INTRODUCTORY. Early in its existence, the State Board of Health, recognizing both its opportunities for usefulness and the limitations in that direction imposed by a moderate yearly appropriation, as compared with the amounts at the disposal of some other state public health departments, devoted itself to those fields of practical work, in which there appeared to be the most urgent need, and contented itself with doing what was possible to do in the direction of original scientific work. Our principal calling, therefore, has been the protection of the public from those causes of disease and death which can be guarded against, the awakening of the people from their spirit of resignation to the inevitableness of pestilential and epidemic prevalences, a belief worthy only of an age of less general enlightenment than our own, and to making suggestions for the improvement of our public health laws. To do creditable work in these directions, it is above all things, necessary to furnish a free and self-govering people trustworthy knowledge about public and private hygiene. They must know the need of doing certain things and of not doing certain other things, and they must know somewhat of the reasons for doing or for abstaining from doing them. To make knowledge of this kind accessible and to popularize it, -to act as an intermediary between scientific workers and the public, has been a large and important part of the duty of the State Board of Health. This educational work has been carried on in three ways: 1st. Through the annual report. The aim has been to make this yearly volume the store house of that part of our current sanitary history worthy of permanent preservation and of papers of interest and of value to private citizens, local boards of health and physicians. 2d. Through circulars and health tracts, giving plain and concise information about health matters which everybody ought to know To render some of the most important elements of sanitary knowledge as far as possible a common possession of the people, the circulars are kept permanently in type and are supplied to members of local boards of health, physicians, clergymen, or to anybody else who will judiciously distribute them, or who wish them for their own use. Exclusive of blanks supplied to local boards of health only, the following circulars have been prepared : Form 21. Practical Facts about Cholera. Earth Closets. Small-pox, its Prevention and Restriction. Does Vaccination Protect? Treatment of the Drowned. Contagious and Parasitic Diseases of Animals. Rules for House Drainage. Diphtheria, Its Prevention and Restriction. Scarlet Fever, Its Prevention and Restriction. Isolation of the Infectious Sick. Motives and Methods for Sewering, Cities, Villages, and Summer Resorts, etc. Contagious Diseases and Contagion. To Teachers. Characteristics of the Infectious Diseases. Prevention of Consumption. 53. La Scarlatine. 3d. 66 64. La Prevention de la Consomption. The Sanitary Inspector, published monthly by the Board. It serves as a medium of communication between the State Board on the one hand and the local boards and the public on the other. It summarizes much of the most important current sanitary news within and outside the State, and gives information which should go into every household. Circumstances render it impossible to send this to the public as an entirely free gift, but its subscription price is made as nearly merely nominal as possible. Thanks to the universal brotherhood of the workers in the cause of public health, the investigations in the well endowed laboratories of Europe and of this country, and the results of the original work of those public health departments that have ample funds, are free and available to all who can obtain and read their works. A survey of the part of this work which the local boards of health are doing, whether in the role of instructors, or as the agents for the execution of our public health laws, gives reason for a good degree of satisfaction. The efficiency of the local boards generally we believe has steadily increased, and a candid examination of the extracts from their annual reports, we think, will substantiate what we say. In the first place, the number of boards reporting to this Board in 1890 is 400 out of a total of 430 towns, against 378 in 1889, and 338 in 1888. Again, it may be observed that outbreaks of diphtheria, scarlet fever and typhoid fever have in almost all instances been confined to the primary cases or the first family. In meeting and talking with members of the local boards, even when from the farms or shops of our smaller and more remote towns, we have often found a remarkably clear understanding of the duties of a local board of health and of the practical application of remedial measures to the prevention or mitigation of threatening conditions. Many of these duties require some degree of technical knowledge and skill of a kind which any intelligent person may master with a little careful attention, but the better with some practical experience in actual work. There is, therefore, a great advantage in the Maine law, which, in the normal course of events, provides that each member shall be appointed for three years, and that only one new hand shall come on the board at a time. With this optimistic view it must be admitted that there are chances enough for improvements in public health work. Infectious Diseases. Of the three most serious infectious diseases, diphtheria, scarlet fever and typhoid fever, it appears from the reports of the local boards of health, that there was only a moderate prevalence in the State generally. There were, however, a few notable local exceptions. Of 400 local boards of health, 120 expressly state that no cases of diphtheria, scarlet fever, or typhoid fever occurred during the year, and 40 other boards do not report cases of these diseases; or a total of 160 towns in which these dis eases are not reported as having occurred. Last year of 378 boards reporting, 159 contained no reports of these infectious diseases. Diphtheria. The reports show that during the year 1890, cases of diphtheria occurred in only 96 towns, as against 138 in 1889. The most serious and prolonged outbreak of this disease occurred in Eastport, apparently due to the causes set forth on pages 11-16. That any intelligent person acquainted with the studies which have been made into the nature of diphtheria in the last few years. should doubt its contagious and infectious qualities, is surprising; and that he, furthermore, should wish to influence his fellow towns-people to take risks with so fearful a disease, even if he entertains the doubt as to contagion, is still more surprising to say the very least. We feel strongly on this subject because we believe that every word of doubt, as to the communicability of diphtheria, every word which leads the people to act carelessly with diphtheria, is a great injustice to them, and often leads to lamentable consequences The people generally are all too ready to generalize from insufficient data. They know of cases of diphtheria from which the disease, as far as can be seen, has not spread although the circumstances seemed favorable for it to do so. Abundant evidence is at hand for just this sort of reasoning to show that neither scarlet fever nor small-pox are contagious The value of this negative kind of evidence is often unduly estimated. As showing the present position of this question, we would say that the leading medical teachers and sanitarians of the present day who do not believe in the contagiousness of diphtheria are very few indeed. We do not know of one of eminence at home or abroad. Diphtheria is to be steadily fought as one of the greatest enemies of child life. Children are to be guarded from its infection as one would protect them from that of small-pox. There is the more reason for doing this, in the fact that, with increasing age, the child outgrows, in a large measure, the susceptibility to the infection. This is well shown in the report made last year to the American Public Health Association, by the Committee on the Cause and Prevention of Diphtheria. Of 19,824 cases collected there were: "Seven per cent. under one year of age; fifty-seven per cent. between one and five years; twenty-eight per cent. between five and ten years; five per cent. between ten and twenty years; two per cent. between twenty and forty years; six-tenths per cent. between forty and sixty years; four-tenths per cent. over sixty years." Thus ninety-two per cent. of the cases occurred in children who had not passed the tenth year. Scarlet Fever. Scarlet fever was reported in 86 towns in 1890 as compared with 82 towns in 1889. In the great majority of outbreaks the disease appears to have been of rather a mild type, as it was in the preceding year. In the latter part of the year, our eastern border was threatened by the prevalence of scarlet fever in a serious form at some points just across the line in New Brunswick. The local board of Forest City, separated from the infection by only a narrow stream and a bridge, acted promptly, and did what it could to prevent the importation of the disease, but it was introduced in spite of its work. From the same source the infection was introduced into Brookton where a newly formed board of health did good work in stamping out the infection. The health officer of Vanceboro gives an instance in his report of criminal carelessness which resulted in an outbreak. In one town the physician attending a case of scarlet fever failed to notify the local board of health as the law plainly provides. The house, therefore, was not placarded; the child was not kept in the sick-room as long as she ought to have been, but was allowed to run out and play with other children while in an infectious condition. One of the playmates, a healthy little boy, had lately come on a visit with his mother, all unconscious of the danger so near. The boy took the disease and died. No wonder the feeling of the parents was one of bitterness for the great wrong which they felt had been done them. Small-Pox. There was but one ontbreak of this disease during the year. As is known to the residents of this State, it was imported by a sailor who it is believed contracted the disease in Porto Rico. The history of this little outbreak emphasizes anew the unreasonableness and the peril of neglecting vaccination, especially by persons who run as many chances of infection as the seafaring class. The master and owners of every ship ought to insist, as far as it is practicable, upon vaccination for their crews. One other piece of advice we think captains of vessels would do well to take willingly from motives of self interest; that is, to report to the quarantine officials at once, if, upon entering port, there is a suspicion of having on board a dangerously contagious disease. The quarantine of the present day is very different from |