physician to cure, if possible, individual cases of disease. It is the labor of the sanitarian to prevent the very inception of disease. In this, his is the higher work, and it is also one which gives greater promise. Dealing largely with communities and with the influences affecting bodies of men in these efforts, their importance rises beyond that which seeks alone to cure the disease of the individual, and preventive medicine assumes a rank beyond the curative.

In all these labors for the physical good of man, it is not to be forgotten that other good is at the same time accomplished for "the same causes which promote physical disease and favor preventable mortality, foster also immorality, degredation and social misery. Uninhabitable habitations, over-crowded rooms, foul air, neglect of personal and public cleanliness, insufficient sanitary appliances, intemperance, uncontrolled habits of impurity; these are not only the factors of disease but they are also the factors of moral degredation." To eradicate these causes of disease and death is therefore to elevate man both morally and intellectually and to assist in his restoration to the likeness of his Maker.

It is not needful here to recapitulate what has been accomplished by State Health Boards since they were first organized in this country in the State of Massachusetts. It would be easy to show that they have proven here, as in England and elsewhere, of real and practical benefit-conservators of their best physical interests and a real blessing to the people of the several States where they are in operation. This has been so manifest indeed, that though less than eight years have elapsed since the inauguration of this movement in this country ten States have already adopted and put into practical operation the idea of STATE MEDICINE, which number will doubtless be considerably increased during the present winter. We believe that it would be easy to demonstrate the wisdom of these organizations not alone on the score of humanity but also on the score of the truest economy, for while there is "nothing so costly as sickness," neither is there. anything which so much contributes either to the happiness, or to the wealth of a State as the health of its citizens. That "public health is public wealth has become a part of the inner consciousness of the people." It is not a hasty or unconsidered statement that we make when we assert that the pecuniary loss to a State from preventable sickness, annually exceeds its entire cost of govern

ment; yet to build an argument in favor of an organization of this character, upon the cost of preventable sickness in money, is to build it upon the lowest and most unworthy ground. If by its investigations into the causes of disease, and its timely words of advice or of warning, it shall be able to save the life of a single citizen, then might a State consider itself repaid for the cost of its Health Board, and humanity might well demand this at its hands. Victories over disease are grand victories, and in the language of Dr. Baker, to those "who shall call forth and so marshal facts and generalize the scattered forces of knowledge as to lead to victory over any one of the causes of disease which now annually destroy our citizens by hundreds or by thousands, humanity may well accord a higher praise than to the most successful of warlike generals."

To enlighten the people concerning such causes; to instruct them that they may escape sickness and death from preventable diseases; to teach them "a better knowledge and observance of hygienic laws," is the legitimate work of a State Board of Health, and is included in the comprehensive term "State Medicine," which, with Dr. Bowditch, we understand to be "a special function of State authority by which it is bound to take care of the public health, to investigate the causes of epidemic and of other diseases, in order that each citizen may not only have as long a life as Nature would give him, but likewise as healthy a life as possible." Certainly "these objects rank among the most important matters discussed by the humanest hearts," and none "can be nobler or more deserving the attention of learned men, of philanthropists, or of statesmen."

The primary object of public medicine," says Dr. Farr, "is to prevent disease; but it also surrounds the sick with conditions most favorable to recovery, and diminishes the death-roll of the people." And the same eminent authority, recognizing the difficulties that environ this labor, says: "Supposing every condition favorable for the most perfect operation of the powers of State Medicine, we should still see grave defects in many persons; shortcomings in others; in many, organic degeneracies; in many, criminal depravities." And he gives, as the closing thought of an able address: “How, out of the existing seed, to raise races of men to divine perfection is the final problem of public medicine."

Accepting these exalted views of State Medicine, and of the duties. of a State Board of Health, the undersigned have entered upon the

duties imposed upon them by the commission of his Excellency the Governor, with a feeling of individual responsibility in view of the greatness of the work before them; with an earnest desire so to meet the varied duties and difficulties which will confront them as that their work will commend itself to the intelligent judgement of the people; and with the hope that they may so inaugurate this new and important dep: rt nent of public service, as to demonstrate its capacity for a usefulness which shall not be limited to the present time, but which will increase with the passage of years, and prove to be a blessing to the people of the State, lasting through all time. In presenting this first annual report, the Board beg leave to say that they regard the work thus far done as largely of a preparatory nature. The time which has elapsed since its organization is much too limited for it to hope for the exhibition of any great results.yet they believe that some good preliminary work has been done, and that there has been awakened in the minds of many of the people a thoughtful interest in sanitary matters, which cannot fail to be productive of future good. It has been the object of the Board to enlist the interest and co-operation of thinking men, both within and without the medical profession. It has been its belief that thus they could best create and develop a public sentiment in favor of hygienic principles and practices. It is painfully evident that this must of necessity be a comparatively slow work-that a large majority of our fellow citizens are both ignorant and careless as regards many of the fundamental principles of hygiene, and that they live in daily and direct disobedience of many of the simplest laws of their physical being.

For the purpose of systematizing the labors of the Board, and of bringing before the people such useful knowledge as is contemplated by the law, each member of the Board has been charged with the special study of some branch of sanitary science, with the view of presenting the result of such investigations to the people. We present herewith the fruit of such labor in a series of papers, which are designed to convey such knowledge in a popular, rather than in a scientific manner, which papers we commend to your attention.

For a more formal and detailed report of the operations of the Board, we refer to the accompanying report of the Secretary.

SMALL POX AND ITS PROPHYLAXIS.

Of the reports here with given, that of Dr. Griffinon Small Pox, will possess special interest from the fact that this disease has been, and now is. unusually prevalent and fatal in various places in the State. We commend its teachings to careful study. Small pox may be pointed to as at once the most amenable of all diseases to prevention, and the most destructive of all diseases when unmodified. Capable, as we believe, of being utterly exterminated, it has lost none of its virulence since the time when, during the single century preceding the discovery of vaccination, it caused the death of 45,000,000 of human beings on the continent of Europe. In the metropolis of this State during the last half of the year just closed, it caused the death of 162 persons, the mortality in one ward reaching in the month of November the frightful figures of 58 per cent. of all cases. As might have been anticipated the health officer reports that the disease has prevailed almost wholly among those who oppose vaccination. We believe that properly applied and enforced, preventive measures might have saved these 162 lives, and the hundreds of other cases of sickness from this loathsome disease which occurred during the same period of time, with all their attendant burthens of woe, of sorrow, of interrupted labor and business, and of enormous expense, but such results can be accomplished only by aid of stringent laws making vaccination and revaccination compulsory. We believe that public opinion and a due regard on the part of the government for the welfare of the people, will in time demand this; but this Board is not now prepared to do more than call your attention to these facts, and to state that in its judgment, based both upon personal observation and extensive correspondence on the subject, much less than one-half of the population of the State are now protected against this dire scourge.

This subject has been deemed of sufficient importance in view of the prevalence of the disease, to call for the issue of a special circular of warning and instruction, which has been widely published in the newspapers of the State, and to some extent distributed to physicians.

SEWERAGE AND DRAINAGE.

The report of Dr. Marks on sewerage and drainage, touches a subject of vital importance to every community. The influence of

drainage upon health, is at the present time attracting very great attention among sanitarians, and it is clearly demonstrable that as the drainage of a district is perfect or imperfect, so certain forms of disease disappear or prevail. No water-soaked ground can ever be healthy, or fit for human habitation. Soil moisture is well known to be one of the prolific causes of the tubercular diseases which annually claim tens of thousands of victims. Dwellings otherwise excellent, are often erected in apparent utter thoughtlessness of the character of the soil on which they are built, or its capacity for drainage, where this should have been a primary consideration, and thus not infrequently there is laid, not only the foundations of a dwelling, but at the same time the foundation of a fever, or a consumption. Imperfect sewerage, where a system is established is also a fruitful cause of disease. The escape of sewage matter into our water-supplies, or the subtle emanations of sewergas into our dwellings are deadly poisons which sap the citadels of life without warning. The subject is a wide and a practical one.

CONSTRUCTION AND VENTILATION OF PUBLIC BUILDINGS.

Somewhat closely connected with the subject of sewerage and drainage is that of the Construction and Ventilation of Public Buildings, upon which a preliminary report is made by General Bintliff. This is also an extensive field for sanitary study intima'ely concerning us all, for however carefully we may construct our own dwellings none of us can escape the evil influences connected with the construction and ventilation of public buildings. This report touches more particularly upon the construction and ventilation of the school buildings in which so large a portion of the time of our children is spent, pointing out some radical defects which exist in them and which lie at the foundation of not a few of the diseases which tend to produce a race of invalids. While there are admitted difficulties attending the securing of a satisfactory system of ventilation, it is yet evident to every thoughtful observer that very many of the existing defects might be avoided, and that in the construction of our lofty school houses and in the general custom of sending to the uppermost rooms the advanced classes of girls who are just developing into womanhood, there is being practiced an evil against which there cannot be uttered too emphatic a remonstrance. We fully endorse and cordially recommend to