0^03 
 
 /W € 
 
 PAST A^HSTID PRESENT 
 
 IN MICHIGAN. 
 
 By HENRI B. BAKER, Secretary State Board of Health. 
 
 [Reprinted frorn the Annual Report of the Secretary of the Michigan State Board of Health, for the 
 
 Fiscal Year, 1893.] 
 
 [Reprint No. 443.] 
 

PAST AND PRESENT MOVEMENTS FOR SANITARY PROGRESS IN MICHIGAN.* 
 
 BY HENRY B. BAKER, SECRETARY STATE BOARD OF HEALTH, LANSING. 
 
 Mr. President, and Members of the State Eclectic Medical and Surgical 
 
 Society : 
 
 Gentlemen: — As executive officer of the State Board of Health, I 
 have to thank you for the invitation, by your committee of arrangements, 
 to place before you a statement of the “Past and Present Movements for 
 Sanitary Progress in Michigan.” On account of the long period of time 
 during which I have been engaged in “Movements for Sanitary Prog- 
 ress,” having been in public-health work for this State since 1870, I 
 shall venture, in this address, to comply with the suggestion of the Chair- 
 man of your committee of arrangements, and suggest a few directions in 
 which, according to my judgment, future movements for sanitary progress 
 may well be pushed. 
 
 Vital Statistics — Experience has proved, I think, that the collection 
 of statistics relating to deaths has generally led to movements for sani- 
 tary progress. In Michigan, an effort was made, by Dr. Foster Pratt and 
 others, as long ago as 1857, for a State law providing for a system of Vital 
 Statistics; but the present law was not enacted until 1867. The law was 
 amended in 1869, but it is still very defective in that the deaths are not 
 recorded sometimes until more than a year after they occur, so that many 
 are forgotten and never recorded. The law should be so amended that the 
 essential facts, relating to each person who dies, shall be plaoed upon 
 record immediately after the death occurs. The plan recommended by 
 statisticians is to require such records to be made before a burial permit is 
 issued. In order that the statistics shall have the greatest value, the law 
 should provide that the records of the causes of death — that is to say the 
 name of the disease and the immediate cause of death, of each decedent 
 shall be certified by a physician. It would be well if these statistics could 
 be collected and compiled by physicians; because if it is done by non- 
 prgfessional persons errors are usually made which impair the value of the 
 statistics. Under the present law in Michigan they are collected by non- 
 professional persons. If they were collected by the health officers most 
 of the errors due to ignorance of professional terms would be avoided 
 because most of the health officers in Michigan are physicians. 
 
 Notwithstanding the imperfections in the law for their collection, the 
 mortality statistics are very valuable. The omissions in the returns are 
 probably about the same in each year, so that one year can profitably be 
 compared with another. Probably, as a rule, one disease is about as well 
 reported as another, so that the relative importance of the several diseases 
 can be learned form the statistics. The same may be true as regards ages 
 of decedents, so the relative mortality at the different ages may perhaps 
 be accurately learned. Therefore, it must not be concluded that because 
 
 *A paper read, by invitation, before the annual meetiog of the State Eclectic Medical Society, at 
 LansiDg, May 10. 1893. 
 
 
CX1V STATE BOARD OF HEALTH.— REPORT OF SECRETARY, 1893. 
 
 the vital statistics are Dot perfect they are not useful. The point I want 
 to make is that it would not cost more than it now does to make them 
 almost perfect, and that ought to be done. 
 
 General Surface and Subsoil Drainage. — In an early period in the 
 history of Michigan, commissioners sent here from Washington to inves- 
 tigate -and report on the geographical features of the State, reported that 
 the State was of no value, because so much of it was swampy. Many 
 years later the U. S. Government donated large amounts of land for drain- 
 age purposes in Michigan. When this was a new State, Dr. Wyman, 
 member of the State legislature, from Lenawee county, introduced a bill 
 which became one of the first, if not the very first general law for the 
 drainage of low lands in Michigan. Such laws have now been in force 
 for many years, and have been a very important movement for the 
 advancement of the public health. The drainage laws always specify that 
 the drainage is for the benefit of the public health. During the early 
 years of its existence, the State Board of Health did much to favor the 
 drainage of low lands. Dr. Henry F. Lyster, a member of this Board, 
 especially devoted much time, thought, and labor to this subject, and sev- 
 eral of his papers attracted considerable attention. Incidental to the gen- 
 eral progress throughout the State, immense progress has been made in 
 the drainage; thus the building of State roads and the building of rail- 
 roads, with ditches on either side, has done much to drain the surface. 
 The clearing of swamps, for agricultural purposes, has done much. The 
 tile drainage of land has contributed. One result of all this work is that 
 today Michigan is the best State in the Union, as a home for healthy, 
 prosperous people. But the point I especially wish to make is that the 
 general surface and sub-soil drainage of the soil has constituted one of the 
 most important “Movements for sanitary progress” which has occurred 
 in Michigan. Those of you who, like myself, were here in an early day 
 will remember that nearly every person who came into this State soon had 
 the ague; many had it till they “wore it out” as the saying was in those 
 days. Now it is very different, — intermittent fever is not so very com- 
 mon. Much of that sickness disappeared many years ago. But intermit- 
 tent fever is still being reduced, — this movement is still in progress. 
 Recently I have prepared a diagram for the Columbian Exposition show- 
 ing the great reduction in the sickness from intermittent fever in Michi- 
 gan in recent years; and I have copies of that diagram, reduced in size, 
 here for distribution.* By examining it you will see that whereas during 
 the five-year period, 1877-81, the per cent of all reports, made by phy- 
 sicians to the State Board of Health, whioh stated that intermittent fever 
 was under observation, was 81, while during the period ten years later 
 (1887-91) the per cent was only forty-three, a reduction of nearly half of 
 the sickness in ten years. This reduction in the sickness has coincided 
 with and followed the several general movements for the surface and sub- 
 soil drainage of the soil, some of which movements have had the benefit 
 of the public health as the avowed object of the work. I believe that the 
 reduction in the sickness has been caused by the drainage, and by the 
 changes associated therewith. These ohanges have cost much money, but 
 the money values of the results are immensely greater; and the value of 
 the decrease in the sickness cannot well be estimated. It is safe to say 
 that the heaviest pecuniary tax upon the people has thereby been done 
 away with. 
 
 ♦ The diagram ie printed on page cxv. 
 
NO. 15 .- DECREASE OF SICKNESS FROM INTERMITTENT FEVER. IN MICHIGAN . 
 
cxvi STATE BOARD OP HEALTH,— REPORT OF SECRETARY, 1893. 
 
 The State Board of Health Movement. — The movement for the cre- 
 ation of the State Board of Health in Michigan began in 1870. I take 
 great pleasure in the fact that I had the honor of starting that movement. 
 One of the first articles published on the subject was in the “University 
 Medical Journal,” then published at Ann Arbor. One of the lines of 
 thought that led me toward the idea of a State Board of Health, was that 
 so thoroughly impressed upon me by three years of service in the medical 
 department of the U. S. Army, during the great war. In the army the 
 surgeon is paid as much when none are sick as if all are sick; his interest 
 and his training lead to the study and practice of army hygiene. Again, 
 the usefulness of general officers for the coordination of the efforts of all 
 small organizations is strongly taught and exemplified in the army, which 
 without such general organization would be only an inefficient mob. 
 Before the establishment of the State Board of Health, the laws of Michi- 
 gan provided for a board of health in every township, city and village in 
 Miohigan; but there was no such local board which was worthy of notice; 
 not even in the largest cities. What was lacking was the generalizing 
 center, to put life, activity, and regularity into the numerous but inactive 
 local boards. The State Board of Health was needed also, to collect 
 important facts from all of the local boards, and to make all such facts 
 available for the use of each and all of them. The State Board of Health 
 was established just twenty years ago, in 1873. The movement for the 
 establishment and for the continuance and proper maintenance of the 
 State Board of Health, deserves to rank as one of the most important 
 “Movements for Sanitary Progress in Michigan.” To most people, who 
 have not given the subject special attention, this will be more apparent 
 after their having investigated the subject. There will not be time at my 
 disposal at this time to enter fully into the investigation; but I wish to 
 mention a few facts bearing upon this subject: 
 
 About as soon as the State Board of Health was established it began 
 to labor for the restriction of scarlet fever. Some (physicians even) 
 combated its teachings to the people that scarlet fever was a dangerous 
 communicable disease; but the State Board of Health kept right on. I 
 have here copies of a diagram, accurately drawn to scale, exhibiting the 
 deaths per ten thousand inhabitants in Michigan before and since the 
 establishment of the State Board of Health, as shown by the statistics col- 
 lected by the Secretary of State.* The mortality statistics are collected, 
 by the Secretary of State, by the same plan now as before the establish- 
 ment of the State Board of Health. There has not been any material 
 change in the plan, probably not much change in the results. The death- 
 rate from scarlet fever since the establishment of the State Board of 
 Health is only about half what it was before. One-half the mortality 
 from scarlet fever is stopped, prevented ; of the children who by the 
 former death-rate would have died from scarlet fever, one-half now live. 
 A great waste of life and treasure has thus been very greatly lessened. 
 
 If this evidence were confined to the mortality statistics only, one might 
 still question whether this great reduction was not due to the better suc- 
 cess of physicians in treating the disease. But the best system of sick- 
 ness statistics in the World has been built up by the Michigan State 
 Board of Health, and the evidence of the sickness statistics collected by 
 the State Board of Health, confirms the mortality statistics, collected by 
 
 * The diagram is printed on page cxvii. 
 
4IVES JAVED FROM: SCARLET FEVER (17 YEARS) 7,265; WALL-POX (17 YEARS) L*2I> TYP H OlO FEVER (12 YEARS) 1,671 
 
 'V*.. 
 
 LIVES. SAVED BY PUBLIC-HEALTH WORK, 
 COMPARISON OF DEATH-RATES IN MICHIGAN 
 FROM SCARLET FEVER AND SMALL-POX BE-* 
 FORE AND SINCE THE STATE BOARD OF 
 HEALTH WAS ESTABLISHED AND FROM TY- 
 PHOID FEVER BEFORE AND SINCE ITS RE- 1 
 STRICTION WAS UNDERTAKEN BY THE STATt 
 BOARD. COMPILED FROM STATE DEPART- 
 MENTS “VITAL STATISTICS'" OF MICHICAN. 
 
 REPORTED DEATHS PER 10,000 INHABITANTS. 
 
 typhoid fever. 
 
 SCARLET FEVER. 
 
 SMALL-POX . > 
 
 1869-73. 
 
 1674-90, 
 
 (SINCE) 
 
 1869-73. 
 
 1674-90 
 
 (SINCE) 
 
 1869-78. 
 
 1879-90. 
 
 BEFORE 
 
 (BEFORE) 
 
 (BEFORE) 
 
 (SINCE) 
 
 4.85 
 
 2.24 
 
cxviii STATE BOARD OF HEALTH.— REPORT OF SECRETARY, 1893. 
 
 the Secretary of State. And it proves that the sickness also has 
 been reduced. I have here copies of a diagram exhibiting by months 
 the relative amount of sickness from scarlet fever in Michigan in 
 two periods, ten years apart, namely from 1877-81, and from 1887 to 1891. 
 From this diagram you will see that there was a great reduction in the 
 sickness from scarlet fever — a decrease of over one-half of the sickness, in 
 recent years.* 
 
 By other systems of reports to the State Board of Health, we gain a 
 knowledge of how this great reduction in the sickness from scarlet fever 
 was accomplished. As you all know, the law provides that every case of 
 "‘disease dangerous to the public health” must be reported to an officer of 
 the local board of health. The law also requires that the local officer shall 
 Teport to the State Board of Health, the local health officer being required 
 to “keep the Secretary of the State Board of Health constantly informed” 
 respecting every such disease in the local health officer’s jurisdiction. On 
 receiving notice of such a disease, there is sent, from the Office of the 
 State Board of Health, pamphlets telling how to restrict that particular 
 disease ; and the health officer is requested to distribute the pamphlets to 
 the neighbors of the person sick. When this is done, some of the neigh- 
 bors of a house placarded for a dangerous disease, are likely to read the 
 pamphlets, and then be more ready to cooperate with the health officer for 
 the restriction of the disease to their neighbor’s house. After the out- 
 break is over, the health officer is required, under the law, to report the 
 facts to the State Board of Health. I have here copies of diagrams which 
 have been compiled from the reports made by the health offioers; the dia- 
 grams are accurately drawn to scale, and exhibit the average cases and 
 deaths per outbreak in all outbreaks in which isolation and disinfection 
 were neglected, compared with all outbreaks in which isolation and disin- 
 fection were enforced. f You will see that there has been a very great differ- 
 ence between those outbreaks in which isolation and disinfection were 
 neglected and those in which these measures were enforced. The total 
 number of outbreaks reported during the five years, 1886-90, was 1,857. 
 It is reasonable to believe that if isolation and disinfection had not been 
 attempted, all outbreaks would have averaged as did those in which these 
 measures were neglected (13.29 cases and .69 deaths per outbreak); and 
 that if in all the outbreaks isolation and disinfection had been enforced, 
 all outbreaks would have averaged only as many cases and deaths as did 
 those in which isolation and disinfection were enforced. If this is cor- 
 rect, then there were prevented from scarlet fever in Michigan during the 
 five years, 1886-90, over thirteen thousand cases of sickness, and nearly 
 seven hundred (690) lives were saved. 
 
 The same diagram includes the evidence relative to diphtheria, concern- 
 ing which the same methods of work are employed by the State Board, 
 and nearly the same by the local boards of health in Michigan. It may 
 be seen that when isolation and disinfection were neglected the average 
 cases of diphtheria were about the same number as were the cases of scar- 
 let fever; but the deaths were about four times as many as they were from 
 scarlet fever. Also that the indicated prevention of sickness and the saving 
 of lives were both greater from diphtheria than from scarlet fever; there 
 having been over fifteen thousand oases of sickness from diphtheria, and 
 over twenty-seven hundred deaths from that disease, prevented by isola- 
 
 * The diagram is printed on page cxix. 
 t The diagram is printed on page cxxi. 
 
r DECREASE OF SICKNESS FROM SCARLET FEVER, IN MICHIGAN 
 
 Curees rtpnsintt ntj Sit h, nest from Scarlet Fever in JhicKigan during two periods of gears, 
 J&T7 m &/ t end 1887- ft. During Ihe first five- gear period the average per cent of reports is XI, 
 during lAf Inti fine-year period it is decrease of over otic-half of the sicKness. 
 
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 'A £ *5 ^ * 
 
 f* a .5^ §*> sL a>‘ « 
 
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 $5 
 
 to 
 
 75 
 
 76 
 65 
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 55 
 
 * Indicating mhal per cent of all reports received sided Hie presence of starbel fever then under the 
 obsrnt.lt on aj the physician s reporting. 
 
 _ QierflOQt) wrrlUij reports of stcKness tort received for the first pericd.and over XH-,000 for the last period. 
 
cxx 
 
 STATE BOARD OF HEALTH.— REPORT OF SECRETARY, 1893. 
 
 tion and disinfection, in Michigan, during the five years 1886-90, 
 inclusive. 
 
 As executive officer of the State Board of Health, it is a great pleasure to 
 me to be able to place before you these evidences of the exceedingly 
 important work which has been done by the local health authorities, and 
 the people of Michigan during recent years. 
 
 So far as relates to the great reduction in the sickness and mortality 
 from scarlet fever and diphtheria in Michigan, it is not mainly due to 
 drainage of the soil, to general sanitary improvements, to advances in the 
 strictly medical soiences, nor to improved therapeutic measures, although 
 there have been great advances along all these lines. As we are now able 
 to prove, the reduction in those diseases has been due mainly to two 
 measures — isolation and disinfection. 
 
 In this great work, the part which the State Board of Health has had, 
 is the education of the people generally throughout the State, concerning 
 the contagiousness of scarlet fever and diphtheria, the facts that both 
 these diseases can be restricted by isolation and disinfection, and in the 
 best methods for accomplishing these measures. The statistics, also, col- 
 lected by the Michigan State Board of Health, have done much to plaoe 
 all these facts upon a scientific basis. 
 
 The methods which this State Board employs for the collection of data, 
 and the spreading of information throughout the State, have already been 
 mentioned. These methods are of interest to all who enjoy studies in the 
 sooial sciences; but, on this occasion, we have time only to glance at 
 them. The main central ideas, relative to the spreading of information, 
 are to obtain, at the time of the occurrence of each disease, information, 
 of the township, city or village in which each disease is ; and to secure, 
 in each such township, city or village, the distribution of pamphlets and 
 diagrams which plainly tell just how to restrict and prevent the disease 
 whioh is then and there present. Sooner or later every portion of the 
 State thus receives this information, at just the time when the people are 
 most interested in the subject, namely at a time when a dangerous disease 
 is threatening their own neighborhood. These methods for the education 
 of the people of Michigan, as to what to do to be saved from the danger- 
 ous communicable diseases, have now been in operation for many years, 
 and it is believed that the people of Michigan are much better informed 
 on these subjects, which are of vital consequence to their happiness, than 
 they would be if such methods had not been maintained. 
 
 The State Board of Health Aids New Health Officers. — One 
 more function of the State Board of Health may well receive a passing 
 notice; I refer to its aid to newly-appointed health officers. There are 
 now in Michigan about fifteen hundred health officers. In every year a 
 few hundreds of these go out of office, other officers take their places, 
 some of whom are entirely new to the work, and have much to learn in 
 order best to guard the life and health of the people in their jurisdictions. 
 On receiving notice of the appointment of such officers, the State Board 
 sends to each such health officer, a number of diagrams, blanks, and pam- 
 phlets which, if carefully studied, will enable the local health officer to 
 have a good knowledge of the laws relating to the public health, and of 
 the best known methods for dealing with each of the most important sub- 
 jects with which the local health officer usually has to deal. 
 
 The Movement for Better Quarantine. — In 1885 cholera was threat- 
 ening this country, and the legislature of Michigan enacted a law giving 
 
ISOLATION AND DISINFECTION RESTRICTED 
 SCARLET FEVER AND DIPHTHERIA IN MICHI- 
 GAN DURING THE 5 YEARS 1886-90. 
 
 SCARLET FEVER. 
 
 IS OLATION AND DIS INFECTION 
 
 neglected .inI1 ewforced .in 
 
 DIPHTHERIA. 
 
 ISOLATION AND DISINFECTION 
 NECLECTED t IN ENFORCED , IN 
 
 .366 OUTBREAKS, 
 AVERACE 
 
 361 OUTBREAKS, 
 AVERAGE 
 
 CASESDEATHS CASES. 
 
 317 OUTBREAKS, 
 AVERACE 
 
 CASES DEATHS 
 
 252 OUTBREAKS, 
 AVERAGE 
 
 CASES DEATHS. 
 
 TOTALS tO UTBREAK 8,1,85 7;CA8ES,N, 31 2sDEATHS,5 9 1 
 INDICATED SAVING OF CASES 13.29 X 1,857 * IF, 312 s I3,3'b8' 
 INDICATED SAVINC OF LIVES .69 X 1,857 • 591 : 690 
 
 %\eik4*i Culkrte** rlitritf Vlyiu ted" »r ‘fnjtmJ 
 
 TOTALS. OUTBREAKS, l.985iCAS£S. II, 634|DE AT HS.2.S7t { 
 IN OICATEO SAVINC OF CASES 13.57 X 1.99511,634:18,302 
 INDICATED SAVINC OF LIVES 2.67 X 1,985-2,870:2.722 
 
cxxii STATE BOARD OF HEALTH.— REPORT OF SECRETARY, 1893, 
 
 to the State Board of Health power and money to maintain a quarantine 
 system. It so happened that the law was made useful for the prevention 
 of the introduction of other diseases which endanger the public health, 
 and, although cholera did not enter, there was soon greater need for efforts 
 to prevent the introduction of small-pox, which in 1885 was epidemic in 
 Montreal. Active measures were then taken under that law, and, although 
 small-pox spread to nearly every State near by, spreading to nine States, 
 no case came into Michigan after the quarantine was established. It 
 should be acknowledged, however, that the case which started the epi- 
 demic in Montreal was that of a sleeping-car conductor, on the Grand 
 Trunk Railroad, who contracted the disease in Michigan, it having been 
 brought from the State of New York before the quarantine system was put 
 in operation. 
 
 The same law has again been acted upon, since September last, to pre- 
 vent the introduction of cholera and other dangerous diseases. And it is 
 noteworthy that during the last quarter of 1892, while all immigrants’ 
 baggage coming into Michigan to stay was being disinfected, the sickness 
 statistics of Michigan show that there was an unusually small amount of 
 sickness in Michigan from many important diseases. This decrease in the 
 sickness has been attributed to the several lines of work done in Michigan 
 with reference more particularly to cholera, such as the disinfection of 
 immigrants’ baggage, just mentioned, the notices to local health officers, 
 of the arrival of immigrants, and the general cleaning up, which, in many 
 places in this State, followed the house-to-house inspections which were 
 carried on by local boards as has long been recommended by this State 
 Board of Health. 
 
 The State quarantine law, enacted in 1885, has been amended and 
 strengthened by the present legislature. The amendments took effect 
 April 26, 1893. 
 
 Present Movements for Sanitary Progress. — Although the duties of 
 the State Board of Health are the fulfillment of the laws as they stand, it 
 would be strange if the board did not find during its long-oontinued labors 
 how laws relating to the public health could be greatly improved, in some 
 respects. 
 
 Annual Public Sanitary Meetings. — Among the several movements 
 for sanitary progress, in which the State Board is now much interested, 
 may be mentioned the proposed law providing for a public meeting of 
 every local board of health, with the citizens of its locality, just before the 
 spring election, the fixing of estimates at that meeting, for work and for 
 expenditures during the coming year, and the making of reports, to the 
 people, of the work, and of the results of the work done during the year 
 then about to close. It is believed that if such a law is enacted, it will 
 supply the means whereby sanitary progress in Michigan will be very 
 greatly promoted. 
 
 Sanitary Inspector, and Special Investigation. — Whenever glanders, 
 rabies, or other dangerous disease in animals occurs in Michigan, the 
 State Live Stock Commission is able to send the State Veterinarian to 
 make a special investigation, and to recommend or take action for the 
 restriction of the disease. Much good has been thus accomplished. 
 Something similar has been done by the State Board of Health relative 
 to diphtheria, small-pox, etc., but the requirements relative to the people 
 are much greater than relative to animals, because there are so many more 
 cases of disease, and more localities where they prevail. And the duties 
 
SANITARY PROGRESS IN MICHIGAN. cxxiii 
 
 . of his office prevent the executive officer of the State Board of Health 
 from visiting so many localities. There is a bill before the legislature 
 designed to make a small appropriation to pay the expenses of an expert 
 inspector to visit and aid localities in investigating the causes of out- 
 breaks of diseases, and in restricting their spread. The special investiga- 
 tions would sometimes involve the analysis of samples of water from dif- 
 ferent sources, the examination of suspected milk supplies, and bacterio- 
 logical examinations to verify the diagnosis of diphtheria, cholera or other 
 disease. It is believed that, by the small outlay proposed, the causes of 
 many outbreaks now unknown could be brought to light, dangerous com- 
 municable diseases could be earlier determined, and many valuable lives 
 could be saved, and expenditures by the people reduced more than the 
 amount of the appropriation. 
 
 Past and Present Movements for the Regulation of the Practice 
 of Medicine. — At the meeting of your State society in Lansing two years 
 ago, I see, by the published report, that you had under consideration the 
 subject of the regulation of medical practice in Michigan. This is a 
 subject in which I have been interested since 1869, when I took part in a 
 discussion, in a legislative committee room in the old State Capitol. 
 Sanitary progress demands that the discussion go on until the legislature 
 shall enact a law which shall greatly advance the standard of requirements 
 of medical practitioners. Under present conditions, the most intelligent 
 of our citizens if taken suddenly sick and unable to direct who shall be 
 employed, are liable to be placed under the care of imposters, or poorly- 
 qualitied practitioners. 
 
 My belief is that no good law will be enacted until doctors, of all 
 classes, good and bad, cease to oppose the enactment of such laws. The 
 quacks, imposters, and incapables all oppose such a law. I believe they 
 would cease their opposition if they could be brought to realize what I 
 believe is the truth, that their own interests would be promoted by almost 
 any good law; because no law would interfere with any such class 
 already practicing. Those of us already in the profession need not fear 
 that we would be interfered with. But what I wish particularly to dwell 
 upon is the importance of guarding one movement for sanitary progress 
 from injury through some other movement. It has been proposed to do 
 in Michigan what has proved so disastrous in one or two other States, 
 namely combine the movement for the regulation of medical practice with 
 the movement for the maintenance of a State Board of Health. Wherever 
 this has been tried, the other sanitary work which ought to be done by a 
 State Board of Health has fallen far short of what it should have been. 
 This is a subject which involves hundreds, even thousands of human lives. 
 Because thousands of human lives have already been saved through meas- 
 ures which the Michigan State Board of Health has been able to establish 
 and maintain, which could not have been maintained if this Board had 
 been hampered with the execution of the law regulating the practice of 
 medicine. Of course, it is true that the regulation of the practice of med- 
 icine is a movement for sanitary progress, it is a movement whioh will 
 greatly promote the public health, but my plea is that the execution of 
 such a law be intrusted to a State Board specially appointed and specially 
 qualified to deal with that important movement. For my own part, I 
 should prefer to have some of the members of such an examining board, 
 selected from among the teachers in the several medical colleges; but I 
 would not permit any single college to control the entrances to the profes- 
 
cxxiv STATE BOARD OF HEALTH.— REPORT OF SECRETARY, 1893. 
 
 sion. And I would be content with a State Board, appointed by the Gov- 
 ernor and Senate, without any other restriction than that its members 
 should be reputable physicians or surgeons. Let us hope that all classes 
 of people will soon come to see that the best interests of all demand a law 
 for the regulation of medical practice. Then there will have been accom- 
 plished one more movement for sanitary progress in Michigan. 
 
 Again, I thank you very cordially for this opportunity to present to you 
 this theme; and I sincerely hope that your meeting here may be both 
 profitable and pleasant. 
 
1 1