' general sanitation. 
Its Important:0 to the Public Wel- 
fare, ami a Pica for Bo'11" 
Methods. 
Heauy B. Bake#; M. D.. 
|WKlaksiag, michM 
©rant* Kapfos ISnjlej 
18. Itm 1" The following discussion, one of the most 
suggestive, thoughtful, practical and plain, 
yet scientific, on the topic of General Sanita- 
tion, eyer produced in our State, was given 
at the State Sanitary Convention last night 
by Dr. Henry B. Baker, of the State Board 
of Health. The Eagle gladly publishes it 
entire, believing that it could not do more 
sorvice for the community by any ether use 
of its columns: 
ent kinds of cleanliness. To illustrate this, - 
it may be sufficient to suggest different i 
standards of cleanliness as follows: The 
housewife has one standard of cleanliness, 
which requires that a dish for the table must 
be thoroughly washed with soap in hot wa- 
ter, rinsed with clear water, and drained or 
wiped dry with a clean cloth. If such a clean 
dish be given to the chemist for his most 
accurate work, he may object that the dish 
is not chemically clean; and he will rinse it 
in alcohol or in a strong acid, or a strong al- 1 
kali, according to the particular form of 
matter which he fears makes it unclean for i 
his purposes, after whioh he also will pro- ' 
nounoe it clean. If this seme dish which has 
been made clean enough for the chemist, be 
given to the biologist who is experimenting 
on the vitality or reproduction of bacteria, 
he will pronounce it unclean for his pur- 
poses, and he will not be satisfied until he 
has submitted it to boiling water for at least 
five minutes, or in dry air to a temperature 
of 240 deg. or 2.50 deg. F., and then he will 
require that it shall not be exposed for an in- J 
stunt to the ordinary air, for fear of its con- , 
tamination by germs which sometimes float 
in the air. He will insist on these condi- 
tions because he has found by experience 
that ordinary cloths, ordiuary air, and ordi- 
nary water generally oontain germs capable 
of reproduction under favoring conditions, 
and sometimes contain t erms capable of re- 
production in the bodies of human beings, 
and of causing such diseases as small pox, 
scarlet fever, diphtheria, eto. The experi- 
ments by Tyndall, Burdon Sanderson, Pas- 
teur and others, on the conditions of life ana 
reprodnc ion of bacteria are of very graRt 
praotical importance in studies for the pre- 
vention of diseases, because they show the 
facts concerning lower organisms similar to 
those which are found to multiply in the hu- 
man body during the coarse of some of the 
communicable diseases, .and because they 
tend to reinforce onr knowledge of methods 
of destroying tbe contagia of some of those 
diseases, such, for instance, as the virus of 
small-pox, and the contagium of scarlet fe- 
ver, which are found to be destroyed nuder 
some of tbe conditions just stated—as by ex- 
posure in dry air to a temperature of 250 
deg. F. Farther experiment may show that 
a lower temperature is sufficient; and this is 
to be expected, because of the comparative 
infrequency of extensile outbreaks of these 
diseases in the hot summer weather, and also 
because of the liability of vaccine virus to 
lose its activity during the heat of summer. 
Returning to our clean dish, which, with a 
little variation, might as well have been a 
clean article of clothing direct from a laun- 
dry, or even new goods from a store, I think 
it is now plain that what is perfectly clean, 
according to one definition, may bo very far 
from clean according to this view of the sub- 
ject, aud with great certainty may convey the 
unseen causes of disease to any susceptible 
person. 
NEW METHODS OF SANITATION DEMANDED. 
What has just been said makes plain the 
necessity for new methods of sanitation. It 
may be well briefly to recapitulate these rea- 
sons in a slightly different manner, in order 
that they may more easily be kept in mind : 
One essential fact to b9 noticed is that, al- 
though the causes of the communicable dis- 
eases are material, “ particulate as it is 
said, they are invisible to the unaided eye, 
and consequently our ideas of cleanliness 
must be so cultivated that we can in imagi- 
nation follow the dissemination of the spe- * 
cijQc contagium whioh we know exists, wheth- 
er it spreads, through the air and is taken in 
with the breath, is conveyed from hand to 
hand in shaking hands, from lip to lip in 
kissing, from one place to another in cloth- 
ing, new goods, boxes or trunks, or in what- 
ever way it is carried from place to place, or 
in whatever manner, as for instance by the 
saliva or expectorations of careless workmen 
or inmates, it is kept in houses or hospitals. , 
DISEASE GERMS, THEIK SIZE, DISTRIBUTION, 
ETO. 
One who has never seen in the microscope 
the “particulate” germs of disease, may bo 
aided in such a scientific use of the imagi- 
nation as has been suggested, by fixing his 
attention upon a form of coutagium in mass 
sufficient to be appreciable to the unaided 
eye. In the small pox vesicle we have tbe 
contagium of that disease in considerable 
quantity ; and bovine vaccine virus, as we 
all know, contains the contagium of cow- 
pox. If we imagine this to be paade up of 
minute granules, of rounded outline, so 
minute that twenty thousand of them will , 
be required to extend an inch in length, we 
shall have an idea whioh will aid the mind in ' 
following the course and spread of disease- 
germs of this nature. We can then easily 
see how such disease-germs may be floated 
off by tbe air, carried in a veil, scarf or 
handkerchief, be stored or conveyed in the * 
clothing, beard or hair, appear as dust in a 
room, be sent in a letter or a paper, be boxed 
up and transported to a distance, washed off 
in water, carried into a privy, pass through 
the entire length of a sewer, or the water- 
pipes which supply pure water, go in the 
milk-can on its round from houso to house, 
or with the delivery-man from the grocer, 
baker, market or laundry. This may serve 
to give us an idea of some of the problems 
with which the health officer has to deal, in 
connection with the res-notion and preven- 
tion of communicable diseases, and Borne 
dea of 
WHAT A HEALTH OFFICER SHOULD KNOW. 
An efficient health officer should have clear 
ideas of the naturo of contagia ; he must 
have a good practical knowledge of the 
means by which, and the manner in which 
they are disseminated ; he should know the 
conditions of their reproduction, within or 
without the body ; he should know the con- 
ditions of iheir existence outside the body; 
and especially of their destruction, for upon 
this, in connection with what has just been 
mentioned, depends his success in restricting 
or preventing communicable diseases. 
A MEDICAL OFFICES OF HEALTH. 
Some of the cities in Michigan do not 
obey the law which requires that the health 
officer shall be a physician. No man can be 
ot much use as a health officer unless ho has 
a good knowledge of biology, at least of the 
general principles. We might better put a 
blacksmith in charge of a milliner’s shop 
than to choose as onr health officer one who 
does not understand the nature of those vital 
actions which human bodies undergo in 
health, and of those processes which are 
• The subject of general sanitation, assigned 
to me by the comm 'tu-e, is 036 so wide in 
extent, and so profound, that I cannot hepe 
to do justice to it gg a whole; therefore, re- 
alizing the fact that n long and heavy load is 
frequently lifted with greatest case when 
only one end is required to be raised at a 
time, and especially that when one end of a 
load is already well raised the most impor- 
tant work ia the raising of the other end, I 
have decided to glance at the general charac- 
ter, scope and importance of the work, ask 
more particular attention to such parts as in 
my opinion are most sadly neglected in Michi- 
gan at this time, and plead for better meth- 
ods and more methods than are now em- 
ployed, especially in certain neglected depart 
raents of general sanitation. In doing this, 
it seems almost essential to consider tbe 
character, necessary acquirements, and duties 
of those who are to do sanitary work ; and 
these ore the officers and members of local 
boards of health, particularly the health offi- 
cers. 
The end of the general subject assigned 
to me, which I propose fio lift on at Jtliia time, ■ 
in accordance witMlhe expressed wt«£ jf the 
committee and with my own judgment, re- 
lates mainly to the restriction and prevention 
of diseases which endanger the public health, 
aud whose causes and modes of communica- 
tion and best methods of prevention are not 
generally well understood. It may be said 
in passing that the department of pnblio san- 
itation which I consider to have already re- 
ceived the greatest attention is that which 
relates to general cleanliness, the removal of 
filth, in the many disagreeable forms in whioh 
it has forced itself upon public attention by 
reason of its intrinsic power of odor or un- 
sightliness. Such nuisanoes exhale powerful 
arguments for their own abatement, and al- 
though there is yet room for an immouse 
amount of work to secure this reujovab those 
who habitually resist or disregard suon argu- 
ments are lower in tbe scale of civilization 
than they to whom I appeal for the restric- 
tion and prevention of oommunicable dis- 
eases, and in regard to other less recognized 
sources of disease. Some of the dangerous 
agents to which I wish to call your attention 
are the contagia of diseases. These are just 
as real as are the evident nuisances, but they 
are as a rule invisible to the naked eye ; aud, 
though they sometimes generate odors, they 
aro themselves usually without odor. And 
yet, though their power is not evident to the 
unaided senses, the earth is strewn with the 
dead because of these disease-germs, and all 
onr paths of life are peopled with crippled 
victims of the many oommunicable diseases 
whioh we neglect to prevent or restrict. 
NEW REQUIREMENTS AND DEFINITIONS OF 
CLEANLINESS. 
In rpsaking of the greater importance in 
the prevention of diseases, of other work 
than that for the suppression of ordinary 
nuisances, the question has been asked if I 
was not forsaking the time-honored doctrine 
that all our ills are duo to filth, and that the j 
single word cleanliness expressed the whole 
sum and substance of general sanitation. To I 
this I reply that very considerable progress 
has been made in onr accurate knowledge 
respecting tbe c tuses of many diseases, and 
respecting tbe conditions essential to differ- 'coincident with disease. While much of the 
knowledge of the physician is entirely inap- 
plicable lo the work of public sanitation, and 
while this work demauds of a health offioer 
muob knowledge which the ordinary physi- 
cian has had no occasion to acquire, still the 
fact remains that in order to become a use-1 
ful health officer, one must have had a thor- 
ough training in the biological sciences 
winch lie at the foundation of the modioal 
sciences. 
A health officer should be sufficiently fa- 
miliar with mycology not only to know that 
certain kinds of fermentation are ordinarily 
harmless, aud certain othor kinds are gon- 
eral'y harmful, but ho should know how to 
stop the harmful fermentation. Inasmuoh 
as nearly all the ferments are invisible to 
the naked eye, a health officer mnst have an 
educated imagination in order sucoessfnlly to 
deal with his everyday work. This is so 
because much of his work should be a battle 
with some of the special ferments. Perhaps 
I can make this plainer by briefly outlining 
what, in the present state of onr knowledge, 
seem to be essential facts in this connection. 
Active cells in the human body act as fer- 
ments, destroying organio matter used as 
food, and creating special products differing 
according to the fnuction of tho particular 
organ in which the action takes place.,ftIn 
thq Wealthy adalk, t.he requirement K*un» to 
be mainly to get from tho food employed 
force to use in brain-work and muscle-work, 
very little being then required for growth or 
development of the body, so that the process 
is one of destruction through fermentations 
which yibld force, for the purposes of life, 
aud poisonous products whioh should be 
thrown out of the body as fast as formed, 
and which should not be again taken into 
the body. A health officer should endeavor 
j to see that all is done that can be done to 
I prevent their being supplied to tho people 
\ again iu the water they drink, tho air they 
breathe, and the food they eat. 
i Immediately npon entrance into tho month 
of a healthy adult persoD, starchy articles of 
food are attacked by one of tho usefnl body 
ferments, in tho saliva, and starch is con- 
verted into one form of sfigar. And here, 
upon the very threshhold as it were, may be- 
gin the battle between usefnl and harmful 
ferments ; indeed it may begin in the food 
before it is put in the mouth, for the yeast 
'i which the cook puts in the dough may con- 
tain other ferments than the harmless yeast 
plant, and thenefore the bread may contain 
not only the products of other ferments than 
veast proper, but also the speoial ferments 
themselves, multiplied greatly in number 
since they left their home in the foul air, or 
well-water. So, also, with the meat, which, 
i however,is not fermented by the .yeast-plant, 
but is decomposed in a manner somewhat 
• similar, by bacteria and similar low organ- 
isms microscopic in size. And here the pro- 
duct is not so frequently sugar and alcohol, 
' but sulphureted and phosphoreted hydrogen, 
butyric and carbonio. acids, ammonia, oto., 
usually bad-smelling products ; and the bad 
odor of the product should warn us of dan- 
ger from those germs which produce decom- 
position. 
In order better to appreciate tho import- 
. ance of the subject, perhaps some other of 
the usefnl ferments of the body should be 
mentioned. We have noticed only the first 
one encountered by the food in the saliva of 
tho mouth. The food meets another in the 
healthy stomaoh, another in the secretions 
from the pancreas, and so on in different 
parts of the body. Suppose each anti every 
one of these natural ferments in the body has 
to divide the food with another special fer- 
ment whsoh goes into the body with the wa- 
ter or food, or enters tho blood in some other 
way, as is believed to be the case in most com- 
municable diseases. Suppose that speoial fer- 
ment to be the one whioh causes small-pox, 
!_the one whioh causes diphtheria, or the one' j 
which causes typhoid fever. We can thus 
see how the gases given off by the longs, and 
how the other exoretions, and the secretions 
of the body may all contain products not nat- 
urally present in them, and a pofsOfl* nert. 
ouly have a feVer but be “ sick all over ” in 
every part of the body. The character of 
the siokuess, from a communicable disease*, 
depends, ns wo know.npoo the particular spe- 
cial ferment, but we need to guard, aud to 
h ive our health authority guard us, against 
danger from every one of those oontagioas 
and infections ferments. 
HEALTH OFFICEB NEEDED FOB EVEEY LOCAL- 
ITY. 
H" ’ 
It is imoprtant that all classes of people 
understand what needs to be done by tbo 
health offioer, beoanse he is a public servant 
dependent upon all classes of people, some- 
times for his official position, aud always for 
that co-operation whioh will render his ef- 
forts most effective. 
If the people of a locality do not think of 
anything for a health offioer to do, they 
will not be likely to employ one, except as a 
form in order to comply with the State law, 
uud will then endeavor to get the cheapest 
man. A prominent newspaper in Detroit 
states the case as follows: “ It is doubtful 
if any board of health, howsoever elaborate | 
and costly, could at present improve the: 
public hoalth of so healthy a city. While 
therefore we may be compelled to have a 
! health officer, as the law seems to require, I 
j to report our vital statistics to Lansing, the : 
common conuod should take care that he ' 
cost as little as possible, and meddle as little 
as possible with the people’s private affairs.” ; 
The writer of tnat paragraph assumes that 
Detroit is a hoalthy oity. I know of no way 
of proving what he assumes, because the 
oity has no reliable vital statistics ; bnt the 
I reports of bnrials in the oity cemeteries in- 
dicate that the deaths from communicable 
diseases are about two hundred and forty 
(240) every year. How long must this 
slaughter go on bofore it will attract the at- 
tention of the newspapers? When General 
Caster’s little band, numbering about the 
same as this, was destroyed, the news 
thrilled the people of this State with an aw- 
ful anguish ; but here are two huudred and 
forty (240) deatns from preventable causes 
in a city repealed every year, and that city 
so healthy that its only need of a health of- 
ficer is to report on vital statistics to Lan- 
sing, aud the oonucil is asked to hire a obenp 
mau to do that. This illustrates the neces- 
sity ft>r more accurate and more general in- 
formation concerning the deaths and the 
causes of deaths which are now permitted to 
destroy people by the hundreds, without at- 
tracting sufficient attention to start efforts 
for their prevention. We need vital statistics, 
and we also need.to act up to the knowledge 
wo already have as to methods of provent- 
| ing the communicable diseases. 
HOW DO HABMFUL FEBMENXS ENTEB THE 
BODY? 
In order to bo able to guard us from the 
communicable diseases, the health officer 
should know the sources of danger, and the 
probable ways in wbicb different diseases en- 
ter the body. Muob remains to bo proved 
in this field of study, but concerning cer- 
tain diseases there is much that seems well 
established. 
TYPHOID FEVEB. 
There is good evidence that the greatest 
danger from typhoid fever oomeB from what 
goes into the stomaoh, and not from the air 
taken into the lungs, and that of all sources 
probably the frequent is water con- 
taminate! with the discharges from persons 
who have had the disease, though an epi- 
demic of about 200 cases in Germany has 
Hieen traced to the eating of the meat of a 
calf which had probably been affected with 
the disease. The poison of the disease 
seems to be reproduced in the intestine and 
not usually on the onter surface of the pa- 
tient. In typhoid fever then the health offi- 
cer need not quarantine or isolate the pa-! 
tieut, for it is not common to have the dis- 
ease spread by breathing the same air in 
which the siok person is ; but the health offi- 
cer should carefully superintend some of the 
details in every oase of typhoid fever. He 
should require the discharges from the 
1 bowels of the patieut to be thoroughly dis- 
infected, and not permit them to go into any 
accumulation of excreta from where they 
may eventually return to plague the hnman 
race. ■ 
It had been thought that typhoid fever has 
sometimes been caused by breathing in the 
ferment given off from decomposing organio 
matter; and diarrheal diseases have been 
known to be caused in a similar manner, al- 
though it has not been demonstrated that the 
ferment was itself inhaled. Generally we 
have a right to lyisume, however, from the 
evidence of observed faots, that wherever wo 
find the odors of decomposition in connec- 
tion with organio matter, there also are the 
special ferments of that particular decompo- 
sition, unless unusual cironmstanoes have 
caused a separation ; for the bacteria of de- 
composition are exceedingly minute, and 
their germs appear constantly to float in the 
air of foul places. The health officer should 
bo required to search out all such plaoos, and 
to abate any snob nuisances. Ily means of 
lectures and circulars, and otherwise he 
should interest all ola6sesas to the best means 
of preventing the disease. If he prevents 
' typhoid fever, he will prevent about five per 
cent, of all the deaths whioh now occur from 
all causes ; and he will save his city from a 
great waste of life and money. 
small-pox. 
Smull-pox is now usually of little conse- 
quence, as it does not cause many deaths in 
intelligent communities, and its prevention is 
easy by timely vaccination and revaecination. 
JBnt it is worth while to understand that its 
onuso probably does not usually enter the 
body as does that of typhoid fever—by the 
mouth— bnt the Bpecial ferment is generally 
inhaled with the air we breathe. And the 
special ferment is reproduced on the outer 
surface of the patient. It is therefore im- 
port nt to isolate persons who have small- 
pox, and to destroy or disinfect not only the 
discharges, bat everything which has been in 
a room with a person sick with that disease. 
An active health organization in a city where 
people are generally intelligent, should, in 
this enlightened age, be ashamed to have an 
opidemio of smull-pox. I am informed that 
in one city in this State where there is a pa- 
per mill, seldom a year passes that a case of 
small-pox does not ocour, but the intelligent 
health officer generally restricts it to the first 
case, and has never had more than two or 
three cases in the outbreak. 
BCABLET FEVEB. 
Scarlet fever is a disease of much greater 
importance in this State than is small-pox. 
Whenever our health authorities Bhall pro- 
tect ns from scarlet fever we will be spared a 
very considerable proportion of oar present 
death-rate, and a vast amount of suffering 
which now follows children through life ; for 
scarlet fever leaves many who linaer on 
through years of imperfect life. In this dis- 
f ease, as in small-pox, the special ferment 
| seems to be reproduced on the outer surface 
f of the body, perhaps, also in the throat and 
throughout the body, so that the discharges 
and everything which comes near the body 
should either be disinfected or destroyed. 
DUTIES OF THE HEALTn OFFICES IN CONNEC- 
TION WITH JCABLKT F£V£B, ETC. 
The health officer should next to the at- 
tending physician bo the first to visit the 
I premises where scarlet fever occurs, and in the interest of the community should super- 
intend and enforce measures for the restric- 
tion of the disease. Tho physician is em 
ployed and paid only for tho benefit of the 
family who employs him. If the community 
I expeots to have its interests subserved, it 
I must employ and pay some one to attend to 
them. The health offloer should put up a 
notioe, to warn those who might otherwise 
enter into danger. He should leave with the 
family plainly printed instructions, aud be- 
fore he leaves he should make sure that the 
methods for the restriction of the disease are 
understood by the family. A city might even 
hotter pay skilled.nurses to remain with the 
sick with a view to preventing the Bpread of 
the disease than have such a disease as scar- 
let fever spread through the city with all the 
chauoos for its germs to remain for all time 
to come to break out again whenever a suffi 
oient number of children come to be of the 
most susceptible age. 
DIPHTHERIA. 
Diphtheria is another disease which is be- 
j ing allowed to destroy the children in this 
I State, in some parts of the State without 
| any proper effort for its resttiction. Its 
special poison is believed to enter the body 
by way of the month and air-passages, aud 
to be communicated by whatever comes in 
contact with the exhalations and excretions 
from the body of the sick person. 
In the restriction of diphtheria, and of the 
other communicable diseases, except small- 
pox, which oan be modified or prevented by 
vaccination, there is a great and generally 
neglected field for aotive work by our health 
authorities, throughout the State, and in 
every year. About one-eighth of all the 
deaths reported in this State are reported as 
caused by the communicable diseases. Among 
these diseases few cause a less number of 
deaths than does small-p6x, but, aside fr am 
vaccination, the methods adopted for its re- 
striction are generally applicable to all the 
others, except perhaps typhoid fever, of 
which mention has already been made. 
THE ECONOMY OF HAVINO A HEALTH OFFICER. 
The State Board of Health has the names 
and post office addresses of over 3,500 phy- 
sioians in Michigan. I think it is safe to 
estimate that the average annual income of 
these doctors is at least $1,000 each ; and, if 
so, the people of this State pay $3,500,000 a 
yoar to those whom they employ to prescribe 
for the sick. If in respect to sickness we 
admit that an “ ounce of prevention is worth 
a pound of cure,” one-sixteenth of $3,500,- 
000 judioiously expended in the prevention 
of siokness would be worth as much to the 
people as the whole sum spent for the oure 
of sickness; or if tho wholo 3,500 doctors 
were employed and the whole $3,500,000 ex- 
pended in the prevention of sickness, the 
benefit to the people would be sixteen times 
as great as now and would have a money 
value of $58,000,000. And yet not all the 
sickness is preventable. The debt of nature 
must bo paid at last. When science has 
failed to prevent siokness the skilfnll physi- 
cian oan often aid in nature’s efforts to re- 
cover strength, and when death i3 certain he 
can often make easier the last days of suffer- 
ing. But oan any rational person suppose 
for an instant that if one-sixteenth of the 
3,500 physicians now employed in prescrib- 
ing for tho oure of disease were constantly 
employed and paid for their services and 
their success in searching out and applying] 
all possible knowledge for the prevention of 
sickness and deaths, it would require near all, 
the remaining 3,282 physioians to prescribe 
for the sickness which would not thus be 
prevented? Oan any one suppose that many 
of the present heavy burdens of the people 
would not be removed? 
Omitting mention of the most important 
direct benefits of the prevention of sickness 
1 and noting only the indirect benefits not so 
frequently dwelt npon, let us think of the 
vast sums of money paid to maintain poor- 
houses, hospitals, insane asylums, asylums for 
the deaf, dumb and blind, jails, and evbn 
prisons; muoh of this expense would then be 
entirely unnecessary ; and many of the caus- 
es for demands now made for private chari- 
ty would not exist; thus, as I believe, not 
only our personal expenses but our State, 
county and municipal taxes would be mate 
rially lessened, the prosperity of our people 
would bo something wonderful wbeu com- 
pared with our present condition, and the 
phrase, “life, liberty, and the pursuit of 
happiness,” would haveits first and last terms 
wonderfully emphasized. 
There is no reason to fear that we should 
suffer for want of doctors, even if we were 
to ask everyone of those now practicing to 
ohange his employment to the prevention of- 
siokness. If more were needed I think they 
would be forthcoming ; but suppose every 
one of tho 1,261 local boards of health in this 
State should constantly employ one physi- 
cian as a health officer, there vould still re- 
main 2,240 doctors to attend to the sickness 
which the other third failed to prevent; and 
the 1,261 physioians who would then be con- 
Oonstantly employed as health officers of lo- 
cal boards of health would cost for permanent 
salaries only a small part of the $3,500,000, 
which is now estimated to be paid to physi- 
cians. 
The main reason why we need an aotive 
heaith officer who understands his business, 
in every city, village and township, is that 
the people do not now seem to know the pre- 
ventable nature of the diseases which kill 
them. In many places they stand by like 
dumb animals, and suffer their children to 
die of diphtheria and other oommunicable 
diseased, and never lift a finger to try to pre- 
vent the spread of these diseases. This 
apathy and iguorant or wilful disregard for 
human life is not confined to the rural dis- 
tricts, but is seen in cities. 
PRACTICAL ILLUSTRATIONS. 
In Detroit, the burials in the city cemete- 
ries indicate that the deaths number about 
2,000 in each year. Of this number, the 
deaths from diseases usually included among 
those which endanger the public health, and 
which therefore are both by the law and by 
sanitarians regarded as preventable, usually 
numbers about 240, which is twelve per cent, 
of the total deaths reported. And this does 
not include consumption, pneumonia, or di-i 
arrhea, many deaths from which diseases I 
believe could be prevented. If we conolnde 
that under good effective sanitary work, the 
sickness oould be reduced by ten per cent, 
the 200 physicians of whom • we have the 
names in Detroit might safely be reduced by 
that proportion ; and if the twenty doctors i 
thus thrown out of employment were em- 
ployed by the city in the work of general and ! 
Bpecial sanitation, I firmly believe that it! 
would be in the direction of true economy for 
the citizens of Detroit. And when I plead for | 
sanitary work, it is not for such work as may j 
be done by a number of city physicians,' 
whose duties are, first, to attend to their own 
private practice ; second, to attend to the 
sick poor within their jurisdiction. This is 
not general sanitation nor work for the pre- 
vention of sickness ; it is not even preventive 
medicine ; it is the same old idea of trying 
to cure what should have been prevented ; it 
is like locking the stable door after tbe horse 
is stolen, and is frequently a waste of time 
and money, because the communicable dis- 
eases are generally as yet self-limited dis- 
eases which run their course under any treat- 
ment, though such care as a skillful phy- 
sician may prescribe may sometimes save 
life. 
The following letter may be put in evi- 
dence as to what is really done in Detroit; 
City of Detroit, 
Clerk’s Office, Feb. 2,1886 V 
Secretary of State Board of Health: * 
Hear Sir: Forms for makln#reports of Board of 
Heaith to your office received. The Board of Health 
of Detroit have not met. durint? the past yoar, so I 
am unable 1o (live the information requested. It Is 
probable that they will hold no more meetings. 
Yours respectfully, 
Harry S. Starkey, 
Ass’t City Clerk. 
A subsequent letter from the same gentle- 
man stated that there was no clerk of a board 
of health, no board of health, and no health 
officer. 
The Board of Health in the city of Detroit’ 
has not met during tho past year! And yet 
we know there have been hundreds of cases 
of ificknesa and many deaths in that city 
from causes believed to he preventable. We 
see accounts of frequent meetings of the 
different medical societies of Detroit and of 
their flourishing condition. There are ex- 
cellent physicians in Detroit, and good hos- 
pitals ; there are medical collages, apd, as I 
am told, there is plenty of material for clin- 
ical illustrations of all sorts of disease ; but 
the board of health has “ not met during the 
past year !” We have, as I have stated, the 
names of about 200 physicians in Detroit. 
I presume there are more than that number. 
Let us supposo that the two hundred physi-, 
cians have an average annual income, from'’ 
their practice, of only one thousand dollars 
each—then the citizens of Detroit pay two 
huudred thousand dollars a year to those 
who prescribe for cases of sickness. And' 
yet we are officially informed that the board 
of health in that city has “ not met daring 
jhe past yoar.” I suppose its motto on this 
subject may fairly bo stated : Two hundred, 
thousand dollars for the cure of disease, but 
not one thousand for its prevention. Under 
such circumstances, I do not wonder that the 
city is ashamed to publish a report of deaths 
and causes of deaths, and that we find it im- 
possible to got such official statistics from 
Detroit, though wo have no difficulty In se- 
curing such reports of the mortality in many 
of the principal ditiea in this and in other 
oountries. 
The health officer of Bay City is not a 
physician, as the law requires where this is 
practicable. He says the physicians do not 
report to him, and that he is entirely unabloi 
to makttlii® reports to the State Board which1 
fire required under tho law. He says there, 
are in Bay City about forty physicians, that 
their annual incomes will average at least 
$2,000 each. That is, the people of Bay City 
pay $80,000 a year to physicians. Suppose 
ten per cent, of those physioians were em- 
ployed and paid by the city to labor for the 
prevention of disease, and held morally re- 
sponsible for the occurrence of preventable 
diseases. Then four physioians would be 
thus constantly employed, and paid $2,000 
each per year, thus diverting $8,000 out of 
the $80,000. Does any one doubt that this 
sum would be saved from the $80,000 now 
ueoe.ssary to be expended in paying physi- 
cians for the cure of sickness? Possibly it | 
might not decrease the siokness ten per cent. I 
the first yoar, but I firmly believe that if 
continued it would be a paying investment 
in the end, for the physioians so emplqyed 
would gradually become sanitarians; and ill 
order for this to be a paying investment the 
first year, it is not necessary that the sickness 
be reduced by 10 per cent., because the doc- 
tor’s fee is frequently only a small part of 
the expense of sickness. 
I suppose most of those present know tbe< 
facts as regards this city of Grand Rapids, 
of which I am not to speak at this time. 
Coming nearer to Grand Rapids, however, ; 
than Detroit or Bay City, the following let- 
ter states the condition of things in Grand 
Haven: 
Krcouder’s Office, ( 
City of Grand Haven, Feb. 2, 1880. j 
Henry B. Baker, Esq., Secretary State Board of j /' Health, L&ueir.g, Mich: 
! Deaji 8in: It will be utterly impossible for me tc 
seud you anything in the shape of an official report, 
! for the reason that our Board of Health have utterly 
ignored the laws of the State relating to sanitary 
matters. We have had a great number of cases of 
diphtheria, scarlet fever, and measles in our city 
during tho yoar 1879, but not reportod to the Board 
of Health as far as I know. 
Very respectfully, 
Thos. F. Hows, 
City lteoorder. 
In Detroit, in Bay City, in Grand Haven, 
! and perhaps in other cities in Michigan, it 
I seems to be considered too expensive to have 
a health officer and pay him, as should be 
done, two thousand dollars a year, and re- | 
l quire his entire energies to bo put forth for 
I the prevention of sickness and deaths. I 
; suppose that one reason for this state of 
thiDga is that to have a health officer re- 
qures some action on the part of city offi- 
cials, and phrhaps a vote to pay him his sal- 
ary, while it is possible, for instanco in the 
city of Detroit, to permit the people of the 
i oity to pay $200,000 a year for physicians 
without any official action whatever. 
We understand very well that there are 
taxes which come by assessments because of 
official action—it may be well for us to un- 
derstand that there art also haftvy expenses 
whyjh may sometime** eomo upun.us without 
offic'al assessment, and even besafise of neg- 
leot to provide for assesments to prevent 
such heavy expenses. 
1 The expense for physicians is only n Small 
part of the cost and losses because of siek- 
, ness. In my plea for bettor methods I rofer . 
to the expense for physicians only, for pur- f 
poses of illustration, because it is for person 
al services somewhat analogous to those which 
would be given by a health officer, and be- 
cause the facts are easily obtained and their j 
j bearing easily understood. I do not see how ! 
| a rational person can examine the fact3, and j 
I not be convinced that at least one skilled l 
physician and sanitarian should bo constant- ; 
ly employed as a health officer in every oity 
and village in the State, and from time to 
time in every township. 
“ KNOWLEDGE IS POWEB.” 
Never yet has the public health service of 
Detroit, Bay Oity, Adrian, Jackson, or in- 
deed of any oity in Michigan been properly 
organized for effective and complete work in 
all branohes of the service. The vital sta- 
tistics of the oity, which lie at tho very foun- 
dation of effective public health service, have 
never been properly collected. No tables 
carefully compiled under the Immediate su- 
, pervision of a medical man or vital statisti- 
cian are regularly published by any city in 
Michigan. Without such means of knowl- 
edge respecting the particular sources of 
danger to life in Detroit or in any city, it is I 
not probable that the oity will ever have the; 
most effective sauitary work. Knowledge is j 
power, in sanitary work as in other pursuits, 
and the most effective public health service 
is based upon accurate knowledge of the 
sources of danger to life and health, within 
the jurisdiction of that service. Complete 
statistics of deaths, where obtained, supply 
the knowledge of relative danger to life from 
each rooognized cause of death ; and such 
statistics, properly studied in connection wilh 
other faots, also load to a knowledge of many 
causes of death not previously kuown. and 
whioh can not otherwise bo ascertained. 
FOB SUCCESSFUL GENEBAL SANITATION, 
it is only by organized effort that the best 
success is attained ; what is needed in this 
city, and in every oity, is that the compara-j 
tively few who really appreciate the very 
great importance of this work shall strongly 
co-operate and bo aotivo and energetic in 
intelligent efforts for the proper, organiza- 
tion aud work of the public health servico. 
It is a subject which deals with, questions 
upon which our very lives depoud, and is so 
far above all the usual questions pf party 
• 
politics that all good people should unite to 
selecWand retain the very best men it is pos- 
sible to soon re, and to see to it th ifrooh 
men shall be supplied with the money and 
Bupport necessary to properly maintain an 
effective public health service. We should 
remember that the most severe tax to pay is 
the “ debt of nature,” aud next to that the 
heavy tax which sickness always entails, and 
in one way or another forces the collection. 
These considerations are too often lost sight 
of by “ penny wise and pound foolish ” city 
authorities who grudgingly dole out a few 
dollars, and sometimes fail to do even that,' 
for the use of the oity beard of health, the 
most important organization in the city, and 
one on whoso proper action depends tho. 
health, life and happiness of the people who 
pay the taxes; for although the sickness 
from preventable causes is usually 
most severe among the poor and ignor- 
ant, communicable diseases are no respeotorB 
of persons, aud tho poorest resident of a 
back alley may be able to give to the richest 
citizen the most loathsome, fatal, or rapidly- 
spreading disease. As “ the strength of a. 
chain is the strength of its weakest link,” so 
the health aud strength of the people or a 
community may depend upon the health and 
strength of tho weakest members. In these 
times of rapid communication among peo- 
ple throughout the world, and close relations 
of members of communities, no man can livej 
for himself alone ; but whether he knows it 
or not, he has a vital interest in the health 
; and prosperity of his fellow beings. 
MISSIONABX BANITABY WOK. 
After the student in sauitary science has 
mastered so much of the physical, medical, 
I sooial jmd other sciences as to enable him to 
| ba of real use to humanity in his particular 
| sphere, his usefulness will then be somewhat 
j in proportion to his ability to impart the re- 
! suits of his research, experience, observation) 
! and study. Therefore one of the most im- 
| portant parts of the work of the leading 
sanitarian i3 now, and it seems to me must 
: always be, somewhat akin to the 
missionary work done by the cler- 
gy. The leading sanitarian nihst 
first labor until he is convinced that he has 
gained at least a part of Nature’s eternal 
truth, and he must then rousb people to an 
appreciation of the direful oousequenoes of 
their own transgressions ; he must point out 
the better way of life, while he denounces 
most of the old ways as sinful, degrading, 
and leading down to death and destruction. 
Stated in this way, it really seems that the 
work is a noble one, because intended to ad- 
vance the best interests of mankind—to pro- 
mote health and happiness among the peo- 
ple. Perhaps it is for this reason that the 
sanitarian is so often forced to carry his 
cro3B ; because we have still with us many 
peoplo who can persecute the apostle of 
science in ways which cause pain if not death. 
People do not seem to like to have their 
transgression of sanitary laws pointed out to 
them. This brings me to consider some 
hindrances to sanitary progress. 
HINDBAN0E3. 
Iu connection with sauitary progross, one 
phenomenon so generally appears that it is 
worthy of mention, because it constantly in- 
terferes with efforts for improvement in al- 
most every line of work. I refer to the op- 
position which is almost uniformly mot when 
any necessity for improvement is pointed 
| out—the opposition coming f rom those most 
closely related to the nuisance or oanse of 
sickness. This may, at first thought, appear 
improbable; but I think yon will find it true, 
as a general rule. 
If a neighbor or the health authority oom- 
plains of a nuisance on a man’s premises, 
the owner insists upon it that it is no more a 
nuisance than is common all about him, and 
that to complain of it ia a mean personal at- 
tack upon himself. He resents it as an in- 
sult. If, after a careful search for the causes 
of an outbreak of typhoid fever, you traoe all 
the eases of the disease to exposure to un- 
sanitary conditions at a certain house, or to 
drinking water from a certain well, the own- 
er of the house or well almost always endeav- 
ors to maintain that hia house or his well is 
in good sanitary condition, and that it is ab- 
surd to believe that you have found the cause 
of the siokness in auything connected with 
his premises. 
If after careful investigation it is found 
that there are sanitary defects inoident to 
certain methods of constructing, heating, 
lighting, or ventilating school buildings, or \ 
to certain methods of study or teaching in., 
our s hools, I think that as a rule those who 
are most closely connected with tho schools, 
and particularly those who feel a certain de- 
gree of responsibility for the best possible 
conditions in our schools, are rather slow to 
acknowledge any such defeots as those point- 
ed out. 
This general principle of opposition to 
change is fonud in individuals, in systems— 
such, for instance, as the public school sys- | 
tem—and in institutions—such as our State I 
institutions, dbme of whioh havo been in- 
spected by members of the State Board of 
Health, sometimes by invitation, but usual- 
ly to the discomfort of the managers of such 
institutions, and their opposition to the con- 
clusions of the inspecting officer. Our hu- 
man nature seems to be opposed to sanitary 
reforms if proscribed for ourselves by others; 
we are usually more willing to believe that 
other people should reform. 
NOT THIS CITY, BUT THE BIVAL CITY. 
The principle of opposition is particular- 
ly noticeable respecting cities. Probably 
many persons in this city would promptly re- 
sent it if I were to say that your oity is wo- 
fully negligeut of tho best interests of hu- 
manity within its limits, that those sacred 
interests of life, health and happiness whioh 
are entrusted to a local board of health Re- 
ceive little or no attention, while other po- 
litical interests of muoh less consequence nb- 
1 sorb all tho taxes you pay and the entire 
time and efforts which your city officials use 
in your interests. Because of this uniform 
dislike of homely truths which apply to our- 
: selves, I shall not tell yon that this is true, 1 
but will only say that I know of a oity in this 
State, similar to this in some respects, and 
whioh we will call “ the rival oity,” in whioh 
the people themselves pay very little atten- 
tion to sauitary subjects; they give such sub- 
jects no serions thought, and the officers 
whom the people elect fairly represent the 
people who eleot them, and they pay no at- 
tention to such snbjoots, and give them no 
earnest thought. They do not seem to care 
whether or not they comply with the State 
law whioh requites that the city shall have a 
health officer, and if they ever appoint one 
his compensation is insufficient, aud he is 
not required to devote all his energies to his 
offioial duties > no thorough attempt is made 
to collect statistics of deaths, aud thus add 
' to the oommon stock of useful knowledge of 
the cinaes of diseases and deaths, and of the 
best means of avoiding such causes ; there 
is no systematic house-to-honse inspection 
for nuisances, and no prompt action for the 
abatement of every nuisanoo ; when an epi- 
demic comes it finds the city unprepared, 
and the cleaning-up process is oommenood 
when it is too late to do an} thing but harm ; 
cases of typhoid fever occasionally occur, 
but no sanitary officer searches diligently un- 
til ho finds aud removes the source of the 
disease ; aud other people are left in ignor- 
ance, to go on and contract the disease if 
.they chanoe-to come under the same dan- 
gerous conditions, whioh to them are un- 
known and therefore unavoidable. 
A case of small-pox ocoars, and to avoid 
a panic or loss of custom to a few merchants and others, the *rnlh is suppressed, the peo- 
ple are not warned that they most be vaooi- 
nated, and an epidemic of small pox occa- 
sionally results. Scarlet fever breaks out, 
bat no active board of health has educated 
the people in tho requirements of the law 
for prompt notioe of such diseases, and it is 
a long time before the board of health re- 
ctives such “official” information of the 
outbreak as to be stirred to action; mean- 
while many families havo buried their loved 
ones—dead of that disease so dreadful to pa- 
rents. Diphtheria dually comes. It had 
prevailed in neighboring places for a long 
time, bnt the members of the board of health 
have not investigated tho subjeot—some of 
them do not know that it is a.communicable 
disease, and oxooodingly dangeroas to the 
pablio health, though they know that the 
deaths occur mostly among the children. 
Many of the dootors call mild cases by other 
names. Nothing is done to stop its spread, 
and very soon there are so mauy souroesthat 
it ia impossible to trace the spread of the 
disease hy contagiou, and the city has one 
more disease fastened upon it, perhaps for 
all time to oomo, though the disease may oc- 
casionally die down for lack of material, on- 
ly to spring up agxiu on tho opening of the 
schools in Autumu, after more children shall 
have grown up to the most susceptible age. 
Bnt this is getting to be a dismal tale. 
What croaker dare stand np and say that tho 
rival oity here described is in any respect sim- 
ilar to this fair city? Fortunately for our 
temporary ease of mind, but, perhaps, un-1 
fortunatoly for our rapid progroas and per- j 
manent safety and happiness, no such gloomy ) 
talk as this ia ever permitted in polite socie- 
ty, and I gladly turn from it. 
MONEY VALUES OF IMPBOVKD SANITARY 
METHODS. 
Mr. Jackson 8 Schultz, of New York, has 
lately said that “ from 1822 to 1810, daring 
the. summer moutns, uo business could be 
done m hides and rags,” because of the na- 
ture of the quarantine, which, however, waH 
the beat known at that time ; that “ tho losa 
to those engaged in commerce and manufac- 
tures requiring thoae articles, mast have been 
at least 100,000,000—a sum sufficient to 
sustain all the health boards in the country.” 
Novo the quarantine is so managed by ex- 
perts as to occasion little interruption to 
commerce or manufactures. He said, “ If 
those trades should be again stopped, it 
would pay them to establish schools and 
hospitals for the ednoation of dootors for 
some'.ime to come.” Perhaps he meant the 
education of sanitarians or health officers. 
He is not a physician, but said he spoke “from 
tho point of view of the tradesman.” His 
itatmnents show that after sanitary progress 
>ias been made, its importance is recognized 
>y soma classes of people. It is to be hoped 
hat the time will soon oome when all classes 
>f people can realize the importance of aid- 
ing its progress. 
If an improved qnarautfno system In New 
fork is worth $ 100,000,000, in eighteen years 
limply to tho business connected with hides I 
>nd rags, then certainly better methods of | 
limitation which are applicable to all kinds 
)f business interests throughout our State | 
nnst be of very considerable importance to j 
he the people of this State. Bocause when- 1 
ivor a prominent oommnnioable disease such 
is diphtheria or scarlet fever breaks out in a 
ilace, business interests are oertain to saffer; 
tnd in spite of. and perhaps because of at- 
ompts to snppressthe knowledge of theont- 
ireak of a oommuuioable disease tho disease 
reqneutly spreads and finally injures the 
msiuess of a place far more than it would 
iave done had the oase beon promptly re- 
torted to a board of health whose known 
ffioiency would be a guarantee that the dis- 
use would woald be at onoe suppressed. 
It ELATION OF SCHOOLS TO PUBLIC SANITATION. 
Business interests in relation to this sub- 
ject ate great, bnt educational interests are 
probably greater, at leant to the rising gener- 
ation which is soon to displace ns. Under 
present imperfeot methods there Beems to be 
no escape from oue of two evils—either the 
schools continue and spread scarlet fever, 
diphtheria and other communicable diseases 
throughout oities and thronghont the State, 
as they are now spreading diphtheria ;*or the 
schools are closed, and thoagh the pablio 
health, which is of the greatest consequence. ; 
is furthered thereby, the whole educational 
work is for the time broken np. What is 
worse, this broaking-up process mast oome 
still more frequently as time goes on, unless 
some improved methods are adopted ; be- 
cause modes of intercommunication are be- 
coming moro complex. Under present meth- 
ods the schools are not closed promptly on 
the outbreak of a oommunicablo disease, but 
only after tho disease is quite general, and as 
i the germs of these diseases remain aotive for 
quite a long time, whenever the schools open, 
at least in the autumn, there is likely to be 
some pupil prepared to oommnnicato one or 
more of the infections diseases. 
For the best interests of the sohools and 
for public health, we need an entirely differ- 
ent sort of work from what we now have, a 
mooli more thorough, systematic, continuous 
and rational enpport of our present laws, 
which seem to be a long way in advance of 
the knowledge or practice of the people, 
j Hnppose that, instead of suffering as we do, a 
i very considerable proportion of the children 
sent to sohool to die or suffer through life 
from the results of dieeaso contracted in 
school, or instead of breaking np ibe schools 
every year or so, and losing the entire bene- 
fits of tho school for a considerable time, wo 
were to employ constantly a few experts to 
do away with both theso evils. To me this 
seems jast as practicable as was the im- 
proved quarantine in New York city, if only 
oar people will uuite in the work. I sup- 
pose that the quarantine system of New York 
city coats about $100,000 dollars a year ; and 
we have seen that a tradesman estimates the 
annual saying to only a few trades to be mil- 
lions of dollars. 
HOW CAN THE SCHOOLS OO ON WITHOUT DIS- 
SEMINATING DISEASE? 
Let ns consider some of the work which 
needs to be done in order that the sohools 
may go on continnonsly and yet not spread 
disease. 
Tho three most important general princi- 
ples of action by tho improved New York 
quarantine are : Isolation of the siok, disin- 
fection of ail infected material, and ventila- 
tion of everything. In ordor that this shall 
bo possible in relation to the schools of a 
city, it is essential to havo suoh a thorough 
organization of tho health authority of a 
oity that suspected cases of communicable j 
disease shall be promptly reported to the j 
board of health and be immediately visited, 
and the truth learned whether or not the cafe 
is one involving danger to the community. { 
The health authority mast be given money , 
sufficient to have anoh work done with as ll 
much promptness as the fire department dis- j 
play in visiting the locality of a reported j 
fire ; and as tho firemen remain until the lire 
is out, so the health department might ha\e 
its officer or employe remain until the dis- 
ease is over. He should watoh and guard the 
public safety. He ought to use disinfectants 
skillfully, and, if need be, as freely as water, 
until all danger of a fresh outbreak should 
be prevented. He shonld see to it that in no 
way does the disease spread. Now, we 
onarantiue all, sick and well, by clos- 
ing the sohqols. An active health de- 
partment should at all times have 
as perfect knowledge of the location 
of oases of diseases which endanger the 
people nnder its protection, as tho fire 
department does of the bandings which 
burning and thus endangering the property 
under its protection. With snoh knowledge 
as this the health department oould furmsh 
the teacher of every sohool in the city with a 
list of all families in which there was a per-' 
son sick with a oommunicable disease, and 
if necessary an agent of the health depart- 
ment or some other person oould act as sen- 
try at each school, and persons liable to oom- 
municate disease oould be kept out. As an 
additional precaution even where there has 
been no known infection, all articles likely 
to oonvey disease into the school oould be 
easily disinfeoted, if it were only a custom to 
do so and provision were made for suoh dis- 
iufeotiou. It would be easy to have a small 
room at every school-house where the outer 
wearing apparel, etc., could be disinfected 
and aired while the wearer was ia school, in- 
stead of having, as is now so commonly the 
oase, the clothing of all closely packed in an 
on ventilated closet. 
GENEBAL BOARDS OF HEALTH. 
Some one may question why, in this papi r 
on general sanitation, so little is said abont 
general boaral of health—State and Na- 
tional. It is not beoause suoh boards are 
not of exceedingly great importance ; for in 
my opinion they are essential to successful 
general sanitary work ; bnt beoause they are 
farther removed from the people for whom 
this paper is intended, and because of the 
truly democratic character of the health laws 
of this 8tate, their theory and underlying 
principles being that 
LOCAL NUISANCES SHOULD BK DEALT WITH 
BY LOCAL AUTHORITIES. 
This principle seems to me to be so mani- 
festly sound, that is unnoessary to dwell up- 
on it; bat iuasmuoh as it is so frequently 
overlooked, it seem neoessary to mention it, 
briefly : The laws of this State give to local 
boards of health almost absolute power 
over everything relating to the restriction 
and prevention of diseases, the abatement of 
nuisances, etc., and no suoh powers are g ven 
to the State Board of Health, which has du- 
ties no less important,but of a different char- 
acter. It will thus be seen that local boards 
of health ate Jostly responsible for preventable 
SICKNESS WITHIN THEIR JURISDICTION. 
As the local boards of health which have 
this absolute power and consequent respons- 
ibiity, are oomposed of jast the men whom 
the people of each locality ohoose to have act 
as the guardians of their lives and health, it 
seems evident that no progress can be made 
except the people themselves shall in some 
way make progress in sanitary knowledge ; 
and as it would be very much like requiring 
a man to raise himself by his boot straps to 
expect that the greatest progress can be made 
without some outside aid, the laws of this 
State make provision for the utilization of 
the best work and experience of each and 
every local board for the benefit of all the 
other boards, through a system of annual 
and speoial reports to the State Board of 
| Health, whioh is charged with the duty of I 
■ collecting and disseminating all sorts of use- \ 
ful information on the oausation, preven- 
tion, and restriotiou of diseases and deaths' 
It may thus be seen that though the State 
Board oollects useful information from all 
possible souroes, it is more or less dependent 
upon local boards, for material to compile, 
collate and utilize for the general good ; and 
its work in diffusing information, and in 
other directions is advanced by whatever ad-- 
vancos the general activity and usefulness of 
the looal boards. We have seen that the local 
boards are what the people make them. So 
that what ia most essential to progress in 
pnblio health, and consequent prosperity, is 
general progross in sanitary knowledge 
among the people. To those good people in 
Detroit and Grand Kapids who, with this ob- j 
jeot in view, hava made these Sanitary Con- 
ventions possible and successful, are due oar-