of Health which stands in the relation of an advisory board to the local boards. All England and Wales is divided into rural sanitary districts, with sub local boards. This arrangement exists also somewhat in France, but there the power of the Central Board is limited to the prevention of outbreaks of contagious diseases. In Munich, Leipsic and Copenhagen, there are institutions for the teaching of hygiene to the people. The Hungarian Minister of Education, M. Trefort, has been making great efforts to have hygiene taught in all high schools by medically trained hygienists, and has created in the University of Prague a special course to teach hygiene to physicians. Stockholm has a fully equipped institution of hygiene. In our own country, a National Board of Health was appointed in 1878 by the Federal government, but no record of any work done can be found. The Encyclopedia says: "Little practical work has been done, the 'board being very much hindered by political intrigue." Some good work has been done by individual State Boards. Nearly every State has a board of health, but their powers are very limited. New York has made State enactments under which action can be taken, but as a rule work must be done under municipal by-laws, which are neither thorough nor effective. Our own State Board is almost entirely limited to the control of the practice of medicine. Michigan is the first State to start a scientific systematic hygiene. A laboratory has been established at Ann Arbor, and a course of lectures begun under a paid professor and assistants. Nearly all the general work done in the United States has been done by the American Public Health Association, which has headquarters at Concord, New Hampshire.

This Association was organized in 1872 by a few prominent physicians, and is now a flourishing society, accomplishing as much good as possible, unsupported by legal authority. The Society published in 1886, at great expense, four essays on sanitary topics, which should be in every school and private library. They are called the Lomb prize essays. Prizes of three and five hundred dollars having been given by Mr. Henry Lomb, of Rochester, New York, to the writers of the accepted essays on the following subjects: Healthy Homes and Foods

for the working classes-the Sanitary Conditions and Necessities of School Houses and School Life-Disinfection and Individual Prophylaxis against Infectious Diseases—the Preventable Causes of Diseases-Injury and Death in American Manufactories and Workshops, and the best means and appliances for preventing and avoiding them. These private societies are doing an immense amount of good, but such an important subject as the regulation of the public health should be under the control of the State.

It is an acknowledged principle in our government that "it is the business of the government to do for the mass of individuals those things which cannot be done or cannot be so well done by individual action." A system somewhat similar to that existing in England would be well suited to our country. There should be in each State a State Board of Health, working in concert and suggesting to each other methods and means through a Central Committee formed from members of all the State Boards. The Central Committee would act as an advisory board, suggesting measures and regulations to be passed upon by the several State Boards; all measures originating with the State Boards being referred before the final decision to the Central Committee for suggestions and corrections. What would be the duties of the State Boards? Within the bounds of sanitary and hygienic legislation they would be almost limitless. It is manifestly impossible in the limits of this article, to go into the details of such a subject. First and foremost they would turn their attention to the medical profession-to reform the profession itself, so that it be worthy the confidence and respect of the public, and so reform the people through education and wise legislation on the subject, that they shall appreciate the profession, and give to physicians the confidence necessary in order that they may do good work for the people.

Place the licensing power to practice medicine in the hands of the State Board, and take it away entirely from the colleges. This alone would weed out at least half of them. Oblige every physician practicing in the same State to pass the same examination, and let it cover at least all the known systems of therapeutics recognized by the people. Gradually concentrate the

medical education of the State in one city and in one college; discourage the building of free dispensaries, except in connection with the hospital and college, and there is no reason why we should not be able to obtain in our own country as thorough an education in medicine as in any country in Europe. Having reformed the doctors, they would turn their attention to the people. They would discourage in every way the manufacture and sale of patent medicines, and under no conditions should these be sold without a physician's prescription. If a physician who knows the ingredients and the effect upon the system, chooses to use them he should be allowed to do so. But drugs in the hands of the people are fast making us a nation of invalids, and materially aiding in filling our insane asylums and homes for the feeble-minded.

Not a drop of medicine should pass into the hands of the people except through a physician's prescription. Give the people the broadest possible education in public and private hygiene. Give them every aid in preserving health and prolonging life, but let drugs be dealt to them sparingly and by a thoroughly trained hand. It behooves every physician who honestly loves his profession and who hopes to see it hold again the place in the minds and hearts of the people which legitimately belongs to such a high calling, to take up this reform in an earnest and bold spirit which must lead to success. It should further be the. duty of the State Board, to follow the example of the American Public Health Association, and circulate literature on all sanitary topics; to introduce bills. into the Legislature to prohibit the marriage of idiots, lunatics, paupers and those affected by incurable diseases; to suggest to Congress measures regulating the quarantine systems, public water supplies, sewerage systems, and construction of public buildings. They would establish sanitary engineering and laboratories for scientific investigation into the cause and prevention of disease; especially of idiocy and insanity. They would introduce the rules of right living into all our schools and universities.

It would further be their duty to instruct the people in private hygiene. Teach them the necessity of pure air and sun

light in their homes-the importance of cleanliness, exercise, rest; of good food and proper clothing; how to avoid in particular, lung, throat and heart troubles. They would organize public baths and gymnasiums, and in every way, public and private, place the people under sanitary conditions. They would explain to women scientifically, philosophically, if need be, why they cannot with impunity, squeeze their lungs into half the space allotted them by nature, and their liver into the other half. They would explain to men why they cannot smoke eleven cigars a day and then sleep soundly at nightwhy they cannot eat highly spiced foods and drink many kinds of wine late into the night, and wake in the morning with a clear brain and a pure heart. They would educate-educate. I am convinced that it is not because of willful carelessness on the part of either men or women, that we are becoming practically a nation of invalids, but because of real ignorance of the laws of health, and of the means to be taken to insure a long life and a natural death.

A physician of large knowledge, once said: "In all my experience I have never known but one man who really died a natural death." The fearful mortality among children should alone open the eyes of the people to the need of some more systematic effort for the promotion of sanitary conditions. Our latest statistics show that one third of the entire mortality occurs among children under five years of age. The little ones come already weak and tired-bearing on their innocent shoulders the sins of many ancestors-make a brief struggle against ail the adverse conditions which surround them, only to fall on the threshold of life, victims to heredity and ignorance. In the days when medicine was left to the schoolmen and the clergy, surely the people were excusable for dying off by the thousands from all sorts of diseases and plagues. But are they to-day, when medicine is becoming to a great extent a popular science? So long as every accident, every death was attributed to some power outside of ourselves, and for which we could not be held responsible, progress in social and sanitary science was impossible. But science has taught us there can be no effect with

out a cause.

We see whole cities depopulated by some terrible diseasewe see crime running rampant in a land blest with an army of good and intelligent men and women. We see starvation in the midst of plenty-sickness, misery and death in a world where there should be perfect health, happiness and life, and we no longer rest satisfied with the assurance that as an enlightened people we are in no way responsible. Surely these evils are no law of nature. There must be a cause, and we cannot shirk the responsibility. Reason tells us we are directly responsible, and the cause must be found.

If we aspire as we should to once more having upon the earth a race of healthy men and women, we must begin with the children. Teach them that it is their sacred duty to care for their bodies, that a sound mind in a sound body is the best gift of the gods, and that this is in their power to obtain. Teach them that death from disease is unnatural and the direct result of a broken law; that the young should never die; that only the old die well. Make the rules of hygiene and of right living part of the curriculum of every school and college in our land. Let physiology be taught on a scientific basis. Let the children learn the structure and functions of their own bodies, as openly and as plainly as they learn their problems in mathematics. Ignorance is not innocence, and knowledge is a powerful weapon against temptation. Let them know and realize the interdependence of mental, moral and physical health. Surround them with every hygienic condition and teach them the fear of nature's laws. Then and then only, may we hope for a race of beings who will one day be worthy to commune with nature, and who, after a wise and useful life spent in harmony with her laws, will deserve their long rest on her bosom.