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so trained that he may give specific instructions to the householder or nurse in these details, and further, he should provide the householder with printed circulars, setting forth clearly and plainly what is common knowledge among medical men concerning methods of isolation and details of disinfection.

The need for this sort of teaching is perfectly evident. First, because many physicians are so busy that they can give but little time to teaching the housewives the information they ought to possess concerning a quarantinable disease, and second, even where such instruction is given by the physician, the housewife, worried, as she often is on account of illness, may forget what she has been taught, hence a repetition on the part of the sanitary authorities can do no harm; and further, the handling of the printed circular to the mother covering the same points on which she had been instructed verbally, gives her an opportunity to read the instructions when she is calm and alone with the sick, and it is very much more likely, under such circumstances, to make the impression desired by the sanitary worker. If the municipal authorities are able to do so, they should provide these circulars to the householder printed in the language with which the family is most familiar.

Within recent years the question of public nuisances and their abatement has taken on an entirely new aspect. A distinguished member of your Society, during the year 1885, impressed a lesson upon the civilized world as to the importance of taking care of human waste that has resulted in the saving of thousands and thousands of lives. I refer to the classical report on the Plymouth epidemic of typhoid fever, written by your own Dr. Lewis H. Taylor.

Following Dr. Taylor's description and the publication of similar reports on smaller epidemics, health authorities concentrated their efforts to keeping human waste out of the public drinking water supply and to-day this is one of the great problems of a centralized public health department.

The awful epidemic of typhoid fever incident to the camp life of our American soldiers during the Spanish-American war proved the common house fly to be responsible for the conveyance of the virus of epidemic disease in filth carried on

their feet and bodies, so that since that time a better reason is at hand for proper disposal of night soil and stable manure. The argument that the full or overflowing privy, foul piggery or ill-kept stable is a nuisance because of the unsightly appearance and horrible stench, is still further strengthened by the damning knowledge that it is a positive menace to health because of the facilities given for breeding and feeding flies.

From the Department's experience in handling typhoid epidemics in large municipalities we have no hesitancy in saying that typhoid fever and probably certain other communicable diseases may be very greatly lessened by routine sanitary inspection, thorough cleansing and disinfection, and the screening of privies in communities still using buildings of this type; by proper removal of stable manure and by the preventing of surface pollutions.

In 1905 the Department handled an outbreak of typhoid fever in the city of Nanticoke, where for the first time in epidemic work every nuisance, such as a full or overflowing privy, every ground pollution of any sort, whether by human excreta direct or by indirect pollution from wash water and kitchen waste was abated and routine disinfection of vaults and ground surfaces was carried out by using freshly burned lime, and we were very much gratified to note that the secondary cases occurring were greatly lessened; and the dragging out of the epidemic long after the water was purified and the primary cases removed to the hospital was prevented thus proving the value of this sort of work. The same sort of experience in a dozen or more epidemics since has led to the conviction that routine work of this sort on the part of municipal health authorities will very greatly lessen the prevalence of typhoid fever and that it will probably do the same thing with diphtheria, scarlet fever, tonsilitis and every filth born dis

ease.

It would not be possible for me to take enough of your time to discuss fully the various phases of work that municipal sanitary authorities should be doing. Probably we might more profitably discuss some definite plan of organization, outlining what would seem to be a good scheme of work in a municipality having a population say of a hundred thousand people.

As already pointed out, the Board of Health should consist of five members, two of whom are to be medical men. This Board of Health is to be appointed by the Mayor of the city, in a city of the third class, and the appointment is to be approved by Select Council. The Board of Health should adopt rules and regulations, determine policies to be followed and elect a Secretary, who shall not be a member of the Board and such additional officers as may be required to perform the city's public health work. The Secretary and his office staff would naturally perform the executive work for the Board. The Secretary should be a full time officer in any city of considerable size and should be the directing head. The Board of Health would discuss with him at their weekly or monthly meetings the various policies to be pursued and would endorse such recommendations as meet with their approval upon needed local legislation prior to its going to the sanitary committee of Councils for shaping into legal ordinances and adoption as local law.

The work directed by the Secretary and staff of the Board might well be divided into six or seven divisions, the first of which might be referred to as "Contagious Diseases". This division of the work would naturally embrace the receipt of morbidity reports from practicing physicians and householders, the enforcement of quarantine regulations in the municipal limits, the disinfection of houses at the conclusion of legal quarantine periods, the issuance of certificates to public school authorities, Sunday-school authorities and libraries, the issuing of wage earners' permits, and if the city is fortunate enough to have that needful institution, an isolation hospital, they might well direct its control and management.

A second division in a good many municipalities might deal with providing and maintaining efficient Water Works and Sewerage Systems, detailed plans of which would be approved by the State Department of Health before installation. In a great many communities this division would come in a Department of Public Works.

A third division of municipal work might be known as that of "Child Hygiene". Under this division an important branch

of the work would deal with the welfare of infants, the home teaching of mothers prior to birth, the education of mothers in the proper care of children at the time they are born, and in the preparation of food stuffs for them, bathing, dressing, and their care during the earliest months of life. In most municipalities the medical inspection of schools might be worked out in this division. Even if the medical inspection of schools would not be done in this division the Secretary should have such close co-operation with the inspector for the School Board that all communicable disease shall be followed up at home, that the under-fed and illy nourished school child shall be given better food and that the mentally or physically defective, the aenemic and the tuberculous may be especially provided for.

Another important division of municipal sanitation is that of Food Inspection. Even though a municipality may not undertake a supervision of slaughter houses and dairy farms outside of the city limits, this work probably being more of a State function, there are certain inspections within the municipality that should be done by health authorities. The handling of the meats, the sanitary condition of the meat shop itself, the display of meat in the markets so as to protect it from flies, dust and other filth, naturally come under a division of this sort. So, too, may the handling of milk within municipal limits whether in the retailer's wagon or in the grocer's shop, come under sanitary supervision of food supplies. Milk shops and retail wagons should be standardized as to cleanliness and milk as to quality and purity. Even the fruits that are displayed for sale need certain supervision by health authorities. What is more common than that the retail grocer or the sidewalk peddler shall display fruits to be eaten raw, within range of swarms of flies or clouds of dust that render it unwholesome. The same argument would seem to make it necessary for the health authorities in different divisions of its work to supervise bakeries and bake shops, and the handling of bread, cakes, crackers, etc., in a way that will protect these important foodstuffs from hurtful influences.

A fifth important division of municipal sanitary work would

naturally deal with nuisances, the question of garbage disposal, the cleanliness of alleys, the prevention of surface pollutions, the proper control of surface drainage, the cleanliness and sanitary condition of privies and backyards, and the sanitary condition of vacant lots so as to protect them from pollution and stagnant water, and lastly, and perhaps most important of all, the work this division could undertake, that of abating mosquito and fly breeding places.

A sixth division of work might deal with Plumbing Inspection. Many municipalities do this work fairly well, but it is very important that this work be done either in the Health Department or in connection with the Building Inspection Department, in order that the installation of plumbing shall be made in a sanitary manner, that all drains shall be properly trapped, that all closets shall be properly vented, and that sewer connections shall be made in such a manner that the danger from the flooding into cellars and basements of dwellings be prevented, and that tenements may be sufficiently supplied with water at convenient places on each floor.

Lastly, every municipality might well establish a Laboratory Service in which cultures from the throats of patients suffering from inflammatory conditions might be studied, in which blood tests might be made where the physician suspects typhoid fever or other infectious disease, where milk might be examined that is believed to be dangerous to health, and where a large amount of routine work might be done in connection with the various activities of the local health authorities.

All of this phase of public health work might be referred to as the executive side of the work and is to be directed by the Secretary and his office staff, and it is safe to say that this part of the executive work in any municipality is the easiest and smallest volume of work to be done.

The Secretary of the Board of Health must be a real educational force in the community. Whilst he may have on the one hand these all important divisions of work well organized and the details well carried out, his duty as a public officer is not yet half finished. It is absolutely essential in these days of efficient organizations and public effort that the health

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