of both sexes, in whose chapel one  of the  sessions  of
our last Convention was held.  The seed there sown,  moreover, fell  on 
56             QUARTER-CENTENNIAL  CELEBRATION

good ground, and will bear fruit all through the State.  Manufacturing
towns as a rule are not  propitious  spots for such meetings.  The people
work hard all day and are fagged out at night, and, if they go out at all
in the evening, wish and need to be amused rather than  instructed.  I
can conceive of no more unsanitary procedure than to invite such people
to spend an evening in a hot, stuffy hall, vainly endeavoring to fix their
attention on  subjects which  they  can only  partially comprehend.
  Of course much of the success  of a convention depends on  the per-
sonality  of the promoter.  As I read  the  accounts  of the conventions
which so rapidly succeed one another in this State, and the machine-like
precision with which they move, it seems as  if the Moses of this "pleasant
peninsula"  had but to wave his staff and smite the flinty hearts of the
citizens of any  desired place, and,  presto, the health-giving waters  flow
forth; the popular preacher gushes with hygienic eloquence, the leading
lawyer spouts streams of off-hand sanitary  lore, and the prominent poli-
tician blows with one breath the trumpet of public health and his own.*
  Now a word  as to the arrangement of the program.  "A prophet is
not without honor save  in his own country*".  The politicians of Moses'
day and  nation had a very small  opinion of his abilities and freely ex-
pressed themselves to that effect.   I once overheard a doctor saying to a
friend, as they  came out arm-in-arm from a Medical  Convention, before
which I had been reading a paper, "I have a good deal better opinion
of that man Lee than they have in Philadelphia."  It is well, therefore,
to have at least one  name on the program  of a well-known man from a
distance, preferably from another State, as  a drawing card. In  Pennsyl-
vania we have several times been  so fortunate as to  avail ourselves for
this purpose  of the abundant material  of this kind furnished by the
Michigan Board, twice, if my memory serves me right, in  the person of
its Secretary, and once in that of the brilliant and gifted A. Arnold
Clark.  I deem  it a privilege to have an opportunity in this presence to
bear testimony to the profound and  lasting impression made by  that
earnest and eloquent young sanitary enthusiast on his audience on that
occasion.  Is it not a melancholy commentary on the  inadequacy of our
sanitary  precautions as yet, that  the title of his  intensely interesting
address was, "The  Germ Army and  how  to Rout It"?  Poor fellow!
Within  two short years he had himself  fallen  under the  combined on-
slaught of the two most formidable divisions of that army.
  Residents of the town, however—local  talent, as it is called—must be
depended on to furnish  the greater number of the papers—and this for
two reasons,  first, because the resident is  more familiar with  the local
conditions, in reference to sewerage, drainage, water-supply and sanitary
measures generally,  which ought always to be freely discussed, than a
stranger can be, and  secondly, because, having once been induced to com-
pose and read a paper on a sanitary subject he will be ever after a sani-
tarian.  This result is unfailing.  I have sometimes, however, resorted to
the plan of having an inspector visit the town shortly before the meeting
to spy out  all its hygienic short-comings and iniquities, and serve them
up as a dainty dish for the delectation of  the  inhabitants.  This  expe-


mo^cfn^^^^^^^^
nent politician," or other person Who U to take par? in th« convention i wnAo 7h«?  P"""1' 
MICHIGAN STATE  BOARD OF HEALTH
57
 dient may be relied upon to produce a somewhat spicy and animated dis-
 cussion.              ,
   Shall "Music,  Heavenly Maid," have  a  place on the program?  The
 majority of our  Board  at first opposed this  device  as not being  suffi-
 ciently scientific  and dignified.  We have since seen the folly of our  way,
 and now avail ourselves of every opportunity to enliven the gloom of the
 proceedings by this means.  Many who come only to listen to the music,
 if not to scoff, may remain to become sanitary saints.
   It must be remembered, however, in this connection, that the audience
 which the speaker sees  before him is by* no means the entire audience
 that he addresses. The  daily press carries his lessons to every home  in
 the town and  in the neighborhood for miles  around.  I was  comforted
 at our first convention, to which reference has been made, when I saw the
 reporters' table well  filled.  Like the poor, we have these ready scribes
 always with us.  I knew they* were mis-spelling the names of members,
 and assigning  papers to the wrong authors,  and accurately describing
 men w*ho w*ere never in the convention at all, and indulging in witticisms
 at the expense of the Board,  but all the same they were letting half a
 million people know  that the convention was going on, and inducing a
 quarter of a million of people to give some heed to what it was doing, and
 to read some of its valuable papers.  So that our work, after all, was far
 reaching in its results.
   It must also be borne in mind that the number of  persons present  at
 any one moment  by no means represents the number of those who are
 present at some time during the sessions.  They are continually coming
 and going,, and  in this way the  actual personal  influence  exerted  is
 greater than the  apparent.
   On the whole are the results of State Sanitary Conventions satisfactory,
 and commensurate with the labor and expense which they  involve?  I
 answer  unhesitatingly—Yes. Every convention of which I have had per-
 sonal knowledge  has  left its impress on  the towm in  which it  was held.
 The local health  authorities have gained new courage for their difficult
 and often unwelcome labors,  while on the other hand the people have
 become more appreciative of their public-spirited efforts.  New* sanitary
 measures are often inaugurated under the spur  of the  momentary in-
 terest and excitement.
   A city in which we met a few years since was treating its sewage in a
 most  unsatisfactory and archaic method, greatly to  its  own  detriment
 and that of its neighbors.  This was freely animadverted on.  Now this
 city has a  sewage-irrigation farm of seventy acres, from which an en-
 tirely innocuous effluent  is poured.  In another city  a  special convention
 was "held to consider  the conditions contributing to the  pollution of the
 stream on whose  banks it stands, and which constitutes the chief water-
 supply of an immense population.  That city was at  that time without
 a sewerage system.  It has since introduced one, but has taken pains,  at
 a great  expense, to protect the stream by the  simultaneous introduction
 of a mechanical filter  plant at the end of its system, which is doing excel-
 lent work.   A movement for an improved water-supply  often originates
in this way.
  So that I, for  one, feel, that in  face  of  the depressing influence  of
meagre audiences, and an apparently apathetic public, there is sufficient
reason for continuing such  efforts, as a reasonable and valuable method
of diffusine: a knowiedge of sanitary science among our people.
         8 
58
QUARTER-CENTENNIAL CELEBRATION
  I trust I shall not be driven ignominiously from the stage if I quote the
effusion of a patriotic poet in reference to a recent event which has now
become historic, as expressive of my attitude on this question.

                 " Oh, dewy was the morning
                    Upon the first of May,
                  And Dewev was the Commodore
                    Within Manilla Bay,
                  And Dewy were the Regent's eyes,
                    Those orbs of royal blue,
                  And do we feel discouraged?
                    I do not think we do."

  Acting Chairman McAlvay—The next subject upon the program is "Annual Con-
ferences of Local Health Officers", by Dr. C. <). Probst, Secretary of the Ohio State
Board of  Health. Ladies and gentlemen. I  take pleasure in  presenting to you
Doctor  Probst:—
  ANNUAL CONFERENCES OF  LOCAL  HEALTH OFFICERS.

BY 0. O. PROBST, M. D , SECRETARY STATE  BOARD OF  HEALTH,  COLUMBUS,
        OHIO, AND SECRETARY  OF  THE AMERICAN PUBLIC HEALTH
                             ASSOCIATION.

  Mr. President, Ladies and Gentlemen:—The  organization of Local
Health Officers' Associations belongs very largely to the last quarter of
this Quarter-Centennial of Sanitation that we are celebrating today; and
it promises to  be an important factor in advancing the cause of  public
sanitation.
  I have endeavored to learn the  form of organization and modes of pro-
cedure of the  sanitary associations, and of the associations  of  health
officers of the States and Provinces having such organizations, and from
this and the experience of my own State, to formulate briefly the  con-
clusions reached as to how annual conferences of  health officers can
be made most successful.
  By health officers is not meant the officer or person usually appointed
by  a board of  health as its executive, but all persons appointed under
the law as members of boards of  health,  or for public sanitary duty*.
  Men of all occupations have found it advantageous to "get together'',
and we have  legal societies, humane societies,  trades assemblies and
various other associations, too numerous to mention.  The reasons for
association are obvious.  The best possible way to  easily  gain accurate
information of  any subject one is engaged in studying is to discuss it with
others who are also making a study of  it.  A generous rivalry for the
best  individual work,  and an  esprit dc corps when concentrated action
is required, is also engendered by such associations.
  A  celebrated American  divine  and author some  years  ago made his
first trip abroad.  He is known at home  as an indefatigable worker.  On
his  return he  told a  friend that he found the theologians of Gerinanv
were accomplishing more in six or seven hours' work than he had been
able to accomplish in ten or twelve.  The reason, he said, was association. 
MICHIGAN  STATE BOARD  OP  HEALTH
59
  Almost nightly a sma-11 circle gathered around a  table in some public
  garden and the day's work of each, if of general interest, was discussed
  amid pleasant surroundings.  Each one thus absorbed the essentials of
  ten or a dozen.  I might add that the American divine expressed a sincere
  regret that conditions in this country made it impossible for him  to form
  here  such  profitable associations.
    A few of the States and one or two of the provinces of Canada have
  formed health officers' associations.  In some of the other States there
  are sanitary associations to which health officers may belong. A sharp
  distinction, I think, should be made between a sanitary* association and
  an association of health officers.   Each has its own field of operation, and
  neither can entirely take the place of the other.  An attempt to com-
  bine them  will leave essential work undone.  As  witnessing  the desir-
  ability of this separation of work, we may point to  our National sanitary
  organizations, which are, on a larger scale, an exact counterpart of our
  State sanitary associations and  State health officers' associations.  Our
  American Public Health Association opens its doors to all who are in-
  terested in public health matters,  and is  a sanitary association.  The
  American Association of State and  Provincial Boards of Health is made
  up exclusively  of health  officials.  It is true  that members of State and
  Provincial  Boards of Health are among the  most active workers in the
  other association, and our health officers should, and  are likely to  be.
  active members of State sanitary* associations.
   To the Michigan State Board of Health belongs the credit, so far as I
  have been able to learn,  of having pushed  the work of sanitary conven-
  tions beyond that of any other State.  It has carried the gospel of sanita-
  tion into all its lands, having since  the year 18S0 held under its auspices
  forty-five sanitary  conventions in as many different cities and villages.
  The good results of such work can  hardly be overestimated, and should
  be prominently mentioned  on  this,  its quarter-centennial day, in recall-
  ing the many'good and  precious gifts the State, through its board of
 health, has  given to the people of  Michigan.  Michigan has also organized
 an Association of Health Officers.
   It is, how*ever, not of sanitary associations but of associations of health
 officers of w*hich I am to speak.  What is their best  form of organization,
 and how* can thev be made the  most useful?  Doubtless  there will be
 differences  of opinion on these subjects.  We must bear in mind, how-
 ever, that differences in  the laws and conditions  of the various States
 and provinces may enter into the question.
   State associations of health officers may be spoken of  first.   It  is the
 writer's belief that these should  be under the direct control of the State
 Board of Health.  Many reasons may be given in favor of this.  First is
 the question of expense.  Meetings of the association, to be of the great-
 est value,  should have  their proceedings reported, published and  dis-
 tributed to  all  members  of boards of health, and to other persons spe-
 cially  interested in  such matters.  In my  State it takes about  twelve
 thousand copies of proceedings to supply members of boards  of  health.
 The cost is annually four to five  hundred dollars.  The postage alone on
 this number of reports would be quite an item, but Ohio, like many other
 States  publishes a monthly journal,  admitted  to  the mails  at  pound
 rates  which effects quite a saving.   The proceedings may be  published
 in the annual  reports of the State  Board of Health, but these reports
are usually  late in appearing—possibly a year or more after the meeting 
60
QUARTER-CENTENNIAL  CELEBRATION
—and the proceedings lose interest.  As a rule the number of annual re-
ports printed is too small to allow of sending a copy to each member of a
board of health.  There are various other expenses of such associations
which need not be itemized.  This cost, it is maintained,  should be borne
by the State and not by the members  of the association. Most of  these
members serve without pay, and many of them have to bear their own
expenses in attending  the meetings.  For the State to pay all  the ex-
penses of the meeting tends to increase the attendance. Without offering
it as a proof of the position here taken, it may be stated as a fact that in
Ohio, where this plan is followed, the  attendance at the  last two annual
meetings of health  officers has been  not less than three hundred and
fifty.
  Another advantage  claimed for the control of these associations by
the State Board of Health is in the  selection of a program.   No one
knows so well as the Secretary of the State Board of Health, the needs
and short-comings of the health officer, and  the subjects that should be
discussed for their benefit.
  Attendance.  Every effort should be made to secure a large attendance.
Newly-appointed health officers and members of boards of health should
be specially urged to come.  The quality of the proceedings may suffer
somewhat, but it should be kept prominently in mind that the real object
of such an association  is the training  of health officials  for the wise en-
forcement of sanitary  laws.  An  appeal should be made to the public
authorities to send delegates from their boards of health to the meeting,
and to pay their expenses.  The advantages to a community of having a
representative at these meetings should be  set forth in an appropriate
circular.
  Program.  The success of the meetings and the maintenance of the asso-
ciation will depend largely upon the character of the programs.   It is no
easy matter to arrange a successful program for such a gathering. It
will be made up of a few men who, from study and long official experience,
are well up in all sanitary matters of the day;  of physicians familiar
with all that bacteriology has given  to sanitary  medicine;  and on the
other hand a number, perhaps the majority, who are profoundly ignorant
of many of the questions wiiich  should be  discussed, but most anxious
to learn their a, b, c, of sanitation,  and especially administrative sanita-
tion.  They are charged with the weighty duty of protecting the public
health by the enforcement of sanitary laws, and yet  have everything to
learn in setting about it.  Topics must be provided which will also  inter-
est the old members and  skilled sanitarians present.  The latter, with a
little manipulation,  may  be made teachers  of those less well  informed.
a role not unattractive to most  men at a public gathering. Those selected
for this purpose must be sincerely anxious  to teach and not merely de-
sirous of displaying their own superior  knowledge,  or  they may  drive
those most needing  instruction out of the association.
  A  question box will  be found to remove many  difficulties.   Delegates
should be asked to  formulate  questions concerning matters which *their
board  of health has not  been  able  to properly manage, or bringing up
local  questions of special home  interest.  Some difficulties  may be en-
countered in having these questions properly answered,  and care should
be taken by the President to have false or faulty answers corrected  V
specified time should be set aside for the question box.
  At all public meetings  of this character the tendency is to provide too 
MICHIGAN  STATE  BOARD  OF  HEALTH
61
 many papers.  This is specially to be deprecated at meetings of health
 officers where a general discussion is the most valuable part of the pro-
 ceedings.  On the other hand it is unwise to simply provide subjects for
 discussion without having persons selected in  advance to write or speak
 upon them.  When this is done the subject is usually very lightly skimmed
 over.
   There must unavoidably  be more  or less  repetition at the different
 meetings to provide instruction for the new members who come  in from
 year to year; but the fundamental  questions of sanitation  should  be
 presented in as many different lights as possible, so as not to be stale
 and uninteresting to those who attend regularly7.  The rapid growth of
 sanitary knowledge permits  of something new  being said each year, even
 on subjects of this character.
   Delegates should be encouraged in taking notes of the essential points
 of the discussions, and in making  a report of the meeting to their boards
 of health.   A written report, which the local papers are usually glad to
 publish, will not only be of educational value,  but will be helpful in con-
 vincing the people that it is  wise  to send delegates to such meetings.  If
 the State Board of Health is to keep control of the association the mem-
 bers of the Board  or its Secretary should not appear too often  on  the
 program.  As a rule they will be  better qualified to discuss  many  of the
 questions desirable to bring up, and the temptation to secure good papers
 will lead the program makers to call upon them frequently for assistance.
 It is well, however, that such honors should be well distributed among
 the health officers.
   In most States it will be found, I think,  that successful meetings can-
 not be held oftener than annually. Where the capital city* is easily ac-
 cessible  there  are advantages in  holding  the  meetings there, and espe-
 cially  at a time when the Legislature is in session.   We are all familiar
 with the many* difficulties in securing sanitary legislation,  even when
 the public benefit is self evident  and the expense to the  State little or
 nothing.  An association of  health officers, where local boards of health
 are well organized, can be of the  greatest assistance in securing desired
 legislation.   Care may be required to  prevent a local matter being made
 the cause for a demand for legislation, undesirable if made general.
   Local  associations  of  health  officers should  be encouraged.  Where
 boards of health are well  organized the county forms a desirable unit.
 An important  function of such a local association is to  insure the en-
 forcement  of proper  measures to control  the  spread of contagious dis-
 eases.  It is a common cause for complaint by  a city  or village that they
 are endangered by the negligence of  a neighboring town in caring  for
 their cases  of  contagious diseases.  School districts frequently overlap,
 so that children living within the jurisdiction of one sanitary authority
 attend school in another.  A county  association of health officers, with
 an executive committee to  look  after such matters, makes it possible
 for mutual assistance of great value to be rendered.   Such an association
 keeps up an interest in boards of health and sanitary matters, and fosters
 a most desirable spirit of  emulation in the enforcement of health laws
 and in keeping towns in a good sanitary condition.  Many* questions of
 a purely local  character, which would burden a State meeting, may be
 considered with advantage at a meeting of the county association.
  With an active association of health officers in  each county, sending
delegates each year to a State convention, the work of all directed and 
62
QUARTER-CENTENNIAL CELEBRATION
correlated by the State Board of Health, the sanitary matters of a State
could not fail to progress in the most satisfactory manner.
  To  recapitulate:  There should be an association of health officers in
every State, independent  of  its  sanitary association.  It is  better that
this should be controlled by the State Board of Health, the State bearing
all expenses.   A large representation should be sought for, and programs
for an audience with varying degrees of sanitary culture should be pro-
vided. The proceedings should be published separately  and widely dis-
tributed.  County associations of health officers, dealing more particularly
with  local matters, and fostering and sustaining the State  association,
should be organized in  every* county.

  Chairman Wells—State Work for the Restriction and Prevention of Diseases is
the next subject upon the program.  It is one of very great importance, and will
be considered by Doctor John S. Fulton, Secretary of the Maryland State Board
of Health, whom I take pleasure in introducing:—
STATE WORK FOR THE RESTRICTION AND PREVENTION OF
                            DISEASES.

BY  JOHN  S.  FULTON,  M. D.,  SECRETARY  STATE  BOARD  OF  HEALTH,
                          BALTIMORE, MD.

  All of you must know the mingled feelings which accompany one to a
first meeting with some distinguished person whom one has long desired
to know7.  Ever since I was asked by the Michigan State Board of Health
to take part in these exercises, I have been suffering that pleasant per-
turbation.   At the first moment one's spirit leaps before him to speak
the homage that he owes, at the next shrinks behind him lest the occa-
sion be too  great.  And few occasions  can be greater  than those upon
which men meet, as we do now, to review* the successful campaign of a
great State  against death, disease, and pain among her citizens.
  The growth of the  science of hygiene has so far proceeded by similar
steps in the same order which characterizes all social developments, and
one may reasonably believe that its future history will follow* the gen-
eral formula of the  older and more advanced evolutions.  Necessarily
progress is not in a right line nor with a straight front.  Humanity, like
the groping phagocyte, thrusts out apparently aimless  pseudopodia,
touching often nothing, sometimes a little thing, and rarely some great
matter; but never failing to recognize, to grasp, and to drag the unthink-
ing mass toward that which it needs.
   Often enough great movements, though guided by*  definite purpose,
reach results quite different from and of greater value than those sought.
Such was the  memorable Winter's Journey*  of  John  Howard, who de-
siring primarily that the jailer  of  Bedfordshire  might  be paid a salary
instead of fees, begot an impulse that gathered strength from day to day,
until British law abolished jail-fees, and initiated the sanitary reform of
prisons and asylums. Then the voice  of humane compassion  began to
prevail in British  politics, and  against even imperial  will  sounded the
doom  of colonial  oppression, slave-trading and slave-holding, religious
persecution, and a barbarous penal code.  Then sanitary legislation upon
grounds of reason and humanity became possible. 
MICHIGAN  STATE  BOARD  OP  HEALTH
63
 -  In times so  ripening Jenner brought forth his imperishable thought,
 and in the historv of vaccination for the next  fifty years the future of
 sanitary legislation was  broadly outlined for two centuries.   Hitherto
 human health  had been of political concern only so far as military and
 naval operations depended for success upon the effectiveness  of human
 tools.  The more or less rational conjectures of  the medical teachers of
 that day offered no firm basis of fact upon which might be built legisla-
 tion to protect the peaceful, home-keeping population.  Here at  length
 was a decisive conquest over a unit of disease,  and toward the applica-
 tion, in express terms of law, of such a victory to the safety of the whole
 people fear and reason alike impelled.  In respect of vaccination against
 small-pox, the principle  is affirmed beyond  controversy that the indi-
 vidual may be  obliged, for the sake of the common welfare, to choose be-
 tween two alternatives: either to acquire immunity  at the  cost of an
 infection produced by design, or else give up his personal liberty for a
 period after each  exposure to small-pox.  This is the farthest reaching
 precedent which has yet appeared in the history of State Medicine.   Since
 civilized nations began to incorporate this scientific procedure into law,
 it  has everywhere by all men been believed that the prevention of small-
 pox is of general no less than of  local concern.  If it be a right function
 of law* to prevent small-pox, then law need only wait for available means
 to prevent other diseases.  One article of the catholic creed of sanitation
 is  that the Ifealth of the people is the charge of the State.
   The force of the older principle, that the health of  the citizens is the
 care of the City, is not in this declaration  diminished  but augmented,
 and with  the  growth  of local  sanitary government, the  functions  of
 central sanitary administration must broaden and deepen.  A republican
 principle so well settled as to need no proclamation is the right to local
 self-government, and wherever this right  is most loudly asserted in re-
 spect of sanitary matters, there  will usually coincide the greatest need
 with  the  least exercise of  self-government.  Since the welfare  of  the
 State can  only be the resultant  of  the welfare  of its component units,
 common sense  will insist that the local administration of sanitary law
 be referred to  some established form.  Such has been the history of all
 law, and nothing different can be expected of sanitary law.  It is  doubt-
 ful if there is vet  anywhere a board of health which  nearly approaches
 perfection, or if there" will be such an example until the sanitary govern-
 ment of states  shall be co-ordinated by national sanitary law, incarnated
 in  a National Bureau of Health.
  Neither in science  nor  in politics do we find  all things ready for  the
 organization and equipment of such  a board of health as could make
 serviceable all the ripe fruits of modern medicine. Nowhere has sanitary-
 legislation grown up symmetrically.  Legislatures have put  into  law,
 without reference  to  previously constituted authority, the sanitary con-
 ceits  of all sorts  of reformers,  moral, religious, philanthropic,  educa-
 tional commercial,  industrial.   The  results  of  administration, though
in  many instances disappointing, have been on  the whole  so profitable
that one must  in  spite of its redundancy rejoice in such  extraordinary
 trrowth as promising that exact knowledge concerning the causes and
movention of disease will not advance much faster than law will follow.
  As a preliminary step toward the plane upon wiiich the sanitary  affairs
 fa state can be best administered, one would suggest the appointment
°f  \ commission to revise and reembody in a workable and understand- 
61
QUARTER-CENTENNIAL CELERBATION
able code those laws which in any* state have  been found useful  in the
protection of human health.  Such a commission would engage first rate
legal talent, experts in the administration of sanitary law, in the  statis-
tics, and in the chemistry and biology of hygiene, engineers  haying spe-
cial  training  in sanitary works, men of wide experience and ripe judg-
ment in the  care of the dependent  and delinquent classes,  and  in the
education of  children.  Happy the state which can associate in one un-
dertaking seven, or  nine,  citizens  possessing such qualifications.  I
doubt if in any state a  committee of recognized authority  upon  these
subjects could be assembled from the ranks of one political party.   Such
men would in  their appointed  work constantly confront questions of
state-craft, and the more clearly they recognized that  public  health is
an important object of practical politics,  the  better would they  build
against the vicissitudes of party, and the more scrupulously  would they
preserve the  treasures new  and old  accumulated in the long history of
hygiene. Our commission would have much in hand besides the organiza-
tion of a State  board of health, but they would have no more important
work, nor any that we can consider on the present occasion.
  Looking at the numerous boards  of health, state and local,  one must
be impressed that the modern idea of a central sanitary authority* is
immeasurably better than  the older  conception of a local sanitary au-
thority, in that  it is designed to be, and usually is exempt from the  depre-
dations of party* traffic.   It is a propitious sign that in  these alleged de-
cadent days  the science of  state medicine should  have this immunity,
for upon this vital quality* depends the strength of the whole structure.
The weakness of local boards in this regard sufficiently  emphasizes with-
out further argument the need and value of a State board of  health.
  The first need of a State  board of health  is  a code of sanitary laws,
covering all  workable ground  without gaps and capable of being am-
plified without  overlapping.  Such a code will  provide  before all things
else, the information which alone can give  to the efforts of the  board
definite direction and  measurable effect.  It is not necessary here to
speak at length of the value of complete systematic registration of vital
statistics. The general  economic worth of such registration w*as  recog-
nized long before its special utility  w*as discovered by  sanitarians. In-
deed modern  state medicine may be  said to be  the unpremeditated as it
is by* far the richest result of the General Registration Act of 1836; and
the foundations of sanitary legislation might not y*et have been securely
laid  if  the administration of that act had been committed to any other
Englishman than the consummate master of  statistical  methods,'Edwin
Chadwick.  The function of vital statistics wiiich is of the highest  use to
the sanitarian is to furnish  true, full, and fresh information'concerning
the causes of death.  As to the cause of death  only* a physician can testify
with authority, and he will  speak most authoritatively if his record be
made at the time and place of death.  There is but one'way to insure im-
mediate registration, and that is to forbid any disposition of a dead body
until a proper record is returned.  The buriarpermit is the key to prompt
registration, and without it no vital statistics  law can be economically
operated.
  An important detail, omitted from American and English  practice, is
the verification of deaths.   The physician too often accepts the state-
ment of an undertaker  or friend that an expected  death has  occurred,
and certifies accordingly.  He makes no visit to substantiate the report 
MICHIGAN  STATE BOARD  OF  HEALTH
65
 nor inquires through how many individuals the rumor has come to him,
 or whether his informant ever saw the patient alive or dead.  This point
 has perhaps no bearing upon the value of statistics, but in  other rela-
 tions it will be found rather a serious omission.
   Since a vital statistics law returns its greatest  profit  to the state in
 information as to causes of death, it is desirable that so  far as possible
 all the details of its administration  should be in the hands  of medical
 officers.  That the mortality  returns are often of great value and com-
 pleteness when compiled by non-medical men does not argue against this
 general principle.   Rather does  it show  that intelligent  laymen may
 acquire much medical knowiedge in the practice of mortality registration,
 and suggests that if such men had been trained first in medicine they
 would have been  yet better statisticians.
   A chief need of registration officers has alw*ays been a  good classifica-
 tion of deaths for statistical  purposes.  The  science of pathology has
 now so far advanced  that a  thoroughly good classification,  capable  of
 universal use, is possible, but it  is not likely that any  State board  of
 health  will set about making one. If statistics  are to be useful in the
 broadest  way, State boards of health must come to a general agreement
 among  themselves on  this point of classification.  At present the need
 of uniformity does not seem to be  very widely felt.
   What a curious reflection it is that we have so long and carefully kept
 our irretrievable account against relentless Death, while against Disease,
 the mitigable agent of Death,  we make only occasional entries. The idea
 of sickness statistics has never been forcibly impressed upon any modern
 legislature, though it has long been  clear to sanitarians that statistics
 of sickness are of more immediate practical utility than returns of death.
 The most convincing political argument developed by Edwin Chadwick
 in his report of 1838 was that the  cost of sickness was the principal item
 in  the burdensome poor  rates. He  did not argue concerning  the  cost
 of death.  It w*as then, as it is now, cheaper to bury a dead man than to
 support a sick one.  The average  assembly-man, so far from  being  con-
 vinced,  smiles at the enthusiasm  of the sanitarian who attempts to im-
 press upon him the economic loss  involved in disabling sickness; but the
 same assembly-man when injured through the neglect of a transporta-
 tion company is sure to assess his disability, whether temporary or per-
 manent, at a good round sum, and the average juror usually agrees with
 him.  If from the value of a  hand or an eye so determined, one should
 try to calculate the cost of total permanent disability from preventable
 disease, court and jury  would  spurn the  reasoning.  The  blindness  of
 municipal and state legislatures to these considerations  illustrates how
 easilv a tax mav be concealed if  it be indirect.  In the army and navy
 where the cost of sickness falls directly on the organization, statistics  of
 sickness are always available.
 Happily it has been shown in one state that statistics of  sickness can be
 systematically gathered  without the aid of law.   It is  the unique dis-
tinction of the Michigan State Board of Health to  possess continuous
records of prevalent sickness for  more than twenty years, and to have
established the surpassing value of such statistics.  For the present such
a possession must,  I  fear,  remain the  envy  of other  State boards  of
health-  One finds it hard to believe that Michigan  medical  men excel
the physicians of other states in mental stature,  and one  must attribute
the sustained success  of  this system not more to the intelligence  and
          9 
66
QUARTER-CENTENNIAL CELEBRATION
fidelity of the individual contributors than to the singular executive skill
and personal influence which has made Lansing the focus of all these
impulses.  If I were a Michigan physician I should count it somewhat of
a distinction to be a local contributor to these reports, for the combined
observations of your one hundred or so observers are more exact in their
indications than those of a thousand physicians returning certificates of
death.
  Not long  ago I had occasion to make from the experience of thirteen
boards of health a composite curve representing the annual diphtheria
mortality by months. One hundred and twenty-five thousand death cer-
tificates entered into the composite, and of the thirteen  separate curves
none  resembled the  composite so nearly as a Michigan  curve  from  the
sickness reports.  I am inclined to believe that the normal seasonal rise
and fall of diphtheria would be as well shown from the  weekly sickness
reports to the Michigan board of  health as from the combined mortality
returns of  the  country.
  Michigan experience affirms it to be as true in practice as it is in theory
that one hundred representative  physicians in active practice  will each
see whatever sickness is  present in  each  locality, and  will be  able to
report year in and year out a fixed proportion of all the disease in  the
state. Unlike mortality statistics, statistics of sickness do not require
to be complete.  Their use  is that  of a sample for analysis.  They  fur-
nish data for reasoning, not arithmevtical results.  It is difficult for a man
who is sensible of his own fallibility to realize that his observations with
those of a hundred  other equally fallible men will yield results of  un-
varying accuracy, but it  is so. "If,"  says Doctor Baker,  "the weekly re-
ports of a  sufficient number of competent  observers,  well distributed
over  a given territory, produce results which are quite consistent from
week to week, from  month to month, and from year to year, such statis-
tics must be accepted under the law of probabilities as sound data."
  A recent step in preventive medicine promises to bring reports of sick-
ness  within easier reach of some  of us.  The establishment  of public
bacteriological laboratories, rendering free  assistance to physicians in
the diagnosis of infectious diseases,  creates a new bond of mutual interest
between sanitarians and practising  physicians.  Such a bond has hitherto
been  lacking, and public health practitioners should let no part of so
important  an  advantage slip from  them.  In  Maryland  we hope to
keep  the physicians  reminded of  their obligations to the  state  by asking
at the beginning of every application for bacteriological  diagnosis, "Are
you  up to  date with your reports  of births, deaths, and infectious  dis-
eases?"
  The short history of state and municipal biological  laboratories  has
abundantly justified their  existence.  They have produced a  copious
literature which is  of current use among clinicians and teachers,  and
have developed  an army* of w*orkers who exert a strong influence on the
medical thought of the day.  Aid to private citizens and to medical men,
valuable though it is, makes but one ite™ x~ oip  credit of a public  bac-
teriological laboratory.  The larger profits are in  the device and control
 of preventive measures,  and in the habitual use of timely information,
 of accumulated records, of  repeated observatm1^ and  of opportunities
 for experimental work. The criticism which has fallen upon some of the
 laboratories, if it be just,  convicts them  of nothing  more serious  than 
MICHIGAN  STATE BOARD  OF  HEALTH
67
 exuberant activity.  No one complains that they have done less than was
 expected of them.'
   Substantial advance in the prevention of disease can only be made
 upon practical application of the truths of pathology.  The activity and
 the productiveness of this branch of medical science in the last twenty
 years exceeds anyihing that the scientific world has ever witnessed, and
 the field promises yet richer fruit.  Out of the harvest already gathered
 much has been profitably applied to prevention, and more is ready for
 practical application as soon as political common-sense shall apprehend
 and approve  it.  We  dare  not  hope that any state or nation will pro-
 portion  its steps to the strides of this science, but it  is a  hopeful sign
 for us all that the American people, w-ho w*aste little courtesy upon things
 not obviously* practical, have recognized the rich  promise  of biological
 research and  have engaged it in the public service.
   State  and local boards of health must both be eternally vigilant of all
 common carriers of infection, and the  State board of health, as having
 the wider horizon, should be entrusted with the primary and  paramount
 authority. The chief common carrier of disease is  water.  In these days
 when the private well is rapidly* being displaced by*, the  pipes of the Com-
 pany, the power of the w*ater-supply for good or evil is greatly augmented.
 The territorial rights  of local  boards cannot be made broad enough  to
 secure adequate supervision and control of  such  large sources  as are
 placed in tribute. Any community  may easily obtain what seems to be
 a clear title to the use of a stream or lake, but the conflicting natural
 rights of other communities and of individuals are soon found  not  to
 have been alienated even by Act of  Assembly. Each and every party to
 such a  contention stands upon his  rights, though none can  obtain  his
 rights until all are obliged by some  commonly respected authority to do
 their several duties.   The example of those states which have vested the
 control of inland waters in their boards  of health deserves  to be gen-
 erally followed.  Commercial companies even when they have used right
 judgment and skill in their first provisions, are less  scrupulous about
 supplementary sources wiien extending their service, and are apt, after
 ever so good a start,  to become indifferent to most considerations aside
 from profit.  Municipal water boards are most heedful  of the  voters and
 taxpayers, who either  drink what is  delivered without grumbling, or else
 demand  that the cost of improvements  shall fall  on land owners outside
 of the city.  A State  board of health, having in  charge all the possibly
 conflicting interests,  will  determine whether the desired  sources may
 properly be laid under tribute; whether the water  is of good  quality, or
 may be  purified and  kept pure;  whether its volume is sufficient; will
 examine the plans for collection,  storage, purification,  and  distribution;
 will secure to the users of the water adequate rights of inspection and ,
 nuisance removal; and will see that  no natural or acquired rights, either
 within or without the city,  are exercised beyond  their reasonable and
 proper use.'
  Closelv related to water supply and equally needing  state supervision
is the disposal of waste.   Sanitary progress should  of course be symmet-
rical, but it  is the peculiar habit of communities to  consider but one
problem  at a  time, and having taken one step to  be content therewith
until growing disappointment  or imminent disaster drives  them  to an-
other.'" Where hygienic education  has proceeded as it should, good meth-
ods of  disposal of waste will have been understood and practiced long 
6S
QUARTER-CENTENNIAL CELEBRATION
before the need of a general water-supply is felt.  That all communities,
even the smallest, shall be instructed in the care of  the  soil  should be
an especial concern of every State board of health. The introduction of
a common-water  supply*,  however excellent, into  an unsewered, unscav-
enged town is not likely  to be an unalloyed blessing.  A  filthy soil  will
be all the filthier after the so-called modern conveniences begin to flood
the tow*n with diluted wastes.   Private wells will become degraded to
disgusting uses, and the area w*hich before had  a  malodorous eruption
on its surface, will  become honeycombed with putrefaction vats.  Good
water supply and sewage disposal are twin necessities.   Neither may
properly be considered apart from the other.  Judicious intervention in
such  local affairs not only  saves  local authorities from  errors against
their  own citizens, but also prevents injury to other  communities.  The
same  scrutiny which a well ordered town gives to the sanitary proposals
of individuals, should be  exercised by a State board  of health over the
sanitary w*orks of cities and corporations.  No community, large or small,
should be permitted to use any natural stream or lake, or to impound any
water, or to  lay  any sewer,  or  acquire a right  to deposit night-soil or
garbage anywhere without  its own limits,  until full plans and details
are submitted to  and approved by some board of general  authority,  who
shall  also examine  all the rights, titles, interests,  and  objections of all
parties  affected or likely to be affected by* the construction or operation
of such works.
  The manufacture and production of food and drink, and the health of
domestic animals, as having important influence upon human health and
comfort, should be regulated by  a law of general application throughout
the State.
  All the matters which we have so far considered relate to general sani-
tation, the main  defensive w*orks against  disease.  They  are certainly a
very* important part of the work of a State board of health, but a central
board which  did not make any aggressive efforts against specific diseases
would fall far short of its legitimate purpose.  The local board must in
every instance first engage a local outbreak of communicable disease,
but the State board of health can always give counsel and  aid, and  should
possess  resources of its  own equal to any emergency that may arise.
Supposing the local officer to be equipped and  competent to manage a
large outbreak, the  State board can make his operations proceed more
smoothly by* instructing  the people concerning the disease then present.
The timely distribution  of well prepared  circular literature,  teaching
people only w*hat they need to know on a present occasion, has long  been
practiced by the Michigan Board of Health, and must have saved many* a
local  health officer from  the stupid or sulky obstruction,  which so often
hampers his efforts.
   But local officers are not always eoual to all probable exigencies.  Sub-
ject to frequent change at the will of party or faction, local boards can-
not maintain  constant efficiency*. In the presence of grave infectious dis
ease the State board of health should always-exercise its powers to the
precise extent necessary to compensate the deficiencies of  the local board.
Tn any crisis utterly beyond the  control  of local  authorities, the State
board should seize the situation as tactfully as they* can, but peremptor-
ily if they must.  An epidemic is more than a local calamity.  It hazards
the safety of the  whole commonwealth.  It is a far move dangerous thing
than  an armed and riotous mob, and must be dealt with as summarily. 
MICHIGAN  STATE BOARD  OF  HEALTH
69
   Wherever any grave infection reaches the proportions of an epidemic,
 the State board of health should co-operate on the spot with even the
 most competent local board, and each should clearly understand and dis-
 charge its own functions.  To the local board properly belongs the actual
 domiciliary work in the front.  The  responsibility behind the fighting
 line should be borne by the  State board.  Particularly should the State
 Board secure to the local board the credit and confidence which-the com-
 munity* owes.  In no other way can the necessary activities go on with-
 out expensive disturbance of the ordinary* life of the place.   As to all
 that threatens public health outside the local  sanitary jurisdiction, the
 State  board  should  exercise its paramount authority7.   These matters
 will relate chiefly to the disposal of dead bodies, and to the movements
 of persons and  things believed or suspected to be capable of carrying
 infection.  Immediate circumstantial information should be furnished to
 other local boards concerning every suspicious person or thing that may
 be moving out of the infected area.
   The running history of every epidemic and of every outbreak, large or
 small, should be preserved.   The management of infectious disease is
 the clinical work of  State medicine,  and without a case book one's ex-
 perience can never be large or comprehensive.  The practice of the Michi-
 gan Board of Health, opening as it does an account with every outbreak,
 and continuing item by item till the incident is closed, has amassed a col-
 lection of histories that any of us may honorably covet.
   The public, including the doctors,  have not yet learned what  an epi-
 demic is, and  local health boards are usually loth to use the term within
 their sanitary* jurisdictions.  This reluctance doubtless grows more out
 of the sensitiveness of large  business  communities, than out of the pro-
 fessional sensitiveness of local officers.  In current use, epidemic means
 simply the prevalence of unusual or dangerous disease.  Fifty cases of
 rabies w*ould  in Detroit seem an epidemic, and your newspapers  would
 reverberate with the horror; but who ever heard of an epidemic of tuber-
 culosis anywhere?   If the 100  deaths from typhoid fever  which occur
 here in a y*ear should all happen in three months, you would refer to the
 1,500 or so cases as an outbreak. If they all should fall in a month, you
 would have to admit the existence of an  epidemic.  The people need to
 know* that in every city or state whose typhoid rate is  year  after year
 above two per thousand, typhoid fever is annually epidemic.  Typhoid.
 fever is as much the sanitary shame of America as yellow fever is the
 opprobium of  the West Indies, or leprosy  of Hawaii.  I suspect we shall
 remove both these latter motes from our neighbor's eyes before we get the
 beam out of our own.
   We have been hearing much recently* about the health of our soldiers at
 the military camps in our own country, and in Cuba.  At the home camps
 we have troops relatively immune to typhoid fever; at the front troops
 o-enerallv susceptible to yellow fever.  Sanitary discipline is perhaps not
 better  at  the front than at  home.  Against typhoid  fever we possess
 preventive measures  of  positive and proven effectiveness;  against yel-
 low* fever our  methods are yet on trial. The sanitary history of the war
 now happily  closing  will furnish us  some valuable lessons.   If as we
 mav anticipate,  the prevalence  and the fatality of yellow fever  among
the troops in Cuba should not greatly exceed that of typhoid at Tampa,
it  should teach us that our own familiar typhoid fever is to us a more
formidable enemy than yellow fever can ever be.   I doubt, however, if 
70             QUARTER-CENTENNIAL  CELEBRATION

sanitarians will be able by one or a hundred modern instances to impress
this lesson  deeply  upon the popular  mind.   Rather  will the  average
citizen perversely draw the single conclusion that yellow fever in Cuba
and typhoid fever in the next block are equally paltry public questions.
  But the barriers of popular misapprehension are not immovable, and
it is the very highest function of a State board of health to remove them.
This is  a labor demanding infinite patience  and tact,  and those of  us
who do not possess these great virtues often wish that we might try upon
our refractory pupils the educational  effect  of  severely punitive laws.
It is  fortunate that  legislatures will  not permit  us  to employ these
strenuous methods.  The education of the people must proceed slowly
but it  may  be pushed forward steadily and somewhat systematically.
Many State boards publish sanitary bulletins which are of some educa-
tional value, but it is a fair criticism upon  all such publications that
they do not meet nor do they* create any considerable popular interest.
Those who read them must possess  a tolerably advanced education  in
hygiene.
  In our medical schools the teaching  of hygiene is feeble and perfunc-
tory, having little or no weight in examination for the degree, so that
even the medical men in this country' have, as a class,  little influence  or
authority* upon the subject.   In England special courses leading to the
degree of Doctor of Sanitary Science  have  been  created, and  hygiene
has proper rank among the subjects of  final examination for the degrees
in medicine and surgery. To  bring about a similar advance in American
medical education is a worthy enterprise for State boards of health.
  Hygiene as taught in the public schools is  concerned exclusively with
personal health, and propagates chiefly the somewhat  contracted view*s
of certain moral reformers. It is to be  hoped  that State boards of health
will some day create a demand  for far  better instruction of youth in the
principles of hygiene than boards of education now provide.  The Michi-
gan Board of Health has recently been successfully laboring to  this end,
both at home and abroad.  The reception accorded to the paper of Pro-
fessor Delos Fall at the National Educational  Association would seem
to promise that other  states  will not allow Michigan a  very long start
in legislation on this subject. The Michigan Teachers' Sanitary Bulletin
has also  lately appeared, and as the way for it was well prepared  in the
Act of 1805 concerning instruction in hygiene in the public schools, the
publication has entered upon a career  of growing influence.
  The sanitary convention or association is of high influence in this work.
The conference of health officers is of primarily technical interest, and  its-
effect on public sentiment cannot be direct, or widespread.
  The Sanitary* Convention, as managed in Michigan, has the same strong
points that we have noted in their distribution of popular literature  on
infectious disease.  They* are only* held in response to local invitation,
some  especial  need of such a convention being always then and there
present.   They are not emergency or  calamity* meetings;  still  less are
they bon-bon parties given by ambitious towns.   They are serious public
assemblies to discuss some timely topic.  The locality is always required
to contribute, its full share to the program, and to arouse in advance  as
much popular interest as possible.  The influence  of each  of these con-
ventions upon the community in which it is held must be lasting, and
ought, it seems to me, to be lively enough to bring about the formation
of local sanitary associations. 
MICHIGAN  STATE  BOARD OF HEALTH
71
    ' Finally it must be the study of every State board of health to estab-
   lish mutually-helpful relations  with all  forces  operating toward the
»   safety and  health of the people, and there are no such intluences, indi-
   vidual or corporate, unable to make a fair exchange of benefits.  As its
   relations with local  boards will be most immediate and constant, I may
   be pardoned  another word on that subject.  The central sanitary au-
   thority must from the beginning assume some reasonable standard of
   efficiency for each locality, and must advance  that standard  from year
   to year.   It may not at once demand that everywhere preventable dis-
   ease shall be forthwith prevented; though that is the ultimate test of suc-
   cess.   But it must require that all  the means available in each locality
   shall be  used to that end, and it must continually point  out and supply
   means.  Wherever local authorities are progressive, though  in practice
   ever so little  in the lead of popular will,  there cordial approval can be
   given without condescension, and co-operation without officiousness. No
   local board will be so excellent that it may be  neglected, and if  any de-
   sires to be neglected, it must be either because the State  board of health
   is inclined to  unwisely act or dictate in local affairs, or because the local
   authorities  wish to give the people  the shadow instead of the substance
   of sanitary government.  In no  department of government  is the ap-
   pearance more easily substituted for the fact, and it must be  remem-
   bered  that  sanitary  misrule is most injurious at those levels of society
   where the  power of individual  self-defense  is feeblest.   It  is for  this
   reason mainly that  I believe in the right use  of  pow*er of intervention
   by a central board of health.  The  times are not yet ripe for  the better
   remedy which will come when courts and legislatures shall  affirm the
   legal accountability*  of local authorities for neglect or malpractice.  That
   justice will  in the future be accorded to the injured citizen, but meantime
   there is  no  check upon municipal sanitary crime unless there be appeal
   to some central sanitary authority* clothed with power  of intervention.
     It will be observed that State boards of health as  I  have  described
   them are executive as well as advisory.  In this respect they would seem
   to differ  from the excellent example wiiose successful career we are here
   to celebrate.  The difference is, however, more apparent than real.  Any-
   one who reads the reports and other publications of the State Board of
   Health of Michigan, (and I advise every one  who does  not read them to
   mend his ways),  will see that how*ever much it may desire to be and to
   remain a purely advisory board, it has done much clinical  as well as
   consultation and laboratory work,  and has done  it all extremely well.
   When popular education  and sanitary  law have  so far advanced that
   every community will  appreciate and provide  for all  its  own sanitary
   needs, and  will  live cleanly with equal respect both to itself and its
   neighbors, then all  State boards of health will be busy enough in ad-
   visory work;  and our  chemists, engineers, biologists,  and statisticians
   will be sufficiently* occupied in keeping us prepared for a higher class
   of consultations.  We all hope to arrive at that consummation sooner or
   later, and  all of us admit with hearty congratulations  that  about the
   speediest and most enduring of our pacemakers is here in Michigan.
    Chairman Wells—Dr. Ernest Wende.  Health Commissioner of Buffalo, enjoys an
  enviable reputation for the systematic, thorough and effective work he  has done in
  thnt Citv  for the restriction of diseases.  You  will doubtless receive the benefit
  nf his experience in this field in the paper on "Municipal Restriction of Diseases",
  bv Doctor Wende, whom I now introduce to you:— 
72
QUARTER-CENTENNIAL CELEBRATION
           MUNICIPAL  RESTRICTION  OF  DISEASES.

    BY ERNEST WENDE, M.  D., HEALTH COMMISSIONER, BUFFALO,  N.  Y.

  It is more than eighteen hundred years  ago, that there was a  set of
men who "thought they ought to be heard for their much speaking."
  As they have propagated exceedingly since that time, and as I observe
that they flourish just now to a surprising  extent, everywhere,  I will do
my best to avoid adding to that prolific race.
  You will remember in Paul Clifford that that  very sagacious person,
Augustus Tomlinson, said, "Life is  short  and  why  should speeches be
long?"
  An aphorism so sensible under all circumstances,  and particularly* in
the circumstance  in which I am placed, I shall practically adopt on the
present occasion.
  Therefore,  no time need be occupied in  rehearsing before this audi-
ence the necessity of municipal action against contagious diseases  and
other adjunct factors that imperil the  well-being of the community*.
  Such diseases and factors are of vital concern to every public body,
to every individual and to  every household as a household, and in propor-
tion as it is appreciated so in proportion an enlightened public  demands
for itself as high a degree  of protection as may  be attained, without  con-
testing its  humane significance and civilizing influence.
  If contagious diseases are preventable, w*hy do  they* continue to  exist?
Why not prevented?  Why not diminished  with the progress of sanitary
science and civilization?   In reply, largely  because of the apathy,  ignor-
ance and unconsciousness on the part of the public  of what may  befall
them,  and  because of  the indifference,  mismanagement  and conflicting
interests on the part of the local health authorities in combatting infec-
tion.
  Until the laity*  better appreciate the benefits resulting from  a willing
and intelligent obedience  to Nature's laws  of how to live and avoid dis-
ease, until  they  recognize the fact that without their assistance, the
efforts of the sanitarian to control contagion and to blot out  sickness,
sorrow and  suffering, but little radical improvement  can be brought
about.
  Then, what is necessary to consummate such  an end?
  1. The education of the masses in all that pertains to public hygiene,
to  enlist their co-operation against carelessness and disregard in the
application of laws or principles for the preservation of health in what-
ever way they may be employed.
  2. Municipal equipment and organization to  carry out modern sanita-
tion, to be of such intelligence and activity as to make it a blessing to
the people and creditable  to a progressive  city.
   3. Strict  ordinances, rules and regulations, the  execution  of  which
should be arbitrary, prompt and impartial.
   4. Laws obtained from the Legislature   of the State giving plenary
powers to the health authorities in matters of  municipal sanitation.
  What should the ordinances embody? 
MICHIGAN  STATE  BOARD  OF HEALTH
73
   1.  A complete classification of the recognized infectious diseases, with
 a specific definition  of the same, for legal guidance and vindication of
 public rights.
   2.  Mandatory notification on the part of the physician or householder,
 through the public telephone system, immediately upon discovery of any
 contagious malady  specified by law,  for  the  action  of the municipal
 health officer.
   3.  The placarding of infected houses as signals of danger, for public
 warning.
   4.  Isolation  at  home,  and prohibition from school attendance,  from
 exposure in public places, or in any way aid in spreading contagion, also
 the rigid enforcement of quarantine wiien indicated, in order to secure
 the full benefit of isolation.
   5.  The proper removal and reception of infected persons, when neces-
 sary, to a suitable hospital.
   6.  Compulsory  vaccination and revaccination  for self-protection and
 for the benefit of others. The failure to provide and enforce this safe-
 guard against small-pox, to allow its  work of death and  disfigurement
 unimpeded is maliciously wicked, and criminally neglectful.
   7.  The sanitary disposition of the dead from infectious and pestilential
 diseases.
   8.  Thorough  cleansing and disinfection of the infected house and its
 contents  under municipal direction, and the destruction of bedding,
 clothing,  and other articles  exposed to infection, also the prohibition of
 throwing any infectious material or rubbish into any receptacle for the
 deposit of refuse without previous disinfection.
   9.  Supervision over the erection of all tenement and lodging houses, to
 insure a standard amount of light, ventilation, plumbing, cubic air space
 and other hygienic features, and by systematic inspection to so maintain
 them.
   10. School-house  inspection  by a medical inspector, with  power to
 regulate and advise  concerning schoolroom sanitation,  plumbing,  sani-
 tary  propositions, personal hygiene, exercise and physical culture, con-
 tagious diseases and the like.
   11. The creation of small parks in connection with public schools, thus
 affording suitable school environment,  ample play-ground,  breathing
 spaces in the crowded districts, and a  corresponding beneficial influence
 upon  the  developmental period  of youth and childhood.
   12.  Thorough inspection of food products, of dairies and cows, prohibi-
 tion of the sale of infected  milk.
   13.  The establishment of free public baths, to be located in the manu-
 facturing centers, and in sections  where the poor predominate.
   Frequent baths  are  invigorating tonics, which restrict disease, pro-
 mote  health, morality* and self-respect.
   14.  An enactment to furnish labor  for  the  unemployed poor, "who,
 through neglect, are  allowed to become sick, a public charge  and hence
 a  double  expense;" as  industry gives  force and  vigor to life, conduces
 health and contentment, which  means municipal economy.
   15.  The establishing of a municipal  bacteriological laboratory  in fur-
 nishing available assistance in  the diagnosis of diphtheria, tuberculosis
and tvphoid fever, and in assisting us to  form  a rational idea  respecting
disinfection, isolation and the prevention and cure of diseases generally.
          10 
71
QUARTER-CENTENNIAL CELEBRATION
   1G. A systematic dissemination of detailed directions and hygienic rules
for the special needs of unsanitary features and conditions of any kind
or nature, and their application judiciously insisted upon.
   17. Rigid enforcement of the  penalties for violation  of all sanitary
laws, and especially those relating to infectious diseases and their con-
trol.
   18. Regulations and  rules defining the  relation of  the medical prac-
titioner to the medical officer of health, regarding their respective duties
to infectious diseases.
   11). Qualifications of  the highest grade in medical officers of health
who should possess technical education, tact, firmness and fearlessness,
and who should be selected on account  of fitness.  The  municipality-
should not be  exposed to an unnecessary risk by politics.  It should over-
ride it.
  20. Arrangements for keeping  the  Health Department open on every
day in the year, and at all hours—day and night—to receive'reports of
infectious diseases so that no time may be lost in taking such imme-
diate action as the emergency demands.
  The scope of this paper precludes the consideration of each proposition
in detail.  However, as a type for the purpose of elucidation and dem-
onstrating the phases in the development of measures adopted for the
restriction of diseases in Buffalo, the three maladies—
  Diphtheria,  as representing the contagious and infectious;
  Tuberculosis, combining  contagion  with heredity;
  Infantile diarrhoea, as illustrating the dietetic and hygienic,—will best
serve the1 object.
  Diphtheria.  The nature of diphtheria, its possibilities and long recog-
nition has attracted the efforts of the sanitarian  and  physician, so that
today* the most glorious triumphs in the reduction of mortality have been
achieved by the employment of preventive  measures.
  Thus, based upon our present sanitary knowledge, we combat it upon
the subjoined  principles.
  a. That it is a contagious, virulent malady*, capable of enormous injury
and dependent upon a specific organism resident in the throat or other
locality attacked.
  b. That under  certain procedures, if possible to carry  forth to a suc-
cessful  end, it could practically be stamped out.
  The group of acute infectious diseases of which diphtheria is  a  repre-
sentative,  demands and should receive the most aggressive action.
  While ever present, its limitations have step by* step progressively, been
circumscribed, and this has been and can be accomplished in communities
upon the following lines:
  First and most important, the prompt recognition of the true nature of
the malady.
  No affection* has been the subject of  more difference of opinion in
diagnosis by the  rank and file of practitioners.  In many cases,  pending
the correct diagnosis of the disease, great havoc has been wrought, while
on the contrary,  the erroneous assumption of its existence has  entailed
anxiety, economic damage, and worse, either a distrust of correct diag-
nosis or apathy towards its possibilities.
  With the possibilities of accurate  diagnosis  by bacteriological tests
it is now incumbent upon all properly protected  municipalities  to have 
MIC BIG AN  STATE BOARD  OF  HEALTH            75
  in  operation and quickly available, the resources  of an  effective labor-
  atory, that,  without delay, the profession can confirm or dismiss cases
  in  doubt.  The value of this method is now no longer questioned by the
  most extreme practitioner, and to  a progressively enlightened public,
  interested in sanitary matters, acquiescense in it is accomplished, if not
  demanded by the public at large.
   The system in vogue  in Buffalo represents what is believed  to be as
  practical and stringent  as circumstances  will permit.  It is obligatory
  upon physicians  to report to the Department of Health (at all times) by
  telephone, which is free of expense to them, each case of diphtheria im-
  mediately  upon discovery as  they come under their notice.
   At least, 21 hours is  saved by  the  telephone,  and notification to the
  public by placarding the house is accomplished just so much  sooner than
  reporting to the  department by mail;  thus possibility of  further spread
  of the disease is  materially reduced.
   If doubt as to the nature of the  malady exists the physician has at his
  command,  in all sections of the  city, the resources of the  laboratory and
 a report  within 24 hours. This procedure is made more available by the
 co-operation of the Police Department.
   In each Police  Station of the  city culture tubes and swabs,.compactly
 put up in a small box with printed directions for inoculating, so simple
 that a novice is capable of following them, can be had by  any physician.
   The culture outfit contains  a  blank  to be filled  out by  the physician,
 furnishing the laboratory  with name  of  patient,  address, duration of
 disease, location of membrane and such other information as the depart-
 ment records require for a full knowledge of the case.
   Through this same  channel the culture outfits  are returned to the
 Health Department, passed upon and within 24 hours or less,  the medical
 man is furnished  with a diagnosis of  his case and the house placarded
 if necessary, without further cognizance on his part.  Through this  sys-
 tem  of co-operation between  the Police and Health  Departments  the
 service is kept entirely under municipal control, and rapidity and free-
 dom from error made definite.
   The placard is  maintained until a bacteriological examination demon-
 strates the  absence of the diphtheria bacilli.
   The placarding  of the house for  the public information is immediately
 followed  by a visit from a Sanitary Inspector who institutes such other
 sanitary measures as seem indicated. A detailed report upon the premises
 is presented by the Inspector, including all  such  features as defective
 plumbing,  unhygienic  surroundings,  possible source  of  the infection,
 together with such recommendations as, in his judgment,  the conditions
 demand;  the Department immediately  ordering rectification of all sani-
 tary defects.  Further aggressive  action is instituted following the In-
 spector's  report,  notably, notification  to school  principals of all cases
 occurring in their districts and  thus interdicting school attendance by
 pupils from quarantined houses; and notification to public libraries that
 the circulation of  infected books  may be prevented.
  The source of milk is also noted  and  the possibility of this  medium as
 the infectious channel considered.  On  account of the importance of  the
 milk supply as a  possible source  of infection,  a special  ledger is pre-
served in the Department  office detailing each milk dealer's route, families
supplied,  source from which  milk is obtained and such other data  as 
76             QUARTER-CENTENNIAL CELEBRATION

may be necessary.  This ledger is posted daily and thus the healthful-
ness of the families  supplied  by each individual  dealer  is constantly
watched.
  As soon as it appears that on  the route of any milk-dealer infectious
disease exists, an immediate investigation is made into every detail of
his business, source of supply and conditions existing there; when,  if
justification appears  to exist or even a doubt, his route is  suspended
until it can be made absolute that his is not the source of danger.
  Furthermore,  the dealers are not allowed to  leave at, or remove from
an  infected household  any  milk receptacle, neither  can a milk-dealer
fill  a milk bottle on his wagon.
  The  feature of milk-dealers' routes and contagious disease supervision
cannot be too strongly commended.
  It has demonstrated its importance  several times in Buffalo in ascer-
taining and determining that to be the source of  infection,  and made
possible the  arrest of several  rapidly  spreading epidemics, notably of
scarlet fever and typhoid.
  In addition to the above, each placarded household is furnished with a
circular printed in  their own language, setting forth the nature of the
disease in question, laws pertaining to quarantine  and instructions for
the care of the sick, disinfection of excreta, and detailed instructions to
prevent further spread of the disease.
  The  feature of municipal placarding  is  the one mostly complained of
on the  part of the infected household and one which in many cases deter-
mines  dishonesty on the part of the attending physician and is a frequent
source of much trouble to those concerned.  The  external evidence of
internal infection is thoroughly appreciated by  those for whom benefit is
intended,  and almost  as thoroughly objected to by  those within.
  More particularly is this  feature in  evidence when placarding inter-
feres with business as when it occurs in connection with a store, or where
other  children in  a household  have to suspend their school life  and
practically be quarantined within. These are cogent reasons to the aver-
age family and when  the moral sense1 of the physician is elastic and the
interests of the household itself made supreme, concealment is attempted,
often successfully, and the  objects of sanitation defeated.
  So much injury or  loss to small stores  has occurred, so much resent-
ment at interruption of routine household work has been  occasioned,
that in certain sections of the city it w*as,  at one time, equivalent to loss
of practice for a medical man to diagnose  and announce diphtheria.
  Thus unfortunate conflict between interest  and  a  sense of duty has
been in evidence in  house placarding for all contagious diseases and it is
to be regretted that there appears to be no feasible w*ay, at present, to
exact official  action in interdicting it.
  In many cases of  this character, the Health Department has been able
to detect  and punish  in court such violations of law,  through complaint
or information furnished by an interested neighborhood.
  This is not, however, to be construed as evidence  of a hiuh sense1 of
duty, but rather as an illustration of the  dependence upon the question
of "Whose ox is being gored."
  The  features of bacteriological laboratory* assistance, house placarding,
expert  sanitary house inspections and investigations,  surveillance of
milk routes  and supplies,  are of supreme importance  and efficiency. 
MICHIGAN  STATE BOARD  OF  HEALTH
77
  Each has its difficulties, but notwithstanding, they are insisted upon and
  enforced.  To the efficiency of enforcement the limitations of the  con-
  tagious  diseases have  been narrowed  and severe epidemic  visitations
  made a  matter  of history.
    If to the factors enumerated could be added a system of compulsory
  official and municipal disinfection, it would almost appear that extermi-
  nation of acute contagious diseases was in sight.
    It is remarkable that municipal equipment for municipal disinfection,
  the most cogent  of measures, should yet be subsidiary.
    To disinfect, as now practiced in most communities, is a matter of de-
  partment recognition carried out under the directions of the physician,
  with such implied efficiency as only the personal factor admits.
    Disinfection, to be efficient, should be obligatory*, arbitrary, made by
  those specially trained  and by up-to-date equipments and applied with
  intimate thoroughness of knowiedge regarding the various agents  and ,
  their particular use and  indications in individual cases.
    The Department of Health should supervise  the disinfection, see that
  contagion is annihilated and a public record maintained of such inspec-
  tion and disinfection.
   From such record,  data should be available for the real estate interests,
  for the public and for house hunters.
   What is more  pitiable, and yes, more preventable, than the  possibility
 of a family of little ones moving into a dwelling, perchance to  be the vic-
 tims of a pestilential infection.
   Medical men .are but too familiar with instances of this character  and
 its results.
   We have  to consider  the most  formidable foe of the  human race—■
 tuberculosis—and one presenting propositions  as difficult as important.
   A notable feature pertaining to it, and beyond question, is its prev-
 alence amongst low*er animals.  No disease equals its fatality nor attacks
 so many of them.   Domestic animals only vary in  susceptibility  and
 those escaping under natural conditions promptly respond and succumb
 when innoculated.   Its  comniunicability and identity in man and  the
 lower animals, its enormous mortality and the methods of dissemination,
 with equally accurate knowledge as to the methods which could restrict
 its prevalence, direct criticism to what is  largely left undone by  the
 State whose attitude in  general is  one of negligence or indifference.
   The cause of this apathy need not detain us, it is explainable  by lack of
 knowledge, experience, conflicting interest, sentiment and the like.   In
 some sections, partial efforts have been and are made, yet the essential
 of  success—uniform  and systematic procedure—is lacking,  and until
 this is obtained, without considering the question of the ways and means,
 compensation, etc., the State, which should  be, if anything, prodigal in
 its expenditure for life  and health, should  maintain the following:
   1. Quarantine  against the introduction  of  tubercular cattle.  This
should be as rigid as that against any pestilential disease in man.
   Security against foreign  invasion circumscribes the conditions and
concentrates aggressive  action at home.
  2. Milk herds and  dairy interests should be  under strict surveillance
and preferably under the license  system.  No dairyman should be per-
mitted to engage in supplying milk without first  obtaining a State license
to do so. which should only  be issued after inspection.   Such inspection 
78
QUARTER-CENTENNIAL CELEBRATION
   should include physical examination of the herds and  the  use of tuber-
   culine test, together with consideration  of all sanitary features  bearing
   upon the animals and protection of milk.
     Buildings should be adapted  to the business, the employes free from
   disease; care of animals,  food, water, details of cleanliness, transporta-
   tion features, and in fact all procedures, should be scrutinized and main-
   tained up to a high standard of sanatory excellence.
     3. No beast should be used for food without satisfactory evidence of iis
   being free from disease.  In cities, the public abbatoir system should pre-
   vail.  The advantages of this are well known.
     It directs and concentrates the slaughter industry, permits inspection
   of all animals  before killing and of the carcass and viscera after, -and
   practically* can be made to preclude the possibility of the consumption
   of unfit meat.
     Of the transmission of tuberculosis by meat or the degree to which the
   liesh of tubercular cattle is fit for use there is some honest difference of
   opinion.  There can be no question, however, that when the infection is
   more or less general  and the animal in poor  condition that  such meat
   should be interdicted.
     Literature pertaining  to  sanatory  matters and  particularly  in  the
   premises under consideration, should be freely extended until those to
   whom directed can know that  sanatory excellence is to their  highest
t   advantage and interest.
     With exclusion from without  and extermination within, with a stand-
   ard  of sanatory excellence,  mandatory-, and  all that it implies, one pro-
   lific source of infection is within reach of State action.
     In the absence of such a protection as  outlined and of jurisdiction, the
   Department of Health of Buffalo, has adopted, under my direction,  a
   scrutiny, incomplete as it may be, which briefly is as follows:
     A record is kept of the conditions that prevail at each dairy supply-
   ing the city with  milk.  This information is obtained  solely  by inquiry
   but has been found generally reliable.
     It  includes  data of the size,  health, tuberculine examination of  the
   herds, character of the water, food, health of employes, methods  of milk-
   ing, cooling, cleansing, transportation, in fact, all  factors bearing upon
   the purity  and protection of the milk.
     Additionally, circulars are caused to be sent, bearing upon the possi-
   bilities, etc., of the business.                                      ,
     When conditions at the dairy appear prejudicial to the public health,.
   from any cause, investigation is made and correction requested.
     In the absence of authority* beyond the municipal limits, when action
   for any cause appears necessary for unsanatory reasons, for failure to
   comply with the Department's request, the product of such dairy is inter-
   dicted at the city line and the dealer to whom consigned notified, until
   such time as the offense is removed.
     With this mode of procedure and its  results, any* city can exercise a
   large influence upon dairies  supplying it, exclude milk from known tuber-
   cular herds, and obtain sanatory protection beyond its own field  of au-
   thority.
     With brief reference to this recognized source1 of tubercular infection
   and the outline of aetion towards its destruction, the more difficult  and; 
MICHIGAN  STATE  BOARD  OF HEALTH
79
  the more  important question of  how  to deal with  the  tubercular  con-
  sumptive presents itself.
    The- consumptive being dangerous, hugely  from his habits, to those
  who incur danger from ignorance or necessity in these directions, sana-
  tory knowledge is more cogently indicated.
    The personal element, the chronic  nature of  the  malady; sentiment,
  social, religious, economic commercial  bearing, all exercise an influence
  and create a public opinion that prohibits a course of procedure towards
  it that is directed towards other contagions.
    It, therefore, is left us to enforce what we can and  thus far and in no
  mean degree bring about such good results as are possible.
    Reporting by physicians and registration by  the Health Department
  of all consumptives, their residences and other facts is reasonable, proper
  and practical, and permits such action by  the authorities, with the co-
  operation of the physician, as can  be exerted.
    By this registration it is possible to cause the dissemination of infor-
  mation of vital interest  for the protection of the' family and the public.
  It is needless to specify; briefly, it should relate to the disposition of the
  sputa, disinfection, and should reach those  for whom intended through
  the physicians in attendance, who can adapt, modify and secure the great-
  est efficiency with the least offense to the individual and household.  It
  permits proper recording, and every  Health Department should, from
  such registration, maintain a register of  all homes, dwellings, etc., sub-
 ject to such infection, record its duration anddate of satisfactory disin-
 fection.   Such register  should  be  available  to the public  and those con-
  templating a change of  house, for their guidance and protection,  and it
  should, by  ordinance, be incumbent  upon  owner or lessee, to  institute
 thorough disinfection under heavy penalty*.
   The disgusting nuisance of indiscriminate expectoration, in street cars,
 streets and public places should be prohibited by law and made more
 efficient by  creating public sentiment against it.
   The difficulty of  enforcing such an ordinance is apparent, therefore,
 the necessity of a strong public co-operation.
   Hotels, boarding, tenement and  lodging houses should have special in-
 formation and modes of  proceduie supplied them, that will enable them
 to adopt  the principles  of prevention or minimizing the possibility of
 infection  to the peculiarities  of their business.
   The street-car conductors should enforce the companies' rules, regard-
 ing spitting upon the ear floors, with vigor, and every car  floor should be
 properly cleaned with suitable disinfecting fluids.
   Cuspidors in public places should contain a disinfecting solution.
   Employes in crowded places, as factories,  work-shops  and similar
 plae-es should  be- subject to  physical surveillance, and offending cases
 weeded out.  Sanatory  rules, cubic air space,  rules regulating  expecto-
 ration, all cogent in the extreme.
   If it is  indicated  to prevent  the introduction into the State of  tuber-
 culous cattle, so much more is it important to exclude all persons suffer-
 ing from  tuberculosis pulmonalis.
   Te> this end, then, entrance  should be  interdicted  and uniformity of
action in all sections of the country aimed at.
  The' emigration of tuberculous  patients in the breaking down  stage
should be interdicted or discouraged, not only on account of the futility 
80
QUARTER-CENTENNIAL CELEBRATION
of it in the majority of cases but from the fact of  their disseminating
contagion.
  No action towards the extinction of tuberculosis in communities would
be complete if it did not take cognizance of the factors bearing upon those
predisposed.
  With this object, the broad field of general attitude  to the health and
physical development of the young, particularly in the  crowded districts,
should receive careful attention.
  This implies supervision of crowded dwellings, and placing them  upon
a healthful standard.
  School hygiene and calisthenics, public  parks, and the well known de-
tails too numerous to mention.
  Attention likewise is necessitated to penal institutions and  the like
where, under the influence of crowding, sedentary life, mental depression,
this malady is prone to  develop.
  Public hospitals should have isolation wards and  not be permitted to
segregate the tubercular in wards with  other medical cases.
  Preferably, hospitals for the special care of this class  of patients should
be provided and  equipped  with the  particular features  necessitated by
the peculiarities of the malady and the morale of the patient.
  The  establishment of State Hospitals for Consumptives is  now receiv-
ing the attention its importance demands.
  In Germany*, these institutions have been in successful  operation for
years.
  Massachusetts  is about to open the first in this country and will be
followed by one in New York State at an early day.
  There is  every  reason  why the State should extend its humanitarian
action  towards this scourge as towards  lunacy.
  Tuberculosis among the poor is disastrous in  its results, bringing un-
told misery to families and pauperism to  the State.
  One  source of infection frequently overlooked is the possibility of dis-
seminating  sickness through the dealers  of second hand clothing and
household effects.
  Every large city has many of these establishments and without doubt
they are frequently the receptacle of cast-off clothing, bedding, etc., from
infected households.
  While, perhaps, it is difficult in every case to  control this condition of
affairs as at present, there can  be no doubt it would be a wise procedure
to supervise this traffic by ordinance and license.
  The  diarrhceal  diseases of infancy* prevail with large mortality among
all  infants but particularly among the poor, and are justly classified as
preventable diseases as they  are due to toxic bacteria.
  The  appreciation of this fact determines the action  of health officials
towards the prevention  of food contamination, the source of infection,
inasmuch as these maladies are in the main limited to  children who have
not the advantage  of breast milk.
  In searching for removable causes of milk infection, none  seems more
cogent than the so-called long  tube nursing bottle.
  It is likely well known to all, and consists of the  usual form  of bottle
with the addition of a rubber tube one foot and over in length ending in
a nipple, the adaptation being made to permit  self-feeding  on  the part 
MICHIGAN  STATE  BOARD  OF  HEALTH
81
 of the child, thus obviating the necessity of an attendant, a device for a
 lazy mother or nurse who is unfitted for her sacred trust.
   Investigation has shown an enormous proportion of diarrhoeal diseases
 in children artificially fed and using this form of contrivance not found
 with the use of others.
   This explanation is found in the fact that it is impossible to keep this
 tubing clean or safe.
   The mother, usually- uneducated in the premises,  cannot, by scalding
 or w*ashing, maintain the inner surface of the tubing in condition so as
 not to contaminate the milk  drawn through it.
   I have conducted  a series of experiments  and investigations in the
 matter,  the details of which I  need not detain you with, the result of
 which, briefly*, may be summarized as follow*s:
   The inner surfaces of  these tubes are found  to be irregular, present
 porosities and the seams are frequently imperfect.
   These indentations  become the rendezvous of colonies of micro-organ-
 isms, which thrive on the milk which stagnates in them and which can-
 not be dislodged by any*  ordinary process of cleansing.
   As a  result of  this condition, milk, receptive of  infection  by nature
 aided by* artificial warmth, becomes an easy medium  for the development
 of toxines.
   At my suggestion, the city of Buffalo has,  by ordinance, prohibited the
 sale and use of these  death-dealing bottles, though not without incurring
 the animus of certain commercial interests w*ho have combined and are
 arrayed to combat the ordinance.
   It is needless to say that the profession has, without question, given its
 hearty support to the stand taken by the Department and that the issue
 will be carried to a finish.
   If ordinances created to correct so patent a cause of infantile mortality
 can be set aside for commercial reasons, health laws in the future will
 have small  chances for their existence.
   Municipal protection of the milk industry constitutes a large and most
 important agent in diminishing the causes of  infantile mortality.
   To secure this end, city  milk  houses should answ*er to the  following
 principal requirements:
   1. Proper light, air and ventilation.
   2. Constructed of non-absorbent material.
   3. Without direct communie ation to sleeping apartments, water-closets
or any unsanatory room.
   4. Use for milk storage solely.
   5. Storage and cooling boxes metallic lined, elevated and placed to per-
mit thorough cleansing.
   6. Sanitary plumbing, outside box ventilation,  indirect drainage.
   7. Sanitary rules posted conspicuously pertaining  to cans and protec-
tion of milk.
   8. Prohibition of the use of disinfectants—any necessity for their use
implying unsanitary  condition.
  9. Prohibiting the  leaving  of bottles or receiving  the  same from any
house placarded for contagious diseases, and prohibiting milk-men  from
refilling  or filling  bottles  on wagon or while on  route.
  The  elimination  of  pernicious influences upon diarrhoeal diseases of
infancy by maintaining a  high degree of excellence in all that bears upon
          11 
82
QUARTER-CENTENNIAL  CELEBRATION
it would be incomplete without the co-operation of  mothers in carrying
out in the home life the principles of infant hygiene.
  To  secure this to the household containing  a  new  born  child, the
Buffalo Department of Health furnishes a circular of information, cover-
ing the essential points which mothers should  observe'  in  the care and
management of the infant.
  That this may  reach and have its influence upon all classes, the matter
is  printed in several languages, is couched in simple words and the
directions  given  plainly and practical.
  Such circulars of instruction should, and, in  Buffalo, include the fol-
lowing:
  1. Directions for  bathing and  cleanliness, for properly  dressing and
changing the infant.
  2. Directions for sleep, regulating the  hours and urgently warning
against the use of sleeping drops, cordials  and the like.
  3. Directions for  securing abundance of  fresh air, suitable hours for
airing the child and the importance of avoiding the devitalizing  effects
of the heat within doors and without.
  4. Directions for simple  household hygiene,  as  regards ventilation,
dampness, odors, etc.
  5. Directions, in detail, for  feeding, weaning, various artificial  foods.
The preservation and sterilization of milk,  methods of  cleansing and
keeping clean feeding bottles,  utensils and the like.
  The selection of proper feeding bottles and condemnation of the long
tube design.
  G. The symptoms readily recognized by mothers necessitating medical
attendance, and the evidence of normal digestion.
  It is  gratifying to know that these circulars are appreciated among
the poorer classes, are lived up to as much as possible and have a salutory
influence in the premises.
  The principles involved in the subject under consideration have of ne-
cessity been but  referred to  and are intended as suggestive and to bring
out the views and experiences of those among you who  have given these
matters much thought.  The field is a most inviting one and it  is through
such exchange of views as is possible here that present action and pro-
cedures can  be fortified, new ones made operative^.
   Sanatory* seiemce  has  been and is so progressive1 that any action that
will proportionately annihilate the various contagions  will redound  to
the happiness and welfare of the community and the honor of our art.

  Chairman Wells—The last topic upon the program for this afternoon, "Sanitation
of the Future," by Prof. Vaughan. will necessarily have to be omitted, owing to the
absence of Prof. Vaughan. This distinguished gentleman is not only a bacteriologist
and sanitarian, he  is in addition to these  a patriot. Early in  the war he offered
his services to his country.  These were promptly accepted by the government, and
Dr. Vaughan was despatched at once to the front.  In  the field and in the hospitals
at Santiago he labored day and night to relieve the sick and the wounded until him-
self stricken with yellow fever.  I am most happy to  announce his recovery from
this disease and that  today he  starts for  his home to regain his strength and to
continue his career of usefulness.
  This concludes our afternoon program and I now declare this session closed. 
                 M[i HIGAN  STATE  BOARD OP  HEALTH             &>

             Eveiling Session, Tuesday, August 9, at 8:00 P. M.

    After music by the Cadillac Hotel Orchestra, the meeting was called to order by
  Hon. Frank Wells.
    Chairman Wells—Our program contemplates the devotion of an hour at this time-
  to five-minute addresses by eminent gentlemen,  from different parts of the country,
  who are engaged in different lines of health work.  While the time allotted to each
  is too short for extended observations upon any of these lines, yet Ave hope to get
  germs  of knowledge from each which we may  take home with us, produce from
  them cultures, and, by aid of our mental microscopes, obtain a better conception ot
  what these germs of knowledge express.  Perhaps by inoculating ourselves with
  cultures of them we may secure immunity from some of  those sanitary fallacies
  which  so often become epidemic.
    We shall first listen to a representative of one of Michigan's  most distant sister
  states  in the south—Dr.  Felix Formento of Louisiana. Dr. Formento  is an ex-
  president of the American Public-Health Association, and has labored many years
  with zeal and efficiency in his own State Board of Health,  of which  he has been a
  most valuable member.  This is not his first visit to Michigan and we hope it will
  not be his  last.  I present to you with pleasure Doctor Felix Formento of New
  Orleans.

           FELIN  FORMENTO,  M.  D,  NEW  ORLEANS, LA.

         EX-PRESIDENT OF AMERICAN* PUBLIC HEALTH  ASSOCIATION.

    It would be  impossible  in  the short space of time allotted  to each
  speaker, to pretend to anything like a set speech.
    I can but express  my grateful thanks to the Board of Health of this
  great State for  the honor they  have conferred upon me by  inviting me
  to say a few words on this grand occasion of the Quarter-Centennial Anni-
  versary* of the establishment of the Michigan State Board of  Health.
   Louisiana sends her greetings  to Michigan.
   The  land of Bienville and Iberville recalls to the land of Cadillac and
  Father Marquette their common origin.
   One  of the first organized in the country, your Board  stands to-day at
  the head of similar organizations, not only* of the United  States, but of
  the civilized world; especially  in matters  pertaining to vital statistics.
 and in  methods of prevention  against domestic diseases and foreign
 pestilence.
   Many of your measures have- served as models  to State and municipal
 Boards throughout this great country.
   Nowhere is  Public  Hygiene more advanced, more  enlightened, than in
 this noble State  of Michigan. You have educated the people to the neces-
 sity of  local sanitation—nowadays, every  citizen, rich or poor,  takes  a
 lively personal interest in hygienic and sanitary matters.  The ignorance,
 indifference and neglect of former  days have given place to  a generous,
 praiseworthy emulation to  improve and beautify your cities, towns and
 villages.  Every one now understands that Public Hygiene has its origin
 in Private Hygiene and that true progress in Sanitary matters must have
 its  point of departure  at the very home, at the fireside of each and  every
 citizen.
  As a result of your enlightened efforts, your  cities and towns have
been made clean, healthy and attractive'.  No State, no country, can boast
of a more beautiful, more charming and more delightful city than this
verv citv of Detroit,  where we  meet to-day under such auspicious  cir-
cumstances. 
!S4             (QUARTER-CENTENNIAL  CELEBRATION

  Thanks to your advanced sanitation, your death-rate has been greatly
lowered  and the public wealth has  been immensely  increased, with  a
corresponding  progress  in  every  branch of human knowledge  and in-
dustry.
  Continue your noble and generous mission, gentlemen.   Your reward
will be the welfare and happiness of your fellow7-citizens, their grateful
appreciation and the blessings of future  generations.
  May I here be permitted  to express a  wish, the wish of a Sanitarian?
There are still several  sanitary practices which are not sufficiently under-
stood and  appreciated by our people; there are still some great  reforms
to be introduced among us, which are especially required in  cities and
thickly-populated localities.
  I refer particularly to Cremation—cremation of garbage as  well as of
human bodies, the latter especially in cases of infectious and contagious
diseases—cremation which  we have  vainly endeavored to introduce in
my native city, where it is perhaps more needed, as a sanitary measure,
than anywhere else, cremation, that great purifier, which destroys and
removes  absolutely* the active' agents of infection and contagion and
solves  forever the problem of  the transportation of the dead, rendered,
thereby,  perfectly innocuous.
  With all the arguments,  sanitary,  philosophical, economical, in favor
of Cremation, why* is it that this essentially useful and hygienic measure
encounters so much opposition among our people?  Can it be on  account
of the  ignorance, bigotry and prejudice  that still exist on  that subject?
We believe that placed under your patronage and championed  by you,
this practice of Cremation would soon become better understood and
appreciated. Who could better enlighten the  people and remove preju-
dice and false ideas, and prepare  public opinion for the adoption of one
of the greatest  sanitary* reforms  of  the age, one w*hich is intended  to
bring sanitary*  results of incalculable importance?
  Another great object worthy of  all your efforts is the problem of local
sanitation in our new conquest, the  Island of Cuba.   You should join,
you  should lead in this new crusade for science against a foreign dis-
ease which should never obtain letters of naturalization among us.  Cuba
must be  regenerated, not only politically and  socially, but hygienically.
It is not enough to have delivered Cuba  from Spanish  tyranny; that was
comparatively an easy* task.  We must free it from Yellow Fever and its
still more pernicious  Malarial Fevers;  they must  be  stamped  out  in
their very cradle.  The problem  is a difficult one,  but not beyond  the
means and resources of Modern Sanitary Science and Sanitary Engineer-
ing.  Our country,  our Southern States  more particularly, must forever
be delivered from  the constant threat  of invasion by an enemy more
dreadful than the foreign armies  and navies of the world.
  The  stamping out of Yellow Fever in Cuba—which will lead to  the
stamping out of the disease in Central and South American countries-
will be the crowning glory of and a lasting monument to  the  wonderful
achievements of American  Sanitary  Science.

  Chairman Wells—The next speaker, though a  Michigan product, was unfortunately
transplanted several years ago to a neighboring State.  Before this event he' had
done good service in the legislature of Michigan, and excellent work as a member
and president of  the Michigan State Board of Health.  New soil often changes or
modifies transplanted products, and the Michigan sanitarian  became a prominent 
MICHIGAN STATE  BOARD OF  HEALTH
85
lawyer of Buffalo, as a result of his change of location.  Early habits could not be
entirely eradicated  however,  and among his several valuable legal writings those
on the public-health laws of the United States, are most valuable.  I introduce to
you Hon Le Roy Parker, ex-president of the Michigan  State Board  of Health.
             HON. LeROY  PARKER,  BUFFALO,  N.  Y.

                PROFESSOR OF LAW; BLFFALO LAW SCHOOL.

   Mr. President and Ladies and Gentlemen:—It is impossible for me
 to fully express the gratification I feel at meeting again with the Michi-
 gan State Board of Health, and to participate in the Quarter-Centennial
 Celebration of its  establishment.   It is a pleasure for all of us to meet
 here and take part in the celebration of the completion of twenty-five
 years of such noble work for humanity as the Michigan State Board of
 Health  has performed, but it  is  doubly  so for me, who for  six years
 served as a member of that Board and participated to some  extent in its
 work.
   At the time of my appointment by Gov. Crosw*ell as a member of the
 Board in 1S77, it had not completed the fourth year of its existence, but
 it had already become a living force  in the work of prevention of dis-
 ease  through the  collection and  tabulation of  vital  statistics and the
 dissemination of valuable and  useful information among the  people of
 the State.  It had  become an educator  of the people in all matters re-
 lating to the maintenance and preservation of their health.  How could
 it be otherwise  when its  first membership consisted of such men as Dr.
 Hitchcock,  Dr.  Bliss, Dr. Kedzie, Rev. Mr. Brigham, Dr.  Lyster, Rev.
 Mr. Goodman, and that indefatigable collector and tabulator  of statistical
 information, whose retention by  the Board  as its Secretary, from  its
 first organization  to  the present  time, is  the best possible  proof of his
 invaluable services, Dr. Henry B.  Baker?
   After  an absence of many years I return,  at the invitation of  your
 Governor, from  New York, the State of my adoption, to the  State where
 I was  born  and where I spent the yews of my early manhood, and find
 that the Michigan State Board of Health is in the very front rank of
 those which are fighting against disease and death, and which,  by its untir-
 ing and well-directed efforts, is adding years to the life of man and wealth
 to the  State.
  It is one of the noblest works  of humanity to prevent disease, disability
 and death, and such  prevention increases, incredibly,  the productive re-
 sources of the Commonwealth.  No economic measure that the State can
 foster, will, in my opinion, (and that opinion is based upon innumerable
 statistics), add more to the sum of human happiness and to the wealth
 of the  people and  the obliteration of preventable  diseases and the con-
 sequent prolongation of hale and productive life.
  I need not quote the figures of  statisticians  to show how  great is the
 drain upon  the purses of the people of the  State for  the  expenses of
 sickness  that might be prevented, nor how great the pecuniary  loss in
the destruction of lives that might be saved for many years of productive
industry.  You are too familiar  with them to require a repetition here.
  In the" introductory address of Dr. Homer O. Hitchcock, at the organi-
zation  of the Board 'of Health of  Michigan, July 30th, 1873, he outlined 
S(i
QUARTER-CENTENNIAL  CELEBRATION
 with  wonderful  prescience  what the'  work  of the  Board should be and
 what might be gained by the people if that work we're carried out.   One
 portion of the work for the Board to do, which he particularly emphasized,
 was " to educate the people in respect to the nature  and causation of diseases and
 the means for their prevention.''
   Following this direction of its first President, the Michigan Board of
 Health has most persistently carried on a campaign of  education, di-
 rected against the ignorance of vital  truths respecting their own bodily-
 welfare which prevailed among the great mass of the people.
   To  get  the  people to  think, it has distributed  broadcast millions of
 pages  of  printed instruction  concerning those  diseases  that were dan-
 gerous to the public health.  It has held sanitary  conventions in almost
 every city and village in the  State, for the more immediate arousing of
 popular interest  and to lead the people to act.   It has  called public at-
 tention, unceasingly, to  the  simple means of preventing disease.  It has
 enlisted the most  cordial co-operation of the Medical profession in its
 preventive work,  thus taking bread out of the doctor's mouths as it were.
   It has inspired the law makers  to  enact the necessary  legislation to
 compel the people to be healthy.  It has created  a  spirit of emulation
 among public  officials to enforce such laws, and, greatest  of all its educa-
 tional  work, it has made the teaching of sanitary-  measures compulsory
 in the  schools of the State.
   This great idea for the education of youth was, I  believe, first urged
 upon the public.by Dr. Baker, the Secretary* of the Board,  at a Sanitary
 Convention, held in Albion in this State, in 1887.  Like other great ideas
 for  the public weal it developed slowly, but in 1895  it became a law of
 the  State.
   The law is as follows:

                         Act  No. 146, Laws of 1895

 An Act to provide for teaching in the public schools, the modes by which the danger-
  ous communicable diseases are spread and the best methods for the restriction and
  prevention of  such diseases.

  Section 1.  The People of the State of Michigan enact, That there  shall be taught
 in every year  in  every  public school in Michigan  the  principal  modes by
 which  each of  the  dangerous communicable diseases  is spread, and  the best
 methods for the restriction and prevention of each such disease.  The State Board
 of Health shall  annually send to the public school superintendents and  teachers
 throughout this State printed data and statements which  shall enable  them to
 comply with this act.  School boards are hereby  required to direct such superin-
 tendents and teachers to give oral and blackboard instruction, using the data and
statements supplied by the State Board of Health.
  Sec. 2. Neglect or refusal on the part of any superintendent or teacher to  com-
 ply with the provisions  of this law, shall be considered a sufficient cause for dis-
 missal from the  school by the school board.  Any  school board wilfully neglecting
 or refusing to comply with any of the provisions of this  act,  shall be subject to
 fine or forfeiture, the same as for neglect of any other duty  pertaining to their office.
 This act shall apply to all schools in this State, including schools  in cities or vil-
 lages, whether incorporated under special charter or under the general laws.

  What a possibility* for incalculable good is embodied in  this law.  In
 the State of Michigan there  are about half a million  school children en-
 rolled, with sixteen thousand teachers, whose duty  it is to teach to them
 the  simple facts  of sanitary  science.   Facts  rather than theories  are
 taught, and we all know that a fact simply taught,  at a time of life when 
MICHIGAN  STATE  BOARD  OF  HEALTH
87
Hie mind is most plastic and impressible, becomes indelibly fixed therein,
while the same fact elaborated into a tract or a treatise too often tails
to impress the maturer mind.
   What will the harvest be after such a planting  of ideas in the minds
of our youth?  Will it  not be rich in a fuller and more perfect life?   In
the greater freedom from disabling ailments; in the practical elimination
of contagious or communicable diseases; in the extension of the period
of productive strength  in man far beyond  his present  capability, and a
vast increase in the' wealth of the State? I firmly  believe that it will.
  Educate the youth of the State  and in the perfection of their manhood
will  the whole Nation rejoice.
            WALTER WYMAN, M.  1)., AYASHINGTOX. D. C.


 SUPERVISING' SURGEON GENERAL OF  THE U. S. MARINE HOSPITAL SERVICE.

   In a letter dated July 30, 1898,  Doctor Wyman wrote the Secretary of the State
 Board of Health, as  follows:  "I look forward  with much pleasurable anticipation
 to the meeting on August 9 and still hope to be able to go. We are right in the
 midst of the fight, however, and just at the present moment I am deeply engrossed
 in preventive measures, against yellow fever from Santiago, of a very broad scope
 and involving many details.  I have not  left town for one day, not even Sunday; so
 that, if I telegraph you I cannot come, you  must feel that  it is because it is abso-
 lutely impossible for me  to get away."

   Chairman Wells—The duties of the head of the Marine-Hospital Service of the U.
 S. are complex, onerous and exacting.  They not only demand that each seaman be-
 longing to the merchant service of the T\ S. shall have the best medical and  surgical
 attendance when sick or injured, but, since  the abolition of the National Board of
 Health, it is made the duty of the supervising officer of this department  to have
 charge of both interstate and seaboard quarantine.  The present incumbent of this
 high office,  Walter Wyman,  Supervising Surgeon General of the Marine Hospital
 Service, who It w*as expected would be one  of  the speakers this  evening, is unable
 to leave his post at this critical period.  I will ask Judge McAlvay  to read a tele-
 gram just received from Doctor Wyman.

                                            Washington, D. C, Aug. 8, 1898.
 Doctor Henry B. Baker, Secretary State Board of Health, Hotel Cadillac,  Detroit,
    Michigan:
   Regret very much  that pressing  duties in connection with quarantine measures
 for return of army prevent my leaving.  Express my  personal regrets to the Gov-
 ernor. Accept my congratulations both  for yourself and the Board of Health on
 this the twenty-fifth  anniversary  of  the Board.


   Chairman Wells-The next  gentleman upon our program is a  former member  of
 the Michigan State Board of Health, and for ten successive years its  president.
 He was one of  its most valued members, and took an  active interest in all  its
 labors   In a  moment  of  weakness  he  yielded to temptation  and  became a
 member of Congress.   It is pleasant  to know that his  reputation has not  appreci-
 ablv suffered from this lapse, nor  has his character been contaminated during the
two terms of his service in that body.   This last statement may have to be quali-
 fied  as this gentleman, Doctor John Avery,  does not seem to be present, although
 he had given us reason to believe he would be here. 
88
QUARTER-CENTENNIAL CELEBRATION
    HON. JOHN  AVERY, M.  D., GREENVILLE, MICHIGAN.


      EX-PRESIDEXT OF THE  STATE BOARD OF HEALTH  OK  MICHIGAN.

  In a letter to the Secretary of the State Board of Health, dated Aug. 9, Doctor
Avery wrote:  "Owing to sickness in my family I find it will be impossible for me
to be present at the Quarter-Centennial Celebration of the Michigan State Board of
Health.  I regret this very much, as I  had anticipated much pleasure in meeting
my  old friends and the many public-health workers who will be present.  The last
quarter of the century has been marked  by great advance in  sanitary science along
the  lines of practical utility, and I congratulate the Michigan  State Board of Health,
that it has kept  fully abreast with this advance."

  Chairman Wells—The relations which exist between the Dominion of Canada and
the  United States are not alone those of a political or commercial nature; there is
a family relation which is stronger than either of these and which  holds in the
bonds of kinship all  people who speak  the English  tongue.   In the hour of trial
this has been made manifest to us in ways that have  strengthened the arms and
inspired the hearts of our patriots and soldiers.  Michigan reciprocates the many ex-
pressions of good will and friendship from  her  relatives over the border, and has
a representative of her closest  neighbor on the east, the  Province of Ontario,  to
speak to you tonight.  We are greatly indebted to him and the board he represents
for  efforts in the past to guard us from dangerous  communicable diseases. I in-
troduce to you Doctor Bryce of Ontario.
        PETER H. BRYCE, M. A., M. D., TORONTO, ONTARIO.

               SECRETARY PROVINCIAL BOARD OF  HEALTH.

  Mr.  Chairman, Ladies and Gentlemen:—On this occasion, called upon
with my fellow sanitarians and this  splendid  audience to celebrate  the
twenty-fifth anniversary of the establishment by law of a department of
public health in Michigan, I feel it especially appropriate that as repre-
senting Canada, I should convey to the people of Michigan the blessing of
a mother to her firstborn and perhaps most illustrious child, who rejoices
in the  fulfillment of the1 motto inscribed by that old hero, Governor Cass,.
on her first State Seal—"Tandem  fit sirculus arbor."

  For  me no page  in the history of the  Michigan peninsula has a  charm
equal to that where the crusader knight and discoverer. La Salle, leaving
his  seignory on the fair Lac Saint Louis, started in 1G70 on his search for
the holy  grail—the  route to China—in this  western world,  and  first
planting the fieur dc lis on Longue Pointe, Lake  Erie, in the name of Louis
le Grand, pushed his canoe- over the perilous lakes and entering the  Strait,
landed where Yon-do-ti-ga, the great village of Detroit, now stands, and
exorcised by axes and elrowning the demon, in the painted Manitou stone,
which  your historic ancestors worshipped on this spot; and how he further
visited dear Pere Marquette at Mirhillimackinac, and the Illinois of Kas-
kaskia, and by  almost superhuman efforts  delineated   your  territory
through crossing from  the now* Chicago  to the Detroit again by  the river
Navier, your own Huron.
  Indeed from the time La Mothe Cadillac built Fort Pontchartrain in
1701 till the time  when General  Brock paid Detroit a friendly visit in
1812 we Canadians have taken the deepest interest in the history and for-
tunes of Michigan, and can rejoice with her citizens in the story of how 
MICHIGAN STATE BOARD OF HEALTH
89
 Lieutenant Gladwin held the fort, as Horatio the bridge,in the old fighting
 frontier days when Pontiac made history, and left us memories of ''Bloody
 Run",  and the base-ball  game at Mackinaw.  But beside the interest
 which  Canadians have shown for the people of Michigan during all these
 centuries you owe us a debt of gratitude for manifold favours. From the
 river Raisin northward and from Marquette southward you hear, whether
 from steamboat captain  or railway brakeman, euphonious names familiar
 to every lover of Old Canada, though often  the  poor name, like an old
 Hag that has done duty, is often sadly tattered and torn; and one may
 be forgiven for recalling  the days  of long ago when he hears of  sueh
 philistinish names as Turkey, Mama Juda and Humbug profaning the
 islands of the noble river.
   Yet  more than thanking us for names, you must thank us Canadians
 for populating your fair land.
   Who docs not know that in the old pioneer days, when many thousands
 were pushing westward to  the new lands from the eastern states and New
 York, that many stayed  with us over in Western Canada, and that after
 being taught many  good and wise things, they pushed on farther west-
 ward, some for your good, and others for the good of the country  they
 left;  so that from 18:>2 onward, Michigan has been employed in making
 homes  for, and having her resources developed by, something  like half
 a million Canadians, and for fear that the records of the patent office, if
 left in Detroit, would show the real nationality of the people of the
 State they were in 1857, quietly transferred to Lansing,  and since that
 time  the title to the property of this State has become very much mixed.
   But if as Tennyson says:

               " This truth within  thy mind rehearse
                That in this boundless universe
                Is boundless better,  boundless worse,"


 this occurrence  Sfeins  to  have  resulted  in  bringing into  touch  with
 these   records  of   the  State  twet patriotic  citizens  and  studious
 physicians,  who delving into historic lore, and reading of the glorious
 deeds of Surgeon George C. Anthon, attached to the Detroit post in the
 old Pontiac days, and of the holy and reverend Father Martin Kundig
 the undying hero of that terrible cholera  year 1SSU, when hexbought an
 old church, and in 21 hours had taken out every alternate  seat and made
 the space into a bed, were fired with a holy desire to emulate such glorious
 achievements and so it came about. Ladies and Gentlemen, that Ira Haw
 lev Bartholomew*  tobiit  1K*!>) and  Dr.  Henry  Brooks  Baker began  the
 crusade in the cause of public health, which resulted in the formation of
 a State Board of Health in lS7:t.  Since that date the attacks upon  the1
 "infidels", and the return assaults of the Saracen foe are matters of history
to all of you.  Of  the workers,  and work  done during these twenty-
 five years'I need not speak at length.  For myself, looking back I find
 that it'is twentv-one years, since, as a teacher of chemistry', I  first vis-
ited Lansing and  met my dear   old  friend,  the  Nestor  I believe
of the  Michigan  State  Board of  Health,  Dr. Kedzie.   I seem almost
to have known the1 work since its inception.  Certainly since 1882 when
the Provincial  Board  of Health  of Ontario  was  created,   I  have
knov. n  the  work and wo'keas of  the Michigan  State Board of Healtp
         12 
no
QUARTER-CENTENNIAL  CELEBRATION
intimately   as   fellow  workers,   and  as  leaders  in  the   holy  war
against disease and all causes of ill health.  Fired with the  enthusiasm
of the Secretary and  members of this Board,  I  trust that something of
it  was transmitted  to  Canada,  and  that in  this, as  in so many  in-
stances, the young man has, from a foreign land, sent back to  the mother,
something from the store of wealth which her lessons taught  him how to
obtain.
  To the people of Michigan who, through their  representative  citizens,
are gathered hero tonight to do honor to themselves  by honoring those
who for twenty-five years, whether in the Legislature, in the State  Hoard,
or who as  officers of health of your 1.500 municipalities, have elevated
the standard of wealth, health and happiness by teaching and helping  the
people to enjoy and preserve the highest gift of the Giver, a  sound mind
in a sound body, I bring  Canada's Greeting to  encourage you  to still
greater efforts  to fulfill to its utmost the ideal of the motto on your State1
crest—
                Si  quaeris peninsulam anwnan circumspicc 1

  Chairman  Wells—However just may be the criticism that States anel governments
make more  liberal contributions to secure health for domestic animals than  for
man, yet the value of work done to prevent diseases in animals can scarcely be over-
stated.  So many diseases  are common to both man and animals  and are cap-
able of being communicated from one' to the other that restriction  of such diseases
in animals  furnishes  a large degree of protection to humanity.  Doctor  Salmon.
Chief of Bureau of Animal Industry, in the Department of Agriculture at Wash-
ington, has  this  work  of restricting diseases ir  animals in charge for the  general
government. Most of you are familiar with his efforts in this direction and  ap-
preciate their value, and I take great pleasure in introducing to this audience Doctor
Salmon of Washington.
         D.  H.  SALMON,  D. V.  M., WASHINGTON, D.  C.

CHIEF   OF   RUREAU  OF • ANIMAL    INDUSTRY,  U.  S.  DEPARTMENT   OF
                             AGRICULTURE.

  I desire to add my congratulations to those of the distinguished gentle-
men who are participating in this notable celebration.  If the founders of
the State Board of Health of Michigan had been endowed with prophetic
vision and had  desired that the first quarter century of this institution's
existence should be passed in the most active period in the history of
sanitary science' they could  not  have selected a more auspicious time
for its organization than the year 1873.  We were then just upon  the
threshold of a new  era.  The human race had reached a point in  its de-
velopment where,  out of the utter  darkness which had enveloped  the
subject since the beginning of history, its foremost investigators, peering
through the obscurity  which surrounded them,  could  discern a faint
ray of light which  appeared to be growing stronger in the field of infec-
tious diseases, and  which had already kindled the hope that in the  full-
ness of time the cause of these plagues v.*ould  be revealed.
  It is impossible  in the time at my disposal  to  so much  as enumerate
the wonderful discoveries which sanitary science  has  laid  at the feet of
humanity during this active and prolific period.   But even  an  enumer-
ation is unnecessary since all remember how closely one announcement of 
MICHIGAN  STATE BOARD  OF  HEALTH
!)L
 successful investigation has followed another, until the causes of many
 of our most dreaded diseases have been made clear.  A few  contagious
 diseases still resist  the powers of the microscope and the culture tube.
 but as one after another has yielded to new methods and greater experi-
 ence, we have confidence that in time all will be conquered.  The pirsent
 condition of knowledge justifies us in asserting that the mystery of con-
 tagion so long impenetrable is solved; that the great scientific principle's
 are established, and that what remain*-  to be learned is for the me>st part
 a matter of details.
  Possibly  the immensity of this achievement does not appeal  to the
 younger sanitarians or  to the laymen with the same force that it does  to
 me.   Having contemplated the blackness of our  ignorance a  quarter  of
 a century ago, and being one of those who sought long and anxiously for
 a favored point at which a  little light could be made to penetrate, I can
 scarcely realize that the night has passed forever, and that  henceforth
 the sanitarian will do his  work in the'  lull light of an almost cloudless
 day.
  The knowledge as to  what constitutes the active principle of infectious
 material enables us to avoid such material in many ways.  It has brought
 us scientific disinfection, the  aseptic treatment of wounds, the methods
 of changing a deadly virus into a prophylactic vaccine, and it has given
 us anti-toxic serums for the prevention and  cure of communicable dis-
 eases.  These are  the results, in general terms,  which to my mind are
 preeminent among  the achievements  in  sanitary  science'  during the
 quarter century in which this Board has participated.
  My work during this period has beeui of a somewhat different character
 from  that  in which most  sanitarians have been engaged.  It has been
 confined entirely te> the diseases of animals, and the  organization and
 direction of work for preventing the spread of such diseases from animal
 to animal and from animals to man.  This service joins and overlaps the
 work  of the Health Boards, and it  has  been  my fortune te>  receive the
 most  eeudial cooperation and the most valuable assistance  from  these
 Boards  in  the  various  State's and municipalities.  It is to the friendly
 relations thus established  that I no doubt owe the opportunity and the'
 pleasure of being here and  taking part in these interesting proceedings.
  Let us consider for a moment what has been accomplished in this spe-
 cial field of sanitation.  Twenty-five years ago,  we' could hardly claim
 that there  was a veterinary profession  in the country, so few were the
 followers  of that branch  of  medical  science.  Animal plagues  were'
 rampant; there was  little knowledge of their nature, or of the means by
 which they  might be controlled; legislation for this purpose had scarcely
 been attempted, and the consumer of meats had practically- no protection
 from dangers due to the ignorance and avarice of the butcher.  We have
 today a Bureau of the Federal Government devoted to this work, which
 receives an appropriation  of nearly a million of  dollars a year and has
 in its  service over one thousand persons.  It is not, however, to the sum
 of  money expended nor to the number of nersons  employed to  which
your attention is especially invited, but rather to the work performed.
' There existed in this country twenty-five years ago, and, I  might say.
fifteen years age),  that terrible scourge of the  bovine race known as  con-
tagious  pleuropneumonia  or  lung plague.  If had gained a  lodgement
in at least  half a dozen States.  It threatened the vast capital of nearly
 a thousand million dollars  which we had invested in the cattle industry, 
!>~             QUARTER-CENTENNIAL CELEBRATION

and it  also seriously  affected the domestic and foreign  eoinmerce iu
bovine animals and their products.  It threatened to this extent the food
supply of the nation.  As it had ravaged the herds of Europe for a  cen-
tury notwithstanding  extraordinary efforts for its  control, there were
many who believed its eradication to be beyond the powers of sanitary
science.  For the sake of brevity. I will merely say that this contagion
has been so completely extirpated from American soil that not a single
case has been observed during the last seven years.
  There was also another fatal disease of  cattle called Texas fever, a
disease with such mysterious  and apparently contradictory  characters
that its very existence was doubted and the accounts of it were pronounced
by some authorities as a  "romance in  pathology."  It was found that the
contagion of this disease exists permanently over an immense area of
our territory, but the mystery has been removed, the problems have
been elucidated and the disease is now so completely under control that
the great mass of  our stock-raisers no longer  give it a thought.  The
discovery that the contagion of this disease remains permanently in the
blood of affected animals and is only disseminated by a particular species
of cattle tick has enabled us to perfect  special prophylactic  measures
which are now about to be introduced. There have for some years been
but two problems which had not been satisfactorily solyed.  Means had
been  devised for  shipping animals from the affected district for  imme-
diate slaughter, and indeed for other purposes during a part of the year,
without danger of disseminating contagion; but it  was desired to take
improved animals into the infected district, and also to freely ship in-
fected cattle without quarantine or  other sanitary restrictions.  After
a long series of investigations the data have been  obtained for accom-
plishing both of these objects,—the former by* inoculation, the latter by
passing the infected animals through a petroleum and sulphur bath.
  We have, also, a disease, or rather two diseases of swine in the United
States wdiich have  destroyed enormous numbers of these animals,  and
thereby blotted out invested  capital  to the extent of thirty to  eighty
million dollars a  year.  To arrest this annual drain upon our  resources
would of itself bring prosperity and wealth to some of our greatest States.
This problem has been one of the most difficult ones, for a number of
reasons, that sanitary* science has ever attempted to  solve; the investiga-
tions have continued for  twenty years with  ample resources supplied by
Congress and it is only within the last year that  we have found a method
of treatment that gave promise of suce ess.  That method consists  of the
use of a spe'edal compound anti-toxic  serum so prepared as to prevent
and cure  both  of these diseases.  It has been  demonstrated  that  this
serum gives excellent results with small  animals in the laboratory and
last year it was used on a small scale in the field, saving 75 per cent of ex-
posed animals, wmereas but 15 per cent were saved without serum. This
year preparations have been made to use the serum upon a large number
of animals—the plan being to treat all  of the  la-rels in a county or in
several counties in which the disease  appears during a  period of  a year,
and then compare the losses in the district where this measure is adopted
with those in adjoining counties.  The application of this remedy, after
the experimental  stage is passed, should undoubtedly be as a sanitary
measure under the  supervision of sanitary authorities and  with  a view
to gradually* eradicate the  disease. 
                MICHIGAN  STATE  BOARD  OF HEALTH             W

    Another public service of vast dimensions which has been inaugurated
  within this period is the' inspection at the lime of slaughter of animals
  the meat of which is intended for  the interstate' or foreign trade.  The
  importance of such an inspection must be apparent to any one who con-
  siders the vast numbers of crippled,  diseased and dead animals which
  arrive at all  large slaughtering places, and the additional fact  that  at
  all such places there are unscrupulous persons ready to impose upon the
  consumers by placing the meat of such animals upon the market.  During
  the last year more  than twenty-seven million animals we're inspected,
  those injured,  diseased or otherwise unfit for  food we're condemned and
  the meat of the healthy ones was certified as free from disease, sound and
  wholesome.
    It has also been found essential to inspect and quarantine animals  of
  all species which  are brought into  the country, in order to prevent the
  importation of contagious disease's.
    There has been briefly sketched  in these few  words a  vast sanitary
  system which the United States Government  applies to animals with a
  view not only  of  controlling the diseases of  animals,  but  of protecting
  the health of  the  people by guarding against the transmission to man-
  kind of  diseases  originating with  animals.  Fvery part of this  system
  including its inception and development has oe-curred during the lifetime
  of this Board.
   We  come together on this occasion and mingle our congratulations
  without  reservation  of any  kind.   The establishment  of  the Michigan
  State Board of Health was a good thing for the State and for the Nation.
  Its growth in power and influence until it has reached the age of a quarter
  of a century is a fit  subject for rejoicins'.  This initial period of its ex-
  istence has fallen in a  time of unrivalled activity*, of dazzling oppor-
  tunities  and  of amazing achievements.   But all  is not  finished.  As
 twenty-five years ago we stood at the threshold of a new era, so today we
 can see the promise of great things that are  to be accomplished in the
 near future.  Let us conserve what we have.   Let us maintain the high
 standard of professional ethics which  has been established in this coun-
 try, which is the glory of our medical profession, and which forbids that
 humanity shall be forced to pay exorbitant tribute to  commercial greed
 in order to benefit  by the great discoveries of medical science. Let us use
 our influence to keep  the production of anti-toxins out of the control of
 monopolies; so that these great discoveries of modern science may re-
 main within the means of the humblest in the  land and may be used for
 animal as well as for human diseases.  Let us stand shoulder to shoulder
 and make the results of the  next <piarter century even more notable than
 have been those of the past.

  Chairman Wells—The state of Kentucky, noted for its blue grass and its corn, is a
land of plenty.  Its blue  grass furnishes food for its splendid  animals and its corn
food and tonic not only for its own but for  the citizens of the whole Union.   But
the state is not  noted for those alone.  It has  for Secretary of its  State Board of
Health a most genial and competent man. whose name appears upon our program
as one of the speakers tonight.  I learn that his duties at home will  prevent Doctor
McCormack being with us this  evening,  and that Doctor Bailey, president of the
Kentucky State Board of Health, will speak in  his place,  rermit me to introduce
te> you Doctor Bailey. 
!H             QUARTER-CENTENNIAL  CELEBRATION

           WILLIAM  BAILEY, M. I)., LOUISVILLE, KY.

             PRESIDENT OF THE  STATE BOARD  OF  HEALTH.

  I have no paper—have had no time to prepare  one; but I present the
congratulations of Kentucky  upon this  occasion,  to the Michigan State
Board of Health upon its successful completion of its twenty-five years of
philanthropic labor.  Knowing .Michigan, knowing its delightful climate,
its  great lakes, its  beautiful cities and the hospitable people, 1 was de-
lighted to  come to this Quarter-Centennial  Celebration, in fact I came
several days ago, and have been enjoying myself to the utmost ever since
I came.
  As to the tonic, which your President  suggests my State is famous for,
I would remind  Mr. Wells that the Elats are broad, and I  find, after
several days' sojourn there with some of Michigan's sanitarians, that the
"tonic" is  exhausted.
  I was surprised to hear the climate of Michigan, its curative waters, its
great lakes and the innumerable delightful resorts so modestly mentioned
by your President.   I am prepared to be more enthusiastic, for the great
e-xpanse of blue water, the cool  pure breezes, the delightfully-tempered
climate and the more than delightful places of rest for the tired and sick
impress me most pleasantly.  My visits to Michigan have been  most de-
lightful. Twenty-five years ago 1 first came to this State seeking health
and rest among the beautiful invigorating scenes, and then  I met Doctor
Connor and Doctor  Jenks.  I first met a representative of the Michigan
State Board of Health in 1879 at Nashville at the meeting of the Ameri-
can Public-Health Association; sinee' then I have missed only one meet-
ing, and some of the'se- men have been present at  nearly all of them.
  We are indebted perhaps to the State Board  of Massachusetts for being
the  first established, and that Board and the Michigan State Board of
Health I regard  as  chief in sanitary matters, and first in the march of
progress for the improvement of the sanitary conditions of the people.
  Your work is not limited to your own State, and to the improvement
of your own people, but its influence' is spread over all the States, and
is a source of encouragement to them, stimulating them to more success-
ful labors,  leading them in the paths of improved sanitation, and teaching
them what may result  from persistent intelligent labor for the good of
mankind.
  These sanitarians deserve' success  in their forward march against dis-
ease and death.  Their opportunities are  very great, and their  responsi-
bilities are in like degree.  I give them God speed.

  Chairman  Wells—It is said of Kentucky that
             "Its corn is full of kernels
             And Colonels  full  of corn."
  Doctor Bailey is not a colonel, and lie is full of good ideas, from whatever securer
they may come.

  Chairman  Wells—Vital statistics are to the sanitarian  what the balance sheet  is
to the merchant.   Each, if correct, shows whether gains have been made or losses
sustained.   Vital statistics in Michigan are not collected by the State Board of
Health,  although it is required by law to make diligent  use of them.  They are 
MICHIGAN  STATE BOARD  OF  HEALTH
95
  under the charge'of a gentleman in this State  who,  in addition to unusually
  efficient work in this department, has secured the passage of an act which has re-
  sulted in giving to Michigan vital statistics as nearly correct as  it is possible to
  have them.  This gentleman, Doctor Wilbur, I now take  pleasure in introducing to
  you.


         ('BESSY L. WILBIJK, M. D., LANSING, MICHIGAN.


     CHIEF OF DIVISION  OF VITAL  STATISTICS,  DEPARTMENT  OF STATE.

   It becomes my pleasant privilege' to say a word as the  representative
  of the vital statistics service of the State, which in Michigan, as you know,
  is not conducted by the State Board of Health  but by the Department of
  State.  The relation of these two  branches of the  public-health service—
  the collection of vital statistics and the practical w*ork of restricting dis-
  ease—is so intimate that in most State's they are  performed by a single
  department of the State government.  In Massachusetts, Michigan, Ohio,
  and Vermont  until  recently,  the  services are distinct for the historical
  reason that the collection of  vital statistics  was begun before the State
  boards of health wore in existence.  Thus we in  the registration work
  may look  upon our friends  in  the health service with a sort of elder-
  sisterly affection, and wdiile not engaged  directly  in the work of sanita-
 tion, we can nevertheless feel a degree of personal pride when we recog-
 nize the good results of such work—it's all in the  family, you know.
   In fact,  the  connection between the modern science of sanitation  and
 the  collection  of vital statistics is even  closer than w*e have suggested.
 With  more time, we might allude to the sequence' of e'vents in Great
 Britain as evidence of this,—how  Dr.  Farr's  great w*ork in the establish-
 ment and administration of the national system of registration of deaths
 first called attention, with proofs that  admitted  of no question, to the
 urgent necessity  for sanitary  improvement.   From that time to the pres-
 ent the most effective workers in sanitation have been those who utilized
 most fully the important lessons of vital statistics.  Individual experience
 is often misleading, because  it does not include  a sufficient number of
 events. Statistics deal with  large numbers, with the movement of the
 population in the mass, so that the individual peculiarities are eliminated,
 and the  great laws of the incidence and prevalence  of diseases stand
 revealed.   But a  mere mass of facts does not constitute statistics, in the
 proper sense, any more than  an undisciplined mob of men would consti-
 tute an army.  Discipline is as  necessary in marshalling facts  in science
 as in arraying men for war, and well-drilled statistics have stormed many
 an outpost ofignorancc in the past, and won many a citadel for hygiene
 from the hands of the enemy.  Only modern  rifles  and smokeless powder
 are of use  on the battlefield today*,' and the sanitary army has little use
 for any other than the best modern equipment in vital statistics.
   I am clad to say that Michigan  has  today a registration system for
 deaths that stands second to no  other  State system in the country for
 promptness and  accuracy.   Fp to less than a year ago  the Michigan
 State Board of Health  had  no reliable statistics of mortality for  the
 Spite and those  that were obtained under the  old law  were so tardy as
tr'bo'of little immediate use.  You have all, I presume, seen the Michi-
n   Monthly Bulletin of Mortality, issued by  the Department of State 
!»<i              QUARTER-CENTENNIAL  CELEBRATION

soon after the close of each month, which shows the deaths from danger-
ous communicable diseases  in  every  city,  village and  township in the
State.  This information is  in time to be of interest to the people and
of practical  importance to  the local  health officers, as well as to the
State Board of  Health.  During the nine months from October, 18!)7,  to
June, 1898, no less than 1,317 deaths from  dangerous communicable dis-
eases were first brought to  the attention of the  State Board of Health
through this Bulletin, the health officers whose duty it was to do so not
having  properly reported  them.  This enabled immediate  action to  be
taken, with the result of undoubtedly limiting the spread  of disease  in
many cases.
  From Connecticut, through New York and Ontario to Michigan, the
epidemic prevalence' of diseases can now be followed in monthly bulle-
tins issued shortly after the close  of  the month.  Such prompt reports,
immediately available for sanitary use, exist: in no other states, that  is,
of course, representing entire State areas.   It is a much simpler matter
to issue a prompt report of urban mortality only.
  The triumphs of the Michigan State Board of Health  in the past have
been  won in the face of many  difficulties as regards exact information
of the  conditions  attending the  mortality of the State.   With these'
hindrances removed, it would seem that we  might anticipate even greater
usefulness in the  future.   In behalf of the Michigan State registration
s< rvice,  and voicing especially,  as I believe, the sympathy and cordial
cei-operation of the nearly 1,500  local registrars of the State in the noole
work  of restricting and preventing disease, I congratulate the Board on
its record in the past and rejoice in the splendid  outlook for the future.
1 thank you  for your kind attention.
  Chairman, Wells—The next speaker, Dr. J. N. Hurty, Secretary of the Indiana Stale
Board  of Health,  is  well known to  most of you  as Secretary  of the Conference'
of State  and Provincial Boards of Health of North America, which opens its ses-
sions here tomorrow.   He is one of the most vigorous of the sanitary workers in this
country,  and is a most loyal citizen of one of our nearest neighbor states.  I intro-
duce to the few of you who do not know him, Dr. J. N. Hurty.


         J. N. HURTY, M.  D., INDIANAPOLIS, INDIANA,

             SECRETARY OF  THE STATE BOARD OF HEALTH.

  l have the honor to bear to this celebration the greetings and congratu-
lations of the State immediately on the south.  Indiana is proud to be  in
geographical as  well as social touch with Michigan.  A  look at the map
shows that my State bears upon her shoulders this beautiful,  salubrious
and enlightened peninsula.  Projecting  north  from Indiana, Michigan
extends into the midst of our great inland seas.  This State is thrice, yes,
four times blessed.  The breezes from the  east lose their dust  and mi-
crobes in  Huron.   The winds from the north are  washed by* mighty
Superior, the air coming from the west is purified  by Lake Michigan, and
the atmosphere w'hich conies  from the south, while not dustless and germ-
less, carries the  spirit of the people of the glorious Hoosier  State.   That
State  which gave  to the world the poet James Whitcomb  Riley, the'
popular novelist Gen. Lew Wallace, and that great statesman  and noble
gentleman, Benjamin Harrison. 
MICHIGAN  STATE BOARD OE  HEALTH
97
    Michigan was wise in that generation, which one quarter of a century
  ago, was so practical as to pass a health law.  I say that generation was
  practical, for what could be more practical than the application to daily
  life of the universally-acknowledged truth—"An  ounce of prevention is
  worth a pound of cure".
    We Americans are fond of telling how very  practical we are, and we
  are practical on  the whole, but still we waste millions of  money and
  incalculable happiness annually, in having diseases which could be pre-
  vented. This impracticability, this failure to apply to our daily life the
  truths of  science,  seems due in part to the superstition that  medicines
  will  cure.  We know very well  that medicines cannot cure,  that they
  simply stimulate or relieve, and that nature alone can  cure.  Yet the
  medicine fetish possesses us,  and  we pour out  millions annually*, for
  drugs. Dr. Frank  Crane remarks:   "The whole earth  teems with adver-
  tised remedies.  The landscape blossoms with them; the bill boards glow
  like Italian sunsets.  Whole editions of dailies, weeklies and  monthlies
  are turned into bulletins  for them.  We have remedies from animals,
  from vegetables, and from  minerals.  From the pines of the north and
  the common smart weed which flourishes in every fence corner, are ex-
  tracted juices which will cure any and all diseases in seven  minutes by
 the watch.
   Cures there  are  by magnetism,  by electricity,  by faith, by christian
 science, by menti-culture, by laying on of hands,  by osteopathy, allopathy,
 homeopathy, hydropathy and just plain mud.   Cures! cures!  cures! are
 everywhere, yet disease and illness stalks in our midst  like a ghost which
 will not down.
   If Dr. Bumstein announces he has discovered a certain cure for con-
 sumption,—and we always know he has done no such thing,—the tidings
 are borne  upon the wings  of lightning,  editorials appear for the nine
 thousandth time hailing the glad news, and immediately thousands rush
 for the nostrum,  pouring out their gold  in yellow streams.  Disappoint-
 ment,  despair and frequently ruin, follow  this awful foolishness. Yet
 a people which brags of being very practical continues the foolishness.
 Even councils  of great  cities,  councils  composed of so-called practical
 business men, of  men who think that that money which is not spent is
 always saved; yet really not appreciating where true economy begins and
 foolish extravagance ends, refuse  to take adequate steps  toward pre-
 vention.  In this  regard, we are truly a stupid  people.  Think of it; we
 refuse or neglect to call a halt to a horrible plague which continually eats
 into our national vitals.  A plague, which annually kills more human
 beings than wars, famines, and alcoholic liquors.  The devastation spread
 bv consumption is greater than that proceeding from small-pox, cholera,
 bubonic plague, diphtheria, scarlet fever, homicide, suicide and drowning.
 When, O when,  will w*e become practical and inaugurate preventive meas-
 ures?  Although  alwavs hopeful, I  nevertheless sometimes become dis-
 couraged at our leaden-footed progress, and  frequently am reminded of
 the story of the multiple marriages, told of  Dr. Samuel -Johnson.  "Dr.
 Johnson", said Boswell, "you remember Lovett of  Ludgate do  you not?"
■'Ye-s, sir", replied Johnson, "I remember him well, what of him"?  "Well
 sir he has  been four times unhappily married and now is to be married
the fifth time, and what do  you say to that"?  "Well sir", said Johnson
in his pompous way, "I denominate that the triumph  of hope."
  The  Michigan State Board of Health  and its very able secretary are
         13 
98
QUARTER-CENTENNIAL  CELEBRATION
 not only an honor to Michigan, but  to the whole country.  The health
 work done in Michigan  has brought  high reputation and honor to the
 State.   May it continue with increasing support.

  Chairman  Wells—We expected to meet tonight the editor of  the journal which
represents the American Medical Association, Doctor John B. Hamilton, Ex-Surgeon
General of the U.  S. Marine Hospital Service, whose active  labors in that service,
together with his work as editor of the Journal, have placed him high in the ladder
of fame.  Unfortunately he is unable to  be present with  us tonight,  and I will
request Judge McAlvay to read a telegram from Doctor Hamilton.  The telegram
is as follows:

                                                   Chicago, 111., Aug. 9, 1898.
Doctor Henry B. Baker,  Secretary State Board of Health, Cadillac Hotel, Detroit,
    Michigan:
  Deeply regret unavoidable detention.  I congratulate you and  your Board  on
quarter century's magnificent record.  Well done good and faithful servants.
                                                     JOHN B. HAMILTON.

  Chairman  Wells—This  concludes this portion  of our evening   program. Mayor
William  C.  Maybury, the Reception Committee, members of the  Michigan  State
Board of Health and distinguished visitors  will now hold a reception in the corridor
adjoining this room, after which refreshments  will be served in  the main dining
room of the hotel, to be followed  by short  speeches from several distinguished
citizens.
  In concluding our exercises here, I desire on behalf of the members of the State
Board of Health to thank the citizens of  Detroit and the various committees ap-
pointed by them for their efforts to render this celebration successful.  I also desire
to thank the many  friends of this  Board for the  kind words they have spoken
today concerning the work of  the Board and its Secretary,  Doctor Baker.  Your
presence on this occasion, together with your appreciative utterances, have rendered
this, celebration of  our quarter  centennial a day long to be remembered.
                               RECEPTION.

  The receiving party were—Hon. William C. Maybury and Miss Guinness, Doctor
Leartus Connor and Mrs. Connor, Doctor Wm. Bailey and Mrs. Bailey, Doctor Ben-
jamin Lee and Mrs. J. E. Emerson, Doctor Henry B. Baker and Mrs. Baker, Doctor
Felix Formento, Doctor C. A. Lindsley, Hon. Frank Wells,  Prof. Delos Fall, Judge
Aaron McAlvay, Doctor Fred Belknap, Doctor Samuel  G. Milner, Doctor Frederick
G. Novy.
  The visitors were presented to the receiving party by:  Doctor E.  S. Sherrill,
Doctor C. W. Hitchcock,  Roberts P. Hudson, and Theo.  R. MacClure.

  After the reception in the corridor, the guests were ushered into the main dining
room of the Hotel Cadillac, where dainty and appropriate refreshments were served.
                       AFTER-DINNER  SPEAKING.

  At the close of the refreshments, Hon. William C. Maybury,  Mayor of Detroit
addressed the guests with one  of his  characteristic after-dinner speeches  and"
introduced Judge Aaron V. McAlvay. member of the State Board of Health,' who
had been  selected to act as toastmaster. Judge McAlvay presided, and with ap-
propriate remarks introduced  Doctor Leartus  Connor, and  Dr. E. S. Sherrill, who
on account of the late hour,  were the  only speakers.  It  is to be regretted that
Doctor Sherrill's remarks cannot be here reproduced, but Doctor Connor's were as
follows: 
               MICHIGAN  STATE  BOARD OF HEALTH

     LEARTUS  CO.X^OR,  A. M., M.  D.,  DETROIT, MICHIGAX.

    In  the early  seventies at a meeting  of  the  Michigan State Medical
  Society, I became acquainted with a tall, pale-faced, dark-eyed  young
  doctor.  His head was full of vital statistics, and  the mathematics  of
  public-health questions.  On all available occasions he sought to enlist
  my co-operation  with his aims and work, finally taking me to a little room
  in Sweet's Hotel he exhibited his work, by means of  diagrams, figures,
  etc.  Later, he left the service of the Secretary of State, after securing
  the enactment of laws providing for the collection and publication of vital
  statistics.  These  laws were the best possible at  that  date, but  he has
  ever since lent his cordial aid to promote their improvement, until in the
  department of death registration it is as  perfect as practicable.
   He  was the moving spirit in the establishment  of the Michigan State
  Board of Health, and to the present has been its guiding  genius.  His
  Board has at  divers times  had representatives from doctors, lawyers,
  ministers, business men, professors,  but as a whole they have heartily
  seconded his plans, and brought to their success all of power they  pos-
  sessed.  From its inception the Michigan  State Board of Health has been
  a unit, clustering about this pale-faced student of public health as soldiers
  about a general,  as sailors about a captain,  as branches about the tree's
 trunk.  Together they have studied the problems of  public health as found
 in Michigan, and together they have applied them for the benefit of all
 the people—all have rejoiced in the  gradual diminution of  sickness and
 mortality of our people, and in  their increased physical vigor.
   It is pertinent  to quote from the lips of the late Dr. Bowditch, founder
 of the Massachusetts State Board of Health, the statement that the work
 of our  pale-faced student friend was easily first of its  kind, and that to
 it he always turned for  aid, with the assurance  that, it exhibited the
 highest skill, the most uncompromising accuracy, and devotion  to the
 cause of public health.
   In one respect the work  of  the Michigan State Board of Health has
 been notable, viz:  its absolute freedom  from any taint of corruption.
 During a quarter of a century it has kept its aims fixed upon  the advance-
 ment of public health, undisturbed  by  personal ambition,  or other en-
 tanglements.  Its earnest Secretary, forgetting personal considerations,
 has given his life to the  advancement of the physical  well  being of our
 people.  It  could not be otherwise than that such  a life would meet an-
 tagonisms,  but it has  never been  my lot to meet  any to controvert his
 single-hearted devotion to the  interest of Michigan's citizens.
   It must be confessed that  public-health service in Michigan has failed
 of such recognition as its merits deserved; far too little financial support
 has been accorded, but it is believed, that year  by year the people  will
 so increase  in knowledge as to instruct their  legislative representatives
 to give the State Board of Health all that support, needful for the protec-
 tion of the health and lives  of its citizens.         _       _
  It gives me pleasure, to direct attention to the spirit which originated,
 and thus far guides the operations of the Michigan State Board of Health;
to note its devotion to the science of Sanitation; its  freedom from political
or other entanglements; and to  say that the pale-faced friend of a quarter
of a century ago, now in the  prime of matured life, still leads,  and is
well known to all  as the earnest student, the distinguished sanitarian,
the clean citizen, the true man—Dr.  H.  B. Baker. 
100
QUARTER-CENTENNIAL  CELEBRATION
  The  meeting broke up at a late hour,  and thus ended  the  proeeeelings  of  the
quarter-centennial celebration of the establishment of the Michigan State Board of
Health.  However, most of the visitors to Michigan remained  to attend and take
part in the proceedings of the  annual meeting  of  the  Conference of State and
Provincial Boards of Health of North America, Avhose program had been arranged
to occupy the  succeeding  two days.  The subjects discussed  at  the Conference
were of immense import.  The proceedings will be published, and any one wishing
a copy can probably purchase one from J. N. Hurty, M. D., Sec.  Conference of'State
and Provincial Boards of Health, Indianapolis, Indiana.
    VISIT TO PARKE, DAVIS & CO., AND RIDE ON DETROIT RIVER.

  The records of so important a meeting and such an enjoyable time would not be
complete without mention of the visit to the plant of Parke, Davis & Co., one of the
largest manufacturing establishments for medical supplies, antitoxin, etc., in the
world, and whose biological department is extensive and unique.   Those wishing
to avail themselves of this opportunity  were taken by street car to this establish-
ment.  Upon arrival, they were received  by Mr.  Parke and his able corps of
assistants,  were served with an elaborate  luncheon, after which the factory was
thoroughly inspected, including the several branches of the biological department,
in which hundreds, even thousands of animals, are used for the production  of anti-
toxins for diphtheria and  other diseases.
  The citizens  of  Detroit had provided  for a boat ride on the charming Detroit
river, and the steamboat was waiting at the dock of Parke, Davis & Co.  The  boat
ride occupied the remainder of the afternoon, and the afternoon entertainment ended
with refreshments at the pavilion of the Wayne Hotel.
  All pronounced the entertainment a success, the visit to  Parke, Davis  & Com-
pany's establishment very  instructive, and extended their thanks and best wishes to
Parke, Davis & Co. and to the members of the  local committee of citizens which
had provided so enjoyable  an event, as well as for the pleasant and very successful
transaction of the business of the quarter-centennial meeting.
  Later, the  State  Board of  Health formally and  unanimously adopted a vote of
thanks to the members of  the  local committees  for their very successful efforts for
the good of the quarter-centennial celebration. 
 
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