be made. Here the state can render valuable assistance and maintain laboratories for the benefit of municipalities which can not have them.
In addition to the measures of prevention and suppression which have been mentioned reference should be made to the preparation and distribution of antitoxin by boards of health. Here we have an application of the laboratory principle applied to the production of a remedy rather than to the discovery of the cause of disease. Antitoxin is a curative measure which may be and is applied more often than not to isolated cases of diphtheria. The beneficent results which have followed the use of this agent in combating one of the most common and fatal of household diseases are unquestioned, but it must not be forgotten that in supplying antitoxin without charge, boards of health lay themselves open to the charge of competing with private manufactories which prepare the same product and are presumably in a legitimate business to make money.
Results seem to show that it is desirable for boards of health to supply antitoxin, but the principle involved is an interesting one. If antitoxin is to be supplied gratis by boards of health, should not those boards also supply disinfectants, concerning which there are no greater frauds in the American markets to-day? And if antitoxin and disinfectants, why not other things such as indispensable articles of clothing?
To enumerate all the functions of boards of health, local and state, would far surpass the necessary limits of this paper, but enough has been said to show warrant for endorsing most of the work being done to approve the extension of some and the limitation of others of the ever-growing activities of health bureaus. A long paper could be written on any of a dozen phases of this subject.
Taking a rapid review of the subjects covered here, we may remark first that boards of health have ample power. The standards of public health and municipal hygiene are continually growing higher.
The dangers from disease in gross epidemic form are becoming less and less, and in their place a new set of hygienic standards is being erected. Some of these new standards verge upon the realm of esthetics. To what extent boards of health are right in extending their efforts to improve municipal conditions which bear remotely, if at all, on disease and death, but undoubtedly affect public comfort, is a question for debate.
To be effective health work must be cooperative. Statistics must be promptly and accurately collected by the ultimate units of sanitary authority, municipal health boards, and transmitted to boards having jurisdiction over larger territory. Whether or not the largest unit of health control should be the state or the nation is a question which this paper need not discuss. It is to be remembered in this connection, however, that state boundaries are only imaginary lines and that some
