ressed this question to a body of physicians who had come there to
appeal for certain sanitary reforms: "What do you want of laws to
prevent folks being sick? Ain't that the way you make your livin'?"
Which is, I fear, typical of the kind of physicians that go into
politics and get into our legislatures, where, unhappily, they are
usually assigned to the public health committees.

Under the State boards, in the well-organized States, are the county
boards and officers, who report to the State boards and may call upon
the latter for advice or help in time of epidemic or danger.

In certain circumstances the State officials may arbitrarily take
charge. This is done in Indiana, in Maryland, in Pennsylvania, and in
Massachusetts. The last State not only grants extraordinary powers to
its health executive, Dr. Charles Harrington, but it appropriated last
year for the work the considerable sum of $136,000. By the issuance
alone of vaccine and antitoxin, the Board saved to the citizens of the
State $210,000, or $74,000 more than the total appropriation for all the
varied work of the institution. Some vague idea of the economy in lives
which it achieves may be gained from the established fact that death
results in only sixteen out of every thousand cases of diphtheria, when
the antitoxin is given on or before the second day of the illness; 110,
when given on the third day; and 210 when the inoculation is performed
later. The old death rate from diphtheria, before antitoxin was
discovered, ranged from 35 to 50 per cent. of those stricken.

[Illustration: DR. THOMAS DARLINGTON

COMMISSIONER OF HEALTH FOR NEW YORK CITY, WHICH HAS THE MOST THOROUGHLY
ORGANIZED CITY HEALTH DEPARTMENT IN THE UNITED STATES]

Finally, there are the city bureaus, with powers vested, as a
rule, in a medical man designated as "health officer," "agent," or
"superintendent." What Massachusetts is to the State boards, New York
City is to the local boards, but with even greater powers. Under the
charter it has full power to make a sanitary code. Matters ranging from
flat wheels on the Metropolitan Street Railway Company's antiquated
cars, to soft coal smoke belched forth from factory chimneys, are
subject to control by the New York City Department of Health. The Essex
Street resident who keeps a pig in the cellar, and the Riverside Drive
house-holder who pounds his piano at 1 A.M. to the detriment of his
neighbor's slumber, are alike amenable to the metro