of locality, employment and condition upon health, and to diffuse information in regard to these things among the people.1

2. Clothing made in unhealthy workshops. Upon notification from the chief of the district police, it is the duty of the board to examine workshops in which clothing is made, and issue the necessary orders to protect the public health. It also has power to protect the public from clothing made in unhealthy workshops outside of the state."

3. Offensive trades. Upon complaint, and after notice and hearing, the board may order the discontinuance of any noxious or offensive trade or occupation in the place where it is at the time established. The location and plans of construction of all crematories,3 and of all swine slaughtering establishments, are subject to the approval of the board, and it may establish regulations for their government. Cities and towns must first secure its approval for taking or purchasing land for the purification and disposal of sewage.5

4. Food and drug inspection. The board appoints inspectors and chemists, and takes the necessary measures to enforce the laws of the state relating to the adulteration of foods and drugs. It may expend eleven thousand dollars annually for this purpose, but not less than three-fifths of this amount must be expended for the enforcement of the laws against the adulteration of milk and milk products."

5. Impure ice. Upon the complaint of twenty-five consumers of ice cut from any pond or stream in the commonwealth, the board, after notice, may give a hearing to determine whether the ice is impure and injurious to health. If found to be injurious, the board may forbid its sale."

Acts, 1888, 101.

3 Ibid., 1885, 265.

5 Acts, 1890, 124.

7 Ibid., 1886, 287.

2 Ibid., 1891, 357; 1892, 296.

Public Statutes, c. 107, §§ 2, 4, 5.

6 Ibid., 1882, 263; 1884, 289; 1891, 412.

6. Water supplies and sewerage. The board has the general oversight and care of all inland waters. It examines them to see whether they are adapted for use as sources of water supply or are in a condition likely to impair the public health. It recommends suitable plans for systems of main sewers and such other measures as it deems necessary for preventing the pollution of water supplies. It may conduct experiments to determine the best methods for the purification and disposal of sewage.1

The board has authority to make rules, regulations and orders for preventing the pollution of streams or ponds used as a source of water supply by any city or town, or any water or ice company. Upon the complaint of the authorities of any city or town or the president of a water or ice company, that the source of supply is being polluted by individuals, the board, after giving notice and hearing, may order them to desist.2

The board consults with and advises cities, towns, corporations, firms and individuals concerning the best source of water supply and the best practicable method of disposing of their sewage; and all such municipalities, associations and individuals must submit to the board for its advice plans of their proposed schemes in relation to water supply and sewage; and all petitions to the legislature for authority to introduce a system of water supply or sewage must be accompanied by the recommendations of the board thereon. It is the duty of the board to report to the attorney-general all cases of failure to comply with the laws relating to the pollution of inland waters.3

7. Infectious and contagious diseases. Local boards of health are required to notify the state board within twentyfour hours after obtaining knowledge of a case of a con3 Ibid., 1888, 375.

1

1 Acts, 1888, 375.

2 Ibid., 1897, 510.

tagious or infectious disease. Upon receipt of information that such a disease exists or is likely to exist in any locality, the board investigates the matter and consults with the local authorities concerning the best means of preventing the spread of the disease; and it may exercise powers coördinate with those of the local board of health. The board has established a plant for the production of antitoxin, for distribution to local boards, hospitals and physicians. It also examines the products of certain diseases sent to it by local boards and physicians for the purpose of determining the disease, notably diphtheria, tuberculosis and malarial fever.

8. Reports of local boards. Local boards of health in cities and towns of more than five thousand inhabitants are required to make annual reports of deaths to the state board, and according to the forms prescribed by it.3

The most important work of the state board has probably been in relation to its control over water supplies and sewerage. Eastern Massachusetts is so thickly dotted with populous cities and towns that central supervision has been absolutely necessary to prevent the streams from being turned into noisome sewers and to protect the water supplies from pollution. When individuals come together in cities a common system of sewerage and water supply becomes necessary; and when cities and villages are themselves closely crowded together as they are in that territory lying within about thirty miles of the state house at Boston, the problem of water supply and sewerage can no longer be left to each individual municipality. It then becomes necessary to provide common water supplies and common main sewers for a number of cities and towns. In this connection the state board has rendered valuable service. At the re

1 Acts, 1893, 302.

1 Ibid., 1894, 218.

3 Ibid.

SO

quest of the legislature it has made careful surveys and prepared elaborate plans for systems of sewers and water supply for extensive districts, and its plans have usually been carried out.

The work of the board in giving advice to local authorities, companies and individuals is extensive and is constantly increasing. Upon request, the experts in the employ of the board examine existing or proposed water supplies, make a careful analysis of the water and report the results. Plans for sewage disposal are also carefully considered. A systematic examination of the water supplies of the state was begun in 1887 and the work has since been continued.'

We see, therefore, that although the state board possesses

1 The death rate in Massachusetts has remained practically stationary during the past forty years in spite of the fact that the average density of population has doubled. Improved sanitary conditions have very nearly counterbalanced the unfavorable influence of increasing density. "Infectious diseases generally, including consumption, have diminished, while most of the so-called local diseases (those of the nervous, respiratory, circulatory organs, etc.), have increased, and the result has been a balance or a maintenance of uniformity in the general death-rate." See Report of the State Board of Health, 1896, pp. 711–829. The work of the state board, especially in the matter of water supplies and sewerage, has doubtless had a very great influence in bringing abont the decline in deaths from infectious diseases.

great powers, it can exercise little direct control over the local authorities. Its chief coercive powers are exercised upon the individual directly. In many cases its powers are simply co-ordinate with those of the local boards; either may act, but in case one acts there is no necessity for action on the part of the other. This is largely the case with reference to food and drug inspection, offensive trades, and contagious diseases. Municipalities, like other corporations and firms, must submit the plans of proposed water supply and sewerage systems to the state board for its advice, but are not compelled to follow the advice given. They must also make reports of deaths and contagious diseases to the state board; the requirement of reports is, however, one of the weakest forms of administrative control.

While the powers of the state board have been enormously increased, it has not been at the expense of the importance of the local boards. The work of the state board has resulted in increased local activity; separate boards of health have been established where none previously existed, and inactive boards have become more efficient. The state board reports that owing to the increased activity of the local boards, its interference in the matter of offensive trades is now seldom called for. A state association of boards of health has been formed for the discussion of matters pertaining to health administration. As the density of population increases, additional powers and duties are being constantly imposed upon the local boards.

There can be no question but that the maintenance of sanitary conditions in any part of the commonwealth is of vital importance to every other part of the commonwealth, but it does not follow from this that the public health administration should be completely centralized. The self-interest of the municipality can in the main be relied upon to lead it to take the necessary sanitary measures. The interests of