fact that genuine small-pox was among us, that the patient not feeling much sick would not call in a physicianincreased the difficulties of management. The exposures resulting from this were necessarily very numerous, and why so many unvaccinated persons escaped, as they unquestionably did, is a mystery. But strange as it may seem, the greatest trouble has come from our own profession. In some instances it arose from inexperience with the disease and the consequent failure to make promptly the correct diagnosis and report the case to the health officers. This was perhaps in some instances excusable, although it must be said that a knowledge of the elementary principles of sanitary rules or a regard for them would have insured the taking of the proper precautions. This, however, was a small matter compared to obstructions to the proper control of the disease which arose in another way, caused probably by unfortunate factional disagreements in the profession in certain communities-very few I am glad to say. I refer to the denial of the correctness of the diagnosis of small-pox by some physicians, thereby furnishing a centre for the intractable members of the community to rally around, and rendering the enforcement of the necessary regulations very much more difficult. Where the dissenting physician saw the case or cases in person it was doubtless an honest difference of opinion, but usually he refused. to visit the patient, while he continued to publicly express his opinions. With the lights before me, I can see no sufficient justification for this attitude on the part of a medical man. In the matter of disease, the physician occupies with the people a position of authority, and as a patriotic citizen, to say nothing of his professional obligations, the abuse of that high position, from whatever motive, in a way calculated to increase the misfortunes of his neighbors, is, to express it in the mildest possible terms, extremely indisIn every instance where the profession was united crete. no trouble was experienced, the authorities, both county and municipal, responding promptly to their suggestions. In addition to directing the movements of the inspector, I have written a great many letters to superintendents of health, mayors, county commissioners, and others, and have prepared two circulars-the first in July, 1898, which was sent with a letter to the editors of the newspapers of the State for publication, and the second in March, 1899, which was printed in the form of a poster, a copy of which is attached, which was sent to the superintendents of health with a letter requesting them to post in conspicuous places. On the whole, when we take into consideration the conditions already alluded to, and, in addition, the imperfections in our sanitary machinery, I think there is good ground for congratulating ourselves and the State that the various outbreaks have been generally so well managed and that so many of the people have been vaccinated. While there has been a good deal of opposition to vaccination, it is gratifying to know that several enterprising communities with officials of nerve carried it out under compulsion, going so far in more than one instance as to commit the recalcitrant to jail, or to work upon the roads, until a more enlightened frame of mind was reached. This is fortunate, for the seeds having been widely distributed, there is reason to fear a recrudescence of the disease next winter and probably in a severe form. The following is a tabulated statement of small-pox in the State from January 12, 1898, to May 1, 1899, when the last official report was received: LEGISLATION. In the early part of the session of the recent Legislature I sent a circular letter to all superintendents of health asking for any suggestions they might have to make as to the amendment of our health law. Many did not reply at all and most of those who did had no amendment to suggest. Among those expressing an opinion, one or two favored an increase in the powers of the Board, for which public sentiment was not yet ready, but most confined themselves to the method of electing the county superintendent of health. They were about equally divided between retaining the present plan of election by the county commissioners and returning to the old plan of election by the county board of health. After very careful consideration of the matter, I finally settled upon a compromise method which, in short, constituted a new county board of health, to be composed of not more than three registered physicians, the county commissioners and the mayor of the county town, which board would elect the superintendent and fix his salary. This was regarded by those with whom I discussed. it as a good solution of the difficulty, but knowing from experience how dangerous a discussion of any technical bill was, with no one on the floor thoroughly understanding it, I decided, after advising with some judicious friends, that the gain to be obtained was not sufficient to justify the risk, and abandoned it. I did, however, after a good deal of tribulation, succeed in securing the enactment of "An Act to Protect Water Supplies," which is an advance on the line of sanitary progress in the State. This matter is fully set forth in an editorial prepared for the May BULLETIN, which is now in press. But the most important legislation bearing on the public health for many years was the amendment of the medical license laws so as to require of all applicants for license a diploma from a medical college in good standing, requiring an attendance of not less than three years and furnishing such facilities for clinical instructions as should meet the approval of the Board of Medical Examiners. It is unnecessary to say that nothing is so important to the preservation of the public health in a community as the thorough and practical education of its physicians. Acting formerly in another capacity, as chairman of the Committee on Legislation of the State Medical Society, I had the honor of assisting in securing the enactment of the amendments. As the medical license laws, as amended, were printed in full in the April number of the BULLETIN, it is unnecessary to discuss this matter further, other than to congratulate the Board and the Society on now having the best medical license law in the country. The annual health conference was held in Winston-Salem on December 7, 1898. I thoroughly advertised it through the local newspapers, which were very kind in doing it, and by means of a circular-letter giving the programme, distributed in advance, but the attendance for a town of that size was a disappointment to us-caused in part, let us hope, by the uncomfortable climatic conditions prevailing at the time. As per appointment, I attended the National Conference of State and Provincial Boards of Health of North America for 1898 at Detroit in August last, and that for 1899 at Richmond the 23d and 24th of this month. These meetings, composed entirely of practical health officers and members of boards of health, have been of value to your Secretary in reviving his interest, stimulating his zeal and in broadening his views. They afford an excellent opportunity in private conversations and in public discussions to compare the work and methods of the different boards, and in conclusion I wish to say, as the result of such a com |