IBS* -//////////////////////////////''" mmmmmmmm. y/////////////////////////////^^^^ 999999999999999999999999999999999999999� .".•:•' ''V-i 8 SURGEON GENERAL'S OFFICE LIBRARY *V* if IWREX "••"^ t Section, tfWjtw "m Mo. iuwn. Wi'#$>*. \., "'•"'•^ v^^;:jc-v7 NLM051297595 A MANUAL FOR BOARDS OF HEALTH AND HEALTH OFFICERS. BY LEWIS BALCH, M. D., Ph. D., •1^ r SECRETARY STATE BOARD OP HEALTH OP NEW YORK ; HEALTH OFFICER OF ALBANY; EMERITUS PROFESSOR OF ANATOMY AND PROFESSOR OP MEDICAL JURISPRUDENCE, ALBANY MEDICAL COLLEGE. BANKS AND BROTHERS. ALBANY, N. Y. NEW YORK. 1893. B/74irn 1893 COPYRIGHTED BY Banks and Brothers, 1893. PREFACE. In presenting this manual for health boards and health officers in the State of New York, but one object has been kept in view — the putting in the hands of those officials of a short, compact guide to follow in the dis- charge of their duties. Literary merit has not been sought, nor has a long disquisition been written on the advantages or needs of public health work. Eeiteration is frequent and purposely so, constant repetition fix- ing the subject on the reader's mind. The manual is not written as a legal work or as an exposition of decisions rendered by the courts on health matters. Neither is it intended as instructing in hygiene. It is simply a practical statement of the duties of health authorities and how they may be done as required by the public health law of this State. It is the result of practical experience both as a local health officer and as secretary of the State Board, and much that is said has already many times been written in answer to inquiries. It refers to legal cases where the subjects treated have been reviewed, but this is merely to show that the text is sustained by authority. 4 Preface. The rules and regulations, forms and circulars in the last chapter are familiar to most boards of health. Those issued by the State Board of Health are so designated. The others are suggestions for forms that may be used to advantage and which are in accordance with the pro- visions of the law and the modes of procedure. The publication of this manual has been asked for by many, and it is hoped it will meet with approval and be an aid to those engaged in the public health service. LEWIS BALCH. Albany, N. Y., June, 1893. A MANUAL BOARDS OF HEALTH HEALTH OFFICERS. CHAPTER I. THE STATE BOARD OF HEALTH, ITS POWERS AND DUTIES. Section 1. When created. How composed. 2. Supervision over local boards; exceptions; specific duties. 3. To formulate method of general system of registra- tion of vital statistics. Power to take charge of. 4. Power to examine nuisances. 5. Water escaping from canals; power of state board over. 6. State buildings and grounds open to inspection. Jurisdiction over lands taken by the state for sanitary purposes. 7. Power to appoint health officers where no board is formed. 8. Adulteration of food and drugs. 9. Tuberculosis in cattle. 10. Glanders in horses. 11. Power to make rules for water supplies. 12. The Walikill creek and Susquehanna river. 13. To publish form of blank for reports of institutions caring for children. 14. Miscellaneous. Section 1. When created. How composed.— In 1880 the legislature created, by the enactment of 6 A Manual for chapter 322 of the Laws of that year, a board of health for the state, giving to it certain general powers over matters of interest to life, and others relating to local boards enabling it to guide and aid them in their work of caring for the public health. The board is com- posed of nine members appointed under the provi- sions of that law and continued under the new one, known as the Public Health Law, chapter 25 of the General Laws, or chapter 661 of the Laws of 1893, which is a codification of all former legislation upon matters pertaining to health. As thus constituted, the board organizes by electing a president from its members (sec. 3, art. I of the Public Health Law), and a secretary, who shall be a person of experience in sanitary affairs, and who is the executive officer of the board. Like other boards of similar nature, it can enact by-laws for the transaction of business, ap- point committees and exercise other like functions. § 2. Supervision over local boards; exceptions; specific duty.—It is given supervision over all local boards of health in the state, exceptiug those of five cities, New York, Brooklyn, Yonkers, Albany and Buffalo, these being exempt, but required by the law to report cases of small-pox, typhus and yellow fever and cholera, and the facts relating thereto, in order that the state board may duly notify other places to insure pro- tection from contagion. (Sees. 24 and 32, art II.) The board is created for a specific object, viz., '-to take cognizance of interests of life and health of the people of the state, and of all matters pertaining thereto." To do this it has the power to inquire into the cause of disease, to investigate any locality, to summon people before it to testify under oath to what they may know of the subject being investigated, issuing subpoenas to Boards of Health. 7 compel their attendance. In order to facilitate an examination, its members or employees have free entry into every place where it is thought necessary to go in pursuit of the causes of the examination, and all persons are forbid hindering such entry. The zeal of local boards in protecting their municipali- ties against disease may carry them too far, and a reso- lution or order made by them may extend beyond the limits of their municipality without intentional excess of jurisdiction, and in such case the state board can reverse or modify such order in its discretion. (Sec. 4.) § 3. To formulate method of general system of registration of vital statistics. Power to take charge of.— The general system of registration of vital statistics is given in charge of the state board. The im- portance and value of these records increases yearly, and every effort is made by the board to perfect their collec- tion and registration. To this end the forms and methods of the work are formulated by the board (sec. 5), and it requires all local boards to follow such regulations as it makes on this subject and to forward every month the certificates received for the month preceding. If a local board fails in compliance with these regulations, the state board may, upon due notice of thirty days to the local board at fault, assume charge of this branch of public health service in that municipality and enforce the rules at the expense of the place, this control to last until the board is satisfied local authorities will do their duty. To the end that the system of vital statistic registration shall be uniform and effective, the board has prepared blank forms for the returns of births, deaths and marriages, which local boards procure where they choose, it being insisted upon, however, that the size of the blank and the subject-matter be the same as the sample 8 A Manual for furnished. And the absolute necessity of this regularity- is easily understood, the state board having to file and keep the original certificates. If various sizes and shapes of form were allowed the filing of nearly one hundred and fifty thousand certificates a year would be double the work than where all are the same. Certified copies of these records, by the president or secretary of the board, are made presumptive evidence of the subject-matter and are constantly sought for. The board further prescribes the methods, forms and rules necessary for the transfer of dead bodies where the burial is to take place outside of the county in which death occurred, and the transit burial permits issued under these rules are accepted by other states into which the remains may be carried. Public carriers cannot receive a body for transportation unless it be accompanied by a proper transit permit issued by the local board of health having jurisdiction where the death took place and in accordance with the form prescribed by the state board. § 4. Power to examine nuisances. — While, as will be seen further on, local boards are more particu- larly charged with the care of the public health in their municipalities, the state board has all the necessary powers to examine into nuisances or matters affecting life and health. (Sec. 6.) Where, however, this is done by the state board, acting as the board, any necessary measures to be taken must be by the local board under the direction of the state board, the local board having to obey all lawful directions given it by that of the state. (Sec. 25, art. II.) In addition to this and independent of local boards, the governor may direct the state board to investigate a matter of importance to health and re- port to him concerning it within the time mentioned in such order. In such case the board proceeds to examine Boards of Health. 9 in the manner considered best to bring out all the facts necessary for full and complete understanding of the nuisance, and on which its recommendations are to be based when it reports to the governor. The board does not declare the matters to be nuisances, but reports and certifies that, in the judgment of the board, they are so, and the governor may so declare them and make an order for their abatement in accordance with the sugges- tions of the board, or he may make such other dispo- sition of the case as appears to him proper. If an order from the governor issues it is to the maintainers of the nuisance directing them to abate in the manner pre- scribed in it, and if the parties notified fail to obey the order, the governor may direct the county officers to abate in the manner set forth, and then the cost be- comes a charge upon the municipality where the nuisance is, to be recovered by the municipality by suit against the original maintainers of the nuisance. In such ex- aminations as these, either by or without an order of the governor, the board can ask members of local boards to serve with it and aid in determining its decision, but such representatives shall not have power to vote upon that decision. The board also can employ experts for this work, or any other it may consider an expert should investigate. (Sec. 8.) § 5. Water escaping from canals; power of state board over.— Water escaping from any canal belonging to the state, and creating a nuisance by causing disease may be, upon complaint being received, examined and ordered abated by the state board with- out appeal either to the governor or calling upon the local health authorities. (Sec. 7.) But before such action can be taken by the board, the leaking of this water must 2 10 A Manual for have caused sickness, and a physician will have to make affidavit to that fact; the affidavit setting forth the character and amount of sickness, so far as it is within his knowledge. The original complaint is the affidavits of three citizens, which show the same, as far as they may be cognizant thereof. If, upon examination by the board, the allegations are sustained, the board re- ports the fact to the superintendent of public works, who causes the trouble to be relieved without delay. § 6. State buildings and grounds open to in- spection. Jurisdiction over lands taken by the state for sanitary purposes.— All state buildings or grounds as well as any maps or plans relating thereto, are always open to the inspection of the state board (sec. 9), and in section 10 a very important addition has been made to the law. Here power is given to the commissioners of the land office to acquire land for sanitary or quarantine purposes if such lands are certi- fied to be necessary by the state board or the health officer of the port of New York, and over lands thus taken by the state, the state board has exclusive sanitary jurisdiction. (Sec. 4.) This relieves local boards from all responsibility if within the limits of such state prop- erty any nuisance of danger to the public health is maintained or arises from the use of the property, placing this responsibility on the state board and by implication holding it liable if by neglect the public health suffers. Experience has proved the necessity of the introduction of these provisions in the law. The duty of protecting the people from invasion of disease is one admitting of no dalliance or interference, and while local boards are properly to care for local interests, which in turn may be common to the whole state, it is but right the state, by its particular board, should care Boards of Health. 11 for all matters of a sanitary nature in places where it exercises its jurisdiction. § 7. Power to appoint health officer where no board is formed.— In line with this advance in the new Public Health Law is another of equal importance. Where, from any cause whatever, the municipal corpora- tion has failed to appoint the health authorities as pro- vided for in article II, the state board may, in such place, exercise all the power given a local board and appoint a health officer whose salary, together with the expenses incurred by the state board, shall be paid by the muni- cipality in question. (Sec. 11.) This power of the state board lasts only, however, as long as the municipal authorities fail in their duty under the law. As soon as they comply with its provisions, the powers of the state board cease and it takes its proper place as an advisory board to the new one created. §8. Adulteration of food and drugs.—Under article III the state board is charged with the work of protecting the people from adulterations in food, drugs and beverages such as wine, spirits and malt liquors. The board appoints analytical chemists to make examina- tions (sec. 42), and also formulates rules and regulations for their guidance. These rules are to be filed in the office of the secretary of state and by him published in the Session Laws. Once in each year, the board is called on to examine the spirituous, fermented or malt liquors, causing samples to be furnished by all manufacturers, and if any are found to contain deleterious articles, the manufacturer is held as having violated the law and put an adulterated substance on the market. (Sec. 43.) Every person manufacturing or offering for sale any article of food or beverage covered by the law, shall fur- nish a sample to the board's collectors upon being ten- 12 A Manual for dered the ordinary price thereof, and refusal to do so subjects the person so refusing to a penalty of $100. (Sec. 44.) Violations of any of the provisions of this article are to be communicated to the district attorney of the county where the offense is committed and he is called upon to prosecute the offender. (Sec. 50.) § 9. Tuberculosis in cattle. — Under article IV, the board is charged with a very important work. Tuber- culosis in cattle is now considered to be communicable to man, and so the board is empowered to arrange for ex- aminations of cattle suffering from this disease. (Sec. 60.) Whenever it is found, measures may be taken to sup- press it and to prevent its spread to other cattle. The board, to do this, appoints such inspectors to examine all cows in a given section as it considers necessary to carry into effect the rules and regulations made by it. (Sec. 61.) These rules at present are the following. It should be said they were formulated under the law passed in 1892, for this work, which has been incorporated in the law now under consideration : STATE BOARD OF HEALTH OF NEW YORK. RULES AND REGULATIONS FOR INSPECTORS, OWNERS OR KEEPERS, AND ALL OTHER PERSONS HATING CHARGE OF CATTLE SUFFERING FROM TUBERCULOSIS OR OTHER INFECTIOUS AND CONTAGIOUS DISEASES. The state board of health, in pursuance of the pow- ers conferred on it by chapter 487 of the Laws of 1892, hereby makes and publishes the following rules and regulations for the guidance of all inspectors, or other persons employed by it in the inspection of milch cows, and other cattle, suffering from tuberculosis, or other in- fectious or contagious diseases, and for the guidance of Boards of Health. 13 owners, keepers and all other persons having charge of cattle. RULES AND REGULATIONS. 1. Inspectors or others shall use all reasonable means to discover tuberculosis or other infectious or contagious diseases in cattle, and report in writing the result of their inspections, not less than once in each month and as much oftener as may be called for by the president or secretary of the board. 2. All owners or keepers of cattle, and all persons having charge thereof, shall allow of such inspection and examination as the employees of this board shall consider necessary, upon said employee presenting his authority to so examine, and all orders made as to de- struction, isolation, disinfection, or other care of cattle suffering from infectious or contagious disease, or sus- pected of so being affected, shall be obeyed by all owners, keepers, or other persons having charge of such cattle. 3. Should the inspectors or others employed by the state board of health find, upon examination, tuber- culosis or other contagious or infectious disease existing in cattle examined by them; they are to direct such quarantine, sequestration, or other measure of protect- ing the public health, or other cattle from the said diseases, as may in the case then under examination be considered by them best. Should the killing of one or more cattle so affected be, in the judgment of the in- spector, necessary for the protection of the public health or other cattle, the inspector, before directing such killing, shall first notify the president or secretary of the state board, reporting the reason why he considers such killing necessary, the name of the owner or owners, the place where said cattle are, and the number to be destroyed. The president or secretary shall then order 14 A Manual for the killing, or such other measures as both or either of them may consider best. 4. All owners, keepers of cattle, or other persons hav- ing charge thereof shall, for the purpose of proper examination thereof, if requested by the inspector of the state board to do so, place the animal to be exam- ined in stanchions, or such other place as may be pro- vided for their restraint, for the time necessary for such examination. 5. To guard against the improper use or disposal of an animal or animals found to be, or suspected of, suffering from tuberculosis, or other contagious or infectious disease, the inspector may place on such ani- mal or animals a lock and chain, or other device for marking said animal or animals, and all owners, keepers of cattle, or other persons having charge thereof, are cautioned against removing said lock and chain or other device, without due permission in writing from an in- spector of this board. And the inspector, at the time of so marking an animal or animals, shall give in writ- ing a notice to the owner, keeper, or person in charge, said notice to set forth the description of said animal or animals, how marked, the reason for said marking, and a warning that the removal of said animal or animals, or the removing or effacing of said markings would be in violation of the provisions of chapter 487 of the Laws of 1892. And in case any owner, keeper, or person in charge of said animal or animals shall so remove or efface said markings, or remove or otherwise dispose of said animal or animals, the inspector shall report the same to the president or secretary of the state board of health, setting forth in said report all facts pertaining to the case. Boards of Health. 15 6. When an animal is, or animals are killed by the order of the president or secretary of the board, upon the report of the inspector as provided for in rule 3, the inspector or other person in the employ of the board directing the killing, shall give a written certificate to the owner, keeper, or other person in charge of the ani- mal or animals so killed, to which he shall make affi- davit, said certificate setting forth a description of the animal, owner, place, when and where killed, and for what reasons. 7. And it is further made the duty of said inspectors to give, in writing, to all owners, keepers of cattle or persons having charge thereof, or public carriers having charge of the transport of cattle, such directions and orders for the disinfection of premises, buildings, boats, railroad cars, stables and all other objects from or by which infection or contagion may take place or be con- veyed, and for the proper disposition of the hides and carcasses of such animal or animals as may be killed under and in accordance with these rules and regula- tions, and all objects which might convey infection or contagion. And it shall be the duty of all owners, keepers of, or other persons in charge of cattle, and of public carriers having the charge of the transport thereof, to obey all such directions and orders of the inspectors for the proper disinfection of all places and objects that may contain or convey infection or conta- gion, or the proper disposal of all hides, carcasses or objects requiring disposal for the protection of the pub- lic health, or other cattle. And the inspector shall, in his monthly report to the president or secretary of the state board of health, set forth in full what directions or orders he has given in the carrying out of the pro- visions of this rule. 16 A Manual for Whenever the board, from the reports of the inspectors, considers that some cattle should be killed to prevent spread of the disease (sec. 62), the authority to kill is forwarded the inspector as required by rule 3, and he gives to the owner a sworn certificate of the killing, which is admitted in evidence of the claim. All claims for the animals so slaughtered are brought before the board of claims, it having exclusive jurisdiction to de- termine the value at the time of killing and of making awards therefor. (Sec. 63.) To refuse to obey or to violate any order of the state board relative to the suppression of tuberculosis in cattle renders the offender liable to a penalty of $100. (Sec. 64.) § 10. Glanders in horses.— Glanders in horses is also to be guarded against by boards of health, but in this case local boards have to do the killing after ex- amination into the case according to rules prescribed by the state board. (Sec. 62.) Horses thus destroyed are paid for by the comptroller on the certificate of the board having jurisdiction, not to exceed in any case the sum of $50 for any one horse. (Sec. 63.) The board has published the following rules for local boards to follow in dealing with cases of glanders: RULES AND REGULATIONS OF THE STATE BOARD OF HEALTH FOR THE DESTRUCTION OF ANIMALS AFFECTED WITH GLANDERS. Whereas, by section 62, of article IV, of chapter 25, of the General Laws, the Public Health Law, chapter 661, of the Laws of 1893, local boards of health in this state are required to destroy animals found with the glanders within their jurisdiction, and the proceedings of said local boards in reference thereto are to be con- Boards of Health. 17 trolled and directed by such rules and regulations as the state board of health shall prescribe: Now, therefore, the said state board of health, by virtue of the power vested in it, has prescribed the fol- lowing rules and regulations to be observed by said local boards of health in carrying out the provisions of said Public Health Law, to-wit: 1. A local board of health being notified of the ex- istence of said disease (glanders) must take proper means to determine the nature of the disease by employing a competent veterinary surgeon or other person or persons who, in their judgment, are competent to pronounce upon the nature of the suspected disease. 2. Upon the written certification of said veterinary surgeon or other person or persons thus employed, said local board of health shall kill, or cause to be killed, any animal or animals having the glanders, and shall cause the carcasses of all animals so killed to be disinfected and buried forthwith, at least three feet below the surface of the ground, and shall further cause all stalls, stables, barns, sheds, halters, harnesses, blankets, buckets, meas- ures, mangers, racks, or other places or utensils which may have been exposed to the contagion of said disease to be thoroughly disinfected and cleaned. 3. Local boards of health are hereby cautioned against too hasty judgment, and advised to use every precaution to insure a correct determination as to the nature of the disease. A record of all proceedings should be placed in writing and filed in the office of the board of health. 4. Local boards must report all action taken to the state board of health. § 11. Power to make rules for water supplies.— Article V confers powers on the state board to make 3 18 A Manual for examinations of potable water supplies and rules for their protection. (Sec. 70.) These rules when made are to be published once a week for six consecutive weeks in at least one newspaper in order that full pub- licity may be given to them, and those affected thereby cannot claim want of knowledge of the rules. For viola- tion, a penalty can be fixed by the board not to exceed $200 for any one offense or refusal to obey. The party benefited pays for this publication, and evidences of it are filed with the county clerk. The person or board having charge of the water supply (sec. 71) may inspect the water-shed to see if the rules made are obeyed. If violations be found, whoever has charge of the water- works shall cause a copy of the rule violated to be served on the offender with an order to comply with the rule. If the offender fails to obey this notice, the state board is to be informed by the party having control of the water supply, and it in turn examines to deter- mine if the charge of violation is well founded. If the state board finds the complaint just, it orders the local board having jurisdiction to enforce the rules and regu- lations, and if the local board fails in ten days to do its duty, the complainants may bring an action in court against the offender for the recovery of the penalty im- posed, and an injunction to insure obedience to the rules in future. But while this can be done, other matters have to be taken into consideration before the parties having charge of the water plant can compel obedience to the rules or the abatement of some insanitary condition. If the discharge of the sewage from a village or hamlet (sec. 72), or any other matter such as out-houses, barns, stables5 pig-pens and the like, so drain as to pollute the water supply, the municipality or corporation owning the water supply have to pay all expenses attendant upon Boards of Health. 19 the removal or change of these sources of contamination, and until they do that and reimburse the owners for any damage that may be done, the rules are inoperative as far as these particular violations are concerned. And no action can be maintained against them until the cor- poration or municipality has done its work in clearing up, paying costs and damage. The owners of the water supply are further required to maintain sewer systems or sewage disposal works where they may be necessary for its protection. The method of ultimate disposal of the sewage, or the plans of sewage disposal works must be approved by the state board before construction. § 12. The Wallkill creek and Susquehanna river.—By special enactments (sees. 73 and 74) the Wallkill creek and Susquehanna river near Binghamton are protected from pollution. For violation of the first a penalty of $50 is provided, and for the second, one of $25; both penalties, when collected, accruing to the benefit of the county treasury. In the protection of the Wallkill creek no mention is made of who is charged with seeing the law obeyed, but in case of the Susquehanna the local board of health having jurisdic- tion where the offense is committed is to examine into the offense, and if one be complained of, to see to its abatement. § 13. To publish form of blank for reports of institutions caring for children. — In article XII, section 204, the state board has to publish the form on which reports are to be made to the local boards of health having jurisdiction, of the sanitary and hygienic condition of institutions for the care of the destitute and orphan children (except hospitals), the report being made by the physician in charge. This form is shown in the chapter on such subjects. 20 A Manual for § 14. Miscellaneous. — This rapid review of the work expected of the state board gives but little insight into the amount of labor performed by it. That is, however, hardly relevant to such a manual as this work is designed to be, but it is not out of place to say the state board stands somewhat in loco parentis to local boards to advise and aid them in their work of guarding the public health; to settle questions pertaining to nuisances; to the collection of vital statistics and many others that are but little thought of and not outlined in the law. In consultation with other state boards of health, it con- siders questions affecting the health of the country and arranges for interchange of information as to contagious diseases or other matters of general interest which may arise. It meets monthly and has laid before it all the work done since its last meeting, and at these meetings plans for the sewerage of villages, which have been sub- mitted under the provisions of chapter 375, Laws of 1889, are examined and passed upon. Committees are also appointed for investigations or any other work which the board may see fit to give them. Its work is steadily increasing and much effort is given to educating local authorities and the people to realize the importance of the public health service. Boards of Health. 21 CHAPTER II. local boards of health, how constructed; pow- ers AND DUTIES. Section 15. The care of the public health a paramount duty. 16. Boards of health, how formed ; officers to be ap- pointed ; vacancies, how filled. 17. Stated times for meeting. To meet if state board requires. 18. Board prescribes duties of health officer and fixes his compensation. Health officer must be a phy- sician. 19. Board has power to employ persons and fix their compensation. 20. Power to make rules and regulations. Rules must be published. 21. Board can impose penalties. 22. In special cases order or rule does not have to be published. 23. Board can issue subpoenas and administer oaths. Committee can hold hearing but not decide. 24. Power to issue warrant. 25. To make complete the registration of vital statistics. Boards purchase their own supplies. Copies of registered certificates presumptive evidence. 26. Duties regarding contagious disease. 27. Patients can be taken to hospital. 28. Vaccine virus to be supplied by board. 29. Contagious diseases in alms-houses. 30. Board may make rules for water supply if it is within its jurisdiction. 31. Complaints by inhabitants must be examined. Power to enter premises. 32. Board can only act on nuisance of danger to health, 33. Board orders abatement of nuisance. Expenses, how recovered. 34. Special power over tenement-house work. 35. Jurisdiction. Combined boards. 22 A Manual for Section 36. Expenses of board, how paid. 37. Power of board to do work necessary to protect public health, if municipality refuses to. § 15. The care of the public health a paramount duty. — The care of the public health is paramount to all things, for unless a people are healthy they cannot perform labor and the state suffers. Therefore it is that in all communities laws affecting public health matters are of necessity more or less arbitrary, for many, without regard to consequences, will not observe hygienic or sani- tary rules and so endanger their neighbors as well as injure themselves, which latter is not of so much moment. The character of many immigrants now coming into the country is such as to be a constant menace to health, for the habits contracted in their own countries are not easily changed. Already the state has suffered from this class of immigrants, and their mode of living is one which tends rather to perpetuate than to kill the contagious germs. Against all, therefore, whether imported or of home production, the only protection is the strong hand of the law, the argumentum ad hominem hav- ing no weight whatever. With this knowledge and that of the absolute need of protection from all sources of disease, the legislature has from time to time passed laws governing health matters and conferring various powers upon boards or officials to act for the care and protection of the public health. These differ- ent laws, in the session of 1893, were codified in one general act — the Public Health Law — and by it, in article II, power is given to local boards of health to guard their municipalities against disease and to compel all therein to live so they and their belongings do not constitute a menace to the health of their neighbors. Boards of Health. 23 § 16. Boards of health, how formed. Officers to be appointed. Vacancies, how filled.— In all cities of the state, villages and towns, boards of health are required by law to organize. In cities, except in New York, Brooklyn, Buffalo, Albany and Yonkers, which are exempt from the action of this law, a board of health is formed by the mayor as president ex officio, and six other members, one of whom shall be a physician, appointed by the common council on the nomination of the -mayor. The term of office is three years, and the board is so nominated as to allow of two members going out of office yearly. (Art. II, sec. 20.) The board ap- points a physician for health officer and such other officers as it considers necessary. In a village the board is appointed by the trustees and consists of not less than three or more than seven members. The persons thus appointed cannot be at the same time trustees of the village, but should be citizens of full age, tax payers, and if the village welfare is a prominent interest with the trustees, men of high standing. These boards are only appointed for one year, and they, after organizing, appoint a health officer and registrar of vital statistics. For towns the board of health is composed of the super- visor, town clerk and justices of the peace, and added to them by themselves, a citizen of the town, of full age. This board of health also holds office for only one year, and is called upon to organize thirty days after the town election. At this meeting, the board having elected its president and secretary, elects a citizen member, appoints a town health officer and some one as registrar. If any vacancy occurs in any local board, if the proper authori- ties do not fill such vacancy within thirty days after its happening, then the county judge shall appoint a suit- able person for the unexpired term of the one making 24 A Manual for the vacancy. These local health boards are not ones that can or cannot be organized at the pleasure of muni- cipal authorities. They are called for by statute and it is obligatory upon those charged with the duty of ap- pointing and those by law constituted members of health boards to fulfill the letter of the law and see to it that each city, village and town has its board duly and legally constituted. It is a duty those charged with cannot get away from and one that can be enforced if necessary. (Sec. 31.) § 17. Stated times for meeting. To meet if state board requires.— Some stated time of meeting should be settled upon by each board. (Sec. 21.) As a general rule, once a month is as frequent as these regular meetings need be held. At them the reports of the health officers, which should be in writing, and of any committees or of inspectors, should be presented, and all orders and regulations formulated and adopted. The board should adopt some short by-laws for its own guid- ance in transacting the business it is called upon to do, as such by-laws will facilitate its work. Special meet- ings may be called at any time, and as often as necessary by the presiding officer of the board if he considers the protection of the public health demand such meetings. If in the presence of an epidemic, the board would probably meet much more frequently than in ordinary times. Such meetings would either be adjourned ones or special, as the case happened. In addition to these meetings, one shall be called if twenty-five residents, of full age, of the municipality, request such meeting, set- ting forth in the petition the necessity for it. The board meets also when required to do so by the state board or its president and secretary (sec. 25), and at such meeting the board must, if requested by the state Boards of Health. 25 board, take definite action on any matter which the latter requires to be considered, and which is properly within the jurisdiction of the local board. § 18. Board prescribes duties of the health officer, and fixes his compensation. Health officer must be a physician.— The board prescribes the powers and duties of the health officer it appoints, who is made by law the chief executive officer of the board, and fixes his compensation. The object of having the health officer the chief executive, and having him a physician, is obvious. He is the sanitary adviser of the board, his professional education fitting him for such a position, and when the board is not in session he is ex- pected to see its orders of general application carried out, and any special ones that may have been made; if the board has not directed otherwise. Being the chief executive officer makes him the one to enforce all orders of the board, even though he is not mentioned in the order or regulation as the one to enforce the rule, for he executes the board's will as its executive officer. The board fixes his compensation in such manner as it considers best, either by a certain salary, or by allowing so much per diem when engaged in his duties, or by paying some agreed on price for each piece of work per- formed. It is undoubtedly best to pay a certain salary as the health officer is always on duty, and not only at certain times or places. § 19. Board has power to employ persons and fix their compensation.—The board may employ such other persons as shall be necessary to enable it to carry into effect its orders and regulations, and fix their compensation. Under the power thus given, the board can employ counsel, experts, inspectors, guards, watch- men, laborers or others that may be required, but it 4 26 A Manual for must always be borne in mind that such persons can only be employed when any or all are necessary for the board in its work of protecting the public health. If the board has no regular counsel and requires legal ad- vice and assistance in an action to enforce an order to abate a nuisance, this section gives the authority to em- ploy such counsel, and the same where, for example, an expert examination by a chemist or bacteriologist is needed of water used for drinking purposes which is suspected of causing disease. Or it may be necessarj to place guards or watchmen over a house quarantined for contagious disease, or to employ laborers to abate a nuisance which the board has ordered removed, and the maintainer failed or refused to obey the order. This, like other implied powers of health boards, is in accord- ance with the fundamental principle that wherever a general power to do a thing is given, every particular power necessary for doing it is included. § 20. Power to make rules and regulations. Rules must be published.— Boards of health make and publish from time to time all such orders and reg- ulations as they shall consider necessary for the proper preservation of life and health, and the execution and enforcement of the Public Health Law in the muni- cipality. These rules are of general application, and are framed to meet all conditions that experience has shown may arise and affect the public health. They are published in such manner as to give them full pub- licity, that all may have a chance to familiarize them- selves with the orders of the board. This publicity may be by publication in one or more papers issued in the place, or in such that circulate amongst the inhabitants, even if not locally printed, or by placards posted in con- spicuous places, or in any way the board considers will Boards of Health. 27 call most attention to them. From time to time they are to be thus published; and as local boards, other than those of cities, change every year, each new board com- ing in publishes once a year. The rules need not be changed from those of the preceding board; and unless some special object is to be gained, it is much better they should not be, people having become familiar with the ones in force; but the board, by resolution, adopts the rules, and thus makes them its own. It is sought, in the making of these general rules, to cover all cases upon which the board may be called to act. This saves the trouble of making special rules, but does not relieve the board from passing upon each case separately and upon its merits. The decision, however, may be under the general rule, in which case it is all the better than where special orders have to be made, for the offense is not unique, and is one the offender should have known was against the published regulations of the board. § 21. Board can impose penalties.— For violation of any of the provisions of any rule of general applica- tion the board can impose a penalty. It is distinctly stated in the law the board may " prescribe and impose penalties for violation or failure to comply with " its orders. Boards cannot fine. To fine is to imply the person imposing the fine has the power to collect the same, but a board of health is not given that power. It is authorized to impose a penalty, in no case to exceed $100, but it must collect this penalty in some court of competent jurisdiction. The defendant has, therefore, a further chance of showing cause why he should not be mulcted. If the court refuses to allow of the penalty being collected, it does not, in any way, relieve the de- fendant from the responsibility of obeying the order of the board to abate the nuisance which called forth the 28 A Manual for imposition of the penalty, for the board only sues in court to recover the penalty, not to adjudicate the question of the nuisance. In placing penalties in any rule, the board must state a fixed sum, not a sliding scale as '' from $5 to $25/' but the fact that the penalty is $5 or $25, as the case may be. § 22. In special cases order or rule does not have to be published. — In certain individual cases, however, not covered by the rules of general application, the board may make an order and under such order the case is decided. These do not have to be published, for no other like case may come before the board, and the order is not one concerning which the general public need charge its mind. The order being a special one, not published, the person to whom it is directed must have it served upon him, and if he cannot be found, it should be posted in some prominent place on the prem- ises to which it has reference. This rule should also be followed in orders made under the regulations of general application. § 23. Board can issue subpoenas and administer oaths. Committees can hold hearing, but not decide. —In the course of its duties it may be necessary for a board to examine more deeply into a given case than usual, one where from conflicting statements no- thing short of examination under oath will clear up the matter and allow of the board coming to a just decision. To this end the board can issue subpoenas and examine witnesses with the same power as a justice of the peace, but no subpoena shall be served outside the jurisdiction of the board, and no witness can be examined on matters not related to the public health. If the whole board does not wish to sit and hear testimony, it may designate one or more of its members to act, and also appoint one Boards of Health. 29 to issue the subpoena. If a committee be appointed to hold the hearing, the committee cannot decide the mat- ter of itself, but must report to the board and it, having considered and adopted the report, decides the question. The board cannot delegate its power to any of its mem- bers or any one else in any case where the law requires the board to pass upon the question. § 24. Power to issue warrant. — When the board finds itself powerless to enforce an order, where the order requires the removal of some person, it may issue its warrant to any constable or policeman to remove the one obstructing, and, if necessary, a warrant to the sher- iff of the county whenever such extreme power is re- quired. The issuing of a warrant may be called for by a person who has been notified to abate a nuisance not only refusing to obey the order of the board, but pre- venting by violence, or a threatened violence, the entry upon his property of those authorized to enter by the board. Or in cases of a great epidemic it may be nec- essary to remove whole families to prevent the spread of contagion, and refusal to obey on their part may call for a warrant or the assistance of the sheriff. § 25. To make complete the registration of vital statistics. Boards purchase their own supplies. Copies of registered certificates pre- sumptive evidence. — Boards of health are to make complete the registration of births, deaths and marriages within the municipality. (Sec. 22.) The state board prescribes the forms upon which the statistics are to be written, and all places must conform to the form thus prescribed. The state board does not issue these certifi- cates to local boards, each local board purchasing its own supplies, but even then the size of the blank and the subject-matter must be exactly as prescribed by the state 30 A Manual for board, and it would be well also if the thickness of the paper could be uniform. It may seem strange to have this statement made, but when one thinks that nearly a hundred and fifty thousand of these certificates were received in the department of vital statistics of the state board for 1892, that all these have to be filed and so kept as to be easily produced, the necessity of absolute uniformity ceases to be a matter of surprise. The im- portance of these records is being slowly realized and boards of health should pay greater attention to educat- ing those whose duty it is to file with them these certifi- cates. In the rules of general application full and explicit statements should be made concerning these certificates, and the penalty, after warning delinquents, enforced. After these certificates are recorded in the local register, they are to be forwarded to the state board. The law requires every parent of a child born, the groom, officiating clergyman or magistrate at a marriage, shall cause a certificate of such birth or marriage to be re- turned within thirty days after the event to the local board of health, and that the birth record shall be at- tested by the physician or midwife in attendance, and the marriage record by the person performing the cere- mony. The cost of registration is not to exceed fifty cents for any one certificate. How this sum, if the whole of it is allowed, is to be expended, lies with the board. It can pay part to the person making the return and part to the registrar, or all to the registrar, or part of the full sum. The board is to make these records complete, and it is left to its discretion what method is best to secure the fullest returns. In cities where the registration is large, a salary is generally paid the regis- trar in place of fees. To bury or remove a body without having first ob- Boards of Health. 31 tained a permit to do so is a misdemeanor. (Sec. 23.) Every death must have made out for it a certificate, signed by the physician last in attendance, the coroner if an inquest has been held, or the affidavit attached to it of some reputable person setting forth the cause of death where neither doctor or coroner was in charge. This is required before a permit for burial or removal can be granted, for the permit can only be granted upon the filing of a certificate of death. The board designates who of its members shall issue the burial permits and also prescribes the sanitary regulations for the interment of bodies. These are rules of general application and relate to the manner in which burials are to be con- ducted, the proper coffining of the body, whether the funeral may be in a church or shall be private and any other precautions considered necessary to protect the public from danger that may come from the corpse. "While payment is arranged for (sec. 22) of a certain sum for the registration of any vital statistic record, no payment is provided for the issuance of a burial permit and nowhere does the law say a charge can be made for such permit. But it is distinctly stated it must be is- sued before a burial can take place and can only be so issued on the filing of a death certificate, therefore as the one is but part of the record required and is not complete or does not finish the matter it represents without the second part, the permit, the whole trans- action is one and it is paid for by the fee allowed by the board for the registration of the death certificate. Copies of any of the records shall be furnished to any person asking, and for the making of such copy a sum not to exceed the price paid for registering the certifi- cate may be charged, and if the copy be duly certified to, an extra fee of twenty-five cents may be required, 32 A Manual for for the certified copy is presumptive evidence of the facts stated therein. § 26. Duties regarding contagious disease. — One of the most important duties of a local board is to guard against the introduction of contagious disease and to provide for its care and limitation if it develops in the municipality. (Sec. 24.) Much may be said on this subject, for it is one engaging attention always. A board is empowered to protect its municipality from the invasion of contagious disease from an infected place by the inspection of all persons and things arriving therefrom. This is quarantine power but it is not de- signed that should small-pox or some other contagious disease break out in one place in the state, every board of health through whose jurisdiction a train passes which came from the infected place should stop that train, fumigate it, hold all passengers under observation and disinfect all baggage. To do so would be an excess of zeal and an injury to the traveling public not justified by the circumstances. For a few cases of contagious disease in one place does not make it a plague spot or of such a menace to health that every article coming from there must undergo inspection after inspection. "The law is common sense " and common sense must be used in construing it. When persons and things come from an infected place, where exists an epidemic of a violent nature, where no precautions are taken to prevent the spread of contagion; then a local board would be justified in taking extreme measures and endeavoring to stop any substance, animate or inanimate, which might communicate he disease. But the next board, after the first had finished with the persons and things, may trust to the work of the first and pass the travelers as safe. Should a case of contagious disease come from an- Boards of Health. 33 other place, the board must take such precautions as will prevent the spread and not only in its own town, but anywhere else. And so if persons move into the jurisdiction of a board and come from a place where sickness of a contagious nature exists, the board by its health officer or some other doctor appointed for the purpose examines to see if the people are healthy and if so, he allows them to settle, but, should the period in which the disease could probably show itself not have wholly elapsed, he should keep a sharp lookout on the new-comers to see that none came down with the sick- ness. § 27. Patients can be taken to hospital. — Where the disease is highly contagious, if the board have a proper place to which the patient can be taken for isola- tion and treatment, it has the right to take the patient to such place. Boards are required to furnish suitable places where contagious diseases are to be cared for. A board is to maintain a strict quarantine and prevent any intercourse that might endanger the public health. This is made the subject of one of the general rules. The board reports promptly to the state board all cases of contagious disease. § 28. Vaccine virus to be supplied by board. — Vaccine virus is also furnished by the board, obtained from such source as shall be approved by the state board, and during an epidemic of small-pox the supply should be frequently renewed so as to have on hand while the epidemic lasts, fresh virus for immediate use. All pub- lic school children are required to be vaccinated. (Art. XII, sec. 200.) The work of thus vaccinating them is put on the school trustees, but the board of health can call upon the trustees to carry out the law if they neglect it. The school trustees being empowered to employ a physi- 5 34 A Manual for cian to vaccinate the children (sec. 201), if they neg- lect the duty after having been notified by the board to comply with the law, the board can appoint the vaccina- tor and collect from the school trustees the cost of the work. §29. Contagious disease in alms-houses. — If contagious disease break out in any county alms-house, and it is likely to endanger the rest of the inmates, the superintendent of the poor may cause the patients to be conveyed to such place as is designated by the health board, for care and treatment. This must be the place designated by the board having jurisdiction where the alms-house is situated, but the cost of maintaining the patient is to be paid by the county. § 30. Boards may make rules for water supply if it is within its jurisdiction.— The water supply of a city or village may become polluted by many causes and disease be traced to its use. The board, if the water-shed or the source from which the water is obtained is within its jurisdiction, can make such rules concerning it as will give protection from contamina- tion. To do this, however, the board must have the entire supply within its jurisdiction, for without such being the case, the rules would only be applicable to that portion within the municipality served by the board and the source of pollution could be entirely outside the corporate lines. In such case the board, finding the water supply a menace to health, could request the state board to make rules for its care under the provisions of Article V. § 31. Complaints by inhabitants must be ex- amined. Power to enter premises.—Complaints of nuisances made by the inhabitants must be examined by boards of health. (Sec. 25.) To so examine the board Boards of Health. 35 has the power to enter upon, or by its members or employees designated to enter, any place and make all examinations necessary to determine the existence of a nuisance, and every one having any thing to do with the place examined must permit such entry. The result of the inspection is to be communicated in writing to the person responsible for the nuisance, owners, agents or occupants, and all of these parties have the right to a similar copy. § 32. Board can only act on nuisance of danger to health.— The board orders the suppression or removal of every nuisance or condition detrimental to health, but confines itself strictly to matters of such character, as it has no authority to deal with other kinds of nuisances. Nor must the board seek to construe by far-fetched reasoning all nuisances of more or less dan- ger to health and therefore under its jurisdiction. This would be an excess of jurisdiction and render the work of the board useless. § 33. Board orders abatement of nuisance. Ex- penses, how recovered.—The board having inspected a nuisance coming under its rules, serves a written notice to abate upon the maintainer. If no compliance is given by the offender, the board has the right (sec. 26) to enter upon the premises and do such work there- on as will abate or remove the nuisance. The mode in which this stage of procedure is reached, will be treated of in the chapter devoted to such subjects, for the board must observe a certain course, otherwise its action will not be legal, and if the defendant appeal to the courts, the board will not be sustained. The expenses to which the board is put in thus abating a nuisance are to be paid by the maintainer and the board brings suit to recover. If judgment is satisfied, the sum recovered is 36 A Manual for paid into the treasury of the municipality, for the ex- penses of the board in doing the work are submitted to the municipality and audited, collected and paid as other such charges are. If the amount is not recovera- ble from the person at fault, the board puts a lien upon the property (sec. 27) in the manner provided for and thus protects the municipality from loss. § 34. Special power over tenement-house work. — Disease may be started in one place, and by means of clothes or other articles be carried to another, thereby causing a serious epidemic. " To prevent this the board is given special oversight (sec. 28) of all places where the occupants engage in their trades in the places in which they live and eat. While the general powers of the board cover these places as they do every other, these were considered of sufficient importance to give specific power in dealing with this class of people. The section is so plain that it needs no explanation, for the procedure of the board is the same in abating nuisances or protect- ing from contagious diseases in these cases as in general ones. Should, however, contagious disease break out in such a tenement-house workshop, and the goods there manufactured are clothes or such like articles, the board can only fully protect by destroying the goods, woolen clothing being especially apt to retain diseased germs. Where tenement-houses are closely crowded, the health of- ficer should examine to see if the ventilation is fully suffi- cient. If it is not, he should, if the rules cover, direct the number of people that can occupy each room; but if the rules do not cover, he should report the matter to the board and suggest an order be made concerning the matter, citing the owner of the tenement before the board at the same time in order that he may have full Boards of Health. 37 knowledge of the proceedings and be informed of what is necessary in the future conduct of his tenement. § 35. Jurisdiction, combined boards.— The juris- diction of a local board is only in its municipality. (Sec. 29.) The city board has no authority outside the city limits, the village board outside its corporate line, or the town board outside of the town. The town board has no authority in a corporate village even though the entire village be within its jurisdiction. If the village has no organized board of health — and the village has to have one or the trustees are liable to punishment in not obeying the requirements of section 20 of article II — the state board can in such a municipality act as a local board. (Sec. 11.) But expense to municipalities may be greatly reduced and equally good protection to public health given by the combining of one or more boards in a sanitary and registration district under the written approval of the state board. The number of the mem- bers of the town board is fixed by law. The village may not be less than three. Supposing a town and village desire to combine, the two boards meet together and organize by appointing a presiding officer and electing a registrar and health officer. Kules of general applica- tion for the whole district are adopted and ordered pub- lished. The persons who are to issue burial permits are designated ; the state board's permission is recorded and the combination is effected. In all matters pertaining to general application, the rules being common, the authority is derived from both boards; but where it is a special case, the authority is given to the officers by the board having jurisdiction where the case is. § 36. Expenses of board, how paid.— The ex- penses of the board (sec. 30), those incurred in the dis- charge of its duties under the law, are to be paid by the 38 A Manual for municipality, the accounts being audited, collected and paid as other such accounts are in the particular locality. The question of these expenses is often a vexatious one. The compensation of the health officer, clerk or registrar is fixed by the board ; and also of any other employees the board may find necessary to help in caring for the public health. Their compensation is fixed by the board and consequently the payment of it is a matter of pass- ing through the form prescribed by the municipality for the auditing of such bills, for the amount, if the bill is a proper one, cannot be reduced by the auditing power ; the law giving the board the authority to fix the amounts. The auditing board, however, has the power to alter the amounts if they are unreasonable or excessive and the health board would then have rendered itself personally liable for the charges if it had personally assured the claimants the amounts would be paid. So all necessary expenses:— the purchase of office supplies, the publishing of the rules and regulations, the cost of printing notices, the legitimate expenses of members if they are put to any in performing their duties, the cost of abat- ing a nuisance; in short, all the expenses incurred by the board in the discharge of its important work are to be "audited, levied, collected and paid." How far can a board go in running up a bill of costs? This question can only be answered by the circumstances of the case. The board must protect the public health or be guilty of non-obedience of law, and to protect the public health oftentimes entails greater expense than any one at first anticipates. The board cannot hesitate. Like all other citizens the members pay their share of the taxes, and consequently, if their acts raise the rate, they suffer with others, but the board must do its duty regardless of cost. Boards of Health. 39 § 37. Power of board to do work necessary to protect public health, if municipality refuses to.— The question is often asked, what power the board has to remedy a condition considered by it to be dangerous to public health and for which the municipality is respon- sible rather than private parties. For instance, a sewer leaks and floods house cellars; sickness is caused and the health board appealed to. The board finds on examina- tion the facts of the complaint to be as stated and notifies the common council to abate the nuisance. The com- mon council refuses to obey or pay any attention to the order. The board can then — the city owning the street and not obeying the order of the board — make contracts for the work of laying a new sewer, if that is the only and proper way the nuisance can be abated. The expense must be borne by the city when the amount is submitted by the board. This will serve as an example of all similar cases. 40 A Manual for CHAPTER III. THE health officer. SECTION 38. Board prescribes duty of health officer. Civil service examination required. Chief executive. 39. Rules of board are the instructions of the health officer. 40. Reports of contagious disease must be made. Dis- eases to be reported. 41. Duty of health officer when contagious disease is reported. 42. Board must supply medical attendance and care for contagious cases if patients are indigent. Con- tagious disease in hotels, boarding-houses and private families. 43. Disinfection. Destruction of articles liable to hold contagion. 44. Health officer must report contagious diseases to state board. 45. Action of health officer upon a complaint. 46. Health officer is always on duty. 47. Health officer should report in writing. 48. Health officer to visit institutions caring for children. 49. Improper food articles fobidden sale. Health officers to seize. 50. Miscellaneous. § 38. Board prescribes duty of health officer. Civil service examination required. Chief execu- tive.—" Every such local board shall prescribe the power and duties of the local health officer, who shall be its chief executive officer, and direct him in the per- formance of his duties and fix his compensation." (Sec. 21.) Boards are required to appoint competent physicians as health officers. (Sec. 20.) The office is not one either of great profit or emolument. It is one full of plenty of hard, disagreeable work, if the health officer dis- Boards of Health. 41 charges his duty. The selection of a health officer is not the smallest duty of the board if it fully intends to do its whole duty in protecting the public health. The responsibility which rests upon the board in this respect is large, for the decision of this, its medical mouthpiece, oftentimes involves grave questions, and consequently the choice of this officer should be made with care and full knowledge of what he may be called upon to do. A doctor having the confidence of the community and of his fellow practitioners in his medical ability, will be a far more efficient guardian of health interests than one lacking these. The health officer is a state officer, it having so been decided by the courts. When he is ap- pointed, the board should notify the civil service com- mission, who arrange for his examination as to his fit- ness for the office, which examination is non-competitive. Having once passed such an examination, he is eligible any time thereafter for the position of health officer, either in the place originally appointed or in any other in the state he may move to. § 39. Rules of board are the instructions of health officer.— The board's rules for protecting the public health are his general instructions, and as he is the chief executive of the board, he is the one to see its orders obeyed. Purposely the law requires him to be a physician, that as executive officer he may know, with- out having to turn to his books or to others to tell him, what things are of menace to health, what danger may come from this or that article exposed in a sick room where contagious disease exists, whether or not a given condition will -cause disease. He has often to decide such questions at once in the board's name and in ac- cordance with its rules of general application. 6 42 A Manual for § 40. Reports of contagious disease must be made. Diseases to be reported.— The rules require physicians and all others knowing of certain diseases in the municipality to report the same to the board or its health officer. The diseases thus called for are generally typhus, typhoid, scarlet and yellow fever, cholera, small- pox, chicken-pox, measles, diphtheria and membranous croup. At first sight, it may appear the reporting of some of these is superfluous, but a little study of the reason for including all will satisfy the most skeptical that full knowledge of the existence of any of them in the municipality is of moment to the public health. Typhoid fever, while not considered contagious, should call the health officer's attention to its cause. Is it an isolated case? Then perhaps it may have been contracted elsewhere, and due care of the discharges by the doctor and those in attendance will prevent its spread. If several cases are present or developing, some direct cause is at hand and the health officer's attention is first directed to the water supply. He, as health officer, should investigate the cause of the outbreak and re- porting to the board the result, measures may be taken that will be of permanent benefit to the health of the community. The presence of typhus fever, it being highly contagious, must be made known to the health authorities that rigid steps may be taken to prevent its spread ; and the same may be said of yellow fever, although the contingency of its making its appearance is but small. Cholera requires active work on the part of the board; small-pox also; and while chicken-pox and measles are of but small account in the rank of contagious diseases, the similarity they bear to small-pox in the earlier eruption is necessary to be borne in mind. Boards of Health. 43 The health officer should know where such diseases are in his jurisdiction, so that if a mistake in diagnosis is followed by an outbreak of small-pox he may be in a position to examine localities where the other cases have been reported. And so with diphtheria and membranous croup, the former highly contagious, the latter not so, yet both having such a similarity of symptoms, that mistakes are often made as to the nature of a case, and danger to the public incurred where it might have been prevented had the health officer been notified of the cases and insisted on precautionary measures even if the patient appeared to him to be suffering from the non- contagious croup. Practically from a sauitary point of view these two diseases may well be considered identical. § 41. Duty of health officer when contagious disease is reported. — And what is the health officer to do if such cases are reported to him ? The rules and regulations provide the method of quarantine. It is his duty to see these carried out. He should visit the case, not as a physician, but as a health officer; see that all proper and necessary precautions are taken to prevent the contagion spreading, explain to those in charge the rules of the board and the penalty for not obeying them. Of the treatment of the patient, unless it has been put under his professional charge by the family or the board, he has nothing to say. That is not his business as health officer; and if other doctors fear improper and unprofessional action on the part of the health offi- cer, the obtaining of reports will be much more diffi- cult, and the health officer who allows himself to inter- fere outside of his plain duty is not fit for the position he has been honored with. The quarantine established by the health officer under orders of the board, in all contagious diseases, is the measure of protection the 44 A Manual for public receives. While having due regard for others and while rigidly fighting the spread of the contagion, consideration for the people thus afflicted must be had and the enforced sequestration made as easy as is com- patible with safety. When the case can be taken to a hospital designed for its care, then the protection to the public is greatly increased and the annoyance of quaran- tine lightened for those undergoing it. § 42. Board must supply medical attendance and care for contagious cases if patients are in- digent. Contagious diseases in hotels, boarding- houses, and private families. — If patients are unable to procure medical attendance and care, and are suffer- ing from contagious disease, the board makes all neces- sary arrangements for the case, and the health officer becomes the medical attendant unless the board employs a physician for the specific purpose. In either case, the health officer has an oversight of all precautions against spread of the disease and must see the board's and his orders in this regard are strictly carried out. Should the case occur in a hotel or boarding-house, while the board can take charge of that part in which the patient is and strictly quarantine it — the sick person being too ill to be moved or there not being a suitable place to move him to — the health officer may advise all inmates, and he should do so, of the danger incurred by being near the case and should forbid any intercourse with that part of the house quarantined except such as he permits. And if the borders all leave, the health officer or the board cannot be held liable by the proprietor for the loss sustained by him in the emptying of his house, for the board has not ordered them away, but has merely pointed out the danger of their staying, and their leaving is an act of their own volition. If the case occurs in a private Boards of Health. 45 house and the patient is to be treated there, the family, other than those necessary to care for the sick, can be directed to leave, especially if it is necessary for their support that they carry on their usual avocations, but, the board or the health officer cannot take other cases of like nature, except it be a member of the same family, to the house for treatment. §43. Disinfection. Destruction of articles liable to hold contagion.— The health officer must see that thorough purification of all places and things exposed to contagious disease is made before allowing them to be used in the ordinary manner. The health officer decides what substances will require destruction, as his medical knowledge is for that purpose, and he causes to be removed all articles that cannot be so disinfected as to be perfectly safe, and has thern destroyed. This he does under the authority of the board, for he cannot act unless by their orders, but as its executive he does not need to call the board together to receive specific direc- tions in each case, the general rules governing such mat- ters being his guide. For articles destroyed the board makes restitution, as they are so destroyed for the pro- tection of the public health, and the public should, therefore, pay for them. To delay until the matter can be settled in court as to the value of such articles, is to run the risk of more cases, and thus endanger the public health far more than the value of any articles necessary to be destroyed could possibly equal. The board, there- fore, by its chief executive, does what is required by the exigencies of the case to prevent others being taken ill — burns, washes, fumigates and disinfects, and settles the amount to be paid, if any, after it has performed its paramount duty of guarding the public health. 46 A Manual for § 44. Health officer must report contagious diseases to state board.— The health officer reports to the state board all cases of contagious disease in order that knowledge of where such are in the state may be had by the state department, and that it may notify other state boards as agreed upon by these bodies in a general conference. And the knowledge that certain diseases exist in certain localities gives the state board the chance of investigating the cause, and of advising measures to be taken which would tend to lessen disease in that municipality. The reporting of small-pox, scarlet fever, diphtheria, typhus fever or cholera in the first instance by the health officer is not paid for, but the state board may require monthly reports of such diseases as it names, for which certain amounts are allowed. (Sec. 24.) The cases thus to be reported monthly are stated in the law, and the amount allowed is also named. The payment for reporting them is made by the municipality in the same way as registrars of vital statistics are paid for their registration when paid by the certificate. The number of diseases reported each month by the health officer are certified to by the secretary of the State board on a return postal card, and this card is the voucher of the health officer that such reports have been made, and on these vouchers the local board allows his account which is to be paid as other such charges are. § 45. Action of health officer upon a com- plaint.— A complaint is received by the board or the health officer of some condition considered by the com- plainant to be insanitary. (Sec. 25.) The health officer inspects, examines into the complaint and notifies the party at fault, in writing, to abate ; giving the reason for such notice, and quoting the rule under which it is issued, by number. This notice is partly printed, the Boards of Health. 47 health officer filling in what is necessary to meet the case under consideration. A reasonable time is granted by the order, say three days, in which the defendant may get to work, and if the health officer meets the per- son at fault it is well to explain what is necessary, a few words oftentimes doing more to accomplish the end sought than a notice only partly understood. Should the notice not be obeyed, the health officer reports the fact to the board at its next meeting, if the case is one that can wait; if not, he reports to the president and suggests a special meeting be called, and advises what further can be done. If the case waits for the regular meeting, the health officer reports, in writing, with the rest of his work, this case; sees that the secretary of the board has given due notice to the defendant of the time and place of meeting; and that a citation has been served upon him to appear before the board to show cause why it should not proceed against him. This brings the case directly under the board, it now being out of the health officer's hands, he having carried out his instructions as far as the law allows, and the decision of the board in the further disposition of the matter will contain further instructions for him if the board so de- sires. Should this happen, the board directing him to enter upon the premises and do such work as may be necessary for the protection of the public health, he obeys such orders and completes the abatement of the nuisance. § 46. Health officer is always on duty.— The health officer is always on duty. He should in his daily rounds while attending to his regular practice observe all matters requiring remedy which come under the jurisdiction of the health board. He can advise in many cases what should be done and thus secure, with- 48 A Manual for out the necessity of an order, the betterment of the sani- tary condition of the municipality, for the welfare of the community is not only his duty as health officer but his interest as a citizen. The healthier a place is the more it prospers. § 47. Health officer should report in writing.— The health officer should always report, in writing, when- ever the board meets, his acts since the previous meeting. These reports become part of the records of the board and should be entered in full on the minute-book. They should include all cases of complaints where he has made inspections, cases of contagious disease and what was done, a statement of the condition of the munici- pality as to prevailing diseases, the cause of such sickness, if he can give it, the sanitary state of the municipality and such recommendations as his experience may sug- gest would be of benefit in adding to the healthfulness of the place. As said before, his being a medical man is required, and, therefore, he is the sanitary adviser of the board. Being in daily contact with the people and see- ing where much may be done to improve the hygienic surroundings, his suggestions should have weight with the board and aid it in the better discharge of its duties. § 48. Health officer to visit institutions caring for children.—If institutions for the care of children are present in the town, other than hospitals, the law requires them to submit, through their medical attend- ant, monthly reports on forms approved by the state board. (Sec. 204.) The health officer should verify these reports from time to time by personal inspection of the institution to see that every sanitary requirement is fulfilled; and if contagious disease is reported from any, he should immediately visit to see what precautions against spread has been taken. The medical attendant Boards of Health. 49 must report to the health officer at once the outbreak of any contagious disease under the general rules of the board, and also state the same in his regular monthly report. § 49. Improper food articles . forbidden sale. Health officer to seize.— Articles improper for food are forbidden sale. Health officers should make them- selves familiar with section 41 of article III, and when they find any substance improper for food being offered for sale, the same should be seized and destroyed. The general rules should also cover this ground, going into particulars as to what should be seized. Where im- proper articles are not exposed or offered for sale in the municipality, but are being shipped to another place within this state, health officers, if conversant of the fact, should telegraph the health authorities of the place to which such articles are consigned that they may seize the same before being sold. 8 50. Miscellaneous. — The familiar quotation has it, " eternal vigilance is the price of liberty," and equally true is it that eternal vigilance will insure healthy com- munities and prevent epidemics of disease. And so the health officer should always be on the watch for the first indication of danger to the public health and be ready for action in its defense. To wait until an epidemic is started is to neglect his duty and to violate his oath of office. To him, as its executive officer, the board looks that nothing happens whereby the health of the municipality is endangered, and he should realize his responsibility and be prepared for the discharge of his duty in a man- ner fitting the honor of his office. 7 50 A Manual for CHAPTER IV. relations of doctors, clergymen, magistrates and others to local boards. Section 51. Why support of the people should be given boards of health. 52. Specific duties of doctors and others, relating to vital statistics. 53. Duty of physicians relating to contagious disease and insanitary conditions. 54. Citizens should give attention to insanitary condi- tions existing on their property. 55. Duty of clergymen, magistrates and grooms relating to marriage certificates. 56. Attorney-general's opinion on return of vital statis- tics. 57. Reasons why physicians and clergymen should return certificates of vital statistics. General considera- tions. § 51. Why support of the people should be given boards of health.— In the social economy all must do their part for the maintenance of the state and law and order. This is a self-evident proposition for without it no common polity could be maintained, and a relapse into the old style of " might makes right " would follow. So in the matter of protecting the pub- lic health, charged by law upon legally constituted bodies whose authority is recognized by all, the great work must be participated in by others not official if the welfare of the community is to be properly pre- served. Unless the people support the officers charged with the execution of the law which they, through their representatives, have enacted, the will of the people becomes absurd and of no avail, and, therefore, all citizens Boards of Health. 51 are or should be as anxious to see carried out the regu- lations published for the protection of health as are the legal officers who enforce the same. § 52. Specific duties of doctors and others relating to vital statistics.— Certain specific duties are placed upon doctors, clergymen, magistrates, par- ents, and grooms of marriages in regard to vital statistic records. The health board is called upon to collect and enter these statistics, but to do so the aid of others must be had. The law, therefore, requires (Art. II, sees. 2i and 22), doctors to sign the cause of death of those they attend in the fatal illness, and the certificates of birth when their services are rendered. Midwives also sign these birth certificates if they attend the case. The doctor says, " But I get nothing for so signing a death or birth return. Can a man be called on to ren- der service to the state without an adequate return for that service ?" A question could be asked for the answer, for every one is notified to pay his taxes within a certain time; and if he fails to do so, he has to pay more. The citizen receives no pay for this service to the state. Instead, if he does not do it, he is punished by increased amounts demanded, and if he fails altogether, his prop- erty is taken to make good the amount. He does re- ceive a benefit for the duty performed in the protection given him and his property by the action of the laws his tax helps to carry out, and exactly in the same way does he receive a return for performing the duty imposed by the law of filling out the vital statistic returns called for by the law. He may not be personally interested in the fact that the child of a patient was born and its birth recorded in the registers of the municipality and the state, but he may again be greatly interested should proof of such an occurrence be needed and the proof 52 A Manual for not be forthcoming because of his neglect to obey the law. He receives a return from the state, less to be sure than in the other instance cited, by the knowledge that his children or grandchildren are so recorded that should cause arise for transcripts of the records, the records are on file and ready for copy. In the case of a death his duty to the community is clear in the filling out of his part of the certificate. The law makes it a misdemeanor to bury a body without a proper return of the death having been filed with the official granting the burial permit, and it requires the doctor last in attendance to insert the cause of death and sign the cer- tificate. His signature is a guarantee that no crime has been attempted, and where danger from the character of the disease was to be apprehended, that he has taken precautions to protect others from it. The importance of this record is equal to the other and an added import- ance is found, for these returns, taken together, give in- formation as to the prevalence of disease and cause inquiries to be made as to what steps are necessary to secure the removal of the cause or a lessening of its baneful effects. By neglect of his duty, imposed by the law, to sign, he makes others violate its provisions, for the body must be buried, and yet the law says it is not to be until he has signed the death certificate and a permit is issued thereon. He commits a misdemeanor and compels another to do likewise. But aside from this, the record is of value to him as to the family of the deceased, for it may be necessary to prove in court facts concerning the death set forth in the certificate which may have interest for the physician as well as for others. The constant call for transcripts of these records prove their great value, and every effort should be made to render them complete. Boards of Health. 53 § 53. Duty of physicians relating to contagious disease and insanitary conditions. — The relation of the doctor to the board in this matter of vital statistics is important, but it is not his only relation nur the most important one. He is of the profession that must deal with disease, and in his hands the physical well being of some portion of the inhabitants is placed by them for care. He should be of the first, therefore, to aid the health authorities in their work of rendering the place where he lives more cleanly and healthy, and, therefore, more attractive to settlers. When called to a case of contagious disease, he should promptly notify the health officer ;md aid in taking all precautions against spread. While this duty may be and is called for by the rules of the board, it is also called for by higher motives than mere obedience to the mandates of health authorities ; it is in the interest of all the inhabitants that contagion should be guarded against, and to no one more than the doctor. Where, in his daily rounds, he sees matters in such an insanitary condition as to be of menace to health, he should use his influence to have them changed, and if that fails, advise the board that it may take measures to do so. The aid physicians can render to constituted authority to improve the sanitary condition of a munici- pality is greater than most doctors think, for they are fitted by their studies to understandingly pass upon such subjects, and the people naturally look to them for guidance in matters pertaining to health. § 54. Citizens should give attention to insani- tary conditions existing on their own property. — If more general knowledge of what tends to improve the public health could be disseminated, more support would be given the efforts of those who try to carry out the behests of the law. If citizens would aid in making 54 A Manual for their municipality healthy by seeing that no insanitary condition exists on their own premises, both they and their neighbors would be better off. If owners of tene- ment-houses would see to it that such places were in and of themselves sanitary, the health authorities could more easily guard against the danger from disease com- ing from the inmates. But it is found that such work is more than neglected. Where the poor, from necessity, have to crowd together in buildings with improper drainage, which is enough of itself to cause disease, the chances of sickness breaking out and spreading is greatly increased. The people may be but able to earn enough for the bare necessities of life and with scant and poor food the condition of the body is depreciated. Add to this conditions which they cannot control: im- pure air, foul emanations from drains and other places, insufficient ventilation of rooms — matters which can be prevented; and a combination is effected which one can only wonder does not cause more disease in our closely settled districts than is shown by statistics. Cer- tain diseases when grafted in such places become almost endemic. The germs find fitting soil in which to grow and, though lying dormant at times, appear in some cases never to entirely die out, asserting their presence from time to time when atmospheric conditions are such as to further their activity, when nothing short of most energetic measures will eradicate them. Those owning such places should understand the danger is not con- fined alone to those living therein. It may be carried by the tenants to houses where they work ; houses in which science aud ample means combined have, in every way, rendered as safe from disease as human ingenuity can make them, and cause death to the more favored inmates. Boards of Health. 55 Insanitary conditions in the better class of houses are equally dangerous. The danger may not be so far reaching, but it is close to the dwellers, and their own interest is to remedy it. Still it is found too often the health board must make peremptory orders to save the people from themselves. It appears that money ex- pended in such matters is considered as money wasted, for nothing shows for the expenditure, and belief of danger is not easily induced until practical experience of its presence has caused a loss more deeply felt than that of the almighty dollar. The work of the health board, therefore—while its per- formance is to be carried on by those appointed to the office, is one in which all not only have an interest, but all should bear their part. Where conditions of menace to health are known to exist, information should be given the board that efforts may be made to improve. Where public needs clearly indicate works of public sanitation — which cannot be carried out except by the suffrage of the inhabitants —; the future benefit should be more considered than the present cost; for not only are they adding to their own healthf ulness, they are insur- ing to those who come after ample protection or at least ;he groundwork on which more can be done if more is needed. War is a state to be dreaded. All play their part if it has to come and all strive to avoid it if possi- ble. Public interest from the rostrum to the work bench is excited and every one does his share to protect the common country from its danger. But disease be- comes familiar by its frequency. It is taken as a visita- tion of the Deity and the preventing of it is to be looked after by boards of health and the doctors. It is an enemy more powerful and more fatal than the greatest nation, but because we must all die, the question of 56 A Manual for entering into a fight with disease is not one to arouse great interest unless the outbreak becomes or is likely to become, of magnitude. Then there is a rushing and a fevered effort to do in short order what should not have to be done—what would not have to be done if all had recognized the importance of the work in their daily routine and kept their own places in such a state as to pre- vent disease gaining a foothold, or had continually given aid and countenance to the health authorities in their efforts to the same end. " Cleanliness is next to Godli- ness" is an old saying, and in one sense it must cer- tainly be true, for many are more godly than clean. By cleanliness alone can disease be successfully kept under. And the people have this matter as much and more in their hands than do the officials. § 55. Duty of clergymen, magistrates and grooms relating to marriages.— Clergymen are also leaders of public thought and teachers of a higher life. Their duty to the public in the returning of marriage cer- tificates is the same as the doctors with births and deaths, Being the only persons, other than certain officials, empowered by law to perform the marriage ceremony, they are called on to certify to such performance and i: goes without saying how important records of such con- tracts are. And as teachers of a higher morality, thej should set the example and follow the divine instruction to "render unto Caesar the things that are Caesar's," for to do otherwise is not to practice what they preach. To set up the dictum of their church as higher than the law of the land in which they live, or to constitute themselves as judges of whether they shall return a marriage certificate or not, is to place themselves at the mercy of the board and to render themselves liable to the penalty under the law. The deficiency in the total Boards of Health. 57 of marriages returned shows conclusively clergymen are derelict in this duty, and but for the forbearance of local boards they would be cited before them to show cause why they should be exempt from obedience to the rules of those boards. The groom of a marriage is respon- sible for the returning of the certificate to the board. But his neglect does not relieve the person performing the ceremony from his responsibility to the state, and the groom, as the generality of men go, is not at the time he is a bridegroom in such a mental condition as to be always in the clearest of mental attitudes or to care whether a certificate is registered. So it is not asking too heavy a work or one requiring too great an expenditure of time or money for the clergyman to relieve the groom of the duty of forwarding the record to the health board and to do it himself. Where a magistrate is the officiating officer, he is likewise required to fill out his portion of the certificate and to return it or see that the groom does. Being a magistrate his orders are more apt to be obeyed in such a matter than the advice of a clergyman to attend to the proper dis- posal of the certificate. § 56. Attorney-general's opinion on return of vital statistics.— It may be well to call attention at this point to the opinion of Hon. Charles F. Tabor, at- torney-general, on this question of making returns of vital statistics. The laws quoted by the learned at- torney-general are now repealed, but they are em- bodied in the new law about which I am writing and in almost precisely the same words, so the opinion is of the same value and weight now as when given. This opin- ion was sought in the case of marriages, but the prin- ciple involved is equally true in the matter of death and birth certificates and has been so quoted since it has been first published. 8 58 A Manual for OPINION OF ATTORNEY-GENERAL ON DUTY OF CLERGYMEN AND MAGISTRATES TO RETURN MARRIAGE CERTIFICATES PROPERLY FILLED OUT TO REGISTERING OFFICER. Chapter 322 of the Laws of 1880 established a state board of health and conferred upon it certain powers. Section 7 provides that " it shall be the duty of the state board of health to have the general supervision of the state system of registration of births, marriages and deaths, and also the registration of prevalent diseases. Said board shall prepare the necessary methods and forms for obtaining and preserving such records and to insure the faithful registration of the same in the several counties and in the central bureau of vital statistics at the Capitol of the state." Chapter 270, Laws of 1885, provides for the formation and organization of local boards of health in the different towns, villages and cities of the state, and confers upon said boards certain powers. Among these powers are those contained in subdivision 5 of section 3, which pro- vides as follows: "To supervise and make complete the registration of all births, marriages and deaths occurring within the limits of its jurisdiction, in accordance with the methods and forms prescribed by the state board of health, and to secure the prompt forwarding of the certificates of birth, marriage and death to the state bureau of vital statistics after local registration, * * * and to secure the completeness of the said registration, it shall be the duty of the parents or custo- dian of every child, and the groom at every marriage, or the clergyman or magistrate performing the ceremony, to secure the return of the record of such birth or mar- Boards of Health. 59 riage to the board of health, or person designated by them, within thirty days from the date of such birth or marriage, and each record shall be duly attested by * * * the clergyman or magistrate officiating at such marriage." It will be observed by these provisions that it is, first, the duty of the state board of health, and it is given the power, to prepare the necessary methods and " forms " to insure the faithful registration of marriages, and that it is also made the duty of local boards of health to supervise and make complete the registration of mar- riages, in accordance with the methods and "forms" prescribed by the state board, and that it is also made the duty of the groom at every marriage, or the clergy- man performing the ceremony, to return, within thirty days, the record of such marriage to the person designated by the board of health, and it is the duty of the clergy- man to attest the certificate. The "form" of the certificate; that is, the facts to be stated therein, is passed upon by the state board of health, and it is for that board to say what facts will give the necessary information as to the performance, etc., of the marriage ceremony; and in accordance with this power and duty the state board has prepared and furnished a certain form of certificate, which, when filled out, will contain all, and no more than the board con- siders necessary to be stated, in order to give the infor- mation contemplated by the acts above referred to. It is not for the person performing the ceremony to say what he, in his judgment, considers a necessary cer- tificate, or for him to furnish simply what he considers the necessary information. That is a matter which the state board of health determines upon, and for that reason the state board is required to prepare the forms 60 A Manual for for the purpose of insuring proper registration; and it is made the duty of the groom or the person performing the marriage cermony, to secure the return of the record, properly attested, and containing a statement of the facts designated by the state board, within the time and in the manner prescribed by the statute. It is true that the statute requires the groom or the clergyman or magistrate performing the ceremony to secure the return of the record of such marriage. It is a co-ordinate duty devolved upon each, and it is the duty of each to see that the requirements of the statute are complied with. The groom could not, of himself, without the assistance of the clergyman performing the ceremony, make the return, for the reason that the return must be attested by the clergyman; nor could the clergyman himself, without the assistance of the groom, make the return, for the reason that the state- ments contained on the back of the certificate relate to matters only within the knowledge of the bride and groom, and for this reason the statute makes the duty a co-ordinate one, resting upon both the clergyman and groom; and I think it is clearly the duty of the clergy- man or person performing the ceremony to see to it, if it lies in his power, that the information contained on the back of the certificate is furnished to the person designated by the local board of health. Very respectfully your obedient servant, CHARLES F. TABOR, Attorney- General. § 57. Reasons why physicians and clergymen should return certificates of vital statistics. Gen- eral considerations.— Physicians and clergymen enjoy certain privileges conceded by the public, as for instance, Boards of Health. 61 freedom from jury duty. The public consider such con- cessions proper and right. It has an equal right to expect of these persons that duties imposed by the law above quoted will be cheerfully and promptly rendered. If the question be carefully studied it will be found these men have benefits which more than compensate for the unpaid duty they are called on to perform by the Public Health Law. It may seem somewhat out of place in a manual for the guidance of health offi- cials, to enter upon the relations of others to them instead of confining the work to their particular duties. But while recognizing the seeming inconsistency, it is more apparent than real, for unless the official knows and can explain to one arguing he is not called on to do any thing, that all the work should be by the official and all directions come from him; the latter will be placed in the position of having to do by the strong hand of the law what could as well and better be accomplished and which would be in the majority of instances readily done, if the matter be only fully understood. Few stop to realize their own responsibility to the community. "What do we have officers for and pay them if we have to do the work?," is a question frequently asked. While the routine labor is given to the public servant, his labor would be useless unless aided and encouraged by the ones for whom it is performed. All thinking persons believe in caring for public health. All would willingly denounce those who are charged with its care if they neglect their duty. But while all are willing to find fault and criticise, all are not equally willing to help or do their share in guarding the public welfare. Let threat of invasion of some epidemic be present and the cry goes up that this or that person or board, whose duty it is to prevent, if possible, such invasion, must do 62 A Manual for something. And many and diverse are the " somethings" that are to be done. Some penny-a-liner calls on the officials to act in ways that would land them behind the bars, for no law could be found for their action. And the writer of the article knows nothing of what he writes other than he is reflecting the opinions of those equally well informed who talk loudly of what should be done. Learned societies meet and pass resolutions that this or that change should be made in the public health service, this or that method of disinfection should be followed, have their valuable deliberations published in the daily press, and then adjourn to attend strictly to their own private interests, never for a moment seeming to think they should do more than merely talk. The life of a health officer is not always "a happy one," for he is blamed for what he does do and blamed if he does not do it. Boards of Health. 63 CHAPTER Y. what constitutes a nuisance; modes of procedure to abate nuisances; power to enforce penal- ties; how they should be collected; citations OF LAW. Section 58. Nuisance defined; example. The right to life, lib- erty and property is not absolute and uncontroll- able. 59. Notice to abate; how made and served. 60. To enforce order board must proceed by due process of law. 61. Order disobeyed; further proceedings of board. 62. Board to enter upon property and abate nuisance. Board will be upheld if procedure is in accordance with law. 63. If judgment is not satisfied, lien is to be placed on property. 64. All proceedings to be recorded. Records presump- tive evidence. 65. Board to fix compensation. Opinion of attorney- general. 66. Procedure in cases of dire necessity. 67. Every nuisance must be considered separately. 68. Each offense should have its particular indictment. Board passes upon what is a nuisance. 69. If municipality is maintainer of nuisance, board may order it to act. Opinion of attorney-general. 70. Physicians must report contagious diseases. Health officer the legal expert to determine diagnosis. 71. Power of board to make rules for plumbing and drainage. 72. Health officers are state officers. § 58. Nuisance denned ; example. The right to life, liberty and property is not absolute or un- controllable.— What is a nuisance ? Easy enough to ask but not so easy to clearly define. Many complaints 64 A Manual for are received by boards of health that are inspired by malice, by a desire to cause annoyance to the one com- plained of by having an inspection made by officers of the board. Oftentimes complaints are made of nui- sances, which have to be corrected, because the com- plainant wishes to retaliate in some way on the maintainer and yet does not care to bring vengeance upon himself. Boards of health, however, cannot con- sider the reason for the complaint if it is made by a citizen. Sufficient that it is made. The law says every board "shall receive and examine into all complaints made by any inhabitants concerning nuisances." (Sec. 25.) It is not discretionary on the part of a board whether the complaint shall be examined or not, it is mandatory, and, therefore, the board must examine into it, and if a nuisance is found to exist, direct its removal or abate- ment; if none is found, to so state. It is then necessary for the board to know what constitutes a nuisance which is of menace to the public health, for over nuisances of other kinds the board has no jurisdiction. A nuisance has been defined as follows : "A nuisance, in the ordinary sense in which the word is used, is any thing that produces an annoyance, any thing that disturbs or is offensive ; but in legal phraseology it is applied to that class of wrongs that arise from the unreasonable, unwarrantable or unlawful use by a person of his own property, real or personal, or from his own improper, indecent or unlawful personal conduct, working an ob- struction of, or injury to, a right of another, or of the public, and producing such material annoyance, dis- comfort or hurt, that the law will presume a consequent damage." (Wood's Law of Nuisances, 2d ed., 1.) While many matters come under the above definition, matters for which the person aggrieved has his remedy Boards of Health. 65 at law, they are not nuisances which he can call upon the board of health to remove, for they do not constitute an injury to his health. As an example, a stable may be of great annoyance to the people living next to it. If the board is complained to it must in its investigation take only into account the question of whether the stable affects the health of the complainants. Is the stable clean ? Yes. Is manure retained in improper recepta- cles and kept so long that decomposition renders it of danger to health ? No. Is the drainage from the stable and washing stand for carriages allowed to stand and become foul ? Or does it find its way into the next house ? No, it is cared for by proper drains. Does the accumulated night air from the stable escape in volume in the morning and affect the health of the complainants? No, the stable is properly ventilated. Do the horses keep up a constant stamping during the night and so prevent sleep? No, all are quiet. Does examination show any person in the complainant's house to have been made ill because of emanations from the stable? No, no one has been ill. Why then the complaint ? There is a smell at times and it is not pleasant to have the stable alongside of the house. The board has no cause for action and should dismiss the complaint, for though the stable may be a nuisance to the people of the house and an annoy- ance, unless it is a nuisance which affects health or is likely to do so in a short time the board cannot act. (Underwood v. Green, 42 N. Y. 140.) The disagree- able odor or the annoyance of having the stable next to the house, while it may be a nuisance and one for which the party aggrieved has his remedy at law, is not one the board of health can order abated. But if it is found, on examination, the emanations from the stable are causing sickness, that the noise of horses is preventing sleep and 9 66 A Manual for so interfering with the comfort and health of the neigh- bors, or any thing else which is an injury to health; the board can properly issue an order requiring abate- ment in such manner as to remove these evils. Per- sons can use their own property as they like, provided it is not of injury to their neighbors. The right to life, liberty and property is not absolute or uncontrollable. (Bertholf v. O'Reilly, 74 N. Y. 509; Stuyvesant v. Mayor of New York, 7 Cow. 588 ; Hodges v. Perrine, 24 Hun, 516 ; Blair v. Forehand, 100 Mass. 136 ; Common- wealth v. Tewksbury, 11 Mete. 55 ; Morey v. Brown, 42 N. H. 373 ; Guillote v. City of New Orleans, 12 La. Ann. 432; Thorpe v. B. & R., 27 Vt. 140; Kings v. Davenport, 98 111. 305 ; Allerton v. City of Chicago, 6 Fed. Rep. 555; People v. Hawley, 3 Mich. 330; 10 id. 489; 11 id. 264; Taylor v. State, 35 Wis. 298; Nodin v. Mayor of Franklin, 4 Yerg. [Tenn.] 163 ; 2 Kent's Com. 339 [margin] ; 1 Dillon on Municipal Corp., §§ 209, 213.) The board, therefore, having examined into a com- plaint satisfies itself before issuing an order concerning the matter complained of, that it is a nuisance or likely to shortly become one of menace to public health. It then issues the order to the maintainer to abate the same. We will suppose the complaint to be a nuisance and one coming under the rules of general application published by the board as provided for in section 21 of article II. § 59. Notice to abate; how made and served.— The notice to abate is served, in writing, upon the main- tainer of the nuisance, owner or occupant, and in the notice is set forth the nature of the nuisance, that com- plaint has been filed and inspection made, that such a nuisance is in violation of such and such a rule made Boards of Health. 67 and published by the board, and that the penalty for violation of that rule is a certain sum. This order is generally served by the health officer, or by an inspector, or whoever is designated to serve such order. It must be personal service, or if the maintainer cannot be found, it may be posted in a conspicuous place upon the premises. (Sec. 21.) A reasonable time is given to comply with the notice, say three days, during which the maintainer is getting ready to do the necessary work. The three days, if that length of time be allowed — the time given is discretionary with the board — even if the person notified at once begins work, may not be long enough to complete it, but he is obeying the order of the board and can- not be molested. But if he makes no effort to comply with the order, refuses to obey or do any thing, the board must proceed further. It has the power to make rules and enforce them. (Sec. 21.) (Polinskv v. People, 73 N. Y. 65; Cronin v. People, 8^5 id. 318; City of Rochester v. Collins, 12 Barb. 559; People v. Cox, 7 Hun, 214; Roberts v. Ogle, 30 111. 459; Cooper v. Schultz, 32 How. 107; Coe v. Schultz, 47 Barb. 64; Meyer v. Special Sessions, 12 Wk. Dig. 367.) § 60. To enforce order, board must proceed by due process of law. — To enforce its order regularly, it must pursue a given course, for it may be necessary in abating the nuisance to take or destroy some property, and the Constitution allows of this being done only according to due process of law. (Walker v. Sauvinet, 92 U. S. 90 ; Westervelt v. Gregg, 12 N. Y 202 ; Bk. of Columbia v. Oakley, 4 Wheat. 235-244; Hurtado v. California, 110 II. S. 537; Weimer v. Banbury, 30 Mich. 201; Blazier v. Miller, 10 Hun, 435 ; Wynehamer v. People, 13 N. Y. 378 ; Taylor v. Porter, 4 Hill, 140; Happy v. Mosher, 48 N. Y. 313 ; People v. Supervisors, 68 A Manual for 70 id. 228; People v. McCarthy, 45 How. Pr. 97 ; Dar- lington v. Mayor of New York, 31 N. Y. 164 ; Rockwell v. Nearing, 35 id. 302; Green v. James, 2 Curtis [C. C] 187.) Every man has a right to defend himself and show cause why he should not be punished. Every one is entitled to his day in court. (See authorities quoted above.) And the actions of health boards in ordinary cases are no exception to general rules. There- fore, while it might be and is, in certain cases (sec. 26), allowable for the board to proceed to abate, to enter upon the property by its agents, officers or servants, and do such work as may be necessary to render this of no danger to public health, the board will more often secure compliance with its orders if it follows a more con- servative method of procedure. § 61. Order disobeyed; further procedure of board — The order is disobeyed. No attention is paid to it by the person notified. The board then should cite the one at fault before it to show cause why he should not have a penalty imposed upon him for failure to obey the rules of the board and an order made by it. This citation should recite the reason for ir, require the defendant to show cause why his property should not be condemned as a nuisance of menace to public health, the rule violated, the penalty, time and place of meeting; and it should be served as a subpoena is served. The defendant can appear either in person or by counsel. When his case is called, the report of the complaint, the complaint-book in which it is entered, should be luid before the board. The health officer generally pre- sents the case to the board ; has the complainant present if necessary; has the inspector or person who examined the complaint also present to show the condition found; if he inspected it himself he so states and shows why there Boards of Health. 69 is menace to health; the order served on the defend- ant to abate is produced and the evidence that nothing has been done by the defendant to comply with or obey. The defendant is then called on to show why the order was not complied with, and after he has introduced his evidence, the board passes judgment on the matter by resolution, either condemning the place as a nuisance of menace and danger to public health, or making such other disposition as may be proper. If the board con- siders it necessary, it can examine all witnesses under oath, having in matters of this kind the same power as is given to justices of the peace. (Sec. 21.) We will consider the board finds a nuisance exists and orders its abatement. The resolution condemning should recite the main facts of the case and why the board condemns. The board then makes the order, directing the defendant to abate the nuisance within such time as may be set by the board, and failing such action on his part, the health officer as the executive officer of the board, is to enter upon the premises, do such work as is necessary to put them in proper sanitary condition and insure them being of no nuisance to the public health, and to proceed to collect, in the name of the municipality, the penalty imposed for violation of the rules before set forth. The rule is again quoted by the number of the section, but the penalty is mentioned in full, and copies of the reso- lution condemning and the order are to be given the defendant. If the defendant fails to appear, either in person or by counsel, or appears and refuses to plead, the board can proceed, for the defendant has waived his constitutional right to be heard. He cannot plead in bar of the board's decision that some other business kept him away or he did not think it necessary to answer, etc. The board practically gives judgment by default, and it 70 A Manual for is perfectly within its rights to do so. The proceedings having closed, the defendant again refuses to obey by doing nothing under the order. If he opposes entry upon the premises at the end of the time allowed in the order to the board's representatives, the board calls upon the constable by issuing to him its warrant to remove the defendant, or calls upon the sheriff in the same manner. § 62. Board to enter upon property and abate nuisance. Board will be upheld if procedure is in accordance with law. — The health officer now enters upon the property, employs the necessary labor to abate the nuisance, and proceeds to sue for the cost of the work, in the name of the municipality. (Sec. 26.) If the board has so directed, he also sues to recover the penalty, and both actions are brought by the counsel of the board, it having power to employ one if there is no regular counsel employed by it. (Sec. 21.) The courts will uphold the board when its procedures have been in accordance with law, clearly within the powers conferred upon it and where there has been no excess of jurisdic- tion. (Weil v. Schultz and Eckel v. Schultz, 33 How. Pr. 7, and Judge Dykman's decision in Turner v. Board of Health of Mt. Yernon ; Board of Health of New Rochelle v. Valentine, 32 St. Rep. 919; Board of Health, Village of Nyack, v. Eells, 20 id. 886; Board of Health, Village of New Brighton, v. School Trus- tees, 18 id. 251.) § 63. If judgment is not satisfied, lien to be placed on property.— If the defendant is not good for the judgment obtained for the cost of the work, the board places a lien upon the property, as provided for in section 27, and recovers by sale of the property the money expended by it in abating the nuisance. The Boards of Health. 71 funds thus collected by suit or by sale are placed in the hands of the treasurer of the county and are an offset to the extra expenses submitted by the board to the board of audit. § 64. All proceedings to be recorded. Records presumptive evidence.— All the proceedings taken by the board, all the resolutions declaring matters nui- sances of menace to health and all orders are spread in full upon the minutes of the board. These become pre- sumptive evidence of the facts set forth and may have to be used if the defendant obtains an injunction against the board restraining it from proceeding fur- ther until hearing can be had before the court to show the board proceeded in a proper manner and by due process of law (City of Salem v. Eastern R. R. Co., 98 Mass. 431.) The injunction may be granted; but where the board's proceedings have clearly been within its power and properly taken, the exercise of dis- cretion by it in matters within its jurisdiction is not reviewable. (Savage v. Board of Health, 33 Barb. 344; Cooper v. Schultz, 32 How. Pr. 107; City of Salem v. Eastern R. R. Co., 98 Mass. 431; lure Weisels, 13 Week. Dig. 185. See also Dykman, J., decision in Turner v. Board of Health, Mt. Vernon.) § 65. Board to fix compensation. Opinion of attorney-general.— When the board employes counsel to act for it, or other persons to do work under it, it fixes the compensation to be paid and such charges are sent to the municipal authorities for payment. The board fixes the amount and audit has to follow. (Wem- mell v. Bd. of Auditors, Town of New Lots, 34 Hun, 336.) The opinion of the attorney-general, herewith given, covers this point: 72 A Manual for STATE OF NEW YORK: Attorney-General's Office, ) Albany, January 23, 1891. ) Lewis Balch, M. D., Secretary State Board of Health: Dear Sir : — In reply to your communication of the 13th instant, asking me if, in my opinion, the board of town or village auditors, or the auditing boards of cities not exempted from the provisions of chapter 270 of the Laws of 1885, have power to reduce the compensation of health officers, after the same has been fixed by the board of health, and also if they have power to reduce the compensation of other persons employed by boards of health below the amount fixed by said board, I beg leave to state as follows: Chapter 270, Laws of 1885, provides for the organiza- tion of boards of health in towns, villages and cities throughout the state, except in the cities of New York, Buffalo, Albany, Yonkers and Brooklyn, and gives such boards certain powers, among which are as follows: Subdivision 2, section 3 : "To prescribe the powers and duties of the local health officer, who shall act as executive officer of the board; to direct him from time to time in the discharge of his duties, and to fix the com' pensation he shall receive," And subdivision 8: "To employ all such persons as shall be necessary to enable them to carry into effect the orders and regulations they shall adopt under the powers vested in them by this act, and to fix their compensa- tion." Section 5 of this act provides that " all expenses in- curred by the several boards of health, in the execution and performance of the duties imposed by this act, shall Boards of Health. 73 be a charge only on their respective cities, villages and towns, and shall be audited, levied, collected and paid in the same manner as other city, village and- town charges are audited, levied, collected and paid." It will be observed by these provisions of the statute that the compensation that the health officer is to receive is to be fixed by the board, and also that the com- pensation of all such persons as may be necessary to enable them to carry into effect the orders, etc., of the board shall be fixed by the board, and when the statute authorizes them to fix the compensation, it can only mean that they shall designate the amount. It does not vest power in any other board to fix such compensation, but expressly gives it to the board of health, and section 5, which provides that all the ex- penses of the board, under the act, shall be audited, levied, collected and paid in the same manner as other city, village and town charges are audited and paid, does not authorize the boards of auditors of such towns, villages or cities to reverse the action of the board of health in fixing the compensation of the health officer and other persons employed by it. The compensation of the health officer and the other persons employed by the board of health must be "audited" at the amounts fixed by the board, and the whole expense audited, levied, collected and paid in the same manner that other city, village or town charges are audited, levied, collected and paid. I am of the opinion, therefore, that generally the boards of town and village auditors, and the auditing boards of cities not exempt from the provisions of the act would have no power to reduce the compensation of health officers appointed by the board of health, or 10 74 A Manual for the compensation of other persons employed by them, under subdivision 8, section 3, supra. Very respectfully, Your obedient servant, CHARLES F. TABOR, Attorney- General. § 66. Procedure in cases of dire necessity.— In following the mode of procedure just recited, time is necessarily taken, for it is rarely that great danger or hurt will follow the delay necessary, and no question but that all rights are conserved and the action of the board is not by due process of law can be raised. (Underwood v. Green, 3 Robertson; 86 Barb.) When, however, the case is one of dire necessity, the board can act at once, and even destroy property without compen- sation to the owner, or without the formality of a legal investigation. (Wynehamer v. People, 13 N. Y. 451; Russell v. Mayor of New York, 2 Denio,485; Stone v. Mayor of New York, 25 Wend. 157; Van Wormer v. The Mayor, 15 id. 262; affirmed, 18 id. 169; Blair v. Forehand, 100 Mass. 140 ; Meeker v. Van Rensselaer, 15 Wend. 397.) For in such case to wait would be to endanger the public health to such an extent as to place the board in the position of neglecting its duty and consequently any citizen could cite the board for such neglect and compel it to do its duty. (People v. Trustees of Village of Edge- water, 37 Hun, 461.) The state of affairs must, however, justify extreme measures and the board is required to show such a condition to exist. In the presence of an epi- demic, where the spread is rapid and radical measures may be required for its arrest, the board has not the time to grant hearings or to hold an investigation, but must proceed at once. In case it were necessary to de- Boards of Health. 75 stroy a house, clothing, merchandise or any other place or substance from which the contagion of the disease could spread and without the destruction of which, in the opinion of the board of health, the disease could not be stayed, the board can destroy, and this without an order to the owner of the property thus destroyed. It is a case of dire necessity and private advantage must give way to public needs. It is with disease in such a case as with conflagrations where whole blocks of buildings are blown up in advance of the flames to break their force and stop the fire. No time is lost in such cases by in- spections and investigations but the fire marshals issue the orders and the buildings are destroyed. And the same reasoning holds good where disease is spreading rapidly. The most stringent measures must be resorted to and without loss of time. It is hardly necessary to say that in all such circumstances, in fact in all with which the health board has to deal, the decision of the board must be given only after careful consideration of the situation and its deliberations be set forth in the min- utes that its actions maybe ready for review if necessary. § 67. Every nuisance must be considered sepa- rately. — In passing upon nuisances, each one must be considered and acted on by itself, even where several are of the same character. Take, for instance, privy vaults in cities. Here the emanations from great numbers of these cess-pools poison the air and are serious detriments to health. In the hot weather, the air being heavy and the contents of the vaults decaying, injurious gases are given off which do not dissipate into the upper air, but float within a comparatively few feet of the ground, and are carried by air currents into dwellings. The board, complaint having been received of one of these nuisances, on inspection, finds a whole 76 A Manual for block or a row of vaults, each as bad and dangerous to public health as its neighbor. The board must consider and act on each one separately; it cannot condemn all in one resolution, but the same method of inspection and proceeding to condemn must be taken for each separate vault. The board cannot assume in advance that all privies are or will become nuisances dangerous to health. (Gregory v. City of New York, 40 N. Y. 273.) The board may, however, forbid in its rules the building of vaults which experience has found are more likely to become nuisances, except in such manner as may be approved by the board, for the law (sec. 21) em- powers the board to make such rules as it deems neces- sary for the preservation of life and health. A rule, therefore, of general application, made and published by the board to prevent or forbidding the building of privy vaults would be a perfectly proper one, and viola- tion of such rule, when the vault was constructed in the manner proscribed by the board, would subject the per- son disobeying to a penalty. For boards of health, if invested by the legislature with the authority to do so, have full power to restrain the use of private property and the acts and business of all persons within the state for any purpose which is incompatible with the public health. (Reed v. People, 1 Park. Cr. 481 ; In re Weisells, 13 Wk. Dig. 185 ; Blazier v. Miller, 10 Hun, 435 ; Polinsky v. People, 73 N. Y. 65; Cronin v. Peo- ple, 82 id. 318 ; City of Rochester v. Collins, 12 Barb. 559; City of Watertown v. Mayo, 109 Mass. 315; Peo- ple v. Hanley, 3 Mich. 330 ; Taylor v. The State, 35 Wis. 298 ; Gregory v. The Mayor of New York, 40 N. Y. 273; Meyer v. Special Sessions, 12 Wk. Dig. 367; Cox v. Special Sessions, 7 Hun, 214.) Boards of Health. 77 § 68. Each offense should have its particular in- dictment. Board passes upon what is a nuis- ance.— If the board has made orders directing a per- son to abate two nuisances of which he is the main- tainer, and has to prosecute to enforce obedience to the orders; if a different penalty for each offense is prescribed, the maintainer cannot be indicted for both in one indictment. Each offense should be made the cause of a separate action. (Reed v. Peo- ple, 1 Park. Cr. 481.) The question of whether or not a nuisance exists is always one on which persons will differ. The owner of a slaughter-house or some fac- tory classed among stench-producing industries will con- tend no nuisance exists. Property, or the use of it, which endangers the health or the comfort of the people, is a public nuisance (Wood on Nuisances, 73), and the board has to determine the fact before issuing an order. The judgment of the board in such matters will not be disturbed, unless it clearly exceeds its authority. (Hart v. Mayor of Albany, 3 Paige Ch. 218; Caines v. City of Syracuse, 29 Hun, 105; Baker v. City of Boston, 12 Pick. [Mass.] 183; Mayor of Monroe v. Geispach, 33 La. Annual, 1011; Opinion of Judge Dykman in Turner v. Board of Health of Mt. Vernon.) The board cannot find • a matter a nuisance which, under any circumstances, is not or cannot be such at common law. (Coe v. Schultz, 47 Barb. 64; Babcock v. City of Buffalo, 56 N. Y. 268; Mayor of New York v. Board of Health, 31 How. Pr. 385; Schuster v. Board of Health, 49 Barb. 450; Yates v. Milwaukee, 10 Wall. [TJ. S.] 497; Underwood v. Green 42 N. Y. 140.) By this is meant a frivolous de- cision that some business or condition is a nuisance of menace to health is not to stand, for the board, while having large discretionary powers (Clark v. Mayor of 78 A Manual por Syracuse, 13 Barb. 35), cannot construe a nuisance out of a condition which under this or that change of circum- stances, or if some event happens of which there is no immediate likelihood, will then be of menace to health. § 69. If municipality is maintainer of nuisance board may order it to act. Opinion of attorney- general.— If a nuisance is in a public place, such as a street or road, the board has the right to order its abate- ment by the maintainers, viz., the city or village authori- ties. As an illustration of this the following may be cited. A petition was received by the state board set- ting forth in affidavits that illness was caused by the leakage of a sewer into cellars. The sewer was a public one, built by the city, and the board of health notified the mayor and common council that it was a nuisance of menace to health by reason of its leaking. No atten- tion was paid to the advice of the board to abate the nuisance and the petition to the state board was the result. The question was submitted to the attorney- general and the following opinion given: OPINION OF ATTORNEY-GENERAL ON POWER OP BOARD OF HEALTH TO LAY A DRAIN OR SEWER IN A PUBLIC STREET, WHICH IS THE ONLY MEANS OP ABATING A NUISANCE WHICH IS DANGER- . OUS AND A MENACE TO THE PUBLIC HEALTH, APTER HAVING DULY REQUESTED THE AUTHORITIES OF SUCH CITY OR VILLAGE TO ABATE SUCH NUISANCE, AND A REFUSAL UPON THEIR PART SO TO DO. STATE OF NEW YORK: Attorney-General's Office, ) Albany, September 24, 1890. J Hon. Lewis Balch, Secretary of State Board of Health: Dear Sir: — In reply to your verbal request for my opinion as to the power of a local board of health to lay Boards of Health. 79 a drain or sewer in a public street, which is the only means of abating a nuisance which is dangerous and a menace to the public health, after having duly requested the authorities of such city or village to abate such nui- sance, and a refusal upon their part so to do, I beg leave to state as follows: By chapter 270 of the Laws of 1885, the organization of local boards of health is provided for, and when organized they have the power (sec. 3, subd. 4) "to receive and examine into the nature of complaints made by any of the inhabitants, concerning nuisances, or causes of danger or injury to life and health within the limits of its jurisdiction; to enter upon or within any place or premises where nuisances or conditions dangerous to life and health are known or believed to exist, and by appointed members or persons, to inspect and examine the same; * * * and every such board of health shall have power, and it shall be its duty to order the suppression and removal of nuisances and conditions detrimental to life and health found to exist within the limits of its jurisdiction;" and (by subd. 6): "To make, and from time to time to pub- lish, in such manner as to secure early and full publicity thereto, all such orders and regulations as they shall think necessary and proper for the preservation of life and health and the successful operation of this law; and to make, without publication thereof, such orders and regulations in special or individual cases, not of general application, as they may see fit, concerning the suppres- sion and removal of nuisances, and concerning all other matters in their judgment detrimental to public health, and to serve copies thereof upon any occupant or occu- pants, and the owner or owners of any premises whereon anv such nuisances or other matters aforesaid shall 80 A Manual for exist, or to post the same in some conspicuous place on such premises." Subd. 8. "To employ all such persons as shall be necessary to enable them to carry into effect the orders and regulations they shall have adopted, and the powers vested in them by this act, and to fix their com- pensation." (§ 4.) " * * * And in case of non-compliance with any order or regulation which shall have been served or posted, as provided in subdivision 6 of section 3 of this act, the said board or its servants or employees may lawfully enter upon any premises to which such order or regulation relates, and suppress or remove the nuisance or other matters in the judgment of said board detrimental to the public health mentioned in such order or regulation, and any other nuisance or matter of the description aforesaid found there existing, and the expense thereof shall be a charge upon the occupant or any or all of the occupants of said premises, or upon the person or persons who have caused or maintained the nuisance or other matter of the description aforesaid, and may be sued for and recovered with costs by said board, in the name of such board in any court having jurisdiction." § 5. '' All expenses incurred by the several boards of hialth in the execution and performance of the duties imposed by this act shall be a charge only on their re- spective cities, villages and towns, and shall be audited, levied, collected and paid in the same manner as other city, village and town charges are audited, levied, col- lected and paid." These provisions, it seems to me, give local boards of health ample power to abate nuisances; and if there is an existing nuisance dangerous to health in a street, Boards of Health. 81 and the city or village authorities refuse to abate the same, it is the duty of the board of health to abate it; and I am of the opinion that if the authorities of the city or village, after having been properly served with an order to abate the nuisance, refuse or neglect to do so, the board of health may abate it; and if the laying of a sewer be the only safe and proper means of abating such nuisance, they may lay such a sewer, and may charge the expense thereof to the city or village, the city or village being the occupant of the street, within the meaning of the word as used in the act above re- ferred to. (Gould v. City of Rochester, 105 N. Y. 46.) The expenses of the board of health in laying such sewer should be audited, levied, collected and paid in the same manner as other city or village charges are audited, levied, collected and paid. Very respectfully, Your obedient servant, CHARLES F. TABOR, Attorney- General. The opinion holds equally good under the present Public Health Law, as the same powers are given boards of health as under chapter 270 of 1885. The munici- palitv can no more maintain a nuisance of menace to health than can an individual, and the board of health has supervision and power over both. § 70. Physicians must report contagious dis- eases. Health officer the legal expert to deter- mine the diagnosis.— In cases of contagious disease, the physician in attendance is bound to report the fact to the board. It makes no difference what precautious he may personally have taken regarding the case, he must notifv the health authorities. And when there is 82 A Manual for a question of diagnosis, the health officer is the expert provided by law to settle the matter, and his determina- tion is the one to be considered final. His inspection of the case can do no harm, for he is merely the official of the board, and is not necessarily in charge of the pa- tient. (Brown v. Purdy et al., 8 St. Rep. 143.) His acts in carrying out the orders of the board in this or any other case, or the acts of any other employee of the board when in pursuance of its orders, are not subject to judicial review. Officers of health boards are pro- tected by reason of the fact that they are such officers. (Van Wormer v. The Mayor, 15 Wend. 262; City of Salem v. Eastern R. R. Co., 98 Mass. 431.) § 71. Power of board to make rules for plumb- ing and drainage.— Special legislation has of late years frequently been sought to give power to health boards to make special rules and regulations for the plumbiug, drainage and ventilation of buildings to be hereafter erected in the various places for which the laws were designed. But such acts are unnecessary, for boards of health have the power now to pass such rules if they consider them required for the protection of the public health. (Sec. 21.) It certainly is a measure for the preservation of life that proper plumbing be put in a house, proper drains be built to carry off the house sewage, and proper ventilation be arranged for, and the board under the general law can prepare such rules govern- ing this work as it may consider necessary and best. § 72. Health officers are state officers. — An im- portant decision was rendered by Judge Haight in the case of Bamber against The City of Rochester, reported in 63 How. Pr. 103. In this case a suit was brought against the city for certain rags destroyed by order of the board of health, but the learned judge decided the city was not lia- Boards of Health. 83 ble for the acts of the board of health. That health boards are appointed or elected to perform a public service, not peculiarly local or corporate, and that the common coun- cil could not control them in the discharge of their duty. '' They are public or state officers." This decision, boards of health should remember, for their duties are such as not only affect the place where they have jurisdiction, but are widespread, and on their vigilance often depends the prevention of the spread of disease to other parts of the state. While carrying out this work,considerations like these should always be before them and, in addition, the knowledge that to them is intrusted the highest interest of the people, the guarding of the public health. 84 A Manual for CHAPTER VI. Section 73. Rules of general application (sanitary regulations recommended by the state board). 74. Circulars relating to prevention of certain diseases. 75. Certificates of births, marriages and deaths. Burial and transit burial permits. How they should be filled up. 76. Complaint of nuisance. Notice to abate. Notice of hearing on. Notice of imposition o/ penalty. 77. Conclusion. § 73. Rules of general application.—Boards of health being required to make rules of general applica- tion for the sanitary government of their several muni- cipalities, to which full publicity is to be given, the state board has issued the following regulations and recom- mended their adoption. It should be borne in mind by boards of health that the law gives them, not the state board, the power to make these rules, and that these formulated by the state board are drawn as suggestions only, and are not ordered. They have been, however, carefully prepared and adoption is advised where they are applicable. Oftentimes some changes are found necessary in different localities to meet conditions there existing which are not general, and such changes are of course made by the local board having jurisdiction. SANITARY REGULATIONS RECOMMENDED FOR ADOPTION BY LOCAL BOARDS OF HEALTH. Section 1. Nuisances denned.—Whatever is dan- gerous to human life or health; whatever.building, or part or cellar thereof, is overcrowded or not provided with adequate means of ingress and egress, or is not sufficiently supported, ventilated, sewered, drained, Boards of Health. 85 lighted or cleaned; and whatever renders soil, air, water or food impure or unwholesome, are declared to be nui- sances and to be illegal; and every person having aided in creating or contributing to the same, or who may support, continue or retain any of them, shall be deemed guilty of a violation of this ordinance, and shall also be liable for the expense of the abatement or remedy required. § 2. Privies, cess-pools, etc.—No privy-pit, cess- pool or reservoir into which any privy, water-closet, stable, sink or other receptacle of refuse or sewage is drained, shall be constructed or maintained in any situa- tion or in any manner whereby, through leakage or over- flow of its contents, it may cause pollution of the soil near or about habitations, or of any well, spring or other source of water used for drinking or culinary purposes; nor shall the overflow from any such reservoir or re- ceptacle be permitted to discharge into any public place or in anywise whereby danger to health may be caused. And every such pit, reservoir or receptacle shall be cleaned and the contents thereof removed at such times and under such precautions as the board of health may prescribe. Violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........for each day's continuance of the nuisance after due notice to abate it from an authorized officer. §3. Sewers, drains, etc.—All house-sewers or drains for the conveyance of deleterious or offensive matters shall be water-tight, and the plans and methods of their construction shall be subject to the approval of the board of health. In streets or avenues where pub- lic sewers are or shall be constructed, the board of health may order house-connections to be made there- with. 86 A Manual for § 4. House-refuse, garbage, etc—No house-refuse, offal, garbage, dead animals, decaying vegetable matter, or organic waste-substance of any kind, shall be thrown upon any street, road or public place, and no putrid or decaying animal or vegetable matter shall be kept in any house, cellar or adjoining outbuilding for more than twenty-four hours. Violation of any of the provisions of this ordinauce shall subject the offending party to a penalty of........ § 5. Filled-in or made land.—No sunken places shall be filled, nor made land constructed, with any materials containing an admixture of putrescible animal or vegetable matter, under a penalty of........for each cart load, or part thereof, of such materials de- posited. § 6. Noxious trades. — No person or company shall erect or maintain any manufactory or place of business dangerous to life or detrimental to health, or where un- wholesome, offensive or deleterious odors, gas, smoke, deposit or exhalations are generated, without the permit of the board of health, and all such establishments shall be kept clean and wholesome so as not to be offensive or prejudicial to public health; nor shall any offensive or deleterious waste-substance, gas-tar, sludge, refuse or in- jurious matter be allowed to accumulate upon the premi- ses or be thrown or allowed to run into any public waters, stream, water-course, street or public place. And every person or company conducting such manufacture or busi- ness shall use the best approved and all reasonable means to prevent the escape of smoke, gases and odors, and to protect the health and safety of all operatives employed therein. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........dollars for each offense. Boards of Health. 8? §7. Unwholesome food. — No meat, fish, bird, fruit, or vegetables, milk, or anything for human food or drink, not being then fresh or properly preserved, sound, wholesome and safe for such use ; nor any flesh of any animal which died by disease, or which was at the time of its death in a sickly or unwholesome condition ; nor the carcass or meat of any calf which was at the date of its death less than four weeks old, or of any lamb which was at the date of its death less than eight weeks old, or of any pig which was at the date of its death less than five weeks old shall be brought within the limits of this municipality nor offered or held for sale as food therein. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........and by the seizure and destruction of such unsound, unwholesome, or immature food substances. § 8. Slaughter-houses, markets, etc. — No person or persons, without the consent of the board of health shall build or use any slaughter-house within the limits of this municipality and the keeping and slaughtering of all cattle, sheep and swine, and the preparation and keep- ing of all meat, fish, birds, or other animal food, shall be in the manner best adapted to secure and continue their wholesomeness as food ; and every butcher or other person owning, leasing or occupying any place, room or building wherein any cattle, sheep or swine have been or are killed or dressed, and every person being the owner, lessee or occupant of any room or stable wherein any animals are kept, or of any market, public or private, shall cause such place, room, building, stable or market, and their yards and appurtenances, to be thoroughly cleansed and purified, and all offal, blood, fat, garbage, refuse and unwholesome and offensive matter to be re- moved therefrom at least once in every twenty-four hours 88 A Manual for after the use thereof for any of the purposes herein re- ferred to, and shall also at all times keep all wood work, save floors and counters, in any building, place or premi- ses aforesaid thoroughly painted or whitewashed; and the floors of such building, place or premises shall be so constructed as to prevent blood or foul liquids or wash- ings from settling in the earth beneath. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........for each day's continuance or repetition of the offense. § 9. Notification of infectious disease.— Every householder or head of family in a house wherein any case of infectious disease may occur shall report the same to the board of health or to the health officer within twelve hours from the time of his or her first knowledge of the nature of such disease ; and, until in- structions are received from the said board or the health officer, shall not permit any clothing or other article which may have been exposed to infection to be removed from the house; nor shall any occupant change his residence elsewhere without the consent of the said board or health officer. Every physician who may be called to attend a case of infectious disease shall, as soon as he discovers the nature thereof, make a written report specifying the name and residence of the patient, the nature of the disease, and any other facts relating thereto which he may deem important to the public health, and affix the date and sign his name thereto, and he shall transmit the same to the board of health within twelve hours as above provided. The diseases to be thus promptly reported are: Asiatic cholera, yellow fever, typhus and typhoid fevers, small-pox, scarlet fever, measles, diph- theria and membranous croup. Any violation of any Boards of Health. 89 of the provisions of this ordinance shall subject the offending party to a penalty of........ § 10. Importation of infected persons or things. — No person or article liable tc propagate a dangerous disease shall be brought within the limits of this muni- cipality unless by the special permit and direction of the board of health; and anyone having knowledge that' such person or article has been brought within such limits shall immediately notify the said board thereof. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........ § 11. Exposure of infected persons or things.— No person shall, within the limits of this municipality, unless by permit of the board of health, carry or remove from one building to another any patient affected with any contagious or infectious disease. Nor shall any person, by any exposure of any individual so affected, or of the body of such individual, or of any article capable of conveying contagion or infection, or by any negligent act connected with the care or custody thereof, or by a needless exposure of himself or herself, cause or con- tribute to the spread of disease from any such individual or dead body. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of not less than........ § 12. Funerals after infectious diseases.— There shall not be a public or church funeral of any person who has died of Asiatic cholera, small-pox, typhus fever, diphtheria, membranous croup, scarlet fever or measles, without the permit of the board of health therefor; and the family of the deceased shall in all such cases limit the attendance to as few as possible, and take all precautions possible to prevent the exposure of other persons tc contagion or infection. Any violation 12 90 A Manual for of any of the provisions of this ordinance shall subject the offending party to a penalty of........ §13. Infectious diseases of animals.— No ani- mal affected with an infectious or contagious disease shall be brought or kept within the limits of this mu- nicipality, except by the permission of the board of health; and the bodies of animals dead of such disease or killed on account thereof, shall not be buried within five hundred feet of any residence, nor disposed of other- wise than as the said board or its health officer shall direct. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........ § 14. Reports of marriages and births.—It shall be the duty of the groom in every marriage, or the cleryman or magistrate performing the ceremony, and of the parents or custodian of every child born, to make sure that the prescribed report of such marriage or birth is presented to the board of health or its regis- tering officer within thirty days, under a penalty of ........for failure to do so; and for each ten days of continued neglect to present such report, after the ex- piration of the first thirty days, an additional penalty of ........shall be incurred. § 18. It shall be the duty of the physician or midwife in attendance at every birth to write out and sign, upon the form prescribed by the state board of health, the certificate of such birth, and leave it with the parent or guardian of the child within........days of such birth. Any violation of the provisions of this ordi- nance shall subject the offending party to a penalty of § 1G. Certificates of death and burial permits.— Every undertaker or other person who may have charge Boards of Health. 91 of the funeral of any dead person, shall procure a properly filled-out certificate of the death and its prob- able cause, in accordance with the form prescribed by the state board of health, and shall present the same to the designated officer or member of the board of health, and obtain a burial or transit permit thereupon, at least twenty-four hours before the time appointed for such funeral; and he shall not remove any dead body until such burial or transit permit shall have been procured. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........ § 17. It shall be the duty of the physician last in attendance upon any person who may die within the limits of the jurisdiction of this board of health, to write out and sign without delay, upon the form prescribed by the state board of health, the professional certificate of the death and send it to or leave it with the family of the deceased, or hand or send it to the undertaker in charge of the remains. In case an inquest has been re- quired by law, the coroner shall fill out the said certifi- cate, and if no inquest has been required by law and no physician has been in attendance, the certificate shall be filled out, setting forth the probable or believed cause of death, by some reputable person known to the officer issuing the burial or transit burial permit, and the said person shall also make affidavit to the facts set forth in the certificate, which affidavit must be attached to said certificate. Any violation of the provisions of this ordinance shall subject the offending party to a penalty of........ § 18. Sextons, cemetery keepers, etc.—Every person who acts as a sexton, or undertaker, or cemetery keeper, within the limits of this municipality, or has the charge or care of any tomb, vault, burying ground 92 A Manual for or other place for the reception of the dead, or where the bodies of any human beings are deposited, shall so conduct his business and so care for any such place above named, as to avoid detriment or danger to public health ; and every person undertaking preparations for the burial of a body dead from contagious or infectious disease, as hereinbefore enumerated, shall adopt such precautions as the board of health may prescribe to pre- vent the spread of such disease. Any violation of any of the provisions of this ordinance shall subject the offending party to a penalty of........ § 19. Duties and powers of health officer.— The health officer is directed and empowered to execute and enforce all sanitary regulations of general obligation now or hereafter to be published by this board ; also to enter upon or within any premises where conditions dangerous to the public health are known or believed to exist, and to examine into the nature of complaints made by any of the inhabitants concerning sources of danger or injury to health ; and he shall preserve accu- rate records of his official actions and report the same to the board of health at its next meeting. And when- ever, in his judgment, danger to public health shall arise requiring special regulation not of gensral applica- tion, he shall forthwith notify the president of the board of health, who shall thereupon convene the board to take such action as may be necessary and proper. § 20. Penalties.— Every "person who willfully vio- lates or refuses to comply with, or who resists any ordi- nance, order, regulation or resolution of the board of health of this municipality will be liable to the arrest, action, penalty, fine and punishment provided and declared in the Public Health Law, chapter 25 of the General Laws, 1893, of which notice must be taken. Boards of Health. 93 § 74. Circulars relating to prevention of certain diseases.— Diphtheria, scarlet fever and small-pox are all preventive diseases if proper measures be taken to exclude them. I am not to be understood as saying that if boards of health exercise great vigilance no more cases of these diseases will be developed. I mean that by care and precaution the spread of each and all can be stopped, and in addition, the germs left by anyone case can be destroyed so thoroughly that none will remain to cause more cases when the conditions shall become favor- able to their activity. As a guide and aid to local boards of health, the state board has issued the following cir- culars, and if attention is given to their contents, and the suggestions carefully followed, much may be done towards lessening the number of cases now reported. Small-pox is rarely found to be epidemic at any place within the state now, for so active are the health author- ities in dealing with this disease when it makes its appearance, that one or two cases generally end the out- break. Could the same decisive measures be taken against diphtheria and scarlet fever, like result would follow. PREVENTION OF DIPHTHERIA. Diphtheria is a preventable disease. Its existence de- pends on conditions that can generally be controlled. It may appear in any community, but it should not be allowed to develop beyond the first case or cases, that make their appearance. CONDITIONS ON WHICH IT DEPENDS. Diphtheria probably always originates from a special poison which develops in the person sick with it. This special poison is given off in the breath, in the dis- 94 A Manual for charges from the mouth, throat and nose, and in some degree, in those from the bowels and bladder. The virus has the property of adhering tenaciously to objects on which it happens to alight. By reason of this, the sick room, its floor, walls, furniture, and all its con- tents become infected with the disease, and continue to be so until the virus is destroyed by cleansing and fumi- gation. The disease may also he carried away by any article coming in contact with the sick, and to which the virus clings, by the clothing, bedding, eating utensils, food, toys, and also by the persons and clothing of those in attendance upon the patient. Another important fact is that the virus is very long lived; articles and premises infected with it, may com- municate the disease for at least several weeks; it may be transported by them with great facility, and to an indefinite distance. A final important point is that bad sanitary conditions favor the development and propagation of the diphtheritic virus. It grows best in places that are damp and foul and ill-ventilated; in cellars moist by imperfect drain- age, and defiled by uncleanly accumulations in the soil about it; in damp, unventilated spaces under floors; in cess-pools, drains and sewers, or any place where there is dampness, filth and imperfect access of fresh air. In large cities, the sewers furnish so favorable a place for the growth of this virus when it gets into them, and its vitality is so great under such surroundings, that their infection may become permanent; no similar conditions, however, need exist in small localities. Diphtheria is contracted by inhalation of air contain- ing the disease-germs coming directly from the sick, or from articles infected by them. It is also communicated Boards of Health. 95 by articles passing from mouth to mouth, such as cups, spoons and toys. The articles by which it is communi- cated may have become infected weeks before, and possi- bly at some locality quite remote. It is contracted by inhaling the air of sewers, cess-pools, cellars, or any damp, foul or ill-ventilated place in which the disease- germs chance to have become planted. Children con- tract diphtheria much more readily than adults. suppression of diphtheria. Every locality is liable to have diphtheria brought into it. It will not continue long if the principal conditions on which its existence mainly depends are removed; if the sick are strictly secluded, the disease-germs destroyed, and all unsanitary conditions which favor their continued development removed. 1. Isolation. — Those sick with diphtheria should be isolated from every one except necessary attendants. This should be done with mild cases as well as severe ones. They should be placed in an upper, airy room, as remote as possible from other living and sleeping rooms. Needless furniture and other articles should be removed from the room. Allow the windows to be open, for the poison does not go far away in the atmosphere; give sunshine and fresh air constantly. The attendants should remember that they carry with them the poison of the disease, and they must keep en- tirely away from others, especially from children, who take diphtheria most readily. No article should leave the room without cleansing or disinfection. Utensils used by the sick should be well cleansed before use by others. Food left by them should be destroyed. Bed and body clothing should, before being taken from the 96 A Manual for room, be placed in disinfectant No. 2, boiling hot, if possible. Cats and dogs should be excluded. The discharges from the mouth and nose must be re- received on cloths that can be burned, or in cups that can be disinfected. Vessels for receiving the discharges from the mouth, nose, kidneys and bowels should con- tain some of disinfectant No. 1 or 3, and after use should be cleansed with boiling water. The patient must not mingle with the well until all traces of the disease have left the throat and nose. Be- fore leaving the sick-room the body should be thoroughly washed, and fresh, uninfected clothing should be put on, leaving every thing else behind to be disinfected. Nurses must observe the same final precautions. 2. General precautions.— All should avoid sources of contagion. Well children had better be removed en- tirely from the house, but should be kept under obser- vation, and if diphtheria develops brought home again so as not to establish a new center. Persons remaining in the house should not go to school, church or any gen- eral gathering, nor to any house where there are young persons. If the disease has secured a foothold in a locality, every case of sore throat should be regarded as suspicious and excluded from schools and from contact with other children. It would be well to make sure that milk is not taken from a dairy where the disease exists. 3. Sanitary precautions.— Houses should be kept clean, dry and well-ventilated ; particular attention should be given to the cellar. Drain pipes and fixtures should be perfect. The premises should be well-drained, leeching cess-pools and privy-vaults removed, all de- composing accumulations of garbage or stable manure cleared away and the place made in every way clean. Boards of Health. 97 These precautions are to be especially observed about domiciles where the disease exists. The condition of school-houses should not be overlooked. 4. In case of death the body should be inclosed in a sheet saturated with disinfectant No. 3, placed in a tight coffin not afterward opened, and burial should be private and with as little delay as possible. disinfection. 1. Of the room.— During its occupancy as a sick- room, the precautions suggested above as to destruction of disease germs attached to articles of any sort before their removal from it should be carefully observed. At the termination of the quarantine the room should be tightly closed and with all its infected contents fumi- gated with the fumes of burning sulphur or of chlorine, which, especially if the latter is used, should be done only by a competent person. Arrange all the contents of the room so that their surfaces are readily reached by the disinfecting gas. The room should remain closed for twenty-four hours, after which it and its contents should be aired thoroughly for several days. The woodwork should also be thoroughly washed, especially the tops of doors and windows, and solution No. 2 or 3 applied. Ceilings should be whitewashed and wall paper removed, and the walls washed with one of the disinfectant solutions. Sulphur fumigation.— Roll sulphur, in the propor- tion of two pounds for a room ten feet square, is burned by placing it in an iron kettle, set in a tub containing a little water to guard against fire. It may be ignited by pouring a little alcohol or kerosene on it. Chlorine fumigation.—Mix well, breaking up all lumps, one part by measure of black oxide of manganese 13 98 A Manual for and two of common salt, and add enough water to make of the consistency of cream. A teacupful of this mix- ture is to be put into a large earthen vessel, as a wash- bowl, one or two of which may be placed in each room. About an equal bulk of commercial sulphuric acid is to be finally poured into each vessel, beginning with the most remote, the person retiring quickly; it is best to pour this from a pitcher; avoid inhaling the fumes by holding a handkerchief over the face. 2. Of the premises.— The entire house should be thoroughly cleansed. The premises also should be cleared of all unsanitary conditions, and all drains, privy vaults and sites of uncleanly accumulations drenched with solution No 1. DISINFECTANT SOLUTIONS. No. 1. Sulphate of iron (copperas), three pounds, warm water, one gallon; for the discharges. This leaves rust spots on clothing. No. 2. Sulphate of zinc (white vitriol), four ounces; common salt, two ounces; water, one gallon. For clothing. No. 3. Corrosive sublimate, sixty grains; water, one gallon. Caution should be had of the dangerously pois- onous character of this solution; it is well, as a precau- tion, to color it by adding an equal quantity (sixty grains to the gallon) of permanganate of potash, with which, however, it stains fabrics, etc. To wash furniture and woodwork. PREVENTION OF SCARLET FEVER Scarlet fever is a preventable disease. It will not spread if careful attention is paid to the rules for its re- striction. Parents, teachers and all who have the care Boards of Health. 99 of children can do much to guard against the occurrence of infection. CONDITIONS ON WHICH IT DEPENDS. Scarlet fever is a disease of early life. Less than five per cent of cases occur after the age of fifteen, and two- thirds of all the deaths from it occur in the first five years of childhood. Especial care should, therefore, be taken to protect children from exposure to it. It varies much in severity, being generally a danger- ous and deadly disease, but it is sometimes so mild as to elude notice. The spread of the disease is not infre- quently increased by failure to detect these mild cases. During the prevalence of an epidemic, cases of sore throat among school children, or children from an in- fected house, should be regarded with suspicion. Severe cases may originate from a mild one. It is infectious from the beginning throughout the course of the illness, and even after all traces of the dis- ease have apparently disappeared from the throat and skin. It is taken by contact with the sick or with arti- cles that have become infected by proximity to them, or from the room which they have occupied. The dis- ease may be carried away to a distance by infected cloth- ing or other articles and so communicated, and persons who have been about the sick, even for but for a very short time, may convey the disease to others. It may probably be communicated also by milk into which the germs of the disease have found their way through proximity to the sick or their surroundings. Scarlet fever, probably, always originates from a special poison, which develops in the person sick with it. This poison is given off in the breath, the dis- charges from the body and the scales from the skin. It 100 A Manual for has the property of adhering tenaciously to objects on which it happens to alight. By reason of this the sick room, its floor, walls and all its contents, especially the bedding, clothing and other articles most closely about the sick, become infected with the disease, and continue to be so until the virus is destroyed by cleansing and fumigation. This virus is very long lived, so that in- fected articles may communicate the disease months after they become infected. Such infected articles may be the means of carrying the disease to another locality, possibly quite remote, and, in fact, this is the most com- mon way for the disease to originate. SUPPRESSION OF SCARLET FEVER. Although a very infectious disease its spread can be controlled by keeping the well away from the sick, and destroying the infection before it can be scattered abroad. General precautions.—All should avoid sources of contagion. It should be borne in mind that adults, although but slightly susceptible to the disease, may carry it away to others after but a momentary exposure. Those who remain in the house where there are cases of the disease, even if th^y never enter the sick room, should carefully avoid contact with others and should not go to school, church or any general gathering nor to any house where there are young persons. If the disease has secured a foothold in a locality, every case of sore throat, or presenting other symptoms found in scarlet fever, should be regarded as suspicious and ex- cluded from school and from contact with other children until its character is determined. It would be well to make sure that milk is not taken from a dairy where the disease exists. Boards of Health. 101 Isolation.— Those sick with scarlet fever should be isolated from every one except necessary attendants. This should be done with mild cases as well as severe ones. They should be placed in an upper airy room as remote as possible from other living and sleeping rooms. Needless furniture, carpets, curtains, unused clothing and other articles which can catch and retain the poison of the disease, and which may be injured by disinfection, should be removed from the room. The attendants should remember that they carry with them the poison of the disease, and they must keep en- tirely away from others, especially from children, who take scarlet fever most readily. No person except those needed for the care of the sick should be allowed to visit the sick room, especially those who have the care of or come in contact with children. Cats and dogs should be excluded. No article should be allowed to leave the room with- out cleausing or disinfection. Utensils used by the sick should be well cleansed before use by others. Food left by them should be destroyed. Bed and body clothing, before being taken from the room, should be placed in disinfectant No. 2 boiling hot if possible; at least it should be taken from the room wet with and afterward boiled in the solution. The discharges from the throat and nose must be received in cloths that can be burned or in cups that can be disinfected. The discharges from the bowels and kidneys should be disinfected with one of the disin- fectant solutions, and afterward buried some distance from the dwelling. The room should be ventilated as thoroughly and con- stantly as possible without incurring the danger of draughts. The entire house ought to be kept clean, 102 A Manual for dry and well ventilated. During the period of desqua- mation it is well that frequent inunction of the body with oil or fatty matter be performed, as by this means the scattering of the scales thrown off from the skin, which contain the contagion of the disease, may be much lessened. Before leaving the sick-room the body should be thoroughly washed, not omitting the head, and fresh, uninfected clothing put on, leaving everything else be- hind to be disinfected. Nurses must observe the same final precautions. The patient should not be allowed to go to school or to mingle in any way with the public for at least five weeks after subsidence of the fever and rash. In case of death the body should be inclosed in a sheet saturated with disinfectant 2 or 3, placed in a tight coffin, not afterwards opened, and burial should be pri- vate and with as little delay as possible. DISINFECTION. Of the room. — During its occupancy as a sick-room, the precautions suggested above as to destruction of disease germs attached to articles of any sort before their removal from it should be carefully observed. At the termination of the quarantine the room should be tightly closed and, with all its infected contents, fumigated with the fumes of burning sulphur or of chlorine, which, especially if the latter is used, should be done, only by a competent person, as the fumes are poisonous. Ar- range all the contents of the room so that their surfaces are readily reached by the disinfecting gas. The room should remain closed for twenty-four hours, after which it and its contents should be aired thoroughly for several days. The woodwork should also be thoroughly washed, especially the tops of doors and windows, and solution Boards of Health. 103 No. 2 or 3 applied. Ceilings should be whitewashed and wall paper removed, and the walls washed with one of the disinfectant solutions. In addition, all things of but little value which have been in the room should be burned, clothing and furnishings which can be so treated should be boiled, and other things exposed to fresh air for several days. The entire house ought to be cleansed and ventilated before being open to the public. Sulphur fumigation. — Roll sulphur, in the propor- tion of two pounds for a room ten feet square, is burned by placing it in an iron kettle, set in a tub containing a little water to guard against fire. It may be ignited by pouring a little alcohol or kerosene on it. Chlorine fumigation.— Mix well, breaking up all lump, sone part by measure of black oxide of manganese and two of common salt, and add enough water to make of the consistency of cream. A teacupful of this mix- ture is to be put into a large earthen vessel, as a wash- bowl, one or two of which may be placed in each room. About an equal bulk of commercial sulphuric acid is to be finally poured into each vessel beginning with the most remote, the person retiring, quickly ; it is best to pour this from a pitcher ; avoid inhaling the flumes by holding a handkerchief over the face. DISINFECTANT SOLUTIONS. No. 1. Sulphate of iron (copperas), three pounds; warm water, one gallon; for the discharges. This leaves rust spots on clothing. No. 2. Sulphate of zinc (white vitriol) four ounces ; common salt, two ounces ; water, one gallon, for cloth- ing, etc. No. 3. Corrosive sublimate (bichloride of mercury), sixty grains; water, one gallon. It should be kept in 104 A Manual for wooden or earthen vessels. Caution should be had of the dangerously poisonous character of this solution ; it is well as a precaution to color it by adding an equal quantity (sixty grains to the gallon) of permanganate of potash, with which, however, it stains fabrics. To wash woodwork and furniture, or for other disinfectant use. No. 4. Chloride of lime of best quality, four ounces ; soft water, one gallon. If good material is used, this is one of the most reliable disinfectants, and may be used for most purposes. PREVENTION OF SMALL-POX. Small-pox is a preventable disease. It is contracted only by exposure to emanations from the body of the sick, or from articles used by them or exposed in their vicinity. It is taken only by those who are unprotected by vaccination, and is liable to appear in any place where there are unvaccinated persons. Its spread is prevented by separating the sick entirely from all but necessary attendants and by vaccinating all in their vicinity. I. BINDING ON SCHOOL TRUSTEES. ARTICLE XII, SECTION 200, CHAPTER 601, LAWS OF 1893. Vaccination of school children.— No child or per- son not vaccinated shall be admitted or received into any of the public schools in the state, and the trustees or other officers having the charge, management or con- trol of such schools shall cause this provision of law to be enforced. They may adopt a resolution excluding such children and persons not vaccinated from such school until vaccinated, and when any such resolution has been adopted, they shall give at least ten days' notice thsreof, by posting copies of the same in at least Boards of Health. 105 two public and conspicuous places within the limits of the school government, and shall announce therein that due provision has been made, specifying it, for the vac- cination of any child or person of suitable age desiring to attend the school, and whose parents or guardians are unable to procure vaccination for them, or who are, by reason of poverty, exempted from taxation in such district. II. BINDING ON LOCAL BOARDS OF HEALTH. ARTICLE II, SECTION 24. Contagious and infectious diseases.— Every such local board of health shall guard against the introduction of contagious and infectious diseases by the exercise of proper and vigilant medical inspection and control of all persons and things arriving in the municipality from in- fected places, or which from any cause are liable to com- municate contagion. It shall require the isolation of all persons and things infected with or exposed to such diseases, and provide suitable places for the treatment and care of sick persons who cannot otherwise be pro- vided for. It shall prohibit and prevent all intercourse and communication with or use of infected premises, places and things, and require, and, if necessary, provide the means for the thorough purification and cleansing of the same before general intercourse with the same or use thereof shall be allowed. It shall report to the state board of health, promptly, the facts relating to contagi- ous and infectious diseases, and every case of small-pox or varioloid within the municipality. Health officers of villages and towns shall report in writing once a month to the state board of health all cases of such infectious and contagious diseases as may be required by the state board of health, and for such reporting the health officer 14 106 A Manual for shall be paid by the municipality employing him, upon the certification of the state board of health, a sum not to exceed twenty cents for each case so reported ; and the health officer shall report annually on or before the first day of January in each year, the number of cases of consumption which have existed in his jurisdiction dur- ing that year, and for each case thus reported, he shall receive a sum not to exceed ten cents, to be paid in the same manner as the other like charges are paid. It shall provide, at stated intervals, a suitable supply of vaccine virus, of a quality and from a source approved by the state board of health, and during an actual epidemic of small-pox obtain fresh supplies of such virus at intervals not exceeding one week, and at all times provide thorough and safe vaccination for all persons in need of the same. If a pestilential, infectious or contagious disease exists in any county alms-house or its vicinity, and the phy- sician thereof shall certify that such disease is likely to endanger the health of its inmates, the county superin- tendent of the poor may cause such inmates or any of them to be removed to such other suitable place in the county as the local board of health of the municipality where the alms-house is situated, may designate, there to be maintained and provided for at the expense of the county, with all necessary medical care and attendance until they shall be safely returned to such alms-house or otherwise discharged. The boards of health of the cities of New York, Brooklyn, Buffalo, Albany and Yonkers, shall report promptly to the state board all cases of small-pox, typhus and yellow fever and cholera and the facts relating thereto. Boards of Health. 107 what to do when small-pox occurs. 1. Remove sick at once to some place provided by health or town authorities, where perfect isolation can be had. (See law governing boards of health above.) A separate place, or even a hut constructed for the pur- pose, should be so prepared as to be safer for the sick than any ordinary dwelling-rooms ; that is, that the fresh air and sanitary care and nursing shall be the best possible, and that it shall be an apartment and locality from which the contagion will not be spread abroad. 2. If removal is impracticable place the sick in an upper, airy room, where complete seclusion can be effected. This room should be stripped of all carpets, upholstered stuff, furniture, clothing, quilts, feather beds, and all articles of any sort not absolutely necessary for the use of the sick. Let it be understood from the first that bedding, clothing, to wis and cloths used by the sick should finally be burned. In such room, with open windows and an open fire, keep the sick and nurses entirely separated (quarantined) from all other persons, and allow no person to enter it or to touch the bedding or clothing used by the sick. No article should be removed from the room until cleansed, disinfected or fumigated. On recovery, the skin being entirely healed and free from all scabs, the patient and nurse must cleanse their bodies carefully, and put on entirely fresh, uninfected clothing before vacating the sick-room, leav- ing everything behind for disinfection. 3. Let all persons who are near the sick be immedi- ately vaccinated afresh. No delay or objection should prevent the vaccination of all persons who have been in any manner exposed, or suspected of exposure, to the 108 A Manual for contagion. A former vaccination, unless recent and effective, is not to be relied upon as protective. All living in the surrounding neighborhood ought to be vaccinated. If fresh vaccine is not at hand, the physi- cian or health officer should immediately telegraph the state board of health. 4. In case of death the body should be inclosed in a sheet saturated with disinfectant solution No. 3, and put into a tight coffin which should not afterward be opened. Burial should be performed with as little de- lay as possible, and entirely privately. INSTRUCTIONS FOR DISINFECTION. (1.) In the sick-room.— The most available agents are fresh air and cleanliness. The clothing, towels, bed- linen, etc., which for any reason are not burned, should, on removal from the patient, and before they are taken from the room, be placed in a pail or tub of solution No. 2 boiling hot, if possible, and then in boiling water for washing. Prolonged heat, as in above 212° F., is the most thorough disinfectant. All vessels used for receiving the discharges from the sick should have some of disinfectant No 1 or 3 constantly therein, and after use should be cleansed with boiling water. (2.) Fumigation.— At the termination of quaran- tine the rooms are to be fumigated with the fumes of burning sulphur or of chlorine. After the room is vacated, close it as tightly as possible, stopping all win- dows, chimney or other outlets. Arrange all the con- tents of the room so that their surfaces may be reached by the disinfectant gas. When prepared the gas is generated, which should be done only by a competent person, and the room is to remain closed for twenty- four hours, after which it and its contents should be Boards of Health. 109 aired thoroughly for several days. The woodwork should also be thoroughly washed, especially the tops of doors and windows, and solution No. 2 or 3 applied. Ceilings should be whitewashed and wall paper removed and the walls washed with one of the disinfectant solu- tions. Sulphur fumigation.—Roll sulphur, in the propor- tion of two pounds for a room ten feet square, is burned by placing it in an iron kettle, set in a tub containing a little water to guard against fire. It may be ignited by pouring a little alcohol or kerosene on it. Chlorine fumigation.—Mix well, breaking up all lumps, one part by measure of black oxide of manganese and two of common salt, and add enough water to make of the consistency of cream. A teacupful of this mix- ture is to be put into a large earthen vessel, as a wash- bowl, one or two of which may be placed in each room. About an equal bulk of commercial sulphuric acid is to be finally poured into each vessel, beginning with the most remote, the person retiring quickly; it is best to pour this from a pitcher; avoid inhaling the fumes by holding a handkerchief over the face. III. DISINFECTANT SOLUTIONS. No. 1. Sulphate of iron (copperas), three pounds, warm water, one gallon; for the discharges. This leaves rust spots on clothing. No. 2. Sulphate of zinc (white vitriol), four ounces; common salt, two ounces; water, one gallon. For clothing No. 3. Corrosive sublimate, sixty grains; water, one gallon. Caution should be had of the dangerously poison- ous character of this solution. N. b.— Solutions of corrosive sublimate should not be placed in metal receptacles, for the salt is decom- 110 A Manual for posed and the mercury precipitated by contact with copper, lead or tin. A wooden tub or earthen crock is a suitable receptacle for such solutions. § 74. Precautions against cholera.— The follow- ing circulars were issued last year (1892), when cholera threatened to invade the state. The general directions set forth in them may well be observed by health authori- ties, as they apply equally to other epidemics besides cholera. The preambles to these circulars are not given here as they are not considered necessary, but the mat- ters to which attention should be directed are published in full. 1. All streets, alleys, docks, yards, outhouses, cellars and other places where dirt collects to be cleaned. Con- stant inspection to be made to insure thorough compli- ance with orders. 2. Railroad stations should be provided with disin- fecting solutions, proper sprinkling pots, and what is re- quired to keep premises clean and constantly disinfected. 3. Closets and urinals of stations to be clean and dis- infected. No accumulations of deleterious matter to be allowed. 4. Water-closets and urinals of cars to be provided with receptacles for retaining the deposits, said recepta- cles to have disinfectants placed therein, and to be removed at intervals in such places, and in such manner as may be determined upon for the most perfect protec- tion against infection. 5. Medical inspection of passengers, if the train comes from an infected station or country. If the exposure has not been sufficient to warrant the detention of pas. sengers, their names and destinations should be obtained and this department notified by telegram that it may warn the health authorities interested. Boards of Health. Ill 6. Passengers found ill with cholera should be removed to proper hospitals provided for their reception. Cars from which they are taken to be fumigated. 7. Should any discharges from persons ill have fallen on the floor or platform of cars or stations, such dis- charges should be disinfected, removed in closed buckets and the place upon which they lay thoroughly cleaned. 8. All cars coming from infected places, if remaining at the point of stopping, should be disinfected before being swept and the sweepings disinfected after collec- tion and burned. 9. Where persons come from infected places or countries by wagon, on horseback, bicycles or on foot, inspection of the passenger or passengers should be made and disinfection of persons and clothing, or quarantine be instituted if considered necessary. 10. Vessels of all kinds to be inspected and if from infected ports fumigated and disinfected. 11. Water-closets and urinals of river and lake boats should be closed while in dock. Proper receptacles containing disinfectants can be substituted so con- structed that removal can be easily made for emptying. The manner and places of deposit for the contents to be designated by the health authorities. 12. Steamboats plying on rivers or small lakes whose waters are used for water supplies, to close water-closets and urinals and substitute proper receptacles contain- ing disinfectants which can be emptied at end of trip in such manner and in such place as may be designated by the health authorities. 13. All passengers on boats or vessels and the crews thereof, to be inspected in same manner as if provided for passengers by trains. 14. All clothing, bedding, bed clothes, table-linen, 112 A Manual for merchandise or other article or articles capable of retain- ing germs and which have been exposed thereto, to be disinfected, or if necessary, destroyed. In addition to the above the following was published: HOSPITALS. 1. Patients taken ill with cholera to be promptly and strictly isolated. When the case occurs in a crowded house, the patient to be removed to a suitable place for treatment. 2. If no building can be procured suitable for hospital purposes, tents or temporary hospitals of wood should be erected. The administrative and kitchen portions of the hospital should be separated from the wards. 3. Hospitals should be well ventilated and kept per- fectly clean, and have water-tight floors. 4. If in large cities, reception hospitals for persons taken suddenly ill in the street should be established at convenient points. From there the patient should be transferred to the general hospital as soon as practicable. DISINFECTANTS. V. The following disinfectants are advised : 1. Heat. — Continued high temperature destroys all forms of life. Boiling for one-half hour will destroy all disease germs. 2. Carbolic acid. — Standard solution No. 1 is composed of six ounces of carbolic acid dis- solved in an equal quantity of glycerine, and then added to one gallon of hot water. This makes, approximately, a five per cent solution (one-twentieth) of carbolic acid. The com- Boards of Health. 113 mercial colored, impure carbolic acid will not answer for this purpose. Great care must be taken that the pure acid does not come in con- tact with the skin. When practicable, the car- bolic solution should be used as hot as possible. 3. Corrosive sublimate (bichloride of mer- cury). — Standard solution No. 2 is composed of sixty grains of pulverized corrosive sublimate and sixty grains of chloride of ammonia, dis- solved in one gallon of water. This solution must be kept iu glass, earthen or wooden vessels (not in metal vessels.) The above solutions are very poisonous when taken by mouth, but are harmless when used externally. 4. Chloride of lime may be used about premises in vaults and cess-pools. VI. Methods of disinfection: 1. Hands and person.— Standard solution No. 1 should be diluted with an equal amount of water. Hands soiled in caring for persons suffering from contagious diseases, or soiled portions of the patient's person, should be im- mediately and thoroughly washed in this solu- tion, and then washed in soap and water. The nails should be kept perfectly clean, and the hands should always be carefully disinfected before eating 2. Soiled clothing, towels, napkins, bedding, etc., should be immediately immersed in stand- ard solution No 1, and soaked for twelve hours, being occasionally moved about in the fluid so as to bring the disinfectant in contact with all parts. They should then be wrung out and 15 114 A Manual for boiled in soapsuds for one hour. Articles such as beds, etc., that cannot be washed, should be burned. 3. Discharges.— Of all kinds from patients suf- fering from contagious diseases, should be received into earthen vessels containing standard solution No. 1. Special care should be ob- served to disinfect at once the vomited matter and the intestinal discharges from cholera patients, as these alone contain the dangerous germs. The volume of the disinfecting solu- tion used should be at least five times as great as that of the discharge. After standing for at least one hour in the disinfecting solution, these discharges may be thrown into the water- closet. Bedding or clothing soiled by the dis- charges must be at once placed in solution No. 1, and the hands of the attendants disinfected as described above. 4. Closets, sinks, etc.— Each time the closet is used for infected material, at least one quart of solution No. 1 should be poured into the emptied pan and allowed to remain there. All discharges should be disinfected before being thrown into the closet. Sinks should be flushed at least once daily with the same solution. 5. Dishes, spoons, etc.— Used by the patient should be kept for his exclusive use, should not be removed from the room, but should be washed there, first in solution No. 1, and then in hot soapsuds. These washing fluids should afterward be thrown into the water- closet. Boards of Health. 115 6. Soiled woodwork, floors, plain furniture, etc.— Should be thoroughly washed with solu- tion No. 2. Upholstered furniture, curtains or carpets, which have been soiled by the dis- charges, should be referred to the health depart- ment for disinfection or destruction. It is important to remember that an abund- ance of fresh air, sunlight, and absolute clean- liness not only help protect the attendant from infection, but also aid in the recovery of the sick. VII. Food and water : Food and drink.— Food thoroughly cooked and drinks that have been boiled are free from disease germs. In presence of an epidemic of cholera or typhoid fever, milk and the water used for drinking, cooking, washing dishes, etc., should be boiled just before using, and all persons should avoid eating fruit, raw vege- tables and ice. Ice may, however, be used when ordered for the sick by a physician. § 75. Certificates of births, marriages and deaths. How they shall be filled up. — The cer- tificates here given are not in the shape nor size required by the board, the page permitting neither. The subject-matter, however, is the same and each cer- tificate is filled out in the manuer desired in those returned to the health boards. The information sought by each certificate is that which experience has proved to be chiefly needed for reference, and it should be care- fully given. The answers to the questions asked by the blank forms are printed in italic as guides to the manner 116 A Manual for in which such certificates should be made out. Under each blank is placed its true measurement, and these sizes must be conformed to for the reasons previously stated. The stubs of certificates are not given, these containing synopses of the information set forth in the certificates and being in themselves the record retained by the persons making the certificates. The certificates should be so marked by crossing out the words not needed, as to show whether they are from a town, vil- lage or city, and the name of the county should be plainly written. Registrars or town clerks, familiar with the handwriting of those signing certificates, when the signatures are somewhat obscure, should rewrite them plainly so that no mistake may be made in the state registration. This duplication of the signature should not erase or obliterate the original, but should be made with pencil or pen anywhere on the margin of the certificate so as to call attention to the original and enable the state registrar to enter the name correctly. Form i. STATE OF NEW YORK. County of Albany. -----------In the Town '(Village) City of New Scotland. Reeistered No. 350 BIR/TH IR^TTTIE^ILsr. 1. Name of Child, James Doe. (in full when possible.) 2. Sex, M. Color or Race, if other than the White................... Date of Birth, May 1st, 1893. (If city, give name, street and number ; if not, give township, (village,) and county. 3. Place of Birth, New Salem. 4. Name of Father, Thomas Doe. (if out of wedlock and name not given, write O. W.) 5. Maiden and full Name of Mother, Margaret Roe. 6. Birthplace (or Country) of Father, U. S. Age, 35. Occupation, Farmer. 7. Birthplace (or Country) of Mother, U. S. Age, 23. 8. Number of this Mother's Previous Children, one. How many of them now living, one. 9. Name and address of Medical Attendant or other \ Attest, JOHN SMITH, M. D., authorized person, in own handwriting, ) New Salem. 10. Date of this Return, May 3d, 1893. 1. Village and city to be crossed out, New Scotland being a town. 118 A Manual foe [Endorsement on back of this certificate.] BIRTH RIETTTRItT. By whom, D. Smith. Name of Child in full, James Doe. When Born, May ist, 1893. Parents' Names, (Mother,) Margaret Roe. (F.) Thomas Doe. If the "given" name is not reported, it should be certified as soon as the child receives its full name. The proper forms (blanks) for attesting and returning the delayed "given" name can be obtained as directed below. Note. — Birth Returns and all Blanks are to be procured of Town, Village and City Boards of Health, for the Registry of Births, Marriages and Deaths. flS~ This Certificate is to be sent-to the State Bureau of Vital Statistics on or before the 15th of the next month, after its date. [Size of blank, 7% by 5 inches.] This Return of Marriage should be made to, and registered by, the Authori- ties specified by I,aw. 49- This Certificate is to be sent to the State Bureau of Vital Statistics, on or before the 15th of the month, after its date and local registry. to g "5 Co I -1 B' na E X & ^3 & 3. 8 tr1 N o & p* p crcj *J 0^ 0 n w ft) © *> b-0 8 0 « 3J 8 <-H 0 a H". *-*« w - q P t^ H 3 s So P O O O l3 > to" Orq ? P h5 W O p 0 P O ft P->. ; 2 O On P* b w s ft3 3 & 3 p 3 p d p. 1 O 5- C/) W 0 N O & 3 w 0 r+ a ^" tr1 s n> 0 CO P £ k & It c\ & O S N 2 ft> O n> O M H I—I l-H o o > Q W 6TI •hiivsh ^o scravog 120 A Manual for [Endorsement on back of this certificate.] Form 7. To the Bureau of Vital Statistics, STATE OF NEW YORK. f~ ~~j^t"* RETURN OF A MARRIAGE In the Town '(Village) City of New Scotland, County of Albany. 1. Full Name of Groom, John Doe. 2. Place of Residence, New Salem, N. Y. 3. Age next Birthday, 31 years.............................. 4......................................................... 5. Occupation, Carpenter. 6. Place of Birth, Albany, U. S. 7. Father's Name, Richard Doe. 8. Mother's Maiden Name, Jane Evans. 9. No. of Groom's Marriage, First. 10. Full Name of Bride, Margaret Roe. Maiden Name, if a Widow.............................. 11. Place of Residence, New Salem, N. Y. 12. Age next Birthday, 19 years.............................. 13........................................................] 14. Place of Birth, New Salem, N. Y. 15. Father's Name, Thomas Roe. 16. Mother's Maiden Name, Margaret Brown. 17. No. of Bride's Marriage, First. N. B.—At Nos. 4 and 13: if of other than the White Race, specify it A Nos. 9 and 17 state whether 1st, 2d, 3d, &c, marriage of each. The signa- tures below of Bride and Groom, should be written out in full for the "given " and family names. Dated at New Salem, N. Y., January 10th, 1893. We, the Groom and Bride named in the above Certificate hereby certify that the information given is correct, to the best of our knowledge and belief. JOHN DOE, (Groom.) MARGARET ROE, (Bride.) Signed in presence of JAMES HENRY, ____________and THOMAS AMES. k. 1. Village and city to be crossed out. [Size of b'ank. 9% by 4^ inches.] County of Albany. ■TATE OF NEW YORK. M— a 01 If ■84]; B CERTIFICATE OF DEATH, In the Town (Village) City of New Scotland. Full Name of Deceased (If an Infant not named, give parents' names.) John Doe. Age, 30 years, 5 months, 10 days. Sex, M. Color (R.«, if other than the White.).............. Single, Married, Widowed (Cross out word, notrequired in tht. line.) 4. Occupation, Laborer. Birthplace (and State or Country.) England. (How long In the United States, If of foreign birth.) 20 years. Father's Name and Birthplace, Richard Doe. (State or Country.) England. Mother's Name and Birthplace, Mary Roe. (State or Country.) England. Form 3. No. of corresponding Entry In Register Book of Deaths to be in- serted here by the Registrar. 29 6. 7- 8. Place Of Death (If an Institution, state its nam s.) New Salem. (How long resident here.) IS years. ( U dyln& aT?y £om Hom*' &'" Bome\ "" ■* \ Residence below. ) 9. Date and Hour of Death :-Died on the 15th day oi January, 1893, at about 10 A.M...........'................. ........ 10. I hereby report this Death, and certify that the foregoing statements are true according to the best of my knowledge. (Signature and residence of Reporter.) JOHN SMITH, ................... 11. I Hereby Certify, That I ittended the deceased from December 30th, 1892, to January r-ith 180? that I last saw him {."n lS;A^'i'l?,lt he diedr°un- the '*lh day ^January, i8?3, about icT o'clock, A.'lfcandtbattctheb"trfw knowledge and belief the caise of his death was as hereunder written • 1___________ Iot e c 5t OI my Cause or Causes of Death. Chief and Determining, Phthisis. Consecutive and Contributing, Hemorrhage. Years, Duration of Disease In Months, Days, H W 122 A Manual for [Endorsement on this certificate is as follows:'] REPORT OF A. DEATH. From William Wilson, Town Clerk. Name of Deceased, John Doe. Date of Death, January 15th, 1893. In the Town (Village) City of New Scotland, County of Albany. Name and P. O. Address of person who gave the Permit of Burial, THOMAS ADDIS, J. P. Note.—Certificates of Death and all blanks are to be procured of City, Village and Town Boards of Health, as provided by the law for the Registry of Marriages, Births and Deaths. &g~ This certificate when filled out, is to be registered without delay and forwarded to the State Bureau of Vital Statistics, Albany, on or before the 15th of the next month [Size of blank 8 1-16 by 7 3-16 inches.] Boards of Health. 123 Where a body is to be buried within the limits of the county, the following is the form of burial permit. Permits to bury are granted by any person authorized to by the board of health having jurisdiction. It is often well in a large township for the board to designate more than one person to issue these permits, as it saves long drives to obtain them by the undertaker. If this is done by the board, the persons authorized by it to issue the permits should be instructed to promptly forward the death certificate, on wnich the permit is granted, to the local registrar, that he may enter it in his book and forward it to the state board, as required by the latter's rules. It may become necessary to transport for burial a body of a person who died of a contagious disease. All public carriers are by the intent of the law forbidden to receive such a corpse, and all boards of health, or those having power to issue, under the authority of a board, transit burial permits, must not so issue these, unless the remains are properly coffined in some metallic sub- stance, and the coffin so sealed that escape of contagion is impossible. The ordinary metallic casket is an ex- pensive affair and not within the means of many. To comply with the law (§ 23), the box in which the coffin is placed can be lined with tin or zinc, and a lid of the same material soldered on before the box top is screwed down. Such a lined box is as safe as a mettalic coffin, and the cost is very much less, while the protection against contagion is equally good. To further insure that no danger shall be by any chance given by the corpse, it should, before being placed in the coffin, be wrapped in a sheet soaked in a strong solution of car- bolic acid. The transit permit should bear upon its face, written there by the person granting the permit, a 124 A Manual for statement that all precautions in accordance with law have been taken to insure the safety of those having to handle the coffin. The simplest form for such a state- ment is, " this body is inclosed in a metallic coffin as re- quired by law," for the lining of the box with zinc or tin makes it practically a metallic coffin, and as the transit permit bears on it the name of the disease from which the patient died, and as all are generally familiar with the names of contagious diseases, the statement of the issuing officer is a guarantee that all precautions have been taken and the provisions of law fully complied with. Form 5. STATE OF NEW YORK. BTJK.IA.Xj permit. In the Town J(Village) City of New Scotland, County of Albany. New Salem, (Dated) January i, 1803. The Certificate of Death having been furnished to me, as required by the Laws of this State, permission is hereby given for the Burial of John Doe, age 20, who died at (dty or Township,) New Salem, New Scotland, in the County of Albany, on 28th December, T802; the cause of death being Pneumonia. Place of Burial, Protestant Cemetery. Sncharrge tf *ST } TH0MAS J0NES> \ (Signed by) GEORGE BRO WN, Residence, New Salem. ) (official title,) Health Officer. 1. Village and city to be crossed out, New Scotland being a town. 126 A Manual for [Endorsement on the back of this permit.] BTTKXAXj PERMIT. Name of Deceased, John Doe. Date of Death, December 28th, 1892. Cause of Death, Pneumonia. In the Town (Village) City of New Scotland, County of Albany. Notb.—This permit is only to be issued for a burial within the county where the death takes place, and is to be kept by the cemetery keeper where the body is buried. It is to be issued on the filing of a death certifi- cate, certified to as required by Section 23 of Chapter 661, I^aws of 1893. Note.—Burial Permits and all Blanks are to be procured of Town and Village Clerks and Boards of Health, for the Registry of Births, Marriages, Deaths and Burials. 1. Village and city to be crossed out. [Size of blank, 7% by 3% inches.] Boards of Health. 127 (See back of this Coupon.) Special Coupon for City Transit When Required. Special Coupon No. Three to Transit Permit No. 15, of the body of Richard Roe, who died at New Salem, N. Y., and is to be buried at Newtown. Permit issued (Dm.) January 10th, 1893, at New Salem, Albany Co., N. Y., tor transit through the city of New York. Signed, THOMAS ADDIS, (Official Title,) Justice 0/the Peace. Before this body leaves the city of New York, through which it is in transit, the ferry or bridge master or transport agent will tear off this coupon and send it to the Health Department of the city, as its regulations may require. iW TMs Permit must in all cases accompany the body to its destination. Coupon No. Two, to Transit Permit of (Name,) Richard Roe, who died at New Salem. Before this body leaves.................the carrier or transportation agen* will tear off this coupon. If otherwise detached from the permit the coupon -uus* not be received. (See back of permit.) Coupon No. One, to Transit Permit of (Name,) Richard Roe, who died at New Salem. Before this body leaves....................the carrier or transportation agent jvill tear off and keep this coupon. If otherwise detached from the permit the coupon must not be received. (See back of permit.) 128 A Manual for (Back of Special Coupon.) When a body from another State or City is in transit for burial, beside the transport coupon some cities, like New York, require that the ferry or transport agent should tear off and return a coupon to their health department, in order that it may have a record. This special coupon is in such cases to be given to the ferry or bridge master or transport agent. We therefore add to the usual coupons i and 2, this special No. 3, for such use when required. When not needed, this coupon should not be given out or should not be signed by the officer issuing the permit. (Back of Transit Permit.) TRANSIT PERMIT. Issued in the Town (Village) City of New Salem, County of Albany. Issued by Thomas Addis, J. P. To whom issued, Thomas Jones. Name of Deceased, Richard Roe. Date of Death, January 8th, 1893. Name of person or carrier in charge, James Roe. Date of Transit, January 9th, 1893. t«'S*'*'g*'u>1>,a*'*"j*,*oo'5(ilt; v v a °*o ° o«OCi(»OHm(NHC0OO«05-*C0C00SJ>^««DOC0«D!>C0(Ne0b' !>OWO>NOH-iHHiNCOeO«l'*T)i-^QOOOM OJ>j>t^^OOaOQOQOGOC»COOOCOCCOOCOQOOOOOOOOOOOaOQOCOQOCC)OOGOOOOOQOCOOOOOQO OOOOOOOOOOOOCXJOOOOOOCOCOOOOOOOQOOOOOOOOOOOOOOOQOOOOOOOCOOOOOOOGOOOQOOOOOOO !—I i—I i—I i—I i—I i—li—Ir-ir-lr-lr-li—liHr-lrHr-li—Ir-li—li—IrHr-li—trHi—I i—I i—Ir-lr-li—li—I H H rIHHrI 228 A Manual for Boards of Health. Laws of Chapter Sections. 1888 ........... 146.............. All. 1888 ......... All. 1888 All. 1888 All. 1888 ......... All. 1889 ......... All. 1889 All. 1889 ......... All. 1889 All. 1889 ........ All. 1890.............. 1890 ........ 100.............. All. 419.............. All. All. 1890........... All. 1890 ........ All. 1892 ........ 486.............. All. 1892 487.............. All. 1892 All except 5. 1892 655.............. All. INDEX. [L. B. is equivalent to Local Board of Health, L. H. 0. to Local Health Officer, S. B. to State Board of Health, and V. S. to Vital Statistics. The numbers refer to the sections.] Abatement: of nuisance, notice ; how made and served............. 59 Adulterations : food, drugs, etc., district attorney to prosecute......... 8 Alms-houses : contagious diseases in................................ 29 Animals: infectious diseases of.................................7313 Attorney-general : opinion on compensation of counsel to L. B............ 65 opinion on power of L. B. to lay sewers or drains....... 69 opinion of, on V. S. certificates........................ 56 Attorney, district. See District Attorney. Audit: of bills contracted by L. B............................ 36 Beer : adulterations of...................................... 8 Births: registration of. See V. S. Blanks: for V. S. certificates.................................75-76 Boarding-house. See Hotel. Bridegrooms : must sign and forward certificates of marriage to L. B... 55 230 Index. Canals : affidavits required on nuisance of escaping water....... 5 escaping water must cause sickness before S. B. can act. 5 nuisance caused by, to be reported to the superintendent of public works.................................... 5 escaping water may constitute nuisance................ 5 Carriers, public : cannot receive dead without transit permits............ 3 Cattle: authority to kill...................................... 91 certificate given when killed.......................... 96 disinfection after disease of............................ 91 examination of, for tuberculosis........................ 9 killing for tuberculosis................................ 93 may be marked for identification...................... 95 must be confined for examination..................... 94 owners must permit examination of.................... 92 payment for, when killed............................ 91 penalty of refusal by owners of, to obey orders of L. B. in case of tuberculosis................................ 9 quarantine of........................................ 93 S. B. rules for tuberculosis in......................... 9 tuberculosis of....................................... 9 Cemeteries: care of..................................,,,,........7318 Certificates: V. S................................................ 75 See Blanks. Cesspools: regulations for....................................... 732 Chemist, analytical: appointed by S. B. to examine food, drugs, etc......... 8 Children: in school, must be vaccinated......................... 28 institutions for the care of, must submit monthly reports, 48 reports by physician of, to L. B....................... 13 S. B. fixes forms of reports of......................... 13 medical officer of, must report contagious diseases at once. 48 Cholera: directions for........................................ 74 must be reported to S. B. by all L. B. at once.......... 2 precautions against............................... 74 Index. 231 Citizens: complaints by, must be examined into by L. B.......... 58 duty of, in health matters............................ 51 may complain to L. B................................ 31 Cleanliness: value of............................................. 54 Clergymen: must sign and forward certificates of marriage........55-57 Clothing: L. B. has power to destroy............................ 34 Contagious disease: destruction of articles after........................... 43 disinfection after..................................... 43 duty of L. B......................................... 26 duty of physicians.................................... 53 epidemics of and proceedings in....................... 66 health officer is legal expert in diagnosis of............ 70 in hotel or boarding-house............................ 42 in private family..................................... 42 monthly reports of, can be paid for.................... 44 must be reported to L. B. by all physicians............ 40 what diseases must be reported to S. B by all L. B's.... 2 what they are........................................ 40 Committee: of L. B. can hear case only............................ 23 Complaints: action of L. H. O. on................................. 45 must be examined into by L. B........................ 58 Council, common: cannot control L. B.................................. 72 Counsel: compensation of..................................... 65 may be employed by L. B...........................19-62 County: may recover cost of abatement of nuisance, by suit only. 4 See Municipality. Courts: L. B. must appeal to, if nuisances are not abated....... 60 Danger: sudden, in epidemics................................. 66 232 Index. Dead: certificate of death is necessary........................ 25 certificate of death may be paid for by L. B............ 25 certificate signed by physician........................7317 no charge for burial permit........................... 25 permit for burial necessary........................... 25 public funerals forbidden.............................7312 transfer regulated by S. B........................... . 3 transit permits accepted by other states................ 3 transit permits necessary............................. 3 Deaths: registration of. See Vital Statistics. Diagnosis: L. H. 0. is legal expert............................... 70 Diptheria: prevention of........................................ 74 suppression of....................................... 74 Disease, contagious : directions to prevent spread.......................... 74 Diseases, infectious: in animals...........................................7313 reports of............................................739 Disinfection: after contagious disease............................... 43 after tuberculosis in cattle............................ 91 solutions for......................................... 74 with chlorine....................................... 74 with sulphur........................................ 74 District attorney: must prosecute adulterations in food, drugs, etc........ 8 Drainage: L. B. has power to regulate, of houses................ 71 Drugs: adulteration to be prevented by S. B................... 8 Emergency: proceedings in....................................... 66 Experts: may be employed by L. B............................. 19 may be employed by S. B............................. 4 Index. 233 Family: contagious disease in................................. 42 Food: improper articles of forbidden sale..................... 49 L. H. O. must seize improper articles of................ 49 S. B. to prevent adulterations of....................... 8 unwholesome....................................... 731 Forms, blank: of V. S. certificates.................................. 75 See Blanks. Funeral: permit necessary.....................................7316 Garbage : regulations of....................................... 734 Governor: has power to order abatement of nuisance.............. 4 may order reports from S. B.......................... 4 Glanders. See Horses. Guards: may be employed by L. B............................. 19 Health: reports on, may be required by governor............... 4 special examinations of, by order of governor........... 4 public, care of, is paramount.......................... 15 Health officer, local: disinfects and destroys............................... 43 duties of, in contagious diseases....................... 41 duties prescribed by L. B............................. 38 duty toward nuisances................................ 45 is always on duty.................................... 46 is a state officer..................................... 38-72 is executive officer of L. B............................ 18 is expert on diagnosis of contagious disease............. 70 is protected.......................................... 70 is sanitary adviser of L. B............................ 18 miscellaneous directions to.......................... 50-54 must be a physician.................................. 38 must pass civil service examination.................... 38 must report contagious diseases to S. B................ 44 must report in writing to L. B....................... 17-47 must see L. B. orders carried out in contagious diseases. 42 must seize improper articles of food.................... 49 must visit institutions for care of children.............. 48 of local board........................................ 16 234 Index. Health officer, local—Continued: pay from the municipality............................ 7 powers of...................................»• >.....7319 should be paid by salary............................... 18 when appointed by S. B.............................. 7 See also Local Board. Health officer, port of New York : may certify land is required for quarantine............ 6 Hotel: Guests must be warned of contagious disease in........ 42 Horses: disinfection after glanders............................ 10 glanders in.......................................... 10 killed with glanders are paid for...................... 10 L. B. must kill horses with glanders................... 10 rules for destruction of............................... 10 veterinary, to be employed by L. B. in cases of glanders. 10 Hospitals: L. B. can remove patients to.......................... 27 Immigrants: a menace to public health............................. 15 Indictment: separate for each nuisance............................ 68 Infection: persons or things must not be moved..................73" Insanitary conditions; dangers of................................ 54 Inspectors of cattle for tuberculosis.............................. 9 Land filled in or made................................... 735 may be acquired for sanitary purposes................. 6 Liquors : manufacturers must supply samples to S. B............ 8 penalty of refusal to supply........................... 8 Local boards of health : accounts of.......................................... 36 accounts passed by auditors of municipality............ 36 action to abate nuisance.............................. 61 all proceedings of, must be recorded................... 64 appointment is obligatory............................. 16 Index. 235 Local boards of health — Continued: brings suit to recover expense of abating nuisance...... 33 compensations fixed by............................... 36 can administer oath to witnesses...................... 23 can employ counsel................................... 62 can enter on property and abate nuisance.............. 61 can give judgment on nuisance by default............. 61 can hear cases in committee........................... 23 can impose penalties for violation of rules.............. 21 can issue subpoenas.................................. 23 can issue warrants................................... 24 can only act when health is in danger................. 32 can place lien on property............................ 63 can proceed when maintainer of nuisance refuses to appear............................................ 61 can regulate building of privy vaults.................. 67 cannot delegate its powers to a committee.............. 23 cannot levy fines..................................... 21 eligibility of members................................ 16 executive officer of, must be a physician............... 16 expenses paid by municipality........................ 36 expenses of work of, paid by municipality............. 33 fixes compensation of counsel......................... 65 has control of water supply in its jurisdiction.......... 30 has especial control over tenement-houses.............. 34 has power to destroy clothing, woolen goods, etc....... 34 has power to enter any premises....................... 31 has power to protect health if municipality refuses..... 37 has quarantine power................................. 26 has right to abate nuisance........................... 33 have no responsibility for state lands.................. 6 how formed......................................... 16 issues permits for burial.............................. 25 jurisdiction confined to municipality................... 35 legal proceedings of, not reviewable by courts.......... 64 limitations of, in proclaiming nuisances................ 68 may abate nuisance maintained by municipality........ 69 may apply to S. B. to guard water supply.............. 30 may employ persons and fix payment.................. 19 may order municipality to abate nuisance.............. 69 members are state officers............................. 72 members can sit with S. B............................ 4 members of town boards.............................. 16 must abate nuisance under order of S. B.............. 4 must act at once in epidemic.......................... 66 must appeal to court to enforce abatement of nuisance.. 60 must appoint physician as health officer............... 38 must consider nuisances separately.................... 67 must decide on committee's report..................... 23 must examine into complaints......................... 31 236 Index. Local boards of health — Continued: must forward V. S. certificates monthly................ 3 must guard against contagious diseases................ 26 must indict each nuisance separately.................. 68 must make complete register of V. S.................. 25 must publish all general rules made.................. 20 must purchase its own supplies....................... 25 must quarantine contagious diseases................... 27 must report to S. B. contagious diseases at once........ 27 must see V. S. certificates are signed................... 55 must supply hospitals for contagious diseases.......... 27 must supply physician and medicine to the poor, when.. 42 must supply vaccine virus............................ 28 must vaccinate school children........................ 28 must watch immigrants from infected centers.......... 26 officers of............................................ 16 officers of, are protected.............................. 70 order of, may be reversed by S. B..................... 2 pays for articles destroyed............................ 43 power to guard against disease........................ 15 power to make necessary rules to preserve health....... 20 power to regulate plumbing and drainage.............. 71 prescribes duties of local health officer and fixes compen- sation ............................................18-38 prescribes sanitary regulations of burials............... 25 proceedings in presence of danger..................... 66 procedure to enforce abatement of nuisance............ 61 reports on nuisances must be in writing................ 31 rules should not be changed.......................... 20 should trust to quarantine by other L. B's.............. 26 special meetings called by presiding officer............. 17 special meetings called by S. B........................ 17 special meetings on petition of citizens................ 17 special orders not published........................... 22 S. B. must approve vaccine virus used by.............. 28 stated time of meeting is necessary.................... 17 suggestions by S. B. for rules to be adopted by......... 73 those L. B.'s exempt from supervision of S. B.......... 2 two or more may be combined......................... 35 under control of S. B................................. 1 vacancies in, must be filled in thirty days.............. 16 vacancies in, how filled............................... 16 when county judge can appoint member of............. 16 when quarantine is necessary......................... 26 will be upheld by courts.............................. 62 See, also, Health Officer, Local. Magistrate: must sign certificate of marriage....................... 55 Index. 237 Maintainer of nuisance: can appear before L. B. by counsel..................... 61 must be notified of hearing before L. B................ 59 must plead or lose his case by default................. 61 See Nuisance. Markets: regulations of....................................... 73« Marriage: certificates signed by................................. 55 penalty for not signing certificates of.................. 55 registration of. See Vital Statistics. Municipality: L. B. can abate nuisance maintained by................ 69 when subject to L. B................................. 69 Nuisance: blanks used.......................................... 76 cost of abatement recovered from maintainer by suit ... 4 defined.............................................. 58 duty of L. H. O. to................................... 45 each must be considered separately.................... 67 each must have separate indictment................... 68 expense of abatement a lien on property............... 33 governor may order county to abate................... 4 limitations of........................................ 68 L. B. can act only when health is impaired by.......... 58 L. B. can enter on property to abate................... 61 L. B. must proceed legally to enforce abatement........ 60 maintainer of, has a right to copy of report on.......... 31 maintainer must pay cost of abatement................ 33 maintainer to be notified and given time to abate........ 45 may be examined by S. B............................. 4 may be investigated by order of governor.............. 4 measures to abate must be taken by L. B............... 4 must be actual....................................... 68 must be dangerous to health.......................... 32 notice to abate; how made and served.................. 59 notice to abate may be posted......................... 59 order of governor to abate may be issued to maintainer.. 4 procedure to enforce abatement........................ 61 when cost of abatement is paid by county.............. 4 written notice to abate required....................... 33 Payment: for articles destroyed by L. H. 0...................... 43 of counsel to L. B.................................... 65 opinion of attorney-general on, to counsel of L. B...... 65 238 Index. Penalties: imposed by L. B...................................... 21 must be collected by courts........................... 21 must be fixed sums................................... 21 Physicians: duty of, to L. B...................................... 53 must report contagious diseases....................... 70 must sign V. S. certificates............................ 57 Plumbing: L. B. has power to regulate........................... 71 Privies: rules for. ........................................... 732 Property: can be destroyed at once in epidemics.................. 66 can have lien placed on, by L. B...................... 63 Public health: law of, reasons for.................................... 15 Quarantine: in contagious diseases................................ 41 land may be acquired for............................. 6 L. B. on infectious diseases...........................7310 power of L. B. to impose.............................. 26 when necessary....................................... 26 Records: charges for certified copies of.......................... 25 of L. B. are presumptive evidence..........,,......... 64 Regulations, sanitary: of L. B. See Rules. Reports: toL. B. fromL. H. 0................................. 47 Rights: of persons must not interfere with those of others...... 58 Rules: for L. B., suggested by S. B........................... 73 Scarlet fever: prevention of........................................ 74 suppression of....................................... 74 School trustees: duty to vaccinate children............................ 28 Index. 239 Secretary of S. B. is executive officer of S. B............................ 1 Sewers: when L. B. can make or repair........................ 37 regulations of........................................ 73J Sextons: duties of............................................7318 Sheriff: must execute warrant of L. B......................... 24 Signatures: on V. S. certificates must be legible.................... 75 Slaughter-house: may be a nuisance.......... ......................... 68 regulations of........................................ 738 Smallpox: must be reported to S- B. by all L. Bs................. 2 prevention of....................................... 73 treatment of cases.................................... 73 Spirits: adulteration of....................................... 8 State board of health: can act as L. B. in a municipality...................... 35 can ask members of L. B. to sit with it................ 4 can certify for pay for monthly reports of contagious disease............................................ *4 can protect water supply.............................. 11 directions to prevent contagious diseases............... 74 has supervision of land for sanitary purposes taken by state...........•................................... ~ has power to appoint L. H. O.......................... 7 has power to examine nuisances....................... 4 law creating.....................•.................... \ L B.'s exempt from supervision of.................... 4 may order abatements of nuisance caused by escaping water of canals.......................•............ *> may assume powers of L. B. if V. S. certificates are not forwarded......................................... «| may be required to report to governor................. 4 may call special meetings of L. B..................... 17 may employ experts.................................. 4 may reverse order of L. B............................ 2 meets every month................................... 14 members and officers of............................... 1 240 Index. State board of health — Continued: miscellaneous work of................................ 14 must prevent adulteration of food or drugs............. 8 powers of, defined.................................... 1-2 power of free entry................................... 2 power to prepare forms of V. S. certificates............ 56 responsible for state lands............................ 6 right of entry in state buildings or lands.............. 6 rules of, for tuberculosis in cattle...................... 9 state acts through, in matters of health................ 6 suggestions for rules to be adopted by L. B............ 73 supervision over L. B. 's............................... 2 when created.................................. ..... 1 State: buildings of, open to S. B............................ 6 lands of, open to S. B................................ 6 Subpoenas from S. B. and L. B. are legal........................ 2-23 Susquehanna river protected from pollution.............................. 12 Tenement (houses): duties of owners..................................... 54 especial control over by L. B.......................... 34 L. H. O. limits number of persons in a room........... 34 owners of, may be cited before L. B.................... 34 Testimony under oath before S B................................ 2 Time: A reasonable, must be given to abate nuisance.......... 59 Town. See Municipality. Trades, noxious: regulations of........................................ 736 Tuberculosis : examination of cattle for.............................. 9 S. B. rules for care of, in cattle....................... g in cattle. See Cattle. Typhus must be reported to S. B. by all L. B.'s................ 2 Vaults : L. B. can forbid building of, when dangerous to health. 67 Index. 241 Vaccine virus approved by S. B. and supplied by L. B............... 28 Village. See Municipality. Vital statistics : attorney-general; opinion on certificates of............. 5G average number certificates filed yearly................ 3 blauk forms for......................................3_75 certificates of........................................ 52 certificates, how filled ............................. 75 certificates signed by.................................. 55 certified copies original certificates are presumptive evi- dence ............................................. 3 cost of registration................................... 25 duties of clergymen, magistrates, parents, physicians and others......................................... 52 forms aud methods prescribed by S. B................. 3 importance of........................................ 25 in charge of S. B..................................... 3 L. B. must forward certificates to S. B................. 3 original certificates kept by S. B............,......... 3 payment of registrar................................. 25 persons obliged to fill out certificates.................. 25 power of S. B. to prepare blanks...................... 56 reasons why clergymen and physicians should fill out certificates of...................................... 57 registrars of, appointed by L. B....................... 16 registers to be kept by L. B........................... 25 registration of, by S. B............................... 3 reports of.....................................7314 reports of...... ............ ....... ..............7315 Wallkill creek: protected from pollution.............................. 12 Warrants: issued by L. B....................................... 24 Watchmen: may be employed by L. B............................ 19 Water—supply of: insanitary conditions of water-shed, how abated........ 11 penalty of breaking rules for protection of............. 11 publication of rules for protection of.................. 11 rules for protection of, made by S. B.................. 11 sewer system on water-shed maintained by owner of water supply...................................... 11 water-shed may be inspected.......................... 11 242 Index. Wine: adulterations of...................................... 8 Witnesses : before L. B. cannot be examined on other than health matters........................................... 23 Woollen goods : L. B. has power to destroy............................ 34 Yellow fever: must be reported to S. B. by all L. B's................. 2 1 I NLM051297595 4853534848482348534823480102022353535348484853535353