The board had to blaze out a new path into regions hitherto unoccupied. At its first meeting Dr. Bowditch said: "I know of no higher office in the State than that which we now hold, viz., that of inaugurating the idea of State medicine in Massachusetts. Upon our high or low appreciation of the position, and of the duties resulting from that position, and upon our wise or foolish performance of these duties, depends the success of the object aimed at. Our work is for the far future as well as for the present. . . . I wish to impress upon you the essential dignity of the offices we now hold, and that we should assume them with minds loyal to the truth. . . . State medicine ranks among the most important matters now discussed by the highest intellects and the humanest hearts in Great Britain. . . . The chief object of the physician is to cure; the far higher aim of State medicine is, by its thorough and scientific investigation of the hidden causes of diseases that are constantly at work in an ignorant and debased community, to prevent the very origination of such diseases." He quoted Simon's "platform," that the sole object of State medicine is "the improvement in human health, and the lengthening out of human life of each individual man and woman." He also cited Dr. Farr's: "The primary object of public medicine is to prevent disease, but it also surrounds the sick with conditions most favorable to recovery, and diminishes the death-roll of the people. But supposing every condition most favorable for the operation of State medicine, we should still see grave defects in many persons; shortcomings in others; in many, organic degeneracies; in many, criminal depravities. How, out of the existing seed, to raise races of men to divine perfection is the final problem of public medicine. Public hygiene is a want, as much as air and public roads and waters are public necessities, and as such, must be cared for and paid for by the community."

The high ideal was nobly lived up to, and in a sort of manifesto addressed to the Municipal Boards of Health, nominally existing in all the towns of the State, they say: "We believe that all citizens have an inherent right to the enjoyment of pure and uncontaminated air and water and soil; that this right should be regarded as belonging to the whole community; and that no one should be allowed to trespass upon it by his carelessness or his avarice, or even by his ignorance. . . . These propositions are recognized in existing statutes, but they are not enforced, and the reason of that is, that the public mind is not sufficiently aware of the dangerous elements around us, does not understand the connection between filth and disease, and is not convinced that undrained land is not wholesome to live upon." The board at once. set about collecting the mortality statistics in the principal cities and towns of the State, and addressed themselves to investigating

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the corruption of springs, wells, reservoirs, and aqueducts, the sale of dangerous drugs, the sale of "swill milk” and watered milk, the sale of unwholesome meat, the condition of tenement and lodging houses, but say that "local and private interests have, it is thought, often been strong enough to paralyze the action of local health authorities "-an opinion that was violently confirmed a few years after, when they found themselves involved in a lawsuit with a powerful firm who were corrupting the water supply of a town with offal. It rendered a report to the Legislature of 1870, when it had been at work only six months, and had little of achievement to relate; but in the lofty ideals it holds up, and its catalogue of reasonable hopes for the future, though only a pamphlet of fifty-eight pages, it remains to this day a good sanitary bible for the earnest disciple. It would be amusing if it were not painful to see how gingerly it walked, claiming only 'advisory" powers, it was by no means firm in the saddle and dreaded lest some "watchdog of the treasury" should land it on the ground. In the second year, an investigation was begun of the possibilities of improvement in tenement houses, which it is not too much to say has led up to the immense improvement in that class of dwellings throughout the United States; and in the third year it was directed by an act of the Legislature on April 6, 1872, to "consider the general subject of the disposition of the sewage of towns and cities and to report to the next Legislature their views, with such information as they can obtain upon the subject, from our own or other lands." This was the beginning of the accurate study of a subject that has a personal interest for every man, woman, and child. It has been prosecuted uninterruptedly since, and at the end of nearly two decades, in 1890, it put forth its monumental and authoritative three-volume report, one of which relates to the general work of the board, one to Purification of Sewage and Water, and one to Examination of Water Supplies. Dr. Bowditch had said in 1869, "Public health has so wide a field that help is needed from all-from the chemist, the engineer, the naturalist, and from the humblest citizen as well as the highest statesman." He didn't mention the bacteriologist, because that interesting personage did not exist. He was beginning to be evolved in Pasteur, who was studying the "parasitic diseases of silkworms," and in Tyndall, who was earnestly probing the truth or falsity of the doctrine of "spontaneous generation," but, as we now know many of him, he was non est. No less than four chemists par excellence, one civil engineer, and one professed biologist, outside the regular corps of medical and other contributors, help to make this a work that puts this country in advance of all Europe, and which will find a place in all scientific libraries.

Typhoid Fever in Michigan in 1890. The figures represent the number of persons per 10,000 inhabitants. They were compiled from the State Board's "Vital Statistics," obtained from the reports of local Health Officers.

In 1876 Dr. Bowditch made an address at Philadelphia on the then status of preventive medicine, in which he prophesied a grand future for it, and said, "The touchstone which tests the

earnestness of any individual or community in reference to any subject is a willingness to spend money in the furtherance of it," and the five hundred dollars that was to be spent in 1849, in finding out whether the State had best do anything toward public hygiene, and the $62,876.82 that was spent in 1893 for expert work by her trained corps of sanitarians, are capital indices of the contrasting condition of public opinion at the two periods.

Knowledge and light can not be fenced in or shut out, and the example set in the early home of the Puritans saw its first answering spark on the Pacific coast. It was only two decades since the irruption of the Forty-niners when California, in 1870, established her State Board, "in order to remain on the level of other intelligent people in other States." Her influential citizens had gone from the East as grown men, and some of them had been disciples of Lemuel Shattuck in Boston. Some of our young States have made astonishing advances, because not hampered with a set of conservative obstructionists, and when once started on the track of progress have shown a fruitful activity quite overshadowing the action of older communities. In the very next year Minnesota established a State Board, and thus a nucleus for the growing work of preventive medicine was planted on the four borders of the land, that at New Orleans being the most palpable and obvious, as the quarantining and disinfecting and fumigating of yellow fever, is a much more perceptible process than the noiseless but sure elimination of malarial fever from Maryland by extensive sanitary underdraining.

Two of the men who had investigated the Maplewood fever were professors in the medical college at Ann Arbor. They were indefatigable in efforts to influence the Legislature, and did not rest till Michigan had a State Board of Health, with Dr. Henry B. Baker as its secretary-an enthusiastic knight of sanitary science, possessed of a phenomenal ingenuity in popularizing its study among the million, and in making its work valuable. The work it has done in reducing the death-rate from scarlatina, diphtheria, and smallpox is a true nineteenth-century miracle.

Maryland and the District of Columbia followed in 1874, Mississippi in 1875, and Tennessee in 1877. It required eight years to get ten boards, and when we scan the legislation that gave them being, and see how little money was given them to work with-scarcely enough to pay necessary postage on the letters that must pass before any rapport could be established between the central authority and the separate municipalities-it is apparent that the public mind was far from convinced as to their utility, and the public heart was by no means "fired" with zeal to aid their work. A pathetic story attaches to the North Carolina Board. Dr. Thomas F. Wood-one of those patient, self

sacrificing men whose worth is never half known till they are dead-had labored unremittingly through the columns of a medical journal that he conducted for a State Board. At last the

Lives saved by Public Health work, by comparison of death rate in Michigan before and after the establishment of the State Board of Health. Compiled from the Vital Statistics gathered by local Health Officers, and showing at a glance the value of enforced sanitation. Lives saved from scarlet fever in seventeen years-7,265.

Legislature yielded to his importunate zeal. He devoted the entire earnings of his journal to sustaining it for four years of "anxiety and hardship"; but the blood of the martyrs has been the most fertilizing material that has ever been expended on this crooked old earth, and before his lamented death in the prime of life in 1892, he saw his State with a thoroughly organized health service in every corner.