May 30, 1 901] 



NA TURE 



11/ 



PUBLIC HEALTH IN AMERICA. 

 'T'HE thirty-first annual report of the State Board of Heahh 

 of Massachusetts, dealing with the work of the various 

 departments during the year 1S99, has lately been issued. These 

 reports are mainly known to this country in connection with the 

 original investigations on the treatment of water and sewage 

 which have for many years past formed an important feature of 

 the work undertaken by this Board of Health. 



The practical outcome of these researches is seen in the 

 recommendations made by the Board to cities and towns, no 

 less than 79 applications for advice regarding the establishment 

 of systems of water supply, drainage and sewerage having been 

 dealt with during the year, and the Board have the satisfaction 

 of reporting that at the end of this period every city in the State 

 and 132 out of a total of 321 towns were provided with public 

 water supplies. If the death-rate from typhoid fever over a 

 series of years be taken as an index of the sanitary condition of 

 a community, then, indeed, the State of Massachusetts has just 

 cause for congratulation on the results of the enlightened policy 

 in regard to questions of hygiene which has been so persistently 

 pursued by, and has so prominently distinguished, its officials. 



In the years 1871-75 the death-rate from typhoid fever in the 

 cities, as well as in the State at large, was as high as 8 '2 per 

 10,000. This figure has gradually been reduced to 2 '6, and in 

 the four years from 1896 to 1S99 the rate has been further 

 brought down to 2'4 per 10,000. Again, while in the period 

 1871-75 there was not a single city amongst the 31 in the State 

 having a lower death-rate from typhoid fever than 2 '7 per 

 10,000, in 1899 there were 24 such cities. The most note- 

 worthy improvement was that of Lawrence, where the typhoid 

 death-rate fell from a mean of ir2 per 10,000 in 1S86-90, and 

 77 in 1891-95, to 2-5 in the four years 1896-99, following the 

 introduction of sand filtration of the water from the Merrimack 

 river supplied to this city. 



In regard to consumption, the Board is able to make a no less 

 satisfactory report, the decline in mortality from this disease 

 having continued with a fairly steady and uniform rate through- 

 out the past fifty years, reaching in 1S99 187 per 10,000. In 

 commenting upon this fact it is pointed out that it is between 

 the ages of 15 and 60 that consumption is most fatal, and that in 

 1894 and 1895, out of 1000 deaths from all causes in Massa- 

 chusetts between these ages 2S8 were due to tuberculosis, whilst 

 in Paris the figures for the same period of life were 400 and in 

 Vienna 459, or nearly one-half of all the deaths at that age. 

 Emphasis is laid upon the necessity for taking further precau- 

 tions for the control and prevention of this most destructive 

 disease, a sentiment which will be given practical effect to this 

 year in England at the British Congress for the Prevention of 

 Consumption, presided over by the King, to be held in London 

 in July. 



Massachusetts is, however, not the only State in America 

 which is alive to the urgency of dealing effectively with this 

 disease. Michigan, which supports a State Agricultural College, 

 has recently issued a valuable Bulletin in which practical 

 methods are suggested for combating this scourge, based upon 

 careful scientific experiments. The writer of the Bulletin states 

 that tuberculosis causes more than twice as many deaths in 

 Michigan as any other single contagious disease, and Dr. Keen, 

 of Rhode Island, has calculated that more than 100,000 persons 

 annually die of consumption in America, and that at this rate 

 out of the 70,000,000 people in the United States 10,000,000 

 are practically condemned to death through tuberculosis. 



In discussing the unusual prevalence of small pox which has , 

 characterised the period covered by the report, a special table ' 

 has been appended showing the comparative fatality of the 

 vaccinated and unvaccinated respectively. This table is based 

 upon carefully compiled statistics kept between the years 1885 

 and 1899, and shows that the deaths from small pox among the 

 vaccinated was 7 '6 per cent, and among the unvaccinated 26 'O 

 per cent., or more than three times as great in the latter case 

 during these fourteen years. 



In the pathological department of the Board much attention 

 has been bestowed upon the preparation of diphtheria antitoxin, 

 and a large number of examinations were made for the verifica- 

 tion of diphtheria germs. The work of this department has 

 largely increased during the year, for considerable quantities of 

 the antitoxin have been used for the immunisation of healthy 

 persons who have been exposed to the infection of diphtheria, 

 whilst at the Children's Hospital, an institution at which several 

 hundred patients are annually received for treatment, medical 



and surgical, but not for infectious diseases, it has been the 

 custom to immunise each patient with diphtheria antitoxin soon 

 after admittance. 



No reference is made to the preparation of antityphoid serum, 

 neither, apparently, have any investigations been carried out 

 with regard to it. Likewise we note that tetanus antitoxin is 

 no longer prepared, the reason given for its discontinuance 

 being that the demand for the serum was small and irregular, 

 and its application usually delayed until the patient was past 

 recovery. 



An interesting section of the report deals with the results of 

 the food and drug inspections. Although the use of preserva- 

 tives or any foreign substance in milk is illegal, 11 '6 per cent, 

 of the samples examined contained a preservative, in the largest 

 number of cases formaldehyde being employed, which is widely 

 used in the United .States under the name of " Freezine." A 

 pamphlet setting forth the special advantagesof this preservative 

 states that "it is not an adulterant, that it immediately evapor- 

 ates, so that it defies detection as soon as it has rendered all the 

 bacteria inert, it is beneficial to the health of infants, many of 

 whom have been saved from sickness and even death by a 

 liberal use of ' Freezine ' in the milk ! " 



Butter, we are informed, was specially tested for the presence 

 of boracic acid in consequence of the alleged extensive use of 

 this ingredient in Great Britain. None was found, which may 

 be attributed to the custom which prevails to a much larger 

 extent in America than in England of eating salt butter, in 

 which case the use of an additional preservative would be 

 superfluous. 



The above brief sketch may give some idea of the general 

 scope of the work undertaken by public boards of health in 

 America. It serves to emphasise, perhaps, that Great Britain 

 is still waiting for an Imperial Board of Ilealth, and that what 

 individual States in America can accomplish we as an Empire 

 are powerless to achieve. G. C. Frankland. 



THE EXTENSION OF KNOWLEDGE. 

 A N inspiring address, dealing with the influence of univer- 

 ■^ sities upon national life, delivered at the Johns Hopkins 

 University at the last commemoration day by Dr. D. J. Hill, 

 assistant secretary of State, is published in one of the University 

 Circulars just received. Students of human history well know 

 that the pursuit of knowledge has been the fundamental factor of 

 progress through many centuries. The earliest universities in 

 Europe were associations of teachers and students with this 

 aim, and they e.xerted a powerful influence upon society long 

 before their existence was recognised by Church or State. " It 

 is not too much to say," remarks Dr. Hill, " that the trans- 

 formation of Europe which marks the distinction between 

 mediii;val and modern times has been chiefly the work of the 

 universities, for they have exercised the most potent influence 

 upon social progress and popular liberty of any single class of 

 human institutions." The spirit which has led to the establish- 

 ment of so many institutions for higher education in the United 

 States, by private munificence, seems to have been inherited 

 from the Pilgrim Fathers. Even when the colony of Massa- 

 chusetts numbered only four thousand, it was decided to found 

 a college ; but the resolution is less astonishing when it is 

 remembered that among the first six hundred settlers one in 

 every thirty was a graduate of Cambridge. 



Dr. Hill concluded his address by referring to the changing 

 conditions of life, and the need for all who are concerned with 

 education to recognise their new obligations and make them- 

 selves equal to their modern mission. This part of the address 

 is reprinted below. 



" It is no longer a question of merely popular education, 

 although that is always fundamental ; it is a question of the 

 higher and the highest education that confronts us now. We 

 have passed the primary stage, the common schools are estab- 

 lished, the colleges exist in sufiicient numbers, and even univer- 

 sities do not need to be multiplied. We have sought the safe- 

 guard of liberty in the universal diffusion of knowledge, but it 

 is not the mere rudiments that have saved us in any great 

 emergency. In what crisis of diplomacy, in what complicated 

 question of finance, in what quandary of economic policy, in 

 what problem of constitutional interpretation have the elemen- 

 tary arts furnished saving knowledge to the nation ? No, in 



NO. 164S VOL. 64] 



