Am.  Jour.  Pharui. 
May,  1915. 
M odern  M edicine. 
231 
In  1869  Massachusetts  established  the  first  State  Board  of  Health. 
California  followed  in  1870.  At  various  periods  since  that  time  each 
State  has  created  some  kind  of  health  organization.  Some  began  as 
quarantine  bodies,  some  as  examining  bodies,  some  as  State  boards 
of  health  de  novo.  The  United  States  Public  Health  Service  has 
recently  issued  an  interesting  summary  of  the  history  and  general 
condition  of  our  State  health  organizations.  A  careful  reading  of 
this  study  must  impress  every  one  with  the  amazing  diversity  of 
method  and  machinery  as  well  as  the  large  amount  of  waste  effort 
required  to  secure  the  creation  and  perpetuation  of  these  boards. 
Examination  of  the  Proceedings  of  the  Association  from  1870  to 
1877  will  show  that  the  principal  force  in  their  creation  was  the 
American  Medical  Association,  and  that  the  most  important  factor 
in  securing  the  establishment  of  these  boards,  in  maintaining  them 
and  in  performing  their  functions  was  the  medical  profession.  Now, 
the  object  of  establishing  these  boards  was  and  is  to  prevent  unneces- 
sary sickness,  reduce  the  death-rate  and  make  the  people  of  the  State 
healthier,  happier,  richer  and  longer  lived.  If  there  is  any  work 
which  is  more  unselfish,  self-sacrificing  and  clearly  for  the  public 
good,  history  does  not  record  it.  Yet  the  principal  difficulty  during 
the  forty-five  years  which  have  elapsed  since  Massachusetts  passed 
her  first  law  has  been  to  convince  enough  of  the  people  of  any  State 
of  the  desirability  of  such  work  to  secure  its  establishment  and  devel- 
opment. Certainly  when  concerted  and  continuous  effort  is  neces- 
sary to  persuade  people  to  allow  themselves  to  be  saved  from  sickness 
and  suffering,  and  when  the  facts  in  the  case  are  as  readily  demon- 
strable as  the  figures  of  the  multiplication  table,  something  must  be 
seriously  wrong  with  the  manner  in  which  this  subject  has  been 
presented  to  make  such  a  situation  possible.  When  the  history  of 
the  last  forty-five  years  is  reviewed,  it  is  not  difficult  to  see  why  the 
task  has  been  a  difficult  one. 
Following  the  development  of  modern  bacteriology  and  pathology 
and  recognition  of  the  possibilities  of  State  activity  in  preventing 
disease,  efforts  began  to  be  made,  as  we  have  seen,  to  utilize  the 
power  of  the  State  for  the  protection  of  the  public.  Now  the  average 
American  has  the  utmost  confidence  in  the  power  of  legislation  to 
accomplish  almost  any  reform.  Here  was  a  field  for  legislation 
entirely  for  the  public  good,  and  yet  the  knowledge  on  which  effective 
legislation  could  be  based  lay  entirely  outside  the  grasp  of  the 
average  citizen.  The  specialist  and  the  expert  are  not  necessarily 
the  wisest  guides  in  legislative  or  public  affairs.    The  expert  is 
