REPORT OF COMMITTEE ON STATE MEDICINE AND HYGIENE.

To the Indiana State Medical Society:

STATE MEDICINE.

The laws of Indiana, governing the practice of medicine, dentistry, pharmacy and health, were reviewed in our report of last year. It now is opportune to comment upon the operation of the laws, to record suits in court brought under them, and give results of such suits.

THE MEDICAL LAW.

A score or more suits have been brought in various counties with varying results. For instance, in Tippecanoe County an osteopath suit resulted in success for the prosecution, while in Allen County a like suit failed.

State vs. Webster, 150 Ind. 607: In this case it is also decided that the Medical Board possesses the right to review the authority upon which a license was granted under the old law, and to withhold a certificate from persons to whom, in the judgment of the Board, licenses have been improperly granted under the previous law.

In the case of Eliza E. Coffin, 152 Ind. 439, the Medical Board refused Eliza E. Coffin a certificate entitling her to practice medicine on the ground that she had been and was guilty of gross immorality. In this case the Supreme Court, sustaining the Board, held that in applications by improper persons for authority to practice medicine it was the duty of the prosecutor to appear and resist, as a representative of the State, it being to the interests of the State as a whole that the people be protected from the admission of improper characters to the medical profession.

THE DENTAL LAW.

In suits under the dental law the same remarks hold as under the medical law. It seems proper to here record two special suits as follows:

In Ferner vs. State, 151 Ind. 247, the constitutionality of the dental law was attacked, and it was held constitutional by the Supreme Court. In case of State vs. Green Clay, in the Criminal

Read first at the (17th) annual meeting of the Indiana State Medical Society.

Court of Marion County, the law was again attacked, and its constitutionality was sustained by Judge Alford. This case was not appealed to the Supreme Court.

THE PHARMACY LAW.

The constitutionalty of the pharmacy law has not been questioned in the courts. John Milton Rhodes, a regular licensed physician, purchased a drugstore June 19, 1899, and made an attempt on July 1 to procure a license as a registered pharmacist, by virtue of having been the owner of a drugstore prior to that date, the Board having refused him a license. He undertook to mandate the Pharmacy Board to grant him one. The case was tried by Judge McMaster in the Superior Court of Marion County, and he held that only persons owning drugstores on and prior to April 27, 1899, were entitled to registration without examination. This decision is very recent, and an appeal has been taken from it to the Supreme Court, but it has not yet been passed upon.

THE HEALTH LAW.

Suits have been brought under this law in fourteen counties. In all but four instances the law has been upheld, and in these four failures lack of evidence was the cause of dismissal. Most of these suits were against physicians for failure to report births and contagious diseases. In every instance the prosecution was not made until the offender had repeated his offense several times and ended by defying the law. Several suits were against undertakers for burying without permits. The great suit, however, which has advanced Indiana greatly in civilization is known as the Blue vs. Beech case, presented by Dr. Cowing, and which follows:

VACCINATION CASE.

[Blue v. Beech, decided February 1. 56 N. E. 89.]

In this case the authority of the State Board of Health to require vaccination before school children should be admitted to the public schools, in the absence of any statute compelling vaccination, was disputed. In deciding the case, the Supreme Court of Indiana held that, where a smallpox epidemic was threatened and the local Board of Health made an order requiring that no unvaccinated child be allowed to attend the public schools during the continuance of such danger, such unvaccinated child may be properly excluded, though well and healthy, and it had, in fact, never been exposed to the disease. The court also held that the State Board of Health possessed the power to adopt a rule requiring

local Boards to compel vaccination of all persons in all cases where an exposure to smallpox is threatened or where there is danger of a smallpox epidemic, and further

That the statute authorizing the State Board of Health to adopt rules and by-laws in harmony with other statutes in relation to the public health to prevent the spread of contagious diseases, and requiring local Boards of Health to take prompt action in all cases to prevent the spread of such diseases, provides also that a local Board of Health has power to require that no unvaccinated child be allowed. to attend the public schools during the continuance of a threatened smallpox epidemic. The Court says:

"In order to secure and promote the public health, the State creates Boards of Health as an instrumentality or agency for that purpose, and Invests them with the power to adopt ordinances, by-laws and regulations necessary to secure the objects of their organization. While it is true that the character or nature of such Boards is administrative only, still the powers conferred upon them by the Legislature, in view of the great public interest confided to them, have always received from courts a liberal construction, and the right of the Legislature to confer upon them the power to make reasonable rules, by-laws and regulations is generally recognized by the authorities. When these Boards duly adopt rules, bylaws and regulations, by virtue of legislative authority, such rules and bylaws, within their respective jurisdictions, have the force and effect of a law of the Legislature; and, like an ordinance or by-law of a municipal corporation, they may be said to be in force by authority of the State.

"As a general proposition, whatever laws or regulations are necessary to protect the public health and secure public comfort is a legislative question, and appropriate measures intended and calculated to accomplish these ends are not subject to judicial review. It can not be successfully asserted that the power of the Boards of Health to adopt rules and bylaws, subject to the provisions of the law by which they are created and in harmony with other statutes, in relation to the public health, in order that an outbreak and spread of contagious and infectious diseases may be prevented, is an improper application of legislative authority and a violation of Article IV, Section 1, of the Constitution. That the power granted to administrative boards of the nature of Boards of Health to adopt rules, by-laws and regulations, reasonably adapted to carry out the purpose or object for which they are created, is not an improper application of authority within the meaning of the Constitution, is no longer an open question, and is well settled by a long line of authorities. It would seem

that the power of the Boards of Health of this State, under the laws relating thereto, to make and adopt all reasonable by-laws, rules and regulations to carry out and effectuate the great interests of the public health confided to them by the Legislature is so well affirmed by the authorities that we may dismiss this feature of contention without further consideration."

MORTALITY STATISTICS.

The mortality statistics for Indiana have now been collected for six months. The figures are quite as accurate as we expect such statistics to be. Each month they have been published in the Bul

letin of the State Board of Health. This Bulletin has a circulation of 2,000 monthly, and is in demand by most of the great colleges of the United States, as Harvard, Yale, Columbia, Johns Hopkins, etc., and requests have also been received from several foreign countries that they be put upon the mailing list. The mortality statistics law is certainly an honor to Indiana. An eminent physician and professor in Connecticut remarked: "It is probable the people of Indiana do not fully understand and appreciate this law, and it is further probable the Legislature did not comprehend its wide-reaching benefits when it was passed."

In the plans of the State Board of Health for presenting the mortality statistics, the Monthly Bulletin gives tables by ages, by important diseases, by counties, by cities and towns, by urban and rural, and finally by a map which divides the State into three sanitary sections-Northern, Central and Southern.

The Northern Section-31 counties, population 892,448-is bounded on the south by Warren, Tippecanoe, Clinton, Tipton, Madison, Delaware and Randolph counties.

The Central Section-33 counties, population 1,022,924, has in its northern tier the counties just named, and is bounded on the south by Sullivan, Greene, Lawrence, Jackson, Jennings, Ripley and Dearborn counties.

The Southern Section-28 counties, population 729,834, has in its northern tier the counties last named, and is bounded upon the south by the Ohio River.

A monthly table of climatic data is also published, the same being furnished by the Indiana Section of U. S. Weather Bureau. It is believed that a few years' statistics arranged and tabulated as described will be found of very great value.

Tuberculosis.-In Indiana, as in other States, tuberculosis is the great destroyer of human life. It is the great white plague which leads all other diseases. Based upon the mortality data for the last six months, there will be this year in Indiana 1,540 tuberculosis deaths, a rate of 12.2 per 100,000, making one death in seven from this preventable cause. Active steps are being taken in European countries and several eastern States toward the prevention of this awful disease, and your committee feels sure the time is ripe in Indiana for the work to begin. This belief is sustained by the fact

that this society only last year sent out to the people resolutions on tuberculosis prevention.

Typhoid Fever. So far as can be learned there is no lessening of this disease in Indiana. On the basis of the mortality statistics for the six months just past, there will be in Indiana in this year fully 2,000 deaths and not less than 20,000 cases from this nasty filth disease.

Diphtheria. There seems to be a considerable decrease in the mortality from this disease in Indiana. At the rate based on the last six months' returns, there will be in this year 974 deaths from diphtheria, a rate of 36.8 per 100,000 of population. The deaths for the preceding year from diphtheria were not less than 1,500. It seems fair to attribute this decrease to the better application of sanitary measures and the administration of antitoxin.

Scarlet Fever. The total deaths for the year, based as above, from scarlet fever, will be 172, a rate of 6.5 per 100,000. This is a decided decrease, due largely, no doubt, to better enforcement of quarantine.

Measles. The cases yearly number into the thousands. The deaths, based as above, will be 60, a rate of 2.2 per 100,000. It would be valuable and interesting to know how many children are annually permanently maimed by this disease.

Puerperal Fever. The deaths from this cause, based as above, will be 186, a rate of 5.1 per 100,000 of population. One hundred and thirty-six mothers is a large number to lose annually, and the figure admonishes doctors to wash their hands and wear clean clothing.

Pneumonia. This disease, the result largely of debility and the breathing of foul air, will destroy this year (based as above) 4,480 persons, a rate of 169.3 per 100,000 of population.

Cancer. At the present rate, 920 people will die of cancer this year. This is a rate of 34.7 per 100,000 people.

TYPHOID FEVER AND ITS COST IN INDIANA ANNUALLY.

To show the waste of life and health entailed by typhoid fever, let us imagine that all the cases of typhoid fever for a year should happen at one time and in one place, and should be cared for in dwellings. The total number of typhoid deaths per annum in Indiana is, in round figures, 2,000. As there are at least ten cases for