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The year's losses from preventable diseases are shown in the next diagram, and for the purpose of comparison the chart of

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No. VI.
Comparative mortality from preventable diseases, July 1, 1898, to

June 30, 1899. (Cancer not properly included.)

this first six months of this period is reproduced from the last report. Tuberculosis is seen to have maintained its preeminence. Influenza and pneumonia having received their winter accessions, assume greater importance in the chart for full twelve months. Typhoid fever subsided during the winter only far enough to be surpassed by pneumonia. The losses inflicted by diphtheria in the six months after January ist were

about equal to those of the preceding six months. Whooping cough and measles destroyed more life, and scarlet fever less life, in the second six months.

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No. VII. Mortality of the principal preventable diseases in the last six months

of 1898. (From the report of 1898.)

Local Boards of Health. When the last report was written there were forty local boards of health in the State, twenty-two county boards and eighteen town boards of health. Since then but two new boards of health have been organized. Somerset County has at last a board of health, having as its Executive Officer Dr. Martin W. Goldsborough, of Princess Anne Hagerstown has also organized a municipal board of health with Dr. T. W. Simmons as Executive Officer. Thurmont, in Frederick County, made an effort to organize a board of health, but is not known to have completed this endeavor.

The Olney Board of Health, in Montgomery County, one of the oldest and most earnest boards in Maryland, has had its use. fulness much impaired by a very curious legal technicality. The Act which created this board of health was omitted from Poe's Code of Public General Laws, probably for the reason that this Act is a local law. The Act was at no time repealed either expressly or by implication in the terms of any subsequent Act, but having once appeared in Poe's Code and having later been omitted from that book, the legal adviser of the County Commissioners of Montgomery County held that the law had ceased to exist and that the Commissioners were not authorized to levy any sum for the maintenance of that board, This may be law, but it is not common sense. On the contrary, it seems to the unsophisticated mind to be uncommon nonsense. Such a view, if it had been reasonable, would have seemed most dangerous to any fair-minded guardian of public safety, and an immediate effort would have been made to repair the damage which such a view entailed. Certainly no intention or desire to stop the work of this board was apparent anywhere outside the office of the County Commissioners. This extraordinary view may have been held for some other reason than that such a view was desirable, but no good result of any sort followed this ruling except the saving of money to the county treasury. The Olney Board of Health paid no salary to any one. It looked after the sanitary welfare of a very enlightened and orderly farming community and sometimes expended as much as twentyfive dollars in a year. The utmost saving possible by destroying this local board of health was the price of fifty circus tickets.

The Hagerstown Board of Health collects information concerning the occurrence of infectious disease and transmits the same to the State Board of Health. If other local boards of health would notify the State Board promptly, giving the postoffice address of each infected family, it would be possible for the State Board to send short communications instructing exposed persons concerning the simple means of avoiding infection. These communications, arriving at a time when their contents would possess immediate personal interest, would be carefully read and the instructions would be practiced. Popular education, which is perhaps the most important work of a State Board of Health, could be pushed forward by this means most rapidly. The distribution of circular literature among persons who are not aware of any impending danger is not likely to have any lasting effect, but the distribution of circulars definitely adapted to an actual and existing condition is sure, by reason of its timeliness, to make an enduring impression.

The Annapolis Board of Health has made an important step forward during the year. A burial permit ordinance has been passed, so that all deaths occurring in that city are recorded at the time of their occurrence. It seems surprising that this town, one of the oldest in the State, and the town of great historic interest, should have had no such records hitherto. This deficiency was in fact so surprising to the recently elected Mayor, Mr. Seidewitz, that he insisted upon its immediate repair.

There are now in Maryland seven towns besides Baltimore which attempt to insure the immediate registration of all deaths by requiring a burial permit in every instance. They are Annapolis, Brunswick, Cumberland, Frederick, Frostburg, Hagerstown, Lonaconing.

In Cumberland, as has been elsewhere remarked, the burialpermit ordinance is neglected, so that the registration of deaths in that town is not so good as in the sparsely-settled and remote communities. All the other towns mentioned are completely successful.

As to the organization of county boards of health in general, it may be said that the system practiced in this State is not a good one. There are very few men on the boards of county commissioners in Maryland who have ever given any consideration to matters of public health, and when the subject is brought to their attention they usually treat it as if the business of sanitation were something to be postponed entirely until some unlikely emergency occurs, and even in the presence of an emergency they are unwilling, as a rule, to make any except temporary provision for the defence of public health.

In some counties the position of health officer is one of the petty political plums. The tenure of office is but one year, and it is sometimes the desire of those making the appointment that the health officer shall do as little as possible. The health officer who does no sanitary work whatever, provided he does not abstract any very considerable sum of money from the public funds, is on the whole the most satisfactory public functionary.

There are a few county boards to whom public health is an object of some importance, and to whom the representations of conscientious health officers are made with good effect; but, excluding health officers, there are not in the State, among all the county boards of health, five men who know the principles of

public hygiene. It is from medical men that a proper appreciaa tion of this subject is to be expected, and while it is undesirable that boards of health should be composed exclusively of medical men, every board should have more than one medical member. At least two men selected for their special fitness should be upon every board of health. One member of the board of county commissioners, one member of the school board, with two reputable physicians, appointed by the Governor of the State, or by the Judge of the Circuit Court, would, after completing their organization by the choice of an executive officer, make a good local board of health. There is certainly need of some sort of organic union between the State and local boards of health. If the choice of an executive officer were made subject to confirmation by the State Board of Health, a reasonable guarantee of efficiency would be secured. In some States the State Board of Health has the power to appoint and to remove local health officers. Here in Maryland that is neither necessary nor desirable.

All local boards of health should be visited several times a year by some representative of the central board of health. In that way the State Board of Health would be enabled to cooperate more intelligently with local boards, and those local officers who are doing their best would be sure of support and encouragement. On the other hand, no better check can well be placed upon indifference, incompetence or malfeasance than the certainty of publicity.

An examination of the reports of local health officers will show measurable improvement in most of them. At least there is no local board of health in the State which seems to call for severe criticism. Last year there were two which deserved unmeasured denunciation. There are still one or two silent boards of health. No harm is known of these dumb devotees of Hygeia. They are probably worth all the nickels bestowed upon them by the communities which maintain them.

If we might select a few of the good local reports in order to show why they are good reports, perhaps the Counties of Washington, Frederick, Cecil, Kent and Queen Anne's may serve that purpose. It is fair to say that of these Washington and Cecil have the best reports. Why? Because they represent better organized work. Besides competent and earnest executive officers these counties have boards of commissioners intelligent enough to appreciate and support the sanitary work of their officers.

In Washington County the county officer receives reports upon certain sanitary matters from fifteen vaccine physicians. These extra duties were laid upon the vaccine physicians at the suggestion of the county officer, and the result is that Washington County is not only the best vaccinated county in the State,

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