different field of labor, but inspired by the same divine thought, Octavia Hill, in London, possessed for long periods of time various pieces of tenement property, each one wretched in itself, and worse in the character of its inmates, and, as a lessee, visitor and friend, cleaned and repaired, made habitable and comfortable, all these hitherto miserable dwellings. In the same spirit a committee of benevolent ladies, to the great saving of health and life, have in charge as many as possible of the more than twenty-two thousand tenement houses in the city of New York.

This kind of service, much of which, and the best of which, is voluntary, has proved one of the grandest physicians of the land. times it is seen in the direct cure of maladies, at times in the general diffusion of knowledge, and at times imparting personal comforts and positive civilization in the worst habitations of the land.

I read of the lives of 10,000 children saved in a short time in England, simply by the agencies of proper care in the use of the gifts of God to man. These agencies have been the medicine of nature, prescribed by a little practical wisdom. I read also in thirteen towns of England of a decrease of more than 17 per cent in the death rates from proper sewerage alone; but there, as here, there remains immense room for improvement. In a country like Belgium, the average lives of the cleanly and thrifty are fifty years, and of the filthy and negligent, the average length of life is only thirty-two years, and Belgium in this respect is not a peculiar country.

All of us, my friends, have many and inalienable rights; but the right of moral, physical and material contaminations of the city, the town, the country, the manufactory, the workshop, and of the dwellings of the people, are not among the rights. The State may repress nuisances, may maintain public, and as far as possible, private health; and all good citizens will not only obey the law, but as far as possible also present in their own lives and living a good example of loyalty for the many who are naturally disobedient.

The wise citizen will not only check disease in himself, but, as far as he is intelligent, avoid the necessity of calling upon a physician to cure preventable disease. Still less should the State be called upon to perform any kind of work which belongs to the citizen.

I leave it to experts and to the doctors to be specific as to the origin, character, extent and definition of diseases. As a layman I see and. comprehend the effect they have upon organized communities, peoples, and large bodies of individuals. I know what foul air, impure water and bad food mean, and I would, if I could, remove them from all conditions of household and animal life. Yes, and I would, if I could, remove them from the face of the earth. I try to distinguish between abnormal decay, common to human existence, and the decay which comes from disease.

The study of chemical combinations, of biological conditions, and of epidemical relations, as a layman, I may not understand, but every one can comprehend what an epidemic is- when in the midst of it-and if he can trace it to foul water, to exposed cess-pools and other tangible offenses, the way is pointed out to remove the cause and to remove the effect of the evil. The sick animal and the sick plant, and whatever causes or enters into the decay of man must be cured, or the natural consequences follow. It is enough to know that the presence and

spread of filth means the presence and spread of disease. There may be other causes of sickness, but this one is self-evident, tangible and remedial, which may not be the fact with the class of diseases caused by air and climate and the atmosphere alone, or by diseases which only skill and study can detect and cure. In the country a belt of trees and a sheet of water, absorbing disease, have often arrested its progress.

The art of prevention in disease, as in other results, is, therefore, the best lesson for the teacher and the student. As the proverb says, “An ounce of prevention is better than a pound of cure." Even the brute creation, as in the marshes near Rome, have, through experiments, shown symptoms of malaria produced by infection of the soil and air.

These lessons are of more importance in crowded communities, and in certain climates, than in the rural districts, or where the air and atmosphere, as by the sea and on the mountains, are of the greatest purity. Every day's record from the large cities teaches us that where there is most life there is most death, even apart from great numbers of people; and much more care, therefore, is necessary to preserve life where the largest number of people are found.

It was the careful statement of your presiding officer, President Billings, last year at New Orleans, that 100,000 lives were lost each year from sheer neglect, and 200,000 cases of prolonged sickness are added during the same year. In reality the dead and the sick, who might be saved, are far beyond these figures. I will not repeat my estimates of last year as to the money and business value of each of these lives, but the loss and cost and value of each one presents a fact beyond dispute. The greatest loss is during the age of childhood; but neglect, ignorance and vice spares neither age, condition nor sex in any of the years of our lives. Of the young it was truly said by Irwin Greenhow, in a report to a general board of health, that the death rates were among the most important studies in sanitary science, because, first of all, they give a very sensitive test of sanitary circumstances; and, secondly, the places where they are most apt to die are necessarily the places where survivors are most sickly, and where, if they survive, they beget a sicklier brood than themselves, even less capable of labor and less susceptible of education. A high local mortality of youth must almost necessarily denote a high local prevalence of the causes which determine a degeneration of race. Dr. West also says the frail child never passes completely into womanhood, but fades and droops in the transition stage through which she has not the strength to pass; and this is the sad record of advancing years. We know from sad experience, how, in the State, pauperism may be perpetuated in the double form of immorality and disease.

Dr. Jarvis, of Massachusetts, in his work on the political economy of health, says that in the seven years from 1865 to 1871 72,727 died in their working period. In the fullness of health and completeness of life they would have had opportunity of laboring for themselves, their families and the public 3,006,350 years, but the total of their labors amounted to only 1,681,125 years, leaving a loss of 1,925,224 years by their premature deaths. This was an annual loss of 276,461 years of service and co-operation. Thus, it appears, that in Massachusetts, one of the most favored States of the country, and of the world, those who died within seven years had contributed to the public support less than one-half, or 46.07 per cent, of what is done in the best conditions of life. He also adds, confirming what I have already said, that it is estimated by

English observations and calculations-no notice is taken of sickness for less than a week -- that for every death there are two persons constantly sick; and that means 730 days sickness and disability for every death.

In 1870 in Massachusetts, amongst the people of the working age, there were 24,554 years and eight months sickness, or disability; or just so much loss of labor.

In contrast to this sad record, let me say that upon the whole the health service of the country, and of the world, is certainly improving; but while this is true, it is necessary to add that, as an entire people, we are only in the beginning of the required work of real civilization. The death rate in the United States army from all causes is but nine per thousand of white men and twenty per thousand of colored troops.

The last annual report of Surgeon General Barnes shows that among the white troops the total number of cases of all kinds reported on the sick list was 37,408, being at the rate of 1,768 per thousand of mean strength. Among the colored troops the total number reported was 4,600, or 1,984 per thousand of mean strength. The total number of deaths from all causes among the white troops was 197, or a deathrate of nine in 1,000 of mean strength; and the total deaths of colored soldiers from all causes was forty-eight, or twenty in 1,000.

In my own State I record with satisfaction that since the establishment of the State Board of Health, as many as fifty, and at one time sixty, local Boards have been organized in a single month. They now exist in the twenty-four cities, three hundred villages, and in nearly all of the towns of the State. The cause of this improvement is due to the fact that physicians in many of the counties of the State, supported by boards of supervisors, village trustees, county, town and district clerks, and, indeed, by nearly all county officers, have been requested to co-operate with the State Board of Health in calling attention to, and in maintaining, public health at home, and to this end they were asked to respond to any and every call looking to private work, and to public meetings for the consideration and discussion of measures relating to drainage, sewerage and general cleanliness; to the ventilation of schools and public institutions; to the supplies of pure water; to the proximity of wells to cesspools and water-closets; to the adulteration of food and drugs, as affecting health, and to all general work which seeks to secure the health of the people. Work at home, as the best missionary field of labor, is the first improvement needed. The best work always begins there.

When, many years ago, Lord Palmerston met his Scotch petitioners, asking for a day of fasting and prayer, he gave them the wise but rather startling answer: "Go home, and see that your towns and cities are freed from those causes and sources of contagion which, if allowed to remain, will breed pestilence and be fruitful in death, in spite of all prayers of a united but inactive people!" And Ruskin, at a later day, declared that " any interference which tends to reform and protect the health of the masses is viewed by them as unwarranted interference with their vested right to inevitable disease and death." Yet this amiable cynic induced Octavia Hill to invest ten thousand pounds sterling of his money in the lowest quarter of the city, where she might witness the transforming power of its worth in sanitary reform. And so this noble woman, aided by Ruskin's magnificent donation of money proved that wealth is health and that health means the happiness of the people.

In this spirit, Ralph Waldo Emerson, many years ago, in his words on "One in Robust Health," said, in a spirit which I have endeavored to inculcate. "The first wealth is health. Sickness is poor-spirited; it must husband its resources to live. But health answers its own ends, and has to spare; runs over and inundates the creeks and neighborhoods of other men's necessity."

Let me prescribe one other rule of business, and for domestic and public duty; banish from your dwellings all possibilities of contamination from effete matter, all noxious and miasmatic gases from fecal decompositions resulting from soil and sewer pipes. Obstructed pipes send back into your closets, sinks and basins the foulest odors, and only the freest flow of water can keep them clear and clean.

If the sources are all pure and the road straight aud clear, there is a way of escape. The head of every house and building should be prac tically a health inspector. Open the doors and windows of your dormitories and school-rooms, that the air of heaven may enter therein. A little care will shut out filth and darkness, and make room for the light of heaven and the vigor of health. One marked feature of our American life is the disease known as fret and worry,

The haste and zeal of the times causes what is called "American nervousness," which means mental and physical derangement, and which, in turn, again means what has been characterized as hypotism, hysteria, catalepsy, somnambulism, and other preternatural and abnormal manifestations and hallucinations, as seen, in part, in Guiteau's villainous purpose, whatever the measure of his alleged insanity, for killing President Garfield. Some of these evils are born of deceit, passion, vanity and imposture. Others are born of intemperate lives and habits and education, and produce insomnia, dyspepsia, irritability, and a long train of nervous diseases, or disorders, characteristic of the times and the people. These are the diseases which lead the way to asylums for the idiotic and the insane, where it is so hard to—

"Minister to the mind diseased,

Pluck from the memory a rooted sorrow;
'Rase out the written troubles of the brain;
And, with some sweet, oblivious antidote,

Cleanse the stuff'd bosom of that perilous stuff
Which weighs upon the heart."

The only offset to this amount of fret and worry is a corresponding reduction of inflammatory diseases; and this, it is said, is almost, if not quite in proportion to the growth of nervous irritability, and also a corresponding increase of longevity where, as one reads, diseases of the many have been most apparent.

But leaving all these specific references to life and death, disease and cure, let me return and close with a single reference as to the duty of the citizen and the obligations of the State, condensing both in the words of another: "Duty is a moral obligation imposed from within; obligation is a duty imposed from without. Duty implies a previous obligation; and an obligation involves a duty. My obligation is to give another man his right; my duty is to do what is right. Hence duty is a wider term than obligation. Duty and right are relative terms. If it be the duty of one party to do something, it is the right of some other party to expect or exact the doing of it."

* * *

MODES AND EXAMPLES ON SANITARY PROCEDURE, ETC.

At the annual meeting in May, 1881, and subsequently, the Secretary was directed to prepare a circular of information upon the best methods of procedure by local sanitary authorities, under the amended laws, against nuisances and other sources of damages to public health. The Board having directed that suitable and most economical plans for contagious disease refuges should be prepared as an appendix to such circular, and that the whole be issued to all local Boards of Health and also be printed in the Second Annual Report, that document is here presented. E. H., Secretary.

[No. 27.]

STATE BOARD OF HEALTH OF NEW YORK.

DUTIES AND PROCEDURES OF LOCAL BOARDS OF HEALTH AND THEIR OFFICERS.— EXAMPLES, METHODS AND SUGGESTIONS.

The laws require the Health Boards to“ have cognizance of the causes of injury or danger to the public health." Full power is given every Board to make and enforce regulations and orders of general obligation, which shall be published and obeyed as laws; also to make special orders, without publication, to be immediately enforced for the suppression of nuisances and of sources of contagious diseases or other great dangers to life and health. In this circular the State Board of Health presents a practical view of sanitary procedures, as they relate to nuisances, the protection of health in schools, the removal of causes of malaria, and the control of contagious diseases. In this service, every local Board of Health is required

To be organized according to the statutes.

To have a competent physician as Health Officer."

To adopt and publish regulations and orders of general obligation. To prescribe "the duties and powers of the local Health Officer." To give information to all inhabitants concerning their duties in regard to the registry of deaths, births and marriages, the burial of the dead, and the sanitary care of contagious diseases, and to designate the persons who shall grant permits for the burial of the dead.

To notify all physicians, clergymen and magistrates of their duty relating to certified records for registration.

To make and preserve accurate records of all official proceedings, and to require the Health Officer to do so in his service.