Of the State boards, perhaps a fourth may be regarded as actively efficient. The rest are honorary and ornamental. Undoubtedly a majority would be ready and willing to perform the services for which they are not (as a rule) paid anything; but they lack any appropriation upon which to work. South Carolina, for example, has an excellent State board. Its president, Dr. Robert Wilson, is an able and public-spirited physician of the highest standing; an earnest student of conditions, and eager for the sanitary betterment of his State. But when he and his board undertook to get one thousand dollars from the legislature to demonstrate the feasibility of enforcing the pure food law and of turning away the decayed meat for which the State is a dumping-ground, they were blandly informed that there was no money available for that purpose. It was in South Carolina, by the way, that a medical politician who served on the public health committee of the legislature addressed 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]