societies and of their auxiliary branches; to also contain a brief summary of the peculiarity of its organization and of the measures being used by it to promote the practice of State medicine. Such report should be published in the annual Transactions of each Society.

3. The publication in the Annual Transactions of this Association of a consolidated report of the above reports from each State, together with special notices of the meritorious work done by any of the branches of this Association.

4. The substitution of a periodical medical journal for the present annual volume of Transactions.

5. The non-recognition by this Association of State societies. which make no provisions encouraging the organization of auxiliary societies in counties, etc.

6. The advisability of electing no person either a permanent member or a member by invitation unless such person be a member of a State medical society-provided that there be such a society recognized by this Association in his State.

7. The advisability of refusing to admit to this Association delegates from societies auxiliary to a State society unless the certificates of delegations be endorsed by an authorized officer of the State society.

8. The advisability of refusing to admit any delegates except those selected from and elected only by voting members who have paid all fees due to their respective county and State societies, and of establishing the principle that only those members of branch societies who are entitled to vote and have paid all fees due shall be entitled to be delegates.

9. The advisability of urging every medical college to have not less than one lecture delivered to every graduating class, on the importance to the profession and to the people of medical organization.

A paper by Dr. F. A. HARRIS, of Massachusetts, on The Medical Examiner System of Massachusetts, and how it Works in Practice, was presented by the Secretary, and was approved for publication after certain slight amendments which were indicated by the Section, for the making of which it was referred to the Secretary.

A paper on the Registration of Diseases, by Dr. G. B. BALCH, of New York, was also read by the Secretary, and, on motion, referred to the Committee of Publication.

The Secretary then read a paper prepared by the Chairman of the Section, Dr. J. S. BILLINGS, U. S. A., on the Construction of Hospitals for Small Towns and Villages, and exhibited accompa

nying lithographic plans of such buildings. The paper was referred to the Committee of Publication.1

Dr. A. S. PAYNE, of Virginia, then read a paper on the Pathognomonic Pulse in Smallpox before Eruption, which, on motion, was referred back to its author for further investigation. The Section then adjourned.

J. T. REEVE, M.D.,
Secretary of Section.

1 This paper, being deemed incomplete by its author, was returned to him at his request for further elaboration and re-presentation to the Section at its next annual meeting.

ADDRESS IN STATE MEDICINE AND PUBLIC

HYGIENE.

BY JOHN S. BILLINGS, M.D.,

SURGEON U. S. ARMY.

THE Record of Progress in State Medicine and Public Hygiene which, in accordance with the rules of the Association, I have to present, is brief. While the number of new patent ventilators, sewer gas traps, sanitary soaps, etc., has been above. the average, it must be admitted that in our knowledge of the causes of disease, or of the means of avoiding or destroying those causes, little or no positive advance has been made during the year, and I shall refer to but two discoveries which have been announced in this branch of medicine, discoveries which if real would be of great interest and importance, but which thus far are in great need of satisfactory proof and confirmation.

The first of these is the announcement to the British Medical Association in August, 1878,' by Ewart and Simpson of the discovery of the specific microphyte of diphtheria. They claim that the specific cause of diphtheria is a minute organism closely analogous to that which is now recognized as being the cause of splenic fever or malignant pustule, namely the bacillus anthracis.

The bacillus of diphtheria is stated to exist in the form of exceedingly minute spores, which on reaching a suitable medium germinate into minute slender rods, or bacilli, which increase by transverse fission. After cultivation in fluids outside the body, at a temperature of about 86°, the products of these spores, when applied to a raw surface, soon lead to the formation of a diphtheritic membrane.

No details of the experiments are given, and as yet we must suspend judgment as to the correctness of the conclusions. The second discovery referred to is that of the cause of ma

1 British Medical Journal, Sept. 7, 1878, p. 367.

larial fevers, announced by Dr. Eklund, surgeon of the Royal Swedish Marine, as due to a peculiar organism called the lymnophysalis hyalina, which he has found in the blood.1

Whether this is correct, or whether it should be classed with the "ague-plant" of Salisbury and the "tubercle-spores" or the asthmatos ciliaris of Cutter, we do not yet know.

In popularizing hygiene more progress has been made during the year than in original discovery, and the advice which has been given to the public on sanitary matters by lecturers and writers has been satisfactory as to quantity at least.

Nor has such popularization been unimportant; on the contrary, it has led to a step in this country from which we have a right to hope for great results.

From the explorations of the Congressional Commission into, and the comments of the daily press upon, the causes of the yellow fever epidemic of last year, it has come to pass that our legislators have been induced to create a National Board of Health.

So long as municipal and State authorities, while almost absolutely ignorant of the laws of preventive medicine, have no proper appreciation of their importance, and are so well satisfied with the existing condition of things as to disregard the warnings given them by their leading physicians and sanitariaus -refusing even to incur the cost of obtaining reliable information or of securing scientific advice-so long there is little hope for public hygiene. But when the epidemic comes it is a stern but, for the time being, very efficacious teacher. And, as Kingsley says, "Baalzebub, god of flies, and of what flies flourish in, always does come sooner or later to visit his worshippers and bestow on them his own Cross of the Legion of Dishonor.

"He is a sunny fiend, and loves not cold, or storm, or tempest, but a bright, hot sun and a broad, blue sky. His selection of victims has often just enough of the irregular and unforeseen about it to confuse the searcher, to belie theories, to harden the hearts of those in authority by furnishing them with excuses for believing that he had nothing to do with drains or polluted water, or filth in any shape, that he was only (such an only!) the Visitation of God."

But one thing they cannot help learning, that in its actual

Archives de méd. navale. Paris, July, 1878, p. 5.

presence whether it be called cholera, or plague, or yellow fever the wise man and the fool are nearly alike powerless; it might have been prevented, it cannot be cured.

And as the plague induced the rulers of continental Europe to establish sanitary organizations as a part of government, and as the cholera effected the same by England, so now the third great plague of modern times, the yellow fever, may have done the same for the United States.

With the law creating the National Board of Health, I presume all are familiar. A heavy burden has been placed upon it, and, if it is to succeed, even partially, it must have your assistance and co-operation. A large part of the information, advice, and support which are essential to its work must come from the' medical profession,-from individual physicians, from County and State medical societies, from State and municipal sanitary organizations. And to this Association, representing as it does. all these, this call for aid from the National Health Board comes with special force and urgency.

Every medical man has information needed by this Board, and is more or less a leader and guider of public opinion as to what it should and should not do;—as to the powers which it should possess; as to the relations which it should have to yourselves and the organizations with which you are connected. Its failure will be in a measure your failure, and its success your success.

The time has come when the character of public health legislation and organizations must be a matter of practical interest to all practitioners of medicine in this country. Sooner or later we must all come into relations with some board of health or sanitary officer. Is it not best, then, that while there is yet time we should exert ourselves to see that these sanitary boards and officials are such as we would desire to have them? that they will do our work while we aid them to do theirs?

Hitherto the great majority of practising physicians and surgeons have taken little interest in public hygiene, and have given little time or thought to the matter. At the meetings of the Section of this Association devoted to Public Hygiene and State Medicine I have rarely during the last five years seen as many as twenty persons present, and the faces have been always the same. The same condition of things exists in the British Medical Association, although not to so marked a degree. This is due largely, of course, to the superior interest of