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ises, especially in passages leading to the room of the patient. The writer has found nothing better than carbolic acid.
6. Regular visits to the premises should be arranged for the physician and the representative of the board.
7. The police and fire department should be notified of the quarantine; the police, that they may aid in making the isolation effectual, and be at hand to attend to contingencies or emergencies arising therefrom, and also to guard against possible incendiarism ; the fire department, that any attempts to burn the buildings might be the more promptly provided for, and in case of fire in the vicinity, the premises be less freely entered. Remarkable circumstances occurring in the history of a board of health in this section, not long since, render these precautions worthy of consideration.
Having thus provided for the care of the patient and those isolated with him, and for the prevention of intercourse between the premises and the community at large, it becomes necessary to maintain, until all danger from this source is over, a rigid and thorough seclusion of all pertaining to the infected habitation.
This segregation of individuals (often quite a number), most of them in good health and able to labor, the interruption of their revenues, but the increase of their expenses, involves many questions of responsibility and legality, that must rest upon the shoulders of the board of health, and that, unless met with prudence and knowledge, may entail litigation and expense upon a town that may so disturb it as to create a distaste for all matters of sanitary control in the future (so capricious is mankind), and a neglect of health interests be long the result. The law has fortunately explicitly determined where the expense of care, etc., shall lie, under varying circumstances. It is beyond question, that an action against a town or other party to recover for wages lost during confinement for weeks in a small-pos habitation, though not ill, would not lie. The question of where the responsibility shall rest for expense if a party so confined is a non-resident and has settlement elsewhere, is one that each case must determine of itself. It is specially enjoined upon boards that, in the interest of common honesty and the continuance of such agencies of control, they manage the business devolving upon them with the wise economy that belongs to individual affairs (but always leaning to the side of safety), and show as a part of sanitary science, that it is in fact not expensive, but economical and productive. That quarantine should be effectual, it must last long enough to allow time for each individual upon the premises to have contracted the disease from even the last day of the patient's desquamation,-i. e., supposing the case to have been an ordinary one, and the particles of falling skin being apparently all gone from the patient by the end of his fourth week of sickness, the inmates of a dwelling should then remain isolated for two weeks thereafter, and be kept meanwhile from all contaminated clothing or bedding, unless the same shall have been as thoroughly purified as possible. Of course, if subsequent cases break out in the dwelling, the initial point of reckoning is transferred from the first patient to the last. In case the patient is removed from his home to a hospital, the remaining inmates will only require to be quarantined till it is reasonably sure that they have not been infected (generally about two weeks), and the same caution will be required as before mentioned for all contagioned articles. That so rigorous and careful a quarantine as is thus provided for has not been generally enforced, the extent of last year's epidemic of smallpox too well attested.
Upon the dissolving of quarantine, certificates should be given to school children, factory employés and others, of their non-liability to communicate disease, and, of course, the danger-signals and prohibition of intercourse will be removed. No patient who has been sick with any contagious disease, recognized as such by statute, should be allowed to leave his room until duly bathed, disinfected and freshly clothed, nor until all infected articles about him have been purified to the satisfaction of the health authorities.
Boards of health will not fail to notice that the powers given them by law, to collect expenses of patients under their care from other towns or the Commonwealth, are in excess of those granted overseers of the poor, and their care of patients is, and should be, entirely independent of such authority. The surprise of the writer may be imagined, when informed by the auditor of the Commonwealth, on presenting a bill of his board for the care of a State patient, that, although it was
evident that the law provided for such payment, and had been upon the statute-book for many years, no prior claim of the kind had, to his knowledge, been made, and certainly no appropriation had ever been made therefor. It would be interesting to know how many town taxes have been invalidated in the past, and how many tax titles are hence insecure, by reason of towns having paid from their treasuries, without authority, the expenses that should have been otherwise borne.
The safeguards that apply to small-pox are also, in the main, applicable to the other contagious diseases, recognized by the law as such.
In reference to typhoid fever, cholera, etc., it is essential for its restriction, that the focal discharge of patients shall not be allowed to disseminate their powers of increase through air, water or food, and regulations to that intent should be established.
The regulation of prostitution, being an offence against morality, has long been under the control of police authority, but it is believed that the conditions that attach thereto have so intimate and vital a relationship to the health of communities, that at least a union of surveillance will erelong be fully recognized as desirable. As an advisory board, health organizations can, under present circumstances, contribute much toward the best control of this potent influence for disease.
The various influences inimical to public health, which reside in bathing-rooms, barbers’ shops, public conveyances, etc., are all matters subject to the controlling regulations and oversight of local boards of health, and should receive their attention,
[Chapter 4.] GENERAL OBSERVATION.-Under this last caption, it is desired simply to call the attention of boards to the work of general scientific and protective oversight it lies within their province and opportunities to undertake.
It is believed that where there are lakes or streams contiguous to towns, it is well for boards to have prepared and conspicuously posted, directions for the resuscitation of drowned persons, after Hall's or Sylvester's methods.
Boards should also have a general review of-
The regulation of gas and mechanical works liable to affect by their smoke, or processes of manufacture, the health of the locality.
The location of buildings, with regard to their supply of light and air.
The condition of lock-ups, jails and almshouses.
They should also carefully observe the mortality records of their town, and the climatic and other general or special influences affecting it, and should contribute by publication to the fund of general sanitary knowledge, any experiences or observations of value. A well-kept meteorological record is both a credit and an aid to any board.
It will not infrequently be well for boards to establish special inquiries and investigations into the character of their peculiar geological, meteorological, or geographical relationships, or into kindred subjects affecting inferentially their public weal.
Public lectures upon hygiene, by parties able to plainly and practically lay before the people the laws and requirements of public and private health, are agencies for good, that every board would do well to inaugurate.
Such are the fields, and such the divisions of labor and observation, that boards of health, wherever situated, are called upon to enter. The sum total of labor performed in a year by a conscientious health officer is very great, and in its accomplishment he must expect to find his chief reward, recognizing the force and beauty of the motto of Haroun-alRaschid, that "He only worships God acceptably who makes himself useful to his creatures."