SUGGESTIONS ON PUBLIC HEALTH WORK IN MICHIGAN. 
PRESIDENTIAL ADDRESS TO THE MICHIGAN STATE BOARD OF HEALTH, LANSING, 
APRIL 9, 1897, 
BY HON. FRANK WELLS, PRESIDENT 
[Reprint No. 491.] 
Gentlemen of the Michigan State Board of Health:— 
Two years ago, when I last had the honor of addressing you in com- 
pliance with the rules of this board, the State and Nation were just recov- 
ering from well-grounded fears that cholera, which had become epidemic 
in many parts of Europe and had menaced us with its horrors, would 
reach our shores. Though the danger from this old enemy of humanity had 
passed, another equally dreaded was still ravaging portions of our land. 
Small-pox was epidemic in Chicago, and had fastened its loathsome fangs 
upon cities and towns of our State. At that time our thoughts and our 
efforts had been directed for nearly three years towards preventing these 
historic giants of destruction from gaining a foothold in Michigan. 
Fortunately the entire country was preserved from an inroad from 
the first of these foes, while science again justified her methods in check- 
ing the ravages of the second. The Michigan State board of health felt 
keenly its responsibility during this period. In few, if in any, of the 
other States of the Union could those having in charge their health inter- 
ests have felt greater responsibility. The pathway of a very large propor- 
tion of the emigrants from Europe lies across the territory of our State. 
It was from this class that the danger had been apprehended, for it was 
this class which it was well known had for many years furnished to our 
people the seeds of many of the dangerous communicable diseases. 
Visitors to the exposition at Chicago, and immigrants in unusually large 
numbers, mostly of the lower classes, passing through our State during 
these years, excited the fears not only of the members of this board but 
of nearly all our citizens. 
Though these fears may now seem like dreams, and no one in Michigan 
today expects or dreads an outbreak of either cholera or small-pox, yet it 
is well to recall the experiences of those days in order to remind us of the 
fact that our fears were largely due to our knowledge of what these two 
enemies had meant to mankind in the past, rather than what they mean 
at the present time. They are conquered foes and wherever intelligence 2 
prevails need not be feared. Our losses from them during a quarter of a 
century does not equal the losses we annually sustain from the weakest 
of the foes which continually menace us. We believe that all these other 
foes which are always with us may in time be rendered equally power- 
less. This is a result we hope and strive for, even though the breeding 
places of these enemies in the old world are continually sending rein- 
forcements to our shores. 
Michigan Especially Endangered by Immigration. 
A marked effect of the danger from cholera and small-pox, so happily 
averted, has been, I believe, to impress upon the members of this board 
and many others this fact—that Michigan is peculiarly liable, from her 
position, to outbreaks of nearly all the dangerous communicable diseases. 
These have been in the past and will continue to be brought into her 
borders by immigrants, from every foreign country. So long as such 
immigrants are permitted to enter and pass through the State without 
inspection or disinfection of baggage, it places upon this board and upon 
many local boards of health, responsibilities and duties unknown to sim- 
ilar boards in most of the other States. Our State and local authorities 
should not, therefore, be censurable because such outbreaks occur, for 
under present conditions they are powerless to prevent them. Such 
authorities are only censurable when they neglect the best known meth- 
ods for their restriction, and epidemics follow as the result of outbreaks. 
I congratulate you on the fact that during the past two years there has 
been, substantially, restriction of all the dangerous communicable dis- 
eases, to the individuals, families or localities in which outbreaks have 
originated. Outbreaks of these diseases have also, with a single excep- 
tion, been less numerous during the last two years than during any of 
the preceding years of which we have records. This important fact, con- 
sidered in connection with the fact that immigration has greatly lessened 
during that period, furnishes additional evidence that it is the European 
immigrant, passing into and through Michigan, who often sows the seeds 
of disease and death among our inhabitants. For this reason, Michigan 
needs from those to whom her health interests are intrusted, both State 
and municipal, unusual courage, judgment and knowledge. 
Another reason why Michigan will always require from such officials 
the exhibition of these qualities, is her natural and geographical situa- 
tion. Her insular position, her vast coast line, and the numerous streams 
and bodies of water which form so large a portion of her surface, are con- 
ditions which render her inhabitants peculiarly liable to certain diseases. 
Michigan is a Summer-Resort State. 
The beautiful shores of the larger lakes that so nearly surround our 
State, their delightful climate during the hot months of the year, 
together with the picturesque and charming inland lakes that diversify 
her landscape, are rapidly causing Michigan to become a deservedly-pop- 
ular health and summer resort for the entire country. Scarcely second in 
value and beauty to similar resorts upon the Atlantic coast, ours have the 
advantage of rapidity and ease of access both by water and land, and of 
the comforts and conveniences of life which many of those upon the 
shores of the ocean do not possess. 3 
Yearly the number of the best citizens of other States who come to 
Michigan for health and recreation during the hot months of summer 
increases. These are welcome guests, for they bring with them intelli- 
gence, culture and wealth. As their host, Michigan should not only do 
all she can to render their visits agreeable, but she should also see to it 
that they are as free from danger of infectious disease as knowledge and 
skill can render them. 
Summer resorts, experience has shown, are peculiarly liable to those 
diseases which arise from the use of contaminated water, and from lack 
of, or defective sewers. Frequently have such resorts been the theatres 
of epidemics, and those who have sought these delightful retreats for the 
restoration of health and strength have found instead disease and death. 
Local health authorities cannot always be depended upon to deal with the 
problems which arise from the varying conditions pertaining to the 
unsanitary surroundings which so often exist at these resorts. One of 
the reasons for this is lack of the necessary knowledge and experience, 
resulting from yearly entire or partial changes in the personnel of such 
authorities. Another reason is the sudden transformation of a sparse 
rural population, during a large portion of the year, to the numbers of a 
city during the summer months. Local authorities usually reside at a 
distance from the scene of these changes, and their attention in such 
cases is rarely called to or their services offered to solve these problems. 
Members of the State board of health of Michigan acquire this experi- 
ence, and for this reason are presumably more competent to advise with 
reference to the questions relating to the health and lives of those who 
live, for longer or shorter periods, directly upon the shores of our exten- 
sive water ways than can those who have no such experience to guide 
them. Such experience must be of yearly increasing value, and should be 
utilized in rendering the growing health and summer resorts of Michigan 
free from those special diseases which always menace aggregations of 
human beings possessing imperfect or no organized methods for their 
prevention. 
State Inspection in Outbreaks of Dangerous Diseases. 
In this connection, it seems to me desirable to call your attention to the 
method adopted two years ago by this board for investigating outbreaks 
of dangerous communicable diseases in localities where the local health 
officials were, from any cause, unable to subdue or discover the cause of 
such outbreaks and there was liability of the disease spreading. When 
appealed to under such circumstances, this board has usually sent, as an 
inspector under act 47, laws of 1893, one of its own employes, Dr. Cater- 
mole, a gentleman qualified by education and practice for this purpose, 
to investigate the character of the disease and all the facts connected 
with its appearance and progress. These have been reported by him to 
this board for its action, and the results have thus far been entirely satis- 
factory. Occasionally the larger experience of Secretary Baker has been 
invoked for this purpose, when his other duties would permit. The plan 
has proved successful in accomplishing perfectly the objects sought in 
such investigations, while the cost to the State has been extremely small. 4 
Actions for Restriction of Diseases Have Been Followed by Decreases in 
■ Sickness and Deaths. 
As yon all know, tlie list of diseases regarded by this board as com- 
municable lias been a continually-increasing one. Whenever, as a result 
of scientific observation and experience, the1 members of the State board 
of health have become convinced that a disease owed its origin to some 
specific organism capable of being transmitted directly or indirectly from 
one person to another, always causing the disease when thus transmitted, 
such disease has been included in the board’s list of dangerous com- 
municable diseases. Local health officers were then admonished of the 
fact, and such rules and regulations as in the board’s judgment seemed 
most practical for the restriction of such disease were furnished. The 
records in the office of this board show that a marked diminution in the 
sickness and death-rate has uniformly followed its action in every disease 
now included in this list, concerning which the advice of this State board 
has been accepted and adopted. 
In none of these diseases has such result been more significant than in 
the last one so classified by this board—consumption. Work of an edu- 
cational character was begun by it upon this disease many years ago. Its 
first leaflet was published in 1891, but it was not until 1893 that it was 
formally included in the list of “diseases dangerous to the public health.” 
It was a surprise to me and it may be to you, to learn how rapidly, 
according to the “sickness-report” cards received at this office, consump- 
tion is diminishing in Michigan. So marked was this reduction during 
the last few years that a comparison of these cards indicate only one-half 
of the number of cases in 1896 that there were in 1886, ten years before. 
The reduction thus indicated has been more marked during the latter por- 
tion of this period, and is especially noticeable during the last two years. 
While the Michigan State board of health may not claim all the credit 
for this remarkable and gratifying result, it is certainly entitled to a 
very large share of it. To my mind, it is to the educational value of its 
literature disseminated among the sufferers from this disease and among 
those exposed to its contagion that this striking diminution is largely 
due. 
New Lines of Sanitary Work. 
While the securing of the enforcement by local health officers of the 
laws relating to isolation and disinfection during outbreaks of contagious 
diseases, and the distribution of its literature at such times must always, 
it now seems, be the most important work of this board, yet there are 
many other lines of work which either in the near or late future it is 
likely to be called upon to perform. These will come as a result of the 
sanitary knowledge which is slowly but surely finding its way into the 
minds of the people. The time is sure to arrive when the general diffu- 
sion of this knowledge will render apparent to the many, as is now dis- 
cerned by the few, various lines of effort whereby this knowledge may be 
made practical for the protection of human life and health. 
Permit me briefly at this time to call vour attention to some of these 
lines; among them, the disposal of garbage, waste and excreta, especially 
outside the larger cities, and the prevention from contamination or the 
purification of water supplies, are becoming every year of more and more 5 
importance. Investigations of outbreaks of typhoid fever and other 
diseases of this class by this board have shown that some, at least, of 
the villages of this State use for drinking water filtrations through all 
the most offensive results of the habitations of mankind. The ordi- 
nary shallow well is the only source of water supply in most of the 
smaller towns of the State. In very few of these is any attention paid 
to the unsanitary surroundings, and in a still less number, if any, is 
water from wells tested until an outbreak of disease has occurred. 
Should it not be the duty of the State to exercise supervision where the 
public health is so vitally concerned, and by means of inspection of the 
water supply of these hamlets, especially during the later months of the 
year, not only furnish some degree of protection, but at the same time 
teach the inhabitants how contamination from this source may be pre- 
vented. An obvious objection is the expense, but when we consider the 
large sums of money placed by the legislatures of Rhode Island and 
Massachusetts at the disposal of their State boards for practical pur- 
poses upon similar lines, in the manufacturing districts of those states, 
the amount required for the purpose I have indicated in this State 
should not be withheld. I believe it will not be when the value of such 
inspection is understood by its citizens. 
Milk and Meat Inspection for the Prevention of Tuberculosis. 
Another line of work which this board has had in view, but in which 
it has been unable to do anything practical, is the inspection of those 
two prime articles of food,—meat and milk. Upon you who know so 
well that a large proportion of infantile mortality is directly traceable 
to the use of cows’ milk, and that this article as well as the flesh of ani- 
mals used for food is liable to contain the organism of tuberculosis, I 
need not urge the importance of State inspection of animals furnishing 
these foods. 
Many of the obscure cases of this common and fatal disease undoubt- 
edly owe their origin to this source. Inspection of cattle seems to be 
imperatively demanded as an important factor in the work of stamping 
out this disease. Fortunately in tuberculin we have an unerring test 
for its existence in animals, so that no loss need be incurred from the 
slaughtering of suspected animals unless they are shown, by this test, 
to have the disease. The Live Stock Commission of this State has its 
veterinarian, Dr. Grange, make tests of herds where it is supposed to 
exist, and good work has been done by it in extirpating the disease from 
such herds. Unfortunately animals may have tuberculosis a long time 
before they show any sign of it to the ordinary observer, and during this 
period a cow may be furnishing milk charged with the germs of this 
disease, for human consumption. This can only be prevented by regu- 
lar and systematic testing of all cows which supply milk for food. Out- 
side of large cities, such inspection can rarely be left to the local health 
officers, for, although the tuberculin test is shown to be reliable, it cannot 
be used by inexperienced hands. It is this board which should take the 
initiative in bringing about government inspection of animals furnish- 
ing the milk supply of the State to its citizens, in order that they may 
be protected from that fatal and insidious disease, consumption, 
through this source. Inspection of meat, though of less importance 6 
because it is usually cooked before being eaten, seems also likely to be 
demanded when the serious consequences which may follow its being 
taken into the stomach before being subjected to sufficient heat to kill 
the organisms, are generally understood. Michigan has properly made 
wise provision to secure its citizens against loss or danger from the 
use of adulterated food. Danger to health or life from the use of such 
food, as we well know, is infinitely less than from the milk or flesh of 
tuberculous animals. 
State Hospital for Consumptives. 
An effort was made by this board two years ago to secure from the 
legislature an appropriation to build and equip a State hospital for con- 
sumptives. Though the project failed at that session of the legislature, 
and though the present may not be an opportune time to again ask that 
body for favorable consideration of this subject, the board has not lost 
sight of this need of the State, nor does it regard it of less importance 
now than when it was first proposed. 
Among the numerous factories in Michigan where articles are pre- 
pared which are intended to go into human mouths or stomachs, many 
consumptives are known to be employed. The disease is liable to be con- 
veyed by means of the articles they handle, and doubtless to this source 
might be traced many obscure cases of tuberculosis. Such articles as 
cigarettes, chewing gum, cigars, capsules, and confectionery, with their 
wrappers, are all liable to become bearers of infection. It would be 
unjust to deprive consumptives who are earning livelihoods in such fac- 
tories of the means of subsistence, but it is still more unjust to permit 
them to become bearers of the disease to others. To provide a hospital for 
this class, where its inmates could be made comfortable, where the chance 
for their improvement would be the best, and where they could learn 
how they could cease to be a menace to family and friends, and to the 
public, would not only be an act of humanity on the part of the State, 
but would materially diminish the spread of this disease. 
The removal of all the causes which promote the continued existence 
of tuberculosis, by the methods we have been considering as well as by 
others we may yet discover, must continue to be one of this board’s 
most important lines of work until the disease has entirely disappeared 
from our midst. 
Sanitary-Science Teaching in the Schools. 
Two years ago an act of the legislature, initiated and advocated by this 
board, was passed which required that every public school in the State 
should give instruction in sanitary science to its pupils, and also required 
the State board of health to supply teachers with its literature for that 
purpose. No step ever taken by the Michigan State board of health 
seemed fraught with more far-reaching consequences than this. It 
placed before a large proportion of the youth of the State knowledge 
concerning the dangerous communicable diseases, their causes and pre- 
vention, far beyond that which was in the possession of the parents of 
most of them. This knowledge, it was felt, when stamped upon the 
impressionable minds of children who were soon to become the men 7 
and women of the State, would result in producing a generation infinitely 
better equipped to contend with the foes of life and health than the 
world had ever before seen. 
Teachers, all over the State, became enthusiastic to learn, and to be 
able to instruct in the new work. In supplying the literature required, 
and in paying postage, even with the aid of the office of the Superintend- 
ent of Public Instruction, the resources of this board were severely 
taxed for this purpose, for the legislature had failed to appropriate any 
money to carry into effect the provisions of the act. An unfortunate 
result of the expenditure of a large portion of our meagre appropria- 
tion for this purpose, as you all know, was the relinquishment of the 
Sanitary Conventions which for many years had been an important and 
valuable work of this board. These conventions were for the instruc- 
tion of adults in sanitary knowledge, in much the same way that chil- 
dren, under the law, are now instructed in the schools. Both kinds of 
instruction are valuable, and this board will not voluntarily relinquish 
either. 
In this connection, it may not be amiss to call attention to the fact 
that no proper text book for teaching sanitary knowledge exists. The 
leaflets of this board, which had been prepared for other purposes, and 
have been used to supplement the leaflet especially prepared for use by 
teachers, contained much needless repetition when used for this pur- 
pose, while they lack the elements of continuity and of the evidences of 
the truths upon which all their statements are based. If this board is 
to continue this work, some one of its members should prepare a text- 
book suitable for use in public schools. Among our members are those 
thoroughly competent for this work. 
Cooperation of State and Local Boards of Health. 
Probably the most important work of the board, in the future as in the 
past, will be the keeping in active operation the best methods for prevent- 
ing the spread of communicable diseases. The practical part of this 
work is wisely left by the law to the local health board and its officers. 
Upon their knowledge, judgment, fidelity and tact must every community 
rely when threatened with the spread of any contagious disease. It is for 
them to see that the means which experience has proved to be the best 
and which they are instructed by the secretary of this board to use are 
never neglected. To increase the efficiency of the local health officers of 
Michigan, and to bring them into closer relations with, the State board, 
three annual conferences of local health officers have been held at Ann 
Arbor. These have convened in the rooms of the State Laboratory of 
Hygiene, giving those in attendance opportunity to observe and become 
familiar with the valuable work and methods of this well-appointed lab- 
oratory. The last of these meetings, held in July last, was well attended 
and was especially valuable and interesting. Dr. Vaughan, the director, 
and his associate, Dr. Novy, did everything in their power to make this, 
as well as the former ones, valuable to the conference. Papers and com- 
munications by these gentlemen, and by other prominent experts in vari- 
ous departments, kept alive the interest for two days, and rendered great 
service to the health interests of the State. 8 
I believe every member of this board is impressed with the importance 
of holding a similar conference every year, for it is manifest that this 
board cannot in the future afford to leave anything undone which will 
bring its members in touch with that large body of generally-intelligent 
men who are now doing so much to preserve the health of the State and 
who seem desirous of still further increasing their power for good in this 
direction. 
Popular Education in Sanitary Knowledge. 
In calling your attention at this time to those lines of work which now 
seem to me to be of most importance for the future, I am not unmindful 
of the fact that none of them are new nor that upon several of them work 
has already been done by you. Neither do I forget that the promotion of 
the objects we have been considering will require both legislation and 
money, and I need not tell you that these are not always to be had for the 
asking merely. I can suggest but one way by which such requirements 
can be secured. It is a way you are already familiar with and have done 
much to effect. It is popular education in sanitary knowledge. The flood 
of light which the last decade has shed upon the causes of all the dan- 
gerous communicable diseases and the methods of their prevention, you 
must continue to disseminate among the people. The prospect for an 
appropriation by the present legislature which will enable you to con- 
tinue such educational work in the schools, and also give you means 
to revive the sanitary conventions which were abandoned two years ago 
for lack of funds, seems at the present time good. Such aid at this time 
means much for health wTork in Michigan. Should it be granted, you will 
be inspired with increased vigor for the achievement of still greater suc- 
cesses than those which have already crowned your efforts, while the 
people you serve will be enriched by the outlay many fold. 
As the pleasant relations I have sustained towards you as your pre- 
siding officer for more than three years terminate today,* and as our 
official relations will doubtless soon cease entirely, it seems a fitting 
time to express to you how agreeable these relations have been to me. I 
assure you, one and all, that I have most heartily appreciated my asso- 
ciation with you, and shall always remember it as one of the happiest 
experiences of my life. To those of you who are to continue to bear 
the burdens and the honors of the noble work upon which we have been 
engaged, there will, I feel, be no lack of zeal in carrying forward the 
purposes for which we have striven and which, I believe, have given to 
this board a reputation and character second to no similar board in our 
country. I shall continue to watch your work with the deepest interest 
and with full faith that, as the years go on, your achievements in life-sav- 
ing work may be even more valuable than they have been during the 
years that are past. 
* [Although President Wells’ term of office as a member the board will soon terminate unless he 
shall be re-appointed, he was, at this meeting, unanimously re-elected President for the ensuing 
term of two years or such shorter time as he shall continue to be a member of the board, H. B. B., 
Secretary ]