officer have been placed upon a definite basis, requiring knowledge, skill, good executive ability, and a full measure of common sense. The knowledge essential to a full understanding of the duties of a health officer cannot be obtained in a day, or even in a year. To commence with, he should have a good education, and should be a respected citizen in the community in which he lives. He should take at least one good sanitary journal, and should study the practical literature of hygiene. He should know definitely certain things relating to all the diseases with which he may be officially brought in contact-their cause, period of incubation, usual duration, the varying degrees of convalescence, how long isolation should be maintained, the method of disinfection-in fact, he should possess a knowledge of preventive medicine sufficient to direct all his official actions along exact and scientific channels. This is not less than what is or may be at any time required of a local health officer. But what have we in New Hampshire? How are the legal protectors of the public health, guardians against scarlet-fever, diphtheria, and a score or two of other no less prolific causes of death, selected? A board of health is elected at the annual town-meeting or is appointed by the selectmen, or possibly this latter board decides to serve in that capacity itself. This board, if it takes any interest in the public health questions of its town, writes the state board of health for "instructions." Circulars, laws, reports, etc., are forwarded, besides letters upon special subjects. By the end of the fiscal year the board has become fairly well qualified to perform its duties; but now comes the annual election, and a new board is elected, to go through the same course and to meet the same end as its predecessor. By this system, which is by no means infrequent, the town is prevented from ever possessing a really efficient board of health. We would, therefore, recommend to the legislature the enactment of a law providing for a board of health in every town, to consist of

three persons, with a term of office so fixed that one member only would be retired from the board each year, and one member elected to fill the vacancy. This would always ensure experienced men upon the board, thus rendering the local boards of health far more efficient than they are under the present method of election and appointment. We believe that such a plan would greatly increase the value of our public health service.

LUNACY.

The State Board of Health constitutes also the State Board of Commissioners of Lunacy. The functions of the board are: The inspection of asylums and institutions in which insane persons are confined, and to commit to the New Hampshire Asylum for the Insane, for remedial treatment, such indigent insane persons as the board may determine to be proper subjects for such treatment. Such cases

are supported, while at the state asylum, at the expense of that state. The operation of the law has been most salutary, as may be seen by an examination of the report of the Board of Commissioners of Lunacy.

In addition to providing remedial treatment for such persons in the pauper classes as need it, such treatment is also provided for the poor who, although not dependent upon town or county, are unable to bear the expense incurred at the state asylum.

Of the total number of persons committed for remedial treatment, by order of this board, during the past four years, 16.13 per cent. have recovered, and 5.37 per cent. have been discharged improved.

THE CATTLE COMMISSION.

As a factor of no small importance in the public health work, as well as for the stock raising interests, should be mentioned the State Board of Cattle Commissioners, of which the secretary of the State Board of Health is a mem

ber, ex officio. The work of the commission is devoted almost wholly to the suppression of tuberculosis among the cattle of the state. During the year 1893, two hundred and twenty one herds have been inspected, from among which one hundred and fifteen tuberculous cattle have been condemned and destroyed. Since it is a settled conclusion that tuberculosis (consumption) may be communicated to the human family by means of tuberculous meat and milk, the effort to stamp out the disease among cattle is of great public importance. A report upon this work may be found upon page 66 of this report.

CONSUMPTION.

The most formidable and fatal of all the diseases that affect the people of this and many other countries, is consumption. The true nature of this terrible malady has, within a few years, been revealed by means of the microscope and by experimental work in the bacteriological laboratories, such as the culture of the germ of the disease, inoculation of lower animals, etc. In fact this disease is now known to be dependent solely upon a germ which must be received from some prior case, either from man or tuberculous animals. This knowledge places consumption, positively and forever, in the list of communicable and preventable diseases, and it is the one malady above all others that will in the future receive the most attention from physicians, sanitarians, and the people as a whole.

Epidemics that slay, relatively, only a few will probably continue to cause temporary excitement in the community and will, of course, demand prompt activity on the part of health officials; but an effort, calm, steady, and continuous, based upon exact knowledge, with simple rules, must be inaugurated and maintained year in and year out to lessen the alarming prevalence of this silent and insidious disease. Fortunately such a work can be carried on without entailing any hardship upon the afflicted, without quarantine or

isolation. The following of a few simple rules, not especially troublesome or inconvenient, is sufficient to protect the other members of a family in which there is a case of consumption.

The energies of some of the state boards of health of this country are now being turned toward this disease. The campaign must be one of education, that every family, if possible, may be instructed in the means of preventing and restricting it. Considerable space has been given to this subject in the recent reports of this board. Elsewhere in this report we give specific recommendations for the prevention and restriction of consumption. A special circular, for general distribution throughout the state, will soon be issued from this office.

DIPHTHERIA.

The mortality from diphtheria has been gradually lessening in this state since 1889, in which year there were returned two hundred and ten deaths from this cause. It is not unreasonable to conclude that the reduction in the prevalence and death-rate of this disease is due largely, if not entirely, to the more energetic action of local boards of health, coupled with a better knowledge on the part of the public in regard to the true character of the malady and the measures necessary to restrict it. It is only in recent years that the communicable nature of diphtheria has been fully realized. A fear of it now pervades every community, so that isolation of individual cases is not only comparatively easy, but is demanded by the public. The law of the state requires every case of diphtheria to be promptly reported to the local board of health, the latter officers being instructed in the sanitary management of the disease by the State Board of Health.

This board also furnishes pamphlets on the "prevention and restriction of diphtheria," free of all expense, to local boards of health for general distribution, or to individuals.

From a sanitary stand-point, "membranous croup" must hereafter be treated as diphtheria by health officers. For an elucidation of this point see page 35 et seq. of this report.

SCARLET-FEVER.

Scarlet-fever in the past ten years has been remarkably lessened in New Hampshire, although it was slightly more prevalent during the year 1893. This increase was due to causes which in most instances might have been avoided. In some localities the spread of the disease was due entirely to the inefficiency of the local board of health—a neglect to isolate effectively and to disinfect properly in the first case, thereby allowing the disease to obtain a foothold. In one section there is strong evidence for the belief that the disease was quite extensively spread by a milk dealer. But there is one way in which scarlet-fever is spread that is not so easily controlled, to wit: Through the medium of very mild cases. Often these cases are not seen by a physician, and do not come under the observation of the health officer. Notwithstanding these facts, scarlet-fever is so effectually controlled under the present system of isolation and disinfection, that the mortality is small compared with its ravages before the inauguration of restrictive and preventive measures.

TYPHOID FEVER.

Typhoid fever is one of the diseases that is spread by sanitary indifference, more commonly through infected water-supplies, and which in years past has often prevailed endemically in many of our towns. In recent years its prevalence has been curtailed to a very marked extent by sanitary work. The introduction of public water-supplies in the cities and larger towns, which formerly depended upon surface wells that could not from the very conditions surrounding them be other than dangerous to health, has diminished typhoid fever very materially. The tabulated