among the various members of a City Council there may be a physician; therefore, the material from which a sanitary committee of Councils can be chosen is necessarily very much restricted.

On the other hand, by taking advantage of the provisions of the Act of 1889, the Mayor may choose five members to constitute a Board of Health from among the medical men and the laity of the entire city and can provide a Board especially qualified for public health work and at the same time relieve the Councils, who have many important official duties to perform from this responsibility.

The Act of 1889, provides a uniform law for the whole State for the management of health affairs in cities of the third class, and has the advantage of having been frequently reviewed and interpreted by the courts.

It gives to the Board of Health powers which are not conferred by law on sanitary committees of Councils and provides a means to prevent the introduction and spread of contagious diseases and to secure the abatement of nuisances.

The Act of May 14, 1909, regulating plumbing and house drainage in cities of the third class, is legislation which is of great importance to all cities. This Act presumes that every city has a Department, Bureau or Board of Health, and does not in any way refer to a sanitary committee. It is probably inoperative in cities in which there are no Boards of Health.

The Act of May 14, 1909, regulating the control of contagious diseases, is an organic law applying to all municipalities of the State. This law also presumes every city to have an established Board of Health. Its enforcement is imposed upon such a body and the fact that any city was without such a Board would probably prevent the enforcement of the Act by the local authorities.

The time has long since passed when the sanitary work of a municipality can be delegated haphazard to untrained men and expect the community to get skillful service from them. The Board of Health has for its chief function the defining of the policies to be followed by the executive officer of the Board, the formulation and endorsement of local legislation believed

to be essential for the proper working out of public health matters and at times the Board may be called upon to Act in a quasi-judicial capacity. The Secretary or executive officer, or Board representative in every large municipality, should be a trained man, with considerable knowledge of medicine, with considerable knowledge of sanitary engineering, including all of its side lines; street cleaning, sewage and garbage disposal, sanitary plumbing, abatement of nuisances, and should have rather a complete knowledge of epidemiology, especially as applied to the communicable diseases prevailing in the State. Such an officer should be a full time salaried man and if he is worth anything at all as a sanitarian, will earn many times the salary the municipality pays him, no matter how high that salary may be. The time has long since passed when the sanitary authorities may rest content by simple enforcement of quarantine measures for the control of communicable diseases and the enforcement of the laws for the abatement of nuisances. Indeed, in these days such administrative details constitute the smallest and easiest part of the executive officer's duties.

It is absolutely essential that citizens of the municipality be educated to a proper appreciation of what sanitary measures mean. We can only go by force a little way in advance of public opinion. The modern sanitarian never takes an advanced step until he has the public prepared to accept it. He must be one of the educational factors in the community as well as an executive officer and he must be surrounded by a corps of sufficient size to enable him to carry out his general campaign. He must be able to secure the co-operation and assistance of all organized effort interested in improving the health and morals of the community as well as those interested in and administering her charities and education.

The policy pursued by the modern health board in regard to contagious diseases is that "every communicable disease is dependent for its spread upon the transfer of tangible material from a specifically infected person to the next victim. He further knows that this infectious material is given off from the affected individual in the body secretions and excretions, ex

cept in that group of diseases in which some insect acts as an intermediate host."

"The value of any policy directed against the control of communicable disease must necessarily be measured by its success in limiting this transfer of infectious material from individual to individual."

In public health work we judge the effectiveness of the campaign in municipalities directly in proportion to the success demonstrated in limiting infectious virus to narrow quarters.

Another feature of health work in relation to communicable diseases that is now receiving the attention of modern sanitarians, and is destined to figure largely in future work, is that of building up the resistance of individuals, thereby lessening their chance of contracting contagious disease even though exposed to its virus.

An organic law of the Commonwealth, framed evidently with the thought in mind that a certain uniformity must exist in public health regulations, provides that certain communicable diseases shall be reportable, that others shall be quarantinable, and further, it fixes certain minimum quarantine periods for the entire Commonwealth. The same Act gives to the municipal Health Board the right to exceed this minimum requirement by such extensions of quarantine periods and such further restrictions of infected individuals or their families as the local Board may see fit to impose, but the same Aet specifically provides that municipal authorities (a fact which Boards of Health or Councils sometimes overlook), may not abridge the organic Act of the Commonwealth or the regulations of the State Department of Health. Some municipalities may not feet that it is incumbent upon them to establish regulations for the control of chickenpox or other so-called minor disease. The law just referred to specifically defines certain measures to be followed, with these diseases, and the community that does not enforce this provision of the Act in relation to the long list of diseases enumerated is not lawabiding. One of the first regulations adopted by the present State Department of Health after Dr. Dixon became Commissioner, and an Act that has probably done more than anything

else in popularizing quarantine and lessening communicable disease is that of establishing regulations defining quarantine and providing procedures to be followed with different dis

eases.

Within the memory of most of you, this community and practically every other community in the Commonwealth was familiar with absolute quarantine only, that is quarantine with guards and those guards usually armed, a relic of the earliest procedures established at the ports of entry in the early history of this country. The method followed was too much quarantine or no quarantine at all. With the advancement of the science of bacteriology in the latter part of the eighties and the early nineties a sufficient knowledge of the cause of communicable disease was acquired to permit health authorities to begin rational enforcement of regulations tending to limit the spread of communicable diseases. We learned the cause of typhoid fever, and how diphtheria and any number of diseases were transmitted, and as we learned something of their cause and transmission, learned necessarily how we might protect ourselves against these infections and that these diseases were for the most part preventable.

The first quarantine procedures introduced for these diseases, however, were in some communities too radical and in others too slight to do any good. The State Department of Health, in formulating quarantine regulations for a number of diseases, specifically provided for a modified definition of quarantine, qualifying the old Standard regulation by naming it absolute quarantine and establishing the new type of regulation, denominating it modified quarantine. Nothing was added to the old type of regulation, but our new type of regulation was worked out with due regard for maximum protection of individuals with minimum loss of earning capacity and a new phase of quarantine procedure began.

As all of you medical men know, modified quarantine may be established for anthrax, chickenpox, diphtheria, erysipelas, German measles, glanders, malarial fever, measles, mumps, relapsing fever, scarlet fever and typhoid fever, and of these modified types of quarantine further regulations provide for

absolute isolation on the part of the person so afflicted; for instance, in scarlet fever or diphtheria, if the person afflicted is isolated from all members of the household, and if the nurse or caretaker at no time comes in contact with persons living in other parts of the dwelling, the wage earner, by changing his clothes, may continue his occupation except with certain extra hazardous lines of work, such as handling food stuffs, working on cloth, etc., the plan being to permit the wage earner to earn a living for himself and family and at the same time teach him a proper appreciation of how individuals may be protected from infectious virus. It is probably true that the chain of household quarantine is sometimes broken and that the infectious virus may occasionally be carried out of the dwelling. This we expect now and then and will continue to meet for a long while. Each such lesson, however, should be used by the sanitary authorities to impress upon the community the importance of attention to detail.

In certain communicable diseases provision is made both by Act and regulation for limiting the movements of the infected individual alone, notably in whooping cough, erysipelas and typhoid fever, where members of a household may continue school attendance even where these diseases are under treatment in a dwelling, provided there is some degree of separation of the sick from the well and that some sort of isolation is continuously kept up and concurrent disinfection of discharges is faithfully carried out.

Municipal sanitary authorities should keep constantly before them charts of all the communicable diseases under quarantine regulation, showing infected dwellings arranged by streets and blocks. Every new case of communicable disease should be carefully investigated and faithful efforts should be made to determine the source of the infection. Every infected dwelling should be studied by a competent inspector and the health officer should be satisfied that all precautions are being taken to limit the virus, not alone to the infected home but to the single room of the dwelling. Any discharges liable to convey the virus should be thoroughly destroyed by means of heat or by use of antiseptics. The visiting sanitary officer should be