GENERAL REPORT.

To the Honorable Senate and House of Representatives:

We congratulate the Legislature of New Hampshire that it has recognized, in the interests of the people, a claim which science and practical experience have demonstrated to be inseparably interwoven with not only the physical, but also the intellectual and moral, welfare of a state or nation.

We have accepted the trust imposed upon us with a deep sense of its high obligations and ever present responsibilities. We have undertaken the work in a field ripe for the harvest, encouraged and animated by the success of similar organizations in other states and countries, feeling confident that this department of the public service will, through its labors, receive the cordial endorsement of the people of the state.

Thus far our work has been largely that of organization; of putting in motion the various forces that are essential to the ultimate accomplishment of the greatest good, enlisting the interest and the aid of such co-workers as are able and willing to make some offering upon the altar of public good.

The intimate and inseparable connection of the physical with the moral and intellectual forces has too long remained unrecognized by the public. The factors which go to make up the component parts of our popular education have been too few, or misapplied; the natural compensation of forces has been too many times ignored. For the fullest development of the moral and intellectual faculties, a healthy physical organization is essential,— a harmonious blending and association of both natural and acquired forces. Children whose health is impaired in the many unventilated pens known as school-rooms are forever robbed of a part of their mental force, unrecognized, perhaps, because the

criterion of measurement is wanting; nevertheless, the inflexible law is brought into operation.

In the recognition of these fundamental principles we cannot overlook the fact, so closely allied are these three distinctive qualities, that whatever impairs one may bring a corresponding disaster to the others.

To distinguish the influences and conditions which, through obvious or subtle operations, affect the health of a community, and through that the capacity and attributes of mind and morals, requires the most comprehensive and exhaustive study of the physician, the sanitarian, and the scientist. No individual or association can undertake and carry along such a labor so well as the state; for authority must be delegated in this as well as in any other department in which the ultimate results are intended for all classes and conditions of the people.

The greatest and primary function of a State Board of Health is an educational one; hence the scope of its observations and duties should be unlimited, at least in all that pertains to the physical welfare of the citizens of the state; and to the attainment of such, the reciprocal relations of other forces, influences, and conditions must be recognized and studied.

The placard "Dangerous," put up at the many cross-roads, possesses the traveller with only a feeling of uncertainty and fear, without indicating to him the special danger, or pointing out the path of safety. So assertions, without convincing evidence, are closely akin to so many idle and ineffective words.

We place ourselves upon the broad platform, that a healthy equilibrium of forces is essential to the highest personal development; that whatever disturbs such an equipoise, however insignificant the cause may appear, is not to be ignored; that only through a healthy body can a healthy mind be secured; and that bad sanitary and hygienic conditions are the cause of many fatal diseases and impaired physical and mental organizations. If the premises are well taken, which we believe, it follows that the sovereign remedy is to be secured only by education.

As a temporary relief for existing evils, other and valuable work must be done. To insist that under certain circumstances water will drown a person avails nothing to the man who has fallen overboard: immediate rescue is his salvation. While we believe

that, in educating the masses upon those subjects which will demonstrate the dangers that result from bad sanitary and hygienic surroundings, we shall accomplish, eventually, better and more lasting results than can be secured by any other means, it by no means follows that our work embraces nothing else. Existing conditions, which to-day are sources of sickness, and which swell our mortality rates to almost criminal proportions, demand the interference of a more executive disposition than comes from the rehearsal of precepts.

The field of sanitary labor is not wholly an untrodden one;— hence our expectations and theories are based upon a foundation far more tangible than speculation. The claims of sanitary science are well established, and as thoroughly demonstrated as those of any other science; still there are innumerable problems yet to be solved.

While there are differences of opinion as to the specific character of certain diseases, the manner of diffusion, and the methods of individual treatment, there is but little questioning of the general conclusion, that many diseases which now claim many victims might be prevented if proper attention were paid to sanitary measures.

THE PROGRESS OF STATE MEDICINE IN THE UNITED STATES.

The wisdom of a department to consider the many vital questions which are embraced in the comprehensive term of State Medicine was long ago demonstrated by the English government, through the reduced rates of mortality that were exhibited as one of the results of the labors of that branch of the public service. In this country, although many philanthropic and public-spirited men long ago advocated persistently, though unsuccessfully, the merits of such labors, no legislative action was taken until 1869, when Massachusetts led the way by creating a State Board of Health; the next year California followed; since which time the work has constantly though slowly progressed, until in 1881 New Hampshire came into line as the twenty-seventh state that now has such a department.

The fearful ravages of yellow fever in the South in 1878 led Congress to seriously consider the subject of preventive medi

cine, and the result of such deliberation was the creation of a National Board of Health, with an appropriation ample for its labors.

The work of this and the various State Boards has already demonstrated the practicability of preventing many diseases. Memphis and New Orleans are positively protected against such terrible epidemics as occurred in 1878, and many times prior to that time.

The rates of mortality of many of our cities and towns have already been reduced, and some epidemics, which formerly were only self-limiting, are now within the control of human agencies. New local Boards of Health have been organized, and older ones stimulated and directed and advised through the State and National Boards. A greater interest has been awakened among the people, and in a few localities voluntary sanitary associations have been formed which have done a vast deal of good. New Orleans, Lynn, and Newport can attest to the value of the work of such associations.

The great progress which has been made in a few years in the United States, in State Medicine, is due solely to the fact that the evidence is conclusive that a large proportion of the deaths that annually occur from contagious and infectious diseases might be prevented; and that unsanitary conditions are the cause of not only many deaths, but much sickness, physical enervation, impaired constitutions, mental imbecility, and premature old age.

With this knowledge, increased powers and facilities have from time to time been granted to many of the State Boards of Health, and the active work, and cordial support from the people, of new Boards, is still further evidence of such progressive ideas.

The American Public Health Association has been largely instrumental in the work of sanitary reform by enlisting the attention of the press and the public, and by its auxiliary assistance to health boards and sanitary associations.

The different State Medical Societies, and the profession generally, with a personal disinterestedness highly creditable, are advocating the strong claims of sanitary science, and are giving valuable assistance to the various health organizations.

It is to be expected that opposition will be met from some