health authority vested in a small board. Public health work has become more complicated and technical with the progress of modern civilization. It includes not only the knowledge of the medical man, but that of the engineer, the chemist, the bacteriologist, and the worker in many other specialties. Even after a code of regulations has been compiled it is of use only as it is applied in a definit way, and to accomplish this it is necessary to have the support of the community, the support not only of the good citizen but of the average citizen, that the regulations may be operativ upon the minority who, from opposition, indifference, or an exaggerated sense of personal liberty, is not willing to be guided by the judgment of the majority. As Emerson has said, a law can have only so much force as it has in the character of many

men.

Dr. Edward Jackson, Denver:

I was much interested in the paper of Dr. Biggs concerning the possibility of obtaining an efficient state sanitary code. State laws have given sufficient authority to local boards and commissions but the possibilities of state legislation have generally been supposed to be confined to the state legislature. This view has been a serious obstacle in obtaining efficient state health regulations. This difficulty has been felt by those administering the health ordinances in Denver, with reference to the milk supply. Denver has had an excellent health department for twenty years, and good regulations with reference to the milk supply but in all that time there has been an obstacle in the control of the portion of the milk supply coming from outside of the City. The lack of state requirements for the inspection of the dairies, cattle, etc., has interfered with the efficiency of the Denver regulations. As I understand Dr. Biggs' paper, the work of the legislativ state commission rests, like our interstate commerce regulations, on a comparatively small number of persons. If such a law, giving legislativ authority within certain definit lines with regard to health matters, operates well and is sustained by the courts of New York, it must have an important influence in other states. Health movements are held back by conflict of authority between states and local authorities, and between state and national authority, and every suggestion we obtain for the overcoming of these obstacles is of very great value. The increasing intercourse between communities raises this issue all the time. We have plenty of authority given to many local boards, but it is not worth half as much as it would be were it made statewide; and the problem is all the time passing beyond state lines. We must depend upon a small commission for efficient health regulations. It is impossible thru any state legislature to get a thoroly wise and effectiv sanitary code.

Dr. B. S. Warren, Washington:

The speaker just preceding me stated that the interstate regulations rested upon a very small peg. I don't think he realized the authority of the Acts of 1890 and 1893. These give the national health authority power to make

regulations. The authority to enforce reasonable regulations has been upheld by the United States courts in the California plague quarantine decision. So far as ascertaining where the disease may be, the Act of 1912 gave the United States Public Health Service authority to investigate the diseases of man without regard to state lines. The broad powers given to the United States Public Health Service by virtue of these three acts would appear to give ample authority for all reasonable regulations promulgated by the Service. The fact that the Act of 1893 did not have a penalty clause for violation of the Act does not weaken the law, as it is easily enforcible by the Department of Justice thru the United States courts.

Dr. Otto R. Eichel, Albany:

It occurs to me that several important facts may interest you in connection with the New York State Sanitary Code and its enforcement, namely, the statutory requirement that the Public Health Council, which enacts the Code, shall consist of six members, three of whom shall be physicians "and shall have had training or experience in sanitary science, and one shall be a sanitary engineer." The law also makes the Commissioner of Health a member of the Council. Therefore, of the seven members, five must have had training or experience in sanitary science. The law empowers the Council to prescribe the qualifications of local health officers, directors and sanitary supervisors of the state department, and of public health nurses,—and such qualifications have been prescribed.

Effort is being made to raise the standards and personnel of the local health officers upon whom depends very largely the routine enforcement of the Code. In the future candidates for appointment must be not less than twenty-eight nor more than sixty years of age, and shall have had certain special training or experience in public health work. To facilitate this the New York University and the University of Syracuse have prepared courses in public health for health officers. In order to meet the prescribed qualifications many health officers have enrolled for such instruction.

The 20, more or less, sanitary supervisors, who maintain general supervision over the work of the many hundreds of local health officers, were appointed two years ago from a competitiv civil service list. All of the men appointed had either special training or experience in sanitary work, and many of them had accomplished some definit constructiv public health work. The supervisor represents the State Health Commissioner in the field, and each covers a district which includes several counties, about 300,000 population, and about 60 local health officers. He acts as an advisory expert and superintendent, and is the essential link between the central state department and the local board. The advent of the sanitary supervisor has been welcomed by local authorities and already his services have become indispensable to them.

The work in New York State is progressing rapidly and there is a noticeable improvement in the standards and efficiency of the local health officers.

In all the larger municipalities there should soon be available for these positions men who have had special training or experience in sanitary science. The result will be constantly better enforcement of the sanitary code and other health regulations and a corresponding improvement in the public health itself.

Dr. George A. Hare, Fresno, Cal.:

It is interesting to note that the Academy is developing a clearing house for practical ideas in health legislation which seems difficult for legislators to obtain in many of our states. The thought I gathered from Dr. Biggs' paper is that the Public Health Council of New York has legislativ and executiv power over all the territory of New York and takes precedence of all local health authorities, with the exception of New York City. I should like to inquire why New York City does not come under the same jurisdiction? Dr. Eichel:

New York City not only has an old, highly organized, and very efficient health department, but its population is much larger than that of the rest of the State. It was therefore deemed entirely unnecessary and impracticable to include Greater New York in the general state health supervision. Dr. Jackson:

Would not the exception, made in regard to New York City not being under the jurisdiction of the Public Health Council, form a precedent for other states?

Dr. J. L. Heffron, Syracuse:

I think the situation is that the Health Department of the City of New York had been so highly organized and had done such splendid work that Dr. Biggs took the law in force in New York City as a model for the State law. As I understand it, the Council is not only a legislativ but an administrativ body.

Dr. Eichel:

In certain details the Code enacted necessarily corresponded with the New York City Code, but the New York City Code was not adopted as the State code. It is of interest to note that a number of municipalities throughout the State have adopted the State Code almost in its entirety as their local regulations, with various additions to meet local conditions.

Dr. Hare:

I have observed that if you cannot get what you want, it is well to want what you can get. New York has set an exceptionally good example in her Public Health Council work as outlined in this paper by Dr. Rucker. I think we shall watch with more than ordinary interest the working out of this plan.

Dr. Rucker, closing:

The vast regulatory powers which the Interstate Commission has all hang upon the Commerce Clause of the Constitution. Section 3 of the Act of February 15, 1893, provides that immediately after the passage of the Act that the Surgeon-General shall examine into all of the regulations of the states for the purpose of finding out whether such regulations are adequate for the prevention of the introduction of disease from abroad and the prevention of disease passing from one state or territory to another and that he shall aid the local and state authorities in the enforcement of these regulations. Should these regulations be found to be inadequate the Secretary of the Treasury shall promulgate regulations for the prevention of infectious and communicable disease from abroad and from one state or territory to another. If the state and local authorities are not willing to enforce such regulations the President shall take measures for their enforcement. There are also penalties of fine and imprisonment for infraction of any regulations made under any of these regulations. There are relatively few regulations,—only 32. The policy has been to pass only regulations which are reasonable-they have to be reasonable from the standpoints of sanitation and common sense to have the force of law. That is the secret of a good public health law. No public health law is worth the paper it is written on unless the people really want to obey it and really want to see it enforced. As a result there has been very little difficulty in getting the Interstate Quarantine Regulations obeyed. As time goes on these regulations will be enlarged but only as rapidly as they are assimilated. The Board which has charge of the preparation of these regulations for the Surgeon-General's signature and Secretary of the Treasury's signature goes on the policy that it will have nothing "dead" in the regulations. In sanitary work you get what you get when you get it, and you don't get ideals; you just get what you can get, and you are mighty thankful to get that. The psychology of Americans is such that if you try to bully them into doing a thing they will turn right around and go the other way as fast as they can, but if you explain a matter and show them they are getting a square deal you can get what you are going after. We have had too much sanitary regulation in this country. We have stuff on our statute books that is worse than useless, and which would never hold in court. Such regulation hurts the cause of public health. The general public in this country is nobody's fool, and people can tell when you are trying to fool them. If, on the other hand, they know you are telling them simply what ought to be done and are asking for their help, then health regulations will be shown to be worth while.

THE DRINK PROBLEM AND LEGISLATION.

By JOHN KOREN, A.B., Boston, Mass.

The differences of opinion about the drink problem appear to be irreconcilable. Many men and more women invest their peculiar doctrine of what should be done to prevent the consumption of intoxicants with a religious significance. They have elevated to a dogma the assumption that every use of liquor, not to mention its manufacture and sale, is sinful. In their eyes men cannot be white sheep, that is morally solvent persons, unless they seek dry pastures for themselves and others. their creed that drink is the chief source of human ailments,mental and physical diseases, poverty and crime. These conceptions bound their ideas of public policies seemingly to the exclusion of all others.

Opposed to this condition of mind-I cannot call it a reasoning opinion-stand those who hold that the liquor question does not present a purely moral issue but, in its public aspects, one of social expediency; and I submit that this view is compatible with as deep a realization of the ills that result from the abuse of drink and with as abundant a desire to counteract it as actuate the extreme reformers.

I said that the two points of view appear irreconcilable. At bottom the reason for this is that the radical among our presentday temperance reformers will not concede that one may be earnestly solicitous about the drink evil while denying the efficacy of their legal specific, and brand those who differ with them at least as unconscious advocates of wrong, if they do not impute to them base motives. I refer to this regretfully, not because the indiscriminate hurling of anathemas hurts much, but because the condition of mind back of it presents one of the greatest obstacles to progressive temperance reform.

To make this statement is to express the belief that the drink evil cannot be cured by sumptuary legislation. My reason for this conviction can be stated simply, and I trust without the acrimony of one who desires to provoke controversy.