*

statute, are sufficient for the search for, seizure, inspection, destruction and disposal of, such injurious compounds or articles as may be legally declared suspicioned, and punishment for possession, manufacture or sale is provided for, though not to the extent that could be desired. As certain Acts require to be adopted by towns before being operative, officers of health should charge themselves with the duty of seeing that the requisite action is taken to make this power of law available. The most important of these Acts is that approved April 20, 1872. It has been found that the publication of the name of guilty sellers or holders of certain articles, has been by far the most efficient of the checks provided. The wise use of this lever is urgently recommended to boards.

The inadequacies of the law in this behalf, and valuable recommendations in reference thereto, are to be found in the last report of the State Board † in a special connection.

It cannot be doubted that a fast advancing public opinion will, erelong, fully recognize the importance of health over and above any squeamish objections to fancied disregard of personal liberty" and property rights, involved in the control of dangerous commodities.

tr

If a mad-dog and nitro-glycerine are dangerous, even though rarely present, agencies, and as such are unquestionably to be taken care of, how much more needfully and constantly so, the food of our infants and invalids, the substances on which our existence depends!

The numerous cases of ice-cream and confectionery poisoning recorded of late, the instances of sickness resultant on sodadrinking, the injurious action of drugs contrary to their normal course, the frequent complaints of bread, meat, fish, vegetables and milk, to say nothing of groceries, etc., all indicate to the intelligent and active health officer the avenues into which his watchfulness should be turned. Where wrong is discovered and pointed out, but persisted in, it becomes a grave and imperative duty to proceed against the offender, without fear or favor.

Prosecution inevitably produces agitation, and agitation

* Gen. Stats., chaps. 49 and 166.

+ Fourth Report State Board of Health, p. 303.

will diffuse intelligence that cannot fail of placing the condemnation of the public upon the perpetrator of wrong and final approval upon the prosecutor. Particular attention may well be given to the manufacture and sale of children's painted toys, of which particular mention has been made in a previous State Board Report. Such possible agencies of the worst results demand insight and regulation.

1

VACCINATION. This great and invaluable aid in the prevention of special disease has its claim as such too well recognized and proven to require any argument here. Foremost in the lists of both preventives and restrictors of a chief disease, disturbing all communities, vaccination is a means of protection that the health officer can never disregard. Its application has been made, by law, almost universal; and the enforcement of the law is alike the duty and the necessity of every health board. A general oversight of a community should be maintained in this regard, and families moving into a town, especially if immigrants from abroad, new operatives at factories, children at public schools, and almshouse or jail inmates, should receive special attention. The police of a town should be instructed to be observant at dépôts, etc., of incoming parties or luggage liable to suspicion, and, if such are discovered, to report the same at once to the health authority. The following regulations are believed to cover the ground, and are based closely upon the relevant law :

REG. 1.—Every child must be vaccinated before two years of age. The board earnestly recommend that all children be vaccinated before six months of age, and that all persons be revaccinated as often as once in five years. REG. 2.-All persons above two years of age who have never been vaccinated must be vaccinated immediately.

REG. 3.—All incorporated manufacturing companies in this town shall cause each new employé to be vaccinated on entrance, unless proof is furnished of successful vaccination within five years.

REG. 4.-The provisions of the 3d Regulation shall also apply to the keeper of the almshouse and jail in reference to each new permanent occupant.

REG. 5.-No person, teacher or scholar, shall become a member of any public school until vaccinated, unless furnishing to the school committee the certificate of a regular physician of this town that he or she has been successfully vaccinated within five years.

REG. 6.—The school committee are required to demand such certificates before granting permits to scholars or appointments to teachers.

* Third Report State Board of Health, p. 28.

Vaccination should be, in every sense, made compulsory; and the protection of the community from so dreadful a disease as small-pox requires something more than the imposition of the trifling fine of five dollars, once a year, for refusal to comply with the sections of law requiring it. It is to be hoped that early legislation will establish a more efficient and equitable control in this regard, as well as provide for vaccination at an earlier age than two years. It would be well for a board, in time of prevalence of small-pox, to secure, for the use of those to be vaccinated at public expense, a regular avenue of supply, and have kept for general advantage a record of public vaccinations with data.

[Chapter 3.]

THE RESTRICTION OF DISEASE.-The work of a local board of health, involved under this second general head, is neither small in amount nor minor in importance. While it is true that by prevention the agencies of restriction are less frequently required, perfect immunity from disease liable to extend itself cannot be expected, and its occurrence is the signal for the active employment of every method possible for restricting its effects to its primary seat and individual.

Of course by far the greater per cent. of disease occurring in northern latitudes, requiring the control of health authorities, is small-pox, and the measures affecting it must be stringent and speedy of application. The following regulations are believed to approximate to what should be embodied in orders for the purpose:

REG. 1.-Any householder, in whose dwelling there shall break out a case of cholera, yellow fever, or small-pox, shall immediately notify the board of health of the same, and, until instructions from the board, shall not permit any clothing, or other property that may have been exposed to infection, to be removed from the house, nor shall any occupant take up residence elsewhere without the consent of the board.

REG. 2.-Any physician who may be called to a case of either of the diseases specified in the foregoing regulations, shall at once report such case to the board, and receive their instructions in regard thereto; and whenever there shall come under the observation of any physician such number of cases of scarlet fever, measles, typhoid fever, dysentery, or "spotted fever," so called, as in his opinion to justify the belief that a considerable epidemic thereof exists, he shall at once report the same to the board, with such suggestions in regard thereto as may seem to him expedient.

REG. 3.-No person sick with any of the diseases specified in Reg. 1, shall be removed at any time except by permission and under direction of the board of health.

REG. 4.-Persons affected with either of the diseases specified in Reg. 1, and all articles infected by the same, must be immediately separated from all persons liable to contract or communicate the disease, and none but nurses and physicians will be allowed access to persons sick with these diseases. REG. 5.-All vessels used by such patients must be emptied immediately after use, and cleansed with boiling water.

REG. 6.-Persons must not leave the premises until they, together with their clothing, etc., shall have been disinfected, and permission given by the board of health.

REG. 7.—All bedding and personal clothing affected with contagion or infection, which can without injury, must be washed in boiling water.

REG. 8.—Infected feather-beds, pillows and hair-mattresses must have their contents taken out and thoroughly fumigated, and their ticks washed in boiling water. Infected straw and excelsior mattresses must have their contents removed and buried, and their ticks washed in boiling water. Infected blankets, sheets and pillow-cases, and all articles in contact with or used by the patient, must be washed in boiling water.

REG. 9.-Personal clothing and bedding, particularly comforters, which cannot be wet without injury, must be disinfected by baking or by fumigation, but no article must be burned without the direction of the board of health, and all disinfection and fumigation not specified in Regs. 7, 8 and 9, must be done by or under the direction of the board.

REG. 10.-No person or article liable to propagate a dangerous disease, shall be brought within the limits of this town without the special consent and direction of the board; and whenever it shall appear to any person that such person or article has been brought into the town, immediate notice thereof shall be given to the board, and, if such person or article remains within the town, the location thereof.

In cases of small-pox, the vaccination of all exposed persons should immediately follow the discovery thereof. In this, and isolation of those infected, is the safety of the public alone to be found, and without these, all other care, disinfection or warnings will be futile. A board of health should early determine what course it will take with reference to cases of small-pox that may appear in their town, and with ample power vested in them by law, whether they will, if not possessing hospital accommodation for contagious diseases, seize and fit properly for such use, or will make quarantined premises of those occupied by the patient when seized with the disease. It is also requisite that the board shall determine who shall be admitted to infected premises, under what restrictions, and how they shall be disinfected. On many accounts, it is believed best for the board to have its own physician or physicians, who alone shall enter quarantined

premises; on others it is better that the regular physician of the patient, if there be such, should attend, under such regulations as will hardly fail to suggest themselves. The weight of argument is believed to be, however, strongly in favor of only as few physicians as possible exposing themselves and others to the possibilities of infection, and these should neglect no safeguards against the spread of the disease.

On the discovery in a town of a case of small-pox, the following routine of action is believed to be substantially that indicated for a board of health :

1. The case having been surely made out, or if in doubt, the danger-flags should be at once conspicuously displayed upon the premises, and the approaches thereto, and all intercommunication with the outside world be forbidden, except such as permitted by the board. It must be definitely understood that no person or article can be suffered to go from the premises and none to come upon, except to remain, and this only by the consent of the board.

2. All persons with whom the patient has recently been brought in contact, whether at home, at work or elsewhere in the town, should be immediately vaccinated. (It will be for the attending physician to determine whether he will vaccinate the patient, and how he will treat him.)

3. The patient (if it be not already done) should be immediately confined to one room, which should be as clean, large and airy, but as secluded, as possible, without carpet, and free from all superfluous furniture, clothing, etc.

This, of course, in case the individual is to remain at his home; otherwise, his removal to hospital will immediately follow the discovery of the disease, and he would there be under the regulations made and provided by the board and their physician in charge.

4. Arrangements should at once be made for the supply of necessities for the patient (to include nurse if necessary) and those quarantined. Purveyors should be instructed to leave their goods at a certain distance, or in such manner as may be prescribed by the board, or to deliver them through the physician or agent of the board.

5. Free use should be made of disinfectants about the prem