of the conditions affecting the public health, and of the actual conditions of health in Michigan before and since the establishment of the board, especially exhibiting, if it be true, that there has been a very marked improvement in the healthfulness of Michigan in recent years, and statements of the principal danger's to life and health at the present time, also an appropriate program for a public meeting for the discussion of measures for the further promotion of the public health in Michigan, the meeting to occur on or about the time of the completion of the twenty-five years of the existence of the board.

Resolved further, That the Governor is hereby authorized and requested to send to the National Conference of State Boards of Health, at its coming meeting in 1897, which is to be held in Nashville, Tennessee, during the centennial exposition, an invitation for the National Conference of State Boards of Health, to hold its next annual meeting in Michigan in the summer of 1898 to aid in celebrating the quarter-centennial of the establishment of the Michigan State Board of Health. Resolved further, That the Governor is hereby authorized and requested to invite to this Quarter-centennial meeting, Surgeon-General Sternberg of the United States Army, Surgeon-General Tryon of the Navy, Surgeon-General Wyman of the Marine Hospital Service, D. E. Salmon, M. D., of the Bureau of Animal Industry, U. S. Department of Agriculture, the officers and members of other State Boards of Health, and of the boards of health of the principal cities in the United States, and other distinguished sanitarians in this and neighboring countries.

Resolved further, That, in case the invitations are accepted, the Railroad Commissioner and the State Board of Health are requested to act, and to coöperate with interested citizens so far as practicable, for facilitating the attendance of representative excursionists from other States, and for placing before those who may visit Michigan on that occasion, the beauties of the numerous delightful summer resorts around the shores of the Great Lakes, and at the numerous inland lakes and other sanitaria, the general healthfulness of the State, and the unparalleled advantages of Michigan as a summer resort State.

Resolved further, That the local boards of health in Michigan be requested to send delegates to this proposed quarter-centennial meeting, in order that they may contribute, for the general welfare of the State, and that they may gain any information which they can for the use and benefit of the public health in their respective localities.

PUBLIC HEALTH LEGISLATION IN MICHIGAN IN 1897.

The following is a copy of the special biennial report of the State Board of Health to the outgoing and incoming Governors. It thus gives the outgoing Governor an account of what has been done that he may commend and suggest future work, and gives the incoming Governor an account from which he can formulate any recommendation he may deem wise. The biennial report reads as follows:

SPECIAL BIENNIAL REPORT OF THE STATE BOARD OF HEALTH

Relative to Public-health Laws and Proposed Legislation in the Interests of Public Health.

To the Present Governor and to the Incoming Governor of Michigan:

Although not required by the letter of the law, public policy dictates that the results of the observations and studies of the State Board of Health, so far as they relate to imperfections in existing laws relating to the public health, or to proposed amendments of those laws, be placed before the retiring Governor and incoming Governor, to the end that in case either of those officials deems it best, convenient opportunity may thus be afforded to bring to the notice of the legislature any such propositions which seem to be for the public good. Accordingly, this special report by the State Board of Health is respectfully submitted.

The State Quarantine Law,-Act 47, 1893.

At the present time, no unusual sickness or mortality is being experienced in Michigan. None is seriously threatened. The State Quarantine Law (Act 47, Laws of 1893), to enable the Governor and the State Board of Health to do certain acts in an emergency, has been acted under a few times during the past two years, with results which have been very satisfactory to this Board and to the people of threatened localities.

Because of the lessened immigration, and because of other conditions, no occasion has seemed to call for such action, under that law, as the inspection of immigrants or travelers at the State line, to keep out dangerous infection. If occasion had demanded such action, it is not probable that it could properly have been taken successfully, for the reason that the law is not so framed as to be useful for that purpose, the State Supreme Court having decided (102 Mich., page 248) that such rules as, in the opinion of the State Board of Health, are required to make the law of use for the purpose of excluding infection from entry into the State, cannot be made and enforced by the State Board of Health. If the people of Michigan wish to provide for an emergency when they are to rely upon the State quarantine law to protect from danger of cholera, small-pox, or any other dangerous disease being brought into the State by immigrants or travelers, further legislation is necessary.

As before suggested, that law is very useful, from time to time, for the investigation of outbreaks within the State of dangerous diseases which may threaten to spread.

Some of the reasons why the present law (Act 47 of 1893) is not useful, for one of the main purposes for which it was enacted, are stated on pages xcvii-xcviii of the Annual Report of the State Board of Health for the year 1894, and on pages lxxxvi-lxxxvii of the Annual Report for the year 1895.

Proposed Amendment of Law Relative to Vital Statistics

The law establishing the State Board of Health says: "They shall especially study the vital statistics of this State, and endeavor to make intelligent and profitable use of the collected records of deaths." This has been done, and the statistics have been found valuable; but their value and usefulness would be very much greater if the law were so amended that the records were made immediately after the occurrence of the deaths, instead of postponing the making of the first record, as is now done, until a year or more has elapsed. In his Annual Report on this subject, the Secretary of State, under whose direction the mortality statistics are collected and published, has recommended the amendment of the law; the chief of the division of vital statistics has drawn a bill which has been considered by a committee of the State Medical Society, by a committee of the State Conference of local health officers, and by a committee of the State Board of Health, all of which organizations have recommended the amendment of the law, and it is hoped that the law may be amended at this coming session of the legislature.

State Hospital for Consumptives.

Although consumption is now well known to be a dangerous communicable disease, and one which among intelligent and well-to-do people is one of the easiest diseases to restrict--by the careful destruction of the infectious sputa—yet that disease still continues to destroy more people in Michigan than does any other disease. The State Board of Health has long recognized the fact that it can never be avoided by the most intelligent and most conscientious classes of our people so long as the ignorant and poor people afflicted with that disease are permitted and by circumstances are forced to continue to infect crowded work-shops, factories, schools and public places. The law requires cases of dangerous communicable diseases to be reported to the local health officer. An important question is what shall be done relative to those consumptives, of both sexes, who, when reported, are found at that stage of most danger of spreading the disease, whom circumstances require to continue to labor, and who have not been taught and who cannot easily be taught how to avoid spreading this most fatal disease to others?

Previous to the last session of the legislature, the State Board of Health had given this subject much consideration. It was considered by the State Conference of local and State health officials, at Ann Arbor in 1894, and resolutions unanimously adopted as follows:

"Resolved, That it is the judgment of this Conference of Health Officers and other delegates of Michigan Boards of Health, that consumption (and other diseases due to the Bacillus tuberculosis) should be included in the list of 'Diseases dangerous to the public health,' referred to in Secs. 1675 and 1676 Howell's Statutes, requiring notice by householders and physicians to the local health officer, as soon as such a disease is recognized.

"Resolved, That we recognize the following facts:

"1. That tuberculosis is the most grave and fatal disease now affecting the health and lives of the people of this State, destroying about three thousand lives per year;

"2. That this disease originates principally by transmission from man to man or from man to animals and again to man;

"3. That the spread of this disease can be best arrested by the disinfection of the sputa and other discharges, by special supervision of those infected, and by the care of such persons under conditions which will prevent the transmission of the disease to others;

"4. That such disinfection and supervision cannot be carried out in the crowded houses of the poorer classes; and

"5. That, under conditions which will prevent reinfection, many consumptives may be permanently cured, and return to their homes and work, educated in the methods of restricting the disease. In view of these facts;

"Resolved, That this Conference, by its officers, respectfully memorialize the next Legislature for an appropriation sufficient for the purpose of building, equipping and maintaining a State Hospital for Consumptives.

"Resolved, That the planning, construction and equipping of the State Hospital for Consumptives may well be entrusted to the State Board of Health.

"Resolved, That the location of the Hospital should be such that it may be accessible by railroad to the thickly-settled parts of the State, and such as to permit of out-door exercise and light out-door labor whenever the weather will permit.

"Resolved, That although consumption is the most dangerous communicable disease, a hospital can be so planned, equipped and managed as that it shall not seriously endanger the neighboring inhabitants; and as it is desirable that it shall contribute the largest amount of sanitary education to the teachers and to the people of the State, therefore,

"Resolved, That it is the judgment of this Conference that the proposed State Hospital for Consumptives should be located at the seat of the State University at Ann Arbor, in order that it may afford the best opportunities for the observation and study of this most important disease, in conjunction with the investigations now being so satisfactorily pursued in bacteriology and other departments of sanitary science, at the State Laboratory of Hygiene.

“Resolved, That this Conference hereby respectfully memorializes the Legislature of Michigan at its next session to take such action as will result in a knowledge of the extent to which the dairy cattle and other animals supplying milk, meat or other food products to the people of Michigan are infected with tuberculosis. Also that it take such action as will tend to stop the spreading of tuberculosis among animals, and from animals to man."

Pursuant to this action, the State Board of Health carefully prepared a bill to establish a State Hospital for Consumptives, and the bill was introduced into both houses of the legislature, it being "Senate bill 433" and "House bill 828." Neither of these bills was given any consideration whatever by the legislature. A copy of the bill is printed on pages xxviii-xxx of the Annual Report of the State Board of Health for 1895.

The question which the State Board of Health wishes to have placed before the present legislature is: Is general poverty and "hard times" a valid reason for not considering a plan designed to lessen, among the people generally, one of the most common causes of poverty and "hard times," namely that most general disease which causes most deaths and most prolonged and expensive sickness and disability for productive labor?

The Regulation of the Practice of Medicine.

At the present time, any person taken suddenly too ill to dictate what physician shall be employed, is liable to be placed in the care of some pretender who holds himself out as a physician. When able to select a physician, people generally have no way whereby they can well judge of the extent of the education and skill of those who appear to be

physicians. Lawyers are not permitted to take charge of the legal interests of the people, which, usually, relate only to pecuniary affairs, except that they shall first pass an examination tending to show them to be qualified for such duties. Physicians deal always with the interests of life and health; yet in Michigan the legislature has not provided for guarding those great interests as well as it has those interests connected with legal controversies.

Recently systematic effort has been made by so-called medical colleges in adjoining States to induce persons in Michigan to purchase diplomas, so that they may register as physicians under the present very imperfect law. Numbers of persons who were not qualified to practice medicine have applied to the county clerks, and in some instances have been permitted to register and enter upon practice as physicians, upon the claim that they were entitled to do so because of such diplomas purchased without their having attended any medical college.

The public health suffers, in many ways, through the ignorance of those who assume to practice medicine: (1) The health and life of persons who come under the care of unqualified physicians are endangered by their ignorance. (2) Dangerous communicable diseases occur in their practice, and such doctors fail to recognize and report them to the local health officer, the disease is not restricted, and unnecessary sickness and loss of life results. (3) Such medical practitioners do not realize the importance of many of the subjects on which the State Board of Health advises the people, consequently they fail to coöperate for the restriction and prevention of diseases. (4) Some of these unqualified persons are chosen as health officers, and thus the health interests of whole communities are jeopardized.

The present law-Act 167 of 1883, as amended by Act 268 of 1887permits any person to practice medicine in Michigan who is a "graduate of any legally authorized medical college in this State or any (one) of the United States, or in any other country." As medical colleges located in adjoining States and claiming to be "legally authorized" advertise extensively in Michigan, and thus induce many unqualified persons to purchase diplomas without attendance at such "colleges," the law is not a sufficient protection. Another serious defect in the law is that it leaves with the several county clerks the decision of who are graduates of legally-authorized medical colleges, and these officers are unable to obtain the necessary information.

The law should be amended so as to require one State commission or board with a central office at the State Capitol to collect the facts which will make it possible to decide not only who are graduates of legally authorized medical colleges, but also who are properly qualified to be entrusted with the health and lives of citizens of Michigan. The law should not permit the registration of any physician except after examination of the physician, or of his diploma and positive knowledge of the standing of the medical college which granted his diploma.

It is probable that the philanthropic medical profession of the State would willingly contribute, as re-registration fees, sufficient money to carry out the provisions of a good law on this subject. Or those hereafter admitted to practice may be made to meet the expenses. But in the opinion of this Board this subject is of sufficient importance to the people of the State to warrant the expenditure of the public money necessary to secure protection from the present evils.