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MUNICIPAL SANITATION 
 
 IN THE 
 
 UNITED STATES 
 
 BY 
 
 CHARLES V. CHAPIN, M. D. 
 
 Superintendent of Health of the City of Providence 
 
 Cbc providence press : 
 
 S X o W & F .\ RNH A M 
 
 I'k< (VIDENCE, K. I . 
 1901 . 
 
COPYRIGHT, 1900, 
 
 By Charles V. Chapin. 
 
 su 
 
 1 
 
PREFACE. 
 
 r T"4IK preparation of the present volume was primarily undertaken to 
 -* inert the author's personal needs. An investigation along several 
 lines of public health work suggested the utility of a comprehensive 
 study of public sanitary methods. As a consequence this volume was 
 prepared and it is hoped that the material here gathered will prove use- 
 ful to other health officers as it has to the author. It is not a treatise 
 on the principles of sanitation and in Pact these principles are rarely 
 referred to, but it is, rather, a compendium of sanitary practice. It is 
 not so much intended to advise what oughl to he done as to record what 
 has heen done. Neither is it intended to he a presentation of the 
 author's own views though these may occasionally be indicated. The 
 subject under consideration is the sanitary functions of munici- 
 palities, the latter term being usctl in its broadest sense, Including 
 cities, villages, townships, and counties. Only the sanitary work of 
 local government is considered and not that of the state or the federal 
 government, except in so far as the latter engage in work which theo- 
 retically belongs to local officials. 
 
 This volume was begun several years ago and though the attempt 
 has been made to bring the parts first written up to date, yet omissions 
 will doubtless be found, During this time many cities have adopted 
 new sanitary methods and sometimes the same citj is used to illustrate 
 the workings of both the old and the new method. Doubtless also man} 
 errors will be found which must be attributed to the shortcomings ot 
 
 the author. These will lie the re readily forgiven D) those wllO ha\c 
 
 experienced the difficult} in compiling municipal reports and searching 
 the maze of municipal and statutory law. 
 
 While in some instances the author has not heen able to scenic in- 
 formation either from printed reports or by correspondence, and that 
 too from some important cities, yet Hi"-; municipal officers have been 
 very kind in answering the queries sent them and have often been to 
 
 347498 
 
iv PRE FA CM 
 
 much labor in preparing a satisfactory reply. The author thoroughly 
 appreciates the assistance thus given without which the volume would 
 have been impossible. 
 
 Many blank forms have been introduced in the appendices as it is 
 believed that these often illustrate methods of work better than any 
 verbal description. A subject index will be found but no place index. 
 A place index without reference to the subject with which the place is 
 connected is of little use and one with such reference would have con- 
 siderably increased the size of an already too bulky volume. 
 
 C. V. c. 
 
 Providence, March, L901. 
 
CONTENTS. 
 
 CHAPTER I. 
 
 SANITARY ORGANIZATION. 
 
 I- M. ES 
 
 Importance of sanitation — spheres of federal, state, and local sanitation- 
 control of the state in local sanitary affairs — local control of sani- 
 tary affairs i r, 
 
 Sanitary organization of counties, townships, and municipalities — legis- 
 lation concerning local sanitary affairs — special — general — legisla- 
 tion incidentally establishing local sanitary authority .... 7 22 
 
 Forms of local sanitary organization — ex-officio hoards — independent 
 hoards or officers — appointment — personnel — organization — terms 
 of office compensation — duties of the sanitary department — execu- 
 tive — general description — health officer and subordinates —appoint- 
 ment, qualifications, terms of service, compensation — civil service 
 regulations — legislative — hy whom exercised — extent of power — 
 model laws — judicial powers ......... 23 49 
 
 References to laws . • .49-51 
 
 CHAPTER II. 
 
 REGISTRATION <>!•' VITAL STATISTICS. 
 
 Relation of the subject to sanitation ........ 52 •">•'; 
 
 Death records — methods of collecting, census enumeration, reports by 
 
 physicians and undertakers permits for burial or removal - items for 
 
 ncord — investigation of causes 
 
 Birth records methods of collecting, census enumeration, reports bj 
 
 physicians, clergymen, parents items of record — still-births 
 Marriage records — licenses, when required, by whom issued, form of 
 
 license, licenses for minors — returns of marriage by persons officiating. 
 Returns and records false returns original returns recording officers 
 
 in different states records, paper, ink forms index correction 
 
 of records— copies of record ......... 
 
 siatc registration reports, local and state registration of physicians, 
 
 undertakers, clergymen, etc. fees for registration penalties 
 Disposal of t he dead regulations in regard to time, place, manner of burial 
 
 — graves, vaults, disinterments cremation ...... 
 
 References to laws 
 
 CHAPTER III. 
 
 \ i I- \ \. KM, 
 
 Duty of municipality abatemenl bj health authorities inspection 
 
 — orders — hearings Bervice of orders tines abatement bj the 
 municipality collection of costs cleansing the premises ■ ■ • 108 122 
 
 Prohibition of nuisances legislation, general statute, special acts, local 
 rule 
 
 Administrative methods inspectors and duties reports records 
 notices to abaft results ol failure to obej notict lin< ab 
 nieiit h\ municipality vacation of the premises .... 120 in 
 
 References to laws .......••••• 
 
 5-1 
 
 71 
 
 i i 
 
 
 
 
 M 
 
 99 
 
 
 104 
 
 lot 
 
 107 
 
VI 
 
 CONTENTS. 
 
 CHAPTER IV. 
 
 SPECIFIC NUISANCES. 
 
 P VGES 
 
 Mostly under local regulations — general prohibitions in regard to filth on 
 private property, in streets — defective plumbing and drainage — cel- 
 lars — overcrowding — general rules in regard to building — digging 
 the soil — weeds — poison ivy — street cars — salt on streets- — noises — 
 spitting ............. 143-160 
 
 Stables, location and licensing, floors, manure receptacle, removing manure 
 — swine licenses — other animals — vaults required where there are no 
 sewers, permits and rules for construction, location, size, materials — 
 cesspools — removal of vaults and cesspools ...... 161-192 
 
 Filth on shores — public dumps — pond-holes and swamps .... 192-199 
 
 Offensive trades — 1. maybe located by sanitary authorities — 2. may be 
 licensed and controlled by regulations — public abattoirs — rules for 
 slaughter houses, rendering, dealing in hides, gas works, tanneries, 
 second-hand clothing — 3. may be forbidden ...... 199-214 
 
 Smoke nuisance, forms of ordinances ........ 214-219 
 
 CHAPTER V. 
 
 PLUMBING. 
 
 Authority for plumbing codes, general sanitary power, special and general 
 
 acts conferring the authority ......... 220-222 
 
 Plumbing codes — plans of plumbing — approval of plans and permits — 
 
 technical details of plumbing codes ....... 222-252 
 
 Department controlling plumbing — examination and licensing of 
 
 plumbers, state and municipal laws — fees — bonds .... 252-257 
 Inspectors — salaries — notification of inspection — inspection — certili- 
 
 cates — penalties ........... 257-201 
 
 CHAPTER VI. 
 
 JVATER, ICE, AND SEWERS. 
 
 Water supplies — municipal ownership — impurities of water — prevention 
 of pollution, state legislation — duties of state boards of health — local 
 regulations — inspection of water sheds — chemical, microscopical and 
 bacteriological examinations ......... 262-274 
 
 Purification of Water Supplies — storage and sedimentation — filtration, 
 
 natural filters, mechanical lifters 274-287 
 
 Wells, investigations, closure — springs ........ 287-202 
 
 Ice- — legislation state and local — licensing dealers ..... 202-200 
 
 Sewers 296-297 
 
 River pollution — sewage disposal ......... 207-304 
 
 References to laws .;o4 
 
 CHAPTER VII. 
 
 FOOD, OTHER THAN DAIRY PRODU< rS. 
 
 Danger from adulterated food — unwholesome food, state laws, food from 
 animals, diseased, wounded, emaciated or dead — undrawn poultry — 
 blown veal — immature animals — cleanliness of markets — control of 
 markets — bakeries — hotels and restaurants — infected food — veget- 
 ables and fruit — bread — canned goods — misrepresentation 
 
 306-324 
 
CONTEXTS. v - 
 
 Adulteration and substitution — state laws, general — drugs, liquors, vine- 
 gar, molasses, sugar, etc. — honey, saleratus, baking powders, poi- 
 sonous coloring matter, candy, jelly, coffee, olive oil. catsup, eggs, lard . 324-337 
 
 Execution of food laws — federal — state — local — inspectors and their 
 work — persons liable and acts forbidden — penalties — condemnations 
 and seizures ............ :;:"!T-.";."i4 
 
 References to laws ............ :;.">4 :'..">7 
 
 CHAPTEB VIII. 
 
 DAIRY PRODI I TS. 
 
 Cheese — imitation to be labeled — not 6© be colored — not to be made or 
 
 sold — branding cheese .......... 35fi 
 
 Butterine — federal legislation — state legislation — butterine to be labeled 
 
 — not to be colored — not to be made or sold — renovated butter . 361-367 
 Milk — state legislation — adulterated denned — milk standards — skim- 
 med milk — condensed milk — cream — penalties — licenses, conditions 
 
 for — enforcement of the laws by state and local inspectors — collectors 
 
 of samples — analysis — methods of inspection, sampling, records . 367-399 
 
 Clean milk — its importance — registration of producers — inspection of 
 herds and dairies, tagging animals, tuberculin test — licensing the pro- 
 ducer — regulations for the care of animals and milk — pasteurized milk . 399 422 
 
 References to laws ............ 422 124 
 
 CHAPTER IX. 
 
 COMMUNK AI'.I.K DISEASES. — LEGISLATION. 
 
 Local control by state agencies — statute legislation local legislation . 425 429 
 Reports of communicable diseases — persons required t" report, t" win. iii 
 reports are made, diseases reported — form of report— payment for 
 reports — false reports — reports to state boards penalty . . 129-442 
 
 Placards diseases placarded— form of placards 142-44" 
 
 Isolation — statute law — isolation of the patient — other members of the 
 family — children — wage-earners -household other families in the 
 house — duration of isolation in different diseases removal of cases 
 
 — infected goods ' '* 1 ' i:; 
 
 School attendance — persons excluded responsibility for exclusion 
 
 schools included in tin- rules -duration of exclusion permits 
 
 closure of schools ......••••• 163 170 
 
 Disposal of dead ho.lies reports by undertaker disinfection "f body, 
 of the room, of die undertaker, of i he coffin time of burial fun< 
 
 — burials — transportation responsibility for violation 
 References to laws 
 
 170 i" 
 
 17^- I- 
 
 CHAPTER X. 
 
 . (,\l \it \ |. \i:i.i; DISEASES. (fONTIXI ED.) VDMIXISTKAT1VI WORK. 
 
 Duties of medical inspector usuallj accepts physicians <liaiMio S is 
 sometimes investigates to give directions sanitary inspections t" 
 take cultures and vaccinate notices to scl Is, 'i' record 
 
 — Biibsequenl supervision guarding houses funeral inspectors 
 determination of end of isolation support of the | r during isolation, 181 »■'- 
 
 Epidemics extraordinary pov imples of management, smallpox, 
 
 yellow fever, typhoid fever, typhus fever, scarlel fever, ami dlphtl 
 
 — prepara! ions foi cholera ...... 
 
 Special Diseases tuberculosis leprosj renereal diseast 
 
viii CONTEXTS. 
 
 CHAPTER XI. 
 
 COMMUNICABLE DISEASES. — (CONTINUED.) — DISINFECTION, LABORATORY 
 
 WORK, VACCINATION, ANTITOXIN. 
 
 PA<i ES 
 
 Disinfection — required — by health department — sulphur — formaldehyde 
 
 — steam disinfection — washing surfaces and goods — details of muni- 
 cipal work — disinfection of vaults and yards ...... 527-556 
 
 Bacteriological laboratory — its purposes — for diagnosis of diphtheria, 
 
 tuberculosis, typhoid, malaria 556-572 
 
 Vaccination — legislation — of school children — control and distribution 
 
 of virus — public vaccination — methods employed .... 573-598 
 
 Antitoxin 598-601 
 
 CHAPTER XII. 
 
 I IOMMUNICABLE DISK ASKS. (CONCLUDED.) 
 
 Hospitals for communicable disease — authority to construct and main- 
 tain — for smallpox — for scarlet fever and diphtheria — for phthisis — 
 sites for hospitals — ambulances 602-630 
 
 Quarantine — maritime — inland ......... 630-664 
 
 CHAPTER XIII. 
 
 REFUSE DISPOSAL. 
 
 Garbage — definition and character — separation from other wastes — recep- 
 tacles anil their location — frequency of collection — hours for removal 
 
 — garbage wagons — methods of collection, by city employees, by con- 
 tract, by licensed scavengers — disposal, on land, in water, feeding to 
 animals, reduction, cremation ......... 665-727 
 
 Dry refuse — character — receptacles, their location — frequency of collec- 
 tion — hours for removal — ash wagons — municipal collection — dis- 
 posal .............. 727-738 
 
 Mixed refuse — receptacles — frequency of collection — refuse wagons — 
 
 municipal collection — disposal ........ 738-741 
 
 Night soil — licenses — apparatus — removal by private scavengers — price 
 of work — municipal removal — frequency of removal— permits —-dis- 
 posal, on land, as commercial fertilizer, into waters, cremation . . 742-757 
 
 Grease and bones — rags and bones — dead animals — other offensive sub- 
 stances 757-763 
 
 street cleaning ............. 764 
 
 CHAPTER XIV. 
 
 MISCELLANEOUS SANITARY WORK. 
 
 Diseases of animals; of legislation — execution of laws — tuberculosis — 
 
 glanders — rabies ........... 705-778 
 
 School hygiene — medical inspection — public baths — control of barbers — 
 gas fitting — lying-in hospitals — baby farms — prevention of blindness 
 
 — nursing bottles — excursions for sick children — protection of child- 
 ren — institutions for children — other institutions — laundry inspec- 
 tion — kerosene— urinals — sick poor — office library —advancement 
 
 of knowledge — finances — tenement houses — lodging houses . . 778-837 
 
 Appendices ............. 841-949 
 
CHAPTER I. 
 SANITARY ORGANIZATION. 
 
 PUBLIC sanitation is a development chiefly of the hnicr half of the 
 present century, but it is not entirely a novelty. Many of the 
 evils with which sanitation deals have long been recognized, and reme- 
 dies for them have been sought through legislation, and many of the 
 advantages which sanitation affords social life arc fully appreciated by 
 the more populous communities. As a rule the subjects with which 
 public sanitation deals have an increasing interest with compactness 
 of population and complexity of social relations. Wherever there 
 are large cities with a highly developed civilization there the aeed of 
 public action in this direction is most acutely felt. Hence we are not 
 surprised that many works which would be included in the discussion 
 of the subject we arc now considering, such as a system of sewerag 
 public water supply and municipal baths, were carried to a high degree 
 of perfection in the cities of ancient Greece and Italy, particularly in 
 the latter. 
 
 < )n the other hand public works of this kind are not needed and are 
 impossible in new communities. .Moreover such communities with a 
 sparse population do not need many police regulations to maintain 
 comfort and health, such as are required as population grows denser. 
 Vet even in new settlements some need is tell for public aid and pro- 
 tection along these lines. This was true of the growing colonies oi the 
 New World. While an organized health department in town or colons 
 
 was not at tirsi thoughl of, yel il was not long before legislation began 
 to recognize that the comfort and health of the people demanded atten- 
 tion, and the germs of our modem sanitarj law appeared. 
 
 The registration of vital statistics was very earl} provided for in the 
 colonics. 1 but though this is now considered the firsl step to be taken 
 in sanitary work and the basis f all I'm nre progress, it was not no con- 
 sidered at that time. The object of such records was legal rather than 
 scientific. The earliesl record thai the writer has met with of sanitary 
 activity, was the action of the selectmen of Boston 9 in 1(578 foil 
 
 1 Virginia, \<i 24 Feb., 1631 2, Hening's Statutes a( I 
 
 ' Boston Record Commissioners 1 Report, Vol. 7, p. 119, 8 Ma 
 
2 & 1 XI TAX Y Oil GANIZA TION. 
 
 shortly by similar action in Salem, 1 in attempting to restrict the spread 
 of smallpox. On the 25th of October, 2 1692, the General Court pro- 
 vided that the selectmen of Boston, Salem and Charlestown, and 
 other market towns of the province, should regulate slaughter houses 
 and similar establishments. In 1693 the Governor and Council quaran- 
 tined at Long Island, Boston Harbor, the fleet of Sir Francis Wheeler 
 which had arrived from Martinique sorely afflicted with what is sup- 
 posed to have been yellow fever. 3 In 1699 4 a law was enacted 
 providing for maritime quarantine, which however was disallowed in 
 privy council on the 2 2d of October of the same year. This act was 
 followed by Rhode Island 5 on the 27th of February, 1711. 
 
 In the sanitary legislation previous to the latter part of the eight- 
 eenth century, executive powers were usually conferred upon the town 
 governments and upon them fell the duty of enforcing sanitary law. 
 This was true of the Massachusetts statute of 1692. In other cases 
 state officers were to administer the law as in Rhode Island in 1711, 
 where justices of the peace were to maintain quarantine. It is only 
 since the establishment of independence that there has been any definite 
 organization of local government for sanitary purposes. 
 
 All police power in the system of government established in the 
 United States is vested in the legislative bodies of the various states. 
 The mechanism by which this power is exercised varies very greatly in 
 different states and at different times ; and even in a single state at one 
 and the same time the police power may be exercised in a variety of 
 ways. 
 
 So far as concerns sanitary affairs, and indeed in all affairs the police 
 powers of the state may be exercised in two general ways : First, the 
 state legislature may enact general laws and provide directly for their 
 enforcement by the appointment of officers in the pay and directly 
 under the control of the state. Or, second, the state may delegate both 
 legislative and executive powers to any local units of government which 
 may exist within the state. The former of these two methods is not 
 the one here under special discussion, though it will be necessary to 
 consider it at times, as spheres of sanitary activity which in one group 
 of states are entirely given over to the towns or counties, are in another 
 group reserved to the state. The details of legislation in regard to the 
 purity of food products, especially dairy products, and the purity of 
 
 1 Act of Salem Selectmen, 18 October, 1678. 
 
 2 Acts and Resolves of the Province of Massachusetts Bay, Vol. I., p. 59. 
 
 8 Acts and Resolves of the Province of Massachusetts Bay, Vol. VII., p. 384. 
 4 Acts and Resolves of the Province of Massachusetts Bay, Vol. I., p. 37*5. 
 8 Laws of the Colony of Rhode Island (1719), Reprint of 1895, p. 65. 
 
& 1 XI TA 11 Y Oli GA NIZ. 1 TION. 3 
 
 inland waters, in regard to the communicable diseases of animals, and 
 in regard to quarantine and the registration of vital statistics, are very 
 commonly reserved to the state. If not formally reserved, the state 
 acts so efficiently and so much better than the local units that" these 
 matters are neglected by the latter. Not only does the state thus 
 through its legislature direct certain sanitary affairs as above, but it 
 employs its executive powers in the same fields. As will be seen in 
 the discussion of these subjects, many states not only have elaborate 
 laws concerning the adulteration of food, and quarantine, but directly 
 control the administration of these laws through tie- agency of state 
 appointed boards or officers. Dairy commissioners, state boards of 
 cattle commissioners, state inspectors of food and state quarantine offi- 
 cers are not uncommon, and the state board of health frequently is 
 given executive control of any or all of these matters. 
 
 The state sanitary organization which is at present established in all 
 the states except Georgia, Idaho, Montana, Oregon and Wyoming, is 
 the embodiment of the interest of the state in sanitary affairs. It is 
 given more or less legislative and executive authority in such matters 
 as experience has shown, or as is hoped, can be best controlled in this 
 way; but take it all in all throughout the states, the state board of 
 health is considered chiefly as an advisory board. It is not to meddle 
 in local affairs any more than is necessary. In other words, the prin- 
 ciple of local self-government in sanitary as in other affairs is in the 
 main recognized and adhered to. 
 
 The most direct and complete control of local affairs by state sani- 
 tary organizations was seen in New Orleans previous to 1898. This 
 
 city was, so far as its sanitary affairs were C 'crned, governed entirely 
 
 and directly by the state board of health and its appointees. There 
 
 was, however, a special reason for this arrangement. The <'it\ oi New 
 
 ( Cleans iS much the largest City of the state, indeed of the W hole south. 
 
 It is the gateway of the Mississippi valley, ami an enormous commerce 
 passes through it. Epidemic disease ma\ find and has found entrance 
 here and devastated a score of states. The safety of the whole state 
 
 being so closely dependent u] the city, the state assumed control ot 
 
 the city so far as its sanitation was concerned. This would probabl) 
 not have been done in a northern state; it lias not been in Massachu- 
 setts, New York or Pennsylvania, for then great seaports, but in the 
 south where the importance of the state as compared with an) oi its 
 parts is so much greater than it is at the north, the proceeding was 
 an unnatural one. This complete control of local sanitary 
 
 the state is found not only in isolated instances life NYw < »: i HIS, but 
 is the settled |.olic\ n\rr the larger |>art of at least ll( state. In 
 
4 SA JSTITAR Y OR GAXIZA TION. 
 
 Florida the county boards of health have been abolished and the state 
 health officer appoints agents' and through them has full control of 
 maritime and domestic quarantine, and the state health officer has large 
 general powers in regard to the abatement of nuisances, and has special 
 executive powers " where two or more railroads meet." 
 
 The control of the state in local sanitary affairs is further seen in 
 those states in which the local sanitary board or officer is appointed by 
 the state. 
 
 In Connecticut the county health officers are appointed by the 
 judges of the superior court and must be attorneys at law. These 
 county health officers appoint the local health officer except in certain 
 municipal corporations. This centralizing of the executive power in 
 sanitary matters is a novel thing in New England, and it is also an 
 extremely novel procedure to vest the entire control of sanitary affairs 
 in the hands of the legal profession. It is not to be wondered at that 
 this system has not met with the approval of some of the best health 
 officers in the state. In Vermont the state board of health appoints 
 the health officer who is ex-qfficio a member of the local board of health 
 and he is also removable by the state board of health. In Indiana the 
 state board of health has not the power of appointment but may 
 remove members of county or municipal boards of health and also 
 health officers for specified cause. 
 
 In Delaware the county health officers, three in number, are ap- 
 pointed by the governor. 
 
 In West Virginia three of the live members of the county boards 
 are appointed by the state board of health, but only on the nomination 
 of the county court. 
 
 In North and South Dakota the state board appoints two of the 
 three members of the county boards. 
 
 In Kentucky the county board, consisting of three or more discreet 
 and intelligent citizens residing in the county, is appointed by the state 
 board of health. 
 
 In Mississippi the county health officers are appointed by the state 
 department of health. 
 
 In South Carolina it was formerly provided that the state board of 
 health should appoint local boards of health in districts where there 
 were none, and under this law the state board did appoint in towns 
 and occasionally in townships, boards consisting usually of one physician 
 and two citizens : but as these boards were often careless and derelict 
 and the state board had no authority to impose a penalty for neglect. 
 
 i Report of State Board of Health, Florida, 1894, p. 21. 
 
SA XH\ \RY OR G < 1 XTZ. 1 TION. 5 
 
 the legislature in 1895 enacted the present law compelling the munici- 
 palities to organize boards of health. 
 
 There are certain isolated instances of a state appointed sanitary 
 executive in municipalities as in Baton Rouge and Shreveport where 
 the governor appoints three of the five members of the local hoard of 
 health. In San Francisco previous to the charter of 1899 the board of 
 health consisted of the mayor of the city and four physicians in good 
 .standing, residing in the city and county of San Francisco, appointed 
 by the governor. So also the recently established hoard of health in 
 Detroit is appointed by the governor. 1 
 
 In several of the states 2 it is provided that when the local authority 
 whose duty it is to appoint a hoard of health fails to appoint, or when 
 the local hoard in any municipality or county fails to act, the state 
 hoard of health shall step in with full executive power. In New 
 Jersey, when a nuisance in one township affects the citizens of another, 
 the state hoard of health has executive powers. In .Minnesota the state 
 board of health may compel two or more townships to act together for 
 the prevention of communicable disease. In New- York the state board 
 may compel action of the local hoard in nuisance cases. 
 
 It is evidently not the intention in these states that the state shall 
 ordinarily exercise general executive functions in local affairs, hut it is 
 deemed so important that no portion of the state shall be without 
 sanitary protection, that the state hoard of health is given BUCh powers 
 in certain contingencies. Even in states like New York and Ohioi 
 where township or similar boards of health are obligatory, or in North 
 Carolina and Colorado, where county hoards are obligatory, the possi- 
 bility of failure to appoint or of failure to act after appointment is pro- 
 vided for. Perhaps the provisions of the New York statutes are as 
 explicit as any. 3 
 
 rn Alabama the state hoard of health, which is the state medical 
 society, is to control and fix the duties of the county hoards, which are 
 t he count \ medical societies. 
 
 1 Michigan, Chapter 10 of L895, Section 5. 
 
 > Arkansas, Delaware, Colorado, Maine. Missouri, New fork, North Carolina, 
 Ohio, Pennsylvania, and V Lrginia. 
 
 n. w Fork, General Laws (1896), Public Elealtb Law, Section 11: 
 
 "Many municipal corporation, authorized bj law to establish a local boat 
 health, shall omil to do so, the state board of health may, in such municipi 
 ezercist the powers of a local board of health and appoint :i health off! 
 and fix his duties and compensation. The compensation of Buch health • 
 theexpenses lawfullj Incurred bj him and bj the state board ol health in 
 municipality shall be a charge upon and paid bj such municipality until 
 as a local board of health shall be established therein, whereup 
 such health officer and of the state board of health conferred b 
 . ease. 11 
 
6 SANITARY ORGANIZATION. 
 
 In many cases, as will be considered later, the state reserves to its 
 state board of health executive powers in matters of quarantine and 
 control of communicable disease. The state board of health also in 
 some states does much executive work in regard to nuisances, the dis- 
 eases of animals, food supplies, the protection of water and ice. In 
 New York and Pennsylvania and some other states the state board 
 appoints its own inspectors, each of whom has his own district. In 
 Pennsylvania these inspectors perform the duties of health officers 
 where none have been appointed by the town, and may assist local 
 health officers where they have been appointed. 
 
 The local political division made use of in sanitary administration 
 varies in different parts of the Union according to the varying promi- 
 nence which such divisions have obtained in the progressive evolution 
 of local government from colonial times. In one state it is the town- 
 ship or city, in another the incorporated village or borough, and in others 
 still, the county or parish. 
 
 As a rule, considerable aggregations of a comparatively dense popu- 
 lation or what are known as cities, control in their capacity as cities, 
 their own sanitary affairs ; but there are exceptions even to this. 
 Reference has been made to the control of New Orleans by the state 
 board of health. Other examples are the former control of Pensacola 
 and Apalachicola, by the counties in which they are contained, and 
 the merging of the sanitary interests of Jersey City in the organization 
 of Hudson County. Not only do cities, as the term is ordinarily 
 understood, have as a rule an independent authority, but smaller aggre- 
 gations, even as small as five hundred persons or less, are often given 
 the same powers. In many states the larger number of the small but 
 more or less compact communities are incorporated either by general 
 laws or special acts under the name of cities, villages, boroughs or 
 " towns." Such incorporations within the townships are very common 
 in the middle, central, and western states. In general it may be said 
 that wherever municipal corporations are found, whether they have a 
 population of 500 or 500,000, they are usually authorized by the state 
 to establish a sanitary organization. 
 
 Outside of municipalities, sanitary organization, usually in the form 
 of boards of health, may be established either in townships or counties. 
 The real political unit in our system of government may be either the 
 township or the county. In New England the comity has always been 
 of little moment, while the powers and importance of the township are 
 very great. In the south, on the other hand, probably owing in part to 
 the sparseness of the population, the county became the important 
 political division. The middle states more nearly resemble the south in 
 
& 1 NIT A RY ORG A XI Z A TIO N. 7 
 
 this particular and the states west of the Alleghanies and north of the 
 Ohio more nearly resemble New England : but nowhere is the county 
 of so little importance as in New England. It would naturally be 
 assumed, therefore, that in New England and the west the township 
 would be made the sanitary unit, and in the middle states, the south, 
 and the far west, where New England influence is less felt, the county 
 would be the unit. This is, in the main. true. 
 
 The following states have county sanitary organization : Alabama, 
 California, Colorado, Connecticut, Delaware, Idaho, Indiana. Kentucky, 
 Kansas, Louisiana, Maryland, Mississippi, Montana. North Carolina, 
 North Dakota, South Dakota, Tennessee, Texas, Utah, Virginia, Wash- 
 ington, West Virginia and Wyoming. 
 
 In New Jersey there were formerly county boards of health, but 
 their place has been taken by the township and municipal boards 
 appointed under the law of March 31, 1887, the board for Hudson 
 County only remaining : but even in this county nearly all the com- 
 munities have their local boards, so that little opportunity is left to the 
 county board for usefulness, and its function is limited to the collectioE 
 of vital statistics. 
 
 In Florida there were until recently two county boards of health, 
 viz., in Escambia and Franklin Comities, containing respectively the 
 important ports of Pensacola and Apalachicola < >ther counties formerly 
 had boards of health, but they have all been abolished in order that the 
 state board of health might have entire charge of quarantine. In Cali- 
 fornia a county board of health is not required by statute in every 
 county, and in many counties there is none. In the other slates above 
 mentioned, the legislature has provided that a sanitary organization 
 shall be established in every county. 
 
 In Idaho and Montana the board of health consists of the board of 
 county commissioners and one physician appointed by them. 
 
 [n Colorado, Indiana, Kansas. Maryland, Tennessee, I tah, Wash- 
 ington and Wyoming certain county officers are made ex-officio boards 
 of health. 
 
 In Colorado. Indiana. Kansas, Maryland. Washington and Wyom 
 it is the countj commissioners that are the board of health ; in Tennes- 
 see the board of health of the county consists of the countj judg 
 chairman, clerk of county court, count} health officer or jail physician, 
 
 with the latter as president : in Utah it is the COUntj Comm 
 and the health officers of the sanitan «Ii>t ri<i >. 
 
 In Alabama, under the sanitarj organization which th< 
 the state medical society is the state board of health, and the county 
 medical societies in affiliation with the state medica 'he 
 
8 SANITAliY ORGANIZATION. 
 
 county boards of health. These county medical societies delegate their 
 health powers to their board of censors. Much the same plan is in 
 vogue in North Carolina where the county boards of health consist of 
 all the registered physicians in the county together with the mayor of 
 the county -town, the chairman of the county commissioners and the 
 city or county surveyor. 
 
 In Delaware, Kansas, Louisiana, North and South Dakota and West 
 Virginia the county board of health is an independent organization. In 
 Delaware it consists of three physicians called county health officers. In 
 West Virginia the county board of health consists of three persons, one 
 of whom shall be a physician and all of whom shall be nominated by 
 the county court and appointed by the state board of health, and these 
 three are to serve together with the president of the county court and 
 the prosecuting attorney of the county. In North and South Dakota 
 the state board of health appoints two persons, who, together with the 
 district attorney of the county, shall serve as the county board of health. 
 In Louisiana the police jury of each parish (county) appoints a board 
 of health consisting of one member from each ward (except municipal 
 wards). Three of the members are to be physicians. 
 
 In Mississippi the state department of health appoints a physician 
 as health officer in each supervisor's district, and these constitute the 
 county board of health. 
 
 In Virginia the county judge must, on recommendation of the 
 medical society, appoint a board of health to consist of three physicians, 
 nominated by the county medical society, the clerk of the court, and 
 the chairman of the board of supervisors. 
 
 In Connecticut and Texas the sanitary affairs are administered by a 
 county health officer and not by a board of health. In Texas this 
 official is called the county physician and is appointed by the county 
 judge. 
 
 The jurisdiction of the county sanitary organization may extend 
 over the whole county including any municipalities which it may con- 
 tain. In Alabama 1 the establishment of other sanitary authority within 
 the count v is forbidden. 
 
 1 Alabama Code (1896): 
 
 Sec. 2433. " No local board of health or executive medical body of any name or 
 kind for the exercise of public health functions, other than the county board of 
 health, must be established in any county, town or city "; but while the established 
 county board is the sole executive it depends largely for its initiative on the local 
 political authorities. 
 
 Sec. 2431. " The court of county commissioners, or the proper corporate authori- 
 ties of any city or town, may jointly or separately invest the county hoard of health 
 with such executive powers and duties as may be deemed necessary for the preser- 
 
& i xn\ i a i " on a a xrz. 1 tion. 9 
 
 In Connecticut the authority of the county health officer is very 
 great and his jurisdiction extends over the whole area of the county. 
 He appoints the local health officers except in those municipal corpora- 
 tions where a sanitary organization is already established, and further- 
 more has control of all the boards of health and health officers in his 
 county. The following sections from the statute explain these relati* >ns: ] 
 
 It shall be the duty of said county health officer to cause the execution of the laws 
 relating to public health, and the prevention and abatement of nuisances dangerous 
 to public health, and of the laws relating to the registration of vital statistics, and 
 to co-operate with and supervise the workings of the boards of health and health 
 officers within his county; and he shall have all the powers <>f a grand juror in each 
 of the several towns within his county, in matters concerning prosecutions for viola- 
 tions of the laws concerning contagious diseases and public health, nuisances inju- 
 rious to health or life, and violation of the by-laws or ordinances relating to public 
 health and contagions diseases, and for the prevention or removal of nuisances dan- 
 gerous to public health, adopted by any incorporated city or borough or any town, 
 and for violation of the laws relating to the registration of \ ital statistics. 
 
 Said county health officer may be removed at any time by any judge of the 
 
 Superior Court. Such county health officer, as s i after his qualification as may 
 
 be, shall by a writing under his hand appoint for each town some discreet person, 
 learned in medical and sanitary science, to be health officer for said town, except in 
 such towns containing incorporated cities or boroughs whose limits are co-terminous 
 with the limits of said town in which there exists under and by virtue of B charter a 
 board of health or health officer or committee. In each town, except in towns 
 having an incorporated city or borough within its limits, said town health officers 
 shall have and exercise all the powers and duties now l>\ law rested in and imposed 
 upon town boards of health ot health officers or committees; and in towns within 
 which there exists a city or borough the limits of which are not co-terminous with 
 the limits of such town and where by charter such city or borough is empowered to 
 appoint a health committee, health officer, or board of health, such town health 
 
 Officer shall exercise the powers and duties of his said office only in such part of said 
 town as is outside the limits of said <it\ or borough. 
 
 Iii Texas tin- stale and county health organization is established 
 
 entirely for the management id' c municable disease, and particular!) 
 
 for quarantine. The count) health officer is here direct!) under the 
 control <>f the state health officer, ami in nun controls tin- health officers 
 of municipalities. 
 
 It would appear thai in tin- Dakotas tlm count) board has jurisdic- 
 tion <>\ IT the W hole ciillllt V. 
 
 The more common plan, however, is lor the county board oi health 
 to have no jurisdiction in villages "i cities with established sanitar) 
 organization. The county board of health is a device confined chiefly 
 
 ration and promotion of the public health, and for the preve n ol the introduction 
 
 or spread of contagious or infectious diseases; such powers t< '•• 
 su. h duties i., he performed under such rules and regulal ona a lay 
 upon between such hoard and such court, as corporate a it! 01 
 
 ' Connecticut. Chapter 248 of L89 I, Si » 
 
1 SAJSTITAM Y OB GAXIZA TIOX. 
 
 to those states in which the population is sparse and in which there are 
 few large towns. It is in these states, too, that the township is least 
 developed. It would appear that the county board of health has proved 
 useful in administering affairs for a widely scattered rural population, 
 but that wherever compact villages and small cities are numerous, these 
 serve better as administrative units : but yet much depends upon the 
 traditional notions of the people in regard to political affairs. Thus in 
 some of the western states it would seem that the distribution of the 
 population would invite the development of the county ; but the influence 
 of the township idea was so great with the early settlers that it stamped 
 itself strongly on the political development of the state, and township 
 and village boards of health are found instead of county boards. Such 
 states are Iowa, Michigan, Minnesota, and Wisconsin. 
 
 In other cases even where count) 7 boards are established they have 
 no jurisdiction over incorporated villages or cities. Thus in West 
 Virginia, 1 " When any town, city or village has a board of health of its 
 own the jurisdiction of the local (county) board shall not extend 
 thereto." 
 
 In Kansas 2 the law provides that "The local boards of health 
 hereby created shall not supersede or in any way interfere with such 
 boards established by municipal regulations in any of the counties of 
 this state." 
 
 Colorado provides that the county board of health shall exercise its 
 powers only " in all parts and portions of each and every county not 
 represented by town or city organization." 
 
 Owing to the fact that the county in the south and west has been 
 developed at the expense of smaller political divisions, it has followed, 
 as has been shown, that the county board of health lias in the states of this 
 section been established to look after the sanitary interests of the people 
 outside of the incorporated municipalities ; but in New England and 
 the northern central states the county has not so much importance in 
 local affairs, for the township performs here many important functions, 
 and among them the supervision of the public health. 
 
 In the New England states and in Illinois, Iowa, Michigan, Minne- 
 sota, New Jersey, New York, Ohio, Pennsylvania and Wisconsin, the 
 township is made the unit of sanitary control. It is true that the town- 
 ship has a considerable importance in some other states, as Kansas, 
 Missouri, the Dakotas and Nebraska, but it is net so highly organized 
 as in the states first mentioned, and the sparseness of the population is 
 
 1 West Virginia, Code (1891), Chapter 150, Sec. 7. 
 
 2 Kansas, General Statutes (1897), Chapter 75, Sec. 11. 
 
& J XI TAB Y OR GA XI Z A TION. \ \ 
 
 not conducive to the formation of township hoards of health, and in 
 most of these western states public sanitation in any form does not 
 receive as much attention as it does in older and more thickly settled 
 communities. 
 
 In most of the states where the township system is in vogue, certain 
 town officials are made ex-offieio hoards of health. These states, together 
 with the officers invested with sanitary powers, are mentioned below. 1 
 It is provided in some of these states that the townships, although 
 authorized to organize an ex-officio hoard, nevertheless may establish a 
 special hoard or health officer and delegate to it or him their sanitary 
 functions. This is true in Massachusetts. New Hampshire, Rhode 
 Island, ami Wisconsin. In Massachusetts about half the townships, 
 including all of less than 3,000 inhabitants, have ex-officio boards of 
 health, hut most of the larger towns and cities have independent boards. 
 
 In Maine it is provided that in each town there must be established 
 a hoard of health of three members. 
 
 In New Hampshire the selectmen of the towns must appoint a board 
 of health. 
 
 In Connecticut, in 1893, the township hoard of health was abolished 
 and a health officer appointed in each town by the county health officer, 
 the town health officer to have all the powers of the old township 
 boards of health. 
 
 In Pennsylvania the act of April 11, 1899, provided that the school 
 directors of every township shall have certain powers for the control oi 
 communicable disease. The feeble development <>t' tin- township in 
 Pennsylvania has never rendered practicable the establishment <>t a 
 strong township sanitary organization. 
 
 As in most of the states which have established county boards <•! 
 health, this board has no jurisdiction over incorporated municipalities. 
 
 1 Illinois. Supervisors, assessor, ami township clerk. 
 
 [owa. Trustees. 
 
 Massachusel ts. Seled men. 
 
 Michigan. Township board, consisting oi the supervisor with two justices "f 
 tin- peace whose terms next expire and the township clerk. 
 
 Minnesota. Supervisors together with a physician when the supervisoi 
 sider it necessary. 
 
 \,w Jersey, rownship committee and assessor with a physician to 
 pointed by the commit tee. 
 
 New Fork. Town board with the addition of one ■ Ithsen appointed b) the 
 
 Ohio. Trustees. 
 
 Rhode Island. Toil n < louncil. 
 
 Vermont. Health officer who is appointed by the stat< boardol • 
 
 with the select men. 
 
 Washington. T<>\\ n board. 
 
 Wisconsin. T'.u n In, aid. 
 
12 SANITARY ORGANIZATION. 
 
 so in the states with the township system, it is not intended that the 
 township board of health should exercise jurisdiction over such corpo- 
 rations. The writer has not found this power in any state, and in 
 several it is expressly provided in the general laws that the townships 
 shall not have this power. Such provisions are found in Connecticut, 1 
 Illinois, New Jersey, New York, and Ohio. 
 
 One of the problems of sanitation is to secure an efficient execution 
 of the laws in rural districts. A good township system is of much 
 assistance in this, but the township needs to be pushed some by the 
 central authority. In most states this is done by moral agencies and 
 excellent results have flowed from such work by the state board of 
 health in Maine, Massachusetts, Michigan, Minnesota and other states. 
 In Connecticut and Vermont the state exercises greater control by ap- 
 pointing the local health officer. In Alabama a different plan is fol- 
 lowed. The county medical society divides up the county into " beats," 
 and these into districts, and sometimes sub districts, and appoints one 
 of its members resident therein a health officer for each district. 
 
 From this brief sketch it is seen that local sanitary administration is 
 provided for hy law over the entire area of thirty-six states including a 
 population of 52,304,922 in 1890, or eighty-three per cent of the total 
 population at the census of that year. Twenty of these states have 
 provided for a county form of sanitary government 2 and sixteen states 
 have a township form of sanitary government. 3 
 
 Then, too, in states where the provisions for local sanitary govern- 
 ment are not complete for the whole territory of the state, such govern- 
 ment may be established by special enactment or charter, and thus a 
 considerable portion of the population may be brought under sanitary 
 administration. Thus in Arkansas, California, Missouri, and Nebraska, 
 the general laws for the incorporation of municipalities provide for the 
 exercise of sanitary functions by the different classes of cities. Thus 
 it appears that a large proportion of the population of the country is 
 nominally under some sort of local sanitary control, either by the 
 county, township or municipality. 
 
 In states where the people have been most thoroughly drilled in the 
 practice of local government, there the local sanitary organization is the 
 
 1 See Connecticut law, p. 9. 
 
 2 Alabama, Colorado, Delaware, Idaho, Indiana, Kansas, Kentucky, Louisiana, 
 Maryland, Mississippi, Montana, North Carolina, North Dakota, South Dakota, 
 Tennessee, Texas, Utah, Washington, Virginia, West Virginia, and Wyoming. 
 
 3 Connecticut, Illinois, Iowa, Maine, Massachusetts, Michigan, Minnesota, New 
 Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, 
 Washington, and Wisconsin. 
 
SANITu I n Y OJR dAXIZ. I TION. 13 
 
 best, so that as a rule the township states are better provided for than 
 those states in which the township system is not well developed. If a 
 township state has a well organized and energetic state board of health, 
 the chance is still better for the general organization of efficient local 
 boards of health. In Minnesota in 1898 all of the thirty-eight cities, 
 and all but twenty-two of the 358 villages and boroughs had a board 
 of health. While a scheme of sanitary administration is nominally pro- 
 vided for the larger portion of our population, it must In- admitted that 
 it is not as a rule very efficient in really rural communities. Little 
 attention is paid to sanitation in the country, and it is almost entirely 
 in compact villages, towns and cities, that successful administration is 
 found. It is with such communities that this wort is chiefly con- 
 cerned. 
 
 In New England the dual conception of the township as both a 
 political and corporate unit, has prevented the development of the true 
 municipality. In New England townships have often attained a popu- 
 lation of 25,000 or 30,000 before changing their democracy for a repre- 
 sentative form of government and taking on the habiliments of a city: 
 and in Connecticut, even with the incorporation of its largest cities, the 
 township system was still retained, the town and city governments ex- 
 isting at one and the same time over the same area. The evils of town- 
 ship government in populous communities have been partly overcome 
 by the limited establishment of tire, school, or taxing districts ; bul the 
 incorporated village and the small city are not common in New Eng- 
 land. Outside of this region the advantages of establishing separate 
 and corporate government for small aggregations of population have 
 Long been recognized, and laws for their incorporation are found on the 
 statute hooks of most states. According to the census of 1890 the 
 urban population of the United States was estimated as about 20,000,- 
 
 000. As a huge pari of this population is living under a pretty well 
 developed sanitary organization, the importance of this pari of our sub- 
 ject is apparent. 
 
 The organization of municipalities may he under special charte 
 general laws. In New England, the cities are usually organized under 
 
 a special charter for each city: and this LS true of man\ of the larger 
 
 cities in other parts of the country : bul niosl of the smaller cities and 
 boroughs, and the villages, are incorporated under general laws. We 
 may look lor the authority for their sanitarj organization in their char- 
 ters or genera] incorporation laws, or in special laws ha their 
 objeel the preservation of the public health. 
 
 Tli.' following is a brief summary ofgeneral legislation in 
 leiviit states in regard to municipal sanitary organization : 
 
14 SANITARY ORGANIZATION. 
 
 Arkansas has two classes of cities and incorporated towns. The 
 city councils in cities of the first and second classes have power to es- 
 tablish boards of health. 
 
 California. " The board of trustees, council or other corresponding- 
 board "... shall " eatablish by ordinance a board of health to 
 consist of five persons, one of whom at least shall be a practising 
 physician . . . or if practicable, a civil engineer." 
 
 Colorado. The mayor and council or trustees, except when it is 
 otherwise provided by charter, are ez-officio boards of health. 
 
 Connecticut. " Where it is not otherwise provided by charter, the 
 mayor of such city, or the warden of such borough, shall nominate some 
 discreet person, learned in medical sanitary science, to be health officer 
 for such city or borough, which nomination will be confirmed or rejected 
 by the common council of such city or the burgesses of such borough 
 within thirty days thereafter." In case of failure on the part of the 
 mayor or warden, the county health officer appoints the local health 
 officer in cities and boroughs. As a matter of fact, of the eighteen 
 cities and twenty boroughs about one-third have health officers appointed 
 by the county health officer. 
 
 Delaware. The common council of every city must appoint annu- 
 ally a board of health of not less than three nor more than seven 
 persons, one of whom must be a physician and one the port physician 
 if there be one. 
 
 Illinois. Cities have power " to appoint a board of health and 
 prescribe its duties and powers." 
 
 Indiana. In Indiana in all three classes of cities the mayor nomi- 
 nates, with the confirmation of the council, three commissioners of 
 health and charities. In unclassified cities the mayor and common 
 council, and in towns the trustees, are ex-offieio boards of health. 
 
 Iowa. The mayor and aldermen of cities and the mayor and council 
 of villages or towns are ez-officio boards of health. 
 
 Kentucky. The cities of the state are divided into six classes and 
 incorporated under general laws. Cities of 10,000 and over are to 
 appoint a board of health consisting of the mayor and six others. In 
 all other cities the boards of trustees or the council must appoint a 
 board of health of three persons not members of the appointing board. 
 
 Louisiana. The council of all municipalities is to appoint a board 
 of health of five members. 
 
 Maine. It is provided that "There shall be a local board of health 
 in each city and town in this state, to be composed of three members, 
 anything in the charter of such city notwithstanding." 
 
SANITu IBY OB GAJSTIZ. 1 TION. \ .5 
 
 Massachusetts. Chapter 332 of the Acts of 1895 provides for a 
 board of three in all cities except those where there is some other 
 charter provision. 
 
 Michigan. The mayor and aldermen of cities and the president and 
 council or trustees of each village which has no charter provisions to 
 the contrary, are ex-officio boards of health, but when they deem it 
 necessary, the council of a city or village may establish a hoard of 
 health. 
 
 Minnesota. The Statutes (1894), Sec. 7048, provide "that all 
 villages, boroughs, and cities shall have a board of health to he chosen 
 and to consist of the number hereinafter provided, anything in the 
 charter of such village or borough notwithstanding." The hoard is to 
 consist of not less than three, one of wiiom is to Ik- a physician to be 
 elected by the council or corresponding body. 
 
 Mississippi. "A city, town or village may pass sanitary laws. 
 establish a board of health, and enforce the collection of births, health 
 and mortuary statistics." 
 
 Missouri. Municipalities are divided into four classes of cities and 
 villages. In cities of the first class, of over 1 00,000. the hoard of health 
 consists of the mayor, the presiding officer of the council, a commis- 
 sioner of police, and two regular practising physicians. The health 
 commissioner, appointed by the mayor and council. is also a member 
 of the hoard. 
 
 Nebraska. Boards of health in municipalities are organized under a 
 general grant of authority to Legislate for the preservation of the public 
 health. 
 
 North Carolina. In North Carolina municipal boards of health are 
 organized under the following : " The authorities of au\ «it\ or town 
 are hereby authorized, not already authorized in its charter, to make 
 such regulations, paj such fees and salaries and Impose such penalties 
 as iii their judgment max he necessarj for the protection and the 
 
 advancement of the public health." 
 
 North Dakota. Cities are to have a board of health to cone 
 four aldermen appointed by the mayor, the health office] wl 
 appointed by the mayor, and the cit\ engineer. 
 
 Ohio. There are in Ohio general incorporation laws forthe munici- 
 palities of the state as required 1>,\ the constitution, bul the classification 
 
 LS such that what are practically charters have been enacted tor the 
 
 more important cities. There are ostensiblj ten classes of citi< 
 villages. Except in the largest cities there must for all incorpoi 
 places lie a board of health consisting of si\ members app • 
 
 council with the mayor in addition as a seventh mm- jim 
 
1 6 X ANITA R Y OB GAXIZA TIOJST. 
 
 Pennsylvania. The organization of cities and boroughs is provided 
 for by the general laws of Pennsylvania and the cities are divided into 
 six classes. In cities of the first class — Philadelphia — the board of 
 health is a bureau in the department of public safety. By a recent act 
 it consists of three members. 
 
 In cities of the second class — Allegheny and Pittsburgh — the 
 health department is also a bureau in the department of public 
 safety. The superintendent of the bureau and the other employees are 
 appointed by the director of public safety. 
 
 In cities of the third class the board of health consists of the mayor 
 and four other persons, or a separate board of health may be appointed 
 as in boroughs. 
 
 In cities of the fourth, fifth and sixth classes, and in boroughs, the 
 board of health consists of five, of whom not less than two in cities and 
 one in boroughs shall be physicians, to be appointed by the mayor or 
 buro-ess with the consent of the council. 
 
 Rhode Island. The board of aldermen (equivalent in the statute to 
 town council) is ex-officio board of health in cities. 
 
 South Carolina. Every city or village shall have a board of health 
 of five persons not members of the council, except that in cities the 
 number may be increased to twenty as the city council may determine. 
 The board of health was formerly elected by the freeholders, but by 
 chapter 285 of 1897 it was changed to appointment by mayor or 
 intendant. 
 
 Texas. The court of county commissioners may appoint a board of 
 health for towns and villages which shall be under the direction of the 
 state health officer. 
 
 Tennessee. Cities of over 5,000 inhabitants must have a board of 
 health. 
 
 Utah. Cities must create a board of health and prescribe the 
 powers and duties of the same. 
 
 Vermont. The health officer, together with "the trustees or bailiff 
 of villages and the aldermen of cities," constitutes the board of health. 
 
 Virginia. Each municipality must, if required by the medical 
 society, have a board of health to consist of three physicians appointed 
 by the corporation judge, but nominated by the local medical society, 
 together with the clerk of the municipal court and the mayor. 
 
 Washington. The common council of cities shall be ex-offieio board 
 of health, or shall appoint wholly or partially from its members a 
 suitable number of persons as a board of health. 
 
 Wisconsin. All the cities of over 2,000 inhabitants are divided 
 into four classes and in these the mayor is to appoint a commissioner of 
 
SANITARY ORGANIZATION. \~ 
 
 health who holds his office for two years, but only a few cities are or- 
 ganized under the provisions of this general law, and most cities have 
 either special charters providing for a sanitary organization or else have 
 established hoards of health under Sec. 1411, Annotated Statutes 
 (1898). This provides that the town board, village hoard or , sommon 
 council of every city shall within thirty days after each annual election 
 organize as a hoard of health, or shall appoint wholly or partially from 
 its own members a suitable number of competent persons who shall or- 
 ganize as a hoard of health. 
 
 In Wyoming the city council of cities and the trustees of towns are 
 ea>-officio boards of health, and each board of health must appoint a 
 health officer. 
 
 Sanitary organization in most of the villages and cities of the 
 country is thus provided for by general laws, and this practice of incor- 
 poration by general legislation has in some states been extended to all 
 the cities even the most populous. Nevertheless the principle of class- 
 ification is such in these laws that of the largest cities each stands alone 
 in its class, and practically receives a special charter. This is true of 
 Cincinnati, Cleveland, and indeed the larger Ohio cities generally, 
 Philadelphia, Indianapolis, Louisville, [Milwaukee, Omaha, St. Louis, 
 and several others. Besides these the following important cities de- 
 pend upon special charters for their sanitan organization: Atlanta. 
 Baltimore, Boston, Brooklyn, Buffalo, Charleston, Chicago, Denver. 
 Detroit, Hartford, .Milwaukee. .Minneapolis. New Haven, New York, 
 Providence, Richmond, St. Paid, San Francisco. In Massachusetts and 
 Rhode Island, though the cities generally have special charters, their 
 sanitary affairs are in most cases governed by general laws. 
 
 There has been much charter making of late and man\ charters of 
 important cities are of \er\ recent date. The tendency of these char- 
 ters is towards making the (hatter a framework onl\ of government, 
 and of Leaving the details to he Idled in by general legislation. The 
 appointmenl and tenure of office of officials, and the relation of depart- 
 ments, the organization of the legislative branch, and the separation o\ 
 Legislative and executive functions are the matters generall} considered. 
 Hence in the Cleveland, Philadelphia and San Francisco charters the 
 powers and duties of the board of health are nol referred to, the} lia 
 been provided for by special enactments or general laws. Notwith- 
 standing this teiideiiiw towards general legislation for tl rganization 
 
 of cities, ami the limitations of the scope of such legislation to funda- 
 mentals, it is nevertheless true that some of the recenl - 
 Lation for cities has been both special and specific; see Chapt< 
 special laws of Minnesota, I s - - 1 . for sanitary ■ 
 
18 & I -W 7'. IB Y OR G. 1 XTZ. I ZmM 
 
 neapolis : and Chapter 10 of 1895 of Michigan for Detroit, and Chap- 
 ter 105 of 1891 of New York for Buffalo. The charter of the City 
 of New York, Chapter 378 of 1807, contains much specific sanitary 
 legislation, but it is mostly adopted from the consolidation act of 
 
 1882. 
 
 While it is generally so arranged by statute that the jurisdiction of 
 county, township and municipal health departments shall not overlap, 
 it is not always so. The authority of count}' over local boards in West 
 Virginia and elsewhere has previously been alluded to. Reverse con- 
 ditions sometimes prevail. In the East it would be rare for a munici- 
 pality to exercise any authority outside of its own corporate limits ; Inn 
 in other sections of the country it is by no means uncommon. In 
 Illinois, cities may legislate concerning offensive trades and similar 
 nuisances for one mile beyond the limits of the city. Chicago by a former 
 city charter was permitted to enforce quarantine regulations to a dis- 
 tance of fifteen miles beyond the city bounds. Indiana cities have 
 jurisdiction for four miles in regard to offensive trades and ten miles in 
 regard to river pollution. Cities in Arkansas have jurisdiction of five 
 miles for quarantine, and in Nebraska, three miles: in Texas and Utah. 
 ten miles. Baltimore has quarantine powers for three miles outside the 
 city limits on land and fifteen miles on water. 
 
 County, township and municipal boards of health are merely different 
 forms of local sanitary organization which have been developed by the 
 varying history of the different sections of our country, or have been 
 necessitated by varying densities of population. In their nature they 
 are all the same, and therefore in considering their powers and duties 
 provided for by statute law, they may all be considered together. The 
 organization of boards of health may be provided for, and their duties 
 and powers prescribed in various ways. In the first place the legislature 
 of the state may provide by special enactment for a sanitary organiza- 
 tion in any particular city, county or other political unit. Second, the 
 state may provide for the establishment of boards of health in any group 
 of localities by means of general laws ; and lastly, the powers of the 
 local sanitary authority may be greatly affected incidentally by laws 
 enacted for specific purposes, but which recognize and make use of an 
 already established organization. Each of these three methods will be 
 separately considered. 
 
 I. Special Legislation for Sanitary Organization. 
 
 Local sanitary authority may be established by a law specifically en- 
 acted for that purpose, or second it may be established by special muni- 
 cipal charter. Special legislation is of course more apt to be found in 
 
SANITARY ORGANIZATION. [9 
 
 thr.se states in which the method of dealing with municipalities is chiefly 
 by means of special legislation, and where there are no general pro- 
 visions for municipal incorporation, but it may be found anywhere, ii 
 was more common in the past than at present for two reasons; first. 
 because the method of dealing with these matters by genera] Legislation 
 is recognized more and more as the better way, and second, because in 
 former years when public sanitation was somewhat novel, it was only 
 exceptional circumstances which could lead a community to see the 
 necessity for any sanitary organization at all. An epidemic, either 
 actual or potential, has been in the past, and is even now. the most com- 
 mon cause for special legislative action in the direction indicated. The 
 presence of yellow fever in Boston in 17 s '.' 1 was the cause of the 
 establishment of the hoard of health in the following year. The hoard 
 of health in Philadelphia in 17l»4 was the result of smallpox in 1793. 9 
 The health department in Providence was organized in 1856 as a 
 result of the cholera epidemic in the preceding year, and the Chicago 
 board of health was established in 1867 in consequence of the interest in 
 sanitary affairs created by cholera in 1866. 3 Yellow fever in Memphis 
 not only resulted in the formation of a well organized health department, 
 hut caused the revocation of the city charter and a reorganization of 
 the city government. The reorganization of the Detroit health depart- 
 ment in 1895 was due to an extensive outbreak of scarlet fever and 
 diphtheria. 
 
 //. General Sanitary Legislation for Sanitary Organization. 
 
 Jn the early history of public sanitation in this couiitrx most of the 
 Legislation would naturally he of a special and local character, called 
 
 for by special events, and fitted for certain localities, usually the more 
 
 populous centres. General laws for the establishment of local sanitary 
 
 authority onl\ came with the development of popular interest in sani- 
 tary affairs. The growth of public sentiment in this direction has been 
 
 greatly favored by the establishment "i -tate boards of health. These 
 boards have done much to produce a demand for local saniiarv organiz- 
 ation and to shape the laws to eflecl it. At the present time, much the 
 
 larger pari of our population is under general saniiarv legislation ; and* 
 this is true of even the largest cities, for the tendencj towards uniform 
 methods of municipal incorporation is yearly wiping out old cha 
 
 and special acts I making general laws of incorporation in their 
 
 place. 
 
 1 Report of the Sanitary Commission of Massachusetts, 1850, p 
 - Philadelphia, Reporl <»f the Board oi Health, 1895, p. • 
 "Chicago, Reporl ol the Board of Health L867 9, it- IW 121. 
 
2( ) SAJSTIT. I R Y OB GA XIZ. i TION. 
 
 It has been shown that twenty-three states have general laws for 
 the organization of county boards of health. In all but California still 
 greater uniformity is secured by making such organization obligatory. 
 County organization is almost invariably under general laws. Some of 
 the few exceptions have been noticed as San Francisco County in Cali- 
 fornia, Escambia and Franklin Counties in Florida, Jackson County in 
 Mississippi, and Hudson Comity in New Jersey. 
 
 For township boards of health also it will be found that general 
 legislation prevails. The number of townships in most of the states is 
 very large, and the importance of the individual township is not very 
 great: moreover the similar character of many townships lends itself 
 to general legislation. Hence in nearly every state in which the town- 
 ship system is at all well established, general laws are found providing 
 for township boards of health. There are such laws in fifteen states, 
 and in all they are mandatory. 
 
 Besides county or township boards of health, thirty-one states pro- 
 vide general laws for the municipal health organization in cities, towns, 
 boroughs or villages. 
 
 III. Greneral Legislation which Incidentally Confers Sanitary Powers. 
 
 While both general and special legislation establishing local sani- 
 tary authority define to a greater or less extent the powers and duties 
 of such authority, it often happens that much of this power is derived 
 from other laws having specific objects in view, and which simply make 
 use of the existing sanitary organization or perhaps other departments 
 or officers, for executive purposes. Thus quarantine laws have from 
 time to time since 1699 been enacted by the different maritime colonies 
 and states. Such laws usually impose duties upon and grant powers 
 to the local officials of seaport towns and cities, or in many cases im- 
 pose these duties on state officers. Laws for the prevention of com- 
 municable disease, for the abatement of nuisances, for the prevention 
 of the adulteration of foods, and for many similar purposes, usually 
 rely tor their execution upon the local government. When the local 
 government has an established board of health or other sanitary organ- 
 ization, it is usually upon such that the duty of enforcing the law is 
 placed. It is from such laws that much of the power of the board of 
 health is derived. 
 
 Laws for establishing boards of health provide for their organization, 
 their membership, election, terms of office, the appointment of sub- 
 ordinates and the like, all of which matters will be duly considered. 
 Sometimes the statute does little more than this, scarcely giving any 
 power or defining any duties. Thus for the county boards of health 
 
SANITARY ORGANIZATION. •_> j 
 
 established in Kansas the only duties prescribed by the statute are by 
 implication, that the health officer appointed by the county board of 
 
 health shall transmit to and fr.uu the the state board of health forms 
 for the registration of vital statistics. But generally the law providing 
 for a health organization defines its powers more or less explicitly. 
 though many additional powers and duties may be provided for in- 
 cidently in other statutes or by special Legislation. 
 
 The powers which may he conferred upon a board of health an- very 
 great. They belong to the general police powers of the state, hut it is 
 not the purpose here to discuss their nature or extent. It is rather the 
 purpose to consider what are the powers and duties with which the 
 various state legislatures have invested the local sanitary organization 
 within their jurisdiction, as well as the nature of the organization, and 
 the channels through which the power is conferred. Most sanitary 
 organizations perform functions which belong in a certain sense to the 
 three greal spheres of governmental activity, the executive, Legislative, 
 and judicial. Primarily the board of health is to see to the enforce- 
 ment of law. Its chief function is executive, hut it happens that the 
 subjects with which it deals require such technical knowledge, and the 
 conditions vary so rapidly with the advance of science, that it is often 
 deemed wise that boards of health should he empowered to make rules 
 in regard to certain matters, such as quarantine and the management of 
 contagious disease, such rules to have the force of law. Then again, 
 the local saintary authority frequently exercises semi-judicial powers 
 as when it determines the fact of a nuisance, or the offensiveness 
 of a trade. Our purpose now is to consider the laws h\ which 
 these greal and varied powers are conferred. Sometimes the powers 
 and duties are provided for in the mosl general \\a\ and again tiny arc 
 enumerated with the greatesl detail and exactness. 
 
 The following are instances where the law is expressed in verj gen- 
 eral terms. In Providence the citj council may make ordinances ** in 
 
 d to health and the prevention and abatement of nuisances.*' Iii 
 North Carolina cities and towns may " make such regulations, |>;i\ such 
 
 fees and salaries and impose such penalties as in their judgment ma> 
 be necessarj for the protection and the advancement of the public 
 
 health." The health depart n hi 1 1 of Ball imore is organized chielh under 
 
 the charier which gives the mayor and council power " to pass ordi- 
 nances to preserve the health of the city." In Massachusetts' the 
 hoard of health of a town -shall make such regulations as il judges 
 iiecessan for the public health and safety, respecting nuin 
 
 of tilth, and causes of sickness." 
 
 Massachusetts Public si itutes, 1882, Chaptei 80 Sec. 18. 
 
22 SANITARY ORGANIZATION. 
 
 Legislatures in providing for local government, seem to have taken 
 very different views of the safest and surest form in which their acts 
 should appear. ( >ccasionally, as in the instances above cited, the acts 
 are brief and the provisions very broad in their grant of powers. That 
 such simple acts and general provisions are sufficient to meet all emer- 
 gencies is probable. See Boehm v. Baltimore 61 Md. 259. Other 
 decisions of the courts would appear to uphold this view: but generally 
 state law makers are not content with simple laws of broad scope, but 
 attempt to specify in detail each of the powers which local govern- 
 ments may exercise, and to map out for them as closely as possible their 
 functions, and prescribe with exactness the manner in which they shall 
 be exercised. In providing for the department of health, the legislature 
 generally adds to a general grant of power, prescriptions as to the form 
 of organization, and enumerates at lesser or greater length the various 
 powers which are conferred and the duties imposed. Thus acts of every 
 variety of extent and complexity of detail are found varying from a 
 few lines to many pages. These different ways of regarding the form 
 of legislation do not seem to depend much upon either time or place. 
 Some of the most general provisions were among the earliest, as the act 
 for establishing boards of health in Massachusetts in 1797 and the 
 charters of Providence and Baltimore which were among the earliest to 
 provide for the regulation of sanitary affairs ; but recently the same 
 broad legislation is seen in Kansas, Kentucky, North Carolina, and 
 several western states. On the other hand, recent acts for the organ- 
 ization of cities of the first class in Indiana occupy about two pages in 
 the bare enumeration of powers concerning sanitary affairs. The same 
 detail is seen in the charter of Buffalo 1891, in the act of 1895 estab- 
 lishing a bureau of health in Pennsylvania cities of the second class, 
 and the act of 1895 establishing a board of health in Detroit is one 
 of the best examples of the control of the legislature over the details 
 of local sanitary affairs. This act covers nearly fourteen pages. It 
 can however scarcely be said that there is an increasing tendency of 
 late years for the legislature to legislate more in detail in regard to 
 sanitary affairs, and when this is done it is doubtless due to an increased 
 interest in sanitary matters. Probably the tendency of legislation in 
 regard to local affairs may be said to be the other way. Special charters 
 and general incorporation laws of late are apt to provide merely for the 
 form of the sanitary organization, and leave its powers and duties to 
 general state legislation appertaining to these matters. The present 
 charters of Philadelphia, Cleveland and San Francisco may be cited as 
 examples of this tendency. 
 
& J XI T. 1 R Y OR a. 1 XI Z. I TION. 23 
 
 /. Form of the Local Sanitary Organization. 
 
 1. Ex-officio Boards and Officers. The legislature very frequently 
 
 makes use of already existing officers to administer sanitary laws: how 
 frequently is shown by a glance at the state legislation that has been 
 
 tlms far summarized. Colorado. Idaho. Indiana, Kansas. Maryland, 
 .Montana. Tennessee Washington and Wyoming have ex-officio county 
 hoards of health, with the addition in Kansas. Idaho, and Montana of 
 one or more physicians. Illinois, Iowa. Massachusetts, Michigan, Min- 
 nesota. New Jersey, Xew York. Ohio. Pennsylvania, Rhode Island. Ver- 
 mont and Wisconsin have ex-officio township boards pf health. New York 
 and Xew -Jersey having one citizen in addition. In Colorado, Iowa, 
 Louisiana. Michigan, Nebraska, Rhode Island, and Vermont, general 
 laws provide that the cities shall have ex-officio hoards of health. More- 
 over, many of the Ohio cities have ex-officio hoards: thus in Cincinnati 
 the board of administration is the hoard of health. In New York the 
 mayor of cities is a member of the board of health unless otherwise 
 provided, and the same is true in many cities with special charters. 
 There are other instances also where special charters provide tor the 
 membership of certain officials on the hoard of health. Below are 
 mentioned sonic of the officials who are found on hoards of health. 1 
 
 1 Asheville. W ( . .Mayor. City Engineer, and Chairman of Committee on Finance. 
 
 Atlanta. Mayor and Chairman of Sanitary Committee of Council. 
 
 Buffalo. Mayer and President of Hoard of Puhlic Works. 
 
 Grand Rapids. Mayor and President of Council. 
 
 Jersey City. Hoard of Police Commissioners (three in number)., the Health 
 Inspector and one City Physician appointed by President of Board of Police Com- 
 missioners. 
 
 Kansas City, city Physician, Chief of Police and Chief of Fire Department 
 
 Knoxville, Mayor and Chairman of Board of Public Works. 
 
 Macon. Mayor. Chairman of Cemeterj Committee of Council and Clerk of 
 ( oiincil. 
 
 Memphis. Mayor, Chief of Police. 
 
 Nashville. Chairman of Board of Public Works. 
 
 N.w York. Health Officer of Pori and President Board of Police. 
 
 North Dakota Cities. Four aldermen appointed by the Mayor/the City Engineer, 
 and the health officer who is appointed by ill" mayor. 
 
 Omaha. Mayor, Chief of Police, Chairman of Commit! n Sewers, ( hairman 
 
 of Committet Streets and Uleys, and inspector of Plumbing. 
 
 Portland, Ore. Mayor. Chairman of Committee on Health and Poli 
 moil Council, Chief of Police, <it.\ Physician, and the Health Commissioi 
 
 Philadelphia. Mayor and the Director of Public Safety. 
 
 Raleigh. Mayor, two Lldermen, Chief of Police, Cit) Utornej and 
 
 Rochester and Somersworth, N. H. City Physician, Ovei 
 Sanitarj « Officer. 
 
 Rockville, 111. Commissioner of Health, Mayor and Chief of Pol 
 
 St. Paul. Chief of Police, Citj Solicitor and Commissioner oi Health. 
 
24 & J -V/ 7'. IB Y OB G. 1 WIZA TION. 
 
 Thus it appears that the majority of the county and township hoards 
 including those in the most populous states and with the best sanitary 
 organization, have ex-ojjicio hoards of health. Moreover, many of the 
 municipalities have similar hoards, and in some states this includes all 
 the cities except those provided for by special statute. 
 
 In other states, county, town or city authority may exercise certain 
 powers in sanitary affairs, as county supervisors and justices of the peace 
 in Virginia. 
 
 2. Independent Sanitary ( hganizations. In Alabama, California, 
 Connecticut, Delaware, Florida, Kentucky, Louisiana, Mississippi, North 
 Carolina, North Dakota, South Dakota, Texas and West Virginia, pro- 
 visions are made for an independent county hoard of health or health 
 officer, but in Alabama and North Carolina it consists of members of 
 the medical society or the physician of the county, and in North Dakota 
 the district attorney is added. Among the township states, Maine and 
 New Hampshire have independent hoards of health, and Connecticut, 
 a health officer; but it is in cities that the administration of sanitary 
 affairs is most commonly provided for by a separate department. 
 Arkansas, Louisiana, .Maine Massachusetts, New York, New Jersey, 
 Pennsylvania in cities of the third class, Delaware, North Carolina. 
 Ohio (in the smaller cities), South Carolina, Utah, Mississippi, Ken- 
 tucky, Tennessee, Indiana, Illinois, Wisconsin, Minnesota, and Cali- 
 fornia provide for the establishment of independent municipal boards 
 of health, and in Rhode Island and Washington, they are permitted; 
 and, as has been said, special municipal legislation usually provides for 
 an independent rathe!' than an ex-officio hoard. In some cities, how- 
 ever, while there are special sanitary officers, they are made a division of, 
 or are under the control of, some other department. This is true of some 
 of the larger cities as provided for by recent charters. .In Philadelphia, 
 Pittsburgh, Louisville, Baltimore, Allegheny and New York cities of 
 the second class, the health department is a bureau of the department 
 of public safety; in the first there is a hoard of health of three members 1 
 and in Allegheny and Pittsburgh the bureau consists simply of a 
 superintendent and other officers appointed by the director. In Balti- 
 
 St. Louis. Mayor, President of Council and Police Commissioner appointed by 
 Mayor. 
 
 San Francisco. Chief of Police and Board of Public Works. 
 
 Santa Barbara, Cal. Mayor and City Engineer. 
 
 Savannah. The Board of Sanitary Commissioners consists of the Mayor and 
 Health Officer, and live others who may be members of the council. 
 
 Wilmington, Del. Port Physician and Chief Engineer of Surveying Department 
 1 Inl899an attempt was made to abolish the board of health, and appoint a 
 single health officer, but the act was defective. 
 
SANITARY ORGANIZATION. 25 
 
 more the commissioner of health is appointed by the mayor but acts 
 under the department of public safety. In Cleveland and Toledo tin- 
 department of police has charge of all matters relating to the public 
 health. The department of police is in charge of a director appointed 
 by the mayor in whom are vested all the duties and powers of the former 
 board of health. In certain cases, particularly among the larger cities 
 another form of sanitary organization has been developed. In these cities 
 the health department is a single-headed department. The tendency of 
 city government at the present time is towards single-headed depart- 
 ments, hut this plan has been extended to the health department perhaps 
 less than to any other. It is probably because in this department are 
 usually lodged great legislative as well as executive powers and it is not 
 in accord with American notions to give much legislative power to one 
 man: and. indeed, it usually happens that when a health commissioner 
 is appointed, his power in this direction is limited or denied entirely, 
 being reserved to the proper legislative branch of the city government. 
 Among the eities with a single-headed department are Baltimore, Chi- 
 cago, Colorado Springs, Denver, the District of Columbia, Milwaukee. 
 
 Minneapolis, New York and Pennsylvania cities of the sec 1 class, 
 
 and also a number of the smaller Wisconsin and Connecticut cities. 
 
 In Brooklyn formerly the health commissioner was appointed ly the 
 mayor for a term of two years, lie was not only the executive head of 
 the health department, appointing all subordinates ami enforcing the 
 laws and ordinances, bul he had also •• power to act in a legislative 
 capacity in regard to all matters pertaining to the public health. He 
 possessed this legislative power however, only eo-ordinatel} with the 
 council by whom all ordinances prepared l>\ him were to he approved 
 before they become a law; and the law read •• No ordinance so prepared 
 and approved shall he repealed 01' amended without the approval oi the 
 
 health commissioner." In Milwaukee, the health commissi \x is to 
 
 ■• provide rules and regulations " to be approved l>\ the common council, 
 hut it does not appear thai he has the quasi veto power which the 
 Brooklyn commissioner possessed. In Chicago, Baltimore, District oi 
 Columbia and Denver the commissioner is simpl) the executive office] 
 in charge of sanitary affairs. He has little or no legislative powers 
 
 these being vested in other branches of the city goveri ml or in the 
 
 case of the District of Columbia in Congress, hi Denver and Colorado 
 Springs the possible disadvantages oi •• one man power arc met, oi 
 attempted to be, b} the unique arrangemenl of an advisor) hoard oi 
 health. This board is extra-legal and is appointed l>) the health 
 mission, m. In Denver il is frequentl} ■■ailed togethei b) ! 
 advice is considered of erreal value. Ii was the intention in thai 
 
26 SANITARY ORGANIZATION. 
 
 that the health department should be a bureau in the department of 
 public safety, the board of public safety to consist of the health com- 
 missioner and the commissioners of fire, police inspection and excise, 
 but for many years that department has had no meeting. 1 In Rich- 
 mond, Va. there is an advisory board of health in addition to the reg- 
 ularly established board. 
 
 While there are not very many cities in which the sanitary powers 
 are formally conferred upon one man, there are many cities including 
 some of the most important in which this is practically the result of 
 the existing organization. This is true of those cities in which the 
 health department is a bureau in the department of public safety. In 
 Cleveland and Cincinnati the department is practically single-headed, 
 and in many cities with independent boards of health it is often the 
 case that a single member, or perhaps the executive officer appointed by 
 the board, practically controls all its action. In some of these cities 
 the other members of the board are a hindrance rather than a help to 
 the one efficient officer. In smaller communities especially when the 
 city or township council, or county commissioners are ex-officio the board 
 of health, the health officer appointed by the board really performs all 
 the necessary functions of the department, except that of legislation. 
 It may thus be fairly stated that while nominally a single-headed health 
 department is not very common, as a matter of fact efficiency is in the 
 majority of cases throughout the United States secured only by -allow- 
 ing one man to control sanitary affairs. A single health officer with- 
 out legislative power is by most state officials of experience, considered 
 more efficient than a board of health. 
 
 II. Appointment of Mauler*. 
 
 Wherever there is an independent board of health it must be either 
 elected or appointed. In almost all cases its membership is made up 
 by the latter method, though until 1897 the South Carolina law pro- 
 vided that the board of health of cities, towns, and villages should be 
 elected by the freeholders. In Massachusetts " the town at the annual 
 meeting or a special meeting called for the purpose may choose by ballot 
 a board of health." 
 
 In a few instances the local board of health is appointed by the 
 governor of the state. This is true of the county board of health in 
 Delaware and of Jackson County in Mississippi. In certain cities, too 
 as in Shreveport and Baton Rouge, La., and hi San Francisco (until 
 1000), and in Detroit. 
 
 1 Denver Report of Bureau of Health, 1895, p. 7. 
 
SANITARY ORGANIZATION. ^7 
 
 In Connecticut the county health officers are appointed by the 
 Supreme Court. In West Virginia, Mississippi, and North and South 
 Dakota the county board is appointed by the state board. 
 
 In Vermont the state board of health appoints the health officer who 
 is ex-officio a member of the local hoard of health. 
 
 The control of the state authorities in these appointments is, how- 
 ever, very exceptional, and almost always the appointment of the local 
 board of health is in the hands of the local government, either connty 
 or municipal. In most states the county boards are ex-officio boards, but 
 in Texas the county health officer is appointed by the county judge. 
 In California the county board of health is appointed by the super- 
 visors, and in Idaho, Montana, and Kansas the board of health consists 
 of the county boards with the addition of one physical] appointed by 
 the board. Township boards of health also are usually ex-officio boards 
 though sometimes with the addition of another member usually a 
 physician appointed by the board as in Xew York. New -Jersey, and 
 Minnesota: but in Maine the " Municipal officers" of towns (town- 
 ships) and in Xew Hampshire the selectmen are required to appoint a 
 board of health, and in Rhode Island the town council is permitted to 
 do so. 
 
 It is in municipalities, particularly the larger, that independent 
 boards of health are most common, and here they are usually appointive. 
 In Xew Hampshire, Delaware, Ohio, Arkansas, Minnesota, Kentucky. 
 and California the general laws provide that the city board of health 
 shall be appointed by the ••council."' "common council," or "city 
 council" as the case may be. In Massachusetts the mayor and board 
 of aldermen conjointly, and in New York, Wisconsin. North Carolina, 
 Arkansas, and Pennsylvania in cities of the third class and in boroughs 
 the mayor and council have the appointing power. In Indiana in the 
 classified cities the commissioners of health and charities are appointed 
 by the mayor, and in Wisconsin the commissioner of health is appointed 
 bythe mayor. In Texas the board of health of towns and villa- 
 appointed bythe county commissioners. In New Mexico the county 
 commissioners may appoint health officers for towns, and in California 
 they must do so for unincorporated towns of over 500 inhabitants. In 
 inia count} and municipal boards of health are appointed b\ the 
 county <»r municipal judge. 
 
 In those cities which have special charters or special acts establish- 
 ing the department of health, all sorts of methods are in vogue, the 
 
 tendency being in recent charters to vest the appointing <<\ the head t 
 the health as of all other departments, exclusively in the hands of the 
 
 mayor. This is tine of Charleston, Milwaukee, New II.; 
 New York, Cleveland, Philadelphia, and San Francisco. 
 
28 & ' #Z 7'. 1 22 F OR £. 1 V7Z.-1 ZYOiV: 
 
 ///. Qualifications of Manlier*. 
 
 In the majority of cases the control of local sanitary affairs is vested 
 in a board of health as distinguished from a bureau or a single com- 
 missioner. The membership of the board of health established under 
 tla- different statutory provisions varies greatly. Some of the ex-officio 
 boards are very large, too large to be useful it is said, as when county 
 boards are composed of the town supervisors, or when the board is com- 
 posed of the aldermen or council of a city. Independent boards are 
 usually smaller, though in South Carolina the number may be twenty : 
 in Charleston it is eleven, three of whom are physicians. Newark lias 
 a board of ten. Seven, five, and three are favorite numbers. There 
 seems to be little choice among these, except that the larger number is 
 usually provided for in the larger communities. In Ohio, New York, 
 and Kentucky it is seven for cities ; in New Jersey, five to nine ; in New 
 Jersey and Delaware, five to seven for towns: in Pennsylvania, South 
 Carolina, and Colorado, five for towns ; in Maine, Massachusetts, Min- 
 nesota, and Missouri, three for cities and towns. 
 
 In the larger Georgia cities and in South Carolina it was originally 
 provided that there should be one member of the board of health from 
 each ward, but this has since been modified in Atlanta, Augusta, and in 
 South Carolina. 
 
 As regards the occupation of the members, the various public offi- 
 cers who are ex-officio members of boards have already been considered. 
 The importance of having a medical man on the board is generally 
 recognized, and it is customary to elect them even when it is not re- 
 quired bylaw; but it is so required in many instances. In Alabama 
 and North Carolina the county boards of health are in the one case all 
 the members of the county medical society, and in the other all the reg- 
 istered physicians in the county. In Connecticut the town health 
 officer, and in Texas, the county health officer are to be physicians. 
 In New York, New Jersey, Pennsylvania and Minnesota, it is provided 
 that one member of the township board of health shall be a physician. 
 In Delaware the comity board of health consists of three physicians, in 
 Virginia three members must lie physicians, and in West Virginia one 
 member is a physician. 
 
 The secretary of the state board of health of Connecticut 1 thinks 
 that laymen make excellent health officers for small townships, and the 
 secretary of the Maine state board of health has found them very use- 
 ful as members of the board of health in country towns. 
 
 Some of the general laws for the organization of municipal boards 
 of health also require the appointment of medical men, as in Pennsyl- 
 
 1 Connecticut, Report state Board of Health 1898, \>. XVII. 
 
SANITARY ORGANIZATION. 29 
 
 vania, Indiana. Delaware, SoutL Carolina. Kentucky and California. 
 Usually when there is a single head for the department it is required 
 that he be a physician. It is not always possible to obtain the service 
 of a physician for this office, and so most laws make the provision that 
 a physician shall be appointed if one is available. The California law 
 requires in municipalities the appointment on the hoard of health, of a 
 civil engineer if possible. Connecticut is the only state that requires 
 that the health officer shall he an attorney. 
 
 The disadvantage of having -'polities'" affect the membership or 
 working of a hoard of health is <>t course apparent. It is so apparent 
 that public opinion has made a stronger demand for purity in the health 
 department than in any other department of municipal affairs. A large 
 proportion of health officers are free from the taint of partisanship, 
 though of course there arc conspicuous exceptions. Bi-partisanship 
 which is generally recognized as a futile means of combating partisan- 
 ship, has rarely been tried in the health department. In New Jersey, 
 however, by the act of 1 5 .March. 1894, it was provided that in cities 
 of the first class, the hoard of health should be bi-partisan. 
 
 TV. Details of Organization. 
 
 In a number of states the statute makes provision for the organiza- 
 tion and meetings of the hoard of health. Such provisions are found 
 in .Minnesota. New York. Ohio, Iowa. South Carolina, New Jersey, 
 Michigan, North Carolina, and North and South Dakota. AmOng the 
 items prescribed are the dates and frequency of meetings, advertise- 
 ment of meetings, regulation of terms of service, the election of presid- 
 ing and recording officers, the keeping of records, taking of oaths ami 
 giving of bonds. The following is an example of these laws.- 1 
 
 11 The members of the board shall severally take and subscribe the oatli pre 
 
 scribed for borough officers, and shall annual 1; organize, by the cboice of "i t 
 
 their members as president. They shall eleel a secretary, who shall keep the 
 utes of their proceedings, and perform such other duties as maj '"• directed by the 
 board ami a health officer, who shall execute the orders of the board, and for thai 
 purpose, the said health officer shall bave and exercise the powers and authority 
 of a policeman of the borough. The secretary and tin- health officer shall r< 
 such salarj a- may be fixed by the board, and shall bold their office during the 
 pleasure of the board. Thej shall severallj give bond to the borough in such 
 as may be fixed by ordinance for the faithful discharge of their duties, and shall 
 also take and subscribe the oath required bj the members of the In. aid. \i 
 
 which shall be collected or received bj the board, or bj anj ofttci i i 
 
 official capacity, shall be paid over inn. the borough treasury monthly 
 with all penalties which shall be recovered for the violation of anj r< 
 board. The president and secretary shall have full power to adn 
 affirmations, In anj proceedings or investigations touching the regulal 
 board, bul shall nol be entitled to receive anj fees tin i 
 
 : Pennsylvania, Chapter42 of 1898, Sec. 3. Breghtly's Purd 
 
30 & J Nl TAR Y OR QA XIZA TION. 
 
 The matters referred to above are generally left largely, if not en- 
 tirely, to the discretion of the local sanitary authority. Rules and by- 
 laws are usually adopted by boards of health to govern them in the 
 conduct of their affairs. Such by-laws may cover such subjects as: 
 1. The appointment or election of officers as president, secretary or 
 clerk, treasurer, etc. 2. The appointment of employees and terms of 
 service of these. 3. The duties of all officers and employees. 4. 
 The appointment of committees and their duties. 5. Time and man- 
 ner of calling meetings. 6. Order of business and similar parlia- 
 mentary rules. 7. Manner of adopting rules and orders. 8. Office 
 rules for business hours, etc. It often happens that some of the above 
 matters are dealt with by statute, and others left to the local govern- 
 ment, or they may be covered by municipal ordinance. Regulations 
 for the appointment and duties of officers are perhaps more often to be 
 found in statute or ordinance, than in by-laws, but the other subjects 
 are usually left to the sanitary department. References to some of 
 these by-laws are given below. 1 
 
 V. Terms of Office. 
 
 It is natural that the terms of office of sanitary officials should vary 
 very much. Unfortunately the idea that fitness is a matter to be at all 
 considered in appointments to office is a somewhat rare notion among 
 the every day citizen as well as among those who are active in political 
 life; and the idea that fitness can be acquired and increased by service 
 is still more rare. The common notion is that one man is as good as 
 another, and that in a democracy everybody ought to have a chance at 
 public honor and emolument. Hence short terms of office are found in 
 many boards of health, f ar oftener, however, in the ex-officio boards than 
 in the independent boards, and oftener in former times than at present. 
 A lengthened term of service for minor executive officers is one line of 
 improvement which American politics are following. This change 
 showed itself as early in the sanitary department as anywhere. The 
 importance of keeping the department of public health free from " pol- 
 itics " lias been very generally recognized, and also the necessity of liav- 
 
 1 Albany. Rules of Board of Health, 1892, 1-21. 
 Augusta, Ga. Rules of Board of Health, 1888, 1-23. 
 Camden. Rules of Board of Health, 1896, 1-10. 
 Cornellsville, Pa. Rules of Board of Health, 1894. 
 Erie. Rules and Regulations of the Board of Health, 1898, pp. 3-9. 
 Macon, (ia. By-Laws of Board of Health, 1894, pp. 5-12. 
 Newark. Rules of Board of Health, 1896. 
 
 Philadelphia. Rules of Board of Health, 1895, 1-36 and 198-9. 
 .Syracuse. Rules and Regulations of the Board of Health, 1898, 1-27. 
 
.v J NITu VET OB GA XIZ. ! TION. 3 ] 
 
 ing trained and experienced men at its head. A long term of office has 
 been considered a means to these ends. Maine, Massachusetts, New 
 York. Ohio, Minnesota, and Kentucky, prescribe three years for their 
 municipal boards of health. Connecticut health officers are appointed 
 for four years and the terms of members of the municipal board of 
 health in Pennsylvania and South Carolina is five years. In the new 
 charter for New York cities of the second class, the term of office of 
 the health officer is for good behavior. Some of our best sanitary 
 officials have been in office for a long time. The writer's predecessor, 
 Dr. Snow of Providence, was in office from 1856 to 1**4. l) r . Durgin 
 has been an employee of the Boston hoard of health since 1867, and 
 secretary of the hoard since 1873 : Dr. Horlbeck has been health officer 
 of Charleston since 1*7'.'. Mr. Gray has been connected with the 
 Pittsburgh health department for twenty-five years, and lias been 
 superintendent of the bureau since Inns. 
 
 Another means of securing intelligent and consistent action in san- 
 itary affairs, is to so arrange appointments to the board of health, that 
 only a part of the membership can he changed at any one time. Thus, 
 if there are three members with terms of three years, one may be ap- 
 pointed each year. This arrangement is prescribed in the statute 1 s- 
 tablishing municipal boards of health in Maine. .Massachusetts. New 
 York, New Jersey, Pennsylvania, Ohio, Minnesota. South Carolina, and 
 Kentucky, and in various .special acts ami charters. 
 
 17. Compensation. 
 
 A very large portion of the country has its sanitary affairs presided 
 
 over by ex-officio boards of health, and as a rule its members receive no 
 extra compensation for their services as health officials. This is not. 
 however, always the case. In New Jersey, members of township 
 boards of health are to receive $2 for each meeting attended. Even 
 w heiv there ;nv i nde] iciidci 1 1 boards of health, it is probabl) the rule 
 for them to serve for nothing iii most "f the smaller communities and 
 
 even in son f the larger, lint in the cit) of New York, the ; 
 
 dent of the board of health receives 87,000, and the others -',.0011 p,., 
 annum. In Boston, the members receives 14,000; in St, Louis, #500 
 in New Bedford, $500 ; in Lynn, $300 ; in Fitchburg, #300; in At- 
 lanta. $100; and in Wilmington, Del., #100. 
 
 'The work of the local sanitary organization, while prima 
 
 chiellv executive, also usually includes legislative fum 
 may perhaps be called judicial functions also. 
 
3 2 s - ' &IT- IKY OR G . i JSTIZ. I TION. 
 
 I, Executive Functions. 
 
 Boards of health are intended, first of all, to execute the sanitary 
 laws of the state or of the locality which they serve. The obligation 
 to perforin executive duties is often implied, but sometimes expressed. 
 At times the duty is imposed in very general terms, and at others it is 
 quite fully specified as in Connecticut 1 and the city of New York. 2 
 The first step to be taken by boards of health is to organize. Presiding 
 and other officers arc to be elected, the time and manner of meetings 
 settled, rules of business adopted, and the keeping of records to be pro- 
 vided for. Many of these matters are to be provided for by statute, but 
 as was stated on page 30, most local boards of health, on their organiza- 
 tion, proceed to adopt by-laws for their subsequent guidance. 
 
 The direct control of communicable diseases and their prevention is 
 the chief purpose of public sanitation. Hence, the sanitary authority 
 has control of all cases of communicable diseases which are reported to 
 it, and must seek out any that may be concealed. Isolation of the sick 
 person and attendants, disinfection, ambulance and hospital service, 
 maritime quarantine, vaccination, the distribution or production of anti- 
 toxin, the maintenance of laboratories, inspection of lodging houses and 
 of tenements, sweat shops, bakeries, and laundries, are all phases of in- 
 fectious disease work. 
 
 Second only to this in the estimation of the public, and in the labor 
 required, is the abatement of nuisances. While in many cases the pre- 
 liminary steps are of a judicial character, the actual abatement of the 
 nuisance is executive work ; and in a large number of cases the nui- 
 sance has been so defined by law that only executive functions are re- 
 quired on the part of the health department. The inspection and 
 analysis of foods, and the seizure of unwholesome, diseased or adulter- 
 ated food, and the apprehension of the sellers, are matters frequently 
 under the control of the board of health. The attempt is also made to 
 regulate many kinds of business and the professions as well, in the in- 
 terests of public health. Licenses are required for physicians, mid- 
 wives, undertakers, plumbers, pharmacists and the like, and for keeping 
 swine, or other animals, maintaining stables, or certain kinds of manu- 
 facturing establishments, or keeping a baby farm. Many, and in fact 
 most of these licenses are issued by the board of health. Most of the 
 above named executive functions are either expressly provided for in 
 the fundamental law establishing the sanitary authority, or they are so 
 commonly recognized as proper and necessary sanitary functions of 
 
 1 See p. 9. 
 
 - New York, Chapter 378 of 1897, Sec. 1109 and 1183. 
 
8ANITA 11 Y OR G. J X/Z. i TION. 
 
 33 
 
 local government, that the power to perform them is construed by the 
 courts as residing even in the most general grant of sanitary authority. 
 
 Other functions, though perhaps of as much real sanitary value to 
 the community, are not usually performed by the health department un- 
 less expressly so provided. Thus, many cities collect and dispose of 
 ashes, night soil, and garbage, hut all do not, and in the majority, per- 
 haps, this business is not in the hands of the health department. Street 
 cleaning, sewer maintenance and construction are less frequently eon- 
 trolled by the health department. The maintenance of an out door 
 medical relief is occasionally in the hands of health officials, and very 
 rarely the general public hospitals. The registration of vital statistics 
 while intimately connected with public sanitation, is often in the hands 
 of officials not connected with this department. All these functions 
 and any other novel or unusual action is usually provided for by spe- 
 cific legislative action. 
 
 It is not intended here to give a summary of legislation on these 
 subjects, or even to give a complete enumeration of the executive 
 functions of boards of health. Their proper consideration is the pur- 
 pose of this hook and the most important functions will he treated in 
 the different chapters, where also the statute laws on the subject will 
 be referred to. 
 
 Subordinate Officers. The appointment of subordinate officers and 
 the hiring of employees is usually in the hands of the hoard of health. 
 though sometimes, as in Buffalo and North Dakota cities, the appoint- 
 ment of the health officer is made by the mayor. The power to appoint 
 Officers and employees may doubtless he assumed as implied in the 
 broader grants of sanitary authority, but \er\ often statutes specifically 
 
 provide for the appointments. Perhaps it »st cases the officers ami 
 
 their manner of appointment are specifically mentioned. In other cas< s 
 the authority to appoint Subordinates is general. The Minnesota 1 law 
 is shown helow . 
 
 Of all employees the health officer is the most important. As has 
 been shown, almost all counties, townships, and municipalities are pro- 
 vided with a hoard of health consisting of three or more members and 
 invested with very great powers, and upon whom are imposed uian\ 
 duties. In small communities, especially rural .• munities, the actual 
 
 1 Minnesota, Statutes 1 1894), Sec. 7n7'_': 
 
 •• Said Boards of Health may emploj :iii such persons as shall be neci 
 into effect the pwn isions of this aci and the regulations dulj established b 
 Boards as herein provided, and maj fls their compensation. The said Bi 
 liaye power to employ physicians and provide necessaries foi 
 poverty, and generally to pay Buch expenses as are necessarily incurred bj th< 
 taking precautions which they may deem aecessarj to the public health. 
 
34 SANITAE Y OM GA JSTIZA TION. 
 
 labor which they are usually called upon to perform is not very great, 
 and oftentimes is divided among the members without the necessity of 
 other assistance. This is the more feasible when one or more medical 
 men are upon the board ; but in nearly all but the smaller communi- 
 ties, and sometimes even there it is felt that the interests of the public- 
 will be best conserved by having a special officer who shall be the 
 executive of the board and do all but its legislative and judicial work, 
 and oftentimes some of the latter. As a general thing it is intended 
 that the board of health shall make rules, issue orders, and decide on 
 matters of general policy, but that the actual executive and adminis- 
 trative work shall be performed by one or more appointees or employees. 
 Such an officer, if there is only one, is commonly called the health 
 officer, and in most counties, townships, villages, and small cities 
 suffices to carry on the sanitary work, but in the larger cities his 
 labors have to be reinforced by that of others until in our largest 
 cities the department of health has a great number of officers, in- 
 spectors, and other employees. In the states named below 1 it is 
 required by the statute that there shall be county or township health 
 officers ; besides these, many of the municipal laws and charters have 
 this requirement. Almost always he is called a health officer, but 
 sometimes he has other titles as shown below. 2 Usually the health 
 officer is not a member of the board, but this is not always the case. 
 In North Carolina, North Dakota, and West Virginia, the health officer 
 is a member of the county board, and in Wisconsin he is ex-officio mem- 
 ber of the board of health of cities, townships, and villages. In Ver- 
 mont he is a member of all local boards. In many cities, also, the 
 health officer or commissioner is a member of the board. Among these 
 may be mentioned Buffalo, Jersey City. Kansas City, Knoxville, 
 Memphis, Omaha, Paterson, St. Louis, San Antonio, and Scranton. 
 
 The health officer is usually elected by the board of health as is 
 provided by the statute in many of the states. But sometimes the 
 
 1 Alabama, Colorado, Connecticut, Iowa, Indiana, Kansas, Kentucky, Maryland, 
 Michigan, Minnesota, North Carolina, North Dakota, Ohio, Rhode Island, South 
 Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, 
 Wisconsin, and Wyoming. 
 
 - In many Massachusetts cities such an executive is known as the agent of the 
 hoard of health. In the city of New York he is the sanitary superintendent. In 
 Providence, North Dakota counties and in North Carolina, he is the superintendent 
 of health, while Newark makes use of the English term, medical officer of health. 
 In Newport, and Wilmington, Del., he is the executive officer. In Knoxville his 
 duties are performed by the secretary, who is a member of the board of health. He 
 is sometimes, as in Buffalo, Omaha, and Reading, called the commissioner of 
 health. He is the superintendent of the bureau of health in Allegheny and Pitts- 
 burgh, and city sanitarian in Indianapolis. In Jersey City he is known as health 
 inspector. In Worcester the clerk of the board of health is the executive officer. 
 
*A XI T A R ] ' OR Q . I XI A. J 7 ION. 
 
 executive officer is not elected by the board of health which he serves. 
 Thus in Buffalo the health commissioner is appointed by the mayor. 
 In Charleston and Providence he is elected by the city council, although 
 in the latter city the board of aldermen is the hoard of health and in 
 the former there is an independent hoard of health. In Maine cities he 
 is elected by the "municipal officers." 
 
 The qualifications of the executive officer are sometimes prescribed 
 by statute. Usually he must he a physician or licensed physician. 
 The Connecticut 1 law requires that he must be "learned in medical and 
 sanitary science." In Indiana 2 he shall be "a graduate of a reputable 
 medical college recognized by the State Board of .Medical Registration and 
 Examination who if not already informed in hygiene and sanitary science 
 shall immediately inform himself according to the requirements of the 
 State Board of Health."' In Buffalo the executive officer must be thirty 
 years of age and have been a practising physician for five years. In 
 the City of New York the sanitary superintendent must have been 
 practising ten years and have been a resident of the city three years. 
 Sometimes, especially in the smaller communities, it is not possible to 
 secure the services of a physician, and laymen are sometimes appointed 
 even to places of great responsibility. The very efficient health officer 
 of Pittsburgh is not a physician, and Worcester and Newton. M 
 Newark- and Montclair, N. .1.. have non-medical men as the* execu- 
 tives of the health department, and in all these places they have done 
 nniisnalh excellenl sanitary work. 
 
 The terms of office for the executive sanitary officer vary as do the 
 terms of office of the other sanitary officials, and the members of the 
 board of health. The tendency is undoubtedly towards longer terms of 
 service. In Buffalo it is five years; in Baltimore, Charleston, Con- 
 necticut, and Indiana, four years ; in Providence, three years. In Cin- 
 cinnati, Newark, and New York cities of the sec >nd class, the term oi 
 office of the health officer is indeterminate, but of course he is remov- 
 able for cause. 
 
 A great many health officers receive no compensation at all but 
 Berve their fellow-citizens simplj from public spirit. Thus in Minne- 
 sota in 1898, of 214 health officers, eighty-three received no pay, 
 one of these was in a city of 5,000 inhabitants. 3 In Alabama none 
 of the county health officers and their assistants receive pay.- 1 In 
 Wisconsin, of li'.'l health officers, 342 had no salary, 5 onh two 
 
 I onnecticut, Chapter l 18 ol 1898, See. 6. 
 - [ndiana, A. i ol L9 tfebruarj . 1899, Si 
 ■ Minnesota Reporl ot State Board ol Elealth, 1898, p. W2. 
 1 Alabama !: ipori ot State Medical S i. p. 02. 
 
 Wisconsin Reporl ol the State Board ol Hi all ' • 
 
36 
 
 n I XTTA R 3 r Oil GA JSTIZA TION. 
 
 paid over #400 and only ten over $50. In Connecticut the health 
 officer receives compensation at the rate of $4 per day of actual service 
 and in Michigan of 'at least #2 per day.' In North Carolina the 
 superintendent of health is to receive the usual medical fees or a salary. 
 In Indiana the statute fixes the compensation as follows :i 
 
 tl The health officer shall receive as compensation, from the county, city or town 
 treasury hy the board electing him, to be paid quarterly on the first Monday in March, 
 July, September, and December, the sum of li cents per capita up to and including 
 100,000 people, but his compensation shall not exceed $1,500 per annum ; the popula- 
 tion to be determined from the school census of the year of the appointment, by 
 multiplying the number of school children as determined by the school census by 
 Si ; Provided, That no incorporated town or city shall pay its secretary less than 
 $ 10 per annum." 
 
 Below are shown the salaries paid the executive sanitary officers in 
 a number of cities. 2 
 
 1 Indiana, Act of 28 April, 1800, Sec. 8. 
 
 2 Allegheny, Supt. of Bureau.... $1,200 
 
 Asbury Park, N. J., Chief Insp'r. 1,000 
 
 Ashland, Wis., Health Officer. ... 800 
 
 Atlanta, Chief Inspector 1,500 
 
 Baltimore, Health Commissioner. 3,500 
 
 Boston, Secretary 4,500 
 
 Bradford, Pa., Health Officer. . . . 840 
 
 Bridgeport, Health Officer 1,200 
 
 Brockton, Health Officer 1,000 
 
 Brookline, Mass., Agent 1,000 
 
 Buffalo, Health Commissioner... 4,000 
 
 Cambridge, Medical Inspector... 3,000 
 
 Charleston, Health Officer 1,800 
 
 Chicago, Health Commissioner... 5,000 
 
 Cleveland, Health Officer 2,700 
 
 Colorado Springs, Health Officer. 500 
 
 Columbus, O., Health Officer. . . . 1,500 
 
 Concord, X. II., Health officer. . . 800 
 
 Dayton, Health Officer 1,000 
 
 Detroit, Health Officer 3,000 
 
 Denver, Health Commissioner... 2,500 
 
 Evansville. Health Officer 780 
 
 Erie, Health ( >fficer 1,200 
 
 Fall River, Agent sou 
 
 Fitchburg, Agent 1,000 
 
 Grand Rapids, Health Officer 1,500 
 
 Hartford, General Inspector 1,800 
 
 Haverhill, Agent 1,000 
 
 Eolyoke, Agent 1,100 
 
 Indianapolis, City Sanitarian 1,800 
 
 Jersey City, Health Inspector... 2,000 
 
 Lawrence, Agent 1 ,200 
 
 Louisville, Health Officer $2,000 
 
 Lowell, Agent 1,800 
 
 Lynn, Chairman 500 
 
 Milwaukee, Health Commissioner. 2,500 
 
 Minneapolis, Health Commis'r. . . 2,250 
 
 Mobile, Health Officer 1,200 
 
 Montclair, X. J., Health Officer.. 1,500 
 
 Nashville, Health Officer 1,500 
 
 Newark, Health Officer 3,000 
 
 Xew Haven, Health Officer 1,500 
 
 New Orleans, Health Officer 5,000 
 
 Newton, Mass., Agent 2,000 
 
 New York City, Sanitary Supt.. . . 0,000 
 
 Paterson, Health Officer 1,100 
 
 Pittsburgh, Supt. of Bureau 2,400 
 
 Providence, Supt. of Health 2,000 
 
 Reading, Health Commissioner.. 700 
 
 Rochester, Health officer 2,600 
 
 St. Louis, Health Commissioner. . 3,000 
 
 St. Paul, Health Commissioner... 2,400 
 
 Salt Lake City, Health Officer .... 1 ,200 
 
 San Antonio, Health Officer 1,800 
 
 San Francisco, .Health Officer. . . . 3,0C0 
 
 Scranton, Health officer S0O 
 
 Seattle, Health Officer 1,420 
 
 Somerville, Mass., Agent .'. 1,200 
 
 Spokane, Health Officer 1,200 
 
 Springfield, Mass., Agent 900 
 
 Syracuse, Health Officer 700 
 
 Toledo, Health Officer 1 ,500 
 
 Trenton, Health Officer 1,500 
 
 Wilmington, Del., Health Officer. 1,100 
 
6'. 1 XITAli Y ORGANIZA TION. :j; 
 
 In villages, towns, and cities of small or moderate size, the health 
 officer is expected to do nearly all of the sanitary work of the com- 
 munity. He acts as the secretary of the board of health, attends per- 
 sonally to communicable diseases, puts up placards, gives instructions, 
 and often does the disinfection himself. He investigates nuisances and 
 prepares the orders which are passed by the board, often serves them? 
 and sees that they are obe}'ed. With increase in tin- size of tin- city 
 come increased duties, the collection of garbage, the care of sick poor. 
 a communicable disease hospital. the registration of vital statistics, ami 
 the supervision of the food supply. It becomes manifestly impossible 
 for a single man. even if he devotes his whole time to tin- work, to 
 attend to all the sanitary duties pertaining to the department. The 
 appointment of subordinates becomes necessary and the health officer 
 then does less of the detail work but attends chiefly to its superin- 
 tendence. In cities of 100,000 and over, if the department of health 
 is even fairly well organized and supported, the duties of the health 
 officer are almost exclusively those of directing, the details being carried 
 out by clerks and inspectors. For examples of rules governing health 
 officers of cities see the printed ordinances and regulations of Charles- 
 ton, Cincinnati. Cleveland, Denver, Mobile, and St. Louis. 
 
 The secretary as well as the president is provided for in ex-officio 
 hoards, but otherwise is usually elected, though not always. Thus 
 Bridgeport and Qtica which have an independent board, have the citj 
 clerk for clerk of the hoard. In Jersey City the clerk of the hoard of 
 police commissioners is clerk of the hoard of health. When chosen, 
 the secretary, unlike the health officer, is more often a member of the 
 board. In small communities his duties would be light, and he would 
 serve without compensation as do the other members. In larger com- 
 munities the duties are often performed h\ the health officer, and often 
 the secretary is an appointee of the hoard with duties sufficient to 
 require ;i salary. In such cases he is often more property termed a clerk 
 than a secretary. 
 
 Among important assistants of the health officer may lie mentioned 
 sanitary and medical inspectors, inspectors of food and milk, clerks or 
 registrars of vital statistics, chemists and bacteriologists. 
 
 All the officials that have been mentioned ma\ he reasonablj looked 
 f«.r in cities of 100,000 and over, and they are often found in much 
 smaller communities. The varying development of different phasi 
 sanitary work in different cities ha- resulted in the appointmeii 
 
 officials in one city that are unknown in other cities of nun ] 
 
 si/.'. Moreover, different local condition- due t" geographical 
 industries and character of population, and the notions of tl 
 
38 S ANITA E Y OR GA NIZA TION. 
 
 in regard to the functions of municipal government, result in the employ- 
 ment in isolated instances of any one of a considerable number of 
 officials that have not yet been mentioned. 
 
 Thus cities which are ports of entry for foreign commerce, and 
 where the state does not control quarantine, require a port physician or 
 similar officer, and in larger ports the establishment of a complete system 
 of quarantine, with boarding officers, physicians, hospital attendants, 
 disinfectors, boatmen and the like. 
 
 Again, some cities consolidate sanitary work with the care of the 
 sick poor, perhaps putting even the hospitals and almshouses in charge 
 of the health department, and thus requiring in addition to physicians, 
 the employment of a large force of nurses, stewards, apothecaries, maids, 
 watchmen, etc. Brooklyn, Colorado Springs, Indianapolis, Jersey City, 
 St. Louis, San Francisco, and Spokane are examples. Other cities 
 which do not have their general hospitals under the health department 
 may yet have their contagious disease hospitals in that department. In 
 fact this is almost always the case, and in large cities this necessitates a 
 considerable force of officers and employees. 
 
 In some cities, as Atlanta, Denver, and Raleigh, the street cleaning, 
 and in many more the collection and disposal of garbage and ashes, and 
 in some of night soil, is carried on by the health department. 
 
 In those sections of the country where much bituminous coal is con- 
 sumed, the smoke nuisance receives attention, and the duty of smoke 
 inspection may belong to the health department. 
 
 In Augusta and Memphis the sewer department is within the juris- 
 diction of the board of health which has charge of the construction as 
 well as the maintenance of the sewers. 
 
 The legal adviser for most health departments is the city, town, or 
 county attorney. The amount of legal work in some of the largest 
 cities, however, renders it necessary that one or more special attorneys 
 be employed for this department. Such special attorneys are found in 
 Cincinnati, New York, Newark, Paterson, Hoboken, and other New 
 Jersey cities, and in even as small a place as Montclair, N. J. Occasion- 
 ally it happens that a board of health in smaller places employs its own 
 attorney for each case as the necessity arises. Such is the policy in 
 Cambridge. The law department in most cities usually has plenty of 
 work, and its time is largely taken up with the defence of suits, the 
 preparation of legal papers and similar matters, and prosecutions 
 usually receive only such attention as can be spared from other work. 
 As the health department is usually on the offensive rather than the 
 defensive, better results can be expected when the department has its 
 own attorney. Thus the executive force of the health department may 
 
SA XITAR Y OB GANIZ. 1 TION. 39 
 
 consist of a single health officer who -performs all the duties of his 
 department. This is the rule in the vast number of smaller com- 
 munities throughout the county; but as we pass to larger aggregations 
 of people we find that the work of sanitary administration increases 
 until in the large cities it necessitates quite an army of officials. 
 
 In the city of Xew York since consolidation, a unique division of 
 the health department has been made, necessitated by the great size and 
 peculiar geography of the city. There are two bureaus in the depart- 
 ment, one to be presided over by the registrar of records, and which 
 is virtually a bureau of vital statistics, and the other presided over by 
 a sanitary superintendent, and which bureau is to perform all other 
 sanitary functions than those relating to registration. For cadi of the 
 five boroughs the board of health is to establish borough offices, for 
 each of which is appointed an assistant sanitary superintendent and 
 assistant registrar of records. These local officers transact the business 
 and keep the records for their respective buroughs, but all act under the 
 direction of the central board of health which has its office in .Manhat- 
 tan. The sanitary superintendent and his live assistants arc the executive 
 officers of the board of health. 
 
 Officers and employees other than the health officer are almosl always 
 appointed by the board of health if there is a board of health. When 
 there is a single head to the department he sometimes has the entire 
 appointing power, as in Buffalo, 1 or more often exercises this power con- 
 jointly. In St. Louis the appointments of the health commissioner are 
 to be confirmed by the board of health, and in Chicago and Denver by 
 the mayor. 
 
 Bonds. Bonds are not infrequently required of the officers of the 
 health department. In St. bonis the health commissioner has to fur- 
 nish bonds in the sum of $10,000. In Chicago the amount is $5,000. 
 Subordinate officers also sometimes have to give bonds. In Cincinnati 
 the amount required of the registrar of vita] statistics, of the inspector 
 of meat, of the milk inspector, ami the sanitar) superintendent, is 
 $2,000. [n smaller cities health officers' ami inspectors' bonds in the 
 sum of $500 or $1,000 are sometimes required. 
 
 The time devoted b\ the health officer and other sanitary officials to 
 the duties of their department varies very much. In country districts 
 and in villages and small cities, the health officer is usually engaged 
 mosl of his time in active practice, if he is a physician. Excepl in 
 
 e rgencies, he is able to satisfactorily perform his duties without 
 
 materiall} encroaching on the time devoted to his privati In 
 
 New V/ork, Chapter L05 oi L891, Sees. 
 
40 61 iNITA K Y OK GANIZA TION. 
 
 larger towns and cities public sanitary duties are more exacting and 
 require more time, perhaps the whole time of one man. In such cases 
 a single health officer may be employed to give his whole time to pub- 
 lic duties, in other cases he will exercise only a general supervision, 
 giving special matters his personal attention, and a subordinate at a 
 smaller compensation, may be employed to do routine work. Occasion- 
 ally, as in Woonsocket, R. L, several health officers are engaged, who 
 shall have separate districts, and thus are required to give only a por- 
 tion of their time each to the public service. In large cities the head 
 of the department is sometimes required to give all his time to the city, 
 and is supposed to be paid a corresponding salary. In other cases it is 
 assumed that he can, by the expenditure of a moderate portion of time 
 each day, successfully direct the department : but in such a case it is 
 supposed that his assistants are very competent persons. 
 
 The working hours for the other officials of the health department 
 vary in different cities. The hours for beginning work are from 7 
 a. .m. to 9 A. M., and for closing, 3 p. M. to 5 p. m., with Saturday 
 afternoons, Sundays, and holidays free. In cities of over 100,000 the 
 office for recording deaths is usually open a part of. Sunday and holi- 
 days, and an officer is also ready to receive communicable disease calls 
 at any hour. 
 
 In the honest endeavor to discharge their duties, sanitary officials 
 must often incur the bitter enmity of those with whom they have to 
 deal, and may lie subject to personal suits for fancied injuries. The 
 writer was subjected to three such suits within a short time while at- 
 tempting to check the spread of a diphtheria outbreak. To prevent 
 such personal liability the section given below Avas enacted in the 
 charter of the city of New York. 1 
 
 In one instance at least, in Charleston, the health officer is liable to 
 a fine for failure to perform his duties. He is to pay $10 for each 
 failure to attend to a complaint of a nuisance, and the amount of the 
 fine is to be taken out of his salary. 2 
 
 1 New York, Chapter 378 of 1897 : 
 
 "Sec. 1196. No member, officer, or agents of said department of health, and no 
 person or persons other than the department of health or the city itself, shall be 
 sued or held to liability, for any act done or omitted by either person aforesaid, in 
 good faith, and with ordinary discretion, on behalf of or under said department, or 
 pursuant to its regulations, ordinances or health laws. And any person whose prop- 
 erty may have been unjustly or illegally destroyed or injured, pursuant to any 
 order, regulation or ordinance, or action of said department of health or its officers, 
 for which no personal liability may exist, as aforesaid, may maintain a proper action 
 against the city for the recovery of the proper compensation or damage. Every such 
 suit must be brought within six months after the cause of action arose, and the re- 
 covery shall be limited to the damages suffered. 11 
 
 2 Charleston, Ordinances of 1897, Sec. 271. 
 
a. 1 NIT. LRY OR GANIZA TION. 4 1 
 
 Civil Service Regulations. The principles of civil service reform have 
 been crystallized in the laws of several states and cities. These laws 
 are made to apply to the department of health as to all other depart- 
 ments, and appointments whether made by commissioner, health officer, 
 or hoard of health, must be in accordance with these rnles. 
 
 Modern civil service rnles involve a certain permanency of tenure of 
 office. Permanency in office should imply a moderate compensation, 
 and it does imply ultimate disability fur the performance of duty. 
 Hence the development of a pension idea as the tenure of office of em- 
 ployees becomes more secure. A pension fund is provided for by Sees. 
 1331 to 1337 of the charter of the city of New York. The fund con- 
 sists of the moneys received for searches and transcripts of births, mar- 
 riages, and deaths, and from lines. The board of health is the trustee 
 of this fund and reports annually to the mayor. A pension consisting 
 of half pay, is given to any physician or other person employed aboul 
 communicable disease, who shall become permanently disabled "while 
 in (In- actual performance of his duty and without fault or misconduct 
 on his part." In case of death. $300 per annum is to be paid to his 
 family. Employees, after twenty years' service, may be retired on half 
 pay. 
 
 ('ivil service reform requires a certain degree of litmus in candi- 
 dates for official positions, and this fitness is to be determined by exam- 
 ination. Unfortunately most appointees to official sanitary positions 
 in the United States, an- entirely untrained for the duties they are to 
 perform. To exhibit some degree of natural ability is all that is asked, 
 and often this is nol required, the sole qualification of the appointee 
 being bis political service to the party which has the appointing power. 
 In England, considerable attention is paid to the education of sanitary 
 officials, ''in it is only just beginning t<> he thought of in this country. 
 With the growth of the reform principle, there is sure to come in the 
 United States ;i demand lor trained officials. Even now some far- 
 sighted persons are preparing for this demand. Rutgers College and 
 the Ohio State University offer courses of instruction lor health officers 
 ami sanitary inspectors, and give certificates to candidates on bu< 
 fully piissiiiL; examination. Lafayette College has ;> coin-.- in hygiene, 
 and the Universitj of Pennsylvania has for some years offered a most 
 excellent course. Unfortunatel} these courses are not taken l»\ men 
 who intend in till sanitary positions, and they will not be so long 
 is known that the successful candidate needs no other recoinnu ml 
 than thai of " influential " friends. 
 
 Among other rules con nly found in sanitary end.-. 1- one which 
 
 forbids the offering of an} obstruction to the health officer or oth< 1 
 
42 SANITARY ORGANIZATION. 
 
 ployees of the sanitary department. As we shall see, the proper offi- 
 cers are frequently, by statute, given authority to enter upon private 
 property in the performance of their sanitary duties, and all persons are 
 warned not to obstruct them. Often this provision is extended so as 
 to forbid interference with any of the authorized functions of this de- 
 partment of municipal administration. 1 
 
 One of the duties of the local sanitary authority is to make reports 
 to the local government and to the state government. The local ordi- 
 nances usually provide that the board of health, like all other depart- 
 ments, shall report annually to the trustees, council, mayor, or some 
 other body or officer. Reports to the state board of health are also 
 usually required. Sometimes this requirement is found in the act es- 
 tablishing the local board, but more often in the act establishing the 
 state board. Most of the laws require annual reports and some require 
 them more frequently, and others prescribe that special reports shall be 
 made when demanded by the state authorities. For the annual reports 
 to the state board, printed schedules are often furnished. The one 
 used in Pennsylvania is given in Appendix 1. This subject will be 
 further considered in the chapter on registration, and in the last 
 chapter. 
 
 II. Legislative Functions. 
 
 Most local sanitary authorities are given legislative powers. Some- 
 times such legislative power is very broad and extensive, and sometimes 
 it is very limited. Sometimes it is conferred upon the state board of 
 health rather than upon local boards, and sometimes both the state and 
 local boards hold it, each to exercise it under certain conditions. Some 
 of the states in which the state board has legislative power are men- 
 tioned below. 2 The power thus given is often limited, frequently to. 
 the management of contagious disease. In other cases, as in Florida, 
 Louisiana, Mississippi, New Hampshire, North Dakota, and South 
 Dakota, it is very general. In Virginia it can be exercised only in 
 
 1 Denver, Ordinances, 44 of 1893, Sec. 12 : 
 
 11 Sec. 12. It shall be unlawful for any person or persons to molest, hinder, inter- 
 fere with or in any manner prevent the said health commissioner, or any individual 
 engaged in the bureau of health of the city, from performing any duty imposed 
 upon him or made by any law of the city or state or any rule of the said commis- 
 sioner ; nor shall anyone interfere with him in any acts done to prevent the spread 
 of contagious diseases, or with any employee of the bureau of health in carrying out 
 any direction of the health commissioner in enforcing any of the laws and ordi- 
 nances of the city in reference to health." 
 
 2 Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Minnesota, 
 Mississippi, Missouri, New Hampshire, New York, North Carolina, North Dakota, 
 Ohio, Pennsylvania, South Dakota, Tennessee, Vermont, Virginia, Wisconsin. 
 
& 1 NIT, iJRY Oil GA XIZA TIOX. 4 3 
 
 epidemics : in Pennsylvania only where there is no local board : in North 
 and South Dakota the local board can make rules only under the super- 
 vision of the state board, and in North Carolina the state board can 
 make rules only during epidemics or where there is no local board. In 
 New York and Virginia the state board of health may modify or amend 
 a local regulation if in its opinion it affects other communities. 
 
 A recent decision of the supreme court of Wisconsin has, however, 
 affirmed that the state board of health being appointive and not a 
 representative body, cannot be clothed with legislative power.* 
 
 Most states, in the laws establishing local sanitary authority", provide 
 for the exercise by that authority of legislative powers, and the same 
 provision is found in most special charters. Whenever an independent 
 board of health is established, power to legislate is generally conferred 
 upon it : but this is not always the case. In some localities, even where 
 the principle of local independence in sanitary affairs is admitted, legis- 
 lative power in such affairs is given to a branch of the city government 
 other than the board of health or health officer on whom is conferred 
 the executive powers. Tints at Bridgeport, although there is an estal>- 
 lished board of health, the city council alone is competent to legislate 
 on sanitary affairs. In Richmond it is the city council, in Memphis the 
 Legislative council, and in San Francisco the board of supervisors, and 
 in Baltimore it is the mayor and city council that are invested with legis- 
 lative powers, although in each of these cities there is a separate board 
 of health. Besides these and other cities provided tor by special 
 charter, there are a number of states in which legislative power in 
 regard to sanitary matters is conferred on the proper legislative depart- 
 ment of the cities. This is true in Illinois, Indiana. Kansas. Kentucky, 
 Missouri, Nebraska. North Carolina, and Texas, though there arc special 
 charters in some of these states making other provisions. Where there 
 is no local board of health, and only a single health commissioner 
 or health officer, such officer is not usually given legislative powei 
 if bo, only to a limited extent. Tims in the District of Columbia the 
 health officer can only make rules in regard to the protection of the 
 
 milk supply. The commissioners of the District of Columbia have 
 some legislative authority in regard to plumbing, garbage, communica- 
 ble disease and sanitary affairs generally, bul Congress has not given 
 them a \en free rein. 
 
 In Chicago the commissioner of health has no legislal ive power, nor 
 have the superintendents of the bureaus in Pittsburg and Allegheny, or 
 
 1 Wisconsin Supreme Court, 23 February, L897, State ex rel. Ida 
 etal., School Board. See also tllinoia Suprem< Court, 10 May, 1807, Potts 
 rs. Breen ei <<i.. and Illinois Supreme Court, it February, I 
 Labangh vs. Board of Education "t District No. 2. 
 
44 SANITARY ORGANIZATION. 
 
 the health officer in Cleveland. In other cities the health officer acts 
 in conjunction with the proper legislative branch of the city govern- 
 ment. In Buffalo,' where there is nominally a board of health, but 
 practically a single head, the health commissioner is to make rules for 
 carrying out ordinances and 
 
 " To propose such ordinances as he shall deem to he required for the protection 
 of the public health and for securing the proper registration of births, marriages 
 and deaths, and such other statistical material as may he necessary for the efficient 
 -working of the department with penalties for their violation, which ordinances, 
 when approved by the board, shall be by him submitted to the council, and when 
 approved by said council, shall have the same force and effect as other ordinances 
 of the city. Xo ordinance so prepared and approved by said common council shall 
 be repealed and annulled without the approval of the health commissioner and board 
 of health, and the common council shall adopt no ordinance relating to governing 
 the matters and things contained in this title, unless the same shall be recommended 
 by the health commissioner and board of health. 11 
 
 In Wisconsin 2 
 
 "The commissioner of public health shall have all the power or authority here- 
 tofore given, or which may hereafter be given, to boards of health by any general 
 law of the state, and it shall be his duty to provide such additional rules and regu- 
 lations as shall be requisite and necessary for the preservation of the health of the 
 people of the city to prevent the spread of contagious diseases, and to cause the 
 removal of all objects detrimental to the health of the people of the city, and to 
 enforce such rules and regulations as are hereinafter provided, etc. 1 ' 
 
 In Connecticut 3 also the health officer has legislative power granted 
 by the following : 
 
 "It shall be sufficient notice to all persons of any regulation of the health officer 
 of any town, if it be published in a newspaper published in the town, if there be 
 one, and posted for three days on each sign post in said town ; and if any person 
 shall willfully violate such rules after they have been so published and posted, or 
 after actual notice thereof shall have been given to him, he shall be fined not more 
 than one hundred dollars." 
 
 It is thus seen that often, perhaps usually, the legislative power 
 granted to a single health officer is subject to limitations by other 
 branches of the local government. Even in the case of regularly 
 established boards of health of several members, its legislative acts often 
 have to be subjected to revision and approval before they may have the 
 force of laws. Thus in Maine 4 the board of health has power 
 
 " To make, alter or amend such orders and by-laws as they shall think necessary 
 and proper for the preservation of life and health and the successful operation of 
 the health laws of the state, subject to the approval of any justice of the supreme 
 judicial court." 
 
 1 New York, Chapter 105 of 1891, Sec. 233. 
 -Wisconsin, .Statutes (1898), Sec. 925 (-108). 
 
 3 Connecticut, Chapter 164 of 1895. 
 
 4 Maine, Supplement Laws (1895), Chapter 14 (2), Sec. 7. 
 
& I XITAE } " OH <3L I XIZ. I TION. 4 5 
 
 In New Hampshire the rules of the local health organization must 
 be approved by the selectmen. A similar provision is made in the laws 
 of Pennsylvania and South Carolina. 
 
 In North Dakota 1 the hoard of health is empowered 
 
 " To make and enforce any and all needful rules and regulations for the preven- 
 tion and cure, and to prevent the spread of any contagious, infectious or malarial 
 diseases among persons and domestic animals,"* "... subject to the super- 
 visory control of the state board of health and the superintendent of public 
 health." 
 
 Usually the legislative power granted to local sanitary organizations 
 is very great, though occasionally it is limited, especially in single- 
 headed departments. Instances of this have just been given, but true 
 boards of health also sometimes have circumscribed powers. Thus in 
 West Virginia, the county board of health is empowered to legislate 
 only in regard to contagious diseases. In Louisiana 2 , the local board of 
 health can pass ordinances 
 
 ••For the exclusion and repression of contagious and infectious diseases; for 
 defining and abating nuisances dangerous to the public health: for regulating drain- 
 age and ventilation with reference to human habitations and places of business and 
 public resort; for the collection and recording of vital statistics." 
 
 Sometimes the phraseology of the statutes conferring legislative 
 
 power is very broad and general, and sometimes it is most specific and 
 
 limited. Sometimes the power is conferred by almost a single line, and 
 
 sometimes several pages are required for the specific enumeration of 
 
 powers conferred. The tendency is rather towards the briefer form, 
 
 and some id' the most important cities are governed by such. The suc- 
 
 of such cities as Brooklyn and Baltimore in maintaining in the 
 
 Courts their authority to Legislate <>n sanitan affairs shows that greal 
 
 powers can he conferred by a very concise act. As examples of state 
 
 laws of ;j similar character the following ma\ he cited : 3 
 
 " The board of health of a town shall make such regulations as it judges m 
 sarv for the public health ami safety respecting nuisances, sources of tilth and 
 causes of sickness." 
 
 i'his Massachusetts law was enacted in IT'.'T and has thus for a full 
 
 century been maintained against all attacks as a c petent authority 
 
 for sanitary legislation mi the part of the towns and cities of the com- 
 monwealth, and it has been copied almosl verbatim in the laws of man\ 
 other state. Broad provisions therefor are amphj sutncienl to give to 
 
 the local sanitary authority all the power neccss;n\ for the exi 
 
 its proper functions. It would seem then that when the various powers 
 
 1 North Dakota, Rei ised Code (18fl it. 
 
 - Louisiana. Chapter 192 of L898, Sec. 7. 
 Massachusetts, Public Statutes, Chapti 
 
46 SANITARY ORGANIZATION. 
 
 conferred are specified by the statute, the law makers had in mind to 
 limit the powers of the local board!; but an examination of the various 
 laws shows that this is not so. It is only rarely that any indication is 
 seen of chariness in conferring power when local boards of health are 
 established. It is generally felt, and correctly so, that a local board of 
 health to be anything else than a farce must have very great powers. 
 Unless such are granted it was worse than foolish to establish the 
 board. Law makers would appear then, in specifying the powers of the 
 local sanitary authority, to be desirous of making sure that all neces- 
 sary powers are granted, rather than of attempting to limit them. 
 Hence it happens that when specific powers are enumerated, they 
 usually include all that an efficient board of health need to exercise. 
 As examples of a somewhat extended enumeration of powers may be 
 cited Chapter 68 of the laws of New Jerse}', 1887, Sec. 12 (General 
 Statutes (1895), p. 1644), and Sec 4134 of the Revised Statutes of 
 Indiana, 1897, giving the powers of cities of the first class. 
 
 The rules and regulations of boards of health cannot conflict with 
 state constitutions or be in any wa}~ contrary to the statute law of the 
 state. This is true whether or not such conflict be specifically forbid- 
 den. Though not usually the case, this conflict is sometimes forbidden, 
 as in Rhode Island. 1 In Iowa the regulations of the local board of 
 health must not be in conflict with the regulations made by the state 
 board of health, 2 and in California they must be "necessary and proper 
 and not contrary to law."3 
 
 Minnesota requires that notice of rules shall be given when no 
 newspaper is published in the town, " by posting up such notice in five 
 (•")) public places therein." A similar provision is found in the Wis- 
 consin law, and in New Jersey. In Hartford and New Haven it is 
 specified that the rules must be published in a newspaper four times ; 
 in New Jersey for two weeks once in each week. In New Jersey 4 also 
 it is required that every sanitary 
 
 " Ordinance shall have three readings before its final passage, and at least one 
 week shall intervene between the second and third readings of said ordinance, and 
 a notice stating the title of said ordinance and the date when it passed its second 
 reading shall be published at least one week prior to its final passage in at least one 
 newspaper published in the township, city, town, borough or other local municipal 
 government, if any newspaper is published therein, and if there be no newspaper 
 published therein, then in some newspaper of the county circulating in such town- 
 ship, city, town, borough or other local municipal government." 
 
 1 Rhode Island, General Laws (1896), Chapter 40, Sec. 29. 
 
 2 Iowa, Code (1897), Chapter 16, Title 12, Sec. 5. 
 
 3 California, Political Code (1SSG), Sec. 3061. 
 
 4 New Jersey, General Statutes (1895), p. 1644, Sec. 4'.t. 
 
SAX IT. illY OR GAJSTIZ. J TION. \ 7 
 
 In Connecticut if there is no newspaper in the town the rules nrav 
 be posted on sign posts and entered in the town records. 
 
 The board or officer legislating must, of course, have the authority to 
 impose penalties, otherwise the rules and regulations would be useless. 
 Sometimes, as in Rhode Island, the penalty is fixed by the statute author. 
 izing the legislation. In many cases it is fixed by other general statutes 
 regulating the legislative functions of local government. When local 
 boards fix the penalties the maximum and sometimes the minimum is 
 fixed by the statute. The smallest maximum that the writer has noticed 
 is $10 in New Hampshire. Usually the maximum penalty allowed for 
 violations of local sanitary regulations i- $100, hut sometimes it i- •^■". , ' 
 and more rarely $25; in Albany, until 1900 it was $1,000. Jn some 
 cities the lines go into the general treasury, hut in others they go to the 
 health department. The alternative of imprisonment for periods up to 
 one year is often allowed. 
 
 Ill Judicial Functions. 
 
 The power and duty of sanitary officials to investigate and abate 
 nuisances is an important part of their functions and implies the exer- 
 cise of quasi judicial powers. If a nuisance is to lie abated through the 
 action of a board of health, it must first of all he determined to 1.,' ;i 
 nuisance, and this question of fact must he decided by the hoard. 
 Sometimes the question is very easily settled, hut often it is not, and 
 occasionally a set 1 lenient can only he arrived at after a Long and patient 
 investigation. In most of the statutes establishing hoards of health 
 this power is only granted by implication in the general granl of powers 
 or in the special provisions for the abatement of nuisances. Sometimes, 
 however, il is specifically recognized and its exercise provided for. The 
 laws 0!' Connecticut l and New Vork 2 furnish examples of this. The 
 New Fork law provides in regard to the hoard of health that 
 
 '• It may issue subpoenas, compel the attendance of witnesses, administer oaths 
 to witnesses ami compel them to testify, and for such purposes it shall have the 
 same powers as a justice of the peace of the state in a civil action of which he has 
 jurisdiction. It may designate bj resolution one of iis members to sign anil issue 
 such subpoenas. No subpoenas shall be served outside the jurisdii tion -■( tin 
 
 Issuing it. and no witness shall be interrogated or compelled t" testify ii] ii 
 
 in- 1 related to the public health." 
 
 The powers conferred upon aboard of health h\ statute 01 ordi- 
 nance cannot usually be delegated h\ it. Thc\ cannot unless the 
 
 1 Connecticut, Chapter 248 of 1898, S< - , 3. 
 
 ' \.u fork, General Laws (1896), p. 2422, Sec. 1. 
 
48 SANITARY ORGANIZATION. 
 
 authority to do so is expressly granted. Sometimes, as in Rhode Island 
 and Massachusetts, certain executive powers belonging to the board of 
 health are exercised by the health officer, a subordinate official ; but 
 this is provided for in the statute. The powers are not delegated by 
 the board. Occasionally the law provides that the powers of the board 
 of health may be delegated. Such authority is given in New Jersey, 1 
 and in Detroit 2 , and in the City of New York 3 . 
 
 In pursuance of the power to legislate which has been granted them, 
 most boards of health adopt more or less extensive rules for the better- 
 ment of the communities under their jurisdiction, and sanitary codes, 
 ordinances, or rules and regulations, are found in almost every com- 
 munity. In the great cities these are often very extensive and cover a 
 wide range of subjects. Almost all legislation, statutory as well as 
 municipal, shows more or less legal and technical ignorance on the part 
 of the framers. It might be expected that boards of health would ex- 
 hibit such failings in a marked degree, and it is to be feared that they 
 often do. Sanitary ordinances, like all laws, should first of all be reason- 
 able. They should also be strong, so that the result aimed at may really 
 be accomplished. It is for the board of health under the constitution 
 and the statutes to determine what -the regulations should be. In draw- 
 ing up the rules it is very necessary to have them express exactly what 
 is intended. There must be no ambiguity. The thing forbidden must 
 be clearly denned and it must also be clear upon whom the penalty must 
 fall. These regulations should be made so that Warrants can be readily 
 drawn and so that proof of violation shall be made as easy as possible 
 for the prosecution. To improve the quality of local legislation, a num- 
 ber of state boards of health have prepared model rules for the guidance 
 of the local boards within their jurisdictions. Such laws are usually 
 prepared after a study of those which have been in successful operation, 
 and as they are revised with care by the state board of health, are very 
 suitable, with perhaps a few local modifications, for adoption by the 
 majority of local health authorities in the state, and such rules are very 
 often so adopted. Among the states which have prepared model ordi- 
 nances may be mentioned; Connecticut, Illinois, Indiana, Iowa, Kansas, 
 Maine, Michigan, New Jersey, North Carolina, New York, New Hainp- 
 
 J New Jersey, (ieneral Statutes. (1895), p. 1642, See. 40. 
 
 - Michigan, Chapter 10 of 1895, Sec. 26. 
 
 3 New York, Chapter 378 of 1897 : 
 
 " Sec. 1182. The board of health may from time to time delegate any portion of 
 its powers to the sanitary superintendent or an assistant sanitary superintendent, to 
 be exercised by such delegate from the time and in manner, and to the extent speci- 
 fied in such delegation in writing. 11 
 
x. 1 Nil \ IRT 11 G A XI Z. 1 TION. 4 j | 
 
 shire, and Pennsylvania. Those of Maine are very brief indeed. ( )n 
 the other hand those of Iowa are very numerous and include matters 
 covered by the statutes and by the regulations of the state board of 
 health. The Pennsylvania rules also are very elaborate and would suf- 
 fice for a great city. They deal very largely with the duties of the 
 board of health and its employees. Among the best of these model 
 codes is that of New York shown in Appendix 2. 
 
 Statutes Providing for the Establishment of Sanitary Authority, 
 sulted in" the preparation of this chapter. 
 
 Alabama. Code (1896), Sees. 2423-2437. 
 
 Arkansas. Cities of the first and second classes. Statutes (1894), Sec. 5203. 
 
 California. Counties, Political Code (1886), Sec. 3059. 
 
 Municipalities, Political Code (1886), Sec. 3061-::. 
 Colorado. Act of IT April, 1893. 
 Connecticut. Chapter 248 of 1893. 
 
 Chapter 144 of 1S95. 
 Delaware. Counties. Revised Code (1893), Chapter 46. 
 
 Municipalities, Laws of Delaware, Vol. 16, Chapter 345. 
 Florida. Revised Statutes (1892), Sees. ~~- 785. 
 
 Chapter 27 of 1897. 
 Idaho. Revised Statutes (1887), Sees. 1150 et seq. 
 
 Illinois. Municipalities. Annotated Statutes (1896), Chapter 24, Sec. 63, seventy- 
 jin to eighty-four. 
 
 Townships. Annotated Statutes (1896), Chapter 139, Sec. L28 130. 
 Indiana. Counties and Municipalities, Act of 28 April, 1899. 
 
 Cities of the flrsl class, Revised Statutes 1 1897), Sees. 1134, 1225. 
 
 Cities of the second class, Revised Statutes (1897), Sees 3984, 1072. 
 
 Cities of the third class, Revised statutes | 1897), Sees. 3959 60. 
 Iowa, (ode | 1897), Sec. 2568 -/ ■-"/. 
 Kansas. Counties, ' reneral Statutes (1897), Chapter 75, Sec. 11. 
 
 Cities of the tit-si class. Statutes (1897), Chapter 32, Sec. 8. 
 
 Cities of the second class. Statutes (1897), Chapter 35, Sec. 95. 
 
 Cities of the third class, Statutes (1897), Chapter 38, Sec. 52. 
 K'i.n it ( kv. Counties, Statutes (1894), Arts. 2047, 2055. 
 
 Municipalities, statutes (1894), Sorts. 2059. 
 
 Cities of the first class, Statutes (1894), Art -'71l'. 
 
 Cities of thr second class. Statutes 1 1894), Art 3058. 
 
 Cities. u the third .lass. Statutes (1894), An. 3290. 
 
 3 Of the fourth class. Statutes , 1894), Art. 3490. 
 
 Louisiana. Constitution (1898), Arts. 296-7. 
 
 Chapter 192 "t 18 
 Maine. Suppleraeni Laws (1895), Chapter 14. 
 Maryland. Counties. Public General Laws (1888), Lrt 18, Sec. 9. 
 M IlSsachi -ins. Townships, Public Statutes (1882), Chapfc 
 
 Municipalities. Chapter 332 of 1895 
 Michigan. Townships, Compiled Laws (1897), Si 
 
 Municipalities, Compiled Laws (1897), Sec. 1459. 
 
 Legislative power, Compiled Laws (1897) 1412. 
 Minm.m.i \. Statutes 1 1894), Set . 7048. 
 
 Cities, statutes (1894), Sec. 1 1">'.'. 
 
 Villages, Statutes (1894), Sec. 1224(28), 1299(80). 
 
 4 
 
5 ( ) & J ATI 1 \ 1 11 3 ' on GA XI Z A TIOX. 
 
 Mississippi. Chapter 15 <>f 1807. 
 
 Municipalities, Annotated Code (1892), Sees. 2281-98. 
 Missouri. Cities of the first class, Revised Statutes (1899), Sec. 5460 et seq. 
 
 Cities of the second class, Revised Statutes (1899), Sec. 5508. 
 
 Cities of the third class, Revised Statutes (1800), Sec. 5842. 
 Montana. Political Code (1895), Sec. 2800. 
 Nebraska. Metropolitan cities, Compiled Statutes (1899), Sec, 794. 
 
 Cities of the first class A, Compiled Statutes (1899), Sec. 1038. 
 
 Cities of the first class B, Compiled Statutes (1899), Sec. 1226. 
 
 Cities of the second class B, Compiled Statutes (1899), Sec. 1012. 
 New Hampshire. Public Statutes (1891), Chapter 108. 
 
 Cities, Public Statutes (1891), Chapter 50, Sec. 10. 
 
 Townships, Chapter 45 of 1897. 
 
 Townships, Chapter 65 of 1899. 
 New Jersey. General Statutes (1805), p. 1036 et seq. 
 
 Cities of the first class, General Statutes (1895) pp. 1047-49. 
 
 Counties, General Statutes (1805), p. 1651. 
 New Mexico. Cities, Compiled Laws (1897), Sec. 2446. 
 
 Towns, Compiled Laws (1807), Sec. 3706. 
 New York. Revised Statutes (1896), p. 2422. General Laws, Chapter 25, Art. 2. 
 North Carolina. Act of 1 March, 1893. 
 North Dakota. Counties, Revised Code (1800), Sees. 245-253. 
 
 Cities, Revised Code (1800), Sees. 254-274. 
 Ohio. Municipalities, Annotated Statutes (1000), Sec. 2113 et seq. 
 
 Townships, Annotated Statutes (1900), Sec. 2121. 
 
 Cities of the first class, 1st grade, Cincinnati. Sec. 2231. 
 
 Cities of the first class, 2d grade, Cleveland, Sec 1545 (41, 45-7). 
 
 Cities of the first class, 3d grade, Toledo, Sec. 2141. 
 
 Cities of the second class. 1st grade. Columbus, Sec. 1545 (-05. -134 et seq). 
 
 Cities of the second class, 3d grade, a Springfield, Sec. 2113. 
 
 Cities of the second class, 3d grade, h Hamilton, Sec. 1545 (-200). 
 
 Cities of the second class, 3d grade, c Portsmouth, Sec. 1707 (-12). 
 Pennsylvania. Cities of the first class, Brightly's Purdon's Digest (1804), p. 1428, 
 Sec. 02; p. 1431, Sees. 115-59. 
 
 Cities of the first class, Two Acts of 22 May, 1899. 
 
 Cities of the second class, Act of 26 June, 1895. 
 
 Cities of the third class, Brightly's Purdon's Digest (1894), p. 1557, Sees. 129-137. 
 
 Boroughs, Brightly's Purdon's Digest (1804). p. 250, Sees. 240-7. 
 
 Townships, Act of 4 April, 1899. 
 Rhode Island. General Laws (1800), Chapter 40, Sees. 13, 14 and 29. 
 
 General Laws (1800), Chapter 91, Sees. 20-22. 
 South Carolina. Act of 5 January, 1895. 
 
 Act of 19 February, 1808. 
 South Dakota. Act of March, 1895. 
 Tennessee. Counties, Code (1800), Sees. 3106-14. 
 
 Municipalities, Code (1800), 3101-14. 
 Texas. Counties, Revised Statutes (1895), Sees. 418, 447-8. 
 
 Municipalities, Revised Statutes, (1805), Sec. 4322 et seq. 
 
 Towns, Chapter 100 of 1899. 
 Utah. Chapter 45 of 1899. 
 
 Municipalities, Revised Statutes ("1898), Sees. 1105, 1109. 
 
 Counties, Revised Statutes (1898), Sees. 1106, 1109. 
 Vermont. Statutes (1804), Sees. 4675-80. 
 Virginia. Act of 7 March, 1000. 
 
& I xrr. IBY <> li (r. I XI Z. J TION. .-, i 
 
 Washington. Counties, Code and Statutes (1897), Sec. 2972. 
 
 Municipalities. Code and Statutes (1897), Sec. 1237. 
 
 Townships, Code and Statutes (1S97), Sec. 629. 
 Wisconsin. Municipalities, Statutes (18 . 925(-107 to ill b). 
 
 Townships, villages and cities. Statutes (18! 5 . 1411-12. 
 West VIRGINIA. Code (1899), Chapter 150. 
 Wyoming. Revised Statutes (1899), Sec. 2226 et seq. 
 
 Charters and Special Acts fob Cities. 
 
 Atlanta. Act of 26 February, 1877; 23 August, 1879; 8 December, 1880; 3 Sep- 
 tember, 1881. 
 
 Augusta, i.a. Act of26 February, 1877; T May. 1877; 29 August, 1879; 8 December, 
 1880; - December, 1888. 
 
 Baltimore. Chapter 123 of 1898, Sec. 31. 
 
 Baton Rouge and Shbevepobt. Act of 20 March, 1878. 
 
 Bridgeport. Aci of 22 March. 1877. 
 
 Bbooklyn. Chapter 307 of 1890. 
 on. Chapter 448 of 1854. 
 
 Bi i'kai.o. Chapter 105 of 1891, Sees. IT. 231 et seq. 
 
 Chicago. Act of 13 February, 1863; 16 February, 1865; 9 March, 1867. 
 
 Denveb. Ad of 11 April. 1891, Sec. 1. 
 
 Di.i boit. Chapter 10 of 1895. 
 
 I)i-i kict of Columbia. Act of Congress, 21 February, 1871; 11 June, 1878; 24 
 April. 1880. 
 
 Babtfobd. Act of 3 March. 1886, "validating' 1 Ordinance ol 26 January, i- 
 
 Manchesteb, X. II. Chapter 165 of 1885. 
 
 Milwaukee. Chapter 184 of 1874, sub-chapter XIII. Chapter 36 of 187 
 
 Minneapolis. Chapter 413, Special Laws, 1889. 
 
 Memphis. Chapter 11 of 1879. 
 
 Newbi bgh, n. Y. Chapter270of 1885. 
 
 Nia\ Baven. Chapter 418 of 1897. 
 
 Xi:\\ Fobk (The City of). Chapter 378 ol 1897. 
 
 Providence. Chapter 598 of 1866, Sec. IX.. Clause I. 
 
 Reading. Ac! of 22 April, 1873. 
 
 Richmond. Chapter 101 of 1870, Sub-Chapter 3, XV XIX. 
 
 is.w Fbancisco. Concurrent Resolutions, Chapter II, 26 Ji ary, 1899. 
 
 Santa Babbaba. \<t of 20 February, 1899. 
 
 St. Paul. < 'barter oi 1874, < lhapter X I. 
 
 Sacbami sto. Aci of 27 March, I 
 
 Si i: \n io\. An of 23 May. 1874. 
 
 Vallejo. Aci of 26 January, 1899 
 
 Wilmington, Del. Laws of Delaware, Vol. 17, Chapter 207. 
 
CHAPTER II. 
 
 REGISTRATION OF VITAL STATISTICS AND DISPOSAL *OF 
 
 THE DEAD. 
 
 THE registration of vital statistics is the firm basis on which the 
 whole structure of sanitary science and practice must rest. In 
 order to learn the laws of disease, to devise remedies, and test them, we 
 must have an approximately accurate knowledge of the movement of 
 population and of the causes of death. Not only is a knowledge of these 
 required, but also an accurate census si lowing the distribution of the 
 population as to age, sex, civil condition, race, etc. Correct knowledge 
 of population and its movements is valuable, not alone to sanitary 
 science, but to the economist, the educator, the penologist, and indeed 
 to the student of every branch of social science. A subject which is 
 of such vast scientific importance should receive most careful govern- 
 mental attention, and every aid should be given in assisting its' investi- 
 gation. Unfortunately scientific considerations have little weight with 
 politicians ; but fortunately there are other reasons which render an 
 accurate record of the movement of population desirable. The main- 
 tenance of property rights requires a correct record of family relations, 
 and is only to be obtained by a public record of each birth, marriage, 
 and death. The advantage of such a record was very early felt among 
 the colonies and was manifested in appropriate legislation. In Virginia 
 on 24 February, 1631, 1 it was enacted that ministers and church wardens 
 should report births, marriages and deaths to the midsummer quarter 
 court. The first registration law in Massachusetts was adopted in 
 1639, 2 and in Plymouth in l<;4li. : > 
 
 The registration of vital statistics is interesting in connection with 
 our subject because of its great value in aiding the progress of sanitary 
 knowledge, and it must also receive our attention because it is often 
 one of the functions of the sanitary department. 
 
 1 Herring's Statutes at Large, Vol. I., p. 155. 
 
 2 Records of Massachusetts, Vol. I., p. 276. 
 
 8 Plymouth Colony Records, Vol. I., p. 96 (3 March, 1G45-G). 
 
REGISTRATION OF VITAL STATISTICS. 53 
 
 There are several reasons for this. The routine work of the health 
 officer requires that he should have the earliest possible knowledge of 
 recognized dangerous communicable diseases, and hence returns of 
 death should properly be made directly to him. It is of great impor- 
 tance that a medical man should, if possible, see all returns of death, to 
 scrutinize the causes, and usually some member of the board of health 
 is the most available medical man for this purpose in the public employ. 
 Sanitary officials are more likely than any others to make a good use of 
 the data obtained, and to record and tabulate the returns properly. 
 Sanitary officials are more likely than any others to secure complete 
 and correct returns. Hence it is very generally the custom in cities, 
 even of moderate size, for the board of health or health officer to be 
 entrusted with the duty of collecting and recording the deaths in the 
 population within its jurisdiction. In any community which is of suffi- 
 cient size to have a permanent office or clerk for the sanitary depart- 
 ment, there can be no doubt that this department should have charge 
 of the registration of deaths. The records of births should be in the 
 hands of such a department, because for other reasons it would be in 
 touch with the physicians who are to make the returns, because it can 
 check returns of births by returns of deaths of infants, and because it 
 can more accurately separate still-births from deaths than could any 
 non-medical recorder. The writer also believes that marriages ought 
 to be recorded by the same authority, even though this might necessitate 
 the issuing of licenses as well. The issuing of marriage licenses and 
 the recording of marriages may no1 seem to be properly a sanitary 
 function, bui it can be besl performed in conjunction with the recording 
 of births and deaths. Marriage i> as important as births and deaths in 
 the movement of population, and under present social conditions all ^i 
 our social problems require a knowledge of this factor. Births, mar- 
 riages and deaths are best collected and recorded- by the same officials, 
 and the sanitary official in cities at Least is the best fitted to have con- 
 trol of it. The experience of the New England townships, and many 
 of our important cities, where the registration of all of these three 
 classes of vital phenomena is done by the same officer, shows that fuller 
 and better returns can be thus obtained. The registration of births, 
 marriages and deaths is a desirable function to have performed by sani- 
 tary officials and is performed by them in many communities. It is 
 therefore discussed in this chapter. The methods employed for obtaining 
 the data necessary for making a full and complete record of ' 
 marriages, and deaths varj greatly in different states and cit 
 in the same state the records of each of these thn 
 
 marriages and deaths, may be collected iii different w: 
 
54 REGISTRATION OF VITAL STATISTICS. 
 
 Deaths. 
 Collection of Death Records. 
 
 Probably the most unsatisfactory method of obtaining death records 
 is by an annual census. This enumeration method has been pursued in 
 the United States censuses, and, as is well known, the results have been 
 very unsatisfactory. This must necessarily be the case, for the memory 
 of people is not to be trusted even in such important matters. Moreover, 
 even the most skilled enumerators are not able by questioning to over- 
 come the stupidity or carelessness of many of the persons questioned, 
 and skilled enumerators are hard to find. Then, too, unless the census 
 is taken on a single day, many persons will, by removal, entirely escape 
 the enumerators. 
 
 This census method is provided for in Iowa, Kansas, Ohio, Penn- 
 sylvania, and Vermont, except in certain municipalities. In Ohio the 
 assessors of each township and ward collect the data required by statute 
 covering all births and deaths that have occurred, and make a return of 
 the same to the probate judge of the county, and the assessor is to 
 state upon oath that " he has made diligent enquiry " to obtain these 
 facts, and he is not to be paid until his work is done to the satisfaction 
 of the probate judge. Provision is by statute made for other methods 
 in cities of over 150,000 inhabitants, and all municipalities are, through 
 their board of health, to have power to register births, marriages, and 
 deaths, and are required to register births and deaths, and all this regis- 
 tration work is under the supervision of the state board of health. 
 
 In Kansas the assessors collect the data for recording births, mar- 
 riages and deaths annually, and physicians are obliged to keep a register 
 of deaths and report them to the local board of health when required by 
 the state board of health. In Pennsylvania the assessors are to make 
 the enumeration semi-annually, " and it shall be the duty of parents, 
 guardians and other persons to furnish to such assessors the information 
 necessary." The assessors make semi-annual returns to the orphans' 
 court and make oath as to their correctness. . In Vermont the clerk of 
 the board of school directors and the clerks of incorporated school dis- 
 tricts are to take a census of births, marriages and deaths, and to report 
 to the town clerk by February first, each year. They are to receive fifteen 
 cents for each birth and death return, to be paid by the town. In 
 Iowa the assessor makes an annual enumeration of births and deaths. 
 
 Another and more satisfactory method is to require certain persons, 
 such as physicians, heads of families, or undertakers, to make returns 
 of deaths, either directly or indirectly, to the officer who is to record 
 
REGIS TIL 1 TION < >F VITAL 8 r J\ i TI& TI( '& 
 
 .... 
 
 them. In most states 1 physicians are required to certify to deaths. In 
 some states the terms doctor or surgeon are used. In Colorado it is 
 provided that "when two or more surgeons, physicians or midwives may 
 have attended professionally at any birth or death, that surgeon, physi- 
 cian or midwife who is oldest in attendance shall make the registry." 
 In California and Kentucky, if two doctors attend, the eldest of the 
 two shall sign. Usually it is -every physician who shall have attended 
 a person in his last sickness"* who shall give a certificate. In Minne- 
 apolis 2 it is "every physician who shall be in professional attendance 
 upon any person at the time or within twelve hours of the time of 
 death." In Rochester,' 5 in order that none but a person having knowl- 
 edge of the ease shall sign a certificate, it is provided that 
 
 "No physician shall issue any certificate of death under the ordinance of this 
 Board or the laws of this State, unless he was the medical attendant on the person 
 named in said certificate during his or her last illness, provided said person died 
 from natural causes." 
 
 In California "clergymen who officiate at a funeral" are obliged to 
 report the same. In most of the states mentioned coroners as well as 
 
 physicians are obliged to make returns, and in those states which have 
 medical examiners, as Massachusetts, Connecticut, and Rhode Island. 
 officers also are obliged to make special reports of all deaths which 
 they investigate. In California. Delaware. Maine, Massachusetts, Michi- 
 gan, New Hampshire, New Jersey, New York, and Rhode Island under- 
 takers are made responsible for all deaths coming under their charge; 
 also in a number of cities outside of these states. 1 In ( 'alifornia sextons 
 as well as undertakers are to make returns of deaths, and in many cities 
 in other states this is found as a municipal requirement. The form of 
 undertaker's return \\^r<\ in Milwaukee is shown in Appendix ;> >. 
 
 Other persons than those above mentioned are sometimes required 
 to make reports of deaths. Tims in Alabama it is any " other person 
 having at the time of death charge of a sick person," and iii New York 
 City it is the duty of ■•each person being with such deceased person at 
 his nr hei' death, and of the persons occupying or living in an\ bouse 01 
 premises in or on which an\ person \ die." The family is required 
 
 1 Alabama, California, ( lolorado, Connecticut, Delaware, Florida, Illinois, [nd 
 Kansas. Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Ne^ 
 Hampshire, \cw Jersey, N< \\ Sfork, North Dakota, Ohio, Rhode Island, liaji. 
 Vermont, Virginia, Washington, Wesl Virginia, and Wisconsin. 
 
 'Minneapolis, Rules and Regulations, Department of Health (1880), Sec. 28. 
 Rochester, Ordinances, Board of Health, ber6, Sec. 2. 
 
 'Allegheny, Charleston, Cincinnati, Cleveland, Districl of Colu 
 Minneapolis, Mobile, Philadelphia, Pittsburg, Reading, St. Loui Scranton. 
 
56 REGISTRATION OF VITAL STATISTICS. 
 
 to make a report of a death in Connecticut, Delaware, Illinois, Indiana, 
 Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, North 
 Dakota, Vermont, Washington, and West Virginia, and in Pennsylvania 
 the family is to give information to the assessors. In Massachusetts 
 " every householder — the eldest next of kin — the keeper of a work- 
 house, house of correction, prison, hospital or almshouse — and the 
 master or other commanding officer of a ship " shall give notice of 
 deaths among persons under his charge. The law has been adopted in 
 much the same form by several other states. In New Orleans 1 if there 
 is no relative in the parish the report of a death is to be made by the 
 executor if designated or by the landlord. 
 
 A number of states, as California, Maine, Maryland, Massachusetts, 
 and Rhode Island, require reports from the different classes of persons 
 mentioned above, independent of one another, so that in case of failure 
 each is equally liable. In other states, as Connecticut, Illinois, Indiana, 
 Missouri, Vermont, Washington, and West Virginia, the physician is 
 required to report deaths, and the next of kin or householder only when 
 there is no physician in attendance. In many states it is intended and 
 is provided by statute, that the physician and undertaker and sometimes 
 the family also shall act together, and this is doubtless the practice in 
 certain places where it is not prescribed. Thus in Maine and New 
 York the undertaker is to obtain from the physician the certificate of 
 death and present it to the local board of health. In Delaware, Massa- 
 chusetts, New Hampshire, New Jersey, Rhode Island, Vermont, and 
 Wisconsin, and in certain cities, as Atlanta and Cleveland, it is the duty 
 of the physician in attendance at the last sickness to furnish the certifi- 
 cate of death to the undertaker, but in Massachusetts and Wisconsin he 
 is to do so when requested. Nevertheless in practice in Rhode Island 
 the undertaker obtains it from the physician. The best provision is 
 that of the Michigan 2 law : 
 
 " Whenever any person shall die, the undertaker, householder, relative, friend 
 manager of institution, sexton or other person superintending the burial of said 
 deceased person shall cause a certificate of death to be filled out with all of the per- 
 sonal and family particulars required in section three of this act, and attested by 
 the signature of a relative or some competent person acquainted with the facts. 
 The physician who attended the deceased person during his last illness shall fill 
 out the medical certificate of cause of death. 11 
 
 In Denver and St. Louis the physician is to furnish two certificates, 
 one to the undertaker and one to the commissioner of health. The 
 blanks for both of these are furnished attached to one stub. In Omaha 
 
 1 New Orleans, Act number 80, approved 20 April, 1877, Sec. 10. 
 
 2 Michigan, Compiled Laws (1897), Sec. 4615. 
 
REGISTRATION OF VITAL STATISTICS. :,; 
 
 the physician reports upon a postal card directly to the board of health 
 the facts as shown below 1 and the undertaker obtains the rest of the 
 items before a permit is given. 
 
 In order to insure that physicians shall report all the deaths which 
 occur in their practice, it is advisable that they keep a current record of 
 the same. A number of states and cities require this. Thus in the 
 City of New York 2 
 
 " Every physician and professional adviser who has attended any person during a 
 last illness or has been present by request at the death of any person, shall make 
 and preserve a registry of such death, stating the cause thereof, and specifying the 
 date, hour, place, and street number of the place of such death.' 1 
 
 This rule has been copied in Chicago, Omaha, and other cities. 
 Even where it is not the law it is sometimes the custom, as when blank 
 certificates in book form with stubs are furnished to the physicians b\ 
 the state or city. 
 
 The interval of time after a death during which the return must be 
 made is important. It is necessary that births, marriages and deaths 
 should be reported promptly, otherwise they are forgotten and fail of 
 record altogether. In those states and cities in which a permit is 
 required before burial or removal, it is scarcely necessary to li\ this 
 limit. A very short limit is sometimes set for reporting deaths from 
 certain contagious diseases. Thus in Philadelphia physicians are 
 obliged to sign certificates of death from contagious diseases in twenty- 
 loiir hours, all others in forty-eight hours. 3 In Maine 4 the certificate 
 shall be madeand forwarded immediately. Such a regulation is hardly 
 
 Physicians are subject to prosecution ami fine for failure to return Certificate ol Death 
 to Commissioners ol Health within 241 re. 
 
 Certificate ok Death— Omaha, Neb. 
 
 
 Name 
 
 Sea 
 
 Married, Single or Widowed [Jf^^*] A- V,.. 
 
 Mo 
 
 Residence No. street 
 
 
 Date "*l l >« -: » t ii Duration of last illness 
 
 
 Cause ol Death primary 
 
 
 " " " — secondary 
 
 
 When no I »octor, in he i 
 signed bj « on r. i 
 
 
 M. I). 
 
 I ' adertaker 
 -city of \rw Fork, Sanitary Code (1809), Sec. I7'.». 
 :1 Philadelphia, Rules of Board of Bealth i L8 206. 
 
 1 Maine. Chapter lis .a 1891, amended by Chapter 154 of 1895, S< 
 
58 BEGISTRATION OF VITAL STATISTICS. 
 
 necesssary now that reports of cases of contagious disease are required, 
 and the local board of health is thus supposed to have a knowledge of all 
 cases, alive or dead. The limit for reporting deaths from other diseases 
 varies very much. In Illinois, Missouri, Washington, West Virginia, 
 and in certain cities, as Camden and Newark, N. J., reports of deaths 
 are to be made within thirty days. In Ohio cities physicians are to send 
 in their returns by the second Monday of each month, and in Denver 
 by the fifth day of each month. In Minnesota deaths are to be reported 
 within ten days. In New York City the family and friends are liable 
 to a fine if death is not reported in five days. In North Dakota the 
 time is five days. In Denver coroners must make their reports in 
 three days. In Charleston the doctor must report in three days. In 
 Philadelphia and Rhode Island physicians must sign the certificates of 
 death in forty-eight hours, and in Yonkers coroners must report within 
 the same time. In Vermont and in Brooklyn, Chicago, Erie, Mil- 
 waukee, Memphis, Omaha, and Rochester, deaths must be reported in 
 thirty-six hours. In Buffalo, Detroit, the District of Columbia, Flor- 
 ence, S. ('., Newburg, X. Y., Omaha, and Reading, the returns of deaths 
 must be made within twenty-four hours. In Portland, Ore., the time is 
 twelve hours. In Scranton and Albany the certificate of death must be 
 presented to the board of health twenty-four hours before burial. In 
 Xew York City coroners are obliged to report to the board of health as 
 soon as they are called to a death. In Milwaukee where the physician 
 is to report direct to the health department and not through the under- 
 taker, stamped envelopes are furnished on application, and in Omaha 
 postal cards. 
 
 The best method that can be devised to secure prompt and certain 
 returns of deaths is to require a permit from the board of health or some 
 official before burial or removal can take place. Burial and transit per- 
 mits are the first requisite of correct death registration, at least under 
 such conditions as exist in the United States. They are required by 
 statute in fifteen states, 1 and in many cities outside of these states. 2 
 In California. Massachusetts, Michigan, Xew York, in Xew Hampshire 
 cities, and in Wisconsin, and in most cities having local rules of their 
 own, the certificate of death is to be presented, and the permit obtained 
 
 California, Connecticut, Delaware. Florida, Indiana, Maine, MassachnsKs. 
 Michigan. Ohio, New Hampshire, Xew Jersey, except in unincorporated districts. 
 Xew York, Utah, Vermont, and Wisconsin, 
 
 -Atlanta, Baltimore, Denver, District of Columbia, Charleston, Chicago, Cincin- 
 nati, Cleveland, Erie, Florence. S. C, Minneapolis, Mobile, New Orleans, Omaha, 
 
 Pennsylvania cities of the second class, Philadelphia, Providence, Reading, Scran- 
 ton and .St. Lot i is. 
 
REGISTRATION OF VITAL STATISTICS. 59 
 
 from the local sanitary authorities when such have been established ; 
 but in Connecticut, Maine, New Hampshire and New Jersey the permit 
 for burial is to be issued by the town clerk or city clerk, and in Ver- 
 mont by thf town clerk, except in cases of communicable diseases. In 
 California, if there is no board of health, the permit is issued by a 
 justice of the peace. In Cleveland the permit is to be obtained from 
 the health officer or from a police station. In New Jersey 1 when it is 
 impossible to obtain a permit from the town clerk it may he obtained 
 from a judge or justice. 
 
 In Delaware a permit is not required, but undertakers are forbidden 
 to inter until a certificate lias been obtained from the physician. There 
 seems to be no valid reason why permits should not he required in all 
 cities, and the only objection to this requirement elsewhere — the diffi- 
 culty of obtaining a permit in sparsely settled regions — may he met as 
 in Connecticut, Maine and New Hampshire, by the appointment of sub- 
 registrars to issue permits. The Maine law is given below. 2 
 
 1 New Jersey, General Statutes (1895), p. 2008, Si 
 
 "That in case where, on account of the absence of the registrar of vital statistics 
 or the clerk of any city, borough, town or local municipal government, or for any 
 other sufficient reason, it may he impossible to obtain from such registrar or clerk a 
 permit in time for burial, it shall he lawful for any judge of the court of common 
 pleas or any justice of the peace of the county in which the deatb occurred, on 
 presentation of the certificate of deatb to him, ami being satisfied that such certifi- 
 cate is genuine, ami that no permit can he obtained in time for burial from the 
 clerk aforesaid, t" issue a special permit for burial in the following form: li 
 being impossible to obtain a burial permit from the registrar of vital statistics 
 or the clerk of i he [stating here t lie name of the city, borough, town or other local 
 municipal government], on accounl of state here the reason], I . a judge of the court 
 of common pleas or a justice of the peace], of the county of , do hereby 
 
 grant this special permit for the burial of . whose death has been 
 
 duly certified to me." which permit shall he dated and signed by such judg 
 justice; the said judge or justice shall transcribe a copy of said permit upon the 
 
 back of the certificate of death, shall give th iginal permit to the person deliver 
 
 ing to him the certificate of death, and shall transmit the certificate with the trans- 
 cription theron indorsed, by mail, in an envelope marked "burial permit.'" to the 
 state in i tea u of vital statistics, at Trenton; the judge or justice who shall issue anj 
 such permit shall be entitled to charge and receive from the person presenting to 
 him such certificate of death the sum of fifteen cents." 
 
 2 Maine, Chapter 118 of 1891, a- amended by Chapter i"> I of Ifi 
 "Se( rios 8. The town or city clerk shall appoint two suitable and propei 
 sons, in each town or city, as sub-regist tars, who shall be authorized to issue b 
 permits based upon a death certificate, as hereinbefore provided, in the same man- 
 
 mi as is required of the town or city clerk; and t he said record of death upon 
 
 the permit is issued shall be forwarded to the town clerk within 
 
 receiving the same, and all permits by whomsoever iss 1 shall be returned I 
 
 town clerk as re.pt i red bj section seven of this act. The appointniei 
 
 t rats shall he made with reference to locality, BO as to best suit t he 
 
60 REGISTRATION OF VITAL STATISTICS. 
 
 To provide for unincorporated regions it was enacted in Maine that 
 the death, marriage or birth should be reported to the nearest town 
 clerk and recorded by him. 1 In Michigan permits are not required in 
 sparsely settled townships having an average density of population of 
 less than five (5) persons per square mile at the time of the last pre- 
 ceding United States or State Census ; but when that density of popu- 
 lation is reached, the law is to go into effect. In New Jersey for the 
 convenience of undertakers it is provided that when a burial is to be in 
 a place other than the township where the death took place the under- 
 taker may present the certificate of death in the town of burial or in his 
 own town, and there receive the permit, but he must deposit with the 
 certificate two cents for postage, and the registrar must send the certifi- 
 cate by mail to the township where the death occurred. 
 
 Trouble has arisen in Pennsylvania where a cemetery lies in two 
 municipalities, so that a statute was necessary which declared that a 
 burial permit issued by either is valid. 
 
 As an example of statutory provisions requiring burial permits, the 
 following from the Michigan 2 law may be cited : 
 
 " The body of no person whose death occurs in the state shall be interred, 
 deposited in a vault or tomb or otherwise, or removed from the township, village or 
 city in which the death occurred, until a permit for burial or removal shall have 
 been properly issued by the clerk of the township, village or city in which the death 
 occurs." 
 
 Various forms of burial permits are used. A very simple form has 
 been used in Providence for over forty years and has been entirely sat- 
 isfactory. Indeed, if the permit is merely to be kept by the undertaker, 
 or presented at a local cemetery, a simpler form giving merely the date 
 of issuing the permit, date of death, name of deceased, place of burial, 
 and undertakers name might do just as well. If it is desired to 
 keep a record of permits issued, as is the custom in many places, the 
 permits may be attached to a stub and bound in book form as in 
 Michigan. If it is required that the undertaker leave the permit with 
 the keeper of the cemetery, it is well to have a voucher attached for the 
 undertaker to keep, as in the form recommended in Maine. The rules 
 
 the inhabitants of the town, and such appointment shall be in writing and recorded 
 in the office of the town or city clerk. 
 
 " Section 9. Town clerks and sub-registrars may issue burial permits to persons 
 in contiguous towns, when by so doing it would be more convenient for those seek- 
 ing a permit, but in all cases the permit shall be made returnable to the town clerk 
 of the town in which the death occurred.'" 
 
 1 Maine, Chapter 118 of 1891, as amended by Chapter 154 of 1895, Sec. 20. 
 2 Michigan, Compiled Laws (1897), Sec. 4614. 
 
REGISTRATION OF VITAL STATISTICS. 61 
 
 recommended by the American Association of General Baggage Agents 
 and adopted by a large number of states, require that every body ship- 
 ped by a common carrier shall be accompanied by a transit permit and 
 "the transit permit must be made in duplicate with the signatures of 
 all attesting parties. The duplicate copies shall be sent to the secre- 
 tary of state or provincial board of health of the state or province from 
 which the shipment was made. 
 
 When dead bodies are shipped by express the whole original transit 
 permit shall be pasted upon the outside box, and the duplicate for- 
 warded by the express agent to the secretary of the state or provincial 
 board of health of the state or province from which such shipment was 
 made." 
 
 Examples of different forms of permit are shown in Appendices 
 4 to 7. In Denver and St. Louis two certificates are furnished by the 
 physician, one of which is taken by the undertaker to the health depart- 
 ment and endorsed on the back. It then serves as a permit and is left 
 at the cemetery. 
 
 The object of requiring permits before burial is to secure the report- 
 ing of all deaths that occur, and therefore failure to obtain such a per- 
 mit is punished by fine. In addition to such requirement and its pen- 
 alty, a second safeguard is sometimes made use of. \.>t only is the 
 undertaker required to obtain a permit before the burial of the body, 
 but he is obliged to deliver it, together with the body, to the keeper of 
 the cemetery, who in turn is required to return it to the officer by whom 
 it was originally issued. By this means the chance of a death occurring 
 without a record of the same is very much lessened. 
 
 To secure the greatest value from such a regulation it should be 
 part of the statute law as it is in Maim-. If it is merely a local regula- 
 tion no control is had of burials in out of town cemeteries, and espe- 
 cially when the body is removed by out of town undertakers, as may 
 easily be done without the knowledge of the local registrar. Local 
 regulations of this kind are found in Charleston, Cleveland, District of 
 Columbia, Memphis, Minneapolis, New burgh. New York, Omaha, Phil- 
 adelphia, St. Louis, Scranton, and honkers. In Buffalo the sextons 
 
 nd in the permits annually; in Newburgh every three months: in 
 Yonkers on the first of every month; in Omaha within five days ; but 
 
 in most cities they arc returned weekly. In Maine the permits are to 
 
 be returned to the clerk of the town within six days after the da 
 
 burial. 
 
 In Cambridge, Mass., permits are to lie returned if nol used. 
 In certain other cities, n- Atlanta, Augusta, Lowell, Milwaukee, and 
 New Orleans, sextons arc required to keep a complete i 
 
62 
 
 REGISTRATION OF VITAL STATISTICS. 
 
 burials, and in some cities to report the in to the health department. 
 The form used for this in Milwaukee is given below. 1 
 
 Sometimes a permit is required when a body is to pass through a 
 city as in Cleveland, the District of Columbia, Minneapolis, Newark, 
 and New York. Occasionally, as in St. Louis, it is specified that it 
 shall not be required. 
 
 Whenever a body is brought into a township for burial it is advis- 
 able that that fact should be recorded. Permits for burial are in such 
 cases required in many cities, as Atlanta, Buffalo, Cambridge, Mobile, 
 Newark, Paterson, Philadelphia, Reading, St. Louis, Wilmington, Del., 
 and Yonkers. In Philadelphia the transit permit in such cases must 
 also have the local undertaker's certificate which must state the place 
 from which the burial is to take place. If an out of town body in St. 
 Louis is not accompanied by a certificate of death, it must be referred 
 to the coroner. In Wilmington, Del., a body dead of contagious dis- 
 ease cannot be brought into the city for six months after death. In New 
 Jersey 2 it is provided that when a body is brought into the state for 
 burial it must be accompanied by a certificate of death, or else one mast 
 be obtained from some physician in the town or city where the burial 
 is to take place, and a permit for burial must then be obtained. In 
 Connecticut 3 the permit in such cases must be obtained of the registrar 
 of the town where the burial is to take place. The Maine law is very 
 similar. In Providence permits for burial of bodies brought to the city 
 are not required, but undertakers must in all cases return certificates 
 of death within ten days after the body has been brought into the 
 city. 
 
 In California, Delaware, and New York, undertakers are forbidden to 
 bury a body until a permit is obtained, and if this is strictly enforced it 
 
 Milwaukee, Wis.. 
 
 189. 
 
 To 
 
 Registrar of Vital Statistics. 
 Sir: Following is a list of burial permits received at the 
 for the month of 189- 
 
 Cemetery 
 
 Secretary. 
 
 Permit 
 No. 
 
 NAME. 
 
 Date 
 of 
 
 Burial. 
 
 Permit 
 No. 
 
 NAME. 
 
 Date 
 
 of 
 Burial. 
 
 2 New Jersey, General Statutes (1895), p. 2008, Sec. 7. 
 
 3 Connecticut, Chapter 155 of 1893, Sec. 3. 
 
REGISTRATION OF VITAL STATISTICS. 63 
 
 would apply to bodies brought into the town for burial as well as those 
 of persons who died there. 
 
 The laws which require permits generally specify that no body 
 shall be ''buried, removed from the city or otherwise disposed of" 
 without the permit, and in the California law is added the word 
 cremated. In Wisconsin no undertaker is to prepare a body tor incinera- 
 tion without a permit. 
 
 For legal, genealogical and other purposes, it is very desirable thai 
 the deaths, births, and marriages of members of resident families should 
 be recorded in the place of residence, even if the birth, marriage, or 
 death takes place elsewhere. In the case of deaths, if the body is 
 returned to the place of residence for burial, as frequently happens, and 
 if such burials are reported, the facts may go on record. The .Maine, 
 Massachusetts, NVw Hampshire, and Rhode Island laws contemplate the 
 record of the births, marriages, and deaths in the place of residence, and 
 the provisions in Rhode Island are given below. 1 
 
 If a similar law should be adopted in all states, records of this kind 
 could be made very complete. It is sometimes objected that in regard 
 to births and marriages it is an unwise provision. It is said that a 
 certainty of the. publicity of a marriage or birth at home will often deter 
 a man from marrying the woman with whom he has had improper rela- 
 tions, while if secrecy for the time could lie secured he would be read} 
 to enter into marriage Whether such a view of the law is warranted 
 it is perhaps not easy to determine. 
 
 Items required "/> Death Returns. 
 
 The information concerning deaths required for record varies very 
 much in different cities and states. There has been a progressive in- 
 crease in the number of facts to be recorded. Ill the earliest colonial 
 
 1 Rhode Island. General Laws. Chapter LOO, Sec. IT. as amended by Chapter L262 
 ef the Public Laws: 
 
 "Tlie clerk or regis! rar of each town and citj shall on the flrsl daj "i cadi and 
 every month make a certified copy of all births, marriages, and deaths recorded in 
 
 the books of sail I tOWD OT city during (lie |'le\ in I Is 111' ail li. \\ he never the | 'ale Ills ,.| 
 
 the child born, or the bride or the groom, or the deceased person, were resident in 
 : 1 1 1 > other town or city in i his state or in anj other state ai the time of said birth, 
 marriage or death ; and shall I ransmii such certified copies to the clerk or regisl rar 
 of the town, city or state in which such parents of the child born, the bride or the 
 
 gr or the deceased, wen- resident al the time of said birth, marriage, or death, 
 
 stating in case oi a birth, the name of the streel and number of the house, if anj 
 where such parents resided, the place of birth of such parents and the maiden name 
 of t he 1 1 km her. whenever the same can be ascertained ; and the clerk or i 
 receiving such certified copies shall record the same in the books kepi for recording 
 births, marriages, and deaths. Such certified copies shall be made upon blanks to 
 be furnished for thai purpose h.v the secretary of the -cue board of health." 
 
64 REGISTRATION OF VITAL STATISTICS. 
 
 records it was customary to record in most cases merely the name and 
 date of death, though the age or parents* or husband's name was some- 
 times given. It is only during the present century that additions have 
 been made to those simple records. About the beginning of the cen- 
 tury the cause of death began to be recorded in Boston and Philadel- 
 phia, but it was not for many years and until after the development of 
 interest in public sanitation, that this became general. With the in- 
 crease of population better means of identification were needed, and age, 
 names of parents, etc., came to be added. With the great interest 
 which has been aroused during the last half of the century in sanita- 
 tion, in social science, and in statistics, a large number of items have 
 been considered desirable in death returns. Undoubtedly the more 
 facts that can be recorded accurately, the better will it be for the prog- 
 ress of science ; but there must be a limit. If too many data are re- 
 quired, or data which it is not easy for the reporter to ascertain, care- 
 fully made returns cannot be expected, and inaccuracies will result which 
 will be anything but helpful to science. 
 
 Much care should be used in devising a schedule of items for death 
 returns, and probably the value of any form can be fully tested only by 
 experience. It seems to the writer that in order to satisfy sanitary and 
 social requirements a return of death should contain 
 
 Name, 
 
 Date of death, 
 
 Place of death, 
 
 Usual residence, 
 
 Age, 
 
 Sex, 
 
 Color or race, 
 
 Civil condition, 
 
 Husband's name, if wife or widow, 
 
 Occupation, 
 
 Place of burial, 
 
 Cause of death. 
 
 These should be certified to by the physician and undertaker if such 
 were in attendance. The above are essential and are required wherever 
 registration is at all satisfactory. Other items which are often required 
 and are very useful are 
 Birthplace, 
 Names of parents, 
 Birthplaces of parents, 
 Duration of disease. 
 
REGISTRATION OF VITAL STATISTICS. ,;;, 
 
 Some of the above items require explanation. 
 
 Place of death. 
 
 The Massachusetts, Michigan, Pennsylvania and other laws specify 
 that if in a city, the ward, street, and number of the house must be 
 given. In Charleston if the death occurs in an institution the name 
 of the institution must be given. In Buffalo and Brooklyn the floor of 
 the house must be given and the number of families in the house. In 
 Connecticut the number of families must be given in the usual resi- 
 dence, if the deceased resided in a tenement house. 
 Age. 
 
 In Massachusetts one of the requirements of the death certificate is 
 "the supposed age,"' presumably to indicate that if the exact age is not 
 known the approximate age should be given. In Wisconsin and 
 Michigan it is specified that the age shall be given in years, months and 
 days. In New Jersey and Buffalo a blank for hours is left. The Wis- 
 consin law and the blanks used in Rhode Island require the date of 
 birth of the deceased, and it would appear that fewer errors would 
 occur if this were given. Relatives remember the date of birth, not 
 the age in years, months and days, and for them or the undertaker to 
 calculate the latter is not a particularly easy arithmetical problem. 
 
 Color. 
 
 The color distinctions usually made are White and Colored, though 
 distinctions in the latter as Mulatto and Quadroon arc sometimes asked 
 for. This distinction of Black and Mulatto would be very valuable if 
 it could be obtained, but attempts to obtain it do not seem to be suc- 
 cessful. Indian and Chinese are racial distinctions, but are sometimes 
 noted under this heading. In California and Milwaukee race is to he 
 Specified, the intention doubtleS8 being to require a distinction to be 
 made between Caucasian so-called, Indian and Chinese. I'rohabb it 
 WOUld be best to have one item, Ibice or ( lolor, and the individual Would 
 
 then be designated as White, Colored, Indian, or Mongolian, which 
 would meet all conditions now commonly existing in the United States. 
 ( Occupation. 
 
 In Wisconsin it is to be reported " whether the deceased was ever a 
 soldier or sailor in the service of the United States. 
 
 Place of Burial. 
 
 The Michigan Law requires " the proposed place of burial or place 
 
 and route of removal." 
 ( 'anse of I )eath. 
 
 Mosl forms for returns of death ash for Cause of death.' Prii 
 Secondary? and a etimes a line is given for complications. 
 
66 B.EG is TEA TION OF I Y 7\ I L S T. I TIS TIC 1 S. 
 
 writer has found that much confusion exists in the minds of physicians 
 as to whether Primary ? refers to time or to the importance of the dis- 
 eased condition. Furthermore many feel obliged to write in two causes 
 instead of one in every case. It lias been found possible to obtain a 
 better picture of disease conditions by dropping the words primary and 
 secondary, and adding several blank lines to encourage a detailed ac- 
 count of the case. This appears to be quite important. It is utterly 
 impossible in many cases to give a correct explanation of a death in a 
 single line, and the attempt to do so is quite likely to be misleading. 
 If the physician can be induced to tell the story at some length, greater 
 accuracy is more likely to be obtained. The Massachusetts law only 
 requires the primary and secondary causes if " the deceased was a 
 soldier or sailor who served in the War of the Rebellion.*' 
 
 Accuracy in stating the cause or causes of death is of the utmost 
 importance and every registrar knows that a considerable proportion of 
 the returns coming to him are valueless in this respect. How to get 
 better results is one of the most important problems in registration. 
 Intelligence and education on the part of the medical attendant is the 
 chief factor in correct diagnosis, and whatever tends to raise the stand- 
 ard of the profession in these respects makes for more perfect registra- 
 tion. Progress must be slow, but the adoption of the practice of licens- 
 ing physicians, and establishing a high educational qualification, will do 
 much for registration, as it will also for sanitation proper. With the 
 licensing of a physician must go a rule forbidding all but licensed medi- 
 cal men signing a death return. Such a rule is now in force in a few 
 cities as the District of Columbia, Charleston, Rochester, and St. Louis. 
 Even the best educated physician at times cannot arrive at the true 
 cause of death without an autopsy. We cannot expect to see the power 
 to make autopsies conferred by law, but it is easily observed that the 
 higher the education and abilities of the physician the more often are 
 autopsies performed. The higher the intelligence the more sensibly are 
 the limitations of diagnosis perceived, and the more urgently and suc- 
 cessfully are post mortem examinations sought. In Denver 1 the health 
 commissioner is authorized to order an autopsy in obscure cases. 
 
 I Denver Ordinances, No. 44 of 1893, Sec. 152 : 
 
 II Whenever, in the opinion of the health commissioner the canse of death of any 
 person as given in the certificate of the physician, coroner or other professional at- 
 tendant of the deceased person is incorrect, obscure or false, and it is in the health 
 commissioner's judgment in the interest of the public health that such cause of 
 death shall more accurately, truthfully and correctly be ascertained, it shall be the 
 duty of the health commissioner to make, or cause to be made, a post mortem exam- 
 ination of the body of such deceased person, and to this end he is hereby empowered 
 to enter upon any premises in order to discover and properly examine such dead body, 
 or to cause such dead body to be disinterred, if it has been already buried. 1 ' 
 
REGIS TJL 1 TION OF VITA I S T. I TIS Tit <S. \ j 7 
 
 It is not, however, likely that in American communities, public 
 opinion would permit of such a procedure other than in very excep- 
 tional cases. 
 
 One of the most effectual methods of improving- the character of 
 physicians' returns of the cause of death is by letters of inquiry sent out 
 by the registrar who receives the returns. Busy practitioners arc often 
 careless in filling out returns, and frequently they do not appreciate 
 the importance of certain points which are of the greatest value in 
 compiling statistics. Mistakes and ommissions in returns of death can 
 be largely overcome by correspondence between the registrar and the 
 physicians. In Providence a blank form is used for convenience in 
 sending out these inquiries, a stamped return envelope is enclosed, and 
 it is seldom that such a communication fails to elicit a courteous and 
 satisfactory response. The following by-laws are enforced by the board 
 of health of the City of New York: 
 
 " Certificates of death willb< returned for additional information, which give any 
 <>f the following diseases, without explanation, as the sole cause <>f death : 
 Abortion, Erysipelas, Meningitis, Phlebitis, 
 
 Cellulitis. Gangrene. .Metritis. Py»mia, 
 
 Childbirth, Gastritis, Miscarriage, Septicaemia, 
 
 Convulsions, Hemorrhage, Peritonitis, Tetanus. 
 
 (Am one of these may be t he result of an injury, and thus lie a subject for 
 investigation by a coroner. If it is ma. the certificate should make that facl plain. 1 
 
 No certificate will be accepted which gives a mere symptom as the sole <- ; ei^c of 
 death (such as 'asphyxia,' 'debility, 1 'dropsy, 1 'heart failure, 1 etc'. 1. unless accom- 
 panied by a satisfactory written explanation." 
 
 To prevent ;t common form of unsatisfactory and careless return it 
 is provided in Maine and Connecticut l>\ statute, and in Philadelphia 
 by regulation, that death certificates with -heart failure" as a can-' oi 
 death will not be received : and in Wisconsin and Iowa this cause will 
 not l»e received on a transportation permit. In the latter state the 
 reason is given that it was used by unscrupulous persons to conceal 
 death from contagious disease. 1 
 
 Another difficulty in the wa\ of obtaining a satisfactory legist ration 
 
 of causes is the fact that a ceil a in number of deal lis occur w it ho ill the 
 attendance of a medical man. It is necessary that all such should be 
 
 Investigated l>\ some competent person. Of course if violence is sus- 
 pected, it is a proper case for the medical examiner or coroner whose 
 report will he returned in due season, as is provided for l>\ the laws 
 governing such cases ; bul often persons die suddenl} when there is no 
 suspicion id' violence, and it is these that need special investigation. 
 In Alabama the count} health officer is to "make such 1 irtifi 
 
 1 [owa, hep, ,n of the State Board of Health 1801, p. 104. 
 
68 REGISTRATION OF VITAL STATISTICS. 
 
 otherwise a proper certificate cannot be obtained/' In Connecticut, 1 
 "in case no physician attended such deceased person, or in case of the 
 inability of the attending physician, by reason of sickness, death, or 
 absence, to make out said certificate, the nearest of kin shall procure 
 such certificate from some other reputable physician or member of the 
 board of health of the town in which such person died." 
 
 In California and Utah when there is no physician, the cause of 
 death must be sworn to by two reputable citizens (except that in Utah 
 cities the case is to be investigated by the health officer) and in New 
 York in non-medico-legal cases, it must be " sworn to by some credible 
 person known to the officer granting the permit." In Atlanta and Buf- 
 falo the city physician is to certify to all deaths without a medical 
 attendant, and in Cleveland it is a similar officer known as the district 
 physician. In New York when no physician is in attendance, an affi- 
 davit must be attached to the certificate stating the circumstances of 
 death. In Massachusetts the chairman of the board of health or any 
 physician employed by any city or town for that purpose shall sign the 
 certificate. In Michigan the registrar is to refer such returns to the 
 health officer, except that when the health officer is not a physician the 
 registrar is to fill the return to the best of his ability. In New Hamp- 
 shire the town clerk is to get the facts from relatives. In Wisconsin 
 any physician or justice of the peace may be employed to sign the 
 return where there has been no physician in attendance. In New 
 Jersey if no physician attended such deceased person, or if the attend- 
 ing physician is absent or sick any physician may view the body and 
 sign the certificate. The best provision appears to be that of the 
 Rhode Island law: 2 
 
 " Whenever the body of a person is lying dead in any town or city who has been 
 unattended by a physician in his or her last sickness, the town or city clerk, or in 
 the city of Providence the city registrar, shall call upon a registered physician or the 
 medical examiner of the district in which the remains are lying, to inquire into and 
 to certify as to the cause and manner of death, and shall allow to said physician or 
 medical examiner the fee of two dollars which shall be paid out of the town or city 
 treasury of said town or city upon the order of said town or city clerk or registrar.' 1 
 
 In Providence the registrar has under this law requested the chief 
 of police to instruct his officers to promptly report all sudden deaths or 
 deaths without medical attendance to the medical examiner. If the 
 latter decides that there is a suspicion of violence he makes it a medical 
 examiner's case and receives his fee, four dollars from the state. If it 
 
 1 Connecticut, Chapter 155 of 1893, Sec. 1. 
 
 2 Rhode Island, Chapter 452 of the Public Laws, amending Sec. 9 of Chapter 100 
 of the General Paws. 
 
REG IS TEA TION F VI T. i I s r. 1 77 8 77 C& 69 
 
 is not a medical examiner's case he reports the probable cause of death 
 to the registrar and receives two dollars from the city. By this method 
 satisfactory returns are promptly obtained. If cases without suspicion 
 of violence are reported to the registrar by undertakers or any others 
 than the police, the registrar sends the medical inspector of the depart- 
 ment to investigate the case. 
 Undertaker's Name and Address. 
 
 Wherever the undertaker is wholly or partially responsible for returns 
 of death he is required to sign the same, and sometimes as in Michigan 
 his address is to be given. In Massachusetts, New Jersey, Denver, 
 the City of New York, and Pennsylvania cities of the second class, the 
 place of business of the undertaker is to be given and in Cleveland his 
 office or residence. 
 Physician's Name and Address. 
 
 Usually it is deemed sufficient for the physician to certify as to the 
 cause of death, but sometimes as in Michigan, Massachusetts, New 
 Jersey. New York, Buffalo, Detroit, Denver, and Pennsylvania cities 
 of the second class his address is to be given. 
 Birthplace. 
 
 The Pennsylvania law requires the "street and number if possible,'' 
 and'the Michigan law the " state or county if not born in Michigan.' 1 
 It is often impossible to determine the exact place of birth, but it is 
 usually possible to ascertain whether or no1 it was in the United Slates. 
 As this is of great importance for statistical purposes it is necessary 
 for the registrars to instruct undertakers and other reporters concern- 
 ing it. Sometimes nativity is required instead of birthplace, in which 
 case the country of birth or nationality is intended. 
 Names of Parents. 
 
 In Pennsylvania tins is only required in case of minors, and in 
 Charleston in the case of unnamed infants. By name of mother is 
 usually meant and often specified the maiden name. 
 
 Birthplaces of Parents. 
 
 It is highPj desirable that theseshould be given it possible, ami the] 
 are asked lor on the returns of .Maine, Massachusetts, Michigan, New 
 Hampshire, and Rhode [sland. In Delaware the "name and nation of 
 the parents"is asked for. Here again the distinction between the 
 United States and foreign countries can usually be made even when 
 more accurate data are Lacking, and should always be insisted on. It 
 
 is probably this distinction of native and foreign that is intended where 
 merely nativity of parents is asked lor as in the I Ynnsyh ania ■•ltd 
 
 but full information should be (riven if it can be obtained. 
 
7() REGISTRATION OF VITAL STATISTICS. 
 
 Duration of the Disease. 
 
 Usually the duration of both primary and secondary causes of death 
 is asked for, and in Providence this distinction is retained under dura- 
 tion although it is omitted from cause. 
 
 Other items are occasionally noted on death returns. 
 The Date when Physician last saw Patient. 
 
 This is required in Charleston, where the physician is to subscribe 
 to the following : " I hereby certify that I attended deceased from 
 
 18 to 18 that I last saw alive on the 
 
 day of 18 " 
 
 A similar form is used in Michigan, New Jersey, and New York. 
 
 Place where Disease was Contracted. 
 
 Among the items required by the Colorado law are -when and 
 where the disease was contracted," and the same phrase with the 
 proviso, " if known.*' is found in the rules of the Omaha department of 
 health and upon the certificate in Mobile. 
 
 Term of Residence. 
 
 In Buffalo, Charleston, the District of Columbia, Minneapolis, and 
 Pennsylvania cities of the second class, the time of residence in the 
 place of decease is to be given. In Buffalo, Charleston, and the City 
 of New York, if the deceased was of foreign birth, the duration of resi- 
 dence in the United States as well as in the city must be given. In 
 Minneapolis, New Jersey, and Iowa, the time of residence in the state 
 is asked for. 
 Place of Previous Residence. 
 
 In Pennsylvania cities of the second class, the place of previous 
 residence is required, and also in Cincinnati, but only -in case of non- 
 residents"; this is practically the same as - usual residence." So also 
 in Charleston the returns from institutions must give the residence 
 before admission. 
 
 Date of Burial. 
 
 This is required in Maine, New Hampshire, Pennsylvania, Cleve- 
 land: and in Buffalo, Cincinnati, and Detroit, the day and hour of the 
 funeral. 
 
 Name of Wife. 
 
 In the case of married women and widows the name of the husband 
 is usually required. . In the case of a married man the name of the wife 
 is required in Rhode Island. Virginia. Wisconsin, and Detroit. 
 
 Age at First Marriage. 
 
 This is one of the questions to be answered on returns of death in 
 Michigan. 
 
REGISTRATION OF VITAL STATISTICS. ~\ 
 
 Parent of how many Children, of whom how many are living. 
 
 It is evident that if these questions could be truthfully answered 
 we could speedily reach conclusions as to the absolute fertility of our 
 population, and the relative fertility of different classes. We have as 
 yet nowhere in the United States been able to settle these questions by 
 an enumeration or registration of births. The results of the experi- 
 ments in .Michigan will he awaited with much interest. Their value 
 must depend entirely upon the degree of accuracy with which the 
 answers to these queries can lie obtained. 
 
 The number and date of the burial permit must he noted on the 
 death return in Wisconsin. The Michigan law requires that the return 
 he numbered, and the blanks furnished in New York, have ;i place 
 for a serial number. The Minnesota blanks have a place for date of 
 return. In Connecticut the date when the certificate is received is en- 
 dorsed on the back, and in Massachusetts the date of filing is noted on 
 the back. 
 Name of Informant. 
 
 The personal and family particulars required for a return of a death 
 must usually he furnished by some one other than the undertaker or the 
 physician. The Michigan law prescribes that the person who gives the 
 information shall sign the return and append his address. Iii Rhode 
 [sland the name of the informant is required (but not the signature). 
 and in New Orleans the ••name, age and residence of the declarant and 
 
 his relationship, if any. to the deceased.*" It is of great convenience to 
 
 the recording officer and conduces to accuracy if the items on the return 
 
 arc arranged as nearly as possible in the same order that they are on the 
 permanent record if such record is to he made. Forms of death returns 
 arc shown in Appendices 8 to 1 -1. 
 
 Births. 
 
 Records of births like records of deaths are obtained in various 
 ways. One method is 1>\ enumeration. This method is vm unsatis- 
 factory, but is employed in Michigan, Ohio (excepl in cities of the firsl 
 
 class), and Pennsylvania, and Iowa in 1898 went back to this thod. 
 
 Until 1896 ii was the onlj thod in Rhode Island. Besides the above 
 
 states, Kansas, Maine. Massachusetts, New Jersey and Rhode Island 
 supplement the reports of physicians l>\ an annual enumeration. In 
 Michigan the township supervisors between 1" April and 1 Jun 
 each year make an enumeration of all births occurring during the year 
 ending on the ; Mst of the preceding December, and forward the returns 
 
 to the count} clerk: except thai in Detroil the comn :ounci] 
 
 appoint persons especiall} for this work. In Pennsylvania the 
 
72 REGISTRATION OF VITAL STATISTICS. 
 
 make the enumeration semi-annually. In Kansas, Maine, New Jersey, 
 and Ohio the assessors make the enumeration annually, and in Massa- 
 schusetts and Rhode Island the town clerks make the enumeration in 
 January of each year ; but in Providence the city registrar makes the 
 enumeration semi-annually. This method is very unsatisfactory, and in 
 the city of the writer skilled enumerators fail to obtain nearly forty per 
 cent, of the births. 
 
 The usual method of securing birth records in the United States is 
 to require reports from the attending physician or midwife. 1 
 
 Usually it is the physician or midwife or accoucheur who is to re- 
 port, and sometimes it is " any other person in charge," as in Maine. 
 In Delaware 2 it is the "physician present at the birth of any child, or (if 
 not present at the birth of the child) who attends the case of any mother 
 during her lying-in period," ..." and every midwife present at 
 the time of, or within five days after the birth of any child, where no 
 physician is attending said case." In Alabama, California, and in a few 
 cities, as Brooklyn, New York, Chicago, Cleveland, Denver, Omaha, and 
 the Pennsylvania cities of the second class, the physicians are to keep 
 registers of all births attended. 
 
 Another method is to require the parents or householder to report 
 the births of their children or such as occur in their families. Wiscon- 
 sin is the only state which relies upon this method alone, and as the law 
 only went into effect 1 July, 1897, it has never as yet had a fair trial 
 in this country. 3 There are, however, a number of states in which the 
 parents and head of the family are made equally responsible with the 
 physician in reporting births, the same persons usually being specifically 
 mentioned that are named in the corresponding sections of the law- 
 requiring reports of deaths. Sometimes the responsibility rests on both 
 parent and physician, and sometimes the parent is required to report 
 only when there is no physician or midwife in attendance. In New 
 Orleans 4 "it shall be the duty of the father, or, in his default, of any 
 person present at the birth of any child, to report within twenty-four 
 
 1 The following states have such laws upon their statute books: Alabama, Cali- 
 fornia. Colorado, Connecticut, Delaware, Florida, Illinois, Indiana, Kansas, Ken- 
 tucky, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, 
 New York, North Dakota, Rhode Island, Utah, Vermont, Washington and Wis- 
 consin. It is also required in the cities of Atlanta, Florence, S. C, Memphis, 
 Mobile, Omaha, Philadelphia, the Pennsylvania cities of the second class, and 
 Scranton. 
 
 2 Delaware Revised Code (1893), p. 405 (Chapter 381, Vol. 16, Laws of Delaware.) 
 
 3 This law was repealed in 1899, and reports are now required from physicians and 
 midwives, as well as from parents. 
 
 * Louisiana, Chapter 80 of 1877, Sec. 9. 
 
REGISTRATION OF VITAL STATISTICS. 
 
 i •> 
 
 hours from the date of said birth, at the office of the board of health, 
 such birth, which report shall be recorded in presence of two witnesses." 
 
 In Providence for a year or two before the enactment of the statute 
 requiring physicians and mid wives to report, physicians were requested 
 to report births, and clergymen baptisms, and they were paid ten cents 
 for each birth and baptism reported. With a little urging, reports were 
 obtained from most of the Catholic and Episcopal churches and from 
 many of the physicians. After the statute went into effect requiring 
 reports from physicians, the report of baptisms was no longer sought, 
 except from the French, Italian, and Portuguese churches. It is found 
 that the reports from these churches are still needed to complete and 
 correct returns received from other sources. 
 
 The Vermont statute provides that the head of a family moving into 
 the state may have the births of his children recorded. 
 
 Examples of forms for birth returns are shown in Appendices 12 
 and 13. 
 Time Limit for Reports. 
 
 In California, Colorado, Delaware, and Utah the returns of births 
 must be made by doctors and midwives quarterly. In Massachusetts 
 parents must report in forty days. In Connecticut, Maryland, Massa- 
 chusetts, and Rhode Island physicians must report monthly. In Con- 
 necticut and Rhode Island physicians and midwives must report during 
 the first week of the next month, and in Maryland and Massachusetts 
 during the lirst five days of the succeeding month. In Illinois. New 
 Jersey, New York, Washington, and Wisconsin the time is thirty days: 
 in Minnesota, Vermont, Cincinnati, Cleveland, the Citj of New Y^ork, 
 Paterson, Pennsylvania cities of the second class, and Scranton, ten 
 days, in St. Louis and Mobile, seven days, ami in Maine. New Hamp- 
 shire, and the District of Columbia, six days: in North Dakota, 
 
 Chicago, St. Paul, and Memphis, five days, for midwives in Maryland 
 four days: in Buffalo and Charleston, three days, and in Omaha and 
 New Orleans, twenty-four hours. Promptness is evidently desired, but 
 it is to be feared that it is frequently not obtained. Physicians, left to 
 their own devices, are apt to he dilatory. Sometimes efforts are made 
 to secure promptness otherwise than by the threat of penalties. In 
 New- Jersey the Law requires that the assessors shall annually, in April, 
 
 send to the physicians twelve stamped and addressed envelopes in which 
 
 the\ shall semi in their returns monthly. In Providence physicians 
 are furnished with return envelopes, and doubtless this practice is fol- 
 Lowed in other cities, In Cincinnati the sanitarj police keep a list ot 
 clergymen, doctors, and midwives, and call on them monthly lor then 
 returns. In Philadelphia there are two collectors of vital statistics who 
 
74 REGISTRATION OF VITAL STATISTICS. 
 
 visit practitioners of midwifery monthly to collect returns of births. 
 Nevertheless the number of births recorded in these two cities is doubt- 
 less much less than the number which actually occurs. In Chicago, 
 where the Illinois law has for twenty years required that doctors and 
 midwives shall report births without compensation, the returns were 
 very defective. Physicians would not take the trouble to make out a 
 long report and send it in at their own expense without compensation. 
 To lessen their" labor the commissioner of health now distributes postal 
 cards on which only the items necessary for identification are to be 
 given. The form of card used is shown below. 1 
 
 On receipt of this card the registrar proceeds to obtain from the 
 parents the rest of the required information ; by this means the commis- 
 sioner. Dr. Arthur K. Reynolds, succeeded in a few months in securing 
 a twelvefold increase in the number of births reported. Another 
 method of securing an interest in the subject and consequently better 
 returns may be described in the commissioner's words: 
 
 1 Report of a Birth. 
 
 "Sections 1485, 1486, of the Laws and Ordinances of the City of Chicago, require 
 that any Physician, Midwife or other person who attends upon a birth shall report 
 the same to the Department of Health within five (5) days after its occurrence. 
 
 Filling out this Card and its deposit in a letter box will fulfill the requirement 
 and avoid the penalty for neglect. 
 
 The Recorder of Births will furnish these Carols on request. 
 
 To the Recorder of Births : Chicago, 189 ... . 
 
 Doctor : A living child was horn to 
 
 (1. Male or female. Parentage, if other than White.) 
 
 (2. Full name of one Parent. ) 
 
 at Ward 
 
 (3. Exact address of place of birth.) 
 
 on the day of 189 .... 
 
 (4) (4) 
 
 Attendant : 
 
 Address: 
 
 Carefully Follow These Instructions: Wbite in the numbered blank spaces 
 above — 
 
 1. Male or female, as the case may be. If the child is not of white parentage, 
 add. after the word 'male 1 or -female,' the word African, Indian. Chinese, etc. ^ 
 as the case may be. If a still-birth, strike out the word 'living. 1 2. Full name of 
 Mother or Father. :!. Number of House, name of Street, and number of Ward. 
 4. Day and Month of Birth. 5. Name and address of Attendant; if a Physician, add 
 the letters, M. D. 
 
REGISTRATION OF VITAL STATISTICS. 75 
 
 '• With a view to increasing interest, and so to securing fuller returns, the Com- 
 missioner obtained the publication in some of the city evening papers of all births 
 reported, on representing to the editors that birth notices should he as interesting 
 to their readers as 'death notices, 1 to which space is readily given. Sneh hesita- 
 tion as was met with at once yielded when it was urged that a knowledge of the 
 city's birth rate was important for various reasons, that the publication of births 
 would aid in securing such knowledge, and that it was a recognized function of the 
 public press to secure and publish information of service to the public interests as 
 well as to the individual. 
 
 Publication was begun on August 12th, and the results were at once apparent. 
 During the TO days prior to August 15th there were 5,122 births reported — an aver- 
 age of 67 per day. During the succeeding 70 days, up to the close of < ►ctober 
 births were reported — an average of 90 per day, and an increase of 34 per cent. 
 
 The publication embraces the name of mother and her residence, sex of child 
 (son or daughter), and name of attendant. To meet the objection of some physicians 
 to the alleged quasi-advertising flavor of this publication it was found necessary to 
 furnish a special card for the exclusive use of physicians; and the raid tirsi pre- 
 pared — copy above given — is now used by midwives only. 
 
 This Physician's Eeport of a Birth card has the letters l M. I>." added to the line 
 for the attendant's name and the following note at the bottom of the raid: 
 
 'If the Physician notes an objection to the publication of this birth, 
 or of uis Name as Attendant, the objection wtli be respected." 1 
 
 It' physicians report births promptly, they certainly cannot, in manj 
 
 5, give the name of the child. To obtain this for the record it is 
 accessary for the recording officer to communicate with the parents. 
 For this purpose special blanks arc often provided. The form used in 
 Maine is shown in Appendix 15. 
 Items required for Birth Records. 
 
 For purposes of identification a birth record should have the 
 Name, 
 Sex, 
 
 I >ate of Birth, 
 Place of Birth, 
 Parents' Names and Parents' Residence. 
 
 A considerable number of other items are desirable both for identifi- 
 cation and for scientific purposes. 
 I >ate of birth. 
 
 Under this heading it is often specified that the hour id' birth shall 
 be given, and sometimes, as in Wisconsin, the da\ oi the week us well 
 as i he day of t he month. 
 .Maiden Name of Mother is required in almost all records oi births. 
 
 Father's Occupation is also very useful for identificati md is fre 
 
 quently required. 
 
 Name of Physician or other Reporter is always to be signed to returns 
 of lpirth made by them, and in Connecticut and a few other places the 
 physician's address is to be given also. 
 
76 REGISTRATION OF VITAL STATISTICS. 
 
 Date of Certificate is often required, as is also the 
 Date of Return. 
 
 Sometimes, as in Massachusetts, the date of return or of filing the 
 return is to be noted on the back. 
 
 A serial number is often placed on returns beginning with the first 
 return of each year. 
 
 A number of other items are sometimes added for the sake of their 
 scientific interest. Among them are 
 Color, which is required in most returns. 
 Race is required in Alabama and California, 
 
 ■Color of Parents is required in Connecticut, Maine, New Hampshire and 
 Rhode Island. 
 
 Nativity of Parents is required in Connecticut, Michigan, Minnesota, 
 New Jersey, and the District of Columbia. 
 Birthplace of Parents. 
 
 Instead of nativity, birthplace is required in Maine, Massachusetts, 
 New Hampshire, Pennsylvania cities of the second class, Rhode Island, 
 Wisconsin, Cleveland, and the City of New York. 
 
 Parents' Age is required in Delaware, Connecticut, Minnesota, New 
 Hampshire, Rhode Island, Cleveland, and the City of New York. 
 Number of the Child of the Mother, that is the number of children 
 the mother has had, including the one named in the return. This as 
 well as the preceding is useful for identification, but it is chiefly for 
 its scientific value that it should be recorded. It is required in Con- 
 necticut, Delaware, Iowa under the old law, Maine, Minnesota, New 
 Hampshire, New York, and Rhode Island. In New Jersey the num- 
 ber of children by this marriage are required, and in Wisconsin "the 
 names of other issue living (born of the same parents)." In New 
 York in addition to the number of children born the number now 
 living is required. When the number of children is required together 
 with the age of the mother, valuable information can be obtained in 
 regard to fertility at different ages. When the number of the child 
 and nativity or birthplace of the parents is obtained together with their 
 ages, much may be learned of the fertility of different nationalities. 
 Child's Number in the Family is required in Delaware and must be 
 of value from a sociological point of view as showing the size of the 
 family. 
 Still-born. 
 
 Whatever is done with still-births, whether they are recorded with 
 births, with deaths, or separately, it is often considered advisable to 
 provide on birth returns opportunity for designating whether or not the 
 child is still-born. Such an item is found in Colorado, Kentucky, 
 
REGISTRATION OF VITAL STATISTICS. 77 
 
 Maine, New Hampshire, and the District of Columbia, and special 
 blanks for still-births are used in New Jersey, New York, in Iowa under 
 the old law, and in Pennsylvania. In Rhode Island and Wisconsin the 
 fact of still-birth is to be noted under -remarks" as it doubtless is in 
 other places. 
 Illegitimacy. 
 
 This condition has received little recognition in American registra- 
 tion laws. In Virginia the law requires the name, occupation and 
 residence of the father "if the child be bora in wedlock" and presum- 
 ably they are to be omitted, if not so born. In New -Jersey and New 
 York if the child is born out of wedlock and the father's name is not 
 given the letters ( ). W. are to appear on the return. In Iowa, under 
 the old law, it was to be stated whether the child was born in wedlock 
 or not. 
 
 The Massachusetts law is as follows r 1 
 
 " In the record of the birth of an illegitmate child the name and other facts re- 
 lating to the father shall not be recorded unless at the joint request in wiitiny of 
 both father and mother. The term ' illegitimate, 1 shall not be used in the record 
 of a birth unless the fact has been legally determined or upon the sworn statement 
 of both the father and mother." 
 
 In Rhode Island and Wisconsin illegitimacy is to be noted in the 
 space on the return left for remarks. 
 Part Presenting is to be noted on returns of births in Mobile. 
 
 STILL-BIRTHS. 
 
 Still-births may be recorded as births, or as deaths, or as both, in 
 Massachusetts, Rhode Island. Vermont, and sometimes in Connecticut, 
 and in each event the usual blank for returning births and deaths is 
 employed. In Massachusetts it is required thai the word still-born 
 shall be entered in the record of both birth and death. But in some 
 states and cities special blanks are used which differ somewhal from 
 those used for either births or deaths. The form used in New Jerse} 
 is shown in Appendix L6 and is substantially the same as that used in 
 other places. 
 
 MARRIAGES. 
 
 While the registration of marriages bears no immediate relation to 
 sanitary science or practice, it is considered in this connection because 
 the registration is usually performed bj the same officer who registers 
 births and deaths, and because ii seems to the writer that there is no 
 question thai these latter should be registered b\ the sanitary offi 
 
 1 Massachusetts, Chapter 444, of 1887, Sec. 1. 
 
78 REGISTRATION OF VITAL STATISTICS. 
 
 at least in all municipalities of considerable size, and perhaps in all 
 communities. 
 
 There is little doubt that a most important requisite for complete 
 registration is a requirement that a license shall be issued to the con- 
 tracting parties before the marriage is solemnized. Clergymen, justices 
 of the peace and others authorized to solemnize marriages are probably 
 as forgetful and careless as other people. Under the most favorable 
 circumstances a certain number of certificates of marriage are not re- 
 turned by the officiating parties as required. If complete returns are 
 desired everything should be done to facilitate the return of the certi- 
 ficate. If the clergyman has a blank already filled except for one or 
 two small items, he is less likely to neglect to return it than if an ex- 
 tended form has to be filled by him. It is also important that the 
 marriage record should be accurate as well as complete. The registra- 
 tion officer is much more likely to feel the necessity of this than is the 
 person who officiates at the marriage. Experience has amply proven 
 that records of marriage are much more nearly accurate when they are 
 made from a license prepared in the record office and requiring only the 
 signature of the person officiating to become a certificate of the 
 marriage. The following data in regard to marriages are largely taken 
 from a special report on " Marriage and Divorce " prepared by Hon. 
 Carroll D. Wright, United States Commissioner of Labor. 
 
 The following is a list of the states and territories which require a 
 license as a preliminary to marriage, also the officer who issues the 
 same and the fee required : 
 
 State. Officer Issuing. Fees. 
 
 Alabama Probate Judge 81 50 
 
 Arizona Probate Judge 50 
 
 Arkansas Clerk of County Court 2 50 
 
 California County Clerk 2 50 
 
 Colorado County Clerk 1 00 
 
 Connecticut Registrar, Births, Marriages, Deaths 50 
 
 I >elaware Clerk or Justice of Peace $2 33 — 2 83 
 
 District of Columbia Clerk of Supreme Court 1 00 
 
 Florida Clerk of Circuit Court 2 00 
 
 ■Georgia Ordinary, or Clerk to Ordinary 1 50 
 
 Idaho County Recorder 1 00 
 
 Illinois County Clerk 1 00—1 50 
 
 Indiana Clerk of Circuit Court 2 00 
 
 Iowa Clerk of Circuit Court 1 00 
 
 Kansas Probate Judge 2 00 
 
 Kentucky County Clerk 1 50 
 
 Louisiana Clerk of District Court - 00 
 
 Maine Town Clerk 50 
 
 Maryland Clerk of Circuit Court 1 00 
 
 Massachusetts Town Clerk or Registrar 50 
 
 Michigan County Clerk- 50 
 

 
 1-2 
 
 :; 
 
 oo 
 
 1 
 
 00 
 
 2 
 
 mi 
 
 1 
 
 50 
 
 2 
 
 00 
 
 1 
 
 00 
 
 
 50 
 
 1 
 
 50 
 
 75 
 
 1 1— ■_' 
 
 67 
 
 
 50 
 
 1 
 
 00 
 
 1 
 
 00 
 
 1 
 
 50 
 
 
 50 
 
 1 
 
 mi 
 
 ■ • 
 
 00 
 
 1 
 
 
 
 50 
 
 3 
 
 00 
 
 RE(r is Til, I TION F I V 7\ I L 8 7\ I TIS Tit '& 
 
 State. Officer Issuing. 
 
 Minnesota Clerk of District Court 
 
 Mississippi Clerk of Circuit Court 
 
 Missouri County Recorder 
 
 Montana Probate Judge 
 
 Nebraska County Judge 
 
 Nevada County Clerk 
 
 New Hampshire Tovrn Clerk 
 
 New Jersey County Clerk 
 
 North Carolina Registrar of Deeds 
 
 Ohio Probate Judge 
 
 Oklahoma Probate Judge 
 
 < » regon County Clerk •_' i m i 
 
 Pennsylvania Clerk of Orphans Court 
 
 Rhode Island Town or City Clerk 
 
 Tennessee Clerk of County Court 
 
 Texas Clerk of County Court 
 
 Utah Clerk of Probate Court 
 
 Vermont Town Clerk 
 
 Virginia Clerk. County. City, or Corporation Court. 
 
 Washington County Auditor 
 
 West Virginia Clerk of County Court 
 
 Wisconsin ( "ounty Clerk 
 
 Wy< iming County Clerk 
 
 *A license is required only when both parties are non-residents. 
 
 In Alabama. Georgia, Florida, Kentucky. Indiana, Minnesota. Mississippi, 
 Ohio, Oregon, Virginia. West Virginia, and Wisconsin, the license is issued in the 
 county in which the woman resides. In Tennessee it is to issue from the county 
 where the woman resides <.r where the marriage is solemnized. In Connecticut, 
 Illinois, Louisiana, Maryland. Montana. Nebraska, North Carolina, Pennsylvania, 
 and Wyoming, it is issued in the county or town where the marriage is to lake place. 
 In Michigan the license is issued in the county in which either party resides, and in 
 
 Nevada in the county in which both or one of the parties resides. In Massachusetts, 
 
 Maine. New Hampshire, and Rhode Island a license must l btained from the town 
 
 in which each of the parties resides, and in Vermont from the town in which the 
 groom resides, or if he lives oul of the state from the town in which the bride 
 resides. In the New England states and Minnesota, if the parties are non-residents, 
 and in Virginia, if the bride is a non-resident, the license is to issue from the town 
 or county in which the marriage takes place. En Nevada if the parties are noi 
 dents the license may issue from any county. In Wisconsin the license mils! be 
 obtained five days before the ceremony. This is the only state with such a require 
 menl . 
 
 Of the officers who issue marriage licenses ;tll but ii\«' record t li«- 
 certificates utter they are returned. The five are in California, Dela- 
 ware, Nevada, and Wisconsin, where the marriage is recorded l>\ the 
 recorder of deeds, and in Washington, where il is recorded l>\ the probate 
 judge. In the Now England states the license is called a certifi 
 winch term is also applied toil when it is returned with the clergyman '* 
 endorsement upon it. Some confusion is apl to arise unless this unfor- 
 i unate use of i he \\ "ids is kept in mind. 
 
80 REGISTRATION OF VITAL STATISTICS. 
 
 There are two objects to be secured in requiring marriage licenses. 
 One, which has been considered, is to secure completeness and accuracy 
 of returns, the other is to prevent the marriage of persons whom it is 
 unlawful to join in marriage. Several states do not require a license 
 when public notice of the marriage has been previously given by the 
 publication of "banns." This is the law in Delaware, Georgia, Mary- 
 land, and Ohio. The following is the law in Maryland : " The name 
 of the parties intending to be married shall be thrice published in some 
 church or house of religious worship in the county where the woman 
 resides, on three several Sundays, by some minister residing in said 
 county." In Delaware this is not required in the case of a marriage of 
 colored persons. In Delaware and Ohio the banns must be published at 
 least ten days prior to the marriage. It is evident that in the minds of 
 the framers of such laws, the registration of the marriage was a minor 
 matter. 
 Contents and Form of Marriage License. 
 
 One use of a marriage license is to make sure an accurate return of 
 marriage from the person officiating. The data necessary for record are 
 upon it and all the clergyman or other person officiating has to do is to 
 certify as to the marriage. The marriage license is a basis for the mar- 
 riage record, and should therefore contain all the data necessary for 
 such record. There is rather more uniformity in regard to the items 
 required for records of marriages than for the records of either births 
 or deaths. The most essential and usual items to be found on marriage 
 licenses are as follows : 
 Groom. 
 
 Name, 
 
 Occupation, 
 
 Residence, 
 
 Birthplace, 
 
 Color. 
 Bride. 
 
 Name, 
 
 Maiden name if previously married, 
 
 Residence, 
 
 Birthplace, 
 
 Age, 
 
 Color. 
 
 Civil Condition of the Groom and Bride. 
 
 A statement as to whether single, widowed or divorced is almost 
 always required. Most laws require a record of whether the marriage 
 is the first, second or other marriage. 
 
REGISTRATION OF VITAL STATISTICS. SI 
 
 Occupation of the Bride. 
 
 This is required in Maine, Massachusetts, New Hampshire, New 
 Jersey, and Rhode Island. 
 Age of the Parties. 
 
 Sometimes the age is to be given in years, months and days, some- 
 times the age at the next birthday, as in Iowa and Buffalo, and some- 
 times the age at the nearest birthday, as in New Jersey. If not other- 
 wise expressed, the age in years at the last birthday is intended. In 
 Providence it is the custom, though not required by law, to state the 
 date of birth as well as the age in years. 
 Data Concerning Parents. 
 
 The names of the parents of the contracting parties are in most 
 states to appear on the license. 
 Color of Parent-. 
 < Occupation of Parents. 
 Birthplace of Parents. 
 
 In Connecticut the nationalty of the parents is required instead of 
 birth places. 
 \-e of Parents. 
 
 This is required in New Hampshire. 
 
 The marriage license must also have the date and place of issue. 
 ami must have the written and signed statement of the licensing officer 
 that the license has been duly recorded or the ••intention declared." 
 
 A certificate or return of marriage tnusl of course have other items 
 besides tin- family history required for the license. The license, in 
 those >iates where a license is required, becomes a certificate by the 
 written statemenl upon it by the person officiating that the parties 
 named have been legally joined in marriage. The items required on a 
 certificate of marriage are as follows: 
 Date of Marriage, 
 
 Place of .Marriage, 
 
 Signature of Person officiating. 
 
 ( Other items are often required. 
 Official Position or Denomination of the person officiating. 
 
 This is Usually required, and in Rochester the name of the church 
 
 to which the clergyman is attached. In Delaware the "ceremon} 
 employed " is required. The following is t he Massachusetts law : ' 
 
 "The words 'official station, 1 as used oi a person solemnizing .1 mai 
 chapter three hundred ot the acts of the year eighteen hundred and a 
 shall be taken and deemed to mean the office bj 1 Irtue oi \\ hich said pi 1 
 
 1 Massachusetts, Chapter 124 oi L897, Si 
 
82 REGISTRATION OF VITAL STATISTICS. 
 
 nizes such a marriage; and to describe such office in returns of marriages the words 
 ' justice of the peace. 1 'minister of the gospel, 1 'clergyman, 1 'priest, 1 or 'rabbi, 1 
 only shall be used. 1 ' 
 
 In Rhode Island, where the term " official station " occurs in the 
 law, it is interpreted to mean in the case of clergymen, the denomina- 
 tion. 
 
 ( )ther items occasionally noted are 
 Names of Witnesses to the ceremony. 
 
 These are often required to appear on the returns of marriage, but 
 they are not so required in Connecticut, Delaware, Maine, Massachu- 
 setts, and Xew Hampshire. 
 Residence of Witnesses. 
 
 This is required in Michigan, Xew Jersey, and Rochester. 
 Residence of Person Officiating. 
 
 This is a requirement in Maine, Massachusetts, Xew Hampshire, 
 and Xew York. 
 
 A form of marriage license may be found in Appendix 17. 
 
 Most states have a considerable number of regulations as to who 
 shall marry, such as the prohibition of consanguineous marriages, 
 limitations as regards the marriage of minors and divorced persons, but 
 these have no special interest in this connection. They must of course 
 be followed by the officers who issue the licenses, and means are often 
 provided by law for ascertaining the facts, such as administering oaths, 
 etc. Limitations as to the marriageable age of minors are very com- 
 mon and vary considerably in different states. Xearly all require the 
 consent of parents or guardian and the following states require a 
 written consent which is presumably filed by the officer issuing the 
 license : California, Connecticut, Georgia, Iowa, Maine, Montana, 
 Xew Jersey, North Carolina, Oregon, Rhode Island, Tennessee, Ver- 
 mont, Washington, and Wisconsin. 
 
 In Alabama, Arkansas, Kentucky, Maryland, Massachusetts, 
 Minnesota, Mississippi, Missouri, Xebraska, Nevada, New Jersey, New 
 Mexico, ( )hio, Pennsylvania, Utah, Virginia, West Virginia, and 
 Wyoming, the minor's permit may be either verbal or written. 
 
 In the states named below 1 the law requires that the person solemn- 
 izing a marriage shall keep a record thereof. 
 
 In Alabama and Mississippi, when a marriage is solemnized by the 
 pastor of an}' religious society, the clerk or keeper of the minutes of 
 
 1 California, Colorado, Delaware, Idaho, Kentucky, Maine, Massachusetts, Michi- 
 gan, Minnesota, Missouri, Nevada, New Hampshire, New Mexico. New York, South 
 Dakota, Wisconsin. 
 
B EGIS TIL i TION OF I 1 T. J L 8 T i TIS Tit >. 
 
 
 such society is required to make a record of such marriage in a book 
 to be kept for that purpose. 
 
 In Maryland the certificate of agreement of the parties to a Quaker 
 
 marriage, signed by at least twelve witnesses, must he recorded among 
 the records of the society, or in some court of record in the city or 
 county where the marriage occurred. 
 
 In Ohio, in cities which are co-extensive with the counties in which 
 they are situated, persons authorized to solemnize marriages are required 
 to keep a record thereof. 
 
 The usual way of keeping such a register is by means of stubs. 
 
 Nearly all states require that the person solemnizing a man 
 shall make a return thereof to some officer who is to record the same : 
 but in New Jersey there is no provision for record after return. 
 Below 1 is a list of the states requiring such return with the name of 
 the officer to whom the return is made. An example of a marriage 
 return is shown in Appendix 18. 
 
 1 In those states marked with an * the return is made to the sai ficer who 
 
 issues tii'' license. 
 
 State "i territory- 
 
 Return made to— 
 
 *Aiabaina Fudge of probate, cm 
 
 A rizona < lounty recorder. | a) 
 
 •Arkansas (6). . Clerk of county court. (a) 
 
 < lalifornia < lounty recorder. | c i 
 
 *( lolorado . . . . < lounty clerk. 
 ♦Connecticut... Registrar of births, mar- 
 riages ami <leatlis. (a i 
 Dakota (North). City or town clerk, or 
 register of deeds. 
 
 Delaware Recorder of deeds. 
 
 *D. of Columbia Clerk of supreme court. 
 
 Florida < llerk of circuit court. 
 
 *( i-eorgia < Ordinary, (a) 
 
 *idaln> County recorder. 
 
 •Illinois < lounty clerk. | c I 
 
 ♦Indiana Clerk of circuil court, (r) 
 
 •Iowa < llerk of circuit court. 
 
 • Kansas.. Probate judge, [a i 
 
 ■ Kent uckj . . < lounty rink, (a I 
 
 •Louisiana Clerk of district court. (a) 
 
 ' Maim- Town clerk - 
 
 ■ .Maty la in I . Clerk of circuit court, (a) 
 "Massachusetts Town clerk or registrar. 
 
 I", c) 
 
 • M ichigan.. . < lounty clerk, i" > 
 •Minnesota Clerk of district court, (c) 
 
 State or territory 
 
 •Mississippi .. . 
 
 *M issouri 
 
 •Montana 
 
 ' Nebraska 
 
 Nevada 
 
 ■ N> \\ llani|i.. . . 
 New Jersey .... 
 
 \i\\ Mexico. . . 
 New York 
 
 • Ni >r1 bCarolina 
 ••< >hio 
 
 • < >regon 
 
 ■ Pennsj l\ ania . 
 
 Rhode Island . 
 
 essee.. 
 
 I. :as . . .. 
 
 I'lah 
 
 ■ Ven t 
 
 V irginia 
 
 Washington 
 
 ■ \\ '. -i v irginia. 
 Wisconsin.. 
 
 \\'\ oming 
 
 Return mai 
 
 Clerk of circuit couj I 
 County recorder, (c) 
 Probate judge, (a i 
 County judge, (a, c) 
 Recorder ol deeds 
 Town rlerk. («/) 
 Local board of health. 
 ( llerk of probate court.(c ' 
 Local board of dealt li. 
 Regist rar of ilmls. 
 Probate judge, (a 
 County clerk 
 ( llerk nt' orphan's court. 
 
 I", c) 
 Tow n or city clei i 
 
 i -i gist rar. (c) 
 ( llerk of county court i" i 
 ( llerk of county court, (a) 
 
 < llerk "t probate cou i 
 Town clerk, i" i 
 
 ( llerk of count j 
 
 corpora) ion court. 
 Probate judge, (c) 
 
 < llei h of < ntj cou i 
 
 ter of deeds, i u 
 Co intj clerk 
 
 a Of the county, town, etc., whence license issued. 
 
 b The return must be made bj the person who obtained the lic< 
 
 c Of the county, town, etc., wherein the marriage is solemn 
 
84 REGISTRATION OF VITAL STATISTICS. 
 
 In South Dakota the provisions for returns of marriage are not com- 
 pulsory. The statutes provide that a certificate may be obtained from 
 the person solemnizing a marriage upon the request of either of the 
 parties, and may be filed with the clerk of the city or town where the 
 marriage occurred, or where either of the parties resides, or with the 
 registrar of deeds. 
 
 In Iowa, when the services of a clergyman or a magistrate are dis- 
 pensed with, the husband must make the return. 
 
 In New York such return shall be made by the person solemnizing 
 or by the " groom." 
 
 In the following states the return of marriage is to be made to the 
 town or county where the license is issued : Alabama, Arizona, Arkan- 
 sas, Connecticut, Georgia, Kansas, Kentucky, Louisiana. Maryland, 
 Michigan, Montana, New Hampshire, North Carolina, Ohio, Tennessee, 
 Texas, Utah, Vermont, Virginia, and West Virginia. The return is to 
 be made to the town or county where the marriage is solemnized in 
 California, Colorado, Delaware, Idaho, Illinois, Indiana, Minnesota, 
 Mississippi, Missouri. Nebraska, New Hampshire (for non-residents), 
 Nevada, New Mexico, Oregon, Rhode Island, Washington, and Wyo- 
 ming. In Maine, Massachusetts, Nebraska, Pennsylvania, and Wis- 
 consin, a return must be made by the person solemnizing the marriage 
 to the town or county where it was solemnized and also to the town 
 where the license was issued. 
 
 The time within which marriage returns must be made is usually a 
 month or thirty days, but in the District of Columbia it is forty-eight 
 hours; Indiana and Memphis, five days ; Maine, six days ; Wilmington, 
 ten days; Pennsylvania cities of the second class on the third day of 
 each quarter. In Philadelphia the collectors of vital statistics, and in 
 Cincinnati the sanitary police call upon the clergymen for them at regu- 
 lar intervals. 
 
 Sometimes, as in Kansas, in addition to the returns of clergymen the 
 assessors make an annual enumeration of marriages together with births 
 and deaths. 
 
 " In addition to the requirements of the territorial statutes on the 
 subject of marriage records it is provided by act of Congress, Approved 
 March 3, 1887 (24 Stat., 636), that in all the territories a certificate of 
 every marriage performed therein, signed by the parties and by the 
 person solemnizing, be filed by such person in the office of the probate 
 court, or, if there be none, in the office of a court having probate powers, 
 in the county or district where the marriage occurred, which certificate 
 shall be immediately recorded/' 
 
r eg rs rn. 1 nox of \ it, i l s r. 1 tis Tit 's. 85 
 
 In a few states provision is made for the return of marriages cele- 
 brated beyond the limits of the state. 
 
 In Maine the statutes provide that when residents of the state are 
 married in another state and return to the state to reside they shall file 
 a certificate or declaration of their marriage with the clerks of the 
 towns in which they respectively lived. -In Massachusetts and New 
 Hampshire, under similar circumstances, it is provided that such certifi- 
 cate shall be filed with the clerk of the town where either of them lived. 
 In Vermont, when a male resident of the state is married without the 
 state the statutes require that he shall deposit with the clerk of the 
 town where he resides a certificate embracing the statistics required by 
 law in marriage certificates. The statutes also provide that the head of 
 a family who moves into and becomes a permanent resident of the state 
 may cause a certificate of his marriage to be recorded in the office of 
 the clerk of the town where he resides. 
 
 In Virginia and West Virginia it is provided that if either or both 
 of the parties to a marriage celebrated without the state he residents of 
 the state, a certificate or statement of such marriage, verified by the 
 aflidavit of a witness thereto, may be returned to the clerk of court of 
 the county or corporatioE where the husband resides (or if he be not a 
 resident of the state, where the wife resides), and an abstract thereof 
 shall be recorded by such clerk as in other cases. 
 
 In Wisconsin, where any marriage celebrated in the state shall not 
 have been returned and registered as provided by law, or when any 
 person may have married, who was a child of a citizen of the state, or 
 when any person so married elsewhere was bef< re oral the time of such 
 marriage, or subsequently thereto shall have become, a resilient of the 
 state, upon presenting and filing with the proper register of deeds proofs 
 of marriage, either b\ the affidavit of the person performing the cere- 
 mony, or if such proof can not be made, then by affidavit of a witness 
 or witnesses thereto, such register shall enter the facts so proved upon 
 
 his marriage register." 
 
 It is not at all likely that compulsory laws like those of Maine. 
 New Hampshire, Vermont, and Massachusetts can be thoroughly en- 
 forced. It is possible perhaps in towns with a small population where 
 mosl of the inhabitants are known to the register, but not in cities. It 
 
 certainly is not enforced in the large Massachusetts cities. 
 
 RETURNS A.ND RECORDS. 
 
 False Returns. 
 
 It is of course a very grave matter for a person to make a false 
 
 turn of a birth, marriage or death. Penalties are provided lor such an 
 
 offense in Maine, Massachusetts, Michigan, New Jersey, Wisconsin, 
 
86 REGISTRATION OF VITAL STATISTICS. 
 
 and in the City of New York, and other cities. The following is the 
 New Jersey law : l 
 
 " That any minister of the gospel, magistrate, physician, midwife or other per- 
 son, who shall knowingly make any false certificate of marriage, birth or death, 
 shall he deemed guilty of a misdemeanor, and on conviction thereof shall be liable 
 to a fine not exceeding one hundred dollars or imprisonment in the county jail for a 
 period not exceeding three months, or both, at the discretion of the court. 1 ' 
 
 The Massachusetts law affixes a penalty for altering a marriage 
 certificate. 
 
 hi Connecticut a penalty is imposed upon the registrar for making a 
 false entry. 
 
 Original Returns. 
 
 It is frequently prescribed that these shall be written legibly, spelled 
 correctly, and written in ink. The former of these requirements is 
 difficult to have fulfilled, but the latter certainly should be insisted on. 
 
 The time of receiving or filing the original returns by the town or 
 county clerks is sometimes to be endorsed upon the return as in Con- 
 necticut, Massachusetts, Michigan, and Wisconsin. A place for this 
 endorsement is printed on the back as on the Massachusetts returns. 
 
 Often a blank is left for a number, and in Michigan the registrar is 
 required by law to " number all certificates consecutively in the order in 
 which they are received, beginning with number 1 for the first death 
 which occurs in each year. 1 ' This is doubtless of assistance to the sec- 
 retary of state to whom the returns are sent, and who has to certify to 
 the county auditors the amount due each registrar for making returns. 
 Sometimes the number of the burial permit is to be stamped upon 
 the return of a death. 
 
 The original returns are usually filed and preserved by the registrar 
 who receives them. This is the rule in all the New England states. 
 In some cases these originals serve as the permanent record and are 
 bound and indexed. This is the method of keeping the record in the 
 City of New York. 
 
 In New York state and in Michigan the originals are at once re- 
 corded by the local registrar and returned monthly to the state regis- 
 trar by whom they are indexed, bound and preserved. 
 
 In New Jersey there is no provision in the law for local record, 
 though one is made in very many places, but the returns are to be 
 sent to the state bureau of vital statistics, and the law provides that 
 they shall be arranged according to political divisions. In the above 
 states exception is made for certain cities which may send transcripts 
 
 1 New Jersey, General Statutes (1895), p. 2010, Sec. 11. 
 
HE GTs TRA TION OF VITAL S T. I TIS TI( 'S. 87 
 
 to the state registrar and preserve the originals. In Minnesota the 
 original returns are to be sent by the secretary of state to the comity 
 clerks. In Wisconsin returns are received by the board of health or 
 town clerks and sent to the registrar of deeds for the county. The 
 law does not require local record. 
 
 The preservation of original papers, like returns of births, mar- 
 riages and deaths, presents quite an important problem. These must in 
 the course of years become so great in number that it will be with 
 difficulty that proper storage room can be found for them. It is a ques- 
 tion whether it is not best to record in books every item contained in 
 them and then destroy them. 
 Blanks for Returns. 
 
 These are almost always furnished by the state. It is only in this 
 way that uniformity can be secured. They are usually distributed to 
 clergymen, undertakers, physicians, and the like by the town or county 
 clerks or other recording officers. Usually the blanks are furnished by 
 the state board of health, as in Arkansas. California, Colorado. Florida, 
 Illinois, Indiana, Kansas, Maine, Maryland, Missouri. New Hampshire, 
 New Jersey, New- York, Rhode island, Vermont, West Virginia, and 
 low a for marriages ; but in Massachusetts, Michigan and Wisconsin 
 they are furnished by the secretary of state, and in North Dakota and 
 Virginia by the state auditor. In Pennsylvania, except in the Large 
 cities, blanks are to be furnished by the county commissioners; but in 
 Delaware the county recorder is to furnish the blank returns. 
 
 In some states in which there are no general registration laws, as 
 Georgia, South Carolina, Tennessee, and others like Pennsylvania 
 where the laws are very imperfect, there are nevertheless importanl 
 cities which have long had a good system of registration and which tor 
 their blanks, books and laws have to depend upon themselves alone. 
 
 I!, cording Officers. 
 
 In nearly every instance the officer to whom returns of births, mar- 
 riages, and deaths are made is to record them. This record, however, 
 
 is not required by statute in si ■ states, as Florida, New Jersey, and 
 
 Wisconsin, and in certain cities. The following is a list of the officers 
 who are ex-officio charged with the duty of recording vital statistics in 
 the different states : 
 
 State. Receiver, Recorder. 
 
 Alabama Counts Sealtb ( (fficer. < ountj Health Offl 
 
 California County Recorder. . . Countj Recorder. 
 
 Colorad Board of Bealth. 
 
 Connecticut Town Clerk Town Clerk, 
 
 Delaware Recorderof Deeds Recorder of Deeds. 
 
88 REGISTRATION OF VITAL STATISTICS. 
 
 State. Receiver. Recorder. 
 
 Florida State Board of Health. 
 
 Illinois County Clerk County Clerk. 
 
 Indiana Health Officer Health Officer (undertakers 
 
 are registrars in unincor- 
 porated places). 
 
 Iowa Clerk Dist. Court Clerk Dist. Court. 
 
 Kentucky County Clerk County Clerk. 
 
 Maine Town Clerk Town Clerk. 
 
 Maryland Health Officer. Health Officer. 
 
 Massaclmsetts Town Clerk Town Clerk. 
 
 Michigan Health Officer Health Officer. 
 
 Minnesota Health Officer Health Officer. 
 
 Mississippi County Board of Health. . . .County Board of Health. 
 
 Montana County Clerk County Clerk. 
 
 New Hampshire Town Clerk Town Clerk. 
 
 New Jersey Town Clerk or Assessor 
 
 New York Board of Health Board of Health. 
 
 North Carolina County Supt. of Health .... County Supt. of Health. 
 
 North Dakota Health Officer Health Officer. 
 
 Pennsylvania Clerk Orphan's Court Clerk Orphan's Court. 
 
 ' Rhode Island Town Clerk Town Clerk. 
 
 Utah County Clerk County Clerk. 
 
 Virginia County Clerk County Clerk. 
 
 Vermont Town Clerk Town Clerk. 
 
 Washington County Auditor County Auditor. 
 
 West Virginia County Clerk County Clerk. 
 
 Wisconsin Health Officer or Clerk County Register of Deeds. 
 
 In place of the above mentioned officers other persons are some- 
 times to perform these duties. Thus in Ohio in villages and cities the 
 board of health, and in New Hampshire the board of health of cities, 
 is to record births and deaths. In New Jersey it is the registrar or 
 clerk of cities who is to receive returns, and such may record the same, 
 and the registrars of Michigan cities may keep the original returns and 
 send copies to the secretary of state. 
 
 In many cities provision is made by charter or otherwise for the 
 appointment of special officers to be registrars of vital statistics. 
 Among such cities are Atlanta, Boston, Buffalo, Camden, Chicago, Cin- 
 cinnati, the District of Columbia, Lowell, Milwaukee, New York, Phila- 
 delphia, Paterson, Providence, Portland, Me., Rochester, Syracuse, and 
 Wilmington, Del. Among the smaller communities which have a 
 registrar is Asbury Park, N. J. 
 
 Sometimes as in Buffalo, Memphis, and the District of Columbia, 
 the registrars are merely clerks in the department of health. Usually 
 the registrar is a member of that department, but in Boston and Provi- 
 dence he is an independent officer, but in Providence the same person 
 has usually been elected registrar and executive officer of the health 
 department. 
 
REGISTRATION OF VITAL STATISTICS. go, 
 
 As it is sometimes necessary for registrars to administer oaths, to 
 determine the truth of statements made to them, this power is often 
 granted to them and they may sometimes have a seal as in Connecticut 
 and in Boston. 
 
 Records. 
 
 Most laws require that births, marriages, and deaths shall he recorded 
 in separate books, though as has been stated in a few instances the 
 original returns serve as the record. In Pittsburgh the record page for 
 deaths has space for only two records which are fac-similies of the 
 original returns. 
 
 When any considerable number of items are to be entered, a single 
 page scarcely gives space enough without making the record hook entirely 
 too cumbersome. Hence these records usually extend across two pages 
 which have the same number. The folio has a proper heading and is 
 ruled into columns for the various items which are usually prescribed 
 by statute or by the state registration officer. The record books them- 
 selves are also of ten furnished by the state, as in .Massachusetts and Dela- 
 ware, by the secretary of state: Rhode Island, by the state hoard of 
 health : Washington and .Minnesota, by the county auditor : and in < Miio 
 by the county judge. In this way uniformity is secured and a better 
 paper and printing is obtained. 
 
 In many records there is a space at the bottom of even page for 
 the signature of the registrar attesting that the record is correct. 
 
 In some states as Maim'. New Hampshire, and Rhode Island returns 
 me to he recorded " chronologically." In Rhode Island this is inter- 
 preted to mean in the order in which the events occurred. So that the 
 record tor a given period of time cannot he made until sufficienl time 
 has elapsed for all the returns to he in. In Delaware the returns are to 
 he recorded " under the letter of the alphabel t<> which they respectively 
 belong." In Virginia they are to he alphabetical!} arranged. In most 
 regulations concerning this point records are to he made in the order 
 in which the returns are received. 
 
 Deaths of paupers shall he especially designated as siieh ill records 
 
 in Mobile. 
 
 In Rhode Island the law requires that births, marriages, and deaths 
 of residents and non-residents shall be recorded separately. This is 
 
 interpreted to mean that the births, marriages, and deaths in the families 
 
 of the residents of the town, but occurring out of the town shall be 
 recorded separate!} from those which occur in the town. It is import- 
 ant that such should be recorded', bul the} Bhould not of course he 
 reckoned in am tables of vital statistics. In Providence deaths in the 
 
90 REGISTRATION OF VITAL STATISTICS. 
 
 city of persons of foreign parentage, are recorded separately from those 
 of American parentage. 
 
 The problem of dealing with the deaths in prisons, hospitals, and 
 almshouses is a difficult one. In Massachusetts 1 
 
 "The superintendent of the state almshouse shall obtain, record, and make 
 return of the facts in relation to the births and deaths which occur in his institution, 
 in like manner as is required by town clerks. The clerk of a town in which such 
 almshouse is located shall, in relation to the births and deaths of persons in said 
 almshouse, be exempt from the duties otherwise required of him by this act." 
 
 It is of the greatest importance that records should be as permanent 
 as possible, and to secure this only the most durable paper and ink 
 should be employed. If the state furnishes the record books there is 
 no reason why they should not always be of the best, but it is feared 
 that this is far from the case. In regard to paper the Massachusetts 
 law provides as follows : 2 
 
 "The matters of public record in any office shall be entered or recorded on paper 
 made wholly of linen, of a firm texture, well sized, and well finished; and in the 
 selection of paper for such records a preference shall be given to linen paper of 
 American manufacture, if it is marked in water line with the word ' linen,' and also 
 with the name of the manufacturer." 
 
 Ink is very apt to be poor in quality, to injure the paper and fade 
 rapidly. Massachusetts and Connecticut have prescribed what ink shall 
 be used. The following is the law in those states : 3 
 
 " Section 1. No person having the care or custody of any book of record or 
 registry in any of the departments or offices of the Commonwealth, shall use or allow 
 to be used upon such books any ink excepting such as is furnished by the secretary 
 of the Commonwealth. 
 
 " Sec. 2. The secretary of the Commonwealth shall from time to time advertise 
 for proposals to furnish the several departments and offices of the Commonwealth in 
 which books of record or registry are kept with ink of a standard and upon condi- 
 tions to be established by the secretary at such periods and in such quantities as 
 may be required, and may contract for the same. 
 
 "Sec. 3. The ink so furnished shall be examined from time to time by a chemist 
 to be designated by the secretary of the Commonwealth, and if at any time said ink 
 shall be found to be inferior to the established standard the secretary shall have 
 authority to cancel any contract made for furnishing said ink, and the quantity so 
 found inferior shall not be paid for." 
 
 It is sometimes prescribed that records shall be written, but if that 
 is intended to exclude typewriting it is not a wise provision. Type 
 written records are more legible and take up considerable less space 
 than written records. Moreover, a black carbon ribbon gives a more 
 
 1 Massachusetts, Chapter 44-1 of 1897, Sec. 22. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 37, Sec. 1. 
 
 3 Massachusetts, Chapter 378 of 1894. 
 
REGISTRATION OF VITAL STATISTICS. 91 
 
 permanent and unalterable record than can any fluid ink. The type 
 writer has been used for records in Providence since 1890. The sheets 
 are written separately and bound in temporary covers until enough have 
 accumulated for permanent landing. 
 
 In Michigan towns the death permits are furnished the towns in 
 books with stubs and the stubs are to be kept as the local town record. 
 See examples of forms of records in Appendices 11' to 21. 
 
 Index. 
 
 A record without an index loses a large part of its value. Hence the 
 indexing of records is usually required. As was stated above, in Dela- 
 ware and Virginia the returns are recorded alphabetically, but in Dela- 
 ware there must besides be an index for each book. Usually in the 
 records of births, marriages and deaths, each volume is indexed separ- 
 ately and the names are indexed as they are recorded under the initial 
 letter only. This method has not such very serious defects in small 
 places where one book serves for a great many years; but for large 
 places it is almost valueless. Even when an index is strictly alpha- 
 betical and vet only covers a year or other brief period, the labor of 
 searching records is considerable. In New York City until recently, and 
 in Buffalo and some other cities, the busk system of index is in use : 
 in the District of Columbia and Hartford, the Burr index : in Lynn, the 
 Schlicht; in Rochester, the Graves; and in Pittsburgh, Stephens and 
 .Mckees index is used. All of these are book indexes. The book 
 which is used as an index has margin letters which are so arranged 
 that the names may be entered in small groups which are si rid 1\ alpha- 
 betical and which are SO small that il is easy to run the group through 
 for : in \ particular name. It. however, takes some care to enter the 
 
 names properly. In the borough of .Manhattan, a temporary card index, 
 which is strict!) alphabetical is made, and from it an index is printed 
 each month, and the pages are SO arranged that the different months ot 
 of the same letter are bound consecutively in the annual volume. I'he 
 cost of printing the annual index of about 200,000 names is some $6,000. 
 
 In .Manhattan a card index of deaths l>\ streets is kepi to facilitate the 
 search for foreign names which are so often spelled erroneously. 
 
 By far the best index is the card index, and there is no good reason 
 why this should not be universally employed. The labor of making a 
 card index is no greater than that of making an} other index; in fact, 
 it is rather less, and it may be made to extend over an\ desired period 
 of years. The only limit is the amount of space available. When the 
 index becomes too huge it should be printed. To print one hundred 
 copies of an index from cards ought not to COSl over one and one- 
 
92 REGISTRATION OF VITAL STATISTICS. 
 
 half cents per name, and some return could be had from sale of copies, 
 and in many places a larger edition would be profitable. If it is worth 
 while to record births, marriages and deaths at a cost of from five cents 
 to fifty cents per name, it is worth while to make a compact printed index 
 at a cost of one and one-half cents. A card index has been used in 
 Providence since 1890, and the printing of the index of names previ- 
 ously recorded, from 1636 to 1890, has now been nearly completed. 
 In all, there are about two hundred and fifty thousand names in ten 
 volumes. 
 
 The following is the form of card used and a sample of the printed 
 
 index : 
 
 Size 2x5 Inches. 
 
 Delfino, Giovanni 
 
 16 501 
 
 s. of Guglielmo & Margherita 
 
 
 June 8 1899 
 
 
 o 
 
 
 BIRTHS RECORDED IX PROVIDENCE 
 
 Vol. Page. 
 
 Fury Maria of William and Catherine Aug 20 1874 10: 
 
 Fury Mary C of William and Catherine June 9 1K73 10 
 
 Fury Mary E of Bartholomew and Margaret Mar 31 1872 9 
 
 Fury Mary E of James and Bridget Sept 14 1878 11 
 
 Fury Mary J of Thomas and Ellen July 22 1874 10 
 
 Fury d of Thomas and Ellen Sept 3 1879 11 
 
 47 
 24S 
 156 
 159 
 23S 
 
 Custody of Record*. 
 
 In some states the law requires that records shall be open to the 
 public, but in others there are restrictions. Thus in Delaware a fee of 
 fifteen cents is charged for searching the record, but "said register 
 shall at all times be accessible to physicians, clergymen, and lawyers 
 without charge," and a similar rule is found in Pennsylvania. In 
 Cleveland and the Pennsylvania cities of the second class, the indexes 
 "shall at all reasonable times be open to the examination of persons 
 interested therein." The recording officer who has charge of records is, 
 of course, responsible for their safe keeping, and will only allow them to 
 be examined when he considers it safe to do so. 
 
 Amendment of Records. 
 
 Errors and omissions frequently occur in records, altogether too 
 frequently in this country. Some registrars take it upon themselves to 
 make corrections, but in the absence of statutory provisions it is doubt- 
 ful if they have a right to do so. In a few states changes in the record 
 
REGISTRATION OF VITAL STATISTICS. 93 
 
 are provided for. In Connecticut the registrar " shall amend bis records 
 as he may discover mistakes or omissions therein." In 1895 registrars 
 were directed to complete the records since 1850 from the records of 
 public officials, church societies, or from parents, physicians, and mid- 
 wives. In New Orleans a marriage may he recorded on "the produc- 
 tion of the affidavits of the contracting parties ami at least one of the 
 witnesses or the officer, priest, or ecclesiastic celebrating." Tin- Massa- 
 chusetts law requires that a deposition must he made under oath by a 
 person whose duty it was to furnish information for the original record 
 and the registrar is to record these additions in a separate hook. 
 
 In Maryland the registrar "shall amend his records as he shall dis- 
 cover mistakes and omissions." In New Hampshire the town clerk may 
 record facts in regard to births, marriages, and deaths •• which have not 
 been officially reported to him," and he may insert •• in the records and 
 returns the name of any child which may have been omitted from the 
 official return of a birth." The best law seems to he that of Rhode 
 Island which is less cumhersome than the Massachusetts law. and prob- 
 ably protects the records as well. 1 
 
 ( 'opies of Record. 
 
 A considerable number of states specify that copies of record shall 
 he sufficient evidence in legal proceedings of the facts recorded. In 
 Massachusetts a copy may he signed by the city or town clerk or as 
 ant clerk for the time being. Sometimes a -duh certified copy is 
 required," and the use of a town or <it\ seal maj serve as a certifica- 
 tion, [n Connecticut the registrars are to provide seals of their own. 
 A fee is usually charged for such copies of record. Usually the copy 
 is an exact copy of the original record representing a section ,,t' the 
 page with the rulings and headings as there given. An example is 
 given in Appendix 22. 
 
 1 Rhode I > la 1 ul. Chapter 616 of the Public Laws (2 March, 1899), amending Chap 
 ter 100 "i 1 1 1 « - ( General Laws: 
 
 Sec. 25. It" ii shall come to the knowledge of a town clerk, or anj person, 
 appointed am lei- the provisions of section 1 of this chapter, thai anj birth, marriage, 
 or death which has occurred in his town or city has nol been returned i" him as 
 required by this chapter, or lias nol been recorded, such town clerk or person sliall 
 record the facts called for bj section 3 of this chapter, to the extent he shall n 
 in an] way anj credible information of the same. If anj error shall !><■ made in 
 the return of any birth, marriage, or death, or shall be discovered In the records ol 
 births, marriages, or deaths, such error shall be corrected without erasure. 1 n 
 case the source ol information, from which the addition 01 correction is made, and 
 the date of making the same sliall be noted on the face of the record and 
 clerk or person shall attest the same by his signature then ." 
 
94 REGISTRATION OF VITAL STATISTICS. 
 
 State Registration of Vital Statistics. 
 
 Some sort of a state registration of vital statistics is found in most 
 of the more populous states. In the majority of them it is true the 
 results are of very little value owing to the very defective returns, par- 
 ticularly the returns of births. According to Dr. Cressy Wilbur, 1 the 
 following states had in 1895 an approximately correct registration of 
 ■deaths : Connecticut, Delaware, Maine, Massachusetts, New Hamp- 
 shire, New Jersey, New York, Rhode Island, and Vermont. Since then, 
 by the exertions of Dr. Wilbur and Dr. Hurty, Michigan and Indiana 
 have been added to the list. The registration of marriages is more 
 defective than that of deaths, and the registration of births is more 
 defective still, and probably not even approximately correct in any state. 
 
 The following is a list of states in which there is an attempt at state 
 registration together with the officer having charge of it : 
 
 Alabama State board of health. Minnesota State board of health. 
 
 Arkansas State board of health. Mississippi State board of health. 
 
 California State board of health. New Hampshire . . State board of health. 
 
 Colorado State board of health. New Jersey State board of health. 
 
 Connecticut State board of health. New York State board of health. 
 
 Delaware State board of health. North Carolina. . .State board of health. 
 
 Florida State board of health. North Dakota State baard of heolth. 
 
 Indiana State board of health. Rhode Island State board of health. 
 
 Iowa State board of health. South Carolina . . . State board of health. 
 
 Kansas State board of health. Utah State board of health. 
 
 Kentucky State auditor Vermont State board of health. 
 
 Maine State board of health. Virginia State auditor. 
 
 Maryland State board of health. Washington State board of health. 
 
 Massachusetts. . . .Secretary of state. . . . West Virginia State board of health. 
 
 Michigan Secretary of state. . . . Wisconsin State board of health. 
 
 In order to have state registration, reports must be made by the 
 local registrars to the central office. As has been shown, the original 
 returns are sent to the state registrar in New York, New Jersey, and in 
 Michigan so far as deaths are concerned. In other states copies of the 
 returns are sent, as in Connecticut, Maryland, Maine, and New Hamp- 
 shire. In Connecticut the copies are on cards, white, for births ; blue, 
 for still-births ; brown, for marriages ; and buff, for deaths, so that they 
 can be easiby arranged alphabetically or otherwise. For an example of 
 these cards see Appendix 23. 
 
 In most states a copy of the record book is made on folios of the 
 same size and ruling, and then is sent to the state registration office. 
 In Providence the original record and the copy are made at the same 
 time on a typewriter. The Fisher book-typewriter is at present used 
 for this. In other states the copies are made on one side only. Some- 
 
 1 American Public Health Association, Reports and Papers, 1806, p. 237. 
 
BEG is TEA TION F I r IT 1 L S 7\ I Tls Til \* q - 
 
 times the state registrar requires that if all blanks are not filled! the 
 reason must lie given in a letter to accompany the report. 
 
 Envelopes are furnished by the state for these returns and often a 
 memorandum of the number of births, marriages, and deaths reported 
 is to accompany the returns. 
 
 It is important for the state registrar to have a report regularly from 
 each local registrar, whether any records are made or not. When no 
 returns of births, marriages, and deaths are received by the local regis- 
 trar, a special form of report is sent in. Tims in Connecticut, where 
 cards of different colors are used for state returns of births, marriages, 
 and deaths, a special card of another color still, but of the same size, is 
 used when no returns have been received. 
 
 In certain states, besides the copies of returns or records, which are 
 sent annually to the state registrar, monthly summaries of births, mar- 
 riages, and deaths are required by the registrar, and perhaps also by the 
 state board of health if that body does not have charge of state regis- 
 tration. The form used in Rhode Island for such a report is shown in 
 Appendix 24. In New York returns are to be sent to the secretary 
 of the state board of health promptly after record. The returns are to 
 be sent to the state registrar monthly in New Jersey and Michieran, 
 Copies of record are to be sent in quarterly in California. Connecticut, 
 Delaware, Washington, and Wisconsin. In most states such reports are 
 made annually. 
 
 The original returns or copies thereof or copies of record which are 
 sen; to the state registrar are usually to be preserved b\ him, and he is 
 t'rei| iicni 1\ required to bind and index them as in .Michigan and New Jer- 
 sey. This requirement appears to be due to a mistake >tion as to 
 
 the functions of ;i state registrar. His duty should be to supervise n 
 
 tration and to arrange and publish statistical <lat;i obtained thereby. It 
 i- a well nigh useless expense to try and make the state collections of 
 records useful as ;i storehouse of the facts of personal history. Indi- 
 vidual records should be somdit in the town and counts records, not in 
 the state records. It is much better to perfect the index of local 
 records than to go to the expense of indexing those of the state. 
 
 Reports of /,<»•,// Registrars. 
 
 The publication of vital statistics is most useful and necessary. 
 
 Such publication can llsnall\ be best made b\ the state ; but the 1' 
 
 tration of vital statistics in the United States began in the cities, 
 attained greater perfection there, and continued for man} years before 
 it became general throughoul the state. The cities were the leaders in 
 
 this. The\ also published reports before it \\;i> done ly the Btute. \~ 
 
96 REGISTRATION OF VITAL STATISTICS. 
 
 these reports date back earlier than state reports, and as the statistics 
 are better in some cases, and the reports more extensive, it may be 
 advisable to continue them for many years to come ; but if the state 
 treatment of this subject should ever become as perfect as it is hoped it 
 may, it will become possible to do away with the publishing of local 
 reports. The ordinances of Providence 1 require that 
 
 " The city registrar shall cause an abstract of the returns of death made to him 
 to be published in all the newspapers which contract to do the city printing, 
 monthly, and oftener if required by the board of health. He shall also on or before 
 the first day of April, annually, prepare and present to the city council a statement 
 of the number of births, marriages and deaths which occurred in the city during the 
 year ending with the thirty-first day of December next preceding, with such other 
 information and suggestions in relation thereto as he may deem useful for the pro- 
 motion of the public health, and other interests of the city.'" 
 
 A large majority of the cities and towns which publish annual health 
 reports publish in them quite a full account of the deaths which have 
 occurred during the year, and a few report births and marriages as well. 
 Besides these a considerable number of cities publish monthly and some 
 few weekly abstracts of births, marriages and deaths. This subject will 
 be again considered in Chapter XIII. 
 
 Registration of Physicians and Others. 
 
 in order to secure the best control of the returns of births, marriages, 
 and deaths it is necessary for the recording officer to have a knowledge 
 of the names and addresses of all persons who are required to make 
 such returns. At the present time nearly all the states have laws for 
 the licensing of physicians, and some of them for the licensing of mid- 
 wives. Many of these laws regulating the practice of medicine require 
 the registration of the name and address of the physician or midwife 
 with the local officer whose duty it is to record births, marriages, and 
 deaths. Marriage laws sometimes provide that clergymen shall register 
 their names and sometimes it is necessary for them to take out licenses. 
 The state sometimes provides for the licensing of undertakers by the 
 towns as in Rhode Island. In Pennsylvania a state board for the 
 regulation of undertaking has been established. This board consists of 
 five undertakers appointed by the governor. All persons engaged as 
 undertakers may register with the board for a fee of ten dollars. In the 
 future all persons desiring to become undertakers must be examined 
 particularly as to their ability to care for bodies, dead of contagious 
 disease, and may be licensed for twenty-five dollars. All licensed 
 undertakers must register with the local board of health. "No person 
 can act as undertaker unless so licensed. There is a similar law in 
 
 1 Providence, Ordinances (1900), Chapter 44, Sec. 8. 
 
REGIS TJ! A TION OF 1 7 T. 1 L S T. I TJs Tit .v 97 
 
 Maine. Nebraska, New York, South Dakota, and West Virginia, and in 
 Iowa, Masachusetts, Minnesota, and New Hampshire the board of 
 health is to license undertakers. Besides provisions in license laws 
 requiring the registration of physicians, clergymen, undertakers, etc., the 
 registration laws themselves also sometimes contain this requirement. 
 Many cities also have local regulations requiring the registration of 
 persons concerned in the reporting of births, marriages, and deaths. 1 
 Sextons are required to be registered in Connecticut, and in Cleveland, 
 Memphis. Minneapolis, St. Louis, and Syracuse. 
 
 Fees. 
 
 A very considerable proportion of the recorders of vital statistics are 
 paid for their services by means of fees. Whether or not this method 
 of payment is desirable will not here be discussed. It is. however, a 
 very common method of paying town and county clerks. In cities of 
 considerable size it is not generally advised, and the recording and 
 similar officers of such cities are frequently in receipt of salaries. In 
 Massachusetts and Michigan the law provides that in cities of over 
 10,000 inhabitants a salary may be granted instead of fees for the 
 recording of vital statistics. The following are some of the fees com- 
 monly paid : 
 
 for ( 'ollecting and Receiving Records. 
 
 In Connecticut and Massachusetts fifty cents is paid for collecting 
 and recording data concerning each birth: as the fee for recording in 
 these states is twenty cents, the fee for collecting must be thirt) cents. 
 In Maine and New Hampshire the fee for collecting is twenty-five cents. 
 In Vermont and Wisconsin fifteen cents each is paid for collecting birth 
 and death records, and in Rhode Island fifteen cents for births, and in 
 Michigan ten cents. In Pennsylvania the fee paid the assessors for 
 collecting records of births and deaths is fifteen cents, and in Kentucky 
 it is two cents. In Connecticut ten cents is paid for inserting the name 
 of the child iii birth returns which are thus defective. 
 
 /•'"/■ Reporting Births, I>r,iths, and Marriages. 
 
 In Rhode Island undertakers are paid five cents for each certificate 
 of death, and in Wisconsin physicians are paid twenty-five cents. In 
 Delaware five cents is paid for each birth, marriage, and death reported. 
 
 In Connecticut, .Maine. Massachusetts. New York, Rhode Island, and 
 
 Virginia, twenty-five cents, ami in Vermont ten cents, for births. In 
 
 l Among these Mi;i\ lie I nen I iellei I |{r< •• ik I V II, Buffalo, < 'le\e|;|lnl. Dl 
 
 District of Columbia, Erie, Minneapolis, Omaha, the Pennsylvania i-ities r»f the 
 second class, Philadelphia, Rochester, Wilmington. 
 
9 8 REG is Til. 1 77 X F T r IT. i L $ 7\ 1 TIS Tics. 
 
 New Hampshire twenty-five cents is paid for returns of births, mar- 
 riages, and deaths. In New York and Rhode Island twenty-five cents 
 is paid for returns of marriages. In Connecticut registrars receive five 
 cents for receiving and certifying returns of deaths and births; in New 
 Jersey, ten cents, and in Wisconsin, fifteen cents. 
 
 For Recording. 
 
 In Michigan twenty-five cents is the fee for receiving, recording and 
 returning deaths, and the same amount is paid in Minnesota for the 
 same service in regard to births and deaths. In Connecticut, Massa- 
 chusetts, and Rhode Island twenty cents each is the fee for receiving, 
 recording, indexing and returning records of births, marriages, and 
 deaths, except that in Connecticut for sending returns to the state 
 registrar each month the local registrar receives in addition two dollars, 
 or if over two hundred names, two cents per name. In California, 
 Maine, New Hampshire, and Vermont the fee for recording, indexing 
 and returning is fifteen cents. In Delaware and West Virginia it is 
 fifteen cents. In Pennsylvania the fee for recording is five cents, and 
 in New Jersey cities three cents. In New Orleans fifty cents is charged 
 the family for recording births and deaths, and one dollar for marriages. 
 
 For Searching Records. 
 
 In most states and cities the examination of records is free to the 
 public, but sometimes a fee is prescribed for a search of the records by 
 the officer in charge. In Pennsylvania this is ten cents; in Delaware, 
 fifteen cents; in Brooklyn it is fifty cents for each year covered by the 
 search, but in that city no charge is made for a copy of record, but 
 twenty-five cents is required for certification. 1 
 
 For I '"j'n of Record. 
 
 Generally the fee fixed for a copy of record is for a certified copy. 
 In New Jersey a copy of record is ten cents: in Sacramento, twenty-five 
 cents, in Delaware, thirty cents ; in Providence, forty cents ; in New York, 
 Pennsylvania, New ( hleans ( births and deaths), Wilmington, fifty cents ; 
 in Cleveland, Cincinnati, St. Louis, and New Orleans (marriages), one 
 dollar: in San Francisco one dollar and one-half. In the District of 
 Columbia, Louisville, and in San Francisco, for widows and children of 
 soldiers no charge is made. 
 
 For Copies of Record Sent to Other Towns. 
 
 Such copies must be sent under the Massachusetts law, and the 
 clerk receives therefor twenty-five cents for each return. 
 
 1 These were the rules before consolidation with New York. 
 
REGIS TEA TION OF \ r H\ I L 8 T 1 Tls Til '& 99 
 
 For Burial and Disinterment Permits. 
 
 Undertakers are sometimes required to pay for burial permits. In 
 Connecticut and Vermont, Bradford and Reading, J'a.. and Pawtucket, 
 R. I., the fee is twenty-five cents. For disinterment permits the t 
 twenty-five cents in Connecticut, New Orleans, and Reading; fifty 
 
 cents in Philadelphia, and two dollars in California. 
 
 Penalties. 
 
 A penalty is usually imposed for the violation of registration laws. 
 Not only are the physicians, midwives, undertakers, parents, clergymen, 
 etc. liable for failure to send in the required returns, but the registrar 
 is also liable if he neglects his duties. 
 
 The penalty varies from a minimun of five dollars in Colorado and 
 Delaware to a maximum of one hundred dollars in Indiana. Maine, 
 Michigan, and New Hampshire. 
 
 Disposal of the Dead. 
 
 Power to make rules and regulations concerning the disposal of the 
 dead has been given to towns and cities by general statute in several 
 states as in Massachusetts, Michigan, New Jersey. New York. Penn- 
 sylvania, and by special legislation to many cities, in the case of Phila- 
 delphia as early as 22 April, 17i>4. 
 
 Some of the above states and certain others, as ( !olorado and Illinois, 
 vest the control of cemeteries in the hands of the local government, 
 authorizing it to forbid the further use of cemeteries, and to prescribe 
 regulations for new ones. Cemeteries are also very often owned or 
 managed by corporations, church or otherwise, ami are therefore subjeel 
 to their charters, which frequently prescribe many details of their man- 
 agement. Many towns and cities own cemeteries, the ownership in 
 many cases dating from the firsl set t lenient . Moreover the regulation 
 of the disposal of human remains is so manifestly a matter which may 
 effect the public health, that control of it by the local sanitary author- 
 ity is assumed in any broad grant of powers. Most of the legislation 
 in regard to cemeteries concerns the relations of the corporation to the 
 lot or grave owners, the protection of the grounds, etc., and does not 
 relate to sanitary matters, these being usually left to the local hoard of 
 
 health. Isnalh a municipal cemetery is managed b} a commit 
 
 hill sol i let i nies it is entirely in the hands of the hoard of health. Among 
 
 important cities whose health department manages their munii 
 cemeteries ma\ be mentioned Boston, Baltimore, New Orl< I 
 
 San Francisco. 
 
100 REGISTRATION OF VITAL STATISTICS 
 
 The danger of the contamination of water supplies by cemeteries 
 has been much discussed. The best information seems to be that the 
 danger is very small; but the law given below has recently been passed 
 in Pennsylvania. 1 
 
 In Lowell it is required that a plan of drainage of cemeteries shall 
 be filed with the board of health. 
 
 As the town and cities and local health authorities have such con- 
 trol and power over the disposal of the dead, most of the regulations 
 in regard to these matters are found among local sanitary enactments, 
 rather than in the state laws. Many regulations have to do with the 
 care of bodies dead with contagious disease, but these will be considered 
 in another chapter. Sometimes very general provisions are found 
 requiring the sanitary disposition of bodies. The New York 2 rule is 
 
 " That no person shall retain, expose, or allow to be retained or exposed, the dead 
 body of any human being to the peril or prejudice of the life or health of any 
 person. 1 ' 
 
 Carrying of Bead Bodies. 
 
 The removal of a body in any public carriage is sometimes forbidden 
 as in Hartford 3 and Providence. 
 
 Time of Burial. 
 
 In order to prevent concealment of crimes or contagious disease, it 
 is sometimes forbidden that burials shall take place during the night. 4 
 
 The time during which bodies may remain unburied is frequently a 
 subject of regulation. In Florida and New Orleans this is twenty-four 
 hours in summer ; and in Florida forty-eight, and in New Orleans thirty- 
 six hours in winter. In the city of Xew York the limit is four days 
 unless a permit stating the time the body may remain unburied is 
 obtained from the health department. In Minnesota the time is four 
 
 1 Chapter 151 of 1895: 
 
 tk Section 1. Be it enacted, etc., That it shall be unlawful to use for the burial 
 of the dead, any land, the drainage from which passes into any stream furnishing 
 the whole or any portion of the water supply of any city, except beyond the dis- 
 tance of one mile from such city : Provided however, That the prohibitions of this 
 act shall not be enforceable against any land now devoted to burial purposes in 
 which there shall have heretofore been burials and sales of burial lots. 1 '' 
 
 2 City of New York, Sanitary Code (1899), Sec. 175. 
 
 3 Hartford, Ordinances, Chapter XVIII. : 
 
 " Sec. 15. No hack or public carriage, owned or kept for hire, shall be used for 
 transporting the body of any person who shall have died of disease. 
 
 4 Boston, Ordinances, Chapter 49: 
 
 11 Sec. 20. No person shall bury a dead body, or cause one to be buried, at any 
 other time than between sunrise and sunset, except in accordance with a permit 
 from the Board of Health. " 
 
REG is TRA TION F \ r IT. I L S T. J Tls Tit .\ mi 
 
 days. In Buffalo the time for which a permit may be given is six days, 
 and without special permission a body may remain unburied not over 
 three da} - s. The time in deaths from contagious dist-as.- is often made 
 less than this, frequently twenty-four hours. Besides regulations such 
 as the above, the health officer sometimes has power to order burial. 1 
 
 The two sections following the one given below provide for the 
 service of the orders and instruct the police to report to the health 
 commissioner when bodies are kept too long- without burial, and to 
 assist in enforcing the commissioner's orders in regard to the same. In 
 the City of New York the hoard of health may peremptorily order the 
 burial of bodies even in coroners' cases. The storing of dead bodies 
 except for •• freezing or embalming" is forbidden in Memphis. 
 
 Embalming. 
 
 In order to prevent the concealment of criminal poisoning the fol- 
 lowing lias been enacted in Buffalo: - 
 
 • Sec. 71. STo person shall embalm any dead body without a written certificate 
 from the attending physician that there an- no facts attending the illness and deatli 
 of the person that would preclude such embalming from a medico-legal standpoint. 
 Provisions of tins ordinance shall not apply to cases of death from injury or acci- 
 dent. 
 
 ■• Sec. 72. No person, company, or corporation shall embalm the body of a 
 deceased person unless he or it shall have firsl conformed to the rules and regula- 
 tions prescribed by the coroner, and procured a permitfrom the health commis- 
 sioner, nor shall such permii be granted until all the rules and regulations of the 
 department of health or the commissioner have been complied with." 
 
 Buriah only hi Cemetery. 
 
 Burial elsewhere than in a cemetery is forbidden in ( Charleston, ( Cin- 
 cinnati, New Orleans. Newport. Providence, Heading. St. Louis, and 
 
 other cities. Ill St. LOUIS and Newport the health officer is directed to 
 
 disinter all bodies buried contrary to this rule. 
 
 1 st. Louis, ( Ordinances I L893), Chapter \ I V. : 
 
 1 Sec. 306. Interment, when ordered to be made. Whenever the inter 
 men I of the body of any deceased person in the limits of the citj of St. Louis has 
 in the opinion of the health commissioner been unnecessarily delayed, or where for 
 sanitarj reasons the interment of the bodj as aforesaid should take place forthwith, 
 or where in the opinion of the said health commissioner such delaj tnaj be injurious 
 t.. the public health, or endanger the li\«'> of the citizens of this city, it shall !><• Ins 
 
 dut\ to issue ; rder directing that said bodj shall be interred forthwith. 
 
 order shall be directed to the relatives, friends, person or persons having in • 
 the body of Buch deceased person. If the relatives, friends, person or persons, 
 a> aforesaid, fail or refuse to obej said order, then and in that case the liealtl 
 mission. u- shall have the power to remove such body, and it shall be his dutj to 
 cause the body to !><• immediately interred in the public cemeti 
 Buffalo, Ordinances (1897), Chapter X \\ . 
 
102 REGISTRATION OF VITAL STATISTICS. 
 
 Depth of Grace. 
 
 This is very commonly regulated. It must be three feet deep in 
 New ( h'leans, five feet in Fitchburg, six feet deep or four below the 
 level of the street in the City of New York, Buffalo, and Memphis ; 
 six feet in Philadelphia, St. Louis, and Yonkers ; and eight in the built 
 up portion of Philadelphia. The top of the coffin must be three feet 
 below the surface in Boston, Cambridge, and Newport ; three and one- 
 half in New Jersey, if the coffin is four feet long or less ; four in Bridge- 
 port and in New Jersey, if the coffin is over four feet long ; and five in 
 Atlanta. In New Orleans graves must never be less than two feet 
 apart. 
 
 Only One Body in a Grave. 
 
 In Atlanta, Buffalo, and Charleston it is forbidden to place more 
 than one body in a grave. In Lowell only two bodies may be in one 
 grave, and in other cities only one body may be placed in a grave except 
 that a child may be buried with a parent. 
 
 Grave to be Immediately Filled. 
 
 According to the New Jersey statute, and the rules of the Lowell 
 board of health, a grave must be immediately filled when the body is 
 placed in it. 
 
 Vaults and Their Use. 
 
 Instead of burial in graves, deposit in a vault or tomb is sometimes 
 the method employed for disposing of bodies. This is not considered 
 desirable, and from its expense and perhaps other reasons, is not very 
 common. Sometimes the construction and use of such vaults is for- 
 bidden as in Charleston and Philadelphia. 1 
 
 In other cities permits are required for the construction of vaults. 
 In Yonkers a permit is required for the use of a vault. The method of 
 construction of vaults is often regulated and sometimes, as in Buffalo, 
 the plans must be approved. 
 
 Receiving Va nits. 
 
 Most cemeteries have a common receiving vault in which bodies may 
 temporarily remain awaiting burial or transportation. Often the length 
 
 1 Philadelphia, Rules of Board of Health (1895), Sec. 205e: 
 
 " The placing of a dead body in any unsealed overground vault, catacomb or 
 other receptacle above ground or in underground vaults, except such as are fitted 
 with a stone covering to be tightly cemented after each interment, is strictly pro- 
 hibited, unless the coffin or casket, containing the remains, shall be first per- 
 manently and hermetically sealed in a metal case. This rule does not apply to 
 receiving vaults." 
 
REGISTRATION OF VITAL STATISTICS. 103 
 
 of time a body may remain in the vault is limited. Thus in New Jersey 
 a body cannot remain in a vault over forty-eight In mis between tin- Hist 
 of May and the first of November, unless the vault is below ground, or 
 the body is in an air tight casket. In Buffalo 1 and some other cities it 
 is seventy-two hours during the same season. In Cincinnati 2 a body 
 may remain in a vault for live days. In Newport, R. I., 3 a body may 
 remain in a vault for ten days only, without a permit, and must be in 
 a strong, tight box ready for removal. 
 
 Inspection ami Disinfection of Vaults. 
 
 In a number of cities it is prescribed that vaults shall be inspected 
 and cleansed from time to time. In Ihiffalo they are to be emptied and 
 cleansed on the first of May of each year. The Newport. R. I., rule is 
 given below. 4 
 
 Disinterments. 
 
 Permits are required for the disinterment of bodies by the laws of 
 California, Connecticut. Iowa. Ohio, Maine. New Hampshire ( for cities), 
 New Jersey, and in Atlanta. Augusta. Boston, Buffalo, Cambridge. 
 Charleston, Lowell. Memphis, Milwaukee, Minneapolis, New Orleans, 
 and Wilmington. It is sometimes required, as in Ohio, that the appli- 
 cation must be made by the next of kin and must be sworn to. In 
 Wisconsin the permit must be approved by the state board of health. 
 Forms for such application and for permits are shown in Appendix -•">. 
 
 In San Francisco" it is required 
 
 " That tin- Inspector of Vaults ami Disinterments lie instructed to see that disin- 
 terments and removals of human remains from the cemeteries shall be conducted 
 
 so as not to he offensive to the senses, or injurious to public health." 
 
 » Buffalo, Ordinances tls'.'Ti. Chapter 25, Sec. 46. 
 
 Cincinnati, Manual of Health Department (1898), Sec. 100. 
 Newport. Ordinances (1892), Chapter 23, Sec. 12. 
 
 • \cwport. Ordinances (1892-), Chapter 23, Sec. 11: 
 
 •■ Every vault or tomb, buill wholly or partially above the surface of the ground 
 ami used or designed for t he reception of dead ho<]ies in anj cemetery or other place 
 in said city, shall he examined ami shall he opened bj the proprietor thereof, or by 
 the person or persons in charge thereof , for examination by the mayor or the in- 
 spector of nuisances, or any member of the board of health of said city, or any 
 person designated i>> said hoard whenever and as often as either of the above named 
 city officers or any person designated by said hoard as aforesaid, shall dea 
 requesl the same, and shall he thoroughlj cleansed ami purified by such proprietor, 
 f>r person or persons in charge thereof, under the direction of said inspector of 
 nuisances, or of a person designated by said hoard as aforesaid, as often as such 
 
 inspector, or SUCh last named person shall require the same to he done, n 
 ing four t hues in any one \ ear. 
 
 San Francisco, Rules of the Board of Health, -:i Dee. 1884. 
 
104 REGISTRATION OF VITAL STATISTICS. 
 
 In Philadelphia permits for removal from grave to grave or cemetery 
 to cemetery in the city may be given by the clerk, but all other disin- 
 terment permits must be given by the board. In Pennsylvania disin- 
 terments must not take place between sunset and sunrise. In Phila- 
 delphia permits must be used within seventy-two hours after they are 
 issued. In Ohio disinterments cannot be made between April 1st and 
 October 1st. The Wilmington rules require that a disinterment shall 
 not be made within six months after death, and in California a body 
 cannot be disinterred for a year without consent of the mayor and coun- 
 cil. In ( )hio the disinterment of contagious disease is forbidden, and 
 in New Jersey it can only be disinterred when in a metallic coffin. In 
 Buffalo such a body cannot be disinterred for ten years after burial. 
 In San Francisco there are two disinterment inspectors who supervise 
 all disinterments and collect the fees. 
 
 Cremation has received statutory recognition in several states, as 
 Connecticut, Massachusetts, Minnesota, and Pennsylvania. In Massa- 
 chusetts no body shall be cremated within forty-eight hours after death, 
 except in cases of contagions disease, and not until it has been viewed 
 by the medical examiner and his certificate been given that judicial 
 inquiry is not necessary. A somewhat similar law is found in Con- 
 necticut. In Pennsylvania where burial permits are not required, it is 
 neccessary that, prior to cremation, a permit shall be obtained from the 
 health authorities of the locality where the crematory is situated. In 
 St. Louis 1 a written application must be made by the friends of the 
 deceased and may be refused by the health commissioner if he is not 
 satisfied that it is propel' to cremate the body. In Minnesota a body 
 may be cremated on request of friends. In San Francisco 2 it is forbid- 
 den to construct a crematory within three hundred feet of a street or 
 park, and a crematory must be operated so as not to be detrimental to 
 public health and decency. In ( ionnecticut plans of the crematory must 
 be approved by the state board of health. In Buffalo 3 a coffin used to 
 convey a body to a crematory must not be used again. 
 
 The use of bodies for dissection is permitted and regulated by the 
 laws of several states. 
 
 The regulation found in Cincinnati, which forbids the placing in the 
 streets of ice which has been used upon dead bodies, is in the line of 
 decency, but it hardly seems that such a regulation ought to be neces- 
 sary. 
 
 1 St. Louis, Ordinances (1892). Sec. 309. 
 
 -San Francisco, Rule of Board of Health, March 21, 1894. 
 
 ■'■ Buffalo, Ordinances (1897), Chapter 25, Sec. 53. 
 
REGISTRATION OF VITAL STATISTICS. j()5 
 
 STATUTES CONSULTED IN THE PREPARATION OF THIS ChAPTEK. 
 
 Alabama. Registration, Code (1896), Sees. 2436-41. 
 
 Marriage, Code (1896), Sees. 2837-51. 
 Arizona. Registration, Penal Code (1887), Sec. 640. 
 
 Marriage, Chapter 77 of 1891, 
 Arkansas. Registration, Statutes (1894), Sees. 519-20. 
 
 Marriage, Statutes (1894), Sees. 4906-39. 
 California. Registration, Political Code (1880), Sees. 3074-84. 
 
 Disinterments. Act of 13 March, 1889. 
 
 Marriage, Civil Code (1885), Sees. 68-79. 
 Colorado. Registration. Act of 17 April, 1893, Sees. 46-50. 
 
 Cemeteries, Act of 17 April, 1893, See. 54. 
 
 Marriage, Annotated statutes (1891), Sees. 2988-3006. 
 Connecticut. Registration, General statutes (1888), Sees. 98-116, 2582. 
 
 Registration, Chapter 155 of 1893. 
 
 Registration, Fees, Chapter 166 of 1893. 
 
 Registration. Completing Records, Chapter 195 of 1895. 
 
 Registration, Fees, Chapter 1'.' of L897. 
 
 Registration, Completing Records, Chapter 121 of 1897. 
 
 Cremation, Chapter 228 of 1895. 
 
 .Marriage, General Statutes (1888), Sees. 27*7 89. 
 
 Marriage, Chapter 6:'. of 1895. 
 Delaware. Registration, Revised Code (1893), p. 594. Chapter 74. 
 
 Marriage, Revised Code (1893), p. 405, Chapter 381, Vol. in. Laws of Delaware. 
 Florida. Registration, Chapter 33 of 1899. 
 
 Marriage, Revised statutes (1892), Sees. 2055 60. 
 Georgia. Marriage. Code (1882), Sees. 1703-10. 
 Idaho. Marriage, Act of 14 February, 1899. 
 1 1, i, inoi-. Registration, Annotated statutes (1896), Chapter L26a, Sees. ;; 9. 
 
 Marriage, Annotated Statutes (1896), Chapter 89. 
 Indiana. Registration. Acl of 28 \|>ril. L899. 
 
 Marriage. Statutes (1897), Sees. 7642 52. 
 low \. Registration, ('ode (1897), Sees. 2565 7. 
 
 Marriage, Code (1897), Sees. :;i in 52. 
 K \ \ - \-. Registral ion. < General Statutes (1897), Chapter 75, Sec. 9. 
 
 Marriage, General Statutes (1897), Chapter 123. 
 Kenti cky. Registration, Mamies (1894), Sees. 2581 90. 
 
 Marriage, statutes (1894), Sees. 2096 --'in;. 
 Louisiana. Registration, Revised Code (1889), Sees. 338 18. 
 i rat ion. Chapter 192 of 1898. 
 
 Marriage. Revised Civil Code (1889), Arts. 99 L09. 
 M mm.. Registration, statutes. Supple t (1895), p. 370, Intending Chaptt i 
 
 Registration, Chapter 282 of 1897. 
 
 Marriage, Revised statutes (1883), Chapter 59. 
 M \ i;\ land. Registration, Chapter 312 of 1898. 
 
 Anat ical Material, Chapter L66 of 1890. 
 
 Marriage, Public General Laws (1888 . Lrt. 62. 
 Massachusetts. R< gistration, Public Statute Sec. 18. 
 
 Registration, Chapter ill of 1897. 
 
 Burials, chapter 278 of 1885. 
 
 Burials, Chapter i:;7 of L897. 
 
 i remation, chapter 265 of 1885. 
 Anatomical Material, Chapter 179 ol 1898. 
 
 Marriage. Public Statutes | L882), Chapter I 15. 
 
106 REGISTRATION OF VITAL STATISTICS. 
 
 Massachusetts, continued. 
 
 Marriage, Chapter 300 of 1892. 
 
 Marriage, Chapter 401 and 409 of 1894. 
 
 Marriage, Chapter 424 of 1897. 
 
 Marriage. Chapter 197 and 887 of 1899. 
 Michigan. Registration, Compiled Laws (1897). Sees. 4014-20. 
 
 Burials, Compiled Laws (1S97), Sec. 4414. 
 
 Marriage, Compiled Laws (1897), Sees. 8602-10. 
 
 Marriage, Chapter 247 of 1899. 
 Minnesota. Registration, Statutes (1894). Sees. 436-441. 107. 
 
 Cremation, Chapter 132 of 1897. 
 
 Marriage. Statutes (1894). Sees. 4768-84. 
 Mississippi. Registration, Chapter 15 of 1897. 
 
 Marriage, Annotated Code (1892), Sees. 2860-65. 
 Missouri. Marriage, Revised Statutes (1899), Sees. 4315-22. 
 Montana. Registration, Political Code (1895), Sees. 2870-75. 
 
 Marriage, Civil Code (1895), Sees. 70-80. 
 Nebraska. Embalmers, Chapter 52 of 1899. 
 
 Marriage, Compiled Statutes (1899), Sees. 3642-58. 
 Nevada. Marriage, General Statutes (1885), Sec. 470. 
 
 Marriage, Chapter 35 of 1899. 
 New Hampshire. Registration, Public Statutes (1891), Chapter 178. 
 
 Registration, Chapter 53 of 1895. 
 
 Registration. Chapters 6 and 17 of 1899. 
 
 Embalmers, Chapter 76 of IS! if*. 
 
 Marriage, Public Statutes (1891), Chapter 174. 
 
 Marriage. Chapter is of 1897. 
 New Jersey. Registration, General Statutes (1895), p. 2006. 
 
 Burials, General Statutes (1895), p. 1645, Sec. 12, XIV. 
 
 Burials, General Statutes (1895). p. 76, Sec. 16. 
 
 Anatomical Material, Chapter 395 of 1895. 
 
 Marriage, General Statutes (1895), p. 2003. 
 
 Marriage, Chapter 193 of 1897. 
 
 Marriage, Chapter 119 of 1898. 
 
 Cemeteries, General Statutes (1895), p. 849. 
 New Mexico. Marriage, Compiled Laws (1897), Sees. 1413-30. 
 
 New Yoke. Registration, General Laws (1896), p. 2422. Public Health Law. 
 Chapter 25, Sees, 5, 22, 23. 
 
 Registration, Chapter 138 of 1897. 
 
 Embalmers, Chapter 555 of 1S98. 
 
 Marriage, Genera] Laws (1896), p. 930, Domestic Relations Law, Chapter 48, 
 Art. II. 
 
 Marriage, Chapter 272 of 1896. 
 North Carolina. Registration. Act of 1 March, 1893. 
 
 Marriage, Code (1883), Sees. 1809-18. 
 North Dakota. Registration, Revised Code (1899), Sec. 274 a-g. 
 
 Marriage, Revised Code (1899). Sees. 7272-5. 
 Ohio. Registration. Annotated Statutes (1900), Sees. 6395-9. 
 
 Marriage. Annotated statutes (1900), Sees. 6884-94. 
 Oklahoma. Marriage. Chapter _'•"» of 1897. 
 Oregon. Marriage. Annotated Laws (1892), Sees. 2852-8. 
 Pennsylvania. Registration, Brightly's Purdon's Digest (1894). pp. 1851-7. 
 Registration. Chapter 156 of 1895. 
 
 Anatomical Material. Brightly's Purdon's Digest (1894), p. 106. 
 Cremation, Brightly's Purdon's Digest (1894), p. 466. 
 
R EG IS TIL i TION OF VITA L s TA TIS TI< >. 107 
 
 Pennsylvania, continued. 
 
 Cemeteries, Chapter 151 of 1895. 
 
 Marriage, Brightly's Pardon's Digest (1894), p. 1295. 
 Rhode Island. Registration. General Laws (1896), Chapter 100. 
 
 Registration, Chapter 452 of the Public Laws. 
 
 Registration, Chapter 616 of the Public Laws. 
 
 Marriage, General Laws (1896), Chapter 191. 
 
 .Marriage. Chapter 549 of the Public Laws. 
 South Carolina. Registration. Act of •"> January, 1895. 
 
 Registration, Revised statutes (1893), Sees. 2157-67. 
 South Dakota. Embalmers, Chapter 87 of 1899, 
 Tennessee. Marriage, Code (189G), Sees. 4185-200. 
 Texas. Marriage, Chapter 170 of 1899. 
 
 Marriage. Revised Statutes (1895), Sees. 2!i.")4-(iL'. 
 I't ui. Registration, Revised Statutes (1898 ), Sees. 1104, 2o:i! •-:!:). 
 
 Registration, Chapter 45 of 1899. 
 
 Marriage, Revised Statutes (1898), Sees. OOl', 2183-97. 
 VERMONT. Registration. Chapter 59 of 1899. 
 
 Marriage, Statutes (1894), Sees. 2632-4:!. 
 Virginia. Registration, Act of 7 March, 1900. 
 
 Marriage, Code (1887), Sees. 2216-22. 
 Washington. Registration, Code and Statutes (1897), Sees. 2U7>< 69. 
 
 Marriage, Code and Statutes | 1897), Sees. 44G7-83. 
 West Virginia. Registration, Code (1899), Chapter 150, Sees. 23-29. 
 
 Embalmers, Chapter 60 of 1899. 
 
 Marriage, Code H899). Chapter 63. 
 \\ i-. onsin. Registration, Statutes (1898), Sees. 1022-29. 
 
 Registration. Chapter 250 of 1899. 
 
 Marriage, Statutes (1898), Sees. 2328-39. 
 
 Marriage, Chapter 301 of 1899. 
 Wyoming. Marriage, Revised Statutes (1899), Sees. 2955-71. 
 
CHAPTER III. 
 
 NUISANCES. 
 
 IT is the popular idea that the chief function of the board of health is 
 the abatement of nuisances ; and it must indeed be admitted that a 
 large part of the time and energy of sanitary officers is taken up in the 
 performance of this duty. A nuisance has been variously denned by 
 statute and by legal writers, but in general it may be said to be any- 
 thing which is a violation of the maxim, " sic utere tu<> uf alienum n<>n x 
 laedas." It is the use of one's own property in such a way as to 
 injure the rights of another and to inflict damage. 
 The following is a recent statutory definition : ] 
 
 " Whatever is dangerous to human life or health, and whatever renders soil, air, 
 water, or food impure or unwholesome, are declared to be nuisances, and every per- 
 son, either owner, agent, or occupant, having aided in creating or contributing to 
 the same, or who may suffer to continue or retain any of them shall be deemed 
 guilty of a misdemeanor." 
 
 Nuisances therefore may be of very many kinds, and it is not with 
 all nuisances that boards of health usually have to do. Nuisances which 
 more or less directly affect health, and particularly nuisances which con- 
 sist of foul, offensive or otherwise dangerous odors or gases, or which 
 are in any way due to decaying matter, or to impurities of any kind in 
 the air, are the kind, the control of which is usually placed under Tie 
 jurisdiction of the sanitary authority. But long before boards of health 
 were established the control of nuisances was provided for. As early 
 as 1 (>'.>:> the colony of Massachusetts Bay gave the selectmen of certain 
 towns authority to regulate offensive trades. From that time nuisance 
 legislation was frequently resorted to in that and other colonies and in 
 the states; and towns w r ere during the last century and before there 
 was any regularly constituted sanitary authority invested with as broad, 
 and ample powers in regard to nuisances as they now possess. But 
 with the development of interest in sanitary affairs, towards the middle 
 of the present century, a more strict and general application of these 
 laws was felt to be needed. The dangers as well as the discomforts of 
 filth were urged, doubtless extravagantly so, by physicians and others. 
 The newly established boards of health were therefore generally invested 
 
 iUtah, Chapter 4.') of 1899, .Sec. 1. 
 
NVISAJSTCJES. 109 
 
 with the control of nuisances which before had been exercised by the 
 selectmen of towns or the legislative department of cities. It is the 
 general opinion that these matters will he better looked after by the 
 health department than by any other, and we cannot expect this part of 
 the work of the hoard of health to become any less in the future. Our 
 civilization ever demands greater cleanliness and greater freedom from 
 nuisances both private and public; and this is particularly true in 
 municipalities, and the necessity for greater care on the part of the 
 individual lest he permit or cause a nuisance increases with the density 
 of the population. Hence the public demands more than ever before 
 that the municipals/ shall restrain such individual acts as endanger the 
 health and comfort of those affected thereby. Even if it shall in the 
 future l>e shown that tilth is not as directly dangerous to health as it 
 has been believed to be, there is little probability that any community 
 will cease to protect its members from the very great discomfort which 
 cullies from nuisances due to that cause. 
 
 It is not necessary then to take up the consideration of what a nuis- 
 ance is, or discuss the flifference between a private and public nuisance 
 or the redress which an individual has either by abatement or h\ an 
 action for damages. Nor is it the place to consider the suppression of 
 nuisances by injunction. Our subject is the statuory powers possessed 
 by the local health department and the methods which it roiiininiih 
 employs. 
 
 There are two ways in which the government commonly attempts 
 to deal with nuisances. One is by their abatement, the other is h\ 
 endeavoring to prevent their creation by means of appropriate legisla- 
 tive prohibitions. The abatement of nuisances is rarely accomplished 
 through the agency of state sanitan authority, but is usiialh left to 
 the local government. I>nt the authority which the local sanitarj 
 power possesses in this held is generally conferred very explicitel} bj 
 statute law. Usually these state laws prescribe quite minutely the 
 methods to he employed in thus dealing wit h nuisances: but sometimes, 
 particular^ in special charters, the power to abate nuisances is con- 
 ferred iii concise ami general terms, as it is in Chicago, Baltimore, 
 Omaha, and Providence. Of the two methods of dealing with nui- 
 sances, by abatement and by prohibition, the former will be first con- 
 sidered. 
 
 I. Abatement of Nuisances. 
 
 The first general state law that specifically provided for the manner 
 
 in which the local government should order the abate nt of nuisances 
 
 and secure compliance with its order was that enacted in Massachusetts 
 in 17 ( .»7. Thai law has remained practically unchanged upon the 
 
HO NUISANCES. 
 
 statute books until the present writing, over 100 years, and it has served 
 
 for a model, being copied almost verbatim by fourteen other states. 1 
 
 The following is the law : 2 
 
 " The board or the health officer shall order the owner or occupant at his own 
 expense to remove any nuisance, source of filth, or cause of sickness, found on pri- 
 vate property, within twenty-four hours, or such other time as it deems reasonable, 
 after notice served as provided in the following section; and if the owner or occu- 
 pant neglects so to do, he shall forfeit a sum not exceeding twenty dollars for every 
 day during which he knowingly permits such nuisance or cause of sickness to remain 
 after the time prescribed for the removal thereof.'" 
 
 Besides the states above mentioned, at least fifteen others have made 
 provision by general enactments for the abatement of nuisances within 
 their borders, though in Indiana and Texas the law only applies to 
 cities. Moreover, Louisiana, Mississippi, Nebraska, Ohio, and Ten- 
 nessee provide that local governments within their limits may make 
 ordinances for the "abatement of nuisances/' In rare instances the 
 power to abate nuisances is granted in very general terms as in Kansas 
 cities, which have power " to prevent and remove nuisances." Texas 
 and Tennessee have similar laws. Usually, "however, more explicit 
 directions are given as to who shall exercise this authority and how it 
 shall be done. All but a few of the more sparsely settled states have 
 felt the necessity of providing some means for the summary removal of 
 nuisances. 
 
 As regards the larger cities it will be found that many, perhaps 
 most of them, though under special charters and receiving their sanitary 
 establishment from the charters, nevertheless control nuisances under 
 the provisions of general statutes. Yet among the principal cities a 
 considerable number have been given in their charters or other special 
 acts authority to deal summarily with nuisances. Among some of these 
 cities may be mentioned Buffalo, Chicago, District of Columbia. Minne- 
 apolis, New York, St. Louis, and San Francisco. 
 
 As public sanitation in the popular mind consists chiefly in the removal 
 of nuisances, this work is usually and naturally put upon the sanitary 
 authority wherever that is established ; but this is not always the case. 
 Thus in Rhode Island it is the town council (or board of aldermen 
 in cities) which is to order the abatement of nuisances; and until 
 quite recently the selectmen in Vermont had similar duties. Originally 
 this wast lie plan throughout New England, and in Vermont and Rhode 
 Island, where sanitary organization has been the slowest in developing, 
 
 1 Colorado, Connecticut, Iowa, Kentucky, Michigan, Minnesota, New Jersey, 
 North Dakota, Rhode Island, South Carolina, Wisconsin, Vermont, Wyoming, Wash- 
 ington. 
 
 2 Massachusetts Public Statutes (1882), Chapter 80, Sec. 21. 
 
NUISANCES. HI 
 
 it has been the longest retained. The trustees of Indiana townships 
 have the same power. By Chapter 259 of the laws of Pennsylvania 
 for 1895, it was provided that the select and common council of any of 
 the cities of the third class may petition the court of common pleas of 
 the county which shall appoint a commission of six to report to the 
 court on the fact of the nuisance. The parties maintaining- the nuisance 
 have thirty days in which to appeal, and if not abated the city may pro- 
 ceed to abate at once. 
 
 The laws of Alabama, Virginia, and West Virginia are much alike. 
 In Virginia a justice of the corporation may on complaint of the health 
 officer abate a nuisance, and in Alabama the mayor, intendant or 
 justice may do so. In Georgia nuisances may be abated by an order of 
 "two or more justices of the peace of the county, founded upon the 
 opinion of twelve freeholders who shall be summoned, sworn and 
 impaneled for the purpose," and in towns or cities the mayor, intend- 
 ant or commissioners may order a nuisance abated with the advice of the 
 aldermen, wardens, council or commissioners. In West Virginia either 
 a mayor, justice, constable or health officer may abate nuisances. In 
 Washington, a justice when no appeal is taken, or any higher court 
 after conviction tor maintaining a nuisance, may issue a warrant to 
 abate the same. The Illinois and Tennessee laws contain a similar pro- 
 vision. In a few states the control of nuisances is still retained by the 
 state authority. Thus in Florida the state health officer is io abate 
 nuisances, and in Mississippi the state department of health, on com- 
 plaint of a local health officer, though municipalities may make rules 
 for the prevention and abatement of nuisances. In Arkansas the gover- 
 nor may abate a nuisance mi the advice of the state board of health. 
 Certain state boards of health also retain among their other executive 
 powers control over nuisances under certain conditions, as when no local 
 board has been established, or when such board fails Io act. See also 
 
 page •"». 
 
 In New Jersey and Delaware the state board of health is to act il 
 the local board of health fails to do so. and in New .lersev also when 
 
 ;i nuisance in one local sanitary district affects the inhabitants o| 
 another. 
 
 It is usually the board of health that has i he power to order the 
 abatement of nuisances or the single commissioner who takes the place 
 of the board in maii\ cities: but in some localities it is nol necessary 
 
 for the board as a whole to ael in these cases. Thus at Bridgeport the 
 
 "board of health or either mber thereof or an) person under their 
 
 direction or the direction of either of them" ma\ abate nuisances. 
 
 In New Hampshire each member of the board of health ma\ 
 
112 NUISANCES. 
 
 orders. In Massachusetts the board of health or health officer may 
 issue the order, and in Rhode Island the health officer may do so 
 " when the council cannot be conveniently convened." In Cleveland the 
 health officer issues the orders. In some cities the sanitary inspectors 
 or similar officers have delegated to them the power to issue nuisance 
 orders. This is so in Atlanta, Augusta, and the District of Columbia. 
 
 When a board of health or its agents are given authority over 
 nuisances, it is generally assumed that power to enter upon private 
 premises for purposes of inspection is included. This may the more 
 reasonably be assumed when the board as is often the case is directed 
 to " examine into nuisances " ; but power to enter private premises is 
 specifically given in many statutes relating to this subject. 1 
 
 Sometimes, as in Connecticut, it is simply provided that the " health 
 officer may enter all places when such board shall have just cause to 
 suspect any such nuisances or causes of filth to exist." In West Vir- 
 ginia such inspection may be made " except in the night time." The 
 Detroit law is as follows : 2 
 
 l 'Also to enter upon or within any place or premises, where conditions dan- 
 gerous to the public health are known or believed to exist, and by appointed mem- 
 bers or persons to inspect and examine the same for the protection of life and health 
 and for no other purposes ; and all owners, agents, and occupants shall permit and 
 facilitate such sanitary examinations, and it shall be the duty of said board of health 
 to furnish such owners or occupants a written statement of results or conclusions 
 of such examination" — " The members of said board, the health officer, or any of 
 the sanitary inspectors, and such other officer or person, as may at any time be by 
 said board authorized, 7iiay, without fee or hindrance, enter, examine or survey all 
 grounds, erections, vehicles, structures, apartments, buildings, and places in said 
 city, including vessels of all kinds in the water, and all cellars, sewers, passages and 
 excavations of every sort, and inspect the safety and sanitary condition and make 
 plans, drawings, and descriptions thereof, according to the order and regulation of 
 said board. Said board may make and publish a report of the sanitary condition, 
 and the result of the inspection of any place, matter or thing in said city, so inspected, 
 or otherwise as aforesaid, so far as, in the opinion of said board, such publication 
 may be useful. 11 
 
 A considerable number of cities which have no such specific statutory 
 provision in their charters, nevertheless by virtue of their general 
 legislative powers in regard to sanitation have included such pro- 
 visions in their ordinances or the rules of their health department. 3 
 
 1 Among such statutes are those of Alabama, Colorado, Connecticut, Delaware, 
 Iowa, Maine, Massachusetts, Michigan, Minnesota, New Hampshire, Pennsylvania, 
 South Carolina, Utah, Virginia, West Virginia, and Wisconsin. Such power is 
 granted in the special legislation of several cities, as Detroit, Pennsylvania cities 
 of the second class, and the City of New York. 
 
 - Michigan, Chapter 10 of 1895, Sec. 7. 
 
 3 Among these are Albany, Atlanta, Bridgeport, Charleston, Chicago. Cleveland, 
 Denver, Jersey City, Memphis, Mobile, Newark, Newport, New York, Omaha, 
 Rochester, St. Louis, Utica, and Yonkers. 
 
NUISANCES. 113 
 
 In many of these ordinances it is also provided that no one shall 
 obstruct the officers in their inspections. 
 
 Occasionally health officials have been annoyed by unauthorized 
 persons representing themselves as inspectors and thus gaining access 
 to private premises for various illegitimate purposes. This is some- 
 times forbidden by law as by a recent enactment of Congress for the 
 District of Columbia. 1 
 
 A number of the state laws make provision for the inspection of 
 private premises only when in the ordinary course of work such entry 
 is refused. Most of these laws follow the Massachusetts statute which 
 was first enacted in 1816. It is given below. 2 
 
 Most of the modifications of this law provide for the different 
 officials, who in the various states shall issue the warrants and make 
 the inspections : and occasionally the limitation as to " reasonable time " 
 is made specific by the words, "between sunrise and sunset." 
 
 Most of the legislation concerning nuisances provides specifically 
 for the issuing of orders to the parties interested before the nuisance is 
 abated. It is claimed that this is not necessary, and the Alabama and 
 Virginia statutes do not seem to contemplate it. nor does the ordinance 
 in Bridgeport prescribe it: and in some cities it is specified that under 
 certain conditions a nuisance may be abated without the service of any 
 order. It may be done in San Francisco when the nuisance is on the 
 property of the city or of a non-resident: in New Haven and Omaha, 
 
 1 •-/>'< it enacted by the SenaU and linns* •>/ Representatives of tin United States 
 (if America in Congress assembled, That it shall he unlawful for any person in the 
 District of Columbia to falsely represent himself or herself as being an inspector "t 
 the health department oi said District, or an inspector of any department of the 
 District government ; ami any person so offending shall he deemed guilty of a mis- 
 demeanor, and on conviction in the police court of said District shall he punished 
 by a tine of net less than ten dollars nor more than fifty dollars for the first offense, 
 ami for cadi subsequent offense by a line of not less than fifty dollars nor more than 
 one hundred dollars, or imprisonment in the jail of the District not exceeding six 
 
 months, or both, in the discretion of the court. 
 
 "Approved, March 2, 1897." 
 
 - Massachusetts. Public stat ut es 1 1882), Chapter BO, Sec. 27: 
 
 " When the board thinks it necessary for the preservation of the lives or health 
 
 of the inhabitants to enter any land, building, or premises, or \ esse l within its town. 
 for the purpose of examining into and destroying, removing or preventing a nuisance, 
 
 source of tilth, or cause of sickness, and t he board or anj agent thereof sent for t hat 
 
 purpose is refused such entry, any member of the board or such agent mas make com 
 plaint under oath to anj just ice of any court of record or to two justices of the peace 
 of the county, stating the facts of the case so far as he has knowledge tin 
 and said justice or justices may t hereupon issue a warrant, directed to the sheriff oi 
 
 any of the deputies, to such agent of the hoard, or to any constable of such town. 
 
 commanding him to take sufficient aid. ami at anj reasonable time repair to the 
 place where such nuisance, source of filth, or cause of sickness complained of may 
 he, and to destroy, remove, or prevent t he same, under the direction oi the board." 
 
114 NUISANCES. 
 
 when the owner is unknown ; in Minneapolis, when he cannot be found ; 
 
 in Pennsylvania cities of the second class and in Milwaukee, when the 
 
 owners of unoccupied property live out of the city or cannot be found. 
 
 In St. Louis if the owner cannot be found, and the statement by the 
 
 officer on the return is conclusive of this, the order must be advertised 
 
 two days in the newspaper doing the city printing. In Cleveland the 
 
 health officer may "in case of necessity" "abate a nuisance without 
 
 notice." 
 
 The ordinances of Denver provide : 1 
 
 " Non-residents owning property on which a nuisance exists, and who have been 
 notified thereof and given sufficient time to appear before the health commissioner 
 in reference thereto, and who fail or refuse to appear or to have the nuisance remedied 
 as directed, shall be given ten days' notice by publication, and upon continued refusal 
 or omission to comply, the premises may be placarded by the health commissioner 
 and declared a nuisance prejudicial to the public health or unfit for human habita- 
 tion." 
 
 Usually it is provided that an order to abate a nuisance shall be 
 directed to the owner or occupant of the property on which the nuis- 
 ance is found. This was the form of the Massachusetts law, and it has 
 been retained in those states which have copied Massachusetts, and it 
 appears in the general nuisance laws of many other states and in most 
 city charters. Sometimes, as in North Carolina, the occupant is put 
 first and the owner is only notified when the premises are unoccupied. 
 In cities of the second class in Pennsylvania the term tenant is used, 
 and in Hartford occupant or tenant. Several laws specify still further 
 the parties to be notified. In Delaware it is " the person to whom it 
 belongs or in whose possession, or on whose property it is, or the per- 
 son causing the nuisance." In Florida, " the person committing, creat- 
 ing, maintaining or keeping '* the nuisance. In Ohio the nuisance may 
 be ordered abated by " the owner, agent, or other person or persons 
 having control of the same, or being responsible for the condition." In 
 the District of Columbia the order is to the person "permitting, creating, 
 or keeping the nuisance " ; in Wilmington, Del., to " the owner, agent, 
 occupant, or other person causing" the same. The following is the law 
 in the City of Xew York: 2 
 
 : - Service of any order of said board of health shall be deemed sufficient if made 
 upon a principal person interested in or upon a principal officer charged with duty 
 in respect of the business, property, matter, or thing, or the nuisance or abuse to 
 which said order relates; or upon a person, officer or department, or one of the 
 department who may be most interested in or affected by its execution. If said 
 order relate to any building, or the drainage, sewerage, cleaning, purification, or 
 ventilation thereof, or of any lot or ground on or in which such building stands, 
 used for, or intended to be rented as, the residence or lodging place of several per- 
 
 1 Denver, Ordinance 44 of 1893, Sec. 156. 
 
 2 New York, Chapter 378 of 1897, Sec. 1224. 
 
NUISANCES. 115 
 
 sons, or as a tenement bouse or lodging house, service of such order on the agent of 
 any person or persons for the renting of such building, lot or ground, or for the col- 
 lecting of the rent thereof, or of the party thereof to which said order may relate, 
 shall be of the same effect and validity as due service made upon the principal of such 
 agents and upon the owners, lessees, tenants, occupants of such buildings or parts 
 thereof, or of the subject matter to which such order relates."' 
 
 In Minnesota the order may be served on the agent. The Denver 
 ordinances ! prescribe that 
 
 " Whenever the owner or owners of any property are not present in Denver, or 
 when any estate is held in trust for minor heirs, the person receiving the rents of the 
 same may be held responsible for the execution of any orders made by the health 
 commissioner for the sanitary improvement of the property. 1 ' 
 
 Usually no provision is made for a preliminary hearing, though it is 
 sometimes urged that such should be granted. In Denver, however, ii 
 is required that a hearing shall be given after a two days' notice, and in 
 the City of New York and in Detroit a hearing must In- griven if 
 requested. In Ohio and Georgia a hearing must be held before a nui- 
 sance is abated by the board of health. The following is the < >hio law : - 
 
 • l In all cases where the order of the board of health is neglected or disregarded, 
 in whole or in part, the board may elect to cause the arrest and prosecution of the 
 person or persons offending as hereinafter provided, or may elect to do and perform, 
 by its officers and employes, what the off ending party should have done. It the latter 
 course is chosen, before the execution of the order of the board is begun, ii shall 
 cause a citation to issue, and be served upon the person or persons responsible, if 
 residing within the jurisdiction of the board ; but if not, shall cause it to be mailed 
 by registered letter to such person, if the address is known or can be found by 
 ordinary diligence; and if the address cannot be found by ordinary diligence, shall 
 cause the citation to be left upon the premises, in charge of any person residing 
 thereon. The citation shall briefly recite the cause of complaint and require the 
 owner or other person or persons responsible to appear before the board of health 
 at a time or place stated, or as soon thereafter as a bearing can be had. and show 
 cause, it' any. why the board shall ool proceed and furnish the material and labor 
 neci ssary to, and remove the cause of complaint."" 
 
 Doubtless il is uncommon for health officials excepl in urgenl cases 
 to proceed immediately to indict the penalty as soon as the time speci- 
 fied in the order has elapsed. When good cause is shown further action 
 is often delayed in the matter, al the option of the executive officer. 
 Occasional!} provision is made for such an extension of time. Thus in 
 Hartford, 3 
 
 •• It the party served with an order bj the board "i health before the execul 
 
 of the order is commenced, apply to the board t<« have its order or its execution 
 
 stayed or i lined, ii shall be the duty of the board to temporarily suspend <>r 
 
 modify if. and give the party, as the case may require, a reasonable and fair oppoi 
 
 t unity to he heard and to present proofs and lads against the execution of the oi-der. 
 
 "i iii ta\ or of iis modifical ion." 
 
 1 Denver, Ordinance 1 1 of L893, Sei , L38. 
 
 1 Ohio, Annotated Statutes | L900), Sec. 2129. 
 
 Hartford, Ordinance of 20 January, !>>•">. see. r. 
 
116 NUISANCES. 
 
 Often no directions are given in regard to the service of the order, 
 and sometimes the matter of the service of these and other orders and 
 notices is covered by other statutes. Frequently, however, provision is 
 made for the service. The following is the section of the Massa- 
 chusetts statute relating to this : 1 
 
 "Such order shall he made in writing, and served by any person competent to 
 serve a notice in a civil suit, personally on the owner, occupant, or his authorized 
 a^ent; or a copy of the order may be left at the last and usual place of abode of the 
 owner, occupant, or agent, if he is known and within the state. But if the premises 
 are unoccupied and the residence of the owner or agent is unknown or without the 
 state, the notice may be served by posting the same on the premises and advertising 
 in one or more public newspapers in such manner and for such length of time as the 
 board or health officer may direct." 
 
 Posting on the premises without advertising is provided for in the 
 New York and New Jersey law. In Cleveland when after " due search, 
 neither owner or occupant can be found, or are non-residents," the notice 
 may be posted on the front door, or wall, or fence, and an advertisement 
 inserted for one week in the daily newspapers of the city, and the cost 
 of advertising can be collected with the cost of abating the nuisance. 
 The fact that the owner is often so difficult to reach, and that in point 
 of fact it is the agent that is sometimes the one most responsible for the 
 nuisance, has led to the service of the notice upon him, he being sup- 
 posed to be in communication with the owner and responsible to him. 
 This service is permitted by the Massachusetts and Rhode Island law, 
 and in the City of New York. The New Jersey statute provides for a 
 dual service, one notice upon the " owner or owners " and " a duplicate 
 of the notice so given shall be left with one or more of the tenants or 
 occupants." In New Hampshire the notice may be left at the abode of 
 the owner. In some cities, as Chicago 2 and Denver, 3 the abatement of 
 a nuisance is facilitated by a requirement that the agent of the property 
 shall disclose the name of the owner when required by the health officer 
 to do so. 
 
 Many of the laws refer to the time which shall be given the parties 
 maintaining a nuisance to abate the same. In several states the time 
 specified in the statute to be allowed for the abatement of the nuisance 
 is twenty-four hours. This is the law in Colorado, Minnesota, North 
 Carolina, Vermont, and Wisconsin. In the District of Columbia, 
 Florida, Iowa, Massachusetts, and Rhode Island the time is twenty-four 
 hours "or such other reasonable time" as may be directed. In Con- 
 
 1 Massachusetts, Public Statutes (1882), Chapter 80, £ec. 22. 
 -Chicago, Municipal Code (1881), ^'ec. 1S77, 
 3 Denver, Ordinance 44 of 1898, ^ec. 83. 
 
NUISAN'CJSS. 117 
 
 necticut and Delaware, and in Philadelphia, the time given shall be that 
 directed by the health officer or the board of health. In Denver it is 
 such time as may seem " reasonable to the health officer.'" In Provi- 
 dence most of the orders give seven days for abatement. In the City 
 of New York and Detroit " it is five days, or less if so stated in time of 
 pestilence." In Buffalo the time is five days, in San Francisco and 
 Jersey City three days, in Atlanta six hours. 
 
 By Chapter 143, Georgia Laws of 1895, it is provided that in 
 comities in which there is a city of over 60,000 inhabitants an order to 
 bury offensive animal or vegetable matter must lie complied with in 
 three hours. In Wyoming the time given to abate a nuisance is by 
 statute twenty-four hours, and a continuance of neglect is considered 
 an additional offence for each twenty-four hours of continuance. 
 
 In Boston, although permitted by statute to iix '-a reasonable time.*' 
 the board of health on account of the difficulty in proving what is 
 reasonable always fixes the time in the order as twenty-four hours, for 
 the law reads " twenty-four hours or such other time as it deems rea- 
 sonable *' : but alter the service of the orders, what seems to the board 
 as a reasonable time, is always given before further action is taken. It 
 is probable that sanitary authorities very rarely take advantage of the 
 short interval permitted by the statutes. As a rule much more than 
 twenty-four hours is given, usually several days, and often the time is 
 further extended at the instance of the parties to whom the orders are 
 issued. Undue haste in the abatement of nuisances is not a character- 
 istic of sanitary officials. It does not take many days in a health office 
 to learn thai those injured by the nuisance I'eel that the proceedings are 
 far i"i i slow. 
 
 After the time specified in the order lias elapsed two modes of 
 action are usually open to the officials. A criminal action may be 
 brought against the parties who have failed to obey the Older and the\ 
 may be lined, or the nuisance may be summarily abated. It is also 
 possible that both of these courses may be pursued. 
 
 The penalty provided for failure to comply with orders i>> abate 
 nuisances of course varies considerably in different states. Usually il 
 is a line, though occasionally imprisonmenl is an alternative. In 
 
 Detroil the person violating an order of the board of health ma\ be im 
 
 prisoned not to exceed six months. In Ohio if a person fails to obey 
 an order he is subjeel to a line of one hundred dollars or imprisonment 
 for ninety days, bul shall not be imprisoned for the first offence. In 
 the case of a corporation the line maybe three hundred dollars and 
 
 "any officer of the corporation having authority in the matter ami per- 
 mitting the violation shall be subject to a line or imprisonment, or 
 
118 NUISANCES. 
 
 both." 1 The procedure in such cases is given below. 2 In Delaware 
 delinquents are to be fined or to be sent to jail until the fine is paid. 
 The average fine is perhaps not to exceed fifty dollars. The smallest 
 is in North Carolina where the fine is one dollar for each day of 
 neglect. In St. Louis it is not to exceed five hundred dollars, and 
 in Detroit not to exceed one thousand dollars. In several states as 
 Iowa, Massachusetts, North Carolina and Rhode Island, the law pro- 
 vides that the fine may be imposed for each day during which neglect 
 of the order continues. As in most cases the order to abate a nuisance 
 is to be served on the " owner or occupant," so in most cases it is on 
 the owner or occupant that the fine is to be imposed. When the notice 
 is served on the occupant alone as in North Carolina, it is the latter 
 that is to suffer the penalty. In Detroit it is "every person who shall 
 wilfully violate or refuse to obey " the order ; and in Ohio the board of 
 health may cause the arrest or prosecution of " the person or persons 
 offending." 
 
 After the service of an order and the expiration of the time specified 
 therein the board of health or its agents may abate the nuisance. In 
 Ohio before the nuisance can be abated the owner must be cited to 
 appear as is shown by the law quoted on page 115. In St. Louis the 
 health commissioner is to abate the nuisance if after the specified time 
 it is not done, " or if the owner fails to show good cause why he cannot 
 or ought not to comply." 
 
 1 Ohio, Annotated Statutes (1900), Sees. 2137-8. 
 
 2 Ohio, Annotated Statutes (1900) : 
 
 "Sec. 2139. Prosecutions under this chapter and the civil action provided for in 
 the preceding section shall be instituted before any justice of the peace within the 
 county, or justice of the peace, mayor, or police judge of the city or village where 
 the offense was committed, or the offending person resides. If imprisonment is, or 
 may be a primary penalty, the court shall, after plea of not guilty, unless a trial by 
 jury is waived, issue a venire to any constable of the county, containing the names 
 of sixteen electors residing within the county, to serve as jurors to try such cause. 
 Each party shall be entitled to two peremptory challenges, and challenges for cause 
 in all particulars, as in criminal cases in the court of common pleas. If the sixteen 
 names be exhausted without obtaining a panel of twelve, the court may direct the 
 constable to summon any of the bystanders, to fill the panel to twelve, or on 
 demand, shall issue other venires for four electors at a time until the panel of 
 twelve is full. In prosecutions under this chapter, no deposit for costs shall be re- 
 quired; and a judgment or verdict of guilty shall be immediately followed by sen- 
 tence and execution thereof, unless suspended pending the preparation and allow- 
 ance of a bill of exceptions; and all fines collected under this cbapter shall be paid 
 to the treasurer of the municipality or township and credited to the sanitary fund of 
 the board of health instituting the prosecution. No fine imposed in any prosecu- 
 tion under this section shall be remitted by the magistrate before whom the com- 
 plaint is made. 1 ' 
 
NUISAN'CES. 119 
 
 The following is an important section of the New Jersey law: 1 
 
 "And be it enacted, That no injunction shall issue oiit of any of the courts of this 
 state, to stay, stop or enjoin proceedings, or to prevent any Ideal board of health 
 from proceeding ^vith the removal of any alleged nuisance, source of foulness or 
 cause of sickness, hazardous to the public health, until such board has been duly 
 notified to appear and be present at the hearing of such application, and has an 
 opportunity to be heard thereon." 
 
 In almost all eases the law in regard to abating nuisances is permis- 
 sive, "the board of health may cause the nuisance to be abated"; but 
 sometimes, as in Connecticut, Florida, and New Jersey, and some other 
 cities, it is mandatory, the "board of health shall cause the nuisance to 
 be abated." Occasionally more specific directions are given as to who 
 shall abate the nuisance. In Pennsylvania boroughs the order -shall lie 
 executed by the health officer, his subordinates and workmen." In 
 Detroit it is the board of health, "its officers and employees." who may 
 lawfully enter upon any premises and suppress or remove the nuisance. 
 In Bridgeport "the board of health or either of the members thereof or 
 any person under their direction may at anytime abate or remove nui- 
 sances." In Alabama "the mayor or intendant, or a justice of the 
 peace of the county in which such lot, house or vessel is, ma\ issue his 
 warrant, directed to the sheriff, marshal, constable, or other lawful 
 office] 1 , requiring him to enter such house, lot or vessel, and under the 
 direction of such health officer, to remove such infected person, or to 
 remove or destroy the source of infection or disease." The Virginia 
 law is very like that in Georgia, and it is the sheriff or deputy sheriff of 
 the county who is to abate. In Buffalo the department of public works 
 is to abate nuisances. 
 
 Usually it is intended that the costs of abating ;i nuisance shall be 
 paid by the owners of the property on which it is found: but sometimes 
 no such provision is found in the law. It is not in Delaware. In North 
 Carolina the health officer can only abate a nuisance when the owner 
 pleads poverty, as is shown below. 2 
 
 1 New Jersey, General Statutes (1895), p. L638, Sec. 1"». 
 North Carolina, A.t of I March, L893, Sec. 22: 
 
 "Whenever and wherever a nuisance upon premises shall exisl which in the 
 opinion of the countj superintendent <a health is dangerous to the public health, it 
 shall be his duty t<> notify in writing the parties occupying the premises (or the 
 owner, it' i he premises are not occupied) of its existence, its character and the means 
 i if abating it. I * | •< >n this notification i lie parties shall proceed t" abate the nuisance, 
 inn failing to do this shall be adjudged guilty of misdemeanor and shall pay a fine 
 
 of 'MM' dollar a daj dating fr twenty-four hours after the notification has 1 a 
 
 served, the amounts so collected to l»e turned over t" the county treasurer: Pro- 
 vided, however, thai it' the partj notified shall make oath or affirmation before a justice 
 bf the peace "i his or her inability i" carrj "in the directions of the superintendent, 
 
120 NUISANCES. 
 
 In Florida and Detroit the cost of summarily abating a nuisance by 
 the sanitary authority is to be paid by the " person or persons commit- 
 ting, creating, keeping or maintaining such nuisance." In Massachu- 
 setts and Iowa the owner or occupant must be " actually notified." In 
 Massachusetts the costs are to be paid by the " owner or occupant or 
 other person who caused or permitted the same," and a similar provi- 
 sion is found in other states. In New Hampshire, too, to the costs are 
 to be added the fees of the health officer. In Bridgeport it is from the 
 person permitting the nuisance that the cost is to be collected ; in the 
 Pennsylvania cities of the second class, from the person offending ; in 
 Minneapolis from those " who created and suffered such nuisance." In 
 Detroit 1 the cost is a " charge upon the occupant or upon any or all 
 of the occupants " ; but it is further provided 
 
 " In case the common council upon the certificate of said board as to the amount 
 of the expense aforesaid and the purposes for which the same were incurred may 
 cause an assessment to be levied upon said premises and the owner or owners thereof 
 and the same to be collected in the same manner and by the same proceedings as 
 special assessments are levied and collected for the construction of sidewalks in said 
 city. In case such expense is paid by any occupant or lessee of such premises he 
 may recover from any other person having an interest in such premises such propor- 
 tion of the said expense as the court adjudges should justly and equitably be borne 
 by such defendant, and he may deduct and retain from any rent payable to such 
 defendant the amount so recoverable as an offset thereto.'" 
 
 A somewhat similar provision is found in the charter of New York, 2 
 where 
 
 "The charge of abating a nuisance shall be against each of the owners or 
 part owners and each of the lessees and occupants of the building, business, place, 
 property, matter, or thing to which said order relates, and in respect of which said 
 expenses were incurred.'" 
 
 In Indiana the cost of abating the nuisance and ten per cent, additional 
 is to be collected. In Mobile if the owner refuses to pay within three 
 days the cost of abating the nuisance he is to be fined fifty dollars. 
 
 Special provision is made in many statutes for the manner in which 
 the cost of abating a nuisance is to be collected. In Massachusetts 
 the expense incurred in abating a nuisance dangerous to the health is 
 to be recovered from an individual or a corporation by an action of con- 
 
 it shall be dune at the expense of the town, city, or county in which the offender 
 lives. In the latter case the limit of the expense chargeable to the city, town, or 
 county, shall not be more than one hundred dollars in any case; Provided, further, 
 that nothing in this section shall be construed to give the superintendent the power 
 to destroy or injure property without a due process of law as now exists for the 
 abatement of nuisances." 
 
 i Michigan, Chapter 10 of 1895, Sec. 19. 
 
 2 New York, Chapter 378 of 1897, Sec. 1270. 
 
mrisANCEs. 121 
 
 tract, in Iowa by civil action, in Rhode Island by an action of the case, 
 
 in many states like debts or by action of debt. In Albany the action 
 
 may be brought " against the owner or any one or more of the owners." 
 
 In Ohio ] the board of health after abating a nuisance is to 
 
 " Certify the cost and expense to the auditor of the county, and if the material 
 and labor are itemized, and the statement is accompanied by the certificate of the 
 president of the board, attested by the clerk, reciting the order of the board, and 
 that the amount is correct, the auditor shall have no discretion, but shall place the 
 sum against the property upon which the material and labor were expended, which 
 shall, from the date of entry, be a lien upon the property, and be paid as other taxes 
 are paid.'" 
 
 In St. bonis the president of the board of public improvements shall 
 ascertain the cost like- street improvements, and special tax bills are 
 rendered against the property. In Detroit the costs are collected like 
 sidewalk assessments. In Colorado, Milwaukee, and New Haven also 
 the costs are to be assessed like taxes, but in the two cities the abate- 
 ment of nuisances must be done with funds set apart for the purpose. 
 The charter of the City of Xew York provides in an elaborate and 
 explicit manner for the collection of the costs of abating nuisances. 2 
 In Philadelphia, 3 
 
 lt The expenses attending the removal of any nuisance shall be and remain a lien 
 upon the premises from which such nuisance lias lien removed, and it shall be the 
 duty of the said board of health to file the claim therefor against the owner or 
 reputed owner, in the office of the clerkof the district courl for the city and county 
 of Philadelphia, which said court shall, in all cases, have jurisdiction of the same, 
 and the said claims may be tiled, recorded and proceeded on by scir< faciasto recover 
 the same, in like manner as mechanics* liens are recoverable, upon the trial of which, 
 the tact of t In- nuisance shall not be inquired into, and the defendant or defendants 
 shall only he permit ted to give evidence of payment, or that unnecessary expenses 
 wen- incurred by the hoard in the removal of the nuisance." 
 
 Iii some stales, besides the provision made tor the abatement of 
 nuisances by the board of health or other blanches of the local govern- 
 ment, the statutes dired that the courts may after conviction for the 
 maintenance of a nuisance order the nuisance abated at the cost of those 
 maintaining it. Such provisions are found in the Laws of Colorado, 
 Illinois, Iowa, .Michigan, Mississippi, Tennessee, and Washington. 
 
 In Detroit the statute provides for the prevention of a threatened 
 nuisance by injunction by an\ court of equity having jurisdiction and 
 furthermore requires the law department of the cit\ to bring suit for 
 tins purpose when requested by the board of health. 4 'This method oJ 
 
 1 Ohio, Annotated statutes (1900), Sec. 2130. 
 
 \c-a y,,rk. Chapter 378 of 1897, Sees. 1275 L281. 
 
 Pennsylvania, Brightly's Purdon's Digesl (1895), p. 1488, \>t of 7 Lpril, I 
 
 2. 
 1 Michigan, chapter 10 .a is'.'-".. Sec. 29. 
 
122 NUISANCES. 
 
 asking for an injunction to abate a nuisance is provided for in the New 
 Jersey statutes, 1 and is sometimes adopted by local boards of health. 2 
 
 In Mississippi 3 the state board of health when informed by a county 
 health officer may declare a nuisance anything calculated to cause or 
 aggravate contagious or epidemic disease. The board shall notify the 
 district attorney who shall bring the case before the court and a jury 
 trial shall be granted if asked. From the decision there can be no 
 appeal and the nuisance shall be abated. As is shown above, the statute 
 provides that in Philadelphia the decision of the board as to a nuisance 
 cannot be inquired into and in Massachusetts the adjudication that a 
 nuisance exists is conclusive and no appeal lies therefrom. 4 
 
 The cleansing of filthy premises is usually accomplished under gen- 
 eral nuisance laws by orders and forcible abatement, or it may be secured 
 by enforcing such ordinances or local rules as prescribe cleanliness ; but 
 in some states, as Delaware, Maine, Minnesota, and West Virginia, there 
 are special provisions in the statute designed to give the health author- 
 ities power to cause private premises to be promptly cleaned if in a 
 filthy condition. The laws in the first three states above mentioned are 
 very similar. The Delaware statute is given below. 5 A similar pro- 
 vision is found in the law establishing a board of health in the City of 
 New York 6 and Detroit. Besides such special orders some cities pro- 
 vide by general rules for the cleansing of premises, as Fitchburg. 7 
 
 1 New Jersey, General Statutes (1895), p. 1640, Sees. 28-30. 
 
 2 New Jersey, Report of State Board of Health (1897), pp. 155 and 257. 
 
 3 Mississippi, Annotated Code (1892), Sec. 2277. 
 
 4 City of Salem vs. Eastern R. R. Co., 98 Mass., p. 449. 
 
 5 Delaware Laws, Vol. 16, Chapter 345: 
 
 " Sec. 8. The board of health shall have power, in case of the prevalence, or 
 of reasonable ground to apprehend the prevalence of malignant disease within its 
 jurisdiction, to direct especially the cleansing of houses, cellars, yards, docks, or 
 other such places as the board shall consider requisite or prudent for the preserva- 
 tion of the public health, or for the mitigation of disease, and if such direction 
 shall not be observed and fulfilled, within the time prescribed, by the person or 
 persons to whom the directions were given, the said board shall order an officer of 
 the board, or some other person or persons, to carry the same into effect, and the 
 expenses thereof shall be paid by the person or persons to whom the direction was 
 given, unless the board shall otherwise order; and if payment of the same shall not 
 be made on demand, the treasurer of the board, city council, or town commissioners 
 shall pay the same, and shall recover the same, with interest and costs, from the 
 person who ought to have paid the same, as debts of like amount are recoverable. 1 ' 
 
 6 New York, Chapter 378 of 1897, Sec. 1176. 
 
 7 Fitchburg, Rules and Regulations of the Board of Health (1S97): 
 
 " Rule 2. All putrid, decaying or decayed animal or vegetable matter shall be 
 removed from the cellars and outbuildings on or before the first day of June in each 
 year. 
 
 "Rule 7. The owner or lessee of any hotel, lodging or tenement house within 
 the limits of the city shall, when in the opinion of the Board of Health or its duly 
 
NUISAHTCES. 123 
 
 II. Prohibition of Nuisances. 
 A. General Stuff Legislation. 
 
 There has been in the aggregate a great deal of state legislation to 
 prevent nuisances. This may be found in laws of general application 
 and to a still greater extent in special or charter legislation. The gen- 
 eral laws in regard to nuisances more often deal with such special sub- 
 jects as the pollution of potable waters or the regulation of offensive 
 trades, and will be considered in another place. Some state laws, as those 
 of Colorado, Georgia, Utah, and Washington, simply give expression to 
 the principles of common law, defining in general terms what are to 
 be considered nuisances and prescribing methods of procedure and in 
 some cases imposing penalties upon the persons committing them. < M't.n 
 other nuisances than those affecting health are mentioned, and most of 
 this legislation is not such as to he of special interest to sanitary officials. 
 Some statutes of general application do specifically deal with nuisances 
 which usually come under the jurisdiction of boards of health and may 
 be usefully invoked by them in their routine work. 
 
 Among states which have legislation of this character may be men- 
 tioned: California, 1 Connecticut, 2 Florida, 3 Illinois, 4 Indiana."' Iowa, 6 
 Kansas," Maine, 8 Ohio, 9 Tennessee, 1 " Washington, 11 West Virginia. 12 
 The Ohio law is given in Appendix 26. 
 
 Penalties are attached for the violation of the provisions of these 
 statutes and often they are quite severe as shown in the Ohio law. In 
 Illinois the offender shall be lined not exceeding one hundred dollars 
 for the first offence and for a subsequent offence a like amount, and 
 confined in the county jail not exceeding three months. In [owa the 
 line is not to exceed one thousand dollars. In Indiana it is from ten 
 
 authorized agent ii is deemed accessary, whitewash, paint or otherwise clean and 
 make wholesome the walls ami ceilings of the c us ami passage-ways of the build- 
 ing." 
 
 I California, Penal Code (1886), Sec. 370. 
 
 .nnecticut, Chapter s.;l Laws of L889. 
 
 Florida, Art of 1 June, 1895. 
 < Illinois, ( riminal Code | L896) I lhapter 88, Se< , '-'--'1. 
 » Indiana, Statutes | 1894), Sec. 2154. 
 •■ [owa, Code (1897), Sec. -".078. 
 
 Kansas. General Statutes (1897), Sec. 2458. 
 - Maine, Revised Statutes (1883), Chapter IT. Sec. 5-12. 
 
 " < >bio, Annotated Statutes 1 19 Sec. 6921 ■ I aeq. 
 
 io Tennessee, Code L896), Sees. 5689, 57 i''-7. 
 
 II Washington, Chapter 14, Laws of 1895. 
 
 w WYst Virginia, Code (1899), Chapter L50, Sec. ■-'<>. 
 
124 nuisances. 
 
 dollars to five hundred dollars. In West Virginia the fine is from five 
 dollars to fifty dollars. 
 
 In a number of states the court may after conviction for violation 
 of the nuisance laws cause the immediate abatement of the nuisance 
 through the agency of a constable, sheriff or other officer. 
 
 B. Special or Charter Legislation in regard to Nuisances. 
 
 In some charters a considerable number of provisions are found for 
 the prevention of nuisances. Among the cities that are thus legislated 
 for b}^ statute may be mentioned the City of New York, Pennsylvania 
 cities of the second class and Detroit. In the Detroit law there is a 
 provision requiring and regulating water closets in factories, work- 
 shops, offices, etc., and requiring ail such to be properly ventilated, and 
 the same regulations apply to schoolhouses. In Pennsylvania cities 
 of the second class all persons are forbidden putting offensive matter in 
 the streets or on lots or in other places where it may be a nuisance ; 
 and no person may keep his " premises in such a condition as to be 
 offensive to the neighborhood." This law also regulates the slaughter- 
 ing of animals and other offensive trades, provides for the construction 
 and sanitary condition of vaults, drains, etc., and regulates the cleaning 
 of vaults. Besides, or in place of specific prohibitions, very broad pro- 
 hibitions are sometimes found, as in the City of New York, shown 
 below. 1 
 
 C. Local Legislation Concerning Nuisances. 
 
 There can be little doubt that power to legislate concerning nu - 
 sances is implied when general power to legislate on sanitary affairs is 
 conferred even if nuisances are not specifically referred to. The success 
 
 1 New York Chapter 378, of 1897, Sec. 1220: 
 
 "The word ' nuisance,' as used in this act, shall be held to embrace public nui- 
 sance, as known at common law, or in equity jurisprudence; and it is further en- 
 acted that whatever is dangerous to human life or detrimental to health; whatever 
 building or erection, or part or cellar thereof, is overcrowded with occupants, or is 
 not provided with adequate ingress and egress to and from the same, or the apart- 
 ments thereof, or is not sufficiently supported, ventilated, sewered, drained, cleaned, 
 or lighted, in reference to their or its intended or actual use; and whatever renders 
 the air or human food or drink, unwholesome, are also, severally in contemplation 
 of this act, nuisances; and all such nuisances are hereby declared illegal; and each 
 and all persons and corporations who created or contributed thereto, or who may 
 support, continue or maintain or retain them, or any of them, shall be jointly and 
 severally liable for, or toward, the expense of the abatement and remedying of the 
 same; but as between themselves, any such persons and corporations may enforce 
 contribution or collect expenses, according to any legal or equitable relations exist- 
 ing between them; but nothing herein contained shall annul or defeat any common 
 law liability or responsibility in respect of nuisances." 
 
NUISANCES. 125 
 
 of New York and Brooklyn in enforcing the provisions of their sanitary 
 codes attests this. Nevertheless it has been thought advisable in many 
 states to specifically confer such power in regard to nuisances. The 
 following is the Massachusetts law: l 
 
 ■■ The board of health of a town shall make such regulations as it judges neces- 
 sary for the public health and safety, respecting nuisances, sources of filth and causes 
 of sickness, within its town, or on board of vessels within the harbor of such town, 
 and respecting articles which are capable of containing or conveying infection or 
 contagion, or of creating sickness, brought into or conveyed from its town, or into 
 or from any vessel. Whoever violates any such regulation shall forfeit a sum not 
 exceeding one hundred dollars. 1 ' 
 
 This has been closely followed in Colorado, Iowa, Michigan, Ver- 
 mont, and Wisconsin. The New Jersey- law gives the board of health 
 power 
 
 " To define and declare what shall constitute nuisances in lots, streets, docks, 
 wharves, vessels, and piers, and all public or private places.* 1 
 
 This law also gives power of legislation concerning a number of 
 other matters which will be duly considered. In Ohio the board of 
 health may make regulations for " the abatement or suppression of 
 nuisances." Illinois cities and villages may " declare what shall be 
 nuisances and abate the same and impose fines." In .Mississippi muni- 
 cipal corporations have power "to make regulations to prevent, remove 
 and abate nuisances." In Louisiana local boards of health may pass 
 ordinances "for defining and abating nuisances dangerous to the public 
 health." 
 
 Special and charter provisions also often confer this power. Thus 
 in Baltimore the mayor and city council are to pass an ordinance "to 
 prevent and remove nuisances." The Bridgeport city council has power 
 to pass ordinances "relative to all nuisances.** The common council of 
 Chicago IS "to abate and remove nuisances and punish the authors 
 
 thereof by penalties, fine and imprisonment and to define and declare 
 
 what shall be deemed nuisances."' The government of Memphis may 
 "define, prevent and remove nuisances.'* The board of health of San 
 Francisco also may "define" what shall be a nuisance. 
 
 As a rule the number and complexity of these regulations increase 
 with the size <>f the municipality and the densitj of the population. 
 I i.w n ships and villages need comparatively lew ordinances of this Kind. 
 Man\ things ma\ be freely permitted in a sparsely settled region which 
 would be unendurable in a metropolitan city. The end constant^ held 
 
 in view in all these regulations is to secure pure air, pine water and a 
 
 Massachusetts, Public Statutes (1882), Chapter 80, Sec. I s . 
 • Ww Jersey, General Statutes (1895), p. 1680, Sec. 12, ll. 
 
126 isruiSAisrcEs. 
 
 pure soil for all men ; by pure is meant free from decaying organic 
 matter or its products ; free from " filth " and all offensive odors. 
 Therefore rules are made in regard to the disposal of excreta and waste 
 material of all kinds. Cesspools, privy vaults, sewers, drainage and 
 plumbing are to be constructed and maintained in a proper manner. 
 Offensive trades are to be regulated, stables kept clean and refuse of 
 all kinds removed without causing a nuisance. Dwellings are to be 
 properly constructed and not overcrowded, and must be kept clean. A 
 consideration of these local sanitary regulations will be found in the 
 succeeding chapter. 
 
 Administrative Methods of Dealing with Nuisances. 
 
 Most municipalities of less than 20,000 inhabitants compel their 
 health officer or other executive sanitary official to perform the duties 
 of inspector of nuisances. Occasionally, smaller communities have a 
 sanitary inspector, but lie is more often so only in name : practically he 
 is a general executive officer. In New Jersey every town of 2,000 
 inhabitants must appoint a sanitary inspector, and if he neglects his 
 duty, or if one is not appointed by the town, the state board of health 
 may appoint one at a salary of $50 a year to be paid by the town. 1 
 Some cities, much larger than 20,000, have no inspector, as the City of 
 Pawtucket with 40,000, and Providence had no permanent special in- 
 spector of nuisances until 1883, at which time the population was 
 117,000. Inspectors of nuisances are sometimes known by this name, 
 but more often as sanitary inspectors and in many places as sanitary 
 police. Occasionally they are called health inspectors, as in Portland, 
 Me., and New Bedford, or sanitary officers or executive officers, as in 
 St. Louis and Wilmington, Del. In some cities, as in Boston, Cleve- 
 land, Jersey City, Louisville, Memphis, New York, 2 and Spokane, some 
 
 *Xew Jersey, General Statutes (1895), p. 1636, Sees. 30-32. 
 
 2 New York, Chapter 378 of 1897, Sec. 1324: 
 
 "The board of health shall make requisition upon the police board for the detail 
 of at least fifty and not more than one hundred suitable officers and men of at least 
 five years' service in the police force, who shall be selected for their peculiar fitness, 
 for the enforcement of the provisions of the sanitary code and the acts relating to 
 tenement and lodging houses. These officers and men shall be detailed to such ser- 
 vice by the police board, and the department of health shall pay to the police depart- 
 ment monthly, the amount of the pay of the officers and men so detailed, who 
 shall belong to the sanitary company of the police and shall report to the board of 
 health. At least thirty of the officers and men so detailed shall be employed exclu- 
 sively in the enforcement of the laws relating to tenement and lodging houses. The 
 board of health may report back to the police board for punishment, any member 
 of said company guilty of any breach of orders or discipline, or of neglecting his 
 duty, and thereupon the police board shall detail another officer or man in his place, 
 
NUISANCES. 127 
 
 or all of the inspectors are regular members of the police force and 
 detailed for sanitary work, and act under the immediate direction of the 
 health department. Under the old law in the City of New York there 
 were detailed for this purpose in 1896, one sergeant, two roundsmen, and 
 forty-seven policemen (men of long experience in the police force of the 
 city). They are known as the sanitary company of police. In many 
 other cities, as Charleston, Denver, Hartford, Jersey City, Mobile, 
 Omaha, Philadelphia, and Providence, the board of health is authorized 
 to call upon the police for assistance in inspection or else such inspec- 
 tions area prescribed part of the police work. In Chicago the com- 
 missioner of health is authorized to appoint five women as sanitary 
 police at a salary of fifty dollars per month. 1 
 
 In New York in 1896, besides the sanitary police referred to above, 
 there was the sanitary bureau, proper, consisting of a superintendent, 
 assistant superintendent, order clerk, complaint clerk, four other clerks, 
 typewriter, chief inspector with two clerks and thirty-eight sanitary 
 inspectors. Under the charter of the City of New York- the board of 
 health is to appoint fifty sanitary inspectors and may appoint twenty 
 more. Another provision of the charter is thai ,; 
 
 " The board of healtb may, from time to time, engage a suitable person or tier- 
 sons t<> render sanitary engineering service and in make or supervise practical and 
 scientific sanitary investigations ami examinations in the city requiring engineering 
 skill, ami to prepare plans ami reports relative thereto." 
 
 The other large cities have an organization similar to that of New 
 York, though less elaborate, and as we p;i>s to the smaller cities the 
 number of employees becomes less until we at last find only the single 
 health officer. In the smaller cities, where there are only one or two 
 inspectors, they usually work under the immediate supervision of the 
 executive officer of the department, and no formal rules for their guid- 
 ance aie necessary; but in some cities of moderate size and in mosi of 
 the large cities rules are provided lor the conduct of the inspectors. 
 The most elaborate rules are to be found in Atlanta. Augusta, Ch 
 ton. and Cincinnati. The rules for the inspectors in Atlanta are given 
 in Appendix 27. 
 
 The hours of service vary in different cities, being usually from 
 seven to nine boms a day. Sanitary police however, usually have 
 
 ami the .lis, ipiine of the said members ■■!' the sanitary companj shall be in the jurii 
 diction ..t the police department ; bul al any time the board 'if healtb max objeel to 
 the efficiency of any member of said sanitary company, and thereupon another officei 
 <>r man shall he detailed in his place." 
 1 Chicago, Ordinances (1881), Sec. 1 L82. 
 .-. York, i baptei -.7- oi L807, Sec. 1 185. 
 New i'ork, chapter 378 -i 1897, Se< . 1 186. 
 
128 NUISANCES. 
 
 longer hours, the same as the rest of the police force. In many cities, 
 perhaps most, the sanitary inspector, while having working hours fixed 
 by rule are " considered as always on duty." In Denver the inspection 
 hours are 8 A. M. to 4 p. M. with one hour at noon. In Augusta, Ga., from 
 7 A. m. to 6 p. M. with two hours at noon. In most places a two weeks' 
 vacation is allowed, but this as well as the hours of service is usually 
 the same for sanitary inspectors as for other similar city employees. In 
 almost all the large cities sanitary inspectors are required to engage in 
 no other work. In small places where there is only one inspector or 
 where the health official does inspector's work, all his time is not needed 
 for his official duties. Occasionally in large cities, as in Baltimore, 
 where physicians are employed as inspectors, they are only expected to 
 give a part of their time, as much as may be necessary to do the work 
 laid out. Usually they do not wear a uniform unless as sanitary police 
 they are detailed from the regular police force ; but in some cities, as 
 Atlanta, Cambridge, Milwaukee, Cincinnati, Pittsburg, Columbus, Ga., 
 St. Paul, San Francisco, and Reading, uniforms are required. Generally 
 a badge is worn which is exhibited by the inspector to show his authority 
 under the law for entering upon private property and making his exa 
 minations. The table given below 1 shows the number of inspectors and 
 their salaries in certain cities. 
 
 Number of Salary 
 
 City. Population. Inspectors. per annum. 
 
 a i x> i v t ax aaa 9 i Chief $b000 
 
 A sbury Park, N. J 4o,000 2 -,' ' 
 
 ' As st. <o0 
 
 Atlanta 89,872 7 ( Chief 1,500 
 
 Augusta, Ga 39,441 5\ 4 I «00 
 
 Baltimore 508,957 6 4 1,000 
 
 Boston 500,892 16 1,100-1,800 
 
 Brookline 20,000 1 
 
 Buffalo 352,219 4 2 1,000 
 
 Cambridge 91,886 3V 800- 1,000 
 
 Charleston 55,807 4 600 
 
 Chicago 1,698,575 34 1,000 
 
 Cincinnati 325,902 20* 600 
 
 Cleveland 381,768 20 900 
 
 Columbus, ( ) 125,560 8 720 
 
 District of Columbia 278,718 7 1,200 
 
 Dayton 85,333 2 700 
 
 Denver 133,859 11 900 
 
 Kvansville 59,007 1 936 
 
 TT , , -« q-a ^ S Chief 1,800 
 
 Hartford 79,850 2 ' 
 
 < Asst. 600 
 
 1 Chief is allowed board of horse. 
 - Six in summer. 
 
 3 Disinfect. 
 
 4 Look after communicable disease. 
 
NUISANCES. 
 
 L29 
 
 Number of Salary 
 
 City. Population. Inspectors. per annum. 
 
 Indianapolis 169,164 r> : .- 
 
 kowell 94,969 4 |8 00-3 50 per day 
 
 Itfnn 68,513 2 .' l.nnu 
 
 Manchester 56,987 2 
 
 Memphis 102,320 12 
 
 Milwaukee 285,315 13* j Chief 900 
 
 ' Assts. sun 
 
 Minneapolis 202,718 7- 900 
 
 Newark 246,070 15 2 75 per day 
 
 New Haven 108. 027 .;>.- 
 
 New Orleans 287,104 l'.i- j Chief 1,800 
 
 I Assts. 600 
 Newton :j:;.;,s7 3 1 , 2 750 1,000 
 
 Pittsburg 321,616 17- j Chief 1,000 
 
 ! Assts. 900 
 
 Providence 175,597 2 . (Chief 1,200 
 
 Asst. 600 
 Richmond 85,050 4 
 
 Rochester 162,425 5 600 
 
 St. Paul 163,632 6 700 
 
 Sail Lake City 53,531 1 . .. 1,000 
 
 San Francisco 342,782 5 J 1 .200 
 
 Somerville 61,643 1 1,000 
 
 Syracuse 108,374.. •'-• j Chief 1,500 
 
 Ust. 900 
 Toledo 131,822 10 1 , 2 
 
 I'tica 56,382 3 
 
 Wilmington, Del 76,508 4'.- 
 
 From an inspection of the above table it will be seen that the popu- 
 lation served by an inspector varies verj much in different cities. Of 
 the above cities ii is the largest in Providence where there is only one 
 inspector for a population of 87,000. The smallest population for a 
 single inspector is 13,000 in Toledo. The number of persons which 
 one inspector can serve depends somewhat upon the density of the 
 population, though not as much so as one would imagine. While it takes 
 
 time i" go from house to house in a thickly settled region, the nui- 
 sances are usually more 1111 ions and require more attention in such a 
 
 section. Some cities require more careful inspection, owing to the char- 
 acter of the population, industries, geographical position, or long con- 
 tinued neglecl of sanitary work. It is also difficult to compare the 
 work of inspectors, because in some cities they have many more duties 
 
 than in others. In soi it i»-s they apparently do not do more than 
 
 look after complaints that are made by citizens. In others the} n 
 
 1 I nsinfect. 
 Look after communicable disease. 
 
 
130 NUISANCES. 
 
 a systematic inspection of premises outside of houses. In other cities, 
 as Boston, Chicago, and New York, considerable time is given to house 
 to house inspection, particularly in tenement house districts, all parts of 
 the houses being examined. h\ New York City the sanitary police, fifty 
 in number, are detailed exclusively for this work. Again, in some cities, 
 as Augusta, Ga., Baltimore, Cincinnati, Milwaukee, Minneapolis, New 
 Orleans, Pittsburg, San Francisco, and many others, the sanitary 
 inspectors have duties in connection with contagious diseases, such as 
 placarding houses and disinfecting. In San Francisco the plumbing 
 inspectors look after all nuisances connected with plumbing. In New- 
 port the sanitary inspector attends to the flushing of sewers. In other 
 cities, as Charleston, the inspectors have to give much time to enforc- 
 ing the rules in regard to the removal of garbage. In Detroit two 
 inspectors are detailed especially for this work. In Cleveland the sani- 
 tary police collect returns of marriages and births. An average of all 
 the cities in the table gives the population for one inspector as about 
 30,000. 
 
 If there is more than one inspector, the city is divided into districts, 
 and each inspector is assigned to one district and confines his work to 
 it, and thus becomes familiar with it. In Denver this division is a ward. 
 In Newark there is one inspector for each district and also one at large. 
 Usually inspectors report at the health office daily, sometimes twice 
 a day as in Providence. In New York City they report at the depart- 
 ment twice each week, different inspectors reporting on different days. 
 Inspectors in Denver communicate with the office by telephone twice 
 daily besides reporting in person at 4 p. m. daily to write up their day's 
 work in the record book in the office. In Charleston the sanitary 
 inspectors are required to visit fifty premises daily, and they report 
 each day at noon, bringing a report with fifty signatures of the occupants 
 of the premises they have inspected. 
 
 Except in systematic house to house inspection the first step in 
 the suppression of nuisances is the entering of a complaint — citizen's 
 complaint as it is called. Large numbers of such complaints are every- 
 where received, showing that the public expects, demands, and needs 
 protection from nuisances. In some cities anonymous complaints receive 
 no attention, as Brookline, Elmira, and Syracuse. In Albany, Reading, 
 and Scranton it is forbidden by rule to look up such complaints, but in 
 other places they are noticed. The experience of the writer has been 
 that anonymous complaints are about as likely to be well founded as 
 are those where the name of the complainant is given. A considerable 
 number of citizens' complaints are based on spite, or are due to an unrea- 
 sonable fastidiousness. The proportion of unfounded complaints in 
 
■ . NUISANCES. 181 
 
 Providence is about twenty-live per cent. In Newark it is reported 
 to be about the same. Citizens' complaints are usually entered in a 
 book by a clerk or whoever attends to the office. In Buffalo the com- 
 plaint book is classified bystreets. In some places blanks are furnished 
 the complainant on which the formal complaint can be written, or it is 
 written on such a blank for him by the clerk. These may be kept on 
 file in the office or they may be given to the inspector as his memo- 
 randum. The form of the complaint blank used in Buffalo is shown in 
 Appendix 28. Sometimes the inspector in his rounds uses a plain 
 memorandum book for his notes or lie may have one with printed 
 blanks. The form used in Providence is about 3J b\ .">.> inches and 
 contains blanks for the location, owner's name and address, description 
 of the nuisance and the officer's signature. 
 
 It is primarily the duty of the inspector to report the results of his 
 visit to the central office, though he is often expected and required to 
 give advice and directions in regard to minor matters as occasion offers 
 during his rounds. Sometimes, as in Philadelphia, he is to issue and 
 serve a formal notice as soon as a nuisance is discovered. In sue! 
 he would report the service and the nuisance together at the offi< 
 the department. In small places where there is only a health officer, or 
 one sanitary inspector, such officer must himself enter his reports in the 
 office, tile, record and index them and make out the orders, etc. ; but in 
 Larger cities the office work of recording and indexing is often done by 
 special clerk.-. In these cities the inspectors make a formal return for 
 each nuisance found, or if it is a citizen's complaint, or the inspection 
 for contagions disease, or a house to house inspection, a single slip is 
 often handed in for each inspect ion. The inspector's report in Buffalo is 
 exactly like the complaint form shown in Appendix 28. In New Haven 
 the inspector carries with him a book of notices shown in Appendix -W 
 and tills them out as he goes along. When he returns to the office he 
 Copies them on their stubs and then sends t hem to t he owners of 1 lie 
 properties inspected. In Boston, Denver, Indianapolis, Newark, St. 
 
 Louis, and a n ber of other cities a special sanitary inspection is made 
 
 in each case of communicable disease, and often a special blank form is 
 
 prepared for making a return <•! the s e. Some "I these are shown 
 
 in the Appendices to ( lhapter N. 
 
 Besides making reports of individual nuisances, inspectors are 
 frequently required to send in each day or at other stated intervals, 
 summaries ..f the work done b\ them. Besides the reports of the indi- 
 vidual inspectors, weekly or daily reports of chief inspectors are 
 freipieiiih filed, or summaries made of the work of all the inspectors. 
 
 A weekly summary of the work of the sanitary inspector is made b\ 
 
132 NUISANCES. 
 
 the chief inspector in the City of New York, in which the inspections 
 are tabulated as inspections of tenement houses, lodging houses, private 
 dwellings, etc., fifteen items in all. This report is on a double foolscap 
 sheet. For the weekly report of the sanitary police, the chief inspector 
 uses a similar sheet, only the classification of their work is much more 
 complete, as their services are classified under thirty-nine heads and the 
 nuisances acted on are classified under seventy heads. 
 
 House /" House Inspection. 
 
 A few cities, of which New York and Boston are conspicuous exam- 
 ples, carry out a systematic inspection of the houses of certain districts. 
 Other cities in considerable number have at times undertaken a general 
 and thorough dwelling or tenement house inspection in time of impend- 
 ing pestilence, or as the part of a spasmodic effort to put the city in 
 better sanitary condition. As long ago as 1884 the Illinois state board 
 of health made a strong effort to induce all the municipalities in the 
 state to undertake such an inspection as a part of its proposed " sanitary 
 survey," and its efforts have met with very general success. In New 
 Jersey, too, owing largely to the efforts of the state board of health, a 
 number of municipalities make such an annual inspection. In Minne- 
 sota the law requires the health officer to make such an inspection in 
 May of each year, 1 and in Florida the rules of the state board of health 
 require inspection in cities between 1 May and 1 November. Among 
 other cities which maintain such a house to house inspection are Fitch- 
 burg, Mass., Lowell, and Philadelphia. In Lowell a card index is 
 kept, which shows at a glance the sanitary condition of the houses. 
 Many health officers in their reports urge the desirability of such an 
 annual house to house inspection, at least in the tenement districts, and 
 are deterred from making it, simply from lack of funds. Money for 
 such purposes will be granted freely in the face of an epidemic, but 
 withheld at other times. In this connection it may be mentioned that 
 the City of Newton, Mass., in the summer of 1895 made 5500 house 
 to house inspections at a cost of $650, or less than 12 cents per inspec- 
 tion. 
 
 New York presents the best example of house to house inspection. 
 For many years such an inspection has been made twice each }^ear in 
 the tenement house districts. In 1896 the city was divided into thirty- 
 one districts, and for the service there were detailed from the regular 
 police force, forty-seven patrolmen, two roundsmen, and one sergeant. 
 These sanitary police also have to inspect lodging houses and look after 
 the abatement of nuisances. The result of the inspection in 1896 was 
 
 1 Minnesota, Statutes (1894), Sec. 7048. 
 
NUISANCES. 
 
 loo 
 
 the abatement of 38,858 nuisances ; the number of houses inspected 
 was 42,909. 
 
 Examples of forms for house to house inspections may be found in 
 Appendices 30 to 32. 
 
 Nuisances of whatever kind, when reported to the health depart- 
 ment, should be properly recorded. The usual way is to keep such a 
 record in a book. The form used in Providence is shown below. 1 
 
 This book is indexed by owners* names, but it is an excellent plan 
 to have a street index as well. Another method is to keep the record 
 of nuisances on index cards. In Buffalo the report of the inspector 
 (shown in Appendix 28) is put in an envelope 7 by 9 inches, together 
 with any other papers relating to the case and endorsed on the corner 
 as shown below 2 and filed in drawers, being arranged by streets. 
 
 It is sometimes required that records of nuisances shall be open to 
 the public. 
 
 Ord< 
 
 After the report of the inspector has been filed in the health ofHce, 
 the nexl step is the notification of the owner to abate the nuisance, ft 
 is only exceptionally that an order to abate a nuisance can lie mailed as 
 was provided in the old Xew York City law, and even then if prosecution 
 was contemplated a personal notice was usually made. Most nuisance 
 laws require that the order shall he formally served personally, or by 
 leaving at the usual place of abode. This is always considerable trouble 
 and often a matter of much difficulty. Hence it is a common practice 
 
 1 Size of Pagk 13 x 16 I nches. 
 
 v, 
 Notified 
 
 Dateof „ 
 (' plaint. 
 
 LOCATION. 
 
 OWNER. oJgSS*,. 
 
 ( ONDITION. 
 
 \i 1 lo\ 
 1 \M \ 
 
 2371 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 2378 
 
 
 
 
 Complainl Street Owner 
 Ex pires I ospected i>y 
 
 A.l.lr. 
 
134 
 
 NJTIS. J m A'.s. 
 
 to send by mail a letter to the person in charge of the property calling 
 his attention to the nuisance and requesting its prompt removal and 
 perhaps designating the rule, ordinance or statute under which further 
 proceedings may be taken. Often also the inspector at the time of his 
 visit may he able to give such verbal directions and advice to the owner, 
 agent or occupant as will result in the prompt suppression of the nui- 
 sance. These informal notices are not relied upon when the necessity 
 for prompt action is very great, or in those cases when it is known that the 
 owners are liable to be dilatory, but they can safely be sent in a large 
 proportion of cases, and in a majority of them they receive prompt 
 attention. If it is intended that the next procedure on the part of the 
 board of health shall be a prosecution for violation of any specific legis- 
 lation forbidding the nuisance in question, no further order is necessary. 
 When a person permits or commits an act which is definitely forbidden 
 by statute or by a rule of a board of health properly adopted and pro- 
 mulgated it is not required that notice of any kind shall be given before 
 legal proceedings are taken. If it is done, it is a gratuitous proceeding 
 on the part of the sanitary authorities, and is done because experience 
 has taught .that in a large proportion of cases such an informal notice 
 is all that is necessary to secure the abatement of a nuisance. Below 
 is a simple form of blank which may be used by properly rilling, to fit 
 nearly all cases. 1 Most large cities, besides such a general form, have 
 
 Ward 
 No 
 
 Name 
 
 1 Size 4 x 10 Inches. 
 
 S \mtaky Division — Health Department. 
 
 t Owner. 
 ' ( (ccupant 
 / Agent. 
 
 Nuisance 
 
 Ward 
 
 No St. Louis 189.. 
 
 , < iwner. 
 rp ' < tccupant. 
 
 / Agent. 
 
 You are hereby notified that a nuisance exists in 
 the form of 
 
 Location 
 
 Inspection made 180 
 
 By 
 
 File in sanitary office. 
 
 at 
 
 which you are requested to abate or remove at once. 
 Respectfully, 
 
 Inspected by 
 
 Max C. Stabbxoff, 
 Health Commissioner. 
 
 Sanitary Officer, 
 
NTTISANCES. 135 
 
 special blanks, which need no filling out, for the more common forms of 
 nuisances such as privy vaults, cesspools, stable manure, obstructed 
 drains, leaking sink pipes, hog pens, etc. In New York City a blank 
 form of notice is used and posters specifying the particular form of 
 nuisances referred to are fastened to the order. In Denver a summary 
 of some twenty-five of the principal sections of the sanitary ordinance 
 is printed on the back and the nuisance to be abated is referred to by 
 the corresponding number on the face of the order. 
 
 While it is true as was before stated that a formal service of a notice 
 is not usually necessary, preparatory to a criminal action for the viola- 
 tion of such ordinances and rules as forbid specific nuisances, vet some- 
 times such a notice is required by the ordinance itself. The provision 
 given below is from an ordinance adopted in St. Louis, 19 January, 
 1897. ] Similar ordinances are found in Milwaukee and Charleston. 
 
 A- has been shown, the general nuisance laws almost always require 
 that a formal notice or order shall issue for the abatement of the nui- 
 sance. Such orders are usually issued by the board of health or health 
 commissioner, and often by the executive officer of the board of health, 
 and occasionally by the sanitary inspector or by other officers than sani- 
 tary officials. Among cities which authorize inspectors to issue orders 
 may be mentioned Augusta, Ga. Atlanta. Newport. R. [., Cambridge (in 
 pertain cases), 5Toungstown, < >.. and Denver. It is in some statutes pre- 
 scribed that such notices shall be in writing and they are almost always 
 signed by the president or secretary, or clerk of the hoard of health, or 
 by the executive officer. It is of ten required by law that a record shall 
 be kept of all such orders issued, and certainly this is the usual custom. 
 Commonly such a record is kept in a book provided for that purpose. 
 Besides the record hook, the original orders are often kept mi tile in the 
 oft ice. copies being served on the parties interested. In Providence \\ here 
 
 the hoard of aldermen is the hoard of health, the original orders are kept 
 on file in the office of the city clerk who is clerk of the hoard, and they are 
 opied into the records of the meeting. Besides this they are noted in 
 the •• nuisance hook" which is kept in the office of the health depart- 
 ment. The Massachusetts nuisance law is the oldest, and has served 
 as the pattern for many others. The orders issued under it in Boston 
 are shown in Appendix 33. The forms used in Ohio and Rhode Island 
 are shown in Appendices ;> ' 1 and 35. The tonus in use by most local 
 boards will be found more or less like these. The phraseology must, 
 
 1 In the trial of any person charged with a misdemeanor, as defined bj t 1- 
 nance. H must be shown thai s:ii<l party das been notified by the the health 
 
 department, or l>,\ a notice served by the city marshal, to remedj the matter com- 
 plained of, ;in«l thai he or she had failed to obey such notice. 
 
136 NVI8ANCES. 
 
 of course, vary somewhat to correspond to the different statutes. The 
 original almost always has a blank on the reverse for the record of service 
 by the proper officer, and a duplicate or copy, but without the service 
 blanks, is left at the usual place of abode, or served as otherwise pre- 
 scribed. Often the statute or ordinance is printed on some portion of 
 it. Often the copy is made to present a different appearance from the 
 original, being perhaps printed on different colored paper. 
 
 In Philadelphia the nuisances are abated by the board of health 
 under the Act of 29 January, 1818. First " complaints " are made out 
 on blanks as in man}' other cities and given to the inspector. After 
 examination of the premises, the inspector returns the "complaint" 
 with a report of the " nuisance " upon the back. An order is then 
 made out in the office and a copy served by an inspector in whose dis- 
 trict the owner lives. A reprint of the office copy is shown in Appen- 
 dix 36. After the lapse of the required time, the office order is given to 
 the inspector who reports on the back whether it has been complied with. 
 If it has not been the board of health may provide for the summary 
 abatement of the nuisance and this order also is written on the back. 
 Besides reporting his own nuisance work each inspector in Philadelphia 
 makes a weekly return of all notices or bills served for other inspectors. 
 
 After service of the notice to abate a nuisance and after the lapse of 
 the time specified in the notice, one or more inspections are necessary 
 to see that the order has been obeyed. Theoretically, the inspection 
 should be made immediately upon the expiration of the time given, and if 
 the order lias been neglected the penalty should at once be imposed. 
 This, however, is probably rarely the practice. Ample leeway is given 
 in most rases, particularly if it is not believed that the delay is wilful 
 and if the ease is not an especially pressing one. Often very much more 
 than the specified time elapses before the inspection. Such a delay is 
 not so common in the larger cities as in the smaller ones. A report and 
 record of secondary inspections must, of course, be made. Sometimes it 
 is endorsed on the back of the " complaint " as in Philadelphia. Often 
 the result of the inspection is simply noted in the record book. In New 
 York City a separate column in the book is given to each inspection, the 
 name of the inspector being indicated. Often an extension of time is 
 asked for, and it is usually granted if the request appears at all reason- 
 able. As a general thing it may be said that the health officer and 
 others intrusted with this part of sanitary administration are too 
 lenient rather than too severe in dealing with this class of offenders 
 against decency and health. Often a final formal warning notice is sent 
 before any further steps are taken by the authorities. 
 
 If a person who has been asked to abate a nuisance fails to do so, 
 
mri-SANCES. 1^7 
 
 two. or in some cases, three methods may be employed by the authori- 
 ties. 
 
 FlRST. The guilty person maybe proceeded against in court and a 
 fine imposed. Usually the matter is for this purpose placed in the 
 hands of the police or law department of the city, or the attorney of the 
 health department in the few cities which have such an officer. The 
 duty of the inspectors in the case is chiefly that of furnishing testimony. 
 This testimony may be from memory or from inspectors' note honks or 
 from the hooks or papers on file in the office. Sometimes, agam, the law 
 department, when a case is referred for prosecution, sends out a notice 
 that action is about to be taken, thus giving another short period of 
 grace. 
 
 The great objection to procedure by prosecution and tine in nuisance 
 cases is that many times the desired end is not secured owing to the law's 
 delay. If an appeal is taken as it is frequently, months or years may 
 elapse while the case is pending, and all this time the nuisance may con- 
 tinue unabated. The right of appeal is however, sometimes denied. 
 Thus in Mississippi, 1 
 
 "The district judge shall try ail cas< s declared a nuisance by the state 1 >- -aid of 
 health, and there shall lie had a jury trial if desired and there shall be no appeal. 11 
 
 In Wilmington, Del., the statute provides in case of failure to com- 
 ply with an order of the hoard id' health for a line to he recovered in 
 the municipal court of the city, or in default of the same commitment 
 to jail, and "from the judgment id' said court in such cases there shall 
 be no appeal." 
 
 Second. As has been shown, a nuisance, after the formalities required 
 by law have been complied with, may he summarily abated. Nearly all 
 the nuisance laws provide that the authority which is empowered to 
 order nuisances abated also has power if its orders arc not complied 
 
 with to peremptorily abate the nuisance. This is effectual, and though 
 
 it may subject the municipalit) to a suit for damages, it is Ear prefer- 
 able to he a defendant than a plaintiff in such a case, and it is not c - 
 
 mon to find the decision of the board of health as i" ;i nuisance over- 
 ruled by the courts after its abatement. A practical objection to this 
 method of dealing 1 with nuisances is that it entails a considerable ex- 
 pense. This money, while ultimate!) to he returned to the treasury, is 
 a loss during the time occupied b} the Legal proceedings necessar} for 
 its recover) . Furthermore, the cost of abating nuisances, when actually 
 recovered, often goes into some fund other than that controlled l»\ the 
 health department, and hence is a nel Loss to that department. Some- 
 
 1 M ississippi, ,\i tated < lode (1892), Sec. --'^77. 
 
138 NUISANCES. 
 
 times, too, as in New Haven and Philadelphia, it is necessary to defray 
 the cost of abating nuisances out of an appropriation made for that pur- 
 pose, and such an appropriation is not always forthcoming. It follows 
 that this 'summary method of dealing with nuisances is not employed 
 as generally as might be expected. It is common in Philadelphia and 
 in the municipalities of Ohio. 
 
 In Philadelphia, after the board of health has determined on the 
 abatement of a nuisance, this fact with the name of the contractor is 
 endorsed by the health officer on the back of the original order. When 
 the work is done the bill for the same is presented to the owner by an 
 inspector. If not paid, it is referred to the proper legal officer for col- 
 lection. In Newport, R. I., the inspector of nuisances when an order 
 to abate is not obeyed, and the cost of abatement will not be more than 
 ten dollars, is authorized to at once abate the same, the costs to be 
 " sued for by him in an action of assumpsit;"' 1 but it is unusual to 
 give inspectors such powers. In Philadelphia in a suit to recover the 
 costs of abating a nuisance ••the tact of the nuisance shall not be 
 enquired into." 2 In New Jersey it is provided that the courts shall not 
 enjoin a board of health for abating a nuisance until such board has 
 been given a hearing, and also that in ease no nuisance is shown to exist 
 the board of health is not liable unless it is shown that it acted without 
 reasonable cause. 
 
 THIRD. Another and very effective, though indirect method of 
 securing obedience to sanitary orders is not unfrequently employed by 
 health authorities. This is the vacation of premises which are deemed 
 to be in an unsanitary condition. The following is the Massachusetts 
 
 law enacted in 1850 : 3 
 
 i 
 
 " The board, when satisfied upon due examination that a cellar, room, tenement, 
 or building, in its town, occupied as a dwelling-place, has become, by reason of the 
 number of occupants, want of cleanliness, or other cause, unfit for such purpose, 
 and a cause of nuisance or sickness to the occupants or the public, may issue a 
 notice in writing to such occupants, or any of them, requiring the premises to be 
 put into a proper condition as to cleanliness, or, if they see fit, requiring the occu- 
 pants to quit the premises within such time as the board may deem reasonable. If 
 the persons so notified, or any of them, neglect or refuse to comply with the terms 
 of the notice, the board may cause the premises to be properly cleansed at the ex- 
 pense of the owners, or may remove the occupants forcibly and close up the prem- 
 ises, and the same shall not again be occupied as a dwelling-place without the con: 
 sent in writing of the board. If the owner thereafter occupies or knowingly permits 
 the same to be occupied without such permission in writing, he shall forfeit not less 
 than ten nor more than fifty dollars.'' 
 
 1 Newport Ordinances, Chapter 24, Sec. 4. 
 
 2 Pennsylvania, Brightly's Purdon's Digest (1895), p. 1433, (Act of 7 April, 1S30. 
 Sec. 2.) 
 
 :; Massachusetts, Public Statutes (1882), Chapter 80, Sec. 24. 
 
NUISANCES. 139 
 
 Similar laws are found in Colorado, Delaware, Iowa. Maine, New 
 Hampshire, Rhode Island, and South Carolina : and there are like- pro- 
 visions in the special sanitary legislation of various cities, as Detroit, 
 Memphis, and San Francisco. The form of order served upon the 
 tenants in Boston under the Massachusetts law is shown in Appendix 37. 
 
 A curious case occurred in Boston, where the tenants in two houses 
 just alike were ordered to remove. They obeyed the order I >y exchang- 
 ing tenements and thus frustrated the purpose of the board of health. 
 Finally, however, an order to vacate in thirty minutes was issued, and 
 this not being obeyed, the bouses were closed up. 
 
 As has been shown, a number of states provide by statute lor the 
 vacating of unsanitary houses. Outside of these slates, a number of 
 cities have considered it within the sphere of their sanitary powers, 
 though it might not have been expressly so stated in their charters or 
 the general legislation establishing their sanitary authority. Several 
 such cities have therefore in their ordinances or rules provided for the 
 vacation of unsanitary dwellings. Among such cities may be mentioned 
 Bridgeport, Buffalo, Chicago, Minneapolis, Newark, Paterson, Rochester, 
 and San Francisco. Again, in some cities in stales where the vacating 
 is provided for by statute, local rides specify more closely under what 
 conditions and in what manner action shall be taken. In Fitchburg. 1 
 
 •• Whenever, upon due examination, it shall appear to the Board of Health that 
 any tenement or building is not furnished with vaults constructed according to the 
 provisions of these Regulations, or with sufficient privies or water-* losets, or drains 
 under ground for waste water, they will thereupon issue their notice, in writing, to 
 the occupants, <>r any of them, requiring them to remove and quit sucb tenement or 
 building within such time as the Board shall deem reasonable, and the same shall 
 n«it be again occupied as a dwelling place without the consent, in writing, of the 
 Hoard.'" 
 
 Iii Ilolyoke, Mass..- houses will be vacated if there is not 100 cubic 
 feel of aii' space Eor each occupant tor sleeping room. This vacating ol 
 tenements is employed not only when the houses arc entirely until lor 
 habitation and so dilapidated as lo be impossible of repair, bill it is made 
 Use of in cases of obstructed and broken drains, and detective plumbing 
 
 and accumulations of tilth. It is sometimes the quickesl wa\ to bring 
 landlords to terms and secure the abatement of nuisances which might 
 be proceeded against in other ways. A landlord will often adopt every 
 Legal expedient and make use of every delaj ami excuse to put oil abat- 
 ing a nuisance, when he would attend to ii prompt!} if bis attention 
 was called to it by loss of rent, because of a vacanl house. 
 
 i Fitchburg, Rules and Regulations of Board ••!" Health | L807 p. 10 - 
 2 llolvoke. Rules and Regulations of Board of Health (1897), -■ 
 
140 NUISANCER 
 
 When a dwelling has been vacated the best way to insure that it 
 shall not again be occupied is to tear it down. Moreover, by this pro- 
 cedure, whatever nuisance exists will surely be abated. When an 
 order to vacate premises is issued because of some defect which though 
 serious in itself may be easily remedied, it would of course be unreason- 
 able to destroy for such a cause, what is otherwise valuable property ; 
 and indeed in such cases, whatever the defect may be, it is usually 
 promptly remedied by the owner; but when the dwelling is so out of 
 repair and filthy as not to be worth the necessary improvements required 
 to make it a habitable structure, the best course is to demolish it. This 
 is not infrequently done under general nuisance laws. ' Sometimes 
 special provision is made by statute for the destruction of such unwhole- 
 some dwellings. Thus in Memphis 1 the government of the city 
 
 " Shall have power, and it shall be their duty to condemn as nuisances all build- 
 ings, cisterns, wells, privies, and other erections in the Taxing District which, on 
 inspection, shall be found to be unhealthy, and to cause the same to be abated, 
 unless the owners thereof, at their own expense, upon notice, shall reconstruct the 
 same in such manner as shall be prescribed by the laws of the Taxing District." 
 
 Under this provision many buildings are condemned and destroyed 
 each year. In New York City a few years ago by a special act 2 author- 
 ity Mas given to condemn and destroy unwholesome tenement houses. 
 This law has now been incorporated in the charter of greater New York 
 as Sections 1315-16. It provides that the board of health may con- 
 demn and order the removal of any building which from age, defects, 
 structure or position, is a danger to its inhabitants or the inhabitants 
 of adjacent buildings and the defects of which cannot be remedied ; 
 but the owners may institute proceedings in the supreme court for the 
 condemnation of the building. The court, if it is proved that destruc- 
 tion is necessary, appoints a commission to determine the damages. 
 If the building "is unfit and not reasonably capable of being made fit 
 for human habitation " the compensation shall be the value of the 
 material in the building. Under this law during the year 1896, eighty- 
 four houses were vacated for the purposes of condemnation. 3 Some of 
 these cases were brought into court and the action of the board of 
 health was upheld by the lower courts, but the only case which ever 
 went to the appellate division was dismissed on technical grounds. A 
 similar law has been enacted for Boston. 4 Under this law any building 
 may there be vacated 
 
 1 Memphis, Ordinances (1879). Sec. 102. 
 -New York, Act of 9 May, 1895. 
 
 3 New York, Board of Health Report, 1896, pp. 37-41. This report contains a 
 description of some of these premises. 
 
 4 Massachusetts, Chapter 219 of 1897, and 222 of 1899. 
 
NUISANCES. 141 
 
 " Because of age, infection with contagious disease, defects in drainage, plumb- 
 ing or ventilation, or because of the existence of a nuisance on the premises which is 
 likely to cause sickness among its occupants, or among the occupants of other prop- 
 erty in said city, or because it makes other buildings in said vicinity unlit for human 
 habitation or dangerous or injurious to health, or because it prevents proper meas- 
 ures from being carried into effect for remedying any nuisance injurious to health, 
 or other sanitary evils in respecl of such other buildings, so unlit for human habita- 
 tion that the evils in or caused by said building cannot he remedied by repairs or 
 in any other way except by the destruction of said building or of any portion of the 
 same. 11 
 
 It may then be destroyed and tin- damages sustained by tin' owner shall 
 In- paid by the city. The damages arc to be determined by agreement 
 between the owner and the board of health, and arc to lie assessed by 
 jury, as are highway damages. In Boston in 1899 ninety-two buildings 
 were condemned. 
 
 Statutes Consi lted in the Pbepabation of this Chapter. 
 
 A i \isama. Code (1896), Sees. L'4ns. 2429. 
 Abizona. Definition, Penal (ode (1887), Sees. 600- -V 
 A.BK w- \-. Powers of Cities. Statutes (1894), Sec. 5131. 
 California. Definition, Penal Code (1886), Sees. ::~0-4. 
 COLOBADO. Act of IT April, 189§, Sees. 6, ln-14. 
 Connecticut. General Statutes (1888), Sec. 2592. 
 
 Deposit of filth, Chapter 237 of 1889. 
 DEiiAWABE. Revised (ode (1893), p. 298, (Paws of Delaware, Vol. 16, Chapter 345, 
 
 Sees. 3-8.) 
 Fi.okii. \. Revised Statutes (1892), Sec. 77:;. 
 
 An of 1 June. 1895. 
 GrEOBGi \. < !hapter 1 13 of 1895. 
 
 Definition, Code (1882), Sees. 2997, 1094 4100. 
 Illinois. Powers of Cities, Annotated Statutes (1896), Chapter 24, Sec. 63. 
 
 Definition, Annotated statutes (lX'.Mi). Chapter 38, Sec. 369. 
 Im.i \\ \. Let oi 28 April, 1899, S< 
 
 Definition, Statutes . 1894), Sec. 2154. 
 
 Powers of cities. Statutes 1 1894), Sees. 3541, 3794. 
 Idaho. Definition, Statutes (1887), Sees. 3620 25. 
 
 [OWA. Annotated Code (1897), Sees. 2568 9. 
 
 Definition, Annotated Code (1897), Sec. 5078. 
 
 Powers of Cities, Annotated Code (1897), Sees. 696 9, 1032. 
 K \ \s \s. Powers of Cities, 4 reneral Statutes (1897), Chapter 32, Sec. v >. ,/,,-, //,. 
 Ki ah i ky. Statutes (1894), Sees. 2055, 2057 9. 
 Lot isi \\a. Chapter 182 oi L898, Sec. 7. 
 Maine. Supplement Laws (1895), Chapter 17. 
 
 If a by i \\t>. Public General Laws (1888), Lrt. 13 Sec. 5; Chapter 622 of 185)0. 
 Massachusetts Public Statutes (1882), Chapb s. 18 27. 
 
 Michigan. Compiled Laws (1897), Sees. 1412, 1117 •_':;. 
 
 Powers of Municipalities, Compiled Laws (1891 1125. 
 
 Minnesota. Statutes (1894), Sees. 7050 3. 
 
 Powers -I I ities, Statutes 1 1894), Sees. 970 6, 1224, tia nty-thlnl, i ! 
 Definition, statutes (1894), Se< , 6618 et seq. 
 Mississippi. Code 1 1892), Sec. --"-'77. 
 Powers of I ities, < ode | L892), Sec. 29 
 
142 NUISANCES. 
 
 Missouri. Revised Statutes (1899), Sees. Cit.">l-74. 
 
 Definitions. Revised Statutes (1899), Sees. 22:!4-<t. 
 
 Powers of Cities. Revised Statutes (1899), Sees. 5281, 5393, 5455, 5707, 5838, 5842, 
 5961, 6010, 6164. 
 Montana. Definition, Penal Code (180")'. Sec. 672 <t seq. 
 Nebraska. Definition, Compiled Statutes (1899), Sec. 6890 et seq. 
 
 rivers <>f Cities. Compiled Statutes (1899), Sees. 704, 1031. 1032, 1226. 
 New Hampshire. Public Statutes (1891), Chapters 108-9. 
 New Jersey. General Statutes (1895), p. 1644, Sees. G1-G6. 
 New Mexico. Powers of Cities, Compiled Laws (1897), See. 2402 (45). 
 New Yokk. Revised statutes (1896),.p. 2418, Public Health Law. Sees. 25-27. 
 North Carolina. Act of 1 March. 1893, See. 22. 
 
 Definition. Code (1883), Sees. 1297-1324. 
 North Dakota. Code (1895), Sees. 259-60. 
 Ohio. Annotated Statutes (1900), Sees. 2116, 2122, 2128. 
 
 Definitions, Annotated Statutes (1900), Sees. 6919-27. 
 
 Powers of Cities, Annotated Statutes (1900), Sees. 1692, 1878, 1934. 
 Pennsylvania. Powers of Cities. Brightly's Purdon's Digest (1894), p. 1432, Sees. 
 
 123-R54; p. 1558, See. 134; p. 240, Sees. 88-90. 
 Rhode [sland. General Laws (1896), Chapter 91. 
 South Carolina. Revised statutes (1893), See. 962. 
 
 Act of •"> January. 1895, See. 4. 
 Tennessee. Powers of Cities, Code (1896), Sees. 1915(2), 1924. 
 
 Definition, Code (1896), Sees. 6750-6. 
 Texas. Powers of Cities. Revised Statutes (1895), Sees. 447. 542. 
 UTAH. Revised Statutes (1898), See. 11117. 
 
 Chapter 45 of 1899. 
 Virginia. Code (1887), Sees. L728. 
 
 A el of 7 Ma re] i. 1900, Sec. •">. 
 Vermont, statutes (1894), Sees. 4678-80. 
 Washington. Codes and Statutes (1897), Sec. 3000. 
 
 Powers of Cities. Codes ami Statutes (1897), Sees. 739, 855, 942, 1015. 
 West Virginia. Code (1899), Chapter 150, Sec. 20eI-III; Chapter 179, Sees. 10-12. 
 Wisconsin, statutes (1898), Sec. 1414. 
 
 Powers of Cities, statutes (1898), Sees. 892, 925-52(6), (36), (37). 
 Wyoming. Chapter 76 of 1899. 
 
 Atlanta. Chapter 109 of 1874, Sees. «',7-71. 
 
 Boston. Demolishing buildings, Massachusetts, Chapter 219 of 1897, and 222 of 
 
 181 )'. I. 
 
 Buffalo. Chapter 105 of 1891, Sec. 237. 
 
 Bridgeport. Act of 22 March, 1877, See. 24. 
 
 Detroit. Chapter 10 of 1895, Sees. 17-19. 
 
 Hartford. < >rdinance of 27 June. 1885, Sees. 5-6, '• validated " by Act of :', March, 
 
 1886. 
 Memphis. Chapter 11 of 1879, Sec. 3. 
 
 Milwaukee. Chapter 184of 1874, Sub-Chapter 13, Sees. 4-5, and Chapter 36 of 1878. 
 Minneapolis. Chapter 413 of 1889, Sees. 9-10. 
 New Haven. Chapter 418 of 1897, sec. 97. 
 New Yoke City. Chapter 378 of 1897, Sees. 1229, 1287-1294. 
 
 Demolishing buildings, Act of !• May. ISO."). 
 Providence. Rhode Island, Chapter 598 of ism;. Sec. 9, clause 1. 
 St. Louis. Revised Statutes (1899), Sees. '.»465-6. 
 San Francisco. Political Code (1886), Sees. 2038, 3028. 
 Wilmington. Delaware Laws. Vol. 20, Chapter 550, p. 664. 
 
CHAPTER IV. 
 
 SPECIFIC NUISANCES. 
 
 IN the first chapter it was shown that most local governments have 
 been given very great legislative power in regard to sanitary affairs. 
 Sometimes, as in the Massachusetts law and those which follow it, rules 
 may be made "respecting nuisariees" or for the •• prevention of nui- 
 sances." In other cases rules forbidding nuisances may be made by 
 virtue of the power to legislate "for the promotion of health." Some- 
 times it is the board of health or health officer who has this power, bul 
 more often it is the proper legislative branch of the local government. 
 But, however they may be made, almosl every city, and innumerable 
 towns, villages, and townships have their sanitary codes, ordinances, 
 regulations, or rules. A considerable portion of these regulations arc 
 taken up with the consideration. of nuisances. This is particularly true 
 of the large cities where the complexities of urban Life make it much 
 more likely that a man will give offence to his neighbor than in rural 
 districts. 
 
 While very man} communities, particularly the smaller cities ami 
 towns, abate nuisances under state laws enacted for that purpose, as 
 described in the last chapter, many others proceed in a different way. 
 Instead of issuing an order for removal and then proceeding to fine the 
 offender or abate the nuisance if the order is not obeyed, it is customarj 
 when a nuisance is found to prosecute the offender for the violation of 
 ft municipal ordinance, though usually a preliminary notice is sent. In 
 one case the offender is lined for failure to obey a definite order, in the 
 latter for disobeying an established ordinance. Anion g important cities 
 which follow the latter method are Baltimore, Chicago, Denver, .Min- 
 neapolis. Newark. New York, and St. Louis. 
 
 In pursuance of the powers granted, verj man} boards of health 
 exercise their legislative functions in defining what shall be considered 
 nuisances and forbidding the same and affixing penalties for the viola- 
 tion of their rules. Sometimes the rules thus adopted are ven general 
 in their term- nol specifying at all in detail the acts which are forbid- 
 den, bul more Minn such general provisions are found in the statute 
 shown on page 123. Another example of a ver} general statutor} pro- 
 vision forbidding nuisances is found in the charter of the' n 
 
144 SPEl IFK ' XI r ls. I m ' ES. 
 
 York 1 and is shown below. Such general prohibitions are usually not 
 relied on, and specific declarations of nuisances and the prohibition of 
 particular acts are found by most sanitary authorities to be useful, and 
 it is the purpose of the following pages to consider some of these. 
 
 Filth. 
 
 As by far the larger number of nuisances have to deal with filth in 
 one form or another, rules relative to accumulations of filth of various 
 kinds and their removal, are found in all local sanitary legislation. The 
 following are examples of some of these rules : 
 
 " Sec. 2. . Any person or owners, agent, lessees or occupants of any building, yard 
 or lot of ground, who shall allow to accumulate orremain in oron said building, yard 
 or lut of ground, any putrid and unsound meat, pork, fish, bides, decayed vegetables 
 or food, manure, filthy asb heaps, garbage, offal, rubbish, dirt or filth of any kind, 
 which, by its decay or putrefaction, could or would become offensive to human 
 beings, or detrimental to health, or shall create a nuisance, shall be deemed guilty 
 of a misdemeanor, and upon conviction shall be fined not less than ten nor more 
 than one hundred dollars, to be recovered for the use of the City of St. Louis, before 
 any court having competent jurisdiction. 
 
 11 Sec. 6. The words filthy ash heaps, whenever used in this ordinance, shall be 
 held to include cinders, coal and everything that usually remains after fires that has 
 been mixed with garbage or filth of any kind ; the word rubbish shall be held to 
 include all loose and decayed material and dirt-like substances that attends use or 
 decay, or which accumulates from building, storing or cleaning; the word garbage 
 shall be held to include every accumulation of both animal and vegetable matter, 
 liquid or otherwise, that is received from kitchens, and also all putrid and unsound 
 meat, beef, pork, fish, decayed or unsound vegetables or fruits; the word tenement 
 house shall be taken to mean and include every house, building, or portion thereof. 
 which is rented, leased or hired out to be occupied as the home or residence of more 
 than two families living independent of one another. 
 
 " Sec. T. Whenever any owner or agent of any building in the City of St. Louis 
 shall rent, lease or hire out to be occupied, any building, or parts thereof, as a home 
 or residence of more than two families living independent of one another or a build- 
 ing to different persons for stores and offices in said building, giving to each family 
 or person the common right to halls, yards, water closets or privies, or some of them, 
 then such owner or agent shall be liable for the condition of said halls, yards, water 
 closets or privies, and said owner or agent may also be made a defendant in a prose- 
 cution for the violation of the provisions of this ordinance, and be subject to fine, 
 
 1 New York, Chapter 378 of 1897, Sec. 1201: 
 
 " It is hereby delared to be the duty of every owner and part owner and person 
 interested, and of every lessee, tenant, and occupant of, or in any place, water, 
 ground, room, stall, apartment, building, erection, vessel, vehicles matter and thing 
 in said city, and of every person conducting or interested in business therein, or 
 thereat, and of every person who has undertaken to clean any place, ground or 
 street therein, and of every person, public officer, and department having charge of 
 any ground, place, building, or erection therein, to keep, place and preserve the 
 same and every part, and the sewerage, drainage and ventilation thereof in such con- 
 dition, and to conduct the same in such manner, that it shall not be a nuisance, or 
 be dangerous or prejudicial to life or health." 
 
s i>e< j FI( jsnris. i m ws. 14.3 
 
 the same as the occupant of the premises, and any prosecution for violation of this 
 ordinance may be maintained against the occupants, owner and agent of the premises, 
 or either or all of said parties."' l 
 
 In other instances the rule takes the form of a direction to keep the 
 premises clean and in order : 
 
 Sec. 508. >~o person shall suffer or permit any cellar, vault, privy drain, pool, 
 sink, privy, sewer, or other place upon any premises or grounds belonging to or 
 occupied by him or them, to become offensive or injurious to public health. 
 
 "Sec. 510. No owner or occupant or other person having control or charge of 
 any lot, tenement, premises, building or other place shall cause or permit any nui- 
 sance to be or remain in or upon such lot, tenement, building, or other pla< 
 between the same and the centre of the street, lane or alley adjoining." - 
 
 Filth in Streets. 
 
 While filth upon a private property may be a nuisance, on a street 
 or public place it is certain to be so. When a nuisance of this kind 
 exists on private property, ample provision is made in most states for 
 its abatement and usually this can be accomplished before much harm 
 is done. When, however, filth is thrown or left upon the street, thou- 
 sands of persons may be affected before it can be removed ; and as it is 
 usually difficult to find the person who deposited the tilth and compel 
 him to remove it, the cost of removal must be borne by the city. Hence 
 in all cities effort is made to have clean streets, not only by a systematic 
 cleaning by the municipality, but also by attempting to prevent by 
 ordinance the deposit of dirt of any kind in the street. Some of these 
 rules are here given : 
 
 "Sec. 1381. That no swill, brine, urine of animals, or other offensive animal 
 Bubstance, nor any stinking, noxious liquid or other filthy matter of any kind, shall 
 by any person be allowed to run or fall from out of any building, vehicle or erection 
 into or upon any street or public place, or be taken or put therein, save as herein 
 
 elsewhere provided. 
 
 •■ Si .< . 1382. That no butcher's offal or garbage, nor any animals nor any putrid 
 or stinking animal or vegetable matter shall be thrown by any person, or allowed to 
 
 <;o into any street, place, sewer or receiving basin, or into any riser, canal, slip or 
 standing or running water, or excavation, or upon any ground or premises in tin- 
 said city." 
 
 While in some cities, as Philadelphia, Baltimore, and others in the 
 south, the gutters are used as sewers for the conveyance of waste water 
 other than that from water-closets, this practice is not generally con- 
 sidered advisable and is being gradually discontinued in the cities men- 
 tioned. This discharge of waste water into the -utters is therefore 
 generally forbidden : 
 
 1 St. Louis, ■ Ordinance of 18 January, 1891 Si i i. 2, 6, and 7. 
 •Cleveland, < ►rdinances | L892), Chaptei 508 BIO. 
 
 "Chicago, Ordinances (1881), Sees. 1881 
 
 in 
 
146 SPECIFIC NUISANCES. 
 
 1 No person shall use the streets or sidewalks of the city, nor the gutters between, 
 as a drainage to carry off any water that has been used, or other fluids, or soap-suds 
 or dye-stuffs, or liquid manures, or any other liquids, whether from privies or other- 
 wise. Any person discharging, or allowing to be discharged, any such fluids, shall, 
 on conviction of the fact, be fined in a sum not exceeding twenty-five dollars and 
 costs, or condemned to work in the chain-gang not to exceed thirty days, either or 
 both, in the discretion of the court. 1 ' 1 
 
 Other causes of filthy streets are forbidden ; thus in Boston " No 
 
 person shall wash or otherwise clean any animal or vehicle, or shake or 
 
 otherwise clean a mat or carpet in an}" street," 2 and similar rules are 
 
 found in other Massachusetts cities. The washing of vehicles is also 
 
 forbidden in other cities by the regulations relating to 'stables. The 
 
 following forbids the deposit of rubbish in streets : 
 
 "Sec. 1387. That no lime, ashes, coal, dry sand, hair, feathers or other sub- 
 stance that is in a similar manner liable to be blown by the wind, shall be sieved, or 
 agitated or exposed; nor shall any mat, carpet or cloth be shaken or beaten, nor any 
 cloth, yarn, garment or material or substance be scoured, cleaned or hung, nor any 
 business be conducted over or in any street or public place, or where it or particles 
 therefrom or set in motion thereby will pass into any such street or public place, or 
 into any occupied premises; that neither any usual nor any reasonable precaution 
 shall be omitted by any person to prevent fragments or other substances from falling 
 to the peril of life, or dust and light material flying into any street, place or build- 
 ing, from any building or erection while the same is being altered, repaired or 
 demolished or otherwise. 1 ' 3 
 
 "No person shall carry or convey in any vehicle any earth, sand, gravel, dirt, 
 ashes, or any loose fluid or offensive articles or matter, or any articles whatsoever, 
 so that the same shall or may be scattered, dropped, let fall, blown, or spilled there- 
 from, and all vehicles conveying foul, dusty or offensive matter of any sort shall 
 have tight bodies and be closely and securely covered." * 
 
 The cleaning of fish in the street is commonly forbidden, and also 
 the dropping of any refuse from the wagons of venders of any kind of 
 produce and meats : 
 
 " No person shall clean, scale, or wash any fish, meat, clothes, carriage, buggy, 
 or any other thing tending to create a nuisance, on any of the streets, lanes, alleys, 
 public grounds, or markets of the city. 11 5 
 
 One prolific source of nuisance in streets is the obstruction of gut- 
 ters by which filthy water accumulates after every rain, and in warm 
 weather often becomes very offensive. Hence special rules forbidding- 
 such obstruction : 
 
 " That no person shall deposit on any street, alley, private or public place in the 
 limits of the city, or upon any paved street now or hereafter constructed, any dirt, 
 
 1 Atlanta, Sanitary Rules and Regulations, Sec. 83. 
 
 2 Boston, Ordinances (1890), Chapter 49, Sec. 35. 
 
 3 Chicago, Ordinances (1881), Sec. 1387. 
 
 4 District of Columbia, Police Regulations, Chapter 8, Sec. 10 
 
 5 Cleveland, Ordinances (1892), Chapter 30, Sec. 514. 
 
SPJEi IFK ' XI Is. [ \'< Ks. y\~ 
 
 brick or other material, in such manner as to obstruct the free water flow of water 
 along any ditch or gutter." l 
 
 In case gutters should become obstructed, provision is made in some 
 cities, as Baltimore. Camden, and Jersey City, for the abutters to keep 
 the gutters in front of their estates free from obstructions : 
 
 •• No person shall throw, place or deposit, <>r allow to collect on or run over any 
 sidewalk, street, road or alley, any slops, dirty water or filth of any kind; and every 
 person shall keep the gutter in front of his or her premises, occupied as store, 
 factory, dwelling or other building, free from filth, dirt or other obstructions; and 
 every person offending against the provisions of this section shall forfeit and pay a 
 penalty of ten dollars.'" 2 
 
 In other cities, as Baltimore, Cleveland, Memphis, Newark, Rochester, 
 
 St. Louis, and Wilmington, Del., this provision for cleaning by abutters 
 extends to the sidewalks and sometimes includes a portion id' the 
 street : 
 
 li The owners or agents or occupiers of tenements and vacant lots owned by them. 
 under their charge or occupied by them, shall keep the sidewalks and gutters in 
 front of and adjoining their property clean, and also all the private alleys in the rear 
 of or adjoining the property owned by them clean to the center of such alley, and 
 after any fall of snow to be immediately removed from the sidewalk fronting their 
 
 res] tive lots into the carriage way of the street. Any person failing to comply 
 
 with the requirements of this section shall be deemed guilty of a misdemeanor, and 
 upon conviction thereof shall be lined not less than five nor more than twenty 
 
 dollars.' 1 
 
 In Memphis and the District of Columbia the gutters must be 
 cleaned daily between the lirst of May and the first of December. In 
 New York the abutters are onlj required to keep tin- sidewalks clean. 
 On the other hand in Memphis the abutter is required to clean lour feel 
 into the si reel in all cases. 
 
 The condition of private alleys is in inan\ if not most cities a con- 
 stant annoyance to the board of health. .Most cities clean all their 
 public highways at public expense either h\ their own employees or by 
 contract; but the municipality cannol thus directly cleanse private 
 ways without becoming permanent!} responsible for their condition. 
 Moreover, the City in many eases does nol care to expend its inoiie\ iii 
 the cleaning up of what is really private property. The plat owners, 
 not the abutters, are the real owners, and hence ii is clai d \>\ some 
 
 that the eit\ CannOl compel the ; 1 1 » 1 1 1 1 1 * IS to eleall the alle\. But, S8 IS 
 
 shown above, the ordinances of Memphis and St. I is require the 
 
 partial cleansing of alleys, and in Boston ami Haverhill (he cleansing is 
 required \>\ the follow ing : 
 
 i Denver. Ordinance 1 1 of L893, Sec. 78. 
 I amden, Sanitarj < ode I ' 21. 
 
 Louis, Ordinances (1893), Chapter i I. Sec. 374. 
 
148 SPECIFIC NUISANCES. ' 
 
 "No owner or occupant of land abutting on a private passageway and having the 
 right to use such passageway shall suffer any filth, or waste, or stagnant water to 
 remain on that part of the passageway adjoining such land." 1 
 
 In Baltimore if the abutter does not keep the alley clean or if he 
 does not clean it when ordered the city cleans it and charges the cost to 
 the estate. This is done under the ordinances and has been sustained 
 by the courts. Private alleys are treated in a similar way in the Dis- 
 trict of Columbia. Alleys can be and are kept cleaner if they are paved 
 and several cities provide for the paving of private alleys. In Wil- 
 mington, Delaware, it is done under the following ordinance which is 
 sustained by the courts, at least the municipal court : 
 
 " The board of health shall have power to order the paving of any alley, court, 
 yard or street, not owned by the city; provided, that two members of the board 
 shall declare such a course necessary for the preservation of the health of the 
 neighborhood; and if the order of the said board be not executed within the re- 
 quired time, said board shall have authority to have the paving done, and to collect 
 the expenses thereof pro rata, from the parties owning or using such alley, court, 
 yard or street. 1 ' 2 
 
 In Reading whenever a private alley is offensive and a nuisance, and 
 
 needs paving, the following order is issued under the authority granted 
 
 by Chapter 257, of 1874, Sec. 49, which gives cities of the third class 
 
 authority to abate nuisances : 
 
 " Resolved, That the ten-feet-wide alley running 
 
 and between 
 
 streets, is hereby declared a nuisance, 
 
 and the health commissioner is instructed to notify the owners of property abutting 
 
 thereon, to abate said nuisance within days from date, on failure 
 
 of which he is instructed and hereby authorized to have the said alley cleaned and 
 paved, and to proceed to recover the costs thereof from the owners of property 
 abutting thereon. 1 '' 
 
 This is served on the abutters. If they do not pave the alley the 
 city does, and bills are sent to the abutters for the cost. These are 
 generally paid, but if not are sued for, and the courts have always sus- 
 tained the position taken by the city. A number of alleys are treated 
 in this way every year, the number in 1899 being twelve. Previous to 
 1898 the board of health of Boston had authority 3 to order private 
 alleys paved and drained at the expense of the abutters. But in 1898 4 
 the authority to lay out and construct alleys as highways was conferred 
 upon the board of street commissioners. Under this law the assess- 
 ments are to be made as for highways, but the city is not to be liable 
 for defects or for cleaning off the snow. 
 
 1 Boston, Ordinances (1890), Chapter 49, Sec. 25. 
 - Wilmington, Health Ordinance, Sec. 9. 
 
 3 Massachusetts, Chapter 323 of 1891. 
 
 4 Massachusetts, Chapter 298 of 1898. 
 
spE< IFir XV is. \ N( Es. n 4 g 
 
 In some streets the gutters are flushed with water to eleanse them, 
 
 and even the streets themselves are occasionally washed, and Chicago, 
 
 Xew York, Buffalo, and Memphis require that the excess of dirt l>e 
 
 removed before the water is applied : 
 
 '•That every person, when cleaning any street, shall clean, and every~contractor 
 shall cause to he cleaned, the gutters and parts of the street along which the water 
 will run. before using any water to wash the same; and no substance that could be 
 before scraped away shall be washed or allowed to be carried or be put into the 
 sewer, or into any receptacle therewith connected. 1 
 
 Drainage. 
 
 Defects in plumbing and drainage are frequently sources of nui- 
 sance and sometimes also are causes of disease. In order to auard 
 against such mishaps it is first of all desirable that all work of this kind 
 should be done in the best possible way, and at the present time mosl 
 cities and many small towns require a rigid inspection of all new work ; 
 but the plumbing rules, as they are called, usually a Pply only to work 
 constructed after the date of enactment. The future is thus provided 
 for. but other regulations, usually less stringent, are often made to pre- 
 vent or remedy the grosser and more dangerous defects that may be 
 found in old work. 
 
 The following are some of the requirements found in various cities : 
 
 Drains Required. 
 
 •• Nil person shall disrharge any waste water or water from a sink or water-closet 
 except through a drain into a sewer or cesspool, or in accordance with a permit from 
 the board of health.' 1 2 
 
 Drain .Must be Adequate. 
 
 "That it shall be the duty of every person using, making, ")■ having any drain, 
 Boil-pipe, passage or connection between anj sewer (or with either the North or 
 East livers) ami any ground, building, erection, or place of business, and in like 
 manner the duty of t hi' owner and tenant of all grounds, buildings, and erections, 
 and of the parties interested in such place of business or the business thereat, and 
 
 in like manner the duty of all boards, departments, officers ami persons (to the 
 extent of the rigid ami authority of each), to cause ami require thai such drain, 
 soil-pipe, passage, and connection, shall at all times be adequate for its purpose, ami 
 shall convey ami allow, freely ami entirely, to pass whatever enters or should enter 
 the same, and no change of the drainage, sewerage, or the sewer connection of any 
 house or premises, invoh ing changes in the drainage, sewerage, or sewer connection 
 of anj other house or premises, unless aotice of ;u [east thiri\ days in writing 
 
 t hereof shall have I M 'en pre\ iouslj given to tins I »t part men i . 
 
 Drain Musi QOl beak. 
 
 ■ \o person shall sutler any particular drain from any building or land, of which 
 he is the owner or occupant, to leak or be out of repair; nor shall an) persons 
 
 1 The < its of New York. Sanitary Code (1899), Sec. 28. 
 Boston, Ordinances (1890), Ohaptej 19, Sec. 26. 
 Citj of Ne U >, ,,,k. Sanitarj Code I L899 . Sec. 80. 
 
150 SPECIFIC XUISANCES. 
 
 sewage, or waste or stagnant water, to remain in any building, or upon any land 
 of which he is the owner or occupant." x 
 
 Drains, Construction of Trap, etc. 
 
 " Xo owner, occupant, tenant or agent shall construct or cause to be constructed, or 
 maintain any drain or any portion thereof, to connect with any main drain or common 
 sewer, except the same first-mentioned drain if passing under buildings to be used 
 as habitable places, be made of iron pipe, and every such drain shall be so trapped 
 and secured as to prevent the escape therefrom of any offensive odor and poisonous 
 matter. 
 
 "All sewers or drains that pass within fifty feet of any source of water used for 
 drinking or culinary purposes shall be water-tight." 2 
 
 Drains not to be Obstructed. 
 
 "Whenever a water-closet, vault, privy, cesspool, or drain becomes offensive or 
 obstructed, the same shall be cleansed and made free, and the owner, agent, occu- 
 pant, or other person having charge of the premises on which any water-closet, vault, 
 privy, or drain is situated, shall remove, cleanse, alter, amend, or repair the same 
 within such time after notice in writing to that effect given by the board of health 
 as shall be expressed in such notice." 3 
 
 Strainer Required. 
 
 " In all cases where a drain shall be made from any lot, house, or other property 
 into a public sewer constructed by this corporation, there shall be a good and suf- 
 ficient copper or cast-iron strainer inside of the basement or cellar wall of the prop- 
 erty so drained, to prevent any vegetable matter or filth in a solid state from pass- 
 ing into the sewer, and such cellar or basement shall at all times be subject to the 
 inspection of such person as may be authorized by the mayor or corporation to 
 examine the same; and if at any time the strainer shall be found worn out or choked 
 with filth, or if the drain itself shall be choked with filth, the owner or occupier of 
 the premises, either or both of them, shall be fined not less than five dollars nor 
 more than ten dollars for the first offense, and not less than ten nor more than 
 twenty dollars for the second or any subsequent offense, and five dollars for every 
 twenty-four hours during which the strainer or drain shall remain out of repair or 
 be choked up, the said fines to be recovered as other fines of this corporation are 
 recovered.*" A 
 
 Plumbing. 
 
 Defective Plumbing. 
 
 •■ Xo foul or leaking waste, soil, vent, or drain pipe shall be constructed or 
 allowed to remain in any occupied or inhabited building in Denver. To ascertain 
 the sanitary condition of the plumbing and draining in any building the health com- 
 missioner may at any time cause such tests to be applied to it as are demanded by 
 ordinance Xo. 23 of the series of 1892. 
 
 " Whenever any plumbing fixtures in any building are condemned by the plumb- 
 ing inspector of the bureau of health on account of their foul, unwholesome or 
 imperfect condition, they shall be replaced by such apparatus as is demanded by the 
 said plumbing ordinance No. 23 of the series of 1892. 
 
 1 Boston, Ordinances (1890), Chapter 49, Sec. 27. 
 
 2 Albany, Sanitary Ordinances (1892), Sees. 16-17. 
 
 3 Cambridge, Regulations of Board of Health (1894), Sec. 34. 
 
 4 District of Columbia, Webb's Digest, p. 358, Sec. 5. 
 
spjyiFic NUISANCES. 151 
 
 •• When the plumbing in any building is altered or reconstructed by order of the 
 health commissioner, the said commissioner is authorized bo modify the require- 
 ments for the construction of plumbing as provided in said plumbing ordinance No. 
 23. series of 1802; provided, however, that in no case shall plumbing be permitted 
 to remain which, after thorough tests have been applied, may be found to be in 
 unsanitary condition." * 
 
 Traps Required for Fixtures. 
 
 ■ All sinks, basins and stationary tubs in every hotel, lodging, tenement, board- 
 ing-house, or other dwelling in the city of St. Louis, shall be provided with proper 
 stench traps, directly under each sink, basin or stationary tub so connected with 
 waste or soil pipe, and so constructed as directed by the health commissioner, 
 approved by the board of health, and with the traps so adjusted as to prevent the 
 escape therefrom of foul odors and gases.' 1 2 
 
 Ventilation of Soil and Waste Pipes. 
 
 •• No person shall have for use or use any water-closet, urinal, sink, tub or other 
 structure or appliance for receiving, holding or carrying away animal excrement, or 
 refuse from domestic uses, or any pipe or pipes used in house draining; unless each 
 of the same shall be freely ventilated by appliances sufficient to allow the escape of 
 all gases, and to avoid the compression or tension of the air confined in such pipes 
 or drains. 
 
 "The owner of every dwelling house in said city, having a waste or soil pipe 
 placed therein, shall cause the same to be ventilated by extending the same by 
 means of a pipe of the same size to a height of not less than two feet above the 
 roof of the building, or pursuant to the terms of a permit in writing from the board 
 of health." 3 
 
 Sewer Connection from Hydrants. 
 
 ••All persons using city water from hydrants located upon their premises, be, 
 ami they are hereby required to connect drains front the same with the public 
 sewers, where such sewers are laid in the street adjoining their premises; and they 
 are also forbidden to allow waste water to run from their premises upon the side- 
 walks or street." ' 
 
 Sufficient Water for Water-closets. 
 
 "Sec. 112. That all water-closets now, or hereafter, having sewer connections, 
 
 shall also have proper water connection with the city water-works, or from private 
 wind in ills or water- works, where there is an ample flow of water, and all said water- 
 closets shall be so flushed with water, of sufficienl flow and strength, -as will prevent 
 the accumulation of offensive matter, ami will safely and promptly carry off the 
 same into the sew ere." ' 
 
 Obstruction of Water-closets, Vaults, etc. 
 
 The deposil of improper substances in water-closets ami privy vaults 
 is forbidden in many cities. The following is the ordinance in Cleve- 
 land : 
 
 Denver, Ordinance n of L898, Sees. 128, 130, 132. 
 Bt Louis, i Ordinances L893), Chapter l I. Sec. 106. 
 
 ^ onkers, .sanitary Code 1 1892), Sees, -'a and 12. 
 1 Fall River. Regulations of Board of Health (1894), Sec. 21. 
 ■ Atlanta, sanitary Ordinances, Sec. N-. 
 
152 SPECIFIC NUISANCES. 
 
 " No person shall throw into or deposit in any water or privy closet, vault, sink, 
 privy, or cesspool, any offal, ashes, garbage, swill or other substance, except that of 
 which any such place is the appropriate receptacle, and the owner, lessee, agent, 
 tenant, occupant, or other person having control of any building or premises to 
 to which such water or privy closet, vault, sink, privy or cesspool appertains, shall 
 be considered and held responsible for any violation of this section." 1 
 
 In Providence a card giving notice of a similar regulation is fur- 
 nished by the health department without charge. This card is 7 by 14 
 inches and reads as follows: 
 
 "NOTICE TO TENANTS. 
 Any person who places any ashes, sticks, stones, rags, broken crockery, or any- 
 thing else in this closet which may cause it to become obstructed, is liable to a fine 
 of $20. 
 
 Per order of the 
 
 Si I'ERINTENDENT OF HEALTH.' 1 
 
 Water-closet Construction. 
 
 " No water-closet shall be allowed to be placed or maintained in any part of a 
 building where there cannot be a direct communication between the room in which 
 it is situated and the outer air, and all such water-closets shall be required to be 
 directly ventilated into the outer air. No water-closet shall be allowed to be placed 
 or maintained in any situation where its trap shall be at a lower level than the water 
 in the harbor at mean high tide." 2 
 
 Urinals. 
 
 " No person shall mar, misuse, defile, or deface a public urinal, nor attach thereto 
 any hand-bill, advertisement, or drawing." 3 
 
 Cellars. 
 
 Other matters than plumbing and drainage which may affect the 
 sanitary condition of dwellings and cause them to become nuisances or 
 unhealthful, are often regulated by sanitary ordinance. The construc- 
 tion and use of cellars is one of these matters. The New York rule 
 •provides 
 
 " That no owner or lessee of any building, or any part thereof, shall lease or let, 
 or hire out the same or any portion thereof, to be occupied by any person, or allow 
 the same to be occupied, as a place in which, or for any one, to dwell or lodge, 
 except when said buildings or such parts thereof are sufficiently lighted, ventilated, 
 provided and accommodated, and are in all respects in that condition of cleanliness 
 and wholesomeness, for which this Code or any law of this State provides, or in 
 which they or either of them require any such premises to be kept. Nor shall any 
 such person rent, let, hire out, or allow, having power to prevent the same to be 
 used as or for a place of sleeping or residence, any portion or apartment of any 
 building, which apartment or portion has not at least two feet of its height and space 
 above the level of every part of the sidewalk and curbstone of any adjacent street, 
 nor of which the floor is damp by reason of water from the ground, or which is 
 
 1 Cleveland, Ordinances (1892), Chapter 30, Sec. 480. 
 
 2 Bridgeport, Ordinance of 21 September, 1892, Sec. 23. 
 
 3 Boston, Ordinances (1890), Chapter 49, Sec. 11. 
 
SPECIFIC NUISANCES. L53 
 
 impregnated or penetrated by any offensive gas, smell, or exhalation prejudicial to 
 health. But this section shall not prevent the leasing, renting, or occupancy of 
 cellars or rooms less elevated than aforesaid, and as a part of any building rented or 
 let. when they are not let or intended to be occupied or used by any person as a 
 sleeping apartment, or as a principal or sole dwelling apartment. 
 
 "That no person having the right and power to prevent the same, shall know- 
 ingly cause or permit any person to sleep or remain in any cellar, or in any bath- 
 room, or in any room where there is a water-closet, or in any place dangerous or 
 prejudicial to life or health, by reason of a want of ventilation or drainage, or by 
 reason of the presence of any poisonous, noxious, or offensive substance, or other- 
 wise." 1 
 
 Another specific provision is that cellars must be ventilated and 
 
 dry : 
 
 " All cellars must be properly ventilated to keep them dry and healthful; and no 
 stagnant water or tilth, of any kind, will be allowed to remain on any vacant land, 
 or under any building, thereby causing a nuisance." 
 
 " Whenever any cellar, basement or part thereof, or any house or building within 
 the limits of the city of Omaha, shall be found to be damp or moist by reason of 
 leaking or defective hydrants-, water pipes, sewer pipes, cisterns or wells, gutters, 
 drains, rain spouts, or seepage from the surrounding earth, or from a deposit of any 
 kind or nature, or from any cause whatever, shall become detrimental to health, the 
 same shall be deemed a nuisance.' 13 
 
 < )ther provisions relating to cellars are round in the charter of the 
 City of New York, 4 and also in the ordinances of a number of other 
 cities, as Buffalo, Paterson, and Philadelphia. In the latter city cellar 
 tenements lighted only by a door, or collars without a board floor, must 
 he vacated in five days. 
 
 -Roofs Must be Tight. 
 
 ■■ The roof of every house shall be kept in good repair and so as not to leak, and 
 all rain water shall be so drained or conveyed therefrom as to prevenl iis dripping 
 on the ground, or causing dampness in the walls, yard or area.'" 
 
 Fresh Air Inlets. 
 
 "In all dwellings or other buildings heated by furnaces the fresh air duct shall 
 receive its supplj of air from outside the building, and entrance to such air duct 
 
 shall, when possible, be raised above the surface of the ground in such a way as to 
 exclude t he em ranee of tilt h." 
 
 Q-as a"/ to be < hit off. 
 
 '• From and after the passage Of this ordinance, it shall in it l>e lawful for the pro 
 
 prietor or proprietors (either themselves or bj their employees) of anj hotel or 
 
 1 City of New York. Sanitary Code (1899), N. s. •_"-' _':',. 
 
 - Fall River, I: igulations of Hoard .a' Health | 1894 I, Sec. •">". 
 
 < >maha. Rules and Regulations of the Department of Health (1892 Si 
 1 n.-w York, Chapter 878 of 1897, Sees. L809 10. 
 
 ■ Chicago, Ordinances (1881), Sec. 1859. 
 
 ■ Denver. Ordinance 1 1 of L898, Se< , I 18. 
 
154 SPECIFIC NUISANCES. 
 
 boarding house in the city of Atlanta, where any kind of gas is used in bed-rooms 
 for lights, to cut the gas off at any time during the night, except in cases where the 
 premises may be on fire." l 
 
 Overcrowding. 
 
 Overcrowding is one of the chief causes of the spread of communi- 
 cable disease and the conditions which are attendant upon and in- 
 separably connected with the huddling together of human beings are 
 conducive to many other forms of disease. It is only by the most 
 careful attention to every sanitaiy detail that persons can live closely 
 packed together without suffering great physical deterioration. And 
 the immoral effects of crowding are so marked and the tendency in- 
 duced so degrading, that any efficient control of densely packed tene- 
 ments is almost impossible. Hence it is felt that limits must be placed 
 upon the concentration of population to which their poverty is always 
 impelling the poorer classes. One means of checking overcrowding is 
 by the vacation of premises which are found on this account to be a 
 menace, not only to the health of the occupants, but to that of the pub- 
 lic as well. This vacation as we have seen has been provided for by 
 statute in many states. These statutes are usually to be enforced by 
 local boards of health. In some cases, as in Holyoke, Lynn, and New- 
 ton, the degree of overcrowding which will there require the applica- 
 tion of the statute is fixed by a rule of the local board of health : 
 
 " In considering the number of occupants, in accordance with the foregoing sec- 
 tion, this board will consider a sleeping room to be overcrowded unless there should 
 be at least four hundred (400) cubic feet of air space for each inhabitant occupying 
 the same." '-' 
 
 In Newton, Mass., the space required is 500 cubic feet. 
 
 As we have seen, many cities in states where there is no statute 
 law to vacate houses nevertheless incorporate such provisions in their 
 local rules, and sometimes, as in Lynn, the degree of crowding permis- 
 sible is specified. The following is from Denver : 
 
 "In every lodging house, tenement house, hotel, factory, woi'kshop, theatre, 
 assembly hall, office or other building or room where human beings sleep, dwell, 
 congregate or labor, the lighting, ventilation or breathing space shall be sufficient 
 for the preservation of health. To prevent overcrowding, the occupants or visitors 
 of such premises shall be so limited in number that not less than 700 cubic feet of 
 air space, with sufficient means for its frequent renewal shall be provided for each 
 person." 3 
 
 But in New York the rules in regard to tenement houses provide that 
 there shall be 400 cubic feet of air space for each adult and 200 for 
 each child. 
 
 1 Atlanta, Sanitary Ordinances, Sec. 142. 
 
 2 Lynn, Regulations of Board of Health (1894), Rule 22. 
 
 3 Denver, Ordinance 44 of 1893, Sec. 143. 
 
SPEC IFK ■ NUISu 1 m '/:'>'. 155 
 
 There are many other ordinances in regard to the sanitary condi- 
 tions of dwellings and other structures, many of them of a very general 
 nature and intended to cover any and all dangerous defects which may 
 occur, but which cannot from their great variety he all specifically pro- 
 vided for by separate enactments. One of these regulations is here 
 given. See also section 22 of the same code, shown on page 152: 
 
 " That no person shall hereafter erect, or cause to be erected, or converted to a 
 new purpose by alteration, any building or structure, or change the construction of 
 any part of any building by addition or otherwise, so that it, or any part thereof, 
 shall be inadequate or defective in respect to strength, ventilation, light, sewerage, 
 or of any other usual, proper, or necessary provision or precaution for the security 
 of life and health; and no person shall make or use a smoke house or room or appa- 
 ratus for smoking meat, in any tenement or lodging-house, without a permit in 
 writing from the board of health, and subject to the conditions thereof; nor shall 
 the builder, lessee, tenant or occupant of any such, or of any other building or 
 structure, cause or allow any matter or thing to be or to be done in or about any 
 such building or structure dangerous or prejudicial to life or health." 1 
 
 The sanitary condition of schools, factories and tenements and the 
 
 laws regarding them will he considered in another connection. 
 
 There are a number of things which may at times bet nine nuisances 
 or injurious to health, but which are not usually noticed in sanitary 
 regulations. In most extensive sets of sanitary rules some lew of these 
 unimportant or unusual matters are treated of. The following are 
 examples of some of them : 
 
 Upturning the Soil. 
 
 In Augusta, Ga., Charleston, New Orleans, and Savannah and by 
 the rules of the Florida state board of health, the upturning of dirl or 
 soil in large quantities is prohibited from the first id' May to the first oi 
 November without the written permission of the board of health or 
 mayor. The following is the ordinance in Charleston: 2 
 
 "it shall not be lawful to dig up. open; or disturb the surface of the earth. 
 within the limits of the city, between the first day of June and the tii'st daj of Octo- 
 ber, in any year, for the purpose of paving the streets, of excavating for drains, of 
 laying down gas or other pipes, or of carrying on any other public improvement; 
 Provided that any incorporated company, or their agent or agents, may with the 
 consent of the mayor at any time during the year, Laj down service pipes in any 
 street, lane, or alley of the city, in which main pipes have been already laid: upon 
 the express condition and proviso, however, thai between the first day of June and 
 the firsi day of October, in every year, each piece of service pipe shall he laid, and 
 the earth ami pavemenl restored, during the day in which the surface of anj 
 
 lane or alley is opened for the aforesaid purpose." 
 
 The hoard id' health in New Orleans after a careful investigation of 
 the subject has decided that little, if any harm is caused l>\ Mich exca- 
 vations ami it puts little restriction on them. 3 
 
 I ity of Vew York. Sanitarj Code 1 1 - 21. 
 
 - charh ston. Ordinances (1897), Sec. 154. 
 New Orleans, Reporl of Board of Health 1^'.» '.<. p. 18. 
 
156 SPECIFIC NUISANCES. 
 
 Weeds. 
 
 Rules in regard to weeds are also found in Columbus, the District of 
 Columbia, Denver, St. Louis, and Wilmington, and in Iowa the code 
 provides that cities and towns may destroy weeds in lots. 1 The St. 
 Louis ordinance assesses the cost on the property, but owing to the 
 expense and delay of procedure when nuisances are owned by non- 
 residents, as about half the vacant lots are, the health commissioner 
 of that city does not attempt to enforce the ordinance. 
 
 In Columbus the ordinance is similar to that of St. Louis, and in 
 1898 $1,700 was expended in clearing lots of weeds.' A case was 
 brought to test the law, but has not yet been decided. 
 
 In Charleston 2 persons having charge of burial grounds shall cause 
 " rank and offensive weeds " to be pulled up every fortnight and placed 
 in the street for the scavengers to remove and " also to cause the grass 
 which may be growing on such burial ground or church yard to be re- 
 moved or cut, and taken away as often as in the opinion of the board 
 of health the growth thereof may be so rank and luxurious as to endan- 
 ger the health of the city." 
 
 Cabbage Plants. 
 
 " That no cabbage head, cabbage stalk or other portion of any cabbage plant 
 shall be allowed to remain upon any garden, field or open space within the City of 
 Chicago, between the 15th day of October, in any year, and the 15th day of April 
 next thereafter following, nnless the same shall be covered under at least one foot 
 of earth. " 3 
 
 Poisonous Plants. 
 
 The following is from Providence, and occasion for its application 
 not infrequently arises : 
 
 " The owner or accnpant of any land upon which there is any poisonous ivy or 
 any Jamestown or Jimson weed, within fifty feet of any highway or street, shall 
 cause such ivy or weed to be removed within five days after receiving notice so to do 
 from the superintendent of health/' 4 
 
 Ailantus Trees. 
 
 These are often a nuisance and have been so declared in the District 
 of Columbia and New Haven : 
 
 " That ailantus trees, the flowers of which produce offensive and noxious odors, 
 in bloom, in the cities of Washington and Georgetown, or the more densely popu- 
 
 i Iowa, Code (1897), Sec. 696. 
 
 2 Charleston, Ordinances (1897), Sec. 128. 
 
 3 Chicago, Manual of Health Department (1891), p. 77. 
 
 4 Providence, Ordinances (1900), Chapter 19, Sec. 12. 
 
SPECIFIC XUIs. j m ES. 1 5 7 
 
 lated suburbs of said cities, are bereby declared nuisances injurious to health; and 
 any person maintaining such nuisance, who shall fail, after due notice from this 
 board, to abate the same, shall, upon conviction. Be fined not less than five nor more 
 than ten dollars for every such offense." T 
 
 Closets of Railroad Coaches. 
 
 Unless care is taken the water-closets of railroad coaches become 
 a nuisance about stations if the closets are used while the trains are 
 approaching or standing at the stations. This matter is usually looked 
 after by the railroad officials, but at least one city, Atlanta, has a rule 
 in regard to it. 
 
 Street Cars. 
 
 The following rules have been in force in New York City for a 
 number of years : 
 
 " That no railroad car, or vehicle constructed for or engaged in the business of 
 carrying passengers on any line of railroad in the City of New York, and which car 
 is propelled by horse-power, and not by steam-power, shall be used with cushions 
 on the seats or on the backs of the seats thereof. 
 
 '•That each and every car used upon any railroad in the City of New York for 
 the carrying or transportation of passengers, shall on each and every day on which 
 it may be used for the carrying or transportation of passengers, be carefully and 
 thoroughly washed out and cleaned, so that all filth and dirt are removed from t lie 
 inside of said car. And no dirt, sand, ashes or other similar substance shall be 
 deposited by any person operating a railroad or stage line in the City of New York 
 upon the surface of any paved street in said city without a permit from this depart- 
 ment. 
 
 ■ That no person shall at any time cany or convey in or upon any passenger rail- 
 road car, nor shall any conductor or person in charge of any such railroad car allow 
 to be carried or conveyed in or upon such car, except on the front platform, any 
 soiled or dirty articles of clothing or bedding, in baskets or bundles. 
 
 11 That every car used for the transportation of passengers in the City of New 
 York, shall be so constructed as at all times to provide and secure g I ventilation. 
 
 "Every company, corporation or person operating a line of railroad cars for the 
 carriage of passengers l'<>r hire in the City of New York, shall, in connection with 
 the running and operation of cars as aforesaid, have and provide closed cars to i>e 
 
 run on said railroad; and at all times shall have, provide, and operate at least one 
 
 closed car in every four cars so operated and run for the carriage of passengers as 
 aforesaid.* 1 - 
 
 Salt in Streets. 
 
 11 No person shall sprinkle, scatter, or put upon the rails, switches, or other 
 appliances of a street railway in any street, any salt, or mixture "f salt, except in 
 accordance with a permit from the board of health." 8 
 
 1 District of Columbia, A.ct ol L9 November, 1895, s > 
 
 i New York. Sanitary Code (1899), Sees, l-i 188. 
 
 • Boston, Ordinances (1890), Chapter 19, Sec. 10. 
 
158 SPEC IFK ' NT r ISu J N( ' E8. 
 
 Noises. 
 
 Disturbing noises are certainly a nuisance, if not a direct and appre- 
 ciable injury to health. The activities of modern life are constantly 
 increasing the volume of city noises, and some of our leading medical 
 journals are urging the necessity of taking some steps to lessen it. It 
 is claimed that the constant irritation of the nerves produces a very 
 appreciable effect in bringing on that nervous exhaustion, which is the 
 end of man}' a busy man's career. Attempts to control noises are not 
 only seen in general police regulations, but they are often found among 
 sanitary regulations. Rules in regard to noisy animals are referred 
 to on pages 162 and 170. In Boston 1 "No church bell shall be rung 
 to disturb any sick person if forbidden by the board of health." A 
 former Brooklyn 2 rule was as follows : 
 
 "That no person owning or occupying any building or premises shall use the 
 same, or permit the use of the same, or rent the same to be used for any business or 
 employment, or for any purpose of pleasure or recreation, if such use shall, from 
 its boisterous nature, disturb or destroy the peace of the neighborhood in which 
 said building or premises are situated, or be dangerous or detrimental to health." 
 
 In Meadville, Pa., bells and whistles are stopped by the board of 
 health on a physician's certificate that a sick person's condition demands it. 
 
 Roping off Street* in Sickness. 
 
 By an order of the Commissioners of the District of Columbia of 
 23 August, 1883, the health department issues permits to prevent the 
 the passage of vehicles in neighborhoods where persons are so seriously 
 ill as to make such a step necessary. In 1899 sixty-one such permits 
 were issued, but the health officer does not think such an ordinance is 
 required and urges its repeal. 3 
 
 Spitting. 
 
 The first anti-spitting law in the United States was adopted 12 
 May, 1896, in New York City, at the suggestion of Drs. Biggs and 
 Prudden. 4 It was adopted for the purpose of diminishing the spread 
 of tuberculosis. It had been shown that tubercle bacilli are thrown off 
 in large numbers in the sputum of many cases of phthisis, and that this 
 Sputum when it becomes dry on the floor or sidewalk would be readily 
 pulverized and carried about by air currents, and might on reaching 
 the air passages of those who breathed this dust-laden air, cause the 
 disease in them. This danger was believed to be a very real one, and 
 
 1 Boston, Ordinances (1890), Chapter 49, Sec. 12. 
 2 Brooklyn, Sanitary Code (1895), Sec. 179. 
 
 3 District of Columbia, Report of Health Officer (1897), p. 20. 
 
 4 New York City, Report of Board of Health (1896), p. 29. 
 
sl>E< IFIt ■ XVI X J X' ES. 1 59 
 
 hence the ordinance. While the evidence in support of the view that 
 this danger is great enough of itself to warrant such legislation is not 
 entirely satisfactory, the legislation itself has met with very general 
 approval. Spitting on the floor or sidewalk is a dirty habit, creates a 
 nuisance, and is annoying to the majority of persons. It is probably 
 because it prevents nuisance rather than because it prevents disease that 
 the law meets with popular favor. It is, however, usually adopted by 
 boards of health under authority to legislate for the prevention of 
 disease. 
 
 At present such regulations are found in the cities named below. 1 
 but have not yet been incorporated into statute law: but in Indiana 
 they have been promulgated as rules of the state board of health. 
 
 Some of the regulations, especially the earlier ones, forbade spitting 
 in street ears only, as in Baltimore, Minneapolis, Lowell, Lynn, Boston, 
 Cambridge, and New Orleans. 
 
 "Resolved. That the deposit of sputum in street cars is a public nuisance, source 
 of filth and cause of sickness, anil hereby orders: That spitting upon any floor of 
 any street car be, and hereby is prohibited." - 
 
 The word spit has in most of the regulations been deemed sufficient 
 to describe the act which it is desired to prohibit, but it has been fur- 
 ther explained in some cities. It has furthermore been found insuffi- 
 cient to forbid spitting on the floor, and it has been said that persons 
 seeing the rule above given exhibited before them, have deliberately 
 spat upon some other portion of the ear. The Minneapolis rule takes 
 note of both these points : 
 
 " No person shall spit <>r expectorate, or deposit or plate any sputum, .saliva. 
 phlegm, or mucus upon the floor or inside furnishings or equipments or in any place 
 upon the outside, or upon any platform of any street ear while the same is in use 
 upon any of the streets or highways in the City of Minneapolis, or in any manner 
 defile or pollute the floor, furnishings, equipments or platform of any street ear 
 while in use 11 1 K ,n any of the streets or highways of saiil city.' 1 
 
 Most of the more recent rules forbid spitting in any "public con- 
 veyance." Among the conveyances mentioned are "street cars," "rail- 
 road cars," "ferry boat." "omnibus," "hack," ■• carriage.*' "vehicle," 
 •• steam ear.*' and •• Bteamboat." 
 
 1 Boston, Balti re, Buffalo, Brookline, Cambridge, Colorado Springs, Colum- 
 bus, Cleveland, Cincinnati, Camden, Denver, Dayton, Fitchburg, Fall River, Hart- 
 ford, Indianapolis, Jersej City, Kansas City, Louisville, Lowell, Lynn, Minneapolis, 
 
 NYu Fork, Nevi Orleans, Omaha, P ia, ill.. Rochester, Springfield, O., Salem 
 
 Ban Francisco, Scranton, Seattle, Trenton, Waltham, Worcester, and Washin 
 I). ( . 
 
 - Lowell, Reporl of Board of Health, (1898), p. 86. 
 Minneapolis, Ordinance of 25 June, 1897, Sec. 53. 
 
160 SPECIFIC NUISANCES. 
 
 A good many of the rules go further and prohibit spitting on the 
 floor of " public buildings," as in New York City. Among public 
 places mentioned are " public halls," " assembly rooms," " shops," 
 " stores," " halls," " churches," " school houses," " railroad stations," 
 "public places." The Indiana rules forbid spitting on stairways. 
 Some of the rules go further still and forbid spitting upon the sidewalk, 
 as in the present rule in Boston, Cambridge, and Lynn, and in Cin- 
 cinnati, Providence, Brookline, Mass., Springfield, Mass., Colorado 
 Springs, and Rochester : 
 
 "Ordered, That no person shall spit npon the floor of any public conveyance, 
 shop, store, hall, church, school house, railroad station, or other public building in 
 said town, or upon the steps of any of said conveyances or buildings, or upon the 
 sidewalk (spitting into the gutter or street is not forbidden) of any public way in 
 said town. 1 
 
 These rules have very generally met the approval of the street 
 railway and other transportation companies, and they have been very 
 ready to post notices containing the rule, and to assist in its enforce- 
 ment. Some of the rules however, provide that the companies shall 
 do this : 
 
 "Spitting upon the floors of public buildings and of railroad cars and of ferry 
 boats is hereby forbidden, and officers in charge or control of all such buildings, 
 cars and boats shall keep posted permanently in each public building and in each 
 railroad car and in each ferry boat a sufficient number of notices forbidding spitting 
 upon the floors, and janitors of buildings, conductors of cars and employes upon 
 ferry boats shall call the attention of all violators of this ordinance to such notices." 2 
 
 In Providence the street railway company not only posted such 
 notices in its cars, but furnished its conductors with slips on which was 
 printed the rule, and the conductors were directed to hand one of the 
 slips to every person seen violating the rule. In Minneapolis cards 
 containing the rule are printed and very generally distributed by the 
 board of health. In Brookline where spitting on the sidewalk is for- 
 bidden, the police carry copies of the law to show to offenders. 
 
 In order to render compliance witli this rule easier, it is provided in 
 Colorado Springs as follows : 
 
 " Every owner, agent, lessee or occupant of any public hall or building shall 
 provide the same with cuspidors in sufficient number to accommodate the necessi- 
 ties thereof. And any such owner, agent, lessee or occupant who shall refuse or 
 neglect to comply with any order of the health officer in supplying said cuspidors, 
 shall be fined in a sum not less than one dollar nor more than five dollars for each 
 offense." 3 
 
 1 Brookline, Mass., Report of Board of Health (1808), p.- 10, Orders of the Board 
 of Health, No. 16. 
 
 2 New York City, Sanitary Code (1899), Sec. 194. 
 
 3 Colorado Springs, Sanitary Code (1897), Sec. 60. 
 
SPECIFIC NUISANCES. h;i 
 
 In New Orleans the rule first adopted only forbade spitting tobacco 
 on street cars, but it has been recently modified to forbid all spitting-. 
 
 Stables. 
 
 The keeping of horses, swine, cattle, and other domestic animals, can 
 readily be done in the country without nuisance or damage to any one. 
 but as soon as any locality becomes so well occupied that the stables, 
 sheds, and pens in which these animals are kepi must of necessity be 
 near the doors and windows of neighbors, then trouble begins. In vil- 
 lages, towns, and cities the keeping of horses and the storing and dis- 
 posal of stable manure is always a problem winch health officers have 
 to solve. The regulation of such matters well comes within the limits 
 of the general sanitary [towers of local government, but at least two 
 states furnish a special statute on this subject. The Massachusetts 
 act was first passed in 1891, but was amended in 1896 t<> read as fol- 
 lows : l 
 
 •■ No person shall hereafter erect, occupy, it n>e for a stable any building in am 
 city whose population exceeds 5,000, unless firsl licensed to do so by the board of 
 health of said city and in such case only to the extent so licensed."" 
 
 The location (if stables is sometimes limited by statute or ordinance. 
 Tims in Boston a statute 2 provides that no livery stable shall he erected 
 within 1T<» feet of a church without the written consent of the proprie- 
 tors and the permission of the hoard of health. By a more recent act 3 
 this provision applies to all cities, only the distance is made J<hi feet 
 ;ii id the permit must be from the religious society or parish. In Chicago 4 
 no livery stable can he built or kept on air) residential street within 
 Seventy-five feet of the street without the written consent of the owners 
 of 600 feet id' property on each side of the lot. In Cincinnati and 
 Cleveland 5 a written application must he made to the board of health 
 for a Livery stable license giving full particulars, and on residence 
 Btreets License is not to be granted without written consent "I owners 
 of dwellings within 300 feet. 
 
 In most of the Massachusetts cities persons desiring \<> erect a 
 stable have to make a written application, ami in [•"itehburg there must 
 also be filed a plan and description of the stable. A printed notice is 
 then sent tn the applicant explaining the rules that must be followed in 
 the construction of the stable. The license is not issued until the satis- 
 
 i Massachusetts, < lhapter 332 of 1896, also see < lhapter 128 uf L* 
 
 Massachusetts, Chapter 124 of 1810. 
 
 Massachusetts, Chapter 220 of L891. 
 
 • liicago, « Ordinances < 189] i. Sec. 2241. 
 
 ' Ohio, Annotated Statutes (1900), Sees. (2072-20), i S4), | 104 
 n 
 
1 ( ; 2 SPEl IFK XJ T& 1 XCEs. 
 
 factory completion of the building. In Newton, Mass., as soon as an 
 application to erect a stable is received, notices are mailed to owners of 
 adjoining property, and such notices are also posted in the vicinity. 
 Four days are allowed for filing written objections with the board of 
 health. If no objections are filed, the clerk issues a provisional permit. 
 In Providence stables are licensed by the board of aldermen. When a 
 petition is received, it is referred to the alderman of the ward in which 
 the stable is to be built, and the board usually accepts his report and 
 grants the license without conditions. 
 
 The majority of cities have as their first rule a requirement that 
 stables shall be kept clean. Various other matters, as construction of 
 stable, care and removal of manure, and its disposal, commonly receive 
 attention. The following are examples of rules commonly in force : 
 
 Cleanliness Prescribed. 
 
 " The keeper or keepers of a livery or other stahle shall keep his or their stables 
 and stable yard clean." 1 
 
 \<>ise Must Not Disturb Neighborhood. 
 
 L - No person owning, occupying, or having charge of any building, stable, or 
 other premises, shall keep or allow thereon or therein any animals or birds, which 
 shall by noise disturb the quiet or repose of those, or anyone, therein or in the 
 vicinity, to the detriment of the life or health of any human being. Any violations 
 of the provisions of this section shall be punishable by a penalty of twenty-five 
 dollars.'" 2 
 
 Floor to In- Impervious. 
 
 " Every stable or building which may be hereafter constructed or reconstructed 
 in the city of Asbury Park, in which any horse, mule, or cow is kept or stabled, 
 shall be so constructed and drained that no liuid excrement or refuse liquids shall 
 fiow upon or into the ground. All of the surface of the ground beneath every stall 
 in every such building, and for a distance of at least four feet in the rear of every 
 such stall shall be covered and protected from pollution, by a water-tight floor or 
 covering which shall be constructed as follows: 
 
 • Where the said water-tight covering rests directly upon the ground surface, the 
 said covering shall consist of concrete made witli finely broken stone, one part; sharp 
 sand, one part; hydraulic cement, one part: or coarse gravel, two parts; hydraulic 
 cement, one part: to be laid at least three inches in thickness. Upon this concrete 
 foundation a layer, at least two inches in thickness of best asphalt: or a layer, at 
 least two inches in thickness of coal tar concrete: or a layer, at least two inches in 
 thickness of cement concrete made with sharp sand, one part; best Imperial Portland 
 cement, one part, shall be laid. 
 
 • When the water-tight covering is not in contact with the surface of the ground, 
 it shall rest upon joist or floor beams three inches by ten inches, laid twelve inches 
 from centres, and it shall consist of spruce oryellow pine planking, three inches thick 
 and three inches wide, with beveled edges, and it shall be closely laid so that the 
 joints shall be V shaped, and be open at the top one quarter of one inch. Said 
 
 1 Scranton, Pules of Hoard of Health. Sec. 9. 
 
 2 Albany. Ordinances (1892), Sec. 18. 
 
SPEC IEIt ' XI 'Is . 1 m ES. 1 1 ; ; \ 
 
 joints shall be calked with oakum and be made water-tight. Every such water-tight 
 Covering shall be laid upon a grade not less than one-eighth of one inch to each foot, 
 and shall be so drained that all fluids which may fall upon it will lie conveyed to a 
 street sewer or otherwise disposed of subject to the terms of a permit from this 
 board. Portable wooden racks shall be placed upon all such asphalt, coal tar, con- 
 crete or cement concrete floors within said stall. Said wooden racks or floor cov- 
 erings shall be constructed of spruce strips, two inches in thickness, made in two 
 sections, and they shall be so placed that they may be readily removed for 
 cleaning." 1 
 
 The Asbury Park rule has since been declared void by the supreme 
 court of New Jersey. The point made was that it was beyond the power 
 of the board of health to prescribe in what way the floor should be 
 made tight. Nevertheless in a majority of existing rules the method is 
 thus prescribed. 
 
 Receptacle for Manure. 
 
 In very many cities a pit, bin, or cellar is required for the manure: 
 
 •• Every person owning, leasing or occupying any stall, stable, shed, barn or 
 apartment where any horse or any neat cattle shall be kept, and every owner of any 
 horse or head of cattle shall maintain a covered bin, vault or cellar satisfactory to 
 the Superintendent of Health, in which shall be placed all manure or refuse from 
 
 such horse or cattle." - 
 
 in Newark there must be provided an "underground and properly 
 covered manure vault of sufficient capacity to care for all manure that 
 may accumulate in such stable or department ; said vaults shall not be 
 nearer than ten feet to the line of an adjoining lot, street, alley, or 
 public place without a permit from the hoard." It is also often required 
 that all manure shall be kept in the bin or vault, or that " it shall not 
 be allowed to collect in such stable, shed. barn, or apartment, or on the 
 ground outside of said boxes, pits, or vaults " : 
 
 •• The manure pit shall be constructed of brick and stone, laid in cement and so 
 situated as to allow the manure when removed to be loaded inside the stable. 
 
 •• When such water-tight pit or cellar is situated under the building, it shall be 
 ventilated i>y a shaft not less than twelve inches square, carried two feel above the 
 roof of t he main building. 
 
 ■• The drainage of everj stable shall be properly conducted to the proper sewer 
 whenever practicable and to the satisfaction of the board of health. 
 
 14 In every case the ventilation and drainage shall be made satisfactory to the 
 
 hoard of health."" ; 
 
 Iii Lynn and < lambridge it is simpl} required thai no manure shall be 
 allowed to remain uncovered outside of a stable building. In Boston 
 the board of health requires huge stables to keep a wagon on the prem- 
 L8< - and to keep the manure in that. In New York ('ii\ the use ol 
 
 1 Asbury Park, Sanitary Code (1897), Sec. i>. 
 
 ■ Providence, Rules of Board oi Udermen (1! Chapter I. Se< . 0. 
 
 : Fitchbure. Rules and Regulations of Board of Health. Sees. 3, i I 
 
164 8PM t IF It ' N I r IS. I m MS. 
 
 bins or vaults was formerly insisted upon, but lately they have been for- 
 bidden under sidewalks, and their use outside of stables requires a per- 
 mit. The object of the board in discouraging vaults is to encourage the 
 use of baling as a means of storing and removing manure, as is shown in 
 the section of the code here given : 
 
 " That every owner, lessee, tenant, and occupant of any stall, stable, or apart- 
 ment in the built-up portions of the City of New York, in which any horse, cattle, 
 or other animal shall be kept, or of any place in which manure, stable refuse, or any 
 liquid discharge of such animals shall collect or accumulate, shall cause such 
 manure, stable refuse, or liquid to be promptly and properly removed therefrom, 
 and shall at all times keep or cause to be kept such stalls, stables or apartments, and 
 the drains, yards, and appurtenances thereof, in a clean and sanitary condition, so 
 that no offensive odors shall be allowed to escape therefrom. It shall be the duty of 
 every such owner, lessee, tenant or occupant, to cause all manure and stable refuse 
 to be removed daily from such stable or stable premises, unless the same are pressed 
 in bales, barrels or boxes, as hereinafter provided. It shall not be lawful to remove 
 manure and stable refuse in carts or wagons, or to cart the same within the city 
 limits without a permit from the board of health, and such carts and wagons shall 
 lie of a construction approved by said board, and every such cart or wagon must 
 have a permit from the board in writing, and be used in accordance with the terms 
 of such permit and not otherwise. Manure carts and wagons shall be loaded within 
 the stable premises and not upon the street or sidewalk, and shall be removed from 
 such premises in a manner not in any way offensive or to cause any nuisance. All 
 manure and stable refuse when transported through the streets must be so covered 
 and secured that no part of the same will fall upon the street, and so as to prevent 
 the escape of offensive odors, and the same shall not be unloaded or deposited within 
 the city limits, except upon the conditions of a permit in writing from the board of 
 health, and at such docks and places as shall be approved by the board, and to which 
 a permit in writing tor such use shall have previously been granted by said board. 
 No manure or stable refuse shall be allowed to he thrown upon or fall and remain 
 upon any street or sidewalk or upon any ground near any stable, and no manure and 
 stable refuse shall be allowed to remain for more than twenty-four hours in any 
 place within any stable, unless it is pressed in hales, barrels or boxes. No manure 
 vault or receptacle shall be built or used on any premises within the built-up por- 
 tions of the city, nor in any other part of the city, except pursuant to the terms of a 
 permit granted therefor by the board of health. 
 
 :L Every owner, lessee, tenant or occupant of any stall, stable or apartment, in 
 the built-up portions of the City of New York, in which any horse, cattle or other 
 animals shall be kept, and from which the manure and stable refuse is not removed 
 daily as hereinbefore provided, shall cause the same to be pressed in bah s, barrels 
 or boxes, at least once in each day, and so pressed as to reduce the same to not more 
 than one-third of the original bulk. Manure and stable refuse pressed in bales, bar- 
 rels or boxes, shall he removed to such docks or places as shall be approvi d by the 
 board of health, and to which a permit in writing for such use shall have previously 
 been granted by said board, and such hales, barrels and boxes shall not be opened 
 until delivered at such dock or places."' ' 
 
 Amount of Manure Allowed on Promises. 
 
 In Cambridge not more than two cords of manure is allowed to 
 accumulate or remain on the premises. In Newport it is three cords 
 
 1 City of New York, Sanitary Code (1899), Sec. 120. 
 
SPECIFIC NUISANCES. I,;;, 
 
 between the first of May and the first of November. In Lynn owners 
 are not to " allow large quantities of manure to accumulate" between 
 the above dates. In Scranton not more than five wagon loads shall 
 accumulate between the fifteenth of May and the first of November. 
 In Cleveland not more than one two-horse wagon load shall accumulate 
 except at a slaughter-house, where it is removed daily. 
 
 The use of manure as a fertilizer is sometimes permitted l>v ordi- 
 nance : 
 
 "Provided, that a reasonable amount of manure may he allowed at the discretion 
 <>f the health commissioner, to be accumulated on private premises, for the purpose 
 of cultivating the same; and provided further, that whenever, in the opinion of the 
 health commissioner, such accumulation is a nuisance or detrimental to health, it 
 may be forbidden and designated a nuisance under the prior provisions of this ordi- 
 nance. 1 ' ' 
 
 A similar rule is found in Omaha and St. Louis. 
 Permits for Removal. 
 
 As shown above, permits are required for removal in New York 
 City, and they are also required in a few other places. 
 .Manner of Removal. 
 
 .Many cities require the removal of stable manure in tight wagons 
 or covered wagons : 
 
 ll No person shall remove anj manure, excepl in a tight vehicle, with a canvas 
 cover so secured to the sides and ends of the vehicle as to prevent the manure from 
 being dropped while being removed."' - 
 
 ■■ Manure shall not be loaded upon or across any passageway or sidewalk, except 
 in st a hies heretofor constructed from which it is impossible to load it ot berwise, ami 
 in such cases the passageway or sidewalk shall he thoroughly cleaned and swept 
 immediately after such loading." 
 
 The New York rules were given on page L64. Now York was the 
 firsl city to introduce baling manure in order t<» lessen the nuisance 
 arising from its storage and transportation. Haling is encouraged as 
 was show ii. by requiring that manure shall be removed dail\ unless 
 
 baled. \'er\ little mall lire is as yet baled. Ill 1 89l i 1 1 le follow ing \\ ere 
 
 the average daihj receipts at the docks: 
 
 Manure loose in carts .096 tons. 
 
 "barrels 05 " 
 
 in hales I 
 
 Time and Frequency of Removal : 
 
 As was stated abo\e. in New York City, the removal ol stable 
 
 i nre must be dail\ unless it is baled. 
 
 1 Denver. < Ordinance 1 1 of 1893, Sec. 59. 
 Boston, ordinances (1890), Chapter 19, S( 
 Cambridge, Regulations of Board of Health (1897), Sec. i". 
 
1 (j 6 SPE( IF 1 1 ' Xf r IS. 1 m 'Es. 
 
 '• Where one or two horses are kept the manure must be removed once every week 
 in summer and once every two weeks in winter; where three or four horses are 
 kept, and from livery stables, it must be removed every day to the city dump or 
 without the city limits." 1 
 
 . . . "In all cases where this board shall by written notice so require all 
 manure or excreta shall be removed from all stables and premises where it may 
 accumulate as often as once in each week."" 2 
 
 The hours for removal are very often limited, as it is considered that 
 
 in certain locations, or at certain seasons, less nuisance is created by 
 
 removal at night. In Jersey City the hours prescribed for removal are 
 
 between 6 p. m. and 7 A. M. In Camden the inspector may forbid its 
 
 removal between <:! a. m. and 10 p. M. In Newport the hours during 
 
 which it may be removed are 5 p. M. to 10 a. m. between the first of 
 
 May and the first of November. In Boston : 
 
 "No person shall remove manure, or cause or suffer the same to be removed, be- 
 tween the first day of May and the first day of November, except in the night-time, 
 after twelve o'clock, and in accordance with a permit from the board of health. " 3 
 
 In Cincinnati : 
 
 " Every person using any stable, building or structure in which any horse or mule 
 is habitually kept or stabled, is required to remove the manure from such premises 
 at least once every day, except during the months of May, June, July, August, and 
 September, when such manure shall be removed at least twice every day, once before 
 the hour of 8 A. m., and once after the hour of p. m." 4 
 
 In Cleveland stable manure is not to remain on the premises over 
 seventy-two hours between May and September inclusive. 
 
 Disposal of Manure. 
 
 In most sections of the country, stable manure is so valuable to 
 market gardeners in the vicinity of cities and large towns, that its ulti- 
 mate disposal is a problem easily solved. The only question is how to 
 get the manure to the consumer. In most cities, probably all except 
 the very largest, there appears to be no serious objection to carrying it 
 into the country in properly constructed and covered wagons : but in 
 the largest cities, and notably in Xew York, much nuisance has in the 
 past been caused by the transportation of stable manure into the country. 
 The dumps at which it was loaded on to cars and boats, were loudly 
 complained of. The dumps, have however, been largely brought under 
 control by enforcing the provisions of the sanitary code as shown on 
 page 164. These rules require that the manure shall be closely covered 
 when carried through the streets and only deposited at designated 
 
 1 Denver, Ordinance 44 of 1893, Sec. 111. 
 - Newark, Sanitary Code (1888), Sec. 4(3. 
 
 3 Boston, Ordinances, Chapter 49, Sec. 7. 
 
 4 Cincinnati, Manual of Health Department (1898), Sec. 43. 
 
sp E < ■ TFIt ■ XI r ISA m ■ E'S. \ ( 5 7 
 
 places. In Milwaukee the reprehensible practice of burning stable 
 manure seems to have arisen, for the following ordinance was adopted 
 5 March. 1894 : 1 
 
 "The burning of manure in furnaces by manufacturing establishments and other 
 buildings anywhere in the city of Milwaukee for the purpose of keeping up a slow 
 fire through the night, or for any other purpose, thus creating an unbearable stench 
 throughout the eity, shall be deemed and hereby is declared a public nuisance." 
 
 Bedding. 
 
 ■•Nor shall any straw, hay, or other substance, which has been used as bedding 
 
 for animals, be placed or dried upon any street or sidewalk, or root' of any building; 
 nor shall any such straw, hay, or substance be deposited, nor shall accumulation 
 thereof be made, within two hundred feet of any street, without a permit from this 
 department.'" - 
 
 Similar rules are found in Minneapolis and Jersey City. In Fitch 
 burg, "bedding shall not remain outside the stable." 
 
 Washing Wagons, etc. 
 
 "Owners and occupants of livery and other stables within the city, shall not 
 wash or clean their carriages or horses, or cause them to he washed or cleaned in 
 the streets or public ways. They shall keep their stables and yards clean, and uot 
 allow large quantities of manure to accumulate in or near the same at any one time 
 between the first day of May and the firs! day of November, and no manure shall be 
 allowed to accumulate or remain uncovered outside of ;i stable building. 11 
 
 Swine. 
 
 There is probably no more offensive nuisance than a filthy hogpen. 
 The keeping of hogs is a part of the business of the fanner and is 
 necessary in the country, but in rural regions it is comparatively easy 
 to keep swine so that they will not l»e a nuisance to anyone. Not so in 
 villages and cities where the compactness of population is almost cer- 
 tain to make every hogpen a nuisance to some one. The intrinsic dl\ 
 offensive character of the hogpen is recognized in a number of cities 
 which forbid absolutely the keeping of swine within their borders. 
 Among the cities may be mentioned Augusta, Boston, Cleveland, Dis- 
 trict of Columbia, Philadelphia, Raritan, Reading, and Syracuse. In 
 the Philadelphia regulations "the keeping of hogs in the city and 
 county of Philadelphia is absolutely prohibited." Besides the penalty 
 imposed for violation of this, the statute of 5 April, 1849, provides as 
 
 follows : 
 
 • Whenever au> nuisance shall be found anywhere within the jurisdiction of the 
 board of health, by reason of the keeping of hogs or other animals, the board of 
 health, in addition to their power of destroying the pens or other enclosures con- 
 taining such animals, or of otherwise abating and removing such nuisances, be and 
 
 1 .Milwaukee. Report of Board of Health, 1894. 
 1 City of New York. Sanitarj < ode (1899), Sec. 180. 
 Lynn, Board of Health Rule 31. 
 
1CS SPECIFIC NUISANCES. 
 
 they are hereby empowered to seize such animals and deliver them over as forfeited 
 to the guardians for the relief and employment of the poor of the city of Phila- 
 delphia, for the use of said poor, and it shall be the duty of said guardians of the 
 poor, on notice of the board of health, to receive the said animals, and pay the 
 expense of their removal." 
 
 In Delaware local boards of health are authorized by statute to 
 destroy offensive hogpens. 1 A more moderate procedure than the pre- 
 ceding is to forbid the keeping of hogs in certain sections, usually the 
 compact or built up portions of the city. This is the regulation in Fitch- 
 burg, Lowell, Manchester, N. H., Memphis, Newport, R. I., and Rochester. 
 In Bangor, Me., they are not to be kept in the compact part of the city 
 from May to October inclusive. In Atlanta hogpens are declared a nui- 
 sance within one hundred yards of a private residence or on the water- 
 shed of the water works. In Cincinnati hogs are not to be kept "so 
 as to annoy or offend any neighbor or other person whatsoever." In 
 Haverhill " no swine shall lie kept within three rods of any dwelling, 
 and the pens must be kept free from standing water or filth. In Mel- 
 rose, Mass., "no swine are to be kept within fifty feet of a street or 
 within one hundred feet of any dwelling other than that of the owner, 
 or within twenty-five feet of the owner's dwelling.'' In Hartford hog- 
 pens are forbidden if a nuisance, and in Wilmington, Del., if filthy, 
 they are to be removed as are other nuisances. In Fitchburg hogs are 
 not to be kept in or about a stable. In Cincinnati they are not to be 
 about a slaughter house. In Bridgeport they are not to be kept within 
 one hundred feet of a dwelling, street, park, court, church or school, 
 and in Scranton, not within one hundred feet of a street, house, spring, 
 or well used for drinking. In Florence, S. C, no hogs are to lie kept 
 in a lot less than two acres in size. \\\ Connellsville, Pa., swine cannot 
 be kept within one hundred feet of a well, or thirty feet from a house 
 or street unless the pen is two feet from the ground and cleaned weekly. 
 
 The number of swine to be kept is sometimes limited. Thus in 
 Florence the limit is ten, in Chicago it is three. 
 
 The construction of hogpens is rarely regulated, but in Scranton 
 the rules of the board of health require that they shall be so con- 
 structed that 
 
 11 The tloor or floors of the same shall he not less than two feet from the ground 
 in order that the filth accumulating under the same may be easily removed; and 
 such filth accumulating in, about and under the same shall be removed at least once 
 a week and oftener if so ordered, and on the failure of any owner or occupier of such 
 premises so to do, then the same shall be done by the hoard of health at the expense 
 of the owner." - 
 
 1 Delaware Laws, Vol. 10, Chap. 345, Sec. 3. 
 
 - Scranton, Rules and Regulations of Board of Health, Sec 10. 
 
SPEC IFK ' XCls. J m ■ ES. 169 
 
 Most communities rely, not so much on rules and regulations, for 
 the prevention of nuisance from the keeping of hogs, as they do upon 
 licenses. The surest way is to forbid the keeping of hogs without a 
 license, and then withhold or revoke the license if the hogs are, or are 
 likely to become a nuisance. Nearly every city which takes cognizance 
 of the matter at all attempts to control the nuisance in this way. 
 Licenses are usually issued for a year and are revocable. A fee is often 
 charged, varying from ten cents for each hog in Newark, to one dollar 
 in Fitch burg and New Bedford. 
 
 The yarding of hogs for sale or preparatory to slaughter is recog- 
 nized as a different matter from the "keeping '" of hogs, but requires a 
 permit in Chicago, St. Louis, Rochester, and elsewhere. The unload- 
 ing of hogs and driving them through the streets requires a permit in 
 New York City and the manner of driving them also is regulated as 
 is referred to in connection with Slaughter Houses. 
 
 Other Animals. 
 
 Permits are sometimes required for the keeping of other animals 
 than swine, horses, and cattle. Fowls are frequently the cause of con- 
 siderable nuisance, and every health officer in a city of any considerable 
 size must have a good many complaints in regard to them. Geese and 
 ducks ar<- even'worse nuisances than fowls, hut they arc not so com- 
 monly kept. Goats also may become a nuisance. Dogs are a common 
 cause of nuisances from the filth they produce, the noise due to the 
 barking, and their lutes and their destruction of property. The regula- 
 tions concerning the keeping of cows will he considered in connection 
 with the milk supply. The control of dogs is usually attempted by 
 means of general police regulations — provisions being made for their 
 license and for the payment of damages done by the licensed A<>^. 
 This will not be considered in this hook but the measures taken to pre- 
 \eiit the spread of hydrophobia will he considered in connection with 
 diseases of animals. 
 
 There are certain regulations in regard to animals which do not 
 property he long among sanitary rules but yet are sometimes found there. 
 Among such are regulations for the driving of dangerous animals 
 through the streets and for the prevention of the straying of animals 
 on the highways, 1 and the prevention of cruelty to animals such as 
 tying calves by their legs and necks while the} are being transported, 
 and i he overdriving, heating or starving of animals. 2 
 
 ' n\ .a \.-w STork, Sanitary Code (1899) 10. 
 
 - Cincinnati, Manna! of Health Department 1 1- 
 
170 SPECIFIC NUISANCES. 
 
 The yarding of animals, whether they be cattle, swine, geese, goats 
 or horses is forbidden in many cities, as Chicago, Memphis, New York, 
 and Rochester, unless a permit is obtained from the board of health : 
 
 L ' That no cattle, swine, pigs or sheep, geese, goats or horses, shall be yarded 
 within the city of Chicago, without the permit of said commissioner, or otherwise 
 than according to the regulations of the department of health. 111 
 
 Cleanliness of the apartments in which animals are kept is often 
 compulsory, as in Cambridge : 
 
 "All henneries, dog kennels, and pens for any animals shall be kept clean and 
 free from decaying food, and from filth of any kind. The buildings and pens shall 
 be white-washed or disinfected and put in such condition as may be "ordered by the 
 board of health. 11 - 
 
 In Bridgeport 3 the board of health may order the removal of any 
 offensive sty, stable or hennery, and if the order is not obeyed, the 
 board of health may remove it at the cost of the city. 
 
 Animals in Dwellings. 
 
 The keeping of certain animals in dwelling houses is often forbid- 
 den. Among the animals coming under this prohibition are cattle, 
 horses, swine, goats, geese, and fowls. In Fall River fowls are not to 
 be kept in a store. 4 
 
 The following rule is from Lynn: 
 
 u No person shall keep any fowl or animal in any part of a dwelling house, or in 
 any place in the city. where the board of health may deem such keeping detrimental 
 to the health or comfort of the residents of the neighborhood, or to those who may 
 pass thereby; and said board shall have the power to remove or cause to be removed 
 therefrom, any such fowl or animal so kept. 115 
 
 Noisy A n't m<th. 
 
 These are the subject of regulation in several cities. The follow- 
 ing rule from Camden, X. J., being the form generally used: 
 
 " JSY> person owning, occupying or having in charge any stable, house or other 
 premises shall keep, or have or allow thereon, any dog, calf, bird or other animal 
 which shall by noise disturb the quiet or repose of those, or anyone therein, or in 
 the vicinity, nor shall the unnecessary blowing of steam whistles or the unnecessary 
 ringing of bells be permitted in the city, and any person offending against any of 
 the provisions of this section shall forfeit and pay a penalty of ten dollars. 118 
 
 1 Chicago, .Municipal Code (1881), Sec. 1461. 
 
 2 Cambridge, Regulations of Board of Health (1897), Sec. 22. 
 ■' Bridgeport, Ordinances of 1802, No. 14, Sec. 4. 
 
 4 Fall River, Regulations Board of Health (1894), Sec. 50. 
 
 5 Lynn, Rules of Board of Health (1896), Sec. 29. 
 8 Camden, Sanitary Code (1894), Sec. 26. 
 
SP K< IFK ' NT USA m 1 ES. 171 
 
 Breeding of Animals. 
 
 This is forbidden in Buffalo : 
 
 "No person shall maintain any establishment within the city limits for the 
 breeding of animals which may in any manner be detrimental to health."' ' 
 
 Among the animals which are sometimes licensed or concerning 
 which special regulations are adopted are the following: 
 
 Cattle. 
 
 Most regulations in regard to cattle are designed to secure the wel- 
 fare of the animals themselves, but the following from Cleveland has 
 regard to their human neighbors : 
 
 "No person shall keep, stable, or corral any cow, calf or other bovine animal 
 within the city, other than in licensed stock and slaughter yards, nearer than 
 twenty-live feet to any house, building, or place in use as a place of human habita- 
 tion, and in the keeping such animals the distances they shall be kept from human 
 dwelling places are prescribed to be and shall not be less than as follows, to wit: 
 
 For nne animal, as above specified, twenty-rive feet. 
 
 For two animals, as above specified, fifty feet. 
 
 Fur three animals, as above specified, seventy-five feet. 
 
 For four animals, as above specified, one hundred feet. 
 
 And for each additional animal, as above specified, more than four, there must 
 be at least twenty-live additional feet distance observed." '-' 
 
 Fowls. 
 
 Permits are required in Boston, Haverhill, Jersey City, Newton, 
 New York, Rochester, 3 and other cities. In the latter city the permit 
 [uired only in the built up portion of the city, and the application 
 for a permit must be in writing-. In Newton, .Mass.. 1 "No Live fowl 
 shall be permitted to run at large outside the premises of its owner or 
 keeper." In Bradford, Penn., no fowl can be kept within twenty-five 
 feei of a dwelling. See also the rule from Lynn on the preceding 
 page. 
 
 The following rule is found in Erie, Pemi. : 
 
 "All coops or other enclosures for the keeping of geese, ducks, chickens and 
 other poultry shall be not less than ten feet square and five feel high, shall be al 
 le;isi twenty feel from any dwelling, and shall be cleaned al least once a week "i 
 oftener if ae< essary. 11 6 
 
 In Jerse} City, Rochester, and Elmira, ducks and geese, as distinct 
 
 from fowls, are specified as requiring permits. 
 
 1 Buffalo, ( >rdinani es 1892), < lhapter 25, Sec. B. 
 
 - Cleveland, Ordinances (1892), Chapb 528. 
 
 Rochester, Ordinances ol Board "i Health (1895), No. 17, Sec. •''. 
 ' Newton, Report ol Board of Health | 1896), \>. 29. 
 ■ Erie, Rules of Board of Health 1 1898), p. 22. 
 
172 SPECIFIC WZTISAJSTCES. 
 
 Groats. 
 
 Permits are required for goats in Boston, Camden, Fall River, Haver- 
 hill, Jersey City, and Newark. In Lowell goats are not allowed in the 
 "close districts," in which the keeping of swine is forbidden, and else- 
 where a permit is required. Paterson has the following: 
 
 " When a permit to keep goats may be granted it shall be understood that such 
 goats shall be either kept within the premises described in the application or 
 tethered on pasture, and such proviso shall be stated on the permit. 1 
 
 Pigeons. 
 
 ' ' Be > it ordained by the council of the City of Neto Orleans, That it shall be un- 
 lawful for any person or persons owning or harboring pigeons to- allow them to go 
 at large within the city limits." 2 
 
 Vaults and * 'esspools. 
 
 There is probably no form of nuisance which in the aggregate causes 
 so lnuc!) annoyance as privy vaults. A single one of these contrivances 
 may render life in a whole neighborhood almost unendurable in the 
 summer time : and when it is remembered that until within a very few 
 years there was scarcely to be found a city in which large numbers of 
 vaults did not exist, it is not to be wondered at that the department of 
 health has waged an unceasing warfare against them. It is safe to say 
 that before vaults were largely done away with in the city of the writer, 
 over three-quarters of all the complaints made to him were in regard to 
 them. Privy vaults are not only nuisances, they are probably also real 
 sources of danger to health. The excrements in cholera and typhoid 
 and perhaps in other diseases contain large numbers of pathogenic 
 germs, and in fact it is only through the excretions that cholera and 
 typhoid are spread. It is certainly much safer to get rid of all excre- 
 ment promptly by turning it into the sewer than it is to store it up, 
 with all its possible seeds of disease, near our dwelling places. There 
 is every reason to believe that disease germs are harmless after they 
 reach a sewer (unless perchance the latter empties into a public water 
 supply), but there is certainly a possibility they may be spread from a 
 vault. The fact that many cities which have few privy vaults ( and 
 which have a good water supply), are particularly free from typhoid, 
 would lend color to this belief. For these reasons, boards of health have 
 long considered privy vaults things to be rid of, or in failure of this to 
 be rigid!) controlled. Such nuisances as these so manifestly come 
 under the general authority granted to local health boards, that it is 
 rare that special authority in regard to them is conferred by statute. 
 
 1 Paterson. Sanitary Code (1887), p. - JG, Sec. 9. 
 
 - New Orleans, Ordinance N"o. 1390, Council Series of T September, 1886. 
 
sp];< IFl l ■ XI T.v. 1 m 'B& 173 
 
 This is, however, sometimes done. Thus in Rhode Island 1 the town 
 councils may make rules and regulations in regard to privy vaults and 
 cesspools, and may regulate and control the construction of the same 
 In New Jersey 2 hoards of health are to regulate the construction, loca- 
 tion, and manner of emptying cesspools and privies. In Michigan 3 and 
 Colorado 4 hoards of health may regulate the care of vaults and may 
 abolish them. 
 
 Students of social science tell us that many of the institutions and 
 customs which are at the present time unfavorable to the welfare and 
 progress of society, were at a former period of civilization steps in pro- 
 gress. It is much the same with the privy vault. While in a modern 
 city, adequately sewered, privy vaults are nuisances to he abolished as 
 speedily as possihle. it is otherwise in new communities unprovided with 
 underground drains. Here the privy vault marks a forward step. It 
 is far better than the indiscriminate disposal of excreta on the ground. 
 So we find that while in the modern city the privy vanlt is forbidden, 
 it is required in all unsewered districts, whether of city or country. 
 Rules were formerly found which required the construction of a privy 
 vanlt ami cesspool for every house, hut with the introduction of the 
 water close! this was allowed as an alternative, and with the const ruc- 
 tion of sewers the water closet was alone permitted. In a few cities 
 the old rule requiring a privy vault for every house still remains, hut is 
 usually modified h\ a later rule requiring water closets and sewer con- 
 nections where there is a sewer. Sometimes, as in Cleveland, a privy 
 vault or water closet is required "for every building and all premises." 
 In St. Louis they are to he provided for ever} dwelling, store, livery 
 -Stable, tenement house, warehouse, factory, mill, or foundry. In Cleve- 
 land they must be " of sufficient size and number to accommodate all per- 
 sons who work in or inhabit " the premises. In Providence one vaull or 
 w ater-dosei is required for ever) dwelling house. In Boston t he statute 
 requires not less than one to twenty persons." In Chicago " ever} 
 owner, lessee, keeper, or manager shall provide or cause to he provided, 
 adequate privy vaults or water closets." In Denver the health commis- 
 sioner may order the owner, lessee, agent, or occupanl to provide a privy 
 vault, but a hearing must be given if desired. In the District oi 
 Columbia, where persons are employed for trade or business, separate 
 accommodations must be provided for both sexes.* 3 The rules in regard 
 
 1 Rhode Island, General Statutes 1 1890), Chapter 92, S c. 20. 
 
 New Jersey, General Statutes (1895), p. 10.30, Sec. 12. 
 
 Michigan, Compiled Daws (1897), Sees. WOO 7. 
 ' Colorado, A. t of IT April. 1893, Sec. 7. 
 
 Massachusetts, < lhapter 382 ol 1885 Se< , I. 
 
 \ci of Congress of 25 January, 1898. 
 
174 SPEC IFK ' JSTVIjS. 1 NOES. 
 
 to privy vaults and cesspools are often made to apply only to those 
 constructed after the passage of the act. The act of Congress referred 
 to above, prescribing the construction of vaults, was not to affect old 
 vaults until one year after its passage. Old, defective vaults may be 
 removed under general nuisance laws, and then the new vault, which is 
 required, must be built in accordance with the regulations. In Albany 
 the building or " maintenance " of vaults is forbidden without a permit, 
 and in Denver the rules apply to vaults used or maintained as well as 
 those to be constructed. 
 
 Permits. 
 
 In very man}' cities a permit is required from the health department 
 
 before a privy vault or cesspool can be constructed. This must be a 
 
 written or printed permit : 
 
 "Any person intending to construct a privy vault or cesspool, shall first obtain a 
 written permit so to do from the health officer, which permit shall designate the 
 location on lot, distance from any house, well, or spring, the kind of vault and cess- 
 pool, whether to be made water-tight or otherwise, and depth thereof, and shall 
 state that ventilation is required. In case any less depth than ten feet is required in 
 the construction of any privy vault, such permit shall state that the owner, agent, 
 occupant, or person in charge of the same, shall submit to all requirements there- 
 after made by the health officer or the director of police, intended to keep said vault 
 clean and in good condition. Any person violating such permit, or constructing 
 any such vault or cesspool, without obtaining the same, or disregarding the rules, 
 orders or regulations of the director of police, shall be punished as prescribed in 
 this subdivision."' 1 
 
 In ( 'ambridge 
 
 "Every application for such permit must be in writing, accompanied by a plan 
 of the premises showing the nearest adjacent houses, and all public or private ways 
 or places on which the premises abut, and a statement of the number of persons for 
 whose use the vault is intended."" - 
 
 In some places a fee is charged for the permit, as twenty-live cents 
 in Camden. In several cities a permit is only required if the vault or 
 cesspool is to be on the line of a sewered street. Often, as we shall see, 
 vaults and cesspools are forbidden wherever there are sewers, and hence 
 in Cincinnati an application for a permit must be accompanied with a 
 certificate from the proper department that there is no sewer on the 
 street. 
 
 Inspection. 
 
 Most rules which require a permit also require an inspection to see 
 if the terms of the permit or the rules of the department have been com- 
 plied with. Thus in Wilmington : 
 
 1 Cleveland, Ordinances (1892), Chapter 30, Sec. 478. 
 
 - Cambridge, Regulations of Board of Health of 1897, Sec. 33. 
 
SPECIFIC NUISANCES. \ 
 
 i •) 
 
 "The building inspector, who, being satisfied by personal inspection, or by a 
 
 deputy, that this ordinance has been complied with, shall give a certificate to that 
 effect, for which certificate the person so applying shall pay to the building inspector 
 a fee of fifty cents, and the building inspector shall make and preserve a record of 
 all such certificates issued by him, and shall deliver, at the end of every three 
 months, a list of the same to the secretary of the board of health, who shall tran- 
 scribe the same in a book provided for the purpose." ' 
 
 Not only is the usual penalty in the shape of a line imposed in cave 
 vaults are constructed or maintained contrary to the regulations pro- 
 vided, but the vaults may be summarily destroyed. 
 
 •• And in case the condition or construction of any vault or privy shall be different 
 from the requirements of this section, the board of health may cause t lie same to be 
 cleansed, repaired, amended, altered or removed, at the expense of the owner or 
 party occupying the estate in which such privy or vault may be; provided, they shall 
 lirst give such owner or party occupying a legal notice, and allow the space of at 
 least forty-eight hours f< >r such owner or occupant to comply with such notice." -' 
 
 Location. 
 
 The distance of vaults from the street line, lei line, buildings, wells, 
 etc., is often prescribed. The distance which a privy vaull must be set 
 from the line of the lot varies much in different cities. Two feel 
 perhaps, is the most common limit. Usually the limit for the distance 
 from the lot line and the street line is the same, but sometimes it is not. 
 Thus in Buffalo, a vault may he within ten feet of the street (or nearer 
 if an alley), or five feel from the lot line; in Paterson, ten feetfromthe 
 street and four feet from the lot line: in Jersey City, ten feel from the 
 Mivci and three feel from the lot line, and in Newark, ten feel from the 
 street and two feet from the lot line, in Lowell the vault must "he at 
 least two feet from the line of every adjoining lot unless the owner of 
 such lot shall consent and agree otherwise." Vaults must he a certain 
 distance from buildings upon the same or other lots. Thus in Bridge- 
 port no privy vault must he "nearer than twent} feel of the doors or 
 windows of any dwelling house, school or building." In Rochester it 
 must he -at least fifteen feet distant in cither direct ion from any adjoin- 
 ing building used for human habitation or tor the storage oi human 
 
 food.** In Denver the distance is ten feet. In Patersoi privy vault 
 
 shall he within fifteen feet of the foundations of a dwelling house. In 
 A iigusta, ( >;\., t he rule is thai 
 
 "No surface privy Bhall exist within thirtj feel of any dwelling house in this 
 city, if i lie yard iu which it is located be of such length and width as i<> permit such 
 1 . i i \ > to be of like distance from the dwellings surrounding it. In such yards as ii 
 shall be impossible to obtain thirty feel from contiguous dwellings, then such privj 
 shall be placed equidistant from all nearest dwellings as far as practicable." 
 
 ; Wilmington, Health Ordinance, Sec, 7. 
 ' Lowell, Rules of Board of Health (1894), p. 30 * 
 Lugusta, Sanitary Ordinances (188 §< L0. 
 
176 specific NUISANCES. 
 
 In Utica a vault must not be near enough to a house "to be detri- 
 mental." It is still more important that vaults and cesspools should be 
 far enough removed from sources of drinking water to prevent pollu- 
 tion. In Denver no privy vaults shall be built within ten feet of a 
 well, and in Cincinnati it must not be within eight feet of a cistern. In 
 Utah and Utica a vault must be fifty feet from a well; in Camden, 
 sixty feet: in Westbrook, Me., one hundred feet, and Spokane, two 
 hundred feet : 
 
 •■N" privy-vault, cesspool, or reservoir, into which a privy, water closet, cess- 
 pool, stable, or sink, is drained, unless it is water tight shall be constructed, dug or 
 permitted to remain within one hundred and fifty feet of any well, spring, or other 
 source of water, used for drinking or culinary purposes, unless the surface of such 
 vault, cesspool orreservoir is at a lower level than the bottom of such well." ' 
 
 In .Jersey City vaults are not to be "within a distance to be deter- 
 mined by the board of health of any well or cistern," and the distance 
 fixed is ten feet in clay soil and twenty feet in sandy soil. 
 
 It would hardly seem necessary to forbid the location of vaults in 
 
 cellars of dwellings, but such a rule may be found in Buffalo and other 
 
 cities, and sad to say, experience has proved it necessary. In Fall River 
 
 no privy shall open directly from any living or food storage room. In 
 
 Portland, Ore., cesspools and privy vaults may not be built in the 
 
 street. Sometimes specific provision is made for changing the location 
 
 of vaults already built which have become offensive : 
 
 L ' Whenever any privy vault or cesspool is situated upon a lot on a street in which 
 there is no public sewer, if the said privy vault or cesspool from any cause becomes, 
 in the judgment of the board of health, offensive or dangerous to the health of the 
 public, then the board of health may order a change of location of such privy vault 
 or cesspool to some other place on the same premises. In case the owner or owners 
 01 the premises upon which such nuisance exists shall neglect or refuse to obey such 
 order, within seven days after the same has been issued, then the board of health 
 may cause the same to be done at the expense of the city." 1 
 
 Size. 
 
 In Rochester all privy vaults must be of such dimensions as to con- 
 tain at least fifty cubic feet for every family or group of live persons 
 using the same. On the other hand a maximum is prescribed in Cam- 
 bridge; "the cubic contents of any one vault shall not exceed eighty 
 cubic feet unless otherwise stated in the permit." In the District of 
 Columbia 3 the maximum is eight cubic feet, or if a movable receptacle 
 is used two cubic feet. In Fall River it shall not be less than seventy- 
 two cubic feet. In Elmira it must he between fifty and two hundred 
 and sixtv cubic feet. 
 
 1 Seranton, Itules and Regulations of Board of Health (1887), Sec. 11. 
 J Bridgeport, Ordinances (1892), p. 180, Sec. 2. 
 ; Ad of Congress, 25 January, 1898. Sec. 4. 
 
SPECIFIC NUISANCES. \~- 
 
 Depth. 
 
 All sorts of regulations are in force concerning the depth required 
 for privy vaults. Shallow vaults are sometimes prescribed in order that 
 they may hold less and the contents consequently he removed oftener. 
 In other eases boards of health imagine that it is desirable to have them 
 deep in order to keep the contents as far out of the way as possible, 
 and also in order that if it is a leaching vault the liquid may leach away 
 better. Again if leaching vaults are allowed, and wells are also in use 
 to furnish drinking water the shallower the vault the less the danger of 
 contamination. In Xew Orleans privy vaults constructed after the pas- 
 sage of the ordinance are not to extend over two feet below the surface of 
 the ground. In Paterson they must not he more than four feet deep. 
 Most cities, however, require deep vaults. In Jersey City vaults must 
 net he less than eight feet deep. In the Pennsylvania cities of the second 
 class vaults must he at least six feet deep, and in Chicago they must he 
 six feet dee}) if within forty feet of a street, dwelling house or well, 
 hut in such cases they must he water tight. In Cincinnati and St. 
 Louis they must he ten feet deep. 
 
 In Reading, Pa., and Wilmington. Del., vaults must he twenty feet 
 deep except as otherwise provided : 
 
 " The. vaults of every privy which may be constructed within the city limits, shall 
 be digged to the depth of twenty feet, or shall be at least six feet deep, al the option 
 of the owner or proprietor, provided, however, that in case of a well six feet dee]., it 
 shall be luiilt and floored with sound ami well hiirnt h ticks, laid on edge at t he bottom 
 and in cement impervious to water, and the wall shall he puddled with .lay. one 
 tout thick, except when the same is digged in solid clay ground, and also provided, 
 that when rocks, or water permanently springing or flowing into the well from 
 beneath the surface of the ground, or other natural obstacle, render it expedient, in 
 the judgment of the Building Inspector, t hat such well should he made of the depth 
 
 of twenty feet, such well may lie sunk to any depth less than twenty feet and not 
 less than si \ feci . as upon application to him may he allowed by the Building Inspec- 
 tor, who shall consider the circumstances of the particular case and direct such 
 depth as lie deems eX pedient.*' ' 
 
 Materials. 
 
 Unless it is forbidden l>\ law the privy will frequently he sel over a 
 simple hole in the ground 2 and even if a vault is provided it will, unless 
 otherwise ordered, be walled in and prevented from caving h\ what- 
 ever is cheapest and most convenient. Usually this is lumber, or 
 perhaps rough stones, and then come well laid stone walls, and finally 
 brick or stone laid in cement. Rough wooden walls of board or plank. 
 
 or perhaps a hand arc the kinds id' \ault u>nall\ found beneath privies 
 
 Wilmington, Del.. Health ordinance (1802), Sec. 7. 
 
 'The Report of the Health Commissioner of St. I s foi 1893 94, p 
 
 thai there were Large numb< i -i such privies in the city. 
 
 12 
 
178 SPEC IFK ' NUISA 1STCES. 
 
 in the country or small villages, and are not unknown in cities of large 
 size. Thus in San Antonio, a rapidly growing city, the report of the 
 board of health 1 states that in 1892 there were in the city 3,000 lumber 
 vaults, 1,000 barrel vaults, and 1,300 earth vaults, by which latter it is 
 to be supposed is meant the primitive form of vault. 
 
 Most cities require that privy vaults shall be water-tight, and for this 
 purpose specify that they shall be constructed of brick or stone laid in 
 cement. In Cincinnati " in exceptional cases and by special permission 
 will oak plank be allowed as a substitute. " In Bradford, Pa., vaults 
 may be of two-inch plank. Sometimes, as in Newton, the walls are 
 simply to be strong enough to keep from caving. In mo'st cities the 
 walls are to be eight inches thick. In New Orleans the vault " shall if 
 built adjacent to any wall whether party or otherwise be separated there- 
 from by solid masonry of not less than two feet thickness laid in cement 
 and thoroughly waterproof." 
 
 Special attention is also given to the bottom of the vault, In some 
 cities the bottom may be of twelve inches of concrete or of a single 
 piece of flag. While efforts are generally directed to obtaining a water- 
 tight bottom, the opposite condition is occasionally sought, as in a cer- 
 tain Ohio town where vaults must be tiled to carry off the water. In 
 New < )rleans the walls of vaults must be carried one foot above the 
 surface of the ground. In Cleveland all vaults must be constructed 
 in accordance with plans furnished by the health officer. The plans 
 are shown in Fig. 1. 
 
 In Cleveland " ' sewer vaults ' may be connected with the waste 
 water pipes from kitchen sinks and with the rain water spouts from 
 the roofs of dwellings or other buildings with sufficient water supply 
 therefrom to keep the same properly flushed." 2 Vaults or closets 
 flushed with waste water from the house have been used to a limited 
 extent in Providence and Haverhill, but they were not satisfactory. 
 They have also been used in Newark and Paterson, but are now for- 
 bidden in Newark. These vaults receive all the drainage from the house, 
 and the outlet leading to the sewer is closed by a valve which can be 
 raised daily or oftener to flush the vault. The valve and method of 
 flushing may be used in vaults which are flushed with city water. A 
 valve of this type, shown in Fig. 2, is made b} r John Royle & Sons, of 
 Paterson, N. J. 
 
 The commissioner of health in St. Louis recommends that privy 
 vaults be constructed of large vitrified pipes. 3 
 
 1 San Antonio, Report of Health Department for 1892, p. 31. 
 
 2 Cleveland, Ordinances (1892), Chapter 30, Sec. 447. 
 
 3 St. Louis, Report of Health Commissioner, 1893, p. 56. 
 
si 3 /■:< TFU XVISAX< f ES. 
 
 179 
 
 < 8"X 
 
 5:0 
 
 8" > 
 
 Cross-Sect/on A-B 
 
 Fig. 1. 
 Access ;iinl Ventilation. 
 
 It is often specified thai vaults shall Ik- easj of access in inspectors 
 and shall he provided with suitable openings for cleaning, ami thai such 
 openings shall !>»■ properly covered. In some cities vaults must be 
 ventilated. In New < Orleans they '-shall have a tine or ventilator suffi- 
 cienl lor ventilation, extending above the sunt mm I'm- windows or com- 
 munical ing with a chimney . 
 
 Old Wells Nol to !»«■ Used as Vaults. 
 
 Abandoned wells arc willingly used b) landlords a- pri\\ vaults, for 
 their Leaching capacit} is great, as the} extend down into the current 
 
180 
 
 SPE< IFIC Xfls. I X( A.s. 
 
 IZahi^dz/t 
 
 Fie. 2. 
 
 of ground water, and they will therefore last a long time without being 
 
 cleaned. Their capacity for mischief is correspondingly great, for they 
 
 pollute a large area of soil at a depth which prevents rapid oxidation, 
 
 and they arc certain to pollute neighboring wells. Hence this use of 
 
 wells has been in many cities forbidden. Thus in Youngstown, <).: 
 
 " No abandoned well, coal bank, or coal sbaft. whether in operation or otherwise, 
 shall be used as a sink, cesspool, or privy vault." 
 
 An inquiry of the state board of health in 1896 showed that such a 
 use of old wells was generally forbidden in the state of Ohio. 
 Sewer Connection for Vaults. 
 
 The question of connecting privy vaults with sewers has been treated 
 differently in different cities. Sometimes it is considered advisable to 
 connect the vaults with the sewer in order, it is presumed, that as much 
 offensive material as possible may be daily removed from the premises. 
 Thus in Chicago, when on lots adjacent to sewers, vaults must be con- 
 nected therewith. The following regulation was adopted at Asbury 
 Park : 
 
 " Every privy vault, cesspool or catch basin which now is, or which hereafter 
 may be connected with a street sewer, sball be provided with a wrought-iron grat- 
 
s p E( IFIt ' NVI8. 1 m 'ES. 1 s 1 
 
 inc. the openings of which shall not exceed one inch in width. The bars of such 
 grating shall be one-half inch in diameter and every grating shall be of such size as 
 maybe in each case in writing directed by this board; no such grating shall be of 
 less size than fourteen inches square. Said grating shall be placed over the outlet 
 from said vault: the said outlet to be placed in the side of the vault, and the bottom 
 of the outlet to be not more than one inch from the bottom of the vault. A trap 
 shall be placed on the drain from every privy vault or catch basin as near as possible 
 to said vault or catch basin.'" 1 
 
 ( )ii the other hand connection with a sewer is in some cities expressly 
 forbidden, except by permission. The practice of connecting vaults 
 with sewers was formerly recommended in Providence, but it was 
 found very unsatisfactory. To prevent solids from obstructing the 
 drains, the vault had to he practically a catch basin and therefore 
 rein, lined partly full all the time. It was often neglected more than 
 before the connection was made, the owner arguing that the vault would 
 now lake rare of itself, and needed no cleaning. Moreover, the drain 
 sooner or latter was sure to become stopped and then the condition was 
 the same as if no connection had been made. Such connections are not 
 now allowed, and they are forbidden in many other cities. 
 
 The use of "school sinks" has heen advocated in certain cities and 
 under certain conditions as offering a satisfactory substitute for vaults 
 where water closets could not well be put in. A school sink is rssm- 
 tially a long narrow trough Idled with water and used as a vault, and 
 flushed by hand at stated intervals, usually once or twice daily. A 
 brick and cement vault may he constructed, which will answer the pur- 
 pose, hut it is not so si th or durable as iron and is more likely to gel 
 
 out of order. These contrivences are most often used for schoolhouses, 
 workshops, and tenements which have a competenl janitor in charge. 
 They are forbidden in some cities as being less desirable than water- 
 closets : 
 
 •• \'o sluice vault so called, or any form of so called water-closets, ha\ ing ao flush 
 of water applied at the time of using, shall be constructed on any premises in this 
 City. 11 
 
 In Providence they are only allowed in factories, shops, and schools. 
 and experience has shown that in other situations the\ arc quite sure 
 to be neglected. When permitted, their construction and use is regu- 
 lated. Thus in r.uffalo the\ are not to be maintained in an \ cellar. 
 The following is the Cincinnati rule: 
 
 "Basin water-closets oi approved design maj be connected with the sewers. 
 Thej must be bo constructed as to have a proper supplj of water, ami allow tin 
 
 be flushed oul clean to the bott , and they must so be flushed oul al least once 
 
 everj day, and any neglect or failur< his point will render the offender liable to 
 
 1 Asbury Park, Sanitary Code (1897), Sec. 12. 
 
 ■ Cambridge, Regulations oi Board of Health 1 1807), Sec. 82. 
 
182 SPECIFIC NUISANCES. 
 
 be prosecuted for causing a nuisance. They must also be so constructed that the 
 contents can not pass into the sewer without a sufficient quantity of water passing 
 into the sewer at the same time." a 
 
 Overflow. 
 
 Vaults must not be provided with an overflow : 
 
 "No person shall construct any drain for the purpose of conveying the waste water 
 or overflow from any vault or cesspool upon his premises, to the sidewalk, gut- 
 ter or street surface, and all persons who now have such drains are required to 
 remove the same, and no person shall hereafter allow any waste water or overflow 
 from any drain, vault or cesspool to flow from his premises on to the street or side- 
 walk." 2 
 
 Boxes and Earth Closets. 
 
 Tubs, or boxes, or earth closets are sometimes substituted for the 
 
 regulation privy vault. Boxes set above ground instead of an excavated 
 
 vault are in use in several cities, among which may be mentioned 
 
 Atlanta, District of Columbia, Macon, Memphis, Richmond, Warren, 
 
 and other Ohio cities. In Atlanta excavated vaults are forbidden and 
 
 boxes are required. There were in 1898, 10,797 of these in use. In 
 
 Memphis also, privy vaults are forbidden, and it is required that there 
 
 shall be 
 
 " In their stead a receptacle for fecal matter, which may consist of a water-tight 
 box, with handles, holding from three pecks to a bushel, let in under the privy seat, 
 or a bucket or tub of such size and construction as the Board of Health may pre- 
 scribe; or a cement platform, raised at the edges six inches above the earth and 
 sloping toward the centre, may be used, subject to the approval of the Board of 
 Health; and at least once a day the excrement in the receptacle shall be covered 
 with dry earth or dry ashes." 3 
 
 It will be seen from the last clause that the privy receptacles in that 
 city are intended to be earth closets. The same is true in Atlanta 
 Avhere " the contents of such receptacles are to be deodorized or mixed 
 with fine earth or coal ashes daily.*' The material is then removed by 
 the city once or twice a week. These privy boxes are considered by 
 the health department to be far superior to the old-fashioned vaults. 
 The regulations in Warren, O., are still more rigid : 
 
 "In every privy not having sewer connection or vault, there shall be placed 
 a keg, box, or other receptacle containing dry earth, ashes, or lime, or a mixture 
 thereof, and a cup or small shovel with which to apply the same. Such privy 
 drawer or other receptacle in lieu thereof, shall be thoroughly sprinkled at least once 
 each day, with such earth, ashes, lime, or mixture; shall never be allowed to become 
 entirely full; and shall be completely emptied and disinfected as often as once in 
 every six months." 4 
 
 1 Cincinnati, Manual of Health Department (1S08), Sec. o7e. 
 
 2 Fall River, Regulations of Board of Health (1894), Sec. 22. 
 
 3 Memphis, Ordinances (1879), Sec. 258d. 
 
 4 Warren, Sanitary Code (1897), Sec. 24. 
 
&P E( IFK ' XL XV. I X( ■ A'.s. 
 
 183 
 
 A printed notice to this effect is posted in each privy. These 
 privies it will be seen, approach in construction and use, the true earth 
 closets, and it is such privies that are permitted by the rules of 
 Newton and Fitcliburg, and Westbrook, Me. This form of privy has, 
 however, not been much used in New England cities. In the District of 
 Columbia the construction of privies and their receptacles lias been 
 regulated by a recent Act of Congress. 1 The provisions of this act 
 are set forth in the following circular issued by the health officer of the 
 District : 
 
 " The following memoranda, based upon an Act to regulate, in the Districl of 
 Columbia, the disposal of certain refuse, and for other purposes, approved January 
 2.".. 1898, liave been prepared for the guidance of persons contemplating the erection 
 of privies: 
 
 "(1) No privy can be maintained lawfully without a permit from the Health Officer. 
 (2) No privy can be maintained lawfully on any lot for the accommodation of which 
 a public sewer and a public water main are available. (3) No privy can lie con- 
 structed or maintained lawfully unless every part of it is at leas! live feet from the 
 line of any adjoining lot, two feel from any street or public or private passageway, 
 t. , .el from any building used or intended to he used as a dwelling or place of busi- 
 ness, and fifty feet from any well or spring likely to be used as a source of water for 
 drinking or domestic purposes. (4) Every privy must be constructed and main- 
 tained in such manner and position as to afford ready means of access thereto for 
 the purpose of cleaning it, and so as to permit the removal of the contents from the 
 privy to the public street without carrying them through any dwelling-house or 
 place of business. (5) Every privy must be constructed so as to prevent undue 
 exposure of the occupants. 
 
 11 The following figures represent vertical sections of privies, and show such 
 details as are required by law: 
 
 A l. 
 
 A- 
 
 C- 
 
 l-'io. 3. 
 I'm y u nil ;i movable receptacle. 
 
 Fio. i. 
 Privj «uii ■ ptacli 
 
 \<-i oJ < kmgress, 25 January, 1 398. 
 
184 SPECIFIC NUISANCES. 
 
 i. 
 
 lt The following details apply to all privies (See Figures 3 and 4) : 
 
 "(A) A sufficient opening for ventilation, as near the top as practicable, com- 
 municating directly with the external air. 
 
 " (B) A floor paved with some non-absorbent material, and constructed so that 
 its upper surface shall not be in any place less than four inches above the level of 
 the surface of the surrounding ground and have an incline toward the door of the 
 privy of half an inch to the foot. 
 
 " (C) A receptacle for filth, provided with a suitable cover (c)." 
 
 II. 
 
 "If such privies are to be provided with a movable receptacle, the following 
 additional details are necessary (See Figure 3) : 
 
 " (D) A floor over the whole area of the space immediately beneath the seat, 
 the surface of which floor shall not be in any place less than four inches above the 
 level of the surface of the surrounding ground; such floor, and the whole extent of 
 each side of the. space between the floor and the top of the seat, to be constructed 
 of some non-absorbent material. 
 
 L1 (E) The seat, the aperture therein, and the space beneath, must be of sucb 
 dimensions as to permit the movable receptacle for filth (F) to be fitted beneath the 
 seat in such manner and position as to prevent the deposit of filth elsewhere than in 
 the receptacle. The seat shall be so constructed that the whole, or a sufficient part 
 of it, may be readily removed or adjusted so as to afford adequate access to the 
 space beneath for the purpose of cleaning the same and removing the receptacle 
 therefrom or fitting it therein. 
 
 " (F) A receptacle for filth, not exceeding in capacity two cubic feet, made of 
 metal, water-tight, provided with handles, and so constructed that it may be closed 
 with a cover and made air-tight at the time of its removal. 11 
 
 III. 
 
 " The following details apply to privies where the receptacle for fecal matter is 
 fixed (See Figure 4) : 
 
 " (G) The bottom of the receptacle must be in every partat least four inches above 
 the level of the surface of the adjoining ground, and adequate means of access for 
 cleaning the receptacle and removing the filth therefrom must be provided. Such 
 receptacle must not exceed in capacity eight cubic feet, and must be constructed of 
 such material or materials, and in such manner, as to prevent absorption by any part 
 of it of any tilth deposited therein, or any escape of its contents by leakage or other- 
 wise, except in process of cleaning. 
 
 Cesspools. 
 
 These contrivances do not receive the attention given to privy 
 vaults, for they are usually covered and so not offensive, unless their 
 contents overflow, though it is true that they contaminate the soil over 
 a larger area than do vaults, and because of the volume of liquid the 
 contents are more likely to leach into wells. It is a common provision, 
 however, to require cesspools to receive all the house drainage of those 
 premises which are not situated on the line of sewered streets. Thus 
 in Camden : 
 
 lt That no person shall draw off, empty, pump, or allow to run into any ground, 
 gutter, water-course, alley, or street the contents of any sink, cesspool, or privy- 
 vault, or any kitchen, laundry, or other waste water, or any water or liquor dele- 
 terious to health, used by any manufacturer or other person in any trade or other- 
 
SPEC IFK XUISAX< ES. 1 8 5 
 
 wise, from any house, premises, place of business, manufactory, hotel, restaurant 
 or other place or building in this city; such drainage, when not connected -with a 
 sewer, must be collected into water-tight cesspools or reservoirs, provided with the 
 proper traps and properly covered, and the contents of said cesspools cleaned and 
 removed as prescribed in section 8, under a penalty of ten dollars." 1 
 
 Sometimes, as in Denver, it is required that cesspools be ventilated. 
 It is seen from the above that the pipe leading to a cesspool from the 
 house must be trapped, and this requirement is found in other cities. 
 In several Massachusetts cities a minimum capacity of eighty cubic 
 feet is provided for; in Lynn this is to be measured two feet below the 
 ground. In Minneapolis the cesspool "is to be of such dimensions as 
 the inspector of buildings may direct." In Augusta, Ga., cesspools are 
 forbidden and must be discontinued and filled up within such time as 
 Hi- president of the board of health may direct. 
 
 Permits for cesspools are also sometimes required, for their construc- 
 tion may be supervised by the board of health. The location of cess- 
 pools is usually the same as that prescribed tor vaults; bin in Omaha 
 instead of being required to be a certain distance from the lot line, they 
 are required to lie as far towards the rear line of the lot on the alley as 
 possible. This is doubtless because a covered cesspool can be no 
 offense to owners id' the alley, and the farther it is from the house the 
 Less danger there is of its leaching into the cellar. It is in a few cities 
 as Cambridge, Camden, Omaha, Paterson, and Asbury Park, required 
 that cesspools are to be water tight, but it can baldly be possible that 
 this ruli' is enforced. In other cities a more reasonable requirement is 
 that cesspools shall be tight in certain locations. Thus in Fall River, 
 Haverhill, and Lawrence, if within twenty feet of the lot line or the 
 foundation of a dwelling, or within fifty feet of ;i well, a cesspool must 
 be '-absolutely waier tight." The following rules have been recently 
 recommended by the state board of health of Michigan for the location 
 of vaults and cesspools : 
 
 '■ill Forbid tin- construction or reconstruction of anj cesspool, within one 
 hundred feel of any well the water from which is used for drinking or culinary pur- 
 poses, however such cesspool is constructed, which is to receive the contents <•!' ;i 
 water closet; (2) forbid the construction or reconstruction of anj privj vault within 
 one hundred feel of any such well; (8) require, or al leasl recommend, the use of the 
 
 <lr\ earth closet and frequent re val of its contents wherever there is ma a public 
 
 waul- supply ami complete water carriage disposal of excreta through sewers; 
 (4) recommend and so far as possible secure the extension of the water supply and 
 public sewers, wherever this extension is practicable, to all residences or buildings 
 
 where otherwise there are wells endangered bj privies or cessj Is; and (6) forbid 
 
 the use of cesspools and privj vaults wherever it is pracl icable to obtain sew it con- 
 ■ II.*'- 
 
 1 Camden, Sanitarj Code (1888), Sec. '••. 
 
 - Michigan, Board of Health. Abstract of Proceedings, i"> January, 1808, p. 7. 
 
186 SPECIFIC NUISANCES. 
 
 Cesspools like vaults must have proper approaches for cleaning and 
 they must usually be covered over. 
 
 Care of Vaults. 
 
 Rules for the maintenance of privy vaults are as necessary as for 
 their construction. Naturally such regulations are found almost exclu- 
 sively in local ordinances or rules of boards of health, but occasionally 
 they are found in statutes. Thus in the act creating a bureau of health 
 in the Pennsylvania cities of the second class, 1 the owner of the vault 
 which has become offensive, is liable to a fine of twenty-five dollars a day ; 
 and in New Mexico 2 it is required by statute that water closets, vaults 
 and cesspools must " be kept in a healthful condition." The local rules 
 in regard to vaults are often of this same general character. In Boston 
 11 no person shall maintain a water closet, vault or privy in an unwhole- 
 some, unclean or imperfect place or condition." More specific rules are, 
 however, frequently found. Thus as was shown on page 152, it is often 
 prescribed what shall not be allowed to go into a vault, and in Cleve- 
 land it is expressly provided who shall be responsible for a violation of 
 this rule. In New Bedford if garbage is found in a vault it is at once 
 cleaned by the board of health at the owner's expense. A large amount 
 of liquid of any kind in a privy vault renders it particularly offensive 
 and hence it is often forbidden. In Newark the sanitary code provides: 
 
 " That no rain water leader, waste-pipe or soil-pipe shall discharge or run into 
 any privy vault, nor shall any slops or filthy water he deposited therein, unless said 
 privy vault shall be connected with a sewer. 11 3 
 
 The purpose is here evidently to permit the discharge of liquid into 
 a vault if it is at once permitted to run out again ; but this will do little 
 to prevent the nuisance, and the rule in Cincinnati is better ; " no roof 
 or surface water, or kitchen slops shall be allowed to flow into any privy 
 vault.'" 
 
 An ordinary provision is that a vault shall not overflow or become 
 full to within a certain distance of the top, Thus in Yonkers, the sani- 
 tary code provides as follows : 
 
 " Sec. 71. No person shall draw off, or allow to run off into or upon any ground, 
 street or place in the City of Yonkers, the contents (or any part thereof) of any 
 vault, privy, cistern, cesspool or sink; nor shall any owner, tenant or occupant of 
 any building to which any vault, sink, privy or cesspool shall appertain or be at- 
 tached, permit the contents or any part thereof, to flow therefrom, or to rise within 
 two feet of any part of the surface of the adjoining ground, or permit said contents 
 to become offensive." 
 
 1 Pennsylvania, Chapter •i.jS of 1895, Sec. 7. 
 
 3 New Mexico, Chapter 30 of 1891. 
 
 - Newark, Sanitary Code (1888), Sec. 35. 
 
SPECIFIC NUISANCES. 1ST 
 
 In Asbury Park and Fitchburg the distance is one foot; in Provi- 
 dence and Holyoke one and one-half feet ; in Colorado Springs, Denver, 
 and Omaha two and a half. In Philadelphia when the contents are three 
 feet from the top, 01 when it leaks into a cellar, a vault must be at once 
 eleaiH-d: in Cincinnati and other Ohio cities, when four feet from the 
 top. 
 
 When a vault docs become offensive or a nuisance, the nuisance 
 may be abated under a general nuisance law. In the District of Col- 
 umbia the recent Act of Congress referred to, authorizes the health 
 officer to clean privies and assess the cost as a tax against the property. 
 
 Ordinances frequently require the disinfection of vaults: 
 
 "Sec. •">U. All putrid oroffensive material of any kind whatsoever and the night 
 soil and the contents of sinks, privies, cesspools, garbage cans and all noxious sub- 
 stance in said city and every receptacle of offensive matter shall be treated with dis- 
 infectants of such kinds, and at such times and in such manner as may be required 
 by the health commissioner." ' 
 
 In Fall River vaults must be disinfected often enough to keep them 
 free from all offensive odors. Jn Augusta. G-a., privies must be disin- 
 fected every two weeks. 
 
 Iii Charleston vaults must be cleaned once a year. In Camden 
 vaults must be cleaned yearly before the first of May. In Fall River 
 they must be cleaned whenever they become offensive. Probably the 
 general custom, if not the law, is to cause vaults to be cleaned once 
 each year. The reports from Ohio cities to the state board of health in 
 1896 showed that some cities did not require cleaning more than once 
 in two. three and four years and even five years. A few cities required 
 it twice a year and one board of health required cleansing monthly, bul 
 earth closets were there hugely used. Many cities provide that when 
 vaults are cleaned they must be cleaned to the bottom. 
 
 In Atlanta the sanitary inspectors are required during the spi-i inl- 
 and summer months to inspect each privy weekly, and if it is found 
 offensive, to notify the owner or occupanl to pul ii in order forthwith. 
 Failure to carry oul the order within six hours subjects the owner to a 
 fine or imprisonment. 
 
 Removal and Destruction of Vaults. 
 
 Even with the greatest care iii the municipal supervision of vaults, 
 the\ arc almost always nuisances. Health officials are without excep- 
 tion, agreed thai the only way to be rid of this nuisance, is to abolish 
 the vaults; I nit the dest ruction of j » i i \ \ vaults requires the substitution 
 of something else. The general opinion is that water closets connected 
 
 1 Denver. < Ordinance it of 1898. 
 
188 SPEC IFK ' xris. 1 m 1 ES. 
 
 with the sewers, are in most cases the best arrangements for the disposal 
 of excreta. To he rid of as many privy vaults as possible within his 
 jurisdiction, and substitute water closets and sewer connections, is an 
 object that every health officer has in mind. The authority to make 
 rules for the destruction of privy vaults, and for providing proper sewer 
 connections, is doubtless included in every general grant of sanitary 
 legislative power, so that there has not been much special legislation on 
 this subject. 
 
 Nearly all cities that are provided with a sewer system that is at all 
 adequate, are making strenuous efforts to be rid of their privy vaults 
 and cesspools, and this is true of the smallest towns as well as of the 
 largest. Nearly every health report gives a list of vaults abolished 
 during the year. This work requires in the aggregate a large expendi- 
 ture by the house owner, and in many cases it entails some hardship. 
 It must therefore be prosecuted with judgment and some moderation in 
 times of depression, such as prevailed from 1893 to 1898. Many cities 
 report that not as many vaults were abolished in 1894-7 as in the years 
 just preceding. Cities that have long pursued the policy of getting 
 rid of their vaults, are now almost free from these nuisances. New York 
 City is a conspicuous example, and there are few vaults now remaining 
 below Harlem River. Boston and some other of the Massachusetts 
 cities, as Worcester, Newton, and the town of Brookline, have very few 
 vaults. < hi the other hand they are very numerous in Baltimore, Phil- 
 adelphia, Chicago, and St. Louis. In Chicago in 1892 there were 
 ■40,000. In Buffalo at that time there were over 25,000, but in four 
 years" time 12,000 of them were abolished. 
 
 The desired end is frequently accomplished by local regulations, 
 
 which may take various forms. Thus the maintenance or construction 
 
 of vaults on sewered streets may be forbidden. Sometimes, as in 
 
 Bridgeport, the prohibition is only to apply to the future construction 
 
 of vaults, more often it applies to all existing vaults as well as to future 
 
 constructions : 
 
 "No privy vault, cesspool or receptacle of filth of any kind shall hereafter be 
 constructed, allowed or maintained upon any lot or premises abutting upon a street 
 in which a public sewer is laid, but proper water closets, school sinks, latrines, or 
 some means approved by this board, with a properly laid pipe, shall be provided, 
 which shall discharge into said sewer; and all such water closets, latrines, or other 
 means, shall be provided with a flow of water sufficient to wash all filth into the 
 public sewer, under a penalty of twenty dollars for a violation of any part of the 
 provisions of this section. 1 " 1 
 
 In Milwaukee the construction of vaults is forbidden only in certain 
 districts, which are defined by the ordinance. Sometimes the prohibi- 
 
 1 Camden, Sanitary Code (1894), Sec 2. 
 
sl'K( IFH ' XUISA X( Ks. Ig9 
 
 tion applies only to vaults, as in Milwaukee and Cincinnati, but in most 
 cities cesspools as well as privy vaults arc forbidden. In other cities. 
 
 as Newark, vaults and cessj Is art- not to be constructed on the line 
 
 of a sewered street without a permit from the board of health. 
 
 As most cities require all buildings to be supplied with either a 
 privy vault or water closet, the rides just referred to practically compel 
 the putting in of water closets. Other cities, as Atlanta, Camden, 
 Cleveland, Newburgh, and Paterson have rules which definitely require 
 water closets for all houses on sewered streets. 
 
 At other times the local regulation takes the form of a requirement 
 that the drainage of premises shall be connected with the sewer. Per- 
 haps the most complete rules governing this matter arc those recently 
 enacted for the District of Columbia. 1 As Congress reserves to itself 
 legislative power in such matters, this act is practically a local regula- 
 tion. According to this ad every lot on a sewered street must be con- 
 nected with the sewer, so that all the drainage of such lot, except human 
 urine and fecal matter, shall flow into the sewer, but if there is a water 
 main in the street, then all the drainage, whether water or liquid refuse 
 of any kind, shall flow into the sewer; but it is further provided that 
 when there is upon the lot -any building used or intended to be used 
 as a dwelling, or in which persons are employed or intended to be cm 
 ployed in any manufacture, trade, or business, or any stable, shed, pen, 
 or place where cows, horses, mules, or other animals are kept," the lot 
 shall be connected with both sewer ami water main, but if there is no 
 such structure on the lot. it need not be connected with either unless 
 ordered by the health officer. The health officer is to enforce this law 
 by ordering these connections made, ami after thirty days" notice the 
 Commissioners of the District may, after proper notice, do the work and 
 the cost is to be included in the tax Levy. 
 
 Sometimes the wording; of the Law as to what drainage shall be con- 
 nected with the sewer is general, as in the Providence act, where it is 
 to be ■•the drainage of the land and premises."' In the District oi 
 Columbia it is. us shown above, more specific. Many cities, however, 
 do not include so much of the drainage in their forced connections. 
 'I'll ns in Augusta, Ga., il is "all slops or other matter as this board shall 
 decide. "" In .\lb.in\ water closets and sinks are to be connected with 
 the sewer; in Haverhill all "sink water mid waste water," and in Pater- 
 son "nil ^lo|».s. filthy water and Liquid waste." 
 
 Various expressions arc used to define the Locations in which vaults 
 and cesspools are forbidden, ns on "lots adjoining a sewered street, 
 
 "abutting on a Streel in which a public sewer is laid,*' or "when a 
 1 An of Congress, L9 May. 1890. 
 
190 SJPJZC IFK ' NUISA X( JJS. 
 
 public sewer abuts the estate," or " on the line of a sewered street," or 
 "adjacent to a street in which there is a main or common sewer," on 
 ** lots bordering on a public or private sewer," or " situated on a public 
 or private street, court or passageway, in which there is a public sewer." 
 In other cities, as Yonkers, no vaults or cesspools are allowed " wher- 
 ever it is practicable to connect any premises in the city with a public 
 sewer," or in Atlanta, " when sewerage is accessible," or in Little Falls, 
 N. Y., "if within a reasonable distance "; in Spokane, "if within 300 
 feet of a street and the land is platted"; in Manchester, N. H., "within 
 100 feet." This is quite an important point, as estates are not infre- 
 quently situated only a short distance from the sewer, when it would 
 lie perfectly feasible to connect by means of a private drain. In St. 
 Louis the connection must be made with street drains, whether private 
 or public. 
 
 Usually water mains are laid wherever sewers are, generally preced- 
 ing the latter ; but there are exceptions, and in some cities it is not 
 deemed wise to forbid the use of vaults (thus necessitating water 
 closets), unless there is assured a sufficient water supply to flush them. 
 The rule in Buffalo forbids vaults and cesspools only on those streets 
 within the city " where there is a sewer, and the city water is in said 
 street." 
 
 Power to compel the destruction of privy vaults is contained in the 
 general power over nuisances (provided, of course, that the vault is a 
 nuisance, as can be shown of most of them). In Fitchburg, Lowell, 
 and some other Massachusetts cities, vaults are thus dealt with. A case 
 in Lowell was carried to the superior court, and a decision favorable to 
 the city secured. In Philadelphia also, vaults are abolished as nui- 
 sances and the courts have upheld this action. 1 
 
 At least three states, Massachusetts, 2 Michigan, 3 and New Jersey 4 
 have enacted general laws for the' removal of privy vaults and the mak- 
 ing of sewer connections, and there are special acts for Boston, 5 Man- 
 chester,' 1 and Providence. 7 The following is from Massachusetts : 
 
 " No privy vault shall be established in a city which accepts this act either upon 
 premises situated on a public or private street, court or passage way, where there is 
 
 1 Pennsylvania, Supreme Court Reports 3, p. 239; John W. Adams vs. Board of 
 Health. 
 
 2 Massachusetts, Chapters 74 and 132 of 1890. 
 
 3 Michigan, Compiled Laws (1897), Sec. 44lit>. 
 
 4 New Jersey, Chapter 345 of 1896. 
 
 6 Massachusetts, Chapter 450 of 1889. 
 8 New Hampshire, Chapter 165 of 1885, Sec. 7. 
 
 '• Rhode Island, Chapter 777 of the Public Laws as amended by Chapter 1407 of 
 the Public Laws. 
 
spE< IF1 ( ' XI r IS, 1 N( JJs. 19] 
 
 a public sewer opposite thereto, or upon premises connected with a public or private 
 sewer, without permission in writing first obtained from the board of health <>f such 
 city. And whenever there is in such city a privy vault so situated which, in the 
 opinion of the hoard of health of such city, is injurious to the public health, said 
 board shall declare the same to be a nuisance, ami forbid its continuance, and sec- 
 tions twenty-one t<> twenty-three inclusive of chapter eighty of the Public Statutes 
 shall apply to such nuisances so declared.'" ' 
 
 As will be seen from the above, tin- act must be accepted by a city 
 before it becomes operative in that city. A number of the Massachu- 
 setts cities have accepted this ad and are removing their vaults under 
 it. The form of order used in Cambridge is shown in Appendix 38. 
 
 The Massachusetts law also compels connection with the sewer: 
 
 •• Every building situated on a public or private street, court or passageway, in 
 which there is a public sewer, shall, when required by the hoard of health of the 
 city or town in which it stands, he connected by a good and sufficient particular 
 drain with such public sewer.'" 2 
 
 The Providence act is as follows: 
 
 " The Hoard of Aldermen of the City of Providence may compel any abutting 
 owner or occupant of laud upon any street in said city in which there is a sewer, t" 
 
 connect the drainage of his land and premises with such sewer, and may direct said 
 owner or occupant to lill up and destroy any cesspool, privy-vault, or ether arrange- 
 ment for the reception of drainage." 
 
 The law also provides for the service id' the orders and for an appeal, 
 hut even during the pendency of the appeal the hoard of aldermen "may 
 
 cause ;iii\ cissj 1, privy vault, or other arrangement for the reception 
 
 of drainage to lie filled up and destroyed." The hoard id' aldermen 
 acting under this law caused a certain vault to lie filled after the appeal 
 from the order was taken. This ease was argued at Length before the 
 appellate division of the supreme court and a somewhat length} decision 
 amply affirmed the hoard's pow er. 8 
 
 The Boston act requires the construction of water closets ;is well as 
 
 a connection with the sewer, and iii a case where a vault was connected 
 
 with the sewer and occasionally Hushed with water, the intent of the 
 law to require true water closets, was affirmed in the superior court. 1 
 
 A special limit of time is given l»\ some rules for getting rid of vaults 
 on streets in which new sewers are built In 1'atersoii this is si\t\ days. 
 As the burden of sewer assessments is quite heavy in some cities a much 
 Longer time is often allowed. In Providence over a year's time is 
 
 Massachusetts, Chapter 74 oi L890, Sec. L. 
 Massachusetts, Chapter 182 of L890, Sec. 1. 
 
 Rhode Island Reports, Vol. 20, Pari 1.. \>. 285. Harrington vs. Board .a Alder 
 men "i i'p.\ idence. 
 
 '• 155 Massachusetts, p. 281, Commonwealth vs. Mercy Roberts. 
 
192 SPECIFIC NUISANCES. 
 
 usually granted after the building of a sewer, unless the vault is par- 
 ticularly offensive. 
 
 A penalty in the form of a fine is usually imposed for violations of 
 rules requiring sewer connections. In St. Louis the fine is from fifty 
 dollars to two hundred dollars per day. Besides a penalty for failure 
 to make sewer connection as provided by law it is sometimes as in 
 Yonkers prescribed that " no house hereafter erected shall be inhabited 
 or used by any person before the same shall be connected with a public 
 sewer if practicable." 
 
 Filling Vaults. 
 
 When privy vaults and cesspools are no longer in use or are ordered 
 destroyed, it is quite necessary that the entire contents should be removed 
 and they be tilled up with some clean material as earth, sand, gravel 
 or ashes. Some rules require that they shall be disinfected, and that 
 they shall be filled under the supervision or direction of the board of 
 health. 
 
 Private Sewage Disposal. 
 
 For the District of Columbia the following provision has recently 
 
 been enacted : 
 
 ■ L Sec. 13. That no person shall, in said district, construct or maintain any sys- 
 tem of sewage disposal by means of broad irrigation, sub-soil irrigation or other- 
 wise, except upon a permit issued by the commissioners of said district. Applica- 
 tions for said permit shall be in writing to said commissioners and shall be accom- 
 panied by detailed plans of the system which it is proposed to construct and main- 
 tain; and no permit shall be issued under this section until said commissioners are 
 satislied that said system can be maintained without nuisance or danger to public 
 health." J 
 
 Filthy Shores. 
 
 A peculiar form of nuisance has received special attention in Brook- 
 lyn and is liable to be found in any seaboard city, though the conditions 
 for its development are much more favorable in Brooklyn than else- 
 where. For a number of years past Brooklyn has had a regular patrol 
 of its shore line for the purpose of keeping it free from offensive material 
 cast upon it by the tides. Brooklyn has nearly fifty miles of shore 
 front, much of which is of great value for recreative purposes. Three 
 inspectors and a force of shore laborers are employed during the sum- 
 mer months. From two to five laborers are employed for each inspector, 
 the largest number during the very hot weather. The following table 
 shows the work of the Coney Island district force for eight months 
 beginning April 1, 1895 : 2 
 
 1 Act of Congress 25 January, 1898. 
 
 2 Brooklyn, Report of Department of Health, 1895. 
 
spei 'if n ■ m 'is. i m fs. 
 
 193 
 
 Table by Months. Showing the Wokk Accomplished fob the Eight 
 Months Beginning April 1, 1895. 
 
 April 
 
 May 
 
 June 
 
 July 
 
 August . . . 
 
 September 
 
 ber.. . . 
 
 November . 
 
 180 
 129 
 
 144 
 52 
 68 
 53 
 40 
 7.-. 
 
 - r. 
 
 - 
 
 169 170 
 
 167 128 
 lit; 94 
 
 03 - 
 
 :— jj 
 
 82 
 
 171 
 
 116 
 
 38 
 
 56 
 
 147 
 
 14:1 
 
 203 
 
 29 
 
 58 
 
 60 100 
 
 120 20 
 
 147 220 
 
 76 600 
 
 107 669 
 
 191 413 
 
 lit:; IMS 
 
 255 58 
 
 
 
 
 '— 
 
 20 
 
 36 
 
 9 
 
 •JO 
 
 14 
 
 
 
 6 
 
 15 
 
 40 
 
 23 
 
 2 
 
 298 
 
 29 
 
 7 
 
 249 
 
 41 
 
 
 
 95 
 
 4 
 
 70 
 
 255 
 
 23 
 
 10 
 154 
 
 79 
 1,025 
 
 166 
 
 74S 
 
 001 
 
 2 1,286 
 
 1,536 
 
 1.110 
 
 1 769 
 1 610 
 
 Totals 741 915 972|1,239|2,218 106 154 1,025 28 4 7,462 
 
 Human bodies, one each in May, July, August and November 4 
 
 Gr^nd total 7.466 
 
 The inspectors showed that a very considerable number of the dead 
 animals came from the shores in and about New York Bay, but a large 
 part of the garbage and most of the nuisance was due to the illegal 
 dumping of garbage from the garbage scows of the various cities and 
 towns. Newport has had some trouble from garbage on the beach, but 
 the matter of prevention lies in the city's own hands, as all the garbage 
 dumped at sea is from that municipality. Trouble has occurred from 
 other sources, and it became necessary to forbid the burial upon the 
 beach of dead animals and garbage. 
 
 In Cambridge, at one time, a boat was kept on the river for eight or 
 ten months of the year, to bury or send down stream offensive matters 
 that floated onto the shore. 1 
 
 Public Dumps. 
 
 The disposal of refuse will be considered in another chapter, but 
 there is a form of refuse nuisance which perhaps had best be mentioned 
 here; and thai is the nuisance arising from dumps. Tins is no new 
 cause of offence, for hanciaiii- has given a very vivid description of the 
 dumping grounds of ancient Rome. From that time till the present, 
 wherever there have been cities there has probably been t rouble from those 
 
 spots which ale sel aside for. 0T ale unconsciously selected as the com- 
 mon place of deposit for indiscriminate refuse. Vacant lots or lands 
 
 wherever they are found in a eit\ are very attractive to the eyes of all 
 
 scavengers and all others who have an) material whatever thai is use- 
 
 and an encumbrance. Even in those cities in which the inunici- 
 
 ; Cambridge, Report of the Board of Health 1892, p. 7. 
 Boston Medical and Surgical Journal 1886, Vol. ( \\\. p. 541, 
 
 13 
 
194 SPECIFIC NUISANCES. 
 
 pality removes garbage, night soil, ashes and rubbish, such lots in a sur- 
 prisingly short time become covered with all sorts of litter which private 
 parties find more convenient to dispose of hi that way than to retain upon 
 their premises until the stated calls of the official scavengers. Thus 
 nuisances arise, although the city may be doing its best to promptly 
 remove all refuse and dispose of it without injury to its citizens. In 
 those cities in which the removal of any of the above specified forms of 
 waste is left to the individual, and is accomplished through the agency 
 of private scavengers the dump nuisance is, of course, much worse. 
 When much organic matter in the shape of garbage, decayed vegetables, 
 dead animals and the like find their way to a dump, the stench in 
 warm weather becomes almost unbearable ; but even a small amount of 
 such matter on the surface of the ground is a serious annoyance to 
 neighbors. Moreover, the papers, straw and fine ashes which are con- 
 stantly in dry weather blown from the surface of a dump render it 
 almost impossible to keep clean premises in the vicinity. Dumps are 
 the resort of children and others seeking coal, kindling wood, junk, etc., 
 and the temptation to set fire to the paper and other inflammable material 
 is very great, so that smouldering fires are an almost constant adjunct to 
 a dump, and the smoke of a slowly consuming mass of rubbish brings a 
 still larger area under the influence of the nuisance. Hence dumps have 
 received much official notice. The best remedy is an efficient removal 
 and destruction of refuse by the city. Next, and in addition to this, is 
 a control of the dumps by rules and supervision. New York and 
 Brooklyn where there was formerly much trouble from dumps forbade 
 the deposit of offensive material on vacant lots by the following: 
 
 " That no animal or vegetable substance nor street sweepings, muck or silt, nor 
 dirt gathered in cleaning yards, buildings, docks or slips, nor waste of mills or fac- 
 tories, nor any materials which are offensive, or tend by decay to become putrid, or 
 to render the atmosphere impure or unwholesome shall be deposited or used to fill 
 up or raise the surface or level of any lot, grounds, dock, wharf, or pier, in or ad- 
 jacent to the built-up portions of said city, or any ground tilled for the purpose of 
 building thereon, unless pursuant to a special permit from the department of 
 heal tlu 
 
 " That no ground or material filled with offensive matter or substance, or that 
 will emit or allow to arise, through or from the same any offensive smell or dele- 
 terious exhalation, shall (adjacent to or within the built-up portion of said city) be 
 opened or turned up or the surface thereof removed, between the first day of May 
 and the first day of October of any year, except according to permit first therefor 
 obtained from the department of health." x 
 
 A somewhat similar provision is found in the charter of the City of 
 New York. In Providence the duty of preventing nuisance from the 
 deposit of such material on vacant lots is placed upon the owner : 
 
 1 City of New York, Sanitary Code (1899), Sees. 103 and 104. 
 
SPECIFIC NUISANCES. 195 
 
 11 Whenever land is used as a dumping ground, the owner or owners of such 
 ground or the agent of said owner or owners, shall cause all offensive or decaying 
 matters to be completely covered with earth or clean ashes immediately upon the 
 deposit of such matter. 1 ' x 
 
 Iii Jersey City sunken lots must be fenced for the same reason, and 
 also to prevent persons falling in. In Cambridge it is also provided 
 that if the owner of a vacant lot wishes to raise the grade he must 
 obtain a permit from the board of health: 
 
 •• No person owning or occupying any premises within the limits of the City of 
 Cambridge, and no city officer controlling or in charge of city premises, shall cause 
 any ashes, or refuse material to be placed thereon, or shall allow such premises to 
 be used as a public dump for ashes, refuse or other material without a permit from 
 the board of health, and only in accordance with such permit. 
 
 lc Any person owning or occupying any premises with this city, and desiring to 
 fill such premises with dry waste, ashes, or rubbish, shall make written application 
 to the board of health describing the land and the filling material proposed, and also 
 the sources from which he proposes to obtain the material. 
 
 ■■A copy of Sections 46, 47. 48, and 49 of these regulations shall be posted con- 
 spicuously on each clumping ground in this city. 
 
 • The permits named in Section 46 shall be in force for three months, and may be 
 renewed thereafter for periods not exceeding one month each by the Clerk of this 
 Board." - 
 
 In Cleveland similar permission is required and the director of 
 public works can order the lot drained before it is filled. 
 
 Providence has special regulations to stop the nuisance caused by 
 flying and burning papers: 
 
 •• No person shall dump or deposit, or set fire to any waste paper or other inflam- 
 mable material, except upon land owned or rented by such person." 8 
 
 It is easy enough to make such rules, but difficult enough to enforce 
 them. To enforce them absolutely it would require an officer day and 
 night on every place in the city which is used as a dump. Constant 
 supervision is necessary. In Brooklyn there were in 1895 sixteen 
 regular inspectors of the dumps, but the results were far from satisfac- 
 tory. Notwithstanding the sixteen inspectors the dumps of Brooklyn 
 cannot be in ;i \er\ sa \ < >ry <•< >nd it ion if one can judge from the nine 
 photographs following page -'1\ of the reporl of the health department 
 for 1895. 
 
 A better plan than mere inspection is the employment by the city 
 of a mart or men on the dump to keep ii iii order. Level it off, prevent 
 the dumping of offensive matter, put out fires and cover the decompos. 
 ing matter which is certain to find its \\a\ there somehow or other, no 
 
 1 Providence, Ordinances (1900), Chaptei 19, Sec. 6. 
 
 'Cambridge, Regulations of the Board of Health (1897), Sees. 16, 19, and 51. 
 Providence, Ordinances (1900), Chapter 19, Sec. 9. 
 
1 96 SPEt 'IF It ' N I 7& l x< 'US. 
 
 matter how strict the supervision. Of course when a city does the 
 
 removing of ashes and rubbish with its own teams, it should, and usually 
 
 does take care of its dumps if it has any within the limits of the city ; 
 
 but even when the scavenging is left to private endeavor it is also often 
 
 considered a duty to look after the dumping places. In Providence the 
 
 city employs a man to look after a large dump on private land near the 
 
 centre of the city, and all parties are encouraged to use this as a dump 
 
 in order that the material may be as well cared for as possible. Dumps 
 
 are at the best, a nuisance to all who live or do business near them ; but 
 
 those cities which do not insist rigidly on the separation of different 
 
 kinds of refuse, and which have no crematory for combustible rubbish, 
 
 are liable to have trouble from dumps as long as vacant lots exist to 
 
 tempt deposits. In this connection may be quoted the following rule 
 
 of the board of health of Fitchburg : 
 
 " No person shall burn on premises occupied by him any garbage, refuse woolen, 
 silk, leather or india rubber goods or other substances so that the same shall evolve 
 offensive odors and gases while burning." 1 
 
 Not only is the filling of lots with rubbish and offensive matters 
 forbidden or controlled as above, but the opening or disturbing of such 
 lots is also regulated. This is included in the New York rules quoted, 
 and in similar rules in other cities. 
 
 Lot* Covered with Stagnant Water. 
 
 Town or city lots covered with stagnant water require quite a dif- 
 ferent treatment from large areas of swampy land in agricultural dis- 
 tricts. The area of such city lots is not usually great, they do not as 
 a rule need draining, but simply filling, and the cost of making the 
 improvement is generally offset by a corresponding gain in the value of 
 the property. Such lots are often serious nuisances for they may not 
 only help the spread of malarial disease, but they often are depositories 
 of all sorts of filth ; in fact " dumps," and hence are offensive because 
 of the foul odors that come from them. It would seem reasonable to 
 deal with such conditions by means of the power given in general nui- 
 sance laws. Stagnant pond-holes can be abated as are other nuisances. 
 The case of the City of Salem vs. Eastern Railroad Co. 2 demonstrates 
 this. Nevertheless it is sometimes deemed advisable to make special 
 statutory provision for this form of nuisance : 
 
 " The board of health shall have full power and authority to make such by-laws 
 and ordinances as said board shall, from time to time, deem necessary and proper, 
 for the filling, draining and regulating of any grounds, yards or cellars, within the 
 city, that may be sunken, clamp or unwholesome, or which it may deem proper to- 
 
 1 Fitchburg, Rules of the Board of Health (1897), p. 4, Rule 3. 
 - Massachusetts Reports, Vol. 98, p. 431. 
 
SPECIFIC NUISANCES. 197 
 
 fill, drain, raise, lower or regulate, and also, for causing all such lots of ground in 
 the city adjoining the Hudson river or the East river, or Long Island sound, as it 
 may. from time to time, think proper, to he filled with wholesome earth or other 
 solid materials, so far into the said rivers respectively as said board shall, from time 
 to time, derm expedient for promoting the health of the said city.'" ' 
 
 See also ( )hi<> Annotated Statutes ( 1 900 ). Section -l\ i9. In Boston 2 
 the board of health may, when the public health demands, order any 
 
 lots not on tidewater filled to a height of eleven foot above mean low 
 water. Considerable opposition was manifested by the owners, but bills 
 in equity were brought in the superior court and decrees obtained, and 
 since then many areas have been filled. In very many cities rules art- 
 adopted in relation to lots covered with stagnant water without any 
 such statutory provision, for there is little doubt that power to legislate 
 in this direction is included in any general grant of sanitary legislative 
 power. 
 
 The damming or obstructing the flow of water so as to cause this 
 nuisance is forbidden in Atlanta and Youngstown, where a line with a 
 maximum of $500 is to be imposed. In Denver, Omaha, Paterson, and 
 Rending a pond of stagnant water on a lot is declared a nuisance and 
 the owner of the lot is therefore subjected to a fine. In other cities, as 
 Augusta, Ga., District of Columbia, Jersey City, New Orleans, and 
 Rochester, the owner of such a lot is to lie ordered to lill or drain it and 
 on rieglecl so to do is lined. 'J 'he time given varies from three days in 
 .Jersey City to sixty in New Orleans. In Newark it was, however, found 
 necessary to forbid the filling of lots in the summer on account of the 
 mixed garbage that was dumped. 3 
 
 In Atlanta, Camden, Charleston, Cleveland, Hartford, and St. Louis, 
 an order to till or drain wet and sunken lots may be issued by the eit\ 
 council in Hartford, city marshal in Atlanta, the inspector in Camden, 
 and the hoard of health in the other cities. If the order to till is not 
 obeyed, the proper authorities can do the work and collect the costs from 
 the owners, and in Charleston it is expresslj provided that the owners 
 shall in addition be subject to a line. 
 
 Swampy Lands. 
 
 For centuries wet, swampy, and boggj lands have been considered 
 
 nnhe;dtli\ : ami there is most excellenl reason for believing that such 
 
 localities are indeed fertile fields lor the developmenl of malarial dis- 
 ease. It is natural that the dread of malaria should cause \er\ great 
 efforts to be made by communities to get rid of such dangerous nui- 
 
 New York. Chapter :;7- ol L897, Sec. 121 I. 
 
 Massachusetts, Chapter 842 of 1898. 
 
 Newark, Report of the Board of Health (1897), p. it. 
 
198 SPECIFIC NUISANCES. 
 
 sances. A score of centuries ago extensive works were undertaken in 
 Italy for the purpose of draining marshes and rendering the surrounding 
 region healthful, as well as for bringing new areas under cultivation. 
 Similar undertakings have' been carried out as occasion arose in all 
 civilized lands. 
 
 The fens of England have thus been largely freed from malarial dis- 
 ease, as have numerous areas in our own country. When extensive 
 drainage works are undertaken for improving a considerable territory, it 
 is almost always with the chief purpose in view of obtaining a pecuniary 
 reward in the shape of large areas of fertile land. A secondary purpose 
 of rendering the region more salubrious may or may not be in mind, 
 and in any event it is usually considered of less importance than that 
 first mentioned. 
 
 At least seventeen states and territories have laws which provide 
 for the drainage of wet and swampy lands. In very many of these 
 states, especially those in which there are large areas of inarshes which 
 are likely to repay in agricultural products the cost of drainage, very 
 elaborate and comprehensive laws, often covering many pages, provide 
 for the drainage of these lands on a large scale. Such laws provide for 
 the appointment or election of township or county drainage commis- 
 sioners who are to exercise control and supervision of drainage opera- 
 tions within their respective jurisdictions. The township commissioner 
 has jurisdiction over drains which begin and end in the township ; the 
 county commissioner controls drains which extend from one township 
 to another. Usually the inception of the work lies with the land 
 owners, some number of whom even as small as five, may petition for 
 the commissioner. The commissioner then may investigate, and if in 
 his opinion the proposed improvement will conduce to public health 
 or convenience, he may make a survey and lay out the course of the 
 drain or drains. 
 
 Cases arise which are not as simple as the filling of city lots and 
 which do not, on the other hand, require such extensive treatment as is 
 necessary for the draining of large areas. It frequently happens that in 
 the country, and sometimes too within the city limits, considerable areas 
 of swampy land are found which would never be drained for agricultural 
 purposes, and yet it may not be deemed advisable to let their improve- 
 ment depend upon a routine nuisance order of a board of health. In 
 Massachusetts 1 there are special statutory provisions in regard to just 
 such " wet, rotten, or spongy lands covered with stagnant water," which 
 are declared to be nuisances. On petition in regard to such lands, the 
 
 1 Massachusetts, Public Statutes (1882), Chapter 80, Sees. 28-35, and Chapter 338 
 of 1887. 
 
SPECIFIC NUISANCES. 199 
 
 board of health shall investigate, and if they deem action advisable, give 
 a hearing and notify all interested parties to be present. The board of 
 health may thereupon order the nuisance abated and abate the same, 
 and the damages awarded shall be paid by the town, and assessments 
 shall be made upon the town or others for benefits ; but any person 
 aggrieved by the order may appeal to the superior court, and during the 
 pendency of such appeal all proceedings in abatement are stayed. This 
 law has been found so unsatisfactory that the city of Boston secured the 
 passage of the special act referred to on page 197. In several other 
 states, as New Hampshire, Oregon, Pennsylvania, Tennessee, Virginia, 
 and West Virginia, there are somewhat similar laws providing for the 
 abatement of nuisances of this character and the assessment of the costs 
 of abating them. In several of these laws special attention appears to 
 be given to the relief of those owners of such unwholesome property 
 who desire to drain it; but are prevented b}~ a lack of proper outlet, the 
 natural outlet being controlled by parties who will not co-operate. In 
 New Hampshire the selectmen or aldermen are given authority to act 
 in such cases, but in most other states commissioners are to be appointed. 
 In the City of New York 1 the board of health, when in its opinion the 
 public health requires such drainage of lands, may prepare and adopt 
 plans for the same, acquire right of way, and cause a commissioner to 
 make the necessary estimates and assessments as in the case of the lay- 
 out of streets. In Connecticut, 2 " when there shall exist upon any prem- 
 ises contiguous to any dwelling house, swampy or wet places or de- 
 pressions in which a foul and unhealthy condition permanently exists 
 arising from natural causes," the health officer may cause them to be 
 filled at the cost of the town, but unless expressly authorized by the 
 town, only $300 can he spent in any one year. In New York, 3 if the 
 state board of health shall find that overflow from any canal is the cause 
 of unhealthy, swampy places, it shall report to the superintendent of 
 public works, who shall forthwith abate the same. 
 
 Offensive Trades. 
 
 As was stated in chapter I. the earliest colonial legislation in regard 
 to offensive trades was in .Massachusetts in 1692. Unfortunately, the 
 
 necessit) for such legislation remaining on the statute hooks has eon- 
 tinned to the present day, and such laws are found no! in Massaehu- 
 set ts alone, hut in \ er\ man y ot I ier st ates. Besides sneh general laws 
 
 relative to offensive trades this subject is considered in charters and 
 
 1 \.u Fork, Chapter 878 01 L897, Sees. L214 1218. 
 
 ( lonnecticut, Chapter L62 oi L895. 
 ' New Fork, General Laws (1896), p. 2418, Public Health r.aw. Sec. 7. 
 
200 SPECIFIC NUISANCES. 
 
 special legislation, as in New York, Philadelphia, Memphis, and some 
 other places. Many cities, perhaps the majority, provide by means of 
 local regulations for the control of offensive trades. Even those cities 
 which have charter provisions relating to this subject or which are 
 situated in states which have legislated upon it, nevertheless seek fur- 
 ther restrictions by means of their own rules. Thus although there is 
 statutory legislation in New York in regard to offensive trades both in 
 the general laws and in the charter for New York City, yet the sanitary 
 code of the latter city has a score or more of provisions relating to this 
 subject. Most of the local regulation of nuisances of this kind is based 
 upon the grant of general legislative power on sanitary subjects. The 
 courts thus seem to uphold the notion of the close relationship between 
 noisome trades and unhealthy conditions of life. In Brooklyn where 
 the broad terms of the act simply authorize legislation " in regard to all 
 matters pertaining to public health" there has been much local legisla- 
 tion of this kind. References to some of the statutes relating to offen- 
 sive trades are shown below. 1 
 
 There are several ways of dealing with offensive trades : they ma}' 
 be relegated to some locality where little or no harm may be done, they 
 may be controlled by some sort of official supervision, or lastly, they 
 may be suppressed. 
 
 I. 
 
 • The Massachusetts colonial law of 1692 provided for the location 
 
 •of offensive trades and this provision has been retained till the present 
 
 time : 
 
 tl The board of health of a town shall from time to time assign certain places for 
 the exercise of any trade or employment which is a nuisance or hurtful to the inhabit- 
 ants, or dangerous to the public health, or the exercise of which is attended by 
 
 1 Arizona. Chapter 52 of 1895. 
 Colorado. Act of 17 April, 1893, Sees. 51-53. 
 Kansas. General Statutes (1897), Sees. 340-1. 
 Massachusetts. Public Statutes (1882), Chapter 80, Sees. 84-95. 
 
 Chapter 106 and 193 of 1889. 
 
 Chapter 428 of 1897. 
 Michigan. Compiled Laws (1897), Sees. 445(3-8. 
 Minnesota. Statutes (1894), Sees. 1489-97. 
 
 Chapter 175 of 1899. 
 Missouri. Revised Statutes (1899), Sees. 2234-9. 
 
 Chapter 96 of 1899. 
 New York. Revised Statutes (1896), p. 917, Domestic Commerce Law, Sec. 
 
 38a-c. 
 Ohio. Annotated Statutes (1900), Sees. 6919-27. 
 Pennsylvania. Brightly's Purdon's Digest (1894), p. 1612. 
 Rhode Island. General Laws (1896), Chapter 93. 
 Vermont. Statutes (1894), Sec. 4604. 
 
SPECIFIC NUISANCES. 201 
 
 noisome and injurious odors, or is otherwise injurious to their estates, and may pro 
 hihit the exercise of such trade or employment in places not so assigned; the board 
 may also prohibit such exercise within the limits of the town or in any particular 
 locality thereof. All such assignments shall be entered in the records of the town, 
 and may be revoked when the board shall think proper." ' 
 
 The phraseology of this act also appears in the laws of Colorado, 
 Illinois, .Maine. Michigan, Minnesota, Rhode Island, and Wisconsin, and 
 perhaps other states. Sometimes the statute is mandatory as in Mas- 
 sachusetts, and sometimes permissive as in Rhode Island. Usually 
 every noxious trade is included in the operation of the law, but in some 
 states only specified trades. In Wisconsin the law only provides for the 
 location of slaughter-houses in cities. The Rhode Island law names 
 "the business of boiling hones, depositing filth, keeping swine, or 
 slaughtering cattle or other animals," and "the business of expressing 
 oil from fish," but a later section provides as follows: 
 
 "The provisions of sections eight, nine, ten and eleven of this chapter shall 
 extend to tlie place of any manufacture of, or of working in any article or substance 
 the manufacture of which shall he deleterious t<> the health of the neighborhood." 2 
 
 While the promotion of public health is the main.purpose of these 
 
 laws governing offensive trades, yet they are often intended to have a 
 rather broader scope as is shown by both the Massachusetts and Rhode 
 Ishmd statutes. The Massachusetts law contemplates municipal con- 
 trol in trades which are not only "hurtful to the inhabitants or danger- 
 ous to the public health," hut also such as are ••otherwise injurious to 
 their estates," and in Rhode Island the city government may forbid 
 trades when "the public health or the public comfort and convenience " 
 so require. 
 
 Sometimes the state law prescribes where offensive trades may not 
 be located. Thus the Ohio law 8 forbids such trades within a certain 
 distance of state instil iitions. 
 
 This control of offensive trades is usually placed in the hands of 
 
 the board of health, but sometimes, as in Rhode [sland, where the town 
 
 council and its e<| nivalent the board of aldermen of cities is ex-officio 
 the hoard of health, ami where nevertheless the towns and cities arc 
 
 authorized to establish independent hoards of health ami have in many 
 case- done go, the right tn locate offensive trades is still vested ill the 
 
 town council. In Maine where independent hoards of health are obli- 
 gator} ,control of this class of nuisances is si ill vested iii t he "municipal 
 offices." Sometimes, as in Denver, where permits for offensive trades 
 
 1 Massachusetts, Public Statutes i L882), Chapter 80, Sec. 84. 
 - Rhode [sland, General Laws (1896), Chapter 91, Sec. 19. 
 < 'hi... Revised Statutes 1 1900), Se< , 8924. 
 
202 «P E( IFK ' NUISAm Ks. 
 
 are granted by the city council, they can only be granted with the 
 approval of the health commissioner. In Chicago slaughter-house per- 
 mits are issued by the mayor. In Cleveland the permit is to be issued 
 by the director of police. In Rochester the ordinance requires that 
 " such permit must be applied for in writing, specifying the nature and 
 precise location of the business or proposed business, and such applica- 
 tion shall not be acted upon until the second regular meeting after snch 
 application." In Philadelphia : 
 
 "No permit shall be granted to any person or persons to carry on the business of 
 boiling bones and dead animals until after a careful inspection of the locality, build- 
 ings, apparatus, and the plans for conducting the business, and the approval of the 
 sanitary committee." J 
 
 To the power to locate offensive trades is usually added the power 
 to revoke the order granting such location. Such power of revocation 
 lies with the board of health or other board locating the trade, but in 
 some states, as in Colorado, Massachusetts, Michigan, and Minnesota, 
 provision is made for the revocation of the permit by the proper court. 2 
 
 In Rhode Island the withdrawal of the right to slaughter must only 
 be after giving. two months' notice to the owner in writing. In that 
 state damage may by proper action be obtained from the town for any 
 loss " resulting from such suspension or withdrawal " of location of 
 slaughter-houses, but curiously enough a later provision removes an} 7 
 such liability on the part of the town in the case of the fish oil business. 
 
 As the only object of this location of offensive trades is to secure 
 their removal from parts of the town or city where they would consti- 
 tute a nuisance, the board of health may forbid their continuance in all 
 other sections than those in which they have been located. In Rhode 
 Island this prohibition is contained in the statute and also the penalty, 
 which for most trades is fixed at $50 per day. 
 
 II. 
 
 A second method of dealing witli noxious trades is by the exercise 
 of some control over their management. Such control assumes that the 
 nuisance arising from the business is not necessary, but arises from 
 defective construction of buildings, or apparatus, or from its negligent 
 
 1 Philadelphia, Rules of the Board of Health (1895), Sec. 182. 
 -Massachusetts, Public Statutes (1S82), Chapter 80, Sec. 85: 
 
 " When it appears on a trial before the superior court for the couuty upon a com- 
 plaint made by any person, that a place or building so assigned has become a nui- 
 sance by reason of offensive smells or exhalations proceeding from the same, or is 
 otherwise hurtful or dangerous to the neighborhood or to travellers, the court may 
 revoke such assignment and prohibit the further use of such place or building for 
 the exercise of either of the aforesaid trades or employments, and may cause such 
 nuisance to be removed or prevented.' 11 
 
S P EC IFir xrisA m <jES. 203 
 
 operation. It is hoped that when the necessity for better methods is 
 felt through pressure brought by the community the business may be 
 conducted without nuisance. 
 
 One way of securing better methods of conducting such trades is by 
 licensing them. The theory of the license (when it is really a license 
 and not used chiefly as a means of raising a revenue) is that the license 
 will only be issued under such conditions as will secure a reasonable 
 conduct on the part of those to whom the license is granted. The so- 
 called offensive trades are thus often granted permits by boards of 
 health, the board of health presumably requiring the fulfilment of such 
 conditions as will render the trade inoffensive, or comparatively so 
 Sometimes the granting of such permission or license is provider! for by 
 statute as in New Hampshire ' and Vermont. 
 
 More often the licensing of offensive trades is exercised by town 
 and city governments simply as one of their sanitary functions, without 
 the grant of special authority. In most ordinances the offensive trades 
 to be licensed are specified; more rarely as in Albany and Lynn the 
 ordinance is framed in general terms only. 2 
 
 Among the trades specified as requiring permits in various cities 
 may be mentioned the tanning, skinning, scouring or dressing of hides, 
 or of leather, the storing of green hides, the making of varnish or boil- 
 ing of oil, distilleries, the making of lamp black, turpentine, or tar, the 
 boiling of offal, bones, or swill fat, bone crushing, boiling, grinding, 
 burning; shell burning, gut cleaning, glue making, the beating, drying, 
 storing, shipping, or transporting of blood scrap, grease or offensive 
 animal or vegetable matter; the manufacture of materials for manure, 
 the maintenance of stock yards and pens, slaughter-houses, soap, coal- 
 oil and vitriol factories: the storing of fertilizers ; gas works, blacksmith 
 shops, potters' shops, pottery kilns, vinegar yards, and depositories of 
 dead animals, manufactures of asphalt, breweries, fonnderies. the smoking 
 
 1 New Hampshire, Public Statutes (1891), Chapter 108, Sec. 15: 
 ■•If a person shall use or occupy a building or place near a dwelling-house or 
 schoolhouse, or in the compact pari of a town Cor a slaughter-house, a pla 
 deposit "i green pelts or skins, or for trying tallow, currying leather, or carrying 
 >.ii any other business thai is offensive to the public, without the written permis- 
 sion of the health officers of the town, he shall forfeit ten dollars for each month 
 such building or place shall be so used or occupied, to be recovered for the use of 
 
 t lie tt>\\ II." 
 
 Llbany, Sanitarj Ordinances (1892), Sec. B: 
 ■• No person or company si mil erect or maintain anj manufactory "i place of busi- 
 ness dangerous to life or detrimental to health, or where unwholesome, offensive or 
 deleterious "<l'»rs, 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, bo ;ts no! n> i>e offensive or prejudicial to public health/ 1 
 
204 SPEl IFIC milSANt Es. 
 
 of fish, or meat ; manufactures of starch, leather, chemicals, fertilizers ; 
 the buying, selling, or storing of skins, hides, rags, bones, or similar 
 articles : making egg dressing, candle factories, hemp factories, pork 
 houses, sausage houses, acid restoring, manufacturing copperas from 
 sludge acid, distilling sludge acid, making potassic cyanide, stone quarries, 
 and brick kilns. 
 
 Hogpens and the collection and removal of waste products, as soap 
 grease, night soil, and garbage, often require licenses, but these subjects 
 are considered in another connection. 
 
 Usually no fee is charged for the licenses granted for this purpose, 
 but in Philadelphia and Cleveland a charge of $10 per annum is made, 
 and in Chicago the fee for a slaughter-house license is $100 per annum, 
 and for a tannery, $50 per annum. In Arizona a $10 fee must be paid 
 for the preliminary inspection of a slaughter-house. 1 Usually a record 
 must be kept of all such licenses. 
 
 In Wilmington, Del., offensive trades located within one mile of the 
 city must obtain a license. 
 
 The licensing of trades to be of value as ameans'of preventing 
 nuisance, implies the affixing of conditions either understood or expressed, 
 under which the trade shall be followed, and sometimes, as in New York 
 and Illinois, the power to do so is specifically granted. In Cincinnati 
 a regulation of the board of public improvement requires the attach- 
 ment of conditions to the permit. In Pennsylvania bone boiling and 
 other offensive trades can only be carried on " subject to the supervision 
 and under the regulation of the state board of health." 2 
 
 A very large number of cities and some states have adopted more 
 or less extensive rules for the regulation of offensive trades. Such regu- 
 lations are sometimes of a very general character, as in Indiana, Ten- 
 nessee, and the cities of Albany, Chicago, 3 Lynn, Memphis, Mobile, and 
 Scranton. 4 
 
 1 Arizona, Chapter 52 of 1895. 
 
 2 Pennsylvania, Act of 19 May, 1897. 
 
 8 Chicago, Ordinances (1881), Sec. 1380: 
 
 " That no person shall permit or have any offensive water or other liquid or sub- 
 stance on his premises or grounds to the prejudice of life or health, whether for use 
 in any trade or otherwise. And every such establishment now existing shall be kept 
 cleanly and wholesome, and be so conducted in every particular as not to be offen- 
 sive or prejudicial to life or health. 11 
 
 4 Scranton, Rules and Regulations of Board of Health, Sec. 7 : 
 
 " 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 or 
 waste substance, refuse or injurious matter be allowed to accumulate upon the 
 premises, or be thrown or allowed to run into any public waters, streams, water- 
 courses, street, road, or public place, unless by sewer connection. And every person 
 
spK( l/V( ■ JSTl r IS, 1 X< E& -j ( ) 5 
 
 In place of or in addition to such general prescriptions as to the 
 conduct of offensive trades many cities have made specific rules for the 
 regulation of special kinds of business. Of all trades thai of slaughter- 
 ing animals appears to be the most productive of nuisance. Other 
 offensive trades may be localized in certain sections of the country or 
 in a few cities or even in a single city : but slaughter-houses are very 
 numerous in all sections of the land, and are found in the largest cities 
 and in the smallest villages, and even in the open country. The nature 
 of the business is such that without great care a most serious nuisance 
 at once arises. Hence slaughtering has received more attention than 
 other trades. The Massachusetts law of 1692 mentions "slaughter- 
 houses,'" and many a modern ordinance deals with "slaughter-houses 
 and other establishments from which noisome odors may arise." 
 
 Effort is sometimes made to secure a concentration of the slaughter- 
 ing business and thus obtain a better control. 
 
 In 1870 1 the Brighton abattoir was incorporated. This association 
 could condemn hind within two miles of a certain point in the town of 
 Brighton (adjoining Boston) "as the board of health of the city of 
 Boston shall by vote determine to be suitable for the carrying on of 
 said business." This land was to be paid for by condemnation proceed- 
 ings. A slaughter-house was then to be erected: "but no bunding 
 shall be erected until the plans thereof with all details of construction 
 shall have been submitted to and approved by said board of health 
 of the city of Boston or some person designated by said board to examine 
 said plans." In 1876 2 slaughtering was forbidden in Boston excepl on 
 the property of the Butchers' Slaughtering and .Melting Association 
 (Brighton Abattoir), and the members were required to slaughter all 
 animals brought to them for thai purpose, the Boston board of health 
 in cases of disagreement to appoint inspectors and make regulations. 
 
 New Orleans by ordinance of 31 March, 1891, and by a charter granted 
 
 in 1895, has also established a modern abattoir. The abattoir at Terre 
 Ilante is under municipal control and all other slaughter-houses are 
 abolished. In L874 8 a general law was enacted to promote the for- 
 mation of Swine Slaughtering Associations. Under this law a corpo- 
 ration with a capital of $100,000 to $500,000 can condemn not over 
 100 acres of land for the purpose of conducting its business, but the 
 
 or company conducting such manufacture or business shall use the best approved 
 
 ami all reasonable means to prevent il sea] t smoke, gases, and odors, and to 
 
 protect the health ami safety of all operatives employed therein. 11 
 
 1 Massachusetts, Chapter 365 of 1870. 
 - Massachusetts, Chapter I it of 1876. 
 Massachusetts, Public Statutes 1 1882), Chapter 197. 
 
206 SPECIFIC NUISANCES. 
 
 location must be approved by the state board of health and the alder- 
 men of the city or the selectmen of the town in which it is situated. 
 The land damages are to be determined by prescribed legal proceedings 
 before the superior court. The corporation may erect buildings for its 
 business, but " no such buildings shall be erected until the plans thereof, 
 with all details of construction have been submitted to and approved 
 by said state board of health or some person designated to examine 
 them." Each member of the corporation may conduct a slaughtering 
 business on the premises and permits may be granted others to do so. 
 
 Rules for the location, arrangement, and construction of slaughter- 
 houses are often found. In the City of New York it is forbidden to 
 kill any animal in a market, and no slaughter-house can be on the same 
 lot with a dwelling. All slaughter-houses must have adequate connec- 
 tion with the sewer. A water-tight floor is essential, and in Cincinnati 
 there " must be no breakage of joints nor openings of any kind except 
 into the sewer." It is often required that swine shall not be kept in or 
 about a slaughter-house. The reason is that the swine always create a 
 nuisance and that they are very liable to become infected with tuber- 
 culosis, trichinosis or other contagious disease. It is frequently pre- 
 scribed that no blood pit or dung pit shall be allowed in a slaughter- 
 house. Cleanliness is essential and is prescribed by the following: 
 
 " Tliat every butcher and every person owning, leasing or occupying any place, 
 room or building where any cattle have been or are killed or dressed, and every per- 
 son being the owner, lessee or occupant of any room or stable where any cattle may 
 be kept, or market, public or private, and, having power and authority so to do, 
 shall cause such place, room, building, stall (and market, being private), and their 
 yards and appurtenances to be thoroughly cleansed and purified, and all offal, blood, 
 fat, garbage, refuse and unwholesome or offensive matter to be tberefrom removed 
 at least once in every twenty-four hours after the use thereof for any of the purposes 
 herein referred to; and shall, also, at all times (unless some public authority pre- 
 vents), keep all woodwork, save floors and counters, in any building, place or pre- 
 mises aforesaid, thoroughly painted or whitewashed. 1 ' 1 
 
 The following is a rule of the Pennsylvania state board of health : 
 
 tl The owners, agents or occupiers of all slaughter-houses are required during 
 the months of June, July, August and September, to distribute twice in each week 
 not less than twenty-five pounds of chloride of lime about the premises, and also 
 to remove the contents of any manure-pit or manure-pile on the premises, once in 
 each week, the said premises and contents of manure-pits being hereby declared to 
 be nuisances prejudicial to the public health, unless subject to frequent disinfection 
 and cleaning as herein indicated." 
 
 A most elaborate set of regulations is found in Boston concerning 
 the Brighton abattoir. 2 
 
 'New York, Sanitary Code (1899), Sec. 83. 
 
 2 Boston, Manual of the Health Department (1890), p. 28. 
 
SPECIFIC NUISANCES. 207 
 
 The sanitary code of the City of New York provides for the driving 
 .of animals to the slaughter-house : 
 
 "And no pigs, swine or cattle shall be unloaded from any cars upon any street or 
 public place in the City of New York, except pursuant to a written permit from this 
 Department. 
 
 Nor shall any cattle, pigs, swine or sheep be driven to any slaughter-house in the 
 Borough of Brooklyn, except between the hours of eight of the evening and one 
 hour after sunrise of the next morning: nor shall more than twenty cattle, or more 
 than one hundred pigs or swine, or more than one hundred and fifty sheep, be driven 
 together; and they shall be driven in streets and avenues (leading toward their desti- 
 nation), where they will least endanger the lives of human beings, as the Depart- 
 ment (if Health may designate, provided, that when the landing or transportation of 
 cattle shall have been delayed or prevented by ice, fog or unavoidable accident, the 
 Department of Health may. at its discretion, give a permit to land and drive such 
 cattle at other hours than those herein designated. 
 
 Hut in no case shall cattle he driven past any school or church." 1 
 
 Rules are of no avail without frequent inspection, and in Wilming- 
 ton the ordinance provides that the inspector shall visit each slaughter- 
 house once a week, and for neglect, shall he fined S$5. 
 
 The rendering- of grease is, unless carried on with great care a fer- 
 tile source of nuisance. The rendering of dead animals also is especially 
 liable to become a nuisance, and hence is absolutely forbidden within the 
 limits of a number of cities. The rendering of other materials, even 
 when perfectly fresh, has to he carefully guarded, and in many places 
 rules governing this business have been incorporated in the sanitan 
 regulations. The most important points to he controlled are the con- 
 struction of the works, the care and cleanliness with which they are 
 conducted, and the materials treated. The rules adopted in New York 
 and Philadelphia, lien given, illustrate these points: 
 
 " That no person shall boil any offal, swill, hones or fat in the built up portions 
 of said city, save in ordinary cooking, . . . except with a permit from the 
 depart menl of health. 
 
 • l That all persons engaged in the business of boiling or rendering of Eat, lard or 
 animal matter, shall cause tin- scrap or residuum to be so dried or otherwise pre- 
 pared as effectually to deprive such material of all offensive odors, ami to preserve 
 t he same cut irely inoffensive immediately after t he removal thereof from t he recept- 
 acles in which the rendering process maj he conducted, 
 
 -■ Thai no fat, tallow or lanl shall be melted or rendered, except when fresh from 
 
 the slaughtered animal, ami taken directly from the places of slaughter in the Cit] 
 
 ■ ■I New York, and in a condition free from sourness and taint ami all ot her causes Of 
 
 offense at the time of rendering, and that all melting and rendering are to be in 
 Bteam-tighl vessels, the gases and odors therefrom to he destroyed bj combustion or 
 other means equalrj effective, and according to the best and most improved means 
 and processes; and everything preceding, following, and in connection with such 
 melting and rendering, and the premises where the same shall be conducted, must 
 be free fr all offensive odor, and other cause of detriment to the public health. 
 
 1 New York. Sanitarj (ode (1899), Sec. 69. 
 
208 s PEC IFK ' XI r ISA m 1 E8. 
 
 No fat, lard or tallow, shall be brought into the City of New York to be rendered or 
 melted, and none is to be rendered or melted that has come from any place outside 
 of said city, except as part of the living animal and except such fat as is suitable for" 
 food purposes, and is handled in accordance with the terms of a special permit in 
 writing from the Department of Health. 11 1 
 
 " The floors of all bone boiling establishments and depositories of dead animals 
 shall be paved with asphalt, or with brick or stone well laid in cement, or with some 
 other impervious material, and shall be well drained. All such establishments shall 
 have an adequate water supply, and a proper arrangement of hose or pipes, as will 
 enable thorough cleanliness to be maintained. 
 
 " The boiling of bones and dead animals, etc., shall be conducted in steam-tight 
 kettles, boilers or cauldrons, from which the foul vapors shall first be conducted 
 through scrubbers or condensers, and then into the back part of the- ash-pit of the 
 furnace fire, to be consumed, or by other apparatus equally efficient in preventing or 
 counteracting the offensive effluvia. 
 
 " When bones are being dried after boiling they shall be placed in a closed cham- 
 ber, through which shall be passed, by means of pipes, large volumes of fresh air, 
 the outlet pipe terminating in the fire-pit. 1 ' 2 
 
 These rules embody the essentials of good rendering ; steam-tight 
 apparatus, the proper disposal of steam and gases, and cleanliness. 
 
 Special acts have recently been passed in Pennsylvania 3 and Minne- 
 sota 4 in regard to rendering, and other methods of disposing of material 
 from dead animals. The Pennsylvania law requires that all establish- 
 ments used for such purposes shall be licensed by the board of health 
 and shall be conducted in accordance with the rules of the state board 
 of health. Such rules the state board has adopted, and it has also pre- 
 pared a model form for the license. The Minnesota law is apparently 
 designed primarily to prevent the use of parts of dead animals for human 
 food, and this is very explicitly forbidden. Any method of disposing 
 of dead animals and parts thereof to make any article of commerce, 
 requires an annual permit from the state board of health, for which $10 
 is paid : but butchers may render the materials produced on their own 
 premises. 
 
 Dealing in hides is frequently the subject of sanitary legislation. 
 In New Orleans it is forbidden to bring into the city airy hides " which 
 may tend to produce infection or in any way to injure or endanger 
 health." In Philadelphia the vessel inspector on application being 
 made for a permit to land hides is to " examine said hides and report as 
 to their condition. Should they be found sound the permit so applied 
 for shall be issued ; but should they be reported unsound, the applica- 
 
 1 New York, Sanitary Code (1899), Sees. 99, 101, 106. 
 
 2 Philadelphia, Kules of the Board of Health (1895), Sees. 184-6. 
 
 3 Pennsylvania, Chapter 56 of 1897. 
 
 4 Minnesota, Chapter 175 of 1899. 
 
s pecifk ' isruis. i m i es. 2 < ) 9 
 
 fcion shall be referred to the board for action.*" Other regulations are 
 here shown : 
 
 ■• No person shall keep for more than twenty-four hours any uncured hides, 
 except at the place where the same are to be manufactured. 
 
 "No person shall cause, or suffer or permit any skunk or coon skins, or other 
 skins of any kind, or the skins of any other animals, which emit an offensive odor, 
 or are in a condition detrimental to the public health, to be dressed, cleaned, kept, 
 stored or received in or upon the premises owned or occupied l>y him or them.'' 1 ' 
 
 In St. Louis the time during which hides may be kept is six hours. 
 The Boston rule reads as follows: 
 
 •• No green or green-salted hides or skins, or horns, shall be cured, stored, or 
 
 suffered to remain within the limits of the city, except upon floors which shall be 
 made tight and impervious to liquids, with a proper pitch, so that all liquids and 
 tilth shall readily escape from the floor into a suitable drain, the floors to he kepi at 
 all times in a neat and cleanly condition, and so disinfected that no offensive odors 
 shall arise therefrom. No such hides or skins shall at any time be suffered to remain 
 in or upon any street, place, or sidewalk. All horns shall be immediately removed 
 and placed in brine, or under a cover of salt. If the hides, skins, or horns are 
 stored in the basement of any building, there shall lie such ventilation as shall 
 secure the remainder of the building and t he public from offensive odors. 11 '-' 
 
 The charter of the City of New York 3 gives the board of health 
 
 power to determine where hides shall he stored and if necessary to 
 order their removal or destruction or to remove and destroy them if the 
 order is not obeyed. 
 
 The sale of guano or fertilizers is sometimes regulated. In Atlanta 
 guano is not to he kepi for sale within three hundred yards of a dwell- 
 ing or place of business. In Fall River "no person shall he allowed to 
 keep for sale, or other purpose, any guano or fertilizer of am kind in 
 any place within the city, unless by permission of the hoard id' health." 
 ( )n certain parts of the Atlantic seaboard fish are spread upon the 
 land as a manure. In Newport, \\. I., the following was the rule adopted 
 to prevent nuisance from this : 
 
 •• No fish intended tor manure shall be deposited or spread upon any land within 
 one mile of the compact part of the city, or within fiftj rods from anj public high- 
 way or road, in any other part of said city, unless such tish shall he so covered with 
 earth, sand or other materials, that no offensive smell shall arise therefrom; nor 
 
 shall any person cause any such fish to he conveyed into or through any public street 
 of said city in anj wagon, art, or other vehicle, unless the same he perfect Ij water- 
 tight." ' 
 
 (01s works are often a nuisance, and New York and Chicago have 
 
 the following rule : 
 
 •• 'I' hat no person ..r company being a manufacturer of gas, or engaged about the 
 manufacture thereof, shall throw or deposit or id low to run. or having the right or 
 
 ' Cleveland, Ordinances (1892), Chapter 30, Sees. 503 i. 
 
 Boston, lodes of Board of Health 1 1890). 
 
 New York, Chapter 378 of 1897, Sees. L207, 1209, 1211. 
 ■ Newport, Ordinances, Chapter 24, Sec. I. 
 
 1 1 
 
210 SPECIFIC NUISANCES. 
 
 power to prevent the same, shall permit to be thrown or deposited in any public 
 waters, river, canal, slip, or into any sewer therewith connected, or into any street 
 or public place, any gas-tar or any refuse matter of or from any gas-house, works or 
 manufactory; nor shall any such person or company allow any substance or odor to 
 escape from such house, works or manufactory, or make any gas of such ingredients 
 or quality that any substance shall escape therefrom, or be formed in the process of 
 burning any gas, which shall he offensive or dangerous, or prejudicial to life or 
 health. Nor shall any such person or company fail to use the most approved or all 
 reasonable means for preventing the escape of odors." 1 
 
 Tanneries are a source of nuisance from various causes, but par- 
 ticularly from the wastes of various kinds that are produced. The fol- 
 lowing are the rules in regard to tanneries in force in Lowell, Maine : 
 
 "It shall be the duty of every owner, agenl or superintendent of a tannery to 
 prevent the accumulations of fleshings or other offensive waste matter in or about 
 the tannery over which he has ownership or authority. All fleshings shall be re- 
 moved daily, and buried at the time of removal. 
 
 •'No fleshings shall be deposited near enough to any highway to be offensive to 
 persons travelling in said highways, nor near enough to dwellings or places of busi- 
 ness to be offensive to persons dwelling or staying therein. 
 
 11 The removal of fleshings and other waste matters of tanneries, and the disposal 
 of them shall be only in strict accordance with the orders of the local board of 
 health." '- 
 
 The dealing in second-hand clothing is not exactly an offensive 
 trade in the sense in which that term is generally used, but it is often ;t 
 nuisance and is sometimes regulated. Recent experiments by William 
 (i. Bissell, bacteriologist of the Buffalo health department, have demon- 
 strated that second-hand clothing may lie the bearer of tubercular 
 bacilli, as it doubtless may of other pathogenic organisms/ 1 The Atlanta 
 regulation in regard to second-hand clothing was doubtless adopted as a 
 precaution against yellow fever : 
 
 "No license shall issue to any merchant or dealer in second-hand clothing until 
 
 the applicant shall file with the city clerk an affidavit in writing, stating that the 
 applicanl does not have on hand, directly or indirectly, and will not, during the 
 period covered by the license applied for, buy, receive, keep on hand, sell or deal, 
 directly or indirectly, in any second-hand clothing imported into said city which has 
 not been properly disinfected, and certified and registered as required by law of 
 Georgia. For making a false affidavit to obtain the license aforesaid the affiant shall 
 be subject to the penalty prescribed in fourth section of this ordinance. 
 
 " It shall not be lawful for any merchant or dealer in this city to sell, expose or 
 offer for sale, at his place of business or elsewhere in said city, any second-hand 
 clothing, or to open any package, case, or lot of second-hand clothing shipped into 
 said city, or for any railroad employee or other person to remove the same when so 
 shipped here from the depot or express office, without first obtaining a written per- 
 mit from a sanitary inspector, which permit shall only be given upon its being made 
 to appear to such inspector by such merchant or dealer that he has a certificate from 
 
 1 Chicago, Ordinances (1881), Sec. 1392. 
 
 2 Lowell, Me., Rules of Board of Health (1802), Sees. 1, 2, 3. 
 
 3 Buffalo, Monthly Report of the Department of Health, March, 1899. 
 
SPEC IFK ■ NZTIS. 1 N't 'A'S. 211 
 
 the proper officer of the board of health of the place from which said clothing may 
 have been shipped, which certificate shall set forth the charactei and number of 
 garments to which it refers: that they have been properly disinfected and when, and 
 that there is no danger of spreading contagious diseases therefrom: Provided, the 
 certificate presented of the officer of the place shipped from shall not be conclusive 
 on the health officer here, but the sanitary inspector or board of health here may 
 inspect the same, and if found to be contagious, such clothing shall be condemned 
 and notallowed to be sold until properly disinfected. Such merchant or dealer shall 
 pay to said sanitary inspector a fee of one dollar for each shipment of such clothing 
 examined and certified as above provided, which said fee shall be turned into the 
 city treasury through the clerk of council. Such inspector shall also file with the 
 clerk of council a duplicate of each certificate given.'" ' 
 
 The following regulations arc found in regard to the storage and 
 
 use of rags : 
 
 •• Hereafter no rays or other dangerous material shall be sold or manufactured 
 into articles to be sold for personal use. unless such rags or material shall havi 
 previously so thoroughly disinfected as to destroy all genus of disease in a manner 
 satisfactory to the board of health."' - 
 
 ■• No rags, old paper, or other refuse material, gathered or recovered from any 
 BOUrce, shall be broughl into or allowed to remain within any building used as a 
 dwelling." ; 
 
 The following rule is found in New York: 
 
 •■That the owners, lessees, tenants and managers of every blacksmith or other 
 shop, forge, coal-yard, foundry, manufactory and premises where any business is 
 done, shall cause all ashes, cinders, rubbish, dirl and refuse to be removed to some 
 proper place, so thai the same shall not accumulate at any of the above-mentioned 
 premises, or in the appurtenances thereof, nor the same become filthy or offensive, 
 nor shall any smoke, cinders, dust, gas, or offensive odor be allowed to escape from 
 an\ such building, place or premises, to the detrimeni or annoyance of any person 
 not being therein or thereupon engaged.' 1 4 
 
 III. 
 
 While some noxious trades may properly !»• conducted in sparsely 
 settled sections of a township or city, and while all the so called offen- 
 sive trades need regulation and supervision, there are certain trades that 
 must he absolutelj forbidden in some municipalities. Moreover, any 
 trade may he so managed, either through the ignorance or wilfulness 
 of the operators, thai it is hopeless to exped an\ abatement id' the nui- 
 sanee except by the complete suppression of the husiiicss. The prohi- 
 bition id' trades is sometimes found in statute law. as in the charter of 
 the ( it \ of New York : 
 
 ■' It shall nol be lawful for an] person or persons, incorporated or unincorpor 
 a ted, to carry on. establish, prosecute, or continue, within the borougli of Manhat- 
 
 1 At lauta. Sanitarj < lode, Sec, i 1 1. 
 
 • olorado, An ,,t i;, April. L893, Sec. 16. 
 
 Boston, Hoard of Health Regulations, 28 February, 1899. 
 1 New \ ork, Sanitarj Code 1 1899), S'< ■ . mi. 
 
2 1 '2 SP E( JFK ' XI Vs. i N'( 'ES. 
 
 tan, the occupation, or trade, or business of bone boiling, bone burning, bone grind- 
 ing, horse skinning, cow skinning, or skinning of dead animals, or the boiling of 
 offal, and any such establishment or establishments, or place of such business exist- 
 ing within said borough, shall be forthwith removed out of said borough, and such 
 trade, occupation, or business shall be forthwith abated and discontinued, provided 
 that nothing in this section contained shall apply to the slaughtering or dressing of 
 animals for sale in said city. It shall be the duty of the board of health to ascertain 
 whether any such trade or business is carried on, or continued, or established, within 
 the limits aforesaid, and to make and cause an order to be served, in the same man- 
 ner as other orders of said department are made and served, directing the discon- 
 tinuance of said trade or business, and the removal of all offensive or unwholesome 
 materials or things appertaining to said trade or business. Any such business car- 
 ried on elsewhere within the city of New York shall be subject to reasonable regu- 
 lations to be prescribed by the board of health, and may, upon its recommendation, 
 be prohibited in any borough or part of any borough by the municipal assembly. 1 ' 1 
 
 More often, however, it is the authority to prohibit that is given to 
 the local government, as in the Massachusetts law.- A very large num- 
 ber of municipalities have taken advantage of the power thus conferred 
 and have prohibited certain offensive trades within their limits or in 
 some cases, as in Chicago, within a certain area outside their limits. 
 hi Atlanta slaughter-houses are forbidden within the city and upon the 
 water shed from which the city obtains its water. Sometimes the pro- 
 hibition is made to apply only to trades to be established in the future, 
 as in Wilmington, Del. 
 
 If, notwithstanding the prohibition, the trade is still followed, the 
 remedy is found in a penalty in the form of a line, which may be col- 
 lected for each day during which the offense is persisted in. The fine 
 for violations of these laws is usually somewhat greater than for ordinary 
 nuisance laws: $50 is a common amount, but in Ohio it is $500. In 
 Bridgeport.it is $20 per day. But the imposition of a line is not a very- 
 satisfactory way of abating a nuisance, especially such a nuisance as is 
 caused by offensive trades. Considerable pecuniary interests are usually 
 involved, and often the business creating the nuisance is of great magni- 
 tude. In such cases every possible appeal will lie taken and all the 
 tactics known to the legal profession will be made use of to perpetuate 
 the nuisance. Hence has been felt the need of some summary method 
 of dealing with such nuisances. In 1855 in Massachusetts 3 it was pro- 
 vided that the board of health could take all measures necessary to sup- 
 press the trade. Recently in Wisconsin the mayor or other municipal 
 executive is required to remove such slaughter-houses as are forbidden 
 by the statute, and if such officer fails in this duty he is to lie lined from 
 $15 to $50. The Rhode Island law is here given: 
 
 1 New York, Chapter 378 of 1897, Sec. 1212. 
 -Massachusetts, Public Statutes (1882), Chapter 80, Sec. 84. 
 :: Massachusetts, Public Statutes (1882), Chapter 80, Sec. 87. 
 
SPECIFIC NUISANCES. 213 
 
 •• Section 1. When any building or premises in any city in this state are occu- 
 pied or nsed for carrying on the business of slaughtering cattle, sheep or other 
 animals. or for a melting' or rendering establishment, or for other noxious or offen- 
 sive trades, occupations or employments, the board of aldermen, sitting- as a board 
 of health, after appointing a time and place for a hearing, and after giving notice 
 thereof to all persons interested, by public advertisement or otherwise, and after 
 such notice and hearing, if in its judgment the public health or the public comfort 
 and convenience so require, may prohibit by its order or decree the exercise of such 
 trade, occupation or employment in such building and on such premises, indefinitely, 
 or for such time as it shall find that the public health or the public comfort and 
 convenience shall require. 
 
 "Sec. 2. A copy of the order or decree of prohibition under the preceding 
 tion shall he served by the city sergeant upon tire occupant or person having charge 
 of such building and premises where such trade, employment or occupation is exer- 
 cised. If the party upon whom snch order is served, for twenty-four hours after 
 such service refuses or neglects to obey said order or de< ree, the board of aldermen 
 in;i\ take all necessary measures to prevent such exercise, and any person thereafter 
 continuing so to occupy or use such building and premises shall forfeit the sum of 
 two hundred dollars for every month of such occupancy and use. and in like propor- 
 tion for a longer or shorter time, to be recovered by the city treasurer in tin action 
 of t he case. 
 
 •■ Sec. ■'!. Any person aggrieved by the order or decree of the board of aldermen 
 
 under section one of this chapter may. within three days from the service aforesaid 
 thereof upon him, appeal to the common pleas division of the supreme courl within 
 and for the county where such city is situated, by filing his reasons of appeal, to- 
 1 with an attested copy of the whole proceedings appealed from, in the clerk's 
 office of said court, and said court if in session shall, or, if not in session, any justice 
 of the supreme courl upon application made to him shall, forthwith hear said 
 appeal; and either party to the proceedings may have a trial by jurj of all questions 
 of fact, by filing with the clerk of said court a demand for the same at least two 
 days before the clay assigned for hearing. In case of such demand, if said common 
 pleas division of the supreme court shall not be in session for the purpose of jury- 
 trials, the clerk shall immediately issue a writ of venire facias directed to the sheriff 
 of t he county or his deputy, ret) Hiring him to summon twelve jurors, being good ami 
 lawful men of the county, to try such issue; and if there shall not be a sufficient 
 number of jurors attending in pursuance of such writ from which a jury may be 
 impaneled, such court or justice shall direct the issuing of other writs of venire 
 facias to complete a jury. If any person aggrieved shall, by reason of accident or 
 
 mistake, fail to appeal as aforesaid ir :un such order or decree, and shall make 
 
 it appear to such court or justice that such failure was caused by accident or mis- 
 take, he may at any tine within i Inn \ days from the service of t he copy of t he on lei 
 or decree aforesaid upon bim, appeal from such order or decree and prosecute the 
 same as aforesaid, with t he same effect as if done within the said three days. 
 
 li Sec. I. During the pendency of the appeal such trade, occupation or eniploj 
 men i shall uot he exercised con i rary to such order or decree ; ami upon any violation 
 of such order or decree, the appeal shall forthwith he dismissed. 
 
 S] ■ . ■">. Sucb court or justice, upon the trial of an\ appeal, shall give judg 
 nieiil . agreeable to law anil in accordance with t he fact as found, (hat such order > r 
 
 decree he affirmed or annulled, or such court or justice maj alter or modify the 
 
 order or decree, or u] a jury-trial the jury may alter or modify t he order ordi 
 
 and thereupon the verdict and judgment shall have the authoritj and . : 
 
 original order from which no appeal had been taken. If ll rder or d. 
 
 affirmed, altered, oi modified, the citj shall recover its costs against the appellant: 
 
2 ] 4 SPEC IFK ' m 7 a . J X< h's. 
 
 if it is annulled, damages by reason of obeying such order or decree of the board of 
 aldermen may be recovered by such appellant against the city, in any court of com- 
 petent jurisdiction, in an action of the case. 7 ' 1 
 
 Under ihis law it appears to be possible to promptly suppress any 
 noxious or offensive trade. Yet ample provision is made for the owners 
 of the property to obtain as prompt justice as possible at the hands 
 of the highest legal tribunal. 
 
 In most cities the sanitary inspectors or the executive head of the 
 department manage the regulation of the offensive trades: but in New 
 York special inspectors are employed for this purpose. In 189b, the 
 last year in which a report of the health department was printed, there 
 were two such inspectors, and an interesting account of their work may 
 be found on pp. 204-210 of thai report. 
 
 Smoke. 
 
 The following (ities have anti-smoke legislation: Boston, Buffalo, 
 Chicago, Cincinnati, Cleveland, Denver, Detroit, District of Columbia, 
 Indianapolis, Kansas City, Louisiana cities of over 5,000 inhabitants, 
 Memphis, Milwaukee, Minneapolis, the City of New York, Omaha, St. 
 Louis, St. Paul, Toledo, Pittsburgh, and Yonkers. 
 
 The abatement of the smoke nuisance is usually placed in the hands 
 of the health department. This is quite natural, as most nuisances are 
 referred to that department, but the engineering department with its 
 superior knowledge of mechanical processes might perhaps be better 
 entrusted with it. The health department has jurisdiction in Chicago, 
 Cleveland, Denver, District of Columbia, Kansas City, Memphis. Mil- 
 waukee, Minneapolis, New York, and Yonkers. In Cincinnati, Omaha, 
 and New < Weans it is the city engineer, in Indianapolis the inspector of 
 buildings; in Buffalo, St. Louis, and Pittsburgh, the department of 
 public works. The Boston act authorizes the mayor to name the officer 
 who shall be entrusted with its enforcement. It is now in the street 
 department. 
 
 There are several types of smoke laws. New York City acts under 
 
 the following rules of the sanitary code : 
 
 "Sec. 134. That the owners, lessees, tenants, and managers of every blacksmith 
 or other shop, forge, coal yard, foundry, manufactory, and premises where any busi- 
 ness is done, or in or upon which an engine or boilers are used, shall cause all ashes, 
 cinders, rubbish, dirt and refuse to be removed to some proper place, so that the 
 same shall not accumulate at any of the above-mentioned premises or in the appur- 
 tenances thereof, not the same become filthy or offensive. Xor shall any owner, 
 lessee, tenant, manager, engineer, fireman, or any other person, cause or allow any 
 smoke, cinders, dust, gas, steam or offensive odor to escape or be discharged from 
 any such building, place or premises; and every furnace employed in the working of 
 
 i Rhode Island. General Laws (1896), Chapter 93. 
 
S PEC TFK ■ Xf T.s . 1 m ' ES. 2 1 5 
 
 engines by steam, or in any mill, factory, printing house, dye factory. iron foundry, 
 glass bouse, distillery, brew house, sugar refinery, bake house, gas works, or in any 
 other buildings used for the purposes of trade or manufacture shall be so con- 
 structed as to consume or burn the smoke arising therefrom." ' 
 
 Chicago, Detroit, Omaha, Milwaukee, Minneapolis, St. Paul, and 
 
 [ndianapolis have ordinances very much alike. The following is the 
 
 Chicago ordinance and tinder it the health department lias done ranch 
 
 to suppress the smoke nuisance : 
 
 "The emission of dense smoke from the smoke stack of any boat or locomotive, 
 or from any chimney anywhere within the city, shall be deemed and is hereby 
 declared to be a public nuisance: Provided, that chimneys of buildings used exclu- 
 sively for private residences shall not In- deemed within the provisions of this ordi- 
 nance. 
 
 •The owner or owners of any boat or locomotive engine, and the person or 
 persons employed as engineer or otherwise in the working of the engine or ei a 
 in said boat or in operating sucb locomotive, and the proprietor. Lessee, and occu- 
 pant of any building who .shall permit or allow dense smoke to issue or be emitted 
 from the smoke stack of any such boat or locomotive or the chii iy of any build- 
 ing within the corporate limits, shall be deemed and held guilty of creating a nui- 
 sance, and shall for every such offense be lined in a sum noi less than live dollars. 
 nor more than fifty dollars." 1 
 
 The Detroit 3 ordinance forbids " dense smoke or smoke containing 
 s<>ot or other substances in sufficient quantity to permit the deposits of 
 such sooi or other substances on any surface within the corporate limits 
 of the city." The [ndianapolis ordinance requires the building inspec- 
 tor to >ei\o a ten days' notice. The Buffalo ordinance is somewhat 
 re explicit in the Language employed : 
 
 ••It shall not be lawful within the limits of the City oi Buffalo for any person or 
 persons, firm or corporation, or any servant, agent, or employee of any person, linn, 
 or cor | .oral ion, to permit or allow, or cause to be permitted or allowed, the discharge 
 or escape into the open air of large quantities of smoke, soot, dust, gas, steam, or 
 offensive odor, or to permil or allow any smoke, soot, dust, gas, steam, or offensive 
 odor to escape in such manner or in sucb quantities as to cause or have a natural 
 tendency to cause injury, detriment, or annoyance to any person or persons or the 
 public, or to endanger the public, or to endanger the comfort, repose, health, or 
 safeis of any person or persons, or the public, or in such manner as to cause or to 
 have a rial oral tendency to cause injury or damage to business or property." 
 
 Section -J. forbids any person, etc., to permit the above. Section 3 
 
 forbids the discharge of •■ fine ■sand, dirt, or particles of earth or other 
 
 material."* Section I makes ii the duty of all street inspectors and 
 
 police to report violations and procure evidence and witnesses. 
 
 The Milwaukee ordinance provides thai : 
 
 ''Hereafter, before approving plans ami specifications for the erection ol anj 
 business building or factory within the limits aforesaid, it shall be the duty of the 
 
 \ew y.,rk City, Sanitarj Code (1899), Sec. 134 as amended 2 November, 1899. 
 ( hicago, Ordinances (1881), sees. 1650 and 1651. 
 Detroit, Rei ised I Ordinances 1 1895), Chapter 90. 
 ; Buffalo, Ordinances, Chapter i_. 2-'. February, 1897. 
 
216 8PM IFIi ' NUISANCES. 
 
 inspector of buildings of the City of Milwaukee to see that proper provision is 
 made in said plans and specifications to prevent the emission of dense smoke from 
 the chimney <>f said building." 1 
 
 The Minneapolis ordinance especially mentions not only the engineer 
 but the " general manager, superintendent, yardmaster, or other officer 
 of any railroad company having charge or control of the operation of 
 any locomotive " as responsible for smoke from the same. The Cleve- 
 land ordinance is somewhat different from those just referred to. It 
 was only adopted in that city after some adverse decisions under former 
 ordinances : 
 
 " Be it ordained by the council of the City of Cleveland, That whoever, as owner, 
 agent, lessee, engineer, fireman, or employe, having charge or control of, or operat- 
 ing any boat, locomotive, stationary engine or boiler, manufactory, building or 
 premises within the corporate limits of the City of Cleveland, and who shall causes 
 permit, or allow smoke containing unconsumed particles of matter commonly called 
 soot, of such density and volume as to he injurious to health or property. Ot 
 annoying to the inhabitants of said city, or any part thereof, to issue from any smoke- 
 stack or chimney of such boat, locomotive, stationary engine or boiler, manufactory, 
 building or premises, or from any smokestack or chimney connected therewith, for 
 more than ten (10) minutes in any one hour shall be deemed guilty of a misde- 
 meanor and shall upon conviction thereof be lined not less than ten dollars nor more 
 than fifty dollars for the first offense, and not less than twenty-five dollars nor more 
 than one hundred dollars for each subsequent offense."' - 
 
 The Denver ordinance authorizes the health commissioner to order 
 the abatement of the smoke nuisance whenever he finds that practicable 
 
 methods for doing so have been devised: 
 
 " Whenever in the opinion of the health commissioner, such apparatus is obtain- 
 able as may seem, after a fair trial, to be capable of effectually and economically 
 consuming or destroying smoke from chimneys or other outlets and from furnaces 
 or tires, or when any device for abolishing such smoke shall have been satisfactorily 
 established, the health commissioner shall have power to cause the abatement of 
 such smoke nuisance whenever, in his opinion, it interferes with the comfort OT 
 endangers the health of any of the inhabitants of the City of Denver." 
 
 The Kansas City ordinance is as follows: 
 
 "That dense black or thick gray smoke, issuing from any chimney, tlue. smoke- 
 stack, or from any other source within the corporate limits of Kansas City in such 
 quantities or in such manner as to be deleterious or offensive to health, or productive 
 of physical discomfort,' or as to detract from the ordinary enjoyments of life, or be 
 damaging to property, or impair the comfortable enjoyment thereof, is hereby de- 
 clared to be a nuisance. 
 
 •'That no person, firm or corporation, shall, within the corporate limits of 
 Kansas City, make, use. keep or maintain any fire in any furnace, engine or device 
 in which fires are used, kept or maintained for any purpose whatever, in such man- 
 ner as to cause dense black or thick gray smoke to issue in such quantities or in such 
 
 1 Milwaukee, Ordinance of 3 February, 1896, Sec. •".. 
 
 2 Cleveland Ordinance Xo. 20,550, Sec. 1. 
 Denver. Ordinance Xo. 44 of 1893, Sec. 149. 
 
8PE( IFK ' XI ISAX< Ks. 21 7 
 
 manner as to be deleterious or offensive to health, or productive of physical discom- 
 fort, or as to detract f rniii the ordinary enjoyment of life, or be damaging to property . 
 
 or impair the comfortable enjoyment thereof. "' 1 
 
 The Louisiana statute requires that within twelve months after 
 passage all steam plants of over ten horse-power shall provide an 
 appliance which shall consume seventy-five per cent, of the smoke. 
 
 The act for Boston is as follows: 
 
 "In the City of Boston, the emission into tin- open air of dark smoke or thick 
 
 graj S ke for more than live minutes continuously, or the emission of such smoke 
 
 during more than twenty-five per cent, of any continuous period of twenty-foui 
 hours is hereby declared a nuisance." 2 
 
 This law applies to whoever commit or suffer the same on any 
 premises owned or occupied by them mid upon anyone who in an\ way 
 participates in permitting it. 
 
 The Brooklyn act pursued a different method from any thus far 
 gi ven : 
 
 " No factory, engine room or electrical station shall use what is known as soft 
 
 coal for fuel in the furnaces of such factories, engine room or electrical stations 
 Within a radius of four miles of the City Hall in the City of Brooklyn, except for the 
 purpose of heating or welding iron or steel; any violation of this act shall subject 
 the proprietors or corporation that shall violate it to a fine of not more than one 
 hundred dollars, the same to he collected h\ the proper city authorities and placed 
 in the county treasury, and such authorities shall see that this law is enforced." 
 
 This act has recently ( L899) been sustained by the supreme court 
 in a suit brought againsi the Nassau Electric Railway Co. 
 
 The penalties tor violations of these laws are often very considerable, 
 not to exceed $250 in Buffalo, $50 in .Milwaukee. $25 per day in 
 Louisiana. #10 to $100 per week in Boston. 
 
 Smoke ordinances are of no use unless continued attention is given 
 to their enforcement, [n Chicago for a dozen years there lias been a 
 special detail of inspectors for this class of nuisances. There ai 
 inspectors at a salary of $1,000 per year : also a chief inspector. Smoke 
 
 is considered to he dense if the inspector cannot sec through it. 
 
 The great trouble reported in Chicago 4 is that the boiler capacitj oi 
 st of the plants is greatlj overtaxed. This renders rapid firing 
 
 nei essan and makes the application of consumers difficult. The 
 
 greatesl difficult} was experienced with locomotives and tow-boats; bul 
 h\ persistenl Labor in 1896, of the 1,408 locomotives entering Chioago 
 
 l.l' s l had keen equipped with smoke consumers. The child inspector. 
 
 Kansas < itj . ( Ordinance No. LO, 168. 
 Massachusetts, < lhapter 389 ot 18 
 V.uk. Chapter 322 of 1895. 
 1 Chicago, Report ot Departme i Health. 1895 6, p 
 
2 1 8 SPEC TFIC JSTl TISA N~OMS. 
 
 however, reported that no successful consumer had been devised for 
 marine engines. This form of smoke producer is especially annoying 
 in Chicago where the river passes through such a crowded part of the 
 city. 
 
 Cincinnati is another city which has given much attention to the 
 abatement of the smoke nuisance. This work is in that city in the 
 hands of the city engineer. A special report published by him in 1893 
 stated that the previous year, the first of the enforcement of the law, 
 was chiefly devoted to litigation. The regularity with which offenders 
 were convicted soon produced a spirit of compliance and smoke pre" 
 venting methods were rapidly adopted. No smoke consuming device is 
 recommended, but the law is enforced and owners of boilers have to 
 select their own methods of prevention. 
 
 The following recommendations are printed in a circular issued by 
 the engineer: 
 
 "1. Have a hot fire. Give the gas sufficient space and time to burn before the 
 fire is below a red heat. 
 
 "2. Fire in small quantities over one part of the grate at a time. The other 
 parts should be closely watched and promptly attended to. 
 
 L ' 3. Keep a clean fire all the time. Never keep a set of bare grate-bars in ser- 
 vice that are warped and burned, because the air-spaces become closed. Keep the 
 side walls of furnace in good repair, ash-pit free from ashes, and bridge-wall clean 
 and in repair. Do not permit deposits to accumulate back of the bridge-wall. 
 
 • ; 4. ' Clean Hues or tubes at least once each day. 
 
 "5. Do not delay if draught is not good, but attend to it immediately, as good 
 draught is important in attaining good combustion." 
 
 In Cleveland the smoke ordinance was first adopted in 1893. One 
 hundred and twenty notices to abate the nuisance were issued and mostly 
 complied with. The health officer reported that the manufacturers were 
 overrun with agents for smoke consumers. The market was flooded with 
 numberless contrivances, most of them worthless. Mechanical stokers 
 were largely introduced and found very satisfactory. In some cases the 
 evaporation was raised from six and one-half to ten and one-half pounds 
 of water per pound of coal. 1 In January, 1895, a court decision declared 
 the law unconstitutional, and an appeal was made to the legislature for 
 authority to declare what is a nuisance, and a new ordinance was adopted 
 in September, 1896, and the health officer at once proceeded to enforce 
 it. Again, in 1897, the ordinance was thrown out as unconstitutional, 
 and the present ordinance, which was given on another page, was 
 adopted. 
 
 All of the cities hitherto referred to have attempted to get rid of the 
 smoke nuisance by encouraging the use of some so called smoke con- 
 
 1 Cleveland, Report of Health Division (1895), p. 7. 
 
spK< IFK ' NT/ISA m /:s. 2 1 9 
 
 suniing or smoke preventing device. In 1894 the New York City 
 board of health caused a systematic inspection to be made of all places 
 within the city limits where coal was used for steaming purposes. It 
 was found that while the majority who used bituminous coal were offend- 
 ers, yet some who used this coal produced little smoke, although they 
 did not use smoke consuming devices. The engineers of these firms 
 were able to so manage their fires as to wholly consume their fuel. 
 The engineer was made to burn all his coal or leave: 
 
 ■■ An examination of the method of firing by which all the bituminous coal was 
 consumed was made. The fireman shoveled the coal into the front of the fire-box, 
 w here he left it for a short time. Here the more volatile gases were driven off and 
 the dense smoke resulting from the firsl combustion was produced. The gases and 
 the smoke had then to i>ass over the bed of live coals, extending to the l ire- wall, and 
 in this passage to meet the fresh air coming up from the ash-pit through the grate- 
 bars As a result, the inflammable gases and the smoke were wholly consumed. 
 The fireman then opened the door, and with his rake moved the now glowing coals 
 hack toward the fire-wall and once more shoveled fresh coal to the front of the lire- 
 box, where the process was repeated. This method of firing made the fireman 
 work harder and tire more frequently, bul with it every particle of the coal was 
 consumed, and neither the dense smoke nor the "blacks' 1 were produced from the 
 stack." ' 
 
 The board of health, through its inspectors, urged this method of 
 smoke prevention in preference to the use of "preventers," and it is 
 claimed met usually with a favorable reception. It is said that the 
 majority of plants in New York City now emil little smoke. .More 
 trouble was found in dealing with the planing nulls and other establish- 
 ments burning shavings and sawdust. Smoke will arise from such even 
 with the most careful firing. 
 
 In St. Louis, of 2,453 boilers in 1896 7 there were only 1:23 not 
 provided with smoke consumers, and these were mostly low pressure 
 boilers used for beating. 
 
 ■New Fork, Report of Board of Health (1894), p. 58. 
 
CHAPTER V. 
 
 PLUMBING. 
 
 THE municipal control of plumbing in the United States dates back less 
 than twenty years. This control was urged primarily by boards of 
 health or persons interested in sanitation, and therefore the enforcement 
 of the earlier plumbing rules was entrusted to the local sanitary author- 
 ities. While it would be more logical to vest this function in another 
 department, that of the inspection of buildings, the earlier practice has 
 been adhered to, and at present the control of plumbing is in most cities 
 in the hands of the health department. This custom is doubtless due 
 both to precedent and to the popular notion of the very intimate con- 
 nection between poor plumbing and disease. Of over one hundred 
 cities which have plumbing rules, in all but about twenty they are 
 administered by the health department. 
 
 ( )f all the important cities considered, only the following have no 
 plumbing code or inspection: Augusta, (la., Bridgeport, Concord. 
 Dayton, Evansville, Indianapolis, Louisville, Macon, New Orleans, 
 and Wheeling. 
 
 A few cities, as Lowell, Mass., 1 in 1878, Providence, 2 1878, and St. 
 Louis, 3 in 1880, had some simple plumbing regulations, but the first 
 complete plumbing codes were adopted in 1881. During that year sets 
 of plumbing rules were adopted by Lawrence, Mass., District of Colum- 
 bia, Brooklyn, and probably Chicago. The first of these adopted were 
 those of Lawrence, 22 July, 1881. 4 
 
 Some of the plumbing codes were adopted in pursuance of statutes 
 enacted for this purpose. The first of these acts was Chapter 133 of 
 the Massachusetts laws of 1877, and the act of 30 May, 1881, of Illi- 
 nois, empowered cities of over 50,000 to regulate their plumbing and 
 drainage. By the act of 4 June, 1881, of New York, the cities of New r 
 York and Brooklyn were authorized to adopt plumbing rules. Most of 
 the plumbing codes have, however, been adopted under the general 
 
 i Report of Board of Health (1878), p. 7. 
 
 - Rhode Island, Public Laws, Chapter G88, Sec. 28. 
 
 3 Sanitary Engineer (1880), p. 85. 
 
 i 6th Report of Lawrence Board of Health. 
 
PLUMBING. 221 
 
 statutory provisions which confer power on local governments to legis- 
 late on sanitary affairs. Some of the Massachusetts cities, as Lowell, 
 Lawrence, and New Bedford, adopt their plumbing rides under Public 
 Statutes. Chapter 80, Section 18, which authorizes a hoard of health to 
 ••make such regulations as it judges necessary for the public health and 
 safety." In .Maine they are adopted as by-laws "necessary and proper 
 for the preservation of life and health." In New Hampshire plumbing 
 rules are made in pursuance of the statute, which authorizes the health 
 officers to make rules such "as the health and safety of the people may 
 require." In Baltimore plumbing rules are adopted as " necessary for 
 the preservation of the health of the city." 
 
 Although it appears to he perfectly competent lor cities to regulate 
 plumbing under such general provisions, nevertheless, there have been 
 quite a number of acts, both special and general, conferring this power, 
 and in several instances the local regulations are made a part of the 
 legislative act. Tims the plumbing of Boston 1 and Cincinnati 2 is con- 
 trolled directly by statute, and Albany, Brooklyn, Detroit. New York. 
 Pawtucket, and Providence adopted plumbing rules in accordance with 
 special acts. At the present time the following states have laws which 
 provide tor the local control of plumbing: California, 3 Illinois forcities 
 of over .",0.000. ' Massachusetts."' New Jersey, 6 New York, 7 Ohio, 8 
 Pennsylvania, 9 South Carolina, 10 Washington, 11 and Wisconsin. 1 - The 
 following is the Massachusetts law: 
 
 ■ Each city and town of five thousand inhabitants or more in this Commonwealth, 
 ;m<l every town having a system of water supply or sewerage, shall by ordinance or 
 by-law, within six months from the passage of this net prescribe rules and regula- 
 tions t'"i tin' materials, construction, alteration, and inspection of pipes, tanks. 
 faucets, calves, and other fixtures by and through which waste water or sewage is 
 used and carried, and provide thai no such pipes, tanks, faucets, valves, or other 
 fixtures shall be placed in any building in such city or town excepl in accordance 
 with [dans which shall be approved by the in. aid of health of such city or town, or 
 
 1 Massachusetts, Chapter 119 of 1892. 
 
 -ohio. Annotated Statutes (1900), Sees. 25751 53) to I L23). 
 i lalifornia, Chapter 1 I of 1885. 
 
 1 Illinois, Annotated Statutes 1 1896), Sec. - 
 
 ■ Massachusetts, Chapter 177 of 1893, Sec. 6. 
 
 ■ w Jersey, General Statutes (1895), pp. 1642, Sec. 39, 1643 
 49 (XI). 
 
 Now York. Revised Statutes (1895), p. 135. 
 Ohio, Annotated Statutes (1900), Sec. 1238 I 10). 
 1 Pennsylvania, Chapter 186 of 1895, and Chapter 133 of i - 
 it h ( larolina, \<\ of 5 Januarj . L895, Sec. 3. 
 1 ' Washington, ( ode i 1899) Si i s. 1248 54. 
 
 Wisconsin, Statutes (1898) Sees. 959 ( 23) < 59), 1418a. 
 
222 PLC MB IN '(,. 
 
 such person or persons as said board of health may designate; and shall further pro- 
 vide that lid plumbing work shall be done except in the case of repair of leaks, with- 
 out a permit being first issued therefor upon such terms and conditions as such city 
 and town shall prescribe. The provisions of this section shall not apply to the city 
 of Boston or to any officer or board thereof." l 
 
 \\\ New Jersey all local boards of health, except township boards, 
 have a similar power, and township boards also when there is a public 
 water supply, but this statute is permissive, not mandatory. In New 
 York there must be established in cities an examining board for 
 plumbers, and this board may formulate in conjunction with the local 
 boards of health a code of plumbing rules. In Ohio the boards of health 
 of cities of 5,000 or of those having a water supply, shall make a plumb- 
 ing code which shall be approved by the council. The remaining state 
 laws present no Aery different features. In Pennsylvania the law is 
 mandatory, but is not to apply to cities or boroughs having no public- 
 water supply or system of sewerage. 
 
 Plumbing (Odes. 
 
 In accordance with the various statutory provisions, plumbing regu- 
 lations have been adopted in almost all the larger cities of the United 
 States, and also in very many of the smaller cities, towns, and villages 
 which are provided with a sewerage system. The intention in the fol- 
 lowing pages is to present a summary of the local regulations govern- 
 ing plumbing and drainage. The first rule printed under each heading 
 may be considered to lie typical of the majority of cities or of the codes 
 most recently adopted. In a general way it may be affirmed that small 
 towns and villages do not appear to need as elaborate a set of rules as 
 larger places ; but of communities that have attained the size of 20,000 
 or over there does not seem to be much difference in the character of 
 the rules adopted, except that in almost all cases the most recent rules 
 are the most stringent and complete. Some of the state boards of health 
 have issued model plumbing laws applicable to the smaller places which 
 may not lie able, through their local boards, to give the subject the study 
 required to formulate a good set of rules. 
 
 The following are issued by the state board of health of Maine: 
 
 "• 1. — Before proceeding to construct any portion of the drainage system of a 
 building, the owner, builder, or person constructing the same shall hie with the 
 hoard of health a plan thereof showing the whole drainage system, from its connec- 
 tion with the common sewer to its terminus in the house, together with the location 
 and sizes of all branches, traps, ventilating pipes and fixtures; and no such work 
 shall be done in any building without the approval of said Board of Health (Health 
 < >fficer or Inspector). 
 
 2. — Tlie sewage from each building on every street provided with a common sewer 
 shall be conducted into said se^er; and, if such sewer is not provided, the sewage 
 
 : Massachusetts, Chapter 477 of 1893, Sec. 6. 
 
PLUMBING. 223 
 
 shall be disposed of in a manner satisfactory to the Board of Health i Health Officer 
 or Inspector). 
 
 "3. — That portion <>f the house drain which is outside of the building and more 
 than five feet from the foundation walls shall be constructed of iron pipe or sail 
 glazed vitrified dram pipe. 
 
 ■•4. — That portion -of the drain-pipe within the building, and outside within five 
 feet of the foundation walls, together with the soil pipe, shall he constructed oi 
 cast iron with leaded joints, or of wrought iron with screw couplings. The waste 
 pipe connected with the conductors from the roofs and other pipes inside the build- 
 ing, or outside and within live feet of the foundation walls, shall he constructed of 
 iron with leaded joints, or screw couplings. 
 
 ■• .">. — The house drain and other pipes for the conveyance of sewage shall he laid 
 with uniform grade and with a fall of not less than one inch in four feet, except in 
 those eases where the Board of Health may permit otherwise. 
 
 •• 'i. — Tin' main bouse drain shall he provided with a trap, which shall he located 
 just outside.,]' just inside the house walls and beyond all house connections. All 
 pipes connecting a water-closet with a soil pipe shall he trapped, each separately, 
 ami close to the connection with each water-closet. All waste pipes shall be trapped, 
 ea<-h separately, and eh.se to the connections with each bath, sink, bowl, set of tubs, 
 or other fixture. 
 
 •• T — All soil pipes shall he carried to their full size through ami at least two feet 
 above the roof and left open. A. provision shall also he made for admitting air to 
 the house-drain side of the main trap. 
 
 "8 -The joints in the vitrified pipe shall be carefully cemented under and around 
 the pipe, and the joints in the cast-iron pipe shall he run ami calked with lead. Con- 
 nection of lead pipes with iron pipes shall he made with brass ferules properly 
 soldered and calked to the iron. 
 
 11 9- A.11 changes in direction shall be made with curved pipes, and all connections 
 shall be made with V branch pipes. All joints and pipes shall be made air-tight. 
 The whole work shall be done by skillful mechanics in a thorough and workmanlike 
 ma line!-, and sat isfactorihj i" t he Board of Health (Health Officer or Inspector). 
 
 " 10. — All drains now built shall be reconstructed, whenever in the opinion of 
 tlie Board of Health it may be necessary. 
 
 The state board of health of Connecticut litis formulated a some- 
 what more elaborate code which may be found mi page 298 id' their 
 
 report for 1894. New Jersej has a del code for which sec state 
 
 board of health circular L.W. Pennsylvania and Ohio also liav< 
 of mode] rules. 
 
 The following is u summary of the plumbing regulations of the more 
 important cities : 
 PI, his ,i ,nl Spt cification%. 
 
 ■' Before the construction, reconstruction, alterati ■ repair (excepl as herein 
 
 after providi d) of anj portion of the plumbing and drainage system of anj bunding, 
 suitable plans of all work proposed to be done shall be filed at the office of the 
 • inissioner of Health bj the architect, or by the owner or agenl of the property." : 
 
 The builder or other dul} authorized person, or plumber, or ever} 
 person doing plumbing work, are occasionally named and sometin 
 
 Brook l\ n. Sec. I. 
 This chaptei was written before Brooklyn became a pari ol Ne\> \->ik. and al that timi 
 plumbing code ol l". klyn u.i of the mosl i plete. 
 
224 PLUMBING. 
 
 is not specified who shall file plans, but the requirement is impersonal, 
 " plans shall be filed." 
 
 Plans and Drawings. 
 
 " For the best interests of all parties concerned, the architects are required to 
 notify the inspector of plumbing, whenever they have any plans completed for 
 buildings to be erected in the city, so that the inspector may examine the plans and 
 approve or alter them before the plumbers figure on the plumbing work." l 
 
 " Plans will not be required in cases of removal of stoppages, repairs of leaks, and 
 repairs of broken fixtures, tanks, kitchen boilers or faucets.' 2 
 
 " Plumbing work which does not add additional fixtures or cause the entire 
 renewal or remodeling of any soil or waste pipes or changing of the system of using 
 such pipes shall be considered a repair." 3 
 
 Such arc exempt from the requirement of plans. In Somerville the 
 work which requires plans and is subject to the provisions of the rnles 
 is more exactly defined : 
 
 tl The rules and regulations in this ordinance contained are prescribed for the 
 materials, construction, alteration and inspection of all pipes, fittings, tanks, faucets? 
 valves, and other fixtures by and through which waste water or sewage is used and 
 carried, and no such pipes, tanks, faucets, valves, materials, or other fixtures shall 
 be placed in any building in this city except in accordance with plans which shall 
 before such placing of any such fixtures be submitted to and approved by the inspec- 
 tor of buildings, and which shall conform to the provisions of this ordinance." 4 
 
 " Where a number of buildings are situated together on one street, and the 
 plumbing is the same in each and to be done under the same contract, one plan will 
 be permitted for all the buildings. In such case a general plan must be submitted, 
 showing all the houses, and the location of the main drain for each house." 5 
 
 In Asbury Park the "plans and drawings shall be drawn to scale in 
 ink on cloth, or they must be cloth prints of such scale drawings." The 
 Albany rule requires that the drawings shall be of a uniform size, 
 8 x 12} inches, or 16 x 12} inches. 
 
 " Drawings and descriptions of the drainage of buildings erected prior to 1886 
 may be placed on file in the office of the Board of Health. 
 
 " When the drainage of buildings erected prior to 1886 lias been inspected and 
 condemned, plans must be filed, and the new work or alterations shall be executed 
 in accordance with these rules and regulations."" 
 
 In the City of New York and a few other cities, actual plans drawn 
 to scale are required and are kept on file. In many others, perhaps in 
 the majority of cities, the inspectors claim that the requirement of such 
 
 1 Milwaukee, Sec. 5. 
 - Brooklyn, Sec. •'!. 
 :i Cincinnati, Sec. 48. 
 
 4 Somerville, Sec. 10. 
 
 5 Brooklyn, Sec. 4. 
 
 6 Philadelphia, Rules 5 and 7. 
 
plumb IX a. 225 
 
 plans is an unnecessary hardship, and that the inspector can understand 
 the essentials of the scheme perfectly well without them. Moreover, 
 it is claimed that even with the best plans slight deviations will be made 
 in the arrangement of pipes so that for purposes of future reference 
 such plans have much less value than was hoped for. Hence in many 
 cities, even where plans are called for by the rules, the letter of the 
 rule is not enforced and specifications only are required. 
 
 In Appendix 39 is shown the form of specification, or rather 
 description, which is one of the simplest, and is used in Denver. The 
 more elaborate Providence specification also is shown in Appendix 40. 
 In other cities the printed specifications provided for the use of plumbers 
 are much more complete. In Asbury Park a pamphlet four by eight 
 inches of forty pages is provided with much printed description of the 
 plumbing, specifying construction in accordance with the city regula- 
 tions and leaving few blanks to be filled by the plumber. All of these 
 plans and specifications have spaces for the approval of the inspector or 
 other officer. 
 
 Approval of Plans and Permits. 
 
 •• Plans and specifications will be approved or rejected within a reasonable time 
 from the date of riling. In case of disapproval, the one filing the plan will be noti- 
 fied, in writing, of the reasons for such disapproval. 1 ' i 
 
 The time for approval or disapproval is often fixed, from twenty-four 
 hours in Pittsburgh to ten days in Philadelphia. Usually it is forty- 
 eight hours. 
 
 "If the work is not begun under the approved plans within sis months from the 
 date of approval, such plans must be again presented for approval. Plans are ap- 
 proved miller the condition that such approval expires by its own limitations within 
 ■ix months from the date of approval; and where one plan has been submitted Eor 
 
 inure than one building, this rule shall apply as to each of s;iiil buildings as it s;iiil 
 plan had been tiled for Mich building only. 
 
 ■ No change or modification of the approved plans will lie permitted unless such 
 change or modification be authorized by the owner or agent, submitted to the 
 Commissioner of Health and approved and placed on file as in the case of original 
 
 work. 
 
 •• \o portion of i he plumbing or drainage work shall he executed until the a hove 
 mentioned plans and description thereof shall bave been approved bj the Commis- 
 sioner of I halt li." -' 
 
 Besides the approval endorsed on the plans and specifications, a 
 
 notice of approval or a permit fur work is issued in many cities, and in 
 some .iiies a lee is charged for these. The lee varies from lift\ cents 
 
 in Sun Francisco to two dollars in New Jersey cities. In Philadelphia 
 tin- ire is uiie dollar, and, owing to the Large number of plans of old 
 plumbing filed, the department is self-sustaining, 813,756 having been 
 
 1 Brooklyn, See. 6. 
 
 x Brook Ij n. Sims. 8, 0, and 7. 
 16 
 
226 PLUMBING. 
 
 received in 1899. In Providence the "approval" is in the form of a 
 postal which is mailed to the plumber. 
 
 Some system must be followed in the inspector's office in keeping 
 run of the work. In Providence all plans of work in course of con- 
 struction are kept in a cabinet indexed under the name of vlie plumber. 
 When the work is completed the plans and all other papers are filed 
 numerically. Besides this four record books are kept. In the first 
 book the plans are entered consecutively, numbered, with name of street, 
 name of plumber, dates of filing, approval or rejection of plan, applica- 
 tion for inspections, and inspection, page of street index, and remarks. 
 A second book is simply a street index. In a third book is recorded 
 the daily work of the office in inspections, etc. In the last book the 
 description and application with endorsement are entered as a permanent 
 record. 
 Materials and Workmanship. 
 
 "All materials used in the work of plumbing and drainage must be of good 
 quality and free from defects; the work must be executed in a thorough and work- 
 manlike manner." x 
 
 Deviation from Mules Permitted. 
 
 " Deviations and variations from these rules will be allowed when desired if in 
 the opinion of the board of health they will not be or be liable to become, a source 
 of danger to the public health." 2 
 
 In the District of Columbia, Section 15, such permission may only 
 be given in writing. 
 
 " The plumbing inspector shall use his discretion and his decision shall be final in 
 regard to work in old and new buildings which cannot be governed by the rules." 3 
 
 In Somerville, Mass., deviations are not allowed in buildings to be 
 used as dwellings or places of business. 
 
 Connection with Sewer. 
 
 11 Every house and building must be separately and independently connected 
 with the street sewer, except in cases where there may be a house in the rear of 
 the lot where it may be connected with the sewer of the house in front. A house 
 or building shall be defined as an architectural structure covered by one roof and 
 enclosing walls. 
 
 " Porches or the continuation of porch roofs from building to building shall not 
 be considered as a portion of the main structure." 4 
 
 11 Every building provided with water from the city or other water supply shall 
 have a waste pipe, for the conveyance of waste water and sewage, connected with 
 the public sewer or with a particular sewer, or, if there is no such sewer, with a 
 cesspool, constructed as aforesaid as the inspector of buildings or board of health 
 shall require. No drain or sewer from any building shall, without the approval of 
 the inspector of buildings, pass under another building." 5 
 
 1 Brooklyn, Sec. 14. 
 
 2 Hartford, Sec. 49. 
 * Cleveland, Sec. 27. 
 
 4 San Francisco, Sec. 4. 
 
 5 Somerville, Mass., Sec. 13. 
 
PLUMBING. 
 
 227 
 
 In Portland and Reading a separate connection must be made if 
 feasible. In Scranton, in case there are two buildings on one lot, a 
 single sewer connection may be allowed if there is a separate trap and 
 fresh air inlet for each building. In Somerville, Mass.. "a block of two 
 houses may be connected with the public sewer through one pipe, con- 
 nections being made five feet outside of the building." 
 
 The control of the drain in the street to the lot or curb line is 
 usually in the hands of the department which builds and maintains the 
 sewers, and as this is rarely the health department, and as the regula- 
 tions governing this work are not often found in plumbing codes, they 
 will not here be considered. 
 § .. of Drain. 
 
 11 House sewers shall be of not less than the following sizes, and no sewer shall 
 lie smaller than the soil-pipe it serves: 
 
 When fall is \ inch 
 to a foot. 
 
 When fall is 4 inch 
 to a foot. 
 
 Area of Li A 
 
 to hf 
 Drained. 
 
 Size of 
 
 Sewer. 
 
 Area of Lot 
 
 to 111' 
 
 Drained. 
 
 size of 
 s.'\ver. 
 
 2,000 sq. ft. 
 
 3,000 
 
 5,000 
 
 4 inches. 
 
 •>;. 500 sq. ft. 
 
 4,500 
 
 7. •■.mi " 
 
 4 inches. 
 6 
 
 •• No house sewer shall be larger than six indies in diameter. Where the area to 
 in- drained is larger than given in the table, several sewer connections shall lie 
 used." ' 
 
 • Each house sewer shall consist of a separate drain pipe of iron or vitrified 
 
 stone ware of the size specified in the following table for the various a leas, the total 
 area of the lol to he drained being taken to determine the size uf the house sewer: 
 
 -i/i or BOUSE -i:v\ I a;. 
 
 Area 
 
 Inside diameter of 
 
 Least fall. 
 
 to be drained. 
 
 house sew er. 
 
 
 Square feet. 
 
 1 loll. 
 
 Vitrified Pipe. 
 
 
 loo to 2,500 
 
 4" 
 
 
 1 " III lo 
 
 ■_',". 1,1 
 
 ;," 
 
 :," 
 
 1" in 1- 
 
 i.oi 10,000 
 
 r," 
 
 
 1 " Mi 
 
 11 No house sewer greatei than six inches inside diameter shall be allowed with- 
 i, ut the written approval of the superintendent "i sewers. 11 • 
 
 1 Brooklyn, Sec. 16. 
 
 2 Districl of Columbia. Sec. To. 
 
228 PLUMBING. 
 
 Other cities, as Buffalo, Cleveland, Lawrence, and Portland, Me., 
 make six inches a minimum instead of a maximum limit, except that in 
 Cleveland it may be four inches if there are no water-closets. In Hart- 
 ford, Lawrence, and New Bedford the minimum limit is five inches. In 
 Philadelphia the maximum limit is ten inches. Four inches is invari- 
 ably the minimum limit and it is also sometimes specified that it shall 
 not be smaller than the soil pipe which it serves. In Lawrence it must 
 be one inch larger. In New York City the diameter is to be such as 
 the board of health may approve. 
 
 Material and Construction of Drain. 
 
 In most regulations a tile drain is permitted up to within a short 
 
 distance of the house, but in some cities this is not allowable except 
 
 under certain conditions : 
 
 " Where the ground is made or filled in, the house sewer, by which is meant the 
 portion of the drain extending from the public sewer to the front wall, must be of 
 extra heavy iron pipe of such diameter as the Board of Health may approve. Such 
 pipes must be laid with the joints properly caulked with lead." 1 
 
 In Albany the drain must be iron if the land has been filled within 
 
 five years. 
 
 " Sewer pipes in yards may be of the best quality vitrified pipe, with cemented 
 joints, with the following restrictions: They shall not be laid closer than ten feet 
 to any exterior wall of a building, or less than three feet below the surface of the 
 ground, or when the sewer passes near a well, nor will they be allowed in bad or 
 made ground. In all other cases sewers beneath the ground must be of extra heavy 
 cast iron pipe." ' 2 
 
 111 New York City and Rochester it is permitted to lay the tile drain 
 up to the foundation wall, but in most rules, as in Brooklyn above, it 
 must not lie laid within a certain distance of the house. This distance 
 is two feet in Bridgeport and Fall River, three feet in Providence and 
 San Francisco, four feet in Scranton, five feet in Lawrence, New Bed- 
 ford, the District of Columbia, and Philadelphia, six feet in the large 
 New Jersey cities, all of which have a similar code, and ten feet in Somer- 
 ville and Brooklyn. In Milwaukee the drain must be iron if less than 
 eighteen inches below the surface of the ground. In the District of 
 ( olmnbia tile pipe can only be used if connection is made towards the 
 rear. 
 
 Most cities require extra heavy iron pipe within the cellar walls, but 
 sometimes, as in Providence and Cincinnati, tile is allowed under certain 
 conditions. In Cincinnati it may be used when the soil is a natural 
 bed of loam, sand or rock, and in Providence the joints must be made 
 to withstand the water test. The manner of laying is well specified in 
 Pittsburgh, Sec. 10 : 
 
 1 City of Xew York, Sec. 9. 
 
 2 Brooklyn, Sec. 17. 
 
PLUMBING. 229 
 
 ' Outside of building, where the ground is of sufficient solidity for a proper 
 foundation, cylindrical terra-cotta pipe of the best quality, free from tiaws, splits or 
 cracks, perfectly burned and well glazed over the entire inner and outer surfaces, 
 may be used if laid on a smooth bottom with a special groove cut in the bottom of 
 the trench for each hub, in order to give the pipe a solid bearing on irs entire length, 
 and the soil well rammed on each side of the pipe. The spigot and hub ends shall 
 be concentric. The space between the hub and the pipe must be thoroughly filled 
 •with cement mortar, made of equal parts of the best American natural cement and 
 bar sand, thoroughly mixed dry and enough water afterward added to give it 
 proper consistency. The mortar must be mixed in small quantities and used as soon 
 as made. 
 
 "The joints must be carefully wiped out and pointed, and all mortar that may 
 be lefc inside removed, and the pipe left clean and smooth throughout, for which 
 purpose a swab must be used.'" 
 
 In Albany the drains must be laid with the hub end up hill. In 
 
 Asbury Park the drain must he laid on hoards six inches by one inch, 
 
 or if over eight inches in diameter, the plank must be six inches by two 
 
 inches. In Milwaukee " hack filling is to be first hand packed with 
 
 care and then well rammed to prevent the slightest setting of the drain."' 
 
 In Lawrence a drain cannot he laid in the same trench as a sewer or 
 
 water pipe or within four feet of the line of the same. In Milwaukee 
 
 the distance is eighteen inches. 
 
 ■■ Old sewers or In, use drains can lie used for new houses only when found h\ ;m 
 Inspector of this Department to conform in all respects to the regulations governing 
 new sewers and drains."" l 
 
 Soil 'im/ Waste Pipes, Size. 
 
 Soil pipes are never to he less than four inches in diameter. In 
 Lawrence, if there are four water-closets, and in New Bedford, if three 
 or more closets discharge into it, the soil pipe must lie five inches in 
 diameter. 
 
 ■■ In all buildings having three (3) stories the diameter of vertical s..il pipes shall 
 in- one (1) inch greater from a point one (1) foot below the roof than that of the 
 pipe proper, and the increased size of pipe shall continue through ami above the 
 roof. 
 
 •In buildings having more than three (.".(stories, vertical soil pipes shall be 
 Increased one (1) inch in diameter at each twenty-five (25) feel oi elevation above 
 the third story." - 
 
 •■ Traps ami branch waste pipes shall he ..t' t lie following si/.es : 
 
 For lias iiis and pant ry sinks 1 '. inches. 
 
 Slop sinks :l " 
 
 Kitchen sinks 1 or 2 
 
 Ba1 b tubs it. or 2 
 
 Crinals I or 'J 
 
 Laundry tuhs l : . or 2 
 
 Water-closets t 
 
 1 Citj Of New York. See. 17. 
 
 I >is1 rid of < Jolumbia, Sec. 88. 
 • Brooklyn, Sec. 86. 
 
230 PLUMBING. 
 
 In Scranton and Reading one and one-quarter inches is allowed for 
 basins, pantry, and kitchen sinks. In Hartford basins may have one 
 and one-quarter inch pipes. In Lawrence it is specified that these are 
 inside measurements, and pipe must be gauged by the plumbing inspec- 
 tor. In Cleveland a stack for wastes must never be less than two 
 inches. In Hartford two fixtures require a one and one-half inch pipe. 
 In Haverhill and New Bedford two fixtures require a two-inch pipe, 
 and in Fitchburg two to six fixtures a two-inch pipe, and over six fix- 
 tures a three-inch waste pipe. In the New Jersey cities five sinks 
 require a three-inch pipe. In Brooklyn eight fixtures require a three- 
 inch pipe, three to seven fixtures a two-inch pipe, and three fixtures 
 one and a-half inch pipe. In New Bedford and Hartford horizontal 
 waste pipes for sinks must be three inches in diameter. 
 
 Soil and Waste Pipes, Material. 
 
 "Sewer pipes above the ground and all soil, waste, and vent pipes sliall be of 
 extra heavy cast iron or heavy wrought iron or steel pipe. Wrought iron pipe shall 
 be asphalted, galvanized or otherwise made rustless. Lead pipes will be allowed 
 only in short lengths and when they are exposed to view. If nickel-plated or 
 polished brass pipes are used, they shall be of iron-pipe size and of heavy pipe. No 
 brass pipe less than fa of an inch in thickness will be allowed.' 1 l 
 
 "All drain and anti-syphon pipes of cast-iron shall be sound, free from holes, 
 and of a uniform thickness, and shall conform to the following relative weights: 
 
 
 Standard. 
 
 
 
 Extra Heavy. 
 
 
 2 inch 
 
 pipe 
 
 4 lbs. 
 
 per foot. 
 
 2 
 
 incl 
 
 i pipe 
 
 5i lbs. 
 
 per 
 
 foot. 
 
 3 " 
 
 " 
 
 6 " 
 
 " 
 
 b 
 
 " 
 
 " 
 
 91 " 
 
 
 " 
 
 4 " 
 
 " 
 
 9 " 
 
 I I 
 
 4 
 
 " 
 
 ' l 
 
 13 tl 
 
 
 " 
 
 5 " 
 
 " 
 
 12 " 
 
 " 
 
 5 
 
 " 
 
 11 
 
 17 " 
 
 
 tl 
 
 6 lt 
 
 " 
 
 15 " 
 
 " 
 
 6 
 
 lb 
 
 " 
 
 20 " 
 
 
 " 
 
 7 " 
 
 " 
 
 20 " 
 
 " 
 
 7 
 
 " 
 
 " 
 
 27 " 
 
 
 l ' 
 
 8 " 
 " 
 
 it 
 
 25 " 
 35 " 
 
 tt 
 
 8 
 10 
 
 L 
 
 tt 
 
 33* lt 
 45 " 
 
 
 ' 
 
 2 " 
 
 " 
 
 45 tl 
 
 lt 
 
 12 
 
 " 
 
 " 
 
 54 " 
 
 
 tt 2 
 
 Ordinary iron soil pipe is permitted in place of the extra heavy 
 under certain conditions in many cities. Thus in Providence, Somer- 
 ville, New Haven, and Philadelphia, only soil pipe below ground need 
 be extra heavy. In Cleveland and San Francisco extra heavy is required 
 in buildings of over four stories. In Manchester, N. H., soil pipes carry- 
 ing discharges from water-closets must be extra heavy. In Cleveland 
 and Providence the thickness of standard ordinary pipe is specified, 
 four-inch pipe one-eighth of an inch thick, five to six-inch pipe five- 
 thirty-seconds of an inch thick, and a proportional thickness for greater 
 diameters. 
 
 1 Brooklyn, Sec. 25. 
 a Philadelphia, Rule 23. 
 
PLUMBING. 231 
 
 "All wrought-iron and steel pipe must be equal in quality to "standard,' 1 and be 
 properly tested by tbe manufacturer. All sucb pipe must be lap-welded, and shall 
 be galvanized. Xu plain black pipe will be permitted. Each length of said pipe 
 shall have the weight per foot and maker's name stamped upon it. Fittings for 
 wrought iron or steel vent pipes may be cast or malleable steam and water fittings. 
 Fittings for waste or soil pipes must be the special, extra heavy cast-iron recessed 
 and threaded drainage fittings, with smooth interior water-way, so as to give a uni- 
 form grade to branch of not less than one-quarter of an inch per foot. All joints 
 shall be screwed joints, made up with red lead, and the burr formed in cutting must 
 be carefully reamed out. The pipe shall not be less than the following average 
 thicknesses and weight per lineal foot: 
 
 Weight per 
 Diameters. Thicknesses. lineal foot. 
 \\ inches .14 inches 2.68 pounds 
 
 2 inches .15 inches 3.61 pounds 
 2£ inches .20 inches 5.74 pounds 
 
 3 inches .21 inches T..")4 pounds 
 34 inches .22 inches 9.00 pounds 
 
 4 inches .23 inches 10.66 pounds 
 44 inches .24 inches 12.34 pounds 
 
 5 inches .25 inches l-t.r><i pounds 
 
 6 inches .28 inches 18.76 pounds l 
 
 In Detroit "wrought iron or steel pipe of one and a half inch or 
 more in diameter must be but-welded and smaller sizes lap-welded." 
 
 "All cast-iron pipe used shall have cast upon it, directly back of the hub of each 
 section, the weight per lineal foot and the name of the manufacturer, in characters 
 not less than one-half (i) inch in length. 1 ' 2 
 
 Iii Philadelphia considerable pipe lias recently been found which was 
 of less weight than indicated by the figures upon it. 
 
 The question of tarring cast-iron pipe is treated differently in differ- 
 ent cities. Often, as above, it is merely required that iron pipe shall be 
 asphalted or tarred. In Cincinnati, Milwaukee, Providence, and Roches- 
 ter the pipe niiisi be tarred before putting up: 
 
 "Cast-iron soil, waste, or vent pipes before being put in place shall be coated 
 
 inside and out with coal-tar pitch applied hot." 
 
 ■ I ion pipes used in plumbing shall, before being put iii place, be first tested by 
 
 the water or kerosene test and tlien coated inside and out witb coal-tar pitch applied 
 
 hot, or with paint, or with some equivalent substance.' 1 ' 
 
 There is a similar rule in the District of Columbia and Baltimore. 
 Iii New York city and Asluirv Park, on the other band, no tar- 
 coated cast-iron pipe is allowed. 
 
 1 Asbury Park, Sec. 31. 
 
 a I )| }| lict oi < 'olumbia, See. 1 10. 
 
 Proi idence, Sec. 7. 
 • Boston, Sec. 127. 
 
232 PLUMBING. 
 
 Metal pipes are not always admissible, hence in Providence : 
 
 " Soil and waste-pipes and their branches shall be of iron, lead, or brass, except 
 in manufacturing establishments where acids are used, in which case such material 
 shall be used as shall be approved by said inspector. 1 " 1 
 
 In the City of New York all fittings used with iron pipe " shall cor- 
 respond with it in weight and quality." 
 
 "All lead pipes, bends, and traps must be drawn and of not less than the follow- 
 ing weights per lineal foot: 
 
 1^ inches 3+ pounds 
 
 2 " 5 
 
 3 " (5 " 
 
 4 " 8 " a 
 
 In Hartford and Providence one and one-half inch pipe may weigh 
 three pounds, and in New York City and Scranton two-inch pipe may 
 weigh four pounds. 
 
 "All brass pipe for waste and vent pipes and solder nipples must be thoroughly 
 annealed, seamless drawn brass tubing of standard iron pipe guage. Connections 
 with said brass pipe and between brass pipe and traps, or between brass pipe and 
 iron pipe must not be made with slip joints or couplings. Threaded connections on 
 brass pipe must be of the same size as iron pipe threads for the same size of pipe 
 and be tapered. The following average thicknesses and weights per lineal foot will 
 be required: 
 
 Weights per 
 
 Diameters. Thickness. lineal foot. 
 
 1| inches .14 inches 2.84 pounds 
 
 2 inches .15 inches 3.82 pounds 
 24 inches .20 inches 6.08 pounds 
 
 3 inches .21 inches 7.92 pounds 
 34 inches .22 inches 9.54 pounds 
 
 4 inches .23 inches 11.29 pounds * 
 
 As shown in rule 25 of Brooklyn, given above, lead waste pipe is 
 usually allowed in short lengths. In San Francisco it may " be used 
 only as branches to connect with cast or wrought iron ; said branches 
 shall not exceed five feet in length." In Hartford the length may be 
 six feet. In Lowell waste pipes over two inches must be iron. In 
 Reading " lead wastes may be used for horizontal lines that are two 
 inches or less in diameter." 
 
 Joint* in J'/'pes. 
 
 "Joints in earthen pipe shall be made with pure cement. 
 
 11 Joints in cast iron pipe shall be made with pure lead, well caulked, and no 
 paint, varnish or putty will be allowed until the joints have been tested. 
 " Joints in wrought iron or steel pipe shall be screw joints. 
 
 1 Providence, Sec. 5. 
 
 2 Brooklyn, Sec. 37. 
 
 8 Asbury Park, Sec. 33. 
 
PLUMBING. 233 
 
 " Joints in lead pipe shall be in all cases wiped or overcast. 
 
 11 Joints between lead and iron pipes shall be made by extra heavy cast, or pref- 
 erably drawn, brass screw nipples, or with such caulking ferrules of the full size of 
 the iron pipe. The thickness of all brass thimbles or ferrules shall be at least one- 
 eight of an inch." 2 
 
 " . . •. Brass ferrules must be best quality, bell shaped, extra heavy cast brass, 
 not less than four inches long and two and one-quarter inches, three and one-half 
 inches, and four and one-half inches in diameter, and not less than the following 
 weights: 
 
 Diameter. Weight. 
 
 '1\ inches 1 pound, ounces 
 
 '■', . inches 1 pound, 12 ounces 
 
 -H inches 2 pounds. 8 ounces 
 
 "One and one-half-inch ferrules axe-not permitted. Soldering nipples musi !"■ 
 heavy casl brass, or of brass pipe, iron pipe size. When cast they must not be less 
 than the folic .winy weights: 
 
 Diameters. Weights. 
 
 li inches pounds. 8 ounces 
 
 1 inches pounds, 14 ounces 
 
 •_' inches 1 pound, b' ounces 
 
 3 inches 2 pounds, ounces 
 
 4 inches '■'> pounds. 8 oun< i 
 
 In Providence joints in earthen pipe shall be made with Portland 
 or hydraulic cement and sand in proper proportions and in Pittsburg, 
 as above, the proportions of cemenl and sand arc specified. 
 
 In the joints of oast iron pipes, Rochester requires not loss than 
 twelve mmces of lead for each inch of the diameter of the pipe so con- 
 nected. A few cities permit "rust joints carefully and properly made." 
 In Now Bedford they musi be one and one-half inches deep. In Phila- 
 delphia they may be of "cemenl made of iron filings and solammoniac, 
 so a> io make them gas tight." 
 
 In Manchester, N. II.. Fall River and Haverhill, joints in load pipe 
 arc to ho wiped joints ••when practicable." Screw joints must be made 
 up with rod load or be steam tight. In Manchester, Portsmouth, Haver- 
 hill, and Now Bedford saddle hnhs arc forbidden and in the District of 
 Columbia -no soil or waste pipe shall be tapped." In Lawrence sad- 
 dle hubs are allowed when it is impossible to connect otherwise. In 
 Now Bedford double hubs are prohibited on all oast iron soil or waste 
 pipes. In Hartford rubber vent couplings and brass vent unions for 
 lead and iron pipe will not ho allowed under any circumstances. In 
 Fitchburg " combination brass ferrules with ground joints may be used. 1 
 
 Pitch. 
 
 ■The inclination of water-closet, kitchen and all othei drains do! over sj\ in 
 in diameter, liable to receive solid substances, shall not be less than one-half an inch 
 
 1 I ; i ... 1, 1 \ n Se< , 29. 
 bury Park, s '-c. :;::. 
 
234 PLUMBING. 
 
 in two feet; and of cellar or other drains, to receive water only, one-quarter of an 
 
 inch in two feet." x 
 
 The same is found in Milwaukee and Cleveland. In Albany the 
 drain inside the house may have a pitch of one-eighth inch per foot and 
 outside the house one-quarter inch per foot. Usually one-quarter inch 
 per foot is the minimum pitch allowed. In the District of Columbia 
 the minimum pitch for a drain is one-fifth inch per foot and the rules 
 further prescribe that : 
 
 "• No house sewer shall be laid with a less fall than required by this table, or 
 with a greater fall at or within four (4) feet of the junction witli the main sewer 
 than two (2) inches vertical in three (3) inches horizontal. 
 
 " The limits of grade specified are intended to apply only to extreme and unusual 
 cases; in all ordinary cases a practically uniform grade shall be preserved from a 
 point five (5) feet exterior to the building served or the building line thereof to the 
 junction with the main sewer."' 2 
 
 Changes in Direction. 
 
 In Lowell changes in direction of soil pipes shall be made with slow 
 curves. 
 
 " The arrangement of drain, soil, waste and vent pipes must be as direct as pos- 
 sible. All changes in the direction of drain, soil or waste pipes shall be made with 
 Y branches, 1-16, 1-6, or 1-8 bends. Offsets may be used, provided the angle they 
 present is not less than that represented by a 1-6 bend." 3 
 
 In Brooklyn offsets must " be made with forty-five degree bends or 
 similar fittings," and in that and some other cities " the use of T-Y's 
 will be permitted on upright lines only. 
 
 Openings for Pipes. 
 
 Jn Boston the "drain shall not be subjected to pressure where it 
 passes through a wall." 
 
 In Pittsburg, when the house drain passes through a new foundation 
 
 wall, a relieving arch shall be built over it with a two-inch space on 
 
 either side of the drain. In Fall River there must also be a two-inch 
 
 space on top ; and in the District of Columbia " there shall be built into 
 
 the wall during its construction an iron pipe not less than two inches 
 
 in diameter greater then the pipe proposed to be run." 
 
 " Wherever pipes pass through floors, the openings in both floors and ceilings 
 shall be tightly closed to prevent the passage of air currents from one story to 
 another, or from the pipes into the ceiling spaces in a horizontal direction." 4 
 
 Supports for Pipes. 
 
 " Whenever practicable, sewer pipes within the buildings shall be supported by 
 substantial brick piers, or properly secured to walls, or suspended to floor timbers 
 
 1 Providence, .Sec. 10. 
 
 2 District of Columbia, Sec. 70. 
 
 3 San Francisco, Sec. 2. 
 
 4 Brooklyn, Sec. 42. 
 
PLUMBING. 235 
 
 by strong iron hangers. When sewers are necessarily laid below the floor, brick 
 manholes shall be built to give access to all handholes.' 1 1 
 
 In Portland " they may be laid in a brick or cemented trench in the 
 
 cellar bottom." 
 
 "... When required by the inspector of buildings, drain pipes below a 
 cellar floor shall be laid in a brick trench with a concrete bottom, and shall be 
 accessible through sufficient unattached covers."' - 
 
 In Boston this is the rule in every instance. 
 
 Supports. 
 
 In Manchester, N. H., when any floor other than earth is to be laid 
 over a pipe in a basement or cellar it must be laid in a trench. In 
 
 Philadelphia "it may be constructed along the foundation walls above 
 the cellar floor, resting on nine (9) inch brick piers laid in cement mor- 
 tar, said piers to be not nunc than seven (7) feet apart, and securely 
 fastened to said walls." 
 
 "All soil and waste pipes shall be properly fastened and secured with either 
 heavy wrought iron straps or hooks. If hooks are used they shall be forged out of 
 one piece of iron, not welded." ; 
 
 " Wrought iron hangers (double hangers), one-half inch in diameter, will be 
 required for five and six inch pipe, three-eighths inch for three and four inch pipe, 
 and one-quarter inch for two inch pipe. Hangers, clamps, or suitable brick piers 
 must lx' placed at intervals of seven and one-half feet." 4 
 
 In Now Haven and Haverhill supports may be ten feet apart, and 
 in Scranton there must be a support for every Length of pipe. In 
 Asonry Park the use of pipe hooks for supporting pipes is pr< hibited. 
 
 ■•All connections of l< sad supplies, waste, vent, or flush pipes shall he made by 
 1 1 i*-;i ii-^ of wiped joints, and shall be supported their entire length by means of lead 
 tacks or clips screwed to boards provided for the purpose." •"■ 
 
 In Hartford and Rochester vertical soil pipes musl rest <»n a pier or 
 foundation. 
 
 Exposure of Pipes and Fixtures. 
 
 "The drain, soil, and waste pipes, and the traps must, it pracl it aide, be exposed 
 to\iiu for ready inspection at all times and for convenience in repairing. When 
 necessarily placed within partition or in recesses of walls, soil, waste pipes should 
 be covered with woodwork so fastened with screws as to be readilj removed; in no 
 hall t hey be absolutely inaccessible. It is recommended to place soil and other 
 vertical pipes in a special shaft between or adjacenl to the water closets and bath 
 room, and serving as a ventilating shafl for them. This shaft should be at least two 
 
 1 Brooklyn, Sec. 18. 
 " Somen tile, Sec. •_'". 
 
 San Francisco, Sec. l I. 
 1 Hartford Sec. 16. 
 • Hartford, Sec. 88. 
 
236 PLUMBING. 
 
 and one-half feet square. It should extend from the cellar through the roof, and 
 should he covered by a " louvered skylight," it should be accessible at every story 
 and should have a very open but strong grating at each floor to stand upon. Shafts 
 not less than three square feet in area are required in tenement houses to ventilate 
 interior water-closets." 1 
 
 In Reading, when sewers are below floors, manholes must be pro- 
 vided to give access to the cleansing branches. 
 
 " No soil pipe shall be run up outside of any building, or between the studdings 
 or between the walls of rooms. 
 
 "Where a lead waste, or ventilation pipe, passes through between the floors, 
 ceiling or other places accessible to rats, such pipes must be encased with sheet tin, 
 copper or galvanized iron." 2 
 
 111 Milwaukee no soil or waste pipe shall be placed in a recess in 
 the outside wall. In the District of Columbia '.' all soil, drain, waste, 
 and vent pipes shall lie located inside of buildings. In Brooklyn the 
 enclosing of water-closets with wooden casing will not be permitted. 
 
 "The space in and around water-closets, and wash bowls, shall not be enclosed 
 by woodwork, but shall remain open and exposed to view, except that a closet may 
 be made under a wash bowl, when provided with a suitable door." 3 
 
 "In tenement and apartment houses sinks must be entirely open and placed on 
 iron legs or brackets without any enclosing woodwork." 4 
 
 Cleanouts. 
 
 " Cleanouts shall be placed in horizontal drain and waste pipes close to Y 
 branches, and at every right angle turn in the drain. All traps shall be provided 
 with suitable accessible openings for cleaning purposes, and all such openings or 
 cleanouts shall be exposed to view. Traps with covers depending on putty connec- 
 tions to make them tight are prohibited." ° 
 
 hi Xew Bedford cleanouts must be placed where the inspector may 
 designate and shall be approved by him. 
 
 " Cleanouts for inspection purposes, corresponding in size with the drain or 
 waste pipe, with covers to handholes made gas and air tight, and of a pattern ap- 
 proved by the board of health, shall be provided at intervals of not more thaii 
 twenty feet, and one such opening shall be requred at each horizontal branch of 
 fifteen feet; and on all pipes laid beneath the ground said cleanouts must be in 
 bricked and cemented pits, and easy of access." 
 
 In Detroit cleanouts must be brought up to floor level with branches 
 and curves. 
 
 1 Cleveland, Rule 4. 
 
 - Lawrence, Sec. 4, Rule 5, and Sec. 6, Rule 9. 
 
 3 Worcester, Sec. 15. 
 
 4 Asbury Park, Sec. 22. 
 
 5 Hartford, Sec. 6. 
 
 6 Haverhill, Sec. 10. 
 
PLUMBING. 237 
 
 ■ Each vertical soil pipe shall be provided near its lower end with a T branch, 
 
 suitably located, and having a cast-iron plug not less than four inches in diameter 
 leaded in." * 
 
 In Asbury Park cleanouts must not be more than twenty-five feet 
 apart and the main trap and cleanout must be in an eight-inch brick well 
 
 with iron or stone cover if in the cellar : 
 
 " Brass screw caps for cleanouts must be extra heavy, not less than one-eighth 
 of an inch thick, and must have a flange of not less than three-sixteenths of an inch 
 thick. The screw cap must have a solid square, or hexagonal nut not less than one 
 (1) inch high, with a diameter not less than one and one-half (14) inches. The body 
 of the cleanout ferrule must not be less in weight and thickness than the caulking 
 ferrule for the same size of pipe. Where cleanouts are required by the rules and by 
 the approved plan the screw cap must be of brass. The engaging parts must have 
 not less than six (6) threads of iron pipe size and be tapered. Cleanouts must be of 
 full size of the trap up to four (4) inches in diameter, and not less than four (4) 
 Inches for longer traps."' - 
 
 Termination of Pipes at Roof. 
 
 "All soil and waste pipes shall be carried undiminished in size to a height at 
 least two feet above the roof, except in the case of roofs of tenement houses or roofs 
 used for drying purposes, in which case they shall extend seven feet above the roof 
 and be suitably braced. Such pipes shall terminate at a point approved by the com- 
 missioner of health. Pipes on extension roofs when within twenty feet of any win- 
 dow, shall be carried up and continued above the main roof, and where necessarily 
 carried up on the outside of the main building, they shall have a diameter of not 
 less than four inches. There shall be no caps, cowls, ventilators or return bends 
 put on the ends of the pipes above the roof, and the mouths of all such pipes on the 
 roof shall be kept wide open. The size of all pipes shall be increased one inch from 
 a point just below the roof to the terminal of the pipe above t lie roof, but no pipe 
 above the roof shall have a diameter less than four inches. Iron, brass or copper 
 wire baskets will be permitted in the mouths of pipes to keep out obstructions. 
 Vent pipes may be carried above the roof in the same manner as soil ;ui<l waste pipes, 
 or they may be connected with a soil or waste pipe above the highest floor." 
 
 The height to which the pipe must be carried varies in different 
 cities. In Brooklyn,, as above, and Somerville and Portsmouth, N. 1 1., it 
 is two feet. In Bridgeport, Chicago, Cincinnati, Cleveland, Lawrence, 
 and New Bedford it is one foot. In Denver the soil pipe must be car- 
 ried to a height six indies above the ridge or the fire wall, if the i< »< » t" is 
 Mat: in San Francisco, t\\<> feel above the highest line <>l roof <>r 
 
 Coping. The soil pipe is to be increased one inch in diameter one fool 
 
 below the roof in Chicago, and two feel below in Fall River. In Cleve- 
 land the soil pipe is to be one size larger where it passes through the 
 roof and never less than tour inches. In Rochester the soil pipe must 
 
 lie three feet ;il i< >\ e ;i 1 1 \ WllldnW ;ilid live feet ll < 'III Mil \ el I i II 11 le\ . Ill 
 
 1 District of Columbia, - 
 
 \ ibury Park, Sec. :;:;. 
 
 i; ki\n. Sec. 38. 
 
238 PLUMB IX a. 
 
 Portsmouth, N. H., it must extend five feet above the roof if fifteen 
 feet from a window, and in Somerville and New Haven if ten feet from 
 a window ; and in the New Jersey cities if twenty feet from a window it 
 must extend above the main roof. In New Bedford it must be away 
 from all windows. In Lawrence it must be two feet above the highest 
 opening in the building. In Lowell "said roof opening must be at a 
 point where it cannot ventilate into a window of any dwelling." In 
 Albany the soil pipe is to be one inch larger above the roof and is only 
 required to extend two feet when it receives discharges from fixtures on 
 two or more floors. In Paterson and Hartford if in flat tenement roofs 
 the pipe must extend six feet, and in Reading five feet. In Cleveland 
 if in an ell it is to extend above the main roof. In Lowell it must be 
 as high as the ridge pole. In Providence it must be carried to such a 
 height as the inspector may direct. In Fall River " all branches of soil 
 pipe ten feet or more in length shall be continued full size through the 
 roof or be taken into the soil pipe above the highest fixtures unless 
 otherwise permitted." In Haverhill soil pipes of ten feet arid waste 
 pipes of fifteen feet length must be carried separately through the roof 
 
 RaiwrWater Leaders. 
 
 "Rain-water leaders must never be used as soil, waste or vent pipes, nor shall 
 any soil, waste or vent pipe be used as a leader. Where the leader is within the 
 house it must be of extra heavy cast iron pipe with leaded joints, or of heavy 
 asphalted or galvanized wrought iron pipe with screw joints. When outside the 
 house, if of sheet metal, with slip joints, and, if connected with the drain, it must 
 be trapped beneath the ground or just inside the wall, the trap being arranged so as 
 to prevent freezing. In every case where a leader opens near a window or light shaft 
 it must be properly trapped at its base. The joint between inside iron leaders and 
 the roof must be made tight by means of a brass ferrule and lead or copper pipe, 
 properly connected to rain-water inlet head on root/" ' 
 
 In Albany leaders are to be trapped only when they open within 
 twenty feet of a window, and in Hartford and San Francisco the dis- 
 tance is ten feet. In Hartford " all leader drains from two feet above 
 the ground to the distance of six feet from the outside of the cellar 
 walls of buildings shall be of extra heavy cast-iron pipe." In San Fran- 
 cisco leaders must be of cast-iron five feet above the ground. In Haver- 
 hill they must enter the drain at such a point and in such a manner as 
 to prevent syphoning. In San Francisco "the connection between cast- 
 iron and sheet-iron leader pipe is to be made with brass ferrules soldered 
 to leader and caulked into cast-iron." 
 
 " Drains from rain-water leaders shall connect with the sewer outside of house 
 trap with a cast-iron L Y ' branch trap and cleanout, and if properly supplied with 
 clear water from flushing tank to maintain seal in trap, may be of first-class vitrified 
 
 1 Brooklyn, Sec. 23. 
 
PLUMBING. 239 
 
 pipe, provided that all rises to, and at least eight inches above grade, shall lie oi 
 cast-iron."" l 
 
 "All leaders from points below line of main roof must discharge into open trapped 
 hoppers, and said hoppers supplied from snitahle interior fixture, same as above 
 provided for in surface drains.' 1 - 
 
 Main Trap. 
 
 ■\ running or P trap, of form approved by the Inspector of Plumbing, shall be 
 placed on every bouse sewer, except where there is no plumbing fixture located 
 within the building under or through which the house sewer is laid. Such trap 
 shall be placed at an accessible point, if practicable within the wall of the building. 
 and a vertical pipe of the same diameter, and provided with a brass trap screw, shall 
 be constructed over the trap to admit of cleaning the same. 
 
 •A brick manhole provided with cast-iron frame and air-tight cover maybe used 
 
 n lieu of tlie vertical pipe to afford easy access to the trap." 
 i 
 
 In Pittsburgh it is provided that the trap must ho inside the huilding, 
 
 in which case tin- cleanout must not be on the sewer side. In New 
 
 York City and other cities the trap must he placed ••near the front of 
 
 the house" either inside or outside. In the large New Jersey cities the 
 
 bleanout is to he made tight with cement. New Bedford provides for 
 
 the co-operation of plumber and drain layer: 
 
 "When the city drain pipe layer is ready to connect the vitrified pipe with the 
 iron pipe the plumber shall have the iron pipe caulked into the running trap; he 
 shall place the trap in position for the drain layer to make the cement connection. 
 All cast-iron soil pipe shall he laid by the plumber. 11 
 
 In Manchester, N. II., and Hartford, a main trap in the drain is not 
 
 required, and in Albany it may he omitted with the approval of the 
 
 board of health. In Manchester if the trap is omitted the fresh air 
 iidet is also to he omitted. 
 
 Back Pressim Valve. 
 
 "All permits for connecting with public sewers are given on condition that 
 owners take all risk of damages thai may result from water setting hack into 
 premises from the main sewer, ami in order to prevent as much as possible 1 he sel- 
 ling hack of water the owner is hereb] required at his own cost and risk to put in a 
 self-aci ing or oth.i valve in all cases when a back tlow from a sewer is is to be appre- 
 hended and it shall he the duty of I he owner to keep I he \al\e in order, and he shall 
 
 he responsible for its action in all cases. When the sewer connection is of iron and 
 carried up within tin- premises as a closed pipe, without openings or connections ol 
 an\ kind, above the level of any possible back-flow, the flood-valve mag he dis- 
 pensed wit h." ' 
 
 In Lawrence aiea drains must he suppled with hack pressure valves. 
 See also snh-soil drains. 
 
 i Detroit, Rule is. 
 1 San Francisco, s > 
 
 I >ist i i. t '.I < dluinhia. >its. 1 I I •">. 
 
 ' Dist ret ,,t ( lolumbia, Sec. 86. 
 
240 PLUMBING. 
 
 Trap* for Fixtures. 
 
 ''Every water-closet, urinal, sink, basin or bath, or set of wash trays, must be 
 separately and effectively trapped. The traps must be placed as near to the fixtures 
 as possible, and in no case more than two feet from the fixtures. In no case shall 
 the trap of one fixture connect with the trap of another." 1 
 
 In other cities the words " other fixtures " are added after traps and 
 sometimes urinal and hydrant wastes are named and usually the trap 
 must be set as " near as practicable." In Lawrence the trap must be a 
 four-inch bottle trap or other trap approved by the board of health. 
 
 Many cities do not go so far as San Francisco in forbidding that any 
 two fixtures shall have a common trap, though it is often ordered 
 that : 
 
 "In no case shall the waste from a bath tub, basin, sink, or other fixture be con- 
 nected with a water-closet trap." 2 
 
 In Portland, Me., and New Bedford no bath waste shall be con- 
 nected with a set tub or sink-waste ; but in Worcester and Somerville, 
 Mass., fixtures may have a common trap if they are not distant from it 
 more than three feet, and in Somerville the trap must have a diameter 
 of three and one-half inches. 
 
 "Traps and branch waste pipes shall be of the following sizes: 
 
 Fi »r basins and pantry sinks 1£ inches. 
 
 Slop sinks 3 " 
 
 Kitchen sinks 1^ or 2 " 
 
 Bath tubs H or 2 " 
 
 Urinals H or 2 " 
 
 Laundry tubs 1| or 2 " 
 
 Water-closets ± " 3 
 
 In the District of Columbia " No trap with a hand-hole cover shall 
 be used/' 
 
 Traps at the foot of vertical soil pipes are forbidden in many cities. 
 
 Area <<n<t Surface Drains. 
 
 " No opening shall be provided in the sewer pipe of any building for the purpose 
 of surface drainage unless said opening is properly trapped and supplied with water 
 from a suitable fixture. When said surface drain is situated at a distance greater 
 than twenty feet, reckoning in a horizontal line from said suitable fixture, then it 
 may be supplied by a hose-bibb. Bell traps strictly prohibited." 4 
 
 In Pittsburgh this connection must not be used as a fresh air inlet. 
 Masons' traps in such positions are prohibited in New York City, and 
 in Chicago no catch basin will be allowed in any building: 
 
 1 >San Francisco, .Sec •!'■',. 
 
 2 Brooklyn, Sec. 34. 
 
 3 Brooklyn, Sec. 36. 
 
 4 San Francisco, Sec. 25. 
 
PLUMBING. 241 
 
 •■All pipes that must be left open to drain cellars, areas, yards or gardens, shall 
 he connected with suitable catch-basins, the bottoms of which shall not he less than 
 two and one-half feet below the bottom of the outlet pipe, the size, form and con- 
 struction of which are to be prescribed by the officer named in section three. . . . 
 When the end of thedrain pipe is connected with a temporary wooden catch-basin for 
 draining foundations during the erection of buildings, the drain-layer shall he held 
 risible for dirt, sand or any other substance getting into the drain or sewer 
 from such temporary catch-basins." 1 
 
 •• Every cellar shall have a trap for surface drainage provided with a brass clean- 
 out plug caulked into the inlet of same, and must be located where it will he a 
 sible at all times. 
 
 •■ Surface drains must never be connected directly with the trap, hut shall enter 
 an open well that shall be built around the trap." - 
 
 ••The superficial area of every catch-basin hereafter constructed shall not be 
 greater than four hundred and fifty-six square inches, and except in cases where the 
 catch-basin is to be placed in the street, the same shall be covered with a flagging 
 stone with movable iron cover; in cases where the catch-basin is to be placed in the 
 street or adjoining the wall of any building it shall he of iron of such construction 
 as may be approved by this Board. 
 
 Ghreast Trap. 
 
 •• Waste pipes from kitchen sinks in any hotel, restaurant or other public cook- 
 ing establishment, and in every dwelling house, shall run separate to a grease trap 
 in yard when practicable; and when the same is nol practicable to put in yard, a 
 • trap must be placed belovj each sink, with water jacket to keep the water in 
 i rap chilled. 
 
 " Grease traps in yards shall be constructed of hydraulic cement, sand and gravel 
 in the proportions of one pari cement to three parts of all other material, or of 
 earthen ware or brick, laid in hydraulic cement, and in case of brick being used, 
 the wall shall be plastered on ail sides and bottom with hydraulic cement mortar at 
 Ii-asi one inch thick, made in proportion of one of cemenl t" two of sand, with eight- 
 inch wall. Grease traps to have stone or iron covers, the same to he not more than 
 six inches he low grade. ' Srease tra ps for small building or ordinary dwelling houses 
 to be not less than twenty-four inches in diameter. Motels, restaurants or other 
 cooking establishments to have the size of urease traps not less than forty inches in 
 diamett r. ami according to tie- directions of the plumbing Inspector." 4 
 
 Fr< sll Air I, iht. 
 
 •■ Everj sewer shall have a fresh air inlet of not less than four inches internal 
 diameter entering the sewer between the intercepting trap and all house connec- 
 tions, and extending to the external air al leasl one foot above the surface of the 
 ground at a place shown on the approved plan. When it is nol pracl icable to extend 
 the fresh air inlet above the ground, it shall i>e carried to the curb ami terminate in 
 a suitable receptacle, covered by an iron grating. 
 
 In Pittsburgh the inlel musl have an accessible cleanout and 
 
 •• Where ail inlets are lo.ated oft the stairway, on grass plats, lawns, etc., they 
 
 shall extend not less than six inches, nor more than fifteen inches above the surface 
 
 1 Proi id< nee, Sec. L3. 
 - Hartford, Sec. 9. 
 
 \siinn Park, Sec. '.i. 
 
 1 I )en\ ei . Sees. 1 I and 5. 
 
 Brooklyn, Sec. 21. 
 16 
 
242 PLUMBIXG. 
 
 of the ground, and be protected by a cowl securely fastened with bolts. Where the 
 fresh air inlet is placed at the curb, there shall be at least three feet of extra heavy 
 cast-iron pipe extended up even with pavement, and covered with strong iron 
 grating." 
 
 In Rochester the inlet must extend twelve inches above the ground 
 and be provided with a suitable cap. In the District of Columbia it 
 must have a one-quarter bend and grating. 
 
 In Milwaukee the inlet must enter drain just six feet inside the 
 trap. 
 
 In the District of Columbia the inlet must be six inches in diameter, 
 in Portland, Me., three inches, and in Milwaukee two inches. 
 
 In Xew York City the inlet must be not less than fifteen feet from 
 the nearest window, and no cold air box from a furnace shall be so 
 placed that it can possibly draw air from it. In Hartford, Lowell, and 
 San Francisco it must not be within ten feet of a window. In Mil- 
 waukee it must be four feet from a window ; in Detroit and Xew Bed- 
 ford five feet or -such distance as the inspector may direct, and in Port 
 land eight feet from window or cold air box of furnace. 
 
 In Philadelphia there must be a second inlet " at the rear of the 
 system of plumbing when the vertical line of soil pipe is located in the 
 central part of the building and is deemed insufficient to ventilate the 
 entire system." 
 
 Back Air Pipes Required. 
 
 Nearly all plumbing rules require that '• traps must be protected 
 
 from siphonage by special air pipes." Such pipes are not, however, 
 
 invariably required : 
 
 "... Water-sealing traps of any pattern may be used when separate air 
 \>\\h' connections from the top of the same are provided: where separate air-pipe 
 connections are not provided, traps which will not unseal shall be used; such traps 
 to be first approved by the inspector of plumbing.'" 2 
 
 Similar provisions are found in Atlanta and Albany, and in Roches- 
 ter back airing may be omitted by special permit of the board of health. 
 In Detroit, where any fixtures are not more than five feet from a verti- 
 cal run of soil pipe, and no fixture over the same, the back vent may 
 be omitted. In Portsmouth the maximum distance is four feet meas- 
 ured from the centre of the trap to the hub of the Y on the main 
 pipe : 
 
 " Where a sink, bath tub, wash bowl, wash tub, urinal, or any other plumbing 
 fixture is located on a floor not more than six feet from the ground (within build- 
 ing), and no fixture or fixtures connected or to be connected to waste pipe, the two- 
 inch waste pipe with increaser shall be run to and through the roof; re-vents may 
 
 1 Providence, Sec. 17. 
 
PLTTMB1NG. 943 
 
 be dispensed with, provided, the trap of the fixture is not more than five feet from 
 the waste pipe. 1 " 1 
 
 In Fall River all traps liable to be siphoned or affected by l>ack 
 pressure shall be protected therefrom by a special air-pipe. In the 
 District of Columbia and San Francisco traps shall lie vented " except- 
 ing that in the case of the upper, and only water-closet on a soil pipe 
 and having its centre within two feet of the centre of the stack, it will 
 not he required.*' In Cincinnati a single fixture discharging into an 
 Open drain needs no vent pipe. In Buffalo "the use of non-siphoning 
 automatic fixtures of old buildings only allowed at the discretion of the 
 health officer." In New Haven Sanitas traps are allowed without 
 vents. In New Jersey cities traps must be vented by an air pipe, 
 
 "Or by some approved automatic vent. Approved mechanical traps may be 
 substituted where it is necessary or advisable, but only on special permit from the 
 Board of Health." 
 
 The McLellan vent is often used in Newark, as many as 42i> having 
 been put in in 1896. It has been permitted in Albany, but has not 
 been satisfactory, as the mercury is driven out when obstructions are 
 forced. 2 
 
 ■■ Ventilating pipes must be run with as few bends as possible, and the branches 
 must be connected to main vent at an angle of not less than forty-five degrees, and 
 in- increased in size every thirty feet. When combined the vent pipes must be in- 
 creased in size according to the following table: 
 
 •• In ;ill buildings of four stories or less — 
 
 "Branch rents "i water-closets shall not be of a size less than the following: 
 
 " (The term ' Branch Vent' as here applied shall be construed to mean all that 
 vi-nt pipe located between the fixture and the point where the vent joins into the 
 main verl ical vent.) 
 
 • Four water eh, sets may be vented into a li.l-inch branch vent. 
 
 •■ Five to eighl water-closets may be vented into a 3-inch branch vent. 
 
 ■• Nine or more water-closets may he vented into a 1-inch branch vent. 
 
 •• Single water-closets located in the basement or firs! floor of a building, if the 
 soil pipe drop does not exceed 10 feet, may be vented with a 2-inch vent pipe for a 
 distance of 30 feet; when the vent is longer than 30 feet, then 1 he entire venl shall 
 
 he J -inch until the distance of 60 feet, when it shall be increased to .".-inch to a 
 
 finish, in all cases where the soil pipe has a drop greater than 10 feet, then the 
 soil pipe shall he continued full bore to a point •_' feel above root, and act as a vent 
 pipe. 
 
 •• In each ami every building to be used as a residence or otherwise, ami where a 
 closet or closets is, or are, situated either within the premises, or within ten 
 
 t the outside walls "I said premises, then, in an\ and all cases, it shall he 
 
 required thai at hast one four-inch venl pipe he continued to above the root line. 
 and this, irrespei tive "I what distance the soil pipe may drop. 
 
 ■ ■ Three wash has ins. baths or similar fixtures may he vented bj a 2-incli vertical 
 
 vent pipe. 
 
 ' ( Ihicago, See. 37. 
 Albany, Repori oi Board of Health (1898), p. l»». 
 
244 PLUMBING. 
 
 " Six similar fixtures by a 2i-inch vertical vent pipe. 
 
 li Twelve similar fixtures by a 3-inch vertical vent pipe. 
 
 •• When more than 12 fixtures, they may be vented by a 4-inch vertical vent pipe. 
 Single one and one-half inch traps may be vented by a one and one-half inch vent 
 pipe when the vent does notexceed twenty-five feet. When it is in excess of twenty- 
 five feet, then the entire main vent shall be of two-inch pipe. 
 
 " When one and one-half inch branch vents are used on fixtures the said branch 
 vent shall not exceed five feet. In the calculation of the relation of basins, baths. 
 and similar fixtures towards water-closets, it shall be reckoned that four basins or 
 baths or similar fixtures shall equal two water closets, and so on, at that ratio. 
 
 •' When more than sixteen wash basins, baths or similar fixtures are on a line and 
 are situated in a live-story building or over, below the fifth floor, then the vertical 
 vent, from the fifth floor up. must not be less than four-inch pipe. 
 
 ■• On buildings five stories or over not more than twenty feet may be used as a 
 branch vent."' 1 
 
 Li Denver not more than thirty feet of one and one-quarter inch 
 pipe can be used for a vent for one fixture, thirty feet of one and one- 
 half fur two fixtures, and thirty feet of two inch-pipe for water-closetSs 
 In Somerville vent pipes of less than thirty feet must lie two inches, 
 and over thirty feet three inches in diameter. In Hartford vents for 
 three water-closets must be two-inch, for more than three water-closets 
 three-inch, and vents for four fixtures other than water-closets must be 
 one and one-half-inch, and for more than four fixtures two-inch. In 
 Cleveland one fixture may have a one and one-quarter-inch vent, ami 
 two fixtures one and one-half. In buildings of over four stories water 
 closet vents must be three inches and fixture vents two inches in diame- 
 ter. In the District of Columbia in three story buildings with three 
 water-closets or three fixtures there must lie a vertical vent to which 
 all vents lead, increasing in diameter to equal the combined diameter of 
 the vents entering it. 
 
 Most cities, like San Francisco, require that vent pipes shall extend 
 above the roof in the same manner as soil pipes and usually they must 
 never be less than four inches in diameter: or they may combine and 
 enter the soil pipe above the highest fixture: the distance above the 
 fixture is specified as three and one-half feet in San Francisco and 
 Cleveland, five feet in Detroit, and six inches in Bridgeport : but Denver 
 requires that in buildings of more than two stories the vent pipes 
 must run separately through the roof. In Hartford if fixtures are eight 
 feet from a line of vent they must have a separate vent to the roof. 
 
 It is usually provided that vent pipes must have a continuous slope 
 to prevent filling with condensation. 
 
 New Bedford requires siphon closets to be vented from the lead bend. 
 
 The use of lead pipe for vents is usually restricted to short lengths. 
 
 1 San Francisco. Sec. 28. 
 
PLUMBING. 245 
 
 In Cleveland it must not be lighter than extra light. In Boston, Somer- 
 ville, and Manchester, X. H., lead can be used only when exposed to 
 view. In New Haven lead is not permitted. 
 
 Safe Wastes. 
 
 ■■ Every safe waste under a basin, bath, water-closet, tank or other fixture, must 
 lie drained with a special pipe of lead, galvanized or dipped iron pipe, of a diameter 
 not less than one inch bore, and in no case directly connected with any soil, waste, 
 vent, drain or sewer, hut made to discharge outside of house. Urinal safe waste 
 may he connected with main waste or soil pipe; provided, suitable traps are pro- 
 vided to botli urinal and safe wastes, and both properly vented ami both supplied 
 with water." ! 
 
 ■• Wherever safes are placed under lixtures the safe wastes shall be run separately 
 to t lie basement or cellar, and be closed by a hinged brass flap valve, or other approved 
 device, to prevent cellar air from rising through the pipe. In tenement houses the 
 safe wastes shall be extended to the roof. Urinal platforms shall not be provided 
 with safe wastes."" - 
 
 Iii the City of New York water-closets, and in the District of Colum- 
 bia any fixtures cased with wood must have a safe drained as above. In 
 Cleveland wastes from stopcocks must not run into soil or waste pipes. 
 
 // ■ . igerator Wastes. 
 
 ■ No waste pipe from a refrigerator or other receptacle where food is kept shall 
 he connected with a drain, soil or other waste pipe. Refrigerator wastes must be of 
 a diameter of not less than one and one-half inches, and so arranged as to be properly 
 Bushed. They shall empty over a water supplied sink, the mouth of the pipe to 
 have a brass-hinged flap valve. In tenement houses, vertical lines of refrigerator 
 Wastes shall have a diameter of at least two inches, and shall extend through the 
 roof for ventilation." 3 
 
 In New York refrigerator wastes must not discharge on in the 
 
 ground. 
 
 ■• No waste pipe from any refrigerator, or other receptacle in which provisions 
 are stored shall discharge into the soil of am cellar bottom, or into the soil beneath 
 any floor of any building; or into any wast.-, drain or soil pipe. 
 
 In Rochester refrigerator wastes musl be as Bhorl as possible. 
 ' ' 'flotv Pipes. 
 
 14 Overflow pipes from li\t ures must, in each case, lie connected on the inlet side 
 of t he t rap. 
 
 " The overflow pipes from water-closet cisterns may discharge int.. the v.. 
 closet howl, an open sink, or where its discharge will attract at tent ion and indicate 
 thai waste of water is occurring, but not into the soil or waste pipe, nor into the 
 
 dram or sew .•!.'" 
 
 Francisco, Sec. ■'■>'<. 
 Brooklj n, Si 
 
 i; kiyn, Sec. 89. 
 
 1 Providence, Sec. 20. 
 
 1 1 ot N 'eu Y. irk . s '-' S !■■ and 50. 
 
246 PLUMBING. 
 
 In Rochester they may run into a roof gutter. 
 
 Water-closets to be Provided. 
 
 "All buildings that are located upon a street in which a public sewer exists must 
 be provided with water-closets either in the house or yard. When there is no sewer 
 in the street, and no practicable way of reaching a sewer in an adjacent street, water- 
 closets may be connected with a water-tight cesspool, or privy vaults will be per- 
 mitted. 11 J 
 
 In New York there must be one water-closet for every fifteen per- 
 sons, in Rochester one for every ten ; in Somerville, Mass., one for 
 each family; in Albany one for two families; and in Fitchburg and 
 Worcester one for each family and every fifteen persons. 
 
 Certain Water-closets Prohibited. 
 
 "Privy sinks, pan closets and all water-closets having any mechanism in connec- 
 tion with the bowl, forming a mechanical seal, are prohibited." 2 
 
 " Hopper closets shall not be allowed inside any building or enclosed porch. 
 They may, however, be used in yards or upon open porches. Provided, they are 
 supplied with a tank." 3 
 
 New Bedford forbids the use of long hoppers and Hartford forbids 
 iron hoppers and offset washout closets. The District of Columbia, 
 requires every water-closet to have a rim. Asbury Park forbids long 
 hoppers except where there is exposure to frost. All iron traps must 
 be porcelain lined. 
 
 Water-closet Floor Flanges. 
 
 " Earthern or iron water-closets, having traps above the floor, using lead con«- 
 nections, must have a cast brass flange, not less than one-eighth inch thick, soldered 
 to the lead and bolted to trap of closet, the joint being made perfectly air-tight." 4 
 
 " Floor plates shall be used with earthenware water-closet traps, and the joints 
 shall be secure and gas tight. Brass bolts and a brass flange not less than one-quarter 
 of an inch in thickness, soldered to lead bend and fitted with a rubber gasket or 
 white lead putty to insure a tight joint, shall be used." 5 
 
 In Cleveland and Philadelphia the flange may be three-sixteenths of 
 an inch thick. In Buffalo pasteboard gaskets may be used. In Asbury 
 Park the use of rubber washers for floor connections is prohibited. 
 
 Seat Ventilation for Water-closet. 
 
 "No water-closet shall be set in any room or apartment that has not a window 
 having an area of at least three square feet opening directly to the external air, 
 unless there is a local vent, with its opening under or near the seat of the closet, 
 
 1 Brooklyn, Sec. 45. 
 
 2 Brooklyn, Sec. 46. 
 
 3 San Francisco, Sec. 41. 
 
 4 Brooklyn, Sec. 48. 
 
 5 New Bedford, Sec. 20. 
 
PLUMBING. 247 
 
 and carried to and entering a chimney tine above all openings for stoves or venti- 
 lating registers or continued up through the roof, with heat or other means provided 
 to ensure a steady current of air. 
 
 "Such pipes shall be of copper or galvanized iron, and connections with crockery 
 shall be made with a brass, lead or copper sleeve, with the joint white-leaded; they 
 shall not be less than two inches in diameter for distances of less than thirty feet, 
 and for any further distance their diameter shall be increased to three inches. 
 
 '■When more than one closet connects with such pipe, its capacity shall be at 
 least equal to that of all pipes that enter it.' 1 * 
 
 ln Fitchburg the diameter of local vent for one closet shall he two 
 inch.es, for two to four closets three inches, and for any number exceed- 
 ing four closets a proportionally increased diameter. If there is no 
 heated fine the vent shall enter the kitchen chimney above the highest 
 opening. The connection with the chimney shall he made with cast- 
 iron or other suitable material of a size not less than one size larger 
 than the vent. In Lawrence the connection with the closet is to lie 
 made tight with paint and plastic putty or other composition acceptable 
 tn the hoard of health. 
 
 Loeation ,i,nl Ventilation of Water-closet. 
 
 •■ Water-closets must never be placed in an unventilated room or compartment. 
 In every case the compartment must lie open to the outer air, or be ventilated by 
 means of an air-shaft not used to ventilate any living or sleeping room, and having 
 an area of at least four square feet, and an opening at the roof to the external air of 
 an area equal to the area of the shaft. Id no buildings will water-closets be allowed 
 in cellars, except by special permit from the Department of Health.'" - 
 
 In Now York city. Fall River. Rochester, Lawrence, and Worcester 
 
 the area <d' the ventilating shaft may he three square feet. 
 
 •• No water-closet shall he set up in any room or apartment that has not a window 
 having an area of at least three square feet opening directly to the external air; 
 they will, however, he permitted in rooms or apartments baving.no windows com- 
 municating directly with the external air, providing that there is a duct to the open 
 air through a heated Hue with an opening under, or near the seat of the water-closet 
 for taking air: and such air ducts shall enter the flue above all openings for stoves. 1 ' 
 
 It is absolutely forbidden t<> place water-closets in cellars in New 
 
 York City, Buffalo, Pittsburgh, and Hartford. 
 
 • This ride dues not apply to old property where i t her place can he provided; 
 
 [n which case the walls of closet rooms must he lathed ami plastered or sheathed 
 with plain matched l>i>ar<ls. ami floors of rooms ami passageway shall he cither con- 
 crete, cement, or boarded. Entrance to he sufficiently lighted ami tree Erom any 
 
 means of probable foul deposits."" ' 
 
 Iii Bridgeporl wooden floors shall nut he placed under an\ water 
 closel below the firsl or main floor; all such plumbing as shall he placed 
 
 ■ Haverhill. Sec. 7. 
 oklj ii. Sec. 50. 
 tall River, Sec. 11. 
 
 1 Lawrence. Sec. 7. Rule 8. 
 
248 PLUMBING. 
 
 in cellars or basements shall rest on solid masonry. In Cleveland water- 
 closets must not be located in the sleeping apartment of any building. 
 
 " Each room or stall in which a closet is set will be well lighted. No direct sup- 
 ply closet shall be set unless located outside the building proper in places where 
 tanks cannot be made secure from frost, and no such location of closets shall be 
 allowed unless the board lias become satisfied that it is impracticable to put closets 
 in the building proper. When direct supply closets are allowed they shall receive 
 their water supply directly from the main through fixtures, service pipe, and con- 
 nections approved by the board of health." : 
 
 '• Water-closets, when placed in the yard, shall be so arranged as to be conven- 
 iently and adequately flushed, and their water supply pipes and traps shall be pro- 
 tected from freezing by placing them in a hopper-pit, at least three and one-half 
 (:•>! ) feet below the surface of the ground, the walls of which shall be of brick or 
 stone laid in cement mortar. The waste water from the hopper stop-cock shall be 
 conveyed to the drain through a three-eighths (■§) inch pipe, properly connected. 
 
 " The enclosure of the yard water-closet shall be ventilated by slatted openings, 
 and there shall be a trap door in the floor of sufficient size for access to the hopper- 
 pit." 2 
 
 '.'All vaults condemned as nuisances must have hopper closets substituted, prop- 
 erly trapped and connected to sewer with proper ventilation, and shall not be built 
 over main house sewer, but should be placed on a branch, suitably trapped and sup- 
 plied with water for flushing and connected with main sewer from house.' 1 3 
 
 Water-closet Supply. 
 
 " Every water-closet within or adjoining the house must be supplied with water 
 from a separate tank or cistern containing at least ten gallons below the overflow, 
 and shall have a flushing pipe not less than one and one-quarter inches in diameter. 
 Cistern valves shall be so fitted and adjusted as to prevent waste of water. When 
 the tank or cistern is located outside the water-closet compartment, the stand pipe 
 shall be covered by a float valve to prevent circulation of air from the water-closet 
 to the adjoining room." 4 
 
 Many cities permit a group of closets on one floor to be flushed 
 from one tank, but this is not permitted in tenement houses in New 
 York City. In Worcester water-closet tanks can be used for no other 
 purpose except with the permission of the board of health. But usually 
 there is no exception to the rule that they shall not be so used. 
 
 In the District of Columbia and Rochester, when the pressure is not 
 sufficient to supply these tanks, adequate pumps must be provided. In 
 New York : 
 
 " Where the pressure of Croton water is insufficient to supply water-closets or 
 other fixtures in tenement and lodging houses, factories or workshops, water must 
 be supplied for such fixtures from a house tank of such size as to afford an adequate 
 supply at all times." 5 
 
 1 Portsmouth, Sec. 11. 
 
 2 Philadelphia, Rules 41-2. 
 
 3 Detroit, Pvule 33. 
 
 4 Brooklyn, Sec. 47. 
 
 5 City of Xew York, Sec. 51. 
 
PLUMBING. 24! > 
 
 The size of the discharge pipe must be one inch in Boston, and one 
 and one-eighth inch in Cincinnati. In Philadelphia the tank must hold 
 eight gallons when full up to the level of the overflow pipe, except that 
 automatic or siphon closets shall hold live gallons. The same rule is 
 found in. Reading, hut in Cleveland and Scranton the automatic tanks 
 must hold six gallons. Tanks supplied under street pressure must 
 have a one-inch overflow in Somerville, and in Albany tin- overflow may 
 •Miter inside the inlet of the tiap. 
 
 Many cities allow outside closets to be flushed direct: 
 
 •■ Water-closets which are Located away from the building may he arranged so as 
 td receive their water supply directly from the main, but they must he so arranged 
 as to be conveniently and adequately" flushed and efficiently protected from freez- 
 ing." > 
 
 A new device for flushing closets, called the " flushometer," has 
 been introduced and is permitted by a recent Philadelphia rule. 
 
 Strainers. 
 
 •■All waste pipes, from fixtures other than water-closets, must he provided at the 
 outlet of such fixtures with strong metallic strainers, to exclude from such waste 
 pipes all substances likely to obstruct them." : 
 
 Wooden Tubs and Sinks Prohibited. 
 
 In Brooklyn "wooden laundry tubs are prohibited; all such fixtures 
 shall eoiisist of non-absorbent materials." A similar rule is found in 
 the District of Columbia, Chicago, Lawrence. Lowell, Pittsburgh, and 
 Other cities. In Worcester wooden tubs and sinks are prohibited, unless 
 rendered impervious to water. In Asbury Park cement as well as wood 
 is forbidden, but wooden sinks may, with the approval of the hoard ol 
 
 health, he allowed for washing dishes. 
 
 Bath-Tubs Required. 
 
 In Baltimore a recent ordinance requires a hath tub in every new 
 hou 
 
 Hot Water Boilers. 
 
 •■All hoi water boilers sel hereafter shall be provided with a steam exhaust or 
 expansion pipe Leading up to and above the tank which supplies the water to the 
 boiler. This lank shall he Located s<> n- to prevent danger from freezing. When 
 pressure boilers are used they shall be provided with vacuum valves or some other 
 suitable appliance to prevent the collapse or bursting <>( the boiler." 
 
 In Pittsburgh •• the sediment pipe of kitchen boilers must not be 
 connected on the nutlet side of the sink trap. 
 
 1 Bridgeport, Sec. 51. 
 A Ibanj . Sec. 37. 
 Fitchbure, Sec. 31. 
 
250 PLUMBING. 
 
 Sub-soil Drains. 
 
 " Sub-soil drainage pipes shall be provided with back water valves and connected 
 with drains from rain leaders, or else provided with trap and valve and connected 
 with the main drain outside of house trap. 11 1 
 
 Back pressure valves are also required on subsoil drains in other 
 cities. 
 
 No Steam to be Allowed to Enter Sewers. 
 
 " No steam exhaust, blow-off, or drip pipe shall connect directly with the sewer, 
 house drain, soil, waste or vent pipe, or with any rain-water conductor. Steam 
 shall be discharged into a blow-off or condensing tank, the waste or overflow of 
 which shall be connected with the house sewer outside of the house trap. Joints 
 of the blow-off pipe shall be screw joints, or in case of cast-iron pipe they shall be 
 rust joints. 11 2 
 
 The condenser must be for low pressure of not less than twenty 
 gallons and for high pressure of not less than forty gallons, with a vent 
 leading from the dome of a diameter not less than that of the discharge 
 pipe. In Providence the size of the condenser is to be determined by 
 the inspector. 
 
 "No steam exhaust, hot water, or hot blow-off pipes from any steam boiler, 
 acids, chemicals, refuse, manufacturers 1 waste, noxious gas, or vapors shall be con- 
 nected with or be discharged into any soil or waste pipe or its connection with the 
 main or street sewer. All steam or hot water pipes from any steam boiler or heat- 
 ing apparatus if to be discharged into a sewer through the house drain, must be 
 trapped and be connected on the sewer side of the running trap. 
 
 "The waste from the condenser to sewer side of running trap shall be galvanized 
 pipe with screw joints. 3 
 
 Public Urinals. 
 
 In Denver all public urinals must be supplied with a flush tank, the 
 flush to be connected with urinal and head of trap. 
 
 Water Service. 
 
 Rules governing the construction of water supply pipes are usually 
 prepared and enforced by the water commissioners or water company. 
 As defects in this department of plumbing produce uneconomic rather 
 than unsanitary consequences their prevention may safely be left to the 
 officers most interested in preventing waste. Nevertheless there is a 
 manifest convenience in having all the plumbing inspected and con- 
 trolled by one inspector. Hence a number of cities do regulate this 
 work partially if not entirely by their plumbing codes : 
 
 "Tanks for drinking water are objectionable, but if indispensable, they must 
 never be lined with lead, galvanized iron or zinc. They should be constructed of 
 iron, or of wood lined with tinned and planished copper, or of wood alone. 11 4 
 
 1 Detroit, Rule 19. 
 
 2 Brooklyn, Sec. 54. 
 
 3 Cleveland, Sec. 21. 
 
 4 City of New York, Sec. 52. 
 
PLUMBING. 251 
 
 "All supply pipes situated in exposed places shall be protected from the frost, 
 and wherever practicable water pipes shall be kept away from any exterior wall. 
 Horizontal lines of lead supply-pipe shall be properly supported throughout their 
 entire length, and so arranged as to be easily and quickly drained. Vertical lines of 
 supply-pipe shall be supported by tacks soldered to the pipe and placed not more 
 than two feet apart. All joints in lead supply-pipes shall be wiped joints. 
 
 •Lead supply-pipes under pressure from the street mains shall be of standard 
 lead pipe known as 'A A.' having not less than the foil, .winy weights: 
 f inch pipe, Ik lbs. per foot. 
 
 i " 
 
 •_' 
 
 I •■ 
 
 •• 2| 
 
 I " 
 
 ■ ;_ 
 
 1 
 
 ■i\ 
 
 1± " 
 
 •■ 5| 
 
 u •• ;i 7 " " 4tl 
 
 As an example of the more extended regulations governing this 
 class of work, such as are adopted by water boards, reference may be 
 had to the plumbing regulations of the District of Columbia, Sees. 34-66. 
 
 Application of Rules to Old Plumbing. 
 
 Unless otherwise specified, plumbing rules do not apply to work 
 constructed before their adoption: but BOmetimes under the authority 
 of statute law the board of health or other body which adopts these 
 rules makes them applicable in a greater or less degree to old plumbing 
 as well as new. Usually the new rides are to be applied when changes 
 arc made. In some cities the rules are to apply only when old plumb- 
 ing has been condemned by the board of health : 
 
 •• When the drainage of buildings erected prior to 1886 lias been inspected and 
 condemned, plans must be hied, and the new work of alterations shall be executed 
 in accordance with these rules and regulations." - 
 
 In Philadelphia a very large amount of old plumbing has been 
 renewed, and it is said to be difficult to let a house without good 
 modem plumbing. The extent of these renovations is well shown by 
 the fact that in 1896 there were filed in Philadelphia 6,648 plumbing 
 
 plans for now buildings and 9,078 for old buildings. 
 
 •• When a building has been inspected and the plumbing work condemned by the 
 building inspector as being in an unsanitary condition, notice shall i>e given in writ- 
 ing to that • ffect, informing the agent or owner of the said building what character 
 of repairs or improvements are to be made, and if there are any objections to the 
 repairs or improvements ordered, they must lie filed in the health office, within a 
 period of three (3) days, and if objections are qoI so filed the alterations or improve- 
 ments liiusi be made ;i> directed. 
 
 '•It' objections are bo made, the agent or owner shall be heard by the health 
 officer, and fiis decision shall be final and conclusive as to the repairs or alterations 
 to be made; provided, if anj questions are involved, which require consideration 
 
 1 Brooklj n. Bees. W l. 
 - Philadelphia, Rule 7. 
 
252 PLUMBING, 
 
 and action of the board of health in the judgment of the health officer, the same shall 
 he submitted to the board of health for determination.'" : 
 
 "It shall be his (inspector of plumbing) duty at any time during reasonable 
 hours, under like direction, on application of the owner or occupant, or the com- 
 plaint under oath of any reputable citizen, to inspect or cause to be inspected any 
 house in said district, and to examine the plumbing, drainage, and ventilation of 
 seAvers thereof. 
 
 "And he shall, after inspection and upon approval by his immediate superior, 
 serve a notice on the owner, or agent, of the premises, directing such changes as are 
 necessary to make the plumbing conform to the plumbing regulations, to be com- 
 menced within ten days from the date of the service of the notice and completed 
 within a reasonable time thereafter.' 1 2 
 
 But it is provided in addition that there may be an appeal by the 
 owner (who shall deposit twenty dollars) to the engineer commis- 
 sioner who shall order a re-examination by three inspectors. If this 
 report confirms the first the changes must be begun in five days, and 
 failure is to be followed by prosecution. 
 
 Administration of Plumbing Codes. 
 
 As has been said, the execution of plumbing laws is usually in the 
 hands of the board of health. This is true of nearly one hundred 
 cities and towns of which inquiry was made. The following is a list 
 of cities in which the plumbing is otherwise controlled: 
 
 New York Department of Buildings. 
 
 Boston Building Department. 
 
 Milwaukee City Engineer's Department. 
 
 Cambridge Supt. of Buildings. 
 
 Cincinnati Inspector of Buildings. 
 
 St. Loins Board of Public Improvement. 
 
 Somerville, Mass Inspector of Buildings. 
 
 Butte, Mont Inspector of Buildings. 
 
 Newton, Mass Inspector of Buildings. 
 
 New London, Conn Board of Sewer Commissioners. 
 
 Erie, Penn Water Department. 
 
 Providence Independent Department. 
 
 Omaha Independent Department. 
 
 Pawtucket Independent Department. 
 
 Memphis Independent Department. 
 
 Columbus Department of Public Improvements. 
 
 Minneapolis Building Department. 
 
 Licensing of Plumbers. 
 
 It has of late come to be generally considered that the first step in 
 securing good plumbing is to secure good plumbers. To bring this 
 about examining boards are established to examine and license plumbers. 
 
 1 San Francisco, Sec. 47. 
 
 2 District of Columbia, Sec. 3. 
 
PLUMBING. 253 
 
 Most of the examinations are made under state law. Such laws are 
 found in the District of Columbia, 1 Illinois.' 2 Maryland for Baltimore, 3 
 Massachusetts, 4 Minnesota." New Hampshire, 6 New York," Ohio, 8 Penn- 
 sylvania, for cities of the second class." Texas. 1 " Washington. 11 and Wis- 
 consin, 12 and in all of them provision is made for the examination of 
 fche plumbers by a properly constituted board. 
 
 Of the above states, in Maryland and Minnesota the examining 
 hoard is a state board and is appointed by the Governor. In both states 
 the term of service is two years. In Maryland the hoard consists of 
 three practical plumbers, the commissioner of health of Baltimore and 
 a member of the state hoard of health. In Minnesota the hoard con- 
 sists of two master plumbers, two journeymen and one plumbing inspec- 
 tor of ,-niy city of the first class. 
 
 In the other states the law provides for a local examining hoard as 
 follows : 
 
 Massachusetts. In cities of 5,000 inhabitants, or those with a water 
 and sewerage system there must he an examining board to consist of 
 the chairman of the hoard of health, the inspector of buildings, and a 
 plumber appointed by the hoard of health. If there is no inspector of 
 buildings there must he two plumbers. 
 
 New York. In all cities except the City of New York and Albany 
 the- examining hoard appointed by the mayor is to consist of two master 
 plumbers, one journeyman, each of ten years' experience, the chief 
 engineer of sewers, and the chief inspector of plumbing. 
 
 Illinois. In cities and villages of over 10,000 inhabitants, the hoard 
 consists of the chairman of the hoard of health, one master plumber and 
 one journeyman. 
 
 Washington. In cities of the first class the examining board con- 
 sists of the president of the board of health, the inspector of plumbing, 
 one master plumber ami two journeymen. If there is no inspector 
 another master plumber is added. 
 
 1 District of Columbia, A<t of 23 April. 1892. 
 -' [llinois, A.( of 10 .Imp-. 1897. 
 
 Maryland, Chapter 139 of 1896. 
 1 Massachusetts, Chapter 477 of. 1893, 155 ol 1894, and 153 of 18 
 
 Minnesota, Chapter 319 of 1897. 
 
 \c u Hampshire, Chapter 55 of 1899. 
 
 ■ New Fork, Revised Statutes (1895), p. 137. 
 Ohio, Annotated Statutes (1900), Sec. 12381 10). 
 
 ■ I'.nn \ i>. ania, * hapter l J6 i if 1895. 
 "' Texas, Chapter 163 oi 1897. 
 
 11 Washington, Code 1 1- 1248 '■'. 
 
 '- Wisconsin, Statutes (1898 - .959 
 
254 PL UMBixa. 
 
 New Hampshire. In cities and towns which accept the act, the 
 mayor in cities, and the selectmen in towns appoint the board. 
 
 Texas. In cities with sewers or cesspools the hoard consists of a 
 member of the board of health, the city engineer, the plumbing inspec- 
 tor, one master plumber, and one journeyman, each of five years" ex- 
 perience. 
 
 Ohio. The Ohio law is like that of Massachusetts, except that two 
 master plumbers and one journeyman are on the board. Physicians 
 may be appointed in the place of plumbers if the latter are not avail- 
 able. 
 
 Wisconsin. In cities of the first, second, and third class, the board 
 consists of the commissioner of public works, or the chairman of the board 
 of health, the inspector of plumbing, and a plum Iter appointed by the 
 mayor. If there is no inspector of plumbing, there shall be two 
 plumbers appointed by the mayor. 
 
 In all of these boards the members are to serve without pay, except 
 in Massachusetts, where the plumber is to receive five dollars per day 
 for actual service. 
 
 These laws are all mandatory and require the establishment of the 
 licensing board and forbid any one acting as master or journeyman 
 plumber without a certificate, which shall be given only when the can- 
 didate has passed a practical and satisfactory examination. Usually it 
 is sufficient for one member of a firm to have a license. In Massachu- 
 setts the board examines, but the board of health or inspector of build- 
 ings issues the license. The New York law differs from the other 
 laws in requiring an examination of master plumbers only : but all 
 licensed plumbers may register with the board of health in New York. 
 
 < hitside of the states which have by statute provided for the ex- 
 amination of plumbers several cities have adopted this plan, sometimes 
 With and sometimes without special legislative sanction. Among these 
 are Atlanta, Chicago, Detroit, Hartford, New Haven, Pennsylvania 
 cities of the second class, Portland, Me., San Francisco, St. Louis, and 
 Savannah. In Atlanta the examining board consists of a master and 
 journeyman plumber, chief sanitary inspector, the city engineer, and 
 secretary of board of health. In Portland, Hartford, and San Fran- 
 cisco, it is the board of health ; in Detroit it is a special board appointed 
 by the board of health. 
 
 In Chicago the commissioner of health appoints a competent 
 plumber to be examiner. In that city only masters are examined; in 
 Hartford only journeymen, but in other cities both classes. In the 
 District of Columbia masters and journeymen are to be examined by a 
 board appointed by the commissioners of the district. In Denver, while 
 
PLUMBING. 2-35 
 
 there is no examination, the license has to be approved by a board con- 
 sisting of a member of the master plumbers' association, a member of 
 the journeymen plumbers' union and the plumbing inspector: the asso- 
 ciation members are to be elected by their respective associations. In 
 St. Louis plumbers are examined by the supervisor of plumbing (chief 
 inspector). 
 
 The rules governing the examinations in Detroit are given below. 1 
 
 Somewhat more elaborate rules are found in the District of Colum- 
 bia ( sections A to -I ). 
 
 The states and cities which provide for the examination of plumbers 
 usually provide also for the issuing of a license or certificate, and the 
 registration of the name and address of the plumber with the board of 
 health or other department having charge of the plumbing. 
 
 As the licensing of plumbers is of value to the plumber as well as to 
 
 1 Detroit Rules for Plumbing and Drainage: 
 
 "Rule 6. Application for examination of master plumbers will be received by 
 tin- clerk of the board and ailed upon at the next regular meeting, and shall be 
 properly tilled out and acknowledged and tiled with the clerk before being received 
 by the Hoard of Kxaininers. The applicant shall state on oath, and in his own hand- 
 Writing, that he is a citizen of the United States; that he is a party directly inter- 
 ested in tin- license, giving his fidl name, residence, street and number, his term of 
 residence in the city, ami the names of the parties, firms or corporations in whose 
 service he has been. He shall also state his business or employment during the live 
 years immediately preceding the date of application, as well as the number of years 
 during which he has been engaged in the business, trade or calling of plumbing. 
 The application must be accompanied by a certificate signed b\ not less than two 
 reputable citizens of Detroit, stating that they are personally acquainted with the 
 applicant and believe him to he of good moral character ami temperate babits. The 
 examination will he of such character as to fcesl the litncss and qualifications "f the 
 applicant for the trade, business or calling of plumbing, who must have a standing 
 of at least sixty per cent, in his examination to he entitled to a certificate of com- 
 petency. Falsehood or fraud in the examination shall be a sufficient cause for a 
 refusal"!' his certificate, together with the dismissal of his application. When the 
 applicant fails to pass the examination he shall not be entitled to another examina- 
 tion before the next regular meeting of the board. 
 
 •■ hi it 7. There will be two grades of examinations for journeymen plumbers, 
 viz. : « Ordinary and honorary. The applicant can select the grade, and if successful 
 he will be furnished with a certificate "t competency in cither grade ns the case may 
 be. bui he cannot take the honorary grade until he has passed a successful examina- 
 tion in the ordinary grade. If the candidate fails to pass the examination in either 
 he shall uot be entitled to another examination before the expiration of one 
 month from date of failure. The applicant who applies foj a certificate of compe- 
 ther ordinary or honorary journeyman plumber, must give his full name. 
 
 residence, street number, term Of residence in t he city, if a citizen ; the names i d the 
 
 parties, firms or corporations in whose services he has been; where be served his 
 apprenticeship; how long he has been engaged as a journeyman plumber. If the 
 
 said journeyman plumber wishes to engage in business for himself at any time, he 
 
 must comply with section -± <>f the rules relating t^ master plumbers, before engag 
 
 ing i herein.*' 
 
256 PLUMBING. 
 
 the public it is deemed wise in many cities to charge a fee for the 
 license or for the examination. 
 
 The following are some of the fees : 
 
 City or State. Master. Journeyman. Annual Renewal. 
 
 Massachusetts 82 00 - 50 $ 50 
 
 Xew York 5 00 
 
 Ohio 5 00 1 00 
 
 Pennsylvania cities of the second class. . 5 00 50 
 
 Maryland 3 00 3 00 1 00 
 
 Illinois 5 00 1 00 
 
 Minnesota 3 00 3 00 1 00 
 
 Wisconsin 2 00 50 ' 50 
 
 Washington 5 00 1 00 1 00 
 
 Chicago :)0 00 30 00 
 
 Denver 10 00 10 00 
 
 New Haven 1 00 1 00 1 00 
 
 Reading 100 loo i 00 
 
 ■San Francisco 1 00 1 00 1 00 
 
 Texas 3 00 2 00 
 
 In a number of cities, as Philadelphia and Providence, no fee is 
 charged. 
 
 As has been seen an annual license only is granted in most in- 
 stances, but in the District of Columbia the license is for live years, and 
 in Philadelphia and other Pennsylvania cities and in Xew Vork the 
 duration of license is indeterminate. 
 
 The special act tor Philadelphia and also the general act for Penn- 
 sylvania cities and boroughs and the Xew Jersey law provide simply 
 for the registration of plumbers, they do not refer to a license : but in 
 certain cities at least, as Philadelphia, Scranton and Reading, " certifi- 
 cates of registration "' are issued which are practically licenses, and in 
 Reading a fee is charged for this. This practice of registration is fol- 
 lowed in certain other cities, as Pawtucket, Manchester, and Ports- 
 mouth. X. H. In Pawtucket the plumber must notify the inspector of 
 any change in his place of business. 
 
 In Buffalo a list of licensed plumbers must lie published once a 
 year in the paper receiving the city advertising. In Hartford the list 
 must be published in the city year book. 
 
 Bonds, 
 
 In a number of cities plumbers are required to give bond. 1 
 
 The usual amount of the bond is $5 1,000. In the District of Coluni- 
 
 1 Chicago Plumbing Code, Sec. 2: 
 "... Every such person shall, with such application, trie with the city clerk a 
 bond, signed by two or more sureties, to be approved by the city clerk, in the sum 
 of three thousand (3.000) dollars, conditioned that the applicant shall indemnify 
 
PLUMBING. 257 
 
 bia and Baltimore it is $2,000; in Chicago and Denver, #3,000; in 
 Cincinnati and San Francisco. $500. 
 
 Inspectors. 
 
 The next step after the adoption of plumbing rules and the licens- 
 ing of plumbers is the appointment of inspectors. This has in many 
 cases been done without special legislation under the grant of general 
 sanitary powers, as in Baltimore, or under a special statute authorizing 
 the •• regulation of plumbing and drainage," as in New Jersey. But 
 several states have enacted general laws authorizing the appointment of 
 plumbing inspectors and the same power has been given to individual 
 cities by special acts. Massachusetts, New Hampshire, New York. 
 Ohio, and Pennsylvania for cities of the second class have not only 
 authorized but directed the appointment of plumbing inspectors, also 
 Washington for the cities of the first class with water and sewers, 
 Wisconsin for cities of first to third class, and Texas for cities with 
 sewers. 
 
 Several cities have rules for the government of their inspectors. 
 The San Francisco rules are given below. 1 
 
 and save harmless the City of Chicago from all accidents and damages which may 
 be caused by any negligence, unskilfulness or inadequacy in the execution or pro- 
 tection <>f any work be may do under and by virtue of his license, if issued, and that 
 he will conform to all lawful requirements and regulations of the city pertaining to 
 the business of plumbing in accordance with the ordinances of the city, and with 
 the rules and regulations of the department of public works, and the department of 
 health. The city clerk shall notify the commissioner of health of the filing of all 
 such applh at ions and bonds." 
 
 1 San Francisco. Plumbing Code: 
 
 ''Section 61. Fntsr — The Plumbing Inspector shall be in attendance at the 
 Health Office between the hours of 8 and 9.30 \. «. and 4 to 5 p. \i.. to receive plans 
 oi proposed plumbing and drainage, and to make appointments for the inspection 
 
 of the work in the course of construction. 
 
 'Second Be shall number and file all plans and specifications accepted, and 
 
 record in the Hoard of Health the names of the owner and architect, and plumber, 
 and local ion of work. 
 
 • Thikd He shall, upon being notified, examine all plumbing work before the 
 same is covered up and concealed, and. if found to be iii accordance with the rules 
 of the Board of Health, upon presentation of an accurate plan ami specification of 
 
 same by the plumber, shall issue a certificate to that effect. It. on examination of 
 
 said work, he finds any violation of the rules oi t he Board of Health, he shall report 
 the same to the Health Officer with a note explaining the necessary corrections, and 
 have if altered accordingly. Upon completion of any plumbing work he shall ex- 
 amine the same, ami if found to he in accordance with the rules of the Board of 
 Health, and the plans ami specifications filed, he shall issue a final certificate. 
 
 i"i kiii He must make a monthly report to the Board oi Health of the num- 
 ber of plans ami specifications received; the number approved and rejected; also 
 stating the number of first and final examinations made, and where and by whom 
 
 17 
 
Allegheny. 
 
 Minneapolis. 
 
 258 PLUMBING. 
 
 The following is a list of cities having inspectors of plumbing and 
 also the salaries of the inspectors : 
 
 Number of Annual 
 
 City. Inspectors. Salaries. 
 
 ( 1 $1,200 
 
 ! 1 864 
 
 Baltimore 1 1,200 
 
 R . ( 1 2,500 
 
 B ° St0n 1 10 1,400-1,800 
 
 Brockton I 1 1,200 2 
 
 Cambridge 1 1,000 
 
 Chicago 14 1,000 
 
 Cincinnati 2 ._ 1,100 
 
 Columbus 1 •" 900 
 
 Dayton 1 1,000 . 
 
 Denver 2 1,200 
 
 Fitchburg 1 1,000 
 
 Hartford 1 1,200 . 
 
 Haverhill 1 1,000 
 
 Holyoke 1 1,000 
 
 Lawrence 2 1,200 
 
 Lynn 1 per inspection 5 
 
 „., , \ 1 1,500 s 
 
 Milwaukee > g 12003 
 
 < 1 1,000 
 
 ' I 1 900 
 
 Newark 1 1,200 
 
 New Bedford 1 1,400 
 
 New Haven 1 1,200 
 
 Newton 1 1,250 
 
 New York, (Manhattan and Bronx) J Vino i'-nn 
 
 ( So 1,1UU— l,oOU 
 
 Paterson 1 1,375 
 
 Philadelphia 13 1,200 
 
 , 1 1,800 
 
 Pittsburgh ] 2 1,500 
 
 ' 2 1,200 
 
 „ ., < 1 1,500-' 
 
 Providence j g 1Q ^ 
 
 Reading 1 1,000 
 
 , 1 1,500 
 
 San Francisco ] 3 1,200 
 
 ' 1 900 
 
 Somerville 1 1,200 
 
 Springfield, Mass 1 1,100 
 
 Syracuse 2 1,200 
 
 the rules have been violated, and such other matter as may be required by the Board 
 of Health. 
 
 "Fifth — The Assistant Inspector of Plumbing and Drainage will act under the 
 orders of the Inspector of Plumbing and Drainage, and assist him in discharge of 
 his duties.' 1 
 
 1 Also disinfects. 
 
 2 Has horse and buggy in addition. 
 
 3 Furnish own horse and buggy. 
 
PLUMBING. . 259 
 
 Notification of Inspection. 
 
 " The department of health must be notified when the work is begun, and when 
 any work is ready for inspection. All work must be left uncovered and convenient 
 for examination until inspected and approved. No notice shall be sent for any 
 inspection until the work is entirely ready for thorough inspection. In case of any 
 violation of this regulation, the approval of said plans may be at once revoked by 
 the commissioner of health, and upon notice of such revocation being given, all 
 work under said plans must cease.' 1 
 
 In Milwaukee the notification must be in writing and specify the 
 plan number. In Lowell the notification must be at least eight hours 
 before the work is sufficiently advanced for such inspection. Failure to 
 be ready for inspection at the time set requires some penalty. In San 
 Francisco it is deemed sufficient cause for suspension of license for such 
 time as the hoard of health may deem proper. In Reading if the work 
 is not ready another notice must be sent and if the work is not then 
 ready one dollar will be charged for receiving a third notice. In Provi- 
 dence : 
 
 " . . . In case it shall be necessary for said inspector to inspect said work 
 more than once, by reason of the same not being ready for final inspection, after 
 notice has been given the inspector of the completion of said work, then said inspec- 
 tor shall charge and collect from said plumber the sum of fifty rents for each visit 
 of inspection required to be made as aforesaid." 2 
 
 Inspection of Work. 
 
 In Pittsburgh the inspector must examine the work within three 
 days alter receiving notice that it is ready for inspection: in Ports- 
 mouth and Manchester, N. II., within twenty-tour hours. In Albany 
 the sewer connection must be inspected in twenty-four hours, and the 
 Other work in three days after notice. If it is not inspected in that 
 time the plumber may cover in the work and complete the job. 
 
 "All soil, waste and vent pipe must be tested i>\ the plumber in charge with a 
 water test, as directed by the inspector, and in the presence of the inspector. All 
 openings having been closed by the plumber in charge of the work, pipe-joints, fit- 
 tings, or fixtures thus shown to be defective or wronglj placed must be replaced 
 within three days and again tested if required by the inspector. None of the said 
 pipes shall be covered from sight till they have been shown to stand the test pre- 
 scribed to the satisfai tion of the inspector. After the plumbing work of the build- 
 ing has been tested as directed, no alteration will be permitted except upon written 
 application of the plumber in charge of the work. Permits must l>e taken out 
 before work will be inspected. Notice must be sent to the said inspector when 
 work is sufficiently advanced for inspection. No inspection will be made on legal 
 bolidaj s." a 
 
 " Tin- plumber shall test all soil, waste, drain, and venl pipes in the presence of 
 the plumbing inspector, by the water test, or by such other methods as may he 
 
 Brooklj n, Sec. 10, 
 Proi idence, Sec. 4. 
 Cleveland, Sec. 20. 
 
260 PLUMBING. 
 
 approved by the board of health, the pressure to be applied as directed by the 
 inspector, the test to be made as follows: All connections must be made with the 
 exception of the main trap clean-out for the testing- plug. Place traps in their 
 proper places. Connect all back vent pipes to traps, caulk all ferrules in soil and 
 waste pipes, place all iron hangers and other supports in their position." 1 
 
 "The entire system of plumbing, including lead, connections, and drains within 
 the building, must be tested by filling the whole system with water, and having it 
 remain filled for at least twenty-four hours.'" 2 
 
 Iii Rochester stop-cocks shall be placed at the foot of vertical soil or 
 waste pipes for the convenience of the plumbing inspector of the board 
 of health. Other cities than New Bedford permit or require other tests 
 than the water test. Thus in Providence the test is the water test " or if 
 that is not practicable, the air-pressure, peppermint, or other reliable 
 test." In Pittsburgh the peppermint test is permitted, and in Scranton 
 the smoke or peppermint test, and in many New Jersey cities the pepper- 
 mint, ether, or smoke test. In Asbury Park, Montclair, and Newark 
 the smoke test is usually employed. In New Haven and Asbury Park 
 a five-pound air-pressure, and in the District of Columbia a two-pound 
 air-pressure test is allowed. In Manchester the smoke test may be 
 used if no water is to be had. 
 
 After this preliminary test a certificate is usually given approving 
 the work already done. After the work is entirely completed a final 
 inspection is usually required for which another application must be 
 made. 
 
 The peppermint or other practical test is allowed for the final test 
 in several cities. In Providence the final test is simply an inspection 
 and no mechanical test is employed other than the first water test. 
 
 After the completion of the final test a certificate is in many cities 
 given to the plumber to show that the work has been properly done. 
 The form used in Denver is shown in Appendix 41, a similar form 
 being kept as a stub. 
 
 In several cities drain layers are a distinct class from plumbers and 
 have separate licenses. In such cases separate plans, inspections, and 
 approvals are required for the drain layers' work. These usually follow 
 the same form and procedure as provided for plumbers. 
 
 In many cities also it is provided that " plumbing work shall not be 
 used unless the same has first been tested and approved in writing " by 
 the inspector: 
 
 " Plumbing work shall not be used unless the same has been first tested at the 
 expense of the plumber, in the presence of the authorized inspector with the water 
 
 1 New Bedford, Sec. XXIII (3). 
 
 2 Hartford, Sec. 44. 
 
PLUMBING. 261 
 
 test, or if that is not practicable, with the air pressure, peppermint, or other reliable 
 test, and by hirn approved in •writing." 1 
 
 111 Hartford : 
 •• Until such certificate is issued, it shall not be lawful for the owner, manager, 
 or agent of said property to allow the same to be occupied for human habitation." 2 
 
 Penalty for Defective Work. 
 
 Violations of plumbing rules, like any other municipal regulations, 
 
 are punished by fine or imprisonment, but, as is usual in such minor police 
 
 regulations, the penalties are not severe. Another and more effectual 
 
 penalty is the revocation of the license of the plumber. In New York 
 
 this is provided for by statute : 
 
 " But such registration may be canceled by such board of health or superintend- 
 ent of the department of buildings in the city of Xew York for a violation of the 
 rules and regulations for the plumbing and drainage of such city, duly adopted and 
 in force therein, after a hearing had before said board of health, or superintendent 
 of the department of buildings in the city of New York, as the case may be, and 
 upon a prior notice of not less than ten days, stating the grounds of complaint, and 
 serve upon the person charged with the violation of the aforesaid rules and regula- 
 tions: but such revocation shall not be operative, unless concurred in by a majority 
 of the local board of examiners.*' 3 
 
 Another penalty still is to remove defective work : 
 
 ••The inspector of plumbing shall promptly condemn and order the removal of 
 any defective material, bad workmanship, or of any work done otherwise than in 
 accordance with the provisions of these regulations." 4 
 
 1 Providence, Sec. 22. 
 
 - Hartford, Ordinance of 1 March, 1887. 
 
 ■ New York, Revised Statutes (1895), p. 437, Sec. 6. 
 
 4 District of Columbia, Sec. 38. 
 
CHAPTER VI. 
 
 AVATER, ICE, AND SEWERS. 
 
 A PLENTIFUL supply of pure water is one of the prime requisites 
 of municipal sanitation. Such a supply can only be. furnished 
 through a system of mains operated by a public or quasi-public corpora- 
 tion. The demand for municipal water works in the United States has 
 been very great. According to the " Manual of American Water 
 Works " for 1897, 1 there were at the opening of this century seventeen 
 such water works in operation. In 1896 there were 3,196. Of these 
 water works 1,690, or more than one-half were owned by municipalities. 
 The tendency for the city to own and operate its works seems to be a 
 growing one, and the manual referred to gives a list covering two 
 closely printed pages, of cities in which the water works have changed 
 from private to public ownership. This list includes some of the most 
 important cities of the country. The list of cities which have changed 
 from public to private ownership is small, and the cities are small. As 
 regards the quantity of water furnished, the cities and companies in the 
 United States seem to have done all that could be desired. In fact 
 they have done more than is necessary. There is little doubt that more 
 than half the water furnished in the United States is wasted. The per 
 capita comsumption in American cities is twice as great as in European 
 cities, and in the comparatively few American cities which are metered 
 the per capita consumption is not half what it is in the average unmet- 
 ered city. 2 It has been argued that the use of meters tends to reduce 
 the consumption of water to too low a minimum, but such is decidedly 
 not the experience in the city of the writer. Meters diminish waste, 
 not the legitimate use of water. 
 
 The sources of the water supplies of the United States are veiy 
 varied ; lakes and ponds, storage reservoirs, rivers and deep wells being 
 the most important. The character of the water of course varies from 
 that which is desirable in every respect, to that which is barely endur- 
 able. There are many conditions of water which must be taken into 
 consideration when estimating its desirability or permissibility as a 
 municipal supply. 
 
 1 Published by the Engineering News Publishing Company, New York. 
 
 2 Water supplies. William P. Mason, 1896, p. 438 et seq. 
 
WATER, ICE, AXD SEWERS. 263 
 
 Ch em ical Compositio n . 
 
 Water which contains too much mineral substance in solution is 
 not desirable, as it renders the water unsuitable for boiler or laundry 
 use. 
 
 Suspended Mutter. 
 
 The chief form in which suspended matter is found in potable waters 
 is in the form of tine silt, which is carried along by the current of a very 
 large proportion of the rivers of the United States. More rarely organic 
 matter of vegetable origin may be held in suspension in sufficient quan- 
 tity to be an offence. 
 
 Color. 
 
 The more coloring matter the less pleasant is the appearance of the 
 water to the consumer. 
 
 Taste and Odor. 
 
 A slight vegetable, swampy, or peaty taste is not very objectionable, 
 but is certainly far from desirable. Unfortunately this is not the only 
 tasi<- which is found in water, for under certain conditions the growth 
 and decay of algae give rise to most disagreeable " fishy " tastes, and 
 also to bad odors. Sometimes these are sufficient to render the water 
 positively nauseous. 
 
 Pathogenic Organisms. 
 
 The most serious contamination of drinking water is disease germs. 
 Of these the typhoid bacillus is by far the most important. It is pos- 
 sible thai certain diarrhceal affections may be carried in drinking water. 
 but the evidence is not clear. Cholera is known to be disseminated 
 through the medium of public supplies, but has not gained a foothold 
 here for a quarter of a century, and meanwhile typhoid has claimed 
 hundreds of thousands of victims and a very Large number of the discs 
 were undoubtedly caused by drinking the water of contaminated muni- 
 cipal supplies. 
 
 The health officer is, of course, most directly interested in the last 
 form of contamination. It is his business to labor for the suppression 
 of the infectious diseases of which typhoid is one of the most important. 
 His chic!' concern is to see to it that water is tree from dangerous 
 organisms; but he should not neglect the other factors which go to 
 make a -ood water supply. It is of great importance thai a water sup- 
 ply be attractive to the eye and taste, or a pleasant, but dangerous well 
 may be preferred in its stead. It is also very desirable thai the water 
 should be soft, so that it will be sought for in ever} house and every 
 manufactory; and il is furthermore desirable that the price be reason- 
 
264 WATER, ICE, AND SEWERS. 
 
 able, that its use may not be restricted by the poor or by parsimonious 
 landlords and corporations. The health officer should remember that 
 he is doing much to promote health when he gives his influence to 
 secure any of these desirable conditions of municipal water supply. 
 
 Usually, the health officer, particularly the local health officer, does 
 not have very much to do directly with the control of the water supply. 
 The actual labor of introducing and caring for a water supply is gen- 
 erally in the hands of the engineering or public works department, or 
 special commissions, or private companies. Yet it is true that in cer- 
 tain states and cities health officials have done very much for the im- 
 provement of the water supplies within their jurisdictions. 
 
 The duties of the state boards of health in Massachusetts, Minnesota, 
 and New York in regard to the prevention and abatement of nuisances 
 causing pollution of potable waters will be referred to on another page. 
 Further than this, local governments in these states and in North Caro- 
 lina are required to consult with and receive advice from the state board 
 of health in regard to introducing or extending their water supply. In 
 Ohio the law goes further than this and requires the towns and cities to 
 heed the advice of the state board. 1 
 
 Besides thus specifically advising and controlling the local supplies, 
 the state board of health may do very much by a systematic study and 
 investigation of the existing and available supplies of drinking water for 
 cities and towns, and by a careful investigation of the various scientific 
 problems connected with the furnishing of a pure municipal water. 
 The state of Massachusetts has set an example in this work which it 
 will be difficult for others to equal and which none have yet attempted 
 to do. The now well known results of the Lawrence filter experiments 
 are classics in this line of work, and the Massachusetts board of 
 health, and the men that have been associated with it, have done more 
 than all others to awaken an interest in pure water, and, what is more, 
 they have shown how it is possible to secure it. The board has also 
 since 1887 conducted a systematic investigation of the water supplies 
 of the state, and has published its results in a voluminous special report 
 in 1890, and in its annual reports since that date. Connecticut, New Jer- 
 sey, New York, and Ohio have also investigated local supplies, the lat- 
 ter state having recently (1898) issued a special report. The control 
 which is exercised or the influence which is exerted by some of the 
 
 1 Ohio, Annotated Statutes (1900), Sees. 409-25: 
 
 " And no city, village, corporation or person shall introduce a public water sup- 
 ply or system of sewerage, or change or extend any public water supply or outlet 
 of any system of sewerage now in use, unless the proposed source of such water 
 supply or outlet for such sewerage system shall have been submitted to and received 
 the approval of the state board of health. (O. L. Vol. 90, p. 94.) 
 
WATER, ICE. AND SEWERS. 265 
 
 state boards above mentioned in regard to sewage disposal is of great 
 importance in connection with the maintenance of the purity of water- 
 supplies. 
 
 Such general investigations as are above referred to should, in the 
 opinion of the writer, be undertaken by the state as they have been in 
 Connecticut, Massachusetts, and Ohio ; but in default of this the cities 
 have, outside of these states, been very largely obliged to do work of 
 this kind themselves. Local boards of health have thus very generally 
 felt it their duty to advise concerning the adoption or improvement of 
 the water supply of their city, and have been obliged to undertake 
 inspections and investigations in regard to its purity. It will generally 
 be found that local boards of health are in advance of the public, and 
 in advance of the other municipal officers in demanding the introduc- 
 tion of sanitary purification of water. A perusal of the reports from 
 year to year of Baltimore, Chicago, Cincinnati, Denver, District of Col- 
 umbia, Minneapolis, Philadelphia, Pittsburgh, Providence, Reading, 
 Rochester, St. Louis, Scranton, and Syracuse will show that local 
 boards of health have been alive to the needs of their cities and have 
 often for years called in vain for purer water. They have made inves- 
 tigations and have shown conclusively that the water was dangerously 
 contaminated, and they have also shown the remedy. Local boards of 
 health may, outside of their advisory capacity, exert an actual control 
 Over their water by patrol and enforcing pollution laws and by carrying 
 on systematic analysis of the water. This will be referred to on a suc- 
 ceeding page. The legislation concerning the pollution of potable 
 waters will now be considered. 
 
 Prevention of Pollution by Legislation. 
 
 There is considerable statutory legislation intended to prevent the 
 pollution of public water supplies. 3 Much of this is of a very general 
 nature and dates back to the time when the exael danger to be appre- 
 hended in water pollution was not as well understood as it is at the pres- 
 ent time. .Much of this legislation is evidently based on the Massa- 
 chusetts statute of L843. 2 Some of the laws specify more I'nIK than 
 
 'Such laws are found in California, Connecticut, Delaware, Illinois, Indiana, 
 K;ihn;in. Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Ne^i 
 Hampshire, Sevt Jersey, Ne\i Fork, North Carolina, Ohio, Oregon, Tennessee, 
 Virginia, Wesl Virginia, and Wisconsin. 
 
 Massachusetts, Public Statutes (1882), Chapter 208, s ''.-. 7: 
 
 •• Whoever w ilfully or maliciously defiles, corrupts, or makes impure any spring, 
 or other source of water, or reservoir, or destroys or injures any pipe, conductor of 
 water, or other property pertaining to an aqueduct, or ;ii<ls or abets in any such 
 trespass, shall be punished by line no! exceeding one thousand dollars, or by impris- 
 onment in the j;iil nol exceeding one year 
 
266 WATER, ICE, AND 8 E WEES. 
 
 that of Massachuaetts the waters that shall not be corrupted, as water 
 courses, streams of running- water, pond, well, fountain, cistern, other 
 place from which water is procured for drinking purposes, streams 
 from which towns are supplied, brook, canal, river, water used for do- 
 mestic purposes, or used for man or beast. 
 
 The act of pollution is sometimes more specifically defined. Thus 
 among the things that must not be put into the water are mentioned, 
 carcasses of dead animals, slaughter-house refuse, contents of privy 
 vaults, cesspools and drains, human animal excrement ; slops, filth, dye- 
 stuffs, drugs, chemicals, putrid, noisome, nauseous and offensive sub- 
 stances ; decaying animal or vegetable matter and sewage ; and nothing 
 must be done to befoul or pollute the water or injure health. Usually 
 in these laws the words " wilfully *' and " maliciously " are omitted, but 
 sometimes they are retained. In Kentucky it is forbidden to place such 
 materials within twenty-five feet of the bank, and a later Massachusetts 
 statute places the limit at five rods. A statute more explicit than the 
 Massachusetts type has been enacted in New Hampshire and is given 
 below. 1 A later law, and one making better application of our present 
 knowledge, is that of Virginia, but it is not applicable to water sheds 
 having an area of over fifty square miles. 2 
 
 1 New Hampshire, Public Statutes (1891), 108, Sec. 13: 
 
 " If a person shall place, leave, or cause to be placed or left, in or near a lake, 
 pond, reservoir, or stream tributary thereto, from which the water supply for domestic 
 purposes of a city, town, or village is taken, in whole or in part, any substance or 
 fluid that may cause the water thereof to become impure or unfit for such purposes, 
 he shall be fined not exceeding twenty dollars, or be imprisoned not exceeding thirty 
 days, or both.' 1 
 
 2 Virginia, Chapter 460 of 1892 : 
 
 ''Section 1. Be it enacted by the general assembly of Virginia, That it shall 
 be unlawful, except as hereinafter provided, for any person to defile or render im- 
 pure, turbid or offensive the water used for the supply of any city or town of this 
 state, or the sources or streams used for furnishing such supply, or to endanger the 
 parity thereof by the following means, or any of them, to wit: by washing or bath- 
 ing therein, or by casting into any spring, well, pond, lake or reservoir from which 
 supply is drawn, or into any stream so used, or the tributary thereof, above the 
 point where such supply is taken out of such stream, or is impounded for the pur- 
 poses of such supply, or into any canal, acqueduct or other channel or receptacle for 
 water connected with any works for furnishing a public water supply, any offal, 
 dead fish, or carcass of any animal, or any human or animal filth, or other foul or 
 waste animal matter, — or any waste vegetable or mineral substance, or the refuse 
 of any mine, manufactory or manufacturing process, or by discharging or permitting 
 to flow into any such source, spring, well, reservoir, pond, stream, or the tributary 
 thereof, canal, acqueduct or other receptacle for water, the contents of any sewer, 
 privy, stable or barn yard, or the impure drainage of any mine, any crude or refined 
 petroleum, chemicals, or any foul, noxious, or offensive drainage whatsoever, or by 
 constructing or maintaining any privy vault or cesspool, or by storing manure or 
 other stable fertilizer of any offensive character, or by disposing of the carcass of 
 
WATER, KE. AXU sEWERs. 267 
 
 The bathing in waters used for domestic supply is prohibited in 
 Massachusetts, Connecticut, and New Hampshire within one quarter 
 mile of intake. In Maine, Minnesota and North Dakota it is forbidden 
 to place upon the ice any substances which would pollute the water, 
 and in Massachusetts horses must not be driven upon such ice. 1 In 
 North Carolina it is forbidden to " empty on the water shed of any pond 
 or stream furnishing the source of water supply of any public institu- 
 tion, city or town, the undisinfected discharges of a person sick with 
 cholera or typhoid fever." The cutting of ice on waters used for a 
 public supply is regulated in New Hampshire. 2 
 
 The injurious effects of cemeteries bordering upon a public water 
 supply have been considerably discussed, and a careful consideration of 
 the subject may be found in the reports of the Pennsylvania state board 
 of health. 3 While it was felt that it would be dangerous for the un- 
 altered drainage of cemeteries to flow into a river used as a source of 
 public supply, yet the danger of locating near such a river is not very 
 great. A law was enacted in Pennsylvania 4 that was declared uncon- 
 stitutional and another was enacted in 1895. s This law forbids the use 
 
 any animal, or any foul, noxious or putrescible substance, whether solid or fluid 
 and whether the same be buried or not, -within two hundred feet of any water 
 course, canal, pond, or lake aforesaid, which is liable to contamination by the wash- 
 ing thereof or percolation therefrom: provided that nothing in this act contained 
 shall be construed to authorize the pollution of any of the waters in this state in any 
 manner now contrary to law: and provided further, that this act shall not apply to 
 streams, the draining area of which, above the point where the water thereof is 
 withdraw n for the supply of any city or town, or is impounded for the purposes of 
 such supply, shall exceed fifty square miles." 
 
 Massachusetts. Public Statutes (1882), Chapter 80: 
 "Sec. 101. Whoever drives a horse on the ice on a pond, the water of which is 
 used for the purpose of domestic water supply for a city or town, shall be punished 
 lis line not exceeding fifty dollars, or imprisonment not exceeding thirty days. 
 
 1 'Se< . 102. The preceding section shall nol apply to persons engaged in cutting 
 or harvesting ice from such ponds, or in bauling logs, \\ 1. or lumber." 
 
 \ew Hampshire, Vt of 28 March. 1895: 
 
 Si ■ . -. No person shall cut or take ice Erom any lake, pond, or reservoir used 
 as the source of a public water or ice supply for domestic purposes for man. un- 
 less he lirst shall comply in all respects with sii.h reasonable rules and regulations 
 in regard t" the manner and place of cutting and taking such ice on said lake, pond, 
 or reservoir, as may be prescribed by the local board of control or officers of a water 
 company, wl ay have charge of the works of anj city or town supplying its in- 
 habitants with water from said lake, pond, or reservoir. The supreme court shall 
 have power to issue injunctions restraining any person from cutting or taking ice 
 from such lakes, ponds, or reservoirs until thej have complied with the reasonable 
 regulations made as aforesaid." 
 
 Pennsylvania, Mate Hoard of Health Report, 1894, p. 99, etseq. 
 ' Pennsylvania, Brightly's, Purdon's Digest (1895), ; .6. 
 
 Pennsylvania, Act of 24 June, 1895. 
 
268 WATER, ICE, AND HEWERS. 
 
 for a burial ground of any land the drainage of which reaches a water 
 supply within one mile of the city using the supply, but it does not 
 apply to grounds in use at the time of its passage. The Connecticut 
 law is given below. 1 
 
 Besides the general legislation for the protection of water supplies 
 that has been referred to, there has been a good deal of a special char- 
 acter to meet the requirements of individual towns and cities. Some 
 of this is found in the form of special acts. One of the earliest of 
 these was that for Philadelphia. 2 Among recent acts may be mentioned 
 those of Paterson 3 and Manchester, N. H. 4 
 
 In New York, where power to legislate in regard to the protection 
 of water supplies has been delegated to the state board of health, that 
 board has made rules, often elaborate ones, to meet the exigencies of 
 individual cities, as Brooklyn, 5 Rochester, 5 Sing Sing, 5 New York, 6 New- 
 burgh, Elmira," Syracuse, 7 Utica, 7 Mount Vernon, 8 Peekskill, 8 Sara- 
 toga, 8 and many others. The Massachusetts state board of health is 
 authorized 9 to make similar rules and has done so for the Metropolitan 
 Water Board (Boston), and for Cambridge. These rules are very com- 
 plete and specific. 10 The North Dakota state board of health also has 
 made regulations for the protection of potable waters. 
 
 These regulations cover a great variety of detail concerning the 
 location and construction of privy vaults, cesspools and the care and 
 disposal of house slops, sewage, wash water, garbage, manure, dead ani- 
 mals, manufacturers' wastes, etc. The rules for Brooklyn (Ridgewood 
 
 1 Connecticut, General Statutes (1888): 
 
 " Skc. 2655. No cemetery or place of sepulture shall hereafter be located or 
 established within one-half mile of any reservor from which the inhabitants of any 
 town, city, or borough are supplied with water, nor shall such reservor be located 
 or established within one-half mile of any cemetery or place of sepulture, unless the 
 Superior Court of the county wherein such cemetery or place of sepulture or reser- 
 voir is located shall, upon application and such notice as it may deem proper, find 
 that such cemetery or place of sepulture or such reservoir so proposed to be located 
 is of public convenience and necessity, and will not be detrimental to the public 
 health.'" 
 
 2 Pennsylvania, Act of 12 April, 1828. 
 New Jersey, Act of 28 March, 1895. 
 
 4 New Hampshire, 1891. 
 
 5 New York, State Board of Health Report, Vol. XV., p. 309 et seq. 
 
 6 New York, State Board of Health Report, Vol. XIV., p. 565 et seq. 
 
 7 New York, State Board of Health Report, Vol. XVII., p. 402 et seq. 
 
 8 New York, State Board of Health Report, Vol. XVIII., 343 et seq. 
 
 9 Massachusetts, Chapter 488 of 1895, Sec. 24. 
 
 10 Massachusetts, Senate Doc. No. 4, 1900, Water Supply and Sewage, 10 January, 
 p. 118 et seq. 
 
WATER, ICE, A XI) SEWERS. 269 
 
 water), cover seven pages. Other legislation forbidding the pollution of 
 public supplies is to be found in the charters of water companies and 
 in the special acts authorizing municipalities to construct water works. 
 
 As may be seen from the examples given, and would he seen from 
 a study of the other laws, the penalties are as they should be, rather 
 severe; but besides criminal action for the violation of the statutes 
 other courses may be open for the cities that are injured by the pollu- 
 tion. Action may be taken to get rid of the nuisance by calling in the 
 aid of the state board of health. In one state at least, Xew Hamp- 
 shire, the statute directs the local government to abate the nuisance, 
 and in Connecticut the statute directs that appeal be had tothe cou 
 
 While most state boards of health are authorized in a general way 
 in their advisory capacity to assist cities, towns, and villages in select- 
 ing or improving their water supplies, it is only in a few states that 
 these boards have any real power to enforce their decision or to aid 
 the towns in bringing to justice the offenders against the laws relative 
 to the pollution of streams. Massachusetts, Minnesota, Xew York, and 
 Ohio have however given their state board of health considerable power 
 in such matters. The action of the state board of health may relate to 
 the abatement of nuisances on the banks of streams, or it may have to 
 do with the more important subject of the approval of new work, and 
 in this respect the state board of health holds a position somewhat like 
 that of the local government board in England which exercises a con- 
 trol over all the municipal public works in the kingdom. The state 
 
 'Xew Hampshire, Public Statutes (1891), Chapter 108: 
 
 Si c. 14. The board of health of the town, or the water commissioners having 
 charge of the water supply, or the proprietors thereof, may remove such substance 
 or fluid; and they may recover the expense of removal from the person who placed 
 the same or caused it to be placed in or near the water as aforesaid, in an action on 
 the case." 
 
 The section preceding the above is given on p. 266. 
 
 Connecticut, Chapter 203 of 1895: 
 
 L4 Sec. l. Section 2656 of the General Statutes is herebj amended to read a^ 
 follows: Whenever any land or building is so used, occupied, or suffered to re ma in, 
 that it is a source of injury to the water stored in anj reservoir used for supplying 
 an\ town. city, or borough with water, or to any source ot' supply to any such reser- 
 voir, or when any such water is liable to pollution in consequence of the use ol the 
 same, either the authoriti ^ of such town. city, or borough, or the company having 
 charge ol said water, may bring their petition to the superior court in and for the 
 
 county in which said town, city, borough Or COmpanj is located tor relief; and said 
 
 court.uiK.ii such petition, shall have full power as a couri of equity to order the 
 removal "i any building, to enjoin any use or occupation "i anj land or building, ■■> 
 
 ■ a said water, which i^ detrimental t" said water, oi- i,, make any other order tem- 
 porary or permanent which in its judgmenl may be oecessarj i" preserve the purity 
 of said water. 
 
270 WATER, ICE, AND SEWERS. 
 
 board of health, unlike the English board, only takes cognizance of the 
 sanitary works of sewerage and water works. 
 
 In Massachusetts 1 the state board of health on application of the 
 mayor of a city, the selectmen of a town, or the president of a water or 
 ice company complaining that the water or ice supply of the city or 
 town is polluted, shall give a hearing, after due notice to all parties 
 interested. If after the hearing, the state board of health so deter- 
 mines, they 
 
 • shall prohibit the deposit, keeping, or discharge of any such material or other 
 cause of pollution as aforesaid, and shall order any person to desist therefrom and 
 to remove any such material theretofore deposited, or other cause of-pollution; but 
 said board shall not prohibit the cultivation and use of the soil in the ordinary 
 methods of agriculture, provided that no human excrement is used thereon. But 
 said board shall not prohibit the use of any structure which was in existence at the 
 time of the passage of this act, in case the complaint referring to or including said 
 structure is made by the board of water commissioners of any city or town, or by 
 any water or ice company, unless the board of water commissioners or the water or 
 ice company making the complaint, shall file with said state board of health an 
 order or vote of its city council, selectmen, or water or ice company respectively, to 
 the effect that such city, town, or water or ice company will at its own expense make 
 such changes in said structure or its location as said board shall deem expedient. 
 Such order or yote shall be binding on such city, town, or water or ice company; 
 and, when such changes shall have been made, all damages occasioned thereby shall 
 be paid by such city, town, or- water or ice company; and if the parties cannot agree 
 thereon such damages shall be determined by a jury on petition of either party, 
 filed in the clerk's office of the superior court in the county where the premises are 
 located, in the manner provided by law in relation to determining the damages 
 occasioned by taking land for highways in such city or town, or in the case of a 
 water or ice company, in the city or town in which said structure is located." 
 
 The succeeding sections of the law relate to appeals and to the 
 power of the courts to enforce the orders of the board. The Minne- 
 sota law is quite similar. 
 
 In Xew York 2 the state board of health may make rules and regu- 
 lations in regard to the protection of water supply, and such regu- 
 lations may even go so far as to require the construction of municipal 
 systems of sewerage, the removal of buildings and interference with 
 industries ; but in all cases the water company or municipality benefited 
 must bear the cost. If a regulation of the state board is violated the 
 state board may investigate and direct the local board of health to 
 enforce the regulation. By the act of 1892 3 a town may bring action 
 against parties who pollute its water supply, provided the fact of pollu- 
 tion is attested by the state board of health and also provided that the 
 town does not itself pollute a stream. 
 
 1 Massachusetts, Chapter 510 of 1897, Sec. 3. 
 
 2 Xew York, Revised Statutes (1895), p. 2437, Sees. 70-2. 
 
 3 Xew York, Revised Statutes (1895), p. 2439, Sec. 72a-d. 
 
WATER, ICE, AX1> SEWEBS. 271 
 
 Of course, statutory legislation in regard to water protection is 
 much more important and useful than any local regulation can be, for 
 it is only in rare instances that the source of a municipal supply is 
 entirely within the city's jurisdiction. A part of the supply, however, 
 often is within the city limits, and sometimes as in Chicago, the whole of 
 the pollution comes from the city itself. A considerable number of 
 cities have therefore made rule^ for the protection of their water sup- 
 plies. Usually these rules have no special legislative sanction, though 
 in Illinois 1 , and New Jersey 2 local governments are authorized to make 
 such regulations. In Xew Jersey the hoard of health is given this 
 [lower. The provisions given below were found in Brooklyn 1 and regu- 
 lations of a similar general character have been adopted in Augusta, 
 Gra., Chicago, Cincinnati. Denver, Memphis, Omaha, Yonkers, and other 
 cities. 
 
 It makes very little difference what legislation there may he con- 
 cerning water pollution, unless active measures are taken to maintain a 
 constant supervision over the water and the hanks of the rivers or lakes 
 from which it is obtained. There are two means which may be combined 
 in securing this supervision. < >ne is the inspection or patrol of the water 
 shed, and the other is the laboratory study of specimens of the water. 
 Patrol of the banks of lakes or streams which are likely to yield con- 
 taminated water is of the utmost value. Even when not backed by 
 sufficient legislative power, the inspector, if diligent, alert, and tactful, 
 
 •Illinois, Annotated Statutes (1896), Chapter 24, Sec. 126. 
 
 - New Jersey, General Statutes (1895), p. 1647, Sec, 19 | XII). 
 Brooklj M. Sanitary ( lode: 
 
 "Sec. 46. That no person shall throw or allow to run or pass in any public 
 reservoir, water pipe or aqueduct, or into or upon any border or margin thereof, or 
 excavation or stream therewith connected, any animal, vegetable or mineral sub- 
 Btanc< whatever; nor shall any person allow the same to be done (having power or 
 right to prevent the same), nor shall any person do or permit to in- done (having 
 right or power to prevent the same), any ad or thing that will impair or imperil t he 
 purity or wholesomeness of any water or other fluid used or designed as a drink in 
 any part of said citj ; nor shall any person bathe nor (except in the dischai 
 public dutj i put anj pari of his person into such water, nor shall any unauthorized 
 person open anj erection or unscrew anj hydrant holding such water. 
 
 "Sec. IT. That it shall hi' the duty of every person, officer, department ami 
 board, having any authority ami control in regard to anj water designed Cor human 
 consumption (and within t he proper sphere of the duty of each thereof), to take all 
 usual ami also all reasonable measures and precautions to secure and preserve the 
 purity ami wholesomeness of such water. 
 
 "Sec. is. Thai no person shall destroy nor in anywise injure or impair any drink- 
 ing hydrant, or pan thereof, in the said city; nor shall anj person interfere with 
 the use of or enjoyment of the water therein, or therefrom, or interrupt the flow 
 thereof, or as a drink; nor shall anj person put any dirty, poisonous, medicinal or 
 any noxious substance into or near said water or hydrant, whereby such water i> 
 made or maj hi' regarded as dangerous or unwholesome as a drink. 11 
 
272 WATER, ICE, AND SEWER8. 
 
 can accomplish no mean results. If the laws are capable of enforce- 
 ment he can of course do much more. 
 
 When the water supply of a city comes from a very large water 
 shed, particularly if it is situated partly outside of the state in which 
 the city is located, it is hardly practicable to accomplish much by patrol. 
 So, too, when the chief source of pollution is municipal sewage, patrol 
 can be of little avail. There are, however, many cities which take their 
 water from a small area where the pollution is mostly from isolated 
 houses, barns or mills, where patrol may give a very great degree of 
 security, particularly if there is good statutory law against pollution. 
 Many cities have adopted this method of protecting their supplies. 
 Most communities having a doubtful supply have probably made occa- 
 sional efforts to improve it by the personal visits of an inspector, but 
 some have gone farther than this and maintain a permanent supervision. 
 Providence began in 1875 with a thorough investigation of the sources 
 of pollution of its public supply. During the next ten years the board 
 of water commissioners attempted, under a very defective law, to get 
 rid of most of the contamination. The health department then made 
 several inspections of the water shed, and the presence of typhoid fever 
 called attention to the subject, and a man was employed a considerable 
 part of the time to look after the nuisances along the banks. Since 
 1889 an inspector employed by the commissioner of public works at a 
 salary of -f 1,200 has devoted all his time to the work, and recently 
 another inspector has been employed at a salary of $1,000, and though 
 there has been a great increase of population, there is far less pollution 
 than at any time since the supply was made use of. In Baltimore 1 
 since 1896 an inspector, a physician, under the health department, has 
 made daily inspections of the water shed and has secured many volun- 
 tary abatements of dangerous nuisances ; but all offenders have not 
 willingly complied with his requirements, for in 1897, 2 of ninety-five 
 orders, fifteen were followed by suit. About the same time the Brook- 
 lyn health department 3 established a laboratory at a convenient location 
 on the water shed of its supply, and together with a daily collection 
 and examination of specimens, made note of all possible sources of con- 
 tamination. Interesting photographs of some of these offenses are shown 
 in the report for 1895, page 272. In Manchester, N. H., 4 where the 
 water supply is taken from a lake, the shores of which are occupied by 
 
 1 Baltimore, Report of Health Department (1896), p. 11. 
 
 2 Baltimore, Report of Health Department (1897), p. 16. 
 
 3 Brooklyn, Report of Department of Health (1895), p. 272; (1896), pp. 123 and 
 216. 
 
 4 Manchester, Report of Board of Health (1897), p. 25. 
 
WATER, ICK AND SEWERS. 273 
 
 summer cottages and are used for picnics, the board of health maintains 
 a daily inspection during the summer season, and on Sundays and holi- 
 days the inspector is on hand all day. Bathing and washing are pre- 
 vented, also the flow of sewage, and the throwing of rubbish in the 
 water. The Newark 2 and Scranton 2 boards of health make annual 
 inspections. 
 
 Another method of supervising the water supply is by frequent 
 examinations of the water itself. There are three general laboratory 
 methods of testing water. One of these, the oldest method, is the 
 chemical examination, which consists chiefly in estimating the amount 
 of the different forms of nitrogen " albuminoid ammonia," "free ammo- 
 nia," nitrites and nitrates, and also the amount of chlorine present. 
 Contrary to the popular notion, the interpretation of the results of the 
 chemical examination of the water is by no means easy. A chemist 
 must have a full knowledge of the history of the water in order to form 
 even an approximate estimate of its sanitary condition. Nevertheless, 
 the chemical examination of drinking water is of very great importance, 
 and much information can be derived from it which is of value in 
 determining whether or not a given water may safely be used for drink- 
 ing. Of late years the biological examination of water has come to be 
 considered important, and here again two methods are made use of for 
 the study of two classes of organisms. The algce are plants of con- 
 siderable microscopic size and they can be isolated and studied by filter- 
 ing a sample through a coarse filter and washing the filter in a small 
 volume of water which may be examined at once under the microscope. 
 The role played by these organisms in producing disagreeable odors and 
 tasns iii certain waters has made such microscopical examination of 
 water very useful in the care of waters that are likely to be so affected. 
 Lastly the bacteriological method of water examination has been made use 
 of to study those minute organisms which can only be isolated and studied 
 by growing them in artificial culture media. The number of bacteria 
 present iii waters is often an excellent index of their contamination, and 
 the presence of certain species is of still greater value. The presence 
 pf tyhoid or cholera organisms would of course condemn a water, and 
 the presence of any form of bacteria characteristic of fecal matter should 
 do the same. The proper study of municipal water supplies requires 
 then the inspection of the source of the supply, the chemical and bacte- 
 riological examination of samples, and often the microscopical examina- 
 tion also. Cities which wish to secure or maintain as good a water 
 supply as possible cannot afford to iie-led an\ of this work, though 
 
 1 Newark, Report oi Board <>i Health (1897), \>. 24. 
 Scranton, Report ol Board ol Bealth (1894). 
 
274 WATER, ICE, AND SEWERS. 
 
 the completeness with which it is necessary to follow it out will vary in 
 individual cases. 
 
 In a number of cities the examination of water samples is in the 
 hands of the board of health, partly because the health department 
 appreciates more fully than any other department the necessity for 
 vigilance in such matters, and partly because other laboratory work is 
 done by that department, rendering the employment of chemists and 
 bacteriologists a necessity. Among the cities in which the health 
 department carries on regular chemical examinations of the public water 
 supply may be mentioned Baltimore, Brooklyn, Buffalo, Chicago, Den- 
 ver, Hartford, Lawrence, Newark, and New York City. 
 
 Bacteriological tests are made in Albany, Buffalo, Denver, Hartford, 
 Lawrence, Newark, and New York City. 
 
 Miscroscopical tests are carried on very extensively in Brooklyn 
 under the direction of George C. Whipple, and at Albany, Boston, 
 Lynn, Pittsburgh, and to some extent at Buffalo, and also by the water 
 company at Wilkesbarre, Penn. Sometimes water tests are made 
 monthly as in Rochester, bi-monthly as in Providence, bi-weekly as in 
 Hartford, weekly as in New York, or daily as in Buffalo. 
 
 A law was passed in Michigan 1 in 1897, by which, on resolution of 
 any municipal council, water may be sent to the state university for 
 analysis, the municipality to pay only the cost of materials used in 
 making the analysis. 
 
 Purification of Public Water Sulplies. 
 
 It not infrequently happens that it is practically impossible for a 
 community to secure a water supply which is free from dangerous pol- 
 lution. It is of course wise to keep in mind the maxim of Dr. Kedzie, 
 that what is needed in water supplies is "innocence not repentance," 
 nevertheless an " innocent " supply cannot in some cases be obtained 
 for a sum of money that can be appropriated. The community must 
 drink contaminated water or else purify it. The most essential thing 
 to get rid of is, of course, the pathogenic bacteria, of which at present, 
 so far as we know, the typhoid bacillus is the one constant menace. 
 But, as has been previously alluded to, it is also important to get rid of 
 color, suspended matter, taste and odor. Fortunately, both taste and odor 
 can usually be prevented, and bacteria, suspended matter and color can 
 be removed by one and the same process. The seriously disagreeable 
 tastes and odors in water are usually due to the growth of algas and 
 this can largely be prevented. The principal means of prevention are 
 
 1 Michigan, Compiled Laws (1897), See. 4484. 
 
WATER, KK. AND SEWERS. 275 
 
 the proper construction and cleansing of reservoirs. Reservoirs with 
 hard, clean bottoms, particularly if they are deep, are unfavorable to 
 the growth of alga', but certain waters will grow algae even in deep 
 reservoirs or tanks. This is particularly true of ground waters, and in 
 such cases the reservoirs may be covered, as the algae will not grow with- 
 out the sunlight. In Boston where the supply was drawn from several 
 sources, it was found that the alga' rarely grew in more than one reser- 
 voir at a time, and by care that could be shut off before harm was done. 
 There are three practical methods of purification in use, aeration, 
 sedimentation and filtration. 
 
 Aeration. 
 
 At one time it was believed by many that this would do much 
 towards purifying water, even if dangerously polluted. It is now known 
 that this was a false hope and the field for aeration is much restricted. 
 It is now rarely employed and only to get rid of odors and tastes. 
 Among the cities which make use of aeration are Rochester and Albany. 
 
 Storage and Sedimentation. 
 
 This method of purifying water by allowing time for the suspended 
 matter to settle to the bottom, has long been employed to clarify muddy 
 waters. It has only within very recent years been learned that this is 
 also a most excellent method of getting rid of disease germs, and indeed 
 of all kinds of bacteria. The pathogenic bacteria which are feared in 
 drinking water, do not thrive in that medium, but rapidly die out. 
 These as well as the other non-pathogenic forms are largely carried to 
 the bottom by their own weight, or by the precipitation of other ma- 
 terials. River waters stored in large reservoirs often lose in a few 
 weeks ninety to ninety-five per cent, of their bacterial contents. While 
 reservoirs are frequently constructed for the purpose of removing silt 
 from water, they have probably never been constructed for the express 
 purpose of freeing water from pathogenic organisms, and they are not 
 likely to be; but in any consideration of water works construction or 
 extension, it is well to keep iii mind this useful result of the Btorage of 
 water. Unfortunately the storage of water has. as has been shown, its 
 disadvantages as well as its advantages, for the storage of certain waters 
 yen greatl) favors the growth of alga'. 
 
 filtration. 
 
 The first extensive successful filters were those constructed by the 
 London water companies. These niters have nov been in use about fiftj 
 years. They are in most instances great^ assisted to their success by 
 the large storage reservoirs in which the water remains .1 considerable 
 
276 WATER, ICE, AND SEWERS. 
 
 time before it is allowed to pass on to the filter beds. The excellent 
 results obtained by these filters and their storage reservoirs, was largely 
 due to a happy chance, for at the time they were built and for many 
 years afterwards, the true nature of the dangerous constituents of river 
 water was not known. It was only with the development of bac- 
 teriology that the action of filters could be studied in a satisfactory and 
 scientific manner, and rational deductions made for their improvement. 
 Though for many years and to a very recent date the London filters 
 served as the best models, yet it was not from their management that a 
 correct knowledge was derived of the way in which filters should be 
 constructed and operated. It was the engineer of the Berlin water 
 works and the officers of the Massachusetts state board of health who 
 first placed the art of filtration on a scientific basis. 
 
 While filters are exceedingly common on the continent of Europe 
 they have not been used at all in the United States until a quite recent 
 period, and then usually in a very unscientific manner. The European 
 filters are almost without exception patterned on the London model. 
 They consist of beds of sand through which the water slowly percolates 
 downwards. In the United States nearly all the filters until within the 
 last two or three years have been of a very different type. In them the 
 water is passed rapidly through the sand, and before its passage there 
 is added to it a small amount of some coagulant such as sulphate of 
 alumina. The bed of the filter is frequently agitated to clean it. The 
 European method is in the United States usually spoken of as " natural 
 filtration " and the latter method as " mechanical filtration," though 
 neither of these terms is desirable or descriptive of the process. 
 
 Natural Filtration. 
 
 Most natural filter beds are provided with sedimentation basins of 
 varying capacity in which the water may deposit a part of its impurities 
 before it passes on to the filters. In the case of very muddy waters 
 such a basin or reservoir is a necessity. A filter consists of a bed of 
 sand of about an acre in area and enclosed by masonry or other embank- 
 ment. Some beds are much larger than that, and some smaller, but an 
 acre is a convenient size. The sand bed consists of several layers, 
 coarse materials being placed at the bottom and about two feet of a 
 moderately fine sand at the top. It is this layer that is the essential 
 part of the filter and it is quite necessary to secure sand of the right 
 quality ; it should be sharp but even. The total thickness of the filter 
 is from four to six feet, and it has a system of under drains at the 
 bottom which carry off the filtered water to the reservoir or pump well 
 as the case may be. The filter is filled beneath to drive the air out and 
 the water is allowed to stand at a depth of three to six feet above the 
 
WATER. K'K AND SEWERS. 
 
 277 
 
 Z c 
 
Zi 
 
 WATER, ICE, AND &EWEBS. 
 
 surface of the sand. Often the water is allowed to rest for twenty-four 
 hours before the filter is started, and the first water which passes through 
 runs to waste. The efficiency of the filter depends upon the layer of 
 dirt and slime which is precipitated upon the surface of the sand from 
 the water standing upon it and from that which first passes through. 
 The efficiency of the filter is also in a general way the converse of the 
 rate of filtration, the higher the rate the less is the water improved by 
 its passage. The rates now deemed most advantageous range from 
 2,000,000 to 4,000,000 gallons per acre each twenty-four hours. With 
 the increasing deposit of sediment on the surface of the filter, less and 
 less water will pass through under a given head. The head of water 
 on these filters does not usually exceed four feet. Various contrivances 
 are employed to regulate the head of water on the filter but in all cases 
 constant supervision is necessary. When through the clogging of the 
 filter the rate becomes too slow to furnish the needed water, the filter 
 has to be cleaned by drawing off the water and scraping about a half an 
 inch from the surface of the sand. 
 
 In cold climates much difficulty is experienced in cleaning the filter in 
 the winter time. It is necessary to wait for a thaw when the ice is melted 
 or else to cut it and remove it. Care must also be taken that the sand 
 does not freeze when the water is drawn. If a very large area of filter- 
 ing surface is provided so that the rate may be slow, the time between 
 scrapings may be lengthened so as to lessen the difficulties of winter 
 
 Plan and Section of Water Filtration Bed, Lawrence, Mass., Hiram F. Mills, Designing Engineer. 
 
WATER, ICE, AND SEWERS. 
 
 279 
 
280 WATER, ICE, AND SEWERS. 
 
 cleaning ; but the best method in regions where the temperature falls 
 below 30° F., is to cover the filters. 
 
 The earliest natural sand filter constructed in this country was at 
 Poughkeepsie. It has never been carefully operated for the purpose of 
 removing bacteria, and comparatively few bacterial counts have been 
 made of the water. The cost of cleaning is said to be $2.99 per million 
 gallons, but little can be inferred from these figures as to the cost of 
 operating filters for bacterial efficiency. Small sand filters have also 
 been constructed at Greenwich, Conn., Ilion, N. Y., Nantucket, Mass., 
 Mt. Vernon, N. Y. 
 
 In 1893 a sand filter was built at Lawrence, Mass., for the purpose 
 of removing the dangerous bacteria from the Merrimac River water. 
 This filter lias apparently done its work well, for Lawrence has since 
 been free from the outbreaks of typhoid which were formerly so common. 
 The filter has an area of two and one-half acres and was intended to 
 yield a flow of 5,000,000 gallons. See Figs. 5 and 6 from plates loaned 
 by the superintendent of the Lawrence Water Works. This filter is 
 not constructed according to the best design, and in a climate as cold as 
 Lawrence should be covered. Hence the cost of cleaning is high. 
 This should not, however, be taken as an indication of what the cost of 
 operating the best form of modern filter would be. 
 
 A filter was put in operation in Albany in 1899 which ma} T be con- 
 sidered representative of the best ideas in regard to sand filtration. 
 This filter 1 consists of a series of eight basins having an area each of 
 about 0.7 of an acre. The normal rate of filtration is 3,000,000 gallons 
 per acre daily, and with one basin out of use for cleaning, the capacity 
 of the whole filter would be 14,700,000 gallons per day. The cost of 
 the filters was about -$255,000 exclusive of land and engineering. ' 
 
 In order to protect them from freezing the filters are arched over 
 with brickwork supported on brick piers. The whole is covered with 
 two feet of earth and grassed over. Access is gained through numer- 
 ous manholes which are protected by double steel covers. The tops of 
 the manholes are carried up six inches above the grass. The water is 
 collected underneath the filter by six-inch vitrified drains laid with open 
 joints. The pipes are of this large size in order to prevent the slightest 
 friction and consequent irregular action of the filter. The collectors 
 are thirty-inch pipes. 
 
 The gravel surrounding the under drains is of three grades. The 
 first immediately surrounding the drain consists of stones, one to two 
 
 1 This account of the Albany filter is taken from the Proceedings of the Ameri- 
 can Society of Civil Engineers, November, 1899, and the electrotypes for the accom- 
 panying illustrations were loaned by the society. 
 
WATER, ICE, AND SEWERS. 
 
 281 
 
 
 . 
 
 
 
 1 
 
 i 
 
 
 5JL 
 
 Fig. 8. 
 Interior view of the Albany Filter. Bbowiog drains before they were covered with gravel. 
 
 i "i \ 1 1 i:i 1 1 > Filter, showing sand in place before watei Is turned, 
 
282 WATER, ICE, AND SEWERS. 
 
 inches in diameter. This is covered with gravel between one inch and 
 three-eighths of an inch in diameter. The finest gravel is intermediate, 
 between three-eighths and three-sixteenths of an inch in diameter. The 
 thickness of the latter layer is about two inches. Above the gravel is 
 four feet of sand. The specifications for this sand require that it shall 
 be clean, river, beach, or bank sand with either sharp or rounded grains, 
 that it shall be free from clay, dust or organic impurities. The sand 
 has effective sizes averaging 0.31 millimeter. 
 
 The dirty sand which is removed from time to time is thoroughly 
 washed and again replaced in the filters. Two ejector sand-washing 
 machines are provided at convenient places between the filters. In 
 them the dirty sand is mixed with water and is thrown up lyy an ejector, 
 after which it runs through a chute into a receptacle from which it is 
 again lifted by another ejector. It passes altogether through five 
 ejectors, a part of the dirty water being wasted each time. The sand 
 is finally collected from the last ejector where it is allowed to deposit 
 from the water. 
 
 The report of the board of water commissioners for 1899 states that 
 the filters were put in operation in August, 1899, and by the end of the 
 year they had reached a bacterial efficiency of over ninety-nine per cent. 
 The cost of operating the filters was $1.67 per million gallons. This 
 included laboratory supervision. 
 Mechanical Filters. 
 
 These filters consist usually of cylindrical wooden or metal tanks. 
 One type of the filter, the pressure filter, is a horizontal, or sometimes a 
 vertical, closed tank in which is a bed of sand or crushed quartz. When 
 it is necessary to clean the filter the current of water is reversed through 
 the effluent pipes and the sand is cleaned by the action of the water. 
 Various types of pressure filters are made by the New York Filter 
 Manufacturing Company. Such filters are in use at Oakland, Cal., 
 Atlanta, Long Branch, Kingston, N. Y., Asheville, N. C, Raleigh, Nash- 
 ville, Davenport, la., Little Rock, Ark. This filter is shown hi Fig. 11. 
 
 A style of filter similar to the above has recently been put on the 
 market by the Continental Filter Company, in which the agitation of 
 the sand during washing is accomplished by the use of compressed air. 
 This filter is in use at Asbury Park, N. J., and Vincennes, Ind. 
 
 The gravity type of mechanical filter is represented by the Morrison- 
 Jewell filter, made by the New York Filter Manufacturing Company. 
 This filter consists af an open perpendicular tank of wood or steel with 
 about two feet of crushed quartz in the bottom. In this quartz are a series 
 of rakes which can be rotated by machinery. When it is necessary to 
 clean the filter the current of water is reversed and sent up through the 
 
WATER, KK AND SEWERS. 
 
 283 
 
284 
 
 WATER, ICE, AND SEWERS. 
 
 Fig. 11. 
 Pressure Filter made by New York Filter Manufacturing Co. 
 
 outlet pipes and is greatly aided in scouring the sand by the agitation 
 of the rotating rakes. These tanks are from fifteen to twenty-four feet 
 inside diameter. They are now constructed with a sediment compart- 
 ment occupying the lower portion, in which a part of the coagulated 
 material may be precipitated before the water flows on the surface of 
 the sand. These gravity filters of different forms are in use at Augusta, 
 Ga., Quincy, 111., Burlington, Cedar Rapids, Keokuk, Ottumwa, Dubuque, 
 la., Lexington, Ky., St. Joseph, Mo., Elmira, Niagara Falls, N. Y., 
 Lorain, O., York, Penn., East Providence, R. I., Columbia, S. C, Knox- 
 ville, and Norfolk. Some of these plants furnish as high as 9,000,000 
 or 10,000,000 gallons per day. 
 
 The rate of filtration in these mechanical filters is very high, so that 
 only a small area of tank is needed to supply a large amount of water. 
 With a rate of 124,000,000 gallons per acre per day, a tank fifteen feet 
 in diameter will give a practical daily yield of 500,000 gallons of fil- 
 tered water. 
 
 The mechanical filters can only be operated by the addition to the 
 applied water of some coagulant. The salts of aluminum or iron are 
 usually employed, and the commercial sulphate of alumina is preferred. 
 This substance tends to coagulate some of the dissolved organic matter 
 
I J r A TER, ri 7'. . 1 XJ> SE ^ 1 7:7,' S. 
 
 285 
 
 in the water, but it acts chiefly through the flocculent precipitate of 
 hydrate of alumina which is formed by the decomposition of the sulphate 
 bv the carbonates naturally in solution in the water. The amount of 
 sulphate of alumina which it is necessary to add varies from 0.6 to 3 
 trains per gallon. The precipitated hydrate falling on the surface of 
 the sand serves the purpose of the layer of slime in the natural filter to 
 catch the bacteria and other suspended particles. If the sulphate of 
 alumina is properly used, none of the undecomposed sulphate or of the 
 precipitated hydrates passes into the effluent. 
 
 Very few tests have been made of the bacterial efficiency of this type 
 of filter except on experimental work at Providence, Louisville, Cin- 
 cinnati, and Pittsburgh : but as in some of these experiments, filters of 
 ordinary size, operated in the ordinal}' way. were used, there is no rea- 
 son why the experimental results should not be considered fairly satisfac- 
 tory. In the Cincinnati experiments, according to Fuller's report, over 
 ninety-nine per cent, of the bacteria were removed. 1 A six weeks' test 
 made during the ordinary runs of the East Providence filter showed a 
 bacterial efficiency of 99.20 per cent. At Lorain, 0.. the filters were 
 tested under the direction of the state board of health and showed a 
 high degree of efficiency. While several of the mechanical filters, so 
 
 ' - ■ . ■-■ . ■ ' — lain — : - - ■» > -V :■- ' - :' ■' . ' - v ■* -"- -r- 1 : ~r " : """ ' 
 
 Fig. 12. 
 
 Mechanical Filter. Section ol East Providence Filter House From plate loam 
 American Bocietj ol Civil Engine* 
 
 Report <.f the investigations on the Purification ..f tin- Ohio River Water, by the 
 Board of Trustees, Cincinnati, 1899 ( 
 
2 86 
 
 WATER, ICE, AND SEWERS. 
 
 Fig. IS. 
 
 Seventeen Foot Jewel Subsidence Gravity Filter. 
 
 called, were installed largely for the purpose of freeing the water from 
 pathogenic organisms, none of them are operated under bacteriological 
 control. 
 
 That the removal of ninety-seven to ninety-nine per cent, of the bac- 
 teria from polluted water is sufficient to remove the danger due to the 
 presence of disease germs is amply proved by many well known examples. 
 The history of Altona and Hamburgh in the cholera epidemic of 1886 
 is known to almost every one. The freedom of London from typhoid 
 
WATER, K'E. AND SEWERS. 287 
 
 and the history of typhus in Zurich, Buda-Pesth and Berlin, as well as 
 the good results obtained in our own country at Lawrence, show that 
 filters may be relied on to remove pathogenic bacteria from water. 
 There has yet been no opportunity to show similar brilliant practical 
 results from the use of mechanical filters, but as they do the same bac- 
 teriological work they will doubtless when the opportunity presents, 
 prove as useful as the natural filters. 
 
 The cost of constructing natural filters is considerably more than for 
 mechanical filters, particularly if the former have to be covered. The 
 cost of operating appears to be not very different. Every individual 
 city must make a special study of its own conditions and only after 
 seeking the best expert advice decide upon that method of improving 
 its water supply which best suits its needs. 
 
 Wells. 
 
 It is an unquestioned fact that wells are sometimes contaminated in 
 such a manner as to cause disease in those who drink their waters. 
 There are many notable instances of such on record and most health 
 officers of extended experience have had personal knowledge of epi- 
 demics caused in this way. Cholera and typhoid are the two diseases 
 which without question may be spread through the agency of well 
 water. While the danger from contaminated well water must be 
 admitted, the degree of danger is not so apparent, though it is believed 
 by those who have given it most attention to be very considerable. It 
 is usually stated that the introduction of a reasonably pure public supply 
 in cities almost always results in a diminution of the death rate from 
 typhoid fever, and many statistics are presented to support this view. 
 There are several classes of wells, the dug wells, or the shallow driven 
 wells which penetrate less than a hundred feet, and the deep or artesian 
 wells which nia\ extend one or two thousand feet into the earth. As a 
 rule the more shallow the well, the more liable it is to contamination. 
 but quite deep driven wells are sometimes contaminated. The danger 
 in the use of wells depends in the main, probablj on their contamination 
 with human excreta contained in the seepage from privy vaults and 
 
 Cesspools, or the Leakage from drains. Well water is usually more 
 
 palatable than the softer waters which are generall) furnished in public 
 
 supplies, and in summer are desired on account of their coolness. I n- 
 
 I'ortunateh a small ai int of contamination, entirely too small to be 
 
 delected h\ t a>l e or sn le 1 1, is a li I pi V sil I'licieli t to cause disease. Ileiice 
 
 it often requires considerable pressure either through persuasion or at 
 
 the hand of the law, to prevent persons from drinking dangerous water. 
 Fortunately there are factors which tend tO discourage the use of Well 
 
288 WATER, ICE, AND XEWEI1S. 
 
 water. City water is generally introduced into dwellings for convenience 
 in washing, cleaning, and bathing. Once in, it is more convenient to 
 use it for drinking than it is to use well water, and, moreover, as long- 
 as the cost of the city water has to be borne, it is considered a waste to 
 spend money to keep pumps and buckets in order, or to clean the well. 
 Hence in most towns with a public water supply, the wells fall rapidly 
 into disuse without any compulsion. Thus in the city of the writer, 
 fourteen years after water was introduced, there were only 1,424 w r ells 
 in use, though no effort had been made by the city to close them. The 
 use of many thousands had voluntarily been given up. At that time 
 the population of the city was about 118,000 living in over 15,000 
 dwellings, and there were towards 13,000 connections with the water 
 mains. Compulsion is, however, at times necessary to secure the 
 abandonment of a dangerous well, and this is particularly necessary 
 where the water rates are unreasonably high. 
 
 There are various ways of gaining information as to the dangerous 
 character of a well. One of the most useful is an inspection of the sur- 
 roundings. If there are cesspools, privy vaults, or drains, especially 
 such drains as are liable to be defective, near a well, it is likely to be 
 contaminated. As a rule the nearer the source of contamination, the 
 greater the danger ; but much depends on the character of the soil. A 
 sandy soil is the least dangerous, a seamy rock the most. A well on 
 the premises where the writer formerly lived was contaminated by a 
 privy vault 300 feet up the hill, but only after there had been a large 
 amount of blasting in the neighborhood, which probably opened up new 
 seams in the rock. No hard and fast rules can be given as to the 
 desirable distance of a well from a cesspool, but the inspector must 
 bring to bear an experienced judgment and must take into account the 
 character of soil, depth of well, and direction of flow of ground and 
 surface waters. 
 
 Secondly, chemical examination is of very great assistance. It 
 furnishes a pretty safe indication of the amount of organic and excre- 
 mental pollution, but here, too, the analysis must be interpreted with 
 care and intelligence. 
 
 Lastly, a biological examination may be made. If typhoid or even 
 suspiciously fecal bacteria are found, the question is settled, but on the 
 other hand their absence gives no surety for the safety of the water. 
 Bacteriological tests are difficult to apply, and of comparatively little 
 value. 
 
 It is often necessary for the person on whom the responsibility rests 
 to carefully consider every point, but when the alternative is a reason- 
 ably pure municipal supply, the well ought never to be given the benefit 
 of the doubt. 
 
WATER. ICE, AND SEWERS. 289 
 
 There is very little statutory legislation in regard to wells. The 
 general provisions concerning the pollution of potable waters some- 
 times mention wells, but not usually. In two states at least there is 
 some provision made for the closing of wells. Thus in New Hamp- 
 shire : l 
 
 " Whenever any well, spring, or [other] water supply is suspected of being 
 polluted by sewage or other matters dangerous to health, the health officer or offi- 
 cers in any town or city where such water supply exists may cause an analysis of 
 the suspected water to be made by a competent chemist, without expense to the 
 owner, and if the analysis shows the water to be unfit for drinking purposes, said 
 liealth officer or officers, upon obtaining the indorsement of the state board of health 
 may prohibit its use, and, if it be from a well, may cause the same to be closed if in 
 the judgment of said state board of health such action is necessary. The state 
 board of health shall authorize such investigations whenever deemed necessary for 
 the public good. 1 ' 
 
 In New Jersey 2 the local hoard of health may "order not to he used 
 or close any well, the water of which is polluted or detrimental to the 
 public health.'' In the absence of such statutory authority, the local 
 government may make regulations or issue orders under a general grant 
 of sanitary power, and many cities or hoards of health have done so. 
 Among cities that have done so are Bridgeport, Denver, Fitehburg, 
 Haverhill, Indianapolis, .Memphis, New Orleans, New York City, 
 Omaha, Rochester. Scrantoii. Spokane. St. Louis, and Yonkers. 
 
 One of the provisions sometimes adopted is that vaults, cesspools, 
 and drains must be located a certain distance away from the well. 
 Some of these rules were referred to on page 176. A rule somewhat 
 different from those which specify the distance of possible sources of 
 pollution is found in Fitehburg. 8 
 
 Instead of attempting to protect wells, most cities, tow us, and villages, 
 with a good piil. lie water supply, consider it the besl policy to discon- 
 tinue the nse of all wells, or at least of all wells that are considered 
 likely t<> he dangerous. There are few cities which have absolutely 
 
 ordained thai all wells shall he abandoned, but in Erie 4 well water must 
 not l.c used when it is possible to make connection with the « it\ water, 
 nor if the well is within 1 00 feet of a vault or cesspool. Sometimes 
 the use of wells is forbidden unless a permit is granted. 6 A similar 
 
 • Bampshire, Public Statutes (1891), Chapter 108, Se< , it. 
 - \.u Jersey, General Statutes (1896), p. 1644, Sec. 19 (XII). 
 :( Fitehburg, Rules and Regulations ol the Board of Health 1 1897), p. II, Rule 2: 
 • . cesspool or privy, or privy vault shall be established en land where there 
 is anj well, spring, or other source of water supply used for culinary or domestic 
 purposes, ezcepl by special permil in writing first obtained from (he board of 
 health. 11 
 
 •Erie, Rules and Regulations of Board <>f Health (1898), p. 19. 
 Rochester, Ordinances of Board "I Health, Number 20: 
 
 11 Water from wells in the city of Rochester shall ii case he used for drink or 
 
 in the preparation of food for human beings, except under and pursuant to the con- 
 
290 WATER, ICE, AND SEWERS. 
 
 rule is found in the sanitary code of the City of New York, but it 
 only applies to tenement and lodging houses, and hotels and office 
 buildings. 1 
 
 In New Orleans 2 no one may use water from any well, canal, sewer, 
 ditch, or other excavation in the ground "for the purpose of making 
 bread or any other article intended for human consumption or subsist- 
 ence," or for washing utensils used for preparing food or drink. 
 
 Most of the municipal regulations have reference to the abandon- 
 ment or closing of wells. In southern cities as Memphis where cisterns 
 are often used to furnish domestic supply the board of health may close 
 them also. Sometimes the rule or ordinance requires the health officer 
 or board of health to close the well when he " is satisfied " that it is 
 dangerous or polluted, or when he " finds it " so, or when it " appears 
 on examination " or " on satisfactory evidence " to be so. In St. Louis 3 
 whenever a chemical analysis shows a well to be impure or unwhole- 
 some, it shall be deemed a nuisance. In Omaha the well is to be con- 
 demned by a chemical or other test, and in Denver if a chemical test or 
 its location shows it to be probably unwholesome. As was stated above, 
 chemical analyses have to be interpreted with some caution and with 
 reference to the location of the well, hence arbitrary standards of purity 
 are not usually established ; but in St. Louis 4 such a standard was 
 adopted upon the advice of a committee of expert chemists. The stand- 
 ard is as follows : All wells are to be condemned as impure and unwhole- 
 some which contain : 
 
 " First, more than 0.05 parts of nitrogen in t^he form of nitrates per million parts 
 of water; or, second, more than 0.01 parts of nitrogen in the form of nitrates per 
 million parts of water, in conjunction with 0.15 parts of nitrogen in the form of 
 "free" ammonia per million parts of water, and 100 parts of chlorine per million 
 parts of water; or, third, nitrogen in the form of " albuminoid " ammonia to the 
 extent of 0.2 parts per million parts of water; or, fourth, phosphoric acid or phos- 
 phates as acertained by the characteristic turbidity produced upon the addition of 
 ammonia molybdate. 1 ' 
 
 After it has been determined that a well is to be abandoned, a notice 
 is issued to the responsible parties to fill it with earth, and if this is not 
 done, the board of health is to do it. 5 
 
 ditions of a permit in writing from the health department. The said permit shall 
 be granted only upon a certificate from the health office declaring the water of the 
 well in question to be free from noxious substances or influences and that it is suit- 
 able for human food and drink." 
 
 1 New York, Sanitary Code (1899), Sec. 62. 
 
 2 New Orleans, Ordinance No. 127, Council Series, 13 February, 1883, Sec. 4. 
 
 3 St. Louis, Ordinances (1893), Chapter 14, Sec. 453. 
 
 4 St. Louis, Report of Health Commissioner (1895-G), p. 112. 
 
 5 Bridgeport, Ordinances (1892), Chapter 14: 
 
 ; ' Sec. 32. That whenever the board of health shall have satisfactory evidence 
 that any well, the water of which is used for domestic purposes, has become pol- 
 
WATER, TCM, AND SEWERS. 291 
 
 That city wells ought to be abolished, may certainly he affirmed if 
 the teaching's of the chemist are to be followed. Thus in Brooklyn in 
 1884, 1 of 296 wells analyzed, 230 were by the chemical analysis con- 
 demned. In Newark 2 of 462 wells, 57.17 per cent, were considered to 
 be contaminated, 27.30 per cent, suspicious, and 15.53 per cent, pass- 
 able. In Minneapolis" of 376 wells from which samples were analyzed, 
 two-thirds were more or less polluted with sewage, and of seventeen 
 wells supplying bakeries, thirteen were reported as utterly unfit for use. 
 The department closed some of the worst wells but was loath to close 
 others as the city water was considered little better, and while improve- 
 ments were being made in the city supply, the citizens were left tree to 
 make their choice. In St. Louis 4 of 101 wells examined, thirty-eight 
 wen- condemned. The health officer of Syracuse 5 says that chemical 
 examination shows that nearly all wells are unfit for use. The reports 
 for Brooklyn and Newark above referred to, give the details of the 
 analysis for each well and also other data concerning the well, and simi- 
 lar data may be found in the reports of Baltimore,' 5 Milwaukee, 7 Phila- 
 delphia. s Charleston, 9 and Maine. 10 In Charleston bacteriological exam- 
 ination was made of 171 samples from wells and in one of these typhoid 
 bacilli were found and in one colon bacilli. In Memphis the board of 
 health frequently inspects the wells and cisterns used for domestic 
 supply and frequently condemns the shallow surface wells. 
 
 Springs. 
 
 There is no essential difference between wells and springs, for both 
 have their origin in the great body of ground water. Springs are less 
 likely to be contaminated than wells for the\ are less likely to be found 
 
 Luted ami rendered unsafe for potable use. notice to discontinue the use of said pol- 
 luted water shall be senl to the owner, agent, lessee, or party in charge of said well, 
 and at the discretion of the board the owner, lessee, agent, or party in charge of 
 said well may be ordered in writing to close or fill up said well. It the said order 
 
 is not complied with within the time therein specified, this section skill be deemed 
 
 violated, and the board may proceed to cause the said well to be closed or filled up. 
 the owner, a^ent. lesser. ..i' party in charge paying all expenses therefor.' 1 
 1 Brooklyn, Special Report of Commissioner of Health, on Pump Wells. 
 Newark, Reporl of Health Department (1894), pp. 70, 92, and 120. 
 
 • Minneapolis, Reporl of Department of Health (1897), p. 28. 
 •St. Louis, Reporl of Health Commissioner (1895 6), p. L12. 
 'Syracuse, Reporl of Board of Health (1894), p. 24. 
 
 • Baltimore, Report of Board of Health (1898), pp. 80-88. 
 
 Milwaukee, Report of Commissioner of Heaith for year ending \ iuii 1899, p. 98. 
 Philadelphia, Report of Bureau of Health. (1898), p. L45. 
 i lharleston, Reporl of Department of Health (1898), 
 Maine. Reporl ot state Board of Health (1896 7), p. IT. 
 
292 WATER, ICE, AND SEWERS. 
 
 in thickly settled regions, for when the land is well occupied, as in cities 
 the ground water is carried away by drains, or used up in wells so that 
 the natural springs are dried up and do not furnish a sanitary problem 
 in many cities. Occasion ally, however, springs do exist in cities and 
 sometimes are found to be polluted. Thus in Reading 1 a local outbreak 
 of typhoid in the suburbs threw suspicion on certain springs, and chem- 
 ical analysis indicated that they were decidedly polluted. In Nashville 
 in 1898 2 four springs and a well which were suspected of contamination 
 were subjected to chemical analysis and condemned, and in one of the 
 springs colon bacilli were afterwards found. 
 
 Since the attention of the public has been drawn to the danger in 
 the use of contaminated municipal supplies, there has developed quite 
 a trade in spring waters in a number of cities which have the misfor- 
 tune to be supplied with dangerous, dirt} r , or offensive water. Spring 
 waters are colorless and hard enough to be agreeable, and hence are pre- 
 ferred by consumers, as well as purchased for prudential reasons. It is 
 quite possible, however, that the consumers in purchasing spring waters 
 may be .leaning upon a broken reed, for springs may be impure as are 
 wells and rivers ; also " spring water " may, by an unscrupulous dealer 
 be drawn from a neighboring sewage polluted well, and even if pure in 
 the spring, it may by handling, be grossly contaminated. Hence some 
 cities have given this subject attention. In Providence 3 in 1893 nearly 
 2,000 gallons of spring water were sold daily at an average price of six 
 cents per gallon. This water was taken from nineteen springs. All of 
 these were carefully examined and a bacteriological analysis was made 
 of their waters. The results of the examinations and also of the chem- 
 ical analyses which had been made by reliable chemists, was favorable 
 in all but four springs. The position of these four showed that they 
 were liable to contamination, and one of them came to the surface 
 immediately beneath one of the trunk sewers recently constructed. 
 The publication of the results of. the investigation effectually stopped 
 the sale of water from the suspicious springs. A similar investigation 
 of springs in Massachusetts was made by the state board of health in 
 1891. 4 
 
 Ice. 
 
 It was at one time supposed that the freezing of water purified it, and 
 so it does to a slight extent under certain conditions ; but the researches 
 of Prudden Sedgwick Park 5 have shown that it will not kill pathogenic 
 
 1 Reading, Report of Board of Health (1890), pp. 9-13. 
 Nashville, Report of Board of Health (1898), p. 6. 
 
 3 Providence, Report of Superintendent of Health (1893), p. :'.T. 
 
 4 Massachusetts, Report of State Board of Health (1891), p. 353. 
 
 5 Boston Journal of Medical Sciences, Vol. 8, p. 213. 
 
WATER, ICE, AND SEWERS. 293 
 
 bacteria even if they be exposed to severe cold for a long period. 
 These investigations have caused health officials to give increased atten- 
 tion to ice supplies, and at present quite a number of states and cities 
 inspect ice, or the sources from which it is obtained, or control its cut- 
 ting and sale. While it cannot be denied that it is possible for disease 
 to be caused by the ingestion of ice containing typhoid germs or other 
 pathogenic organisms, or perhaps even when it contains unorganized 
 poisonous substances, it is nevertheless true that very few, if any. out- 
 breaks of disease have ever been traced to the use of ice. 
 
 Statutory legislation looking to the prevention of the sale of impure 
 ice has been enacted in several states. In Massachusetts cities may 
 make regulations in regard to ice. 1 
 
 In New Jersey, cities of the first class are given authority to make 
 ordinances in regard to ice. The Wisconsin law forbids the sale for 
 domestic, culinary or drinking purposes, of ice containing mud, decayed 
 vegetation or animal matter, foreign matter or malarial substance. 
 Dealers shall have a sign upon their wagons showing where the ice is 
 cut or made, and if it is sold for cooking purposes only, that fact must 
 be stated on the sign. In Cleveland a similar provision is found in the 
 ordinance, and it is required that the letters shall be six inches high. 
 Massachusetts also has a law which authorizes the state board of health 
 on petition of twenty-five consumers of ice to investigate the supply and 
 make orders concerning the same. In New Hampshire local boards of 
 health may inspeel the sources of their ice supplies, and it' they deem 
 the ice impure may order the sale stopped. In New Jersey no ice can 
 be cut within a city or town for use in such city, borough or township 
 without a permit from the local board of health, and no ice can be sold 
 without such a permit. The board of health may revoke permits and 
 forbid the sale of ice when in their judgment its use would be detri- 
 mental to the public health. The penalty for disobedience of the orders 
 pf the board of health or of the statute is punishable by a fine of $500 
 Or six months' imprisonment or both. The Illinois act of L899 forbids 
 the sale of ice made from water below the standard prescribed by the 
 
 slate board of health. 
 
 The New Jersey law forbids the malicious pollution of ice, and in 
 New Hampshire the acl of 1895 concerning the pollution of water sup- 
 plies applies to water from which ice is cut. 
 
 Although, as is thus shown, only a tew states have authorized any 
 
 1 Massachusetts, < liapterS38of 18 
 
 ities may make ordinances to secure the inspection of ice sold within their 
 limits and !■> prevenl the sale "t impure ice. and thej may establish penalties for the 
 violation of such ordinances, nol exceeding twenty dollars for each offen 
 
294 WATER, ICE, AND SEWEJts. 
 
 action concerning ice, on the part of cities or boards of health, } T et a 
 number of cities outside of those states have thus acted. Among cities 
 which have made rules in regard to their ice supplies may be mentioned 
 Albany, Baltimore, Bridgeport, Brooldine, Mass., Buffalo, Cambridge, 
 Chicago, Cleveland, Denver, Detroit, Elmira, N. Y., Meadville, Pa., 
 Milwaukee, Minneapolis, North Adams, Mass., Paterson, Rochester, 
 Salt Lake City, St. Louis, and Syracuse. In some of the cities, as 
 Albany, the only rule is one which simply prohibits the sale of impure 
 ice. Other cities forbid the harvesting and importation of ice as well as 
 its sale : 
 
 " No person shall bring, store, sell, deliver or distribute, or cause to be brought, 
 stored, sold, delivered or distributed, within the limits of the City of Minneapolis, 
 any ice for domestic use or cooling purposes within said city which shall have been 
 formed or produced by the freezing of unwholesome, impure or contaminated water, 
 or water the use of which would be deleterious to health. And no person shall, within 
 or without the limits of the City of Minneapolis, cut, harvest, or in any way obtain 
 any ice intended for domestic use or cooling purposes within said city, in or from any 
 river, stream, lake or other body of water, the waters of which are unwholesome, 
 impure or contaminated, or the use of which would be deleterious to health.' 11 l 
 
 Still more elaborate rules are those of Chicago 2 and Cleveland, 3 
 
 though in the latter city little attempt is made to enforce them. 
 
 The Chicago ordinance provides for the issuing of licenses, defines what 
 
 is meant by domestic use and what is meant by impure ice, forbids the 
 
 taking of ice from certain localities, requires the inspection of vehicles 
 
 and the places where ice is stored, and authorizes the commissioner of 
 
 health to make rules for storing, delivery and inspection. Cleveland 
 
 also attempts to define what is meant by impure ice. The following is 
 
 from Cleveland, where ice may be condemned and seized if it 
 
 "Be found to contain any nitrogen as nitrites, or any pathogenic bacteria, or 
 more than five-tenths (0.5) parts nitrogen as nitrates in one million, or more than 
 two parts of chlorine in one million, or more than five- tenths parts albuminoid am- 
 monia in one million, or over one hundred colonies bacteria in one cubic centimeter, 
 or any colonies of bacteria of the gas producing kind; and the loss on ignition at a 
 red heat must be less than one-half the total solids. In ice which has been stored 
 or packed no account shall be taken of the ammonia or nitrates. 11 
 
 Usually it is only attempted to control the sale of ice when it is to 
 be used in such a manner as to enter into the food or drink of man. 
 Thus we find in the Albany rule the limiting terms " in connection with 
 drinking water, liquids or foods." Other regulations forbid its use for 
 " drinking water or beverages," " for drinking or eating," " or in any 
 way for human consumption." In Chicago impure ice must not be sold 
 
 Minneapolis, Ordinance of 20 December, 1897, •'Sec 53a: 
 - Chicago, Ordinance of 25 May, 1896. 
 3 Cleveland, Ordinances (1802), Chapter MO, .Sees. 555-501. 
 
WATER, ICE, AND SEWERS. 295 
 
 " from house to house or to hotels, restaurants, saloons or other places 
 where such iee may be used in contact with food or drink," but such ice 
 may be sold for certain purposes as shown below. 1 
 
 Another useful method of dealing- with the Bale of ice is to require 
 permits as in Xew Jersey, or the registration of the dealers as in some 
 Massachusetts cities. Other cities outside of these states, as Baltimore, 
 Chicago, Cleveland, Denver, St. Louis, Minneapolis, and Salt Lake City, 
 require dealers to take out permits and refuse to grant them if the source 
 from which the ice is obtained is not satisfactory: but in Cleveland, 
 Denver, and St. Louis a permit is only required for the cutting or sale 
 of impure ice for cooling purposes or of ice from certain localities. In 
 Si. Loins and Denver the licensee is obliged to give a bond, in the 
 former city in the sum of S'2,000. 
 
 The method employed in Cambridge, Mass., is shown by the rules 
 given below. 2 Whether or not there are regulations governing the ice 
 
 1 Chicago, Ordinance 25 May 1896: 
 
 • Sec. 5. This ordinance shall not be construed to prohibit the selling or deliver- 
 ing of impure ice to be used only for packing or cooling purposes, that is to say. tor 
 use in refrigerators, refrigerator cars, freezing machines, rooms and other places 
 where it will not come in contact with articles of food or drink; provided, that a 
 permit be first obtained from the commissioner of health to sell, deliver, or use 
 impure ice for the purposes aforesaid and for no other purpose. 
 
 •■ Whenever any impure ice for packing or cooling purposes shall be sold or de- 
 livered from any wagon or other vehicle the driver or other person in charge thereof 
 shall carry a supply of printed cards, on which shall be printed in large legible let- 
 ters the words; "Ice for Packing and Cooling Purposes Only. Not for Domestic 
 I'se." and he shall hand with each delivery of such ice one such card to each cus- 
 tomer thereof, or to the person who receives the same, and shall take at the same 
 time a receipt, which shall be given him by such purchaser or recipient, on which 
 receipt the said words shall be similarly printed. No ice for packing or cooling pur- 
 poses shall be sold or delivered in the City of Chicago by any person, tirin or cor" 
 poration without such permit, or ot lie r wise than in conformity with the provisions 
 of i his sect ion. 11 
 
 2 Cambridge, Ordinance, 29 December, 1897: 
 
 "Section 1. Every person, arm or corporation before selling or delivering ice 
 
 in this city after the first day of February, A. I). 1898, shall prior to such sale or 
 
 delivery register at the office of the board of health the name and location of the 
 body or bodies of water from which saiil ice so to he sold or delivered has been cut, 
 <>r from which the water has Keen taken for its manufacture. Such registration 
 shall be subscribed and sworn to bj the person so proposing to sell or cause to be 
 delivered said ice, or in the case of a firm, by one of the members of the Arm, or in 
 the case of a corporation, by the president, general manager, or one of the board of 
 directors of the corporal ion. 
 
 Sec. -. Everj person, firm or corporal ion who sells, delivers or causes to be 
 delivered ice in this city after the tirst day of February, V I ». 1898, shall permit the 
 board of health and it- inspectors at all reasonable times to have access to and 
 Ireel] examine the ice intended for such sale or delivery, and shall permit samples 
 to be taken by said board or its inspectors tor the purpose of analysis. 
 
 "Sec. 3. The hoard of health shall investigate the sources ol supply of i< 
 
296 WATER, ICE, AND SEWERS. 
 
 supply, or whether or not permits for dealers are required, an inspection 
 of the source of supply and examination of the ice may be carried on 
 with advantage, and even in the absence of all legislation, the publish- 
 ing in reports or otherwise of the results of such examinations may 
 accomplish much in improving the supply. Among cities which report 
 examination of their ice supply and its source may be mentioned Balti- 
 more, 1 Boston, 2 Brookline, Mass., 3 Cambridge, Chicago, 4 Cleveland, 5 
 Providence, 6 and Salt Lake City." The examination consists in most 
 cases of an inspection of the pond, lake or river from which the ice is 
 cut and perhaps an inspection of more or less of the drainage area from 
 which the water is derived. Samples of ice are also analyzed both 
 chemically and bacteriologically. The water from the melted ice is, 
 of course, examined in these tests as is ordinary water, but certain 
 precautions should be taken in securing the sample of ice and meltmg 
 the same, to insure a fair sample and protection from accidental con- 
 tamination. 
 
 Sewers. 
 
 This subject will not here receive much attention, for the building 
 and construction of sewers is almost always in charge of engineers and 
 public works officials. The problems of sewer construction are engi- 
 neering problems, and if a city employs skilled engineers the health 
 officer need not worry about the sewers. Even the need for sewers has 
 scarcely to be urged by health officers. The public so well appreciates 
 their advantages that they are usually demanded when needed, even if 
 they must be entirely paid for by the abutters. Sometimes the health 
 officer may be of service in hastening the action of a dilatory council. 
 In Boston 8 the board of aldermen, when the board of health so requests 
 
 sold or delivered and cause inspection and analysis to be made of the ice from said 
 sources. And if upon such investigation, inspection and analysis and upon hearing, 
 it shall deem and adjudge ice derived from any source to be impure and injurious to 
 the public health, it may prohibit the sale or delivery in this city of such ice or of 
 any other ice which has been intermingled with ice from such source. Notice of 
 such prohibition shall be given in the manner provided by law for giving notice of 
 the regulations of the board of health, and such notice shall be deemed legal notice 
 to all persons." 
 
 1 Baltimore, Report of Department of Health (1898), p. 72. 
 
 2 Boston, Report of Board of Health (1809), p. 87. 
 
 3 Massachusetts, Report of State Board of Health (1896), p. 87o. 
 
 4 Chicago, Report of Department of Health (1895-6), p. 215. 
 
 5 Cleveland, Report of Health Officer (1896), p. 36; (1897), p. 47. 
 
 6 Providence, Report of Superintendent of Health (1889), p. 48. 
 
 ■ Salt Lake City, Report of Board of Health (1897), p. 61; (1898), p. 67. 
 8 Massachusetts, Chapter 450 of 1889, Sec. 2. 
 
WATER, K'K AJSTB SB WEBS. 297 
 
 and states that the public health requires it, must provide sewers, but 
 the amount to be so expended in any one year shall not exceed 810,000. 
 In only a few cities is the work of sewer construction undertaken by 
 the health department. The most conspicuous examples are Augusta, 
 Ga., and Memphis. In St. Louis in 1893 over one-rlfth of the appro- 
 priation of the health department was used to construct shallow tem- 
 porary sewers to relieve the sewage ditches in certain parts' of the city. 
 
 Ordinances and rules in regard to the construction and maintenance 
 of sewers are occasionally found, and they are sometimes in the sanitary 
 codes, but they usually date back to the time when sewers or drains 
 Were constructed by private enterprise. In recent times, since sewers 
 have been constructed by the municipality and with engineering advice, 
 details have been wisely left to the engineers. While local boards of 
 health rarely advise in regard to sewer construction, it is otherwise with 
 the state board of health. In Massachusetts 1 all municipalities apply- 
 ing to the legislature tor authority to construct sewers, must apply to 
 the state board of health for advice. A similar provision that the state 
 board is to be consulted, is also found in North Carolina. 2 A number 
 of the state boards frequently advise on this subject, especially for the 
 smaller cities and villages. Notable among such are those of Massa- 
 chusetts, New York, and ( )hio. 
 
 Rules to prevent putting improper substances into sewers are of 
 course not infrequently found in municipal ordinances and codes. 
 Among the concise and comprehensive rules of this kind are those found 
 in the District of Columbia, but such rules had perhaps better be sug- 
 gested by the engineer rather than the health officer: 
 
 •• No person shall throw, cast, lay, deposit, drop, or leave in <<r upon any public 
 sew. rin the District of Columbia, or any trap, basin, inlet, grating, manhole, or 
 other appurtenances of any public sewer, any sticks, stones, brick, earth, gravel, 
 dirt, mud, bay, straw, manure, rubbish, litter, sweepings, offal, vegetables, garbage, 
 shrubs, branches, twigs, leaves, papers, cinders, or refuse matter of any kind : 
 Provided, Thatthe provisions of this paragraph shall no! apply to matter discharged 
 through a house sewei into a j ■ 1 1 1 > 1 i < - sewer." 
 
 Riveb Pollution. 
 
 The pollution of public water supplies ami their purification have 
 been here considered because of the direct bearing of the subjeci upon 
 public health. The pollution with sewage, manufacturers' wastes, and 
 other offensive substances of rivers and public waters which are not 
 
 1 Massachusetts, Chapter ;:T.". .a :;. 
 
 North Carolina. V t ol 1 Mar. h, I-'.':'.. Sec. 1'.'. 
 
 Distrietol Columbia, Police Regulations (1898), \ii.T. 
 
298 WATER, ICE. AND SEWERS. 
 
 used for drinking purposes does not affect the health in a direct manner, 
 and indeed the effect on health of such nuisances is not well understood, 
 and has in the past probably been overestimated. Excessive pollution 
 does, however, constitute a nuisance, often a very grievous one, and 
 health officers are always expected to be greatly interested in all efforts for 
 its abatement. That they are thus interested is sh< >wn by their reports, for 
 a perusal of those of Augusta, Ga., Baltimore, Boston, Bridgeport, Cam- 
 bridge, Chicago, Cincinnati, Denver, Detroit, Fitchburg, Hartford, Mil- 
 waukee, Paterson, Providence and Salem, shows that the health depart- 
 ment frequently calls attention to the offense caused by polluted waters 
 and the necessity for taking some action to remedy it. When the pollu- 
 tion is within the municipal limits and is caused by private parties, and 
 especially if the amount of pollution by any one party is not very great, 
 the health department is quite likely to take action under the nuisance 
 laws, and order the nuisance abated. In this way privies are removed 
 from over streams, drains are cut off, and the dumping of offensive matter 
 is stopped. More rarely is action brought for the violation of some ordi- 
 nance or statute. But when the pollution is considerable in amount, 
 and affects a large body of water, and when it is due to the discharge 
 of municipal sewage or wastes from large manufactories, and especially 
 when the pollution takes place outside of the limits of the municipality 
 affected, the local board of health has little power to act. It is in these 
 cases that the state authorities can perform useful functions, and the 
 investigations made, and work done by the state board of health in 
 Connecticut, Massachusetts, Minnesota, New Jersey, Xew York, Ohio, 
 and Rhode Island are well known. 
 
 There is a good deal of statutory legislation to prevent the pol- 
 lution of waters that are used as the sources of domestic supply, but 
 there is not very much that is of use in protecting other waters from 
 offensive pollution. A number of states, as Arkansas, Connecticut, 
 Georgia, Illinois, Iowa, Kentucky, Michigan, Ohio, and West Virginia, 
 forbid the deposit of dead animals in streams or public waters. Some 
 of the laws, particularly those of West Virginia, California, and Ohio, 
 forbid the discharge of many offensive materials into public waters, and 
 included among them are several forms of manufacturers" refuse, as 
 wastes from gas works, oil refineries, and cheese factories. The Ohio 
 statutes also impose a penalty for "whoever renders impure any water 
 course, stream, or water." 
 
 A large number of cities have adopted rules forbidding pollution of 
 public waters by the deposit of filth, night soil, offal, dead animals, etc. 
 Most of these have been adopted to meet some local condition and to 
 prevent some special pollution occurring within the city limits. < hie 
 
WATER, ICE, AX I> SEWERS. 299 
 
 of the most general and comprehensive of these laws is that of the City 
 of New York. 1 
 
 These local regulations are generally adopted under the general 
 grant of sanitary powers, hut in Illinois and Michigan, cities and vil- 
 lages are especially authorized to make rules for the protection of their 
 public waters. 
 
 A consideration of the existing legislation in regard to river pol- 
 lution reveals the fact that in this country there has as yet heen none 
 which can he of much value in preventing any serious pollution. Such 
 pollution is almost always due to the discharge of sewage and manu- 
 facturers' wastes, and it may well be believed that a statute must be 
 most carefully drawn to make it possible to bring a criminal action with 
 any degree of success. Most of the efforts to prevent river pollution 
 by legal means have been made by manufacturers and have been by 
 suits at common law. and occasionally municipalities have proceeded, 
 and been proceeded against under the same common law. ■ 
 
 Some of the statutes relating to state boards of health, as those of 
 Massachusetts, New Jersey, and New York, provide for the prevention 
 of future pollution by requiring the approval of the board for all pro- 
 jects of sewerage and sewage disposal. 
 
 The chief sources of water pollution are municipal sewage and 
 manufacturers' wastes. In the case of the Latter, if the manufactories 
 are situated within reach of the city sewers the usual method is to 
 require them to discharge into such sewers, ami then if necessary the 
 whole volume of sewage is treated together. Sometimes it is advisable 
 in the cases of certain wastes that would injure or clog the sewers, and 
 in other cases when sewers are not available, it is necessary to compel 
 the manufacturers to purify their wastes. This cannot usually be 
 accomplished by a simple order of the board of health, tor manufac- 
 turers who have establishments Large enough to make a serious nuisance 
 
 of this kind usually base money enough to make a strong Lega] fight, 
 and a Legal fighl of sneb importance is not usually entered into nnlos 
 ordered by t be council. If manufacturers are to purify their wastes, 
 they must in general follow much the same plans thai cities do in the 
 proper disposal of their sewage. Therefore the prevention of water 
 
 1 Neu York, Sanitary Code (1899) : 
 Sec. L96. That no person, persons, company or corporal ion shall < -a use. permit 
 or allow any sewage, drainage, factor] refuse or anj foul or offensive !i<|ni<l or other 
 
 material to Bow, leak, escaj r !"■ emptied or discharged into the waters "f any 
 
 river, stream, canal, harbor, bay, or estuary, or into the sea within the city limits, 
 excepting under low-water mark, and in such manner and under such nni.iith.ns 
 tliai uo nuisance can or shall be caused thereby or as a result thereof. 11 
 
300 WATER, ICE, AND SEWERS. 
 
 pollution resolves itself into the question of applying the best system 
 of sewage disposal and selecting a system which will cause the least 
 nuisance. The health officer is interested in using his influence to 
 secure the adoption of the best and at the same time the most econom- 
 ical method. Sewage disposal is primarily a subject for engineering 
 consideration, but the health officer should be able to co-operate intel- 
 ligently with the engineer in securing popular support for the work 
 that needs to be done. 
 
 Disposal by Discharge into Large Bodies of Water. 
 
 If sewage is discharged into a large enough body of water in such 
 manner that it quickly becomes diffused through it, it is so gradually 
 oxidized as not to give rise to any serious offense. .Many of our 
 largest cities are fortunately so situated that this can readily be done, as- 
 New York, Philadelphia, St. Louis, and New Orleans. Other cities have 
 not been so fortunately situated, but have had to construct expensive 
 works to carry their sewage to such a point that it would be sufficiently 
 diluted. Among such, the most notable is Chicago, which by its drainage 
 canal discharges its sewage ultimately into the Mississippi. Another 
 city, Boston, was obliged to construct long and expensive sewers and to 
 erect pumping engines to carry its sewage into deep water. Providence 
 built an intercepting sewer to carry its sewage to deeper water, but the 
 result was not satisfactory as there was not volume enough for dilution, 
 and other methods had to be adopted as was advised by the engineers 
 in the first place. 
 
 Broad Irrigation. 
 
 By this is meant the discharge of sewage on to the surface of large 
 areas in such a manner as to secure the gathering of crops of forage, or 
 other agricultural products. It is thought by those not acquainted with 
 the subject that owing to the produce secured, this ought to be the must 
 economical method of sewage disposal. The large area required, which 
 near cities is usually expensive, the cost of preparation and the labor 
 of maintenance make it probably the least economical method. Even if 
 not prohibited by the expense, most cities would be prevented from 
 adopting this method because sufficient land cannot be obtained near the 
 city at any price. It is usually estimated that an acre is required for 
 every 1,000 of the population. Broad irrigation has been adopted at only 
 a few cities in this country. One of the first of these was Pullman, 111., 
 but the works were not always adequate to care for all the sewage. 
 Other places where it is employed are Plainfield and Princeton, N. J., 
 Oberlin, O., Lyons, N. Y., Los Angeles and Pasadena, Cal., and Helena, 
 Mont. 
 
WATER, ICE, AND SEWERS. 
 
 301 
 
302 WATER, K'E AND s EWE lis. 
 
 Intermittent Filtration. 
 
 It has been found that if sewage is passed at intervals through prop- 
 erly prepared soil, it will be purified to a greater or lesser degree, depend- 
 ing upon the care that the process receives. It is necessary, however, that 
 sufficient time should be given between the applications of sewage for air 
 to penetrate the bed. It is only in this way that it is possible to preserve 
 the activity of the bacteria which oxidize the organic matter in the 
 sewage. Very much less area is required than for irrigation, and the 
 operation of the system is less expensive. The study of the principles 
 underlying the purification of sewage by intermittent filtration have been 
 most carefully carried on at the experiment station of the Massachusetts 
 state board of health at Lawrence, and the work there done has placed 
 the practice on a sound basis of fact. This method of purifying sewage 
 is probably more popular in the United States than any other. 
 
 Among examples of intermittent filtration are the works at South 
 Framingham, Marlboro, Brockton, and fifteen other towns in Massa- 
 chusetts, Pawtucket, and Woonsocket, R. I., and at Danbury, and Meri- 
 den, Conn. 
 
 A modification of intermittent filtration has recently been put in prac- 
 tice at Willow Grove, near Philadelphia. The system was originated 
 by Colonel Waring. The sewage is first run through a strainer which 
 receives about 3,000,000 gallons per acre, and is then run on to a coke 
 filter which is aerated by air driven forcibly through it. It is claimed 
 to care for 800,000 gallons of sewage per day per acre. 
 
 At Reading and Atlantic City a unique method of treatment has 
 been applied for a number of years. The filter bed is raised several feet 
 above the ground, and the sewage after filtering through the bed drops 
 in a sort of rain onto the gutters below. By thus passing through the 
 air it is supposed to be oxidized, but it is said to be merely strained in 
 the filter, and deodorized below. This is the so-called West system. 
 
 The Septic Tank. 
 
 Quite recently a new method of sewage disposal has been much dis- 
 cussed and to some extent, utilized. This is the septic tank in which 
 the sewage is allowed to rest, and be subjected to the oxidizing action 
 of microbes. It may be used alone or as an aid to intermittent filtra- 
 tion. One is in operation at Pawtucket, R. I. 
 
 Chemical Precipitation. 
 
 The application of chemicals to sewage, sometimes lime, but more 
 often salts of aluminum, causes a coagulation of some of the dissolved 
 organic matter which precipitates and carries the suspended matter 
 down witli it. After settling, the supernatant clear liquid is allowed to 
 
ill TE1L I< K . 1 NB S E WEE \ 
 
 303 
 
304 WATER, ICE, AND SEWERS. 
 
 flow away, and the precipitated " sludge " is pumped into presses and 
 pressed into a cake, which may be used as a fertilizer, burned, or used 
 for filling, or transported to sea. This method of treating sewage was 
 adopted at Coney Island, Orange, N. J., the World's Fair Grounds in 
 Chicago, Worcester, Providence, Ilion, N. Y., Alt. Vernon, N. Y., Chau- 
 tauqua, N. Y. 
 
 Statutes Consulted in the Preparation of this Chapter. 
 
 California. Criminal Code (1886), Sees. 1357, 1376. 
 Connecticut. General Statutes (1888), Sees. 2652-5. 
 
 Chapters 28 and 203 of 1895. 
 Delaware. Revised Code (1893), p. 926, (Delaware Laws, Vol. 12, Chapter 405.) 
 Illinois. Annotated Statutes (1896), Chapter 38, Sees. 369, (2), (3); Chapter 24, 
 
 Art. 10, Sec. 2. 
 Indiana. Statutes (1897), Sees. 2017, 2195. 
 Iowa. Code (1897), Sec. 4979. 
 
 Kansas. General Statutes (1897), Chapter 100, Sees. 338-9. 
 Kentucky. Statutes (1894), Sec. 1278. 
 Maine. Chapter 82 of 1891. 
 
 Maryland. Public General Laws (1888), Vol. I., p. 550, Sec. 277. 
 Massachusetts. Public Statutes (1882), Chapter 80, Sees. 96-7, 101-2. 
 
 Chapter 208, Sees. 7-8. 
 
 Chapter 172 of 1884. 
 
 Chapter 274 of 1886. 
 
 Chapter 160 and 375 of 1888. 
 Michigan. Compiled Laws (1897), Sec. 11432. 
 Minnesota. Statutes (1894), Sees. 430-1, 6642. 
 New Hampshire. Public Statutes (1891), Chapter 108, Sees. 13-15. 
 
 Act of 28 March, 1895. 
 New Jersey. General Statutes (1895), p. 1644, Sec. 49, (XII), pp. 1107, 1109, 2215. 
 New York. Revised Statutes (1895), p. 2437, Sees. 70-72d. 
 North Carolina. Act of 1 March, 1893, Sees. 18-21. 
 Ohio. Annotated Statutes (1900), Sees. 409(-26), 6921, 6923, 6925. 
 Oregon. Annotated Laws (1892), Sec. 198. 
 Tennessee. Code (1896), Sec. 6869. 
 Virginia. Code (1887), Sec. 3812. 
 
 Chapter 460 of 1892. 
 West Virginia. Code (1899), Chapter 150, Sec. 20b and c. 
 
 Ice. 
 
 Illinois. Act of 24 April, 1899, Sec. 18. 
 
 Massachusetts. Chapter 287 of 1886 and 338 of 1895. 
 
 New Hampshire. Acts of 25 March and 28 March, 1895. 
 
 New Jersey. Revised Statutes (1895), pp. 1650, Sees. 87-90, 1695. 
 
 Wisconsin. Statutes (1898), Sec. 4607k. 
 
WATER, /'A'. AND SEWERS. 
 
 3(»5 
 
CHAPTER VII. 
 
 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 THE consumption of adulterated or decayed food and drink is popu- 
 larly supposed to be a common cause of ill health, and the pre- 
 vention of the sale and use of such is considered to be one of the proper 
 sanitary functions of the state. There seems to be abundant evidence 
 that adulterated, infected, and impure milk and milk that is approach- 
 ing', though it may not have reached the stage of " souring," is most 
 harmful, particularly to young children of whose diet it forms a large 
 part. Rut with the exception of what has been proved in regard to 
 milk, we do not know so very much about the unwholesome character 
 of food adulteration or the disease producing qualities of food nearing, 
 or even actually undergoing putrefactive changes. The use of poison- 
 ous substances, as the salts of lead, arsenic, copper, etc., in coloring 
 matters, or the addition of indigestible substances like " terra alba," or 
 the presence of infectious material capable of transmission to man as 
 trichina?, are of course recognized as dangerous ; but the more common 
 adulterants, like glucose in sugars and molasses, inert substances in the 
 spices and condiments, chickory in coffee, the use of the cheaper fats, 
 like cottonseed oil and tallow in lard and butter, or of water in wines 
 and liquors, probably have little or no injurious effect upon health, and 
 perhaps may even sometimes be an advantage. So, too, in regard to 
 stale and partially decayed food, we are as yet very much in the dark 
 as to what is and what is not really unwholesome. There is, it is true, 
 plenty of evidence of the occasional formation of poisonous ptomaines 
 or similar substances in putrefying food, and it is a very common notion 
 among physicians that the " summer complaints," as they are called, 
 are due to the eating of more or less stale food containing pathogenic 
 bacteria or other organisms. Yet we are after all very uncertain as to 
 the exact conditions necessary to render stale food unwholesome, and 
 we know that large quantities of stale fermenting and putrefying food 
 are eaten with impunity, and often by preference. The question of the 
 harmfulness of eating the flesh of immature or diseased animals is also 
 not fully answered. In making these observations it is not meant to 
 deny the importance of the subject, for it is a very important one, 
 but the writer would urge its further study and meanwhile the exercise 
 
FOOD OTHER THAX DAIRY PRODUCTS. 307 
 
 of great care in asserting the harmf illness of any particular food sub- 
 stance. 
 
 In the light of our present knowledge it appears that the condition 
 of food sold, with a few important exceptions, is an economic rather 
 than a sanitary affair. Nevertheless, there are reasons why the control 
 of food supplies should be hi the hands of the sanitary authority. 
 While many, perhaps most adulterants are harmless, some are certainly 
 not so, and that reason and the fact that at present we cannot always 
 draw a sharp line between the harmless and harmful would logically 
 yest their control with the health department. This department is 
 more often perhaps than any other, able to deal with scientific problems, 
 and the analysis and examination of food present such problems. A 
 municipal laboratory is probably best administered by the sanitary de- 
 partment. In the sphere of state action the board of health is often 
 well equipped for this work, though the department of agriculture, state 
 experiment station, or state uniyersity, where such are established, may 
 be the best agents for such investigations. A disadvantage of having 
 the control of foods in the hands of the local health authorities is that 
 on that account, both by them and by the public the sanitary phase of 
 the work is made unduly prominent, whereas its economic bearings are 
 really the most important. What lias been said of food in general does 
 not apply to milk. The chemical and bacteriological purity of milk is 
 of prime sanitary importance, and its control lias in practice hitherto 
 almost always proved best in the hands of the local board of health. 
 The consideration of milk will be deferred to the succeeding chapter, 
 and we will now occupy ourselyes with the consideration of the adul- 
 terations and other possibly unwholesome conditions of other food sub- 
 Stances. 
 
 There are great differences in food laws and in their administration. 
 The control of food substances as regards both legislation and execution 
 is sometimes national, sometimes state, and sometimes municipal. The 
 federal government, by virtue of its authority to control interstate ami 
 foreign commerce, has legislated concerning the wholesomeness and 
 purity of food supplies and has a large force of inspectors constantly at 
 
 work. The chief held covered by the federal officers is the inspection 
 
 of cattle intended for slaughter, and also .if the various products sent 
 
 out Er tiie slaughter-houses. 
 
 Much of the legislation, especially that concerning adulterations, is 
 state Legislation, and the execution of these laws is vested in state offi- 
 cers. The execution of milk laws i> more often in the hands of local 
 boards of health. As regards the use of food from diseased animals 
 state laws are common and state inspection also. Local regulations are 
 
308 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 of course found on all of these subjects, but the special field of local 
 legislation is the control of the sale of foods which are undergoing 
 putrefactive^changes. Putrefaction in this connection of course is not 
 confined to its popular use, but embraces any of those degenerative 
 changes which are produced by the action of saprophytic organisms, 
 though the 5 material may not have become actually rotten. The in- 
 spection of food to determine whether it is fresh enough for use, and 
 the seizure of such that has passed the limit, is usually the function 
 of the local board of health, and the rules regulating this are local 
 rules. 
 
 Unwholesome Food. 
 
 Some of the earliest legislation in regard to food was of a very gen- 
 eral character, and similar laws are to-day found on the statute books 
 of most of the states. In 1784 Massachusetts 1 enacted the following: 
 
 tl If any person shall sell any such diseased, corrupted, contagious, or unwhole- 
 some provisions, whether for meat or drink, knowing the same without making it 
 known to the huyer. . . ." 
 
 The law as modified by subsequent amendments now stands on the 
 statute books as follows : 
 
 " Whoever knowingly sells any kind of diseased, corrupted, or unwholesome 
 provisions, whether for meat or drink, without making the same fully known to the 
 huyer, shall be punished by imprisonment in the jail not exceeding six months, or 
 by tine not exceeding two hundred dollars." 2 
 
 This has been copied verbatim by at least ten states, Colorado, Iowa, 
 Kansas, Maine, Michigan, Oregon, South Dakota, Virginia, West Vir- 
 ginia, and Wisconsin, and in Ohio, Oklahoma, and by Rhode Island 
 with the addition of the word adulterated. It also appears in the local 
 legislation of several cities. 
 
 California, Montana, and South Dakota have the provisions shown 
 below. 3 
 
 A number of other states and cities have laws which while the ex- 
 act phraseology of the Massachusetts statute is not adopted, yet attempt 
 to cover the same ground in the same general way. These laws are 
 sometimes a little more explicit as to what are the " provisions," the 
 
 1 Massachusetts, Chapter 50 of 1784. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 208, Sec. 1. 
 a California, Penal Code (1886), Sec. 383: 
 
 " Every person who knowingly sells, or keeps, or offers for sale, or otherwise 
 disposes of any article of food, drink, drug or medicine, knowing that the same lias 
 become tainted, decayed, spoiled, or otherwise unwholesome or unfit to be eaten or 
 drunk, with intent to permit the same to be eaten or drunk, is guilty of a misde- 
 meanor. 11 
 
FOOD OTHER THAW DAIRY PRODUCTS. 309 
 
 sale of which is to be regulated. Thus in Maryland 1 it is "unwhole- 
 some provisions such as poultry, game, flesh or preparation of flesh, 
 fruits, vegetables, bread, flour, meal, milk or other things intended to 
 be used for human food." Fish and eggs are included in many laws, 
 and sometimes nuts. 
 
 The conditions that render the provisions unwholesome are also 
 specified to some extent. Thus in Ohio and Rhode Island the word 
 adulterated is added to the law. In Louisiana food must not be 
 " tainted " or " in a condition of decomposition or unfit for food." 
 Stale, impure, putrid, sour, slimy, diseased, unhealthy, emaciated, un- 
 sound, from animals that have died or are too young, not being fresh or 
 properly preserved, are expressions frequently used. 
 
 The following rule, or one substantially like it, is found in Buffalo, 
 Bridgeport, Cincinnati, Cleveland, Memphis, Newark, New York, and 
 Rochester: 
 
 "That no cased, blown, plaited, raised, stuffed, putrid, impure or unhealthy or 
 unwholesome meat or fish, bird or fowl shall beheld, bought <>v Mild or offered for 
 sale for human food, or held or kept in any market, public or private, or any public 
 place in said city."' 2 
 
 Besides the regulations which have just been considered and which 
 are of a rather general character, there are numerous rules found mostly 
 in municipal codes which are intended to apply to special conditions or 
 particular kinds of food. 
 
 Diseased Food. 
 
 Food from animals which are diseased at the time of killing Is 
 assumed to be unwholesome. In many instances this is without doubt 
 the case. The flesh from animals suffering from trichinosis is quite 
 likely to produce the disease if eaten without thorough cooking, and 
 the meal of tuberculous animals and those afflicted with aetininiycosis 
 is often dangerously infected. Other diseases we know- less about, but 
 it is perhaps a not unreasonable safeguard to require that no material 
 
 from diseased animals shall be offered as food. When, as is so conn i 
 
 in genera] laws on this subject, the sale of "diseased "' provisions is for- 
 bidden, it may be assumed thai food from diseased animals is meant. 
 Sometimes, however, this meaning is made (dear in the law. Thus in 
 Louisiana 8 it is enacted •• Thai it shall be unlawful for any person or 
 persons to slaughter for food and offer for sale an\ cattle, hogs or 
 sheep the same being in an unhealthy condition.'" A similar provision 
 
 1 Maryland, Chapter 804 ox L890, Sec. 52. 
 New York City Similar; Code I 1899), S( 
 Louisiana, A- I of 3 Mar< h, L880, Sec. 8. 
 
310 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 is found in Indiana, Kentucky, Maine, Missouri, Nebraska and Penn- 
 sylvania cities of the second class. 1 In St. Louis : 2 
 
 "Any person . . . who shall sell . . . meats from any cattle, hogs, 
 sheep or calves that were unsound, sick or diseased or out of condition at the time 
 they were slaughtered shall be guilty of a misdemeanor . . ." 
 
 In Iowa it is unlawful to buy, sell or give away diseased swine. 3 
 In Minnesota 4 it is unlawful to use any part of a diseased animal for 
 the preparation of food and its use for other purposes must be licensed 
 by the state board of health. 
 
 It is usually in these rules provided that all sickly animals shall be 
 reported to the board of health. Much of the legislation concerning 
 contagious diseases of animals has reference to the prevention of the 
 use for food and the proper disposition of all animals suffering from 
 these diseases. Then again the Federal inspection of animals is in- 
 tended to prevent the slaughter for food of all diseased animals so that 
 much, perhaps most, of the control of " diseased " food depends upon 
 other means than food laws proper. 
 
 Food from Over-heated and Feverish Animals. 
 
 Animals become feverish from driving or transportation, and many 
 cities forbid their being slaughtered under such conditions. Such a 
 regulation is found in Atlanta, Bridgeport, Chicago, Elmira, Memphis, 
 the City of New York, Yonkers, and other cities, and in Paterson it is 
 added that they shall not be slaughtered until twenty-four hours after 
 unloading. The New Orleans ordinance forbids the use of food from 
 animals " run down by dogs." 
 
 Wounded Animals Not to be Used for Food. 
 
 Indiana and a number of cities, as Atlanta, New Orleans, and Penn- 
 sylvania cities of the second class, forbid the use of maimed or wounded 
 animals as food. The following is the regulation in Atlanta and is 
 very specific in many other respects as well as in regard to wounded 
 animals : 
 
 " That no animals or fish that died by disease or accident, no carcass of any calf, 
 pig or lamb, which, at the time of being killed was less than six weeks old, and no 
 meat therefrom, nor any animal, nor meat therefrom, killed while feverish, bruised, 
 disabled, injured with broken limbs, or otherwise; heavy with young, jaded or 
 fatigued from long driving or shipping, shall be used as food." 5 
 
 1 Pennsylvania, Chapter 258 of 1895, Sec. 13. 
 
 2 St. Louis, Ordinances (1893), Chapter 14, Sec. 359. 
 s Iowa, Chapter 113 of 1898. 
 
 4 Minnesota, Cliapter 175 of 1899. 
 
 5 Atlanta, Regulations of Board of Health, Sec. 101. 
 
FOOD OTHER 1HAJST DAIRY PRODUCTS. 311 
 
 Pregnant Animals Not to be Used for Food. 
 
 In Atlanta, as above, and also in Cincinnati, it is forbidden to use 
 the flesh of pregnant animals for food. 
 
 Food from Emaciated Animals. 
 
 In Bridgeport, Chicago, New York, and Pennsylvania cities of the 
 second class, it is forbidden to slaughter or use the food from " meagre " 
 or " emaciated " or " famished " animals. 
 
 Food from Dead Animals. 
 
 It is very common to forbid the sale of meat of animals that have 
 died, either from disease or accident. Such a regulation is found in 
 Albany, Atlanta, Augusta, Ga., Camden, Chicago, Minneapolis, New- 
 burgh, New Orleans, New York, Paterson, Utica, and Yonkers. The 
 following are the words of the New Orleans ordinance : 2 
 
 •• No person shall sell . . . the flesh of any animal which died from disease, 
 accident, or casualty or other means than the usual manner of slaughtering animals 
 for food/' 
 
 In Chicago 2 it is forbidden to carry the carcass of a dead animal 
 within the precints of any slaughter-house in the city ; and in Buffalo 3 
 it is the duty of the cattle inspector that 
 
 " He shall immediately notify the owner, agent or consignee of any dead cattle, 
 hogs, sheep or lambs that may arrive in the city of Buffalo, to take the same to some 
 
 b< yard within one hour after the train upon which they arrive is unloaded. In 
 
 case any such owner, agent or consignee shall refuse or neglect to so take the same 
 within the time herein prescribed, it shall be the duty of the inspector, and he shall 
 have power, to forthwith remove the same to some bone-yard and dispose of the 
 same to the best advantage. 1 ' 
 
 Animals must be Bled, Cleaned, and Cooled. 
 
 All large animals must be so treated before they can be ottered for 
 Bale according to the rules of Chicago, Denver, Memphis, Minneapolis, 
 Omaha, and New York. The following is the rule in New York and 
 has been copied very generally bythe other cities mentioned : 
 
 "Thai oo meal or dead animal above the size of a rabbit shall be taken to any 
 public or private markel for food, until the same shall have fully cooled after kill- 
 ing, nor until the entrails, heads, and feet (ezcepl of poultry and game, and except 
 the head and feet of swine) shall have been removed." 4 
 
 1 N.'w Orleans, Ordinance No. U56, C. S., as amended by Ordinance 4274, 5917, 
 and 0691, Sec. L3. 
 
 'Chicago, Ordinance of I January, i s '.»7, Sec. I. 
 Buffalo, Ordinances (1897), Chapter 26, s .'". 108. 
 \. u Xork, Sanitary Code | L899), s ''<-. 17. 
 
312 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 Side of Undrawn Poultry. 
 
 The question as to whether poultry should be sold without having 
 the viscera removed has been much discussed. If the entrails remain 
 the odors and taste from the offensive matter in the gut are absorbed 
 by the surrounding tissues which are therefore more or less disagreeable 
 to the consumer. On the other hand it is claimed by the dealers, decom- 
 position of the muscular tissue takes place sooner when the viscera are 
 removed. The consumer then would naturally prefer that the poultry 
 be promptly drawn, while the dealers prefer that they should not be, as 
 they thus keep longer in a saleable condition. The Massachusetts law 
 requires that they shall be drawn, but in Boston at least it is a dead 
 letter. 1 In Minnesota 2 plucked poultry, and game, and rabbits must be 
 drawn. A similar rule is found in Cincinnati, Buffalo, and Erie. In 
 Detroit the crops of poultry must be removed before they are sold. 
 
 Blown Veal and Mutton. 
 
 The practice of blowing carcasses i. e., injecting air under the super- 
 ficial fascia, is resorted to to a considerable extent in order that the 
 meat shall present a better appearance, as the air in the tissues makes 
 it look like fat. It is a reprehensible practice as it is in the nature of a 
 fraud, and furthermore it is not desirable to have saliva from a butcher 
 injected into the animal through a dirty pipe stem ; an accident which 
 doubtless sometimes occurs. Hence in a number of cities mentioned on 
 page 306 the sale of meat so treated is forbidden by a rule there given. 
 It is also the rule in Cleveland, and the superintendent of markets is 
 directed to see that it is strictly enforced. In New Orleans 3 it is pro- 
 vided that the carcasses shall only be blown by means of a bellows and 
 that no animals over fifteen months of age shall be blown at all. The 
 practice in that city is to ship calves to market blown and with the 
 hides on. They present a bloated and disgusting appearance and the 
 inspector in that city is decidedly of the opinion that blowing should 
 be forbidden. It is the opinion of the inspector that blowing hastens 
 decomposition and it is likely that this is so, as, if bellows are used, 
 the air pumped in must carry many micro-organisms directly into the 
 tissues. 
 
 1 Massachusetts, Chapter 94 of 1887: 
 
 "No poultry, except it be alive, shall be sold or exposed for sale until it has been 
 properly dressed, by the removal of the crop and entrails when containing food." 
 
 2 Minnesota, Chapter 211 of 189.",. 
 
 3 New Orleans, Ordinances, No. 421 C. S., adopted 28 August, 1883. 
 
FOOD OTHER THAN DAIRY PRODUCTS. 313 
 
 Food from Immature Animals. 
 
 It is generally assumed that the flesh of immature animals is neither 
 as wholesome or nutritious as that of adults, and that the flesh of very 
 young animals is often positively injurious. However the facts may be, 
 there is a very general attempt to forbid the sale of such in the United 
 States. General provisions that immature animals shall not be used for 
 food are sometimes found as in Pennsylvania cities of the second class : l 
 but usually such regulations are of a specific character and state definitely 
 the age limit of the animals. The animals usually referred to, are 
 calves, pigs, and lambs. There is not very much temptation to send 
 young lambs to market, neither is the demand for young pigs very 
 great. By far the most important traffic in young animals is in calves. 
 Veal is a popular article of food, and it is not considered profitable by 
 dairymen to keep the calves any longer than is necessary. The demand 
 for the milk of the cow leads them to dispose of the calf at the earliest 
 moment. Hence a very large number of young calves are thrown upon 
 the market. To prevent the sale of such immature animals for food, 
 statutes are found in several states and local regulations in many cities. 2 
 Nunc of the statutes except that of Vermont, refer to any animal 
 Other than calves, but nearly all of the local rules including those of 
 cities in the states mentioned include calves, lambs, and pigs. The 
 Limit prescribed for the different animals is in almost all cases for 
 calves, four weeks; for pigs, five weeks; for lambs, eight weeks. The 
 exceptions are two weeks for calves in Portland. Ore., three weeks in 
 Pennsylvania, one month in Buffalo, five weeks in Hartford, and six 
 weeks in Missouri, Atlanta, and Spokane, but according to a statement 
 in -.Municipality and County."' Vol. : '>. page 161, "As a matter of pre- 
 cedent and standard, calves weighing less than fortj to sixty pounds 
 and under six weeks, are in Buffalo unconditionally condemned," by 
 the slaughter-house inspectors. In New York the duty of enforcing 
 the law is placed upon the commissioner of agriculture, and it is for- 
 bidden to transport veal without a tag. For pigs the time is in Scran- 
 ton, three weeks; New Orleans, Cincinnati, and Qtica, four weeks ; and 
 in Atlanta and Spokane, six weeks. In addition to the time limit the 
 ordinance in Rochester requires thai a veal shall weigh at least seventy 
 pounds, and in New York City forty-five pounds. In the enforcement 
 
 1 Pennsylvania, Chapter 258 01 1895, Sec. 18. 
 
 Indiana, Maim-. Massachusetts, Missouri, x> u Fork, Ohio, Oregon, Penn- 
 
 s> Ivania, and Rhode Islam! all have laws upon this subject, and manj cities outside 
 
 ol these states may be mentioned as Atlanta, Bridgeport, Buffalo, Camden, Chicago, 
 
 Denver, Erie, Hartford, Minneapolis, Newark, New Orleans, Omaha, and Paterson. 
 
314 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 of these laws, the question as to whether an individual veal is of the 
 
 age required is to be settled by the judgment of the inspector or other 
 
 witnesses. To arrive at a correct conclusion is not always an easy 
 
 matter, and if a weight limit was fixed by law probably the laws could 
 
 be better enforced. In some cities the inspectors fix a weight limit 
 
 which shall be the guide for their judgment as to whether a particular 
 
 carcass is under age or not. 
 
 The best of the state laws is that of Rhode Island : 1 
 
 " Every person who shall kill, or cause to be killed, for the purpose of sale, any 
 calf less than four weeks old, or shall sell, or have in his possession with intent to 
 sell, the flesh of any calf which he knows to have been killed when less than four 
 weeks old, shall be fined not exceeding twenty dollars." 
 
 The Maine, Massachusetts, and Ohio laws insert the word know- 
 ingly, thus making proof of violation more difficult. This, however, 
 does not apply to the killing, but only to the selling, thus rendering it 
 easier to convict of the former than of the latter offence. The Mas- 
 sachusetts law is, however, superior in this respect, that it provides for 
 inspection and seizure : 2 
 
 "Said inspectors may inspect all veal found in said cities or towns or offered or 
 exposed for sale or kept with intent to sell therein, and if said veal is, in the judg- 
 ment of the inspector, that of a calf killed under four weeks old, he shall seize the 
 same and cause it to be destroyed or disposed of as provided in the preceding sec- 
 tion, subject, however, to the provisions therein contained concerning appeal and 
 the disposal of moneys.'" 
 
 Cleanliness of Markets. 
 
 It is highly desirable that markets should be kept in as neat and 
 clean condition as possible. ^Esthetic reasons alone are sufficiently 
 weighty to require this ; but there are other reasons more imperative. 
 Provisions, especially meat, fish, milk and dairy products, very readily 
 become dirty and are not readily cleaned. They easily become infected. 
 Putrefaction which it is desirable from every point of view to prevent 
 or put off as long as possible is hastened by exposure to filth. Hence 
 regulations have been adopted in many cities to secure greater cleanliness 
 in markets. Below 3 are the rules which have been adopted in Chicago 
 and Atlanta. 
 
 i Rhode Island General Statutes (1896), Chapter 282, Sec. 3. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 58, Sec. 3. 
 
 3 Chicago, Ordinances (1881), Sec. 1405: 
 
 " That every person being the owner, lessee, or occupant of any room, stall or 
 place where any meat, fish or vegetables designed or held for human food shall be 
 stored or kept, or shall be held or offered for sale, shall put and keep such room, 
 stall and place and its appurtenances in a clean and wholesome condition; and every 
 person having charge, or being interested, or engaged whether as principal or agent, 
 in the care, or in respect to the custody or sale of any meat, fish, birds, fowl or 
 vegetables designed for human food, shall put and preserve the same in a clean and 
 
FOOD THER TH AX DAIR Y PR OD UC Ts. 3 1 5 
 
 In New Orleans 1 each market stall must be provided with a covered 
 
 garbage barrel in which all refuse must be placed and none thrown on 
 
 the floor ; and 2 
 
 " During the half hour immediately after the closing of said market butchers or 
 other persons hiring or occupying their respective stalls, stands and tables shall be 
 bound to scrape, wash and cleanse the same, so as to keep the said stalls, stands and 
 tables in the highest state of cleanliness, and every person neglecting to comply 
 punctually with the terms and conditions of this section, or who shall not quit the 
 said market at the hour specified, shall be subject to the penalties stipulated in sec- 
 tion 32 of this ordinance. 11 
 
 Iii Cincinnati fish must not be cleaned in a market. The follow- 
 ing is the rule in Asbury Park 8 in regard to fish markets : 
 
 "All portions of the floor, and the side walls to a height of three feet above the 
 floor of every store, market or apartment where fish or shellfish or other substance 
 subject to rapid decay is held for sale or stored shall be constructed of tiling, flag- 
 ging stone or cement concrete, and be made water tight. All such floors shall be 
 properly graded and drained, and all offal, refuse and unwholesome or offensive 
 matter shall be removed therefrom at least once in every twenty-four hours, and said 
 floors and side walls shall at all times be kept clean and free from offensive odors. 11 
 
 Iii New York and Chicago it is forbidden to slaughter any animals 
 
 in a market; and in many other cities, and indeed in these cities, the 
 
 same end is accomplished by the regulations governing slaughter-houses 
 
 and slaughtering; but "animal'' in this connection is not assumed to 
 
 include poultry. The killing of poultry in markets is also forbidden in 
 
 some cities, as Newark 4 and Boston. 
 
 wholesome condition, and shall not allow the same or any part thereof to be poi- 
 soned, infected, or rendered unsafe or unwholesome for human food. 11 
 Atlanta, Rules and Regulations of Board of Health, Sec. 101: 
 ■• Nil animal shall be . . . killed or kept in same building, or in so close prox- 
 imity with fumes of gas or diseased or other spoilt meats, or dead carcasses, as to be 
 contaminated therefrom or rendered unwholesome or unhealthy thereby, or hauled 
 in the same vehicle, or manipulated with tools used on diseased or other dead car- 
 casses as aforesaid, or dressed or kept in any building wherein animals, or parts of 
 
 animals, dead from injury or disease are Stored, kept or rendered, or wherein decom- 
 posed, putrid or offensive meals of any kind are kept, or within one hundred feet of 
 any building wherein animals dead as aforesaid, or other unsound meats are stored, 
 kept or rendered, or dressed, or kept in any house or upon premises which are not 
 clean and maintained in a pure and wholesome condition bj necessary disinfection, 
 
 flushing, washing, scalding and lime washing, and the removal therefrom of all 
 
 accumulations of filth and of all decomposing and offensive matter, shall be brought 
 into said city, or in said city sold, held, oi ottered for sale ;is food." 
 
 1 New Orleans, Ordinance 1155, C. s .. as amended i,\ Ordinances 1724,5917, 6691, 
 L6. 
 
 New Orleans, Ordinance 1155, C. s -- as amended by Ordinances 1724, • «o 17. 6691, 
 24. 
 
 Lsbury Park. Sanitary Code (1897), Sec. 87. 
 
 1 Newark. Sanitary ('ode (1888), Sec. 15: 
 
 "Thai no person Or persons <.r corporation shall kill, scald, pick Or dress any 
 
 chicken, turkey, duck, goose or other feathered animal within the limits of any mar- 
 ket, public or private, within the City of Newark." 
 
316 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 The Hebrew method of killing fowl in houses and small markets is 
 productive of much offence where many of this race congregate. In 
 Boston public killing places for poultry have been established. Licenses 
 are granted for these places and the proprietor then rents coops at a rate 
 approved by the board of health. An elaborate set of rules 1 were 
 adopted for their control and they are frequently inspected, but at the 
 best they are offensive places. In New York also a license is required 
 for killing fowl. 
 
 Control of Markets. 
 
 A most important means of controlling markets is by the establish- 
 ment of public markets or market places. In some cases these markets 
 are the property of the city, and in others they are owned by quasi public 
 chartered corporations. In either case the business done by the indi- 
 viduals or firms who occupy them is more easily controlled than it is 
 when separate markets are scattered all over the city. In the case of 
 public markets the superintendent and his subordinates may easily serve 
 as inspectors, and being constantly on the premises their services in this 
 direction are very efficient. In a number of cities they are directly 
 charged with the enforcement of the rules concerning the wholesomeness 
 of the food exhibited. Thus in Cincinnati 2 the superintendent is to 
 seize all unwholesome or otherwise proscribed provisions. A large pro- 
 portion of the cities of the United States have such public markets. 
 They have been established, however, not so much for sanitary as for 
 economic reasons. In the city of the writer there is no such market, 
 but there has been for years much agitation of the subject and there is 
 a strong desire on the part of many that the city should establish such 
 a market. Both in cities where there is and in those where there is not 
 a public market, there are private markets and peddlers' wagons. In 
 some cities the license system of control is adopted for these, parti- 
 cularly the peddlers' wagons. Among the cities in which markets are 
 licensed may be mentioned Chicago, Denver, and New Orleans. In 
 Denver the application must be approved by the health commissioner 
 and the fire and police boards. In Chicago the fee for a market license 
 is fifteen dollars per annum, in Denver it is fifty dollars. 
 
 The licensing of peddlers' carts is more common than the licensing 
 of markets. Sometimes a nominal fee is charged for these licenses on 
 the ground that no burden should be placed upon men of moderate 
 means engaged in a legitimate business. At other times a considerable 
 fee, as twenty-five to fifty dollars is charged, the idea being to obtain a 
 
 1 Boston, Report of Board of Health (1800), p. 96. 
 
 2 Cincinnati, Manual of Department of Health (1898), p. 111. 
 
FOOD OTHER THAN DAIRY PRODUCTS. 317 
 
 rental for the use of the streets to do business in. In Denver the 
 license fee for peddlers is four hundred dollars and is doubtless in- 
 tended to be prohibitive. 
 
 By a system of license it is possible to require a properly constructed 
 market or wagon before the license is granted, and strong after-control 
 is exercised by making use of the power to revoke whenever it is found 
 that improper food is sold. It is necessary that rules should be framed 
 to secure the cleanliness of these wagons. The Boston rules are given 
 below. 1 
 
 In Brooklyn it was required that the wagon boxes of fish peddlers 
 be lined with zinc as must the boxes in front of markets. 
 
 In New ( Orleans, no crabs or shrimps shall be sold in any market 
 after ten a. m., or from any cart from 1 May to 1 October. 
 
 In Denver and Erie the cleanliness of employes as well as of mar- 
 kets is prescribed. 2 
 
 In Rochester filthy barrels and boxes must not be used for holding 
 food. 3 
 
 The exposure of meat to the dust of the streets is considered 
 dangerous and is forbidden in the City of New York. 4 See also the 
 
 i Boston, Ordinances (1890), Chaper 49, Sees. 2 and 88: 
 
 ■ No person shall, at any time, have in his possession with intent to sell, fish of 
 any kind, except flounders, smelts, and other small tish, salmon, and shad, until the 
 same have been cleansed of their entrails and other refuse parts, nor fish of any 
 kind, unless they are kept in covered stalls, or fish-boxes, or in covered carts, which 
 shall be clean and in good order, and well secured from the cays of the sun. 
 
 ■ No hawker or peddler shall carry or convey any articles enumerated in section 
 ,,n.- of chapter sixty-eight <>f the Public Statutes in any manner thai will tend to in- 
 jure or anie>y the public health or comfort, n<>r otherwise than in vehicles or recep- 
 tacles which are neat and clean and do noi leak, and have printed mi them in letters 
 and figures al leasi two inches in height the name of the person selling, and the 
 number given him by the Board of Health, and which are approved on the firs! 
 Monday in every month by the Board of Health."' 
 
 Erie, Rules of Board of Health, Sec. •!-. 
 
 ■ No i ni tdicr. or other person in his employ, shall appear for the purpose of eut- 
 ting, handling or rending meat, unless he shall be neatly dressed in a white Erock, 
 or with a white a | Ton and whit.- oversleeves extending above the elbows." 
 
 Rochester, Board of Health Ordinances, No. 22, Sec. 1: 
 
 No person or persons, linn or corporation, shall keep or convey flour or any 
 
 article of human food in barrels, casks, boxes or any receptacle that has become 
 musty or otherwise polluted, under a penalty of ten dollars ($10.00) for each and 
 ever; offense." 
 
 ■ New York Sanitarj I ode 1 1899), Sec. IT: 
 ". . . nor shall the body or an] part thereof of any animal which is to b< 
 B8 food be carted or carried through the streets, excepl \\ be covered so as to pro- 
 
 teet ii from dust or dirt, and n eat, poultrj or game shall be hung or exposed for 
 
 sale outside of any shop or store in this city or in the open windows or doorways 
 thereof.' 1 
 
318 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 Boston rules. A similar rule is found in San Francisco and Portland, 
 Ore., and in Minnesota 1 a statute provides that fresh meat in transit 
 shall be covered to keep off flies. In Colorado Springs fruit must be 
 covered to keep off the dust. 2 
 
 The most common place to find filth in markets is the ice-box, and 
 regulations concerning its care are found in Chicago, New York, Mem- 
 phis, and Scranton. In Scranton the inspector is required to inspect 
 ice-boxes as often as possible and see that they are kept clean, and this 
 is doubtless the practice of the inspectors of other cities where it is not 
 prescribed. The other cities mentioned above have the .following rule : 
 
 " That no butcher or dealer shall keep in any market any refrigerator or ice-box, 
 unless the same shall be lined with lead or some proper metalic substance, so as to 
 be water-tight, nor unless the same be provided with a pipe of lead, zinc or copper, 
 leading therefrom to the nearest gutter or proper waste pipe." 3 
 
 Bakeries. 
 
 Connecticut, Massachusetts, Minnesota, New Jersey, New York, 
 Ohio, Pennsylvania, and Wisconsin have laws in regard to the construc- 
 tion and management of bakeries, mostly of quite recent passage, and 
 Baltimore by a special act is authorized to inspect bakeries. 4 These 
 laws have, perhaps, aimed as much to improve the sanitary conditions 
 under which the bakers labor as to secure cleaner and better bread. 
 They have received the support, and have perhaps been passed in some 
 cases at the instance of the bakers' unions. The best law appears to be 
 that of Pennsylvania, though it does not differ in essentials from that 
 of other states. The provisions of the act are shown below. 5 
 
 1 Minnesota, Chapter 200 of 1895. 
 
 2 Colorado Springs, Ordinances of 18 January, 1894, Sec. 21 : 
 
 "All fruit intended to be eaten in the form in which it is sold, such as dates, figs, 
 and raisins, shall, when kept or offered for sale, be securely covered with glass or 
 wooden cases so as to protect the same from contact with flies and dust." 
 New York Sanitary Code (1899), Sec. 53. 
 
 4 Maryland, Chapter 273 of 1896. 
 
 5 Pennsylvania, Act of 27 May, 1897 : 
 
 "Section 2. All buildings or rooms occupied as a biscuit, bread, pretzel, pie 
 or cake bakery, or maccaroni establishment, shall be drained and plumbed in the 
 manner directed by the rules and regulations governing the house drainage and 
 plumbing as prescribed by law, and all rooms used for the purpose aforesaid shall 
 be ventilated by means of air shafts, windows or ventilating pipes, so as to insure a 
 free circulation of fresh air. No cellar or basement, not now used for a bakery, 
 shall hereafter be occupied and used as a bakery, unless the proprietor shall have 
 previously complied with the sanitary provisions of this act. 
 
 "Section 3. Every room used for the manufacture of flour or meal food pro- 
 ducts shall have an impervious floor, constructed of cement or of tiles laid in 
 
FOOD OTHER THAN DAIRY PRODUCTS. 319 
 
 In New Jersey, Ohio, and Pennsylvania, the factory inspector is to 
 enforce these laws and may give certificates that the law has been com- 
 plied with. In Massachusetts the local board of health is to enforce 
 the law. The report of the Brooklyn (X. Y.), health department for 
 1896 shows that the inspectors found the bakeries in that city in good 
 condition and in the cities of Massachusetts flagrant violations by bakers 
 of sanitary principles are not common. In 180(3 Milwaukee passed an 
 ordinance providing that all bakeries and candy manufactories should 
 be kept clean and wholesome. It is reported 1 that some of the bakeries 
 in that city were in bad condition and many of them were so in New 
 Haven 2 and San Francisco. 3 
 
 cement, or of wood of which all the crevices shall be filled in with putty, and the 
 whole surface treated with oil varnish. The inside walls and ceiling shall be plas- 
 tered and either be painted with oil paint, three (3) coats, or be lime-washed, or the 
 side walls plastered and wainscoted to the height of six (6). feet from the floor, and 
 painted or oiled; when painted, shall be renewed at least once in every five years 
 and shall be washed with hot water and soap at least once in every three (3) months; 
 when lime-washed the lime-washing shall be renewed at least once in every three (3) 
 months. The furniture and utensils in such room shall be so arranged that the 
 furniture and floor may at all times be kept in a thoroughly sanitary and clean 
 condition. Xo domestic or pet animal shall be allowed in a room used as a biscuit, 
 bread, pie or cake bakery, or in any room in such bakery where flour or meal pro- 
 ducts are stored. 
 
 "SECTION 4. The manufactured flour and meal food products shall be kept in 
 perfectly dry and airy rooms, so arranged that the floors, shelves and all other 
 places for storing the same can be easily and perfectly cleaned. 
 
 " Section 5. Every such bakery shall be provided with a proper wash-room 
 and water closet or closets, apart from the bakeroom or rooms where the manufac- 
 ture of such food products is conducted, and no water closet, earth closet, privy or 
 ash pit shall be within or communicate directly with the bake room of any bakery, 
 hotel or public restaurant. 
 
 11 Section <>. Every sleeping room for persons employed in every bakery shall 
 be kept separate from the room or rooms where flour or meal products are manu- 
 factured or stored, and shall be provided with one or more external glazed wind- 
 ows, eaeh of which shall be at least nine (9) superficial feet in area, of winch at 
 least four and one-half (4£) superficial feet shall be made to open for ventilation; 
 and such sleeping places when they are on the same Ihn.r as the bakery, shall be in- 
 spected in order to maintain them in a condition of cleanliness. 
 
 "Sei i ion t. No employer shall knowingly require, permil or suffer any person 
 to work in his bakeshop who is affected with consumption of the lungs, or with 
 ■crofulous diseases, or with any veneral diseases, or with any communicable skin 
 affection, and every employer is hereby required to maintain himself and his em- 
 ployees in a clean condition while engaged in the manufacture, handling or sale of 
 such food products, and it is hereby made die duty of the Board of Health to en- 
 force the provisions of this section/ 1 
 
 Milwaukee, Reporl of Health Commissioner (1896 7), p. 20. 
 
 \eu Haven, Reporl of Board oi Health (1897), p. 29. 
 
 San Francisco, Reporl of Department of Health (1897), p. 196. 
 
320 FOOD OTHER THAR DAIRY PRODUCTS. 
 
 In Erie a regulation has been adopted by the board of health requir- 
 ing that bakers 7 delivery wagons must be kept clean. 1 
 
 New Orleans has a bakery ordinance and the following is the schedule 
 of items inquired into by the inspectors : 
 
 Inspection of Bakery No 
 
 Owned by 
 
 Condition of Drainage 
 
 Condition of Premises and Yards 
 
 Condition of Privy Vault and Kind 
 
 Condition of Floor of Bake Shop 
 
 Condition of Sponge Trough and Moulding Bench 
 
 Condition of Raising Box .' 
 
 Condition of Cushions and Covers 
 
 Condition of Bread Pans and Moulds 
 
 Water Supply 
 
 Hydrant, is it Filtered ? 
 
 Cisterns, number Capacity 
 
 Distance from Cisterns to Privy Vaults 
 
 Condition of Stable 
 
 Distance from Stable to Bake Shop 
 
 Amount of Flour Used per Day 
 
 Kind of Flour Used 
 
 Kind of Yeast Used 
 
 Sickness on Premises Acute 
 
 Chronic Infectious 
 
 General Remarks 
 
 Inspection Made 189. . 
 
 By Officer 
 
 Hotels "in/ Restaurants. 
 
 Those who framed the food laws undoubtedly intended them to 
 apply to markets, peddlers, wholesale provision houses, etc. The sale 
 of provisions however takes place in hotels and restaurants, and the 
 laws might fairly be interpreted to cover such sales ; but it has been 
 deemed advisible to make special provisions for this in the rules of 
 Chicago, Denver, District of Columbia, New York City, 2 and Omaha. 
 
 iErie, Rules of Board of Health: 
 
 " All vehicles from which any biscuit, bread, pretzel or other bakeshop product 
 is sold in the city of Erie shall be kept in a clean and sanitary condition, and all 
 baskets, boxes, or other receptacles in which any of the aforesaid products are con- 
 veyed through the streets shall be closely covered in a way and manner that will 
 protect them from any pollution whatsoever. 1 ' 
 
 2 City of New York, Sanitary Code (1899) : 
 
 " Sec. 49. That no person, being the manager or keeper of any saloon, board- 
 ing-house, or lodging-house, or being employed as clerk, servant, or agent thereat, 
 shall therein or thereat, offer or have, for food or drink, or to be eaten or drank, 
 any poisonous, deleterious, or unwholesome substance, nor allow anything therein 
 to be done or to occur, dangerous to life or prejudicial to health." 
 
FOOD OTHER THAN DAIRY PRODUCTS. 321 
 
 A more explicit rule in regard to kitchen cleanliness is found in Colo- 
 rado Springs. 1 
 
 In Denver the health commissioner is directed to inspect hotels and 
 restaurants at frequent intervals. 
 
 Vegetables <<u<l Fruit. 
 
 Special rules are sometimes found in regard to vegetables and fruit. 
 
 " No person shall land on any wharf or other place, or shall bring into the city, 
 any decayed or damaged vegetables <>r fruits. 
 
 " Xo person shall hold, sell or offer for sale, or bring into the city, any decayed 
 or damaged vegetables or fruit." 
 
 "It shall be unlawful for anyone to sell, offer for sale, or have in his possession 
 with intent to sell, any unripe, over-ripe, decayed or unwholesome fruit or vege- 
 tables; and the health officer and all officers of the department of health are author- 
 ized and directed to immediately confiscate and destroy any such fruit or vegetables 
 when offered for sale. " - 
 
 " No person shall bring into the city, or have in his possession with intent to sell, 
 or sell, any vegetables, excepting green peas or beans in the pods, and green corn in 
 the inner husks, which have not previously been divested of all parts not commonly 
 used for food; and no person shall have such parts in his possession in any market- 
 place, nor in a cart or vehicle used for the sale of vegetables or other articles of 
 food." 3 
 
 in San Francisco 4 fruit and berries must be packed in new, clean 
 boxes. In the report of the board of health of Asbury Park for 1892, 
 opposite page 26, is a photograph showing berry boxes culled out of a 
 garbage dump for subsequent use, so thai it would appear that the San 
 Francisco rule is nol uncalled for. 
 
 Flesh of Unclean Animate. 
 
 ". . . Nor shall any person sell or expose or offer for sale the flesh <>f any dog, 
 cat, or any unclean animal." 5 
 
 Metal Soda Fountains. 
 
 "In t he sal<- of. or keeping for sale, any beverage or drink, qo person shall keep 
 or use any tap, faucet, tank, fountain or vessel, or any pipeor conduii in connection 
 therewith, which shall be composed of or made with brass, lead, copper, or other 
 metal or metallic substances thai are or will be affected by liquids so t kit dangerous, 
 unwholesome or deleterious compounds are formed therein or thereby, or such 
 
 I Colorado Springs, Sanitary ('ode. Sec. IT: 
 
 II In the kitchen of restaurants and hotels and in all places where the floor may 
 receive moisture, ftlth, or decomposed matters the flooring shall be made of water- 
 proof material. No such Hour shall bave under ii spaces which are not readily 
 accessible, and th<' drainage shall in all cases be sufficient to remove the waste from 
 t lie building in a manner satisfactory to the health officer. 11 
 
 Cincinnati, Manual of Health Department (1898), p. 98. 
 Boston, ■ Ordinances i L890), Chapter 49, Sec. •". 
 l San Francisco, Reporl of Board of Health (1897), p. s - 
 New Orleans, Ordinance No. H55, s '-<-. 18. 
 
322 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 that beer, soda water, syrups or other liquids, or any beverage, drink or flavoring 
 material drawn therefrom shall be unwholesome, dangerous or detrimental to 
 health." 1 
 
 Fish- Cars near Sewers. 
 
 "No fish-car, lobster-car, ark, or other receptacle for fish or lobsters, shall be 
 kept or put within one hundred and fifty feet of the mouth of any sewer. 11 2 
 
 Much has of late been written about the clanger of keejDing oysters 
 in sewage polluted waters, but there does not appear to be any legisla- 
 tion on the subject. 
 
 Bread. 
 
 The earliest food regulation that the writer has found was an act of 
 
 the Pennsylvania legislature, 18 March, 1775, in regard to bread: 
 
 1 ' If any person or persons shall adulterate or mix any improper and unwhole- 
 some ingredient in any kind of flour of which bread shall be made as aforesaid, every 
 such person or persons, being thereof legally convicted before any magistrate or 
 justice of the city, borough or county where such bread shall be so made, sold, or 
 exposed to sale, who is hereby authorized and empowered to hear, try and deter- 
 mine the same, shall forfeit and pay the sum of five pounds for every such offence. 11 
 
 An almost identical provision has recently been adopted in New 
 Jersey 3 and a similar law is on the statute books of Kentucky. 4 In the 
 District of Columbia bread must not contain any alum, sulphate of 
 copper, borax, sulphate of zinc, or other poisonous ingredient, and it 
 must not contain more than 31 per cent, of moisture, 2 per cent, of ash, 
 or less than 6.25 per cent, of albuminoids. 5 
 
 Canned Goods. 
 
 The danger in the use of canned goods has been much discussed and 
 the likelihood of finding spoiled goods or metallic poisons in the cans 
 is not a remote one. There has not, however, been much legislation on 
 the subject. 
 
 Iowa and Michigan have the following : 6 
 
 "It shall hereafter be unlawful in this state for any packer of, or dealer in, 
 hermetically sealed, canned or preserved fruits, vegetables, or other articles of food, 
 to knowingly offer such canned or preserved articles for sale for consumption in this 
 state after October 1, 1886, unless the cans or jars which contain the same shall bear 
 the name, address and place of business of the person, firm or corporation that 
 canned or packed the articles so offered, or the name of the wholesale dealer in the 
 state who sells or offers the same for sale, together in all cases with the name of the 
 
 *New York, Sanitary Code (1899), Sec. 191. 
 
 2 Newport, Rules of the Board of Health, Sec. 15. 
 
 3 New Jersey, Public Laws (1890), p. 2G1. 
 
 4 Kentucky, Statutes (1894), Sec. 1273, 
 
 5 Act of Congress of 17 February, 1898, Sec. 3. 
 * Iowa, Code (1897), Sees. 4994-5. 
 
FOOD OTHER THAN DAIRY PRODUCTS. 323 
 
 state, city, town or village, where the same were packed, plainly printed thereon, 
 preceded by the words, L packed at,' such name, address and place of business shall 
 be plainly printed on the label, together with the mark or term indicating clearly 
 the grade <>r quality of the articles contained therein. 
 
 •All packers of, and dealers in soaked goods or goods put up from products dried 
 or cured before canning, shall in addition to complying with provisions of section 
 one of this act, cause to be plainly branded on the face of the label in good, legible 
 {type, one-half of an inch in height, and three-eighths of an inch in width, the word 
 ' soaked.' " 
 
 There is a similar law in Kentucky, except that in the latter state 
 the name of maker and quality of goods must be stamped on the can. 
 An earlier law, but one not as good as the above, was enacted in 
 Illinois in 1885. Laws have also recently been enacted in Ohio, 
 Massachusetts, and Wisconsin. Maryland formerly had a law of this 
 kind, but it was recently repealed. 1 
 
 Misrepresentation Forbidden. 
 
 New York and Memphis have the following: 
 
 " That do meat, fish, fruit, vegetables or milk, or unwholesome liquid shall 
 knowingly be bought, sold, held, offered for sale, labeled, or any representation 
 made in respect thereof, under a false name or quality, or as being what the same is 
 not, as respects wholesomeness, soundness, or safety for food or drink." - 
 
 Such a rule would prevent the sale of shark for halibut as happened 
 in Sun Francisco, 3 or of cats for rabbits, or horse meat for beef. In 
 New Jersey a recent law allows local boards of health to regulate the 
 suit- of horse flesh. 
 
 Misbranding. 
 
 The selling of one food substance in place of another is forbidden in 
 
 a number of general food laws. Tims the Massachusetts laws and those 
 
 copied from it, forbid the sale of food "if it is an imitation of or is sold 
 
 under the name o. another article." The provisions of this law which 
 
 permit the sale of mixtures or c pounds that are so labeled, implies 
 
 the prohibition of any false label. The laws in regard to milk, lard, 
 
 butterine, vinegar, wines, etc., ;\\s<> have sections which provide a penalty 
 
 for marking goods with a false label or failing to mark with a true 
 
 label. Tims in Michigan : ' 
 
 " Wl vet shall falsely brand, mark, stencil, or label an article or product re- 
 quired bj this act to be branded, marked, stenciled, or labeled, or sball remove, 
 alter, deface, mutilate, obliterate, imitate, or counterfeit any brand, mark, stencil, 
 or label so required, shall be deemed guilty of a misdemeanor. . . ." 
 
 1 Maryland, Chapter 148 ol 1898. 
 
 \ru fork, Sanitary Code (1899), Sec. 51. 
 ' San Francisco, Report of Board of Health (1897), p. 7. 
 
 Michigan, Compiled Laws (1897), Sec. 5027. 
 
324 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 Citizens' Reports. 
 
 Most of the regulations which forbid the sale of flesh of diseased 
 animals require that all persons having a knowledge of such diseased 
 animals shall report them to the proper authorities. Also the laws 
 and regulations in regard to contagious disease of animals have the 
 same requirement. The ordinances of Chicago and Minneapolis go 
 farther than this : 
 
 " That it shall be the duty of every person knowing of any fish, meat, fowls, 
 birds or vegetables being bought, sold or offered or held for sale as food for human 
 beings, or being in any market public or private in said city, and not being sound, 
 healthy or wholesome for such food, to forthwith report such facts and the particu- 
 lars relating thereto, to the department of health or to one of its officers or in- 
 spectors." 1 
 
 ADULTERATION AND SUBSTITUTION. 
 
 Laws in regard to adulteration are found in both federal and state 
 statutes and in municipal ordinances. Of these by far the most import- 
 ant are the state laws. The only federal statute in regard to adultera- 
 tions forbids the importation of adulterated foods, drugs, or liquors. 2 
 Some sort of state legislation on the subject of adulteration of food is 
 found in every state and territory except Texas. 
 
 In a few of the states, as Rhode Island, the terms of the act are 
 very general and vague, but in most states the laws are sufficiently 
 explicit to make them of value in dealing with this subject. Besides 
 such laws, which are designed to cover adulterations in general, there 
 are many special provisions and separate acts relating to special materi- 
 als, as milk, butter, drugs, vinegar, molasses, etc., which will be referred 
 to in detail. 
 
 General Prohibitions. 
 
 The Ohio and Rhode Island laws simply forbid the sale of " adul- 
 terated provisions, whether for food or drink," and the Louisiana law 
 is nearly as concise. The following somewhat more explicit form was 
 adopted in Michigan, and has been in substance copied by Colorado, 
 Idaho, Indiana, Kansas, Maryland, and Montana ; but some of these 
 states have further provisions defining the terms used : 
 
 " If any person shall fraudulently adulterate, for the purpose of sale, any sub- 
 stance intended for food, or any wine, spirits, malt liquor, or other liquor intended 
 for drinking, he shall upon conviction be punished by imprisonment in the county 
 jail not more than one year, or by fine not exceeding three hundred dollars, and the 
 article so adulterated shall be forfeited and destroyed." 3 
 
 1 Chicago, Ordinances (1881), Sec. 1407. 
 
 2 Act of Congress, Approved 30 August, 1890, Sees. 2-4. 
 
 3 Michigan, Compiled Laws (1897), Sec. 11406. 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 325 
 
 Somewhat similar legislation is found in Georgia, Maine, Missouri, 
 South Carolina, Vermont, Virginia, and West Virginia, and also in 
 states in which the laws are more extensive and explicit, general provi- 
 sions are also found. 
 
 Another form of general prohibition in regard to adulteration and 
 the sale of adulterated products was enacted in Illinois and has been 
 closely copied by Iowa and New Mexico: 
 
 "That no person shall mix, color, stain, or powder, or ordei <>r permit any other 
 person in his or her employ to mix, color, stain, or powder any article of food with 
 any ingredient or material so as to render the article injuries to health or depreciate 
 the value thereof, with intent that the same may he sold; and no person shall sell 
 or offer for sale any such article so mixed, colored, stained or powdered. Xo 
 person shall mix, color, stain, or powder any article of food, drink, or medicine, or 
 any article which enters into the composition of food, drink, or medicine, with any 
 other ingredient or material, whether injurious to health or not, for the purpose of 
 gain or profit, or sell or offer the same for sale, or order or permit any other person 
 to sell or offer for sale, any article so mixed, colored, stained, or powdered, unless 
 tin- same he so manufactured, used, or sold, or offered for sale, under its true 
 and appropriate name, and notice that the same is mixed or impure is marked, 
 printed, or stamped, upon each package, roll, parcel, or vessel containing the 
 same, so as to be and remain at all times readily visible, or unless the person 
 purchasing the same is fully informed by the seller of the true name and ingre- 
 dients (if other than such as are known by the common name thereof) of such 
 article of food, drink, or medicine, at the time of making sale thereof, or offering to 
 sell the same.*' 1 
 
 Some of the laws that have been referred to define with more or less 
 definiteness what substances are not to be adulterated and in what 
 adulteration consists: but those states in which the subject has received 
 the most attention and where active measures are taken to prevent and 
 punish adulteration usually define these things with the utmost exact- 
 ness. Massachusetts has long waged an active warfare against adulter- 
 ation and her statute may be given as a good example. Other states 
 with similar laws which sometimes closely follow that of .Massachusetts 
 
 are California, Connecticut, District of Columbia, Illinois, Indiana, 
 Kansas, Kentucky, Michigan, Mississippi, Nebraska, New Jersey, New 
 York. North Carolina, Ohio, Oregon, Pennsylvania, South Dakota, 
 Tennessee, and Wisconsin : 
 
 "An article shall be deemed to be adulterated within the meaning of this act, — 
 
 "(a) In the case of drags, (1.) [f, when sold under or by a name recognized 
 
 bj t lie I cited Mates Pharmacopoeia, it differs from the standard of strength, quality, 
 
 or purity laid down therein, unless tl -der calls foi an article inferior to such 
 
 staiiilanl. or unless such difference is made known or so appears i" the purchase] at 
 
 the ti f such sale; (2.) tf, when sold underor by a name nol recognized in the 
 
 United states Pharmacopoeia but which is found in some other pharmacopoeia, ox 
 other standard work on materia medica, i\ differs materially tr the standard of 
 
 1 Illinois, Annotated Statutes (1896), Chapter 88, Sec. 27. 
 
326 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 strength, quality, or purity laid down in such work; (3.) If its strength or purity 
 falls below the professed standard under which it is sold: 
 
 11 (6. ) In the case of food, — (1. ) If any substance or substances have been mixed 
 with it so as to reduce, or lower, or injuriously affect its quality or strength; (2.) If 
 any inferior or cheaper substance or substances have been substituted wholly or in 
 part for it; (3.) If any valuable constituent has been wholly or in part abstracted 
 from it; (4.) If it is an imitation of, or is sold under the name of, another article; 
 (5.) If it consists wholly or in part of a diseased, decomposed, putrid, or rotten 
 animal or vegetable substance, whether manufactured or not, or, in the case of milk, 
 if it is the produce of a diseased animal; (6.) If it is colored, coated, polished, or 
 powdered, whereby damage is concealed, or if it is made to appear better or of 
 greater value than it really is; (7.) If it contains any added poiso.ious ingredient, 
 or any ingredient which may render it injurious to the health of a person consum- 
 ing it. 
 
 " The provisions of this act shall not apply to mixtures or compounds recognized 
 as ordinary articles of food or drinks, provided that the same are not injurious to 
 health, and are distinctly labeled as mixtures or compounds. And no prosecutions 
 shall at any time be maintained under said act concerning any drug the standard of 
 strength and purity whereof has been raised since the issue of the last edition of 
 the United States Pharmacopoeia, unless and until such change of standard has been 
 published throughout the Commonwealth. 1 '' l 
 
 The act relating to the District of Columbia contains eleven other 
 definitions of special foods and gives evidence of being a carefully pre- 
 pared law. 
 
 Additional definitions of an adulterated food found in the Con- 
 necticut law are, " if made to appear of greater value than it is " or " if 
 it contain any antiseptic or preservative not evident or not known to 
 the purchaser or consumer." 
 
 In Ohio mixtures are allowed only if " each and every package sold 
 or offered for sale be distinctly labled as mixtures or compounds with the 
 name and per cent, of each ingredient therein, and are not injurious to 
 health." The following are the provisions of the Connecticut and Ten- 
 nessee laws in regard to compounds and the addition of legitimate sub- 
 stances : 
 
 '■'■Provided, that an article or food product shall not be deemed adulterated or 
 misbranded within the meaning of this act in the following cases: (a) In the case 
 of mixtures or compounds which may be now or from time to time hereafter known 
 as articles of food under their own distinctive names, and not included in definition 
 fourth of this section; (6) in the case of articles labeled, branded, or tagged, so as 
 plainly and correctly to show that they are mixtures, compounds, combinations, or 
 blends; (c) when any matter or ingredient is added to a food because the same is 
 required for the protection or preparation thereof as an article of commerce in a fit 
 state for carriage or consumption, and not fraudulently to increase the bulk, weight, 
 or measure of the food or to conceal the inferior quality thereof; (d) when a food is 
 \mavoidably mixed with some extraneous matter in the process of collection or 
 preparation." 2 
 
 1 Massachusetts, Chapter 263 of 1882, Sec. 3, as amended by Chapter 280 of 1884, 
 Sees. 5 and 7. 
 
 2 Connecticut, Chapter 235 of 1895, Sec. 3. 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 327 
 
 The Michigan law requires that all compounds shall bear 011 the 
 package the name of the manufacturer. 1 
 
 These laws relate to the adulteration of food and drugs, and the 
 word "food"' in them is variously defined. The definition of the Mas- 
 sachusetts law includes " confectionery, condiments, and all articles 
 used as food or drink by man " and the same is found in New Jersey and 
 New York. One section of the Maryland law refers to " any article of 
 food or dietetics." In Connecticut food is anything " used as food or 
 drink of man, horses, or cattle." 
 
 Besides the laws in regard to adulterations in general there are many 
 statutes dealing specifically with various kinds of food. 
 
 Ih-n./x and M< dicines. 
 
 The adulteration of drugs is specifically forbidden in seventeen states. 
 but usually the term is used in connection with " food, liquors," etc., in 
 a general law, or else perhaps a single brief paragraph is devoted to 
 them. No more explicit prohibitions are found than in the general 
 adulteration law of Massachusetts which has been copied by very many 
 states. 
 
 TAquor% <m<l Wines. 
 
 In Colorado, the District of Columbia, Indiana, Iowa, Kansas, Mary- 
 land, Michigan, Missouri, Montana, Nebraska, New Hampshire, South 
 Dakota, and Wisconsin "wine, spirits, malt liquors, and liquors" are 
 mentioned in the law which forbids adulteration, and wines and liquors 
 are also specified in the general adulteration law of Georgia, Kentucky. 
 Maine, and Rhode Island. More extensive legislation is found in 
 Indiana, .Massachusetts, Minnesota, New York, Ohio, Pennsylvania, and 
 Rhode Island. These laws provide that wines and liquors shall not be 
 adulterated. 2 In the District of Columbia wines, malt liquors, and cider 
 must not contain salicylic acid. The .Minnesota law forbids adultera- 
 tion with substances that are injurious when the wine or liquor is used 
 as a beverage. 
 
 New York and Ohio also have \er\ specific regulations in regard to 
 the production and composition of wines, both of these states being 
 large wine producers. By section 16 of the Public Health haw of 
 
 Michigan, Compiled Laws (1897), Sec. 5012. 
 - Massachusetts, Public Statutes (1882), Chapter 208, Sec. 4: 
 •■ Whoever adulterates, for the purpose of sale, any liquor used or intended for 
 
 drink, with Indian cockle, vitriol, grains of paradise, opium, alum, capsicum, cop- 
 peras, laurel-water. Logwood, Brazil wood, cochineal, sugar of lead. ..1 an] other 
 substance which is poisonous or injurious to health, ami whoever knowingly sells 
 any such liquor so adulterated, shall be punished by imprisonment in the state 
 prison not exceeding three years; and the articles so adulterated shall he forfeited." 
 
328 WOOD O THE 11 THAN DAIRY PliODUCTS. 
 
 New York the adulterations of wine are defined ; by section 47, pure 
 wine is defined as containing seventy-five per cent, pure fruit juices, and 
 by section 48, " wine which contains less than seventy-five per cent, and 
 more than fifty per cent, of pure grape or other undried fruit juice and 
 is otherwise pure," shall be labelled " half wine," and if it contains less 
 than fifty per cent, pure shall be labeled " made wine." The Ohio law 
 is very similar to this, but it requires the labeling of " pure wine " as 
 such with the addition of the name of the manufactory. Michigan and 
 Pennsylvania 1 have a similar provision in regard to all alcoholic bever- 
 ages. Ohio 2 has a penalty for the improper use of branded packages. 
 
 In Nebraska it is forbidden to put adulterated wines in packages 
 marked as containing wine grown in the state. 
 
 Missouri has a law 3 which forbids the use in the manufacture of 
 beer of anything except hops, barley, malt, and pure yeast. 
 
 In New York the law provides for the yearly analysis of samples 
 from breweries and distilleries in the state. 4 
 
 The penalties for the violation of these laws are usually more severe 
 than for the violation of general adulteration laws, the maximum often 
 being |1,000 fine or one year imprisonment and also the cost of analysis. 
 The goods also are often forfeited. Proof of guilt is rendered easy by 
 the provisions in Michigan, Pennsylvania, and Rhode Island, that the 
 having in possession of adulterated liquor is prima facie evidence of 
 violation of the law. 
 
 Vinegar. 
 
 Vinegar is especially mentioned in nearly a dozen states as among 
 the substances not to be adulterated. The Massachusetts law, which 
 has been copied in most of its features, has the following as its most 
 important sections : 
 
 " Every person who manufactures for sale, or offers or exposes for sale as cider 
 vinegar, any vinegar not the legitimate product of pure apple juice, known as apple 
 
 1 Pennsylvania, Act of 14 April, 1863, Sec. 2: 
 
 "It shall be the duty of any person or persons engaged in the manufacture and 
 sale of intoxicating malt or alcoholic liquors, or in rectifying or preparing the same 
 in any way, to brand on each barrel, cask or other vessel containing the same, the 
 name or names of the person or persons manufacturing, rectifying or preparing the 
 same, and also these words, "containing no deleterious drugs or added poison; " 
 and shall also certify the same fact or facts to the purchaser over his, her or their 
 own proper signature. 1 ' 
 
 2 Ohio, Annotated Statutes (1900), Sec. 7074: 
 
 "Whoever puts into any barrel, cask or other vessel, branded or marked pure by 
 any inspector in this state, adulterated liquors, or knowingly sells or offers for sale 
 such liquors so branded, shall be imprisoned in the penitentiary not more than 
 twelve months." 
 
 3 Missouri, Revised Statutes (1889), Sec. 3889. 
 
 4 New York, Revised Statutes (1895), p. 2418 (Public Health Law, Sec. 43.) 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 329 
 
 cider or vinegar, not made exclusively of said apple cider or vinegar, into which any 
 foreign snhstance, ingredients, drugs or acids have been introduced, as may appear 
 by proper tests, shall for each such offence be punished by fine of not less than fifty 
 BOX more than one hundred dollars. 
 
 " Every person who manufactures for sale, or offers or exposes for sale, any vine- 
 gar found upon proper tests to contain any preparation of lead, copper, sulphuric 
 acid or other ingredients injurious to health, shall for each such offence be punished 
 by fine of not less than one hundred dollars. 
 
 "All vinegars shall be without artificial coloring matter, and shall have an acidity 
 equivalent to the presence of not less than four and one-half per cent, by weight of 
 absolute acetic acid, and in the case of cider vinegar shall contain in addition not 
 less than two per cent, by weight of cider vinegar solids upon full evaporation over 
 boiling water, and if any vinegar contains any artificial coloring matter or less than 
 the above amount of acidity, or in the case of cider vinegar, if it contains less than 
 the above amount of acidity or of cider vinegar solids, it shall be deemed to be adul- 
 terated within tiie meaning of this act. 11 * 
 
 Iii Illinois the requirement is one and one-quarter per cent, of vine- 
 gar solids, in the District of Columbia it is four per cent, of acetic acid. 
 
 In several of the states, as Maine, Wisconsin, Minnesota, Indiana, 
 and Rhode Island it is forbidden to "label, brand or sell as cider vine- 
 gar, or as apple vinegar, any vinegar not the legitimate product of pure 
 apple juice, or not made exclusively from apple cider." In Minnesota 2 
 and Wisconsin there arc also stringent regulations in regard to the 
 in, irking on the package of tin- strength of the vinegar. 
 
 In Massachusetts and Rhode Island the inspectors <»f milk and in 
 Several of the other states the dairy or food commissioners are intrusted 
 with the enforcement of this law. These officers are usually given 
 the power l<> enter premises and collect samples, and all persons are for- 
 bidden under penalties to obstruct them, and the reports of public 
 analysts are prima facie evidence. 
 
 The proof required jfor a conviction for the violation of vinegar laws 
 is well stated in ( 'onnect iciil : ;; 
 
 1 Massachusetts, Public Statutes (1882), Chapter 60, Sees. 69 To, Chapter 257 of 
 1883, and Chapter 150 of 1885. 
 
 " Minnesota, Statutes 1 1.894), Sec. 7020: 
 
 "All manufacturers of vinegar in the state of Minnesota, and all persons who 
 reduce or rebarrel \ inegar in this state, and all persons who bandle vinegar in lots of 
 one barrel or more, are hereby required to stencil or mark in black figures at least 
 one inch in length, at the head of each barrel of vinegar boughi or sold bj 1 hem. the 
 kind of vinegar contained in each package or barrel, together with the name of the 
 manufacturer and location of the factory \\ here the same is made, and the standard 
 strength of the vinegar contained in the package or barrel, which latter shall he 
 denoted bj the number of grains of pure bi-carbonate of potash required to neu- 
 tralize one fluid ounce of vinegar. \n\ neglecl so to mark or stencil each pack- 
 1 barrel, or any false marking of packages or barrels, shall be deemed a misde- 
 meanor, and shall be punished by a line of ttol less than twenty-five (25) dollars, aoi 
 more thai ■ hundred (100) dollars and costs." 
 
 8 Connecticut, Chapters W and 284 of 1889, Sec. S. 
 
330 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 " . . . No person shall sell, or offer, or expose for sale, or exchange, cr solicit, 
 or receive any order for the sale or delivery within this state or for delivery without 
 this state for shipment into this state: first, any vinegar, as cider vinegar, not wholly 
 produced from the juice of apples; or second, any vinegar, or article sold or to be 
 sold as vinegar, in which has been added any drug, or any hurtful or foreign sub- 
 stance, or any coloring matter, or any acid other than acetic; or third, any vinegar 
 not having an acetic acidity equivalent to the presence therein of not less than four 
 per centum by weight of absolute acetic acid, and in case of cider vinegar, not less 
 than two per centum by weight of cider vinegar solids upon full evaporation over 
 boiling water; or fourth, any vinegar made in this state and purchased by the person 
 last mentioned of the maker in a barrel, cask, keg, or other package not branded, 
 stenciled, or painted as required by a previous section of this act. Any person vio- 
 lating this section of this act shall be fined ten dollars for a first offense, and for a 
 second or later offense fifty dollars. The delivery of any of the above mentioned 
 articles upon any order solicited or received within this state shall be conclusive 
 evidence that the order upon which such delivery was made was for such articles, 
 and shall render the person soliciting or receiving such order liable to the penalty 
 above prescribed.' 1 
 
 Molasses, Sugar, Honey, etc. 
 
 The chief adulterant of these food materials is glucose and its use 
 for this purpose is forbidden by a statute which is found in Colorado, 
 Iowa, Maryland, Michigan, New York, and Vermont. This law forbids 
 any one to mix glucose with syrup or sugar in Iowa, and with syrup, 
 honey, or sugar in the other states ; but in each of the states it is per- 
 missible so to use glucose provided the per cent, of glucose is marked 
 on the package and made known to the buyer. In Maryland glucose 
 may be used in candy. The following is the Connecticut law in regard 
 to molasses : 
 
 "Any person who shall adulterate any molasses, or who shall sell, or offer or 
 expose for sale, or who shall solicit or receive any order for the sale or delivery 
 within this State, or for delivery without this State for shipment into this State of 
 any molasses adulterated with salts of tin, terra alba, glucose, dextrose, starch 
 sugar, corn syrup, or other preparations of or from starch, shall be fined not more 
 than five hundred dollars, or imprisoned not more than one year or both.'" 1 
 
 In Massachusetts syrup and molasses must bear the maker's name. 
 
 A similar provision is also found in the same state in regard to sugar, and 
 
 in Maine in regard to both sugar and molasses. Louisiana being the chief 
 
 seat of the manufacture of molasses it is not surprising that explicit 
 
 laws are found in that state and also additional ordinances in New 
 
 Orleans : 
 
 lt Be it enacted by the General Assembly of the State of Louisiana, That who- 
 ever shall knowingly sell or offer for sale, ship or place, upon the market for sale, 
 either by sample, hogshead, barrel, package or otherwise, any sugar or molasses 
 adulterated with glucose or any foreign substance, without branding or stamping it 
 as such in clear, legible letters, shall be punished by imprisonment not exceeding 
 six months, and by a fine of not less than two hundred dollars nor more than one 
 thousand dollars for each offense.'" 2 
 
 1 Connecticut, General Statutes (1888), Sec. 2622. 
 
 2 Louisiana, Chapter 49 of 1886. 
 
FOOD OTHER THAX DAIRY PRODUCTS. 33] 
 
 "That it shall be unlawful for any person or persons to engage, employ, or hire 
 any one to adulterate any molasses, syrup, or other liquid or saccharine matter, with 
 zinc, tin or other chemical deleterious and injurious to public health. 
 
 " That it shall be unlawful for any person or persons to sell, cause to be sold, 
 buy or cause to be bought, to dispose of, or cause to be disposed of in any way or 
 manner, any molasses, syrup, or any liquid, or saccharine matter, adulterated with 
 zinc, tin, or any other chemical injurious or deleterious to public health." 1 
 
 The following is found in Vermont : 
 
 "A person who adulterates maple sugar, maple syrup, or bees 1 honey with cane 
 sugar, glucose, or any substance whatever, for the purpose of sale, or who know- 
 ingly sells maple sugar, maple syrup, or bees' honey that has been adulterated, shall 
 be punished by a fine of not more than two hundred dollars and not less than fifty 
 dollars for each offense. One-half of such fine shall go to the complainant." 2 
 
 Honey. 
 
 In California, Minnesota, New York, youth Dakota, and Wisconsin 
 a special provision is made in regard to honey : 
 
 " It shall be unlawful f<>r any person or persons within the State of Minnesota to 
 offer for sale or have in their possession with intent to sell, sell or cause to be soldr 
 honey compounded, manufactured from, or mixed with glucose, sugar syrup of any 
 kind, or any substance whatever not the legitimate and exclusiue product of the 
 honey bee, unless the package containing same is so marked and represented as such 
 and bearing the label upon the package printed thereon in heavy Gothic capitals, 
 eighteen point, the name of the person or persons having compounded, manufac- 
 tured, or mixed the same, and the name of the substance or material from which it 
 is compounded, manufactured, or mixed with. 
 
 "It shall be unlawful for any person or persons within the State of Minnesota to 
 offer, or have in their possession, for sale, sell, or cause to be sold, honey which has 
 not been made by the bees from the natural secretion of flowers and plants, but 
 which has been stored or made by the bees from glucose, sugar, syrup, or any other 
 material or substance fed to them; unless the same is marked, represented and 
 designated as such, and bearing a label upon each package printed in heavy Gothic 
 capitals, eighteen point, thereon, the name of the person or persons who fed or 
 caused to be fed, the substance or material from which the same is stored or made, 
 and the name of the substance or material from which the said honey is stored or 
 made." 
 
 "Flour "it'/ Bread. 
 
 • \o manufacturer or other person shall sell, prepare, deliver, put up, expose, 
 • if offer tor sale any article, substance, of com pound under or by the name of wheat, 
 meal, graham meal, or graham dour made in imitation of pure wheal meal and not 
 oonsisting exclusively and wholly of pure wheat meal, unless every box, bucket, 
 barrel, or wrapper in or under which said article is sold, delivered, or exposed for 
 ■ale bears on the top oi outer side thereof, in letters noi less than half an inch in 
 
 h and plainlj exposed to \ iew the wards Ll compound wheat." ' 
 
 The adulteration of grain and meal is also forbidden in Vermont. 
 
 1 New Orleans. Ordinance No. 10086, 11 December, 1894. 
 
 Vermont, Statutes (1894), s^ . 1844. 
 J Minnesota, Statutes (1894), Sees. 7088 0. 
 1 Maine, supplement of Laws (1896), p. 506, Chapter 267 of 1889. 
 
332 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 In Illinois bread is the first food named in the general adulteration 
 law, and it is also mentioned in the Missouri law. 
 
 The adulteration of wheat flour, with other cereals, particularly 
 maize, has increased very much of late and the war revenue law 1 takes 
 cognizance of this fact and attempts to prevent the fraudulent sale of 
 the compound. The law provides that makers of mixed flour shall pay 
 a tax of $12 per year and that all packages shall be marked with the 
 words " mixed flour " in plain black letters not less than two niches 
 high, also with the weight of the contents, the names of the ingredients 
 and the name of the packer and place of packing.. There shall be 
 affixed to the package the following notice : 
 
 " Notice. — The manufacturer (or packer, as the case may be) of the mixed flour 
 herein contained has complied with all the requirements of law. Every person 
 is cautioned not to use this package or label again or to remove the contents with- 
 out destroying the revenue stamp thereon, under the penalty prescribed by law in 
 such cases." 
 
 The flour also pays a tax of four cents per barrel, two cents per one- 
 half barrel, one cent per one-quarter barrel, and one-half cent per one- 
 eighth barrel or less, the tax to be paid by stamps. There is also a pro- 
 vision for the marking and stamping of all imported mixed flours. 
 
 Fumigated Grrain. 
 
 •'Any person who shall fumigate any barley, wheat, or other grain by the use of 
 sulphur or other substance, or shall in any way, or by the use of any chemical, 
 material, or process, affect the color or healthfulness of such grain, or who shall 
 sell, or offer for sale, any such grain, knowing that the same has been fumigated, or 
 the color or healthfulness so affected, shall be punished by imprisonment in the 
 county jail not more than one month or by fine not exceeding fifty dollars.' 1 2 
 
 The sale of fumigated grain is also forbidden in Illinois. 
 
 Buckwheat Flour. 
 
 In Michigan adulterated buckwheat flour is defined as follows : 
 
 "Sec. 2. Buckwheat flour shall be deemed to be adulterated within the mean- 
 ing of this act, first, if any substance or substances have been mixed with it so as to 
 to lower or depreciate or injuriously affect its quality, strength or purity; second, if 
 an inferior or cheaper substance or substances have been substituted wholly or in 
 part for it; third, if any valuable constituent or ingredient has been wholly or in part 
 abstracted from it; fourth, if it is sold under the name of another article; fifth, if it 
 contains an added substance or ingredient which is poisonous or injurious to the 
 health. 1 ' 3 
 
 Substitutes and compounds must be labeled. 
 
 1 Act of Congress, 13 January, 1898, Sees. 35 to 49. 
 
 2 Wisconsin, Statutes (1898), Sec. 4606. 
 
 3 Michigan, Compiled Laws (1897), Sec. 4995. 
 
FOOD OTHER THAN DAIRY PRODUCTS. 333 
 
 Saleratus and Cream of Tartar. 
 
 '•Every person who shall sell saleratus, bicarbonate of soda or cream of tartar, 
 which has been adulterated and thereby rendered an impure article, shall be fined 
 twenty dollars, together with the cost of testing and analyzing such impure article." 3 
 
 The law also provides for the appointment of inspectors by the 
 towns and cities, but as the only compensation is a fee to be paid by 
 any person who presents a sample for analysis, it is not surprising that 
 the law is never enforced. 
 
 Baking Poivch rs. 
 
 The question of the injurious effects of alum in baking powders has 
 been much discussed and a very extended consideration of the subject 
 may be found in a bulletin issued by the Department of Agriculture. 2 
 Opinions differ as to whether the small amount of alum remaining in 
 food in which alum baking powder is used is injurious, and consequently 
 opinions differ as to the advisability of legislation on the subject. In 
 most states there is no prohibition of such a use of alum, but in Min- 
 nesota there was a very stringent law to forbid the sale of baking 
 powders containing alum unless that fact is plainly marked upon the 
 package. This was afterwards repealed, and the present law. which is 
 very explicit, requires that all baking powders shall have the ingredi- 
 ents and amounts marked on the package. 8 
 
 In South Dakota all compounds containing alum must be plainly 
 so marked. 4 
 
 • Poisonous lii'jr< dients. 
 
 The following is from Missouri: 
 
 " It shall he unlawful for any person or corporation (hung business in this state 
 to manufacture, sell, or offer to sell any article, compound or preparation for the 
 
 purpose 'if being used, or which is intended to he used in the preparation Of tin id in 
 
 which article, compound or preparation there is any arsenic calomel, bismuth, 
 ammonia or alum." "' 
 
 Poisonous ( 'oloriny Matter. 
 
 The following are some of the laws and rules relating to such color- 
 ing matter : 
 
 •■ Whoever bj himself 01 by his servant or agent, or as theservanl or agent of anj 
 other person, manufactures, sells or exchanges, or lias in his custody or possession 
 wiili i ii i in i to sell or exchange, or exposes or offers for sale or exchange, any ehil- 
 
 1 Rhode Island, General haws (1896), Chapter 138. 
 
 Hull, iin I ; Division of Chemistry, U. S. Department of Agriculture, p. 571. 
 
 Minnesota, Chapter 245 of L899. 
 1 South Dakota, Chapter B9 of 1899. 
 
 Missouri, Act of 1 1 May. L899. 
 
334 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 droit's toys or confectionery, containing or coated wholly or in part with arsenic, 
 shall be punished by fine of not less than fifty nor more than one hundred dollars." 1 
 
 " That no person by himself or his agent or servants, nor as an agent or servant 
 shall manufacture, sell, offer for sale, expose for sale, or have in his possession with 
 intent to sell, any cakes or biscuits in which yolka, yolkaline, tumeric, chrome yel- 
 low or any other substitute for eggs of like nature has been used, except there be 
 displayed in a public manner on the package in which such cakes and biscuits are 
 carried, or on the place, receptacle or holder in which such articles are placed for 
 sale a label, show card or sign, on which shall be printed in letters oi the English 
 language at least three inches high and one and one-half inches wide the words, 
 4 these cakes and biscuits are colored with an artificial substitute for eggs. 1 " 2 
 
 Candy. 
 
 A little manual published in 1897 by the National Confectioners' 
 Association 3 gives all the state legislation concerning the adulteration 
 of candy in force 1 April, 1897. The association lias evidently been 
 very active and claimed to have secured legislation in twenty states. 
 The avowed purpose of the association is to secure laws against noxious 
 adulterant as distinguished from fraudulent ones. 
 
 The act as drawn up by this association has evidently served as the 
 basis of the law in at least twenty-six states, 4 though as is usual in such 
 cases it has been variously modified by the wisdom of committees and 
 legislatures, but unlike many such acts, its main purpose does not seem 
 to have been subverted by any such amendments. The writer does not 
 know what was the form of the act as drawn by the association, but the 
 law in Minnesota would appear to be typical of this class of legislation : 
 
 " No person shall, by himself, his servant or agent, or as the servant or agent of 
 any other person or corporation, manufacture for sale or knowingly sell or offer for' 
 sale any candy adulterated by the admixture of terra alba, barytes, tale or any other 
 mineral substance, by poisonous colors or flavors or other ingredients deleterious to 
 health." 5 
 
 In Maine in addition to the substances usually specified as " dele- 
 terious " there are named " brandy, whiskey, rum, wine or any alcoholic 
 liquor in liquid form," and it is also forbidden to " offer for sale any 
 candy under the name of brandy, whiskey, rum, or wine drops,'' and the 
 
 1 Massachusetts, Chapter 374 of 18!>1 : 
 
 2 New Jersey, Laws of 1895, p. 473. 
 
 8 The secretary in 1897 was F. D. Seward, of the F. D. Seward Confectionery Com- 
 pany, St. Louis. The book bears the imprint of the Confectioners' Journal Print, 
 Philadelphia. 
 
 1 The states which have this form of law are Alabama, Connecticut, California, 
 Delaware, Georgia, Illinois, Indiana, Maine, Maryland, Michigan, Minnesota, Mis- 
 souri, Montana, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, 
 Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, 
 Vermont, and Wyoming. 
 
 5 Minnesota, Act of 25 April, 1895. 
 
FOOD THE R Til AX DAIRY PRODUCTS. 335 
 
 prohibition relates to -lozenges"' as well as candy. In Maryland a 
 narcotic is not to be added to candy. The following is the' Massachu- 
 setts law in regard to alcohol in candy: 
 
 " Xo person shall sell to any child under sixteen years of age any randy or other 
 artii ,-le. inclosing liquid or syrup containing more than one per centum of alcohol." ' 
 
 Besides the states mentioned, several have provisions in their fend 
 laws in regard to candy. In Massachusetts "confectionery" is included 
 in the definition of food by Chapter 171 of 1886 and the same word is 
 found in the similar law in New York, and in the Wisconsin and Ken- 
 tucky adulteration law it is '•candy or sweetmeat.'* and in Illinois 
 u candy and confection," and in Mississippi "candy, confects, and sweet- 
 meats" that are controlled by the law. 
 
 The Montana law, and the Vermont law referred to on page 331, 
 appear to be the only laws which forbid the use of glucose in candy. 
 
 For the use of arsenic in candy see the Massachusetts law on page 
 833. 
 
 Fruit Jelly. 
 
 ■• No person, firm, or corporation in this Mate shall manufacture for sale, or sell, 
 or offer or expose for sale, as fruit jelly or fruit butter, any jelly or imitation fruit 
 butter or other similar compound made oi composed in whole or in part of gl 
 dextrine, starch or other substances, and colored in imitation of fruit jelly or fruit 
 butter: nor shall any such jelly, fruit butter or compound be manufactured, or sold. 
 or offered cor sale, under any name or designation whatever, unless the same shall 
 be composed entirely of ingredients not injurious to health, and shall not be colored 
 in imitation of fruit jelly, and every can, pail, or package of such jelly or butter 
 •old in this State shall be distinctly ami durably labeled ••Imitation fruit jelly or 
 butter." with 1 lie name of the manufacturer and the place where made. Whoever 
 violates the provisions of this section shall be deemed guilty of a misdemeanor, and 
 when convicted thereof shall be punished by a fine of nol less than fifty nor more 
 than live hundred dollars, or by imprisonmenl in the county jail or State House of 
 Correction and Reformatory at Ionia for nol less than ninety days nor more than 
 £wo years, or by both such fine and imprisonmenl in the discretion of the court." 3 
 
 A more extensive and carefully prepared law on this subjed is also 
 found in Minnesota. 3 South Dakota and Illinois also have jelly laws. 
 
 Coffee. 
 
 The adulteration of ground coffee is very common and the manu- 
 facture of the coffee berries themselves is nol unknown, yel there 
 appears to be \<i\ little special legislation on this subject. Adultera- 
 tions of coffee are usually punished through the general laws. The 
 following is found in Michigan : 
 
 ■ No person shall manufacture "i sell, or offer tor s;iie. any manufactured or arti- 
 ficial coffee berry in imitation of the genuine berry. No person shall manufacture, 
 
 1 Massachusetts, chapter 883 of 1891. 
 
 - Michigan, Compiled Laws (1897), Sec. 5022. 
 
 '• Minnesota. Chapter I'm oi 1897. 
 
336 FOOD OTHER THAX DAIRY PRODUCTS. 
 
 sell or offer for sale any ground or prepared coffee, which is adulterated withchicoiy 
 or other substances not injurious to health, unless each package thereof shall he 
 distinctly labeled or marked "Coffee compound, 11 together with the name and 
 address of the manufacturer or compounder thereof. 11 a 
 
 In the District of Columbia coffee must be made entirely of the 
 seed of caffea arabica. 
 
 Olive Oil. 
 
 The statute in California 2 provides that the producer or dealer in 
 olive oil may prepare a label and file the same with the state board of 
 agriculture together with the affidavit that the oil will be pure. The 
 manufacture or sale of adulterated oil is forbidden. In the District of 
 Columbia olive oil must be made exclusively from the olive berry (olea 
 Europcea). 
 
 Catsup. 
 
 The San Francisco Board of Health 3 has established a standard of 
 tomato catsup. It must contain twenty-five per cent, of organic solids 
 including ash, and be free from antiseptics and coloring matter. 
 
 Eggs. 
 
 Artificial eggs are said by the lay press to be manufactured by 
 ingenious Parisian artisans, but they do not appear to have been heard 
 of in this country. Nevertheless a substance has been sold which is 
 intended for use by bakers to make cake appear as if eggs had been 
 used. See the New Jersey Law on page 334. 
 
 Lard. 
 
 The practice of adding beef suet and cotton seed oil to lard met 
 with great opposition among the manufacturers of pure lard and as a 
 result of the agitation laws against the adulteration of lard are found 
 in a number of states. Good laws in regard to lard adulteration or 
 lard mixtures are found in Maine, Michigan, Minnesota, and Massachu- 
 setts. The law in the latter state is as follows : 
 
 " No manufacturer or other person shall sell, deliver, prepare, put up, expose or 
 offer for sale any lard, or any article intended for xise as lard, which contains any 
 ingredient hut the pure fat of swine, in any tierce, bucket, pail, or other vessel or 
 wrapper, or under any label, bearing the words " pure, 11 "refined, 1 ' "family, 11 or 
 either of them, alone or in combination with other words, nor unless every vessel, 
 wrapper, or label, in or under which such article is sold or delivered, or prepared, 
 put up, or exposed for sale, bears on the top or outer side thereof, in letters not less 
 than one-half inch in length and plainly exposed to view, the words: — Compound 
 Lard. 11 * 
 
 1 Michigan, Compiled Laws (1897), Sec. 5024. 
 
 2 California, Chapter 47 of 1891. 
 
 3 San Francisco, Report of Board of Health (1897), pp. 8, 209. 
 * Massachusetts, Chapter 449 of 1887, Sec. 1. 
 
FOOD OTHER THAN DAIRY PBDOUCTS. 337 
 
 The most stringent and complete law is that of Minnesota. 1 This 
 law forbids the sale "as lard of any substance not the legitimate and 
 exclusive product of the fat of the hog,*' unless it shall be labeled in 
 letters imt less than one inch in length, and shall have the name of the 
 manufacturer and the location of the manufactory in letters of the 
 same size, and the names and proportions of the ingredients in letters 
 one-half inch in length. If it is a " mixture or componnd of animal or 
 vegetable oils or fats other than hog fat in the form of lard," it shall be 
 labeled " hard Substitutes." If it is a mixture of the above with lard 
 it shall be labeled "Adulterated Lard." Dealers and traders must also 
 mark goods in a similar manner with letters half the above size, and 
 must give a card to the customer stating the facts. Keepers of hotels 
 and restaurants are controlled by the following: 
 
 "Every person who manufactures tor sale, or who offers or exposes for sale or 
 sells, or who serves to guests as keeper of hotel, restaurant, dining room, or in any 
 other capacity, articles of food which have been prepared, either wholly or in part, 
 with lanl substitutes, or adulterated lard as herein before defined, shall at the time 
 of sale furnish to the purchaser a card upon which is distinctly and legibly printed 
 the words. 'This food is prepared with lard substitute (or adulterated lard),' or in 
 case no bill of fare is provided, there shall be kept constantly posted upon each of the 
 sides of the dining room, in a conspicuous position, cards, upon the face of which is 
 distinctly and legibly printed in the English language, and in letters of sufficient size 
 to be visible from all parts of the room. l Lard substitute (or adulterated lard) is 
 used in the preparation of the food served here."'" 
 
 The state dairy commission is to enforce the law and has the power 
 
 of search and seizure. The penalty is twenty-live dollars to titty dollars 
 or i bitty to sixty days. 
 
 EXECUTION OF FOOD LAWS. 
 
 Food laws may be executed by the ted,. nil governmenl and by the 
 states and by municipalities. The Laws, as bias been shown, are federal, 
 Btate and local, but most laws are of little value, unless there are efficient 
 officers charged with their execution. Tins is must assuredly true of 
 food laws. Greal pecuniary rewards often tempi their \i<»lati<>n and 
 often the nature of the offence is such that it escapes detection unless 
 
 there is aii expert constant 1\ on the alert to discover it. The whole 
 value of these Laws depends on the efficiency of their execution. There 
 must be not only statutes ami ordinances, but inspectors and chemists. 
 
 The latter are even inmv important than the former, fur the mere 
 
 exposure and publication of frauds even if there are no laws to reach 
 the offender, often have ;i must wholesome deterrent effect. 
 
 [Minnesota, Statutes (1894), Sees. f02fl 37. 
 
338 FOOD OTHER THAX DAIRY PRODUCTS. 
 
 I. Federal Inspection. 
 
 The federal government has laws against the importation of adulter- 
 ated food and drugs, the importation of adulterated tea, and the impor- 
 tation of diseased cattle. There is also the oleomargarine law and the 
 flour law. The United States has also by virtue of its control of inter- 
 state commerce forbidden the transportation of diseased meat from one 
 state to another. The enforcement of the importation law is in the 
 hands of the secretary of the treasury, who makes use of the regular 
 custom house inspectors and employs such experts as may be necessary. 
 The oleomargarine law is executed by the internal revenue commis- 
 sioner and is administered chiefly from a revenue point of view. 
 
 The government also inspects the exports of cattle and meat, but 
 this is of value to the producers of our own country and the consumers 
 of other countries and does not affect our own consumers. 
 
 The control and inspection of interstate commerce in meat and 
 other slaughter-house products is by far the most important sanitary 
 work of the government relating to foods. By the act of 3 March 1891, 
 the inspection of the slaughtering of animals intended for interstate or 
 foreign trade was inaugurated under the control of the bureau of animal 
 industry of the department of agriculture. It is intended that this 
 inspection shall cover all the animals slaughtered for these trades, but 
 at first it was possible to inspect at only a few of the most important 
 slaughtering centres. Even now the inspection does not include all 
 animals even for the interstate trade, though in 1898 these inspections 
 were carried on at 138 abattoirs in thirty-five cities. The number of 
 animals inspected was 51,335,398, of which 116,176 were condemned. 
 Two million eight hundred and two thousand eight hundred and forty- 
 six samples of pork were examined microscopically, of which about 
 one per cent, were condemned. All animals are inspected by a veteri- 
 narian before killing and if they are not passed they are sent to special 
 pens, the most are slaughtered and so disposed of that they cannot be 
 used for food. The rest are kept until they recover or die. Pregnant 
 animals are sent to the country until such times as they may be fit to 
 kill. Veterinary inspectors are constantly on the killing floor and 
 examine the viscera of each animal slaughtered. Every quarter of beef 
 bears a numbered tag. In the case of hogs, one or more samples are 
 cut from each carcass which is tagged and the samples numbered in dupli- 
 cate. Each sample is twice examined microscopically for trichinosis. 
 Piece examination of bacon and ham is carried on to some. extent and 
 the packages that are passed are stamped. The carcasses that are con- 
 demned should be sent at once to the tankage room, but their disposi- 
 tion cannot always be controlled by the federal inspectors, and for this 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 339 
 
 reason the co-operation of the local inspectors is always to be desired. 
 The cost of the inspections in 1898 was 0.8 cent per head. 
 
 II. State Inspection. 
 
 The inspection of meat, fish, vegetables, fruit, milk, and other per- 
 ishable material is usually in the hands of the local authorities as the 
 State could not without an army of inspectors properly do this work. 
 This is not true of Maryland where food inspectors are appointed by 
 the state board of health, who look after meat, fish, fruit, and animals 
 intended for slaughter : but the state hoard of health, besides the special 
 inspectors employed by it. invests all local health officers with the 
 authority of inspectors. 1 
 
 The control of adulterations and substitutions is however usually a 
 stat<- charge and is not given much attention by the cities and towns. 
 In some states, as Indiana. Maryland. Massachusetts, New Hampshire, 
 and New York the state board of health is required to take cognizance 
 of these matters: but in other states it is the dairy or food commis- 
 sioner wlio is invested with this control. The states having such a 
 commission are Colorado, Connecticut, Illinois, Michigan, Minnesota, 
 Hew Jersey, Ohio, Oregon, Pennsylvania, Washington, and Wisconsin. 
 
 In .Massachusetts three members of the state board of agriculture 
 appointed by the governor constitute a dairy bureau, and in New York 
 the commissioner of agriculture enforces the law in regard to dairy 
 products, but not in regard to other foods. In Kentucky the director 
 of the agriculture experimenl station is to appoint food inspectors and 
 fix the standard for food materials when they are not fixed by statute. 
 Such food commissioners are usually appointed by the governor, but in 
 Ohio the commissioner is elected by the people, and in Oregon b\ the 
 
 legislature, in New Jersey he is appointed by the state board of health, 
 
 and in Pennsylvania by the state board of agriculture. The term of 
 office is two years, and the salary varies from $1,000 in Oregon to 
 |2,000 iii New Jersej and Pennsylvania, and in Wisconsin $2,500. 
 The commissioner usually has a clerk or secretary and has one or more 
 assistants provided, or may appoinl inspectors. The stale board of 
 health or the food commissioners are usually empowered to appoinl or 
 employ chemists ami analysts: but in Wisconsin the analyses arc to ]»■ 
 made al the -tat" university, in Colorado at the state agricultural col- 
 and in Connecticut and Kentucky at the experiment station oi- 
 ly an\ state chemist, and in the District of Columbia the commissioner 
 of internal revenue shall make the analysis. In Ohio an) chemist may 
 
 1 Maryland, Report ..f State Board of Health (1891), p. 26, Rule L. 
 
340 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 be employed. It is usually provided that the official analysis shall be 
 'prima facie evidence. 
 
 The following are the rules governing the inspectors and analysts in 
 New Jersey : 
 
 DUTIES OF INSPECTORS. 
 
 "1. The Inspector is to buy samples of food or drugs, and to seal each sample 
 in the presence of a witness, if prosecution is intended. 
 
 "2. The Inspector must affix to each, sample a label bearing the number as 
 authorized for that purpose. 
 
 "3. Under no circumstance is the inspector to inform the analyst as to the 
 source of the sample before the analysis shall have been completed. 
 
 " 4. Inspectors are to keep a record of each sample as follows: 
 
 (1) Number of sample. 
 
 (2) Date and time of purchase. » 
 
 (3) Xame of witness to sealing. 
 
 (4) Xame and address of seller. 
 
 (5) Name and address of producer, manufacturer, or wholesaler, when known, 
 
 with marks on original package. 
 
 (6) Name of analyst and date of sending. 
 
 (7) How sent to analyst. 
 
 "5. If the seller desires a portion of the sample, the inspector is to deliver it 
 under seal. The duplicate sample left with seller should have a label containing the 
 the same marks as are affixed to the portion taken by the inspector. 
 
 "6. The inspector is to deliver the sample to the analyst, taking his receipt for 
 same, or he may send it by registered mail, express, or special messenger. 
 
 " 1. The chemist or analyst is to analyze the samples immediately upon receipt 
 thereof. 
 
 "1. Samples, with the exception of milk and similar perishable articles, are to 
 be divided by the analyst and a portion sealed up, and a copy of the original label 
 affixed, or the original package preserved, after removing sufficient for analysis, for 
 three months. 
 
 "3. Should the result of an analysis be disputed in any case in which analysis 
 has been ordered by the state board of health, the defendant or person selling the 
 sample in question, or his attorney, may appeal to said board through its secretary, 
 and said secretary shall then require another chemist to repeat the analysis, using a 
 duplicate portion of the original sample. But when such an appeal shall be made, 
 a sum of money sufficient to cover the expenses of the second analysis shall be 
 deposited with the secretary of the state board of health; which sum shall be paid 
 to the analyst designated, as required above, to make said second analysis, in case 
 the analysis shall be found to agree with the first in all essential particulars. But 
 in case the sample has been procured by the dairy commissioner, or inspectors 
 appointed by him, any such appeal shall be to the dairy commissioner, and the 
 money deposit for the second analysis be made with him, subject to the conditions 
 above stated. 
 
 " 4. In the case of all articles having a standard of purity fixed by any of the 
 laws of the state, the certificate of the analyst should show the relation of the article 
 in qnestion to that standard. 
 
 " 5 Eacli analyst should keep a record-book, in which should be entered notes 
 as follows: 
 
 (1) From whom the sample is received. 
 
 (2) Date, time and manner of receiving the sample. 
 
 (3) Marks on package, sealed or not. 
 
 (4) Results of analysis in detail. 
 
WOOD OTHER THAN DAIRY PRODUCTS. 341 
 
 "G. At the completion of the analysis, a certificate in the form given below 
 shall be forwarded to the board of health if the analysis had been ordered through 
 •sit, or to the dairy commissioner if ordered through him. 
 
 CERTIFICATE. 
 
 To whom it linn/ concern : 
 
 "I, , a Chemist appointed by the State 
 
 Board of Health of New Jersey, under the provisions of an act entitled 'An act to 
 prevent the adulteration of food or drugs." approved March 25th, 1881. do hereby 
 
 certify that 1 received from on the 
 
 day of 188 . . a sample of 
 
 sealed as required by the rules of said Board, and bearing the following marks to 
 wit: 
 
 "I carefully mixed said sample and have analyzed the same, and hereby certify 
 and declare the results of my analysis to be as follows: 
 
 [Signature.] 
 
 ■• T. Samples sent to analysts are to be retained for the space of three months." 
 
 Massachusetts has probably done more than any other state to stop 
 adulteration. The work of the state hoard of health was begun in 
 1 vv i!. and up to November, 1899, 110,000 samples had been examined, 1 
 1,500 prosecutions entered, of which thirty-live were appealed to the 
 supreme court. About 110,000 annually are expended and the average 
 eosl of collection, examination, and prosecution per sample is $1.34. 
 During the period covered by the operations of the hoard the per cent- 
 age of adulterations has diminished one-half. Investigations in the 
 aeighboring state of Rhode Island where there is no attempl to sup- 
 press adulteration show that it is much more common than in Massa- 
 chusetts. There can be little doubt that the amount expended for this 
 Service in Massachusetts is saved many times to the citizens. 
 
 ///. Local Inspection. 
 
 The authority to appoint inspectors is usually exercised by cities hy 
 
 virtue <>f their grant of general sanitary powers, but it is sometimes 
 specifically conferred. Thus in Massachusetts- it is provided that the 
 board of health shall appoint ■ or more persons to be inspectors of 
 
 provisions and of animals intended tor slaughter or the production of 
 milk. In Utah cities of 10,000 and over are required to appoint meat 
 inspectors who are to inspect all cattle before slaughtering, and also the 
 carcasses after slaughter and tag them. They may also he required to 
 perform other duties relating to food inspection. In Mississippi ; the 
 
 1 Paper by Dr. S. W. Abbott, Papers American Publii Bealth Association, Vol.26, 
 277. 
 
 v.. sacbusetts, Chapter W8 ol 1899, Sec. 20. 
 
 Mississippi, Code 1 1892), Sec. 2098. 
 
342 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 county supervisors and mayors and aldermen have similar powers, 
 but the law is permissive. In Louisiana 1 the law requires the regular 
 police to enforce the food laws, but it is useless to expect any efficient* 
 action without special officers, and in New Orleans special inspectors 
 are employed. A few cities, as Providence, 2 and Baltimore, 3 have 
 authority granted by special acts. Most cities of 50,000 inhabitants or 
 over and a number which are smaller than this have one or more special 
 inspectors of provisions exclusive of milk inspectors. In smaller cities 
 and towns the labor of looking after the food supply is performed by a 
 general sanitary inspector or perhaps by the health .officer himself and 
 is only one of his multifarious duties. Even in communities of con- 
 siderable size, the inspection of food is joined to the other duties of a 
 single officer. Thus in Knoxville, whatever food inspection there is, is 
 done by the secretary of the board of health. In Terra Haute it is one 
 the duties of the sanitary inspector, and in Youngstown, O., of the 
 sealer of weights and measures. In Nashville the food inspector also 
 fumigates and inspects houses. It might be imagined that the duties of 
 food inspector could be well joined with those of milk inspector, but 
 this is not often done. The reason presumably is that a milk inspector 
 is usually a chemist and whether or not all his time is given to the com- 
 munity his services are too valuable to permit of his making routine 
 inspection of markets and slaughter-houses. The duties of the two 
 offices are, however, coupled in Atlanta (where formerly the same officer 
 was inspector of plumbing), Allegheny, Cleveland, Colorado Springs, 
 Columbus, Evansville, Kansas City, Lynn, Meadville, Penn., Oakland, 
 Cal., Rochester, Salt Lake City, Scranton, Tiffin, O. ; but in Atlanta 
 the inspector only collects samples and the analyses of the milk are 
 made by the city chemist, and in Columbus and Lynn samples of milk 
 are not analyzed by the inspector, but are sent to a chemist. In Cleve- 
 land the milk and food inspector, who is a chemist, has the assistance of 
 a messenger and a sanitary policeman, and much of the control of mar- 
 kets is in the hands of the superintendent of markets. 
 
 In San Francisco the market inspectors are required to visit all 
 public institutions and inspect the meat to see if the contracts are ful- 
 filled. 4 
 
 In those cities which own or control public markets, whether or not 
 this department is under the control of the board of health, as it is in 
 Cincinnati, the superintendent of markets and his subordinates perform 
 
 1 Louisiana, Act of 3 March, 1880. 
 
 2 Rhode Island, Act of 5 March, 1858. 
 
 3 Maryland, Chapter 53 of 1891. 
 
 4 San Francisco, Rule of Board of Health, 20 January, 1802. 
 
FOOD OTHER TIIAX DAIRY PRODUCTS. 343 
 
 a large part of the work of supervision of the character of the goods 
 sold. Sometimes this is simply an implied part of their duties, but 
 again it is strictly prescribed, as in Cincinnati 1 and Reading, and in the 
 latter city the commissioner of markets is also sealer of weights and 
 measures, but a special food inspector is desired. 
 
 In the larger cities more than one inspector is needed to look after 
 foods, and sometimes the different inspectors have their duties some- 
 what specialized. In St. Paul there is one live stock inspector, and 
 one meat inspector who looks after provisions in general. In Boston 
 there is a like arrangement, only there are two provision inspectors. 
 In the District of Columbia there is besides the three food inspectors, 
 an inspector of marine products 2 and a dairy inspector. In Baltimore, 
 Minneapolis, and San Francisco there is a special inspector for bakeries. 
 In Pittsburgh there is a meat inspector and a vegetable inspector. 
 In Xew York there were in 1896, three fruit inspectors, three meat 
 inspectors and two fish inspectors. In Philadelphia the meat inspect- 
 ors are in the bureau of police. 
 
 There are three general classes of food inspectors, although the dis- 
 tinction litt ween them is not always well marked and the functions of 
 each are in some cases performed by one and the same person. 
 
 First. There is a live stock inspector. He must have some knowl- 
 edge of veterinary science and to be entirely successful should be a skilled 
 veterinarian and have a thorough knowledge of pathological processes 
 and be an adept in the use of the microscope. Such inspectors are 
 mostly in the employ of the United States at the great slaughtering 
 centres, but they are also found as local inspectors in a few cities, as 
 Boston. Buffalo, Denver, Nashville, Xew Orleans, Omaha, and St. Paul- 
 Some smaller places, as Brookline and Haverhill, Mass., and Oakland, 
 Cal., employ veterinarians for the routine market inspections. 
 
 Seem id. There is the inspector of groceries, drugs, condiments, etc. 
 Such inspectors are in some cases skilled chemists. In other cases they 
 are raerel) collectors of samples for analysis, also obtaining evidence 
 for the prosecution of offenders. This class of inspectors are mostly 
 state officials. 
 
 Lastly. There are the "meat," "food," and "provision" inspectors 
 wliosc (lni\ it is to make frequenl inspection of markets, peddlers' 
 wagons, shops, wholesale and commission houses, wharves and vessels, 
 and to determine the wholesomeness of the Broods offered for sale. The 
 
 'Cincinnati, Manual Health Department 1898, pp. ill 118. 
 Most of bis work is done on the wharf where oysters and crabs are discharged 
 ami in the summer when the oyster trade is small he inspects watermelons and 
 'it her 1 ruck brought by boat. 
 
344 FOOD OTIIEIi THAN DAIRY PRODUCTS. 
 
 goods examined by such inspectors are such as meat, fish, poultry, fruit, 
 vegetables, etc. Inspectors of this kind are usually employees of the 
 cities and towns and are members of the health department. 
 
 Sometimes, as in Mississippi, inspectors are under bond (in that 
 state #500), to "perform their duties without fraud, favor, or par- 
 tiality." In St. Louis the meat inspectors are under #4,000 bonds. 
 
 The following list shows how many inspectors are employed and 
 what salaries are paid in a number of important cities : 
 
 Number of - Annual 
 
 City. Inspectors. Salary. 
 
 Allegheny 1 meat and milk $1,000 
 
 Baltimore 1 meat and provision 1,000 
 
 1 bakery 1,200 
 
 Boston 1 veterinarian 2,200 
 
 1 inspector 1,000 
 
 1 inspector 1,200 
 
 1 inspector 900 
 
 Brookline 1 provision and milk 600 
 
 Brooklyn ( Borough of) 1 chief 2,500 
 
 4 food 1,000 
 
 4 meat 1,200 
 
 1 meat 1,000 
 
 1 meat 900 
 
 Chicago 1 meat 1,200 
 
 5 meat 1,000 
 
 3 ice 900 
 
 Cleveland 1 food and milk 1,000 
 
 1 food and milk 900 
 
 1 food and milk 600 
 
 1 food and milk 300 
 
 Columbus 1 meat and milk 1,000 
 
 Denver 1 meat 1,080 
 
 1 meat 900 
 
 District of Columbia 3 food 1,200 
 
 Evansville 1 food and milk 900 
 
 Fitchburg 1 food 900 
 
 Haverhill 1 meat and provision 900 
 
 Louisville 1 live stock 1,200 
 
 1 live stock 900 
 
 Lynn 2 food and milk 800 
 
 Milwaukee 4 food 1,100 
 
 Minneapolis 1 meat 1,350 
 
 1 bread and milk 1,100 
 
 Newark 2 food 1,000 
 
 New Orleans 1 veterinarian 1,500 
 
 13 food 600 
 
 New York (Borough of Manhattan) . . 1 chief 2,500 
 
 8 fruit 1,200 
 
 4 meat 1,200 
 
 3 fish 1,200 
 
 1 fish 600 
 
FOOD OTHER THAN DAIRY PRODUCTS. 345 
 
 Number of Annual 
 
 City. Inspectors. Salary. 
 
 Philadelphia 1 meat 1,350 
 
 1 meat 1,000 
 
 1 meat 925 
 
 1 veterinarian 1,000 
 
 Pittsburgh 1 meat 1,800 
 
 1 vegetable 900 
 
 Providence 1 provision 1,200 
 
 St. Louis 6 food 1,440 ' 
 
 St. Paul 1 meat 900 
 
 1 live stock 900 
 
 San Francisco 8 food and milk 900 
 
 1 bakery 900 
 
 '> market 900 
 
 Syracuse 1 food T - J> l ' 
 
 All inspectors of whatever class must have free access to all goods 
 to be examined, and must often have power to take samples for further 
 examination. Such power is specifically given by statute in many 
 states, and is also conferred by the regulations of many cities. Among 
 tin- states which have such laws or laws fori lidding interference with 
 inspectors may be mentioned, Colorado, Massachusetts, .Minnesota. New 
 Jersey. Ohio. Oregon, and Wisconsin. The Massachusetts law merely 
 forbids any one to hinder, obstruct, or in any way interfere with any 
 properly appointed inspector, analyst, or other officer in the performance 
 of his duty. 
 
 The Massachusetts law provides that when it is believed that an\ 
 unwholesome provisions are concealed, the inspector may. on complaint 
 to the proper magistrate, obtain a search warrant and seize the goods. 
 In these cases the magistrate is to determine whether the articles shall 
 be destroyed or returned to the owner. 
 
 The most stringenl law is that of Minnesota in regard to dairy pro- 
 ducts : 
 
 •■ The said commissioner and assistant commissioners, and such experts, chemists, 
 agents, and counsel as they shall duly authorize for the purpose, shall have access, 
 Ingress, and egress to all places of business, Factories, farms, buildings, carriages, 
 vessels, and cans used in the manufacture and sale of any dairy product or any 
 imitations thereof. They also shall have power and authority t" open anj package, 
 i a n. <>r vessel containing such articles which maj be manufacl ured, sold, or exposed 
 for sale, in violation of the provisions of this act, and may inspect the contents 
 
 therein, ami may take samples therefrom tor analysis." 
 
 Ill order to prevent adulteration frauds it is iieeessan for samples 
 to lie taken from the suspected goods. This is provided for in the 
 Minnesota law referred to above where the dairv commissioner and his 
 
 Inspectors are required to furnish their own horse ami buggy, 
 - Minnesota, Statutes i L894), Sec. 7000. 
 
346 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 assistants may " take samples for analysis." The following is the Ten- 
 nessee law : 
 
 " Be it further enacted, That every person who manufactures or offers for sale or 
 delivers to a purchaser any articles of food or drink shall furnish upon demand a 
 sample of such article of food or drink to any person duly authorized by the state 
 hoard of health to receive the same, and who shall apply to such manufacturer or 
 vender or person delivering to any purchaser such article of food or drink for such 
 sample for such use in sufficient quantities for the analysis of any such article or 
 articles in his or her possession and in the presence of such dealer and an author- 
 ized agent of the said state board of health if so desired by either party, said sample 
 shall be divided into three parts, and each part shall be sealed by the seal of the 
 state board of health, one part shall be left with dealer, one delivered to the state 
 board of health, and one to be deposited with the district attorney for the district 
 in which the sample is taken. Said manufacturer or dealer may have the sample 
 left with him analyzed at his own expense and if the results of said analysis differ 
 from those of the state board of health, the sample in the hand of the district attor- 
 ney shall be analyzed by a third chemist or expert who shall be chosen and agreed 
 upon by the said dealer and the state board of health, and the whole evidence shall 
 be laid before the court. 11 1 
 
 The above law provides fur no compensation for the sample, but 
 most states follow the Massachusetts law which provides for the com- 
 pulsory purchase of samples : 
 
 "Every person offering or exposing for sale, or delivering to a purchaser, any 
 drug or article of food included in the provisions of this act, shall furnish to any 
 analyst or other officer or agent appointed hereunder, who shall apply to him for 
 the purpose and shall tender to him the value of the same, a sample sufficient for 
 the purpose of the analysis of any such drug or article of food which is in his pos- 
 session. 11 2 
 
 The next section of the statute imposes a penalty for refusing to sell 
 to any person. 
 
 In order to protect the seller it is necessary to carefully guard the 
 sample so that it shall not be tampered with, and this is accomplished 
 by dividing it into parts which are held by different persons as shown 
 in the laws above quoted. 
 
 Special methods have to be pursued and special rules devised in 
 regard to the inspection of slaughtering. In New Orleans 3 the follow- 
 ing rules are in force : 
 
 "All livers, lungs (lights), spleens (melts), and tongues of beeves and cows, shall 
 be hung on racks, provided for that purpose, immediately after the slaughtering and 
 removal from the carcasses of the animals, and shall there remain until the meat 
 inspector of of the board of health shall have examined and inspected the same, and 
 shall not be removed therefrom except by the permission of said inspector, and all 
 such organs shall be marked by the butchers, on placing them on the rack herein- 
 before provided, in such manner that the said organs canbe easily identified with the 
 
 1 Tennessee, Chapter 260 of 1897, Sec. 6. 
 
 2 Massachusetts, Chapter 263 of 1882, Sec. 6. 
 
 3 Louisiana, Report of State Board of Health (1893-4), p. 73. 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 347 
 
 carcasses from which they have been removed: provided, however, that in the event 
 of the failure of the inspector to make such inspection before G.30 p. m. in summer 
 (April 1, to September 30). and 5.30 p. m. in winter (October 1 to March 31) each 
 day, permission is hereby granted to the butchers to remove such organs. 
 
 "At least one inch of the diaphragm or skirt of all carcasses of all slaughtered 
 animals shall be left on the animal slaughtered, until the meat inspector shall have 
 exa7)iined, inspected, and passed the same, and that the parietal pleurae or the lining 
 of the chest cavity, and the parietal peritoneum or casing of the abdominal cavity, 
 ordinarily removed in the process commonly known as "stripping, 11 shall be allowed 
 to remain upon the carcass, and shall not be removed therefrom by the process 
 known as "stripping" until after the inspections of the meat inspector. 
 
 " In the event of the rejection of any animal by the said inspector, permission is 
 hereby granted to the owner of said animal so rejected to kill another one in order 
 to replace same, even after the hours aforementioned. 
 
 In New ( )rleans all meat imported into the city and all slaughtered in 
 the city must he stamped by the inspector before it is offered for sale. 
 In Colorado Springs, Fall River, and Haverhill a similar rule is in 
 force. 
 
 The inspection of animals immediately before or at the time of 
 slaughter is now largely in the hands of the federal authorities. Yet 
 the government inspectors are not located at any but the larger estab- 
 lishments so that there is still a considerable field for local work. More- 
 over the federal inspectors have no authoritative control over the 
 disposal <»f any diseased animal or carcass unless it is destined for 
 interstate or foreign trade. It can be used tor any purpose within the 
 state where slaughtered. The assistance of local inspectors is needed 
 t<> see that improper use is not made of such food material. Local 
 inspectors should and usually do work in entire harmony with the 
 inspectors of the department of agriculture. In Chicago five local 
 inspectors are constantly on duty at the Union Stock Yards. Four 
 inspectors are also employed to look out for dressed meat that arrives 
 on the ears. In order to avoid the inspectors at Chicago, animals that 
 are likely to be condemned are retained at points outside of Chicago 
 and slaughtered, and it is to look out for this meat that inspectors 
 Watch over railroad traffic in dressed meat. The following rules have 
 been adopted in Chicago to enable the local Inspectors to prevenl the 
 use of condemned f 1 : 
 
 "Thai :ill meat condemned in the Citj of Chicago by Government or State Meat 
 Inspectors, shall be destroyed under the supervision and subjeel to the directions "f 
 ty Meat i nspectors. 
 
 I hat no owner .,1' a slaughter-house shall slaughter cattle, sheep, or liogs after 
 tlie hour of 7.00 o'clock e. m.. or on Sundays, without lirst notifying the Citj Meat 
 
 Inspectors. 
 
 ••.Ml emaciated cattle condemned in the City of Chicago shall be destroyed by, 
 
 and under i he supervision and subject to the directions of, the City Meat [nspectors. 
 v. carcasses of dead animals shall he brought within the precincts "i anj 
 slaughter-house in the City of Chicago." ' 
 
 'Chicago, Ordinances of I January, 1897. 
 
348 
 
 FOOD OTHER THAN DAIRY PRODUCTS 
 
 In Buffalo the same sort of control is exercised in order to secure 
 the immediate destruction of food condemned by federal and local 
 inspectors. 
 
 The inspection of food is usually at slaughter-houses or in markets 
 and shops. The inspection of places where food is prepared for imme- 
 diate consumption is generally neglected, or at least there is little 
 account of such in the reports of the inspectors ; but in two cities at 
 least, Denver and New Orleans, the inspection of hotel and restaurant 
 kitchens is required. 
 
 Inspectors of provisions should, of course, keep a record of inspec- 
 tions made, and particularly of all goods condemned. An ordinary 
 blank book may be used for this as in Providence, one book for each 
 ward, of convenient size to be carried in the pocket and enough space 
 given to each market to record the inspections and condemnations for 
 the year. The form used in New York City is shown below. 1 
 
 Daily, weekly or monthly reports are required of the inspectors in 
 many cities. These are often made on printed forms, good examples of 
 which may be seen in Denver, the District of Columbia, and New York. 
 
 Person* Liable and Acts Forbidden. 
 
 In a great many of the laws in regard to unwholesome and adul 
 terated food the penalty is upon the person who " knowingly " sells- 
 adulterates, etc. This is very often the case in the older laws, par- 
 ticularly those relating- to " decayed, diseased and unwholesome provi- 
 sions." It is also found in some of the adulteration laws, as in Iowa, in 
 the oleo law; in Maine, in the vinegar and molasses law; in Ohio, in 
 the vinegar law : in the District of Columbia and Maryland, in the gen- 
 eral adulteration law ; and in many milk laws. Recently the word 
 lias been stricken from the Michigan oleo law where it had for some 
 time been a considerable hindrance to successful prosecution. The 
 Massachusetts law, copied by many other states, makes it an offence to 
 " knowingly " sell veal under four weeks of age, but the word is omitted 
 from the prohibition of slaughtering calves under age, thus rendering 
 ] >r< isecution af this latter offence much the easier. The addition of this 
 
 Date Hour 
 
 Street and Number 
 
 Name of ( >wner 
 
 Business 
 
 From whom Purchased 
 
 Condition of Store 
 
 Condition of Ice Box 
 
 Condemned, 
 
 
 
 Character. Pounds. 
 
 Total. 
 
 
 
 
 
 
 
 
 
 Total. . . . 
 
 
 
 
 No. of Inspection 
 
 Remarks. 
 
FOOT) OTHER Til AX DAIRY PRODUCTS. 349 
 
 word throws directly upon the plaintiff the burden of the proof that the 
 accused has knowledge that the goods in question were -diseased, cor- 
 rupted or unwholesome." This is, of course, a difficult thing to prove. 
 and many a guilty person has as a consequence escaped. 
 
 The following which is found in many of the candy laws illustrates 
 the strictness and specific character of much of this food legislation: 
 
 • No person, firm or corporation shall, either directly or by agent or employe, or 
 as the agent or employe of any other person, firm, or corporation, manufacture for 
 sale, nr knowingly sell, or offer for sale. . . ." 1 ' 
 
 The making of the selling only of the unwholesome provisions an 
 offence greatly detracts from the value of such laws. If it is neces- 
 sary to prove a sale of unwholesome provisions before any action can 
 be taken, very little preventive work can he done. Hence thrsc regula- 
 tions often prescribe other offences than selling. Thus in Buffalo 2 " Xo 
 11 or persons shall bring into the city. sell, offer, or have for sale 
 for human food." In Oregon it is forbidden " to sell or exchange or 
 offer for sale or exchange." And in Xew York City it is provided 
 
 " That no person shall sell, or give to any other person, or permit such other 
 person to get (having the right and ability to prevent the same) any drink, food or 
 dress, when such first-named person may have reason to think or believe that such 
 drink, food or dress may cause danger or detriment to life." 3 
 
 In .Milwaukee it is forbidden to "give away for food" unwhole- 
 some materials. 
 
 Not only is it forbidden in Illinois to sell butterine, but no one 
 -may give to any person" a substitute for butter. The same provision 
 is found in Louisiana. 
 
 The Cleveland ordinance defines still further what shall be deemed 
 
 evidence of offering for sale : 4 
 
 •■ The fact of any cattle, sheep, hoi; or Lamb being in any sto«k yard or slaughter- 
 house pen shall be considered sufficient evidence that the same is being exposed 
 there for sale ; and the fact thai any carcass of any cattle, hog, sheep or lamb, 01 
 any part thereof, is found in any slaughter-house, or any public or private market 
 or place, dressed and prepared as such meats usually are for market, shall be deemed 
 sutii' ienl evidence that the same is for sale for human food." 
 
 In Iowa. 
 
 ■■ Whoever shall have possession or control of any imitation butter or imitation 
 cheese or any substance designed to be used as a substitute for butter or cheese con- 
 trary to the provisions of this act shall be construed to have possession of property 
 
 with intent to use it with the intent of committing a public offence." 
 
 Nevada, Compiled Laws (1900), Sec. 5076. 
 
 Buffalo, Ordinances (1802), Chapter 25, Sec. 84. 
 
 City of \-'\\ JTork, sanitary Code (1899), Sec. 67. 
 1 Cleveland Ordinances, Chapter 80, s '''-. 586. 
 ' Iowa, Code, 1 L897), Sec. 2621. 
 
350 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 In Iowa no person may have unmarked butterine in his possession 
 except for consumption by himself or family. In Iowa no carrier shall 
 receive butterine not properly marked. The Michigan law is as fol- 
 lows : 
 
 " The presence of such oleomargarine, butterine, or other substance resembling 
 butter, in any such place before mentioned where food is sold or furnished to per- 
 sons paying for the same, shall be prima facie evidence in any court before which 
 any person violating the provisions of this act may be brought for examination or 
 trial, that such person has sold and offered for sale as butter, such substance re- 
 sembling butter.'" 1 
 
 As was shown above, the Massachusetts and most of the other state 
 laws forbid the sale of unwholesome provisions only "for meat or 
 drink," and sometimes the law goes further as in Buffalo, and forbids 
 its sale for " human food," or in Maryland when " intended to be used 
 for human food." 2 Under such provisions it would be possible to sell 
 unwholesome food for the use of animals or for a fertilizer, but unless 
 the use of the food is so specified, it would not be possible to sell it at 
 all. It is not so specified in the Louisiana law. On the other hand, 
 the usual form of the law might at times prevent a conviction, owing 
 to the difficulty of proving that the goods were sold for " meat or 
 drink " or for " human food." 
 
 The Michigan adulteration law is as follows, and similar provisions 
 are found in the Massachusetts oleo law and in other states : 
 
 "The taking of orders or the making of agreements or contracts, by any person, 
 firm, or corporation, or by any agent or representative thereof, for the future deliv- 
 ery of any of the articles, products, goods, wares, or merchandise embraced within 
 the provisions of this act, shall be deemed a sale within the meaning of this act." 3 
 
 Not only is it forbidden to sell and manufacture adulterated sub- 
 stances, but in some instances it is forbidden to sell food which con- 
 tains such articles. Thus the Connecticut oleo law reads : 
 
 "No baker or vender of food shall sell or expose for sale any article of food con- 
 taining imitation butter, unless such baker or vendor shall maintain the same kind 
 of a sign as hereinbefore prescribed, in the way and manner prescribed in that con- 
 nection, except that the word "used " shall be substituted for the word " sold. 1 ' If 
 the selling be done from a wagon or other vehicle, such vehicle shall conspicuously 
 bear such a sign. 
 
 " Xo keeper of a hotel, boarding house, or restaurant, temporary or permanent, 
 shall furnish any guest with imitation butter, or food containing it, unless such 
 keeper shall maintain in plain sight of all guests sitting at tables where food is 
 served such a sign or signs as hereinbefore prescribed, except that the word " used " 
 shall be substituted for the word " sold." * 
 
 1 Michigan, Compiled Laws (1807), Sec. 4991. 
 
 2 Maryland, Chapter 604 of 1890, Sec. 52. 
 
 3 Michigan, Compiled Laws (1897), Sec. 5026. 
 
 4 Connecticut, General Laws (1888), Sees. 2616-7. 
 
FOOD OTHER THAN DAIRY PRODUCTS. :;:,] 
 
 Further information in regard to the wording of food laws may be 
 obtained from the milk laws which will be considered in the next chap- 
 ter. 
 ]', nalties. 
 
 The penalties attaching to the violation of the food laws, particularly 
 the adulteration laws, are the most severe found in any of the so-called 
 sanitary legislation. The injury to health is slight or nil but the 
 penalty is great, while for the violation of laws which may produce 
 vast injury to health the penalty is often nominal. The severity of 
 food law penalties does not represent the feelings of the public in regard 
 to the importance of the subject, but rather the legislative influence of 
 the commercial interests which usually secure this class of legislation. 
 
 Violation of food laws are of course punished by fine or imprison- 
 ment. The fines ranere from a ten dollar minimum in Tennessee to 
 a two thousand dollar maximum in Illinois, and the imprisonment from 
 thirty days to five years. Three hundred dollars to five hundred dollars 
 or one year are common maxima. 
 
 These aie not the only punishments inflicted. Unwholesome or 
 adulterated foods are usually seized and destroyed. Nearly all the 
 laws, state and municipal, contemplate or provide for the destruction 
 o| condemned material. Unfortunately the federal law in regard to 
 live stock inspection cannot constitutionally make use of this police 
 [tower, and this is the chief reason why the federal inspectors at the 
 great slaughtering centres need to be aided by local laws and inspectors 
 to secure the destruction of animals which have failed to pass the 
 inspectors of the depart nieiit of agriculture. Hence the rule in Chicago 
 page 347) that all meat condemned by the federal inspectors 
 shall lie destroyed under the supervision of the city meat inspectors. 
 Nearly all cities and a number of states provide that their food inspec- 
 tors shall seize and destroy articles offered for sale in violation of the 
 laws. As regards perishable articles, meat, fruit, vegetables, etc., this 
 is the method usually pursued to prevenl the sale of such as are unlit 
 for food. The frequenl routine inspection of shops permits of the 
 seizure of a large proportion of such undesirable food and this penalty 
 w of enforcement. It is. moreover, prompt, and its deterrent effeel 
 is probabl} almost as great as a prosecution. Sometimes the law is so 
 
 worded that seizure is practically the only course. Thus in Massachu- 
 setts where the law forbids the sale of veal only when the seller knows 
 it is under age, proof of this offence becomes almost impossible to 
 obtain : but i ther act 1 permits inspectors to seize and destro} all veal 
 
 1 Massachusetts, Public Statutes (1882), Sec. 2. 
 
352 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 which they believe to be under four weeks of age. This power of 
 seizure and destruction is sometimes safe-guarded. Thus : 
 
 " . . . If, at the time of the seizure, the owner of the property seized notifies 
 in writing the inspector seizing the same of his desire to appeal to the board of 
 health, said inspector shall cause said animals, meat, fish, vegetables, produce, fruit, 
 or provisions to be inspected by said board of health, or by a committee thereof con- 
 sisting of not less than two members; and if said board or committee find the same 
 to be tainted, diseased, corrupted or unwholesome, they shall order the same to be 
 destroyed or disposed of otherwise than for food. If said board or committee do 
 not so find, they shall order said animals, meat, fish, vegetables, produce, fruit, or 
 provisions to be forthwith returned to the owner thereof." 1 
 
 In New York, Yonkers, Memphis, and Cleveland provision is made 
 for the presence of witnesses to determine whether or not a given article 
 of food should be destroyed. The inspector in Cleveland is to call 
 upon " two reputable persons competent to judge," and shall follow 
 their decision if they agree, but if they do not agree, the inspector is to 
 refer the matter to the health officer. In making seizures under this 
 law three employees of the health department may make the inspections 
 together. In most legislation no provision for witnesses is made, and 
 the decision in regard to the condition of the goods is left to the 
 single inspector. 
 
 After goods are condemned they should be destroyed so that they 
 cannot by any possibility be sold to consumers. Many times their 
 destruction is left to the dealer, in which case it is expected that the 
 fear of a subsequent inspection to see if the order is carried out, and 
 the threat of a fine, is sufficient to secure the end sought. Thus in 
 some cities the owner is directly required by the law to destroy the 
 goods, and failure to do so is punished by a fine of one hundred dol- 
 lars in Atlanta 2 and of fifty dollars in Maryland. Often the provision is 
 made that the condemned material shall be tagged by the inspector. 
 This is required in Jersey City, Bridgeport, Newark, and St. Louis. 
 The Newark rule is as follows : 
 
 "That upon any cattle, meat, fish, birds, fowls, fruit, nuts or vegetables being 
 found by any inspector or other officer of the board of health, in a condition which 
 renders the same unsafe or unwholesome for human food, it shall be the duty of 
 said inspector or officer to affix to said article or articles a label on which shall be 
 written or printed the words l Condemned by direction of the Board of Health, 
 Newark, N. J. 1 and when anything included within the provisions of this section 
 shall be found in numbers, quantity or bulk, it shall only be necessary for said in- 
 spector or officer to affix one such label to a conspicuous part of the box, tin, basket, 
 compartment or other place or thing containing the same, and he shall forthwith 
 report every such condemnation at the office of the board. And no person or per- 
 sons shall destroy, deface, conceal, interfere with or remove any label affixed by any 
 
 1 Massachusetts, Public Statutes (1882), Chapter 58, .Sec. 3. 
 - Atlanta, Sanitary Rules and Regulations, Sec. 100. 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 353 
 
 inspector or officer of this board as aforesaid. It shall be the duty of the owner or 
 person in charge of any matter or substances that have been condemned, to imme- 
 diately remove the same from any market, street or place, and convey the same to 
 such place as may be designated by the inspector or officer, and such articles shall 
 pot be sold or offered for sale, nor in anyway disposed of, and in case the owner 
 or person in charge shall fail or neglect, or refuse to remove said articles within 
 three hours after having been notified to do so. the same may be removed by the in- 
 spector or other officer of this board, the owner or person in charge paying all 
 expenses therefor." : 
 
 Sometimes the destruction of the goods is secured by the inspectors 
 pouring a little kerosene upon them which, of course, effectually pre- 
 vents their sale for food. This is the practice in Providence, Colorado 
 Springs, St. Paul, and Kansas City. In St. Louis- the inspectors are 
 to mark or to mutilate the goods as they deem best to indicate their 
 condemnation, and the owners shall within forty-eight hours inform the 
 commissioner in writing under oath what disposition they have made of 
 the condemned material. In Brooklyn canned goods when condemned 
 are punched by the inspector and left to he redeemed. 
 
 In some of the larger cities periodic inspections are made with a team 
 to seize and carry away at once the goods as fast as condemned. This 
 is done in New York among the retail dealers on the two favorite mar- 
 ket days each week, and also on Saturday night. In Providence such 
 raids are frequently made, but at irregular interyals. In Boston all con- 
 demned meat is tagged and is given to the ••hone-man'" who pays for it 
 :hc regular price for such goods. Usually no compensation is made for 
 the seizure of unwholesome provisions. In Mississippi 3 the law pro- 
 vides that if there is any value to the condemned goods they shall be 
 forfeited to the county where they are offered for sale. In Massa- 
 chusetts the law provides that the proceeds of their sale shall go to 
 the owner. Sometimes a consignee from whom the goods are seized is 
 entirely innocent as the goods may have been shipped or received in 
 bad condition. To enable the consignee to recover from the consignor 
 Dr transportation company a certificate is sometimes given stating the 
 facts ot the seizure. The form nscil in Providence is shown in 
 Appendix [2. 
 
 In Cincinnati ' the person occupying a stall in a public market from 
 whom decayed food shall be seized shall forfeil his stall and " never 
 thereafter be permitted to rent or occupy one." When animals are 
 condemned ;it slaughter-houses they are nol nsinilh seized but are killed 
 
 1 Newark, Sanitarj Code i L888), Sec. 30. 
 
 Louis, Ordinances (1893), Chapter 14, $ec. 358. 
 Mississippi, Annotated Code (1892), Sec. 2105. 
 
 icinnati, .Manual of Health Department, (1898), p. 111. 
 
354 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 and utilized by tanking under the supervision of the inspectors. In 
 Brooklyn l considerable trouble was at one time occasioned in the con- 
 demnation of imported goods owing to friction between the local health 
 department and the customs officials, but it was afterwards amicably 
 adjusted. In Boston where much fruit is imported the co-operation of 
 the customs officers, the transportation companies, and the health depart- 
 ment inspectors, renders supervision of this traffic easy. 
 
 While the loss of property by seizure, and the infliction of a fine in 
 court, has a deterrent effect, probably it has a much less effect than the 
 fear of public exposure. Hence the following provisions of the Massa- 
 chusetts law : 
 
 "The place where property condemned under this chapter is found, and the 
 name of every person in whose possession it is found, and of every person convicted 
 of an offence under the preceding section, shall be published in two newspapers pub- 
 lished in the county in which the property was found or the conviction took place. 11 2 
 
 Similar laws are found in Connecticut and Tennesee, but in Ten- 
 nessee the names shall not be published till after conviction, and in Con- 
 necticut the parties from whom the goods were taken may add to the 
 advertisement the name of the persons from whom they purchased. In 
 Connecticut and in a number of other states the cost of the analysis 
 shall be paid by the parties from whom the sample was obtained if 
 adulterated, but by the town if the goods prove to be pure. 
 
 Besides affixing a penalty, the law in Michigan, Rhode Island, 
 Nebraska, Iowa, Missouri, and Pennsylvania provides that no action 
 upon any contract shall be maintained to recover upon any contract for 
 any illegal sale of such goods. 
 
 Statutes Consulted in the Prepabation of this Chapter. 
 
 Alabama. General adulteration, bread, liquor, Code (1897), Sees. 5821-8. 
 Arizona. General adulteration, Chapter 105 of 1887. 
 
 Meat inspection. Act of 21 March, 1895. 
 California. General adulteration, Code (1886), Sec. 382, Chapter 70 of 1895. 
 
 Provisions, Code (1886), See. :'.s;;. 
 
 Candy, Code (1886), Sec. 401. 
 
 Olive oil, Chapter 47 of 1891. 
 
 Honey, Chapter 104 of 1895. 
 Colorado. General adulteration, Annotated Statutes (1891), Sees. 12-14, Act of 
 17 April, 1893, Sees. 61-3. 
 
 Meat, Annotated Statutes, (1891), Sees. 18-21. 
 
 Liquors, Annotated Statutes (1891), Sees. 27-33. 
 Connecticut. General adulteration, General Statutes (1888), Sec. 2648, Chapter 
 235 of 1895. 
 
 Vinegar, Chapters 60 and 234 of 1889. 
 
 1 Brooklyn, Report of Department of Health, (1896), p. 41. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 58, Sec. 6. 
 
FOOD OTHER Til AX DAIRY PRODUCTS. 355 
 
 Connecticut, ContiniH d. 
 
 Candy, Chapter 183 of 1895. 
 Molasses, Chapter 157 of 18!>.">. 
 Sugar, Ceneral Statutes (1888), Sec. 2650. 
 Hakeries, Chapter 174 of 1807. 
 Delaware. Candy, Chapter 200 of 1895. 
 District ok Columbia. Ceneral adulteration. Act of IT February, 1898. 
 
 Candy, Act of 5 May, L898. 
 FLORIDA. Meat, Chapter 30 of 1891, Rules of State Board of Health, 1 April, 1896. 
 Georgia, (reneral adulteration. Code (1882), Art. 3004. 
 Bread. Code (1882), Art. 4551. 
 Wines, etc., Laws of 1892, p. 130. 
 Idaho. General adulteration, Revised Statutes (1887). Sec. 6918. 
 
 Candy. Art of 16 February, 1899. 
 Illinois. Ceneral adulteration, bread, candy, canned goods, lard, drugs, liquors, 
 and vinegar, veal, jelly, extracts, Annotated Statutes (1896), Chapter 38, Sees. 
 12-44, Act of 24 April. 1899. 
 [KDIAN \. Provisions and adulterations, various and general, Statutes (1897), Sees. 
 2183-94, Act of 28 February. 1899. 
 Candy. Art of :; March, 1899. 
 low \. Provisions and adulterations, various and general, Code (1897), Sees. 4502, 
 4980-6,4992-7. 
 Vinegar, Art of '.» March, 1899. 
 Diseased pork, Art of 12 April, 1898. 
 K \\-\-. Adulterations, general and various. General Statutes (1896), pp. 353-358. 
 Kentucky. General adulteration, provisions, candy, honey, vinegar, lard, liquids, 
 Statutes (1894), Sees. 1272 83, •-'■-'no. Chapter 52 of 1898. 
 iind goods, Chapter 32 of 1896. 
 Loi isiana. General adulterations, Act of 5 July, 1882; Provisions, Act of 3 March, 
 
 1880. 
 Maine. Adulterations, general and various, Revised statutes (1883), Chapter 128, 
 Supplement Laws (1895), pp. 504 »i. 
 Meat. Chapter 144 of 1895. 
 MARYLAND. Provisions, adulterations, general and various. Chapter 604 of 1890. 
 Candy, Chapter :;1T of 1890. 
 Bakeries, Chapter 27:; of L896. 
 
 Cakes, Public General Laws (1888), Art. 27. Sec. 138. 
 Massachusetts. General adulteration, provisions, veal. Public Statutes (1882), 
 Chapters 208 and 263 of 1882; 344 of isut : and 27 j of 1896. 
 Lard, Chapter 1 l'.' of L887. 
 Poultry, Chapter 94 of L887. 
 Pish, Public Statutes 1882), Chapter 56, Sec. 15. 
 Chocolate, Public statutes < lss-_'(. Chapter no. 
 Vinegar, Public statutes ( 1882), chapter 60; 257 of 1888; 307 of 1884, and 150 of 
 
 Candy, Chapters 333 of L891 and 279 of 1895. 
 
 Arsenic, Chapter :;74 of L891. 
 
 Bakeries, Chapter US of 1896. 
 
 Inspectors, Public Statutes (1882), Chapter 58; Chapters 145 and 132 of 1892. 
 
 t aimed goods, molasses and syrup, Chapter 344 of l v '.'7. 
 
 Michigan. Adulteration, general and various, Compiled Laws (1897), Sees. 4978 
 5029. 
 Provisions and adulterations, Compiled Laws (1897), Sees. 11404 29. 
 Wines and liquors, Compiled Laws •'■- .5408 8. 
 
 Drugs, Compiled Law- (1897), Sec. 5818. 
 
356 FOOD OTHER THAN DAIRY PRODUCTS. 
 
 Minnesota. Various adulterations, Statutes (1804), Sees. 6625, 6985 to 7022. 
 
 Candy, Chapter 204 of 1895. 
 
 Bakeries, Chapter 199 of 1895. 
 
 Poultry, Chapter 201 of 1895. 
 
 Meat, Chapter 200 of 1895, and 175 of 1899. 
 
 Food Commissioner, Chapter 295 of 1895. 
 Mississippi. General adulteration, Annotated Code (1892), Sees. 952, 2100-7, 2095-9, 
 
 Chapter 29 of 1892. 
 Missouri. Various adulterations, Revised Statutes (1889), Sees. 3876-88. 
 
 Candy, Act of 1 April, 1891. 
 
 Chemical adulterants, Act of 11 May, 1899. 
 Montana. Adulterations, provisions, Penal Code (1895), Sees. 682-3. 
 
 Candy, Act of 22 February, 1899. 
 Nebraska. Food Commission, dairy products and vinegar. Compiled Statutes 
 (1899), Sees. 3207-3211g. 
 
 Liquors, Compiled Statutes (1899), Sec. 3603. 
 
 Drugs. Compiled Statutes (1899), Sec. 3730. 
 Nevada. Provisions, Compiled Laws (1900), Sees. 826-30. 
 
 Candy,. Compiled Laws (1900), Sees. 5076-8. 
 New Hampshire. General adulteration, Chapters 39 and 200 of 1891. 
 
 Candy, Chapter 58 of 1899. 
 New Jersey. General adulteration, Revised Statutes (1895), p. 1104. ei seq. 
 
 Candy, Public Laws (1895), p. 279. 
 
 Coloring matter, Public Laws (1895), p. 47M. 
 
 Bread, Public Laws (1896), p. 261. 
 
 Hakeries, Public Laws (1896), p. 266 
 
 Horse meat, Public Laws (1899), p. .*>17. 
 New Mexico. Provisions and adulterations, Compiled Laws (1897). Sees. 1244-57. 
 New York. General adulteration, wine, liquors, sugar, honey, Revised Statutes 
 (1895), p. 2418 (Public Health Law, Sees. 40-50). 
 
 Bakeries, Chapter 415 of 1898, Art. VIII. 
 
 Vinegar, Revised Statutes (1S95), p. 38 (Agricultural Law, Sees. 50-3). 
 
 Veal, Chapter 491 of 1898. 
 North Carolina. General adulteration, Chapters 122 of 1895 and 86 and 369 of 
 
 1 SI M.I. 
 
 North Dakota. Candy, Act of 12 March, 1897. 
 
 Ohio. Various adulterations, Annotated Statutes (1900), Sees. 4200 (-1) to (-HI). 
 
 * Bakeries, Annotated Statutes (1900), Sees. 4364 (-71-72). 
 
 Provisions, veal, Annotated Statutes (1900), Sees. 0928 and 0928 (-1). 
 
 Liquors, Annotated Statutes (1900), Sees. 6950, 7074, 8082-3. 
 
 Canned goods, Annotated Statutes (1900), Sees. 7072-4. 
 Oklahoma. Provisions and adulterations, Compiled Statutes (1893), Sees. :;4.'!, 2204, 
 
 •2436, 2*537, 2043. 
 Oregon. Adulterations and provisions, Annotated Laws (1892). Sees. 1978-80, Act 
 of 21 February, 1893. 
 
 Candy, Act of 10 February, 1899. 
 Pennsylvania, (reneral adulteration. Acts of 20 .Line. 1895, and ."> July, 1895. 
 
 Flour, Act of 18 March, 1775. 
 
 Lard, Act of 6 June, 1891. 
 
 Provisions, Act of 7 May, 1855. 
 
 Candy, Act of 23 May, 1887. 
 
 Liquors, Acts of 20 March. 1800, 14 April, 1803, :i April, 1S72, 2 June, 1881. 
 
 A'inegar, Act of 5 July, 1895. 
 
 Bakeries, Act of 27 May, 1S97. 
 
FOOD OTHER THAN DAIRY PRODUCTS. :;:,7 
 
 Rhode Island. Provisions, liquor, veal, (General Laws (1890), Chapter 282. 
 
 Saleratus, General Laws (1896), Chapter 138. 
 
 Vinegar, General Laws (1896), Chapter 148. 
 
 Liquors. General Laws (1896), Chapter 161. 
 
 Candy. Act of 15 May. 1896. 
 South Carolina. Provisions ard adulteration, Revised Statutes (1893), Sec. 266. 
 
 Candy. Act of 9 March, 1896. 
 Soi in Dakota. General adulteration. Compiled Laws (1887), Sees. 6654-5, Chap- 
 ter 89 of 1899. 
 Texxessee. Adulterations. Chapter 45 of 1897. 
 
 ( andy. Chapter 33 of 1887. 
 Utah. Inspection, statutes (1898), Sees. 2446-50. 
 
 Drugs, statutes (1898), Sec. 1726. 
 
 Various adulterations, Statutes (1898), Sees. 4283-90. 
 
 Vinegar. Chapter 36 of 1899. 
 Vermoxt. Various adulterations, statutes (1894), Sees. 4332-43. 
 
 Provisions, veal, drugs. Statutes (1S94), Sees. 5073-0. 
 Vii;o[\i \. Adulterations and provisions, Code (1887), See-,. :;sll-12. 
 IFasiiixgtox. Provisions, Code (1897), See. 7275. 
 
 General adulteration. Chapter 113 of 1899. 
 West Virgixi \. General adulteration. Code (1899), Chapter ir>0. See. 20. 
 Wi-i oxsix. Provisions, adulterations, general and various, Statutes (1898). 
 4599-4601b, 4607f-i. 
 
 Dairy and Food Commission, statutes (1894), Sees. 1410-1410d. 
 
 Bakeries, statutes (1894), 4608i-k. 
 Wyoming, (andy. Revised statutes (1899), See. 2223. 
 
 Drugs, Revised statutes (1899), Sees. 2668-70. 
 
CHAPTER VIII. 
 
 DAIRY PRODUCTS. 
 
 THE adulteration of butter and cheese or the sale of imitations very 
 seriously affects the pocket-books of the dairymen. As dairymen 
 form a large and influential class throughout the country, it might be 
 expected that stringent legislation concerning this class of adulteration 
 would be very common. As a matter of fact, laws relating to butter 
 and cheese are found in all but six of the states and territories. The 
 dairy division, bureau of animal industry, department of agriculture has 
 published a reprint (Dairy Bulletin Number 21) of the state laws relat- 
 ing to dairy products. These laws, together with a summary, are also 
 printed in the fourteenth report of the bureau of animal industry. The 
 facts here presented are taken largely from this compilation. 
 
 CHEESE. 
 
 Most of the agricultural states, and also the District of Columbia 
 have statutes forbidding the manufacture and sale of adulterated cheese. 
 Sophisticated cheese is not so common as artificial butter but its manu- 
 facture and sale is opposed by the same interests, and in many states it 
 is treated of in the same statute with butter. Cheese is often defined 
 in these statutes, usually in a manner similar to butter (see p. 364). 
 There are three ways of dealing with the artificial cheese question. 
 
 First. 
 
 It is sometimes made an offence to manufacture or sell such cheese 
 unless it is plainly so labeled. This is the method pursued in the Dis- 
 trict of Columbia, Illinois, Indiana, Massachusetts, Missouri, Montana, 
 Xew Hampshire, North Dakota, Ohio, Oregon, Tennessee, and West 
 Virginia. The Massachusetts law is given below. 1 
 
 1 Massachusetts, Chapter 352 of 1885 : 
 
 " Whoever, by himself or his agents, sells, exposes for sale, or has in his posses- 
 sion with intent to sell, any article, substance, or compound made in imitation or 
 semblance of cheese, or as a substitute for cheese, and not made exclusively and 
 wholly of milk or cream, or containing any fats, oils, or grease not produced from 
 milk or cream, shall have the words " imitation cheese," stamped, labeled, or 
 marked, in printed letters of plain, uncondensed Gothic type, not less than one inch 
 in length, so that said words cannot be easily defaced, upon the side of every cheese 
 
da 111 ) r PR on zrt ' TjS. 3 5 9 
 
 Another act 1 fixes the penalty at $100 for first offence, and 1200 for 
 each subsequent offence for selling contrary to the above or defacing the 
 iil>ed labels. 
 
 Secotul. 
 
 It may be forbidden to manufacture or sell imitation cheese unless 
 
 it is labeled and unless it is nncolored. The Iowa- oleo law after elabo- 
 rately stipulating how artificial butter and cheese must be sold provides 
 that : 
 
 ■■ No <>ne shall color with any matter whatever any substance intended as a sub- 
 stitute for butter or cheese so as to cause it to resemble true dairy products, or com- 
 bine any animal fat. vegetable oil or ether substance with butter or cheese, or 
 combine with any substance whatever intended as a substitute for butter or cheese 
 anything of any kind or nature for the purpose or with the effect of imparting to 
 tin- compound the color of yellow butter or cheese, the product of the milk or cream 
 • f cows, or use, solicit orders for delivery, keep for sale, or sell, any such stibstance 
 so colored and disguised as a substitute for butter or cheese; but nothing in this 
 chapter shall be construed to prohibit the use of salt, rennet, or harmless coloring 
 matter in making butter or cheese from such milk or cream."' 
 
 A similar method is pursued in California, Colorado, Maryland, 
 Nebraska, New Jersey, Georgia, South Carolina, and Utah. 
 
 Third. 
 
 The attempt has been made to absolutely forbid the making and Bale 
 
 of artificial cheese and butter. Laws like the following have been passed 
 
 in several states, but though still on the statute books, have been rendered 
 
 void by decisions of the United States Supreme Court: 
 
 ■ So person, firm, or corporate body shall manufacture out of any oleaginous 
 lubstance or any compound of the same, other than the product from unadulterated 
 milk or of cream from the same, any article designed to take the place of butter or 
 cheese produced from pure unadulterated milk or cream from the same, or of any 
 imitation or adulterated butter or cheese, nor shall sell, or offer for sale, or have in 
 hi>. her or then- possession with intent to sell the same as an article of food." 8 
 
 A fuller consideration of the above laws will be found under butter, 
 as mosl of the cheese laws arc identical with the butter laws. 
 
 cloth or I >a i id arouml the same, and upon the top and side of everj tub, firkin, i>"\. oi 
 package containing any of said article, substance, or compound. Ami in case ol retail 
 •ales of any of said article, substance or compound not in the original pack 
 the seller shall, by himseli or his agents, attach to each package so sold ai retail, 
 ami shall deliver therewith to the purchaser, a label or wrapper bearing in a con- 
 ipicuous place upon the outside c,f the package the words ••imitation cheese.'" in 
 printed letters of plain, un condensed Gothic type, not less than one-half inch in 
 length." 
 
 Massachusetts, Chapter 317 of 1886, Sec. 2. 
 
 [owa Code 1 1807), Sec. 2518. 
 
 Pennsylvania, .Brigbtly'a Purdon's Digest (1894), p. 1621, Sec. 1. 
 
360 DAIRY PRODUCTS. 
 
 A different sort of legislation in regard to cheese is found in Kansas, 
 Nebraska, Indiana, Wisconsin, Virginia, Connecticut, New Jersey, New 
 York, Illinois, Minnesota, 1 Michigan, and Oklahoma. The other statutes 
 aim at the prevention of the manufacture of artificial cheese, but these 
 states attempt to aid the creameries in making a good article, by insist- 
 ing that the materials sold to them shall be pure. 
 
 Quite a number of states have laws regulating the marking or brand- 
 ing the different varieties of legitimate cheese. 2 Most of these permit 
 the manufacture of skimmed milk cheese, and require that it shall 
 be so marked or branded. In Colorado cheese must be so marked if 
 less than thirty-five per cent, of its total solids consists of butter fat. 
 In Minnesota cheese shall be marked " skim cheese " if less than forty- 
 five per cent, of its total solids is fats, in Illinois if less than forty-eight 
 per cent. In Ohio the proportion of fats to total solids is under twenty 
 per cent, for skimmed cheese. In Pennsylvania if cheese contains less 
 than eight per cent, butter fat it is skimmed cheese. In Colorado the limit 
 is fifteen per cent. fat. In Wisconsin skimmed cheese must be ten 
 inches in diameter and nine inches high. In California cheese is to be 
 branded "California half skim cheese " if it contains less than thirty 
 per cent, and more than fifteen per cent. fat. In Pennsylvania cheese 
 is to be branded " three-fourths cream " if it contains between twenty- 
 four per cent, and thirty-two per cent, butter fat, "one-half cream" if it 
 contains from sixteen per cent, to twenty-four per cent., and " one-fourth 
 cream'" if it contains from eight per cent, to sixteen per cent, butter 
 fats. In Washington half skimmed cheese is that which contains from 
 fifteen per cent, to thirty per cent, butter fats or from which only half 
 the cream has been extracted. "Full cream cheese" is usually defined 
 as that made wholly from pure milk from which none of the fat has 
 been removed, but the percentage of fat required is sometimes specified. 
 Thus in California and Washington it is thirty per cent., in Colorado, 
 thirty-five per cent, of the total solids, in Minnesota, forty-five per cent, 
 of the total solids, in Illinois forty -eight per cent., and in Pennsylvania 
 thirty-two per cent. 
 
 1 Minnesota, Chapter 295 of 1899: 
 
 " Sec. 14. No person by himself or his agents or servants shall sell, supply or 
 bring to be manufactured, to any butter or cheese manufactory any milk diluted 
 with water or any other substance whatever, or any unclean; impure, unhealthy, 
 adulterated or unwholesome milk, or milk from which any cream has been taken 
 (except pure skim milk to skim cheese factories), or shall keep back any part of the 
 milk commonly known as " stoppings," or shall bring or supply milk which is sour, 
 t«> any butter or cheese manufactory (except pure skim milk to skim milk cheese 
 factories. 7 '') 
 
 2 California, Colorado, District of Columbia, Iowa, Indiana, Maryland, Michigan, 
 Minnesota, Missouri, New York, Ohio, Pennsylvania, Vermont, Virginia, West Vir- 
 ginia, Washington, and Wisconsin. 
 
DAIRY PRODUCTS. 361 
 
 In Michigan. Minnesota, New York, Ohio, and Washington, and a 
 •number of other states, registered brands for full cream cheese may lie 
 obtained from the dairy commissioner, for which a fee is usually charged. 
 The specifications in regard to size and character of marks arc often as 
 specific as they are in the corresponding laws for butterine. Fancy 
 cheeses are usually exempted from the action of these laws. 
 
 BUTTER. 
 
 A few states have laws to secure the delivery of pure milk or cream 
 to creameries. An example of one of these acts was given on page 
 160. There is, however, a great mass of legislation directed against 
 the manufacture and use of butter substitutes, such as butterine or 
 oleomargarine as it is variously called. 
 
 It cannot be maintained that the use of butterine is any more in- 
 jurious to health than is the use of butter. Opposition to the use of 
 butterine comes from the manufacturers of butter who fear that their 
 prices will be lowered and trade injured. They can very justly demand 
 that butterine shall be sold under its true name, but to go farther than 
 this as is done by many of the laws, and attempt to check its legitimate 
 sale, is a great wrong. In any event, it is an economic, rather than a 
 sanitary question, and it is only discussed in these pages because sani- 
 tary officials ate often entrusted with the execution of the laws and 
 because the statutes relating to oleomargarine are properly to be classed 
 with the adulteration laws. 
 
 As there can be DO federal legislation in regard to adulterations of 
 domestic products except by some subterfuge, and as the dairy interests 
 were strong enough to successfully demand such legislation, a law was 
 passed by Congress in 1886 ostensibly to raise revenue, but really to 
 hinder the sale of oleomargarine. By this law manufacturers pa\ a 
 tax of $600 per annum, wholesalers $480 and retailers $48. Besides 
 these taxes the manufacturer is to pa\ two cents a pound. This tax 
 is paid by stamps which are affixed to packages. The manufacturer 
 musl pack ill woollen packages of not less than tell pounds, and retail- 
 ers must sell from these, and all packages and all wrappers must be 
 distinctly marked. The commissioner of internal revenue enforces the 
 law. Oleomargarine for export does nol pay the tax but must be 
 
 properl} labeled. 
 
 All the states and territories including the District of Columbia, ex- 
 
 cept Arizona, Kansas. New Mexico, Texas and Wyoming, have butter- 
 ine legislation of varying stringency. These laws, like the cheese laws 
 steal the subject In several differenl ways. 
 
362 DAIRY PRODUCTS. 
 
 First. 
 
 The attempt is made simply to secure the sale of butterine under its 
 true name, and for this purpose it is required that it be properly 
 labeled. 
 
 Some of these laws are not very specific. Thus in Maryland r 1 
 
 " . . . no person shall mix any . . . oleomargarine, suine, beef fat, 
 lard, or any other foreign substance with any butter, cheese intended for human 
 food . . . without distinctly marking, stamping or labeling the article or the 
 package containing the same with the true and appropriate name of such adulter- 
 ant, and the percentage in which it is used for the purpose of adulteration, or enters 
 into the composition of the article so adulterated." 
 
 The statute is not very different in Louisiana, Indiana, Missouri, 
 and Nebraska. In Rhode Island and West Virginia the law requires 
 that the original package shall be marked oleomargarine, in Rhode 
 Island in letters one-half inch high, and also if sold from the tub it 
 must be delivered in a wrapper on which the word shall be printed or 
 stamped. In Rhode Island no attempt whatever has been made to en- 
 force this law, yet there is little doubt that by far the larger part of the 
 butterine is sold in accordance with its provisions. The writer has 
 reason to believe that if its enforcement were reasonably followed up, 
 the law would prove amply sufficient to prevent the sale of butterine 
 as butter; but the promoters of these laws are not so anxious to pre- 
 vent the fraudulent sale of butterine as they are to prevent butter sub 
 stitutes from becoming popular. It is invariably required that the 
 original packages in which butterine is received shall be plainly marked 
 to indicate the character of the contents. Furthermore, such packages 
 are required by law to have the revenue stamp affixed. To prevent 
 marking with letters too small to be seen, the size is often prescribed. 
 The Massachusetts law is shown below. 2 In Connecticut the marking 
 must be " at all times in plain sight " and in black Roman letters not 
 less than one inch wide and two inches long on a light ground. In 
 Michigan the label is to be upon the top and side and burned or painted 
 in black permanent paint in Roman letters one inch in length. In 
 Iowa the letters are to be one inch long by one-half inch wide. In 
 Wisconsin the marking must be in "ordinary bold faced capital letters 
 
 i Maryland, Chapter 004 of 1800. Sec. 40. 
 
 - Massachusetts, Public Statutes (18S2), Chapter 56, Sec. IT: 
 
 "And in cases of retail sales of any of said article, substance, or compound not in 
 the original packages, the seller shall, by himself or bis agents, attach to each 
 package so sold, and shall deliver therewith to the purchaser, a label or wrapper 
 bearing in a conspicuous place, upon the outside of the package, the words " imi- 
 tation butter," " oleomargarine,'" or " butterine,' 1 and no other words, in printed 
 letters, in a straight line of plain, nncondensed Gothic type, not less than one-half 
 inch in length. "" 
 
DAIRY PRODUCTS. 363 
 
 not less than five line pica in size." In New Jersey the package must 
 be marked with a black painted stripe three inches wide running around 
 the package midway between the top and bottom, and must lie branded 
 on the outside. of the cover and on the outside of the package in two 
 places as nearly opposite each other as possible, the title in Roman 
 letters one-half inch high and one-quarter inch broad, and -said name 
 shall be ten inches long." In New Jersey the package must also have 
 a label or brand showing the name and address of the manufacturer and 
 the location of the factoiy. 
 
 The package in which butterine is retailed also must be labeled. 
 
 Similar provisions are found in Wisconsin, Michigan, Connecticut, 
 Iowa, and in addition to this in Iowa. Michigan and Illinois the seller 
 must distinctly inform the purchaser at the time of sale of the character 
 of the goods. 
 
 In North Carolina the oleo label must give the ingredients of which 
 the oleo is composed and also the proportions. 
 
 In addition to the United States license which all dealers are obliged 
 to take out, some states, as Massachusetts and Connecticut, require 
 local registration. In Massachusetts dealers are to register with the 
 Inspector of milk and pay a fee of fifty cents. In Connecticut they 
 register with the dairy commissioner. In Mississippi dealers must pay 
 a license ice of fifty dollars and also a vender's tax of five dollars. In 
 Montana dealers must pay a tax of ten cents for each pound sold. In 
 Oregon a record must be kept of all sales. 
 
 Not only must butterine packages be labeled, but in man) states 
 si-ns must be exhibited stating the tact that butter substitutes are sold 
 tor used. 1 These signs are to be furnished at cost by the dairy com- 
 missioner. Bakers ami venders of food and keepers of hotels, boarding- 
 houses and restaurants, if furnishing butterine or fond containing it, 
 bust display similar signs substituting the word used tor sold. The 
 
 Iowa law also specifies that the keepers of saloons, lunch counters and 
 
 places of public entertainment or any person having charge thereof or 
 pmployed thereat, or any person furnishing board lor members of his 
 
 nnecticut, Chapter 11 1 ..! 1893, Sec. -': 
 ■ First, tin- seller shall maintain in plain sight, over or nexi the main outer en- 
 trance "i i he premises where the selling is done, a sign bearing in plain black Roman 
 . not less than two inches wide ami four inches long, on a white ground, the 
 wen U "sold here," preceded by t he name of t he imitation art i ele. [f the selling is 
 done from a wagon or other vehicle, such vehicle shall conspicuously hear upon its 
 outside "ii botli sides of sail I wagon or vehicle such a sign. If the delivering is done 
 from a wagon or other vehicle, such vehicle shall conspicuously bear upon its out- 
 •ide "ii botli sides ol said wagon "r vehicle a sign bearing in plain, Mack l;.. man lei 
 ot less than two inches wide and four inches long, on a white ground, the 
 "delivered here," (acceded l.\ the name .,f the imitation article" 
 
364 DAIRY PRODUCTS. 
 
 own family or for any employees where such hoard is furnished as com- 
 pensation or part of compensation, shall keep a card conspicuously be- 
 fore each table; the card to be ten by fourteen inches, white, with plain 
 black Roman letters one inch by one-half inch, stating "Substitute 
 for butter used here."' In Michigan it is necessary to have the sign on 
 the outside door conspicuously hung in the centre, and placed on the 
 walls. States which have such provisions requiring labels and signs 
 are Florida, Georgia, Indiana, Maryland, Massachusetts, Michigan, 
 Minnesota, Montana, Nebraska, Ohio, South Carolina, South Dakota. 
 Vermont, Utah, Virginia, and Wisconsin. 
 
 It is in most states, which require the marking of butterine, forbid- 
 den to destroy the marks. 1 
 
 As these acts deal with pure butter and butter substitutes and as 
 penalties are usually imposed for selling goods that are not pure butter, 
 these terms must be defined. The following is from the United States 
 Statute : 2 
 
 1 ' That for the purpose of this act the word -butter' 1 shall be understood to 
 mean the food product usually known as butter, and which is made exclusively 
 from milk or cream, or both, with or without common salt, and with or without 
 coloring matter. 11 
 
 Second. 
 
 The restrictions upon the sale of butterine that have been given not 
 being deemed satisfactory in several states, the sale of such substances 
 has been absolutely forbidden. This is accomplished either directly or 
 by a subterfuge. The subterfuge employed is a regulation of the 
 coloring of the material. Unless artificial yellow coloring matter is 
 added in the process of manufacture, butterine would be so nearly white 
 as not to be attractive, and hence would find no sale. Therefore several 
 states have forbidden the sale of butter substitutes containing artificial 
 yellow coloring matter. 3 
 
 1 Massachusetts, Public Statutes (1882), Chapter 56, Sec. 19, as amended by 
 Chapter 317 of 1886: 
 
 "Whoever, with intent to deceive, defaces, erases, cancels, or removes any mark, 
 stamp, brand, label, or wrapper provided for in such sections, or in any manner 
 shall falsely label, stamp, or mark any box, tub, article, or package marked, stamped, 
 or labelled as aforesaid, shall for every such offence forfeit to the city or town where 
 the offence was committed one hundred dollars, and for a second and each subse- 
 quent offence two hundred dollars. 11 
 
 -United States Statutes, 49th Congress. Session I. (1886), Chapter 840, Sec. 1. 
 Alabama, California, Colorado, Connecticut, Delaware, District of Columbia, 
 Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, 
 Montana, Nebraska, New Hampshire, New Jersey, New York, North Dakota, Ohio, 
 South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington, 
 West Virginia, and Wisconsin. 
 
DAIRY PRODUCTS. 355 
 
 It is worthy of note that several of these laws, like that of Iowa, 
 while forbidding the use of coloring matter in butterine, permit it in 
 butter. 
 
 T<> make butterine still more unattractive and unsaleable, it is re- 
 quired in South Dakota, Vermont, and West Virginia that it be colored 
 bright pink. This last provision has however been rendered inoperative 
 by the decisions of the federal courts. 
 
 Third. 
 
 Several states still have laws upon their statute books like that 
 shown on page 3o9, which unconditionally forbid the manufacture and 
 salt- of oleomargarine, but they have not been upheld by the courts and 
 cannot therefore be enforced. 
 
 In California, Michigan, Ohio, and Wisconsin butterine cannot be 
 used in any penal or charitable state institution. 
 
 This brief summary is enough to show that the drastic- character of 
 these laws is not equalled by any sanitary legislation. Not only are 
 the laws severe, but special agencies have been called into play to secure 
 their enforcement. The state food and dairy commissions have been 
 established largely for the purpose of preventing the sale of substitutes 
 tor butter, cheese and lard. It is very evident that these laws aim not 
 BO much to protect the consumer against fraud as to protect dairymen 
 in their business. It is interesting to compare the attitude of tin- dairy 
 interests towards these laws which have not been particularly asked for 
 by 'he public and which aim at the suppression of a harmless food, with 
 their hostile attitude towards milk laws which are asked tor by the 
 consumer and are aimed at a most harmful adulteration. 
 
 I!, novnted or PmceHH Butter. 
 
 It is possible to so treat bad or partly rancid butter b\ rendering 
 
 and purifying, and perhaps mixing with other butter or cream or churn- 
 ing with milk, as to make a product which, while of poor grade, is yet 
 saleable. Several states have laws against Belling such butter without 
 marking it as such. 1 
 
 One of the most recent acts is that of Minnesota 2 given below, 
 Minnesota :; also has a law which forbids the sale of butter made under 
 the Quinness patent (adulterated with casein) unless it is so marked. 
 
 California, Illinois Massachusetts, Michigan, Minnesota, New i'ork, North 
 Dakota, Pennsylvania, and Wisconsin. 
 
 Minnesota, Chapter 94 of 1899: 
 
 ■ Sect ion 1. \(, person, firm, corporation, agent or employe shall manufact are, 
 si-ll. 1. tier or expose for sale, in tliis state, any butter that is produced by taking 
 original parking stock butter, or other butter, or both, and melting the same so that 
 ; Minnesota, Chapter 1 ti of 1887. 
 
366 DAIRY PRODUCTS. 
 
 MILK. 
 
 Milk is m far more urgent need of protection than any other food. 
 It is far more liable to adulteration and pollution than any other im- 
 portant food and its adulteration and pollution is attended with far more 
 serious consequences. Cows' milk is the sole food of a large number of 
 infants, the chief food of nearly all young children and the mainstay in 
 the nourishment of adults in sickness and convalescence. The impor- 
 tance of protecting this food has long been recognized and far greater 
 efforts have been made for this than for the control of any other food 
 material ; but the ease with which milk can be adulterated, and the 
 great profit of the operation, are obstacles which can be overcome only 
 by the utmost vigilance in the enforcement of stringent laws ; and the 
 labor and care which are required on the part of the producer to secure 
 a clean milk are so great that little progress has yet been made towards 
 obtaining this much to be desired result. 
 
 The temptations for milk adulterations are so great that many yield 
 among the producers, and also among the middle-men and peddlers, when 
 such intervene between the producer and the consumer. An important 
 source of trouble is the nature of the methods which must be employed 
 to determine adulteration. The principles of chemical analysis are so 
 little understood by men of average education that it is comparatively 
 easy for unscrupulous milkmen and their still more unscrupulous at- 
 torneys to convince honest producers and dealers that the inspectors and 
 chemists are unjust and perhaps unprincipled in the methods employed 
 to secure convictions. By such persuasions the adulterators can present 
 a powerful and often very respectable front to any effort to secure the 
 purity of the milk supply. 
 
 The subject naturally divides itself into two parts : First, the pre- 
 vention of the sale of adulterated or diluted milk, or milk poor in nutri- 
 tive ingredients, and secondly, the attempt to secure clean milk, milk 
 which is free from dirt, and particularly milk which is free from the 
 micro-organisms, either pathogenic germs, or those which simply injure 
 the quality of the milk. The first of these has received by far the 
 greater attention, and for thirty years an active warfare has been waged 
 
 the butter fat can be drawn off or extracted, then mixing the said butter fat with 
 skimmed milk, or milk, or cream, or other milk product, and rechurning or rework- 
 ing the said mixture, or that produced by any process that is commonly known as 
 boiled, process or renovated butter, unless the same is branded or marked as pro- 
 vided in section 2 of this act. 
 
 " Sec. 2. No person, firm, corporation, agent or employe shall sell, offer or 
 expose for sale, or deliver to purchaser, any boiled, process or renovated butter, as 
 defined in section 1 of this act, unless the words ' Renovated Butter 1 shall be plainly 
 branded. ..." 
 
DAIRY PRODUCTS. 367 
 
 in the larger cities against diluted milk. The cleanliness of milk has, 
 however, only lately received much attention, and in fact, it is only 
 lately that the true importance of cleanliness has been understood. 
 Comparatively little has yet been accomplished in this direction. The 
 prevent ion of the sale of diluted milk will be considered first. 
 
 ADULTERATED MILK. 
 
 Legislatio)i. 
 
 There is no federal milk law, but much has been done in the spheres 
 of both state and municipal legislation. As in all food legislation, the 
 Btate laws are the most important, though many valuable municipal 
 regulations are found, particularly concerning cows and stables. 
 
 Some sort of milk legislation is found in all the states except Alabama, 
 Arizona. Arkansas, Delaware. Florida, Idaho. Louisiana, Mississippi, 
 Montana. New Mexico, North Carolina, South Dakota, Tenni 
 Texas. West Virginia, and Wyoming. The fact that all of the above 
 Bxcepl Arizona and New Mexico have oleo laws directed against a far 
 less serious form of substitution offers food for reflection. While there 
 is no general legislation on this subject in the above states, several 
 cities situated in them, either, as is usually the case, by virtue of their 
 general sanitary powers, or under a special statute, have attempted to 
 protect themselves by local regulations. Among such cities maybe 
 mentioned Wilmington, Del., New Orleans, Nashville, Memphis. 
 
 Of course it is possible to tight milk adulteration under the general 
 laws againsl food adulteration, which in excellent form have been en- 
 acted in some of the states mentioned, as Tennessee and Mississippi, but 
 always much more satisfactory to act under a special statute. 
 
 Milk legislation must first of all define what kind of milk shall not 
 old. The following are some of the laws under which excellent 
 work has been done : 
 
 Massai husetts, Public Statutes i L882), Chapter 57: 
 
 ■• m < . 5 cis amended by section 2, chapter 318, acts of L886) : Whoever, by him- 
 lelf or by his servanl or agent, or as the servant or agenl of any other person, sells 
 ■ hanges, or delivers, or lias in his custody or possession with intenl to sell or 
 exchange, or exposes or offers Eor sale or exchange, adulterated milk, or milk to 
 which water <>r any other foreign substance has been added, or milk produced from 
 cows ted on the ref use of distilleries, or from sick or diseased cows, or milk not ol 
 
 g I standard quality, shall for a tiist offense be punished by fine of uot less than 
 
 l il'iy nor more than two hundred dollars; for a second offense by fine of nol less than 
 
 '•a.- hundred nor more than three hundred dollars, or bj imprisonment in the bouse 
 
 irrection for nol less than sixty days; and for a subsequent offense by fine of 
 
 fifty dollars and bj imprisonment in the 1 se of correction for nol less than sixtj 
 
 nor more than ninety daj s. 
 
 11 Sec. 9 (as amended in section 6 of chapter 352 of the acts of the year 1885, and 
 tion 2 of chapter 318 of the acts ol the year 1886, and bj section 2, chapter 398, 
 
3f>8 DAIEY PRODUCTS. 
 
 acts of 1890) : In all prosecutions under this chapter, if the milk is shown upon 
 analysis to contain less than thirteen per cent, of milk solids, or to contain less than 
 nine and three-tenths per cent, of milk solids exclusive of far. or to contain less than 
 three and seven-tenths per cent, of fat, it shall be deemed for the purposes of this 
 act to be not of good standard quality, except during the months of April, May, June. 
 July, August, and September, when milk containing less than twelve per cent, of 
 milk solids, or less than nine per cent, of milk solids exclusive of fat. or less than 
 three per cent, of fat, shall be deemed to be not of good standard quality. 1 ' 
 
 New York, Revised statutes (1895), p. 38 (Agricultural Law): 
 
 " Sec. '22. No person shall sell or exchange, offer or expose for sale or exchange, 
 any unclean, impure, unhealthy, adulterated, or unwholesome milk, or any cream 
 from the same, or sell or exchange, or offer or expose for sale or exchange, any 
 article of food made from such milk, or of or from cream from the same, or manu- 
 facture from any such milk or cream from the same any article of food. 
 
 "The term adulterated milk, when so used, means: 
 
 " 1. Milk containing more than eighty-eight per centum of water or fluids. 
 
 " 2. Milk containing less than twelve per centum of milk solids. 
 • 3. Milk containing less than three per centum of fats. 
 
 " 4. Milk drawn from cows within fifteen days before and live days after parturi- 
 tion. 
 
 •• •">. Milk drawn from animals fed on distillery waste or any substance in a state 
 of fermentation or putrefaction or on any unhealthy food. 
 
 •• 6. Milk drawn from cows kept in a crowded or unhealthy condition. 
 
 "7. Milk from which any part of the cream has been removed. 
 
 ••s. Milk which lias been diluted with water or any other fluid, Or to which has 
 been added or into which has been introduced any foreign substance whatever. 
 
 •All adulterated milk shall be deemed unclean, unhealthy, impure, and unwhole- 
 some. The terms pure milk or unadulterated milk, when used singly or together. 
 mean sweet milk not adulterated, and the terms pure cream or unadulterated cream, 
 when used singly or together, mean cream taken from pure and unadulterated 
 milk. 11 
 
 It is seen from the above that milk which it is forbidden to sell is 
 variously described and many definitions other than those above men- 
 tioned are sometimes found. Not only is adulterated, impure, unhealthy 
 and unwholesome milk forbidden, but it must not lie unclean in Georgia, 
 Minnesota, and Iowa, tainted or corrupted in Illinois, unmerchantable 
 in Washington and Wisconsin. Deleterious substances must not he 
 added in Indiana, Kansas, Kentucky, Maine and other states, and in many 
 places it must not he watered. In Pennsylvania and Colorado ice must 
 not be added to it, In Virginia milk must not he sour and oil must not 
 be mixed with it. In New York, Indiana, Maine, Michigan, Nebraska. 
 Rhode Island. Vermont, and Virginia it is forbidden to sell milk from 
 which any [>art of the cream has been removed ( except as provided 
 for skimmed milk). In Georgia, Illinois, Indiana, Iowa, Michigan, 
 Nebraska, Vermont, and Virginia milk must not be sold from which has 
 been taken what is known as strippings. 
 
 The use of coloring matter has been forbidden in Oklahoma and in 
 Omaha and Denver, and such a provision would be frequently found it 
 
DAIRY PRODUCTS. 369 
 
 it were not that it is forbidden by the general adulteration laws of quite 
 a number of states. 
 
 The use of preservatives is forbidden in Michigan, Minnesota, New 
 Jersey, Pennsylvania. Washington, and "Wisconsin. The increasing use 
 of antiseptics will probably call for more of such legislation in the near 
 future. The Pennsylvania law is given below. 1 
 
 As it is properly assumed that milk from sick or poorly nourished 
 cows will be dilute even if not diluted, and will be deficient in valuable 
 nutritive qualities, milk of this character is frequently proscribed, as in 
 the Massachusetts and New York statutes above given. Most milk 
 laws forbid the sale of milk from sick or diseased cows, in Indiana from 
 injured cows, and in Bridgeport from disabled cows. Various forms of 
 sickness an- sometimes specifically named, as ulcers, abscesses, and run- 
 ning soies in Georgia and Iowa. Tuberculosis is especially named in 
 New Hampshire, Milwaukee, Portland, Lynn, and a number of other 
 cities. Besides New York, California. Georgia, Iowa. Minnesota, 
 <>n, Washington and Chicago. Atlanta, and New Haven forbid the 
 sale of milk drawn from cows fifteen days before or five days after 
 calving. In Wisconsin and Minnesota it is fifteen days before ami four 
 days after, in Indianapolis sixty days before and twelve days after, in 
 Denver fifteen days before and after, and in Bradford, Pa., it is merely 
 forbidden for four days before calving. In Colorado it is forbidden to 
 sell colostrum. 
 
 The Stabling of COWS has a marked effect upon the milk, hence the 
 provision of the New York law that milk shall be considered "adulter- 
 ated when drawn from cows kept in a crowded or unhealthy condition." 
 A. similar provision is found in New Hampshire, California, Ohio, Wash- 
 ington and Atlanta, the City of New York.- Chicago. Buffalo, Cleve- 
 land, Louisville, Denver, Rochester, and a number of other cities. 
 
 By "swill milk," is usually meant the milk from cows \\-<\ on " dis- 
 
 Pennsylvania, Chapter 118 of 1897: 
 ec. I. That the sale or offering for sale of milk '>r cream for human consump- 
 tion in i Jii>. commons ealt li to which has Kern added boracic acid salt, boracic acid, 
 ■alicylic acid, salicylate of soda, or an] other injurious compound or substanci 
 artificially coloring the same shall I ■ * - a misdemeanoi and punishable by a line of 
 not less than fifty nor more than one hundred dollars, or imprisonment no! exceed- 
 ing sixty days, or both, or either, at the discretion oi the court." 
 k Sfork, Sanitarj Code (1899), Sec. 59: 
 
 n"i shall any preson bring or send to said citj any unwholesome, 
 
 skimmed, watered or adulterated milk. ..r milk known as "swill milk," or milk 
 
 hoi ws ■•! other animals that for the most part have been kepi in stables, or that 
 
 iiav.- been fed in whole or in part on swill, or milk from sick or diseased cows oi 
 ftther animals, or anj butter or cheese made from any such milk, '.r an] unwhole- 
 some hut ter or cheese.' 1 
 
370 DAIRY PRODUCTS. 
 
 tillery slops," or refuse from distilleries and the sale of this sort of milk 
 is forbidden by the majority of milk laws and the feeding of refuse 
 from vinegar factories is forbidden in Chicago, Omaha, and Milwaukee. 
 The use of " brewers grains" is not so universally condemned as that of 
 distillery refuse, but it is forbidden in Indiana, Kentucky, Maine, Mich- 
 igan, Minnesota, New Hampshire, Utah, Denver, Omaha, Scranton, and 
 other places. They may be used in Rochester if not over three clays 
 old. While there is some dispute as to the use of brewers' grains, there 
 is none as to the use of garbage, and the provision of the New York 
 law which is also found in several other states that milk shall not be 
 drawn from " cows fed on any substance in a state of fermentation or 
 putrefaction," is intended to cover garbage and also distillery refuse and 
 brewers' grains as usually fed. Lest this provision be too sweeping, it 
 is provided in New York and Minnesota : 1 " This section shall not 
 prevent the feeding of ensilage from silos." 
 
 Massachusetts, 2 New Jersey, and Colorado specifically forbid the 
 feeding of garbage to milch cows, and so do the City of New York, 
 District of Columbia, Rochester, and many other cities. 
 
 A very excellent provision is found in New Orleans 3 which could 
 be well adopted in many other cities. The practice of selling spring 
 water in cities has furnished an excuse to milkmen for carrying cans of 
 water in their wagons. By so doing they can readily evade the inspec- 
 tor by adulterating the milk as it is delivered, thus having no watered 
 milk on hand from which the inspector can take samples. 
 
 The primary object of most of our milk legislation was the preven- 
 tion of the sale of watered or skimmed milk as pure full milk. The 
 watering and skimming of milk are by far the most common forms of 
 tampering with this food, though the addition of coloring matter, as 
 annatto, and preservatives, as borax, salicylic acid, and formalin, is not 
 very uncommon in the cities. All of these adulterations may be readily 
 detected by chemical tests. 
 
 1 Minnesota, Chapter 295 of 1899, Sec. 5. 
 
 2 Massachusetts, Chapter 326 of 1889: 
 
 *' Whoever knowingly feeds or has in his possession with intent to feed to any 
 milch cow, any garbage, refuse or offal collected by any city or town, or by any 
 person having authority from any city or town, by contract or otherwise, shall be 
 punished by imprisonment in the jail or house of correction not exceeding sixty days 
 or by a tine not exceeding one hundred dollars." 
 
 3 " New Orleans, Ordinance No. 7583, 16 May, 1893: 
 
 " . . . That no vendor of milk in the public streets and places shall place 
 within, or carry, or have, in or about the vehicle in which the milk shall be carried 
 or kept for sale, or from which it is sold, or have in any can or vessel carried by 
 hand at the same time as milk is similarly carried for sale, any water or liquid of 
 any description other than milk or cream." 
 
I) AIR Y PR 01) UCTS. 
 
 371 
 
 It will be seen at once that while it is easy to forbid the sale of milk 
 which is of poor quality, from any one of the numerous causes above 
 given, it is no easy matter to prove to a jury that a given sample of 
 milk is watered, adulterated, impure, drawn from cows diseased, fed on 
 distillery slops, etc. Normal milk, that is milk drawn from approxi- 
 mately healthy animals in fair condition, has such a variable composi- 
 tion that it would be an almost hopeless task to prove beyond a reason- 
 aide doubt in the minds of twelve men that a certain lot was "not of 
 good standard quality." Heme it has been found necessary to fix a 
 legal standard and provide that milk which is below that standard shall 
 be considered adulterated. 
 
 The following are the state and municipal standards adopted: 
 
 Milk .Standards. 
 
 STATES. 
 
 Dist. of Columbia 
 
 Georgia 
 
 Iowa 
 
 Maine 
 
 Massachusetts 
 
 April-Sept 
 
 Michigan 
 
 Total 
 
 solids. 
 
 Percent. 
 
 Minnesota 
 
 New | [ampshire. . 
 
 H ■ '■ Jersey 
 
 New Ymk 
 
 Ohio 
 
 May and .June. 
 
 n 
 
 Pennsylvania 
 
 cities _■ I and 3d class.) 
 
 Rhode Island 
 
 • s "uth Carolina . . . 
 Vermont 
 
 Ma\ and -I line . 
 
 Washington 
 
 Wisconsin 
 
 12.5 
 12 
 13 
 12 
 12.5 
 Sp.grav. 
 1.029-33 
 13 
 13 
 12 
 12 
 12 
 
 11.5 
 12 
 
 12.5 
 Sp.grav. 
 L.029-33 
 
 12 
 
 Solids 
 not fat 
 
 Perct 
 
 9 
 8.5 
 
 12.5 
 12 
 
 9.3 
 
 8.5 
 9.25 
 
 Perct 
 3.5 
 
 3.5 
 
 3 
 
 3 
 
 3.7 
 
 3 
 
 3 
 
 3.5 
 
 3 
 3 
 
 3 
 
 12 p. c. 
 cream 
 
 by \ol. 
 
 2.5 
 3 
 
 CITIES. 
 
 Atlanta. . . 
 Baltimore. 
 
 Bridgeport 
 
 Chicago 
 
 Colorado Springs. 
 
 Denver 
 
 New Haven 
 
 New Orleans. 
 
 Omaha 
 
 St. Louis. . . . 
 San Antonio. 
 
 San Francisco. 
 
 Total 
 solids. 
 
 Percent, 
 
 12 
 
 12 
 Sp.grav. 
 1.029+ 
 
 12 
 
 1? 
 12 
 11.5 
 Sp.grai . 
 1.029+ 
 
 13 
 
 Sp.grav. 
 
 1.029+ 
 
 12 
 
 12 
 
 12 
 
 Sp.grav. 
 
 1.029+ 
 
 12 
 
 Solids 
 not fat. 
 
 Perct. 
 
 Fat. 
 
 Perct 
 3 
 3 
 
 3.5 
 
 3.5 
 
 3 
 
 2.8 
 3 
 
 Thai these standards are In-low the average of the milk sold in the 
 emu in unities to which the} apply, is shown by tests in manj cities. Thus 
 in 1898, in .Milwaukee, 1 of 6,328 samples, including those which were 
 idulterated, the average percentage of fal was 3.76. In Cleveland the 
 average of (3,002 samples was, fats, :> >.s per cent, and solids L2.S1 per 
 
 Milwaukee, Report of Commissi ir of Health for year ending \pni. 1899, p. 9. 
 
372 DAIRY PRODUCTS. 
 
 cent. This included 647 samples which were below the standard. 1 In 
 the District of Columbia 2 in 1897 the average of 193 samples of pine 
 milk taken during the year was 3.84 per cent, fats, the lowest being 
 11.85 per cent, solids and 3 per cent. fats. The New York 3 , inspectors 
 find that " for the greater part of the year the majority of the herds 
 supplying the city yield milk containing four per cent, and over of 
 fat."' In Newport, R. I., in 1896, the average of 38 samples (all that 
 were taken) was 3.75 per cent, fat, or 50 per cent, above the state 
 standard. 
 
 It is also to be remembered that prosecutions are rarely undertaken 
 unless the samples fall one-half of one per cent, below standard, as it is 
 unwise usually to go before a jury on a less margin. 
 
 The only real objection to fixing a milk standard is that it is mani- 
 festly unfair and unreasonable to fix a very high standard or a standard 
 which shall be above the average of milk produced. As a matter of 
 fact nearly all existing standards are much below the average. The 
 result is,, that unscrupulous producers and dealers, and their number is 
 legion, soon learn to test their milk and water it down to the legal 
 standard. This is a serious evil, but a far less evil than indiscriminate 
 watering that would take place without regulation by means of a legal- 
 ized standard. 
 
 The groundless objections that are urged against a legal standard 
 are that it is unjust, unless fixed so low as to pass the poorest milk 
 which any cow can produce. Such a low standard would of course be 
 useless, for very poor milk can be obtained from poor cows poorly fed. 
 Reasonably good cows, reasonably fed, will always yield a milk fully up 
 to even a high standard as standards go. 
 
 It is objected that the state has no right to attempt to improve or 
 regulate the breed of cows or quality of milk by legislation. It is the 
 opinion of the writer that this is a perfectly proper governmental 
 function and similar supervision has long been exerted in other direc- 
 tions. The state establishes the weight of a bushel of oats and by so 
 doing it requires that a certain minimum of nutriment shall be con- 
 tained. The state can as well establish a minimum for the nutritive 
 qualities of milk. 
 
 Skimmed Milk. 
 
 The temptation to sell as pure milk, milk from which a part of the 
 cream has been removed, is almost as great as is the temptation to sell 
 watered milk. The sale of such milk, even as skimmed milk, is there- 
 
 1 Cleveland, Report of Public Health Division (1890), p. 40. 
 
 2 District of Columbia, Report of Health Officer (1897), p. 36. 
 
 s City of New York, Report of Department of Health (1896), p. 170. 
 
I>MliY PRODUCTS. 
 
 6 i 6 
 
 fore prohibited in many states along with milk that is " impure, adulter- 
 ated, or unwholesome.'' The sale of such milk is absolutely prohibited 
 in Georgia, Indiana, Kansas, Kentucky, Nebraska, Vermont, Virginia, 
 and Washington. In Michigan it is forbidden to sell it to creameries, 
 and in New York it must not be sold except to skim cheese factories. 
 except when it is properly designated, and its sale is absolutely prohib- 
 ited in the City of Xew York. In Xew Jersey the absolute prohibi- 
 tion «»nly applies to cities of the first class. In the District of Columbia 
 and Massachusetts skimmed milk must not be sold if it contains less 
 than 9.3 per cent, of milk solids exclusive of fat. In Milwaukee it is 
 forbidden to sell skimmed milk containing less than !» per cent, of milk 
 solids exclusive of butter fat. In Buffalo 1 "skimmed milk must not 
 contain a less percentage of casein and salts than that contained in 
 unskimmed milk." In Pennsylvania skimmed milk must not contain 
 less than -.'•> per cent, fat and must have a sp. gr. of 1.032 to 1.037. 
 In Rhode Island, if milk contains less than 2.5 per cent, of milk fats 
 it shall be labeled ''skimmed." Usually the provisions in regard to 
 skimmed milk define the article as milk from which "cream has been 
 removed " or "from which the cream or any part thereof has been 
 remoA ed." 
 
 The following is the New York law: 2 
 
 'JExcept in the counties of New York and Kings, the prohibitions contained in 
 
 this article against the sale of adulterated milk shall not apply to skim milk, which 
 i> clean, pure, healthy, wholesome and unadulterated, except by skimming, sold for 
 use in the county in which it is produced i>r an adjoining county, if it is sold for 
 and as skimmed milk." 
 
 Several of the above mentioned states are engaged very extensively 
 in the manufacturing of cheese and butter, and it is to protect the 
 creameries chiefly that these provisions are made. In fact, the prohibi- 
 tion is in a number of the states. Indiana, Kansas, .Michigan, Nebraska. 
 and New York, contained in aids referring principally to creameries. 
 
 Some other states, as .Maine, .Massachusetts. Nevada, Ohio, Penn- 
 sylvania, South Carolina, and the cities of Balti re ami Denver, forbid 
 
 the sale of skimmed milk only when il is sold as the pure article. 
 -Maine. Nevada, and South Carolina arc the only ones of these states 
 that do not go further, and specify how its character shall be indicated 
 when sold. 
 
 Very great objection is in some quarters made to the sale of 
 '•separator"" milk under the name "skimmed milk," as the former con- 
 tains less than 0.5 per cent. fat. 'This is forbidden by the Pennsylvania 
 
 Buffalo, Ordinances, chapter 25, Sec. 92. 
 - 'New York. Revised Statutes (1806), p. 38 (Agricultural Law, Sec. 81). 
 
374 I>4 IRY PR OJJ UC T8. 
 
 law, but an unfavorable decision was recently given by the court. 1 It 
 would certainly seem that separator milk ought not to be sold except 
 under its true name. 
 
 Express directions are given as to how the skimmed milk shall be 
 labeled in many states and cities. 2 The following is the Massachusetts 
 law: 
 
 " No person, by himself or his agents, shall sell, exchange, or deliver, or have in 
 his custody or possession with intent to sell, exchange, or deliver, milk from which 
 the cream or any part thereof has been removed, unless in a conspicuous place upon 
 every vessel, can, or package of more than two quarts capacity from or in which such 
 milk is sold, exchanged, or delivered the words 'Skimmed milk' are distinctly 
 marked in plain, uncondensed Gothic letters not less than one inch in length, said 
 marking to be in dark letters on a light ground, and to be on the vessel, can, or 
 package itself and not upon a detachable label or tag; and unless in a conspicuous 
 place upon every vessel, can, or package of two quarts or less capacity from or in 
 which such milk is sold, exchanged, or delivered the words 'Skimmed milk' are 
 distinctly marked in plain, uncondensed Gothic letters, said marking to be in dark 
 letters on a light ground, and to be either on the vessel, can, or package itself, or 
 upon a detachable label or tag. Whoever violates the provisions of this section shall 
 ,be punished by the penalties provided in section five.'" 3 
 
 In Connecticut the label must not be over six inches below the top 
 of the can. The New Jersey law is like the Connecticut, except that it 
 requires the label to be soldered to the can, as do the regulations of 
 Rochester 4 and Yonkers, when the milk is sold from a can. In those 
 cities when sold from any other vessel the letters are to be fastened 
 thereto as the board of health or milk inspector may direct. In Chicago 5 
 and Milwaukee there is to be 
 
 " Conspicuously attached thereto a steel or metal plate tab on which shall be 
 engrossed the words ' Skimmed Milk,' in large, plain, distinct letters; said steel or 
 metal plate tab shall not be less than three (3) inches by five (5) inches in size." 
 
 In Scranton there is to be attached a printed tag. In Rhode Island, 
 Ohio, and District of Columbia the label is to be attached above the 
 centre of the can, and in Minnesota it is to be on top or where it can 
 be plainly seen. The size of the letters is often specified. Usually it 
 is 1 inch high, sometimes 1 by 1-2 inch, but in Omaha it is 2 inches. 
 In New Haven the letters must be black. In Baltimore the words 
 
 1 Commonwealth vs. Ilufnal, Supreme Court, 7 January, 1898. 
 
 -Connecticut, District of Columbia, Illinois, Massachusetts, Minnesota, New 
 Hampshire, New Jersey, Ohio, Pennsylvania, Rhode Island, and outside of these 
 states in Atlanta, Buffalo, Chicago, Milwaukee, Minneapolis, New Orleans, Omaha, 
 Rochester, and Yonkers. 
 
 : * Massachusetts, Public Statutes (1882), Chapter 57, Sec. 7, as amended by Chap- 
 ter 352 of 1885, and 398 of 1896. 
 
 4 Rochester, Ordinances of Board of Health No. 1G, Sec. 4. 
 
 5 Chicago, Ordinances of 21 November, 1892, Sec. 19. 
 
DAIRY PRODUCTS. 875 
 
 skimmed milk must be visible across the street. While most of the 
 laws merely require the marking of the cans, Buffalo and Fitchburg 
 require that the wagon shall be marked also, and in Fitchburg a special 
 license must be obtained. 
 
 < 'ondensed Milk. 
 
 Massachusets, New York, and Ohio are the only states which have 
 regulations concerning condensed milk. The Massachusetts statute 
 merely requires that every package of condensed milk shall be marked 
 with the name of the maker, the brand and the contents, 
 
 The New York and Ohio laws are alike; 1 
 
 •• N'ii person shall manufacture, sell, exchange, expose, or offer for sale or ex- 
 change, any condensed milk, unless the package, tan, or vessel containing the same 
 shall hi; distinctly labeled, stamped, or marked with its true name, brand, by whom 
 and under what name made, and no condensed milk shall he made, exchanged, ex- 
 posed, or offered for sale or exchange, unless the same be made from pure, clean, 
 healthy, fresh, unadulterated, and wholesome milk, from which theYream has not 
 been removed, or unless the proportion of milk solids contained in the condensed 
 milk shall be in amount the equivalent of twelve per centum of milk snlids in crude 
 milk, and of such solids twenty-live per centum shall be fat. 11 
 
 A similar rule is found in Chicago. 2 In the City of New York it is 
 forbidden to sell adulterated condensed milk. 
 
 •■ The term "adulterated," when used in this section, refers to condensed milk in 
 which the amount of fat is less than twenty-five per cent. <>f the milk solids con- 
 tained therein, or to which any foreign substance whatever lias been added, except- 
 ing sugars, as in preserved milks.'' ; 
 
 In St. Louis it is provided that condensed milk, cream and butter- 
 milk are exempt from the provisions of the milk law. In Omaha it is 
 permitted to sell sour milk and buttermilk. 1 
 
 Each of the inspectors in the City of New York are instructed to 
 obtain three samples of condensed milk each week. 
 
 < 'ream. 
 
 A number of the milk laws include the word cream in the provision 
 
 Which forbids the sale of adulterated, diseased and unwholes e milk, 
 
 though in St. bonis it is expressly exempted from the action of the 
 ordinance. Chicago has a special section Eor cream 6 which, after for- 
 
 »Ohio, A.nnatated Statutes (1900), Sees. 12004 42). 
 'Chicago, Ordinance of 21 November, 1892, See. 26. 
 
 \e U y,,ik. Sanitarj Code i L899), See. 65, 
 ' < imaha, M ilk < Ordinance, Sec. 10: 
 
 •• Nothing in this ordinance shall i>e so construed as in prohibit the sale .a sour 
 milk or what is known as buttermilk, provided the same is produced from pure, 
 wholesome milk ami is sold as such." 
 
 icago, Ordinance of 21 November, 1892, Sec. 20. 
 
376 DAIRY PRODUCTS. 
 
 bidding the sale of cream taken from milk the sale of which is pro- 
 hibited, fixes a standard of 15 per cent. fat. In Denver the standard 
 is 25 per cent, solids, of which 16.25 per cent, must be fat. In San 
 Francisco the percentage of fat must be 9.5 per cent, in January, Feb- 
 ruary, April, May, and June ; 9 per cent, in March, July, August, Sep- 
 tember; 10.5 per cent, in October, November, and December. In Min- 
 nesota the statute fixes the standard of cream at 20 per cent. fat. In 
 St. Louis it is 22 per cent, solids, of which 12 per cent, shall be fat. 
 
 In milk laws, as in all adulteration laws, it is necessary to describe 
 the material which is proscribed, the act which is forbidden, and the 
 persons liable. The provisions in regard to the character of the milk 
 have been considered. Among the many provisions of the different 
 state laws defining the forbidden act may be mentioned the following : 
 No person shall sell, exchange, furnish, supply, distribute, deliver, expose 
 for sale, etc., have in possession or custody with intent to sell, etc., 
 cause to be sold, etc., deliver for domestic use, sell for human food, 
 bring to another for domestic or potable use, or to be connected with 
 any product of human food, transport or carry for the purpose of sale. 
 The word knowingly is added in Georgia, Indiana, Kansas, Kentucky, 
 Maine, Nebraska, Nevada, Pennsylvania, Virginia ; and willfully in 
 Maine. The act of adulteration is forbidden in California, Michigan, 
 New Hampshire, and Pennsylvania. 
 
 Many laws simply provide that "no person shall sell," and in 
 Georgia and South Carolina the words " corporation " and " agent " are 
 added. In Illinois, Indiana, Kansas, Kentucky, Nebraska, and Virginia 
 " whoever " sells adulterated milk is liable to suffer the penalty. In a 
 few states more specific terms are employed ; in the Connecticut law 
 " No person by himself or his agents or his servants ; " in Rhode Island 
 " Every person . . . for himself, or as the employee of any other 
 person ; " in New Hampshire " every person acting as the employee of 
 another." The laws of Massachusetts, Michigan, and Ohio make use 
 of the expression " whoever by himself or by his servant or agent or as 
 the servant or agent of any other person." 
 
 The penalties prescribed for the violation of milk laws are often 
 quite severe, though on the whole not so severe as for the violation of 
 the butterine laws. Penalties may be of various kinds, as fines, im- 
 prisonment, advertising, revocation of license, and destruction of the 
 milk. 
 
 The lowest minimum fine is $5 in the District of Columbia, the 
 highest minimum is §50 in Ohio and Vermont. The smallest maximum 
 is |50 in Minnesota, the highest -^500 in Indiana and St. Louis. The 
 average fine is perhaps from $25 to $100. Imprisonment is an alter- 
 
DAIRY PRODUCTS. 377 
 
 native in the District of Columbia, Idaho, Illinois, Massachusetts, Min- 
 nesota. Nevada, New Hampshire, Ohio, Oklahoma, and Washington: 
 the maximum is six months in Washington. The District of Columbia, 
 Maine. Massachusetts, Ohio, New Jersey, and Rhode Island have more 
 severe punishment for the second and subsequent offence than for the 
 first. In Massachusetts and Rhode Island the first offence is punished 
 by fine, but in Rhode Island the second offence and in Massachusetts 
 the third offence must be punished by imprisonment. It is sometimes 
 provided, as in Vermont, that the person injured by the sale of bad 
 milk may recover damages from the seller. 
 
 The Massachusetts, New Hampshire, and Rhode Island 1 laws pro- 
 vide that the names of convicted dealers shall be published, and this is 
 the practice in Chicago and some other cities. In Philadelphia the 
 names of dealers against whom legal action is taken are published in 
 the newspapers. In Nashville and in Warren, O., all the milk analyses 
 are published. 
 
 In most cities a person may not sell milk without a license, and in 
 such cases the revocation of the license after violation of the milk laws 
 is a most severe and effectual means of punishment. It does not 
 appear that any of the statutes which provide for the licensing of 
 dealers, except that of New Hampshire, provide for the revocation of 
 the license: but such is the practice in Buffalo, Chicago, Cleveland, the 
 District of Columbia, Milwaukee. Minneapolis, New Haven, Rochester, 
 and other cities. In Minneapolis, however, it is done under the 
 charter, 2 and perhaps the same is true of other cities. In \e\\ Jersey 
 a person twice convicted of violating the state law is not allowed to 
 sell milk for two years. In Yoiingstou n. < >., the dealer also forfeits 
 his bond of #300. 
 
 It is very often possible for inspectors acting under the general food 
 laws t<» seize and destio\ adulterated milk; but special provision is 
 made for this in New York, 3 and in the regulations of Milwaukee.' San 
 Francisco, Fitchburg, Chicago, 6 and other cities: and the reports show- 
 that it is the practice in Allegheny, Baltimore, Bradford, Pa., Denver, 
 and the C it} of New York. In Milwaukee the inspectors must take 
 
 1 Rhode Island, General Laws (1896), Chapter 146: 
 
 "Sec. 12. Every inspector of milk shall cause the name and place of business 
 <>f all persons convicted under this chapter to be published in i\\" newspapers 
 published in the town or countj where the offense shall have been committed'. 11 
 
 Minnesota, Chapter it::. Special Laws 1 1889), Sub-Chapter I. Sec. 16. 
 \eu STork, Revised Statutes (1806), p. 2418 (Public Health Law, Sec. 45). 
 ' Milwaukee, Ordinance, 19 October, 1891, Sec. 12. 
 Chicago, Ordinance, 21 November, 1892, Sec. 30. 
 
378 DAIRY PRODUCTS. 
 
 duplicate samples from all milk destroyed, and give one sample to the 
 dealer together with a certificate of the amount destroyed. If the 
 analysis shall show that the milk is not adulterated, it must be paid for 
 by the city. 
 
 Licenses. 
 
 One of the most valuable means of controlling the milk supply is 
 by licensing the dealers in that commodity. This is a very general 
 practice in American cities. The licensing of dealers is required in the 
 District of Columbia, Iowa, Massachusetts, Minnesota, New Hampshire, 
 North Dakota, and Rhode Island, and is permitted by the laws of New 
 Jersey. In Massachusetts, New Hampshire, and Rhode Island it is 
 restricted to those cities and towns in which milk inspectors are ap- 
 pointed, in Minnesota to cities and towns of over 1,000 inhabitants, and 
 in Iowa to cities of 10,000 inhabitants and over. Sometimes, as in the 
 District of Columbia, only those who bring milk into the city are 
 licensed. In other places, as Rhode Island and Buffalo, peddlers only 
 are licensed, but in most cases all dealers in milk, whether peddlers or 
 storekeepers, are licensed, though in many instances, as in Massachu- 
 setts, Minnesota, New Hampshire, and the City of New York, the two 
 classes are treated somewhat differently. The Massachusetts law is 
 given below. 1 
 
 1 Massachusetts, Public Statutes (1882), Chapter o7, Sees. .°> and 4: 
 "In all cities, and in all towns in which there is an inspector of milk, every 
 person who conveys milk in carriages or otherwise for the purpose of selling- the 
 same in such city or town shall annually, on the first day of May, or within thirty 
 days thereafter, be licensed by the inspector or inspectors of milk of such city or 
 town to sell milk within the limits thereof, and shall pay to such inspector or in- 
 spectors fifty cents each to the use of the city or town. The inspector or inspectors 
 shall pay over monthly to the treasurer of such city or town all sums collected by 
 him or them. Licenses shall be issued only in the names of the owners of carriages 
 or other vehicles, and shall for the purposes of this chapter be conclusive evidence 
 of ownership. No license shall be sold, assigned, or transferred. Each license shall 
 record the name, residence, place of business, number of carriages or other vehicles 
 used, name and residence of every driver or other person engaged in carrying or 
 selling said milk, and the number of the license. Each licensee shall before engag- 
 ing in the sale of milk cause his name, the number of his license, and his place of 
 business to be legibly placed on each outer side of all carriages or vehicles used by 
 him in the conveyance and sale of milk, and he shall report to the inspector or in- 
 spectors any change of driver or other person employed by him which may occur 
 during the term of his license. Whoever, without being first licensed under the 
 provisions of this section, sells milk or exposes it for sale from carriages or other 
 vehicles, or has it in his custody or possession with intent so to sell, and whoever 
 violates any of the provisions of this section, shall for a first offence be punished by 
 fine of not less than thirty nor more than one hundred dollars; for a second offense 
 by fine of not less than fifty nor more than three hundred dollars; and for a subse- 
 
DAIRY PRODUCTS. 379 
 
 Besides the general laws providing for the licensing of milk dealers, 
 a number of cities have such provisions in their charters, or are author- 
 ized to do it by special acts, as Baltimore 1 and Xc\v Haven. Again 
 many cities control their milk supply by virtue of their grant of general 
 sanitary authority, even if milk is not specifically mentioned in the 
 enabling act. Among such cities are Buffalo, Cincinnati, Cleveland, 
 Nashville, New York, and Rochester. 
 
 The authority which grants the license varies in different localties. 
 In Iowa the whole matter of milk control, including the issuing of 
 licenses, is in the hands of the state dairy commissioner. The New 
 Jersey laws permit the common council or other governing body of 
 cities and towns to provide for licensing as they may decide best. In 
 Massachusetts, New Hampshire and Rhode Island, where milk inspect- 
 ors are in most cities independent officers, elected by the city council, 
 the licensing of dealers is left to the inspectors. In most cases it is the 
 sanitary authority which issues milk licenses. Sometimes it is the 
 board of health or department of health, as in Allegheny, Atlanta, 
 Detroit, Louisville, New Haven, New York, Pittsburgh, and Rochester. 
 In the District of Columbia, Chicago, Denver and Omaha, it is the 
 health commissioner. In Cleveland it is the director of police of which 
 department the health bureau is a part; in Buffalo, the mayor, in 
 Minneapolis, the city council, in Scranton, it is the secretary of the 
 board of health, and in Cincinnati and other Ohio cities, the health 
 officer. 
 
 The recent movement of health officers to secure good milk requi res 
 the control, or at least inspection of the conditions under which the 
 milk is produced and hence a knowledge of the producers is required. 
 'I'he tracing of adulteration and the following up of outbreaks of disease 
 presupposes a knowledge of the location of the producer of every can of 
 
 milk. d'<» se< are the informati scessary tor a proper control ot a 
 
 milk supply many cities require the applicant for a license to furnish 
 
 the data required for such control. An g the cities which do this 
 
 ma\ be mentioned Buffalo, Chicago, Cleveland, Denver, District oJ 
 
 Columbia, Minneapolis. New Orleans, and the City of New York, 
 
 (|iicin offense by fine of titty dollars and by imprisonment in the bouse of correction 
 fur ma less than thirty aor more than sixty days. 
 
 •• Every person before selling mili or offering it for sale in a store, booth, stand. 
 or market place in a city or in a town in which an inspector or inspectors of milk 
 ;m appointed shall register in the books of such inspector or inspectors, and shall 
 pay to liim or them fifty cents to the use of such city or town; ami whoever oeg- 
 o to register shall be punished for each offense by fine no! exceeding twentj 
 dollars/ 1 
 
 1 Maryland, Chapter 58 of 1894. 
 
380 DAIRY PRODUCTS. 
 
 and some smaller cities, as Asbiuy Park, X. J., Nashua, X. H., Lynn, 
 Warren, ( ).. and Yonkers. A committee appointed by the Massachu- 
 setts Association of Boards of Health which gave the question of milk 
 supply most careful study reported this as the first step necessaiy for a 
 proper control. 1 Most of the cities mentioned require a written ap- 
 plication usually on blanks furnished by the city. Forms of application 
 are shown in Appendices 43-45. 
 
 In the District of Columbia the application must be •' accompanied 
 by such detailed description of the dairy farm where said milk is pro- 
 duced as said health officer ma}" require and by a sworn statement as to 
 the physical condition of the cattle supplying the milk.'" In Cleveland 
 and Denver the information derived in this way is to be recorded in a 
 •book which is to be open to the inspection of the public. In Cleveland 2 
 and Louisville the license is granted only on condition " that no milk 
 shall be sold contrary to the provisions of the preceding section." viz. : 
 the rules against adulteration, etc. In Baltimore, Colorado Springs, and 
 Lynn, a license is not issued until the premises of the producer have 
 been inspected. 
 
 In Minnesota all peddlers or venders of milk in cities must make 
 quarterly reports to the state dairy commissioner on blanks furnished 
 by him of the amount of business transacted. In Iowa there is a sim- 
 ilar law. In Asbury Park 3 milk dealers are required to furnish to the 
 board of health when requested a list of persons from whom they buy, 
 and also of their customers. 
 
 In most state and city regulations it is provided that licenses shall 
 be issued annually, though in the City of New York and a few small 
 places this does not appear to be the case. It is certain that licenses to 
 be of much value to the city must be renewed annually, or else, as in 
 New York, the licensee must be required to give notice at once of any 
 change in the information given on the blank : and the licensees must 
 be held strictly to this. 
 
 In regard to fees for the licenses, three methods may be pursued : 
 no fee mav be charged : the fee may be nominal, or it may be made a 
 source of revenue. In Atlanta, Baltimore, Cincinnati. District of Col- 
 umbia, Minnesota, Providence, Rochester, Yonkers, and a few other 
 places no fee is charged. In Hartford it is twenty-five cents. In Massa- 
 chusetts. Xew Hampshire, and Xew Haven it is fifty cents. In Cleve- 
 land, Denver, Iowa, and Minnesota it is one dollar. In Buffalo it is two 
 
 Journal of Massachusetts Association of Boards of Health. December. 1897. Vol. 
 VII., p. 119. 
 
 2 Cleveland. Ordinances, Chapter 30, Sec. 551. 
 
 3 Asbury Park, X. J., Sanitary Code(189T), Sees. 7 and 8. 
 
DAIRY PRODUCTS. 381 
 
 dollars for each vehicle and three dollars for each dealer who brings 
 milk into the city. In Yoimgstown, O., the fee is one dollar and twenty- 
 five cents (twenty-five cents for the clerk). In Chicago and Omaha 
 the fee is ten dollars : and in Fort Wayne. Ind., twenty-five dollars, but 
 in Omaha: 
 
 •Any person owning less than ten (10) cows and delivering milk by hand, or from 
 his or her residence, shall pay a license fee of one dollar ($1.00) for each cow, and 
 any person selling milk from any store or other place of business, and selling less 
 than ten gallons per day. shall pay a license fee of live dollars (15.00). 
 
 In Chicago the amount received for milk licenses goes to the labor- 
 atory fund. In that city the rule about licensing provides: 
 
 •• That tliis section shall not apply to private persons who own one or more cows 
 and who sell milk therefrom to their neighbors or customers by peddling the same 
 by hand."' 
 
 Iowa. Buffalo, Chicago, Denver, and Omaha require that a license 
 
 shall be taken out for each wagon. Examples of licenses are shown in 
 Appendix 40. 
 
 For tin- purpose of the easy identification of licensees it is usually 
 provided that the wagons used by them shall be marked in some con- 
 spicuous and distinctive manner. Such a requirement is found in the 
 laws of California, Illinois. Massachusetts, Minnesota. New Hampshire. 
 Rhode Island, and in Pennsylvania in boroughs of over 1,000, hut is 
 usualh dealt with in the local regulations of cities. Almost all of 
 these regulations require that the name of the licensee he placed on the 
 Jragon, though in one instance " City .Milk License " with the date is 
 all that is required 1 and in Chicago the name is not required. Massa- 
 chusetts, New Hampshire, Buffalo, Chicago, Denver, District of Colum- 
 bia, Kite hburg, Minneapolis, and some other cities require the number 
 of tin- license. California, .Massachusetts. Minnesota, and New Hamp- 
 shire require that the place of business as well as the name shall appear, 
 while Illinois. Atlanta, District of Columbia, New Orleans, and Penn- 
 sylvania cities of the second class require the name of the daily or the 
 place from which the milk is obtained. 
 
 Most of the rules require that the lettering shall be "legible" or 
 
 f Conspicuous," or " plain," and some, as Denver that it shall be kept 
 |0. When milk is uol -old from a wagon, but from a can carried b\ 
 
 hand, or is sold in a store, it is sometimes required thai the can shall be 
 
 marked. The Rochester rule is given below.- In other cities than 
 
 1 Little Falls, N. V. 
 
 1 Rochester, Ordinances of Board of Health, No. 16, Sec. i 
 " Sucli license number shall lie painted on such wagon or vehicle m numbers not 
 less than three indies in height, in what is known as Gothic characters, ami shall be 
 
382 DAIRY PRODUCTS. 
 
 Rochester the size of letters or figures is specified. Sometimes, as in 
 New Orleans, like Rochester it is three inches. In Atlanta it is four 
 inches, Cincinnati two inches, Colorado Springs and Denver one and 
 one-half inches. In Fitchburg the number " must be painted on both 
 sides of the wagon in letters two inches in length and one and one-half 
 inches in width, and in some color contrasting with that of the wagon." x 
 Plain, satisfactory, and uniform lettering is secured in Chicago, Mil- 
 waukee, 2 and Omaha 3 by requiring that the licensee shall exhibit on 
 both sides of his wagon a tin sign furnished by the city free of charge. 
 
 Besides lettering the wagons several cities provide that the license 
 shall be kept posted in the wagon at all times. This is the rule in 
 Denver, Colorado Springs, Fitchburg, and Scranton, and in Fitchburg 
 the licenses for stores which in Massachusetts is different from that for 
 wagons, must be kept posted in the stores, and a similar rule is in force 
 in Minneapolis and Milwaukee, in which city the notice is furnished by 
 the inspector. 
 
 It is a great help to the inspector to have a sign of some sort ex- 
 hibited in stores showing from what dealer or dairy the milk was obtained ; 
 hence such a regulation is found in a number of cities, as Buffalo, the 
 District of Columbia, Cincinnati, Cleveland, and Louisville. In the 
 District of Columbia it must be posted in bakeries as well. 
 
 Each of the inspectors in the City of New York is instructed to 
 procure three samples of cream each week, but as there is no legal 
 standard for cream, the samples are tested for coloring matter and pre- 
 servatives only. They vary much in their fat contents. 4 
 
 Inspection. 
 
 Milk laws are of little value unless active measures are taken to 
 enforce them. There must be a constant supervision of the dealers and 
 inspection of the milk. This is so important that a number of states in 
 their food, milk or dairy legislation have provided for it. Sometimes 
 
 placed on such wagon or vehicle under the direction of the board of health or its 
 milk inspector; and in case milk is sold from cans or vessels, where no wagon or 
 other vehicle is used, then the license number of the person, persons, or corporation 
 selling, or offering for sale such milk, shall be placed in a conspicuous place on such 
 can or vessel, in such manner as to style of number and method of fastening the 
 same on such can or vessel as to meet the approval of the board of health or its 
 milk inspector, or, if such milk is sold, or exposed for sale within a store or house, 
 then such license number shall be exposed in some conspicuous place in said store 
 or house. 11 
 
 1 Fitchburg, Rules and Regulations, Board of Health (1S97), p. 32, rule 7. 
 
 2 Milwaukee, Ordinance of 23 October, 1891. 
 
 3 Omaha, Milk Ordinance, Sec. 4. 
 
 4 New York, Report of Board of Health (1896), p. 172. 
 
DAIRY PRODUCTS. 383 
 
 this control is exercised wholly or partially through state agencies. In 
 some states, as in Massachusetts and Maryland, the state board of health 
 through its agents looks after the milk as well as other foods. Usually 
 the work of the state inspectors is confined to the smaller cities and 
 villages, as most of the larger communities are provided with their own 
 local inspectors. Other states have dairy or dairy and food commis- 
 sioners who perform similar functions. In Iowa, Washington, and Wis- 
 consin the commissioner apparently has full control of the milk supply, 
 there being no local inspectors except in Milwaukee. In Iowa the 
 dairy commissioner is authorized by statute to appoint an agent in each 
 city of over 10,000 inhabitants, to collect from each dealer not more 
 than four times a month, samples of milk offered for sale. The com- 
 pensation is three dollars for each day actually employed. There are 
 thirteen such cities in Iowa where 500 dealers supply milk to 40,000 
 families. There is one agent in each city appointed by the state dairy 
 commissioner. 1 In Pennsylvania, Ohio, and Michigan the daily com- 
 missioner, and in Pennsylvania the state board of agriculture look after 
 the local milk supply to some extent. 
 
 The chief need for milk inspection is in the cities, and usually the 
 cities appoint their own inspectors. Doubtless it is possible under a 
 grant of general sanitary legislative power for municipalities to provide 
 for milk inspection, even though no direct authority is given in the 
 general statutes or in their charters. There is no legislation providing 
 for the appointment of milk inspectors in Ohio, Illinois, Nebraska, Xew 
 York. Missouri, Tennessee, and Kentucky, yet many of the important 
 cities in those states have appointed milk inspectors and adopted rules 
 for the control of the milk supply, though there is no specific authority 
 in their charters for them to do so. 
 
 The importance of milk inspection has induced several states to 
 Legislate concerning it.'- 
 
 The Maine, Massachusetts, New Hampshire, and Rhode Island laws 
 
 an- milch alike. The following is that of .Massachusetts: :; 
 
 •• Tin- mayor and aldermen of cities shall, and the selectmen of towns may. 
 
 annually appoint oi r more persons to be inspectors of milk for their respective 
 
 places, who shall he sworn before entering upon tin- duties of their office. Bach 
 inspector shall publish a notice of his appointment Eor two weeks in a newspaper 
 published in his citj or town, or, if no newspaper is published therein, In- shall post 
 up such notice in two <>v more public places in such city or town. 
 
 - mIi inspectors shall keep an office ami shall record in ln.oks kept for tin- pur- 
 
 l Iowa, Report of Dairy Commissioner (1897), p. 186. 
 
 •Among these an- Colorado, Mainr. Massachusetts. Michigan, Minnesota, NTe^ 
 Hampshire, \'-u Jersey, Pennsylvania, ami Rhode Islam). 
 
 Massachusetts, Public Statutes 1882), Chapter 57, s «-rs. l •_'. as amended bj 
 Chapter 318 ol 1886. 
 
384 DAIRY PRODUCTS. 
 
 pose the names and places of business of all persons engaged in the sale of milk in 
 their city or town. Said inspectors may, with the approval of the mayor or the 
 selectmen, employ suitable persons to act as collectors of samples, who shall be 
 sworn before entering upon their duties. Said inspectors, or the collectors em- 
 ployed and qualified as aforesaid, may enter all places where milk is stored or kept 
 for sale, and all carriages used for the conveyance of milk, and the said inspectors 
 or the collectors may take samples for analysis from all such places or carriages, and 
 at the same time a portion of each sample so taken, shall, if the person taking the 
 same be requested so to do, be sealed and delivered to the owner or person from 
 whose possession the same is taken and a receipt given therefor to the person taking 
 the same. 
 
 " The inspectors shall cause the samples of milk so taken to be analyzed or other- 
 wise satisfactorily tested, the results of which analysis or test they shall record and 
 preserve as evidence. The inspectors shall receive such compensation as the mayor 
 and aldermen or selectmen may determine." 
 
 As in Massachusetts, so in Maine, the law is mandatory, but only 
 for towns of over 3,000 inhabitants. The other state laws are only per- 
 missive. The Minnesota statute which was enacted in 1895 gives au- 
 thority to appoint inspectors of milk, dairies, and dairy herds. 
 
 With the exception of Colorado and New Jersey all of the laws 
 above referred to place the appointment of milk inspectors in the hands 
 of the city council or similar body rather than in the hands of the board 
 of health. In Colorado the statute gives the power to the board of 
 health, and in New Jersey the cities may so provide if they so desire. 
 It is an important question whether the control of" the milk supply 
 should be under the jurisdiction of the board of health or confined to an 
 independent officer. The state legislators have evidently thought best 
 to make the milk inspector an independent officer appointed by the city 
 council. The cities have thought otherwise, for by special acts the 
 cities of Boston and Lynn have, within a few years, succeeded in placing 
 their milk supply under the control of the board of health, and in those 
 states in which the statutes do not provide how the inspectors shall be 
 appointed they are usually in the board of health. This is true of Bal- 
 timore, Buffalo, Chicago, Cincinnati, Cleveland, District of Columbia, 
 Minneapolis, Nashville, New York, Omaha, Philadelphia, Pittsburgh, 
 Rochester, and San Francisco. The efficiency of some of these cities 
 in looking after their milk supply would indicate that such an arrange- 
 ment is satisfactory. If the sanitary condition of v the cows, dairies, 
 wagons, vessels, etc., is to be controlled at all, it would seem that the 
 health department would have better facilities for doing it than an inde- 
 pendent officer. A recent discussion by health officers in Massachu- 
 setts 1 brought out the fact that while milk inspectors were appointed 
 by the councils, rules for the control of dairies must be made by boards 
 
 1 Journal of the Massachusetts Association of Boards of Health, Vol. VII, p. 116. 
 
DAIRY PRODUCTS. 335 
 
 of health, and it appeared that unless the milk inspector was also ap- 
 pointed by the board of health there might easily be an unfortunate 
 conflict. Effort is made in some .Massachusetts cities, as Lowell and 
 Fitehburg, to secure co-operation between the milk inspectors and the 
 board of health, but such efforts may not always he successful. 
 
 Several of the inspection laws, as those of Massachusetts, Xew 
 Hampshire, Rhode Island, and Wisconsin, give the inspectors the right 
 t<» enter premises and vehicles for the purpose of taking samples, and 
 similar provisions arc found in municipal ordinances. 
 
 I'm successful milk inspection three things are to he done ; first the 
 milk must be inspected in the hands of producers and dealers: second. 
 the samples must he tested and analyzed: third, the offenders must he 
 prosecuted. In many cities all these things may he done by one and 
 the same person, usually the milk inspector, hut perhaps by the food 
 inspector, the chemist or the health officer. Other cities, particularly 
 the larger cities, have found it advisable to separate these functions 
 among different officers. To consider the last first, it may he said that 
 in the majority of places the police or law officers actually see to the 
 preparation of the evidence and the presentation of the cases for prose- 
 cution, or else this work is done under their immediate supervision. 
 The milk acts do not usually refer to this matter as it is covered by 
 other laws, lait in Rhode Island the inspector is empowered by the 
 act 10 prosecute, and in the District of Columbia and Hartford it is 
 made the duty of the city attorney, and in Detroit of the chief of 
 police. 
 
 The successful prosecution of milk adulterators presupposes the 
 chemical analysis of the suspected milk. Hence milk inspectors are 
 usually chemists or else have a chemist under them, or refer directly to 
 the municipal chemist. Thus in Baltimore, Brooklyn, Buffalo, Chicago, 
 Cleveland, Milwaukee, the City of New York, and San Francisco, the 
 inspection of milk is made a part of the general food inspection, and in 
 nearl\ even instance thai division or bureau is presided over by a 
 chemist, and in ever) instance has a chemist in its employ. In New 
 Orleans the city chemist looks after the milk supply. In other cities. 
 ;is Atlanta, Newark. Pittsburgh, and doubtless many smaller places, the 
 milk inspector is simph an inspector and collector of samples, and 
 hands over the samples to the < - i 1 \ chemist for analysis. When the 
 milk inspection is not merged in a division ,,\' food inspection, by far 
 
 the st common way is to require the milk inspector to he a chemist 
 
 skilled in milk analysis. 
 
 W Idle milk inspectors who are trained chemists do often make all 
 their own inspections and collect their samples, yet ii hardly seems 
 
386 DAIRY PRODUCTS. 
 
 wise to employ a skilled person for such service, and in large cities 
 it is necessary for the chemist to have assistants to collect samples. 
 
 The appointment of collectors by the inspectors is provided for in 
 the Massachusetts and Rhode Island laws, and such officers have been 
 appointed elsewhere, as in Chicago, Milwaukee, New Orleans, New 
 York, Philadelphia, and San Francisco. In Detroit the police, in Cleve- 
 land the sanitary police, and in Milwaukee sanitary inspectors are some- 
 times detailed to collect samples. In Chicago the inspectors wear the 
 badge and insignia of the police (furnished at their own expense). 
 It might be expected that this would identify them too readily to the 
 milk dealers, thus giving one with poor milk a chance to get out of the 
 way. 
 
 Sometimes, as has been said, the milk inspection in the larger cities 
 is made a part of the general food inspection. In other cities the milk 
 inspector is sometimes a food, meat or vegetable inspector as well. This 
 is true of a number of the Massachusetts cities, and Allegheny, Atlanta, 
 Columbus, Evansville, Newark, Salt Lake City, Scranton, and Youngs- 
 town, O. In San Antonio and Hartford the sealer of weights and meas- 
 ures is the milk inspector. In Lancaster, Penn., and Memphis the health 
 officer makes the tests of the milk and is practically the inspector. In 
 Terre Haute, Ind., the sanitary inspector must be a skilled milk in- 
 spector, and in Warren, (..)., the sanitary policeman is the milk inspec- 
 tor. In Brookline and Pittsfield, Mass., the milk inspector is also the 
 veterinarian. 
 
 The following is a list of cities with the officials controlling the milk 
 supply and their salaries : 
 
 Number of Annual 
 
 City. Inspectors. Salary. 
 
 Baltimore 2 milk inspectors 1,000 
 
 Boston 1 chemist 3,000 
 
 1 chemist 2,400 
 
 3 collectors per day 3 
 
 Buffalo 2 milk inspectors 1 ,000 
 
 Chicago 1 milk inspector 1,500 
 
 6 milk inspectors 900 
 
 Cincinnati 1 chemist 1,200 
 
 Denver 1 chemist 900 
 
 Hartford '. 1 chemist 1.000 1 
 
 Milwaukee 1 chemist 1,200 
 
 1 milk inspector 800 
 
 Minneapolis 1 bread and milk inspector 900 
 
 1 veterinarian 1,000 
 
 2 dairy inspectors 1,000 
 
 Newark 1 milk inspector 1,000 
 
 New Orleans 1 milk inspector 1,300 
 
 1 Is also sealer of weights and measures. 
 
DAIRY PBODUCTS 387 
 
 Number of Annual 
 
 City. [nspectors. Salary. 
 
 New York (Borough of Manhattan) . . 1 milk inspector 1,500 
 
 i> milk inspectors 1,200 
 
 Philadelphia 1 chief milk inspector 1,900 
 
 4 assistant milk inspectors 1,020 
 
 5 collectors 720 
 
 Pittsburgh 1 chemist 1,500 
 
 1 collector 1,200 
 
 Providence 1 chemist 2,000 
 
 1 chemist 800 
 
 _' collectors per week 15 
 
 Rochester 1 chemist 1,200 
 
 1 collector 2,100 
 
 1 collector 600 
 
 St. Louis 1 milk inspector 1,500 
 
 2 dairy inspectors 2,100 
 
 St. Paul 4 milk inspectors 900 
 
 s > ra< use 1 milk inspector 1,200 
 
 For salaries of food and milk inspectors see also p. :'.44. 
 
 The methods employed in supervising the milk supply vary in dif- 
 ferent cities, owing to the differences in the source of supply and man- 
 ner of distribution. In cities containing up to 100,000 inhabitants, and 
 Sometimes in larger cities surrounded by an easily accessible agricultural 
 feountry, the milk is chiefly distributed directly to the customers by the 
 producer. The farmer keeps his own cows and sells the milk to the 
 consumer, delivering it from his wagon which is driven to the city in 
 the earl} hours of the morning. Sometimes he may buy some milk 
 from his neighbors, and occasionally a country dealer may buy all the 
 milk which In- delivers to his customers. In Providence about four- 
 fifths of the milk is thus brought in on wagons from a distance of a 
 dozen miles or less. In the larger cities the milk supply must neces- 
 sarily coine chiefly from a longer distance, and this has necessitated its 
 transportation by railroad and the development of the middleman. 
 
 Boston 1 and New York- are excellent examples of this class of city. In 
 Boston about three-fourths of the milk is railroad milk and in New 
 JTork a much larger proportion. In Boston some of the milk comes a 
 distance of 1 |<i miles, and in New Fork 300 miles. The transportation 
 companies use ice freely in specially constructed ears : the milk nsnalh 
 arrives in the city in good condition, that is, it is not sour. This milk 
 is purchased of the fanners by middlemen who have depots in the <it\ 
 ;it which it is received. In some cities the business has been much con- 
 
 Milk supply of Boston and other Ne^ England cities. Bulletin 20. Bureau "' 
 
 Animal Industry. I. S. Department "i Agriculture, 1808. 
 
 tf< \ Fork, Report of Depari at of Health (1800), pp. 90-04. 
 
388 DAIRY PRODUCTS. 
 
 solidated and is in the hands of a few persons who distribute the milk 
 from very extensive establishments. These middlemen sell to the 
 retail dealers who distribute it to their customers each morning. The 
 milk is usually at least thirty-six hours old before it reaches the con- 
 sumer. Milk is also sold from stores, the amount sold in this way dif- 
 fering greatly in different cities. Usually the amount is greater in 
 larger than in smaller places. Generally some milk is produced in the 
 city itself. Usually the amount is not large. In New York it is about 
 five per cent, of the total supply ; in Baltimore ten per cent. ; more than 
 is brought in on wagons. 
 
 In those towns and cities where milk is distributed from wagons by 
 the producer directly to the consumer, with perhaps the intervention of 
 a few stores, the problem of the inspector or collector, for usually there 
 is only one for such a town, is comparatively simple. He has to be on 
 hand early in the morning to intercept the milkmen on their way from 
 the country to the city, and later to visit the stores. In the larger cities 
 it is necessary not only to inspect the milk on the wagons and in the 
 stores, but also to look after it while it is in the depots of the middle- 
 men and as it is received from the railroads. The relative attention 
 given to these different parts of the business varies, as the experience 
 in different cities has shown, that one part or another is the greatest 
 seat of danger. In Boston. Chicago, New York, and Philadelphia com- 
 paratively little attention is given to the receiving depots, while the 
 reverse is true in Baltimore, Cleveland, and San Francisco. In San 
 Francisco the milk comes into the city through four stations and every 
 can is tested. The inspectors claim that subsequent tests from the 
 Avagons in the city show that the milk is not adulterated by the dealers 
 after it leaves the station. In Baltimore the incoming milk is tested at 
 six stations. In New York, Chicago, and Denver most attention is 
 given to stores; in the first named city seven out of eight inspectors are 
 occupied mostly in this work, and only occasionally visit receiving- 
 depots, and one only is detailed to look after the milk as it is delivered 
 from wagons. In the large cities of Brooklyn, Chicago, New York, and 
 Philadelphia, where there are several inspectors, each inspector is usu- 
 ally assigned to a certain district of the city, and in Brooklyn and 
 Chicago the assignment is frequently changed. Usually inspectors 
 make their rounds on foot, but in Providence, owing to the speed with 
 which certain milkmen drove out of sight at the collector's approach, 
 the latter was furnished a horse and buggy, which he uses in his work. 
 In Providence and Newark the inspectors direct their attention chiefly 
 to the wagons of the peddlers. 
 
 The inspectors" and collectors' outfit and duties vary according as 
 
DAIRY PRODUCTS. 389 
 
 different methods of testing are relied upon. There are two main 
 methods of testing milk: one is by the use of the lactometer to deter- 
 mine its specific gravity, and the other is by chemical analysis which 
 determines the percentage of solids and of fat. 
 
 A practical difficulty in the use of the lactometer is that it is only 
 reliable at the temperature for which it is graduated. If the milk is 
 above or below that temperature the readings will not be correct. 
 Hence this instrument should always be used in conjunction with a 
 thermometer, and the best lactometers have a thermometer blown in the 
 glass with the graduation above that of the lactometer. Lactometers 
 are usually intended to be used at a temperature of 60 , and if the milk 
 is above or below that, a correction must be made by means of a table 
 which has been prepared for that purpose, or for ordinary usage one 
 degree of the board of health lactometer, so-called, must be subtracted 
 from every three degrees which falls below 60 c or added for every three 
 degrees above. Even this correction is not reliable for over 10° of tem- 
 perature either way. and it is more satisfactory if the milk is within 5 
 of il<» . (Mm- greal objection to the use of the lactometer is that while 
 the removal of cream raises the specific gravity the addition of water 
 towers it so that the skillful milkman by employing both processes can 
 produce with much profit to himself a fluid with the specific gravity of 
 pnaltered milk. The watery blue appearance of this watered ami 
 skimmed milk would betray its character to the skilled inspector. 
 Special instruments have been devised to supplement the skill of the 
 observer in detecting the removal of cream. A.mong such that have 
 been to some extent used by milk inspectors are the pioscope and lacto- 
 scope. 
 
 The former of these consists of a disc of hard rubber with a depres- 
 sion in the centre and the rim surrounding this painted in segments to 
 pepresenl cream and milks of various degrees of richness. A drop of milk 
 is placed in the centre and covered with a glass to give a uniform thick- 
 ness. The color of the milk is then compared with standard colors on 
 the rim. The pioscope is used some m San Francisco. The lactoscope 
 is used somewhat in Philadelphia and a \\'\v other cities. Neither of 
 the two instruments is used nearly as much as the lactometer. 
 
 Formerly the lactometer was much relied upon in milk inspections 
 
 and was used exclusively in inan\ large cities, and conviction OH its 
 evidence was secured in New York in 1878 in the celebrated "milk 
 
 cases" 1 and more recently in Baltimore. 2 The difficulties in the m 
 
 the lactometer have been referred to. the must important being that 
 
 except in the hands of a skilled and careful observer, much watered 
 
 1 The People vs. Daniel Schrumpf, Supreme < lourt, A.pri] term, 1878. 
 -.lelin W. Deems vs. Mayor and Citj I ouncil of Baltimore, 1894. 
 
390 DAIR Y PR OB J 7 ' 7'.s. 
 
 milk will l>e passed as pure: but the skill of an inspector is very uncer- 
 tain ground to rest a case on before a jury. The fact that few states or 
 cities have fixed the standard for milk in terms of specific gravity still 
 further limits the use of this instrument, for it can only be used suc- 
 cessfully for prosecutions when the standard is fixed in specific gravity 
 degrees. A specific gravity standard is established in Michigan, Oregon, 
 Pennsylvania cities of the second class. Baltimore, New Haven. New 
 Orleans, San Francisco, and San Antonio. Its showings may, however, 
 be used as a basis for destroying milk as is done in New York and Bal- 
 timore, and in Baltimore it is the sole reliance in such cases. But the 
 chief use of the lactometer is to furnish a rough test to guide the 
 inspector. If he finds that the readings indicate a quality below the 
 standard, he takes a sample for chemical analysis ; if otherwise he passes 
 on to another inspection. In this way it is claimed much labor is saved 
 the chemist and a much larger amount of milk can come under the cog- 
 nizance of the inspector. In the majority of cities the inspectors are 
 provided with means for using the lactometer, and also for taking samples 
 of suspected milk. 
 
 The following instructions for the use of the lactometer are given 
 by the board of health in New York City : x 
 
 "To test for water the lactometer can be used as follows: Stir the milk to be 
 tested so that a fair sample can be taken. Warm or cool enough milk to 60° Fahren- 
 heit to fill the testing cylinder. Insert the lactometer in the milk in the testing 
 cylinder, being careful not to wet that part of the stem above the milk, and observe 
 where it floats. Pure niilk will not fall below the 100° mark on the lactometer 
 at 60° temperature. It must be remembered that skimming the milk will make 
 the lactometer float higher, and the addition of water or cream may make it sink 
 lower than 100°, but if the appearance of the milk upon the lactometer is noted, no 
 one can mistake watered milk for milk to which cream has been added, nor pure 
 milk for milk from which the cream has been removed, as in skimmed milk. In 
 other words, if the lactometer floats below 100° and the milk looks thin, water has 
 been added. If it floats above 100° and the milk looks thin, it may be skimmed, or 
 skimmed and watered. But if it floats above 100° and looks creamy and yellow 
 and sticks to the glass, you can be reasonably sure that it is pure. Good average 
 milk will indicate about 109° on the lactometer at a temperature of 60° Fahrenheit, 
 and show about fourteen per cent, of cream by the cream test." 
 
 The method of milk inspection is perhaps as complete as anywhere 
 
 in New York City : 2 
 
 11 Each inspector is provided with a suitable bag containing a lactometer and 
 thermometer, both of which have a distinguishing number, they having been tested 
 as to their accuracy by the chemists, and the record of such tests kept for reference; 
 the number of the instrument, the date tested, the results and the name of the 
 chemist who performed the test are tabulated, so that should any dispute arise as 
 to the accuracy of any instrument used this record can be referred to. 
 
 iCity of New York. Report of the Department of Health (1896), p. 110. 
 2 City of New York, Report of Department of Health (1896), p. 97, et seq. 
 
DAIRY PRODUCTS. 
 
 391 
 
 •• Hi- is also provided with an inspection book, which is numbered with consecu- 
 tive numbers (see diagram), indicating the proper number of the inspection: 
 
 26 
 
 Date Hour 
 
 Street and Number 
 
 Name of < >wner 
 
 Business 
 
 From whom purchased 
 
 Number of Quarts sold Daily 
 
 Ian \m. 
 
 Amount of Contents. 
 
 Temper- Lactometer Appear- 
 Lactometer. :ltnri . at godeg. ance. O dor - ' 
 
 1 
 
 
 
 
 •2 
 
 
 
 
 3 
 
 
 
 
 
 4 
 
 
 
 
 
 Xo. of inspection, N 1626. 
 Marks on < 'ans. 
 
 REMARKS. 
 
 — also a stub-hook numbered with consecutive numbers of milk samples taken, as 
 
 follows : 
 
 Health Department, City of New York. 
 division of tood inspection \m> offensive trades. 
 
 Date 
 
 Xo. of Inspection . 
 Inspector 
 
 Witness 
 
 Name of < >\vner 
 
 Address 
 
 (Quarts Destroyed 
 Adulteration 
 
 Sample No , 
 
 Health Department, City of New Vokk. 
 division of food inspection and 0ffensiv] trades 
 
 ■tote 
 
 No. of Inspection 
 Inspector 
 
 Wit ness 
 
 Name of < >wner 
 Address 
 
 Quarts Destroyed 
 
 Ad u It e rat ion 
 
 Sample No 
 
 as required l>> Chapter 338, Laws of L898. 
 
 Six-ounce bottles for samples to be delivered to render, both sides of this bot- 
 tle perforated wit li a small hole to permii sealing with wire and lead seal ; w ire and 
 •eals and brad-awl and sealing iron, this latter having ' Health Department, V 'i 
 on reverse of die, and the distinguishing letter of the inspector, as A, K. ('. •• 
 the nbverse side. 
 
 " Four-ounce wide-mouth bottles for milk samples to be delivered to Department 
 Chemist. 
 
392 DAIRY PRODUCTS. 
 
 "A testing cylinder to hold the milk under examination, towels, labels, etc. Each 
 inspector is required to wear his official badge at all times when on duty. 
 
 ^— i - " The cylinder used to contain the milk under examination is 
 
 y ^ made in the following shape : 
 
 " The tin cup at the bottom holding a little alcohol, this enables 
 the inspector to readily warm the milk to sixty degrees Fahrenheit 
 by pouring a little alcohol in this cup, igniting the same and stirring 
 contents, while burning, with the thermometer, until the desired 
 temperature is attained. 
 
 " Chapter 338 of the Laws of 1893 requires every inspector tak- 
 ing a sample of milk for analysis to deliver to the vender or his 
 representative a sealed sample and in the presence of a witness. 
 
 " In order to comply with this law, it has been found convenient 
 to have an officer detailed from the sanitary police, to accompany 
 the inspector and so act as the witness and generally assist." 
 
 Other states and cities besides New York have regulations in regard 
 to sampling milk. In Massachusetts, Vermont, and Washington dupli- 
 cate samples must be furnished the dealer if asked for, but in Massa- 
 chusetts 1 if such a duplicate sample is not given, the evidence derived 
 from the sample taken shall be received in court. In Vermont 2 the 
 sample must be taken in the presence of the dealer and a disinterested 
 witness, and must be labeled and the label signed by the witness. A 
 witness is also required in Milwaukee, and in the District of Columbia 
 two witnesses. In Massachusetts 3 a recent law requires that the 
 analysis must within ten days be sent to the person from whom the 
 sample was obtained. 
 
 In Chicago the inspector on taking a sample makes out two slips, 
 one of which is kept in the office, and the other is given to the dealer. 
 The latter slip is shown in Appendix 47. If the dealer brings this to 
 the office, which he usually does, he can have noted upon it the results 
 of the analysis. 
 
 In Chicago each inspector carries a case of twenty-four half pint 
 bottles. In Detroit seven ounce square bottles are used. In Massa- 
 chusetts the counterfeiting of the inspector's seal is forbidden. 4 
 
 In New York City " The inspector, before the examination of the 
 milk, either in a store or upon a cart, as in the course of delivery to 
 
 1 Massachusetts, Chapter 318 of 1886, Sec. 3. 
 -Vermont, Statutes (1894), Sees. 4329-30. 
 
 3 Massachusetts, Chapter 109 of 1S99. 
 
 4 Massachusetts, Chapter 398 of 1896, Sec. 3 : 
 
 " Whoever makes, causes to be made, uses, or has in his possession any imita- 
 tion or counterfeit of any seal used by any inspector of milk, collector of samples, 
 or other official engaged in the inspection of milk, and whoever changes or in 
 any way tampers with any sample taken or sealed as provided in section two, 
 shall be punished by a fine of not less than one hundred dollars and by imprison- 
 ment in the house of correction not less than three nor more than six months." 
 
DAIRY PRODUCTS. 
 
 393 
 
 customers, ascertains, first, if the owner has a permit to sell milk, and 
 such facts as are necessary to fill in the blanks on his inspection books, 
 and also such information as might become necessary should subse- 
 quent legal steps be taken. Having recorded such information on his 
 inspection book, he next proceeds to obtain the lactometric standing as 
 follows : " In order to take a fair sample, the milk in the vessel from 
 which the sample is taken must be thoroughly mixed.'" This is doubt- 
 less the usual practice with inspectors, but it rarely receives legislative 
 notice as it does in the District of Columbia, where it is provided 1 that 
 -such sampling shall be made according to the Babcock method, to wit: 
 dumping tin- milk from one can to another not less than twice before 
 sampling." In New York- the inspector after taking his sample makes 
 the lactometer test. 
 
 " If from this examination he believes the milk to be adulterated by the addition 
 <>f water or by the removal of part of the cream, or should the taste, odor, etc., 
 indicate some other form of adulteration, the six-ounce bottle, having holes through 
 the neck, is filled from the testing cyclinder, the cork inserted, a wire passed 
 through the holes in the neck of the bottle and the cork, then twisted around the 
 bottle, the blank lead seal slipped over the ends of wire and sealed with sealing 
 iron, as in diagram. 
 
 ■• Upon tin- bottle he fastens the label required by chapter 338 bj means of gum 
 which is on the label pari of stub-boob leaf; this label, filled out as required by 
 
 law. and in the presence of the officer, delivers this sealed and labeled sample to the 
 
 render or his representative. 
 
 •• The four-ounce wide-mouthed bottle is now tilled with the milk from i lie cylin- 
 der, a label pasted upon it on which the number of the inspection ami sample 
 number is written, this latter sample being the one taken for deliver; to the 
 department chemist. Should more than one sample he taken, each bottle delivered 
 
 to the \iiii!er is marked with I he sa m pie mi in her on its la he I hy means of a marking 
 
 'lia i no ni I. This prevents the soaking off of a label frpm one sample bottle and t rans- 
 
 A.-t of 2 March, 1805, Sec. 18. 
 City of New York. Report of Kcparlinent of Health (1896), p 
 
394 
 
 JtAIBY PRODUCTS. 
 
 f erring it to one of the others, which might not be adulterated, so that on the trial, 
 if one took place, there would be a discrepancy between the results of the analysis 
 of the sample of milk made by the department chemist and those obtained by some 
 chemist employed by the vender. 
 
 " If the milk is found to be apparently pure, only the record of the result of the 
 inspection is made, and the inspector proceeds to the next place where he intends 
 to inspect the milk. 
 
 "The condensed milk is obtained for the same reason, and also to determine 
 whether it was made from skimmed or partly skimmed milk. 
 
 "After obtaining a sample, the inspector returns to headquarters and delivers 
 it to the chemist for analysis, the method of delivery being as follows : 
 
 "Upon arrival at the office, he (ills out a card, prepared for subsequent card in- 
 dexing, as in the diagram. 
 
 Form G 23-1897. C. R. Xo. 31S8. 
 
 Page No. 336. Health Department City of New York. Permit No. 8096. 
 
 3d Division (Food Inspection, Offensive Trades and Mercantile Establishments). 
 
 Inspection No. R565. Sample No. 55. Date, Jan. 31, 1897. Time, 10 a. m. 
 
 Name, Doe, John, s Business, Grocer. Years in Business, 10 years. 
 
 Address, 1200 East 16th st. Who in charge, Doe, John. 
 
 From whom purchased, D. Water, 186 Rock st. Qts. sold daily, 40. 
 
 Can 
 
 No 
 
 Con- 
 tents. 
 
 Lat-t. 
 
 Temp. 
 
 Lc't at 60' 
 
 : I2 1 ' 
 
 Can Marks. 
 
 1 
 P. II 
 
 4 
 
 01° 
 
 Appear- : Can Con- L t 
 ance,etc. | NoJtents. 
 
 Thin 
 taste, 
 flat. 
 
 Lact. No. 583. 
 Ther. No. 601. 
 
 Temp. Lc't at 60° 
 
 Appear- 
 ance, etc. 
 
 Witness, Officer Roe. 
 Dipper in Can ? Yes. 
 
 Citizen's Complaint No. 1230. 
 Held on Bail 1st Dist. Court,-! 100. 2/4/97. 
 Result of Trial, 2/10/97. Fined $150 at 
 \_) Court of Special Sessions. 
 
 Was Can Wired ? No. 
 Location of Can? In ice-box at rear of 
 store. 
 
 Date Received To Inspector 
 
 Time Q Offense. 
 
 Inspector 1st 
 
 2d 
 
 3d 
 
 Analysis, ' 'an No. 4th 
 
 Water ~) Results. 
 
 Fat I 
 
 Total Solids [ 
 
 Solids not fat J 
 
 Approved : 
 
 Assistant Chemist. 
 
 Sanitary Superintendent. 
 
 Chief Inspector. 
 
DAIR V PBODUCTS. 
 
 :;<»5 
 
 ^-except he does not at that time fill in the vender's name. (The s at name of 
 vender or representative indicates that proof of ownership was obtained.) lie then 
 delivers the sample, labeled with sample number and inspection number (only) to 
 the chemist, who signs and dates the card. This is returned to the clerk for entry 
 in the record book and indexed, a sample page of which is given below: 
 
 No 
 
 Inspector 
 
 Analyst 
 
 < obtained fn >m 
 
 Date obtained. . 
 Date delivered. 
 Date reported. 
 
 Reason for obtaining sample. 
 
 Analysis. 
 
 Lactometer at 60° Fahr. . . . 
 Equiv. to Specific Gravity . 
 Reaction to Litmus Paper. 
 
 Odor 
 
 Remarks 
 
 Water 
 
 Fat 
 
 Sugar 
 
 Casein and Albumin. 
 Salts 
 
 Total Solids 
 
 Solids not Fat 
 
 Fat by Lactoscope 
 
 •• The data obtained from the card being copied in it, together with the name of 
 tin- vender, this being taken from the stub of the "bottle label book," which stub 
 i- delivered with this card. 
 
 ••At the end of forty-eight hours after reception of sample the card is delivered 
 to the chemist, who indorses upon it the results of the analysis and returns it to the 
 chief inspector, who. after careful examination, stamps on it "Arrest, 11 or "Do Nbl 
 
 Arrest.' 1 The results of the analysis, etc., are entered in the milk 1 k, also this 
 
 iecisioo of t he chief inspector. 
 
 , Date Received, Jan. :Jlst, 1897 
 Time. 12 \i. 
 
 To inspector, Feb. 4th, 1897, 10.00 \. m. 
 Q Offense. 
 
 lsi 
 
 2d 
 
 Inspector Brown. 3d 
 
 . 1 inlh/sis. < ilu \n. I. 4tll 
 
 Water, 89.31 percent ] Results. 
 
 Fa i. 3.59 per cent I Solids 10 per cent. low. 
 
 Total Solids, 10.69 per cent Borax and Formalin. Negative. 
 
 Solids no! fat, 7.10 per cent J 
 
 Read ion. Normal. A pproved : 
 
 I II \i:i.i:s F. ROBERTS, M. D. 
 Sanitary Superinti 
 EDMUND CLARK, 
 
 . Issistant < 'hemist. 
 Feb. 2d, L897. i:i>\\ \i;i> W. MARTIN, 
 
 Feb. 2d, 1897. ( 'hief Inspector. 
 
196 
 
 DAIll Y PR OB UC Ts. 
 
 "He stamps 'Arrest 1 if the total solids are five per cent, or more below the 
 legal standard of twelve per cent. ; or if the amount of fat contained is ten per cent, 
 or more below the legal standard of three per cent., or, as in condensed milk, if the 
 arm Hint of fat contained is ten percent, or more below the legal standard of fat 
 (condensed milk must contain fat equivalent to twenty-five per cent, of the total 
 milk solids found) ; or if the cream, milk or condensed milk contains any antiseptic 
 or foreign substance. 
 
 "Should the adulteration be less, however, than in the cases cited, ' Do Not 
 Arrest' is stamped upon the card. This card is now forwarded to the sanitary 
 superintendent, who approves or disapproves the decision of the chief inspector and 
 returns the same. 
 
 " The inspector is then notified to appear at the office, and the card delivered to 
 him, with instructions for further procedure. 
 
 "Although this may appear complicated, yet usually only a few hours over the 
 forty-eight required elapse between the delivery of the sample for analysis and the 
 obtaining of the warrant, should sufficient adulteration be detected for this course 
 to lie pursued. 
 
 "At the end of each day the inspector writes on a suitable blank, headed as 
 below: 
 
 No. 
 
 Date. 
 
 Name. 
 
 Location. 
 
 Permit 
 
 No. 
 
 Lac. 
 
 — the result of his day's work. This is forwarded by mail, reaches the office in the 
 morning and is from time to time verified by a reinspection of the places recorded, 
 by another inspector who has been selected to act as " Roundsman " to check and 
 verify the work. 
 
 '•At the end of the week, a report — summary of the week — is made out and 
 delivered in person at Headquarters at 9 A. m. Mondays, as in sample given: 
 
 Health Department of the City of New York, \ 
 
 Sanitary B treat-, v. 
 
 New York 189 ) 
 
 To the Chief Inspector of the Division of Food Inspection and Ofl'ryisice Trades: 
 
 " Sir — I have the honor to submit the following report of the work performed 
 
 by me in the Inspection of Milk for the week ending Saturday 189 
 
 Sunday 
 
 Monday 
 
 Tuesday : 
 
 Wednesday 
 
 Thursday 
 
 Friday 
 
 .Saturday 
 
I) AIR Y PR 01) U< ■ TS. 
 
 
 Sow. 
 
 Mox. 
 
 Ties. 
 
 Wed. 
 
 Tucks. 
 
 FBI. 
 
 S \ r. 
 
 Total. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " Citizens' Complaints Re- 
 
 
 
 
 
 
 
 
 
 " citizens' Complaints held 
 
 
 
 
 
 
 
 Original Complaints by In- 
 
 
 
 
 
 
 
 
 Citizens' Complaints Re- 
 
 
 
 
 
 
 
 
 
 " Citizens' Complaints Re- 
 
 
 
 
 
 
 
 
 
 Citizens' Complaints under 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 " Quarts Adulterated Milk De- 
 
 
 
 
 
 
 
 
 
 Days in Country or at Labora- 
 
 
 
 
 
 
 
 
 
 
 
 :::::::: 
 
 
 
 
 
 
 
 II, -hi on Bail 
 
 
 
 
 
 
 
 
 
 Trials at Special or General 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Respectfully submitted, 
 
 Milk Inspector. 
 
 The duty of the collector is to collect and deliver to the chemist 
 samples of milk, secure all evidence that it may be necessary to use in 
 case 'it' trial, and to keep a careful record of all his proceedings. The 
 chemist on his part must analyze with great care the samples given 
 him, preserving with certainty their identity all the time, and he too 
 must carefully record his work and be prepared to explain and justify 
 it on the witness stand. In all but the largest cities all this frequently 
 has to be dmie by one man. Occasionally, as in Philadelphia, 1 St. 
 Louis, 2 and Atlanta,'' specific rules are provided for the inspectors. 
 
 As most of the milk laws prescribe a standard in terms of total 
 milk solids and milk fats, it is these elements which it is the business 
 • if the chemist to determine. The methods employed do not tall within 
 the scope of this work. The technology of milk analysis may be studied 
 in Leffman and Imam's Analysis of Milk and Milk Products, and Par- 
 tington and Wall's Trstiny Milk and its Products, h is sufficient to 
 lay that the fiaboock and Adams methods are usually adopted for the 
 estimation of the tats. There is very little legislation in regard to milk 
 analyses other than such as specifies whal chemists may be employed 
 
 id that the analyses made by them: shall be accepted :is prima facie 
 
 L Philadelphia, Rules of Board of Health (1895), til 150. 
 St. Louis. Ordinances (1893), Chapter 14, Sec. 864. 
 Atlanta, < Ordinance of 22 Maj . 1898. 
 
 ai 
 
398 DAIRY PRODUCTS. 
 
 evidence ; but in Maine 1 and Vermont 2 it is prescribed that all meas- 
 uring instruments used in milk analyses shall be first tested (in Maine 
 this is done by the director of the State College Experiment Station), that 
 sulphuric acid used in the Babcock test shall have a sp. gr. of 1.82 and 
 that no person shall test milk unless he or she has a certificate of com- 
 petency from the Dairy School. 
 
 Not only are samples collected by city officials tested in municipal 
 Laboratories, but usually the offer is made to test samples brought in by 
 citizens. A certain number avail themselves of this offer. Thus in 
 Boston in 1896 there were 277 citizens' samples, in "Cleveland in 1897 
 sixty-two samples. 
 
 Generally it is considered unwise to prosecute on citizens" samples, 
 but if they are found to be below the standard the dealer is followed 
 up by the city inspector: but in Chicago the ordinance provides that if 
 such samples are below the standard " steps shall be taken for a prose- 
 cution." 
 
 In Chicago, and doubtless in many other cities, it is customary to 
 have an analysis made by two chemists when a case is likely to go to 
 court. 
 
 When milk is found to be below the standard the authorities may 
 proceed at once to the prosecution of the offender, or if the offence is 
 the first one, or if it is believed that the dealer in whose possession it 
 was found is innocent of adulteration and the victim of another, a 
 warning notice may be sent. The form used in Minneapolis is shown 
 in Appendix 48. 
 
 It frequently happens that a dealer will so deliver milk that the last 
 half of the can will be much below the standard. If that is probably 
 the case a notice is sent. The Indianapolis form is shown below. 3 
 
 1 Maine, Chapter 169 of 1895. 
 - Vermont, Chapter 81 of 1899. 
 
 3 City of Indiaxapolis. 
 
 BUREAU OF MILK INSPECTION. 
 
 Lt You are hereby informed that a sample of milk recently obtained from you proved 
 
 not to conform to the requirements of the Ordinances. Your attention is called to the 
 fact that tli<' sale of such mill,' or its possession with intent to sell renders you liable to 
 the penalties provided by law. The sample was from a part of a can, and its poor 
 quality was owing to a deficiency i)i cream, which, by careless handling, may Jtave 
 been poured off witli the first part sold. 
 
 City Sanitarian. 
 To 
 
J) AIRY PRODUCTS. WWW 
 
 In Chicago, Philadelphia, and other cities, dealers are encouraged to 
 bring to the city inspector samples of milk to he tested when the}' sus- 
 pect that the producer may he furnishing milk below the standard. In 
 Brookline, Mass., one day in the week is set apart for this. In Phila- 
 delphia the dealers are also encouraged to use the lactometer, and a 
 circular is sent to them from the hoard of health advising them to pur- 
 chase a lactometer and thermometer and test all milk purchased. The 
 dealers are also invited to visit the milk inspector's office and receive 
 instruction in the use of the instrument. 
 
 Unclean .Milk. 
 
 Within the last few years there has grown up a very strong desire 
 on the part of sanitary officials and progressive medical men for clean 
 milk. At present this desire only affects a small part of the consumers. 
 ilic greal body of whom are content to use the dirty milk which is gen- 
 erally furnished by dairymen. It is possible at a few places, for 
 persons who are willing to pay a considerable advance for it. to obtain 
 clean milk, hut the demand is not great, and the supply is scarcely 
 equal to the demand. The great majority of milk consumers in cities 
 at Least, do not care whether their milk is clean or dirty, nor do they 
 care very much about the amount of fat it contains, provided it is cheap, 
 that is provided the price per quart is low-. At present the price of 
 dean milk appears to he necessarily higher than that ^\' dirty milk, hut 
 it does not follow that it will always he so. The history of improve- 
 ments in other forms of business leads us to suppose that it will he 
 possible tor producers to markedly improve their product without 
 increasing the cost, provided they are forced to it by competition or 
 otherwise. 
 
 If the mass of consumers continue to consider merelj the number 
 of cents per quarl which the) are obliged to pay, without regard to 
 quality, ami there is every reason to believe that they will so continue 
 there is little chance of improvement through competition, h there- 
 fore seenis to be Likely thai the milk supply so far as cleanliness is con- 
 cerned can onl\ he improved by official control. Such control is being 
 \er\ general!) urged by sanitary officials, ami also by dairy commis- 
 sioners, department of agriculture ami experimenl station officials, and 
 other educated ami experienced men who have at heart the interests oi 
 both producer and consumer. 
 
 I'»\ clean milk is meant milk free, mil only from dirt, as il is prop- 
 
 erl\ undersl I. but free IV disease producing organisms, and as free 
 
 as possible from organisms which injure the qualit) and "keeping" 
 
 power of the milk. There are several reasons wh) it is desirable that 
 
 milk shonld he dean. The least iinporlant of these is that milk con- 
 
400 DAIRY PRODUCTS., 
 
 taming cow dung and similar substances, offends the aesthetic sense : 
 but this however, has little weight with the majority. Secondly, the 
 presence of manure, hair, dirt, etc., and certain kinds of bacteria, as well 
 as the use of improper food, and the improper use of certain foods, 
 gives a peculiar " cowey " or " turnipy " taste to milk which is positively 
 disagreeable to a great many consumers and leads them to seek another 
 dealer or give up the use of raw milk. Third, the more bacteria there 
 are in milk the sooner it sours or undergoes putrefactive changes and 
 the greater the loss to the producer and consumer. This fact is one of 
 the most powerful levers to be employed in the effort to improve the 
 supply, for it is an argument which affects the pocket. Fourth, the 
 danger of producing contagious disease by dirty milk. The danger of 
 spreading scarlet fever, diphtheria, and typhoid fever will be alluded to 
 when considering those diseases. The danger of transmitting tubercu- 
 losis through the medium of milk has received a vast amount of con- 
 sideration of late, and though this danger is a real one, the relative 
 importance of this cause of human tuberculosis has not been definitely 
 determined. Lastly, there is a very great danger of gastro-intestinal 
 disturbances in infants and young children from the ingestion of milk 
 containing large numbers of bacteria. The harm may come from 
 changes produced by the bacteria in the milk before ingestion, or it may 
 come from the activity of the organisms in the gastro-intestinal tract. 
 The exact aetiology of gastro-intestinal troubles is as yet little known. 
 and accurate statistics in regard to infant mortality due to infected milk 
 are as yet lacking, yet there is little doubt in the minds of the best 
 observers that the most of the gastro-intestinal diseases of infants are 
 due to defects in the milk supply. 
 
 In order to obtain clean milk for the public, it is necessary to con- 
 trol the methods of producing milk and handling it on the way from 
 the producer to the customer. 
 
 Control of Herds and Dairies. 
 
 There has within recent years been some legislation providing for 
 the inspection or licensing of milch cows. Thus in Wisconsin 1 the 
 dairy commissioner may appoint an agent for the inspection of dairies. 
 In California 2 the state dairy commissioner is required to inspect dairies. 
 Maryland 3 requires dairymen to register their herds and provides for 
 their inspection.- 
 
 1 Wisconsin, Statutes (1898), Sec. 1410. 
 
 2 California, Chapter 136 of 1899. 
 
 3 Maryland, Chapter 300 of 1898, Sees. 19-20: 
 
 "It shall be the duty of all dairymen or herdsmen or private individuals sup- 
 plying milk to cities, towns, or villages, to register their herds of cattle with the 
 
DAIRY PRODUCTS. 401 
 
 The first public act authorizing cities to protect their milk supply 
 by control of the dairies was passed in Minnesota 1 in 1895. This law 
 lias been sustained by the courts 2 as has also the Maryland law. A 
 recent act in New Jersey 3 while not specifically providing for the 
 licensing and inspection of dairies apparently authorizes it. Special acts 
 authorizing such inspection have been passed for the District of Col- 
 umbia 4 and Pennsylvania cities of the second class. 5 
 
 Notwithstanding the dearth of specific legislative authority, a con- 
 siderable number of cities have taken more or less energetic action 
 looking to the supervision of the sources of their milk supply. In 
 many instances the action taken is merely one of inspection, advice 
 and publicity, no control being exercised. In others control is exer- 
 cised over the dairies within the jurisdiction of the municipality, and 
 in others still the attempt is made to control all the sources of the milk 
 supply of the city. In most instances what is accomplished is done 
 nnd<r the grant of general sanitary power. 
 
 A number of cities have merely made inspections of the dairies and 
 usually only those within the city limits. Sometimes such inspections 
 have been made but once, to call to the public notice the condition of 
 
 Live Stock Sanitary Board; in violation of which the parties offending shall he lined 
 rmt less than "in- dollar nor more than twenty for each offense. 
 
 •• It shall he the duly of the hive Stuck Sanitary Hoard to have inspected at least 
 annually, without notice to the owner or those in charge of any dairy or the parties 
 supplying milk as named in section l!t of this article, the premises wherein cows are 
 kept, and if such premises are found in an unsanitary condition the said board may 
 prohibit the sale and shipment of milk from such premises until such time as such 
 premises shall conform to the following sanitary rules.' 1 
 
 (These rules as well as the complete law may be found in the seventh report of 
 the state \ eterinarian.) 
 
 1 Minnesota, Chapter 203 of 1895: 
 
 "Sec. I. The city council of any city may by ordinance provide for the inspec- 
 tion of milk and of dairies and of dairy herds kept for the production of milk "Within 
 
 its limits, and issue licenses, for which no fee shall be charged, for the sale of milk 
 
 within its limits and regulate the same, and may authorize and empower the hoard 
 of health to enforce all laws and ordinances relating to the production and sale of 
 milk and the inspection of dairies and dairy herds producing milk for sale or con- 
 sumption within such city, and to appoint such inspectors, experts, ami chemists 
 necessary for the proper enforcement of such laws and ordinances, their com- 
 pensation to he lixed bj the citj council ; and sin- h inspectors, experts, and chemists 
 shall he possessed of such necessary power within the limits of such citj as shall be 
 nhed l.\ ordinance, but no such ordinance shall conflict with any law of this 
 Stat. 
 
 siatc of Minnesota oa. Mans < '. Nelson. October term of Supreme Court. 1896. 
 Neu Jersey, Act of 28 April, 1897. 
 ' Act of Congress, -J March, 1896. 
 Pennsylvania. U-1 of 26 June, 1895, Sec. 11. 
 
402 DAIRY PRODUCTS. 
 
 the dairies in the hope of inducing some municipal action to bring 
 about their improvement. Again such inspections are made annually 
 or oftener. Often when decided nuisances are found they are abated 
 under the nuisance laws. The results of all such investigations are 
 usually published in reports which do some good in calling the atten- 
 tion of the public tp the carelessness with which the milk supply is pro- 
 duced and handled. 
 
 The first step in the control of the sources of the milk supply is to 
 know where these sources are. This can only be done through the 
 licensing of milk dealers in the city and making it a' requirement that 
 the dealer shall keep the milk inspector informed as to where the milk 
 which lie sells is produced. The obtaining of such information is pro- 
 vided for in the New Jersey, District of Columbia and Minneapolis acts 
 referred to on page 400, and this method, though without special legis- 
 lative sanction, is adopted in Boston, Buffalo, Lynn, Meadville, Pa., 
 Milwaukee, Nashua, New York, Omaha, and many other cities. 
 
 The blank form used for giving the information required before a 
 license is issued varies somewhat in different cities. Those used in 
 Boston and Minneapolis are given in Appendices 43 to 45. Not very 
 much information is here required beyond a bare statement of where 
 the milk is obtained. 
 
 For the purpose of facilitating the tracing to the producer of all 
 milk sold in New York, 
 
 "The information obtained from the application blanks of wholesalers is entered 
 upon cards and arranged as follows (example of card given) " : 
 
 N. Y., Sus. & 
 W. R. R. 
 
 s Hrs. 
 
 Stillwell, James, Milford, Pike Co., Perm. 
 
 B. < ). B. 13. 
 100 Qts. 
 
 Durham. 
 
 20. 
 
 Well. 
 
 Port Jervis, Orange Co., N. Y. A. m. and p. m. 
 7.00 P. M. John Doe, 830 W. 42d St.. N. Y. C. 
 
 O 
 
 The cards are first sorted as to railroads, then as to stations, then alphabetically, 
 so that the names and addresses, amount of milk produced, etc., for all localities 
 can be ascertained at a glance. 
 
 For instance, a milk dealer named John .Smith obtains his supply from the Erie 
 Railroad from Goshen. Looking at Erie Railroad cards we find Goshen, and the 
 farmers supplying John Smith are A., B., etc., and we find on the appropriate cards 
 the number of cows, quarts of milk given, character of water-supply, time of ship- 
 ment, delivery, etc. 11 
 
 In New York also a map is prepared on which is marked the loca- 
 tion of all dairy farms under the observation of the department. 
 
 A second step is to provide for an inspection of the herds and dairies 
 from which the milk is derived. AYithout such inspection it is of 
 course impossible to secure any efficient control over most of the con- 
 ditions which determine the cleanliness and wholesomeness of the milk. 
 
 
DA IE Y PR OJD UC TS. 
 
 403 
 
 An inspection for purposes of control may be confined to the producers 
 within the city limits, as in the City of New York, Baltimore, Boston, 
 Brookline, Mass.. Cincinnati, Cleveland, District of Columbia, Grand 
 Rapids, Newton, Pittsburg, Newark, and Waltham, or it may extend 
 to all the producers supplying the city wherever they may be located 
 even if in an adjoining state, as in Asbury Park, X. J.. Atlanta, 
 Buffalo, Denver, Detroit. Los Angeles, Lynn, Meadville, Penn.. Mil- 
 waukee. Minneapolis, Nashua, X. II., Oakland, CaL, Omaha. Pittsfield, 
 Mass., Portland, Me., Rochester, St. Louis, St. Paul, Syracuse, War- 
 ren, ').. and Westbrook, Mi-. While the latter method of inspection 
 of the whole supply is the goal to be desired, the control of the 
 city dairies is easier to start with and may perhaps be extended to 
 the others. Certainly the work done by some cities, as Boston, New 
 York, and the District of Columbia, in. controlling their local supply, is 
 most commendable and may serve as a model for more extended efforts 
 on their part, as well as for other cities. This dairy inspection where- 
 ever it has been carried out has been under the direction of the local 
 health department, though state officials have sometimes been called 
 npon to assist. As the health of the animals is an important considera- 
 tion "" all dairy farms, it is advisable that a veterinarian should make 
 the inspection, or at least be called upon to examine the cows. This is 
 done in Baltimore. Brookline, Denver, District of Columbia, Lynn. 
 Minneapolis, New York, St. Louis. St. Paul, and ether cities. In Asbury 
 Park ;in agent of the state dairy commissioner inspects the herds. 
 In Denver the inspection is made in conjunction with state cattle com- 
 Brissioners and the tuberculin used is furnished by the United States 
 department of agriculture. In Portland, Me., and Westbrook. Me., 
 the animals are examined by the state board of cattle commissioners. 
 
 The result of tin* dairy farm inspection is usually reported to the 
 board of health on blanks furnished for that purpose. The blank used 
 in the District of Columbia may be found in Appendix 50. Besides 
 the filing of this report in New York, a card index is prepared giving 
 ii] in- side of the card the more general results of the sanitary in- 
 spection, ami upon the other the outline plan of the stable. 
 
 B496 
 1246 
 
 7/30/95 
 7/30/95 
 
 Map No. 1000. 
 line. Richard, 1200 W. 81st >t. 
 
 V.. >.i < low > 
 
 Wat., 
 
 Milk 
 
 in 
 12760 
 a981 
 
 Stable, l>ri<U. •_'::• 10> 20. Water for Cows, Croton. 
 Ventilation, good. Water foi washing,! roton. 
 No. Of CU. It. air \n-v COW, 1840. Disposal of Milk. Sold. 
 
 Drainage, Citj s e\\ er. 
 Manure. Removed 1 >ailj . 
 
 1 an- i, COWS, Good. 
 
 i londil ion "f < '"\\ s < rood. ^-^ 
 Pood, bran, meal. Iiaj . \_J 
 
404 
 
 J) A IB Y PR OJD TIL ' IS. 
 
 Something besides inspection is in a few cities undertaken in order 
 to 1 tetter control the condition of the animals kept by the milk pro- 
 ducers. In New York City at the time of inspection, a steel tag is 
 fastened in the right ear of the cow at a point where it is least liable to 
 be rubbed off. Each tag has a different number. The day after the 
 inspection and tagging, the cow is tested with tuberculin. 1 If any 
 animal is found to be tuberculous, 
 
 tl The healthy cows are then separated from those found to he tuberculous, and 
 a chain made of steel, with welded links, is fastened around the neck of the con- 
 demned animal by means of a padlock numbered and marked " Health Department.'" 
 This lock is sent to the inspector unlocked. He locks the chain with it, and this 
 chain cannot be removed until the time of killing as the key is kept at headquarters 
 and is not at any time in the possession of any one except the chief inspector. 
 
 "These latter are taken to a convenient place and slaughtered, with the consent 
 of tlie owner, and an autopsy made in each case. The carcass is taken to the < "tt'ai 
 Dock or destroyed in offal tank; the killing bed is then washed and disinfected, and 
 the healthy cows are allowed to return to the stable." 
 
 A record of all this work is kept as follows: 
 
 "A card is prepared giving tag number of each cow. date tagged and date and 
 result of tuberculin test (see diagram below): 
 
 
 8496 
 
 7,30/95 
 
 Wagon 1". 1246 
 
 7,30,95 
 
 730 
 
 9/4/96 
 
 • 9/5/96 
 
 731 
 
 9/4/90 
 
 9/5/96 
 
 732 
 
 9/4/90 
 
 9/5/96 
 
 t:;:; 
 
 9/4/96 
 
 9/5/96 
 
 7:H 
 
 9/4/96 
 
 9/5/96 
 
 7:;:. 
 
 9/4/90 
 
 9/5/96 
 
 730 
 
 9/4/90 
 
 9/5/90 ' 
 
 Roe, Richard, 1200 W. 01st st. 
 
 No. of Cows, 10 
 
 .Map No. loi ii. 
 
 o. K. 
 
 O. K. 
 
 O. K. 
 Positive. 
 
 (). K. 
 
 (). K. 
 Positive. 
 
 O 
 
 — and is indexed under location. 
 
 1 The details of this test are given on pp. 117-119 of the Report of the Department 
 of Health of the City of New York (1896). 
 
DAIRY PRODUCTS. 
 
 405 
 
 " The tag number of all cows examined and killed is entered upon cards as 
 follows: 
 
 "No. 1. A plain card, as in diagram below, where the cow is examined and 
 passed as being healthy. 
 
 Tag No. 
 
 Date Examined. 
 
 Smith; John. 1.3 Kossuth St. 
 
 
 26 
 
 12/12/96 
 
 Red cow. white star, dehorned. 
 
 f~\ Inspector. 
 
 ■■ No. 2. A card with the upper projection at the left, as in diagram, when the 
 ow has been condemned and slaughtered: the result of the autopsy being entered 
 tpon the reverse, as in diagram below: 
 
 Tag No. ii.". 
 5/12/96. 
 
 J. dm Doe, 1000 14th ave. 
 Red Cow. 
 
 O 
 
 Inspi ctor. 
 
 Result <>f Autopsy. 
 Liver. 
 Lungs. 
 K idneys, 
 Mammary Glands, 
 
 O 
 
 Tag No. 25. 
 
 Inspector. 
 
 ■■ No. 3. A card with the projection in the middle, where the cow is examined, 
 classed as suspicious and held for examination, as in diagram below: 
 
 Reinspecl Tag, No. 5. 
 
 Tagged Ll/12/96. 
 
 Richard Hoc. in Boulder st 
 
 Black Cow, white star, while spot on righl shoulder. 
 
 O 
 
 Inapt ctor. 
 
 ■•No. i. And a card with tin- projection at the righl end, when the cow lias 
 
 been examined, passed a-~ healthy and subsequent |y killed where we could examine 
 
 its condition. The entries being the same us in No. 2. 
 
 "These tag-numbered cards are then kept on file in consecutive numbers, chang- 
 ing them as the results require. 
 
406 
 
 DA III Y PR OJJ UC TS. 
 
 "A temperature book is kept in which all of the temperatures in each test are 
 recorded (see example below): 
 
 
 1896. 
 Date. 
 
 6 
 
 53 
 
 -.i- 
 
 -. 
 H 
 
 r.ii 
 
 Temperature (Beforki. 
 
 6 
 
 r- 
 
 Z 
 > 
 < 
 
 
 .5 at 
 
 = = 
 
 - s 
 3> ■_ 
 ■2 » 
 
 ■■j 
 
 
 CO 
 
 cS 
 
 ?■! 
 
 z. 
 
 S p. 111. 
 
 11 11. 111. 
 
 Amount, 
 Carb. 
 
 Aug. 11 
 
 103.6 
 
 104.9 
 
 104.5 
 
 105.2 105" 1(14.(1 
 
 104.6+ 
 
 105.2 
 
 Neck K 
 
 30 c.c. E. 
 
 
 
 
 
 
 
 
 T I : MPERATUB E I A FTER). 
 
 it 
 
 o 
 3 
 
 105.3 
 
 Interval be- 
 tween injec- 
 tion and rise 
 of tempera- 
 ture above 
 in a \ i in u in 
 normal. 
 
 Duration of 
 
 rise. 
 
 < 
 
 2 
 
 Z 
 
 
 189G. 
 Date. 
 
 33 
 
 /- 
 
 ^ 
 
 a 
 
 CI 
 
 IO 
 
 s 
 
 V- 
 
 3 
 
 Name, etc. 
 
 Aug.ll. 
 
 103. 
 
 104.8 104.8 
 
 105.3 
 
 11)4.5- 
 
 Hrs. 
 
 19 
 
 Hrs. 
 
 1" 
 
 Negative 
 
 Pat. 11. Dunn. 
 530-42 E. 68th st. 
 
 In this way a full and compete record is kept, and one that is easily referred to. 
 
 It is the opinion of the department officials in New York that the 
 freeing from tuberculosis of the cows kept in the city, will, through 
 competition, result in a similar but voluntary purging of the country 
 herds. 
 
 Among other cities which require the tuberculin test are Brookline, 
 Mass., Denver, Lynn, Minneapolis, Portland, Me., St. Paul, and West- 
 brook, Me. In San Francisco it was attempted, but owing to violent 
 opposition, had to be given up. Legislation could not be obtained 
 empowering the board of health to apply the test to all cows supplying 
 the city, and the dairymen in the city represented that it would be a 
 hardship to eradicate the disease from their herds, and let outside 
 dairymen go free. 1 Examples are given below of a local ordinance 
 under which the tuberculin test is required. 2 
 
 1 San Francisco, Report of Health Department (1897-8), p. 182. 
 
 2 Westbrook, Me., Rules and Regulations, Board of Health, 10 June, 1897: 
 
 " Sec. 1. No person shall at any time by himself, his clerk, his servant or agent, 
 directly or indirectly, sell or offer for sale any milk or cream within the City of 
 Westbrook, except sterilized milk or cream, unless the cow from which such milk 
 or cream was taken shall have first been examined by the board of cattle commis- 
 sioners, or by some veterinarian appointed by them or approved by the board of 
 mayor and aldermen of Westbrook and a certificate filed by such examiner with the 
 secretary of the board of health, showing that such cow is healthy and free from 
 disease, and such certificate shall remain in force one year.'' 
 
 Lynn, Regulations of Board of Health, 2 March, 1896: 
 
 "On and after May 1, 1896, for all milk brought into or offered for sale in the 
 City of Lynn, satisfactory evidence will be required of the producer and dealer by 
 
DAIRY PRODUCTS. 407 
 
 In New ( )rleans and St. Paul free inspection of dairy farms was 
 offered, but not required by the health department. It was intended 
 that a certificate should he given all herds free from diseases, and that 
 this certificate would be valuable enough to induce the dairymen to 
 apply for inspection. The board of health in Xew Orleans 1 reports 
 this a failure, and the health commissioner of St. Paul'- says it was only 
 a partial success. In the latter city it lias now been succeeded by com- 
 pulsory examination. In Indianapolis, on the other hand, the volun- 
 tary method seems to have been successful. 3 The following is from a 
 letter by Dr. Hurty of the Indiana state hoard of health to Dr. Knopf in 
 regard to what lias been done in that city: 
 
 •■ The city board of health induced one of the prominent dairymen to write a let- 
 ter, requesting that his herd be tested with tuberculin, and also that a sanitary sur- 
 vey he made of his dairy and suggestions be made for sanitary improvements, he 
 promising to destroy all cattle which reacted to the tubeculin test, and to make all 
 sanitary improvements suggested. For tin's he was to receive a certificate from the 
 board of health simply stating the facts of t lie case. This, you see. was a true com- 
 mercial method. The work was done, as above indicated, and immediately the 
 popular demand arose for the milk supplied from tuberculin-tested animals. Every 
 dairy supplying milk in this city has now been tested and sanitary surveys made as 
 above. About six per cent, of the dairy cattle have been killed, and in every instance 
 it was discovered that the tuberculin test was accurate and absolute, This method 
 seems better than the legal method." 
 
 Besides the City of New York. Minneapolis, .Milwaukee, and Lynn. 
 Mass., tag the animals which successfully pass the tuberculin test. 
 
 To insure the city against the importation of infected animals the 
 rule given below has recently been adopted in the Citj of New York. 4 
 
 the board of health that the milk has been drawn from healthy cows. The condi- 
 tion of health is to be based upon results of tuberculin test by a veterinarian that is 
 satisfactory to the state cattle commission and to the inspector of milk tor the Citj 
 of I. vnn. After test each animal to have ear tag and certificate of health. Also that 
 tlie animals used are properly fed and the premises occupied by them are iii a 
 
 condition of sanitation." 
 
 1 Louisiana. Mate Board of Health Report (1892 3), p. 118. 
 St. Paul, Report of Health Commissioner (1896), p. 4. 
 
 Proplylaxis and Treatment of Puh arj Tuberculosis, Knopf, p. 77. 
 
 M ity of New York, Sanitary (ode (1899), as amended 15 February, 1899: 
 
 ■ M ' . 135. Thai no diseased or sickly cat! le, swine or sheep, nor any horse, dog 
 
 or cat, which is suffering from, or lias been exposed to any disease which is con 
 is anion"; such animals shall he broughl into the Citj of New N ork. All per- 
 sons, corporations, or companies bringing milch cows into the Citj of New Fork 
 shall furnish a certificate signed l>> a veterinarian who is a graduate of a recognized 
 Veterinarj College, with the date of gradual ion and the name of college from which 
 the degree was received, to the effect that said cows are free from tuberculosis as 
 far as may he determined by physical examination and the ttiberculin test, said 
 certificate shall ^i\e a number which has been permanently attached to each cow, 
 ami a description sufficiently accurate for identification, stating the date (which 
 
408 DAIRY PRODUCTS. 
 
 In most states the cattle laws would provide for the disposal of the 
 animals condemned in dairy inspections and such would be killed ; but 
 local regulations appear to be necessary in most cities to prevent the 
 sale of milk from animals that have been condemned, before they are 
 finally disposed of. The St. Louis regulation is given below. 1 
 
 While an annual inspection is excellent and is maintained by most 
 of the cities referred to in the last few pages, yet a more frequent 
 inspection is desirable and is sometimes carried out. Thus in Warren, 
 O., the dairies are inspected two or three times each year ; in Syracuse, 
 twice a year; in Omaha they are inspected every two months ; in Brook- 
 line, Mass., twice each year, and also several times in the District of 
 Columbia. In Minneapolis, Newton, Mass., and Richmond, Ind., the 
 dairies are inspected monthly. 
 
 In order to obtain prompt information in regard to disease among 
 cows, it is provided in the rules of the District of Columbia as follows: 
 
 lt It shall be the duty of any person having charge or control of any prem- 
 ises upon which cows are kept to notify the health officer, in writing, of the 
 existence of any contagious or infectious disease among such cows, within twenty- 
 four hours of the discovery thereof, and to thoroughly isolate any cow or cows 
 affected or which may reasonably be believed to be infected, and to exercise such 
 other precautions as may be directed, in writing, by the health officer." 
 
 must be not more than sixty days prior to the time they are brought into the city), 
 the place of examination, the temperature of the cow or cows at intervals of three 
 hours for twelve hours before the subcutaneous injection of the tuberculin, the pre- 
 paration of tuberculin used, the location of the injection, the quantity injected, the 
 temperature at the tenth hour after the injection of the tuberculin and every three 
 hours after the aforesaid tenth hour for twelve hours, or until the reaction is com- 
 pleted. No cow with a certificate which states that said cow gave a reaction of two 
 degrees F. after the injection with 0. 5 c. c of the tuberculin prepared by the depart- 
 ment of health of the City of New York (or its equivalent), diluted with ten times 
 its volume of a 0.5 per cent, watery solution of carbolic acid, shall be brought into 
 the City of New York." 
 
 1 St. Louis, Ordinance of 6 April, 1896 : 
 
 " Sec. 16. When said veterinary surgeon or surgeons shall find any cow or cows 
 in a dairy, from which dairy milk is brought into this city for sale, to be diseased, 
 they shall immediately make a repqrt of the facts in duplicate; one of said reports 
 to be delivered to the health commissioner, and the other to the person, firm or cor- 
 poration receiving and disposing of the milk from such cows. On receipt of a report 
 that milk from the diseased cows is being brought into this city the health commis- 
 sioner shall issue an order forbidding its sale in the City of St. Louis until such time 
 as the health commissioner is satisfied by approved veterinary certificate that such 
 diseased cows have been separated from the balance of the herd; and if the parties 
 who shall have been served with such order fail to obey the same the health com- 
 missioner is hereby empowered to give notice to the citizens of St. Louis through 
 the newspapers doing the city printing, stating all the facts in the case, and to warn 
 them against the use of such milk. And said parties may be proceeded against in 
 the manner prescribed by the provisions of this ordinance." 
 
DAIRY PRODUCTS. 401) 
 
 The results of dairy inspection show that if it is desired to have 
 clean milk from healthy cows, the average dairy is not at the present 
 time in any condition to supply it. Thus in New York in 1896 1 out 
 of 1,123 cows tested with tuberculin l ( .'i ) were condemned. In Denver 2 
 four per cent, of the cows tested with tuberculin were condemed, in 
 Lynn 3 of 3,471 cows tested 562 were condemned, in Minneapolis 4 of 
 4. <»:;»; cows tested 172 wen- condemned, In Omaha"' of 3,977 cows, 140 
 were condemned. Of 1,356 cows in the District of Columbia 6 ")- were 
 condemned, in Syracuse 7 of 3,843 cows 300 were tuberculous. In 
 Philadelphia 8 101 out of 382, and in St. Paul 9 154 out of 2,084 cows 
 were infected. In this connection it is well to remember that not only 
 is there danger of the spread of tuberculosis through the milk of tuber- 
 culous cows but this milk is usually deficient in fat. 
 
 Of ninety-seven dairies inspected in Baltimore in 1894 10 eighteen 
 were reported in bad condition. In Concord, .Mass.. 11 on a second inspec- 
 tion twenty-one per cent, of the farms were in fair condition, and 
 twenty-three percent, in bad condition. In Somerville, Mass., 12 of thirty- 
 seven applications to keep cows, seven were refused on account of the 
 condition of the stables, etc. In Rochester 13 many of the stables were 
 in bad condition, the pails, strainers, and cans were not clean, there was 
 insufficient water and no way of heating it for washing, and the stables 
 and milk rooms wen- dirty. In fact the conditions were such that when 
 the health officer desired to obtain milk which should be clean and suita- 
 ble for pasteurization he could not find a single dealer able to supply it, 
 and Dr. Getty in Yonkers bad much the same experience. The veter- 
 inarian of the District of Columbia states that on his first inspection he 
 found the thinks of hundreds of cows caked with manure, thus ensur- 
 ing dirty milk. The same undesirable conditions were found in Mil- 
 waukee " where a microscopical examination of the milk showed 
 
 I New York. Report <.f Department of Health (1896), \<. 124. 
 -Denver. Report of Bureau of Health (1896), p. 81. 
 
 Massachusetts, State Board of Health Report (1896), p. 881. 
 ' Minneapolis, Report of Health Department (1899), i>. .°>7. 
 "Omaha, Report of Health Department (1897), p. L2. 
 
 District of Columbia, Report of Health Officer (1897), p. 78. 
 'Syracuse, Report of Board of Health (1899), p. 7. 
 
 Philadelphia, Report of Bureau of Health (1899), p. L25. 
 ISt Paul, Report of Commissioner of Health (1899), p. 7. 
 
 Haiti re, Report of Health Department (1894), p. 18. 
 
 II Massachusetts, Mate Board of Health Report (1897), p. 668. 
 
 merville, Report of Board of Health i L897). 
 Rochester, Report of Health Department (1897). 
 u .Milwaukee. Report of Commissioner of Health for year ending April, 1897, p. L0. 
 
410 DAIRY PRODUCTS. 
 
 " manure, bits of cow food, numerous hairs, mould and fungous growths, 
 bits of insects, threads, human hair, moss, and other disgusting sub- 
 stances." The secretary of the state board of health in Providence 
 could not get a quart of milk which did not show an appreciable sedi- 
 ment of dirt, and an examination of the dairies in that city 1 showed 
 that twenty-five per cent, were in bad condition. Out of eighty-three 
 applications for dairy farm licenses in the District of Columbia in 1897 
 thirty-nine were refused. In New Orleans 2 an inspection showed that 
 many of the cow stables were in a filthy condition and the water used 
 for washing was grossly contaminated. Photographs of the premises 
 are shown in the report referred to. In St. Louis : 3 
 
 "An examination of the dairies disclosed that a fearful condition existed. Cows 
 covered with filth were confined continually in small, hadly ventilated stables, the 
 manure forced into sewers or thrown into small water courses, creating a stench 
 that was intolerable; the milk cooled in wells and cisterns, the water of which from 
 the surroundings must necessarily be impure ; milk placed in filthy cans by unwashed 
 hands, and the atmosphere of the stables where the milk cans were allowed to 
 remain charged with odorous gases and teeming with pestiferous germs; the cows 
 showing unmistakable signs of being unhealthy, everything and everywhere show- 
 ing a complete absence of the first principles of cleanliness, and a total ignorance 
 of any of the requirements of sanitation; in fact, the condition of the cows, the 
 places where the milk was kept, and the general surroundings being simply inde- 
 scribable." 
 
 Besides inspecting dairy farms and stables and testing and tagging 
 cows, another and very effectual method of controlling milk production 
 may be adopted, and that is the licensing of the producer. This is cer- 
 tainly the best way of controlling the milk supply produced within the 
 city limits, for the license may be withheld or revoked if the conditions 
 are not satisfactory. For producers outside the municipality a similar 
 control may be exercised if license to import or sell is refused unless 
 the conditions of production are satisfactory. Such discriminating 
 licensing presupposes a complete knowledge of the sources of supply 
 and a thorough inspection of all producers' premises and animals. How 
 this may be accomplished has been shown on the preceding pages. 
 Among the cities which license cow stables only within their corporate 
 limits may be mentioned Baltimore, Boston, Brookline, Mass., Chicago, 
 Cincinnati, District of Columbia, Newark, New Bedford, Newton, New 
 York, Paterson, Pittsburgh, Somerville, and Waltham, Mass. In 
 Philadelphia it is forbidden to keep cows in the city except in the rural 
 portions, and the health officers of Newark, Milwaukee, and other cities 
 express a desire to do the same. Usually no fee is charged for such a 
 
 1 Providence, Report of Superintendent of Health (1896), p. 44. 
 
 2 Louisiana, Report of Board of Health (1892-93), p. 114. 
 
 3 St. Louis, Report of Health Commissioner (1895-6), p. 27. 
 
DAIRY PRODUCTS. 41 1 
 
 license but sometimes it is, as in Buffalo, where it is one dollar, and in 
 Newark, where it is ten cents. 
 
 The following cities make a more or less determined effort to con- 
 trol on the lines laid down, their entire milk supply : Buffalo, Detroit, 
 Denver. Indianapolis. Meadville, Pa., Milwaukee, Minneapolis, Mont- 
 clair. X. .J.. Nashua, N. H., Omaha, Portland, Me., Ninth Adams, Mass.. 
 St. Louis, St. Paul, and several smaller Minnesota cities. Pittsfield, 
 Mass., Westbrook, Me., and Warren. ( ). The District of Columbia at- 
 tempted to control its rural supply by requiring a certificate of inspec- 
 tion of all of the country herds from which milk was sent to the city: 
 hut this resulted in failure, as the farmers could enploy any veteri- 
 narian and most of them did not prove reliable. But good results are 
 obtained when, as in Lynn, Portland and Westbrook, the certificate must 
 be from the cattle commissioners or some veterinarian satisfactory to 
 tlieni or the board of health or the city officers, or in Asbury Park, 
 N. J., where the inspection is made under the direction of the state 
 dairy commissioner. 
 
 In St. Louis two veterinary physicians are appointed by the health 
 commissioner with the approval of the hoard of health, who receive 
 $175 per month each, and are obliged to keep a horse and buggy at 
 their own expense, and are empowered to visit dairy farms within 150 
 miles of the city. 
 
 The larger cities have not accomplished as much as the smaller : 
 of the former, Denver, Minneapolis and St. Louis have done the most. 
 Minneapolis having been the most successful. The best examples of 
 milk control, so far as the producer is concerned, are to be sought among 
 the smaller cities and towns. 
 
 Regulation* for the Care of Milk. 
 
 A number of cities have made rules for the proper care of milk so 
 thai it shall be delivered to consumers in the best possible condition. 
 Man\ of these rules are not intended to be enforced by penalties hut 
 pre rather intended as directions for the education of the producer and 
 dealer. A number of states, as Illinois, Minnesota, West Virginia, and 
 Wisconsin, have general provisions in their milk laws requiring thai 
 cows shall be properly cared for, housed and fed, but iii the absence of 
 ■pec i fie regulations ii is not Likely that they can accomplish much. 
 Such general provisions are also found in a number of cities, as Atlanta, 
 Boston, Buffalo, Chicago, Cincinnati, Denver, .Memphis, Minneapolis, 
 Omaha, and Paterson. The following from Minnesota 1 ma\ be given 
 
 ils One Of I he mosl explicit Of these J 
 
 1 Minnesota, Chapter 295 of L890, Sec. •"». 
 
412 DAIRY PRODUCTS. 
 
 " No person shall keep cows for the production of milk for sale or consumption 
 within the City of Minneapolis in an over-crowded condition, or in stables which are 
 not properly ventilated, or which are filthy from an accumulation of animal refuse, 
 or from any other cause; nor shall milk for such purposes be drawn from cows 
 which are themselves in a condition of filth or uncleanliness, or from cows which 
 are affected with tuberculosis or any other form of disease, or from cows which are 
 fed, either wholly or in part, upon distillery waste or brewery grains, or the waste 
 of vinegar factories, in a fermented condition, or upon any other form of food which 
 will produce milk which is unhealthy or unwholesome, or from cows which are 
 supplied with water which is impure or unwholesome; and all milk thus produced 
 is hereby declared to be unclean, impure, unhealthy, and unwholesome milk. 11 
 
 To accomplish anything in the way of education, rules must be 
 more explicit and cover a wider range. The following rules are given 
 as a basis for preparing such a set of regulations for municipal use. 
 These rules were prepared by the bureau of animal industry of the 
 department of agriculture, and are especially worthy of consideration 
 because they come from such a source. The department of agricul- 
 ture has primarily at heart the interests of the producer and strives to 
 recommend such measures as will serve the pecuniary interests of the 
 dairymen. The department evidently believes that it pays the pro- 
 ducer to furnish high grade products and attempts to show how it may 
 be done. These rules which are here given are intended to be printed 
 on a large card and hung in the stable : 
 
 FIFTY DIaRY RULFS. 
 UNITED STATES DEPARTMENT OF AGRICULTURE, 
 
 BUREAU OF ANIMAL INDUSTRY — DAIRY DIVISION. 
 
 (from farmers 1 bulletin no. G.3. ) 
 
 THE OWNER AND HIS HELPERS. 
 
 1. Read current dairy literature and keep posted on new ideas. 
 
 2. Observe and enforce the utmost cleanliness about the cattle, their attendants, 
 the stable, the dairy, and all utensils. 
 
 3. A person suffering from any disease, or who has been exposed to a contagious 
 disease, must remain away from the cows and the milk. 
 
 THE STABLE. 
 
 4. Keep dairy cattle in a room or building by themselves. It is preferable to 
 have no cellar below and no storage loft above. 
 
 5. Stables should be well ventilated, lighted and drained ; should have tight floors 
 and walls and be plainly constructed. 
 
 0. Never use musty or dirty litter. 
 
 7. Allow no strong smelling material in the stable for any length of time. Store 
 the manure under cover outside the cow stable and remove it to a distance as often 
 as practicable. 
 
DAIRY PRODUCTS. 41 S 
 
 8. Whitewash the stable once or twice a year; use land plaster in the manure 
 gutters daily. 
 
 9. Use no dry, dusty feed just previous to milking; if fodder is dusty sprinkle 
 it before it is fed. 
 
 10. Clean and thoroughly air the stable before milking; in hot weather sprinkle 
 the floor. 
 
 11. Keep the stable and dairy room in good condition, and then insist that the 
 dairy, factory, or place where the milk goes be kept equally well. 
 
 THE COWS. 
 
 12. Have the herd examined at least twice a year by a skilled veterinarian. 
 
 13. Promptly remove from the herd any animal suspected of being in bad health, 
 and reject her milk. Never add an animal to the herd until certain it is free from 
 disease, especially tuberculosis. 
 
 14. Do not move cows faster than a comfortable -walk while on the way to place 
 of milking or feeding. 
 
 15. Never allow the cows to be excited by hard driving, abuse, loud talking, or 
 unnecessary disturbance; do not expose them to cold or storms. 
 
 16. Do not change the feed suddenly. 
 
 IT. Feed liberally, and use only fresh, palatable feed stuffs; in no case should 
 decomposed or moldy material be used. 
 
 18. Provide water in abundance, easy of access, and always pure; fresh, but not 
 too cold. 
 
 19. Salt should always be accessible. 
 
 20. Do not allow any strong llavored food, like garlic, cabbage, and turnips, to 
 be eaten, except immediately after milking. 
 
 21. Clean the entire body of the cow daily. If hair in the region of the udder 
 
 is riot easily kept clean it should be clipped. 
 
 22. Do not use the milk within twenty days before calving, nor for three to five 
 days afterwards. 
 
 ■i-',. The milker should be clean in all respects; he should not use tobacco; he 
 should wash and dry his hands just before milking. 
 
 24. The milker should wear a (dean outer garment, used only when milking, 
 and kept in a clean place at other times. 
 
 25. Brusli the udder and surrounding parts jusi before milking, and wipe them 
 wit h a clean, damp clot h or sponge. 
 
 •_'<',. Milk quietly, quickly, cleanly, and thoroughly. Cows do not like nunc, 
 Bssary noise or delay. Commence milking at exactly the same hour every morning 
 and evening, and milk the cows in the same older. 
 
 •_'T. Throw away (but not on the floor better in the gutter) the firsl lew streams 
 
 from each teat ; this milk is very watery and of little value, bill it may injure the 
 
 lest. 
 
 28. If in any milking a part of the milk is bloody or stringy or unnatural in 
 appearance, the whole mess should he rejected. 
 
 29. Milk with dry hands: never allow the hands to come in contact with the 
 milk. 
 
 30. Do not allow dogs. eats, or loafers to he around at milking time. 
 
 31. If any accident occurs bj which a pail lull or partlj lull of milk becomes 
 
 dirty, do not trj to remedj this bj straining, hut reject all this milk and rinse the 
 pail'. 
 
 .;■_'. Weigh and record the milk given bj each row. and take a sample morning 
 and night, at least once a week, for testing by the fat test. 
 
414 DAIRY PRODUCTS. 
 
 CAKE OF MILK. 
 
 33. Remove the milk of every cow at once from the stable to a clean, dry room, 
 where the air is pure and sweet. Do not allow cans to remain in stables while they 
 are being filled. 
 
 34. Strain the milk through a metal gauze and a flannel cloth or layer of cotton, 
 as soon as it is drawn. 
 
 35. Aerate and cool the milk as soon as strained. If an apparatus for airing and 
 cooling at the same time is not at hand, the milk should be aired first. This must 
 be done in pure air, and it should then be cooled to 45 degrees if the milk is for 
 shipment, or to 60 degrees if for home use or delivery to a factory. 
 
 36. Never close a can containing warm milk which has not been aerated. 
 
 37. If cover is left off the can, a piece of cloth or mosquito netting should be 
 used to keep out insects. 
 
 38. If milk is stored, it should be held in tanks of fresh, cold water (renewed 
 daily), in a clean dry, cold room. Unless it is desired to remove cream, it should 
 be stirred with a tin stirrer often enough to prevent forming a thick cream layer. 
 
 39. Keep the night milk under shelter so rain can not get into the cans. In 
 warm weather hold it in a tank of fresh cold water. 
 
 40. Never mix fresh warm milk with that which has been cooled. 
 
 41. Do not allow the milk to freeze. 
 
 42. Under no circumstances should anything be added to milk to prevent its 
 souring. Cleanliness and cold are the only preventives needed. 
 
 43. All milk should be in good condition when delivered. This may make it 
 necessary to deliver twice a day during the hottest weather. 
 
 44. When cans are hauled far they should be full, and carried in a spring 
 wagon. 
 
 45. In hot weather cover the cans, when moved in a wagon, with a clean wet 
 blanket or canvas. 
 
 THE UTENSILS. 
 
 46. Milk utensils for farm use should be made of metal and have all joints 
 smoothly soldered. Never allow them to become rusty or rough inside. 
 
 47. Do not haul waste products back to the farm in the same can used for deliv- 
 ering milk. When this is unavoidable, insist that the skim milk or whey tank be 
 kept clean. 
 
 48. Cans used for the return of skim milk or whey should be emptied and 
 cleaned as soon as they arrive at the farm. 
 
 49. Clean all dairy utensils by first thoroughly rinsing them in warm water; 
 then clean inside and out with a brush and hot water in which a cleaning material 
 is dissolved; then rinse and, lastly, sterilize by boiling water or steam. Use pure 
 water only. 
 
 50. After cleaning, keep utensils, inverted, in pure air, and sun if possible, 
 until wanted for use. 
 
 Rules ill regard to the care of cows and milk have been promulgated 
 by the Illinois state board of health (30 September, 1895), and have 
 been adopted in Boston, District of Columbia, Fitchburg, Haverhill, In- 
 dianapolis, New York, Philadelphia, and St. Louis. A few rules touch- 
 ing two or three of these points are found in a number of other cities 
 and sometimes in state legislation. None of the municipal regulations 
 equal in fullness those above given though they may in some respects be 
 more suitable for municipal needs. 
 
DAIRY PRODUCTS. 415 
 
 The necessity of providing more explicitly for the construction of 
 new stables is felt in cities. Thus in St. Louis : 1 
 
 '•. . . All single stalls shall be at least three feet wide, double stalls six feet 
 wide, and all stalls shall be at least seven feet long; the height of ceilings from the 
 floor shall be at least eight feet; the floors must be of tight plank, or be paved with 
 brick or stone, laid in cement: if payed with brick or stone, then the earth below it 
 shall be sufficiently solid to prevent its becoming a receptacle of filth and offensive 
 matter: the floors of the stalls shall slope down into a drain or gutter, which shall 
 be at least twelve inches wide and four inches deep, and said drain or gutter shall 
 Connect with and lead into a sewer through two intervening catch basins or tightly 
 cemented cesspools, so that waste matter can be carried or hauled away. Openings 
 tor ventilation must be placed on at least two sides of the building, with openings 
 not less than two feet square for every double stall or two single stalls, and there 
 must lie roomj ventilators in the roof not less than one for every twenty feet or 
 fraction thereof in the length of the building." 
 
 In St. Louis provision is also made for the reconstruction of old 
 Stables. 2 See also rules in regard to stables on page 161. 
 
 The rules of the Illinois state board of health (which were adopted 
 on the suggestion of the Chicago commissioner of health), of the Dis- 
 trict of Columbia and other cities also require the connection of stables 
 with the sewer. 
 
 The area provided for the cows is variously prescribed : in the 
 Illinois rules, Brookline, the District of Columbia, and Indianapolis. 
 
 1 St. Louis. Ordinance of 6 April. 1896. 
 
 - St. Louis. < Ordinance of 6 April, 1896: 
 
 "Sec. 9. All dairies or cow stables, now erected or established, when found to 
 be so badly lighted or ventilated as to be injurious or unhealthy for cows, or not 
 provided with legal caoh basins or tightly cemented cesspools, so thai waste matter 
 
 can be carried or hauled away, or shall be conducted iii an uncleanly manner, shall 
 be deemed a nuisance. It shall be the duty of the board of Health when any report 
 shall be made of the bad or improper construction of any dairy or cow stable, or of 
 any nuisance created by any dairy, cow stable or cow lot. to notify the owner or 
 proprietor thereof to shovi cause before the said board of Health at the time and 
 place specified in said notice, why said dairy or cow stable should not be altered or 
 changed, or such detects remedied or nuisance' removed, which notice for the part] 
 complained against to appear shall be served at hast five days before the date 
 specified in such notice; said notice shall be served bj leaving the same al the place 
 of business or residence of the parties to be affected therebj bj some officer or per- 
 son duly qualified to certifj to such not ice; and all not ices of this kind issued by the 
 
 board of Health shall he signed by the presiding officer of the board of Health or 
 the Health Commissioner. At the time fixed in said notice the parties may appear 
 in person or bj attorney, or cause maj be shown bj affidavit, and if in the opinion 
 of the Board of Health and Health Commissioner no good and sufficient cause he 
 show ii w h\ the said nuisance should not be abated, discontinued or removed, or 
 
 •aid cow stables reconstructed, the Healtb Commissi r shall order t he sail I parties 
 
 to abate, discontinue, re ve, or reconstruct the same within such time as the 
 
 Health Commissioner may deem reasonable and necessary. It. upon the hearing of 
 the affidavits and the evidence adduced in the case, the Hoard shall find the tacts to 
 
 he in favor Ol the parties before them, and so decide, the case shall be dismissed. 
 
416 DAIRY PRODUCTS. 
 
 each animal must have 500 cubic feet of space ; but in new stables in 
 Brookline they must have 700 cubic feet; in Oregon 1 800 cubic feet, in 
 Boston and Brookline, 1,000 cubic feet. In Oregon, Illinois, and the 
 District of Columbia the stalls must be four feet wide. In New York 
 City and in the rural parts of Rochester, only fifteen cows are allowed 
 per acre, and in Buffalo only one cow per acre. In the built up por- 
 tion of Rochester and Macon, Ga., there may be one cow to each lot 
 (33 feet by 100 feet). In Boston one cow to each 3,000 square feet. 
 In Brookline stables must have ventilators in the roof and sliding glass 
 windows at the sides. In Fitchburg the walls and ceilings must be 
 thoroughly cleaned of all litter, cobwebs, etc., at least once a month. 
 No swine may be kept in a cow stable in Newton, Mass., and no manure 
 shall be kept in the cellar in the latter town. The Illinois and District 
 of Columbia rules require that the manure shall be kept in a water 
 tight receptacle outside of the stable. The condition of the cow yard 
 is prescribed in Illinois and District of Columbia. 2 
 
 In regard to cows the Fitchburg rules require grooming only three 
 times a week. In Philadelphia the feeding of turnips, cabbage and any- 
 thing which may give a taste to the milk is forbidden entirely, and 
 there is a similar rule in Indianapolis. In Cincinnati cows must be put 
 out to pasture twelve hours daily from May 1 to October 1. 
 
 There is a difference of opinion as to the advisability of washing 
 the teats and udder, but it is prescribed in the New York, Philadelphia. 
 and Fitchburg rules, and, in addition, the Fitchburg rules require that 
 the udder and flank shall be carded and brushed before milking. 
 
 The experience of Detroit, 3 Grand Rapids 4 and Providence, and prob- 
 ably other cities, that milkmen will carry garbage back to their farms in 
 milk wagons and even in milk cans has led to the addition to the milk 
 rules of a prohibition of this practice. 
 
 The use of bottles for delivering milk has its advantages in that 
 there is less handling and exposure of the milk, and hence it can he 
 kept cleaner. Tests of bottled milk at Montclair, N. J., showed that 
 samples contained 24,817 bacteria per c. c. while the average of can milk 
 was 208,875 per c. c. 
 
 1 Oregon, Act of 25 February, 1893, Sec. 3. 
 
 - District of Columbia, Rules of the Health officer: 
 
 Lt Sec. 12. Any inelosure in which cows are kept shall be graded and drained so 
 as to keep the surface reasonably dry and to prevent the accumulation of water 
 therein, except as may be permitted for the purpose of supplying drinking water: 
 no garbage, urine, fecal matter, or similar substances shall be placed or allowed to 
 remain in such inelosure, and no open drain shall be allowed to run through it. 11 
 
 3 Michigan, Proceedings Third Annual Convention of Health Officers, p. 57. 
 
 4 Same, p. 6"). 
 
DAIRY PRODUCTS. 417 
 
 The objection to the use of bottles is that they are not readily ster- 
 ilized with boiling water without serious breakage, and that as they may 
 be carried into the houses and even rooms and put into the hands of 
 persons sick with contagious disease, such disease may be spread in that 
 maimer. Instances of such are reported. It is said also that quart 
 bottles a little under size are readily purchased. 1 To prevent danger 
 from contagious disease in bottles the Buffalo, Chicago, and Yonkers 
 rules forbid their delivery where there is contagious disease. In bos 
 Aug* des the use of bottles is forbidden at all times. 2 The following 
 statute in regard to cleansing bottles and other vessels is found in 
 Minnesota." See also the New York rules below. : 
 
 "Any person or persons, linn or corporation who receives any milk or cream, 
 in cans, bottles, or vessels, which has been transported over any railroad or 
 boat line, where such cans, bottles, or vessels are to be returned, shall cause the 
 said cans, bottles, or vessels to be emptied before the said milk or cream contained 
 then in shall become sour, and shall cause the said cans, bottles, and vessels to be 
 immediately washed and thoroughly cleansed and aired." 
 
 The rules proposed by the Massachusetts Association of Boards of 
 Health 4 in addition, prescribe that all utensils in which milk is delivered 
 to the consumer shall be not only cleaned but be sterilized before they 
 are used again. This rule has been adopted in Boston. The New York 
 City rules require that all utensils shall be washed with boiling water 
 and soda, soap or alkali, ami then rinsed with plain boiling water. 
 
 The rules of the department of agriculture relate to the producer, 
 rather than the dealer, and experience has shown that additional care 
 must be exercised by every dealer if it is desired that the milk shall 
 reach the consumer in the best possible condition. The following are 
 the rides adopted in New York City: 
 
 •• .Milk should In- kept in some place where diisl and other impurities cannot tall 
 Into it. such as a box with tight-fitting cover; preferably an icebox. 
 
 ■■ The milk should be kept ai as low a temperature as possible, not above fifty 
 
 degrees Fahrenheit. 
 
 "After I he day's sales are over, the measures and utensils used in t he sale of milk 
 
 shoulil he thoroughly cleaned with boiling water, to which a small amount of soda 
 has been added in the proportion of one tablespoonful of washing soda to a gallon 
 of water. 
 
 I he overflow pipe from the icebox in which the milk is kepi must not b< 
 
 ne, -ti-il directly with the ilniiii pi| • sewer, lull must discharge in|o an open, 
 
 water-supplied, properly-trapped, sewer-connected sink (see Section tl of the Sani- 
 tary ( 'ode I. 
 
 i Philadelphia, Report of Board of Eealth i 1896), p. I I". 
 
 Angeles, Resolution of Board ol Eealth, 10 April. 18H0, 
 Minnesota. Chapter ■-'"'-' -I' L895. 
 4 Journal ol Massachusetts Association of Hoards of Health. Vol. VII., p. 120. 
 
418 DAIRY PRODUCTS. 
 
 " The icebox in which the milk is kept should be cleaned, by scrubbing out with 
 hot soda solution made as in No. 3, at least twice a week. 
 
 " In selling milk, stir up the contents of the can thoroughly before measuring 
 out the amount desired. This will prevent unintentional skimming. In this way 
 the last quart of milk sold from the can will contain as much cream as the first quart 
 sold. 
 
 " It sometimes happens that in cold weather the milk may be delivered to the 
 dealer more or less frozen. If such is the case, detach the ice from the side of the 
 can and gently heat the contents until the ice is all melted. If there is much ice in 
 the can it is absolutely necessary to do this before selling the milk, otherwise the 
 liquid part dipped out and sold at first will contain more of the solid part of the 
 milk and cream, while the ice remaining and consisting principally of water, will 
 after a time melt, and the result will be milk containing more water than pure milk, 
 and this might be enough to appear as though the milk had been adulterated with 
 water. 
 
 "Do not place ice in the milk if it is desired to cool it or keep it cold, as the ice 
 will melt and you will then have adulterated the milk with water. 
 
 " Milk shall not be kept for sale or stored in any room used for sleeping or domes- 
 tic purposes or opening into the same. 
 
 " Milk must not be transferred from cans to bottles or other vessels on streets or 
 on ferries or at depots, except when transferred to vessel of purchaser at time of 
 delivery. 
 
 " Milk shall not be sold in bottles except under the following rules: 
 
 "Bottles must be washed clean with a hot water solution of soap, or soda or 
 some other alkali, and then with hot water before filling with milk. 
 
 " Bottles must not be filled except at the dairy or creamery, and in the city only 
 in rooms so situated as to prevent the contamination of the milk by dust from the 
 streets or other impurities. 
 
 " Bottles must not be washed or filled witli milk in any room used for sleeping or 
 domestic purposes or opening into the same. 11 
 
 The rules of the board of health of Little Rock, X. Y., require that 
 every person delivering milk " shall prevent the temperature thereof 
 rising above sixty-two degrees by the use of ice, covered conveyances or 
 preferably by the use of separate bottles kept on ice." 
 
 The following rule in regard to conveyances was adopted in Mil- 
 waukee : 1 
 
 " No person or persons shall bring to or deliver milk in the City of Milwaukee, 
 for the purpose of retailing the same to consumers in the City of Milwaukee, 
 in any open or uncovered wagon, cart or conveyance of any kind; and all milk here- 
 after to be brought to the City of Milwaukee to be retailed to consumers, or for that 
 purpose to be delivered in the City of Milwaukee, shall be brought to said city and 
 delivered in cars, wagons or carts so constructed that the covering hereinbefore pro- 
 vided for shall not come in contact with the cans or vessels containing the milk, and 
 shall protect such milk and the cans or vessels containing the same from the sun and 
 rain, and as far as practicable from the dust and all the impurities of the air. 11 
 
 In Erie, Penn., the wagons must be equipped with iceboxes in June, 
 July, August, and September. In Indianapolis milk on the way to 
 dealers must be covered with canvas. 
 
 1 Milwaukee, Ordinance of 19 October, 1891, Sec. 4. 
 
DAIRY PRODUCTS. 419 
 
 The committee appointed by the Massachusetts Association of Boards 
 of Health prepared with great care some rules on this subject which in a 
 slightly modified form have been adopted in Boston : 1 
 
 "No person in the City of Huston engaged in the business of producing milk 
 for sale, and no person engaged in the business of storing or delivering milk in 
 said city, shall store, cool or mix said milk in any room which is occupied by horses, 
 cows or other animals. All rooms in which milk is stored, cooled or mixed, shall 
 be provided with tight walls and floor and kept constantly clean. The walls and 
 floors of said rooms to be of such a construction as to allow easy and thorough 
 eleansing. The room or rooms aforesaid shall contain proper appliances for wash- 
 tog or sterilizing all utensils actually employed in the storage, sale or distribution 
 of milk, and all such apparatus and utensils shall be washed witli boiling water or 
 sterilized by steam regularly after being so used. 
 
 •■ No urinal, water-closet or privy shall be located in the rooms called for in the 
 preceding section, or so situated as to pollute the atmosphere of said rooms. 
 
 "All milk produced in the City of Boston for sale shall be strained, cooled or 
 stored as soon as it is drawn from the cow." 
 
 The danger of the spread of contagious disease through the agency 
 of milk naturally receives fur more attention from health officers than 
 from dairy officials. Though the danger from this source is not great, 
 relative to the amount of business done, yet in the aggregate it is con- 
 siderable, and a large number of outbreaks of typhoid fever, scarlet 
 fever, and diphtheria have been traced to contaminated milk vessels or 
 infected milkmen. 2 There is considerable legislation found in regard to 
 infected milk, though very little of it is statutory. The following is 
 the New Jersey law : ,; 
 
 •■ That w hen the state board of health, or any officer thereof, duly author- 
 ized in writing by such board to act for or on behalf of said board, shall have 
 reason to believe thai any milk has been contaminated by the emanations, exhala- 
 tions or discharges of anj person sick with communicable disease, it shall he lawful 
 
 for the said state hoard of health, or the officer so authorized to act in the premises. 
 
 to prohibit the transportation or sale of any milk suspected to be contaminated as 
 
 aforesaid, and also to prohihit the transportation or sale of any milk which may lie 
 
 produced, stored, kepi or found upon anj [premises infected by such disease ; such 
 prohihit ion shall continue until t he state board of health, or the officer authorized 
 to acl in the premises as aforesaid, shall in writing remove such prohibition. 11 
 
 Regulations intended t<> prevent the spread of contagious disease 
 
 through the agency of milk are found in the rides of the Illinois, Ii.ua, 
 
 a iic I North Dakota state boards of health, and of Boston, Buffalo, Chit 
 Colorado Springs, the District of Columbia, Milwaukee. Omaha, St. 
 
 Louis, and other cities, hut the best provisions that the writer has seen. 
 
 1 Boston, bull's of Hoard of Health, 22 December, 18! 
 -The District of Columbia, Report of Bealth Officer (1895), p. 299. 
 \.u Jersey, Chapter :;Ti of L896. 
 
420 DAIRY PRODUCTS. 
 
 are those proposed by the Massachusetts Association of Boards of 
 health. 1 
 
 Some of the rules, as those of Iowa and North Dakota, abso- 
 lutely forbid the sale of milk from premises where there is contagious 
 disease. In Brookline, Mass., no person with phthisis can be employed 
 in the milk business. 
 
 In Chicago milkmen are notified of contagious diseases among their 
 customers. The use of tickets for the payment of milk is forbidden in 
 Gardner, Mass., Little Rock, N. Y., Meadville, Pa., and, Richmond, Ind. 
 
 To insure compliance with its rules, the Philadelphia board of health 
 has added to its rules 2 that 
 
 tl Failure or neglect to comply with the foregoing rules and regulations will 
 subject the offender to the seizure of his or her cows and their delivery to the 
 Guardians of the Poor in accordance with the provisions of the act of April 5, 
 1849." 
 
 PASTEURIZED .MILK. 
 
 As soon as the danger of feeding to infants milk rich in bacteria 
 was recognized, the attempt was made to overcome the difficulty by 
 sterilization; but it was soon found that this rendered the milk less 
 digestible, and that nearly as good practical results could be obtained by 
 a partial sterilization at lower temperature, by which all but the most 
 resistent germs would be destroyed, and at which temperature the milk 
 would be only slightly altered. This pasteurization like sterilization was 
 first done in private families on the advice of physicians, but soon cer- 
 tain dairymen took up the practice in order to meet the demand of the 
 better class of their customers who called for it on their physicians" 
 advice. At present there are in most large cities private dealers or 
 dairymen who supply a limited demand for pasteurized milk. The 
 advantages of pasteurized milk as an infants* food are so great, and the 
 
 1 Journal of Massachusetts Association of Boards of Health, Vol. VII., p. 122: 
 
 u Every person engaged in the production, storage, transportation, sale, deliv- 
 ery, or distribution of milk, shall immediately, on the occurrence of any case or 
 cases of infectious disease, such as typhoid, scarlet fever or diphtheria, either 
 in himself or in his family, or amongst his employees or within the building or 
 premises where milk is stored, produced, sold, or distributed, take care that the 
 local board of health is notified of such case or cases, and at the same time suspend 
 the sale or distribution of milk until authorized to resume the same by the local 
 board of health. 
 
 l 'It shall be unlawful for any person suffering from a contagious or infectious 
 disease, such as typhoid fever, scarlet fever, or diphtheria, to handle, transport, 
 deliver, mix, taste, work over, or distribute milk, or in or about places where 
 milk is stored, sold, or distributed, or to serve as a milker or milkman. No vessels 
 which have been handled by persons suffering from such diseases shall be used to 
 hold or convey milk. 1 ' 
 
 J Philadelphia, Report of Board of Health (1895), p. 278. 
 
DAIRY PRODUCTS. 421 
 
 chances of the poor who need it most, appreciating it and paying* for 
 it are so slight, that the necessity for its distribution quickly appealed 
 to the hearts of the charitable. The distribution of pasteurized milk at 
 a price below cost has become a feature of the charitable work in New 
 York, Brooklyn. Cleveland, Rochester, Yonkers, and other cities. The 
 most important of these charities is that conducted by the Hon. Nathan 
 Strauss of New York and begun by him in 1893. 1 Through the efforts 
 of Mr. Strauss 596,677 bottles of pasteurized milk were distributed in 
 1900. He also furnished a certain amount of milk modified according 
 to the formula of certain well known physicians. During the years 
 that bis milk has been coming into use. there has been a decided falling 
 off in infant mortality in New York, and it is claimed that it is due to 
 that cause. Similar reports are sent out from Brooklyn. 2 
 
 Rochester is the only city so far as the writer knows where such dis- 
 tribution of milk has been undertaken by the health department. An 
 account of the method employed in that city may be found in the report 
 Off the health department for 1897, p. 13, from which the following 
 extracts are taken : 
 
 •We. therefore, established a milk depot in one of the most populous districts 
 of the city where we supplied milk in nursing bottles, ready for feeding, after the 
 plan of Siebert, of New York City, slightly modified to meet the small fund avail- 
 able for this [impose. For this depol we had a large, light, uewly-papered, clean 
 store with counters dividing it in half. In the rear of the counter a long work table, 
 gas stove, large sink and large refrigerator were placed. A supply of four and eight 
 oiiuee nursing bottles and corks, together with an Arnold sterilizer, capable of bold- 
 Log six dozen bottles ami the necessary cleaning appliances, etc., completed our out- 
 tit. At this depot was stationed a nurse, whose services were donated by the 
 Rochester City Hospital. A woman to wash bottles assisted the nurse. 
 
 •■ The milk was received from rows that had passed the tuberculin test and who 
 were daily groomed, well fed, and watered, and their udders well washed. The 
 COWS were inspected by our milk inspector. The milk was received in squat twelve 
 quart cans belonging to the department. These cans were sterilized for forty-five min- 
 utes in the steam sterilizer and then sealed. Around the neck of these cans was placed 
 a wide rubber hand and a sterile paper envelope containing two squares of sterile 
 eheese cloth sufficient to cover the mouths of the cans. Through one of these cloth 
 gguares the cov» was to have been milked directly into the sterilized can. When the 
 milking was finished, the first piece of cloth was to have been thrown awaj and the 
 lecond piece placed over the mouth of the can, while t lie can was placed in ice water 
 t" cool. When the milk was received at the depot it was immediately prepared, 
 
 Pasteurized, and put up in bottles as indicated in Siebert's table. 
 
 ■ When a mothei came to the depol for milk, the nurse, in the absence of direc- 
 tion from a physician, advised about the general can of her child, using the little 
 
 pamphlet as a guide. If the mother was QUrsing her child, tie nurse endeavored to 
 
 tier continue to do so, if the age, weight, and general devolopmenl of the child 
 seemed to indicate thai it was best. It the child was a bottle-fed child, the nurse 
 
 
 Forum, November, 1894, and circular letter of Nathan Strauss, IS Nov., 1900. 
 2 Brooklyn. Report of Health Department (1896), pp. 55 and 89. 
 
422 DAIRY PRODUCTS. 
 
 weighed the child, and, in the absence of any direction from the physician, directed 
 the mother how to feed it. The milk was sold in nursing bottles only, at the uni- 
 form price of about two cents per pint, the cost of the milk. No milk Was sold by 
 measure. Milk was only sold after the weight and general development of the child 
 had been observed by the nurse. 
 
 "The difficulty of securing clean milk to start with was an almost insuperable 
 obstacle to the success of the project. 
 
 "Notwithstanding the care taken to sterilize the milk cans, the bottles, corks, 
 and everything that could possibly come in contact with the milk, the difficulties in 
 producing a clean milk supply were very great. Wheu our milk station was started, 
 one of the most intelligent and painstaking milk producers in this section was asked 
 to supply us with milk. Specific directions were given to him as to just how the 
 milk should be put into our cans. Our cans after they were sterilized, closed and 
 sealed, were to be sent to his dairy. The cows 1 udders were to be washed, and 
 milked directly into our cans; the cans were to be covered with a double thickness 
 of dairy cloth and placed in ice water to cool. We found upon examination that 
 those directions were not being carried out. The cows were being milked into the 
 milkman's own cans, the milk put into a cooler, stirred with a piece of broomstitk. 
 poured into our cans, which were allowed to stand open, and sent to our milk depot 
 for distribution. Some of the milk that came to lis was absolutely bad. Upon uncl- 
 ing this state of things we immediately stopped getting milk from this man, and 
 upon advice of our milk inspectors selected a man whom they thought, out of all 
 the milk producers sending milk into the city of Rochester, would be the man best 
 calculated to give us a good, clean milk supply. Our further observation proved 
 that this was not so. Inspections by our milk inspectors of this stable showed that 
 the milkmen were milking with dirty hands into their own pails in a dusty stable; 
 that they were leaving our sterilized milk cans open, and upon several occasions we 
 received milk, with a dusty, cowey taste, and on one occasion milk that was sour. 
 
 " These experiences have taught us that the only way in which we can secure a 
 good milk supply for little children is to rent our own cows, rent a stable and pas- 
 ture for the season, and produce our own milk under conditions over which we have 
 absolute control." 
 
 In Rochester in 1899, there were five stations with a nurse at each 
 station. The nurses were paid $10 per week and four cents per quart 
 was paid for the milk. The total cost was about one cent per bottle. 
 About 40,000 bottles were distributed to 100 children, most of whom 
 were sick. The milk that was purchased averaged under 25,000 bac- 
 teria per c. c. Excellent work of a similar character has been done 
 in Yonkers under the direction of Dr. S. E. Gettv. 
 
 Statutes Consulted in the Peparation of this Chapter. 
 
 Alabama. Butter, Chapter 408 of 1895 and 597 of 1897. 
 Arkansas. Butter, Statutes (1894), Sees. 1586-90. 
 California. Butter, Chapters 75 of 1897 and 25 of 1899. 
 
 Cheese, Chapter 76 of 1897. 
 
 Dairy bureau, Chapters 38 of 1897, 75 of 1897 and 136 of 1899. 
 
 Milk, Chapter 136 of 1899. 
 Colorado. Butter, Annotated Statutes (1891), Chapter I, Sees. 1-8. 
 
 Dairy Commissioner, (butter and milk), Chapter 19 of 1895. 
 
 Milk, Act of 17 April, 1893, Sees. 69-72. 
 
DAIRY PRODUCTS. 423 
 
 COHHECTICUT. Butter. Chapters 114 of 1893 and 32 of 1895. 
 
 Dairy Commissioner, Chapter, 114 of 1893. 
 
 Milk and butter, General Statutes (1888), Sees. 14-03. 
 
 Milk Inspectors, Chapter 209 of 1899. 
 Delaware. Butter, Chapter 209 of 1895. 
 District of Columbia. Butter, Act of 25 January, 1879. 
 
 Milk, Act of 2 March, 1895. 
 Florida. Butter, Chapter 328 of 1881. 
 Georgi \. Butter and cheese, Act of 16 December, 1896. 
 
 Milk, Act of 16 December, Ism;,. 
 In aiio. Butter, Act of 6 March, 1899. 
 
 ILLINOIS. Butter and cheese. Annotated Statutes (1896), Chapter 38, Sees. 19-35; 
 Act of 14 June, 1897. 
 
 Milk. Annotated Statutes (1896), Chapter 38, Sees. 37-42; Rules of State Board of 
 Health, 30 September, 1895; Act of 7 June, 1897. 
 Indiana. Milk, Statutes (1897). Sees. 2191-2. 
 
 Butter. Statutes (1897), Sees. 2171a. 
 Iowa. Dairy products, Code (1897), Sees. 2515-28. 
 
 Milk, Code (1897), Sees. 4989-91. 
 Kan- vs. Milk. General Statutes (1897), Sees. 322-:;. 
 Kentucky. Butter, statutes (1894),Sec. 1283. 
 
 Milk, Statutes i 1894), Sec. 1274. 
 Loi isian \. Butter, Act of 8 July, 1886. 
 Maine. Butter and cheese, Revised statutes (1883), Chapter 128, Sees. 3-0. 
 
 Milk. Revised Statutes (1883), Chapter;;-. Sees. 44-7. 
 
 Chapters 20 of 1887, 255 of 1893 and 292 of 1897. 
 
 Testing Milk, Chapter 109 of L895. 
 Maryland. Butter and cheese Public General Laws (1888), Art. 27, Sees. 88-91 : 
 Chapter 604 of 1890. 
 
 Milk. Chapter 306 of L898. 
 Massachusetts. Butter and cheese, Public Statutes (1882), Chapter 50, Sec 17 
 etseq. Chapters 310 of 1884, 317 of 1886,356 of 1885, 58of 1891 and 340 of 
 L890. 
 
 Dairy bureau. Chapters 112 of 189] and 280 of 1894. 
 
 Milk. Public Statutes i L882), Chapter 57; chapters 310 of 1884, 352 of 1885, 318 of 
 1886, 425 of 1894, 264 of 1896; condensed milk. 109 and 223 of 1899. 
 Michigan. Butter and cheese, Compiled Laws (1897), Sees. 5013-17; Chapters 147 
 and 254 of L899. 
 
 Milk. Compiled Laws 1897), Sees. 11,412 25; Chapter L06 of 1899. 
 Minn i. -(.i \. Dairy products, Chapters 94, 257, 295 of 1899. 
 
 Milk. Statutes (1894), Sees. 6992 7005. 
 
 Milk, powers of cities, Chapter 203 of 1895. 
 Mi isissippi. Butter, Code | L892), Sec. L242. 
 
 MlSHOI RI. Blltter and cheese. Le\ ised S|;i| ulcs | 1899), Sees. 2270 6, 
 Milk, powers Of cities. Revised StatUteS i L899), See. 6165. 
 
 Montana. Butter and cheese, Penal Code (1895), Sees. 684 6, Political Cod< 
 4064. 
 
 Milch cows, Penal Code i L895), Sec. L095. 
 Nehrask \. 1 lu tier and cheese. Compiled Statutes (1899), Sees. 8211 8211g. 
 
 Milk. Compiled Statutes (1899), Sees. 6898, 6940. 
 
 Food Commission (1899), Sees. 8207 and 321 lg. 
 Ni.\ \o\. Butter, Compiled Laws (1900) Sees. 1906 8. 
 
 Milk. Compiled Laws , L900), Set !. 1897 1901. 
 Ni \\ Hampshire. Dairy products, Public Statutes (1891), Chapter 127; Chapters 
 
 37 of L893, 115 of L895 and 58 ol 
 
424 DAIRY PRODUCTS. 
 
 New Jersey. Butter and cheese, General Statutes (1895), p. 1167, Sees. 4-22, p. 1167. 
 Sees. 23-28, p. 1169, Sees. 29-30. 
 
 Milk, General Statutes (1895), p. 1169, Sees. 3, 33^3, 51-54, 65-66; Chapters 152 
 of 1897 and 182 of 1898. 
 
 Dairy Commissioner, General Statutes (1895), p. 1169, Sec. 31-2, p. 1177, Sec. 91. 
 New York. Butter and cheese, Revised Statutes (1895), p. 38 (Agricultural Law, 
 Sees. 20 et seq. ) ; Chapter 149 of 1899. 
 
 Milk, Revised Statutes (1895), p. 38, (Agricultural Law. Sec. 20 et seq.); Chapter 
 153 of 1898. 
 
 Commissioner of Agriculture, Revised Statutes (1895), p. 38, (Agricultural Law, 
 Sees. 1-12. 
 Noeth Carolina. Butter, Chapter 106 of 1895. 
 
 North Dakota. Dairy products, Chapter 49 of 1895, and 72 of 1899. 
 Ohio. Butter, Annotated Statutes (1900), Sees. 4200(-14), et seq. 
 
 Milk, Annotated Statutes (1900), Sees 4200(-9), et seq. 
 Oklahoma. Dairy products, Compiled Statutes (1893), Sec. 2443. 
 Oregon. Milk, Annotated Laws (1892), Chapter 36, Sees. 3, 13. 
 
 Dairy products, Act of 25 February, 1893. 
 Pennsylvania. Butter and cheese, Brightly 1 * Purdon's Digest (1894), p. 1621, 
 Chapter 234 of 1895. 
 
 Milk, Brightly 1 * Purdon's Digest (1894), p. 1332, Chapter 118 of 1897. 
 
 Cheese, Chapter 164 of 1897. 
 
 Renovated Butter, Chapter 121 of 1899. 
 
 Dairy Commission, Brightly 1 * Purdor^s Digest (1894), p. 1621. 
 Rhode Island. Butter, General Laws (1896), Chapter 146. 
 
 Milk, General Laws (1896), Chapter 147, and Act of 13 May, 1896. 
 South Carolina. Dairy products, Actof 9 March, 1896. 
 South Dakota. Butter, Chapter 65 of 1897. 
 Tennessee. Butter. Chapter 101 of 1895. 
 Utah. Butter and cheese, Revised Statutes (1898), Sees. 734-40. 
 
 Milk, Revised Statutes (1898), Sees. 731-3, Chapter 34 of 1898. 
 
 Dairy Commission, Revised Statutes (1898), Sees. 2446-50. 
 Vermont. Butter and cheese, Statutes (1894), Sees. 4332-7. 
 
 Milk, Statutes (1894), Sees. 4327-30, 4975, Chapter 81 of 1898. 
 Virginia. Butter and cheese, Code (1887), Sees. 1900-1, Chapters 526 of 1891-2, 
 and 146 of 1897-8. 
 
 Milk, Code (1887), Sec. 1899, Chapter 526 of 1891-2, Sec. 3. 
 Washington. Butter and cheese, Code (1899), Sees. 2844-7, Chapter 43 of 1899. 
 
 Milk, Code (1899), Sees. 2842-3, 2851-4. 
 
 Dairy Commission, Code (1899), Sec. 2848 et seq. 
 Wj:st Virginia. Butter and cheese, Code (1899), Chapter 150, Sec. 20a. 
 Wisconsin. Butter, Statutes (1898), Sec. 4607 c-e, Chapter 76 of 1899. 
 
 Milk, Statutes (1898), Sees. 4607-b, Chapter 313 of 1899. 
 
 Food Commission, Statutes (1899), Sees. 1410-10d. 
 
CHAPTER IX. 
 
 COMMUNICABLE DISEASES. 
 Legislation. 
 
 IN one sense the prevention of the importation of communicable dis- 
 eases, or quarantine service, is the most important work of the health 
 officer. That prevention is better than cure is as true of the outbreak 
 of disease in a community as it is of its attack on the individual: but 
 after all, it is only in comparatively few instances that quarantine can 
 be successfully invoked. It is only at seaports that maritime quarantine 
 can be enforced, and inland quarantine is of use in only the rarer dis- 
 eases, so that very few health officers really have any quarantine duties 
 to perform and most of them only give a part, and often a small part of 
 their time to them; bu1 there are few boards of health which do no1 
 bave some of the commoner tonus of communicable diseases constantly 
 present, so that the problem of how to deal with communicable diseases 
 actually existent occupies a Large part of the attention of sanitary 
 authorities and is the important problem with which they have to deal. 
 The attempt to check the spread of communicable diseases by proper 
 management is no new thing and was made in early colonial times. 
 During the smallpox outbreak in .Massachusetts Bay in 1678, the town 
 officers of Boston ' and Salem 2 adopted measures of isolation and disin- 
 fection not unlike what would he employed at the present time. From 
 that time to the present our town and state governments have con- 
 tinued to practice and to improve methods of control, doI onh of small- 
 P"\. but of an increasing number of other communicable diseases. 
 
 The local management of communicable dise;ise> i> usuall} left in 
 the hands of the local authorities, county or municipal, hut sometimes 
 it is assumed by the state government and more rarely h\ the federal 
 government. In Florida, where the local hoards of health have been 
 abolished, the control of communicable diseases must he in the hands 
 
 Boston, Record Commissioners 1 I ;* ■ | >< ■ rt^. Vol. 7. p, 119. 
 -Act of Salem Selectmen, 18 October, 1678. 
 
426 COMMUNICABLE DISEASES. 
 
 of the state officers. In other states the state authorities are to take 
 charge of outbreaks under certain circumstances. Thus in Mississippi : l 
 
 "When yellow fever or other epidemic or contagions disease shall make its ap- 
 pearance, the state board of health shall take charge of the infected district or 
 locality and enforce such rules and take such measures as it may deem necessary to 
 prevent the spread of the disease or to suppress it." 
 
 And in Massachusetts : 2 
 
 " If smallpox or any other contagions or infectious disease dangerous to the pub- 
 lic health exists, or is likely to exist in any place within the state, the, state board 
 shall investigate the same, and the means of preventing the spread thereof, and shall 
 consult thereon with the local authorities, and shall have co-ordinate powers as a 
 board of health, in every place, with the board of health or health officer thereof, or 
 with the mayor and aldermen or the selectmen, if no such board or officer exists in 
 such place. 1 ' 
 
 In a few other states, as Maryland, Minnesota, North Carolina, and 
 Ohio, it is provided that in emergencies the state board of health shall 
 assume control of outbreaks of communicable diseases, 3 and as was shown 
 on page 5, the state board of health in several states is authorized to exer- 
 cise executive functions in those communities where the local authori- 
 ties fail. Furthermore in many states the state board of health is estab- 
 lished as an advisory board, and in almost all states local health officers 
 are accustomed to call on the state board of health for advice and assist- 
 ance in outbreaks of communicable diseases and not infrequently the 
 state board is invited to take entire charge. 
 
 Even in such a state as Massachusetts, which probably contains more 
 efficient local boards than any other state, the advice of the state board 
 is frequently called for even in such cities as Lowell, Newburyport, and 
 Springfield. The board, owing to the increase in this work, has recently 
 detailed a medical man as special inspector. It is his duty to visit all 
 towns which apply for advice in regard to communicable diseases and 
 
 1 Mississippi, Annotated Code (1892), Sec. 2279. 
 
 2 Masssachusetts, Public Statutes (1882), Chapter 80, Sec. 2. 
 
 3 Ohio, Annotated Statutes (1900), Sec. 2143: 
 
 " The state board of health, or the board of health of any city, village or town- 
 ship, in time of epidemic, or threatened epidemic, may establish a quarantine on 
 vessels, railroads, stages, or any other public or private vehicles conveying persons, 
 baggage or freight, or used for such purpose, and may make such rules and regula- 
 tions as may be deemed wise and necessary for the protection of the health of the 
 people of the community or state. Such quarantine and rules and regulations, when 
 .established by a local board of health, after careful investigation by the proper officer 
 of the state board of health, may be altered, relaxed, or abolished by the order of 
 said state board of health, and thereafter no change shall be made except by order 
 of the state board of health, or to meet some new and sudden emergency. (O. L., 
 vol. 90, March 14, 1893.)" 
 
COMMUNICABLE DISEASES. 427 
 
 in some cases when the board learns that the local officers do not seem 
 able to cope with the outbreaks the state board takes the initiative. 
 
 It is. however, more in accord with American principles of govern- 
 ment that the control of communicable disease should be entirely in the 
 hands of local officers, and in the vast majority of cases it is so. The 
 Local sanitary authority is established chiefly for this purpose, and in 
 very many states the law expressly confers the necessary executive and 
 legislative authority, and requires strict performance of duty on the part 
 of the local officers. Local sanitary officers are authorized to maintain 
 isolation, to remove to a hospital, to disinfect, and often to carry out 
 the rides and directions of the state board of health. An example of a 
 rather full narration of such powers and duties is found in Maine. 1 
 
 Sometimes the authority is granted in less specific terms, as in New 
 Jersey. 2 
 
 The powers above given are very broad, but they are broader still 
 for certain cities. The extraordinary powers given to the board of 
 health in the City of New York will be noted in connection with the 
 consideration of epidemics, and in addition that board is authorized in 
 such emergencies to spend $80,000 in excess of its appropriation. 3 Sim- 
 ilar provisions are found in Buffalo 4 and Pennsylvania cities of the 
 second class/ 1 and certain cities which have been given very broad san- 
 
 1 Maine, Chapter L23 of L887, as amended by Chapter L39 of L895: 
 
 •■ Si.c . t. III. To guard against the introduction of contagious and infectious 
 
 diseases, by tl zeroise of proper and vigilant medical inspection and control of all 
 
 persons and things coming wit Inn the limits of its jurisdiction from infected places. 
 
 or which tor any cause, are Liable to communicate contagion; to give public notice 
 of infected places, by displaying red flags or by posting placards on the entrances of 
 the premises; to require the isolation of all persons and things that are infected 
 with, or have been exposed to, contagious or infectious diseases, and to provide 
 tuitable places foi the reception of the same; and to furnish medical treatment and 
 Care for persons sick with such diseases who cannol otherwise he provided tor; to 
 prohibit and prevent all intercourse and communication with, or use of, infected 
 premises, places and things, and to require, and, if necessary, to provide the means 
 for the thorough cleansing and disinfection of the same before general intercourse 
 
 therewith, or use thereof, shall he allowed. And it shall he its duty to report to the 
 
 state board of health promptly, facts which relate to infectious and epidemic dis- 
 eases, ami every case of smallpox, varioloid, diphtheria, and scarlet fever, occurring 
 wit hin t he limits of its jurisdiction. 11 
 
 » New Jersey, General Statutes (1895), p. 1644, Sec. 19, III: 
 
 " To | ire vent the spreading of dangerous epidemics or contagious diseases, and to 
 
 declare that the same has become epidemic, ami to maintain and enfore proper ami 
 
 sufficient quarantine whenever dee d necessary.' 1 
 
 Neu York, Chapter 878 of 1897, Sec. iitt. 
 \cw York, chapter LOB of L801, Sec. --'::<•>. 
 Pennsylvania, Act of 26 June, 1896, Sec. 28. 
 
428 COMMUNICABLE DISEASES. 
 
 itary authority by statute have conferred the same upon their board of 
 health or health commissioner, as St. Louis 1 and Chicago. 2 
 
 While the executive control of communicable diseases is chiefly in 
 the hands of the local health authorities, it is not so with legislation. 
 Communicable diseases are largely dealt with by statutory legislation, 
 though there is also a great amount of municipal law-making on this 
 subject. 
 
 All but the following states have some restrictions applicable to com- 
 municable diseases upon their statute books. These states are Nebraska, 
 Kansas, Arkansas, Oregon. This statement has no reference to quar- 
 antine regulations. 
 
 Furthermore, a number of states have given their state board of 
 health authority to make regulations in regard to communicable 
 diseases. It is recognized that the framing of rules for the manage- 
 ment of communicable diseases requires a high degree of technical 
 knowledge and also that the science of preventive medicine and our 
 knowledge of these diseases is advancing rapidly, and laws on this sub- 
 ject need frequent revision. The following states give the state board 
 of health authority to make regulations in regard to contagious diseases : 
 Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, 
 Minnesota, Mississippi, Missouri, New Hampshire, North Dakota, Ohio, 
 South Dakota,Tennessee, Vermont, Virginia, Wisconsin ; but in Maryland 
 and Missouri this power is only to be exercised in serious outbreaks. 
 Such rules have been adopted in Florida. Indiana, Iowa, Mississippi, 
 Missouri, North Dakota, Ohio, South Dakota, Vermont, Wisconsin. But 
 in Wisconsin such rules have been declared unconstitutional by the 
 Supreme Court. 3 
 
 While legislative power is thus exercised by the legislature and con- 
 ferred upon the state board of health in many states, in no instance is it 
 withheld from the local units of government. Counties or municipali- 
 ties, or both, can in all states make rules in regard to communicable 
 diseases. When cities or boards of health can make rules " in regard 
 to health '" they can certainly make rules in regard to communicable 
 disease, so that any general grant of legislative power in sanitary 
 matters would involve the power to make rules concerning the subject 
 that we are now considering. In a few states only, as Connecticut, 
 Illinois, New Hampshire, New Jersey, New York, North Carolina, and 
 in a few cities, as Baltimore and Providence, does the local government 
 
 1 St. Louis Ordinances (1893), Chapter 14, Sec. 436. 
 
 2 Chicago Municipal Code (1881), Sec. 1189. 
 
 3 Wisconsin Supreme Court, 23 February, 1897. State ex rel. Adams vs. Burdge 
 et (d, School Board. 
 
COJIJfCXK \ 1 BLK DISK A SBS. 420 
 
 depend on such general provisions. In most states authority is expressly 
 given to make regulations in regard to communicable diseases. Thus 
 in. Maine 1 " towns may establish by-laws for protection against conta. 
 gious diseases." In Massachusetts 2 the board of health shall make reg- 
 ulations concerning "causes of sickness " and concerning" articles which 
 are capable of i ontaining or conveying infection or contagion, or of 
 creating sickness." In Alabama :: •• the court of county commis- 
 sioners • • • may make such rules and regulations as are necessary to 
 prevent the introduction and spread of contagious or infectious diseases." 
 Although Pennsylvania has as explicit statute law as any state for the 
 prevention of communicable diseases, nevertheless, power is given to 
 local boards of health to supplement the state law with rules of their 
 own. 4 
 
 Sometimes authority to make these rules is granted to the local 
 sanitary authorities, as in Massachusetts and Pennsylvania above, and 
 sometimes to the township, city or county, as in Alabama and Maine, in 
 which case of course the ordinances are enacted by the representative 
 legislative assembly of the township, city or county as the case ma\ be. 
 
 Having thus noted the statutory basis for the regulation of con- 
 tagious diseases we may proceed to consider the regulations actually in 
 force and the means taken to secure their enforcement. 
 
 Report* of Communicable Diseases. 
 
 Before the health officer can do anything to prevent the spread of 
 feommunicable disease he must be aware of its existence. As early as 
 1721 5 the colony of Rhode Island provided that tavern keepers should 
 report cases of communicable disease, and in 1 7 4 -V' the law was enacted 
 in nearly its present form. Similar laws were enacted in the other 
 colonics, and from that time until the present the report of smallpox 
 to the local authorities has been compulsory. It was not however until 
 
 Maine, Revised Statutes, Chapter 14, Sec. :!'''. 
 J Ma ssaoh u setts Public Statutes, Chapter 18, Sec. 18. 
 
 Uabama, Civil Code (1896), Sec. 1515. 
 1 Pennsylvania, Chapter 124 of 1895, s '-<'. 19: 
 
 "The health authorities of the several municipalities of this Commonwealth 
 shall, and they are hereby authorized and empowered to establish rules and regula- 
 tions regarding the isolation of persons who may be suffering from any of the 
 es mentioned in section four of this act, and for the destruction, disinfection 
 :ni'i fumigation of bedding, clothing or other infected articles, and for the disinfei 
 tion and fumigation of houses and premises, and for the carrying oul of the provis- 
 ions of this act, as thej may in good faith declare the public safety and health de- 
 Band, which rules and regulations they may from time bo time alter or amend/ 1 
 • Rhode Island Digest of 1730, p. 119. 
 1 Digest of 17 1.".. p, _'7 I. 
 
430 C OMM I XI CABLE D ISIS A SE\S. 
 
 the latter half and almost the last quarter of the nineteenth century 
 that the notification of the more common communicable diseases was 
 generall} r required. 
 
 At present the following states have state laws requiring the 
 report of communicable diseases : Alabama, Colorado, Connecticut, 
 Florida, Georgia, Kentucky, Maine, Maryland, Massachusetts, Michi- 
 gan, Minnesota, Mississippi, New Hampshire, New Jersey, North 
 Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Caro- 
 lina, Tennessee, Utah, Vermont, Washington, West .Virginia, Wiscon- 
 sin, and Wyoming have statutes covering the subject, while Indiana, 
 Iowa, Mississippi, New Hampshire, North Dakota, South Dakota, 
 Ohio Texas, Vermont, have regulations made by the state board of 
 health, and Mississippi, New Hampshire, Ohio, and Vermont have both. 
 In the states which do not by state law require the report of com- 
 municable diseases there are many communities which have made it a 
 part of their local regulations. Thus it is required by the model sani- 
 tary regulations of New York and has been adopted by all the principal 
 cities and by a large number of the smaller communities in that state. 
 
 Persons Required to Report. 
 
 The physician who attends a case of communicable disease is ex- 
 pected to have the first and best knowledge of the case, and it is he who 
 in every instance is required to report it to the authorities. The fol- 
 lowing is the wording of the law in Pennsylvania : 2 
 
 ". . . That every physician located or practicing in any of the municipalities 
 of this Commonwealth who shall know that any person whom he or she is called 
 upon to visit or who comes or is brought to him or her for examination is suffering 
 from or is afflicted with cholera, smallpox, etc. . . ." 
 
 When more than one physician has been called to a case, the case is 
 sometimes not reported as each physician may think the other has ful- 
 filled the law. This is guarded against by the sanitary code of the 
 City of New York. 2 
 
 In Camden 3 it is provided that reports of communicable disease by 
 physicians shall be confidential, but how the subsequent necessary steps 
 
 1 Pennsylvania, Chapter 124 of 1895, Sec. 1. 
 
 2 The City of New York, Sanitary Code, 1899 : 
 
 " Sec. 145. That every physician shall report to the Sanitary Bureau, in writing, 
 every person having a contagious disease (and the state of his or her disease, and 
 his or her place of dwelling and name if known), which such physician has pre- 
 scribed for or attended for the first time since having such a contagious disease, dur- 
 ing any part of the preceding twenty-four hours; but not more than two reports 
 shall be required in one week concerning the same person; but every attending or 
 practicing physician thereat must, at his peril, see that such report is or has been 
 made by some attending physician." 
 
 3 Camden, Sanitary Code (1894), Sec. 11. 
 
C OMMUNICA BLE DISK. 1 8E8. 431 
 
 for the control of the case can be taken and this provision be respected, 
 it is difficult to see. But it not infrequently happens that a physician 
 is not called, and sometimes this is intentionally done so that the case 
 may not be reported. Consequently it is often required that the head 
 of the household or an)- person having a knowledge of the case shall 
 report. Usually the responsibility is laid conjointly on both the 
 physician and the head of the household, but in New Hampshire, New 
 Jersey and Wisconsin the latter is only required to report when there 
 is no physician in attendance. The "head of the family" is made 
 responsible in Alabama, Kentucky, Ohio, and Vermont, the "head of 
 the household" in Tennessee; the u householder ** in Colorado, Maine, 
 Massachusetts, Michigan, New Hampshire, New Jersey. North Carolina, 
 Rhode Island, and Wisconsin, and the "tenant" in Michigan. Any 
 gterson knowing of ;i case of contagions disease is required to report in 
 Georgia, Indiana, Minnesota. North Dakota, Rhode Island, and New 
 York City. In Ohio "the owner or agent of the owner of any build- 
 ing in which a person resides " is responsible. Many of the old laws 
 required innkeepers to report, and this is true at present of the laws in 
 Michigan, Minnesota ;tnd New York City. In Minnesota, "every 
 keeper of any private house, boarding house or lodging house and every 
 inn keeper and hotel keeper . . . and every person knowing of 
 any person sick with contagious disease shall report the same." 1 In 
 Buffalo '-the nurse or midwife in charge " and "the officer in charge of 
 any public institution," in Denver " any policeman," in St. Louis •• the 
 police department," in Reading and Rochester " the nurse." in Albany 
 ami Fitchburg the " parent or guardian," in Atlanta any "citizen," and 
 in Chicago " any other person hearing of a case" are required to report. 
 Examples of other municipal regulations are given below. 2 
 
 ■ Minnesota Chapter 132 <>t L883, Sees. 22 :;. 
 New Orleans, Ordinances No. 1916, Administration Scries 1879, An. 155(21): 
 
 " The coroner or coroners, or his or their deputies, masters "t any water-craft, 
 boarding or I- ■< t u i u ^ house keepers, principals or masters of any boarding schools or 
 seminary, and all practitioners of medicine, surgeons, obstetricians or physicians, 
 
 apothecaries, chemists, druggists, midwives and all persons who as ' pretend to 
 
 ase medical, obstetrical or surgical means I'm- t he treatment of disease, disorder "i 
 lesion, are herebj required, each, any, or all of them, ;is the case maj be, to report 
 i" the 1m. aid of health. of the Mate of Louisiana, all eases oi : ontagious, infectious, 
 epidemological diseases, especially cholera, yellow fever, trichinosis, typhus or ship 
 lever, smallpox, diphtheria, or any of the grades of such diseases, or any others that 
 ma\ he specified by the board of health, or maj !»<■ generally adjudged contagious 
 or infectious, within twenty-four hours after t he same maj come under their treat 
 nient . i ognizance or supen ision." 
 
 Minneapolis, Ordinance "f 26 June, 1897, Sec. I 
 
 " I. very proprietor, manager, superintendent, principal, owner, agent, or ether 
 person in charge ol anj hotel, boarding house, boarding school, tenement hou 
 
432 COMMUNICABLE DISEASES. 
 
 Rules like that of New York shown below are found in many mari- 
 time cities and several inland cities, as Denver, Memphis, and Omaha 1 
 have applied the principle to railroad trains. 
 
 While many persons beside the physician are thus made responsible, 
 it is he who is chiefly looked to for official information of communicable 
 diseases, and it is he who reports nearly all recognized cases. Legal 
 action for failure to report is rarely brought against any one other than 
 a physician. Occasionally, however, the law is by the local board of 
 health enforced against the head of the family. Thus in Fitchburg 2 
 during an outbreak of measles in 1897 over half the cases were reported 
 by parents. In Boston both parents have been fined $100 for failure to 
 report. 
 
 While the great majority of cases of communicable disease are 
 treated by physicians, and if the notification laws are enforced are 
 reported by them, it is undoubtedly the small minority of unreported 
 cases which do the most harm in spreading the disease. Hence health 
 officers have made great efforts to get at these cases. Often the in- 
 spector of the department, while making his visits, learns of cases in 
 the neighborhood, cases which have not received a physician's care,, 
 either because of intention to conceal the case or because of careless 
 neglect. School teachers often learn of cases, and for many years it has 
 been the practice in Fitchburg, Oakland, Cal., Providence, and other 
 
 other place of residence, or of any hospital, asylum or other public institution 
 within said city, in which any contagious or infectious disease may be discovered, 
 shall give immediate notice to the department of health of said city of the exist- 
 ence therein of such contagious or infectious disease, and of the name or names of 
 the person or persons affected therewith. 11 
 
 New York, Chapter 378 of 1897, Sec. 1251 : 
 
 " Every master, owner or consignee of a vessel lying at a wharf or in the harbor 
 of the City of New York, shall make a like report, and within the same period, of 
 the name of every sick person on board of such vessel.' 1 
 
 1 Omaha, Rules of the Department of Health, Rule 5: 
 
 tl Whenever any person on any railroad train coming into Omaha shall show 
 symptoms indicating an attack of small-pox or other contagious disease, or when- 
 ever any such facts shall come to the knowledge of the conductor or the person in 
 charge of any such train, as shall lead him to suppose that any person on his train 
 is attacked with small-pox, or is infected with the disease, it shall be his duty, 
 before he shall have reached a point within five miles of the city limits, to telegraph 
 such fact to the mayor or commissioner of health, and whenever it shall be impossi- 
 ble to send such telegram, said conductor, or person having such train in charge, 
 and having a person on board so suspected by him of having the small-pox or other 
 contagious or infectious disease, shall detain such person on the train on reaching 
 Omaha until he shall have notified the mayor or commissioner of health, or some 
 officer of the health department thereof of such fact, and until a reasonable time 
 shall have elapsed after such notice for the health department of the city to take 
 charge of such person. 11 
 
 2 Fitchburg, Report of Board of Health (1897), p. 32. 
 
COMMUNICABLE DISEASES. 433 
 
 cities to supply the public school teachers with cards similar to those 
 furnished physicians to report to the health department any suspicious 
 eases of communicable disease that they may hear of. These cases are 
 then investigated by the inspector. In Iowa 1 a rule requiring reports 
 from teachers has recently been adopted. 
 
 Teachers are also required to report in Cincinnati, 2 Minneapolis, 3 
 Omaha, 4 New Orleans, 5 and the City of New York, 6 and in the latter 
 city the rule is made applicable to teachers in private schools, night 
 schools and Sunday schools. Boston improved upon this plan by estab- 
 lishing in 1894 a daily medical inspection of schools. This will be 
 more fully considered in another connection, and it is sufficient here to 
 state that many cases of communicable disease are thus found and 
 isolated, which would otherwise have mingled freely with the other 
 pupils, and doubtless often served as the starting point of outbreaks. 
 
 In most instances the physician or other person is to report cases 
 occurring in the city, township, county, or other sanitary district to 
 which the law applies, but in St. Louis cases within twelve miles of 
 the city, in Omaha within three miles, and in Memphis within one mile, 
 are to be reported. 
 
 Officer* to whom Report is Made. 
 
 In almost all cases the reports an- to be made to the health authori- 
 though iii some of the older laws it is otherwise. Thus in Rhode 
 Island the report is to the " town council," in Iowa to the " mayor 01 
 township clerk." in (Georgia and Florida (where there are no local boards 
 of health) to the mayor or county commissioner, and also to the state 
 board <>!' health in Florida, and in Mississippi and New Orleans reports 
 are to be made to the state board of health, in Pennsylvania and Ten- 
 eessee to the health authorities, in Alabama, Colorado, Connecticut, 
 
 Florida, Maine, Michigan, North Carolina, and Vevi it to the health 
 
 officer, but in most of the laws the report is to be made to the board of 
 health. In Brooklyn reports were to be made to the inspectors of the 
 
 district where the case resided. 
 
 i Iowa, Kules of the State Board of Health, Feb. 24, 1899, Rule I: 
 "Every school teacher who discovers among his or her pupils a case of these 
 Contagious diseases, must immediately reporl the fact to the mayor or township 
 
 elerk, ;in i! ase may be; als... to the superintendent or principal of the school, and 
 
 t" the parents of the children, and must scud the pupils thus afflicted m their homes 
 at once.' 1 
 
 Cincinnati, Manual of Health Department (1898), Sec. 89. 
 Se< p. 131. 
 'Omaha, Rules and Regulations ol Board of Health (1892), Sec. 13. 
 See p. 131. 
 \. w Vork, Rules oi the Board of Education (1899) S< 
 
434 COMMUNICABLE DISEASES. 
 
 How Made. 
 
 Often no reference is made to the manner in which the report shall be 
 sent. In a good many regulations, however, it is required that it be 
 in writing, as in Connecticut, Maryland, Massachusetts, Michigan, Min- 
 nesota, New Jersey, and North Dakota. In Maine the " notice shall be 
 given either at the office of the health officer or by a communication 
 addressed to him and duly mailed within the time specified " ; in New 
 Hampshire it " shall be given verbally to one of the health officers," or 
 else mailed. In Washington " the notices required may be sent by 
 mail or except in the case of cities, may be given to or left at the 
 residence of any member of the board of health." 
 
 The writer has seen no reference in the rules to the use of the tele- 
 phone as a means of reporting cases of contagious disease, but it is 
 often used. In Providence physicians are requested to use the telephone 
 when they can conveniently do so, and more than half the reports are 
 received in that way, and much time is thereby gained. This practice 
 in that city is steadily increasing. The report as received is at once 
 recorded on a blank form like that used for mail reports and the hour 
 of reception and name of receiver noted. In Buffalo, where the tariff 
 for telephone use is so much per message, the health department pays 
 the cost of the message. In Newark the use of the telephone is dis- 
 couraged, partly because as a payment of ten cents is made for each 
 return a written report is desirable as evidence, and second because it is 
 claimed that there is greater liability to error in the use of the telephone ; 
 but the experience of Providence shows that as many mistakes are made 
 in writen as in telephonic reports. 
 
 Time for Making Reports. 
 
 It is desirable to have reports of communicable diseases made as 
 promptly as possible, hence in Maryland, Massachusetts, Michigan, New 
 Hampshire, Rhode Island, and Washington they must be made " im- 
 mediately " or " at once." In Texas the time is six hours, in Con- 
 necticut, Ohio, Paterson, and St. Louis it is twelve hours, and in Iowa, 
 Kentucky, Maine, Minnesota, North Carolina, North Dakota, and Wis- 
 consin, twenty-four hours. In New York City 1 and in several cities 
 which copy from it, boarding-house keepers shall within six hours notify 
 the health department, if a seafaring man has been taken sick at their 
 house. 
 
 The following rule is found in Reading and some other Pennsyl- 
 vania cities 2 and in Wilmington, Del. : 
 
 ' ' Such report shall be made within six hours after knowledge of such case or 
 cases occurring between six o'clock a. m. and six o'clock p. m., or within eighteen 
 
 1 New York, Sanitary Code (1899), Sec. 150. 
 
 2 Reading, Rules and regulations, Board of Health (1896), Sec. 7. 
 
COMMUNICABLE DISEASES. 435 
 
 hours, if knowledge of such case be received between six o'clock p. m. and six 
 o'clock a. in. 
 
 In Bradford, Pa., 1 the report is to be made in three hours, or if after 
 six P. m. before nine o'clock the next morning. In Camden and Pater- 
 son deaths from communicable disease are to be reported in three hours 
 and six hours respectively, while cases are to be reported in twenty-four 
 hours and twelve hours. In Washington the physician is liable to a 
 penalty only after the lapse of forty-eight hours. In San Antonio 2 
 boxes of printed cards for the report of communicable diseases are left 
 at various drug stores and collections are made from these stores twice 
 each day by the police. 
 
 Most of the state laws require physicians and others to report cases 
 of communicable diseases of which they maj^ " know." This is true of 
 the laws in Indiana, Michigan, Minnesota, North Carolina, Pennsylvania, 
 South Dakota, Vermont, and Washington. In Michigan and Minnesota 
 they are to report cases of which they are "informed" or "which they 
 hear of." A more important provision is found in Florida, Indiana, 
 New Hampshire, Oklahoma, Rhode . Island, and South Dakota, namely, 
 that "suspected" cases shall be reported. A physician or other person 
 is not to wait until fully satisfied as to the diagnosis, but is to report 
 tin- cases as soon as suspicion arises that it may belong to the list re- 
 quiring notification, if it is desired to restrain persons who have the 
 virns of the disease in their person chough they may not be sick, it is 
 necessary that all communicable disease laws should specifically mention 
 "infected "' as well as -sick'* persons, but this as yet has not often been 
 done. 
 
 The following definition is Erom the District of < lolurabia : :; " -A case 
 oi contagious disease' shall be held to mean any person suffering from 
 jury such disease. Any person shall be held to be suffering from a con- 
 tagious disease who is so infected h\ such disease as to be capable of 
 transmitting it toothers. The presence of the ordinary clinical sym- 
 totns of any contagious disease shall be prima facie evidence that such 
 
 ease is 01' was such a disease: and the presence in such ease of the spe- 
 cific bacteria of such disease shall he conclusive e\ ideiice that such case 
 
 is or was such disease." 
 
 In a lew cities, as Albany, 4 report isto be made of any persons "ex- 
 posed to such contagious disease." I'snalh the statutes and regula- 
 tions require the report of every case of communicable disease, and the 
 Minneapolis rules specif} thai not onlj the first, but subsequent cases 
 
 Bradford, Rules of Board of Bealth, Sec. 72. 
 
 mi Antonio, Report of Department of Health, 1898, p. 18. 
 The District of Columbia, A.t of Congress, S March, 1897, Sec. L. 
 1 Albam . Rules and Regulations, Board of Health, 1892, Sec. 2. 
 
436 COMMUNICABLE DISEASES. 
 
 in a family shall be reported. In Providence where the medical 
 inspector maintains supervision of the family, the rule in regard to re- 
 quiring reports from physicians of secondary cases is not enforced, and. 
 little inconvenience results. In some cities physicians are required to 
 report to the health department when the patient has recovered. In 
 Mobile also in cases of yellow fever a daily report is required from the 
 physician. 
 
 Diseases to be Reported. 
 
 In most regulations the diseases to be reported are specifically 
 named, but always there is an additional requirement that communicable 
 diseases in general shall be reported. This broad provision is variously 
 worded. Thus " pestilential or infectious " diseases are to be reported 
 in Alabama ; diseases " dangerous " or " dangerous to the public health " 
 in Colorado, Massachusetts, Michigan, Wisconsin, and Vermont ; " con- 
 tagious or infectious diseases " in Connecticut, Massachusetts, Maryland, 
 New Jersey, Rhode Island, and South Carolina ; " contagious diseases " in 
 Indiana, Minnesota, Vermont, and Wisconsin ; " epidemic diseases " in 
 Kentucky ; " virulent contagious diseases " in Mississippi ; and the dis- 
 eases named by the state board of health in New Jersey, Ohio, and 
 Washington, and " communicable diseases " in New Jersey and Ten- 
 nessee. In West Virginia " epidemic " diseases are to be reported. In 
 Connecticut and Tennessee " venereal diseases " are excepted from the 
 contagious diseases to be reported. In St. Louis " malignant " diseases 
 are included in the rule. 
 
 Besides the requirement as to the class of diseases to be reported, 
 most laws specifically mention the diseases which it is intended shall be 
 covered by the law. Usually the local health authorities insist upon 
 the report of such diseases as are specifically named and ignore the 
 requirement of the law as to other communicable diseases. If circum- 
 stances require the report of another disease not specifically mentioned, 
 or of a new disease, the health authorities usually give ample notice that 
 such disease is to be reported before any action is taken against a per- 
 son for failure to report. In a few states, as Alabama and South Caro- 
 lina, no diseases are mentioned by name. The following are the diseases 
 that are usually specifically named as coming under the notification law 
 in American states and cities: 
 
 Smallpox. Nearly every notification law specifically mentions small- 
 pox as a disease to be reported, and the laws of Rhode Island : and 
 Georgia 2 mention no other. 
 
 1 Rhode Island, General Statutes (1896), Chapter 94, Sec. 13. 
 
 2 Georgia, Code (1882), Sec. 1386. 
 
( ' OMMUNIt 1 ABL E J)ISE\ 1 8 ES. 4 :) 7 
 
 Cholera. Nearly as many states mention this disease as smallpox, 
 Maryland,' Massachusetts. Minnesota, and North Carolina being the 
 exceptions. 
 
 Scarlet Fever is named in the following state laws, viz. : those of 
 Colorado, Connecticut, Indiana, Iowa, Kentucky. Maine, Maryland' 
 Massachusetts. Michigan, Minnesota. Mississippi, New Hampshire, New 
 Jersey. North Carolina, Ohio, Pennsylvania, South Dakota. Washing- 
 ton. West Virginia, and Wisconsin. 
 
 Diphtheria is mentioned in same states as scarlet fever. 
 
 <',-<>ii/, <>,- Membranous <'rmij) is to be reported by the laws of Con- 
 necticut. Indiana, Iowa, Maine, Maryland, New Hampshire, New Jersey, 
 and Pennsylvania. 
 
 The recognition of the fact that a large proportion if not all cases of 
 membranous croup are really diphtheria is somewhat recent, and as city 
 councils or hoards of health are usually less conservative than state 
 legislatures, it is not surprising that a number of cities require the 
 report <>i croup, although it is not required by their state law. This is 
 true of Albany. Boston, Brookline, Mass., Cambridge, Chicago, Cin- 
 cinnati, Cleveland. Fitchburg, Grand Rapids, Haverhill, Holyoke, 
 Kansas City, Lowell. Lynn, Macon, Memphis, Minneapolis, Newburg, 
 New Bedford, Newport, R. I., New York City. Omaha, Providence, 
 Salem. St. Louis, Seattle. Spokane, Springfield, Mass., Wilmington, and 
 Xoungstown, O. It was formerly reported in Newton, Mass., but is not 
 now, owing to the objections of physicians. 
 
 Sore Throat. Since it lias been demonstrated that diphtheria is due 
 to the diphtheria bacillus, it has been (dear that many cases of appar- 
 ently benign sore throat are really diphtheria and are not only danger- 
 ous to the patients themselves but to the public The advantage of 
 having all cases of sore throat submitted to bacteriological examination. 
 M is done l>\ the best educated pi i \ sieiai is is manifest. In Providence 
 the attempt was made to require the report of sore throats, but at the 
 
 parnesl solicitation of the medical profession it was abandoned. In 
 Spokane the rule given below has been adopted. 1 
 
 1 Spokane, Ordinances, Number A. 661, 2 October, L896, Sec. 1 : 
 I hat whenever any person shall know of the existence of any diphtheria] symp- 
 toms, and whenever an; guardian, parent or person who has charge ol any child, 
 children or other person, and such child, children or other person shall show indica- 
 tions of sore throat or other diphtherial symptoms, such guardian, parent or person 
 having the charge or control "I any child, children or other person shall immediately 
 report the same u> the health officer or :> member of the board of health of the City 
 of Spokane; and anj guardian, parent or other person having charge of any child, 
 children or person, either temporarily or permanently, \\h«. shall fail, refuse or 
 neglect to comply with the provisions of this ordinance, or shall fail, refuse or neglect 
 
 
438 COMMUNICABLE DISEASES. 
 
 It was also ordained at the same time that the board of health should 
 investigate such cases, but that section was repealed. 
 
 Yellow Fever is named in the following state laws : Connecticut, 
 Florida, Indiana, Kentucky, Mississippi, New Hampshire, New Jersey, 
 North Carolina, Ohio, Tennessee, and Vermont. 
 
 Typhus Fever has not been very common of late years, although it 
 is serious enough when it does occur. It is to be reported in Connec-, 
 ticut, Maryland, Indiana, Maine, New Hampshire, New Jersey, North 
 Carolina, Ohio, and Vermont. 
 
 Typhoid Fever is required in physicians' reports in only a few states, 
 viz. : Connecticut, Iowa, Maine, Maryland, New Hampshire, New Jer- 
 sey, and Ohio. The reason for this probably is that stringent methods 
 of isolation or disinfection are not usually adopted in these cases. The 
 chief value of the reports of typhoid is that they often enable the sani- 
 tary officers to discover in the milk or water supply the source of an 
 outbreak and thus to check its spread. Such work, however, is much 
 more often possible and necessary in cities than in the country, so that 
 most cities have thought it wise to require reports of typhoid. Typhoid 
 is not reported in the District of Columbia, Dayton, Jersey City, Mem- 
 phis, Omaha, St. Paul, Terre Haute, and Toledo. 
 
 Measles is to be reported in Indiana, Iowa, Maryland, New Hamp- 
 shire, Ohio, South Dakota, Utah, and in the following cities : Chicago, 
 Indianapolis, Kansas City, New Bedford, Newburgh, New Haven, New- 
 port, Newton, New York, Omaha, Portland, Me., Portland, Ore., Raleigh, 
 Rochester, St. Louis, San Antonio, San Francisco, Savannah, Scranton, 
 Seattle, Spokane, Syracuse, Terre Haute, Toledo, Utica, Worcester, 
 Yonkers, and Youngstown. 
 
 Whooping Cough is to be reported by the laws of Iowa, Maine, 
 Maryland, and Utah, and in the following cities : Chicago, Cincinnati, 
 Cleveland, Columbus, Grand Rapids, Haverhill, Minneapolis, Mobile, 
 New Bedford, Portland, Raleigh, St. Louis, San Antonio, Scranton, 
 Seattle, Spokane, Toledo, and Youngstown. 
 
 Phthisis or Consumption. Much discussion has arisen as to the • 
 advisability of requiring reports of this disease and physicians have not 
 very generally approved of it. Nevertheless it is required in Maine, 
 Michigan, and a considerable number of cities. Among these are 
 Alameda, CaL, Asbury Park, Boston, Buffalo, Cincinnati, New York 
 City, Salt Lake City, Trenton, and Yonkers. 
 
 In Washington, Asbury Park, Minneapolis, San Francisco, and 
 Syracuse, " tuberculosis " is to be reported. 
 
 to comply with all the orders of the health officer or physicians appointed by him or 
 the board of health, shall be punishable by a line not exceeding one hundred dol- 
 lars." 
 
COMMUNICABLE DISEASES. 439 
 
 The rule in regard to reporting consumption in New York City is 
 given below. 1 
 
 Cerebrospinal Meningitis is to be reported in Indiada, Pennsyl- 
 vania, Buffalo, Evansville, Fitchburg, Holyoke, Mass., Jerse}* City, 
 Lynn, Michigan, Minneapolis, Xew York City, Portland, Me., Raleigh, 
 Rochester, St. Louis, San Antonio, Spokane, Utica, and Yonkers. 
 
 Chicken Pox is to be reported in Albany, Baltimore, Cincinnati, 
 Grand Rapids, New York, Raleigh, and St. Louis. In Boston, during 
 outbreaks of smallpox, the board of health requires reports of chicken 
 pox, and probably under such circumstances it is required in other 
 cities. 
 
 Lepras// is to be reported in California, Connecticut, Iowa, Maine, 
 New Jersey, North Carolina, and Pennsylvania. 
 
 Hydrophobia in animals is considered in connection with diseases 
 of animals. ^Yhen it occurs in man, it is to be reported in Ohio and in 
 Scran ton. 
 
 Erysipelas is to be reported in Detroit, New York City, Portland, 
 Ore., Rochester, and St. Louis, and "epidemic erysipelas " in Ohio. 
 
 Mumps is to be reported in Maryland, Grand Rapids, and Raleigh. 
 
 Puerperal Fever is to be reported in Iowa, Ohio, Chicago, Grand 
 Rapids, Raleigh, Rochester, St. Louis, and Utica. 
 
 Relapsing Fever is to be reported in Pennsylvania, Buffalo, Roches- 
 ter, (Jtica, and Yonkers. 
 
 Dysentery in •• epidemic " form is to be reported in Ohio. It is also 
 reported in Scranton. 
 
 Grerman Measles is to be reported in Seattle. 
 
 Trichinosis is to be reported in New Jersey and North Carolina. 
 
 Plague is to be reported in District of Columbia and New Jersey. 
 
 1 The City of New York, Sanitary Code 1899, Sec. 153: 
 
 ■ That pulmonary tuberculosis is hereby declared to be an infectious and com- 
 municable disease, dangerous to the public health. It shall be the duly of every 
 physician in i his city to report to the Sanitary Bureau in writ ing t he name, age, sex, 
 Occupation and address of every person having such disease who has been attended 
 by or who has come under the observation of such physician for the first time. 
 within one week of such time. It shall also be the duty of the commissioners or 
 managers, or tin' principal, superintendent or physician of each and every public or 
 private institution or dispensary in tins city to report to the Sanitarj Bureau in 
 writing, or to cause such report to be made i>\ some proper and competent person, 
 •the name, age, sex, occupation ami last address of everj person afflicted with this 
 
 disease who is in their care or who has COU16 under their observation within one 
 Week o| such time. It shall he the duty of every person sick with this disease and 
 of every person in attendance upon anyone sick with this disease, ami of the 
 
 authorities of public and private institutions or dispensaries, to observe ami enforce 
 all the sanitary rules and regulations of the board of health for preventing the 
 
 spread of pulmonary tllben ulosis. " 
 
440 COMMUNICABLE DISEASES. 
 
 Pneumonia is to be reported in Hartford. 
 
 Glanders is to be reported in Detroit, District of Columbia, and 
 Scranton. 
 
 Malaria is to be reported in Oakland, Cal. 
 
 Form of Report. Very many of the statutes prescribe the items 
 
 which shall be given when reports of a case of communicable disease are 
 
 sent to the health department. In Pennsylvania l the physician shall 
 
 " Forthwith make report in writing or upon blanks to be furnished for that 
 purpose, to the health authorities of the municipality in which said person may be 
 located, which said report shall, over his or her own signature, state the name of 
 the disease and the name, age and sex of the person suffering therefrom, and 
 shall also set forth by street and number, or otherwise sufficiently designate the 
 house, room or other place in which said person may be located, together with 
 such other information relating thereto as may be deemed important by said health 
 authorities." 
 
 As in the above Pennsylvania law, provisions are found in other 
 statutes and local regulations that blank forms for reports shall be fur- 
 nished by the health authorities. Whether or not this is specified in 
 the laws, it is the general custom. In Newark, however, since a fee 
 has been paid for returns, blanks are not furnished, but this is not 
 approved of by the health department. These blanks are distributed to 
 physicians and others by the local health authorities and are usually 
 furnished by them, but sometimes, as in Vermont and South Dakota, 
 they are furnished by the state board of health. Generally the blanks 
 are in the form of a postal card with the address printed on the face. 
 Sometimes, as in Mobile and Philadelphia, a letter sheet is used. Ex- 
 amples of forms are shown in Appendices 51-6. It will be seen from 
 these that the number of items varies considerably. It is probable that 
 the fewer blanks the physician has to fill, the more prompt and com- 
 plete will be the returns. 
 
 Sometimes cities furnish unstamped cards or plain sheets for these 
 reports in order that they may be mailed in an envelope. This is some- 
 times done at the request of physicians who do not wish a chance 
 reader to be informed of the case. When stamped return letter sheets 
 were furnished by the post office department they were used for reports 
 in Albany. In some cities, as Milwaukee and Savannah, the blanks are 
 furnished in pad form with a stub which may be filed and kept by the 
 physician as a memorandum. Occasionally, as shown in the appendix, 
 special forms are used for special diseases. 
 
 Payment for Reports. This is rarely made and there are judicial 
 decisions which show that it is not necessary. 2 Nevertheless it has 
 
 1 Pennsylvania, Chapter 124 of 1895, Sec. 1. 
 
 2 Connecticut Supreme Court, 1 December, 1887. State vs. Nathaniel E. Wordin. 
 
COMMUNICABLE DISEASES. 441 
 
 been considered advisable by some states and cities to make a small pay- 
 ment for such reports. Michigan and New Jersey have such provision 
 in their laws and the amount in each is ten cents for every report. In 
 Newton, Mass.. the same fee is paid. 
 
 False Reports. Great injury might be done by the false report of a 
 communicable disease but no penalty for such has been noted; the fol- 
 lowing from Reading 1 might be applied: 
 
 •• No physician shall intentionally, in his reports to the Board, exaggerate the 
 number of cases of contagious disease under his care. 11 
 
 False rumors are forbidden by the Florida statute : 2 
 
 •• Any person or persons who shall falsely or maliciously disseminate or spread 
 rumors or reports concerning the existence of any infectious or contagious disease, 
 shall be guilty of a misdemeanor, and upon conviction thereof, shall be punished as 
 provided by section 765. 
 
 Reports to the State Board of Health. Besides the states of Flor- 
 ida aod Mississippi which require reports direct to the state board of 
 health, a number of states require reports of communicable diseases 
 fn nu local boards to the state board. 3 Other states than these secure 
 such reports either by voluntary action of the local boards or because 
 the general reports which local boards are required to make include 
 returns of communicable diseases. In some cases reports are to be 
 made by telegraph. In Wisconsin the health officer may use the mail or 
 telegraph as he sees fit. In Vermont reports of cholera, smallpox, 
 typhus and yellow fever are to be telegraphed. In Massachusetts cases 
 of smallpox arc to be reported to the state board in twenty-four hours. 
 In Washington smallpox, cholera, yellow fever and typhus are to be 
 reported in three days. In Illinois the first case of smallpox, typhoid 
 fever, cholera or yellow fever,shall be promptly reported to the state 
 board and the prevalence and progress of any epidemic disease shall be 
 
 promptly reported. In Tennessee Michigan, and New Hampshire the 
 
 first case of an outbreak is to be promptly reported, and in New 
 Hampshire and Michigan its subsequent progress is to be reported 
 weekly. The tonus used in New Hampshire arc shown in Appendices 
 57 58. 
 
 In New Jersey weekly reports are required. These are on cards and 
 
 arc filed alphabetically, and al80 recorded by tall) in a large book so 
 that the state board of health can easily keep informed of the amount of 
 communicable disease in all parts of the state. In (' ecticut, South 
 
 1 Reading, Rules and Regulations of the Board of Bealth, Sec. 8. 
 
 1 Florida, Revised Statutes (1892), Sec. 766. 
 
 Connecticut, Illinois, Kentucky, Maine, Maryland, Massachusetts, Michigan, 
 New Hampshire, Ne^i Jersey, North Carolina, Ohio, South Dakoto, Tenni 
 Washington, West Virginia, New 5Tork, Wisconsin and Vermont. 
 
442 COMMUNICABLE DISEASES. 
 
 Dakota and New York monthly, and in Kentucky and West Virginia, 
 quarterly reports are made. In New York reports of phthisis are to be 
 made annually. 
 
 In Vermont health officers receive fifteen cents for each case of com- 
 municable disease reported to the state board of health and in New 
 York twenty cents except for phthisis for which the fee is ten cents. 
 
 In Vermont when a case of communicable disease is brought in from 
 another town in the state the health officer is to notify that town. 1 
 
 In Michigan a very full report must be sent by the local health 
 officer to the state board of health after every outbreak of communicable 
 disease. 
 
 Penalty. Usually quite severe penalties are prescribed for failure 
 to report communicable diseases. From twenty-five dollars to one hun- 
 dred dollars are common maxima for fines, but it is two hundred dollars 
 in Massachusetts and Michigan and one thousand dollars in Florida. 
 In Florida the delinquent may be imprisoned thirty days and in Michi- 
 gan ninety days. 
 
 Placard*. In most communities the first step to be taken to con- 
 trol the spread of communicable diseases is to put a placard or sign 
 upon the infected premises to notify the public of the presence of the 
 disease. Signs have been used for this purpose for many years in 
 smallpox and perhaps other serious diseases ; but it is only within late 
 years that the custom has been followed in such diseases as scarlet 
 fever, diphtheria and measles. At present placarding is a very general 
 procedure throughout the United States. 2 
 
 1 Vermont State Board of Health Rules: 
 
 "Article 3. Whenever smallpox, cholera, yellow fever, diphtheria, scarlet 
 fever or typhoid fever appears in any town or city, the health officer of such town or 
 city, shall personally investigate the origin of the disease. In case he shall find evi- 
 dence that the disease was imported to his town or city from some other town or 
 city in this state, he shall immediately notify the health officer of such other town 
 or city giving him his reasons for suspecting the disease was brought from such 
 other town or city." 
 
 2 The following states provide by statute or regulation of their state board of 
 health for the placarding of infected premises: Colorado, Iowa, Indiana, Louisiana, 
 Michigan, Minnesota, North Carolina, Oklahoma, New Hampshire, Ohio, South 
 Dakota, North Dakota, Utah, Vermont, Wisconsin, and in Maine and South Caro- 
 lina the board of health may placard. Outside of the above ftates the following 
 important cities make use of placards or other warning signs: Bridgeport, Boston, 
 Fall River, Lowell, Newbury, New Haven, Newport, R. L, Providence, Newton, 
 Mass., Omaha, Portland, Me., Rochester, Somerville, Spokane, Springfield, Mass., 
 St. Louis, Charleston, Milwaukee, Taunton, Cambridge, Fitchburg, Haverhill, 
 Lynn, Macon, Memphis, Mobile, Salt Lake City, San Francisco, Worcester, District 
 of Columbia, Yonkers, Seattle, Kansas City, Sacramento, Norwich, Conn., Buffalo, 
 Newark, New Bedford, New Orleans, Florence, S. C, Knoxville, Baltimore, Cam- 
 den, Jersey City, Lawrence, Louisville, Paterson, Pawtucket, R. I , Portland, Ore., 
 San Antonio, St. Joseph, Mo., Pittsburgh, Allegheny, Reading, Scranton and Troy. 
 
COMMUNICABLE DISEASES. 443 
 
 A great many smaller places of which the writer has knowledge 
 also use placards. The only cities which he has visited, or with which 
 he has corresponded, which do not placard at all are Hartford, Rich- 
 mond. Wheeling, Wilmington, Del., and Augusta, (la. In Xew Haven 
 however, the health officer informed the writer that he did not consider 
 the practice a good one and in Philadelphia many of the medical pro- 
 fession are strongly opposed to it. On the other hand it is the ex- 
 perience of the writer that nothing which is so little trouble to the 
 health department and causes so little hardship to the family is pro- 
 ductive of such good results. 
 
 In Richmond placards were formerly used, but are not now. In 
 New York City placards are used only on stores and tenement houses. 
 In Chicago it is at the option of the attending physician whether houses 
 are placarded or not; it is not done if he assumes the responsibility of 
 isolation. In Mobile notices are used only for smallpox. In Atlanta, 
 according to the rule, scarlet fever is placarded only where there is 
 absence of isolation. In Philadelphia 1 the rule is that houses are not 
 to be placarded when a guard has been placed or when the responsible 
 head of a family guarantees isolation. 
 
 In some states, as in New Hampshire, it is provided that all com- 
 municable diseases | which require notification) shall be placarded. This 
 of course includes typhoid, but it is probably not generally done in 
 this disease. Indeed there is no reason why eases should be so desig- 
 nated. 
 
 Every city and state which specifies what diseases shall be thus 
 
 _ nated. names smallpox, scarlet fever, diphtheria, and croup (if re- 
 ported). Cholera is named in Iowa. New Hampshire, Indiana, North 
 Carolina, Vermont, and South Dakota, and St. Louis, Pittsburgh, Mem- 
 phis, and Philadelphia. Typhus fever is named in Ohio, New Hamp- 
 shire, North Carolina, Pittsburgh, and Philadelphia, and yellow fever 
 
 in Louisiana, North Carolina, Ohio, Vein t. Philadelphia and some 
 
 southern cities. It is probable that besides smallpox, scarlel fever, 
 diphtheria and croup, nearly all health officers would placard cholera, 
 typhus or plague or else put a guard around the house or remove it to 
 a hospital. The public in an\ evenl would surelj be warned, which is 
 one of the purposes of the placard. 
 
 The chief contention is in regard t<> measles. Warning signs are 
 perhaps not usually employed in this disease, but the} arc required by 
 the laws of Iowa, Michigan, New Hampshire, Ohio, and Vermont, ami 
 an- recommended by the state board of health of Maine, ami the\ are 
 used m Bloomfield, N. J., Central Palls, lb I.. Kansas City, Leomin- 
 
 1 Philadelphia, Rules <.t Board ol Health 1 1806), Sec. '.'::. 
 
444 
 
 COMMUNICABLE DlslJA SE8. 
 
 ster, Mass., Lowell, Macon, Ga., Minneapolis, Newton, Mass., Norwich, 
 Conn., Pawtucket, R. I., Pittsburgh, Rhineland, Wis., and Rochester, 
 but most if not all of the other cities mentioned on page 442 do not 
 use a placard for this disease. 
 
 Mumps are placarded in Cleveland. 
 
 ( 'erebro-spinal meningitis is placarded in Philadelphia and St. Louis. 
 
 Chicken pox is placarded in Cincinnati, and in Columbus, ( )., but 
 in the latter city the card merely states " contagious disease within." 
 
 Whooping cough is to be placarded in Kansas City and Michigan. 1 
 
 In most communities it is the duty of the health officer or other ex- 
 ecutive officer to place the warning sign upon the house or to cause it 
 to be so placed. This is made one of his duties in most of the statutes 
 and rules as in that of Minnesota given below ; but in South Dakota 
 " the county board of health shall cause the attending physician to see 
 that the proper cards or flags of warning " are placed on the house. In 
 Atlanta, Bridgeport, Grand Rapids, and Newark the occupant is to pla- 
 card the house. 
 
 In Wells County, Indiana, when there is doubt as to the nature of 
 a disease and contagion is suspected, the card shown below is placed on 
 the house until the diagnosis is established. 2 
 
 It is generally provided as in the Minnesota law that the sign shall 
 not be removed without the permission of the health officer, and it is to 
 be kept up of course, as long as it is deemed necessary to maintain 
 isolation. A penalty is imposed for removing the card, but as may well 
 be imagined, it can rarely be enforced, as it is extremely difficult to 
 secure evidence necessary to convict. The provisions of the Minnesota 
 law making the occupant responsible are intended to accomplish the 
 desired object in a better way. 3 
 
 1 Michigan, State Board of Health Report (1896), p. 30. 
 
 NOTICE. 
 
 Keep Out. 
 
 Contagion Possima" 
 Within. 
 
 Five Dollars Fine for Removing this Card. 
 
 Dr. Broge S. Horxe, 
 
 Comity Health Officer. 
 
 3 Minnesota, Chapter 133 of 1897: 
 
 " No person or persons shall deface, alter, mutilate, destroy, tear down or re- 
 move any snch notice posted as aforesaid without the permission of the com- 
 missioner of health or health officer who posted the same; and the occupant and 
 person having possession or control of any house or building upon which such 
 
< OMMUJSrii ABLE DISE 1 sEs. 445 
 
 The occupant is also made responsible by the ordinances of Chicago, 
 Denver, Memphis, and Milwaukee. In Buffalo the occupant is to 
 notify the health department if the sign is illegally removed. In Brad- 
 ford, Pa., 1 if the placard is removed the board of health shall publish 
 the name of the head of the family together with the location of the 
 house. 
 
 Warning signs are to be furnished by the sanitary authority and 
 this is specified in most of the laws and rules and is doubtless the uni- 
 versal practice. 
 
 The place where the warning sign is to be posted is often specified. 
 In Minnesota it is "on or near the house." In Indiana, Iowa, Lynn. 
 New Hampshire, and Ohio, in a conspicuous place, in Rochester in a 
 conspicuous place near the main entrance, in Reading and Scrantou on 
 the front door or in a conspicuous place, in Xorth Carolina, South 
 Dakota, Camden, Cincinnati. Cleveland, and Paterson, on the front of the 
 house. It is apparently intended in most regulations that one sign 
 shall suffice, but in North Dakota, 2 Holyoke, and Providence the card 
 is placed on all entrances. In a few cities the warning sign is not 
 placed on the outside of the house, but only on the apartment in which 
 the sick person is to be isolated, the isolation in such cases to be abso- 
 lute.^ 
 
 notice shall be placed or posted as aforesaid shall within twenty-four ( - J4) hours 
 after the destruction or removal of any notice placed or posted on his house or build- 
 ing as aforesaid, notify the commissioner of health or proper health officer of such 
 
 dest ruction or removal of the notice. 
 
 The feci of the alteration, destruction or removal of any such notice shall be 
 prima facie evidence that such notice was so altered, destroyed or removed, as the 
 case may he. by the occupant and person having possession and control of the house 
 6r building on which such notice was placed or posted." 
 
 1 Bradford, Rules of the Board of Health, Sea 74. 
 -' North Dakota. Rules of Male Board of Health, 20 May, 1899: 
 ■■ The health officer shall give notice to the publicof the dangerof infection from 
 such disease, in the house or building, by placing placards with the nan f the dis- 
 ease upon such, in large and distinct printed letters, on the outer walls of the house 
 or building, close to the front, tear and other entrances. 
 
 Milwaukee. Ordinances, Chapter 104 of 19 September, 1892, amending Sec. l96of 
 Chapter 1 t of 1891 
 
 . . . " Provided, however, thai in all cases where an; person residing in any 
 hotel, tenement house or other building, in which more than one family reside, may 
 he infected with any of the diseases herein mentioned, the commissioner of health 
 may in his discretion cause such notice to he placed upon the door of the room 
 occupied by such person, or upon some other door or doors in or to such building, 
 and tl •cupant. manager or lessee of such building shall be subject to the same 
 
 duties ami to a like line of any violation thereof as arc herein imposed upon the 
 occupants of such houses where such notice is placed upon all the outside dooN of 
 t he same." 
 
446 COMMUNICABLE DISEASES. 
 
 Similar provisions are found in Denver and Newton, Mass., and, in 
 the latter cit} T , if the card is removed it shall be then placed on the front 
 door, or above the latter at the discretion of the health commissioner. 
 
 In Boston if isolation in one room or apartment is complete and sat- 
 isfactory, the card is placed on the inner door, if isolation is not satis- 
 factory the patient is removed to the hospital. If the patient cannot 
 be moved to the hospital the card is placed on the outside. In Newark 
 and the District of Columbia the apartment only is placarded. 
 
 The form, size and wording of the warning sign are frequently pre- 
 scribed in the regulations and vary very greatly in different cities. 
 " Flags " are used instead of cards in Atlanta, Camden, Indianapolis, 
 Macon, Mobile, and New Orleans. In Reading a " patch," presumably 
 a piece of cloth, is prescribed. Usually a card is to be put up. The 
 largest that have come to the notice of the writer are those ordered in 
 Macon which are 24" by 28" and by the Iowa state board of health, 
 18" square. The form recommended by the Pennsylvania state board 
 of health is 9" by 18", in Minneapolis they are 11" by 13", in Indiana 
 and South Dakota 12" square, in New Hampshire 6" by 9". Those 
 used in Providence are 5" by 7" and about that size is very commonly 
 used. The smallest cards are used in several Massachusetts cities as 
 Boston, Cambridge, Everett, and Fall River ; those in Cambridge are 3i" 
 by 54". A very long card 7" by 24" is used in Defiance, O., for scarlet 
 fever and one 4|" by 12" in Denver for diphtheria. 
 
 The colors of the cards vary as much as the size. In Pennsylvania, 
 Utah, Baltimore, Bridgeport, Fall River, Lynn, Milwaukee, Newark, 
 New Haven, Newton, Philadelphia, Raleigh, San Francisco, and Seattle, 
 the same color is used for all diseases. Sometimes this is black on white 
 as in San Francisco and Seattle, sometimes red on white as in Fall 
 River and Newark, and again black on yellow in Utah, Baltimore, New 
 Haven, and Philadelphia. More often, however, different colors are 
 used for different diseases. 
 
 For smallpox in Rhode Island, the sign shall be of white with small- 
 pox in black letters six inches high. It is to be in red in Macon and 
 Reading ; yellow in Portland, Ore., and Mobile. For scarlet fever red 
 is usually employed if distinguishing colors are used, sometimes it is 
 black on red ground, and sometimes red on white ground. In the Dis- 
 trict of Columbia the color is pink. In Providence white on red ground 
 is used. It is difficult, however, to get a red card or red ink which will 
 stand sun or rain without fading. 
 
 For diphtheria and croup in Providence black on white is used as it 
 is in Boston, Cambridge, Denver, and New York. In New Hampshire, 
 District of Columbia, Macon, and Taunton blue is the color chosen, and 
 
COMMUNICABLE DISEASES. 447 
 
 green in Portland. Ore. Usually the same color is used for croup and 
 diphtheria, but in New Hampshire they are of different colors. In 
 New ark different colors were formerly used for diphtheria and croup, 
 but it has been deemed best to use the diphtheria card for croup. 
 
 For measles white is used in Macon, yellow in New Hampshire. 
 The signs usually contain in prominent letters the name of the dis- 
 ease, and a warning to persons not to enter the house and a warning 
 not to remove the card. In Denver all but the name of the disease is 
 in very- small letters. Often a section of the law is added. Examples 
 of various styles of placards are shown in Appendices 59—64. 
 
 In many cities the cosmopolitan character of the population requires 
 that cards should be printed in different languages. Often only the 
 language predominating in the neighborhood is used, though sometimes 
 two languages are used on the same card, as in Buffalo, where the mat- 
 ter is printed in both English and German. In Fall River an English 
 and a French card are posted. In Brooklyn formerly cards were 
 printed in English, Italian, Hebrew and German, but only one was as a 
 rule used on a house. The cards were printed with one language on 
 one side and anotheron the other so as to lighten by one-half the weight 
 of cards carried by the inspector. 
 
 Cards are usually fastened to the woodwork of the house with 
 tacks, and in Providence copper tacks are used so as not to deface the 
 house by rust. In many cases in that city the card is simply placed 
 between the curtain and the inside of the glass of the front door. In 
 Philadelphia the warning signs are gummed on the back and are moist- 
 ened and stuck to the house by the inspector. As might be inferred. 
 they are not infrequently washed off by the rain. 
 
 Usually if disinfection is done by the sanitary officials, the warning 
 sign is removed at that time, but in Jersey City it is to be left up for 
 twenty-four boms longer. 
 
 Isolation. 
 
 The isolati f communicable disease is s times prescribed ly 
 
 statute or by rules of the state board of health, but more often by local 
 regulations. 1 
 
 In some of these laws the provisions are verj general, as in North 
 Dakota, 2 \\ here 
 
 "The health officer si ml I ;tt once, after receiving such notification, sec thai the 
 patient is completely isolated from all other occupants of the bouse or building, or 
 removed to a hospital lor such cases. 11 
 
 1 " Isolation is directed i».\ the statutes of Arizona, Florida, Idaho, Iowa. Maine, 
 Maryland, Michigan, Mississippi, Montana. \<w Hampshire, NYw Jersey, Nevada, 
 North Carolina. Rhode Island. Virginia, ami by the state board of health rule- of 
 Indiana. Mississippi, New Hampshire, North Dakota, <>hio. and Vermont." 
 
 J North Dakota. Regulations ol the State Board oi Health, Sec. ■-'. 
 
448 COMMUNICABLE DISEASES. 
 
 In some states the force of the statute is weakened by imposing a 
 penalty only for wilful failure to maintain isolation, as in Michigan and 
 Mississippi. The statute in Maine is much more explicit. 1 The Rhode 
 Island law is superior in omitting the word wilful, but is very defective 
 in not providing that in the case of minors the parents shall be re- 
 sponsible. 2 As the majority of cases of communicable diseases are in 
 children, this is a serious defect. 
 
 Some of the other statutes like that of Rhode Island leave the 
 decision as to isolation in the hands of the local health officer by re- 
 quiring a permit from him for ingress or egress. In Colorado the 
 health officer is to order isolation, in Idaho, the county board of health, 
 and in Florida the state health officer. Sometimes, as in Ohio, 3 the 
 statute without ordering isolation authorizes the local board to en- 
 force it. 
 
 1 Maine, Chapter 123 of 1887, as amended by Chapter 139 of 1895: 
 
 "Sec. 11. No householder in whose dwelling there occurs any of the above- 
 mentioned diseases, shall permit any person suffering from any snch disease, or any 
 clothing or other property to be removed from his house, withontthe consent of the 
 board, or of the health officer, and the said board, or health officer, shall prescribe 
 the conditions of removal. 
 
 "Sec. 12. No parent, guardian, or other person, shall carelessly carry about 
 children or others affected with infections diseases, or knowingly or willfully intro- 
 duce infectious persons into other persons' houses, or permit such children under 
 his care, to attend any school, theatre, church or any public place. 
 
 " Sec. 15. Persons recovering from smallpox, scarlet fever, diphtheria or 
 cholera, and nurses who have been in attendance on any person suffering from any 
 such disease, shall not leave the premises till they have received from the board of 
 health, or health officer, a certificate that they have taken such precautions as to 
 their persons, clothing, and all other things which they propose bringing from the 
 premises as are necessary to insure the immunity from infection of other persons 
 with whom they may come in contact, and no such person shall expose himself in 
 any £>ublic place, shop, street, inn or public conveyance without having first 
 adopted such precautions.'" 
 
 2 Rhode Island General Laws, Chapter 94, Sec. 24: 
 
 "Every person in any house where there is any one sick with the smallpox or 
 other contagious or infectious disease, or who is in any smallpox hospital, who shall 
 voluntarily leave the same without a permit from the town council or the physician 
 employed by such town council, or from the superintendent of health in cities, shall 
 be tined twenty dollars and be imprisoned not exceeding ninety days." 
 
 3 Ohio, Annotated Statutes (1900), Sec. 2117: 
 
 "And when complaint is made, or a reasonable belief exists, that an infectious or 
 contagious disease prevails in any house or other locality, the board may cause such 
 house or locality to be inspected by its proper officers, and on discovering that such 
 infectious or contagious disease exists, may, as it deems best, send persons so 
 diseased to the pest-house or hospital, or may restrain them and others exposed 
 within said house or locality from intercourse with other persons, and prohibit in- 
 gress or egress to or from such premises." 
 
COMMUNICABLE DISEASES. 440 
 
 Occasionally, as in New York City, the statute peremptorily directs 
 absolute isolation. 1 
 
 Most of the isolation of communicable diseases is however done 
 under local regulations adopted by the legislative bodies of cities, town- 
 ships, counties, etc., or by the hoard of health. Local governments, as 
 we have seen, almost always have ample powers granted them to legis- 
 late " in regard to health" or to "prevent disease." Such powers have 
 generally been exercised, and wherever there is an established sanitary 
 authority to enforce them and sometimes where there is not, regula- 
 tions are framed prescribing with more or less minuteness for the isola- 
 tion of cases of communicable diseases. A section from the New York 
 code with very general provisions is given below. 2 
 
 Laws and regulations directing the isolation of persons infected with 
 communicable diseases may lie exceedingly strict, even requiring the 
 absolute separation from the outside world of the whole household or 
 family, as in the provisions of the charter of New York City quoted 
 above, it is not, however, to be supposed that it was intended that the 
 law should be enforced exactly as it reads, and it certainly is not so 
 enforced, though such might be done in cholera, plague or smallpox. 
 It is not every contagious, infectious or pestilential disease thai public 
 opinion would permit to be so treated, and in the opinion of many such 
 stringent measures are not necessary. Instead of ordering complete 
 isolation of the whole household in all cases of communicable disease, 
 laws and regulations may either prescribe under what circumstances and 
 to what extent isolation shall be maintained, or they may leave the 
 details of each case to the board of health or health officer or to the 
 inspector. Or perhaps some of these matters may be decided by the 
 laws and others left to the discretion of the executive officer. 
 
 In most eases the statutes and in many cases the local regulations 
 do not go into details in regard to the diseases to be isolated and the 
 
 Sevr York. Chapter 378 of L897, Sec. 1219: 
 
 •'It shall l»e thr duty of t hi- h., anl of health bo forbid all communication with the 
 house or family infected with any contagious, infectious, or pestilential disease ex- 
 cept by means of physicians, nurses, or messengers t" carry the necessary advice. 
 medicines, and provisions to the afflicted." 
 
 \.w Fork City, Sanitarj Code (1899), Sec. 167: 
 "That in> person shall within this city, without a permit from this department, 
 carry, remove, or cause or permit to be carried or removed, any person sirk with 
 smallpox or other contagious disease, or remove or cause to be removed, any sucb 
 peps, iii from any building or vessel t" any other building or \ esse I or to the shore, or 
 to or from any vehicle in anj pari of the city. Nor shall any person, by anj ex- 
 posure of any individual sick of an; contagious disease, or of the body of such per- 
 son, or by any negligent ad connected therewith, or in respectof the care or custody 
 thereof , or bj a needless exposure of himself, cause or contribute to, or promote 
 
 the spread of disease from any such person, or from any dead body." 
 
450 COMMUNICABLE DISEASES. 
 
 strictness and the length of the isolation. These matters are very often 
 discretionary with the health officer or the inspectors. It is therefore 
 not easy to determine what is the practice in different communities for 
 the details of isolation can only be partially learned from a study of 
 printed regulations. It is very often necessary to personally examine 
 into the methods adopted. 
 
 Isolation of the Patient (when not removed to a hospital). For the 
 more dangerous communicable diseases, as smallpox, typhus fever, 
 cholera, yellow fever, and plague, most boards of health and health 
 officers require the complete seclusion of the patient in one room. For 
 the more common diseases, as scarlet fever and diphtheria, it is usually 
 recommended and often required. The Boston rules are most explicit. 1 
 
 The card shown below 2 is used on the door of the infected apart- 
 
 1 Boston, Rules of the Board of Health, 1 July, 1895: 
 
 " 1. Whoever is infected with smallpox, scarlet fever, diphtheria, or membraneous 
 croup shall immediately proceed to some isolated place or room designated by the 
 board of health, and no person who has been so affected shall leave such place or 
 room, and no article shall be removed from such place or room, until the board of 
 health shall certify in writing that all danger of communicating such disease to 
 others is passed. 
 
 " 2. Every parent or guardian of any child or ward infected with smallpox, scarlet 
 fever, diphtheria or membraneous croup shall immediately cause such child or ward 
 to be conveyed to some isolated place or room approved by the board of health, and 
 no parent or guardian shall permit such child or ward to remove from such place or 
 room until the board of health shall find and certify in writing that all danger of 
 communicating such disease to others has passed. 
 
 "3. No person other than the attending physician, nurse and agents of the board 
 of health shall enter any apartment or other place set apart for the treatment of 
 smallpox, scarlet fever, diphtheria or membraneous croup until the board of health 
 shall certify in writing that such apartment or place has been satisfactorily disin- 
 fected. 
 
 " 4. No person having the care of any other person who has been affected with 
 smallpox, scarlet fever, diphtheria or membraneous croup shall advise or permit 
 such other person to leave any place designated by the board of health as a place of 
 isolation of such infected person before said board of health shall have certified in 
 writing that such person can leave such designated place without danger to others. 
 
 " 5. No physician who has been in attendance upon any person who has been 
 infected with smallpox, scarlet fever, diphtheria or membraneous croup shall advise 
 or knowingly permit such person to leave any place designated by the board of 
 health as a place of isolation of such infected person before said board of health 
 shall have certified in writing that such infected person can leave such place without 
 danger to others. 11 
 
 2 Size 34x54- Inches. 
 
 DIPHTHERIA. 
 
 This door opens to an apartment desig- 
 nated and set apart by the Boai'd of Health, 
 City of Boston, for the isolation of a patient 
 suffering from diphtheria. 
 
COMMUNICABLE DISEASES. 451 
 
 merit. In Newton this card has upon it a copy of the rules. Similar regu- 
 lations are found in Salem, 1 Newton, 2 Lynn, 3 Fitchburg, 4 Newark, 
 Rochester, and for smallpox, yellow fever, typhus fever and cholera in 
 the District of Columbia. 5 
 
 An examination of most of the circulars concerning communicable 
 diseases issued by boards of health will show that this isolation in 
 one room is always recommended even when it is not prescribed. 
 Sometimes, as in Cleveland and Providence, isolation for the patient is 
 ordered only under certain conditions, as when the wage-earner is 
 allowed to go to work and such isolation is necessary to keep him apart 
 from the patient. While it is easy enough to order such a separation 
 of the sick, it is a very difficult matter to enforce it. The writer doubts 
 if it can be done, unless there is a pretty constant supervision on the 
 part of the sanitary officers. There is certainly no other way of know- 
 ing that the order is enforced. Such supervision is not, however, gen- 
 erally maintained. Then again among persons of small means who live 
 in from two to four rooms and perhaps have a large family, it is impos- 
 sible to secure such isolation as is ordered by the Boston rules before 
 given, it is necessary to remove to the hospital cases occurring under 
 such conditions. This is done very frequently in Boston (in about fifty 
 per cent, of all cases), but few other cities have the facilities to care for 
 many hospital patients, it appears to be doubtful therefore, if more 
 than a minority of eases of communicable diseases occurring in the avcr- 
 \ niericaii community are really isolated in one room, rules and 
 orders notwithstanding. 
 
 Sometimes the rules make no pretence of keeping the sick person 
 
 in ■ room, but only forbid egress from thehouse. 6 The keeping of the 
 
 infected person in the house is another matter, and it is doubtless re- 
 quired and usually secured. Moreover, there is no good reason why 
 with ample grounds and no near neighbors, he may not go out of the 
 
 1 S;il. 'in. Report of Board of Health < 1896). 
 
 Newton, Rules ol Board of Bealth (1894), Sec. LI. 
 
 I.\ mi. Rules of Board of Health (1896), p. 5, Sec. 3. 
 1 Fitchburg, Rules ol Board of Health « 1897), p. is. Sec. •"-. 
 
 District of Columbia, A.cl of Congress, 8 March. L897. 
 
 • Denver, < Ordinance 1 1 of 1898, S< 
 • \ II persons having smallpox or any contagious or infectious disease in the city, 
 nr within five miles of the city, who shall refuse to go or cannot be taken to a place 
 prepared or designated for them, arc herebj required to be kept closelj confined 
 within their respective dwellings or places of abode, and to "hey such rules and 
 regulations as maj be adopted bj the bealth commissioner in the premises, and such 
 Orders as may be issued by the said commissioner under the law and ordinances ol 
 laid city." 
 
452 (JOMMUNICABLE DISEA sKs. 
 
 house upon the grounds surrounding it. During convalescence this 
 would often be better both for the patient and for the house and its other 
 inmates. Public opinion is, however, strongly against this, and it is 
 rarely permitted except under very favorable conditions in rural dis- 
 tricts. Most of the regulations refer, to the " sick " person, but of late 
 the expression " person infected " is used, and sometimes there is added 
 " who has recently had " the disease. 
 
 Isolation of the Family. When cases of the more dangerous com- 
 municable diseases, as smallpox, typhus, cholera and yellow fever can- 
 not be removed to a hospital, the complete isolation of the family is 
 invariably required. A number of cities in their rules require more 
 stringent measures for these diseases than for scarlet fever, diphtheria, 
 measles, etc., as Buffalo, Cincinnati, Cleveland, the District of Colum- 
 bia, Macon, Reading, and Wilmington ; and probably all boards of 
 health insist upon it, even if it is not commanded by the rules. In 
 scarlet fever and diphtheria isolation of persons other than the sick is 
 by no means invariably required. It is probably the general rule that 
 the children in such families shall be kept in the house ; it is so in Bal- 
 timore, the District of Columbia, Newark, Pittsburgh, Providence, Wil- 
 mington, and, of course, also in all cities where absolute isolation of the 
 family is maintained, and also probably in most of the cities where 
 wage-earners are kept from work. In Buffalo, Fall River, and Law- 
 rence 1 the children of the tenement must be kept off the street while 
 the card is up. This is not done in Cambridge, Chicago, New Haven, 
 Paterson, and Rochester. The school attendance of such children is. 
 referred to on another page. 
 
 In most communities including such large cities as Chicago, Cin- 
 cinnati, New Haven, New York, Paterson, Philadelphia, and Rochester, 
 wage earners in families with scarlet fever and diphtheria are not kept 
 from work. In some places, as Boston and other Massachusetts cities, 
 and in Buffalo, Cleveland, Newark, Pittsburgh, Providence, St. Paul, 
 and Toledo, they are not permitted to work unless the sick person is 
 kept isolated from the workers, and it is not even then allowed if the 
 worker is brought much in contact with children. In Providence in 
 cases of diphtheria persons may not go to work unless a culture taken 
 from the throat does not show the presence of diphtheria bacilli. In 
 Baltimore a similar requirement is made by the proprietors of some 
 of the mills. The following rules of the state board of health of Iowa 
 state the requirements which must be fulfilled in cases of diphtheria 
 before wage earners can go to work : 2 
 
 1 Lawrence, Rules of the Board of Health, 1 May, 1893, Sec. VI., Rule 5. 
 
 2 Regulations for Quarantine of Communicable Disease, Iowa State Hoard of 
 Health (1899), Rule 9. 
 
COMMUNICABLE DISEASES. 453 
 
 " When a family is quarantined for Diphtheria, the head of the family, or bread- 
 winner, may at the discretion of the local hoard, have the privilege of attending to 
 his regular business, and of going to and from his house only when complying with 
 the following conditions, and the Mayor or Township Clerk (as the case maybe), 
 shall issue a permit therefor: 
 
 " First. — He shall change his clothing before going to and leaving his home to go to 
 his place of business. 
 
 " Second. — He shall wash his hands, face, head, and beard with a two per cent, 
 solution of carbolic acid, each time before leaving his home to go to his place of 
 business. 
 
 • Third. — While in the house he shall not act as nurse nor live in the same room 
 with the sick person. 
 
 •• Fourth. — He shall not attend any public meeting, nor attend any place where 
 persons are congregated. 
 
 • Fifth. — This privilege shall not be granted to school teachers, nor to any person 
 whose business brings him in intimate contact with children.' 1 
 
 Explicit rules governing members of the family other than the sick 
 are tunnel in North Dakota. 1 
 
 In Newark, Providence, Rochester, and Toledo, when workers are to 
 be kept from their tasks, notice is sent to the employer. See Appendix 
 B3. Other forms of notices and of permits to work are also shown in 
 the Appendices 64-67. 
 
 In certain kinds of business the worker is obliged to remove from 
 borne. This in most communities is required of teachers, and, as in 
 Iowa above, the privilege of remaining at home is denied all who come 
 ¥ in intimate contact with children." Letter-carriers, dry goods clerks, 
 
 1 North Dakota, Regulations of State Board of Health: 
 
 ■ The health officer shall rigidly quarantine on the premises upon which the 
 infected house is situated, all the other occupants of the house or building, not ill 
 of the disease, until after : (a) The removal or thorough isolation of the patient; 
 (6) Until after disinfection to the satisfaction of the health officer, of those not ill of 
 the disease, their persons, clothing and that part of the house occupied by them. 
 After all such precautions have been taken, such persons shall not engage in their 
 usual avocations, or in any other way mix or come in contact with other individuals 
 until the liea lth officer shall have given a certificate that in his opinion t he\ may do 
 so without danger of spreading the disease. 
 
 •• in ease the disease be scarlet fever, the certificate releasing from quarantine 
 
 shall not he given by the health officer, to the persons exposed, and who have not 
 had the disease, until alter the usual period of incubation has elapsed, since last 
 exposure, viz.: a period of at least tour days, or longer, at the discretion of the 
 health officer. In the case the disease he diphtheria the quarantine period shall he 
 
 at least tour days, or until a bacteriological examination of the secretions of the 
 pbarnyx or naso-pharnyx has been made, and ton ml tree from the bacillus. Such ex- 
 amination to he at the discretion of the health officer. Incase of smallpox, persons 
 
 who have never had the disease, and who have not well marked vaccinal scars, must 
 not lie released until after a period Ol fourteen days alter last exposure. All who 
 
 have been ex posed must he vaccinated, or re-vaccinated, at c. and t lh.se who have 
 
 had smallpox, or who have on their persons well marked typi< al vaccination 
 
 ma\ he released alter thorough disinfection of pel-sons and clothing, without 
 
 fun her detention. 
 
454 COMMUNICABLE DISEASES. 
 
 dressmakers, waiters, policemen, milkmen, handlers of food stuffs, etc., 
 
 are among business people who are required to remove from the 
 
 infected house. Sometimes these matters are left to the discretion of 
 
 the officer and sometimes they are expressed in formal rules. See 
 
 page 453. 
 
 Sometimes while the members of the family who are well are not 
 
 kept in the house, they are forbidden to go in public places. Thus in 
 
 Iowa 1 "no person residing in such household, family or place shall be 
 
 permitted to attend any public meeting." hi Providence : 2 
 
 "No person living in a family where there is a person sick with smallpox, 
 scarlet fever, diphtheria, membranous croup, or while the warning sign is upon the 
 house, shall visit a theatre, church, a public library, or any public assemblage, 
 without the permission of the Superintendent of Health.'" 
 
 The Iowa rule denning isolation and forbidding ingress and egress 
 from the house is given below. 3 The regulations of many other cities 
 still more explicitly forbid visiting the infected family or house. 4 In 
 New Orleans the householder is required to prevent such visits. 5 In 
 Lawrence " None other than the tenants occupying the tenement where 
 the contagion exists, will be allowed to enter." 
 
 The visits of the physician are sometimes regulated as in Indiana. 6 
 
 1 Iowa, Regulations of State Board of Health (1899), Rule 4. 
 
 2 Providence, Rules of the Board of Aldermen (1899), Chapter I, Sec. 4. 
 
 3 Iowa, Regulations State Board of Health, in regard to Communicable Diseases 
 (1889), Rule": 
 
 "Isolation means the complete exclusion of all other persons from the sick except 
 the nurse and attending physician; that the nurse shall be restrained from going to 
 and from the premises, or mingling with the family; that all well persons shall be 
 prevented from contact with bedding, clothing, food, or other articles that have 
 been used on or about the sick. Where from necessity the parents or family are 
 nurses, the isolation and quarantine applies to them.' 1 
 
 4 Albany, Rules and Regulations of the Board of Health (1892), Sec. 24: 
 
 "No person or persons, excepting those in prof essional attendance upon the sick, 
 shall knowingly visit any dwelling, building or place in which there is any person 
 or thing infected with any malignant or contagious disease, or hold communication 
 or intercourse with any person or thing (to his or their knowledge) exposed to such 
 disease, without the special permit and by the direction of this board or its health 
 officer. 
 
 5 New Orleans, Ordinances, Council Series 2777, Sec. 2: 
 
 "That no householder, whether the owner of the premises, or any part thereof, 
 or possessor or occupant thereof, by lease or otherwise, shall allow or permit con- 
 trary to the order of the board of health of the State of Louisiana, any person or 
 persons to visit any person who may be sick or confined on said premises with any 
 infectious or contagious disease, saving and excepting such person or persons as 
 may be actually and absolutely necessary and essential to the proper care and atten- 
 tion of said sick person or persons." 
 
 6 Indiana, State Board of Health Rules, 15 April, 1898, Rule 12: 
 
 " Every physician attending a case of smallpox, scarlet fever, diphtheria, mem- 
 branous croup or other communicable disease dangerous to public health, shall use 
 every reasonable precaution to prevent communicating the disease to others." 
 
COMMUNICABLE DISEASES. 455 
 
 A similar rule has been adopted by the state board of health of 
 
 North Dakota and Ohio except that the word possible is used instead 
 
 of reasonable. In Utah 1 and Vermont 2 the physician and nurse must 
 
 disinfect themselves and their clothing before leaving the house or 
 
 premises. 
 
 The egress of the nurse is referred to in the Iowa rule and Maine 
 
 statute before quoted and has received attention from the Vermont 
 
 legislators. In Detroit 3 the method of disinfection is described as 
 
 follows : 
 
 •'Any person nursing or taking care of any person sick with either of said diseases 
 shall, before going upon the streets or visiting any other house, take a warm bath, 
 and disinfect the hair of the head, the hands, the finger nails, by means of the above 
 mentioned spray, changing all underclothing and clothing which had been worn 
 while in attendance on the patient, and see that the former underclothing and 
 clothing are thoroughly disinfected by either sulphur, boiling in water, steam, or 
 spraying with disinfectant cologne, and allowed to dry, and shall not attend any non- 
 contagious disease without a permit from the health officer." 
 
 Several of the regulations require parents and others to protect 
 from contagion the children in their care. 4 
 
 Other Families in the House. It is rare that isolation is extended 
 t'i families other than that in which the disease exists even if they 
 live in the same house. It is true that many of the laws referred to 
 above mention the house though the restrictions are only intended to 
 apply to the infected family, but they are then so worded that their 
 application to the whole house is left to the discretion of the health 
 officer. Tims in the Rhode Island law referred to on page 44S no one 
 may leave the house without a permit, but in almost all cases this per- 
 mit can be obtained except for certain members of the infected family. 
 Sometimes the children of other families may be subjected to restric- 
 tions, but rarely adults. Children from the whole house are generally 
 excluded from school. The rule in regard to children in Fall River is 
 given below. 5 
 
 1 Utah, Revised statutes (1898), See. 1112. 
 Vermont, Rules of State Board of Health, 1 June, L899. 
 - Detroit. Ordinance of J) Mas . 1892, Sec. 8. 
 
 1 Michigan, Chapter 15 of 1891, See. 1 : 
 ■■ . . . No <>ne shall iii any waj knowingly or willfully expose or cause to be 
 exposed a minor child or other irresponsible person to danger of contracting any 
 mi.- of 1 he aforesaid diseases." 
 
 Minneapolis, Ordinance of 25 July, 1897, Sec. 11: 
 
 No parent, guardian or custodian of any minor child within said city shall per- 
 mit sinh child to i>e unnecessarily exposed to contagion' or infection from any con- 
 tagious or infect iolls disease." 
 
 Fall River, Orders of the Board of Health. 1 : 
 
 il Ordered, That no child, from any house where t here is a case of scarlet fi 
 
 or diphtheria shall be allowed to mingle with those from any other house, until 
 
45G COMMUNICABLE DISEASES. 
 
 Persons Exposed. Except in smallpox, yellow fever, typhus and 
 cholera, persons who have simply been exposed to the disease are rarely 
 restrained. In the diseases above mentioned, persons exposed by being 
 in the same house, yard, workshop, vessel, etc., are often detained a 
 sufficient time to determine whether or not they have contracted the 
 disease. This will be further considered in treating of the management 
 of outbreaks. In the Ohio state board of health rules, the period of 
 isolation for all persons exposed to the different communicable diseases 
 is specified, but the rule does not definitely require their isolation. The 
 periods are as follows : 
 
 Ohio State Board of Health Rules. 
 
 Diphtheria. For persons associated with, or in the house with the patient: 
 Quarantine until after death or recovery of the patient and disinfection of the prem- 
 ises. 
 
 Scarlet Fever. Quarantine of children associated with or in the house with the 
 patient for ten (10) days after complete desquamation or scaling of patient and dis- 
 infection of the premises. 
 
 Smallpox. For exposed persons: Quarantine for fourteen (14) days from date 
 of last exposure. 
 
 Cholera and Yellow Fever. For exposed persons: Quarantine for five days from 
 date of last exposure. 
 
 Typhus Fever. For exposed persons: Quarantine for twenty-one (21) days from 
 date of last exposure. 
 
 Duration of Isolation. It is of the utmost importance that isolation 
 should be maintained a sufficient length of time. If it is terminated 
 too soon, great hardship is inflicted without accomplishing the intended 
 result. It is not an easy matter in most communicable diseases to 
 determine with accuracy the time at which the patient ceases to be in- 
 fectious. Uncertainty in regard to this is well shown by the varying 
 limits that are set for isolation in different places. In most cases the 
 determination of the period of isolation is left to the local" board of 
 health or health officer, as in Rhode Island (see p. 448). A number of 
 municipal ordinances also specifically refer the matter to the health 
 officer. 
 
 In no state is the period of isolation for communicable disease fixed 
 by statute, but it is by the rules of the state board of health (which 
 have the force of law) in Iowa, Missouri, Ohio, and South Dakota. It 
 is also fixed by ordinance or rule in the cities of Colorado Springs, Con- 
 cord, Denver, Fall River, Framingham, Mass., Holyoke, Lowell, Mil- 
 waukee, Minneapolis, Montclair, N. J., New Bedford, Omaha, Provi- 
 
 after the recovery or death of the patient and the disinfection of the premises and 
 the removal of the card, by a duly authorized agent of the board of health.'" 
 
( ' OMMUNIt \ UJL E D TSEu \ 8 E8. 4 5 7 
 
 dence, Salt Lake City. Syracuse, Utica, and Yonkers, but in many 
 cities it is left to the judgment of the health officer. 
 
 A number of cities leave the duration of isolation to the attending 
 physician. This is true of Baltimore, Cincinnati, Milwaukee, Paterson, 
 Pittsburgh (in scarlet fever). Charleston, Chicago, Cleveland, Portland. 
 Me., Reading, St. Paul, and Wilmington. 
 
 This period of isolation, of course, varies in different diseases and 
 the data collected are as follows. The period of isolation is for: 
 Smallpox. 
 
 Four weeks in Framingham, .Mass. 
 
 Forty days in Colorado Springs, Iowa, and Missouri. 
 
 Six weeks in Concord, Montclair, N. J., and Newark. 
 
 Five days after desquamation in North Dakota. 
 
 Until desquamation is completed in Boston, Cincinnati, Ohio, Prov- 
 idence, and South Dakota. 
 Scarlet Fever. 
 
 After desquamation in New Haven and Seattle. 
 
 Five days after desquamation in North Dakota. 
 
 Ten days after desquamation in Ohio and South Dakota. 
 
 Three weeks in Buffalo, 1 Cambridge, 1 Grand Rapids, Holyoke, 1 
 Lowell, 1 Leominster, Mass., 1 Minneapolis, Newark, 1 New York, 1 Syra- 
 cuse, Utah, and Utica. 
 
 Four weeks in Brookline, Mass., Concord, Kansas City, Newton* 
 Mass., and ( Mnaha. 1 
 
 Thirty days in Milwaukee, 2 Paterson, 2 and Pittsburgh. 2 
 
 Thirty-five days in Colorado Springs and Iowa. 
 
 Five weeks in Providence 1 and Rochester. 1 
 
 Six weeks in New Bedford, St. Paul, and Yonkers. 1 
 
 Six weeks in Denver, Fall River, Framingham, Mass., and Mont- 
 clair, N. J. 
 
 Of 102 replies made to an enquiry by the state board of health of 
 Minnesota 3 of towns in thai state, * stated thai the period of isolation 
 
 \\;is 2 Weeks. IT reported it 3 Weeks. S reported 1 Weeks. 1 reported 5 
 
 weeks, 1\ reported 6 weeks.;! reported 8 weeks, -and 11 determined tin- 
 period of isolation l>\ the duration of desquamation, 
 Diphtheria. 
 
 Until the discover} of the pathogenicity of the Klebs-Loeffler bacil- 
 lus and the developmenl of theculture method of determining its pres- 
 
 1 [solation is continued longei it' desquamation persists. 
 
 J isolation i^ maintained for iliis time, unless the physician certifies thai desqua- 
 mation has ceased, li is never maintained longer even if desquamation continues. 
 Minnesota, Reporl of State Board of Health (1895 B), p. 104. 
 
458 COMMUNICABLE DISEASES. 
 
 ence, it was necessary to fix an arbitrary time limit for isolation in 
 this disease. As the infectious period in this as in most of the com- 
 municable diseases varies in different cases, it was necessary in fixing a 
 time limit to fix some arbitrary time which was supposed to suffice for 
 the majority of cases. This was : 
 
 Two weeks in New Haven and Salt Lake City. 
 
 Ten days after disappearance of membrane in Chicago. 
 
 Fourteen days after recovery in Ohio, South Dakota, and Utah. 
 
 Three weeks in Concord, Grand Rapids, Montclair, 2 and North 
 Dakota. 
 
 Four weeks in Brookline, 2 Fall River (or a negative culture), Fram- 
 ing-ham, Mass., Kansas City, Milwaukee, New Bedford, and Yonkers. 2 
 
 Thirty days in Cleveland, 3 Paterson, 8 Pittsburgh, 1 and St. Paul. 
 
 Thirty-five days in Colorado Springs and Iowa. 
 
 An investigation by the Minnesota state board of health 4 showed 
 that in 1898 121 cities and towns had a time limit for the isolation of 
 diphtheria. In 8 it was for 2 weeks, in 11, 3 weeks; in 10, 4 weeks; 
 in 9, 6 weeks: in 1, 7 weeks, in 12, 2 weeks, and in 13, 3 weeks after 
 recovery. Twenty-eight health officers terminated isolation on securing 
 a negative culture from the throat. 
 
 With the. development of the culture method of determining the 
 presence of the diphtheria bacillus it was believed that there was fur- 
 nished a much more satisfactory method of deciding when a patient was 
 free from infection. Nearly all health officials who are so situated as to 
 have laboratory facilities now make the cessation of isolation depend 
 upon the obtaining of a negative culture from the patient. As may 
 be seen from the facts above given, the arbitrary period of isolation 
 fixed upon previous to the advent of the culture method was about four 
 weeks. By terminating isolation by the usual culture method, the 
 average period of isolation is considerably shortened, the method thus 
 resulting in a very considerable saving in time. 
 
 In most cities one negative culture from the throat of all persons 
 sick is all that is required. In Boston, Brookline, Holyoke, Newton, 
 Springfield, and Waltham, Mass., two successive negatives are neces- 
 sary, and in New Bedford two if four weeks has not elapsed, but if 
 it has, one will suffice. In Minnesota the state board of health has 
 made it a rule that isolation shall continue four weeks unless two nega- 
 
 1 Isolation never continues over thirty days even if diphtheria bacilli persist in 
 the throat. The card is removed before thirty days if the bacilli disappear. 
 
 2 Isolation is continued longer if diphtheria bacilli still remain in the throat. 
 
 3 The time is shortened if the attending physician certifies that there is no danger. 
 
 4 Minnesota, State Board of Health Report (1895-8), p. 403. 
 
( ' OMMUNIi A B L E J>lsL\ 1 8 E& 4 5 9 
 
 tive cultures are obtained. 1 In Boston, Newton, and Springfield the 
 two negative cultures must be at least twenty-four hours apart, and the 
 last one is taken by the health officer. 
 
 In Providence and St. Paul a negative culture is required from the 
 throat of every member of the family, and it has been found that Klebs- 
 Loeffler bacilli are found in the throats of from twelve to eighteen per 
 cent, of the well. 2 In Denver the throats of all the children in the 
 family are in most cases examined. This practice has met with much 
 opposition in both cities. 
 Measles. 
 
 One week in Detroit. 
 
 Two weeks in Buffalo, ('uncord. New York, 3 Providence, and 
 V< inkers. 
 
 Two weeks after eruption fades in Brookline and Fall River. 
 
 Two weeks after recovery in Boston. 
 
 Three weeks in Montelair, \. J.. New Bedford, and Ottumwa, la. 
 Whooping Cough. 
 
 Six weeks in Montelair. X. .J. 
 
 On recovery in Providence. 
 
 As long as the cough lasts in Boston. 
 
 The time limit that is thus set refers of course to those cases in 
 which the patient recovers. If the patient dies the isolation may ter- 
 minate sooner. In most places a private funeral is required and the 
 Warning sign is kept up till after the funeral, and then the premises 
 must usually be disinfected before the placard is removed. Usually the 
 isolation then ceases: sometimes, however, it is required that it be 
 maintained awhile longer; thus in Iowa it must be maintained for 
 Seventeen days after death, in Salt Lake City, seven days. 
 
 While a time limit for isolation is thus fixed by formal ride in many 
 states and cities, numbers of these rules have the proviso that isolation 
 shall he for at least the specified time, and the health officer or the hoard 
 of health has the authority to extend it. Again as the warning sign 
 
 may not be re ved without permission, the health officer has it in his 
 
 power nearly always to extend the period of isolation if he deems neces- 
 sary. This, however, is rarely done ; more often the health officer ex- 
 hibits laxness by terminating isolation before the authorized time. 
 
 Removal of Communicable Diseases. The removal of a case of com- 
 municable disease is such a serious matter thai it is specificalrj forbid- 
 den in several states and a large number of cities. Of course, if the 
 
 1 Minnesota, Regulations State Board oi Health, L2 April, 1898. 
 * Providence, Reports of Superintendent "i Health, 1897 to L900. 
 I f desquamal ion has ceased. 
 
460 COMMUNICABLE DISEASES. 
 
 rules for isolation were carried out from the beginning, there would be 
 no need of additional regulations forbidding the removal of the case 
 from the house, but these latter regulations are rather intended for the 
 period before the case is placed under municipal supervision. The pur- 
 pose of one class of these regulations is to prevent the removal of the 
 patient so that there may not be established a second or perhaps third 
 focus of the disease. Section 167 from the sanitar}* code of New 
 York City, given on page 449, is an example of this and has been very 
 frequently copied by other cities. A somewhat different rule in Cin- 
 cinnati applies to persons exposed as well as to the sick. 1 A similar 
 provision is found in the District of Columbia. Of course, these rules 
 are not intended to forbid removal to the hospital, and this exception is 
 formally made in Buffalo and Fitchburg. In Omaha the physician is 
 particularly forbidden to remove the patient. 
 
 Another class of rules aims at preventing danger to others during, 
 or by the act of transportation, and provides for the disinfection of the 
 vehicle. Maryland, Michigan, Mississippi, ( )hio, and Pennsylvania 2 
 have such rules, and they are found in many cities. The Pennsylvania 
 law puts the penalty upon the sick, but sometimes it is the owner of the 
 vehicle who is made responsible as in the Cincinnati rule given below, 
 and also in Mississipi : 3 
 
 No common carrier shall accept for transportation any person suffering with 
 smallpox, yellow fever, cholera, diphtheria or scarlet fever or any infected article of 
 any character whatever." 
 
 Usually the owner of the vehicle is made responsible for disinfec- 
 tion as in the District of Columbia : 4 
 
 " The owner or driver of any public conveyance, either or both of them, in which 
 has been conveyed any person suffering from a contagious disease shall immediately 
 have such conveyance properly disinfected, and said conveyance shall not again be 
 
 1 Cincinnati, Manual of Health Department (1808), Sec. 76: 
 
 lL Infected Person not to be Removed without Permit. Xo person shall, without 
 a permit from the department, carry or remove from one building to any other, or 
 from any railroad depot to any house, or through the public streets, or from any 
 vessel to the shore, any person sick of any contagious disease, or person that has 
 been exposed to and is liable very soon to develop any such contagious disease, nor 
 any articles that have been exposed to any such disease.'' 1 
 
 2 Pennsylvania, Chapter 124 of 1895, Sec. 15: 
 
 •• No person suffering from any of the diseases mentioned in section four of this 
 act, nor any one who has charge of a person so suffering, shall enter any hired 
 vehicle or other public conveyance, or permit any one in his or her charge who is so 
 suffering to enter such vehicle without previously notifying tho owner or driver 
 thereof that he or the person in his charge is so suffering, and the owner or driver 
 of such vehicle shall immediately provide for the disinfection of such conveyance 
 after it has with the knowledge of such owner or driver conveyed any such sufferer, 
 under the direction of the health authorities. 
 
 3 Mississippi, Rule of State Board of Health (1898), Sec. 9. 
 
 4 The District of Columbia, Act of Congress, 3 March, 1897, Sec. 19. 
 
COMMUNICABLE DISEASE s. 4(31 
 
 used until it has been disinfected to the satisfaction of said health officer, as certified 
 by him." 
 
 In Maryland 1 the person who was conveyed must pay for the disin- 
 fection. In order that the health officer may know of the facts and see 
 that disinfection is done, the District of Columbia rule provides 
 
 •■ That any person suffering from such disease and any person in charge of one 
 so suffering having entered any public conveyance shall forthwith report in writing 
 to said health officer the time of Mich use, the number and kind of conveyance used, 
 and. if known, the name of the driver." 
 
 and there is a similar provision in Maryland. In Buffalo 2 the hospital 
 superintendent must report to the health commissioner when a case of 
 communicable disease is brought in a public conveyance. In Scranton 
 it is required that a copy of the law be posted in each public carriage 
 by the owner, the notice to be furnished by the board of health. In 
 Haverhill all carriages carrying persons from a commmunicable disease 
 funeral are within the meaning of "-transporting communicable diseases." 
 ( See carriages for funerals, page 474.) 
 
 Tnfected 'r<>n,Js. As infection is sometimes carried in articles of 
 various kinds, it is common to forbid the removal from a house where 
 there is communicable disease of anything winch may have become in- 
 fected. Such regulations are found in most cities and in a few slate 
 laws. 3 
 
 Si line of the regulations forbid the removal of articles without a 
 permit from the health authorities, and sometimes it is made an offence 
 to carry infected articles in a public conveyance- 4 
 
 As nothingis more likely to infect clothing than the making of it 
 by persons with communicable disease or persons who have the care of 
 such cases, the making of clothing in infected houses is forbidden in 
 Buffalo, Fitchburg, New York City, Providence, and probably other 
 cities."' Iii Providence the restriction applies only to the family where 
 
 1 Maryland, Chapter 1."..". of 1882, See. <;. 
 Buffalo, Ordinances (1892), Chapter 25, Sec. 151. 
 Pennsylvania, Chapter 124 of 1895, Sec. IT: 
 
 •■ No person shall without previous disinfection give, lend, sell, transmit, "i ex 
 pose any bedding, clothing, rags, or other articles which have been exposed to in- 
 fection: Provided, Thai such rest rid ion shall n. .t apply to the transmission of arti- 
 cles with proper precautions for the purpose of having the same disinfected." 
 
 ' Bridgeport, Ordinances (1892), Chapter l I. Sec. 7: 
 
 •• \'( e shall enter :i passenger <-.ir. street car, steamboat, hack, cab, stage or 
 
 other public conveyance, wearing or having in liis or her possession any clothing oi 
 articles with which he or she shall have been in attendance upon a person sick with 
 diphtheria, smallpox, scarlet fever, or typhus fever, without having had the same 
 disinfected to the satisfaction of tli" li >ard of health. 11 
 Buffalo, Ordinances (1892), Chapter 25, Sec. 24: 
 
 "No person shall make, proem- • cause to be made, any clothing or wea 
 
 apparel "i any kind, in any hous ' building wherein any person shall he sick \\ ith 
 
462 COMMUNICABLE DISEASES. 
 
 the communicable disease exists. A number of the tenement house 
 laws also forbid the making of clothing or carrying on of other trades 
 in tenements where there is communicable disease. 
 
 Milk business when carried on from a house with communicable 
 disease is dangerous, as the infection may be carried by members of the 
 family and may also get into the milk. Regulations concerning the 
 sale of milk when communicable disease invades the family of the pro- 
 ducer or dealer have been referred to on page 419. It is almost always 
 forbidden to sell milk in such cases unless the milk and those who 
 handle it are removed from the infected house. 
 
 When the milkman leaves bottles or cans with the infected family 
 and removes those left the day before, there is danger that the latter 
 may be infected, and that by this means the milkman may carry the 
 disease to others. It is for this reason that the use of bottles has been 
 forbidden in Los Angeles. In other cities it is onl}' forbidden when 
 there is communicable disease in the house. 
 
 Sometimes tickets are used by dealers in payment for milk, bread, 
 etc., and it is provided in Richmond, Ind., 1 Meadville, Pa., and Little 
 Rock, N. Y., that such shall be collected from infected houses and 
 burned. See also page 420. 
 
 It has been supposed that pet animals as dogs and cats are very 
 
 likely to carry infection, and the following rule is found in Meadville, Pa.: 
 
 "No clogs, cats or other household pets, shall be permitted to remain in any 
 house in which there may he a contagious disease; if any such animal has been ex- 
 posed to the contagion it must be disinfected when removed, and not returned until 
 after the house shall have been fumigated. 2 
 
 In Missouri the rules of the state board of health require that all 
 pet animals exposed to smallpox shall be killed and burned. 
 
 Public Libraries and Communicable Disease. Books if handled by 
 persons with a communicable disease are particularly liable to be in- 
 fected, and if they are infected it is very difficult to disinfect them. It 
 is therefore wise to guard against the infection of public libraries which 
 would from their free circulation be especially likely to spread disease. 
 A great many cities, and some states, as Indiana, Ohio, and Vermont, 
 now have regulations in regard to this and seek to prevent the infection 
 of such books. Sometimes the infected family is forbidden to take 
 
 smallpox, varioloid, or other infectious or pestilential disease, except for the per- 
 sonal use of some of the inmates of said house, and no person shall sell or expose 
 for sale any clothing or wearing apparel which shall have been made in any house 
 or building in which there shall have been at the time when said clothing was made, 
 any person sick or infected with any such disease." 
 
 1 Richmond, Ind., Report of Board of Health 1896, p. 5. 
 
 2 Meadville, Rules and Regulations (1895), Rule 30. 
 
< ■ OMMl Wit L I B L E DISEA sEs. 4 Q 3 
 
 books from the library as in Cambridge, Fitchburg, 1 and Lynn. " Cir- 
 culating library " is included in the rule as in Cambridge. In other 
 cases, as in Indiana and Vermont, 2 the librarian is not to send out books. 
 In order that the librarian may be enabled to carry out this law the 
 Vermont rule provides that the health officer shall immediately send 
 notice to the librarian of the name and address of every case of com- 
 municable disease. Similar rules are found in many cities and in others 
 where there is no such rule notice is regularly sent by the health 
 department. In Providence notices are sent to private circulating 
 libraries as well. In Providence a separate card is sent for each case 
 giving the name, residence, disease and date. These are kept in 
 alphabetical arrangement by the librarian and no books are issued to the 
 infected houses and all that have been issued are by him returned to 
 file health department for disinfection. 
 
 After the case has recovered notice is sent to the librarian in Cin- 
 cinnati, Fitchburg, Lynn, Providence and some other cities. 
 
 School Attendance. It is extremely important that children infected 
 with communicable disease should be kept out of school. The very great 
 danger to which large numbers of children would be exposed is reason 
 enough for this : and the public school system is held in such high esteem. 
 and such strenuous efforts are made to prevent everything which would 
 interfere with its success that it is much easier to enforce exclusion from 
 School than it is any other form of isolation. Jt is a well nigh universal 
 rule to exclude from school children infected with communicable disease. 
 State regulations to this effeel are found in many states, 3 and in almost 
 every city or township which has any sanitary regulations at all. 
 
 Hoards of health usually have under the Legislative power granted 
 them, authorit) to make rules in regard to school attendance, but in 
 New Jersey this authority is reserved to the board of education.' In 
 Massachusetts and South Carolina also the school board has this power. 
 
 1 Fitchburg, Regulations of Board of Health, 25 August, 1894, Rule 11: 
 
 ■ No person from ;i family wherein :i <-;im' of Asiatic cholera, yellow fever, small- 
 pox, varioloid, diphtheria, membraneous croup, or scarlet fever exists, shall take 
 :in\ 1 k to or from the public library." 
 
 J Vermont, Regulations ol Man- Board of Health, Lrt. I. 
 
 '■ Librarians receiving sucli notice shall no! alkwi any I ks or period icals to !"• 
 
 taken by such family after such notice, and they skill nol ;ill"\\ anj I I<s then 
 
 held by any member of a family where there is contagious disease to be returned to 
 their libraries until disinfected under the direction of the health officer. 1 
 
 Colorado, Delaware, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mich- 
 igan, Minnesota, North Carolina, <>lii", Oklahoma, Pennsylvania, South Dakota, 
 South Carolina, Tennessee, Utah, Vermont, Virginia, and Wisconsin. 
 
 1 New Jersey, General Statutes (1895), p. 1689, Sec. 22: 
 
 "That any board of education, school trustees or other bodj having control of 
 the public schools may, on account of the prevalence of anj contagious disease, ox 
 
464 COMMUNICABLE DISEASES. 
 
 The following are some of the items found in these school regula- 
 tions : 
 
 Persons Excluded. A good many of the laws simply exclude infected 
 " children " or " pupils," but many exclude " persons " and some men- 
 tion " teachers " and " parents," and in Fall River " janitors " are named 
 in the order. In Cambridge " No person shall attend or visit " a school 
 if living in a house with a communicable disease. 
 
 Persons who are actually sick with communicable disease are invari- 
 ably excluded from school and a number of diseases are at times thus 
 treated which do not require notification and which receive no other 
 attention from sanitary authorities. Thus measles and whooping cough 
 are frequently not reported, but they invariably are excluded from 
 school; mumps and German measles are rarely reported but they are 
 to be excluded by rules of the Iowa state board of health. Ring-worm 
 and itch which are never reported are excluded in Boston, Providence, 
 and doubtless in other places. In Fitchburg purulent ophthalmia is not 
 reported but is to be excluded, and in Bridgeport the same is true of 
 " consumption." 
 
 As it is possible for conscienceless lawyers to raise the quibbling 
 point that a person who is up and about, but who is yet desquamating 
 from smallpox or who has diphtheria bacilli in the throat is not " sick " 
 or " suffering from " or " affected with " a communicable disease, the 
 Indiana 1 state board of health rule excludes any one who " has recently 
 been affected " with the specified disease. A similar provision is found 
 in Minnesota, 2 Albany, Rochester, and in Maine 3 " persons recovering 
 from communicable disease must have a permit before leaving the house. 
 
 Not only is the sick person excluded but also the other members of 
 the family. This is required by rule in smallpox, diphtheria, scarlet 
 fever, and the rarer severe diseases in many states 4 and cities, and even 
 where there is no law on the subject it is almost universally the prac- 
 tice. In New York City in tenement houses the rule is extended to all 
 the families on the floor. 
 
 The rules in other states and cities require the exclusion from school 
 
 to prevent the spread of such contagious disease, prohibit the attendance of any 
 teacher or scholar upon any school under their control, and may specify the time 
 during which such teacher or scholar shall remain away from such school." 
 
 Indiana, State Board of Health Rules, 19 February, 1891. 
 
 -Minnesota, Statutes (1804), Sec. 7045. 
 
 ; Maine, Chapter 123 of 1887 as amended by Chapter 139 of 1895, Sec. 15. 
 
 ••Delaware, Iowa, Kentucky, Massachusetts, North Carolina, Vermont, Atlanta, 
 Baltimore, Brookline, Mass., Concord, Fitchburg, Framingham, Mass., Lowell, 
 Macon, Newton, Mass., New York City, Philadelphia, Spokane, St. Louis, and 
 Syracuse. 
 
( OMMUNIL ABLE D I SEA SES. 465 
 
 of all children living in the house. 1 An inquiry sent out by the Min- 
 nesota state board of health 2 showed that there was only one local 
 board of health in that state which did not exclude from school all 
 children in the infected houses. In Fitchburg a house is defined as 
 follows : 
 
 " In excluding pupils from any house in which smallpox, scarlet fever, diphtheria, 
 and membranous croup exists, two or more buildings must be considered as one 
 house if there is any direct communication between them; or if it is possible to 
 enter or leave the two residences by means of the same hall, stairway, or door." 3 
 
 As most of these rules exclude the person unless or until a permit 
 is given by the health authorities, it is impossible to determine from the 
 rules alone how strictly the exclusion is extended to the whole family or 
 house. It is believed, however, that the permit under the above-men- 
 tioned rules is rarely given to any children living in the house and almost 
 never in the case of members of the family. In Providence all children 
 living in the infected house are excluded whenever it appears to the 
 inspector that the families cannot be trusted to keep isolated from one 
 another. This is in about twenty-five per cent, of the cases. In other 
 eases persons living in the house but not in the family are allowed to go to 
 school, in scarlet fever after one week, and in diphtheria after a negative 
 culture has been obtained from the throat. Out of 210 families where 
 such permits were given in only one did the disease subsequently appear, 
 whieh would indicate that the isolation which the department relied upon 
 was well maintained. ( 'hildren living in the house would be more likely 
 to contract the disease than to carry it to others, and of 540 susceptible 
 children in these houses only one became sick. This would indicate that 
 when there was reasonably good isolation children in other families in 
 the house may with a fair degree of safet\ attend school. Cambridge 
 also follows the Providence plan. In BrookHne, Mass., children from a 
 family where there is whooping cough may attend school only when 
 the\ have previously had the disease. 
 
 Of course, when the rules are so stringent, parents who have siok- 
 ness in their families or house and who wish to send their well children 
 to school, send their children away to board. In such cases in Provi- 
 dence a written permit is given, but only after the Lapse of a week 
 
 in scarlet fever, if the child has not had the disease. If the child has 
 
 bad it, the permit is given at once. In diphtheria a negative cult- 
 ure is required, and then the perinil is given at once. See Appendix 
 
 'Indiana Minnesota, Ohio, Pennsylvania, South Dakota. Tennessee, ami in 
 Bridgeport, Camden, Denver, Fall River, Hartford, Jersey City, Louisville, Newark. 
 \>w [Iaven, New Orleans, Providence, Rochester, Sail Lake City, Worcester, and 
 STonkers. 
 
 Minnesota, State Board "i Health Report (1895 B), p. K)5. 
 
 Fitchburg, Rules of Board of Health (1807), Rule 18. 
 
466 COMMUNICABLE DISEASES. 
 
 68. This permit is of a different color from that used after the card 
 is removed. In Denver as in Providence the period of exclusion is 
 one week after removal from scarlet fever. In Philadelphia it is two 
 weeks. In Providence those exposed to diphtheria may attend school 
 after a single negative culture from the throat, but in Denver a week 
 must elapse and a negative culture be secured. In the City of New 
 York children in institutions are kept out of school for ten days 
 after exposure. 
 
 In many cities persons exposed must not be admitted to school. 
 In Concord such child is to be excluded until a certificate has been 
 granted by the board of health that the period of incubation belonging 
 to the disease to which he has been exposed is passed. Brookline, 
 Mass., Cambridge, Fall River, Fitchburg, Minneapolis, New Haven, 
 Paterson, and Somerville do not allow children in school for two weeks 
 if they have visited a house where there is communicable disease. 1 In 
 Fitchburg and other cities it is also directed that pupils are not to be 
 sent to the house when communicable diseases are believed to exist in 
 the household of absent pupils. A similar provision in the Iowa rules 
 applies to teachers.' 
 
 Responsibility for Exclusion. A considerable number of the regula- 
 tions place the responsibility for exclusion upon the teacher, who is not 
 to permit the child to attend school. This is by far the easiest way to 
 enforce the law, for the teachers are public officials and are therefore 
 more easily controlled, provided, of course, the school authorities are in 
 sympathy with the sanitary officials. Other rules place the responsi- 
 bility upon the parent who is not to send the child to school. Others 
 still make both parties responsible. The ordinance from Rochester is 
 perhaps as explicit as any one rule. 2 
 
 1 Fitchburg, Rules and Regulations of Board of Health (1897), Rule 16: 
 " The principal of any school upon the receipt of information satisfactory to him 
 that any pupil attending school under his charge has visited a household where, at 
 the time of such visit, smallpox, diphtheria, membranous croup, or scarlet fever 
 existed, is authorized to suspend such pupil from school for a period of two weeks 
 next following such visit."' 
 
 - Rochester, Ordinances of the Board of Health (1895), Xo. 11, Sec. 1: 
 " Xo principal, superintendent, teacher or person acting for or representing any 
 such principal, superintendent or teacher of any school, and no parent, master, 
 guardian, or custodian of any minor child shall permit any such child, having 
 scarlet fever, diphtheria, membranous croup, smallpox, measles, whooping cough, 
 or any other dangerous, infectious disease, or any child residing in any house in 
 which any such disease exists or has recently existed, to attend any public or private 
 school, until he or she shall have obtained from this board permission to attend such 
 school. Xor shall any such principal, superintendent, teacher or person acting for 
 or representing any such principal, superintendent or teacher, permit any such child 
 to be unnecessarily exposed or to heedlessly expose any other person to the taking 
 or to the infection of any contagious disease. 1 ' 
 
C OJIML Wit A BLE DISEA SES. 467 
 
 In New Orleans parents must notify teachers of communicable 
 diseases. Atlanta lias a unique provision that physicians must notify 
 the superintendent of schools, but in most cities this is left to the health 
 officer. Sometimes, as in New Orleans, 1 Oklahoma, 2 and St. Louis, 3 - 
 teachers arc explicitly directed to send out all cases of communicable 
 diseases found in the school. 
 
 In Worcester, 4 and doubtless in many other cities, teachers are 
 requested to send away from school any children suspected of having 
 communicable disease, and in Worcester cases of sore throat are to be 
 excluded. 
 
 Schools included in the Rules. Many of the regulations forbid 
 attendance at any school. A few simply apply to public schools. 
 Private schools are named in the regulations in Indiana, Ohio, and in 
 Buffalo, Lowell, the City of New York, and Providence: parochial 
 schools in Indiana, Ohio, and Providence: Sunday schools in Buffalo, 
 Cincinnati, the District of Columbia, Philadelphia, and Providence; 
 night schools in Minneapolis: colleges in Cincinnati and the District of 
 Columbia; seminaries in the District of Columbia; and "any educa- 
 tional institution'" in Providence. 
 
 Duration of Exclusion. Of cour.se children and other persons are 
 not allowed to return to school before the termination of the isolation 
 at home as shown on page 457, that is before the house is disinfected 
 and the warning sign removed. Exclusion will be at least as long as 
 isolation at home and sometimes longer. Some of the regulations as 
 those of Illinois, Buffalo, Concord, Denver, Louisville, New Haven. 
 Paterson, Rochester, and Vonkers prescribe definitely the time during 
 which the exclusion must continue. In the cities above mentioned, the 
 period of exclusion from school is somewhat lunger than the isolation at 
 
 1 New Orleans. Ordinance, Council Series N'<>. 2777, Sec. 6: 
 
 "Thai every principal, teacher or assistant teacher of any ami every private or 
 public school, "ii observing that any child <>r children, pupils of said school, presenl 
 symptoms of any contagious, infectious or pestilential disease, shall send said child 
 or pupil to Baid pupil's or child's domicile and residence, with instructions to the 
 parent or parents, tutor, guardian or other person in charge of said pupil, child or 
 children, to have the said pupil <>r child, or pupils or children examined by the 
 family physician, and said instructions shall be in writing, and in oo case shall said 
 child or children, pupil or pupils, so sent home, be allowed to attend said school 
 thereafter until there shall be produced and filed with said principal, teacher or 
 assistant teacher, a certificate from a licensed physician that said child or children, 
 pupil or pupils, are nol Buffering from any contagious, infectious or pestilential 
 diseases. 11 
 
 'Oklahoma, Rules of Territorial Hoard "f Health. Sec. I. 
 St. Louis, Ordinances i\^>j>. < bapter 14, Sec. 
 
 1 Worcester. Report of Hoard of Health (1895). 
 
468 COMMUNICABLE DISEASES. 
 
 home, usually about two weeks, though in Buffalo it is three weeks and 
 in Louisville twenty days. The laws of Iowa, Massachusetts, North 
 Carolina, and Tennessee require exclusion for two weeks after recovery, 
 (three days after measles in Massachusetts) ; those of Pennsylvania, 
 thirty days after recovery. In Utah exclusion is maintained three 
 weeks after the card is off in scarlet fever, and two weeks after in 
 diphtheria. 
 
 Regulations which allow a permit a certain time after " recovery '" 
 are not definite, as it is impossible to determine exactly when recovery 
 takes place, and practically leave the matter to be decided by the 
 person who gives the permit to return. A number of cities among 
 which are Paterson, Providence, and St. Paul, allow children to return 
 to school as soon as the warning card is removed from the house. 
 
 Return Permits. Most regulations provide that persons may not 
 enter school after communicable disease without a permit. There is, 
 however, some difference of practice in regard to who shall issue the 
 permit. In some places the permit is to be issued by the health departs 
 ment, in others by the attending physician, and in some by both. 
 
 The health department is to issue the permit in Minnesota, Penn- 
 sylvania, South Dakota, Albany, Asbury Park, Baltimore, Bridgeport, 
 Cambridge, Camden, Concord, Denver, Elmira, Macon, Newburgh, New 
 Haven, New York City, Paterson, Providence, San Francisco, and in 
 St. Louis, in smallpox, scarlet fever, and diphtheria. 
 
 The form of permit used in Minneapolis is shown in Appendix 09. 
 It has a stub for record. Providence has a simpler form and the date of 
 granting the permit instead of being noted on a stub, is stamped on the 
 slip on which a record of the case is kept. See Appendix 70. 
 
 In North Carolina, Ohio, Augusta, Charleston, Newark, New Orleans, 
 Boston, and in St. Louis (in whooping cough, measles, and chicken 
 pox), a certificate from the attending physician suffices. In Cleveland, 
 Cincinnati, Fall River, Fitchburg, Jersey City, Newton, Mass., Buffalo, 
 and Rochester, certificates from both physician and health department 
 are required. The form used in Rochester is shown in Appendix 71. 
 
 In Chicago a postal card is sent by the health department to the 
 principal of the school giving notice that the children may return to 
 school. This is printed in red, while the exclusion notices are in black. 
 In Milwaukee a certificate is issued by the health department which 
 may be sliOAvn at the school or library or elsewhere. 
 
 In Delaware the law requires the school officers to issue the per- 
 mit to return to school; in Iowa the mayor or town clerk; and in Mas- 
 sachusetts, North Carolina, Vermont, Louisville, and Spokane, it may be 
 either the board of health or the attending physician. 
 
 
( 'OMMUmC. VBLE DIHE. 1 S ES. 469 
 
 In order that children may understand the rules in regard to com- 
 municable diseases it is required in Scranton that the rules be posted 
 in the schoolroom. 1 In Montclair, X. J., a card stating the period of 
 exclusion is given to the family in each case. 
 
 In Michigan, 2 teachers are required to teach the methods of prevent- 
 ing the spread of communicable diseases. Circulars have been issued 
 by the state board of health to guide the teachers in their instruction, 
 and since 1898 a teachers' monthly bulletin has been sent to all the 
 teachers in the state. A number of the boards of health in other states 
 where it is not required by law, nevertheless send monthly bulletins to 
 teachers. It is to be feared that some of these bulletins need more 
 careful editing. 
 
 Closure of S,-]m<>ls. The question of closing schools to prevent the 
 spread of communicable disease has caused a great deal of discussion. 
 If all the cases of communicable disease could be reported and isolated, 
 there would of course, be no need of closing schools ; but unfortunately 
 this is not done, and sometimes one or more cases continue in school 
 unrecognized perhaps by any one. The chance of this is very much 
 diminished by careful medical supervision; but sometimes cases will 
 elude even the most careful inspection, and in such cases when it is ap- 
 parent that there is an unrecognized case attending the school and in- 
 n, ting the other pupils, the only thing to do is to close the school. 
 
 Several states, among which may be named New Jersey, Kentucky, 
 Ohio, and South Carolina, provide by statute for the closing of schools to 
 prevent the spread of communicable disease. In Ohio 3 the board of health 
 may, "during an epidemic or threatened epidemic close any school." 
 In New Jersey 4 the law does not give control of public schools to the 
 board of health, but to the board of education. 
 
 1 Scranton, Rules and Regulations of Hoard of Health (1893), Sec. 44: 
 
 ■■ . . . And it shall be the dutj of tin- I >• >:i i < t to have this section printed on 
 
 r;nd> mentioning the names of diseases declared communicable and dangerous to 
 the public health in this rule, and posted in every schoolroom in this city; ami it 
 
 shall he the dnt\ of each teacher to read the section to the SCl 1 at least once a 
 
 month and whenever any epidemic shall appear. And it shall he the duty of the 
 board of health to have this section printed on cards and furnished t<, every private 
 
 school, academy, seminary, kindergarten and Sunday scl 1 in this city, and to 
 
 request tie- person or persons in charge of such private institutions to post such 
 
 Bards in conspicuous places, and read t his sect ion to the school at least once a month, 
 and whenever an} epidemic shall prevail." 
 
 - Michigan, Chapter 146 of 1895. 
 Ohio, Ajuiotated statutes (U ). Sec. 2186. 
 
 • New Jersey, General statutes (1896), p. 1689, Sec. 21: 
 
 "That t he board of health of any township, or an\ City, borough, town or other 
 
 local municipal government in this state shall have the righl to declare any epi- 
 demic or cause of ill health to he so injurious or hazardous as to make ii necessary 
 
470 COMMUNICABLE DISEASES. 
 
 In South Carolina 1 the order of a board of health to close schools, 
 must be approved by the city or town council. The closing of schools 
 for communicable disease is, however, usually done by the board of 
 health under its general grant of authority. Often, too, it is done by 
 the school officers simply at the request of the sanitary officers, and 
 sometimes it is done by the school authorities of their own volition. 
 When a medical inspection of schools is maintained, it is said that 
 closure is not so often necessary. 
 
 Disposal of Bodies of Persons Dead of Communicable Diseases. 
 Doubless the danger to be apprehended from such bodies has been much 
 exaggerated. If it were not for the reprehensible practice of kissing 
 the corpse, which strange to say, is not uncommon, the danger from the 
 body itself would be very slight. If this could be prevented, the 
 danger would be from exposure to the members of the family and in- 
 fected articles in the house ; but there is a popular fear of danger from 
 this source, and very stringent regulations regarding the methods of dis- 
 posing of such dead bodies and of conducting funerals are commonly 
 found. Such regulations are found in the statutes of Colorado, Connecti- 
 cut, Maine, Minnesota, Missouri, New Mexico, Pennsylvania, Vermont, 
 and the state board of health rules of Iowa, Indiana, North Carolina, 
 North Dakota, Ohio, and South Dakota, and in the local rules of nearly 
 all cities. 
 
 Report by Undertaker. A good many cities require that under- 
 takers shall immediately report all deaths from communicable diseases. 
 In Rochester the undertaker is to give immediate notice only when 
 there is no physician in attendance. For some reason unknown to the 
 writer, the board of health in Lowell refuses to receive such notice over 
 the telephone. 
 
 Disinfection of the Body. In nearly all city and state rules the 
 undertaker is required to disinfect the body. In Pennsylvania 2 it is 
 simply stated that " it shall be the duty of the undertaker or other per- 
 son or persons having the body in charge to thoroughly disinfect the 
 body." In Connecticut it must be disinfected as required by the state 
 board of health. 3 In most of the rules it is ordered that the body be 
 
 to close any or all of the public or private schools in the limits of such township, or 
 of such city, borough, town or other local municipal government; but in case of 
 public schools, the same shall not be closed except by the direction of the board of 
 education, school trustees, or other body having the control or direction thereof; 
 any such board of education, school trustees, or other body having control of pub- 
 lic schools may in such case cause any or all of the schools under their control to be 
 closed, if in their judgment, such closing be necessary for sanitary purposes. 
 
 1 South Carolina, Act of 5 January, 1895. 
 
 2 Pennsylvania, Chapter 124 of 1895, Sec. 4. 
 
 3 Connecticut, Chapter 100 of 1893, Sec. 1. 
 
COMMUNICABLE DISEASES. 471 
 
 wrapped in a sheet wet with a prescribed disinfecting solution. In 
 Connecticut 1 the rule reads : 
 
 " That the body of any person who died of one of the diseases mentioned in the 
 amendment to section 104, of the General Statutes, shall be prepared for burial by 
 the person having it in charge, by wrapping it in several thicknesses of cloth, wrung 
 out of solution made by dissolving sixty grains of Corrosive Sublimate and two table- 
 spoonfuls of Common Salt in one gallon of hot water, or, out of a solution made by dis- 
 solving six ounces of pure Carbolic Acid [not the commercial, colored, impure Acid), 
 in a gallon of hot water.''' 
 
 In Lynn, Holvoke, Cambridge (see page 472) and Somerville, it is 
 prescribed that the whole body including the face be so wrapped. 
 
 Various disinfectants are ordered as: Bichloride of mercury, 1 to 50 
 in Vermont; 1 to 100 in Denver: 1 to 125 in South Dakota, Youngs- 
 town, and Detroit : 1 to 150 in Colorado Springs ; 1 to 200 in Portland 
 Ore.: 1 to 500 in North Dakota, Boston. Buffalo, and Cambridge: 1 to 
 1,000 in Connecticut and Philadelphia. Carbolic acid 5 per cent, in 
 Connecticut, District of Columbia, and Philadelphia. Chloride of zinc 
 10 per cent, in Holyoke and Lynn. Chloride of lime, 4 per cent, in 
 Philadelphia. Sulphate of zinc, one-half pound to one gallon in Ver- 
 mont. More explicit rules still in regard to disinfection are found in a 
 tew cities as Chicago, Detroit, 2 and Denver/ 1 In Chicago: 
 
 • Before the body is moved or hauled for further treatment, the orifices of the 
 sose and throat, ami in typhoid fever the rectum should be packed with absorbent 
 cotton saturated with an approved disinfectant, or thoroughly cleansed by an in- 
 jection of such disinfectant; after which it may be bathed, dressed and encoffined, 
 either wrapped in a disinfectant sheet or packed in absorbent cotton saturated with 
 the disinfectant. If the face is left exposed, it should be freely sprayed with the 
 
 disinfectant."' 
 
 Iii Denver the body must be embalmed and the cavities stopped and 
 filled with cotton soaked in corrosive sublimate 1 to 100. 
 
 "Disinfection of the Room and the Undertaker. It is not usualh re- 
 quired that the room shall be disinfected before the funeral, but in 
 ( Jhicago : 
 
 •• The entire apartment and its belongings arc to he thoroughly sprayed with an 
 approved disinfectant, also before removal from the death room the exterior of the 
 coffin should he sprayed or sponged with the disinfectant. It may then he removed 
 to a room previously prepared by thorough ventilation, or, if accessary, by disin- 
 fection and from which all unnecessary furniture and other articles have been re- 
 moved. As soon as the bod] is removed from the death chamber, the room should 
 he locked and in. ..he allowed to enter, excepl the disinfectors, until the room and 
 its belongings have been properly treated and made safe.'' 
 
 1 Connecticut, Mate Board of Health Rule, 6 July, 1898. 
 Detroit, Ordinance of 24 May, L892, Sec. 8. 
 Denver, « Ordinance ■»» of 1898, s > <■. 2f>. 
 
472 COMMUNICABLE DISEASES. 
 
 The strictest rules for the undertaker's care of himself are in Detroit r 1 
 
 " . . . Every undertaker having in charge the body of any person who has 
 died of either of the above mentioned diseases shall, during the time he is preparing 
 such body for burial, wear a long rubber overcoat buttoned to the chin, and after 
 he has properly prepared the body, shall spray his hair, beard, hands and boots, 
 especially the soles, with the above disinfectant cologne, and shall wear his rubber 
 coat when carrying or arranging said coffin or casket during the funeral. After said 
 funeral the undertaker shall spray his hair, beard, hands, shoes or boots and rubber 
 coat with said disinfecting cologne before returning home or walking the public 
 streets." 
 
 The Coffin. Almost all the rules require that the body shall be at 
 once placed in a coffin and the coffin closed and not again opened. In 
 the majority of rules the coffin is to be " air-tight," in others it is to be 
 simply "tight," in others "sealed," in Boston and Buffalo, " absolutely 
 tight," in Minnesota " tightly sealed," in Pennsylvania " tightly closed." 
 It is not generally intended by these rules that the coffin shall be 
 " hermetically sealed," though this is required in Erie, but simpl}- 
 securely fastened so that it may not be easily opened. In the City of 
 New York the casket is to be "properly sealed immediately and per- 
 manently." In the District of Columbia the coffin is to be " clamped." 
 In Chicago : 
 
 " The coffin used in such cases should be absolutely water and air-tight so as to 
 prevent leakage of poisonous or offensive fluids or gases during the conduct of the 
 burial. All disinfectants used in such cases should be proven bacterially and 
 chemically proficient." 
 
 In Philadelphia : 2 
 
 "... the entire inner surface of which (lid and all) shall be thoroughly and 
 completely lined with a layer of raw cotton of a thickness of not less than one inch; 
 and said coffin or casket shall be tightly closed with screws or clamps, and n main sfl 
 closed, or the body, wrapped as above, shall be encased in a coffin or casket of metal, 
 with all joints and seams closely soldered." 
 
 The Cambridge and Somerville rule requires the casket to be sealed 
 with wax, 3 and in Portland, Ore., 4 it must be made air tight with putty. 
 
 i Detroit, Ordinance of 24 May, 1892, Sec. 8. 
 
 2 Philadelphia, Hules of the Board of Health (1895), Sec. 205. 
 
 3 Cambridge, Rules of Board of Health (1897), Sec. 7: 
 
 " In all cases of death from diphtheria, membranous croup, scarlet fever, typhoid 
 fever, typhus fever, smallpox or cholera, the undertaker shall wrap the entire body, 
 including face, in a sheet saturated with a solution of one-fifth of one per cent, of 
 bichloride of mercury, and then place it in a tight coffin or casket, and seal the lid in 
 two places with sealing wax, and shall furnish the board with his sworn statement 
 that the foregoing requirements have been complied with." 
 
 4 Portland, Ore., Ordinance 10359, Sec. 14: 
 
 "... the undertaker shall . . . immediately place the said body in a 
 coffin and seal the same as follows: All joints shall be closed with putty, and the 
 same material shall be used around the top and bottom of said coffin, making the 
 same air tight." 
 
COMMUNICABLE DISEASES. 473 
 
 Most of the rules require the bod} r to he put in the casket " im- 
 mediately,'" " at once '" or " as soon as possible.*' In Cleveland how- 
 ever, six hours' time is given, and in Pennsylvania and Louisville six 
 hours if the undertaker is summoned between five a. m., and eleven 
 !•. M., otherwise twelve hours. In Youngstown, < >., it is five hours, in 
 Cambridge eight hours, and in Erie twelve hours. 
 
 In Buffalo, 1 District of Columbia, and Philadelphia, the body must 
 not be placed in an ice box. 
 
 Time, of Burial. It is generally conceded that the sooner the body 
 of a person dead of communicable disease is disposed of, the better it is. 
 Many rules specify the time within which the burial or the funeral 
 must take place. Often it is provided that the health officer may by 
 express permit extend the time. The Iowa rule requires that the body 
 shall be buried immediately, in Florida within six bonis. In Indiana 
 anil South Dakota the time allowed is twelve hours : in Minnesota, 
 Ohio, Albany, Asbury Park, Bridgeport, Buffalo, Fall River, Fitchburg, 
 Haverhill, Lawrence, Newark, San Francisco, Spokane, and New 
 Orleans (in the summer), twenty-four hours; in Wilmington, thirty 
 hours, and in the District of Columbia, Elmira, Louisville, Penn- 
 sylvania, Rochester and New Orleans (in the winter), thirty-six hours. 
 In New Bedford the body must be buried the same day or the next day. 
 
 Privacy of Funeral. Almost all cities require that the funerals of 
 persons who have died of communicable disease shall be "private." 
 Other terms are also used, as it shall be •• strictly private," " there shall 
 not be a public funeral" or a "church" funeral, and in Indiana and 
 Iowa no "school funeral." It is also required that the attendance at 
 the funeral shall be limited to "as few as possible," or that no one shall 
 he present •• whose attendance is unnecessary, or to whom there is 
 danger of contagion thereby." 
 
 The interpretation of such general expressions is of course doubtful 
 and musl be left to the health officer, and in the la.-^t resort to the 
 
 courts. Iii Albany the ordinance requires the health officer to ti\ the 
 limit of attendance; but in man\ of the rules it has been deemed besl 
 
 to define re clearly what is meant by a private funeral and who may 
 
 attend it. In Pennsylvania 2 the attendance i> limited --to the imme- 
 diate adult relatives of the deceased, and the necessary number of adult 
 
 pall bearers." There ma\ he -no child pall bearers or carriers." In 
 
 Iowa, 3 and in Milwaukee 1 there can be •• no pall bearer under twenty 
 
 1 Buffalo, Ordinances (1898), Chapter 25, Sec. ">7. 
 
 Pennsylvania, Chapter L24 ox i*'.'">. Sec. 8. 
 
 Lowa, Regulations <>i State Board .>t Health (1899), Si c. 27. 
 1 Milwaukee, Report oi Health Commissioner for year ending April. 1891, p. 21. 
 
474 COMMUNICABLE DISEASES. 
 
 years of age," and only adults in Providence. In Cleveland 1 and 
 Youngstown no children may attend the funeral. In Holyoke, Lowell, 
 and Lynn the attendance is limited to the " immediate adult relatives," 
 in Lawrence to the " adult family in the house," in Youngstown, O., to the 
 adult members of the family. Only the "near relatives" and other 
 adult persons not exceeding six in number as may be provided by rules 
 of the director of police are allowed to be present in Cleveland. 2 In 
 Newark the " immediate household," in San Francisco and Somerville 
 the " immediate family," and in Providence the " immediate relatives " 
 only are permitted to be present." In Minneapolis and Fitchburg the 
 " immediate family " is still further limited to those " who are resident 
 at the place of death." In Milwaukee only persons who have been 
 already exposed may be present. It is, of course, necessary, if there is 
 any funeral at all, that both undertaker and clergyman shall be present, 
 but their presence is expressly permitted in only a few of the rules, as 
 those in Indiana, Lynn, Milwaukee, Minneapolis, and Providence. In 
 San Francisco the health officer may be present, and in Somerville " those 
 whose business calls them there," which is doubtless intended to include 
 the undertaker and clergyman. In Milwaukee " the clergymen must 
 take all precautions they can command to prevent spreading the con- 
 tagion/'' As nearly all the rules allow the health officer to grant per- 
 mits for other persons, he can readily cause the presence of the clergy- 
 man to conform to the law. Most of these rules refer to funerals, but 
 there may be other gatherings at the house and there may be individual 
 visitors. Hence in Providence and Utiea the persons in charge of the 
 body shall not permit " any assemblage or gathering." In Haverhill 
 " no person shall be allowed to enter the premises where the body is or 
 view the body.'' In Vermont 3 the funeral must be conducted with as 
 little publicity as possible. 
 
 ( 'arriages at Funerals. 
 In Pennsylvania: 4 
 
 " No undertaker, or other person or persons having charge of the funeral or 
 burial of the body of a person who has died of any of the diseases mentioned in sec- 
 tion four of this act, shall in any case furnish, or provide for such funeral, more 
 than the necessary number of conveyances for said adult relatives and pall-bearers, 
 and all such conveyances which may have been used or occupied by any person or 
 persons who have been residing in the same family, or house, with the deceased, 
 shall be fumigated and disinfected at such time and in such manner as may be 
 directed and required by the health authorities." 
 
 1 Cleveland, Ordinances, Chapter 30, Sec. 471. 
 
 2 Cleveland, Ordinances, Chapter 30, Sec. 465. 
 
 3 Vermont, Statutes (1894), Sec. 4687. 
 
 4 Pennsylvania, Chapter 124 of 1895, Sec, 8. 
 
COJEVCXICABZE DISEASES. 475 
 
 In Detroit, 1 
 
 "•No public or private hack, carriage or conveyance used or held for hire shall 
 be hired or used to attend funerals of persons dying of any of the above mentioned 
 diseases without a permit for such use of said carriage first obtained from the health 
 officer." 
 
 In Erie only three carriages are allowed, and in Yonkers only two. 
 In Milwaukee 2 "no person shall be allowed to occupy the same carriage 
 with those who are residing in the infected house." The kind of car- 
 riage that may be used is prescribed in Yonkers. 3 
 
 As in Pennsylvania and Yonkers so in a number of other cities it is- 
 required that carriages used at funerals must be disinfected. 
 
 Place of Funeral. Many of the states forbid a church funeral and 
 sonic few a school funeral. 4 
 
 In Milwaukee and San Francisco it is forbidden to have any funeral 
 at the house (services at the grave probably being permitted). In Prov- 
 idence also services at the grave alone are permitted in smallpox and in 
 cases of scarlet fever and diphtheria that die at the hospital. 
 
 Funeral X<>tirt>. It is important that the funeral notice should be 
 so worded as to warn persons not to come, instead of inviting them. 5 In 
 
 1 Detroit, Ordinance of 24 May, 1892. 
 
 - .Milwaukee. Report of Commissioner of Health, ending April, 1891, p. 21. 
 
 ; STonkers, Sanitary Code (1897), Sec. 38: 
 
 " It shall be unlawful to permit more than two carriages at any such funeral. 
 The carriage or carriages used to convey any person or persons from any infected 
 house to the cemetery or elsewhere shall he upholstered in leather, including all 
 parts of the inside of said carriage, except the floor and other parts composed of 
 solid wood. The undertaker or other person or persons furnishing carriages to 
 
 persons residing in or entering infected 1 m^ shall immediately fumigate or cause 
 
 to he fumigated, and then washed with a disinfecting solution, every such carriage 
 
 before using il tor other purposes under the direct sn pen ision <>t an ci up love of the 
 lmard of health; and hereafter only such carriages shall he used to convey persons 
 
 •offering from contagious diseases to the Fonkers city hospital. Any violation of 
 
 this sect ion will subjeel the offender to one handled dollars tine and imprisonment. 11 
 
 1 Iowa. Mate Board of Health Regulations (1899), Rule 27: 
 No person, company, corporation, or association having charge of or control of 
 any schoolhouse or church, or of any building, room or place used for school ox 
 church purposes, or for anj public assembly, shall permit the bodj of any person 
 dead from anj of the contagious or infectious diseases named in these regulations, 
 or anj other dangerous contagious disease, except typhoid fever, to be taken into 
 lucb schoolhouse, church, building, room or place, for the purpose of holding 
 
 funeral service over such bodj ." 
 
 b Buffalo i Ordinances 1 1898), Chapter 25, Sec. 89: 
 
 u Whenever anj person shall die from any of tin' contagious or infectious dis- 
 eases na nied in seet ion 1 1 , t he undertaker having charge of the preparation and in- 
 terment of the remain8 shall lie il nlj person authorized to insert the public 
 
476 C OMMUWICA BLE I) I SEA SES. 
 
 Albany the funeral must be advertised as private, but the statute in 
 Pennsylvania 1 goes further and requires " that any advertisement of such 
 funeral shall state the cause of death " and in Cleveland 2 the undertaker 
 shall "publicly notify all persons attending such funeral of the name 
 and contagious character of the disease from which the person has died." 
 In Philadelphia 3 " such notice shall contain only the residence, name of 
 deceased, cause of death, and date of death and the words ' no funeral ' 
 and, if desired, the names of the parents." 
 
 Transportation of Bodies. It is in most regulations forbidden that 
 the body of a person dead of communicable disease shall be carried in a 
 public conveyance or hack, or else it is required that it be carried in a 
 hearse or undertaker's wagon. 4 In Buffalo the undertaker with the 
 body must " proceed direct from the house to the burial ground." 
 
 Disposal of the Body. Aery many of the rules as has been shown 
 require that the body shall be permanently disposed of by burial within 
 a limited number of hours. Occasionally it is stipulated that it shall 
 not be placed in a receiving tomb, and in Iowa and Minneapolis it must 
 not be so placed unless it is in an hermetically sealed casket. 
 
 Disinfection of Draperies, Etc The materials used by undertakers 
 about the death room should be disinfected. The Boston rule is given 
 below. 5 
 
 Conditions Requiring Enforcement of Bide*. Many of the rules in 
 
 notice of death, and shall state the cause of death in such notice for which he shall 
 he held responsible. 
 
 " No person shall invite to funerals or any services connected therewith, any per- 
 son whose attendance is not necessary, or to whom, or through whom there is dan- 
 ger of contagion being communicated or spread." 
 
 1 Pennsylvania, Chapter 124 of 1895, Sec. 0. 
 Cleveland, Ordinances, Chapter 30, Sec. 473. 
 
 3 Philadelphia, Pules Board of Health (1895), Sec. 205 K. 
 
 4 Pennsylvania, Chapter 124 of 1895, Sec. 9: 
 
 l ' The body of a person who has died of any of the diseases mentioned in section 
 4 of this Act, shall not be conveyed to or from any dwelling or other building or 
 place to any cemetery or other point or place within or through any of said munici- 
 palities except in a hearse or other vehicle used for the purpose of conveying corpses 
 only, or in such vehicle as shall be satisfactory to the health authorities, and under 
 such regulations as they may in any case adopt. The undertaker and the person or 
 persons having charge of the funeral or transportation of such body shall be respon- 
 sible for any violation of the provision of this section.' 1 
 
 5 Boston, Manual of Health Department (1890), page 33: 
 
 " Draperies (so called) and all articles which have been used about the body of 
 any person who has died of smallpox, diphtheria (including membranous croup, 
 so-called), scarlet fever, typhus fever, typhoid fever, yellow fever, or cholera, or 
 which have been used in the room where such person has died, shall, before being 
 removed from the house, be destroyed by fire, or disinfected to the satisfaction of 
 the Board of Health. 
 
COMMUNICABLE DISEASES. 477 
 
 regard to funerals and burials refer to persons dead of " contagious or 
 infectious diseases." Others either with or without retaining such general 
 terras refer to special diseases, usually smallpox, scarlet fever, diphtheria, 
 croup, and perhaps cholera, typhus, and yellow fever. Measles are 
 added in Charleston, Lowell, Minneapolis, Xewburgh, New York City, 
 Rochester, Providence, Scranton, cerebro-spinal-meningitis in Philadel- 
 phia and Vonkers, and whooping cough in Minnesota. Public funerals 
 in tuberculosis also are forbidden in Minneapolis. 1 
 
 It is not sufficient to control the funerals of those who have died of 
 the diseases mentioned. Other members of the family where the com- 
 municable disease is, may die of non-communicable disease ; but public 
 funerals in such cases would be dangerous, hence in Providence " the 
 funeral of any person who has died while any member of the family is 
 sick with smallpox, scarlet fever, measles, diphtheria, and membranous 
 croup shall be private." 
 
 Responsibility for Violation of Rules. The responsibility for the 
 violation of funeral rules may be placed upon the relatives of the 
 deceased or upon the undertaker, or as in Providence upon the clergy- 
 man. Usually the responsibility of a private funeral is placed upon 
 both the family and the undertaker as in the Pennsylvania law in 
 Appendix 72. For illegal acts connected with the immediate care of the 
 body, the disinfection and closing of the coffin, etc., the undertaker alone 
 is usually held responsible, while for the use of a church the sexton or 
 person in charge is at fault, and for the improper use of carriages the 
 owner or driver. Sometimes the persons attending the funeral are 
 liable as in Somerville. In some cities as Fall River the undertaker is 
 required to notify the family in regard to the rules governing the 
 funeral. The penalty for violation of these rules is often quite high as 
 ■-•:<hi in Denver- and §250 in Milwaukee. 3 
 
 Anyone interested in this subject should study the entire set of 
 funeral regulations contained in the Pennsylvania law and shown in 
 Appendix 72. 
 
 Transportation by Common Carrier. Much attention has of late 
 been given to the transportation of bodies by common carriers, particu- 
 larly the transportation of bodies of persons dead of communicable 
 diseases. This matter has been frequently discussed at the conferences 
 
 of the state boards of health and has also been considered by the bag- 
 gage agents and the undertakers. The state officials have been par- 
 ticularly anxious to guard against the earn ins of communicable disease 
 
 'Minneapolis, Ordinance of 25 June, 1897, Sec. 20. 
 
 - Denver, < >rdinanc< ' oapter 1 1. Sec. 26. 
 
 - Milwaukee, Report -f Health < '< nissioner, year ending April. 1801, page 21. 
 
478 COMMUNICABLE DISEASES. 
 
 from one state to another, and the railroad officials have sought to pro- 
 tect their employees and patrons. The rules known as the Nashville 
 Rules were adopted at a conference of the state boards of health, the 
 National Funeral Directors' Association, and the American Association 
 of General Baggage Agents. These rules are given in Appendix 73. 
 They have been adopted in substantially their present form by the rail- 
 roads represented by the baggage association and by a considerable 
 number of states. 1 
 
 In most cases these have been adopted as rules of the state board 
 of health. 
 
 Some states also have other rules on this subject. In Vermont the 
 transportation of bodies dead of smallpox, cholera, typhus fever, yellow 
 fever, diphtheria, and scarlet fever is forbidden. In California and 
 Maine bodies of persons dead of communicable disease are to be trans- 
 ported only with the permit of the state board of health, and in Massa- 
 chusetts only with a permit from the local board without other restric- 
 tions. In Arkansas, Connecticut, Florida, New Jersey, and New York 
 such bodies may be transported only when disinfected and in her- 
 metically sealed caskets. In Ohio, Tennessee, Virginia, and West Vir- 
 ginia a similar rule is in force, but the method of disinfection is pre- 
 scribed, and it is also required for bodies dead of other diseases if the 
 time to the point of destination is over eighteen hours. The form of 
 permit used under these rules in many states is very large and cumber- 
 some and is printed on yellow paper, while permits for non-communicable 
 diseases are printed on white paper. 
 
 Statutes Consulted in the Preparation of the Chapters on Communi- 
 cable Diseases. 
 
 Alabama. General, and quarantine, Code (1896), Sees. 2392-3, 2403-7, 2429, 2436, 
 2439. 
 
 Quarantine, Code (1896), Sees. 245-51, 2001-8, 2395-2400, 2409-2427. Act of 23 
 February, 1899. 
 Arizona. General, Penal Code (1887), Sees. 633,640; Chapter 29 of 1899. 
 California. General, quarantine, Political Code (1886), Sees. 2798-3063, Penal 
 Code (1886), Sees. 220, 373. 
 
 Vaccination, Political Code (1886), Sees. 2993-4; Chapter 24 of 1899. 
 
 Antitoxin, Chapter 39 of 1895. 
 Colorado. General, quarantine, vaccination, Act of 17 April, 1893. 
 Connecticut, General, General Statutes (1888), Sees. 2603, 2606. 
 
 Notification, Chapters 77 of 1895, 146 and 242 of 1897. 
 
 Funerals, Chapter 155 of 1893, (also rules of state board of health.) 
 
 Quarantine, General Statutes (1888), Sees. 2594-2602. 
 
 Vaccination, General Statutes (1888), Sees. 1747, 2137, 2607. 
 
 Antitoxin, Chapter 252 of 1895. 
 
 1 Alabama, Colorado, Delaware, Illinois, Indiana, Iowa, Louisiana, Maryland, 
 Michigan, Minnesota, Mississippi, Montana, New Hampshire, North Carolina, North 
 Dakota, Ohio, Oklahoma, Pennsylvania, and South Dakota. 
 
COMMUNICABLE DISEASE s. 479 
 
 Delaware. School attendance, vaccination, Act of 21, March, 1883. 
 
 General, Revised Code (1893), p. 298, (Laws of Delaware, Vol. 16, Chapter 345). 
 Quarantine, Revised Code (1893), p. 362, (Laws of Delaware, Chapter 46). 
 District of Columbia. General, Act of 3 March, 1897. 
 Florida, General, quarantine, Revised Statutes (1892), Sees. 764-72; Chapter 34 of 
 
 1899. 
 Georgia. General, quarantine, Code (1882), 1375 to 1393. 
 
 Vaccination, Act of 20 December, 1897. 
 Idaho. Revised Statutes (1887), Sec. 1153; Act of 13 March, 1899. 
 Illinois. Powers of cities, Annotated Statutes (1896), Chapter 24, Sec. 63, seventy- 
 eight. 
 Indiana. Act of 28 April, 1899. 
 low a. Code (1897), Sees. 2564-75. 
 Kansas. Inoculation, General Statutes (1897), Chapter 100, Sec. 321. 
 
 Quarantine, General Statutes (1897), Chapter 75, Sec. 17. 
 Kentucky. Legislation, Statutes (1894), Sees. 2044, 2055, 2059. 
 Quarantine, Statutes (1894), Sec. 2049, 2056, 2062. 
 Vaccination, Statutes (1894), Sees. 4608-14. 
 Louisiana. Chapter 192 of 1898. 
 Vaccination, Chapter 8U of 1S77. 
 Warning sign, Chapter 115 of 1882. 
 Quarantine, Revised Laws (1884), Sees. 3022-62. 
 Maim:. General, quarantine, Revised Statutes (1883), Chapter 14; Supplement 
 Laws (1885-95), Chapter 14. 
 Vaccination, Revised Statutes (1883), Chapter 11, Sec. 87, VIII; Chapter 213 of 
 1889, and 172 of 1893. 
 Maryland. General, Public General Laws (1888), Art. 43, Sees. 8, 14-34; Chapter 
 346 of 1898. 
 Quarantine, Public General Laws (1888), Art. 41, Sec. 71. 
 Massachusetts. General, Public Statutes (1882), Chapter 80, Sec. 39 et seq. 
 Chapters '.'s of 188^ 102 of 1890, 188 of 1891, 138 of 1885, 101 of 1886, 302 of 
 
 1893, 198 of 1885, 4> f 1895, 211 of 18s:,, and 120 of 1891. 
 
 Vaccination, Public Statutes (1882), Chapter 17. Sec. 9, and Chapter 80, Sees. 51 
 
 and 53; Chapters 515 of 1894, and 496 of 1898. 
 Quarantine, Public Statutes (1882), Chapter 80, Sec. 62 et seq.; Chapter 79 of 
 is:.::. 
 MICHIGAN. General, vaccination, quarantine, Compiled Laws <ls<i7). Sees. 4412. 
 
 Il-Jl -54, 1460, (171-83. 
 Minnesota. I leneral, vaccination, quarantine, statutes (1894). Sees. Toe 79; chap- 
 ter 176 ol L898. 
 Warning sign, Chapter L33 of L897. 
 Mississippi. Annotated Code (1892), Sees. 1008-9. 1405 6, 2278. 
 Quarantine, Chapter 79 of 1898. 
 Vaccination, Chapter 69 of L896. 
 Missouri. Revised statutes (1899), Sees. 5281, 5457, 5508, 5961, 5962, 7618-29, 
 
 9764. 
 Mom w \. Penal Code 1 L895), Sees. 874, 694. 
 
 Ni.u Hampshire. General, vaccination, Public statutes (1891), Chapter 110, 
 Chapters 80 of 1898, and 100 of L899. 
 Vaccination, Public Statutes (1891), Chapter 1 10, See. 1 ; Chapter 93, Sec. 2. 
 Quarantine, Public statutes (1891 1, Chapter 111; Chapter 80 of L898. 
 \i;u Jersey. General, General Statutes (1895), p. L644, Sec. 19, Ml.. XIII., p. 
 L645, Sees. 52 .".7; p. L675, Sees. 221 26. 
 Vaccination, General statutes (1895), p. 1639, Sees. 21 26. 
 Antitoxin, General Statutes (1895), p. 1649, Sec. -1. 
 
480 COMMUNICABLE DISEASES. 
 
 New Jersey, continued. 
 
 Notification, General Statutes (1895), p. 1677, Sees. 236^10; p. 1676, Sees. 227-31. 
 
 Quarantine, General Statutes (1895), p. 1671, Sees. 205-215; Chapter 107 of 1897. 
 New Mexico. Compiled Laws (1897), Sees. 3708, 3713-4. 
 
 Vaccination, Compiled Laws (1897), Sees. 3704-5. 
 New York. General, vaccination, Revised Statutes (1896), p. 2418 (Public Health 
 Law, Sees. 24, 200-1). 
 
 Quarantine, Revised Statutes (1896), p. 2418 (Public Health Law, Sees. 80-131g). 
 Nevada. Compiled Laws (1900), Sees. 4983-6. 
 North Carolina. Act of 1 March, 1893. 
 
 Quarantine, Code (1883), Sees. 2893-2922. 
 North Dakota. Political Code (1895), Sees. 195, 201, 263-5, 271-4. 
 Ohio. General, Annotated Statutes (1900), Sees. 409 (-25) (-28), 2115-6, 2118, 2135-6, 
 
 2142-48. 
 Oregon. Quarantine, Annotated Laws (1887), Sees. 2537-39. 
 Pennsylvania. General, Chapters 124 of 1895, and 95 of 1897. 
 
 Quarantine, Brightly's Purdoivs Digest (1894), pp. 1712-24. 
 Rhode Island. General, quarantine, vaccination, General Statutes (1896), Chap- 
 ter 94. 
 
 Quarantine, General Statutes (1896), Chapters 94 and 95. 
 
 Vaccination, General Statutes (1896), Chapter 65, Sec. 14. 
 South Carolina. General, Revised Statutes (1893), Act of 5 January, 1895, Sees. 
 965-8. 
 
 Vaccination, Chapter 78 of 1899. 
 
 Quarantine, Revised Statutes (1893), Sees. 992-1031. 
 South Dakota. Act of 6 March, 1895. 
 Tennessee. Code (1896), Sees. 302-16, 3080-100, 3101-11. 
 Texas. General, quarantine, Revised Statutes (1895), Sees. 538, 541, 543, 4327- 
 
 4342a. 
 Utah. Chapter 45 of 1899. 
 
 Quarantine, Revised Statutes (1898), Sec. 1110. 
 Vermont. General, vaccination, quarantine, Statutes (1894), Sees. 4673, 4680-89. 
 Virginia. General, vaccination, quarantine, Code (1887), Sees. 1496, 1719-28; 
 Chapters 612 of 1895-6, and 1146 of 1899-1900. 
 
 Quarantine, Code (1887), Sees. 1733-41; Acts of 30 April, 1877, and 16 January, 
 1896. 
 Washington. General, quarantine, Codes (1899), Sees. 739, 1238-42, 2972-3009 
 
 Notification of Tuberculosis, Chapter 71 of 1899. 
 West Virginia. Code (1899), Chapter 150. 
 Wisconsin. Statutes (1898), Sees. 1408, 1412a-1416, 4602, 4608d. 
 Wyoming. Chapter 76 of 1899. 
 
' 
 
 I medical inspector 
 
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Table giving tbe number of Cases and DeafhS-from Dipbltoefia anil Cronp, Scarlet Fever and Typboid Fever in certain cities, from/890 to 18W inclusive. 
 
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CHAPTER X. 
 
 COMMUNICABLE DISEASES 
 
 (continued). 
 
 Administrative Work. 
 
 IF the community intends to do anything in the way of official control 
 of communicable disease it is necessary for a sanitary officer to visit 
 the infected premises to leave directions for the management of the case 
 and to see that whatever is required is done. In small communities 
 this work of course falls upon the health officer and is indeed his first 
 and most important duty. In cities in which the health department is 
 of sufficient importance to warrant the employment of subordinate offi- 
 cials to assist the health officer, the work of medical inspection as it is 
 properly called is placed upon an officer especially employed for that 
 purpose, called a medical inspector, or in some cases these duties may 
 be performed incidentally by other subordinate officers. The following 
 shows the number of medical inspectors in some of our larger cities and 
 what salaries they receive : 
 
 Number of Annual 
 
 City. inspectors. Salary. 
 
 Boston 1 medical inspector 2,200 
 
 1 medical inspector 1,400 
 
 Brooklyn (Borough of) 1 chief medical inspector 2,500 
 
 2 diagnosl icians 1,800 
 
 •_' diagnosl icians 1,200 
 
 IT medical inspectors 1,200 
 
 Buffalo 1 medical inspector 1,000 
 
 Cambridge 1 medical inspector 3,000 
 
 Chicago 1 chief medical inspector 2,000 
 
 i" medical inspectors 900 
 
 10 medical inspectors (in winter) ... . 900 
 
 Denver 2 medical inspectors 900 
 
 District of < '"liiinl>i;i 1 medical inspector 1,500 
 
 Hartford 1 medical inspector 600 
 
 Milwaukee 5 assistant health commissioners . . . 900 
 
 Minneapolis. :; assistant health commissioners 1. 
 
 New Bedford 1 medical inspector 500 
 
 Newark I medical inspector. 1,000 
 
 81 
 
482 COMMUNICABLE DISEASES. 
 
 Number of Annual 
 
 City. Inspectors. Salary. 
 
 New York (Borough of Manhattan) . . 1 chief medical inspector $2,500 
 
 2 diagnosticians 1,800 
 
 1 diagnostician 1,500 
 
 1 diagnostician 1,200 
 
 IT medical inspectors 1,200 
 
 Omaha 1 medical inspector 1,200 
 
 Philadelphia 1 chief medical inspector 2,300 
 
 4 assistant medical inspectors 1,200 
 
 Pittsburgh 1 medical inspector 2,400 
 
 Providence 1 medical inspector 1,500 
 
 Rochester 1 medical inspector 1,000 
 
 St. Paul 1 medical inspector 720 
 
 Salt Lake City 1 medical inspector 720 
 
 As eases of communicable disease are likely to come to light at any 
 time of the day or night, the health department is kept open during the 
 whole twenty-four hours of every day in the year in the great cities, and 
 even in such cities as Detroit and Pittsburgh. In smaller places night 
 calls are so rare, and the medical inspector or similar officer so well 
 known, that in emergencies it is expected that he will be sought at his 
 home. 
 
 When a report of communicable disease is received at the health 
 department it should be placed in the hands of the medical inspector as 
 soon as possible. There is some advantage in allowing the inspector to 
 take with him the original report sent in by the physician. By so doing 
 he may be better able to correct errors in the name or address which are 
 likely to occur and thus save valuable time. This is done in St. Paul. 
 If it is done of course the report should first be recorded in the office. 
 It may be at once entered on the permanent record which should be 
 kept by every health department of all cases of communicable disease 
 reported. If the inspector comes regularly to the office he of course 
 gets his report then. In Xew York the inspector calls at the office 
 twice a week only, and the reports in the morning's mail are delivered 
 to him before nine A. M. by the police. In Boston a mimeograph list of 
 the names and addresses of the sick is sent out daily at noon so that it 
 is received by the inspectors at about two P. m. The reports received 
 later are sent to the inspectors by mail. 
 
 In many cities the original returns are at once filed and a blank form 
 or report containing the name and address of the patient is given to the 
 inspector. In many cases the blank carried by the inspector is the one 
 that shall serve as a full report or perhaps a permanent record of the 
 cases as will be referred to below. Sometimes, as in San Francisco and 
 Buffalo, a simple slip is given him on which he is to make a report stat- 
 
t OMMlTJSm - 1 BLE DISE, 1 S E \ 483 
 
 ing briefly what action he took, and giving the name, age, and address 
 
 the patient and the name of the physician. 
 
 In almost all eases the health officials accept the diagnosis of the 
 attending physician who reports the ease, though in Seattle the health 
 officer visits and confirms the diagnosis in every ease reported. 1 In 
 Cambridge the medical inspector sees each case, but keeps his opinion 
 to himself unless called upon by the attending physician. Even when 
 the case is discovered in other ways, if there is a physician in attendance 
 it is usually considered good policy to consult him in regard to the diagno- 
 
 ind not attempt to officially investigate the case. 
 
 .More trouble occurs from diphtheria than any other disease. In 
 diphtheria health officers from the attention that they have given 
 to the subject and theii familiarity with the evidence, recognize the 
 diagnostic significance of the diphtheria bacillus. Practicing physicians, 
 on account of a more limited observation ami because of an occasional 
 failure of the method, frequently do not consider that this organism is a 
 safe, or perhaps even useful aid to diagnosis. Sanitary officials have 
 therefore generally come to think that whenever diphtheria bacilli are 
 found in the throat or QOSe of a person, that person should, so far as his 
 relation with the public is concerned, he treated as if having diphtheria, 
 ami it is the usual custom to treat the cast- in this way no matter what 
 the opinion of the physician may have been, ami no matter if he adheres 
 to it after the culture has been taken. On the other hand the health 
 officer is perfectly ready to treat the rase as diphtheria when the attend- 
 ing physician reports it as such, when no culture has been taken, or 
 even if when a culture has he, -II taken no diphtheria bacilli ate found. 
 I is well known that through errors of technique or from other 
 causes the bacillus is not found on the first culture in ten per cent, or 
 more of tin- cases of true diphtheria this position of the health officer is 
 perfectly logical. Sometimes those physicians who have no confidence 
 in bacteriolog} are very ready to tike advantage of the situation when 
 the bacilli do not happen to he found at first, even if they really believe 
 the case to be diphtheria, and refuse to take another culture, saying thai 
 
 the " health department has decided that it was not diphtheria," and 
 
 that therefore they will not report it as such. The writer takes every 
 sion to urge a second and perhaps a third culture in such cases, and 
 usually if the ease w a ria n t s i I lhe\ ale taken. Personally the writer 
 ha- never seen a case of what he believed to !><■ true diphtheria which 
 did not show diphtheria bacilli on tin- third culture, and probablj three 
 negative cultures ma} he very safety relied upon. 
 
 While it is unwise for the health officer, except when sine of error 
 
 ' Letter it Health I ►fficer, 1895. 
 
484 COMMUNICABLE DISEASES. 
 
 or deceit on the part of the attending physician, to personally investi- 
 gate the case, yet it is sometimes necessary. Moreover, cases are con- 
 stantly occuring in which communicable disease is suspected when there 
 is no physician attending. It has been deemed wise therefor to give 
 the sanitary officers authority to investigate such cases. On page 112 
 reference was made to statutes which confer authority to enter private 
 property to investigate nuisances, and some of these are so worded as 
 to permit the exercise of the same right for the investigation of com- 
 municable diseases. The Massachusetts law has been copied by other 
 states and probably allows and requires the exercise of this power. 1 
 
 Other states, among which may be mentioned Indiana, Maryland, 
 New Hampshire, New Jersey, North Dakota, Ohio, South Carolina, 
 Texas, Virginia, and West Virginia, have either by statute or by rule of 
 the state board of health authorized local boards to examine into cases 
 of suspected communicable disease. 2 In Texas permission must first be 
 asked before the forcible entrance is made. In West Virginia the 
 officers may not enter at night for this purpose. The rules of the In- 
 diana state board of health grant the right of examination only when 
 there is no physician in attendance or when the physician fails to 
 report. The North Dakota rules add that the health officer must " in 
 no way interfere with the treatment of the case." The charter of New 
 York City authorizes the inspection of cases for diagnosis. 15 In New 
 
 1 Massachusetts, Public Statutes (1882), Chapter 80, Sec. 28: 
 
 " The board shall examine into all nuisances, sources of hith and causes of sick- 
 ness." 
 
 2 New Jersey, General Statutes (1895), p. 1645, Sec. 45: 
 
 " That all police justices, recorders, justices of the peace and all other magis" 
 trates are hereby authorized on complaint founded on information and belief, sup- 
 ported by oath or affirmation of any officer or agent of the state board of health or 
 of any local board of health that there is in any dwelling house, store, stable or any 
 building of any kind whatsoever any nuisance affecting health or any person sick of 
 any contagious or infectious disease, or any condition of contagion or infection 
 which may have been caused by any one recently sick of any such disease in such 
 dwelling house, store, stable or any other building, to issue a warrant directed to 
 the sheriff of the county within which such complaint shall be made, or to any con- 
 stable, marshal, police officer or to any officer or agent of such board of health 
 directing him, them or any of them to search in such dwelling house, store, stable 
 or other building for such nuisance affecting health; or for any person sick of any 
 contagious or infectious disease, or for any condition of contagion or infection which 
 may have been caused by anyone recently sick of any such disease in such dwelling 
 house or other place as aforesaid, and if such nuisance be found, to abate the same; 
 and if such sick person be found, to deal with him according to law and the ordi- 
 nances of such board of health; and if such condition of contagion or infection be 
 found to exist, to destroy the same by means of proper disinfection. 
 
 3 New York, Chapter 378 of 1897, Sec. 1184: 
 
 " The sanitary superintendent, the assistant sanitary superintendents, the sani- 
 tary inspectors and the officers of said department may visit all sick persons, who 
 
COMMUNICABLE DISEASES. 485 
 
 Hampshire the authority to enter private premises is granted only to 
 inspectors appointed by the state board of health. A number of cities 
 have similar provisions in their ordinances. In Maryland the state 
 board of health is to decide questions of diagnosis. 1 
 
 While in ordinary cases the diagnosis of the attending physician is 
 usually accepted, it is by no means so with hospital cases. If the city 
 officials an- to remove a case of communicable disease to a hospital it 
 is [tiudent for them to be as sure as possible that the ease is sent to the 
 right ward. It is unfortunate to send a scarlet fever case to a diph- 
 theria ward or chicken pox to the smallpox hospital. Therefore in 
 hospital cases the patient is usually examined by the medical inspector 
 before being placed in the department ambulance. In New York 
 special medical inspectors are detailed for this and are called diagnosti- 
 cians. 
 
 In all cases it is necessary for the medical inspector to exercise the 
 utmost care and judgment so as not to irritate in any way the family of 
 the patient, or the attending physician. 
 
 In the District of Columbia and Philadelphia penalties are imposed 
 tor the obstruction of an officer while discharging the duties above 
 referred to, and in Philadelphia if an aggrieved person after recovery 
 assaults an officer he is to lie fined and imprisoned. 2 
 
 The first thing to be done by the medical inspector on making his 
 visit is to enquire as to the facts of the illness, its duration, origin, etc., 
 the age and other items concerning the patient that it is desirable to 
 record, and also to note whatever is necessary in regard to the other 
 members of the family. As the laws concerning the disease are often 
 applicable to nil members of the family and to all children living in the 
 house, enquiries must be made of the other families living in the house. 
 It is wise to visit the other families first if this is possible, but if not. 
 its is perhaps usually the case, the inspector should not enter the in- 
 fected apartments 80 that he may not be obliged to go directly from an 
 infected to an uninfected family. It is possible ( t hough improbable ) 
 that he might thus convey the disease, but it is chiefly for the moral 
 
 shall be reported t<> tin' department of health as sick of anj contagious, pestilential 
 or infectious disease ami report i" the department "f health, in writing, Ins or their 
 opinion "l t lieir sickness." 
 
 Maryland, Chapter 346 of 1898, Sec. 34E: 
 "All questions of doubl concerning the cause or nature of any sickness believed 
 <>r suspected to lie « . r an infectious or contagious character, shall he referred i" the 
 Btate board <>f health; ami the said hoard shall he authorized to emploj a competent 
 bacteriologist t" conduct inquiries into the nature, source and vehicles of infectious 
 disease/ 1 
 
 Pennsylvania, \<-t of 20 January, 1859, Sec. 28. 
 
486 COMMUNICABLE DISEASES. 
 
 effect that he should thus respect isolation. The data needed for 
 record and as a basis for giving directions for management may lie 
 taken on a special slip from which they may be copied on to a record 
 book, or they may be taken down upon a printed form which shall serve 
 as the permanent record. 
 
 After thoroughly examining into the necessary facts the medical 
 inspector gives directions as to isolation and disinfection. To aid in 
 this most health departments furnish printed circulars which the in- 
 spector may leave with the infected family and perhaps with other 
 families in the house and neighborhood, as in Detroit and Heading. In 
 Louisville circulars are not distributed at all. As such circulars of 
 directions may well be uniform for all communities, and as small com- 
 munities could not well afford to print them, they are furnished by 
 many state boards of health. 1 
 
 Sometimes, as in Connecticut, a card is furnished to be hung in the 
 sick room on which are printed in large type the more important regu- 
 lations. In cities with a large foreign population circulars are often 
 printed in different languages. Sometimes a polyglot circular is issued 
 and sometimes a separate circular in each language. Examples of such 
 circulars are given in Appendices 74-80. 
 
 Besides leaving circulars which contain general directions, it is of 
 course the duty of the medical inspector to give specific directions for 
 the isolation and general management of the case in question. The 
 varying regulations of different states and cities for the control of the 
 patient, the family, and persons living in the house, have already been 
 considered. It is the duty of the inspector to explain all these matters. 
 and to see that they are thoroughly understood. He must also make 
 it understood that the rules are to be obeyed. Usually these directions 
 are given verbally, but the rules of the Iowa and Vermont state boards 
 of health require that they shall be in writing. In Iowa the notice is 
 to be in the name of the mayor or township clerk and is to be served 
 upon the family. In Vermont the notice is issued over the signature 
 of the health officer and is served upon the head of the family. See 
 Appendix 81. 
 
 Sometimes while no formal order for isolation is served, a printed 
 notice in regard to school attendance is left at the house. This is done 
 in Reading, Vonkers, and Charleston. See Appendix 82. 
 
 In Providence it has been the custom for the police to call on the 
 day following the visit of the medical inspector and further insist upon 
 
 1 California. Colorado, Connecticut, Illinois, Indiana, Iowa, Maine. Maryland, 
 Michigan, Minnesota, New Hampshire, New York, North Carolina, Rhode Island, 
 Tennessee, Virginia, and Wisconsin. 
 
I ■ MMl Wfl ■. i 11 LE 1> is EA S E v 4 £ 7 
 
 the measures of isolation ordered. It is believed that the duty of obedi- 
 ence is thus more forcibly inculcated. 
 
 Occasionally a short printed notice of some one regulation maybe 
 left when it is desired to issue a special warning or when the regulation 
 lias been markedly disregarded. Such singling out of a flagrant act is 
 more effectual than to trust to the warning of a general circular of 
 direction-. 
 
 It was formerly the almost universal custom of medical inspectors 
 to make quite a thorough "sanitary survey'" of the infected house and 
 note all nuisances, defective plumbing and drainage and filthy con- 
 ditions in or about the premises! This was done as a result of the 
 teaching of the early European sanitarians that the infectious diseases 
 were largely tilth diseases. These inspections carried on systematic all) 
 have only served to prove that these teachings were not correct. At 
 present very many health officials have discontinued all enquiries into 
 "unsanitary conditions " because it is feared that if emphasis is laid 
 upon such defects the family will feel that the disease is not due to 
 contagion purely, and will he only too ready to attribute its presence to 
 the parsimony of the landlord, rather than failure on their part or their 
 neighbors to maintain isolation. The health officer wishes to have 
 nothing weaken tin- belief that the contagious diseases are contagious. 
 Inspection of the house is very generally omitted in scarlet fever, 
 diphtheria, smallpox, and measles, hut it is very generally made in ty- 
 phoid, for the mode of transmission of this disease is not yet fully 
 understood and it is very possible that " unsanitary conditions " may 
 sometimes he a factor in its spread. Indeed it is known that the con- 
 tamination of drinking water with sewage is sometimes a factor. In 
 some cities the inspection of the premises where there is communicable 
 disease is not made by the medical inspector bul by the sanitary in- 
 spector, as in Chicago, Indianapolis and St. Louis, and a sample of the 
 form \\<i-i\ by the inspector in Indianapolis is shown in Appendix 3 
 In other cases the form used for this purpose also includes that portion 
 of the history of the case which it is necessary to record. It is then 
 made out by the medical inspector in lull and returned to the office 
 where the returns lor the year ma\ he bound together or otherwise 
 tiled. In Appendices 83 I may be found a sample of the style of report 
 which requires a very full examination of the premises. 
 
 In cities where \er\ strict isolation is maintained and the wage 
 earners are kept from work, it is necessarj for the city to support the 
 famil\ when the\ are without means. This is don.' more in Detroit 
 than perhaps any other city, and there the inspector is required to make 
 a report as to the financial condition of the infected family. 
 
488 COMMUNICABLE DISEASES. 
 
 After the medical inspector has left his circulars and given his 
 directions and obtained the data for his report, he may put up the warn- 
 ing sign. This however, is sometimes done by sanitary inspectors or 
 by the police, or by a man appointed especially for that purpose as in 
 St. Louis. In Chicago, Cambridge, Minneapolis and St. Paul the cards 
 are put up by the sanitary inspectors, in Pittsburgh and Detroit by the 
 sanitaiy police. 
 
 When the inspector visits a case of diphtheria he should be pre- 
 pared to take cultures from the throat or nose. Very often the attend- 
 ing physician requests that the inspector take a culture from the 
 patient. In Philadelphia the board of health advertises to take cultures 
 on request. In Providence, children living in the house are not per- 
 mitted to go to school until negative cultures have been obtained from 
 them, and persons living in the family with the case are not allowed to 
 go to work until this has been done. Then, too, the inspector is likely 
 to hear of suspicious cases of sore throat in the neighborhood which are 
 unattended by a physician, and which he should examine. He should 
 therefore carry a number of culture outfits with him. Several ordinary 
 culture boxes may be carried in the pockets, but if many cultures are 
 to be taken, it is important to decrease the burden as much as possible- 
 Hence swabs alone are sometimes carried in place of the complete out- 
 fit. If many tubes are to be carried, it is necessary to use a box or bag. 
 When smallpox is prevalent, the medical inspector should be prepared 
 to vaccinate as he may come across persons whom it is safest to vaccin- 
 ate at once lest they escape from observation. 
 
 After his return to the office it is necessary for the inspector to send 
 out various notices or to see that it is done by the proper clerk. The 
 first and most important notice is that to the schools. Many of the 
 state regulations, as those of Colorado, Maryland, North Carolina, Penn- 
 sylvania, 1 Tennessee, and Vermont, require the health department to 
 notify the school department, and such a requirement is still more often 
 found in municipal regulations. The efficient health officer would send 
 such a notice even if he was not formally directed so to do, and this is 
 probably the reason why the requirement is not universal. 
 
 1 Pennsylvania, Chapter 124 of 1895, Sec. 14: 
 
 " It shall be the duty of the health authorities in the several municipalities as 
 aforesaid, to furnish daily, by mail or otherwise, to principals or other persons in 
 charge of said schools, a printed or written bulletin, containing the name, location 
 and disease of all persons suffering from cholera, smallpox (variola or varioloid), 
 scarlet fever, typhus fever, yellow fever, relapsing fever, diphtheria, diphtheritic 
 croup, membranous croup or leprosy, upon receipt by them of reports of such cases 
 from physicians as recpaired in section one of this act: Provided, That the health 
 authorities of any municipality may, in lieu of the daily bulletin herein required, 
 
( ■ OMMUNICABL E UlsEA SES. 4 8 9 
 
 As a matter of fact various methods are taken to notify the schools. 
 Usually whatever method is taken, the notices are sent daily, but some- 
 times as in Baltimore they are only sent twice a week. In Newark 
 notices are sent to private schools three times a week. In some cases 
 they are sent to the board of education as is required by the laws of 
 Maryland, Tennessee (to the county superintendent if not in a town), 
 and North Carolina. In Massachusetts the statute requires notices to be 
 sent to the school committee. In several cities where it is not prescribed 
 by law this method is followed, as in Bridgeport, Denver. Detroit. Fall 
 River, Fitchburg, Newark, and Youngstown, O. 
 
 Notice reaches the teacher who is to enforce the law sooner if it is 
 sent directly to the school where the pupils attend, and this can be 
 readily done if the medical inspector obtains the facts at the time of his 
 visit. This method of sending the notice directly to the school is prob- 
 ably the one generally followed. 1 When notice is sent to the school 
 department of course a complete list of all cases is sent as in Detroit : 
 but sometimes even then a separate slip is sent for each case as in Fitch- 
 burg. Sometimes when it is sent to the schools direct a complete list 
 of all cases reduplicated on the mimeograph or hektograph is sent as in 
 Boston and Baltimore. When notice is sent only to the school where 
 the pupils attend, usually only the names of the children there attending 
 are sent. Sometimes the Christian names of all the children are sent, 
 but more often only the family name and the address. The form of 
 eard used in the District of Columbia is shown in Appendix 85. In 
 Bridgeport what is practically a copy of the physician's report is sent to 
 the school. Only the family name is used in Chicago, as shown in 
 Appendix 86. This card is a double reply card and the reply card is 
 Used by the principal of the school to report to the health department that 
 the not ice was duly received. Sometimes a copy of the law is printed on 
 
 the card. In Providence for scarlet fever the letters are in red, for 
 diphtheria black, and still another style of card is wsvd for measles. 
 Notices are sent to parochial, private, and other secular schools in the 
 
 same manner. Notices are frequeatly sent to Snndax schools but this is 
 
 by no means universal. In Providence the Sunday school notices arc 
 
 sent to the pastors of the churches. In that citj they are sent daily, 
 
 but in Newark they arc sent on Friday of each week. In some cities 
 
 I no viile thai ;» not ire shall be given to the school ors< Inn. is attended by the children 
 in whose borne or residence any of the diseases mentioned in this section exist, and 
 prescribe the form of said notice." 
 
 1 It certainly is in Albany, Boston, Cambridge, Chicago, District of Columbia, 
 Minneapolis, New Fork, Philadelphia, Providence, (leading, Rochester, s t. Louis, 
 
 San I ran' is. ... :nnl Y..nk«Ts. 
 
400 COMMUNICABLE DISEASES. 
 
 they are sent to the superintendents of the Sunday schools. The 
 medical inspector also sends notices to the public and other libraries, 
 and in those cities where wage earners are kept from work, notices must 
 be sent to the employers. In Detroit the post office authorities are noti- 
 fied of cases of communicable disease. In Providence notices are sent 
 to the da}^ nurseries, in Chicago to milkmen, and to fresh air societies 
 in New York. In Boston where the medical inspector does not visit 
 the office each day a card is sent by him to the office recommending 
 whether the patient should be removed to the hospital or kept at home. 
 In case the latter is decided upon, the notice shown below 1 is sent to 
 the attending physician. 
 
 After the infected house has been visited and the clerical work con- 
 nected with the various notices has been done, it is necessary to make a 
 record of the case, or at least to begin such a record which of course 
 can be completed only with the termination of the case. The import- 
 ance of keeping a good record of all cases of communicable disease can- 
 not be overestimated. There are a great number of unsolved problems 
 connected with the management of communicable diseases and a vast 
 number of observations of the natural history of these diseases must be 
 made before satisfactory solutions can be reached. The importance of 
 keeping such records has been recognized in the statute law of several 
 states and it is required in Maryland, 2 Massachusetts, North Carolina, 
 New Jersey, and South Dakota. 
 
 1 Office of Board of Health, 
 
 Boston,. ]S9 
 
 Doctor 
 
 I have just now made an official visit at the house of your patient 
 at for the 
 
 Board of Health. It will be my duty to cooperate with you in main- 
 taining the necessary isolation of the patient, and, on notice from you or 
 the family of the termination of the disease, to see the patient and certify the 
 facts required by the Board of Health for its action. 
 
 Respectfully, 
 
 Agent, Board of Health. 
 
 - Maryland, Chapter M46 of 1898, Sec. 34C: 
 
 " The Boards of Health in the several cities, towns, and counties shall cause 
 a record to be kept of all reports received in pursuance of the preceding sec- 
 tions and such record shall contain the names of all persons who are sick with infec- 
 tious or contagious diseases, the localities in which they live, the disease with which 
 they are affected, together with the date and names of the persons reporting any 
 such cases, and the record of quarantine, disinfection and other preventive meas- 
 ures.'" 
 
COMMUNICABLE DISEASES. 491 
 
 In Massachusetts the record is to he in hunks furnished by the secre- 
 tary of state. In New York City a similar book is used. Two books 
 are used so that inspectors may not he delayed and the records are 
 entered twice a week when the inspectors call at the office and are 
 signed by them. Another honk which is practically a street index also 
 has all the cases entered in it. A separate book is used for the cases 
 which go to the hospital. 
 
 Another form of record consists of the report of the inspector upon 
 a sheet which is tiled, and perhaps hound, and thus serves as a perma- 
 nent record. These may he indexed by streets or names, or both, or ar- 
 ranged according to one method and indexed by the other. Such forms 
 are used in cities where the sanitary inspection of the infected house 
 is made a feature of the work. Examples of these forms are shown 
 in Appendices 83-4. 
 
 A very convenient form of record is the card record. These cards 
 may he arranged according to streets or by names, or there may he a 
 
 arranged each way. In Providence experience has shown that 
 there is little need for any other that a street index. The form used 
 in Milwaukee is shown in Appendix 87, blue for diphtheria, red for 
 scarlet fever, buff for typhoid, and white for measles and other disi 
 Of course the items diffei somewhat in the different diseases. The 
 record is compact and there is a considerable number of items, more 
 than there is room lor mi most of the hook records, but not as many as 
 it is well to record. 
 
 In Providence a compromise form of record is used. It is used 
 like a card in that the sheets are arranged alphabetically by streets. 
 They are kepi in a drawer with a hoard upon them to keep them flat : 
 hut as they arc of the thickness of ordinary paper they can he easily 
 folded and carried in the pocket. The medical inspector takes blank 
 ones with him and (ills them out as fully as possible, and he also takes 
 them with him when he makes any subsequent visits. All the cases oi 
 all diseases under observation are kepi in a pile together, arranged by 
 streets. When a case has terminated the slips for each disease are kepi 
 
 Separate. At the end of the year thej are assorted and arranged in 
 various ways for ease in making up tables and are finally bound. The 
 form used in diphtheria is shown in Appendix 88. The scarlet fever 
 slips are white, diphtheria green, mid typhoid blue. 
 
 Another useful form of record and > generally used in conjunction 
 
 with book or card records is the map. .Maps are hung in the office 
 and on these are noted all the eases of communicable diseases thai come 
 to the notice of the depart men t . Sometimes a separate map is used for 
 
 each disease and sometimes all are marked on one map. different colors 
 
4112 C OMMXTNICABLE BIsEA SEs. 
 
 being used for the different diseases. Sometimes one map lasts for a 
 whole year or for several years as the phthisis map at Rochester. Some- 
 times a new ma}) is used for each month as in Baltimore, and in Provi- 
 dence a new one on which are marked all diseases, is set up every six 
 months. In Providence the map is mounted over cork and is pasted 
 only around the edges so that it may be easily cut off and filed away. 
 Cases may be designated by spots of ink or pins or both. The most 
 common way is to stick in a red headed pin for scarlet fever as near 
 the location of the case as may be, a black pin for diphtheria and a 
 white pin for typhoid. In Providence where the locations' are marked 
 by both ink and pins the scarlet fever and diphtheria pins are taken out 
 when the cards are removed and a spot of the corresponding color is 
 left on the map. The typhoid pins are left in as long as the map is in 
 use and their location is marked with a T. In Baltimore a separate 
 wafer of brown is stuck on the pins for every case in the house. As a 
 new map is used for each month, the cases carried over from the pre- 
 ceding month are designated by a red wafer. When disinfected the 
 place of the pin is marked in blue. Pin maps are exceedingly useful 
 and show local outbreaks better than any other method. Such maps 
 are used in Asbury Park, Baltimore, Cambridge, Denver, Montclair, 
 N. J., New Bedford, Providence, Rochester, and doubtless in man}* other 
 places. 
 
 To post a placard and exclude children from school may and doubt- 
 less does accomplish much : but unless something more is done, the 
 patient and perhaps other members of the family may pay little heed 
 to isolation. The laws almost invariably require that the patient and 
 other members of the family stay in the house. This they will rarely 
 d< >. particularly members of the family who are well, unless there is 
 some supervision, and unless this supervision is constant it is scarcely 
 possible to believe that our state and municipal laws are at all well en- 
 forced ; and constant supervision is rare in American cities. 
 
 Even if there is only one other visit, a final one, before the card is 
 taken down, it may do some good, for there may be a fear that viola- 
 tions of the law will be discovered: but this is often omitted even in 
 such cities as Cleveland, St. Paul, Chicago, and Cincinnati. In Hart- 
 ford also, only one visit is made at the beginning, but when the attend- 
 ing physician reports that the case is well the patient comes to the 
 office of the medical inspector to show that desquamation has ceased or 
 to have a culture taken. 
 
 In most cities at least two official visits are made to the infected 
 premises, one when the case is reported and one when the warning sign 
 is to be removed. In scarlet fever the object of the visit is to deter- 
 
COMMUNICABLE DISEASES. 493 
 
 mine whether desquamation has ceased, and in diphtheria to take a 
 culture from the throat. Of course, if the patient is not through 
 desquamating or diphtheria bacilli are found, several visits may be re- 
 quired. Usually the first of these "final" visits is not made until a 
 notice is received from the family or from the physician that the case is 
 well and that in scarlet fever desquamation has ceased; but in Roches- 
 ter it is the custom for the medical inspector to visit all cases after the 
 expiration of twenty-one days. 
 
 In some cities a more complete supervision of the cases is main- 
 tained. In Baltimore frequent visits are made, and the same is true of 
 Newport, R. I., Paterson, and Pittsburgh. A still better supervision is 
 secured by daily visits. This is done in Wilmington, Del., where the 
 sanitary inspectors (executive officers), do this work though they are 
 aided by the police. In Detroit, where a stricter isolation is kept up in 
 scarlet fever and diphtheria than in most cities, the inspector is sent to 
 the house within three hours after the case is reported and then visits 
 the house daily. He also makes a daily report to the central office as 
 shown on page 497. 
 
 The only certain means of knowing that isolation is maintained as 
 directed is to guard the premises day and night. This is rarely done 
 in scarlet fever ami diphtheria, though it is reported that in Pittsburgh 
 it i- done in perhaps live peT cent of the cases : and it has been done in 
 special outbreaks as in Salem, Mass., 1 in diphtheria in 1896, and Colum- 
 bus, IikL- in diphtheria in 1897. In Seattle a guard is placed day and 
 night in diphtheria and occasionally in scarlel fever. 3 In the more 
 feared diseases, as smallpox, typhus lever and yellow fever, it would 
 doubtless ofterier be done if it were not that most cases of these dis- 
 a are taken to the hospital. Occasionally, however, it is impossible 
 to provide hospital care owing to lack of facilities, and it is then quite 
 common to set guards about the premises. Tliis method of isolation is 
 Bpecifically provided for in man\ state laws and was referred to on 
 page 148. A similar authority is given by statute in Alabama and in 
 
 Pennsylvania cities of the sec I (lass. When guards are employed 
 
 the\ have to be kept on duty day and night and frequently more than 
 one side of the house has to be guarded. 
 
 In Providence when it has been necessary to care for smallpox in a 
 dwelling, a nurse has been furnished by the city and no other guard has 
 ever been required, though it might be with certain classes of people. 
 A similar practice is sometimes followed in Montclair, N. J., in eases ol 
 
 Salem Report ol Board ol B< alth, I 
 - Indiana Medical Journal, June, 181*7. 
 1.. it,. 1 from Health < (fficer, LI 
 
494 GO MMl WIC L 1 BL E DISE. I 8 ES. 
 
 diphtheria and scarlet fever among the poor. Not only are cases of 
 smallpox thus kept under control, but in some cities all exposed to that 
 disease are confined as in Cleveland, the District of Columbia, and Pitts- 
 1 >uxgh. In other cities as Newark and Providence, this is not done, though 
 of course the exposed persons are kept under daily observation and are 
 thoroughly vaccinated. It is believed in those cities that harsher 
 methods only result in concealment and sometimes in the escape of the 
 persons under suspicion. 
 
 For all this work of controlling isolation the regular police can be 
 of great assistance to the health department. The officer on the beat 
 frequently passes the infected premises, is often acquainted with the 
 inmates of the house, and is very likely to detect any violations of the 
 law and can report them promptly to the health department, In many 
 cities the police are required by ordinance to co-operate with the health 
 department. 1 In order to secure this co-operation on the part of the 
 police in Providence, a slip naming the persons who are not to leave the 
 house is sent through the chief to the officer on the beat, a green slip 
 being used for diphtheria and a white one for scarlet fever. On receipt 
 of the slip the officer visits the house and supplements the directions of 
 the medical inspector with the authority of the law. 
 
 When a death occurs from communicable disease most regulations 
 require that the funeral shall be private. The funeral can very gen- 
 erally be controlled through the undertaker, who is usually licensed by 
 the municipality. If his license is issued by the health department his 
 co-operation is likely to be all the more hearty. Some cities, however, 
 do not rely on this alone, but have one or more inspectors attend the 
 funeral. In Detroit, Lowell, Milwaukee, Newark, and Worcester, a 
 single inspector is present, and in Toledo two inspectors. In Detroit a 
 special "funeral inspector" is employed, and he assists in disinfection. 
 In Providence, when it is suspected that there is an intention to violate 
 the rules, two policemen are detailed for this purpose. The undertaker 
 usually reports if he suspects a violation of rules is intended. 
 
 When the time approaches for the removal of the warning sign or 
 the "raising of quarantine." as it is popularly called, it is necessary 
 that a notice should be sent to the health department by the family or 
 the attending physician. < )f course, in the rare instances where inspec- 
 tion by the health officials is made frequently, such notice is not neces- 
 sary : but in most cities this is not done, and when it is not it is very 
 
 1 Providence, Resolution of the Board of Aldermen, 16 February, 1893: 
 
 " The chief of police be and he is hereby directed to furnish upon call of the 
 
 superintendent of health, such police service in the care of contagious disease as 
 
 the said superintendent of health may require." 
 
COMMUNICABLE DISEASES. 495 
 
 generally the custom to leave a postal card with the family or with the 
 physician, on which notice may lie sent. In Cambridge a postal printed 
 for this [impose and addressed to the health department is left at the 
 house by the medical inspector on his first visit. In Cleveland a slip 
 is left with the family of the patient, but the doctor's signature must he 
 secured before it will he recognized by the health department. See 
 Appendix 89. 
 
 In most cities the report of recovery is to he sent in by the physi- 
 cian instead of the family. In some cities, as St. Louis and Chicago, 
 a formal request i> made to the attending physician to send in bis 
 report. In the latter city a reply postal is used. See Appendix !»<>. In 
 the District of Columbia postal cards of different colors are used for 
 different diseases and in diphtheria the physician is to give the date 
 when the membrane disappeared, and in scarlet fever when desquama- 
 tion ceased. In Boston the physician reports to the medical inspector 
 who visits the case to confirm the facts and report to the hoard of 
 health. 
 
 As in most cities negative cultures from the throat are required 
 before the release from isolation is given, it has gradually come about 
 that the Labor of taking these cultures has fallen chiefly upon the medi- 
 cal inspectors. When the attending physician chooses to take the final 
 cultures he is permitted and sometimes encouraged to do so. but per- 
 haps in the majority of cases he notifies the health department that he is 
 
 through with the case and expect the department to take the cultures. 
 This taking of cultures has become so important a part of sanitary work 
 that in Baltimore a special '-throat inspector" has been appointed for 
 this, and in Rochester an "inspector of diphtheria." In Columbus, < '.. 
 the medical inspector Leaves the culture outfit at the house for the 
 physician and calls for it the next day. In order to prevent too fre- 
 < I lien t calls for cultures from persons anxious to terminate isolation, 
 sonic officers refuse to take a second culture within a week if the first 
 shows that diphtheria bacilli are present. Some officers feel thai cul- 
 tures are called for too early and would fix a minimum time before 
 which they will noi be taken by the medical inspector. Sometimes in 
 Long standing cases the virulence of the bacillus is tested upon guinea 
 pigs and the patient released from isolation if the bacillus appeal- to 
 have lost its virulence. This is the custom in Brookline, Mass.. but it 
 is nut often done, except in prolonged cases, for a negative culture 
 is usually obtained before the animal test is completed. Furthermore, 
 there is very grave doubt as to whether this test is of much value in 
 indicating whether the bacillus is virulent to man. 
 
 in most cases the health departmenl orders the "release ol quaran- 
 
490 COMMUNICABLE DISEASES. 
 
 tine," but in Iowa 1 it must be by order of the mayor or township clerk, 
 but only after disinfection and on the approval of the attending 
 physician. It is usually the custom for the disinfector to remove the 
 warning sign when lie has completed his work, but in cities and towns 
 where disinfection is not compulsory, or is not done by the officials, the 
 householder is directed by the health officer to remove the placard. 
 
 The medical inspector is not only required to keep a record of the 
 cases visited by him but he is obliged in some of the larger cities to 
 make daily or weekly reports to the department of the work done by 
 him. In Buffalo and San Francisco a separate slip is turned in by the 
 inspector for each case. In Philadelphia where a half letter sheet is 
 used by the physician for reporting, there is a space on the back for the 
 report of the medical inspector. A more elaborate form of daily report 
 is used in the District of Columbia stating the number of houses visited 
 and placarded and the number of cultures taken. In Minneapolis a 
 somewhat similar report is made weekly. 
 
 When isolation in communicable disease is maintained by the sani- 
 tary officials with such rigor as to interfere with the work of the wage 
 earners, the support of the family must be provided in other ways, and 
 it should of course properly be provided by the municipality. Assist- 
 ance may be and frequently is furnished by the poor department, but 
 it is not usually done unless the family are at other times recipients. 
 It appears to many much better for the health department to furnish 
 assistance, and there are good reasons for not being too niggardly about 
 it. If the family in which there is communicable disease is to be sub- 
 jected to too great hardships on account of it, many such cases will 
 surely be concealed. On the other hand, they should not be encouraged 
 to expect too much from the community, and it is not easy to hit upon 
 a happy mean. 
 
 Various states, as Massachusetts,- Michigan, North Dakota, and Vir- 
 ginia, have provided that the payment for the care of communicable 
 disease shall be a charge upon the person siek or his parents or guar- 
 dians, and that it shall not be a charge upon the city or state unless the 
 patient is without property. The tendency of these laws is to treat the 
 
 1 Iowa, Rules of State Board of Health, 24 February, 1899, Rule 12. 
 -Massachusetts, Public Statutes (1882), Chapter so, Sec. S3: 
 
 " All reasonable expenses which have been heretofore or may hereafter be in- 
 curred by the board of health of a city or town, in making the provision required by 
 law for a person infected by the smallpox or other disease dangerous to the public 
 health, shall be paid by the person himself, his parents, or master, if able; other- 
 wise by the town in which he has a legal settlement; and if he has no settlement, by 
 the Commonwealth, in which case the bills therefor shall be approved by the state 
 board of lunacy and charity." 
 
( ' OMMl XI< \ J B L E 1> I S h\ I S EJS. 4 <j 7 
 
 patients to whom aid is given as if they were paupers. It is questioned 
 by many whether this is a wise course. If a family is by action of the 
 community deprived of the support furnished by its wage earners should 
 not the family he helped with some degree of liberality, and in such a 
 way as to make them feel that they are not the recipients of charity'/ 
 
 In Providence when a family lias to he helped in this way. owing to 
 Loss of wages, the amount given is paid •• for services in the care of 
 communicable disease." The theory is that if the patient was removed 
 to the hospital, the city would have to pay for the care, in thai city 
 fifteen dollars per week. If by the wage earner remaining at home 
 strict isolation can he maintained, the family receives a certain sum for 
 exercising this rare. The amount paid is seven dollars per week, or if 
 the wages lost are less than that, the amount of the wages is paid. As 
 this plan is less expensive than sending to the hospital, the taxpayers 
 ought not to complain. In 1 900 seventeen cases received *1 ->1 in this way. 
 Dining the same period 147 patients at the hospital cost $6,943.61; 
 
 If absolute isolation is not maintained in these cases, the money is 
 withheld by the health department and the family becomes dependent upon 
 the poo)' department. In Detroit where stricter isolation is maintained 
 than in most cities, tor the year ending 30 June, 1899, support was fur- 
 nished iii 189 families at a cost of $4,617, in 60 of which $597.35 was 
 for fuel. During the year there were 331 houses placarded for dipth- 
 theria and 251 for scarlet fever. In that city the quarantine inspectors, 
 of winch there are two, visit infected houses each day 
 
 ■•in find the necessities of each case, which an- telephoned to the clerk. Prom 
 the number in the family ami age of the occupants, the amount of each article ordered 
 is determined. Each order received is carefully compared with the previous order in 
 order thai the- city may not he imposed upon by over-stocking with things which are 
 m»t needed. Everj order is copied in duplicate, one going to the concern furnishing 
 tin- goods, thence to the party receiving the goods, ami one being retained in the 
 office. Tin- duplicate sent with the order is returned after ailing and compared with 
 the original, width is then used in checking the hill rendered by the contractor at 
 t he end of each i n h." 
 
 On the first visit, the financial condition of the family .is reported on 
 blank- furnished for the purpose. In Seattle, where also absolute 
 isolation i- maintained, in 1899 onlj $200 was expended in supplies for 
 t he poor, alt hough there were in that city * I eases of diphtheria mid 1 12 
 of scarlel fever. 
 
 \'-u Hampshire has recentlj recognized the justice of assisting per- 
 sons confined o\\ Lng to communicable disease :' 
 
 •• Whenever anj person or family is placed in quarantine bj a hoard of health to 
 protect the public against smallpox, scarlet fever, diphtheria, or other dangerous, 
 Infectious, or contagious disease, it shall he the duty oi said board to asMsi such 
 
 \.n\ Hampshire. Chapter II i 189D Sec. I. 
 
498 00 MM I XI CABLE DISEA SES. 
 
 person or family while in quarantine in such mannner as in the judgment of the 
 board may be deemed wise or necessary." 
 
 The expense is to be charged to the health department and not to the 
 poor department unless the persons are already paupers. 
 
 In Minnesota 1 the board of health while maintaining isolation may 
 " provide necessaries for persons in poverty." 
 
 Epidemics. 
 
 In the opinion of the writer the word epidemic should be rarely 
 used as applied to an outbreak of communicable disease ; the latter term 
 is in most cases much to be preferred. The word is a popular one and 
 as ordinarily used implies a condition of great and unusual danger. As 
 that is undoubtedly its meaning, it cannot be accurately defined and the 
 attempts to do so have been futile. The use of a word like this which 
 is not capable of close definition should be discouraged by health officers 
 and scientific men. It is used in this connection because it is here in- 
 tended to refer to just those indefinite conditions of popular fear covered 
 by the word. 
 
 To one who is conversant with sanitary laws it may appear that the 
 authority to control persons and property which is conferred upon sani- 
 tary officers is very great, and is sufficient to meet any emergency. 
 Nevertheless, the harm done by a great epidemic is so great both to the 
 lives and business of a community, that it is often felt that very drastic- 
 measures may be permitted to prevent or check it. Impending pesti- 
 lence is to be feared as is an invading army, and as in war a community 
 is put under martial law, so in times of pestilence the sanitary author- 
 ities are sometimes given extraordinary powers in order the more suc- 
 cessfully to fight the disease. 
 
 Sometimes these extraordinary powers are conferred upon the state 
 board of health as in Indiana, 2 New Jersej^, 3 Nebraska, 4 Maryland, 5 
 Minnesota, 6 Missouri, 7 Ohio, 8 and Wisconsin. 9 In Maryland the state 
 board of health " shall cause all needful sanitary measures and pre- 
 cautions to be taken which the emergency calls for and which may be 
 
 1 Minnesota, Statutes (1894), Sec. 7072. 
 
 2 Indiana, Act of 4 March, 1893. 
 
 3 New Jersey, General Statutes (1895), p. 1636, Sec. 8. 
 
 4 Nebraska, Chapter 51 of 1899. 
 
 5 Maryland, Public General Laws (1888), Art. 43, Sec. 8. 
 
 6 Minnesota, Statutes (1894), Sec. 7045. 
 Missouri, Revised Statutes (1899), Sec. 7522. 
 
 * Ohio, Annotated Statutes (1900), Sec. 2143. 
 9 Wisconsin, Chapter 24 of 1899. 
 
COMMUNIL ABLE DISE, 1 SES. 499 
 
 consistent with law "; and there is an epidemic fund of *10,000 to be 
 drawn upon with the approval of the governor. In AViseonsin and In- 
 diana the amount available is $50,000. In New Jersey the state board 
 of health may spend money in excess of the appropriation with the ap- 
 proval of the governor, the treasurer and the comptroller. 
 
 The greatest [towers are however given to local health authorities 
 rather than to state officials, for the real work of sanitary administra- 
 tion is chiefly in the hands of the former, and they are conferred by 
 special acts rather than general laws. Examples of such powers are 
 found in New York City, 1 Buffalo, 2 St. Louis, 3 Pennsylvania cities of 
 the second class, 4 and New Orleans. 
 
 While the control of communicable disease is usually left to the 
 local authorities, the advice and help of state and federal officials is 
 often sought. Most state boards of health were established largely for 
 the purpose of giving such advice. In the largest cities the health 
 department is usually so well organized that such assistance is not often 
 necessary, but in smaller places even in moderate outbreaks appeal is 
 made to the state board of health for advice, and it is often asked that 
 a state official be sent to thoroughly investigate the conditions and per- 
 haps take charge of the outbreak. In Massachusetts the calls upon the 
 state board are so numerous that a special bureau in charge of an ex- 
 perienced physician has been established to look after this work. As 
 has been elsewhere shown, state boards are sometimes authorized to 
 take the initiative if the local board proves inefficient This is the case 
 in Massachusetts, but in that state it is very rarely found necessary. 
 
 The federal governmenl also through the marine hospital service 
 sometimes ;idvises or takes charge of local epidemics, as in Brunswick, 
 (.a., iii 1893, Birmingham, Ala., in L898, and Hampton. Va., in L899. 
 
 1 \ru Xork, Chapter 378 of L897, Sec. 1178: 
 
 1 ' In the presence of great and imminent peril to the public health bj reason of 
 impending pestilence, it shall be the duty of the hoard of health, having firsl taken 
 and filed among its records what ii shall regard a> sufficient proof to authorize its 
 declaration of such peril, and having duly entered the same in its records, t" tal<<< 
 snrli measures, and to d" and order and cause t" he done, such acts and make such 
 expenditures (beyond those duly estimated tor or provided) for the preservation of 
 the public health (though not herein elsewhere or otherwise authorized) as ii maj 
 
 in g ! faith declare the pnblic safety and health demand, and the mayor shall in 
 
 writing approve. Bui the exercise of this extraordinary power shall also, so far as 
 it involves such excessive expenditures, require the written consent of at least three 
 members of the board of health, and the approval aforesaid of the mayor. Vml 
 Buch peril shall oot be deemed to exist except when, and for such period of time, as 
 the hoard ,,t health ami mayor shall declan 
 \, w fork, Chapter 105 of L801, Sec. -'::»'•. 
 
 Miss,, mi. I,V\ ise.l .statutes i 1899), Sec. •"')•">". 
 
 1 Pennsylvania, Chapter 258 •■) 1895, Sec. 28. 
 
500 C OMM I XI< \ I II L E hisK. [ s ES. 
 
 This service is authorized by an act of Congress approved 15 February, 
 1893^ which directs the supervising' surgeon general to aid and co- 
 operate with local boards in preventing the spread of communicable 
 diseases from one state to another. Of course the federal officers can- 
 not take entire charge of an outbreak in all its details without a request 
 from the local authorities. Such request is sometimes made and it is a 
 little curious that it has hitherto been from communities in the southern 
 states, where sentiment is supposed to be the strongest against federal 
 interference. 
 
 Smallpox. 
 
 It does not require many cases of smallpox to make an epidemic. 
 The number of cases of scarlet fever or diphtheria which will be suffered 
 in a community without producing the notion of an epidemic is very 
 considerable, but if one-tenth as many cases of smallpox should appear, 
 the place would be thrown into a panic at once. It is true that small- 
 pox is usually a more serious disease than diphtheria, but there is no 
 such difference as popular notion would indicate. Even a single case 
 of smallpox in many small communities creates that state of mind 
 which is characteristic of an epidemic, and renders it necessary to do 
 most of the things which are required in an outbreak of real magnitude. 
 
 In Public Health Reports, 20 October, 1890, page 1765, may be found 
 a very good account of methods which it is desirable to follow in out- 
 breaks of smallpox. It is an account of what is attempted by the 
 officers of the marine hospital service when they are called to take 
 charge of an epidemic. 
 
 Discovery of Oases. As has been shown, physicians' reports are the 
 chief source of official knowledge of communicable disease. Reliance 
 upon such, however, is w T ell known to be very unsafe. A study of out- 
 breaks of smallpox and yellow fever will show that they almost always 
 proceed from unrecognized or unreported cases. In many mild cases 
 no physician is called and in such cases often no one is at fault. In 
 other mild and doubtful cases when a physician is called, the report to 
 the authorities is not made because the physician fails to make a cor- 
 rect diagnosis, or in rarer cases because he deliberately conceals the 
 case. Sometimes even severe cases are concealed by the friends of the 
 patient. Failure to diagnose seems to be almost as criminal on the 
 part of the attending physician as deliberate concealment. It can 
 rarely be that a suspicion of the true condition does not cross the phy- 
 sician's mind, and if it does it is his duty to immediately notify the 
 health authorities of it, and let them assume the responsibility of the 
 decision. When the courts will hold the physician to this responsi- 
 bility there will be fewer outbreaks. 
 
COMMUNICABLE DISEASES. :,Ul 
 
 In mild outbreaks great trouble is experienced from the unwilling- 
 ness of the public and often of the physicians to acknowledge the dis- 
 ease; the smallpox of 1899 as also the yellow fever of L898 afford 
 many examples of this. In Muncie, Ind., 1 in 1893 photographs of the 
 serious hospital cases were exposed in public to prove the diagnosis. 
 but they were of little avail. In Warwick County, Ya.- (in which is 
 situated Newport News), in 1899 one of the county supervisors declared 
 that the disease was not smallpox and that vaccination made it worse, 
 and the board of supervisors declared that they would take no action at 
 all. One of these supervisors had smallpox and tended his grocery 
 store during the whole course of the disease. In Alexandria in the 
 same year the city council refused to vaccinate the people, and the 
 mayor advised the sick to eject disinfectors from the house. 
 
 In Boston, Columbus, < ).. and doubtless in other cities it is required 
 that all cases of chicken pox he reported during smallpox outbreaks in 
 older that the health officers may make the 'diagnosis. Even when this 
 is not the law it is the custom during the prevalence of smallpox to 
 call the attention of the hoard of health to all cases not typically chicken 
 pox. In one year in Chicago 350 cases of suspected smallpox, which 
 proved not t<> he that disease, were reported to the board of health. In 
 Brooklyn in 1894 of 913 suspected cases reported 460 were not small- 
 pox. During an epidemic man} suspected cases are reported by the 
 laity and sometimes on good grounds. Three out of five cases of small- 
 pox which came to the writer's notice last spring were reported hv Lay- 
 men. Medical inspection of schools will in most American cities do 
 little to discover smallpox, as the school population is so well protected 
 by vaccination that a relatively small proportion of cases are found in 
 it. Iloiisi- to house inspection is the only method during an outbreak 
 by which concealed or unrecognized cases can he discovered. Such 
 inspection should be repeated after a shorl interval. A partial inspec- 
 tion is sometimes carried on in conjunction with vaccination, particu- 
 larly in t he immediate neighborhood of the infection. Thorough house to 
 
 house inspection is rarely adopted excepl when an outbreak has reached 
 
 alarming proportions, and often noi even then. Such an inspection was 
 carried out in Birmingham, 8 Ala., in L898, h\ the marine hospital 
 service, the inspectors visiting everj room in ever} house, and as a 
 
 result forty-five Cases of smallpox were discovered. 
 
 Isolation. In smallpox it is the universal custom to remove all 
 patients to the hospital or else | nit guards aboul the houses. The former 
 
 1 Indiana, Report ol State Board of Health (1893), \>. 108, ei »eq. 
 * Public Health Reports, Marine Hospital Service (1899), p. 624. 
 'Public Health Reports, Mann.' Hospital Service (1898), p. 247, et seq. 
 
502 COMMUNICABLE DISEASES. 
 
 method is almost always to be preferred. In Brooklyn, Chicago, New 
 Orleans, and Providence it has not alwa} r s been insisted on if 01113- one 
 family occupied the house. In Providence in such cases the health 
 department furnishes the nurse who does not leave the house and acts 
 as guard. In Muncie domiciliary isolation was at first attempted, but 
 the disease continued to spread until all cases were removed to the hos- 
 pital, when it at once ceased, but perhaps the extension of vaccination 
 had something to do with this result. Sometimes it is impossible on 
 account of insufficient hospital facilities, and more rarely it is impos- 
 sible on account of the forcible resistance of the friends of 'the patient. 
 In Chicago in 1894 in one district, 122 cases were treated at home 
 because of lack of hospital accommodations. The objection to removal 
 to the hospital is in some cases not without reason, for the "pest 
 houses " provided axe sometimes a disgrace and not fit for the care of 
 the sick. The removal of patients is sometimes accompanied with dan- 
 ger to the officials. In Muncie, Intl., in 1893 the ambulance attendants 
 were twice tired upon and one was shot in the arm. In Milwaukee in 
 1894 such violent demonstrations were made that the removal had to 
 be given up. The following is from the report of the Wisconsin Board 
 of Health 1893-4, p. 56: 
 
 "On Saturday evening, August 25th, between four and five o'clock, one of the 
 officers of the health department was sent to remove a patient, a child, from "jiil 
 Fifteenth Avenue, in the rear. The party of this place, undoubtedly led to do as 
 he did by the influence above mentioned, had notified the quarantine officers that 
 any person coming there to remove the child would be shot, and he procured a 
 revolver and lay in wait for the health officer. A mob congregated, and when the 
 ambulance drove up with a squad of twelve policemen violent demonstrations began, 
 stones were thrown, the horses struck with the missiles, and a general melee com- 
 menced. The official in charge of the police stated to the health officer that he had 
 not sufficient force to disperse the mob and he would not undertake to do so. The 
 mob was armed with clubs and missiles, the horses were being constantly struck, 
 the health officials resisted, and it was therefore impossible in the absence of a suffi- 
 cient number of police to remove the patient. Xot only is the health department 
 prevented from removing the patient, but in the houses which have been quaran- 
 tined, and from which patients have been removed, we are experiencing great 
 trouble. Last night a mob, numbering in the neighborhood of two hundred people, 
 congregated in front of 972 Orchard St. , and avowed their determination to take 
 away from the house the people who were there quarantined, and the guards on 
 duty at that house, who are quiet, reserved, and respectable men, state this morning 
 that they do not consider their lives safe unless some action is taken to protect them 
 in the duties which they are called upon to perform. This same condition of affairs 
 is a feature at several other houses on the south side. 11 
 
 When it is not possible to remove patients to the hospital, a guard 
 should be placed at the house and kept there day and night. Usually 
 two guards are necessary, one at the front and one at the rear. It is 
 difficult to get reliable guards if many are required, and this is one of 
 
( OMMUNIt A BL E l>lsE. 1 8E8. 503 
 
 the causes of the failure of this method of management. Some guards 
 are liable to be negligent or bribable. The guarding should be begun 
 promptly or it is of little use. In Chicago and Brooklyn in 1894, 
 whenever a report of smallpox reached the health department, an officer 
 was detailed with the medical inspector. In Muncie a guard-house was 
 established in the centre of the infected district, telephone connection 
 made, a captain of guards appointed, and all the guards were boarded 
 and lodged at the guarddiouse, as was also the attending physician. 
 While it is usually considered necessary to isolate suspects in smallpox 
 in some places this is not done. The laws of a number of stales, as 
 those of Alabama, Indiana. Mississippi, Missouri, and Smith Dakota, 
 require the isolation of all persons exposed to smallpox, and the time 
 specified is fourteen days. This practice is also followed in a number 
 of cities outside of these states. The suspects may be either removed 
 to a detention hospital or (after the removal of the sick) be guarded at 
 home. In Alabama it is not permitted to remove a suspect to the hos- 
 pital if he is willing to pay for guards around his house. In Detroit, 
 .Milwaukee, and Rochester, unless the number of suspects is too great, 
 they are generally removed to a hospital. In the District of Columbia 
 a block of tenements near*the smallpox hospital has been hired for this 
 purpose. Among other cities whose recent reports show the isolation 
 of suspects at home are Cleveland. Lowell, Minneapolis, New Bedford, 
 Omaha. Pittsburgh, and St. Paul. Other cities, as Boston, Brooklyn, 
 Chicago, Cincinnati, Newark, and Providence, simply keep the suspeets 
 under observation without placing guards, but of course the} are first 
 vaccinated. In Chicago they are revacqinated every four days until it 
 takes or until the time for probation has passed, and the house is pla- 
 carded, except in the " better class " of families. The duration of the 
 observation of suspects is fourteen days in Alabama. Indiana. Missis- 
 sippi. Miss rnri, South Dakota. Boston, Chicago, Minneapolis. Rochester, 
 and St. Paul; seventeen days in Pittsburgh and Providence; twenty- 
 one days iii Brooklyn and Cleveland. Of course, when absolute isola- 
 tion is maintained, it is necessarj to furnish food, fuel and other neces- 
 saries to those confined. In Newark 1 in 189J a room was hired for a 
 general store ami goods were bought ;it wholesale. A horse and wagon 
 and two men were employed in making daily deliveries. Medical 
 attendance must also be supplied, and in an epidemic special physicians 
 are usually employed whodonol visit other persons, but in Newark the 
 regular physicians to the poor assisted in this. In Muncie the physi- 
 cian won- rubber coat, cap, and boots, and disinfected himself w ith cor- 
 
 Newark, Report of Department ol Public Health (1894), p. 20. 
 
5()4 COMMUNICABLE DISEASES, 
 
 rosive sublimate solution after each visit. In Providence a linen duster 
 or perhaps a suit of overalls and rubbers are worn. 
 
 The problem of furnishing hospital accommodations is often a diffi- 
 cult one. Every town of 25,000 inhabitants should have a good per- 
 manent hospital, but there are many larger than this without any. Even 
 a hospital of reasonable capacity may suddenly become overcrowded so 
 that more room has to be secured on short notice. In some states, as 
 Massachusetts 1 and Michigan, local health authorities may seize build- 
 ings to be used as hospitals, and it would be well if this right was gen- 
 erally granted. In the summer time tents can usually be procured and 
 rapidly set up, but in the winter something more substantial is required. 
 " Portable hospitals " are advertised which can be put up in a hurry but 
 are rarely used. One ward of this kind was set up at the Municipal 
 Hospital in Philadelphia, but cost more, took longer to set up and was 
 not so satisfactory as a similar ward constructed in the usual way. In 
 some cities portable polling booths are used, and these in an emergeney 
 have been utilized as hospitals. Efficient men can however, construct a 
 serviceable ward in a remarkably short time if only a site can be se- 
 cured, and often the city owns land which can be used for the purpose 
 temporarily. For examples of smallpox hospitals see Chapter XII. 
 
 There is sometimes considerable difficulty in guarding these hospi- 
 tals. In Birmingham the plan was adopted " of surrounding the camp 
 with a high barbed-wire fence : thirty feet within this fence a single wire 
 was drawn to mark the dead line, beyond which no patient was allowed 
 to pass, and in this space between dead line and fence the guards were 
 stationed. At night the entire picket line was lighted by large gasoline 
 torches, thereby enabling a small number of guards to effectually pre- 
 vent the escape of convalescents." 
 
 In order to prevent the mingling of infected persons with the well, 
 schools are sometimes closed, and in Muncie, in 1898, the authorities 
 went so far as to issue the proclamation given below 2 and the public 
 library gave out no books. 
 
 Vaccination. Vaccination is without doubt a most valuable means 
 of preventing or stopping an outbreak of smallpox. If every person in 
 
 i Massachusetts, Public States (1882), Chapter 80, Sec. 4;',. 
 
 - Indiana, Report of State Board of Health (1893), page 109: 
 
 • Xo public meeting of any sort should be held. No exercises should be held in 
 any church, lodge, opera house, ball ground or any place of like character Billiard 
 and pool rooms should not be opened to the public. 
 
 " The people generally should remain at their homes as much as possible. Con- 
 gregations of persons on the street should be avoided. The police have been 
 directed by the police commissioners to see that no crowds collect on the streets. 
 Loitering or loafing will subject parties to arrest. 1 ' 
 
< • OMMZ Wl ( A II L E DIjS K, IJSJKJS. 50 5 
 
 a city should be properly vaccinated, there is little doubt that the out- 
 break would promptly come to a close : but in the present state of public 
 opinion, assiduously cultivated as it has been by anti-vaceinationists, a 
 satisfactory general vaccination is impossible except when the public is 
 thoroughly alarmed, and even then it is accomplished with difficulty. 
 Ordinarily all that can be done is to vaccinate the inmates of the in- 
 fected house and perhaps those in the neighborhood, and those in whose 
 company the infected person worked. All this should be promptly 
 done after every case of smallpox. If the outbreak is severe enough to 
 warrant general vaccination, effort should be made to have this done as 
 rapidly as possible. Sometimes advantage can be taken of the fear pro- 
 duced b\ epidemics in other communities. Thus in 1885 when the 
 New England states were greatly alarmed over smallpox in Montreal a 
 general vaccination was undertaken in Providence. Ten physicians 
 were employed who visited each house and offered free vaccination. 
 Vaccinations were also done in all the large manufactories and retail 
 stores and among railway employees. The school children were all vac- 
 cinated previously, as in Providence the law in regard to this is strictly 
 enforced. The papers generally urged vaccination and circulars were 
 distributed through the schools or posted on the city's billboards. By 
 these efforts only about 16,000 persons were vaccinated out of a popu- 
 lation of 118,070, which was not a very satisfactory showing. When 
 smallpox actually exists as an epidemic, many more persons can 
 be vaccinated even if no compulsion is used. It is best to employ as 
 Large a number of vaccinators as possible so as to render the population 
 immune at the earliest moment. It is not always possible to obtain 
 enough medical men, and in Birmingham, in 1898, the marine hospital 
 service employed as vaccinators second course medical students al four 
 dollars per day. Thirtj vaccinators were employed for a population oi 
 about 50,000. In Chicago, in 1894, with a population of a million and 
 a half. 500 vaccinators were employed. In Birmingham the vaccinators 
 made a house to house canvass visiting every room. Each inspector 
 caiiied a note book in which was recorded the name and address ol 
 ever) person, and the date of the Lasl vaccination of such person, mid 
 whether or not such vaccination was successful. He was 
 
 14 to vaccinate all persons who had nol been successful^ vaccinated within the 
 hist year, as evidenced b] an examination "I the scar in each case. . . . N< 
 certificate of vaccination was to be honored, and although this, al Brsi glance, 
 ina\ appeal an unreasonable and arbitrary ruling, still, when the facts are re 
 called that in all large towns there are usually some physicians who will ui\r false 
 certificates for a small fee; thai there are many persons who will forge certificates 
 that certificates issued in g I faith i>\ reliable physicians maj be given i>.\ their re- 
 cipients i" parties who bave aever been vaccinated, and, anally, thai a certiBcate oi 
 
506 C OMMUNKJABLE DISBA SMS. 
 
 vaccination is no evidence that such vaccination was successful, the necessity of 
 the above measures will be easily apparent. 
 
 " The inspectors were especially directed to be at all times courteous in their treat- 
 ment of persons of all classes, to explain to those who objected, the necessity of the 
 measure and report to me daily for prosecution by civil authorities, the names and 
 addresses of those who refused to be vaccinated or to permit an examination of their 
 vaccination marks.'" 1 
 
 Smallpox had prevailed in Birmingham for a year and was very preva- 
 lent when the marine hospital service took hold in January 1898. 
 Many persons had been vaccinated during the preceding months and 
 by the time the house to house canvas was complete nearly every per- 
 son in the city had been vaccinated. This, together with the removal 
 of all patients to the hospital, resulted in the immediate cessation of the 
 outbreak. In any considerable outbreak it is usually the custom not to 
 allow the physicians who visit the sick to vaccinate except in the in- 
 fected houses. In Baltimore, in 1899, thirty extra vaccinators, at a 
 cost of -11,500, vaccinated 60,000 persons. In Nashville, in January 
 1900, thirty inspectors vaccinated 40,000 persons. In Lowell, in 1894, 
 26,685 vaccinations cost $3,686. 
 
 Disinfection. 
 
 Disinfection of both persons and things after cases of smallpox 
 is usually thoroughly carried out. Those persons exposed near the 
 patient are told to bathe, and are usually compelled to change their 
 clothes and leave those they have worn to be disinfected. In Chicago 
 the clothing they wear is sponged with corrosive sublimate before they 
 leave the house. As smallpox usually occurs among the poor there is 
 much material such as mattresses, comforters, carpets, and clothing 
 which is not worth disinfecting and which is burned. Where there is 
 no steam disinfecting plant, it is necessary to burn all of this material. 
 In some cities, as shown by the reports of Augusta, Ga., Indianapolis, 
 Louisville, Detroit, and Providence, such goods if destroyed are paid for 
 by the city. If there is a steam plant, goods of tins character if of any 
 value may be steamed, In New Orleans where there was no steam in 
 1895, wash goods were boiled and left overnight in a solution of 
 bichloride, 1 to 1,000. This can be done in all cities, but if steam is 
 available, it is best to use that. There is considerable clinical evidence 
 to show that sulphur dioxide is a good disinfectant in this disease, and 
 though it has been very generally discarded for formaldehyde it is still 
 used quite often in smallpox, as recently in Atlanta, Birmingham, Cin- 
 cinnati, New Orleans, and Rochester. If sulphur is employed, large 
 
 1 Asst. Surg. G. M. Magruder, Public Health Reports (1898), p. 247. 
 
' ' OMMZTNIl '. I BL E I) I SEA SEs. 5 Q 7 
 
 amounts are used and pains are taken to have the air of the room moist. 
 Formaldehyde also is used. In cheap houses poorly built from which 
 the gas quickly escapes, instead of gaseous disinfection, bichloride in 
 solution maybe applied with a pump such as is used for spraying trees. 
 This was done in Birmingham, New Haven. New Orleans, Muncie, and 
 Providence. For the better class of houses, employees are sent by the 
 health department in Providence, Muncie, and Rochester to wash all 
 floors, woodwork, furniture, etc., and to wipe the walls and ceilings. 
 Particular attention should be given to the privy or water-closets, and, 
 perhaps, as was done in Muncie, to the pump handle and the gate. In 
 Augusta, ( ia., houses are all kept closed for a month after disinfec- 
 tion. 
 
 The cost of outbreaks of smallpox is very great. Even in those 
 where the eases are few in number and the general business interest- of 
 the community are not affected, the amount spent is usually many 
 times greater than would be for scarlet fever or diphtheria. Thus in 
 Atlanta in 1 * ( .»4 the cost of sixty-nine eases was 810,108.7(3, or *147.37 
 per case: in Lowell in 1894 for six eases $4,164.17, or $694.03 per 
 ease, and in 1899 for one case *4 ( .M».4»i : in Newark in 1894 for 131 
 eases $24,572.69, or $187.58 per ease: in Muncie in 1893 for 150 eases 
 $23,217, or $154.78 per ease: in New Bedford in 18i>:'> for three eases 
 $1,178.29, or $392.76 per ease: in Toledo in 1897 for eighteen cases 
 $3,456, or $192 per ease; in Brooklyn in 1894, exclusive of hospital 
 treatment, for 153 cases $27,041.14, or $59.69 per ease: in Montclair, 
 X. .1.. in 1898 for one case $263.50; in Providence in 1899 for live 
 -7:i4.14 or $146.83 per case ; in Augusta, Ga., in 1899 for P."; 
 eases $4,000, or $20.41 per ease: in Portland, Ore., in 1899 for ten 
 eases $815.89 or $81.59 per ease: in the District of Columbia in 
 1898 99 for ninety-eighl eases $25,785.70, or $262.08 per case ; in 
 Columbus, O., « in I*'. 1 '- 1 for seventy-five cases $42,750.85, or $570.01 
 pei' ease. The iost of maintaining the elaborate smallpox hospital in 
 
 Chicago in 1899 was $16,560, and only twenty-One patients were eared 
 
 for. Bui a general communicable disease ambulance service is also 
 maintained at the stable which consumes a considerable part <>l the 
 
 expense. 
 
 ) . How Fever. 
 This is the most difficull disease that public health officials have to 
 
 deal with. Very little is known with defmiteness about the manner in 
 which it is spread, the nature or Location of the poison or the duration 
 
 of infection in the individual. The diagnosis also is difficult. Public 
 
 alarm is so meat on the advent of the disease, and business so greath 
 
508 COMMUNICABLE DISEASES. 
 
 injured, that there is more temptation to conceal this than any other 
 disease. The one great ally of the health officer is frost, which over 
 almost the whole of the United States aids him in suppressing this as it 
 does no other disease. Popular fear of this disease is so great that a 
 single case occurring in any community in the United States may fairly 
 be said to constitute an epidemic. 
 
 The writer lias had ahsolutely no experience in the management of 
 outbreaks of yellow fever and hesitates to describe the methods that 
 have been adopted to meet it. What is here noted is taken largely 
 from the reports of the marine hospital service setting forth what has 
 of late years been done and what is advised by that service. Officers 
 of this service were detailed to assist or direct the outbreaks at Bruns- 
 wick, Ga., in 1893, Biloxi, Miss., New Orleans, Memphis, and many 
 smaller places in 1897 and 1898, and at Hampton, Va., in 1899. 
 
 The management of yellow fever in an infected community of 
 course consists in the application of the principles of isolation and dis- 
 infection. Often cases can be discovered only by house to house in- 
 spection which may have to be repeated as in Hampton, Va., in 1899; 
 Brunswick, Ga., in 1893; and Memphis, in 1897. Colored physicians 
 are said to be extremely useful for this work among the colored popu- 
 lation. Removal to a hospital is desirable as in all other communicable 
 diseases, but can be less often practiced in yellow fever than in small- 
 pox for the disease pursues a rapid course, and except in early stages 
 removal is more dangerous for the patient than in the exanthemata. In 
 Brunswick, in 1893 there was no hospital, and in New Orleans in 1897, 
 of 386 cases, but 202 were treated in the hospital. 
 
 If the patient remains at home all persons except those needed to 
 care for him are removed to the detention hospital, the house is 
 placarded and guards usually placed around it. Guards are not 
 allowed to go freely about the town but must sleep in a guard-house. 
 They are if possible to be immune. The following was the method 
 employed in New Orleans, in 1897 : J 
 
 "A guard was stationed to watch the premises by day and by night, and no one 
 was allowed to enter or leave without a permit, and no such permit was given unless 
 the applicant for same had had yellow fever; lie must have taken a bichloride bath, 
 1-2000, and had been furnished from the outside with an uninfected suit of clothing. 
 If the suit could not be obtained from without, the clothing of anyone about to leave 
 the infected premises had to be exposed to formaldehyde fumes for six hours, 
 using about one gallon of the standard formaldehyde solution to each 25,000 
 cubic feet of air space. When practicable, disinfection of clothing by immersion in 
 a solution of bichloride of mercury 1 to 1,000, followed by careful drying was pre- 
 ferred. 
 
 1 Louisiana, Report of State Hoard of Health, 1896-7, p. TO. 
 
< OMMUNK '. I ll LE I>lsE. 1 ,s /-;.*. ;,i ig 
 
 "No one was allowed to enter the infected premises except physicians and nurses, 
 and minister or priest, and even they were nut allowed to come and go at will, unless 
 they conformed with the Board of Health regulations." 
 
 The care of the sick is usually taken in hand by the sanitary offi- 
 cials. In Brunswick i24~> nurses were employed and thirteen physicians. 
 There were 1070 cases of the disease. .Most of the nurses were paid 
 (1.50 per day. Near of kin were not employed, hut usually a patient 
 was nursed by a friend. 
 
 In any extended outbreak of yellow fever there is sure to be much 
 distress, and relief must he furnished to those in need of food and 
 clothing. This relief is usually in the hands of the health department, 
 or at least is given only under its direction. 
 
 After the recovery or death of the patient the premises must he dis- 
 infected. For bedding, carpets, ami textiles generally, burning is very 
 generally practiced unless the articles are of considerable value. These 
 articles should he replaced by the sanitary authorities. Indeed, the 
 practice of reimbursing for all loss or injury during disinfection was 
 quite generally followed during the last yellow fever outbreaks. Tex- 
 tiles that are not burned should of course, he steamed. The house is 
 generally treated with formaldehyde or sulphur dioxide, or both, hut a 
 more satisfactory method is to drench it with bichloride solution. Pro- 
 longed airing is also efficient, ('heap houses are often destroyed. The 
 surrounding ground requires special treatment in yellow fever: 1 
 
 "The premises outside the houses must he made clear of trash — chips, 
 leaves, pieces of hoard, etc., rotting wood being believed to in- an especially had 
 nidus of infection. The mere wetting of these things as t hey lay with bichloride 
 solution is not thorough disinfection, the underside seldom being reached bj the 
 solution. 
 
 •• It is an injury to wet leaves of living plants with bichloride of mercury. It 
 
 kills the leaves, etc.. and after a rain has washed the bichloride off these dead 
 
 leaves are a good nidus (culture medium) for any infect ion not destroyed, as on the 
 underside of the hat. it is ict reasonable t<> believe that the living leaf would 
 serve such an end. 
 
 •• I-'., 'the thorough wetting of the cleaned ground, ditches, etc.. with bichloride 
 solution or covering it with chloride of I inn' is doubtless efficient, hut unquestion- 
 ably t If disinfection of the outside premises by lire is the method "t election. 
 
 •This is best done by the Barber asphalt furnace as used bj Farrar in New 
 oilcans in 1897, which is fairly manageable. 11 
 
 This Latter method of disinfection has hern used in Now Orleans 
 and will he described in the pages devoted to the consideration of dis- 
 infection. Of course vaults and dr. mis musl be disinfected also. In 
 Now Orleans in 1897 not only were the infected premises, hut also the 
 whole block disinfected in the manner described above, 1 1,120 premises 
 
 1 Reporl ol Supervising Surgeon (ieneral, Marine Hospital Service (1898), p. •'■•"'T. 
 
510 C OMML Wit A BL E U I SEA sES. 
 
 being so treated. The character and extent of the disinfection ma}' be 
 inferred from the amount and kind of materials used. 1 
 
 In 1899 2 the board of health not only disinfected yellow fever prem- 
 ises, but also advised by means of a circular that all houses be treated 
 in the same way where there had been cases of fever concerning which 
 there had been any suspicion. It was advised that the houses be freely 
 opened during cold weather. 
 
 Typhoid Fever. 
 
 The most important thing to do in outbreaks of typhoid fever is to 
 seek out the cause and if possible, remove it. The principal recognized 
 sources of typhoid fever are contaminated water, milk, and occasionally 
 other kinds of food. Too often when the source of the infection is dis- 
 covered all the harm possible has been done. Sometimes the infection is 
 found to still continue, and it should, if possible, be stopped or the 
 public warned against continuing the use of the contaminated water or 
 food. If milk or other food is found to be the source of the trouble it 
 can usually be protected against further infection. If wells or springs 
 are infected their use can be stopped. In the case of a contaminated 
 water supply the public can be warned to boil the water before drink- 
 ing it. But the health department will not do its whole duty unless it 
 makes every effort to have the public supply put in the best possible 
 condition. Public sentiment should be aroused to demand that water 
 should be filtered or the source changed or such other steps taken as 
 may be needed to render the water safe. 
 
 Whenever an exceptional amount of typhoid occurs the health officer 
 should be alert to discover its cause at the earliest possible moment. 
 The reports of many cities show that health officers have often success- 
 fully investigated outbreaks of this disease. Often the local health 
 
 1 Louisiana, State Board of Health Report (1896-7), p. 82: 
 Disinfectants Used During the Yellow Fever Epidemic of 1897 in New 
 
 Orleans. 
 
 Formaldehyde 6,7274 pounds 
 
 Chloride of Calcium 924 ' ' 
 
 Bi-chloride of Mercury 1,743 tl 
 
 Muriate of Ammonia 1,743 " 
 
 Muriatic Acid 4,270 
 
 Sulphur 550 " 
 
 Lime 4,391 barrels 
 
 Chloride of Lime 21,793 pounds 
 
 Carbolic Acid 16^ " 
 
 Wood Alcohol 106 gallons 
 
 Copperas 260 barrels 
 
 - New Orleans, Report of Board of Health (1899), p. 17. 
 
COMMUNICABLE DISEASES. 511 
 
 officer finds it advisable to call in the assistance of state officers because 
 they may have more experience in such matters or because it is neces- 
 sary to go outside the municipality t»> seek for the cause. The Massa- 
 chusetts state board through its agent Professor William T. Sedgwick, 
 has been very successful in investigating these outbreaks, and perhaps 
 the methods employed can be best indicated by narrating the incidents 
 of one of these investigations. The example taken is that of Spring- 
 field, where the outbreak was studied by Professor Sedgwick and the 
 local health officer, Dr. W. II. Chapin. The account is from the 
 twenty-fourth report of the Massachusetts state board of health (for 
 L892), page 715. 
 
 During August, 1892, a large increase in typhoid lever was noted 
 in Springfield, and it was also noted that the increase was confined to 
 mil' district, known as the Mc Knight district. The local health officer 
 promptly began to seek out the cause of the disease. Various theories 
 were advanced, the most tenable of which was that it was due to con- 
 taminated milk. The health officer investigated the milk supply, but, 
 misled by false information, found out nothing. At tliis juncture the 
 assistance of the state board of health was asked for. A detailed inves- 
 tigation of the history of each case was then begun and the results 
 recorded od the blank shown in Appendix 91. In such investiga- 
 tions Professor Sedgwick considers "the fixing of the precise time of 
 infection is of supreme importance for the investigator, and this may 
 often be obtained with considerable accuracy by the date of the physi- 
 cian's first visit or the time of the patient's taking to bed. The former 
 can usually be got from the attending physician : the latter, in a sur- 
 prising number of cases with tolerable accuracy, from the patient or his 
 friends. The location of the patient when attacked is also highly 
 
 important, as possibly indicating the place of infection, the place of 
 work, business or school, giving alternative information of the same 
 nature. The symptoms are asked for partly as a matter of routine. 
 parti} to gel the patient or liis friends to talk and so disarm suspicion. 
 
 and partly for use when it is denied thai the epidemic is real." 
 
 In the Springfield outbreak, after nineteen houses in the infected 
 district had been visited and forty-sis cases examined, it became clear 
 thai all theories hitherto advanced were untenable, excepl the milk 
 theory. The cause could nol be the city water Bupply, for the outbreak 
 was localized in one dist rict. and it could not be due to open sewer man- 
 holes in the streets for the same reason. Theretwas no more defective 
 plumbing in the houses than in others where there was no fever, 
 considerable number of the patients drank no well water, li was nol 
 dm- to infected fruit, vegetables, or ice, for those attacked did nol have 
 
512 COMMUNICABLE DISEASES. 
 
 a common supply of these materials. The only common bond was the 
 milk supply. All but one of the cases took milk from the same milk- 
 man. This rendered it probable that the milk was the source of the 
 trouble. A map was prepared on which were shown all the cases of 
 fever and also all the customers supplied by the suspected milkman. 
 Of the 150 cases reported 101 certainly had his milk, and 35 may have 
 had access to it. There were a few cases in other parts of the city and 
 it was found that some of these were temporarily supplied by this man. 
 The fever developed in about forty per cent, of the houses served by 
 him. The immunity of some was perhaps explained by the fact that 
 he did not obtain all his milk from what afterwards proved to be the 
 infected source. To assist in ferreting out the origin of the outbreak a 
 chart was made to show graphically on what days the cases were taken 
 sick. The facts brought out by the investigation and shown graphically 
 on map and chart conclusively fixed the cause of the outbreak in this 
 man's milk. It then remained to discover how the milk became in 
 fected. At first the dealer concealed the identity of one of the pro- 
 ducers from whom he bought milk, but after much labor this farm was 
 located and it was found that there had been "bilious typhoid fever" 
 there early in the spring and cases of slow fever later. There were two 
 possible ways discovered by which the milk might have become in- 
 fected. The contents of the privy were spread on a lot near the well, 
 and the men walked over this in going to the well, and their boots -were 
 rinsed off on the planking over the well into the water below. In this 
 water bacilli coli communis were found. The cans of milk were 
 cooled in this well and it was found that the water leaked into the cans. 
 Another chance for contamination was directly from the infected hands 
 of convalescents. Owing to the false statements of the dealer it was 
 only with great difficulty that it was determined that the milk from this 
 particular farm went to the infected district. It was necessary in order 
 to show this, to cross-question his assistants and to examine the books 
 of the farmers who supplied him and the books of the Co-operative 
 Milk Association. 
 
 Typhus Fever. 
 
 This has of late been a rare disease, the only notable outbreak for a 
 
 number of years being that in New York City in 1892. The first cases 
 
 were among Jewish immigrants chiefly in lodging houses. During 
 
 February 1<> and 11, sixty-seven cases were discovered in these houses 
 
 and removed to the isolation hospital on North Brother Island: 1 
 
 "All other immigrants who had been exposed to the contagion were removed 
 from the different houses already named, to No. 5 Essex street and Xo. 42 East 
 Twelfth street, where they were put under close sanitary surveillance. For this 
 
 1 New York, Report of Health Department (1892), p. 122. 
 
COMMUNICABLE DISEASES. 513 
 
 purpose a detail of policemen from the sanitary squad was made, and orders given 
 them to permit no person to enter or leave either building without a permit in writ, 
 ing from the chief inspector of the division of contagious diseases. At first this was 
 effected by stationing one officer at each house, and relieving him every eight hours. 
 It subsequently became necessary to double this force, stationing two officers at a 
 time, and it was deemed wise to relieve them from duty at four-hour intervals. The 
 officers were warned of the danger of contracting the disease, and were instructed 
 to keep outside of the houses except in case of necessity requiring their presence 
 within the buildings. Notwithstanding precautions taken to prevent it, cases- 
 occurred almost daily in both these houses. As the occurrence of these cases con- 
 tinued after the period of incubation, dating from the segregation of the suspects in 
 these two houses by the department order, it was deemed wise to vacate both 
 houses and to continue sanitary observation of their occupants on North Brother 
 Island. 
 
 " The first case occurring among the residents of New York, presumably from 
 the contagion brought here by the Hebrews, was that of Max Bnsch, carpenter, em- 
 ployed in the Thalia Theatre. He was taken sick February 19th at No. 53 Bowery. 
 a lodging house, and was removed to Bellevue Hospital. 
 
 •After this secondary cases occurred in a number of houses scattered in various 
 parts of the city. Three cases were received from ships in quarantine. The follow- 
 ing very remarkable fact reflects credit on the efficiency of the department: the total 
 number of residents who contracted typhus fever before June 1st was seventy, of 
 tli is number ten contracted it from contagion in No. 53 Bowery (lodging house) 
 three cases were found at No. 39 Hester Street (a tenement house), four cases were 
 found at No. '_'4<> Cherry Street (a tenement house). These were the only houses in 
 which more than one case occurred. The remaining fifty-three cases were in fifty- 
 three different houses. In other words, in only three of fifty-six houses did more 
 than one case occur.' 1 
 
 ■A description of the means taken to prevent the spread of typhus fever in this 
 outbreak is of interest. These means are twofold, and while they seem simple and 
 easy of application, their detail is exceedingly minute and must be carried out to a 
 degree of perfection. They are as follows: 
 
 1st. Isolation of persons sick with the disease and those who have been exposed 
 to its contagion. 
 
 2d. Thorough disinfection of all infected rooms and materials. 
 
 "The first means was accomplished, as has already been described, by the re- 
 moval of persons sick to the hospital for contagious diseases, and by t lie segrega! ion 
 of the so-called "suspects' 1 in two houses, and their subsequeni removal to North 
 Brother Island. The second means w;is effected, first, by thorough fumigation of 
 infected rooms ami materials in them with sulphur burned in accordance with the 
 rule, of the American Public Health Association. The sulphur is placed in iron 
 receptacles, which are suspended in water, so thai the heal from the burning sul- 
 phur causes a certain amounl of steam to be evaporated from the water, and this 
 adds moisture to the fumes given off '»> the ignited sulphur. In addition to this. 
 the sulphur is ignited by means of alcohol pound over it. The burning of the 
 
 alcohol adils also to the isture given off by the steam. The amount of sulphur 
 
 used is three pounds to every 1,000 cubic feel of air space to be fumigated. After 
 
 Fumigation, the infected t us were thoroughly aired, and the walls, ceilings, and 
 
 Boors subjected to disinfection with a solution of bichloride of mercury. The 
 Btrength of this solution was one pari of mercurj per live hundred of water. After 
 this i real meni the rooms were again fumigated in the manner already described, 
 
 after which they were again aired, and I lie walls, ceilings, and floors scrubbed wiih 
 
 soap and water. All portable materials, such as baggage, bedding, etc., were then 
 
514 COMMUNICABLE DISEASES. 
 
 moved by means of the department wagon to the disinfecting depot at the foot of 
 East Sixteenth street, where they were subjected to disinfection by means of dry 
 and moist heat, in a special chamber bnilt for the purpose, and described in the 
 annual report of the board of health for 1890. The two houses, No. 42 East Twelfth 
 street and No. 5 Essex street, in which the "suspects' 1 were segregated while in 
 the city proper, were not permitted to be occupied for human habitation until a 
 period of fourteen days had elapsed. During this period the windows were kept 
 open so as to permit thorough airing of the dwelling." 
 
 Two cases were on one day found in the alcoholic ward of Bellevue 
 Hospital. One of them had been there five days. During this time, 
 seventy-four persons had been exposed in the same ward and had been 
 discharged. Sixteen left the city, thirty-eight could not be found, and 
 only twenty were found by the inspectors, who endeavored to locate 
 them all. No case developed among them so far as known. On another 
 occasion a case was found in one of the general wards of the same 
 hospital. " No visitors were allowed in the ward for three weeks, and 
 a list of all the occupants with their addresses was furnished the depart- 
 ment, and notice given by the warden when any one was discharged 
 from the ward. An inspector was then sent to find him, if possible, 
 and keep him under observation." 
 
 Scarlet Fever and Diphtheria. 
 
 Usually about the same procedure is followed in extended as in 
 mild outbreaks of these two diseases. It is very seldom that the pub- 
 lic evinces alarm and demands or permits the adoption of unusual 
 methods. Isolation and disinfection are the remedies that are relied on. 
 It is true that in diphtheria antitoxin is a valuable prophylactic; but 
 unfortunately it is expensive, not easily administered, and its proph}-- 
 lactic effect is transitory, lasting perhaps a month. So far as the 
 writer knows it lias never yet been used for the general immunization 
 of a community, though it has been used in this manner in infected 
 families and institutions with markedly beneficial results. In scarlet 
 fever no means of immunization is known. Usually in severe outbreaks 
 of these diseases the health officer can and does secure a stricter enforce- 
 ment of existing laws than at other times. Sometimes popular alarm 
 results in the improvement of methods long known by the sanitary 
 department to be defective, but continued because of the apathy of the 
 public, the council, or the legislature. An epidemic of these commoner 
 diseases sometimes results in a better organization of the health depart- 
 ment, a larger appropriation, the purchase of an ambulance, or a disin- 
 fecting plant, or the construction of a hospital. Sometimes new and 
 more stringent regulations concerning isolation are adopted. More 
 often the health officer merely secures better enforcement of laws sim- 
 
COMMUNICABLE I>lsK. [ sKs. 515 
 
 ply because he lias the active approval of the public, the press, and the 
 physicians. 
 
 Local outbreaks of scarlet fever and diphtheria frequentlv result in 
 the closure of schools, sometimes by the health department and some- 
 times by the school department. If a number of cases of these diseases 
 occur simultaneously or in rapid succession in a given school, it is often 
 an indication that there is in the school an unrecognized source of infec- 
 tion. Sometimes this is by the circumstances rendered almost certain. 
 It is usual in such cases to close the school for a few weeks and to dis- 
 infect it as completely as possible. In Providence, schoolrooms are 
 disinfected by, first, the application of formaldehyde gas ; second, the 
 washing of all desks and other woodwork with a solution of corrosive 
 sublimate one to one thousand; third, all the books, pencils, papers, 
 and kindergarten materials are removed in baskets, and either burned or 
 Submitted to the action of steam. In that city it is rarely that schools 
 have been closed and disinfected. Usually if it is suspected that a 
 school is infected, a thorough inspection is made, and in diphtheria, cul- 
 tures taken, and all suspicious cases kept out of school. The writer 
 believes that with an efficient medical inspection of schools, closure 
 will rarely be necessary. 
 
 As in smallpox and yellow fever, so probably in scarlet fever and 
 diphtheria it is mild and unrecognized or unreported cases which are 
 the chief cause of their spread. Nothing new has of late years been 
 learned concerning the recognition of cases of scarlet lever infection, 
 but it is otherwise with diphtheria. The use of the microscope leads in 
 this disease to the discovery of many persons who are infected though 
 sometimes perfectly well and who may give the contagion to others. 
 In families, in schools, and in institutions, the use of the swab and 
 microscope should lie of great value in checking an outbreak. There 
 have been instances in Baltimore, Denver, Providence, and doubtless 
 Other cities where a routine examination of all the children in a given 
 school has resulted in the isolation of the source (if in feet ion. In 
 Asbnry Park 1 besides a regular medical inspection of the schools and 
 cultures from all suspected eases, there was practiced a weekly disinfec- 
 tion of the schoolrooms with a bichloride spray. Alter spraying the 
 desks and wookwork were wiped off and the floor swept. When diph- 
 theria appears in an orphan asylum, reform school, or similar institution, 
 
 it is extremel} difficult to get rid of it, and. in nian\ such, it has contin- 
 ued epidemic for a long lime, perhaps years. It is now customary in 
 Such cases io take cultures from all the inmates and isolate all who 
 
 have diphtheria bacilli in their throats. In Providence this method was 
 N.-w Jersey, Keporl of State Board <.f Flealtli (1896), page 157. 
 
516 COMMUNICABLE DISEASES. 
 
 followed in two institutions with the result that the disease disappeared, 
 but in one of them several successive negative cultures were taken from 
 both throat and nose. In two other instances in that city this method 
 was not successful. The most conspicuous instance of failure after 
 very great effort, was in a state institution at Owatonna, Minn. 1 Here 
 diphtheria has existed for several years, notwithstanding the practice of 
 ordinary methods of isolation. It was finally determined to pass all 
 members of the school through a " filter." A number of rooms were 
 selected, in each of which a single pupil was placed and retained there 
 until six successive negative cultures were obtained from both nose and 
 throat. All members of the school were passed through these isolation 
 rooms. Of course, thorough disinfection of clothing and rooms was also 
 practiced. Nothwithstanding these efforts, it was found that diphtheria 
 bacilli could be detected in a number of the members of the school and 
 cases of the disease have since occurred there. 
 
 Cholera. 
 
 Since the discovery of the spirillum of Asiatic cholera, this country 
 has twice been threatened by European outbreaks, once in 1885 and 
 again in 1892, but the disease reached our shores only once in 1892, and 
 then did not extend beyond a few cases in New York City. On both 
 occasions of the presence of the disease in Europe, great alarm was felt 
 in the United States and active precautions were taken to prevent its 
 introduction and spread. The quarantine regulations will be elsewhere 
 discussed. It has long been believed that a filthy condition of houses, 
 yards and streets, vacant lots, and streams and ponds of water, conduces 
 to the spread of this disease, and that if a community is kept clean 
 cholera will not prevail to any great extent. Acting on this belief our 
 cities in 1885 and 1892 made very great efforts to put themselves in 
 " better sanitary condition " by a general house cleaning. Nearly all 
 cities employed an additional force of inspectors and made house to 
 house inspections. Owners were ordered to abate nuisances, put 
 plumbing and drainage in order and cleanse their premises. In many 
 cities considerable amounts from the public funds were spent in clean- 
 ing streets, removing filth from vacant lots or draining stagnant ponds, 
 and distributing disinfectants. The following quotations from a report 
 of what was done in Brooklyn 2 will serve as illustrations of the nature 
 of the work done : 
 
 1 F. F. Wesbrook and L. B. Wilson, Transactions of American Public Health 
 Association, Vol. XXV., p. 546. 
 
 2 Preparation of Brooklyn for cholera, J. II. Raymond, M. D., Brooklyn Medical 
 Journal, 10 September, 1892. 
 
CO MMVWIC. 1 B I E D is h\ l s ES. 5 1 7 
 
 " For some time the efforts of the Department of Health had been directed to 
 Closing up the wells of the city, which at the outset of the undertaking numbered 
 three hundred and sixteen, varying in depth from fifteen to one hundred feet. An 
 analysis of the water of these wells showed that of the whole number, but seventeen 
 furnished water tit for consumption. These were, of course, liable at any time to 
 become contaminated. As a result of these efforts all the wells, but one, were 
 
 closed. 
 
 " Special police force was obtained to make repeated examinations of the exist- 
 ing vaults, the exact location of which by street and number was known. 
 
 •• The old fashioned method of emptying privies had been prohibited and the so- 
 called ■ odorless " was the only one permitted. The night-soil was removed to farms 
 and utilized as fertilizer, hut arrangements were made by which, had cholera come, 
 this woidd have been discontinued and the material wouldhave been carried to sen 
 in boats. This latter method of disposal was adopted in August. 1885. 
 
 •• During the season of 1884 and 1885, twenty-three stagnant ponds were drained 
 and tilled; in the whole city there were fifty-nine tilled at an expense of 8:55,108.85. 
 The material employed for this filling was in every case fresh earth or clean ashes, 
 no garbage or other decomposable matter being used in a single instance. 
 
 "During the two years the inspectors made 11,622 inspections of the plumbing in 
 old houses. • 
 
 " As sailors coming to the city were liable to find their way first to the lodging 
 houses, special attention was directed to these. Nine of them with •">:',:! beds existed in 
 the city. These were thoroughly examined from cellar to attic, and when dele 
 plumbing, ventilation, or overcrowding were found, these were corrected. The 
 disinfecting corps disinfected them thoroughly, and it was made a part of the in- 
 spect, ir's duties to visit them often. The proprietors were summoned to the Health 
 < ►ffice and instructed as to the necessity of cleanliness and of prompt notification to 
 the Health Officer of all cases of sickness. 
 
 " The frequency with which disease has been spread by rags made it important 
 to have these under surveillance. 
 
 ••A census showed that there wen- 279 places in which rags were stored. In 
 order to have the necessary control over them, the following ordinance was passed : 
 
 •Section 188. No person engaged in buying, selling or storing skins, hides, rags, 
 
 bones or similar articles, or who has become possessed by purchase or otherwise ol 
 skins, hides, rags, bones or similar articles, for the purpose of selling the same, shall 
 store or keep any of said above mentioned articles within the limits of the Citj of 
 Brooklyn without first obtaining a written permit so to do from the commissioner 
 ,,f health of said city, the terms and conditions of which permit shall be strictlj 
 complied with by the person obtaining the same.' Of the 279 places, lb; were per- 
 mitted to continue, theothers were ordered closed as being unlit places for the busi- 
 ness. 
 
 •• Vacant lots have always proved a standing invitation to householders and others, 
 who have filth to dispose of. To keep such spots in an inoffensive condition a force 
 of thirty-two men with eighteen .arts was kept employed from Maj 15 to December 
 1. 1885, in removing such tilth wherever deposited, in streets, vacant lots or yards. 
 Three t bousand nine hundred and sixty-two loads of su.h material were removed by 
 boat to sea. The cosl of this service was $9,128.89. 
 
 1 ' The total amount of money expended bj the health department in anticipa- 
 tion of cholera over ami above the regular salaries and expenses was |56,785.i 
 
 In N.w York : ' 
 ■• Early in September, it was decided, owing to the presence of cases of Asiatic 
 cholera in the city, to stop the work of trimming the scows of the street cleaning 
 
 \. w York. Report of Health Department (1892), p. B6. 
 
518 COMMUNICABLE DISEASES. 
 
 department. This work consists of gleaning whatever may be of value from the 
 ashes and garbage that are brought to the dumps, such as bones, rags, old iron, bot- 
 tles, etc. The privilege of doing this work is valuable on account of the property 
 obtained, and a source of large revenue to the city. During the prevalence of such 
 infectious disease as Asiatic cholera in the city, the refuse at the dumps would be 
 presumably infected. About the first of November the work was permitted to be 
 resumed, but with the proviso that all gleanings from the dumps should be disin- 
 fected. The latter provision was, with some difficulty, carried into effect. 1 ' 
 
 Circulars giving directions how to prepare for and ward off cholera 
 were issued and very generally distributed in cities. They were usually 
 written in popular language and an example is given in Appendix 92. 
 
 The seaboard states and cities of course redoubled their care in 
 quarantining immigrants as will be shown, but some of the interior 
 states distrusted the efficiency of the methods employed and took addi- 
 tional measures to prevent the introduction of the disease. This was 
 done by the states of Illinois, Michigan, .Minnesota, Wisconsin, and by 
 several of the cities in these states. 
 
 In several cities hospitals were built so as to be ready for the recep- 
 tion of cholera patients. In Boston two such were constructed and 
 also a steam disinfecting plant. 
 
 What was actually done when cholera appeared in New York City 
 is shown by the following extract r 1 
 
 " During the early part of September a stable was constructed on the river front, 
 south of East Sixteenth Street, to be used exclusively by the ambulance service con- 
 nected with cholera in this city. 
 
 Four ambulances, specially designed for this service, were purchased, they were 
 lined with rubber cloth, witli the following equipment: 
 
 " Two mattresses; two pillows — these were covered with rubber sheeting so they 
 could not be infected, and could be readily rendered aseptic; two heavy woolen 
 blankets; two canvas bags, (J feet in length by 24 inches wide, provided with a draw- 
 ing-string for the purpose of encasing the patient while being removed to the vehicle ; 
 two canvas bags, 3 feet in length and 15 inches wide, for the removal of soiled and 
 infected bed linen, clothing, etc.; two bed pans; two emesis basins; one 2-gallon 
 demijohn, containing a solution of bichloride of mercury (1-500) ; twenty pounds of 
 sulphur; one pound of bichloride of mercury; three india-rubber suits; three india- 
 rubber coats; three pairs india-rubber shoes; three pairs india-rubber gloves. 
 
 " Four drivers and four helpers are constantly on duty, two being detailed in 
 relays every twenty-four hours. 1 ' 
 
 "The summer corps of fifty physicians, as well as sixteen additional ones, were 
 transferred for service in the investigation and care of cholera cases. These with 
 the regular inspectorial corps of this division, operated in the following manner: 
 
 11 The six diagnosticians were on duty at all times. 
 
 " The special corps were detailed as follows: 
 
 " Three were stationed at central office to act as ambulance physicians; three 
 were stationed at central office to answer telephone calls; six were stationed at cen- 
 tral office to answer emergency calls, in order to establish the quarantine of the 
 
 iNew York, Report of Health Department (1892), p. 118. 
 
( 'OMMl Wit '. 1 BLE DISEASES. 5 1 9 
 
 houses witliout delay. The remainder were ordered to make house to house inspec- 
 tion, searching for diarrheal cases, and to investigate all cases where death from 
 diarrhoea] diseases had occurred, and also those who had visited the city dispensaries 
 for treatment of diseases of a like character. 
 
 " When a case suspicious of cholera was reported to this division, the diagnos- 
 tican was immediately sent, provided with a sterilized bottle placed in a wooden 
 casing, prepared by the bacteriologist of the department, and a bottle of antiseptic 
 solution to render the same aseptic, subsequent to the placing in it of a specimen of 
 the vomit or diarrheal discharge. If this specimen was procured, it was forwarded 
 immediately to the laboratory of the department. The ambulance was then ordered 
 to be in readiness to start at once. 
 
 " Upon a report being received from the diagnostician that the case was. in his 
 opinion, suffering from, or dead of, the disease, the following line of action was 
 taken : 
 
 lt If the patient was dead, a coffin was placed in the ambulance. 
 
 " The ambulance, with the driver and helper, was notified by telephone to pro- 
 peed immediately to the house, and the ambulance physician and the physician to 
 establish quarantine started from the central office at the same time. 
 
 " The captain in charge of the precinct where the case occurred was notified by 
 polite telegram to detail a police officer for duty under the control of the physician 
 in charge of the quarantine. 
 
 "Upon arriving at the house the driver, helper, and ambulance physician clothed 
 themselves in their rubber suits before entering the apartment. 
 
 "The patient was placed in the large canvas bag, with a drawing string around 
 his neck, and removed from his rooms directly to the ambulance, the phyician in 
 attendance carrying the emesis basin to receive any vomits. The patient was placed 
 in the ambulance ami removed to the Reception Hospital, accompanied by the phy- 
 sician and driver. If the patient had succumbed to the disease, the body was 
 wrapped in a sheet thoroughly saturated with a bichloride solution (l-oOO), placed 
 in the coffin and re \ed to the autopsy room at the Reception Hospital. 
 
 " The helper remained at the house with the quarantine physician, prepared a 
 large quant itj of the solution of bichloride of mercury, and proceeded to disinfect 
 the premises, under tic direction of the physician, in the following manner: 
 
 " All bedding, clothing, carpets, and all textile fabrics in the room where the 
 patient had been were saturated with a disinfecting solution; soiled bedding and 
 
 Infected clothing were placed in canvass hags, the carpets taken from the il \ and 
 
 then removed in a wagon provided for the transportation of infected goods to the 
 disinfecting station at t lie foot of East Sixteenth street and cremated. 
 
 "The walls, floors, and wooden furniture in apartment, the floors, surbase of 
 
 halls, i he floors, SUrbase, balusters, handrails of stairways, the door knolis, faucets 
 
 of water-pipes, the seats and floors of water-closets, were all thoroughly scrubbed 
 wiih hand brushes saturated with a disinfecting solution. The water-closet bowls 
 
 and pipes were thoroughly Hushed with a solution of carbolic acid or milk of 
 lime. 
 
 " The room or rooms which bad been occupied by the patient were fumigated 
 (after the cracks ol doorways and windows were made air-tight, having paper pasted 
 over them) with burning sulphur (3 pounds to the 1,000 cubic feet). After this 
 action had been taken the apartment was placed under strict quarantine, a police 
 
 officer stationed in t he ha 1 1 on t hat H ■, who allowed no one to enter or leave the 
 
 apartment Whenever it was necessary for anj of the quarantined family to visit 
 t he water-closet they were accompanied by the physician in charge "f t lie quarantine 
 and reconducted as quickly as possible t" their rooms. The quarantine physician 
 
 then made a Complete census of the OCCUpantS Of the house nanus, ages, ..ecu 
 pation, and where employed and sent postal cards t" principals, notifying them to 
 exclude from their Schools all children residing in that In. use. I le a Ih .w ed no fain ily 
 
520 OMMUNIGABLE I) I SB A S ES. 
 
 to remove their goods from the house without a permit from the Chief Inspector. 
 He kept surveillance over the water-closets, noting any of the occupants who visited 
 the same more than twice in twenty-four hours. 
 
 "All supplies for the family were purchased and paid for by the quarantine phy- 
 sician, who made a report of the condition of affairs every eight hours by telephone 
 to the central office. 
 
 " This strict quarantine was maintained for seven days from the time the case or 
 body was removed. Then all the persons under quarantine were required to bathe 
 and dress themselves in clothing which had been disinfected by the department, and 
 the clothing they had worn was left in the rooms, and they were required to 
 leave the apartment. 
 
 "The rooms were again scrubbed with disinfectant solution and ,the apartment 
 thoroughly fumigated with sulphur (3 pounds to the 1,000 cubic feet). 
 
 " For the next seven days the premises were visited by the quarantine physician 
 once every twelve hours, and report made by telephone to the central office. 1 ' 
 
 Tuberculosis. 
 
 The first step to be taken in the prevention of tubercular phthisis 
 was the distribution of circulars giving information as to the coutagious 
 character of the disease and the means which should be taken to pre- 
 vent its spread. Until within a very few years physicians have not 
 generally considered this disease contagious, and even now a consider- 
 able number deny it. Thus in Denver in 1897 1 of 215 physicians, 16 
 unqualifiedly denied its contagiousness, and 10 more gave only 
 a qualified assent. In this as on many other subjects the sanitary offi- 
 cials have been foremost in disseminating, even among the medical pro- 
 fession, the results of biological research. As early as 1890 a circular 
 of information of this character was issued by the board of health of 
 New York City. According to S. A. Knopf 2 circulars or similar publi- 
 cations are at present issued by the state board of health of twenty-two 
 states. 3 
 
 In some cities outside of these states, as St. Paul, Chicago, St. Louis, 
 Minneapolis, and Philadelphia, similar circulars have been issued. Ex- 
 amples of these circulars are found in Appendices 93-95. In Minneap- 
 olis the circular is printed in the form of a card which it is intended 
 shall be hung in the room of the sick person. An excellent criticism 
 of these circulars, which it would be well for every one contemplating 
 issuing one to read, may be found in Knopfs article in the Journal of 
 the American Medical Association, 30 October, 1897. In New York 
 
 1 Denver, Report of Bureau of Health (1897-8), p. 53. 
 
 2 The Prophylaxis and Treatment of Pulmonary Tuberculosis (1899), p. 68. 
 
 3 California, Colorado, Connecticut, Delaware, Indiana, Iowa, Kentucky, Maine, 
 Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, 
 Ohio, Rhode Island, South Carolina, Tennessee, Texas, Virginia, West Virginia, and 
 Wisconsin. 
 
( ' MMl 'XI < A B L E J> isK. 1 shs. 521 
 
 City these circulars are sent to the physicians, and distributed among 
 the tenement house population. From 20,000 to30,000are distributed 
 yearly. In Brookline, Mass.. one is sent to every family in the town. 
 In most cities a circular is sent only to persons who are reported as 
 having phthisis. 
 
 The next step in the work of preventing pulmonary tuberculosis is 
 the notification of cases. As was shown on page 438, this is now 
 required in a few cities. The law, however, is not generally enforced, 
 and unless it is proposed to do more then is generally done in the way 
 of investigation, isolation, and disinfection by the sanitary authorities, 
 there hardly seems to be much use in attempting to enforce it. 
 
 In Michigan the state board of health has prepared a blank on which 
 the local health officer is to report all cases of consumption occurring in 
 his township (this disease is to be reported by physicians in that state). 
 A very extended report of the action taken by the patient, his attend- 
 ants, and the health officer must be made to the state board of health on 
 death or recovery. 
 
 The only way in which health officers usually learn of the exist- 
 ence of tuberculosis is by the death returns; but after the death of the 
 patient nothing can be done except to disinfect the room occupied dur- 
 ing the last sickness, or perhaps the whole apartment. This is done in 
 Detroit, New York City, and Philadelphia. Besides this little is done 
 in any city except New York. The board of health of that city is the 
 pioneer of this work: but has not had the CO-Operation of a large part 
 of the medical profession in the city. The work of this department is 
 well set forth in a "Circular of Information for Physicians." 
 
 First. The sanitary code requires that all cases of pulmonary tuber- 
 culosis shall be reported, and. of course, that all deaths shall be reported. 
 The authorities of public institutions are also required to report all cases 
 entering and Leaving the institution and the address from which thej 
 came or to which thej arc going. The cases and deaths are recorded on 
 index cards, red for cases, and blue for deaths, which are arranged by 
 
 streets. Before being arranged the\ are carried to the house to be 
 
 tilled by the inspectors if an inspection is made. See Appendix 96. 
 
 The cases are also noted from year to year on an atlas drawn to a 
 
 scale of LOO feel to the inch. A different mark is used for each year. 
 Iii Rochester a similar record has been kept of deaths since L891 on a 
 large wall map, pins of different colors for different years being used. 
 
 Second. In tenement houses and Lodging houses (unless the attend- 
 ing physician requests not > an inspector is sent to the bouse to instruct 
 the fainiU and lea\e circulars. Subsequent visits arc made and it is 
 
 claimed by the board that the\ find that proper precautions are taken 
 
522 COMMUNICABLE DISEASES. 
 
 in about one-half the cases. In cases residing in other than in tene- 
 ments and lodging houses, no inspection is to be made unless the physi- 
 cian attending so requests. 
 
 Third. When a patient removes or dies the inspector reports to the 
 board what disinfection is required, and the board issues an order to the 
 owner of the premises to disinfect or rather to clean them. In some cases 
 when it is believed that this order will not be promptly complied with, 
 a notice is posted on the apartment stating that it has been occupied by 
 a consumptive and must not be again occupied until disinfected. The- 
 disinfection required is to wash walls and all woodwork with washing 
 soda, one-half pound to a pailful of hot water, and then re-paper, white- 
 wash, and kalsomine. Occasionally goods are taken away and steamed. 
 
 Pennsylvania 1 lias passed a law fori lidding the employment by bakers- 
 of persons having consumption, and the Sanitary Code of Yonkers 2 
 makes it a misdemeanor for bakers or marketmen to pursue their oecu 
 pation if they have this disease. 
 
 The importance of bovine tuberculosis in causing the human dis- 
 ease cannot be here discussed. The control of dairies to prevent the 
 production of tuberculous milk and the effort to eradicate bovine 
 tuberculosis are considered in other chapters. In New York City 
 the board of education requires that applicants for position of teacher 
 shall present a physician's certificate that they are free from tubercu- 
 losis. 
 
 If it is necessary to have isolation hospitals for smallpox, scarlet 
 fever, and diphtheria, it is far more necessary to have them for tuber- 
 culosis, for the welfare of the patient depends upon hospital life far more- 
 than it does in the other diseases, and, as in other diseases, absolute 
 isolation can rarely be obtained outside of a hospital. ^Yhile the build- 
 ing of such hospitals has for several years been urged by boards of 
 health, as yet very little has been accomplished in this direction. There 
 are many successful private sanatoria, 3 but only two or three operated 
 by cities or states. Massachusetts is the pioneer state as it opened its- 
 state tubercular hospital 1 October, 1898. The cost of the hospital was 
 $180,878.85, of which $45,839.87 was for land, sewerage, etc., and 
 #123,684.24 for buildings. 4 The following is from Knopf: 
 
 "The institution consists of a series of two-story buildings arranged in a half- 
 circle, in the middle of which is the administration building. The pavilions are of 
 
 1 Pennsylvania, Chapter 05 of 1897. 
 
 2 Yonkers, Sanitary Code (1897), Sec. 28. 
 
 s See Knopf's Prophylaxis and Treatment of Pulmonary Tuberculosis. 
 4 Second Annual Report, Trustees Massachusetts Hospital for Consumptives and! 
 Tuberculous Patients, p. 23. 
 
< OMMUNK ABL E DlsKA SES. 
 
 523 
 
524 COMMUNICABLE DISEASES. 
 
 two kinds; some have seven small rooms and a large ward for twenty-two patients, 
 and others have the same number of rooms, but the wards are smaller and can accom- 
 modate only ten patients. Each pavilion has a solarium made entirely of glass, and 
 all the buildings are encircled by large verandas. The pavilions on <me side of the 
 administration building are for the women and those on the other side are for men. 
 As the accompanying illustration shows, the buildings are all arranged so as to receive 
 as much sun as possible. There are in all 200 beds. Patients can have their choice 
 in regard to treatment — that is to say, whether they desire to have a regular or a 
 homoeopathic physician for their attendant. 
 
 " What makes this institution particularly interesting is that, inasmuch as its 
 primary purpose is to arrest the disease, and if possible to extirpate it, only such 
 patients will be admitted as are deemed not too far advanced to admit of reasonable 
 hope of radical improvement. In no sense is the hospital to be considered as a home 
 for the hopelessly sick; for, great as is the recognized need for homes of refuge for 
 advanced consumptives, such service is manifestly incompatible with the even more 
 needed service of rescuing lives that can be saved only by sanatorium treatment. 
 ' Patients who do not improve after a stay in the hospital sufficiently long to test 
 the effect of treatment will be advised not to remain, and their friends will be ex- 
 pected to arrange for their removal to surroundings primarily devoted to or better 
 adapted to their comfort. 1 This is a clause contained in the opening announcement, 
 and is one of the most distinct features of the work of the institution. The fact 
 that the charges for patients are uniform and only fifty cents a day, that no private 
 patient will be received, and that private rooms will be allowed only for physical 
 reasons, and, finally, that no extra charges will be made and no fees and tips allowed 
 to be accepted under any circumstances, makes this institution in the truest sense a 
 philanthropical one." 
 
 The state of New York has this year (1900), made an appropriation 
 for a similar hospital. The same state has also authorized cities of 
 250,000 inhabitants to establish phthisis hospitals of their own outside 
 of their limits, hut with the approval of the state board of health, and 
 also of the local board of the town where the hospital is to be. 1 
 
 Cincinnati in 1897 converted the smallpox hospital which is a sub- 
 stantial brick building into a hospital for consumptives. The hospital 
 itself and the administration buildings cost, exclusive of the land, about 
 150,000. It accommodates about sixty to eighty patients, who come 
 from among the poor, who would naturally seek admission to the gen- 
 eral hospital. In fact this institution is primarily intended to afford a 
 place where consumptives may be treated so that it may not be neces- 
 sary for them to be a menace in other institutions. Most of the patients 
 are too advanced to afford much hope of cure, but under the excellent 
 management of Dr. Lyle most of them make some improvement. The 
 hospital is in the outskirts of the city with ample grounds. The cost of 
 maintenance has been $1.25 per day. Between 8 July, 1897, and 
 30 August, 1899, there had been 301 persons admitted. 2 At present 
 (February, 1900,) Dr. Lyle states that there are about sixty patients and 
 the expenses are from $1 to $1.10 per day per patient. 
 
 1 Xew York, Chapter 637 of 1899. 
 
 2 Ohio, Sanitary Bulletin, September, 1899. 
 
COMMl XI< \ J BLE DISK A sEs. 5 o 5 
 
 Cook County, 111., has recently built a hospital for indigent con- 
 sumptives which accommodates 300 persons and is at present ( February, 
 1900,) well filled. 
 
 Leprosy. 
 
 There are a considerable number of lepers in the United States, 
 though it is not known with accuracy how many. They are found in , 
 considerable numbers in California, Iowa, Louisiana, Minnesota, Wis- 
 consin, and arc scattered about other parts of the country. California, 
 Connecticut, Iowa. Maine, North Carolina. New Jersey, and Pennsyl- 
 vania have laws which require the report of these cases to the local 
 health department, but they are not enforced. The United States 
 marine hospital service is at present investigating the prevalence of the 
 disease and it will doubtless soon be known approximately how many 
 lepers there are in the country. The subject has received renewed 
 attention since the acquisition of Hawaii where there are a large num- 
 ber of lepers. 
 
 California 1 has a stringent law forbidding the landing of persons 
 afflicted with leprosy or elephantiasis. The commissioner of immigra- 
 tion is to inspect all vessels bringing Asiatic immigrants and the ship is 
 taxed seventy cents per passenger to pay for the inspection and the 
 care of the infected persons that are found. 
 
 Louisiana 2 provides that lepers shall be confined and the duly of 
 commitment is given to the judges. No one is to harbor a leper. No 
 attempt has been made to enforce this law, but a leper home has been 
 provided by the state at which dwell about forty of the l!<H> lepers. 
 
 The hospital is ■ of the old state quarantine stations, anil the patients 
 
 are eared for by Sisters of Charity/ 1 Philadelphia also has a Leper 
 hospital with four beds, and in New York City lepers have been con- 
 fined on North Brother Island, to which all the major communicable 
 diseases are taken. 
 
 I '< nereal Diseases. 
 
 Accurate statistics in regard to the prevalence of venereal diseases 
 
 are entirely lacking in the United States, but 1 oe doubts that thej 
 
 are exceedingly prevalent. Syphilis has always been considered a seri- 
 ous disease, and recent patholog} seems to teach that gonorrhoea is 
 nearly as bad and much more common. These diseases would certainly 
 
 warrant tin- attention of the health officer if it were not that public seii- 
 
 1 California, Penal Code 1 1886), Bees. 2952 68. 
 - Louisiana, < hapter85 of L892. 
 Reports and Papers American Public Health Association, Vol. XXV., p. 285. 
 
526 COMMUNICABLE DISEASES. 
 
 tiinent is strongly averse to free discussion of the subject or to any 
 official recognition of the conditions which give rise to the diseases. 
 
 A letter addressed last year by Dr. Isadore Dyer of New Orleans 1 
 to the officials of every city of 20,000 inhabitants in the United States 
 brought out the fact that no official effort is anywhere made to restrict 
 these diseases. According to the paper referred to, there are nine cities 
 which attempt by licenses or fines to restrict the number of houses of 
 prostitution, and three cities confine such houses to a particular district. 
 There is no city which attempts by a medical inspection of prostitutes 
 to limit their opportunity for spreading diseases. San Francisco, San 
 Antonio, and St. Louis have attempted to do this, but only for a short 
 time, as public sentiment was strongly opposed to such municipal action. 
 In St. Louis the act was in force from 1870 to 1874, and the amount 
 received from license fees was used to establish a hospital for venereal 
 diseases in women, but the hospital is now used for all diseases of 
 women. In San Antonio in 1880 houses of prostitution were licensed 
 with a fee of ¥500. The city physician examined each prostitute 
 weekly, and if free from disease gave her a certificate and sent a dupli- 
 cate certificate to the city clerk. During the ten months that the law 
 was in operation 2886 examinations were made of 230 women, and 
 forty-two cases of venereal disease were discovered. The ordinances of 
 Denver 2 provide that the health commissioner may inspect prostitutes 
 and isolate those who are infected, but this is nut done. 
 
 In Massachusetts 3 if a ease of venereal disease is found in any pub- 
 lic institution it may be isolated if necessary, and may be kept in isola- 
 tion even after the time of discharge. In Ohio 4 the cost of caring for 
 diseased prostitutes may lie charged to the house. 
 
 A law recently passed in Michigan 5 provides that persons afflicted 
 with syphilis or gonorrhoea shall be incapable of contracting marriage. 
 
 > New < >rleans, Medical and Surgical Journal, December, 1899. 
 2 Denver, Ordinance No. 44 of 1893, Sec. 15:1. 
 :i .Massachusetts, Chapter 420 of 1891. 
 
 4 Ohio, Annotated Statutes (1900), Sec. 2126. 
 
 5 Michigan, Chapter 247 of 1899. 
 
CHAPTER XI. 
 COMMUNICABLE DISEASES 
 
 (continued). 
 
 Disinfection, Laboratory Work, Vaccination, Antitoxin. 
 
 PROBABLY no one will deny the advisability of disinfecting after 
 the communicable diseases, though in the opinion of the writer 
 the danger from goods or rooms exposed to infection lias been consider- 
 ably exaggerated. Disinfection of infected things has been attempted 
 from the earliest times and the practice is more general now than ever 
 before. Owing to our better knowledge of the nature of the disease 
 poisons, or at least some of them, and of the action of disinfectants 
 upon them, modern methods are much more efficienl than those for- 
 merly employed. Disinfection may he practiced during the course oi 
 a disease for there are always certain things, ashed linen and clothing, 
 which must he from time to time removed from the sick room. Disin- 
 fection of this kind is described in the various circulars, examples of 
 which are elsewhere given, and is of course to be carried out hv the 
 family. Sometimes, as in Providence and the District of ( lolumbia, dis- 
 infectants for such purpose are furnished by the health department. 
 Disinfection of the infected premises including goods, after the patient 
 is well, is usually done h\ the sanitarj officials and it is this disinfec- 
 tion which is here considered. 
 
 Disinfection is made compulsory by the laws of several states. 1 
 Many cities outside of these states require disinfection by their local 
 regulations. Even in cities where there are no such regulations, as in 
 Providence, the District of Columbia, and St. Paul, disinfection is 
 nevertheless done bj the health department in nearly ever} case. In 
 several states, as in Massachusetts, it is required thai the disinfection 
 
 Colorado, Indiana, Iowa, Maryland, Massachusetts, Mississippi, Michigan, 
 Nortli Dakota, North Carolina, Ohio, Pennsylvania, South Dakota, Wisconsin, Qtali 
 and Vermont; in Minnesota and New Jersey the local boards of liealth are author- 
 ized t( i disinfeel . 
 
528 COMMUNICABLE DISEASES. 
 
 shall be to the satisfaction of the board of health. The Massachusetts 
 statute is a good example of this class of laws. 1 
 
 Ohio, Pennsylvania, and Wisconsin also require that the owner or 
 householder shall disinfect, but in all of these states wherever there are 
 active sanitary officials, the work is done by them, as it is sure to be 
 done much better than when left to the householder, even if it is done 
 under the direction of the board of health as is required in Iowa, North 
 Carolina, Pennsylvania, North Dakota, South Dakota, and Vermont. 
 In North Carolina the disinfection is to be paid for by the householder 
 if he is able. In St. Paul no charge is made for sulphur fumigation, 
 but if formaldehyde is used a charge of fifty cents a pound is made. 
 
 In North Dakota the law takes the form of a prohibition to " let or 
 hire any house, or room in a house, or building where any of these dis- 
 eases have been, until the same has been thoroughly disinfected." Sim- 
 ilar rules are found in Bridgeport, Buffalo, Macon, Ga., and Salt Lake 
 City. In order to make certain that disinfection has been property per- 
 formed, the North Dakota law and also that of Maryland and Vermont, 
 require that a certificate to that effect shall be given by the health offi- 
 cer. 
 
 In Minnesota and New Jersey the board of health is authorized to 
 destroy goods as well as to disinfect them, and in both states the goods 
 so destroyed must be paid for. Even if this is not so provided by 
 statute it is probable that the courts would award damages as was done 
 under such conditions in Detroit. 2 In New Jersey the board of health 
 must make an inventory of the goods destroyed and immediately certify 
 their value to the municipal authorities who shall pay the sum certified 
 to the owners. Nevertheless, in most cities it is not the general prac- 
 tice to pay for damages inflicted by disinfection. In North Carolina the 
 statute requires the disinfection to be in accordance with the regulations 
 of the state board of health, and in Indiana and Mississippi the state 
 board of health regulations which require disinfection specify how it 
 shall be done. Quite full specifications are given by the state board of 
 health rules of each of these states. 
 
 Methods of Disinfection. 
 
 In 1895 the writer prepared a paper on methods of disinfection in 
 vogue in fifty-live of the principal .cities of the United States. At that 
 time fifty-one of these cities relied on the use of sulphur dioxide and 
 
 1 Massachusetts, Chapter 102 of 1890: 
 
 " . . . . and upon the death, recovery, or removal of such person, such of 
 the rooms of said house and such of the articles therein as, in the opinion of the 
 hoard of health, have been subjected to infection or contagion shall be disinfected 
 by such householder to the satisfaction of said board of health. 1 ' 
 
 - Staff oid vs. Board of Health of Detroit, 8 July, 189G. 
 
COMMl WIl \ J BL K J>lsK. 1 sEs. 529 
 
 only twelve had appliances for steam disinfection. At the present time 
 sulphur has been almost entirely superseded by formaldehyde and there 
 has been a considerable increase in the number of steam appliances. 
 
 There is no doubt that more active measures are taken to disinfect 
 after smallpox, yellow fever, and diseases that appeal to the popular 
 imagination, than after scarlet fever, diphtheria, measles, and phthisis, 
 for the public will submit to and even demand much more in the former 
 than they will in the latter. In smallpox it is customary to burn many 
 articles of little value as old clothes, carpets, cheap mattresses, toys, 
 etc. If steaming facilities are available, probably most things that can 
 be steamed are so treated, and often the woodwork and furniture are 
 washed with a liquid disinfectant, by or under the direct supervision of 
 the .sanitary officials. Furthermore, the rooms are usually fumigated 
 with sulphur dioxide or treated with formaldehyde. Probably ninety- 
 nine per cent, of public disinfection is done for scarlet fever, diphtheria, 
 measles, and phthisis and other common diseases, and most of it for 
 scarlet fever and diphtheria. It is the routine practice in these common 
 diseases which will now be considered. There are three methods 
 employed for disinfection after communicable disease. One consists in 
 the application of gaseous disinfectants to the apartment, another con- 
 sists in subjecting movable articles to the action of steam, and the third 
 consists in washing woodwork, walls, and furniture with a liquid dis- 
 infectant. 
 
 Sulphur Dioxide. In 1895 nearly all cities in the United States 
 relied on sulphur dioxid for disinfecting, only four out of titty-live cities 
 making use of chlorine gas. The experiments conducted by Sternberg 
 and Raymond under the auspices of the American Public Health 
 Association 1 showed that sulphur fumigations are of considerable value 
 in the destrudic f the virus of vaccinia, and presumably thai of small- 
 pox, and also of the known non-spore-forming bacteria. In the absence 
 of anything better, health officers generally persisted in the use of this 
 disinfectant, although ii was known to have almost no penetrating 
 power and was not entirely successful for surfaces even under The mosl 
 favorable conditions, conditions which could not generally be secured. 
 It was shown that a certain amount of moisture was desirable when 
 this substance was used, and as a result of the recommendations of the 
 above mentioned reporl there was generally adopted the method of 
 placing a vessel of burning sulphur in a pan of water. In Providence 
 the oiittit consisted of an iron pol which was placed in a dishpan con- 
 taining about tWO inches of water. The pan stood upon a wire SUp- 
 
 Disinfection and Disinfectants, Reporl of Committee ol American Public Health 
 Association, 1- 
 
.530 C OMML r XK ABLE DISEA sj-;s. 
 
 port -such as is used to stand flatirons on. Sets of tins apparatus were 
 carried about in a wagon and placed in the rooms to be disinfected. 
 About three or four pounds of roll brimstone were used for every 1,000 
 cubic feet of space to be disinfected. An ounce or two of alcohol was 
 poured on the sulphur and set on fire with a match, and the room closed 
 by pasting up the door with strips of paper. Occasionally the windows 
 were pasted if very loose. If the room was to be used the same day, 
 the disinfector generally called to open it as he was used to the action 
 of the gas. The room was usually closed five to eight hours, and if it 
 was left over night, the gas was found to have pretty nearly escaped 
 before morning. 
 
 At one time the so-called sulphur candles were largely sold for 
 domestic disinfection by the householder. These are convenient to 
 carry and light but are not as cheap as roll brimstone, and have rarely 
 been used by health officers, though they have been in Atlanta and New 
 ( hleans even within the last few years. Liquid sulphur dioxide con- 
 densed in tins, was at one time sold by Elmer & Amend of New York, 
 but there was not much demand for it. With the introduction of for- 
 maldehyde, sulphur has generally dropped out of use, though it is some- 
 times used in smallpox, and is employed quite generally in a few cities. 
 In Cincinnati it is used considerably, especially in smallpox, and in 1898 
 it was used some in Philadelphia, New Orleans, St. Paul, Seattle, Erie, 
 and doubtless many smaller places, and in Atlanta it was used in houses 
 that were so open that formaldehyde would escape too rapidly. In 
 Montclair, N. J., in 1897, formaldehyde was tried and given up as value- 
 less, and sulphur was again used. Since then (1899) sulphur has 
 been again abandoned. 
 
 In Denver also sulphur has been used recently and tested on dipb> 
 theria bacilli and under some conditions gave better results than for- 
 maldehyde. 1 On the other hand in tests made by the state board of 
 health of Iowa it failed completely.' 2 
 
 Formaldehyde. The use of this gas was brought to the attention 
 of health officers in 1895-G and rapidly sprang into general favor. Two 
 claims were made for it; that it had great penetrating power and would 
 not injure any articles with which it was liable to be brought in contact. 
 Both of these claims have been substantiated, but the very quality 
 which makes it valuable, its divisibility by virtue of which it will pene- 
 trate fabrics, renders it very difficult to confine in an ordinary house, 
 and greatly interferes with its successful use. It is probably the diffi- 
 
 1 Denver, Report of Bureau of Health (1897-8), p. 101. 
 
 2 Iowa, Tenth Biennial Report of State Board of Health (1898), p. 249. 
 
( ' OMMl Wit '. 1 BI K 1> USE. 1 SES. 
 
 53] 
 
 culty of confining it which has given less success in actual practice than 
 in laboratory experiments. Nevertheless it is, as ordinarily used, prob- 
 ably much better than sulphur, and its introduction marks a step in 
 advance in the art of disinfection. Various methods have been designed 
 for using this substance, and all soils of devices are found. 
 
 Of as much importance as the method of generating the gas is the 
 securing of the room so that the gas will not escape. In most cities 
 some attempt is made to make the room tight by pasting over or stuff- 
 ing all openings. The faithfulness with which this is done is an import- 
 ant factor in the success of the disinfection. Doors and windows, ven- 
 tilators, and chimney openings should of course be pasted, but besides 
 these there are in poorly built houses many openings through which the 
 gas may escape. One of the most convenient methods of pasting over 
 openings is by the use of gummed paper which was introduced by the 
 board of health of Boston. This should be two inches wide and may 
 
 Fig. 18. 
 Method "i applying -mi -.i papei In Providence 
 
532 
 
 COMMUNICABLE 1)1 SEA SES. 
 
 be ordered in rolls of any size, and costs about twenty-five cents a 
 pound. All that needs to be done is to moisten it with a sponge, tear 
 it off the roll and apply to the openings. In Providence the inspector 
 carries the paper in a roll in the basket with his other apparatus and 
 uses it as shown in Fig. 18. In Montclair, N. J., surgeons' adhesive 
 plaster is used for this purpose. 
 
 It is the purpose of the various methods of generating the gas to 
 get as large a quantity into the room in as short a time as possible. It 
 is done in various ways ; it may be generated from wood alcohol, it 
 may be driven off by heat from its solution in formalin or formol, it 
 
 Fig. 19. 
 Ward's Formaldehyde Generator. 
 
 Fig. 20. 
 Ward's Formaldehyde Geivnitor ready for transportation. 
 
t OMMUNIi \ I BLE Dish'. | .s/-;.s. 
 
 533 
 
 Fig. 21. 
 
 The Kulin Formaldehyde Generator. 
 
 may be generated from the solid paraformaldehyde, or formalin may be 
 used as a spray, and the gas allowed to escape from the small droplets 
 (1 f fluid. 
 
 First. Generation from wood alcohoL This was the method first 
 employed, and was then though! to lie the most economical. Platinum, 
 or asbestos treated with platinum salts, have the property if slightly 
 heated of decomposing the vapor of methyl alcohol and producing formal- 
 dehyde. Various forms of apparatus have been devised for this pur- 
 pose, but it is not now generally thoughl thai thej produce as good or 
 lonomical results as may be secured 1>\ other methods. These 
 
 generators are used in Cambridge, Minneapolis, Lynn, and Newton. 
 Those used iii Newton and Cambridge and shown iii Figs. 1'.' and l'ii, 
 are made by W. A. Ward. 5 Harvard Street, Brookline, and cost $20 
 
 each. Another device "f this kind shown in Fig. 1\ has recently heen 
 
 put on the market by the Kulin Formaldehyde Generator Co. of Wash- 
 ington, I). C It lias Keen tested by the officers of I he marine hospital 
 
5b'4 
 
 i 'OMMUNH AJiLE hi SKA SJE8. 
 
 service with very satisfactory results, 1 and is said to have been put in 
 practical service by that department. Tt is sold for £50. 
 
 At one time Eli Lilly & Company of Indianapolis and Richard 
 Kny of New York had on the market a generator operating on this 
 principle. They were used experimentally in a number of cities, among 
 others quite extensively in Dayton, O., but have now pretty generally 
 gone out of use and are not on the market, 
 
 Second. Formalin is a solution of formaldehyde gas in water. 
 That put on the market is supposed to be a saturated solution containing 
 about forty per cent, of formaldehyde. It sells at the present'time in car- 
 boys for about twenty-live cents a pound. It is said that some of it runs 
 less than thirty-eight percent., and it not infrequently contains a precipi- 
 
 Fig. 22. 
 Trillat Autoclave. 
 
 1 Public Health Reports, Marine Hospital Service. 1!) October, 1900. 
 
t oMMVXK \ VBLE I>ls]-;_ f sKs. 
 
 D B 
 
 535 
 
 Fig. 28. 
 i\n\ Bchcerei Vox raaliii Generatoi 
 
536 COMMUNICABLE DISEASES. 
 
 tate of paraformaldehyde which for use in a spray diminishes its value. 
 The term formochloral is applied to formalin to which has been added 
 twenty per cent, of calcium chloride. The addition of the chloride is 
 to prevent the polymerization of the formaldehyde by heat, i. e., its 
 transformation into comparatively inert substances. Ten per cent, of 
 glycerine is sometimes added with the same object in view. Formalin, 
 when heated under pressure, rapidly gives off formaldehyde gas. Sev- 
 eral forms of apparatus have been put upon the market. One made by 
 the Sanitary Construction Company heated the liquid in a coil into 
 which it slowly flowed from the reservoir. H. K. Mulford & Co., of 
 Philadelphia, afterward took their business and sold many of these 
 which are still in use, but this firm has now substituted a simpler 
 arrangement. The Trillat autoclave (Fig. 22), sold by Fries Brothers 
 of New York, operates on the pressure principle. It is used in Atlanta, 
 Fall River, Macon, Ga., Nashville, New Orleans, Pittsburgh, Savannah, 
 and to some extent in Milwaukee and Philadelphia. It costs $100 
 and is shown in the figure. A somewhat similar apparatus is made by 
 the Kny-Scheerer Co. of New York, and is sold for $60. It has been 
 used in the District of Columbia, San Francisco, New Orleans, and 
 Buffalo. See Fig. 23. 
 
 The object of heating the liquid under pressure is to prevent poly- 
 merization or the production of the solid paraformaldehyde or " para- 
 form " instead of the diffusible gas ; but the experiments of Novy 
 showed that it was just as well and even better to carry on the evapora- 
 tion in a vessel with a freer opening and under atmospheric pressure. 
 The gas is thus rapidly disengaged, and if any paraform is left behind 
 after the evaporation of the water it too is speedily returned to gas 
 again. H. K. Mulford & Company now have tins apparatus on the 
 market, using their kerosene burner to heat the liquid. The price for 
 this is $25, the same as that for their old apparatus, and it does not 
 annoy the disinfector by frequent clogging, such as occurred in the 
 coil. It is shown in Figs. 24 and 25. 
 
 Either this or Mulford's coil generator is used in Baltimore, Boston, 
 Cincinnati, Fitchburg, Louisville, Newark, Pittsburgh, and St. Paul. 
 
 Another form of this apparatus (Fig. 26) is made by Charles Lenz & 
 Sons of Philadelphia, and another still by Parke, Davis & Company of 
 Detroit. The cost of the former is $12.50. 
 
 In using all these forms of apparatus it has in the experience of 
 the writer been found convenient to use a larger outlet tube than will 
 go through a keyhole. Moreover, many doors have no keyhole, so that 
 in Providence the disinfector carries a locksmith's screw-driver and 
 takes off the knob and inserts the tube through the opening through 
 the latch. 
 
( OMMUNIi . 1 11 LK 1)1 SEA SES. 
 
 ■^ 
 
 Fig. 24. 
 Mulford's Formaldehyde Generator. 
 
 Fig. 25. 
 
 Diagram Bhowing construction oi 
 Mulford's Generator. 
 
 Mechanical Opekation — A. quantity of solution of Formaldehyde is put into 
 tin- receiver B through the opening A : the heating lamp is lighted, and the chamber 
 I) broughi to ;i red heat. The solution of Formaldehyde in receiver V> is vaporized, 
 rise-, in the top of the dome C, passes down the pipe to the heating chamber 1>. 
 where the gas is no! only superheated but also thoroughlj dried, and passes through 
 the pipe E. 
 
 In many of the Maine towns the gas is generated by soaking a Large 
 i<»ll of shod asbestos in formalin and placing it upon the top of an oil 
 stove in the room t<> !>•• disinfected. 
 
 The amounl of formalin used varies in differenl cities, bul the 
 makers usually recommend from six to ten ounces per 1,000 cubic feel 
 of space to be disinfected, and this is the amounl usually employed. In 
 Boston, however, the routine practice is twent) ounces for the same 
 space, and in Pittsburgh, four pounds. As in the Latter citj test cult- 
 ures are placed in everj room and failures to kill them arc nol infre- 
 quent, the results are no1 reassuring to those places thai rel} on ten 
 ounces. 
 
ru)s 
 
 ( OMMUXK A BLE DISEA SES. 
 
 Fig. 26. 
 The Lentz Formaldehyde Generator. 
 
 Third. From a saturated watery solution of -formaldehyde is de- 
 posited a white solid called paraform or paraformaldehyde, this by dry- 
 ing becomes a powder known as trioxymethelene. Both of these are 
 polymeres of formaldehyde and are both probably found in the com- 
 mercial paraform. The solid is itself inert, but even at room tempera- 
 ture slowly gives off formaldehyde. When heated it is rapidly changed 
 into the gas, and in this manner large quantities can be evolved in a 
 short time. 
 
 Sobering and Glatz have prepared this paraform 
 in pastilles containing one gram each, which are sold 
 in tin boxes of 500 at $3.50 per box. Crude para- 
 form in bulk is also sold by Fries Bros., of New York, 
 at ninety cents a " cake." Sobering has a lamp for 
 heating the pastiles, as shown in Fig. 27. This is 
 sold for '$3, and has been used to some extent in 
 Baltimore, and Providence, and is now used in Monfc- 
 clair, N. J., Memphis, Trenton, Raleigh, Elizabeth, 
 X. J., and Charleston. It however appears to be a 
 very expensive way of generating the gas, and it has 
 been said that if overheated the pastilles sometimes 
 
 Fig. 
 
 Sobering and Glatz's 
 Paraform Lamp. 
 
( ' OMM I WI( A 11 LE DISK. [ s Ks. 5 3 < , 
 
 take lire. It is also considered somewhat dangerous to leave a fire 01 
 lamp of any kind burning in a closed room. In fact to escape a possible 
 danger from fire was one of the reasons why health officers were glad 
 to give up sulphur fumigations. The E. D. Taylor Company of New 
 Brunswick, X. J., furnish a candle made of parafine and paraformalde- 
 hyde which is said to be efficient and easy to use. 1 
 
 Fourth. If a liquid disinfectant of sufficient strength is sent in a 
 fine spray over a room and its contents, everything touched by the spray 
 is sure to lie disinfected. This method has been used a great deal in 
 Paris, but not very much in this country. In Xew Haven and Provi- 
 dence a common garden spray has besn used for disinfecting after 
 smallpox, and this method has been employed in outbreaks at the south 
 by the marine hospital service. In Xew York a spray was tried and 
 abandoned, but in Philadelphia it was used for a number of years and 
 was still in use in 1898. The apparatus cost •-'loo (243 francs in 
 Palis) and was very heavy, requiring two men to lift it. It was made 
 by <ieneste Herscher & Company of Paris. At first a solution of bichlo- 
 ride of mercury was used, but later formalin diluted so as to contain 
 about two per cent, of formaldehyde, about two quarts of this being 
 \\si-i\ for a room. By using formalin it was expected that not only 
 would the things actually touched by the liquid be disinfected, but 
 that hidden surfaces would be disinfected by the gas. The health 
 departmenl of Chicago has devised a different method of usin^ the 
 formalin spray which is designed simply as a means of freeing the gas. 
 The process is described as follows: 
 
 "Seal up all cracks around windows and doors and other places 
 where there is a possibility tor the gas to escape. Hang up large double 
 sheets across the infected rooms on a clothesline. The sheets should 
 be hung by their i'd^^s so us not to he double. On these sheets l>v 
 means of the sprinkling apparatus (see cut) apply the formaldehyde 
 forty per cent., evenly all over the sheets, distributing it as much as 
 
 possible. One sheet should be used for every 1,000 CublC feet, and the 
 
 quantity necessar} lor everj L,000 cubic feet is aboul five ounces or 
 150 c. c. Seal tie- door of exit immediately and allow the formaldehyde, 
 to evaporate spontaneously. Leave the rooms thus fixed for at least 
 five hours or longer if possible. Then remove the sheets and allow to 
 air. All bedding or soiled clothing should he hung up on lm 
 placed over chairs so as to allow the gas to c e to every pari of it. 
 
 All hi ilea I IS. etc.. should be opened. I '.oo|< s a re set on end and opened." 
 '['his method has been used to some e\ tent in P id \ id el ice ( as indeed 
 
 have most other methods of formaldehyde disinfection), bul it is cus- 
 1 Buffalo, Monthly Report of the Departmenl of Health. December, 1900. 
 
540 
 
 COM Ml XI< AH LE DISK A sEs. 
 
 Fig. 28. 
 Behin's Spray Apparatus (Chicago Method). From Bracken's Disinfection and Disinfectants. 
 
 tomaiy there to spray the carpets, mattresses, and sometimes the walls 
 of the room as well, so as to get the direct action of the liquid besides 
 that of the gas. This method was also used in Bridgeport, Conn., 
 Concord, and Detroit. In the District of Columbia where the appro- 
 priation has not been sufficient for the district officials to disinfect 
 every infected house, the householder has been directed to use sheets 
 after the Chicago method. In Asbury Park a twenty per cent, solution 
 of formalin is sprinkled about the room and on suspended sheets by 
 means of a watering-pot, about one quart of the liquid being used for 
 each 1,000 cubic feet of space. It is generally believed that all the dis- 
 infection that is accomplished with formaldehyde occurs during the first 
 few hours of exposure. Usually rooms are not closed for more than 
 five or six hours and are opened by the householder, as the gas that 
 remains is not at all dangerous, though even after airing, enough gas 
 remains in the room for some days to be quite annoying. This could 
 readily be gotten rid of by the use of ammonia gas, but this is rarely 
 resorted to by health officers. 
 
 Strum Disinfection. Textile fabrics, mattresses, pillows, carpets, 
 woolen clothing, etc., can, if infected, only be thoroughly disinfected by 
 
f ■ < >MM I ~XI< '- 1 1'> L E 1> ISK. I sKs. 
 
 541 
 
542 COMMUNICABLE DISEASES. 
 
 subjecting them to the action of steam heat. Formaldehyde may if they 
 are well exposed to it disinfect their surfaces, and it may be that this is 
 generally all that needs to be done. Many sanitary officials have how- 
 ever felt that a more thorough disinfection was necessary, and have pro- 
 vided facilities for using steam. Providence had a steam disinfecting 
 plant for municipal work in 1889, and at the present time one has been 
 provided in New York, Chicago, Philadelphia, Brooklyn, Boston, the 
 District of Columbia, Milwaukee, Charleston, Paterson, New Haven, 
 Pittsburgh, Utica, Syracuse, Worcester, and Newton. 
 
 A steam disinfector consists of a wrought steel or iron chamber usu- 
 ally cylindrical, but sometimes square as in District of Columbia, Phila- 
 delphia, Ttica, and Brooklyn. The cylindrical form is somewhat 
 stronger and cheaper, but those with a nearly square section are some- 
 what easier to fill with goods. They vary in size according to the 
 amount of work demanded of them, usually the diameter varies from .") to 
 8 feet and the length from 10 to 20 feet. The apparatus in Boston is 
 7 by 20 feet, in Philadelphia, 8 by 15 feet, in Providence, 6 by 14 feet, 
 in New Haven, 5 by 8 feet, in Newton, Mass., 5 by 7 feet. Some 
 of the chambers are jacketed, that is, have double walls between which 
 steam can be introduced. In Philadelphia, Boston, Milwaukee, and 
 New Haven the steam chest is not jacketed and in Boston and the Dis- 
 trict of Columbia a sheet metal shield is suspended near the top 
 to keep the drip of condensation from the goods, and between the 
 shield and the shell is a coil of steam pipe which also tends to prevent 
 condensation. The jacket is a very great advantage, as by keeping a 
 higher pressure in the jacket than is maintained in the chamber, all con- 
 densation and dripping in the latter is prevented, except on the door 
 winch cannot be jacketed. In all cases the apparatus should be covered 
 with asbestos magnesia, felt or other heat insulating material. Some 
 of the disinfectors are provided with a vacuum apparatus. This too, is 
 an advantage though not essential. Sometimes a pump may be used for 
 this purpose which is usually operated by steam, as in Brooklyn and 
 New Haven. Sometimes ejectors are used for this purpose, working 
 either with steam or water; they cost much less than pumps but are 
 not so economical in operation. Ejectors are used in Providence and 
 Paterson. If the air is exhausted before the steam is turned on, the 
 penetration of the goods takes place quicker, and if after disinfection 
 the steam is exhausted before the door is opened, there is less moisture 
 condensed when the cold air strikes the goods. There are various ways 
 of fastening the door. Sometimes a wheel and screw in the center 
 of the door are used to force out radial wedges and so close it as at the 
 Boston City Hospital, and sometimes there are a series of cams with 
 
( 'OMMUNIL 'AB L E DISE. 1 S ES. 543 
 
 handles, around the rim, which force the door down on the packing. 
 These are convenient methods but do not make as tight a joint as can 
 be secured with hinged bolts and nuts. Sometimes each nut has a han- 
 dle by which it can be screwed down, as in Brooklyn and Boston, hut 
 usually a ratchet wrench is used which probably is about as good a 
 method as any. The door may be hung by a hinge which is the most 
 common way, in which case the bottom should be supported by a roller 
 to prevent sagging. Sometimes it is preferable to have the door 
 detachable and supported by a turn buckle from an overhead trolley or 
 a crane as is shown in the illustration of the District of Columbia dis- 
 infect or. 
 
 Some of the disinfecting chambers are built with a door at each end 
 and are set in a partition separating two rooms, one of which is used for 
 receiving and the other for delivering goods as in Boston. Philadelphia. 
 and the District of Columbia. In this way, if different men are em- 
 ployed tor collecting and delivering and for loading and unloading the 
 disinfector, there can he no possible chance for reinfection of the goods ; 
 but the writer after ten years" experience with a single door disinfector. 
 has never seen anything to suggest that any other arrangement is nec- 
 essary. The disinfecting chamber is supplied with rails and a car for 
 convenience in loading and unloading, and often with various soil-- o\ 
 racks or cages for separating the goods. 
 
 The car and racks are often made of metal and sometimes iron, in 
 which case they may he covered with canvas to keep rust from the 
 goods. In Providence the cars and racks are made of whitewood which 
 is free from resin and last- for years if the disinfector is used properly: 
 hut if the disinfector IS used so that the wood is exposed to moist steam, 
 the racks will soon he warped out of shape. 
 
 The apparatus should he supplied with ;i safety valve ami steam 
 gauges tor showing the pressure and vacuum, and sometimes an electric 
 
 thermometer is used to indicate when the interior of the g is has been 
 
 brought to a proper temperature. In Pittsburgh with each treatment 
 of goods a self registering thermometer is pul in the steam chamber. 
 This is enclosed in the center of a six-inch roll of cotton which is 
 
 enclosed in a wire basket and Locked by the bacteriologist. 
 
 The following description and figures illustrate the ven complete 
 disinfecting plant in the District of Columbia: 5 
 
 The building containing the machinery is 70 feci long by 32 feet wide, timbei 
 framing 1 covered with corrugated galvanized iron siilrs and roof, hip rafters 12 feet 
 clear i" 1 lie bottom <a 1 mss. granolithic floor with ;i pit Id feel 6 inches wide, 26 feel 
 inches long, ami 1 1 in< lies deep for the sterilizing chamber. 
 
 1 District of Columbia, Report of Bealtli Officer (1896), p. 221. 
 
-344 
 
 ( OMMUNK 'MILE ]>IsEA sEs. 
 
 T _ 
 
 Fig. 30. 
 
 Disinfection Building, District of Columbia. From Report of Health < Hiicer, 189(>, 
 
 " At each end driveways for vans are provided 10 feet wide, and a frame parti- 
 tion divides the building into two apartments, for infected and disinfected articles. 
 Provision is also made for dressing rooms, bath, and closets, accessible from each 
 apartment. 
 
 "■The apparatus consists of a chamber for steam disinfection, boiler and neces- 
 sary appurtenances, chamber for sulphur or other fumigation, vats for bichloride or 
 other liquid disinfection, and sprays for disinfection of the vans. The steam cham- 
 ber is 4 feet 4 inches wide, 5 feet 4 inches high, and 9 feet long, and is made rec- 
 tangular to give the most effective space during exposure, with the greatest 
 economy of steam, and is constructed of an inner and an outer steel shell, forming 
 steam jacket, with cast-iron end frames, intermediate truss bands, and screw-stay 
 construction. 
 
 tl The doors are arranged at both ends, having concave steel plates riveted to cast 
 iron frames, fitted with steam-tight gaskets, and are handled by convenient cranes, 
 being drawn tight by steel eyebolts, swinging in and out of slots in the frames. 
 
 " The system of piping is so arranged as to give thorough control of the circula- 
 tion. Steam may not only be admitted at top and bottom at will, but may also be 
 admitted at either end on top and discharged at opposite end on bottom, or vice 
 versa, so that cross currents are obtained and the steam handled in any manner 
 suited to obtain the best results from the articles being exposed. 
 
 " In this system of piping a patent air exhauster is attached to obtain a partial 
 vacuum in chamber, thus preventing a possibility of life to the germ and securing 
 greater penetration to the steam. 
 
 11 Thermometers, to indicate the temperature, are attached to each door, and 
 gauges are provided to indicate both vacuum and steam pressure and a safety valve is 
 introduced to prevent a possibility of overpressure in the chamber, the amount of 
 working pressure being regulated by a reducing valve in the steam pipe from the 
 boiler. 
 
 "For convenience in handling the goods, two cars are provided, of light iron con- 
 struction, with three removable trays in each, covered^with galvanized screens, and 
 on the top three rows of bronze wardrobe hooks are arranged, so that articles may 
 be laid upon the trays or the trays removed and clothing hung upon the hooks. 
 
C ■ OMMl WIC, I IiLE Bis /-/. j s /•/>. 
 
 545 
 
 The chamber is placed in a pit 14 inches deep, to bring the track in the chamber on 
 a level with the floor, and in this pit are two transfer tables, so that the cars passing 
 in at one end of the chamber, after being unloaded at the other, can be returned to 
 the working end of chamber by means of the transfer tables and side tracks, thus 
 securing a continuous operation and a complete isolation of the infected from the 
 disinfected end of the building. 
 
 "The steam chamber and boiler and all steam pipes are covered with magnesia 
 non-conducting covering to prevent radiation and loss. 
 
 •• The working of such a sterilizing chamber may be described as follows: 
 
 ••The steam, generated at high pressure in the boiler, is reduced to a proper pres- 
 sure by a reducing valve and allowed to circulate continuously in the jacket, slowly 
 at first to avoid sudden expansions. 
 
 •• While the chamber is being slowly heated the goods are loaded upon one of the 
 cars and then pushed into the chamber and the doors closed and made steam and air 
 tight. When the thermometer indicates proper temperature in the inner chamber 
 the air exhauster is started, until a vacuum of 10 to 1") inches is shown on the gauge; 
 then it is stopped and steam is admitted slowly to the inner chamber until there is a 
 pressure of, say 10 pounds. The valves from the jacket are then closed, while the 
 vents are opened so as to allow the steam to escape. 
 
 ••Theair exhauster.is again started and the above process repeated ; then the steam 
 is allowed to circulate through the inner chamber under .'. or 10 pounds pressure, so 
 as to secure a full and perfect exposure of all the articles to the current of steam. 
 After the period of exposure the steam is closed from the inner chamber and the 
 vacuum again started, to remove any condensation which may occur. After the ex- 
 
 Fig. 31. 
 Interior ol Disinfection Bnilding, District ol Columbia, Prom Report ol Health Officer, i-'» 
 
546 COMMUNICABLE DISEASES. 
 
 posure the door at the opposite end of chamber is opened, the car removed and un- 
 loaded, and thence passed to the working end of chamber by means of the transfer 
 tables. 
 
 L - Van sprays consisting of hand pumps attached to proper receptacle for the solu- 
 tion, with hose sufficient to reach the vans conveniently, were provided, but owing to 
 the clogging of the nozzle were abondoned, and the vans are now washed with 
 bichloride. 
 
 "A Kinyoun formaldehyde apparatus such as is used by the Marine Hospital .Ser- 
 vice has recently been attached to steam chamber for treating articles like leather 
 that cannot be subjected to steam.'' 1 
 
 In Brooklyn, in 1894, a disinfecting plant was built at the Kingston 
 Avenue contagious disease hospital. It is a three story brick building and 
 cost $22,103.50. It contains besides the steam chamber, tanks for dis- 
 infecting and cleansing the hospital clothing, and a set of three rooms, 
 through which the hospital patients pass for disinfection at the time of 
 their discharge. The following description of the sterilizer used at 
 Worcester is from the report of the board of health of that city for 
 189$: 
 
 " The sterilizer is a jacketed cylinder seven feet in length and five feet in diam- 
 eter, with doors at both ends. A brick partition crosses the sterilizer in the centre. 
 By this arrangement the ends open into separate rooms, no communication existing 
 between except through the sterilizer. Upon the floor at either end is laid a track; 
 a similar track is laid in the bottom of the sterilizer; an iron carriage is loaded with 
 the infected goods to be sterilized, and is rolled into the sterilizer; the doors are 
 then closed and the steam turned on. After being subjected to the temperature 
 necessary to kill all disease germs, the door at the opposite end is opened and the 
 car run out over the track. This room communicates directly with the laundry, and 
 no goods enter the laundry except in this way, after being thoroughly disinfected. 
 A temperature of 300 degrees can be obtained, although at present it is set to blow 
 off at a pressure of fifteen pounds, giving a temperature of 250 degrees, Fahren- 
 heit. 
 
 " The sterilizer complete was made and set up by the Stewart Boiler Works of 
 this city. The cut of the sterilizer, which accompanies this article, was kindly 
 loaned by that concern. 
 
 " The following test was made: 
 
 " Specimens of the cultures described below were placed in the ordinary glass 
 lubes, the ends plugged with cotton. They were then rolled in thirteen blankets 
 and subjected to a temperature of 225 degrees, Fahrenheit, for one and one-half 
 hours. 
 
 t; Subsequent cultures were made from all these, and all proved to be sterile: 
 Bacillus anthracis. 
 Bacillus diphtheria; (3 cultures). 
 Streptococcus aureus. 
 Staphylococcus pyogenes. 
 Spirillum cholera? asiaticse. 
 Micrococus lanceolatus." 
 
 The cost of a steam disinfecting plant varies greatly depending upon 
 the size and kind of building, the size of steam chamber, the style of 
 cars, the form of vacuum apparatus and whether a special boiler is re- 
 
( 'OMMUWIl \ I BL E DTsK. l SES. 
 
 54' 
 
548 
 
 ( ■ OMM I T NICA 11 L E ]> is K. j sh s. 
 
 Fig. 33. 
 
 Boston Strain Disinfecting Chamber. From Report of Boston Board of Health, 1S92. 
 
 quired. A steam chest of ample size for a city of 150,000 inhabitants 
 and fitted with everything necessary for first-class work ought to be 
 purchased for $1,000. The Paterson chamber cost $815. 
 
 In 1895 a portable steam disinfector was built in Milwaukee at a 
 cost of $1,500. Its weight was 8,220 pounds, and it was three and one 
 half by nine feet inside measurement. Chicago also built a similar van 
 which can he seen in the accompanying illustration. This van is now 
 kept at the hospital and is used as a stationary disinfector, hut it is not 
 often put in service. It is at present believed that a stationary plant is 
 much to he preferred to one that is portable. The latter is expensive 
 toconstruct and more expensive to operate, and in any event can hardly 
 he made large enough. 
 
 It is generally believed that the application of a strong disinfectant 
 solution to floors, wood-work, and furniture is an excellent way to dis- 
 infect them. Washing such things and indeed washing everything that 
 can he washed is usually recommended in disinfection circulars. After 
 cases of communicable disease the family are by circular or otherwise, 
 usually advised to wash with disinfectants all solid surfaces. Carbolic 
 acid in two per cent, solution or corrosive sublimate one to one thousand 
 are recommended. Sometimes these disinfectants are given to the 
 family by the health department. In Providence the disinfector usually 
 leaves at the house several paper pill boxes containing three drams ^i 
 
( OMMUNIi 'ABLE VISE. I SE&. 
 
 519 
 
550 OMM I XI ( A B L 1<; I) lsh\ j sEs. 
 
 corrosive sublimate, about enough to give a strength of one to one thou- 
 sand when dissolved in a pailful of warm water. In Charleston a pound 
 bottle of carbolic crystals together with directions for solution and use 
 are sent to the house in each case of scarlet fever and diphtheria. In 
 the District of Columbia formalin is given to the householder by the 
 municipal disinfector. In most cities, as in Providence, this method of 
 disinfection is left to the family, and unlike Providence the disinfectant 
 is not furnished by the city. In a few cities this disinfection is dime 
 by city employees. In New York City, where public disinfection is 
 done only in tenements and flats, men wash the floors' with brooms 
 dipped in a one to one thousand solution of bichloride, and for other 
 wood-work sponges are used in a solution of one to 2,500. The 
 mercuric salt is carried in thirty grain tablets and is dissolved at 
 the house. In phthisis washing soda is used. In Rochester this wash- 
 ing is relied on as the principal means of disinfection. A man and 
 woman are employed who wash all washable surfaces with bichloride or 
 electrozone, and, at the same time, carpets and upholstered furniture are 
 removed and beaten, and afterwards while the room is damp, it is fumi- 
 gated with sulphur. In Newark the woodwork is washed with bichlo- 
 ride in diphtheria cases. 
 
 Details of Municipal Work hi Disinfection. Many cities distribute 
 to every family with communicable disease a circular explaining the 
 methods of disinfection used. These, of course, vary in substance 
 according to the practice in the different cities. The best general cir- 
 cular on disinfection that the writer has seen is that issued by the state 
 board of health of Maine. As has been stated, most cities and many 
 states require by ordinance or statute, disinfection after every case of 
 communicable disease ; but some cities, as the District of Columbia, St. 
 Paul, and Providence, do not. Nevertheless, their municipal officers 
 offer disinfection, and the offer is usually accepted by the householder. 
 In the District of Columbia, until quite recently, formaldehyde appara- 
 tus was loaned by the city to the householder. Some cities have special 
 employees to do their disinfecting work, while others require sanitary 
 inspectors or medical inspectors to do it in addition to their other duties. 
 The following shows what is done in a number of cities : 
 
 Number of Annual 
 
 City. • Disinfector*. Salary. 
 
 Baltimore 2 disinfectors $800 
 
 Boston 1 chief disinfector 1,000 
 
 10 disinfectors per day 2.25 
 
 Brooklyn (Borough of) 4 disinfectors 900 
 
 Cincinnati 1 disinfector 800 
 
 Chicago 10 disinfectors $1,000 
 
 District of Columbia 2 disinfectors 600 
 
 3 disinfectors 300 
 
 Newark 5 disinfectors per day 2.7."> 
 
COMMUNICABLE DISEASES. 551 
 
 Number of Annual 
 
 City. Disinfectors. Salary. 
 
 New York (Borough of Manhattan) . .'■)! disinfectors 600 to 1,200 
 
 Providence 1 disinfector per week 12 
 
 Rochester 1 disinfector 900 
 
 1 disinfector 400 
 
 St. Louis I) disinfectors 000 
 
 W« trcester 1 disinfector per day 2.75 
 
 In Cambridge, New Haven, Newton, San Francisco, Springfield, 
 Mass., Wilmington, Del., and doubtless in many other smaller places 
 the sanitary inspectors attend to disinfection, and in Brockton this is 
 done by the inspector of plumbing. 
 
 In some cities the health officials rely upon the certificate of the 
 attending physician to determine when the time for disinfection has 
 arrived, but usually in scarlet fever the health officer or medical ins] ice- 
 tor personally examines the patient, and in most places where laboratory 
 facilities are available one or more negative cultures are required in 
 diphtheria. Whenever a disinfector is employed, it is usual for an 
 order to he given him for each place to be disinfected, this order being 
 issued by the health officer or medical inspector. This order contains 
 the items which it is desired to record in regard to the disinfection of 
 the ease, and when returned signed by the disinfector is considered his 
 report, and may be filed away as a record. The form used in ( Ihicago is 
 shown in Appendix; 97. On some forms a list of several places, a day's 
 work, i> put on a single sheet. In Baltimore the return has a blank for the 
 signature of the householder to enable the office to maintain a check upon 
 the work of the disinfector. Sometimes there are a number of items 
 in regard to the history of the ease which the disinfector is required to 
 gather at the time of his visit. This is the case in Newark where the 
 disinfectors placard the house and do practically all the work of med- 
 ical inspectors. In Pittsburgh 1 a card index is kept of all disinfections 
 
 1 Size :: x 5 inches. 
 
 DISINFECTION. 
 \. .. Address St Ave. \ \ Ward 
 
 Householder i Patienl i 
 
 Iiisease No. Rooms 
 
 i lapacity 
 
 Hours exposure to formaldehyde u;<s Amount 
 
 Boom tests; K.I.. B. growth hrs. Anthrax Spores <jrowtli lira. 
 
 Steam sterilization <'. Spores growth lira. 
 
 spores growth Ins. Q 
 
 Result 
 
5 -") 2 C MM I Wit A BLE DISK. I 8 Es. 
 
 on cards which are blue for diphtheria, red for scarlet fever, and white 
 for all other disinfecting. 
 
 In Pennsylvania where there is little official sanitary authority in 
 the smaller places and where disinfection is required by the statute 1 the 
 state board of health has prepared a certificate of disinfection to be 
 signed by the attending physician and returned to the school authorities. 
 In Chicago where the disinfectors are sent to their work on the request 
 of the attending physician they are instructed in scarlet fever cases to 
 examine the patient and to decline to do the work if desquamation still 
 continues. 
 
 In many cities, probably most cities, as Cambridge, Philadelphia, 
 Providence, and Rochester, the disinfector is provided with a horse and 
 wagon to carry his apparatus. In most cities an ordinary light one 
 horse covered express wagon is used for this purpose. In Providence 
 until recently, the same wagon, which has wooden sides and top, was 
 used as an ambulance, but now a Concord wagon is used in disinfec- 
 tions. In Rochester the disinfector is obliged to furnish a team out of 
 his salary of seventy-five dollars per month. The use of the formalde- 
 hyde " regenerator " renders it possible for the disinfector to carry it by 
 hand, and this is done even in such large cities as Baltimore, Cincinnati 
 and to some extent in Philadelphia ; and in Newark the outfit is carried 
 in a leather box to render it less conspicuous. The disinfectors make 
 use of electric cars in getting about in the above cities, but even then if 
 much formalin and a roll of gummed paper is carried, the burden must 
 be considerable. The route can usually be more quickly covered in a 
 wagon than in electric cars, and in Providence the writer is certain that 
 if the horse and wagon were to be given up it would be necessary to 
 hire two disinfectors instead of one. If goods are to be steamed of 
 course wagons must lie provided to carry them. In several cities as in 
 New York and Philadelphia one van or set of vans is used to convey 
 goods to the steam chamber, and another set with different drivers to 
 return them to their owners. In New York the drivers for infected 
 goods wear suits of brown duck, and the drivers for disinfected goods 
 wear white duck suits. In other cities, as Cambridge, Charleston, the 
 District of Columbia, Newton. Mass., and Providence, only one van is 
 used which is disinfected after each trip, usually by washing with 
 bichloride solution. In most cities the goods are tied up in sheets. 
 Sometimes the sheets found in the house are used. In New York 
 sheets of light duck about ten feet square are preferred. In the 
 District of Columbia they arc made of bed ticking. In Providence can- 
 
 1 Pennsylvania, Chapter 124 of 1895; 
 
• C OMMUNIt \ i B L K DIS h\ 1 5 E& . 5 .3 3 
 
 vas bags large enough to easily receive a mattress have been used. 
 They are bound on three sides with rope and have a loop at the corners 
 and the mouth of the bag is closed with a gathering- cord. They cost 
 about six dollars. The van used in Chicago for carrying goods is shown 
 in the illustration on page 540. Often the disinfectors wear their 
 ordinary clothes when about their work, but sometimes, as in Providence, 
 a duster is worn outside and is frequently disinfected. In some cities, 
 as Philadelphia, New York, and Waltham, a complete overall suit of 
 duck or similar material is worn during disinfection. 
 
 Several cities, as Philadelphia and Milwaukee, have printed rules for 
 the guidance of their disinfectors. When the disinfector has arrived at 
 the house and found everything in readiness, he is to at once proceed to 
 his work. This varies of course with the character of the disinfection 
 which the city furnishes, and the space to he disinfected. If isolation 
 in one room has been faithfully carried out, the problem is much sim- 
 plitied. Unfortunately, except in a few cities this is not generally done, 
 and disinfection of several rooms is necessary. In small tenements of 
 two to four rooms, usually the patient has been in all of them. In 
 Toronto in such cases the inhabitants are removed by the city officials 
 during the disinfection, to awaiting room, but the writer has not heard 
 of such an arrangement in the United States. In our cities either the 
 inmates arc simply turned out. or a part of the house is disinfected on 
 one day and the remainder on another day. In many cases, doubtless. 
 when it is claimed by the family that isolation has been maintained, it 
 has not been, and a single room is disinfected when the whole house 
 needs it jusl as much. Directions printed or otherwise are usually left 
 at the infected home early in the disease giving directions how to dis- 
 infect clothing and bedding that can be washed. An example id' such 
 circulars is shown in Appendix 98. < me of the best and most complete 
 •circulars on disinfection is that issued by the state board of health of 
 Maine. Snaking in a disinfectant and boiling is usually recommended 
 and. as has been said, disinfectants tor this purpose are sometimes fur- 
 nished as in Providence, bul in that city. -it least 1 1 1 . ■ x are rarely called 
 for till the termination id' the disease when they are almost always left 
 by the disinfector formalin for clothes and spraj ing upholstered furni- 
 ture, and corrosive Bublimate lor washing woodwork. In Providence, 
 during the course of the disease, clothes which are to go to a lanndiy 
 are called lot- by the health department wagon, and after steaming arc 
 delivered ai the lanndiy in that city also. When washing is found at 
 the house of a washerwoman where there is communicable disease it is 
 
 removed and steamed, and, if already Laundered, it is then returned to 
 
554 COMMUNICABLE DISEASES. ' 
 
 the owner. Laundered clothing is not injured at all when properly 
 steamed in a jacketed chamber. In Rochester when the disinfectors 
 visit a house they put the soiled clothes to soak in a bichloride solution, 
 and in Newark in formalin 1 to 5,000. 
 
 School books and books belonging to public libraries are liable to be 
 infected and are difficult to disinfect. In the case of cheap school books 
 it is doubtless economical to burn them, and this is done in Providence 
 and probably in other cities. In Philadelphia the same plan is pursued 
 in regard to library books, but in Providence these are disinfected with 
 steam, being first set on edge with the leaves apart. This of course 
 destroys leather bindings but causes no other injury. 
 
 In Cincinnati the clothing manufacturers' association employs a man 
 to disinfect for them all clothing which may have become infected in 
 the process of manufacture. 
 
 Disinfect ion of Vaults, Yards, G-utters, etc. 
 
 Formerly when the filth theory of disease dominated nearly all san- 
 itary work, disinfectants were freely applied to all places where filth 
 accumulates. The health department issued circulars showing how dis- 
 infection could be done and sometimes distributed the materials. In 
 some cases the officers actually did the work of disinfection. For many 
 years in New York City and Philadelphia the health department have 
 disinfected gutters and yards with copperas, but recently " electrozone " 
 has been used in Philadelphia. 
 
 At the present time it is considered better to remove filth than to 
 disinfect it, and as to the danger of its giving rise to infectious disease 
 it has been shown that ordinary filth has little if anything to do with 
 scarlet fever, smallpox, whooping cough, typhoid and typhus. It is still 
 not certain how the virus of yellow fever is spread, and it is the opinion 
 of many that it is developed in filth, so that in southern cities which fear 
 this disease, disinfection of filth is held to be more important than it is 
 in northern cities. In Baltimore one man is employed to prepare carbo- 
 late of lime which is distributed for the disinfection of vaults and drains. 
 In Charleston, in 1898, carbolic acid was furnished to 800 persons and 
 lime to 39,782 persons, and there was also distributed 141,300 gallons of 
 copperas solution, one and one-half pounds to the gallon. During the 
 summer time in that city a wagon is kept constantly at work distribut- 
 ing these materials, but if the citizens need them in the winter season 
 they must call at the health department for them. In Baltimore carbol- 
 ate of lime is made by the health department and distributed from the 
 
COMMUNKJABLH DISEASES. 555 
 
 police stations. In Boston the disinfecting corps during summer do a 
 good deal of this disinfection, as shown by the table given below. 1 
 
 In New Orleans, in 1897, 2 during the outbreak of }"ellow fever, the 
 following unique method was adopted for the disinfection of the surface 
 of the ground : 
 
 " A number of small gasoline furnaces on rollers, throwing a sheet of flame on 
 the ground, and used by the Barber Asphalt Company for repairs to asphalt streets, 
 were loaned us by that company in Xew Orleans. These furnaces, which were 
 capable of generating such an intense heat as to burn quickly green vegetables, 
 refuse, and other household debris, without odor, were utilized in the worst infected 
 localities. 
 
 "Owing to the danger of setting houses on fire, the manipulation of these 
 machines required the greatest care. }J 1. Farrar secured the services of an engine 
 of the rire department to attend each corps of this disinfecting brigade. The mode 
 of operation was as follows: All trash and other debris of the yard and alley were 
 removed to the street and then quickly incinerated by the furnace. The yards, 
 alleys, and the exterior of houses were then thoroughly washed with a powerful 
 stream of water furnished by the fire engine, and afterwards the furnace was rolled 
 over the alley, yard, banquette and streets, after the fashion of ironing a garment in 
 a laundry.'" 
 
 When yellow tevei' occurred, the whole block was disinfected with 
 bichloride of mercury and chloride of lime. The board of health states: 
 
 •• It has been our practice, as far as possible, to throw a cordon of disinfection 
 around the infected district. All drains and sinks and surfaces were washed with a 
 bichloride of mercury solution 1-500. The vaults and other places where tilth or de- 
 composition existed, w.re disinfected with chloride of lime. The chloride of lime 
 was used in the strength of three pounds to the average vault, and was used quite 
 freely, when possible, under the houses and also in the street gutters." 
 
 1 Boston, Report of Health Department (1899), p. 37: 
 
 Places Disinfected in Boston, isoo. 
 
 Streets 338 
 
 Places 1,137 
 
 < ourts 1,184 
 
 Alleys 4,113 
 
 Yards 15,599 
 
 Vaults 1,126 
 
 Cellars 9,276 
 
 Gutters 574 
 
 Water-closets 8,856 
 
 Passages ays •;.;:;;»; 
 
 Urinals 768 
 
 Vacant lots ■ 898 
 
 Filthy rooms 
 
 Filthy sheds 6,697 
 
 Sinks 1 ! ; . 1 ! '.7 
 
 ( 'ess|M ioIs 1 4,336 
 
 Total 95,29 1 
 
 ■ Louisiana. Report of State Board of Health (1896-97), pp. 12. and 76. 
 
5 5 6 031 31 UNI CABLE DISEu 1 SMS, 
 
 During this outbreak there were used 21,793 pounds of chloride of 
 lime, 1,743 pounds of bichloride of mercury, and 4,391 barrels of lime 
 and 260 barrels of copperas, besides formaldehyde and sulphur for house 
 disinfection. 
 
 Bacteriological Laborat< >kies. 
 
 The development of the serum culture as the most valuable means 
 of recognizing diphtheria was the chief cause of the establishment of 
 the municipal or state bacteriological laboratory, though something had 
 been done previously to that time. As early as 1888, what was prob- 
 ably the first municipal laboratory was established in Providence b}* 
 the energy of Dr. G. T. Swans, who was at that time medical inspector. 
 The work done by Dr. S warts at first was on water supplies and filters, 
 and he also made use of the laboratory in tracing an outbreak of typhoid 
 in 1888, which was due to pollution of the city supply. The first state 
 laboratory was also established by Dr. Swarts in 1893, when he was 
 elected secretary of the state board of health. There seems to be no 
 difference of opinion as to the necessity for the maintenance of a bac- 
 teriological laboratory by all cities of considerable size, say from 75,000 
 to 100,000 inhabitants, and even by smaller cities if a state or university 
 laboratory is not immediately available. Laboratories have been estab- 
 lished in a large number of cities of the size mentioned. For the 
 country and smaller cities, of course, the maintenance of a bacteriological 
 laboratory would not be warranted by the amount of work needed. 
 For such communities the state laboratory was established. At present 
 the state board of health is thus equipped in Colorado, Delaware, 
 Louisiana, Maryland, Massachusetts. Minnesota, New Jersey, Ohio, 
 Rhode Island, Tennessee, and Vermont. 
 
 In Minnesota in 1898 it was reported that thirty-two towns made 
 use of the state laboratory. In Massachusetts in the same year, although 
 there are a number of local laboratories, there were examined by the 
 state board of health 1,591 diphtheria cultures, 41-~> specimens of sputum 
 and 132 specimens of suspected malarial blood. 
 
 When state laboratories were first projected much difficulty was 
 experienced in sending specimens to them. The post office department 
 refused to accept infectious material or wet or liquid matter ; but mail- 
 ing boxes were devised which are approved by the post office depart- 
 ment. Sometimes cultures are sent to distant laboratories by express. 
 
 There are three uses to which bacteriological laboratories may be 
 put. The original and principal purpose of these laboratories is to per- 
 form routine work in the diagnosis and control of communicable dis- 
 eases. The second purpose is to engage in such work as the produc- 
 tion of the antitoxins, vaccine, tuberculin, etc. The third purpose is 
 
COMMUNIC I VBLE DISK. I SES. 557 
 
 the pursuit of original investigations, work which mpre properly belongs 
 t<> state, federal, or university laboratories, but which sometimes can 
 best be done in connection with municipal work. 
 
 The equipment of the laboratory and the working force employed 
 will of course vary according to the use to which it is to be put. If 
 the laboratory work is to be simply the routine work of examining 
 diphtheria cultures, tuberculous sputum, and typhoid and malarial 
 blood, an extensive laboratory is not needed, and unless the city be a 
 large one, a single bacteriologist with perhaps an assistant to do the 
 manual work, is all that is really needed. The cost of such a labora- 
 tory need not be very great, as a skilful worker can get along with 
 very simple and inexpensive apparatus. He must, however, have a first- 
 class microscope, in the purchase of which parsimony does not pay. 
 Only |300 was at first expended on the Denver laboratory in which 
 much very valuable work lias been done. This expenditure included 
 the microscope. In Hartford the same amount was spent exclusive of 
 tin- microscope. 
 
 If the city is a large one the expense may be somewhat increased in 
 the increased amount of apparatus required. If it is intended to en- 
 courage original research, more elaborate arrangements are necessary. 
 Original scientific research is not properly one of the functions of muni- 
 cipal government : but sometimes knowledge is almost entirely lacking 
 for the solution of some pressing municipal problem, and it is perhaps 
 wise to undertake research which should have been made by others, but 
 which has been neglected. Thus in Berlin the erratic working of the 
 filters called forth the researches of Piefke upon the mechanism of con- 
 tinuous sand filtration; the bad odors in Boston* waters almost qi 
 Bitated the original work on the flora of the water, done under the direc- 
 tion oi the superintendent of the works, to determine the cause of the 
 trouble, and in Providence the investigations of Weston as to the effi- 
 ciency of a "mechanical" filter about to be adopted l>\ the city called 
 public attention to the Value of a method of filtration concerning which 
 
 little had before been known, ('ertaiii lines of investigation can best be 
 
 conducted in the municipal laboratory. Methods of practical house dis- 
 infection can best be studied there and such questions as the variation 
 in the morphology and physiology of the diphtheria bacillus and its dis- 
 tribution. Another reason for offering facilities for original research is 
 
 thatbv bo doing greater inducements are held out for the services of 
 
 first-class men. who if they were not afforded such opportunities, would 
 
 surety gravitate to the universities. For these reasons some of the 
 Larger cities, as Boston, New York. Philadelphia, and Pittsburgh, have 
 Been lit to establish bacteriological Laboratories on a Bomewhal generous 
 
 scale. 
 
558 COMMUNICABLE DISEASES. 
 
 The following are some of the salaries paid for bacteriological 
 work : 
 
 Bacteriologists 
 
 City. and Annual 
 
 Assistants. Salary. 
 
 Baltimore 1 bacteriologist $1,500 
 
 Boston 1 bacteriologist 2,500 
 
 1 bacteriologist 900 
 
 1 clerk 728 
 
 1 assistant per week 13 
 
 Brooklyn 1 bacteriologist TOO 
 
 1 assistant 300 
 
 Buffalo 1 bacteriologist 1,500 
 
 1 assistant 1,200 
 
 Cambridge 1 bacteriologist 1,000 
 
 Charleston 1 bacteriologist 900 
 
 Chicago 1 bacteriologist 1,800 
 
 2 assistants 1 ,000 
 
 Cincinnati 1 bacteriologist 000 
 
 Columbus 1 bacteriologist 400 
 
 Denver 1 bacteriologist 1,500 
 
 Fitchburg 1 bacteriologist per culture 1 
 
 Hartford 1 bacteriologist 600 
 
 Lowell 1 bacteriologist 600 
 
 Lynn 1 bacteriologist 900 
 
 Minneapolis 1 bacteriologist 1,000 
 
 Newark 1 bacteriologist . . 2,000 
 
 Newark 1 assistant 666 
 
 New Haven 1 bacteriologist 800 
 
 New York 1 director 2,500 
 
 1 assistant director 2,000 
 
 2 assistant directors 1,600 
 
 12 bacteriologists 1,200 
 
 Newton 1 bacteriologist 800 
 
 Pittsburgh 1 bacteriologist 1 2,000 
 
 Philadelphia 1 director 2,400 
 
 1 assistant 1,200 
 
 1 assistant 900 
 
 1 assistant 700 
 
 1 clerk 1,000 
 
 1 helper 600 
 
 1 helper 500 
 
 Rochester 1 bacteriologist 1,200 
 
 St. Louis 1 bacteriologist 2,400 
 
 St. Paul 1 bacteriologist 1,200 
 
 1 assistant 300 
 
 San Francisco 1 bacteriologist 1,800 
 
 Springfield, Mass 1 bacteriologist per case 2 
 
 Syracuse 1 bacteriologist 1,000 
 
 Worcester 1 bacteriologist 700 
 
 1 Has other duties connected with the Bureau of Health. 
 
CO MMl WI( - 1 B L E 1)1 ska sKs. 5 5 9 
 
 At present bacteriological laboratories have been established in all 
 of the forty principal cities of the United States except Albany, At- 
 lanta. Cleveland. Jersey City, Omaha, Paterson, Richmond, Scranton, 
 and Toledo. Probably many smaller places do bacteriological work. 
 and among such that have come to the notice of the writer are Brook- 
 line, Mass., Montclair, and Orange, X. J., and Ottumwa, la. 
 
 It is only the routine diagnostic work of the laboratory which will 
 be considered in this connection. The different diseases will lie con- 
 sidered separately. 
 
 Diphtheria. 
 
 In the official diagnostic work done in diptheria and other infectious 
 diseases health officials have been far in advance of the medical pro- 
 fession. Almost as soon as simple methods of technique were de- 
 veloped for the recognition of the diphtheria bacillus, sanitary officials 
 were offering to make such examinations for physicians; but the physi- 
 cians were not ready to avail themselves of the assistance offered, as 
 they had not generally become aware of the value of the latest results 
 of bacteriological research. The first step then in utilizing the serum 
 culture as an aid in the diagnosis of diphtheria was the publishing of 
 information as to its value, and the method by which it could be em- 
 ployed. The earliest bacteriological laboratories issued to the medical 
 profession, as the first step in their work, a circular giving information 
 concerning the value of the serum culture in the diagnosis of diph- 
 theria. As this knowledge has now become common property such 
 a preliminary circular ought not to be necessary, but even as late as 
 October, 1899, the agent of the board of health of Brookline, a resi- 
 dential suburb of Boston, found it advisable to call the attention of 
 the practicing physicians to the value of cultures, although the health 
 departments of his own and the neighboring cities had been usim.; the 
 Culture method for four or five years. 
 
 The outfit for diphtheria cultures consisted at first of aslant tube of 
 Loeffler's blood serum and another test tube containing a sterile cotton 
 swab, both tubes being earried in a box just large enough to hold them. 
 This is also the outfit still generally employed, but in several cities cer- 
 tain modifications have been adopted. The original swab consisted of 
 
 COtton wound on the end of an iron wire and placed in a test tube the 
 
 same size as the serum tube and plugged with cotton. In Philadelphia 
 a number If aluminum wire is used. This is preferred because it can 
 
 lie readily cleaned with dilute sulphuric acid, and because the end can 
 
 be readily nicked with a knife in keep the cotton from slipping. In 
 Boston, brass wiiv is used with one end roughened to hold the cotti. p. 
 
5 6 <■ ' OMM I r XICA BLE DISEA SES. 
 
 In Providence a tinned iron wire is employed (number 17 wire), with 
 the end slightly flattened to better hold the cotton ; these wires cost 
 twenty-five cents a pound, of about 800 wires. Absorbent cotton is 
 used in most cities, but in Boston a non-absorbent cotton of fine grade 
 called " jewelers' cotton ** is used, because it is desired that the swab 
 should be non-absorbent. In Providence raw cotton is used just as it 
 comes from the cards. In Chicago the swab is formed of a wooden 
 skewer, the end on which the cotton is wound being a little smaller 
 than the rest. The swab is kept in a tube of only slightly greater 
 diameter than the skewer and slightly shorter and it is kept in by 
 means of the rubber part of a medicine dropper. Professor Ernst of 
 Harvard University gave up the use of the swab entirely and substi- 
 tuted a small platinum wire about three inches long. This is fastened 
 in a small brass tube and this in turn kept in a little larger tube. When 
 it is to be used, it is pulled out from the larger tube and stuck in the 
 other way with the wire projecting. This was used in Boston and 
 other Massachusetts cities for which Professor Ernst examined and is 
 still employed in Cambridge and Eitchburg. See Eig. 37. 
 
 The serum tubes are almost always not far from one-half inch 
 inside diameter, though somewhat smaller tubes are sometimes used. 
 The length however, lias varied considerably. The tubes used at first 
 in Boston were six-inch, while those put on the market by Parke, Davis 
 & Co. are four-inch. The most common lengths are five and six inches. 
 Common test tubes were used at first and are to some extent at present, 
 but the loss from breakage is very great and it is annoying and some- 
 times dangerous to have them break after inoculation. Hard glass 
 ignition tubes without lip are generally preferred. The prices vary of 
 course with the price of glass, but for a year or two such tubes have 
 been furnished by Whitall, Tatum & Co. at $3.60 per gross. The 
 Boston board of health purchase thick tubes without lip, of J. Elwood 
 Lee Co. of Coshocken, Penn., at $13 per thousand. Recently in Prov- 
 idence about two inches of the tube has been etched with hydrofluoric 
 acid to furnish a surface on which the name of the patient may be 
 written. See Fig. 35. The serum tubes are, of course, plugged with 
 
 WBBt- 
 
 Fig. 35. 
 
 Swab Tube used in Fro\ idence, with etched surface for writing name of patient. 
 
COMMUNIGABLE DISEASES. 5(31 
 
 cotton through which evaporation takes place quite rapidly and this 
 drying up of the serum has rendered it very difficult to keep the tubes 
 at the depots in a suitable condition. In Philadelphia the tubes are 
 covered with rubber, medicine droppers with the rim cut off, being 
 used for the purpose. In Providence small nipples were used but the 
 plan was abandoned as it proved hardly worth the trouble. In Balti- 
 more the tube is sealed by inverting it and dipping the cotton in melted 
 para tine. In Boston a small cork is concealed in the cotton plug to 
 check evaporation. In the District of Columbia the cotton is pressed 
 down into the tube and a sterile cork inserted. In Chicago the use of 
 the tubes for serum has been given up and small flat aluminum boxes 
 are substituted. These are filled with serum and covered, and when 
 sterile, a rubber band is put around the box. making a pretty tight seal. 
 These boxes are compact and do not break and it is claimed that they 
 can be conveniently incubated in an inside vest pocket. They cost 
 #13. o<) per thousand and are made by the Illinois Can Company of Chi- 
 cago. Dr. Gehrmann states that unless great care is taken to obtain 
 perfectly pure aluminum they corrode very rapidly. See Fig. 36. 
 
 Fig. 36. 
 
 Chicago Diphtheria out tit. Wooden spatula, glass slide fur smear, alum inn in i»>\ for medium, 
 with rubber ring to close it, and swab enclosed in tube; all enclosed in a strong envelope. 
 
 The outfit used by Professor Ernst contains two serum tubes, one 
 
 of which is intended to be inoculated from the throat and the other from 
 the nose. One of the difficulties of keeping drug stores and physicians 
 supplied with serum tubes, is that the serum rapidly becomes dry. and 
 if used in this condition, gives verj unsatisfactory results. In a few 
 
 cities serum tubes are not sent out at all, swabs only being supplied to 
 the physicians. This is done in most cases in Columbus, ( >.. Manches- 
 ter. X. II.. in Minneapolis, Nfev Haven, Pittsburgh, Providence, Roches- 
 ter, Springfield, Mass., and in the Delaware and New Jersey state labor- 
 atories. It has been found by experience in these cities that better 
 results by far are obtained by this method than when poor serum tubes 
 
 are used by physicians, as the} certainly will be if generally distrib- 
 
562' 
 
 COMMUNK 'ABLE I) I SEA SEK 
 
 utecl. If the swab is returned to the laboratory within a few hours, 
 and rubbed on a good serum tube, it gives as good results as when it 
 is rubbed on the serum at once. At least this was the result of a large 
 number of comparative tests made in Providence. One advantage of 
 this method is that the bacteriologist is more likly to swab the serum 
 thoroughly than is the practicing physician. In Pittsburgh 1 it was 
 found that better results were obtained from swabs which had been kept 
 even as long as a number of days, than from tubes which had been inoc- 
 ulated at the bedside and kept out of the incubator for some hours. It 
 was explained that tubes so kept probably allowed the growth of sapro- 
 phytic bacteria which obscured the examination, while no such result 
 occurred if the tube was inoculated just before it was put in the incu- 
 bator. The Minnesota state laboratory, however, did not get quite as 
 good results with swabs. 
 
 When a serum tube and a swab tube are sent out together as a 
 " diphtheria outfit," as is done by most laboratories, the two are en- 
 closed in a box which may be made of various materials. In Cam- 
 bridge and Fitchburg the boxes are made of copper of the style shown 
 in Fig. 37. These boxes are 1 by 2 by 6 inches in size and cost eighty 
 
 
 
 
 Fig. 37. 
 Diphtheria Outfit used in Fitchburg. The wire is used for inoculating the serum; a swab in 
 the upper tube is for cover glass examinations. 
 
 cents. They are made by Peter Gray of Boston. The advantage is 
 that they can be readily sterilized and are strong and durable. Their 
 disadvantage is that they are expensive and heavy. When they were 
 used in Boston the department lost about fifty a year and gave them 
 up as they were too expensive. In Buffalo a round wooden box with a 
 screw cover is used. In Cincinnati and Denver a package made of a 
 block of wood bored with two holes is preferred. In New Haven 
 where a swab tube only is sent out, it is enclosed between two grooved 
 
 1 Pittsburgh, Report of Bureau of Health (1895), p. 103. 
 
( ■ OMMUNIi . 1 B L K B IS A'. 1 5 E8. 
 
 563 
 
 Fig. 38. 
 
 Swab Bent out for diphtheria cultures in New Haven, between 
 grooved aud hinged blocks. 
 
 K.-tum K 
 
 •pt.. trty Hull. 
 
 innen poh 
 
 Fig. 39. 
 Swab used for diphtheria culture;- in Minneapolis. No serum tube is sent mit. 
 
 J^. 
 
 Fig. 40. 
 i tiphtheria < (utflt used in Philadelphia. 
 
 pieces of wood hinged a1 one end. Fig. 38. In Minneapolis the swab 
 tube is smt out in ;i tin box. Fig. 39. In Newark. Ww V«»rk and 
 Philadelphia wooden boxes, as shown in Fig. l<». have been adopted. 
 These cannol be sterilized by heat, as the} are glued and varnished, 
 hut they iiia.\ be washed with a disinfectant Thej maybe obtained of 
 Blooniinerdale Bros., Third Avenue and Fifty-ninth Street, New York, 
 at a cosl of >■•!'» per hundred. The} are cheap, Light, and fairly durable. 
 In Baltimore, Boston, the District of Columbia, and Providence, 
 pasteboard boxes an- preferred. The} are made of size to hold two 
 
564 OMMUNICABLE DISEA SE<S. 
 
 tubes and cost $7 per 1,000. They are used only once. Similar boxes 
 are used by the Rhode Island state board of health but they have a 
 partition and cost $1 more. Fig. 41. In Chicago the aluminum box 
 
 Fig. 41. 
 
 Diphtheria Outfit used by the State Board of Health of Rhode Island; 
 pasteboard box with serum tube and cotton swab. 
 
 and the small swab tube are sent out in a tough brown paper envelope. 
 It is certain that the package containing a diphtheria outfit is pretty 
 likely to become infected and should not be sent to another case un- 
 less disinfected. The metal boxes are disinfected when they are used, 
 but the wooden boxes rarely are. In the District of Columbia they were 
 formerly disinfected by washing with a solution of corrosive sublimate, 
 one to two hundred, but they are now disinfected with formaldehyde 
 gas. In New York City they are disinfected. The pasteboard boxes 
 are used only once in Providence and the District of Columbia, but in 
 Boston they are disinfected with dry heat and used several times. It 
 is' important also that the outfit should be as light and compact as 
 possible, qualities which have been secured in the Chicago outfit. In 
 Philadelphia the culture box is sealed when it leaves the laboratory. 
 It also contains unused seals which may be used by the physicians. In 
 Boston and some other cities a spatula made of a thin strip of soft pine 
 five and one-half by five-eighths of an inch is supplied with each outfit 
 and is to be burned at the house. These are purchased of Schlegel & 
 Fottler, seedsmen, at #1.25 per thousand. 
 
 The culture outfit usually contains two printed slips, one contain- 
 ing directions how to take the culture, and the other being a form on 
 which the maker of the culture is to note various items of interest to 
 the bacteriologist or the health officer. Below 1 is a form of direction 
 
 Directions for Making Cultures in Cases of Suspected Diphtheria: 
 " The patient should be placed in a good light, and, if a child, properly held. In 
 cases where it is possible to get a good view of the throat, depress the tongue and 
 rub the cotton swab gently, but freely, against any visible exudate. In other cases, 
 
COMMUNICABLE DISEASES. 565 
 
 which is commonly used and seems to be explicit enough, but physicians 
 sometimes fail to follow it on the first trial. In Providence where a 
 great many outfits are supplied to physicians at the department office, 
 directions are not put in the boxes there, as almost all who call are 
 known to be familiar with the operation. 
 
 In most cities outfits are not distributed to physicians at the health 
 office but are left at stations to be called for by the physician when 
 needed. Experience, however, has shown that they are taken by the 
 physicians and sometimes kept by them a long time and used when very 
 dry. It is the usual custom to leave these outfits at various drug 
 stores scattered in convenient portions of the city. In Buffalo and 
 Philadelphia they are kept at police stations and in Pittsburgh at police 
 and fire stations. In the smaller cities and towns there is no need of 
 such a general distribution, and even in Cambridge they are kept only 
 ai the laboratory and office of the bacteriologist. 
 
 It is of course necessary for the physician to see that his name ami 
 that of the patient accompanies the outfit on its return, and most 
 laboratories have required him to note many other items. When this 
 system was introduced it might have been necessary to ask for more 
 information than now need be required. If there is no official super- 
 vision of the case, the report of the physician is the only way in which 
 information, interesting from a scientific point of view or useful for the 
 work of the laboratory, can be obtained: but if the case is to be t'ol 
 lowed up as it should be, all desired information can be obtained by 
 the medical inspector at his visits. The less the physician is asked to 
 QOte on a written report, the more satisfactory will it be. Some ot the 
 physicians' memoranda which accompany diphtheria outfits have many 
 items. See Appendix 99. 
 
 In Philadelphia the memorandum is in a cardboard book ol eight 
 pages l.l inches by .">.', inches, which is tiled away when returned and 
 serves as a permanent record: it also has blanks on it for the record o! 
 the examination. A card is sent out in Baltimore, and on its return is 
 
 used as a permanent record. See Appendix Phi. 
 
 Including those in which the exudate is confined to the larynx, avoiding the tongue, 
 pass ill'- swab [at back, ami rub it freely againsl the mucous membrane of the 
 pharynx ami tonBils. Without laying the swab down, withdraw the cotton plug 
 from the culture tube, inserl the swab, and rub that portion of if which has touched 
 //,. exudaU gently but thoroughly back "<"' forth over tin aurfaci of the blood 
 terum. Do net push the swab into the blood serum, nor break the surface in any 
 way. Then replace the Bwab in its own tube, plug both tubes, pul them in the 
 box, ami return tin- culture outfit at once to die station from which it was obtained. 
 • \ report will he Forwarded the following morning by mail, or can he obtained bj 
 telephone, after L2 noon. 11 
 
 There is a list nf stations <»n i he reverse. 
 
566 COMMUNICABLE DISEASES. 
 
 All that is required in Providence is the filling of the form shown 
 below which is stamped on the cover of the box. All the other items 
 can be readily obtained in other wa}'s, and the filling out of such a 
 small memorandum causes the physician very little trouble, and it pays 
 the health officer to trouble the practicing physician as little as pos- 
 sible. 1 
 
 In Providence the medical inspector has found it convenient to carry 
 a number of tubes in a large package and mark each tube. The tubes 
 have the upper two inches etched with acid and are written on with an 
 ordinary lead pencil. In some cities, as Baltimore, New York, and 
 Philadelphia, a different memorandum, one containing fewer items, is 
 sent out with outfits intended for secondary cultures, but as culture out- 
 fits will not always be used when intended, confusion must sometimes 
 result. 
 
 It is necessary that all the old tubes should be called in, and fresh 
 tubes supplied at intervals. This is done every two weeks in Balti- 
 more, every six weeks in Hartford, every two months in Boston, and 
 every three months in Cincinnati. In Providence all physicians who 
 ask for them are supplied with swab tubes and boxes which they may 
 keep in their offices or buggies. 
 
 In some cities, as Baltimore, Cambridge, and Providence, the phy- 
 sician must return the inoculated tube to the laboratory, but usually 
 outfits may be returned to the drug stores and other stations, and pro- 
 vision is made for their collection from these. In New York City there 
 are a number of main stations which the laboratory messenger visits at 
 4 p. M. The other stations send the boxes to these before that time. 
 In Pittsburgh the sanitary police collect the tubes at 4.45 p. m., and in 
 Philadelphia and Buffalo they are collected by the police. In Buffalo 
 as soon as the box is received at the police station it is wrapped in a 
 paper with one edge gummed so that it can be sealed and endorsed on 
 the back with the name of physician, name of receiver, and time re- 
 ceived. 
 
 A list on a printed blank, of the pl^sicians and number of outfits, 
 is sent from the stations each day with the package of boxes. 
 
 In Boston the cultures are sent by the drug stores to the laboratory 
 before <i p. m. The messenger receives twenty cents for each trip, and 
 
 
 
 If there 
 
 is any water 
 
 in Se 
 
 ruin Tube, Pour 
 
 it Out. 
 
 Name 
 
 of 
 
 Patient 
 
 
 
 Residence 
 
 
 Docto 
 
 r's 
 
 Name 
 
 RETURN 
 
 TO 
 
 CJTY HALL. 
 
 Date 
 
( OMMUNIi A BLE DlsK. I .v/->. 537 
 
 there is a desire on the part of druggists to secure the privilege of keep- 
 ing outfits. In Newark there is a collector of cultures who receives 
 $750 a year. In Chicago, Detroit, and Providence, if the physicians 
 telephone to the health department a messenger is sent for the outfit. 
 In some of the larger cities the health department is kept open all night 
 for the reception of diphtheria cultures, while in other cities the bac- 
 teriologist sometimes has an incubator at his house, as in Cambridge, 
 ( Ihicago, and Denver. 
 
 While a serum culture is supposed to give correct results in ninety 
 per cent, of the cases, direct examination of a smear from the throat or 
 the swab will only give correct results in from thirty to fifty per cent., 
 yd >ometimes it is so desirable to ascertain the result of the examina- 
 tion promptly, that the examination of the swab may be resorted to. 
 This is done when requested in many laboratories. Of course a posi- 
 tive result only is considered decisive in such cases. In Boston they are 
 made in from rive to ten per cent, of the cases. In about the same 
 number of cases an examination of the growth on the serum is made 
 alter the latter lias remained five hours in the incubator. 
 
 The technique of the laboratory will not be discussed, but only those 
 matters which more directly concern the relations of the health depart- 
 ment to tlie physician and the patient. Suffice it to say that the very 
 best professional work should be done with the greatest care to avoid 
 any mistake. In large laboratories the slides are often examined by 
 two persons, and two or three cover slips arc often taken from each cul- 
 ture. In Philadelphia and Buffalo in order to correct any mistake 
 which may have arisen, the slides are kept for one year. 
 
 Accurate records should be kept of all examinations. In Providence 
 the laboratory record is entered by the examiner in a common blank 
 Itook as lie makes the examination, the principal forms of organisms 
 being noted. The result of the examination whether positive or nega- 
 tive is also entered on the record slip of the case. In Baltimore and 
 Philadelphia, as shown above, the examiner notes his findings on the 
 physician's memoranda, which are preserved, arranged alphabetically or 
 
 h\ BtreetS. In other cities a Separate slip is tilled out by the examiner, 
 
 and in New York all slips are kept in envelopes, on the outside oi which 
 is a summary of results, and the envelopes are arranged in drawers. 
 
 Alter the examination is made the result is Bent to the physician as 
 soon as possible. Most laboratories send their reports by the afternoon 
 mail of the da\ next afteithe taking of the culture. Most laboratories 
 
 offer to answer all telephone requests after noon. In Pro\ ideme nearly 
 all important cultures are examined before nine o'clock of the next day 
 
 anil are telephoned the physicians before that hour, at which time most 
 
568 COMMUNICABLE DISEASES. 
 
 of them go out on their morning calls. The same method is pursued 
 in Brookline, Mass. All reports are telephoned in Cincinnati. When 
 cultures are examined in another city from that in which they are taken, 
 as when the work is done by the state laboratory, results are often tele- 
 graphed at the expense of the city sending the cultures ; but in all cases 
 reports are sent by mail even when they are also telegraphed or tele- 
 phoned. Communications by mail are sometimes sent on postal cards, 
 as in Baltimore, Buffalo, and Providence, but usually they are sent 
 under seal as physicians prefer it. Very often the reports of positive 
 and negative results are sent on cards of different colors or are printed 
 in different colors as in Boston and Philadelphia. Sometimes the report 
 simply states the fact that diphtheria bacilli have or have not been 
 found in the culture referred to. Occasionally other items are added to 
 the report besides the mere statement that diphtheria bacilli are found. 
 In Pittsburgh it is stated whether the diphtheria bacilli are 
 
 1. In pure culture. 
 
 2. Associated with staphylococci-stivptococci-bacterial mixture. 
 
 The form used in Chicago is shown in Appendix 101. 
 
 It is seen that this form is used for reporting both positive and 
 negative results, but as was before stated, usually different and distinc- 
 tive blanks are used for reporting positive and negative results. 
 
 Many of the blank forms state in addition that the case in all prob- 
 ability is not diphtheria and will not be treated as such. It seems 
 unwise to send out such a notice, for it has been shown that the margin 
 for error on the first culture is certainly eight or ten per cent,, and this 
 is too large to warrant the phrase "in all probability."' It would be 
 better to call attention to this chance of error and suggest that if any 
 doubt as to the nature of the case exists, another examination should 
 be made. Such a suggestion is made in the Philadelphia form. 
 
 A certain number of examinations will always be unsatisfactory and 
 indeterminate, and usually in such cases a special form of report is sent 
 out, most of which have been copied from that used in New York City. 
 See Appendix 102. 
 
 The Baltimore report adds very properly that another culture is 
 desired. 
 
 Besides sending the report to the attending physician the bacteri- 
 ologist in New York City sends to each medical inspector a list of all 
 cases in his district which have that day been examined with the results 
 of the examination. In Providence in those cases which the attending 
 physician has turned over to the health department for final cultures, 
 reports of the results are sent to the family. 
 
COMMUNIi \ I BL K VISE. 1 8J8&. 569 
 
 Tuberculosis*. 
 
 The aid given to diagnosis by bacteriological examinations in tuber- 
 cular phthisis, though not as great as in diphtheria, is very important. 
 Most bacteriological laboratories offer the same facilities for bacteriologi- 
 cal examinations in phthisis as in diphtheria, but some do not. Cain- 
 bridge, Detroit. Fitchburg, Hartford, San Francisco, and Worcester, and 
 nmst of the state laboratories make this test. As in diphtheria, explan- 
 atory circulars are usually sent out to physicians as a preliminary to 
 the introduction of this system. In most cities physicians are expected 
 to furnish the receptacle to contain the sputum. Much annoyance is 
 sometimes caused by the use of improper and leaky receptacles, and 
 sometimes suitable ones are furnished by the laboratory. This is done 
 by the state laboratories of Delaware, Rhode Island, New Jersey, and 
 in Pittsburgh and New York City : and in Rhode Island the outfits 
 are left at the same depots as the diphtheria outfits. The outfit used 
 in Rhode Island consists of a glass bottle with screw cap made of metal 
 and enclosed in a stiff pasteboard box. In Pittsburgh an ordinary wide 
 mouth stoppered bottle in a plain wooden box is furnished. Accom- 
 panying the outfit are directions and a blank on which the name of the 
 patient and certain clinical data are to be filled in by the attending 
 physician. See Appendices 103 and 104. 
 
 In New York unless the name of the patient accompanies the 
 sputum, the result of the examination is not sent to the physician, but 
 a notice to that effect is sent instead. Otherwise the result is scut, a 
 positive result on one form and a negative result on another, the latter 
 calling attention to the indecisive character of failure to find bacilli. 
 
 A record book is kepi for all examinations and the data furnished by 
 the physicians are also recorded. A separate book is kept for institu- 
 tions and all discs are noted on a large atlas. 
 
 Typhoid. 
 
 As for tuberculosis so for typhoid, fewer laboratories offer facilities 
 for its diagnosis than for diphtheria. The first step is the issuing of a 
 Circular of information and the preparation of an outfit for collecting 
 and sending the blood to the laboratary. Various methods arc employed 
 forthe latter purpose. Theoretically the best method is to collect a 
 little blood in a capillary tube, but practically it is difficult t<> gel tins 
 done properly, and tubes are rarely provided. In Providence such tubes 
 
 have been used lo a Slight extent bill Hot Willi lllUcll success. Ill New 
 
 York City an outfit is sometimes used which consists of a small glass 
 bulb in a wooden box. a felt vaccine shield and a bit of cant liarides 
 
 plaster. The latter is applied t<> the skin and protected by the felt 
 
570 COMMUNICABLE DISEASES. 
 
 shield. After a blister is raised the glass bulb is rilled from it by gravity 
 and the end sealed. Fig. 42. The most common method is to recom- 
 mend that the blood be collected on a piece of paper. In the Baltimore 
 
 
 Fig. 42. 
 
 Typhoid Outfit used in New York City. Cantharides plaster for 
 raising blister and capillary tube for serum. 
 
 city labor atoiy a piece of paper 2x3^ inches is sent out with the direc- 
 tions that about five large drops of blood should be allowed to dry upon 
 it. In Delaware and New Jersey a piece of paper four inches square 
 is used folded like a powder paper. The Boston outfit is shown in Fig. 
 43. The Maryland state board of health sends out small tin boxes like 
 
 Size 3* x 44- Inches. 
 
 1EALTH OEPAF 
 
 -o 
 
 Fig. 43. 
 
 Typhoid Outfit used in Boston. 
 
 those used in Chicago for diphtheria cultures. These are sent out in 
 pasteboard boxes. In Minnesota aluminum foil is used, and after the 
 blood is gathered upon it it is made into a roll. In Denver, Newark, 
 New York City, Pittsburgh, St. Louis, and some other cities, glass 
 slides in a wooden box are used. See Fief. 44. 
 
( ' OJfJIL 'XI CABLE VISE. I sEs. 
 
 01 
 
 Fig. 44. 
 
 Typhoid Outfit used in Newark. 
 
 Ill Chicago a bit of sterilized mica is wrapped in a sheet of paper 
 and is enclosed in an envelope directed to the health department. The 
 mica is preferred because it does not break and does not absorb the 
 blood. 
 
 Printed directions accompany the outfit and also a blank to be filled 
 by the attending physician. The form used in Baltimore is shown in 
 Appendix 105. 
 
 Reports to the physician must be made and sometimes two forms 
 are used, one for negative and one for positive reports. In Pittsburgh 
 only one form is used for all cases. Records are kept of all examina- 
 tions, either on cards, as in Baltimore and Pittsburgh, or in book form. 
 
 Malaria. 
 
 This disease, though qoI of bacterial origin, has received some atten- 
 tion from health department laboratories. Most laboratories do not 
 offer to examine blood for the malarial organism, but it is done by the 
 state laboratories of .Massachusetts and Maryland, and the city labora- 
 tories of Lowell and Baltimore. In Charleston it is the principal work 
 of the laboratory. The blood is collected and sent in on cover glasses 
 in the manlier prescribed in the directions issued by the laboratory. 
 
 Bacteriological Laboratories are occupied chiefly in the diagnosis of 
 
 the diseases JU81 considered, diphtheria, tuberculosis, typhoid lever, and 
 
 malaria: but they sometimes offer their assistance in other directions. 
 As a bacteriologist must be a good microscopist, his aid ma\ sometimes 
 he asked in the diagnosis of rallies, actynimycosis, glanders, trichinosis, 
 gonorrhoea, cerebronapinal-meningitis, or almost an} parasitic disease, 
 
 but it is seldom that a public offer of assistance is made in an\ of tlie-e. 
 Ileceiiib the bacteriologist of the health department in Minneapolis 
 offered assistance iii the diagnosis of cerebro-spinal-nieiiiugitis and a 
 
572 COMMUNICABLE DISEASES. 
 
 number of cases were investigated by him by means of spinal puncture. 1 
 In Chicago considerable work has been done in the diagnosis of epidemic 
 influenza. The examinations were made chiefly from cultures of the 
 bronchial secretions grown on blood serum. Some examinations were 
 made of the bronchial secretions direct. 2 In Boston many examinations 
 . are made for glanders, and in Minnesota for rabies. 
 
 Persons familiar with danger are apt to become careless of their own 
 safety, and bacteriologists are no exception to the rule. A number of 
 cases are on record where they have been infected during their labora- 
 tory work. The health officer should guard against this'as against all 
 other means of spreading communicable disease, and the board of health 
 of New York City has adopted rules for laboratory work which are in- 
 tended to reduce the danger to a minimum. 3 
 
 1 Minneapolis, Report of Health Department (1899), p. 30. 
 
 - Chicago, Bulletin of Department of Health (January, 1899). 
 
 3 Xew York, Report of Department of Health (1896), p. 222: 
 
 " The following rules for the prevention of possible infection in the bacteriologi- 
 cal laboratories of this department must be strictly obeyed. The assistant directors 
 in immediate charge of said laboratories will enforce the same: 
 
 "First — After handling tubes, bottles, etc., containing diphtheria cultures, 
 samples of sputum or any other possible infectious material, or any culture made 
 from the same, the hands must be thoroughly washed with soap and water, using a 
 nail brush, and must then be rinsed in a solution of bicloride of mercury, 1 to 1,000. 
 This must be done immediately after handling such material, and before proceeding 
 to other work. 
 
 "Second — The hands must be washed and rinsed as above when leaving the 
 laboratory at the lunch hour, or at the conclusion of a day's work. 
 
 " Third — Desks must be thoroughly wiped off at least once daily with a solution 
 of carbolic acid, 5 per cent. Floors must be mopped with the same solution at least 
 once weekly. 
 
 "Fourth — Samples of sputum, diphtheria culture tubes and all other possible 
 infectious material, together with all cultures made from the same, must be steri- 
 lized as soon as work on them is concluded. 
 
 " Fifth — The blanks accompanying samples of sputum must be sterilized imme- 
 diately after unwrapping samples. 
 
 "Sixth — Vials, receptacles, corks, wrappers and everything accompanying 
 samples of infectious material must be sterilized as soon as possible. 11 
 
 " In addition to the above, more specific rules have been formulated and posted, 
 
 regarding the precautions to be taken in handling specimens of sputum. These are 
 
 as follows: 
 
 Direction* for Handling Samples of Sputum. 
 
 First — Receipt of samples: 
 
 (a) Remove outer wrappings and burn them at once. 
 
 (b) Place samples, with blanks, in metallic box and cover with layer of cotton, 
 moistened with 5 per cent, carbolic acid solution. 
 
 (c) Wash the hands with soap, etc. 
 
 Second — Preparations of specimens for examination: 
 (a) Mark blanks and specimens for identification. 
 (ft) Sterilize blanks. 
 
( • OMM I WI( A B L E BltiEA sEs. 573 
 
 Vaccination. 
 
 Vaccination is rightly considered the most important individual 
 prophylaxis against smallpox and a very valuable means of controlling 
 outbreaks of that disease. The ideal condition would be the main- 
 tenance of complete vaccination in every individual in the community. 
 By that means smallpox would be entirely abolished. At the time of 
 the discovery of this measure, it was hoped and expected that this 
 desirable result would soon be accomplished : but the difficulties in 
 maintaining complete vaccination in every one are so great that the end 
 desired seems scarcely nearer than it did a century ago. While it is 
 true that there are in the Tinted States, few. if any, communities which 
 are even approximately protected in this manner, it is also true that 
 vast numbers of individual men, women and children are so protected : 
 and it is furthermore true that in a majority of outbreaks occurring in 
 our cities, vaccination is employed with great effect in subduing them. 
 It is also certain that the vaccination which we have is due almost 
 entirely to the active exertions of sanitary officials. 
 
 Vaccination Legislation. 
 
 Vaccination legislation is very largely statutory, though there are 
 a good many local regulations on the subject. Federal laws concerning 
 vaccination operating uniformly throughout the United States, would 
 of course from a practical standpoint be the most desirable, but they 
 are not permitted under our constitution. The most that the federal 
 government can do is to legislate concerning the vaccination of passen- 
 gers included in foreign and interstate traffic. Under the authority of 
 an act of congress the secretaryof the treasury lias issued the following 
 order to inspectors at foreign ports: 
 
 steerage passengers and crew, coining from districts where smallpox prevails 
 in epidemic form, or who have been exposed to smallpox, shall he vaccinated before 
 embarkation, unless t bey show evidence of immunity to smallpox by previous attack 
 or recent successful vaccination. 1 ' 
 
 Steamship companies also require vaccination and it has been for 
 
 man} years the custom of state and municipal quarantine stations to 
 require the vaccination of immigrants. At Portland, Ore., all unvac- 
 cinated immigrants are required to pay twenty-five cents for being vac- 
 cinated. 
 
 1 1 ,1 Wash 1 he bands \v n li soap, eb . 
 
 (</) Make smears, pul awaj specimens, wipe desk with b percent, carbolic arid 
 
 solnl ion. 
 
 (e) Wash 1 be hands w ith soap. etc. 
 
 I /') Stain smears and mount. 
 
 [g) Wash tin- hands with soap, etc. 
 
574 COMMUNICABLE DISEASES. 
 
 The general grant of sanitary power, particularly of the power to 
 legislate, undoubtedly confers authority to make rules in regard to vac- 
 cination even if the subject is not specifically mentioned. Power to 
 " make rules necessary for the public health " would so evidently cover 
 this subject that it is rarely named in ennabling acts even if other 
 specific subjects are referred to. It is recognized that nothing can be 
 more necessary for the public health than to make rules for vaccination 
 and to provide for its performance. 
 
 It does however sometimes happen that special power is given by 
 statute to make such rules. Thus in Connecticut : J a The health 
 officers may adopt such measures for the general vaccination of the in- 
 habitants of their respective towns as they shall deem proper and nec- 
 essary to prevent the introduction or arrest the progress of smallpox." 
 In Michigan 2 boards of health may order the vaccination of all children 
 or others who have not been vaccinated within five years. In North 
 Carolina, 3 cities, towns and counties may make rules requiring vaccina- 
 tion, and a similar rule is found in Virginia, 4 Colorado, 5 and Kentucky. 6 
 The health officer in the District of Columbia, the board of health in 
 Buffalo, and bureau of health in Pennsylvania cities of the second class 
 have similar powers. In South Carolina the state board of health may 
 order vaccination. 7 
 
 Legislation concerning vaccination may have one of two objects in 
 view. It may provide for the employment of this method of combat- 
 ing outbreaks of smallpox, or it may seek to secure the permanent im- 
 munity of the general population. 
 
 Colorado, Indiana and North Carolina merely authorize the local 
 sanitary authority to provide for vaccination during the prevalence of 
 smallpox, and even then only as an alternative to isolation. In Col- 
 orado the health officer is " to order the prompt isolation or vaccination 
 of persons who have been exposed to smallpox.'" In North Carolina 
 the superintendent of health on the appearance of smallpox is to vac- 
 cinate all poor persons in the neighborhood. 
 
 In Indiana it is a rule of the state board of health which must be 
 promulgated by each local board of health when smallpox occurs or is 
 threatened, " to compel a vaccination or revaccination of all exposed 
 
 1 Connecticut, General Statutes (1888), Sec. 2607. 
 - Michigan, Compiled Laws (1897), Sec. 4465. 
 
 3 North Carolina, Act of 1 March, 1893, Sec. 23. 
 
 4 Virginia, Code (1887), Sec. 1733. 
 
 5 Colorado, Act of 13 April, 1893, Sec. 42. 
 
 6 Kentucky, Statutes (1894), Sec. 4610. 
 South Carolina, Chapter 78 of 1899. 
 
COMMUNIt ABLE DlsE. I 5 ES. 575 
 
 persons.'* Similar provisions are found in New Jersey, but this state 
 has other laws as well. The law for the District of Columbia also re- 
 quires that all persons exposed to smallpox shall he vaccinated, and a 
 similar ordinance is found in Mobile. In addition to this employment 
 of vaccination, the statutes in North Carolina permit the municipalities 
 to make rules in regard to vaccination, and in the District of Columbia 
 allow the health officer to order a general vaccination at his pleasure. 
 In New Mexico the governor may order vaccination and appoint vac- 
 cinators. In Georgia county and municipal authorities may order 
 vaccination to prevent smallpox. 
 
 Most of the vaccination 'laws contemplate the vaccination of the 
 whole population or certain large and susceptible portions of it. The 
 vaccination of school children has very generally and for a long time 
 been considered a practical and effectual method of securing the vac- 
 cination of the larger part of the population at a very susceptible period 
 of life. It is argued, and rightly, that it is not only the right but the 
 duty of the state to protect its schools against the invasion of com- 
 municable disease, and that this method of requiring the vaccination of 
 pupils is a simple and effectual means of preventing the invasion of the 
 schools by smallpox. It is, however, unwise to assume that the vac- 
 cination which is required before entrance into school will protect 
 throughout the school course. If the vaccination is performed just be- 
 fore the beginning of school life and attendance does not continue 
 beyond the twelfth or fourteenth year, one vaccinatioE may perhaps be 
 Sufficient protection, but if the vaccination is done in infancy or school 
 lite extends beyond this age the degree of protection is probably \er\ 
 slight. It is certainly a grave mistake to assume that vaccinations in 
 early life will protect a population when it has become adult. It is this 
 aSSUmptiOD either actually made by or attributed to sanitarians by ain.i- 
 vaccinationists, that has been the text for much of the literature of the 
 
 latter. The vaccination of school children is a valuable means of keeping 
 
 Smallpox out of scl Is and is successfully insisted on in many states: 
 
 but to rely on it to secure an adult immune population, is to rely upon 
 a broken iced. Laws requiring the vaccination of school children 
 have been declared constitutional in Indiana, 1 Pennsylvania, 2 New 
 
 York, 8 ami ( alifornia.' 
 
 Indiana, Report of State Board of Health 1 1894), p. 384. 
 - Pennsylvania, Report of State Board of Health (1895), Vol. 11.. \>. 82. W. F. 
 Sprague vs. .1. E. Baldwin, </. ,,/., L896. 
 
 Brooklyn, Report "' Department •<( Health (1895). 
 
 i alifornia, Report of State Board of Health (1889 90), p. i". r>. K. Abell »*. 
 o. ('. Clark, L890. 
 
576 COMMUNICABLE DISEASES. 
 
 The following states have legislation concerning the vaccination of 
 school children : In several states, Connecticut, Maine, New Jersey, and 
 Ohio, the governing board of the public schools is authorized to make 
 rules excluding all unvaccinated children, but they are not directed to 
 do so. In Connecticut the board must pay for the vaccination of the 
 poor. In Ohio the school board may exclude children who are not vac- 
 cinated and may call on the board of health to vaccinate children 
 whose parents neglect to do it. In New Jerse} r the board of education 
 is empowered to require the vaccination of all school children before 
 admission, and also to require their revaccination if smallpox occurs in 
 the city or district. It is also provided that when the school census is 
 taken, the unvaccinated children shall be so designated, and if their 
 "parents desire them to be protected from smallpox " and are, in the 
 opinion of the board of education, unable to pay for it, they shall be 
 sent to any physician to be vaccinated, who shall receive from the town 
 the sum of fifty cents. 
 
 In California, Delaware, Florida for cities of 2,000 inhabitants. 
 Iowa, 1 Illinois, 1 Maryland, Massachusetts, New Hampshire, North 
 Dakota, 1 New York, Pennsylvania, and Rhode Island, the statutes ex- 
 plicitly forbid the attendance at school of unvaccinated persons, and in 
 Wisconsin a similar rule made by the state board of health was for- 
 merly in force, but has recently 2 been declared unconstitutional, the 
 state board of health not having such legislative power. These laws 
 differ somewhat, although none of them are very extensive. Perhaps 
 one of the clearest, is that of Delaware : 3 
 
 " The trustees or commissioners of school districts, and boards of education, are 
 required, within one month after the passage of this act, to oblige all children 
 applying for admission to the free schools, and all children who have previously 
 been admitted to the said schools, to be vaccinated, unless already protected froBfi 
 smallpox by vaccination or by an attack of smallpox." 
 
 Most of the laws are made applicable to public schools only : but in 
 Florida the superintendents of all institutions of learning are to enforce 
 the law, and in Iowa the rule applies to every person entering any 
 school. A similar rule is enforced in the cities of Denver, Chicago, 
 Cleveland, Minneapolis, Omaha, and St. Louis. 
 
 Though many of these vaccination laws are worded so as to apply 
 only to pupils, yet it certainly ought not to be so, and is not in Iowa, 
 where " every person entering any school " must be vaccinated, and in 
 
 1 In this state it is a rule of the state board of health, made in accordance with 
 the statute organizing the board. 
 
 a Wisconsin, Supreme Court, 23 February, 1897, State rx rel Adams vs. Budge 
 ft. (d. School board. 
 
 3 Delaware, Act of 21 March, 1883, Sec. 1. 
 
COMMUNICABLE DISEASES. 077 
 
 Florida -iin child or person " shall be admitted contrary to tin- rule. 
 The same provision is* found in the California and New York laws. 
 
 Most of the laws simply require that everypupil must he vaccinated, 
 although of course iliis cannot he done in those who have previously 
 had smallpox, and who would by a strict interpretation of the law. he 
 excluded from school privileges. The exception in favor of those who 
 have had smallpox is made in Delaware, New Hampshire, Pennsylvania, 
 and Cleveland. In California the law reads: 
 
 ''provided that any practicing and licensed physician may certify that the child or 
 person has used due diligence and cannot ho vaccinated so as to produce a success- 
 ful vaccination, whereupon such child or person shall be exempted from the opera- 
 tion of tins act." 
 
 A still more important exception is found in .Massachusetts: 1 
 
 ■• \o child who lias not been duly vaccinated shall he admitted to a public school 
 except upon presentation of a certificate signed by a regular practicing physician 
 
 that such chilil is an unfit subject for vaccination."'' 
 
 In Florida 2 it is a rule of the state hoard of health that all children 
 shall he successfully vaccinated unless some reputable physician certifies 
 thai it would he injurious to the .health of the child to vaccinate it. 
 
 It without dotiht frequently happens that a child is not in a suitable 
 condition lor vaccination hut yet might very well lie at school. It is to 
 provide for such cases that the above were enacted ; hut it is claimed by 
 some that this provision is ahused. and many of the Massachusetts 
 
 health officers think that the health officer alone should have authority 
 to grant exemptions from the law. In Iowa children may he tempo- 
 rarily excused from vaccination if they are not well. 
 
 Several of the Laws like that of Delaware merely require that the 
 child be " vaccinated." In Massachusetts and New Hampshire he must 
 he --(Inly vaccinated." In Florida and Rhode Island the vaccination 
 mnsi he •• successful" and in Illinois the vaccination must be "proper 
 and successful," and in the hitter slate the state hoard of health by 
 whom the rule is made have defined very accurately what shall he 
 deemed evidence of a •• proper ami successful vaccination.'" In Penn- 
 sylvania the rules of the state hoard of health formerly required thai no 
 pupil should be admitted who had not been successful!} vaccinated within 
 seven years. A similar rule is found in Chicago, Denver, Omaha, 
 and Spokane, and in Cleveland the period is live years. 
 
 ( >utside the states mentioned as Legislating on the school attendance 
 of mi vaccinated children, the important cities of Cleveland, Omaha, 
 
 Spokane, Mobile, and Denver have local rules of a similar import 
 
 1 Massachusetts, Chapter 196 of 1898, Sec. LI. 
 
 - Florida, Rules of the State Board of Health (1897), Rule 54. 
 
578 COMMTTNIt 'A BLE DISK. 1 6' ES. 
 
 enacted by the sanitary authority, and there are doubtless also a great 
 many smaller places. In St. Louis it is a rule of the school board and 
 has been sustained in the courts. 1 Even in some of the states which 
 have a general compulsory vaccination law it is evidently not well 
 enforced, and it becomes necessary for cities in such states to take 
 additional precautions. Thus in Louisville, Ky., although in a state 
 where it is required that every child be vaccinated before it is a 
 year old, there is a local regulation requiring the vaccination of 
 school children, and in 1894 2 the health officer found 8,039 school 
 children requiring vaccination. Minneapolis, though in a- state having 
 compulsory vaccination, has a local rule concerning school attendance. 
 
 Sometimes the parochial schools have required certificates even when 
 not compelled to do so by law. This was done in accordance with the 
 direction of the bishop in Chicago in 1893 during the smallpox 
 epidemic and in Providence in 1885, when the importation of small- 
 pox from Montreal was feared, but it was not continued in either city. 
 
 In Florida no manufacturer is to admit an employee unless vac- 
 cinated. In Massachusetts the law provides that when the local board 
 of health orders it, all manufacturing corporations shall at their own 
 expense cause all their employees to be vaccinated, and the superin- 
 tendents of all institutions for the dependent and defective classes shall 
 do the same. In Kentucky all inmates of state institutions are required 
 by law to be vaccinated. In Connecticut a law to secure the vaccina- 
 tion of workers in paper mills requires that paper manufacturers shall 
 bear all the expense if any one of their employees is taken sick with the 
 smallpox. In Maine the owners of paper mills must employ no one 
 who is not vaccinated and must prepare a list of all employees in Janu- 
 ary and September, and the board of health must examine the employees 
 in March and October. 
 
 The following is from Maryland: 
 
 " No small fruit-grower, canner, truck farmer, or fish packer shall take into his 
 employ any person or persons who do not show written proof of vaccination of more 
 recent date than July, 1898. Any person or persons violating this law shall he fined 
 nut less than $50 nor exceeding $500." 3 
 
 The persons who handle the rags in paper mills have in past years 
 
 been particularly affected by smallpox, the infection being carried in 
 
 the rags. The benefits arising from vaccination have been so apparent 
 
 to the paper makers of Massachusetts that the large manufacturers of 
 
 paper have always been strong supporters of the vaccination laws of 
 
 that state. 
 
 1 St. Louis, Report of Health Commissioner, 1895-96, p. 44. 
 
 2 Report of Health Officer for year ending 31 August, 1897, p. 5. 
 :i Maryland, Order of State Board of Health, 6 March. 1899. 
 
( ■ OMM I r NJ( '. I B L E D Z3 A'. 1 S ES. .", 7 9 
 
 True compulsory vaccination contemplates the vaccination of the 
 entire community. It seeks to secure immunity from smallpox by 
 having every person in the community vaccinated. To bring about 
 such a result in the United States with a population rapidly shifting 
 
 from city to city and state to state and increased each year by large 
 numbers of immigrants, it would be necessary to require the vaccination 
 of all immigrants and to have compulsory vaccination laws in all the 
 states. Thr latter we are far from having. Given a state even with 
 strict vaccination laws, the amount of executive energy and espionage 
 necessary to secure their absolute enforcement upon a shifting popula- 
 tion is so great that it can hardly lie expected that with our notions of 
 government, it would be possible to have an immune population except 
 perhaps for a brief time during some emergency. Yet there are a good 
 many compulsory vaccination laws on the statute books of the different 
 states and cities, and great effort is made in some localities to enforce 
 them. Most of these laws, however, provide for the compulsory vac- 
 cination i'f children. Florida, Iowa. Kentucky, .Maryland. Massachu- 
 setts, and Minnesota have laws of this character. 
 
 The Florida 1 law simply requires that parents shall have their 
 children vaccinated whenever the health authorities shall direct. The 
 Maryland statute is much the same. In Massachusetts'- the law requires 
 parents and guardians to cause their children and wards to be duly vac- 
 cinated before they attain the age of two years unless a regular prac- 
 ticing physician certifies that they are unfit subjects for vaccination. 
 The most stringent law is found in Kentucky: 3 
 
 '•All persons of the age of twenty-one years ami over, who have not been vac- 
 cinated, or, it vaccinated, not successfully, shall, within three months after this 
 revision takes effect, procure their own vaccination or re-vaccination, as the case 
 may lie. 
 
 ••All parents, guardians and other persons having t he care, custody or control of 
 any child or children, or who ma\ have in their employ any minor or minors, shall 
 have the same vaccinated; and every parent, guardian ami person that m;i\ have the 
 care, custodj or control of anj child horn hereafter, shall have said child vaccinated 
 within twelve months after iis birtli or after it comes under his or her care, custody 
 mi- conl nil. 
 
 "All persons coming into this state 1 » . abide or become citizens "ho have not 
 been vaccinated, or who maj have children under their care or control t hat have not 
 been vaccinated, shall procure the vaccination of themselves and said children within 
 six months aftei coming into the state. 11 
 
 In low ;i o\ 1 ty person over one year of age must be vaccinated unless 
 protected. While compulson vaccination laws are found in onl} a lew 
 
 'Florida, Rules of the State Board of Health (1807), Rule 54. 
 -.Massachusetts, Chapter 515 of 1894, Sees, l 2. 
 Kentuckj . Mai utes i 1804 i, Sees. W08 L0. 
 
580 COM Ml WIG 1 ABLE DIKE A SMS. 
 
 states, there are quite a number of cities outside of these states which 
 have local regulations of like character, as Denver, Jersey City, Memphis, 
 New York, 1 Omaha, and Yonkers. 
 
 \\\ Atlanta every resident of the city is required to be successfully 
 vaccinated or to be vaccinated a sufficient number of times to make it 
 evident that successful vaccination is impossible. A similar rule is found 
 in Scranton. 
 
 In Nashville 2 it was ordered in 1900 that all persons who had not 
 been vaccinated since 1 December, 1899, should be, but the rule was 
 not to apply to persons seventy years of age or over, to 'women more 
 than five months pregnant, nor to any too ill to submit to it. 
 
 There are certain states in which vaccination is not made compul- 
 sory by statute, but in which the local governments are authorized to 
 make it so. Such states are Connecticut, Maine, Michigan, North 
 Carolina, Virginia, and by their charters it is authorized in Buffalo, the 
 District of Columbia, and Pennsylvania cities of the second class. 
 
 Louisiana 3 is the only state in which compulsory vaccination is for- 
 bidden by statute. 
 
 Up to the time of the introduction of bovine virus into the United 
 States, humanized virus, so-called, was employed partly in the form of 
 dried lymph on quills, partly by the arm to arm method, but mostly by 
 triturating and moistening the crusts. Owing to the efforts of Dr. LL 
 L. Martin of Massachusetts the attention of the medical profession was 
 called to the merits of bovine virus, and Dr. Martin was himself the 
 first to furnish a reliable form of this virus in commercial quantities. 
 The use of bovine virus rapidly became popular and almost entirely dis- 
 placed the humanized form. 4 A few physicians in all parts of the coun- 
 try are found who prefer humanized virus, but although it has been 
 preferred by some owing to the better results obtained than from the 
 ivory point bovine, it has not of late been much used on account of 
 popular prejudice. Humanized virus one or two removes from the cow 
 is recommended in Louisville. 5 For twenty-five years, and until within 
 a year or two, almost all the vaccine virus employed in this country 
 was bovine virus furnished on ivory points. 
 
 1 New York City. Sanitary Code (1899), Sec. 108. 
 
 2 Nashville, Order of Board of Health, 5 January, 1900. 
 
 3 Louisiana, Chapter 180 of 1877. 
 
 i Humanized virus has been continuously cultivated in Providence, R. I., and it 
 is probable that this strain is the only pure Jennerian virus to be found in the United 
 States. It has been employed continuously since 1856 by the public vacainator, and 
 since 18G8 careful records have been kept of each transfer. Between 1868 and 1900 
 there were 638 transfers. The virus at the present time produces symptoms and 
 a vesicle precisely like those described and figured by Jenner. 
 
 5 W. P. White, Louisville Medical Monthly, January, 1895. 
 
< OMM I ~XI< \ I B L E 1> ish\ j .s /-/> 58 1 
 
 To provide or control the supply of vaccine virus is very properly 
 
 considered one of the functions of the hoards of health and has been 
 provided for by statute in several states. Some states provide for the 
 supervision and control of the vaccine made or used in the state. Thus 
 in Massachusetts: 1 "All vaccine institutions in the commonwealth shall 
 be under the supervision of the state hoard of health." This law only 
 provides for the control of vaccine made in the state, and the law is of 
 little value as no penalties are attached. The New Jersey 2 statute 
 attempts a supervision of the virus used in the state In California the 
 virus furnished by the vaccine agent must be approved by the state 
 hoard of health. The Maryland 3 law compels care on the part of the 
 physician in selecting- humanized virus. In Indiana it is a rule of the 
 state hoard of health that no humanized virus shall he employed except 
 in an emergency, and in Florida bovine virus is required. The Michigan 
 statute also requires that bovine virus only shall be used in public vac- 
 cinations, and a similar rule is found in Denver and Omaha. 
 
 \\\ only a lew states have the state hoards of health taken it upon 
 themselves to carefully inspect the places where virus is produced, and 
 to test tlie virus and publish the results of their investigations. The 
 state board of health of Tennessee during the summer of L898 directed 
 the state bacteriologist to inspect the vaccine virus farms from which 
 virus was sent to that state. As a result of the investigation the state 
 hoard of health recommended vaccine from three places. In 1896 the 
 state hoard of health of Pennsylvania 4 sent a bacteriologist to examine 
 the principal vaccine establishments of the country. In all fourteen were 
 
 1 Massachusetts, Chapter 355 of L894. 
 \>w Jersey, Public Laws of L895, p. 493, Sec, I: 
 
 "Thai it the board of health of the state of New Jersej shall ascertain any vac- 
 cine virus, antitoxin or oilier animal producl sold, or offered for sale, or held for 
 sale "i- use wit liin this stair for prophylactic or remedial purposes, to lie dangerous 
 t<> human health, or mi impure or inert as te he inefficacious in rendering immune or 
 
 less susceptible to disease anj person in w I i such product may he used, it shall he 
 
 lawful to i' t he said hoard ot health of the state of New Jersey to prohibil i he further 
 sale or use within this state of any vaccine virus, antitoxin or other animal product, 
 as aforesaid, manufactured or produced bj the party who shall have manufactured 
 or produced such dangerous, inert, impure or inefficacious product. 11 
 
 1 .Maryland. Public General Laws, Vol. I., p. 786, Chapter 257 of 1872, see. 5i 
 ■\u\ physician who shall knowingly or wilfully use any virus defective in its 
 
 oat ure, hy having passed through a scrofulous system, from liaving been taken iron; 
 
 one laboring under anj disease of the skin, chronic sore or other febrile or other 
 
 disease, during the progress of the vaccine disease, or any crusl which duriffg the 
 ess oi said vaccine disease, was punctured or had sustained other injury, shall 
 
 upon conviction thereof forfeit and paj a sum not less than 1100, nor more than 
 
 ft 
 
 ' Pennsylvania, Report of State Board of Health (1896), Vol. I., pp. '-"•'. 99, 156. 
 
5 8 2 ( ' OMMl Wit A BL E I) I SEA SES. 
 
 visited by the bacteriologist together with a veterinary surgeon, and a 
 most elaborate and complete investigation was made as to the characters 
 of the farms and the methods employed, and the condition of the virus 
 produced. Only four stations were found worthy of commendation. 
 The Association of State Boards of Health 1 has appointed a committee 
 which has investigated many of the farms with much the same results 
 as given by the Pennsylvania board. The committee has not as yet 
 made its final report recommending the proper method of dealing with 
 this subject. 
 
 Something in the way of determining the character of the virus 
 employed, at least of that employed by the municipal officers, has been 
 done b}* several cities even outside of those which furnish their own 
 virus. In 1895 the bacteriologist of the Chicago board of health tested 
 a large number of samples of virus to determine which was most free 
 from extraneous organisms, and as a result of the tests selected one 
 make which was found to be considerably superior to others. 2 This 
 was a glycerinized virus. Since that time each lot of virus received by 
 the city has been tested : 1. For the presence of bacteria, moulds, etc. 
 2. For tubercle bacilli. 3. To determine its vaccinal value. The 
 virus is received in lots of 5,000 capillary tubes, and of these ten samples 
 are taken at random for each of the above tests. If the results of the 
 tests are not satisfactory the whole lot is returned. This has sometimes 
 been done because of the presence of a large number of bacteria and 
 sometimes because of failure to "take." No tubercle bacilli have ever 
 been found in this or in any of the numerous samples of other makes 
 of virus that have been tested. The department of health of Minne- 
 apolis 3 also tests the virus used by its officers, for tubercle bacilli. 
 In Brooklyn several makes of glycerinized virus were tested in 1896, 
 but all were found to contain bacteria. 4 Charleston and Denver also 
 test their virus for the presence of bacteria. In St. Louis and St. Paul 
 the department of health tests virus for its vaccinal power. 5 
 
 A number of states and cities have deemed it best to furnish virus, 
 and in some cases to produce it. In California 6 there is a state vaccine 
 agent who " must furnish genuine vaccine matter approved by the state 
 board of health to any regular practicing physician in good standing in 
 
 1 Conference of State Boards of Health, Proceedings of 10th and 11th meetings, 
 pp. "A and 70. 
 
 2 Chicago, Report of Department of Health (1895-6), p. 237. 
 
 3 Minneapolis, Report of Department of Health (1S97), p. :!. 
 
 4 Brooklyn, Report of Health Commissioner (1895-0), p. 107. 
 5 St. Louis, Report of Department of Health (1896), p. 112. 
 "California, Civil Code (1886), Sec. 2994. 
 
< ■ OMMUNIt \ 1 BLE I)Ish\ J SES. 5 s ; ; 
 
 his profession in this state. He may charge and receive for every 
 parcel of vaccine matter furnished the sum of five dollars, which is full 
 compensation for his services and expenses." In Georgia the governor 
 is to buy vaccine and distribute it to the "ordinaries of counties."' In 
 Louisiana the state board of health is to furnish " pure, fresh vaccine 
 matter to the district sanitary inspectors and city physicians for the 
 purpose of gratuitous vaccination," the expense to be borne by the state 
 board of health. In Maryland the governor appoints a state vaccine 
 agent who is to have bis agency at Baltimore. The state maintains a 
 vaccine farm and the product is distributed gratuitously. The agent 
 shall advertise monthly in Baltimore and annually in each county. 1 In 
 .Mississippi the state board of health is to furnish virus to the local 
 health officer when lie orders it : but the health officer must previously 
 (or in emergencies as soon as possible) certify to the county clerk the 
 ssity for the order. The secretary of the state board of health 
 must keep virus on hand and the board is to pay for the same. 
 
 The city of Mobile requires its health officer to keep on hand a 
 supply of vaccine virus which shall be distributed to physicians free of 
 '•barge. In Brooklyn, Minneapolis, Philadelphia, and St. Louis, virus 
 is distributed without charge to private physicians. In St. Louis the 
 physician is obliged to report on a blank furnished, the results of the 
 use of the virus. Such distribution is not however common ; but a 
 number of cities, as Chicago, Denver, and Omaha, require the health 
 department to keep on hand a supply of virus, presumably for its own 
 use. 
 
 New York is the only city which prepares its own virus, which it 
 has done since L876. In 1895 this work was turned over to the bac- 
 teriological laboratory and methods of producing virus were thoroughly 
 investigated with the result that the board introduced the use of 
 glycerinized virus. The following is a description of the method em- 
 ployed. 2 The vims made by this board has in the hands of the writer 
 given better results than any he has ever used : 
 
 Maryland, Public General Laws (1888), Vol. I. p. 786, Chapter 257 of L872, 
 Sec. II : 
 
 "The siatc vaccine agent is hereby required to take all steps accessary to repro- 
 duce from the cow true vaccine virus, for the use of physicians residing and prac- 
 ticing medicine and surgery iu the state, and slmi! furnish none more than four re- 
 moves from the cow, if practicable, and none thai lias not been produced under his 
 own supervision and direction; provided, thai he maj take, use and furnish suoh 
 vims furnished t<> him l>> any physician entrusted by him to procure the same; 
 
 audi virus noi to be taken from the arm "i' a <liil<! less than three nths old; and 
 
 the s;ml agent skill reporl annuallj to the governor, the particulars of Ins expendi- 
 tures, and other matters connected with the duties of Ms agency." 
 
 \.w Fork Reporl of Board of Health (1896), p. 235. 
 
584 COMMUNICABLE DISEASES. 
 
 "A ted heifer calf about two months old, in good flesh and health, is placed 
 upon a bench in a special operating room and strapped on its side with one hind leg 
 fastened vertically against the back of the bench. The area between the thighs, 
 covering about ten inches square and including the teats, is shaved and washed 
 with soap and water, with hydrogen peroxide solution, and finally with sterilized 
 water and then dried witli sterilized absorbent cotton. On the area so prepared, 
 one hundred spots are then scarified, each from a quarter to half an inch square. 
 The blood is washed away with sterilized water, and when the bleeding has entirely 
 ceased virus is rubbed on each spot very thoroughly for some minutes; the calf is 
 then returned to its stall. It is examined on the third and following days, and when 
 the vesicles are seen to be at the proper stage of development, which is usually on 
 the sixth day. the calf is again placed upon the bench and the whole shaved area 
 washed twice with sterilized water and once again with peroxide of hydrogen 
 solution. All microscopic dirt and crust is removed and every scarification is 
 cleansed as thoroughly as possible; then with a sterilized curette each scarification 
 is scraped and every particle of pulp removed into a sterilized glass dish. The pulp 
 taken is weighed, comminuted, and mixed with a measured amount of chemically 
 pure glycerin, by being passed between glass rollers on which the glycerin flows. 
 There is thus produced a brown syrupy homogeneous emulsion, which is then 
 drawn by a filter pump into sterilized glass tubes, which when full are sealed in the 
 flame at both ends. Each of these tubes holds about twenty cubic centimeters. 
 Capillary tubes of the mixture are prepared at the same time. The greatest pre- 
 cautions are taken to insure cleanliness in the production and preservation of t he 
 virus. All instruments and receptacles are sterilized, and the operations of inocu- 
 lation and collection are made as nearly aseptic as possible. 
 
 " Before the virus from any animal is used, first, the animal is sent to autopsy and 
 its organs are examined by a veterinarian for any evidences of disease; second, two 
 samples of the virus are given, one to the bacteriologist and the other to the 
 medical tester of virus, and no virus is issued unless the reports of the pathologist, 
 bacteriologist and clinical tester are all satisfactory. The clinical test consists in 
 the inoculation of the virus by scarification, in three places on each of five children 
 who have never been previously vaccinated. There is thus a case test of five and an 
 insertion test of fifteen points, and unless the virus gives one hundred per cent, suc- 
 cess in each, that is, unless there are fifteen vesicles formed as a result of the inser- 
 tion, the virus is not used. 
 
 •■ When there is need for virus, the contents of a large tube are forced into a steril- 
 ized burette and from that drawn off in measured amounts into small sterilized 
 vials, of which there are two sizes. one containing one-fifth of a cubic centimeter for 
 ten vaccinations, and the other one cubic centimeter for fifty vaccinations. These 
 vials are corked with sterilized rubber stoppers. If capillary tubes are needed, the 
 virus is allowed to flow into a sterilized glass box, which is closed by a glass cover 
 pierced by a hole which just admits a capillary tube. One tube after another is 
 then passed through this opening into the virus and sufficient virus drawn into each 
 tube for one vaccination." 
 
 It is not sufficient that laws shall require that persons exposed to 
 smallpox shall be vaccinated, or that this shall be required of school 
 children, or that general compulsory laws shall be upon the statute 
 books. It is necessary that some one shall see to it that these laws are 
 enforced, 'and it is also necessary that some public officer shall be en- 
 trusted with the actual work of vaccinating,. at least so far as the poor 
 are concerned. All of this work naturally falls within the province of 
 the board of health. Sometimes these powers and duties are explicitly 
 
COMMUNICABLE DISEASES. 585 
 
 imposed upon it. but often they are assumed in the general grant of 
 sanitary power. Some of these duties are. however, occasionally thrown 
 upon other officials. 
 
 in states where there is no statutory requirement for vaccination 
 for school children, but where the authority to make such a rule is 
 given to the loeal government, it is sometimes not the board of health 
 that has this authority but the school board. This is so in Connecticut, 
 Maine, New Jersey. Ohio and St. Louis, it would seem to be much 
 more logical tor the board of health to decide such a matter, and more 
 logical still for the compulsory vaccination of school children to he in- 
 sisted on by state law if it is allowed at all. For if it is useful and 
 proper in one community, it is in all: hut perhaps if public sentiment 
 does not permit of a state law it is after all wise to let such cities and 
 towns as desire the protection of their school children by vaccination. 
 insist upon it. 
 
 The enforcement of school vaccination law must primarily rest with 
 the school officials, teachers, superintendents and boards of control. 
 This is directly provided for in most of the laws, as in California. Dela- 
 ware. Florida, Maryland, New Hampshire. New York, .Massachusetts, 
 and in Indiana. Illinois, and Iowa, where the regulation is made by the 
 Btate board of health, that board can call upon the school authorities to 
 enforce it. Sometimes it is the teacher who is required by the statute 
 to enforce the law by excluding the un vaccinated. .More often it is the 
 school hoard or school committee who are supposed to have full con- 
 trol of the teachers. In Maryland 1 the statute directs that no teacher 
 shall admil an unvaccinated child and also that no trustee shall admit 
 such. Practically it is, of course, upon the individual teachers that the 
 labor and responsibilitj of enforcing this law must fall. 
 
 Manifestly, the onh proper way for the teachers to see that the law 
 is obeyed is to require from each child a certificate from some physician 
 or officer that the child is vaccinated within the meaning of the law. 
 The teacher of course is not usually competent to determine this fact. 
 The Rhode Island law requires this certificate which must he from ;i 
 ** practicing pyhsician." Maryland also requires ;i doctor's certificate. 
 
 .Most of the states have no statute law on the suhject hut a number of 
 
 cities have rules. Thus in Cleveland and other Ohio cities there must 
 he a physician's certificate. In Omaha and Chicago the certificate must 
 be from the health commissioner or some licensed physician. In Den- 
 ver il must he from the health commissioner or some physician recog- 
 nized h\ him. In Minneapolis it must he from a resident physician, and 
 in Fitchburg it must he from the hoard of health. 
 
 1 Maryland, Public General Laws | 1888), Vol. I., p. 786, Art 81. 
 
58G COMMUNICABLE DISEA SES. 
 
 The most explicit directions concerning the certificate are not found 
 in any statute or municipal rule but in the regulations of the Illinois 
 state board of health. 1 
 
 In Chicago 2 a certificate is not to be given unless the cicatrix is 
 " not less than one-third inch in diameter, depressed, dead white in 
 color, characteristically pitted, and perfect in outline." The value of the 
 character of the cicatrix as an evidence of the character of the vacccina- 
 tion is accepted by the above rules as it is by most physicians, but that a 
 very " bad " cicatrix may result from a typical vaccinal vesicle is shown 
 by recent observations of the board of health of New York." 3 
 
 Different forms of vaccination certificates are shown in Appendices 
 106-109. In Maryland the vaccination certificate must give the source of 
 the virus used. 4 Of course a physician cannot give a certificate of vaccina- 
 tion immediately after performing the operation, and as the teacher usu- 
 ally desires some proof that the child has attempted to comply with the 
 law, a limited permit is sometimes issued, as in New York City. 
 
 In many places the teacher simply asks to see the certificate and 
 destroys it or gives it back to the pupil. This loose method invariably 
 
 1 " Before being admitted as a pupil in any public school, every child must pre- 
 sent to her or his teacher, a certificate signed by a legally qualified physician stating 
 (1) Name; (2) Age; (3) Residence; (4) Date of Vaccination — as near as may be; 
 (0) Date of Examination, accurately; and (7) Result, as shown on the child's 
 person. 
 
 " The date of examination and the result, as shown on the person of the child, are 
 matters which the physician must testify to of ' his own knowledge. 1 
 
 " Children over the age of fourteen years (approximately,) must present certifi- 
 cates showing that they have been vaccinated, or re-vaccinated, as the case may be, 
 subsequent to this age. 
 
 " A certificate from a legally qualified physician that a given child is protected 
 by a previous attack of smallpox or varioloid; or that it would be dangerous at the 
 present time to vaccinate a given child; or that such insusceptibility has been dem- 
 onstrated as, in itself, amounts to protection — shall be accepted by school author- 
 ities in lieu of the ' satisfactory evidence ' required by this order. 
 
 " Legally qualified physicians may obtain the Scholars' 1 Certificate blanks from 
 teachers, school directors, or other officers of public instruction; from county clerks: 
 or by mail, direct from the Secretary's office at Springfield. 
 
 " Returns of Vaccination Certificates (Form No. 52) should be made on or before 
 the 1st of January of each year. These should contain the names, (and all other 
 information indicated on the return) of every child in attendance who has not been 
 previously accounted for. Such information is not necessary concerning the scholars 
 who have previously complied with the requirement; but it is desired that the total 
 number of such scholars in attendance be reported upon the Return. All Returns 
 should be made through the County Superintendent, who, after examination, will 
 forward them.'' 1 
 
 - Chicago, Report of Department of Health (1895-6), p. 101. 
 
 3 City of New York, Report of Department of Health (1890), p. 241. 
 
 4 Maryland, Report of State Board of Health (1898), p. 21. 
 
CO MMl WI( \ 1 JJ L E I) I SEA SES. :, s 7 
 
 results in a lax enforcement of the law. Teachers should he required 
 to keep a record of the vaccinal condition of all pupils for the inspec- 
 tion of the superintendent or health officer. This is required by the 
 Rhode Island statute: hut it is to lie feared that in most cases the school 
 vaccination laws are not well enforced unless a lively interest and super- 
 vision is maintained by the health department. This is not the case in 
 the writer's own city, but from his own knowledge there are many towns 
 in his state where the law is not well enforced. Reports of other cities 
 sometimes show that the school department would he very lax if not 
 assisted by the health department as appears from the reports of 
 Ghicago, Pittsburgh, [leading, Rochester, St. Louis, and Qtica. In New 
 Jersey, in 1898, 1 of 471. ol 7 enrolled children in the schools. 106,879 
 were unvaccinated. In Chicago, in 1N!>4, 2 the commissioner of health 
 found 70,000 unvaccinated children in an enrollment of 189,000. It 
 was also found that a number of unvaccinated children were attending 
 school on a certificate which was given by some physician either care- 
 lessly or with wilful intent to evade the law. 
 
 There seems, however, to be no reason why school authorities should 
 not enforce the law. In Providence the superintendent of schools sees 
 that the law is obeyed so that there are practically no unvaccinated 
 children in school and this without urging on the part of the health 
 department whose sole province is to offer free vaccination at its 
 
 office. 
 
 If vaccination is to he required for admission to school, it is both 
 just ;iinl necessary that free vaccination should he afforded for those 
 who cannot pay. As a matter of practice in the vaccination of school 
 children, public vaccinators are not apt to enquire too closely as to the 
 financial resources of parents, hut vaccinate every child that can he 
 reached. The family physician cannot fairly complain that he has losl 
 a fee. if he has not taken the trouble to urge the vaccination of his clients' 
 children before they reach the scl 1 age. 
 
 Many of the state laws provide for such gratuitous vaccination. In 
 California, Connecticut, and New York, the school authorities are to 
 provide lor the vaccination. In California the trustees annually or when 
 required h\ the state board "I health must advertise by posting in two 
 places thai provision has been made lor the five vaccination of those too 
 poor to pay. The trustees are also required to make an annual census 
 of ;ill unvaccinated children of school age, and to provide vaccination 
 for all such and give certificates, the cosl t<> he paid out of the common 
 school moneys. In Connecticul and New York 'he i \ i^ to come 
 
 1 \rw Jersey, Report "i State Board of Health (1808), p. 33. 
 * Chicago, Report of Department of Health (1894), p. it:;. 
 
588 ( 'OMMl WICA BLE DISEA SES. 
 
 from the same source. In New York the school officers may appoint 
 a vaccinating' physician (they are required to furnish vaccine in some 
 manner) and fix his compensation. The school officers shall enumerate 
 the mi vaccinated children of school age in their districts, and shall send 
 such as are unable to pay to the aforesaid physician who shall vaccinate 
 and give a certificate. The school trustees shall in their annual report 
 state the number of vaccinated and unvaccinated children in their dis- 
 tricts. 
 
 In all the other states in which statutory provision is made for free 
 vaccination it is the city or township which is to provide and pay for it, 
 and often it is the board of health or health officer that is to vaccinate. 
 I j i .Maine. Michigan, New Hampshire, Vermont, and Virginia, the town- 
 ship is empowered to provide vaccination, but is not required to do so, 
 except in Vermont on order of the state board. It is required of the 
 local government in Delaware, Florida, Kentucky, Maryland, Massa- 
 chusetts, New Jersey, Ohio, and Rhode Island. In Delaware the trustees 
 of the poor for each hundred designate some physician who is to vac- 
 cinate all poor children who apply and give them certificates. In Mary- 
 land if no physician has been regularly appointed public vaccinator, a 
 child unable to pay may apply to any physician who may vaccinate and 
 on making an affidavit of the facts, can collect a lee of fifty cents from 
 the town. In New Jersey much the same plan is followed. The school 
 census shall show whether each child is vaccinated, and if a child is 
 unvaccinated and in the opinion of the school authorities is unable to 
 pay, a permit is given for the child to go to any physician, and such 
 physician may vaccinate, and by presenting to the township such per- 
 mit with the endorsement that the vaccination was successful, shall 
 receive fifty cents. 
 
 In Rhode Island the towns are required to appoint vaccinating phy- 
 sicians and fix the fee. The physicians are to give due notice of public 
 vaccination and are to record in a book the name of each child vaccin- 
 ated and deposit the same with the town clerk. The clerks may charge 
 fees for copies, i. e., certificates of vaccination. Almost always the cer- 
 tificates are given by the physician and the records are not often con- 
 sulted. 
 
 Such are the school laws and the statutory provisions for their 
 enforcement. Let us see what the cities and townships do in executing 
 them. 
 
 In a lew cases, as shown above in Maryland and New Jersey, the 
 statute provides for the vaccination of the poor by any physician, and 
 in Scranton a similar rule is in force, only the physician is to collect 
 from the city his regular fee: but most cities and townships appoint 
 
( ■ OMMl XIi \ 1 BL E D TSEA S ES. ;, s < i 
 
 one or more physicians as public vaccinators who are to do all the 
 gratuitous vaccination. In small communities the health officer fre- 
 quently adds tn his other duties that of public vaccinator. 
 
 The charter of the City of New York. Sec. 1225, provides expressly 
 for the appointment by the hoard of health of such vaccinators. In 
 Fall River 1 the clerk of the hoard of health, who is not a physician, dues 
 the vaccinating under the direction of the city physician. 
 
 There are three general ways in which these vaccinators may accom- 
 plish the object desired. 
 
 First. Due notice may lie given that the vaccinator will he at a 
 certain place at a certain time to vaccinate. In country places and 
 small towns this is very frequently the doctor's office at the doctor's 
 office hours; the doctor, of course, taking the precaution to provide 
 himself with a sufficiency of virus at the beginning of school terms when 
 his services are most in demand. In large communities the vaccination 
 is usually done at the hoard of health, if its office is at some convenient 
 place. In Cincinnati the physicians to the poor vaccinate at their 
 offices. In Providence public vaccination is every Friday at - v. m., 
 except during July and August. In Syracuse vaccination is done at 
 the City Hall two days in the week. The rules of the San Francisco 
 hoard of health require thai the health officer shall offer tree vaccination 
 each day and advertise the time and place in two papers. New York 
 City, Brooklyn, and St. Louis have live vaccination daily at the central 
 office of the health department, and Chicago formerly did, but this lias 
 been given up in that city because it was believed to he harmful to 
 
 crowd together so many children as appeared at such times. 2 In Pitts- 
 burgh, on the other hand, the health officer recommends that the vac- 
 cination at the schools he given up, and that free public vaccination 
 he held twice each year in each ward. In those cities where a number 
 of vaccinating physicians are appointed for house to house work, they 
 are usually also required to vaccinate those who come to their offices. 
 The} must in Philadelphia have in front of their office - Vaccine 
 Physician. Ward ." In Providence tree vaccination except dining 
 
 outbreaks of smallpox is taken advantage of almost exclusively 03 chil- 
 dren under School age or those ahoiit to cuter school. The liuuiher 
 
 vaccinated in 1899 was 2,863, which is probabl} not much under the 
 
 number of new children entering the schools that year. 
 
 A second method of securing the vaccination of school children and 
 at tin- same time aiding in the enforcement of the law is lor the public 
 vaccinator to visit each school and vaccinate all unvaccinated children. 
 
 ! Fall River, Report oi Department of Health (1895), p. 12. 
 
 ■ Chicago, Report of Department ol Health (1896), pp. :; :m<l '.'7. 
 
590 ( OMMl XI< ABLE DISEA SES. 
 
 One difficulty with this method is that it interrupts to some degree the 
 routine of school work. Another is that it is liable to cause friction 
 and trouble with parents. The latter may seriously object to having 
 the public vaccinator perform the operation. As such parents are 
 violating the law by sending their unvaccinated children to school, 
 they have no moral ground for complaint against the vaccinator who 
 makes them conform to the law, but that does not prevent their making- 
 talk, and talk of such kind is bad, particularly if there is already much 
 of an an ti -vaccination sentiment in the community. In Brooklyn this 
 school vaccination resulted in a suit against the health department and 
 the vaccinator by an aggrieved parent, but with a final decision in the 
 supreme court against the plaintiff. 1 
 
 This method of vaccinating school children has recently been 
 adopted in Chicago in place of free vaccination at the city hall. It is 
 also followed in St. Louis, Buffalo, Brooklyn, Pittsburgh, Syracuse and 
 many other cities, and is also frequently adopted in small towns and 
 country districts. In St. Louis there are six vaccinators who visit the 
 parochial as well as the public school. In Buffalo and Newton, Mass., 
 the city physicians do this work. The medical inspectors of schools do 
 some vaccinating in the schools of Boston. 
 
 Lastly there ma} T be employed house to house visitation for the pur- 
 pose of finding and vaccinating all unvaccinated school children ; but 
 this method is usually adopted, not exclusively for this purpose, but to 
 enforce general compulsory vaccination laws, or in the absence of such 
 laws to secure by persuasion as immune a population as possible. 
 Such house to house vaccination is not usually carried on except in the 
 case of outbreaks or threatened outbreaks of smallpox. In a few cities, 
 however, it is employed as a regular routine every year. Among cities 
 which do this may be mentioned Baltimore, Charleston, Philadelphia, 
 and Wilmington. In Baltimore and Philadelphia there is one public 
 vaccinator for each ward, and in Wilmington there are four vaccination 
 districts and one physician for each district. The rules governing these 
 vaccinators in Philadelphia are given below. - 
 
 1 Brooklyn, Report of Department of Health (1895), p. 114. 
 
 2 Philadelphia, Rules of the Board of Health (1895), Sees. 290, 294, 295: 
 
 " The vaccine physicians shall each furnish the board of health quarterly with a 
 list alphabetically arranged of the names, ages, birthplaces, residences and occu- 
 pations (and when children, of the occupation of their parents) of the persons 
 whom he may have successfully vaccinated. In making up the list, place the 
 " primary" and "secondary" cases (re-vaccinations) on separate sheets. 
 
 "The vaccine physicians are required to send, every montfi, to the chief clerk of 
 the board of health, an approximate statement of the number of successful opera- 
 tions. 
 
 "It shall be the duty of the vaccine physician to call on each and every family 
 
COMMUNICABLE DISEASES. 59] 
 
 In Wilmington the vaccine physicians who receive a salary of $100 
 per annum are to make quarterly visits through their districts. All 
 persons vaccinated by them must be seen twice after the insertion of 
 the matter, and the name, age. color and residence of each person vac- 
 cinated must be reported to the council at the end of each year. 1 
 
 There are twenty-three vaccine physicians in Philadelphia, and in 
 1894 and in 1895 they vaccinated about 30,000 persons each year. In 
 L896 about 18,000 were vaccinated. 2 In Baltimore in 1897 the twenty- 
 two vaccinators made 33,733 calls and vaccinated 12,905 persons, of 
 whom 10,188 had not been vaccinated before. They gave 10,447 cer- 
 tificates. 3 In 1899 thirty extra vaccinators vaccinated 60,000 persons. 
 In Chicago in IS'. 1 * ^'»(i physicians vaccinated 1^7.402 persons at a cosl 
 for services and virus of $12,397.66. 4 In New York house to house 
 visits are made every year through the tenement house districts, ten 
 vaccinators being employed. 
 
 Vaccinators must, of course, keep accurate records of all their work. 
 These records may be kept in a large permanent record hook if the 
 work is done at an office, or in small memorandum hooks if it is done 
 from house to house. In the District of Columbia a separate slip is 
 sent in for each person and the slips for each vaccinator for a week are 
 filed in a properly endorsed envelope. 
 
 The payment made to public vaccinators varies. They rarely 
 receive a regular salary for such work exclusively. In Baltimore the 
 salary is $900 p er annum, in Chicago $1,000, in St. Louis $75 per 
 month, in New York City $1,200, in Brooklyn $1,000, in Syracuse 
 $500, and in Wilmington. Del.. $100. Sometimes they are paid a fee 
 lor each successful vaccination, though often it is for each person vac- 
 cinated. In Mississippi the fee is twenty cents for the lirst 300, fifteen 
 cents tor all over 300 and up to 500, and twelve and one-half cents for 
 
 all over 500. In Providence and Reading the fee is twenty-five cents 
 and in Providence the vaccinator furnishes virus (humanized). In 
 that city, in the house to house vaccinating in 1885, fifteen cents was 
 paid, which is entirely too little. In Delaware, Maryland, New Jersey, 
 
 residing in the ward or wards for which he maj be elected, and inquire whether 
 any, and if any, what members thereof may be Liable to smallpox <lisc;i-,r. ami if he 
 find any person or persons so liable, he shall offer gratuitously his services, as vac- 
 cine physician <>!' the ward, t" vaccinate Buch person or persons. The vaccine 
 physician shall receive forty cents for each ami ever; i :ase of su< cessful vaccination 
 performed in any part of the City of Philadelphia." 
 
 Wilmington, Ordinances of 9 February, I860, and 28 December, 1882. 
 Philadelphia, Bepori of Bureau of Health (1896), p. 55. 
 Baltimore, Bepori of Health Department (1897), p. 61. 
 'Chicago, Bepori of Health Department (1897-8), p. 19. 
 
5 < ) 2 C OMMUNICABLE B ISM A sKs. 
 
 Philadelphia, and Pittsburgh the fee is fifty cents. In Scranton the 
 
 vaccinator receives his usual office fee. 
 
 Methods of Vaccination. 
 
 For the following facts the writer is indebted almost entirely to the 
 kindness of Dr. William N. Swift, of New Bedford, who collected the 
 data for a paper read before the Massachusetts Medical Society, 1 June, 
 1894. 
 
 Formal rules for vaccinators are found in only a few cities, as Boston, 
 Philadelphia, and Chicago. 
 
 Form of Virus. As has been said, bovine virus has formany years 
 been almost the only virus used in the United States. Sometimes in 
 epidemics, owing to the difficulty of getting a sufficiency of this virus, 
 it has been necessary to fall back upon the humanized, but more often 
 the reverse has proved true and the bovine has proved of great value in 
 a sudden outbreak because a considerable quantity could be immedi- 
 ately [inrch ased of the producers. The great advantage, however, of 
 the bovine virus is that it effectually does away with the reason for any 
 popular complaint as to the danger of the transmission of syphilis or 
 other human disease. Until very recently most of the bovine virus used 
 was furnished on ivory points, the tips of which are coated with lymph 
 which flows after removing the surface of the eruption on the animals 
 inoculated. These points are usually furnished in metallic cases con- 
 taining ten each. Single points are sold in envelopes. In some cases, and 
 this is a better way, the points are sold in glass bottles, and in others 
 they are wrapped in paper and rubber or other protecting covering. 
 When sent out in metal they should first be wrapped in cotton. 
 
 Very recently a large amount of virus has been furnished in capil- 
 lary tubes. This method has become popular because of the great 
 advantage possessed by virus which is mixed with from forty per cent, 
 to sixty per cent, of glycerine. Such virus soon becomes nearly or quite 
 sterile, and unless infection takes place during, or subsequent to the in- 
 oculation, always gives rise to a typical Jennerian vesicle. Alms on 
 points on the other hand is very apt to be infected with pus producing 
 organisms. This glycerinized virus is usually sent out in capillary 
 tubes. These tubes are generally hermetically sealed at both ends but 
 sometimes they are sealed with wax. The national vaccine establish- 
 ment at Washington sends out glycerinized lymph in small parafine 
 vessels, into each of which an ivory point is sealed with parafine. Mul- 
 ford & Co. have a similar contrivance made of glass and sealed with 
 parafine. 
 
 Most of the lymph tubes contain enough for one vaccination only, 
 but the Lancaster Company put up tubes containing enough for ten, 
 
COMMUNICABLE DISEASES. 593 
 
 twenty, and fifty vaccinations. Some of the makers furnish a small 
 rubber tube for attaching to each capillary tube so that the virus may 
 be blown out. The Welker Company furnishes a large rubber bulb 
 for that purpose, the Mulford Company a smaller bulb (1-2 inch in 
 diameter). 
 
 The Xew York City board of health also sends out virus in glycer- 
 inized sterile vials corked with sterilized rubber stoppers. These are of 
 two sizes, one containing 0.2 c. c. for ten vaccinations and the other 
 1. c. c. tor fifty vaccinations. 
 
 Humanized virus was until recently used almost exclusively by the 
 health department in Providence and was employed also somewhat in 
 Philadelphia. Sometimes small quills are charged from the vesicle on 
 the eighth day, and are usually used the same day, but more often 
 crust- ;ue employed. The crusts are prepared by trituration and the 
 powder is made into a paste with a little glycerine and water. 
 
 Implements for Inoculation. Probably most of those who make use 
 of ivory points use the point itself for scarifying. If care is taken to 
 have sterile points this does away with any danger of infection such as 
 might come from a lancet. The tise of the point, however, is a little 
 more painful than the use of the lancet, so that the latter is preferred by 
 many. Another instrument, a simple scarifier, is sometimes used by 
 public vaccinators and is occasionally furnished by the producers of 
 virus. 
 
 Since the use of virus in liquid form has become more popular, 
 needles are quite frequently used and are very generally furnished, one 
 for each inoculation. This has been the practice in New York City, 
 Denver, St. Paul, and .Minneapolis. The use of separate needles or of the 
 ivory points for puncture or scarification, provided they are surgically 
 clean as they can readily lie made, easily solves the problem of aseptic 
 instruments. For those who prefer a lancet, it is not so easy to secure 
 asepsis. ( >f t he ninety-nine cities which replied to Dr. Swift's enquiries 
 only Cambridge, Chicago, I'tica, Newton, Newburyport, Mass.. Peters- 
 burg, Y;i.. and St. Paul reported that the instruments were sterilized. 
 Cambridge, Chicago, and St. Paul stated thai when a scarifier was used 
 it was heated after each operation, and in Newton the Lancel is thor- 
 oughly boiled before use and then dipped in boiling water for five min- 
 utes after each vaccination. 
 
 Cleansing the Arm. Thirty-nine of the ninety-nine cities reported 
 thai the arm was washed before vaccination, but in not more than 
 
 twenty-eighl was it claimed thai the practice was constant. Several 
 
 state thai the arm was washed with water, and one or two that it was 
 
 washed with soap and water. In Asbury Park one person prepares the 
 
594 COMMUNICABLE I) I SEA SES. 
 
 arm by washing and another vaccinates. Bangor, Me., reported that 
 the arm was washed with soap and water followed by a ten per cent, 
 solution of carbolic acid. In Lewiston,' Me., it is washed with carbolic 
 acid or corrosive sublimate. In St. Paul a five per cent, carbolic acid 
 solution is used. One of the Boston vaccinators used a one to five 
 thousand solution of corrosive sublimate, and in Council Bluffs a one 
 to two thousand solution is used which is then washed off with sterile 
 water. In Minneapolis listerine is used, and in Fitchburg, at times. 
 creolin. In Elizabeth, N. J., Milwaukee, and New Bedford the arm is 
 washed with alcohol. In Chicago the rule is that vaccinators shall 
 refuse to vaccinate a dirty arm or a person with dirty clothing. In all 
 cases they are instructed to thoroughly wash the arm before vaccinating. 
 
 From the above it may fairly be assumed that while in about a third 
 of the larger cities of the United States some attempt is made to wash 
 the dirt from the arm to be vaccinated, this precaution is even in those 
 cities neglected, and there is usually very little sincere effort made to 
 secure a really aseptic skin. 
 
 Methods of Inoculation. By far the most common method is to 
 scarify a portion of the surface and rub in the virus. Minneapolis was 
 the only city which reported that puncture which was done with a 
 needle was the routine method employed. The skin is drawn tight and 
 a good sized needle used. It is now rarely done in that city. A lancet 
 is, however, sometimes used. The New York City board of health 1 
 recently made a series of tests to determine which was the best way to 
 vaccinate, by scarification or by puncture. These scarifications were 
 about three-eighths of an inch square and made with a needle, and the 
 puncture was made by placing a drop of virus on the point of a lancet 
 and inserting it obliquely into the skin. It was found that the former 
 method was more certain to result in inoculation and the latter was freer 
 from chance infection, but, on the whole, was not so desirable as scarifica- 
 tion. 
 
 In scarifying all operators agree that it is very desirable not to draw 
 blood, but only to scrape off the outer layers of the epidermis. Troy and 
 Providence reported that the scarifications cover one-half square inch. 
 New York City has after careful experiment decided upon three-eighths 
 of an inch. In Wilmington, Del., the prescribed size is one-fourth inch, 
 and in Boston one-eighth inch. All agree upon the skin' over the inser- 
 tion of the left deltoid as the best place to vaccinate, but an inspection 
 of many arms vaccinated by many operators would lead one to think 
 that few are particular, and that almost anywhere on the outside of the 
 
 1 New York City, Report of Board of Health (1896), p. 241. 
 
( nynirxKABLE disk. i ses. 595 
 
 arm will do. Some persons insist on being vaccinated on the thigh. 
 When quills or ivory points are used they are first moistened, and no 
 city reported using sterile water for this. In Troy the skin is moistened 
 at the point of scarification. The virus is then rubbed into the abrasion, 
 When liquid virus is used it may be worked in with the lancet or 
 needle : but a number of producers send out little smooth flattened 
 sticks to be used for this purpose. Tests made by the New York board 
 of health showed that it was very essential to rul» the virus into the 
 point of scarification very thoroughly. When it was merely smeared 
 on it was much less likely to take. Jersey City reported that the skin 
 is draw n tight and the virus is rubbed in for three minutes. In Chicago,' 
 Providence, and doubtless in many other cities the virus is rubbed into 
 the scratches which are drawn open by keeping the skin tense. 
 
 It has been claimed by many that it is better to have a number of 
 points of inoculation, and such is very generally the practice in European 
 countries. In the ninety-nine cities investigated by Dr. Swift, the 
 number of insertions is as follows: 
 
 "In fifty-one cities it is the custom to vaccinate at one point; in 
 twenty-six cities at two points: in eleven cities at one or two points; 
 in three cities at three points: in one at four points; in one at five 
 points; in one at one to four points: in one at two to five points, anil 
 in two the answer was variable. 
 
 ••The cities where it is tin- custom to vaccinate atone point include 
 Chicago, New fork, San Francisco, Philadelphia, Washington, New 
 Orleans, Brooklyn, Detroit, Xew Haven, Portland, Me., Richmond, Va., 
 Lowell and Lynn, Mass. 
 
 "It is the custom to vaccinate at two points in Boston, St. Louis, 
 Milwaukee, Pittsburgh, Pa., Worcester, Mass., Savannah, Ga. ; at three 
 points in Providence. In St. Paul, .Minn., two t<> five insertions are 
 made, and at Minneapolis, Minn., five insertions were formerly made, 
 but at present usually only one." 
 
 After Treatment. All agree that the arm should be dry, that is, the 
 
 exuded lymph or blood should have coagulated before i he sleeve is 
 drawn over it. This Is required rather to prevenl the rubbing off of 
 the virus than to prevent the rubbing in of septic matter. The only 
 objei 'ion to glycerinized virus is that it dries so bIowIj that the patients 
 
 are kept waiting a long time and on this accounl the public vaccinators 
 
 in Boston decline to use it. 
 
 In twenty-six of ninety-nine cities, protection of the point of inocu- 
 lation or of the vesicle is Bometimes resorted to and in most of these it 
 
 is the rule. Iii I but fold, Milwaukee, and New York <it\ a loose soft 
 
 cotton or linen bandage is used to protect from the harsher sleeve, and 
 
596 COMMUNICABLE DISEASES. 
 
 in the latter city it is sewed into the sleeve. In St. Paul this is used 
 only when colored underclothes are worn. It is probable that this is 
 more often advised than actually supplied. In Lewiston, Me., and 
 Utica a bandage of sterile gauze is used. In Allegheny, Bangor, Du- 
 buque, Grand Rapids, Harrisburg, Lowell, and Rockport, 111., court 
 plaster, adhesive plaster, or isinglass plaster have been used immediately 
 over the point of inoculation. In Allegheny the court plaster is curved 
 over the vesicle to protect, being attached only at the edges. In Coun- 
 cil Bluffs a corn plaster is put over the point of inoculation and protected 
 by a bandage. Newton covers the insertion with oil silk or gutta 
 percha and fastens the edges with collodion. In Providence various 
 methods of protecting the vesicle were tried, such as large corn plasters, 
 wire cao-es, and absorbent cotton fastened with collodion. None of 
 these were very satisfactory, but the latter was the best. The vaccina- 
 tor in Wilmington, Del., describes his method of protection as follows : 
 
 " Cut two pieces of carbolized gauze each ten layers thick, one and one-fourth 
 inches wide and two inches long. In one of these pieces cut an ellipse one and one- 
 quarter by three-quarters inches and place the piece of gauze on the arm so that the 
 opening comes over the wound. Place the other piece of gauze over this and strap 
 the whole on to the arm with three strips of adhesive plaster." 
 
 A similar method is followed in Lancaster, Pa. In Chicago and 
 New Bedford a " loose sterile pad " is applied to the arm after vaccina- 
 tion. Mulford & Co. have recently put upon the market perforated 
 paper shields with gummed edges which adhere to the arm. The}' are 
 curved so as to raise them above the vesicle. They are used extensively 
 and seem to serve the purpose well. Parke, Davis & Co. furnish an 
 aluminum shield, and there is also a transparent celluloid shield on the 
 market. 
 
 Brief directions for the care of the arm are sometimes given the 
 child at the time of vaccination. 1 
 
 1 New York City : 
 
 Directions to be Observed after Vaccination. 
 
 " Leave the arm bare, or cover it with a thin, loose sleeve of Calico or Muslin. 
 Do not use a woolen sleeve, or put a linen band around the arm, as they irritate, and 
 prevent vaccination from becoming perfect. If the arm becomes much inflamed 
 after the tenth day, do not poultice it, but keep it covered with a cloth wet with 
 lukewarm water. 
 
 " If any bad effects appear to follow vaccination, notify this office, and a physi- 
 cian will be sent to attend the case free of charge." 
 
 Providence : 
 
 "Don't rub or scratch or hurt the vaccine sore. If the skin over it becomes 
 broken, get a few cents' worth of subnitrate of bismuth to dust on the sore so that 
 it will not stick to the sleeve. 
 
 " Don't put a cloth around the arm or any kind of ointment on the sore." 
 
COMMUNICABLE Diseases. 597 
 
 The card on which the Providence directions are printed has upon 
 it the number of the entry of the vaccination in the record book and is 
 used by pupils as a temporary school permit. 
 
 Contra-indications to Vaccination. 
 
 There are certain conditions under which it is unwise to perform 
 vaccination and these are well set forth in the directions to vaccinators 
 in Chicago: 1 
 
 •■ Vaccination being the artificial production of a constitutional disease, it is, 
 manifestly, of the greatest importance that the individual whom it is proposed to 
 subject to its influences should be in as good health as is fairly attainable. There- 
 fore, weak, feeble or sickly infants, those presenting evidence of some disorder of 
 nutrition or of functional disturbance, as from dentition, indigestion, etc., or suffer- 
 ing from diarrhea or other bowel affection or presenting chafed or abraded cutane- 
 ous surfaces on any portion of the body, or any form of cutaneous eruption; or dur- 
 ing the period of weaning — should not be vaccinated except in the presence of 
 smallpox contagion. Acute febrile diseases and intestinal and cutaneous — especially 
 vesicular — affections tend to modify and complicate the vaccinal action, and these 
 conditions, therefore, warrant the postponement of the operation until they have sub- 
 side'!. On the other hand, there are many chronic diseases of a grave character, 
 syphilis, for example, which do not interfere with vaccination, nor contra-indieate 
 the operation. This is especially true of scrofula and consumption, diseases which 
 have been favorably affected to a very marked degree by the introduction of vaccina- 
 tion. Scrofulous subjects, however, or those exhibiting a pre-disposition to that 
 cachexia, should not be vaccinated — except in cases of emergency — during the first 
 year or two of life. Sound judgment dictates that they be protected during this 
 early period of development from any serious constitutional disturbance — and the 
 same may be said of those exhibiting a marked phthisical or tuberculous pre-dis- 
 position. 
 
 ■• ('ndt r ordinary circumstances, neither the menstrual period, gestation or lacta- 
 tion offers am obstacle to vaccination; but cases will occasionally present themselves 
 in which some disturbance or complication of these functions may dictate its tem- 
 porary |>ost ponement. 
 
 " The existence of erysipelas, diphtheria, or scarlet fever on the premises or in 
 the immediate vicinity renders great care necessary, if, indeed, il should not posi- 
 tively forbid the operation. Recenl exposure to the infection of these diseases also 
 makes it advisable to postpone until after the period of incubation. 
 
 "As already intimated, however, there are few, if any, conditions which would 
 justify negleci or even postponement of vaccination in the presence of the smallpox 
 contagion. 
 
 "Within the above limitations vaccination should be performed during the first 
 
 few months alter birth except in the presence Of smallpox, when it should he per- 
 formed iis SO nil 11 s jiiissilih." 
 
 The success iii vaccinating depends very much upon the care and 
 skill of the vaccinator i-\cw when tin' besl virus is furnished. The 
 report of the Now York City board of health in 1874 •">. page L20, 
 shows how much tin- skill of vaccinators varies and also ho\* good men 
 improve. Several men who onlj had ;i percentage of perfect results in 
 
 1 Chicago, Report oi Health Department (1895 6), p. 101. 
 
598 COMMUNICABLE DISEASES. 
 
 primary vaccinations of about 75 per cent, during the first three months, 
 rose to 98 per cent, and even 100 per cent, within a short time, while 
 one man had an average for several months of only 80 per cent, perfect 
 results. The percentage of success in 24,395 primary vaccinations 
 was 86.65. In 1896 with the new glycerine virus there were 1,500 
 consecutive vaccinations without a single failure. 1 
 
 Circulars of information concerning vaccination are sometimes dis- 
 tributed and in many places serve a very useful educational purpose, 
 but in many other localities the only result would be calling out a flood 
 of anti-vaccination literature, and scientific arguments have no influence 
 with the public in the face of an unscientific harangue. 
 
 Antitoxin. 
 
 The free distribution of antitoxin by boards of health, at least in the 
 larger cities, has been very common throughout the United States. This 
 is doubless due to the example set by the board of health of New York 
 City. This board by its investigation of the cultural method of diag- 
 nosis and the use of antitoxin in diphtheria became convinced of the 
 great worth of both, and determined to introduce their use in this 
 country. To do this both had to be made free, and considerable effort 
 was made by the board of health to secure the confidence of the medical 
 profession in them. It may not at first be apparent why the health 
 department should distribute antitoxin any more than any other remedy ; 
 but there are several reasons why it should do so. In the first place it 
 is expensive and the poor cannot afford to pay for it, and most cases of 
 diphtheria are among the poor. It is true, aid for the poor should usu- 
 ally be furnished by the poor department, but it is much more conven- 
 ient for the physician to get his antitoxin from the health department 
 than from the poor department. In fact, he probably never would have 
 been able to get it from the poor department. Antitoxin should be 
 used promptly, and there is less red tape in the health department. The 
 physician brings his culture to the health department and gets his 
 antitoxin promptly for the asking. The health department should assist 
 the physician as much as possible. Below are named some of the cities 
 which early began the free distribution of antitoxin. 2 
 
 None at all was supplied hi Troy until 1900, and in Buffalo, 
 
 1 New York City, Report of Board of Health (1896), p. 237. 
 
 2 Atlanta, Baltimore, Boston, Bridgeport, Brookline, Mass., Cambridge, Chicago, 
 District of Columbia, Concord, X. II., Denver, Fitchburg, Hartford, Haverhill, 
 Mass., Lowell, New Orleans, Newton, Mass., Paterson, Pittsburgh, Portland, Me., 
 Providence, Rochester, Salem, Mass., St. Louis, San Francisco, Syracuse, and Wil- 
 mington, Del. 
 
COMMUNICABLE DISEASES. 599 
 
 Rochester, Utica, Albany, Hartford, and New Haven, the amount is not 
 large for the ability of the patient to pay is carefully questioned. In 
 other cities this is not looked into with so much care lest the patient 
 meanwhile die, hence larger amounts are given away. 
 
 At first circulars of information setting forth the value of antitoxin 
 were distributed, but such are not now necessary. In the larger cities, 
 stations were established for the distribution of the material, usually the 
 same drugstores as those at which diphtheria-culture outfits were kept. 
 In tin* smaller cities, however, it is often given out only at the health 
 department or at the house or office of the health officer, medical inspec- 
 tor, or bacteriologist, and even in as large a city as Pittsburgh this is the 
 practice. Most cities supply antitoxin on the same conditions that it is 
 furnished in New York City. 1 
 
 The amount of antitoxin furnished physicians for their own use and 
 the amount used by the medical inspector of the health department, 
 varies much in different cities. Probably no greater efforts have been 
 made to encourage the use of this remedy and to supply it through 
 municipal inspectors than in New York, Chicago, and Baltimore. In 
 Chicago, particularly, a large amount of antitoxin has been administered 
 by the inspectors of the health department. From 5 October, 1895, to 
 31 March, 1896, 1.771 cases were thus treated by these officers. In 
 New York City, in 1896, about three times as many cases were treated 
 by municipal as by private physicians, but since then the hitter have 
 used it more and more. In most cities most of the administration is 
 done by private physicians, the serum being furnished by the health 
 department. In Providence, at tirst a syringe was furnished by the 
 department, bu1 this was of course soon found to be impracticable as 
 well as unnecessary. The form of application blank used in Chicago 
 is shown in Appendix 1 1 0. 
 
 In other cities a very simple written application only is required 
 which may be \\>^A as a voucher. 
 
 '"First. The Healtb Department will send a Medical inspector to administer 
 antitoxin upon the request of the attending physician. According t" the wishes of 
 tin- attending physician the Inspector will fit I in- to I lew his directions or will use his 
 own judgment in the injection ■•! the antitoxin. When physicians wish to have the 
 Department Inspector administer antitoxin they should telephone the request to the 
 laboratory. 
 
 "Second. 'I' he Healtb Department will furnish antitoxin free to any physician who 
 needs it for a case of diphtheria, in which payment for the remedy is a hardship, on the 
 condition that he will, at the completion of his attendance on the case, till out and send 
 
 to t he Division of Bacteriology, on 1 dan Us I'n in is lied lor I he purpose, a lull report of 
 
 the case. These blanks will he found at the depots where the antitoxin is to be 
 obtained. 
 
 (Third, 'the Health Depart m will sell antitoxin to those who can afford to 
 
 purchase it." 
 
600 COMMUNICABLE DISEASES. 
 
 Most cities require, or at least did require, a clinical report of each 
 case treated, to be made by the attending physician. Blanks for this 
 are furnished by the department. That used in Baltimore is shown in 
 Appendix 111. In Providence no form of this kind is used but en- 
 quiry is made by the medical inspector concerning each case of diph- 
 theria reported and if antitoxin is administered it is noted, together 
 with the date of administration, upon the permanent record of the case. 
 In Pittsburgh a card is used to record the bacteriological findings and 
 the antitoxin data for each case. See Appendix 112. 
 
 Most cities purchase the antitoxin which they use and distribute, 
 but a few produce it. This is done in New York, Pittsburgh, Phila- 
 delphia, St. Louis, and Newark, and was formerly done in Hartford and 
 Boston. For a very large city like New York or Philadelphia it is 
 doubtless more economical to produce antitoxin than to purchase it. In 
 New York City it is estimated that it costs to produce 60,000 c. c. of 
 300 unit strength about $2,200, which is much less than it could be 
 purchased for. But in order to get a high grade product it is necessary 
 to continuously employ the very best scientific talent and the varying 
 fortune of political life is not conducive to the success of the city in 
 this direction, and it is perhaps well that more cities do not at present 
 undertake it. In New York 1 in 1896 there were fifteen horses in use 
 for furnishing antitoxin and from them were obtained from 11-1 bleedings 
 17,853 vials of antitoxin ranging in strength from 150 to 500 units per 
 cubic centimeter. 
 
 In Pittsburgh 2 two horses are kept, though one furnishes all the 
 serum required. In 1899 there were obtained and used 2,145 vials of 
 serum of 2,000 units, some of which, however, was used in neighboring 
 communities. The cost was about •$ 3,000. The method employed in 
 that city may be found in the report for 1895. 3 
 
 In Newark 4 in 1897 five horses were used for obtaining serum. 
 There were obtained 1,726 bottles, of which 1,321 were used in Newark 
 and 268 sold outside the city for which -$318.90 was received. The 
 cost of the care of the horses during this time was $1,286.07. 
 
 In St. Louis in 1897 5 three horses were kept and 11,645 c. c. of 
 antitoxin produced containing 150 units to the c. c. 
 
 Considerable objection has been made by private producers to the 
 action of boards of health in selling their product. In New York City 
 
 1 New York, Board of Health Report (189G), p. 220. 
 
 2 Pittsburgh, Report of Bureau of Health (1898), p. 124. 
 
 3 Pittsburgh, Report of Bureau of Health (1895), p. 116. 
 
 4 Newark, Report of Department of Health (1897), pp. 49 and 63. 
 
 5 .St. Louis, Report of Department of Health (1897), p. 49. 
 
( ' OMML 'XI< - 1 B L E DISK, i SJEH. 601 
 
 the board of health has sold its antitoxin through the drug stores 
 allowing the druggists a ten per cent, profit. Considerable amounts 
 are sold to other cities, notably Chicago. An effort was made to pre- 
 vent this by a legislative act but it was not successful. The charter 
 of New York City permits such sale and the proceeds are to be devoted 
 to laboratory uses. 1 A similar right is given to local boards of health 
 in Xew Jersey.'- To the New York City board of health is due the 
 chief credit for the introduction into this country of the use and manu- 
 facture of diphtheria antitoxin. Furthermore this board because of its 
 researches was enabled to make a much higher grade of antitoxin than 
 was ever made be tore. The manufactures of antitoxin in this country 
 would not have had a market or been able to manufacture the remedy 
 if it had not been for the Xew York board of health ; but it is entirely 
 characteristic of a trade to turn about and strike at the scientific men 
 to whom it owes its being. 
 
 There has been very little done in the way of state supervision of 
 the manufacture and sale of antitoxin. In New Jersey the state board 
 of health may prohibit the sale of antitoxin found to be impure and 
 inert (see page 581). In Wisconsin 3 and Connecticut' it is unlawful to 
 sell antitoxin without the owner's name. In New York' the state board 
 of health requires that antitoxin must be stamped before it is offered 
 for sale by the manufacturers and samples are freq nently tested to deter- 
 mine whether they come up to the required standard. In several states, 
 however, the state board of health lias taken upon itself the task of 
 testing the various antitoxins for sale.' 1 
 
 In California in 1895 7 the state board of health was authorized to 
 distribute antitoxin through the state university. In Massachusetts 
 the state board of health has for several years manufactured antitoxin 
 and distributed it throughout the state through the medium of the 
 local boards. 
 
 \. u Fork, Chapter 378 of 1897, Sec. 1226. 
 
 \. w Jersey, chapter 180 of 1895. 
 ' Wisconsin, Chapter r>'.i of 1897. 
 * Connecticut, Chapter 252 of 1895. 
 
 \rw fork, State Board of Health Report (1898), p. 5. 
 
 Ohio, Report sum- Board <>f 1 1 < -;i i 1 1 1 (1897), p. 137. Pennsylvania, Report of 
 State Board of Health (1896), pp. 29 and 208. 
 
 i alifornia, Chapter 39 of 1895. 
 
CHAPTER XII. 
 
 COMMUNICABLE DISEASES 
 
 (concluded). 
 Hospitals axd Quarantine. 
 
 HOSPITALS for the care of communicable diseases are essential for 
 their control. It is well nigh useless to attempt to enforce isola- 
 tion unless means are provided in hospitals for the proper isolation of 
 the many cases which are sure to develop under conditions where their 
 isolation at home is impossible. It is not only for the welfare of the 
 community, but also for the welfare of the patient that such hospital 
 accommodation should be provided. Many cases of communicable dis- 
 ease cannot receive in their homes the care that they require, and often- 
 times travellers, tramps, and inmates of asylums and general hospitals are 
 attacked with communicable disease, and most of such cases should be 
 for their own good at once removed to a suitable isolation ward. 
 
 Local governments are permitted, and in some cases required, by 
 statute to erect and maintain such hospitals. Cities often have the 
 authority to establish hospitals, and such authority unless it is limited 
 by the proviso that the hospitals are to be for the poor, carries with it 
 the power to establish hospitals for the care of communicable disease. 
 Such general authority to establish hospitals is given to the city coun- 
 cils of cities and boards of trustees in the cities and villages of Illinois. 1 
 Sometimes, as in Maine, Minnesota, and South Carolina, it is provided 
 that communicable disease hospitals may be established in emergencies. 
 In other states, as Alabama, Colorado, Georgia, Maryland, Michigan, 
 Massachusetts, New Jersey, Virginia, Wyoming, and in special acts for 
 various cities, no such restrictions are placed on the authority given. 
 In Michigan such authority is specifically given to the inhabitants of 
 townships. In New Jersey 2 towns or townships may unite in the estab- 
 lishment of such hospitals and 
 
 "the total expenditure for lands and buildings for hospital purposes shall not 
 exceed one-tenth of one per centum of the total sum of assessment for one year, for 
 
 1 Illinois, Annotated Statutes (1896), Chapter 24, Sec. 26. Seventy-seventh. 
 
CO MM CXI<\ 1 B L E DISEA SES. 
 
 003 
 
 Fig. 4.">. 
 
 Smallpox Hospital at Asbury Park. Cost, $544.35. Prom Report oJ State Board of Health of 
 
 \i-u Jersej . 1896. 
 
 Fig. in. 
 Smallpos Hospital, Pawtuoket, i.\ i < ot 
 
604 COMMUNICABLE DISEASES. 
 
 the purpose of taxation in such corporated town, as shown by the duplicate, or 
 other records of assessments for the previous year.' 1 : 
 
 In a few states the establishment of communicable disease hospitals 
 is required by statute. The Massachusetts law enacted in 1701 is still 
 on the statute books, but is probably intended to be enforced only in 
 the emergency of a serious outbreak. 2 This law has been copied by 
 Colorado, Minnesota, and Michigan, but in the latter state is applicable 
 to smallpox only. In Massachusetts 3 the authorities are by an old law 
 empowered to seize buildings for hospital use, and this is sometimes 
 done even at the present time, as in Cambridge, where a dwelling was 
 in 1899 seized for a diphtheria hospital. A similar provision is found 
 in the charter of the City of New York 4 and in Colorado, Maine, Michi- 
 gan, and Wyoming. In Virginia town councils and justices of the 
 peace may establish temporary hospitals and may seize land for that 
 purpose, but damages must be paid as appraised by commissioners 
 appointed under the law. A more recent Massachusetts law provides 
 that hospitals shall be established in cities when deemed necessary by 
 the local board of health: 5 
 
 " In any city in which no suitable hospital accommodations have been provided 
 for the care and treatment of persons suffering from contagious diseases dangerous 
 to the public health, the board of health of such city may address a communication 
 to the mayor thereof, stating that in the opinion of said board the safety of the 
 
 1 New Jersey, Public Laws (1S95), p. 590. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 80, Sec. 75. (First enacted 25 
 June, 1701 (Chapter 9). See Acts and Resolves, Province of Massachusetts Bay, 
 Vol. I., p. 469): 
 
 " When a disease dangerous to the public health breaks out in a town, the board 
 shall immediately provide such hospital or place of reception for the sick and in- 
 fected as is judged best for their accommodation and the safety of the inhabitants, 
 which shall be subject to the regulations of the board; and the board may cause any 
 sick and infected person to be removed thereto, unless his condition will not admit 
 of his removal without danger to his health, in which case the house or place where 
 he remains shall be considered as a hospital, and all persons residing in or in any 
 way concerned within the same shall be subject to the regulations of the board as 
 before provided.' 1 
 
 3 Massachusetts, Public Statutes (1882), Chapter 80, Sec. 43: 
 
 " Two justices of the peace may, if need be, make out a warrant directed to the 
 sheriff of the county or his deputy, or to any constable, requiring them under the 
 direction of the board to remove any person infected with contagious sickness, or to 
 impress and take up convenient houses, lodging, nurses, attendants and other neces- 
 saries, for the accommodation, safety and relief of the sick." 
 
 4 New York City, Chapter 378 of 1897, Sec. 1170: 
 
 " . . . It shall have power to take possession of and occupy for temporary 
 hospitals any building or buildings in said city, during the prevalence of an epidemic, 
 if in the judgment of the board the same may be required, and shall pay for private 
 property so taken a just compensation for the same. . . ." 
 
 5 Massachusetts, Chapter 511 of 1894. 
 
( OMJIUXK \ IBLE BISEA SES. 605 
 
 inhabitants of the city demands that suitable hospital accommodations should be 
 provided for the reception and treatment of persons suffering from such diseases, 
 other than smallpox and those of a venereal nature. The mayor shall forthwith 
 transmit such communication to the city council, and the city council shall forth- 
 with order such hospital accommodations to be provided, and shall make the neces- 
 sary appropriations therefor." 
 
 In Massachusetts it is provided that the hospital for communicable 
 disease shall be within the township limits, but in Michigan and New 
 Jersey it may be otherwise ; though in Xew Jersey, 1 
 
 " when such lands are situate out of the limits of any such incorporated towns 
 as acquire title to the lands, then before using such lands for hospital purposes for 
 persons having contagious diseases, there should be obtained the consent of the 
 township committee or other governing body of the township or other municipality 
 within the limit of which such lands lie and such hospital is erected, that the miiiic 
 may be used for the purpose aforesaid." 
 
 In Colorado and Massachusetts 2 no hospital of this kind is to be 
 established within 100 feet of an inhabited dwelling house within an 
 adjoining town without the consent of the town. In Xew Mexico no 
 pest house is to be established within one mile of an inhabited house. 
 In the District of Columbia a communicable disease hospital may not 
 be within 300 feet of any other building. In California it is forbidden 
 any person to establish or keep a pest house in any city, town or vil- 
 lage, and a similar law is found in Montana. In this connection may 
 he mentioned the laws, relies of olden times, which are still found in 
 some states, as Maine, Kansas, Michigan, and Pennsylvania (referring 
 to Philadelphia), and which forbid inoculation with smallpox. 
 
 While a hospital for communicable disease may be of great value 
 when used merely by those who voluntarily take advantage of its oppor- 
 tunities, yet to make them really efficient in the prevention of such dis- 
 eases, it is accessary often to remove to them forcibly persons who 
 would not voluntarily go. Laws authorizing this are found in a large 
 dumber of states and also in the ordinances of many cities. The earliest 
 I < >tin of the law is found in Massachusetts 1 dating back to 1797, and 
 simply gives the board of health authority to remove cases to -a 
 separate house or otherwise." In New York City 4 the hoard of health 
 -may remove or cause to be removed to a proper place, to be l»\ it 
 designated, anj person Bicfc with any contagious, pestilential or infec- 
 tions disease" 
 
 Most of the laws. lio\\c\er, limit the power of removal to those eases 
 in which it can he done without danger to the patient, ami il is usually 
 
 1 \.'u Jersey, Public Laws (1895), p. 590. 
 
 Massachusetts, Public Statutes, < hapter B0, Sec. 72. 
 
 Massachusetts, Public Statutes (1882), Chapter 80, Sec. i". 
 1 \.w y/ork, Chapter 878 of L897, Sec. 1170. 
 
606 COMMUNICABLE DISEASES. 
 
 provided that if he is not removed, the house in which he remains ma} T 
 be treated as a hospital. In Minnesota when the patient is in a boarding 
 or lodging house, crowded room, vessel or car he may be removed by 
 force. In Atlanta a patient with scarlet fever shall not be removed to 
 the hospital unless isolation is impracticable at home. 1 In Pennsylvania 
 cities of the second class 2 the officers appointed for that purpose are to 
 remove to the hospital all persons sick with infectious disease, but only 
 with the consent of the attending physician. In Bridgeport 3 the removal 
 to the hospital shall be made only when the attending physician, if there 
 is one, shall certify in writing that the removal of such person is neces- 
 sary for the preservation of the public health. When a patient is 
 allowed to remain at home, in order to ensure the maintenance of isola- 
 tion, authority is often given to place guards about the house, thus to 
 ensure control as in a hospital. 
 
 In most of the laws authority is given to remove persons " sick " 
 with the prescribed diseases, but in some laws, as those of Maine, Massa- 
 chusetts, Michigan, and New Hampshire, the law applies to persons 
 " infected," and in Massachusetts " who have recently been infected,"' 
 and in Bridgeport " who shall be suspected of being infected." In 
 most of the statutes the board of health alone is given the power to 
 cause removal to a hospital, but in Wilmington, Del., two-thirds of the 
 board are necessary. Some of the ordinances give the power to other 
 officers. Thus in Chicago, Denver, Omaha, and St. Louis it is the 
 health commissioner, in Philadelphia, the assistant medical inspector, in 
 Newark and Yonkers the health officer. 
 
 When communicable disease occurs in a penal institution, it was 
 feared that there might be a conflict of authority between the sanitary 
 and other officials, and special provision has in several states been made 
 for such cases. The Massachusetts law 4 has been in substance followed 
 by Colorado, Maine, Michigan, Mississippi, and Washington. The suc- 
 ceeding section provides that the presiding officer of the board of health 
 
 1 Atlanta, Rules and Regulations of Board of Health, Sec. 151. 
 
 2 Pennsylvania, Chapter 258 of 1895, Sec. 26. 
 
 3 Bridgeport, Ordinances (1892), Chapter 14, Sec. 3. 
 
 4 Massachusetts, Public Statutes (1882), Chapter 80, Sec. 49: 
 
 " When a person confined in a common jail, house of correction or workhouse, 
 has a disease which, in the opinion of the physician of the board, or of such other 
 physician as it may consult, is dangerous to the safety and health of other prisoners 
 or of the inhabitants of the town, the board shall by its order in writing direct the 
 removal of such person to some hospital or other place of safety, there to be pro- 
 vided for and securely kept so as to prevent his escape until its further order. If 
 such person recovers from the disease, he shall be returned to said prison or other 
 place of confinement." 
 
CO MMUNIi \ 1 B L E D TSEA S E S. 6 ( > 7 
 
 shall report his action to the court. The Massachusetts law also for- 
 bids any city or town officer to send to the state almshouse any person 
 suffering with a disease dangerous to the public health.' 
 
 While municipalities generally have ample authority to establish and 
 maintain hospitals for the care of communicable diseases, and may 
 remove patients to them by force if necessary, yet such hospitals have 
 not been very generally established even in our larger cities. In this 
 respect the towns of the United States are far behind those of England. 
 Provision is made for smallpox much oftener than for the other com- 
 municable diseases because public opinion is very decided about the 
 desirability of removing this disease to a hospital. Yellow fever is 
 another disease in which isolation is demanded by the public, but as it 
 usually occurs at the south, and during warm weather, tent treatment is 
 very generally employed and there is less need of permanent hospital 
 buildings than at the north. Most of the larger cities are provided 
 with some sort of a hospital for the reception of smallpox patients, and 
 indeed a considerable number of quite small places have Bucb hospitals: 
 but some large cities are not so provided. Thus there is no such 
 provision at Omaha. Albany, Portland, Ore., and in 1899 Columbus and 
 Fall River were caught by an outbreak and were obliged to hurriedly 
 erect hospitals, and not long since. Reading and Harrisburgh passed 
 through a similar experience. 
 
 Many of the smallpox hospitals are popularly and even officially 
 known as -pest houses," and the name from one point of view is not a 
 bad one. It is. perhaps, the rule to find these pest houses utterly ltn- 
 
 adapted for the use to which they are put. Every hospital should be 
 cheerful, sunny, comfortable, well heated and ventilated, and provided 
 
 with a plentiful water supply. For communicable disease hospitals it 
 
 is particularly desirable that everything shall be as attractive as possi- 
 ble, in order that patients nia\ willingly go to them. Too many of 
 these hospitals are Lacking in all these qualities. The typical pest house 
 
 is located in a desolate oul of the way place. It can be reached only 
 by a considerable journej Over a bad and seldom travelled road. It is 
 often old, and consists of a small low shed-like Structure with a lew 
 
 I rly arranged rooms, or perhaps, a single room. It is not plastered. 
 
 and has no cellar, and is heated, or not heated, by ;i Stove, The water 
 supply is obtained from an out id' door pump, and the plumbing consists 
 of an iron sink. The furniture usually corresponds. That the picture 
 
 is not exaggerated, the writer knows, for he has spent a Long winter 
 night with a smallpox patient in just such a building. The following 
 figure illustrates one of these buildings : 
 
 1 Massachusetts, Public Statutes (1882), Chapter 86, Sec. 25. 
 
008 COMMUNICABLE DISEASES. 
 
 Fig. 47. 
 
 Smallpox Hospital at Lincoln, R. I.. A town of 10,000 inhabitants. 
 
 It is not to be wondered at that patients and their friends resort to 
 every deception to conceal the disease, in order that they may not be car- 
 ried to such a place. Some of these buildings were put up by com- 
 mittees of citizens long before the establishment of boards of health. 
 They have remained because they have been so rarely used that the im- 
 portance of better things has not been realized. As a rule only the poor 
 are carried to them, and they have not influence enough to cause a 
 change. If a well-to-do patient is carried to one, as happened in the 
 District of Columbia not long since, when an official in the Department 
 of the Interior was attacked with smallpox, a new building speedily 
 results. Excellent hospitals for smallpox are now to be found in 
 Chicago, Cincinnati, Cleveland, the District of Columbia, Milwaukee, 
 and a number of other cities. It is to be hoped that the day of the 
 pest house is waning. 
 
 The location of a smallpox hospital is often a matter of some diffi- 
 culty. Usually it is located in the outskirts of the city and sometimes 
 in a neighboring community. In New York and Boston it is upon an 
 island. In Providence it is on a point projecting into the harbor and 
 entirely isolated, except in hot weather when the adjoining grounds are 
 used as a pleasure resort, In St. Louis it is twelve miles up the river 
 and can be reached only over a most execrable road, and in Cleveland it 
 is quite inaccessible. The plans and elevation of some of these hospi- 
 tals are here shown. 
 
' ' OMMUNICA BLE D isK. I HE '& 
 
 609 
 
 -' 5 - 1 
 
 - * s 
 
 ' - i 
 
 
 
 /. - ~ 
 
 r — ' 
 
 
610 
 
 COMMUNICABLE DISK A sEs. 
 
 HAMLIN AVENUE 
 
 u 
 
 FUTURE TEMPORARY WARDS 
 IN EVENT OF ^r-JALLPOX CPIOEMIC 
 
 i i 
 I i 
 
 ! ! i 
 
 ! ' i 
 
 v L_..._m ; __.j 
 
 BLOCK PLAN 
 
 CHICAGO CITY 
 ISOLATION HOSPITAL 
 
 3CALC f ' 
 
 LAWN DALE AVENUE 
 1 !(.. 49. 
 
((> .1/11/ 1 TNI CA I! L E D rs E. 1 8 E8. 
 
 611 
 
 FIRST FLOOR PLAN 
 CHICAGO CITY 
 ISOLATION HOSPITAL. 
 
 Fig. r>0. 
 
(312 
 
 OMMUNIt ABLE I) I SEA s ES. 
 
 Fig. 51. 
 
 Smallpox Hospital at Muncie, Iml.. built in 1S93, at a cost of about $1,000. From Report of Indiana 
 
 State Board of Health, 1893. 
 
 I ii New Orleans the city does not maintain the smallpox hospital, 
 but patients are cared for by contract at the rate of $3,000 a year up to 
 fifty patients, and #25 per patient for all in excess of that number. 
 
 Next to smallpox in importance as requiring hospital accommoda- 
 tions are diphtheria and scarlet fever. Of course measles, chicken pox, 
 whooping cough, typhus, and other diseases do sometimes require 
 hospital attention but it is only in the largest cities that provision for 
 several diseases is absolutely 7 necessary. The most pressing need is for 
 the treatment of diphtheria and scarlet fever, but by far too many cities 
 have no municipal hospital for these diseases. 1 
 
 It is rare indeed that the health officials are to be blamed for the 
 absence of hospital facilities. Nearly every health report from the 
 cities mentioned clearly sets forth the need of such a hospital and 
 urges the council to make the necessary appropriation. The council 
 however remains apathetic till after a time some prominent person is" 
 endangered by the absence of proper facilities when the hospital is at 
 once erected. 
 
 1 Among such cities may be mentioned: Buffalo, Chicago, Cincinnati, Cleveland, 
 Dayton, Fall River, Fitchburg, Haverhill, Lowell, Oakland, Cal., Pittsburgh, Fort- 
 land, Rochester, Sacramento, St. Paul, San Antonio, San Francisco, Seattle, Somer- 
 ville, Taunton, and Toledo. 
 
COM Ml XI< \ I />' L E I>lsh\ 1 SES. 
 
 613 
 
 ' D • 
 • G.S. • 
 
 - Office. * 
 
 <? 
 
 ?.'•■-■ 
 = 
 
 Bath 
 Rooms. 
 
 - 
 
 * D 
 
 Gentlemen's Ward. 
 
 * * 
 
 No. l. 
 
 v k o ■ 
 
 Si |, ,, Ward for the new 
 
 . ■!'■■-■. 
 
 -L 
 
 Kitchen. 
 
 <;. B. 
 
 cases ami sick 
 
 IIIH'S. 
 
 ~ 2 ~ 
 - -'■' - 
 
 Well, 
 o 
 
 FIG. 
 
 Plan "i Hospital al Muncie, End. 
 
 Explanations. Ba< b arm ol this cross was hit Feel long and 18 feel wide. 
 
 \.i.,u No. 2 Indicates the direction ol guard-house, 200 feel fr hospital. [twasSxri, proi ided 
 
 ■ ith a Btore. 
 
 .\itmu No. i Indicates 1 1 1 « - direction of the disinfection station, 200 feel from hospital, 
 
 I » indicates common doors. 
 
 s. i>. D. Indicates sliding double <l b. 
 
 • • • inilu ;ilc-~ \\ inilou -.. 
 
 < ; . 8. inii Icates gas Bto^ es. 
 
 i w. C. Ind nit' - ladies' watei closet 
 
 < , W. C. Indicates gentlemen's water closet 
 
014 
 
 OOMMUWK A BLE 1)1 SEA SES. 
 
 . * z. 
 
 4 - .- 
 
CO MMl TNI t \ i BLE I) I SEA SES. i ; ] 5 
 
 Then there are some cities which have no municipal hospitals for 
 the care of communicable diseases but send such eases to private in- 
 stitutions to which are paid a certain amount per patient, or a lump sum 
 annually. This method is not usually satisfactory to the sanitary 
 officials for several reasons. First, it greatly facilitates dealings with 
 the family of the sick, and often prevents much friction, if the manage- 
 ment of the patients is controlled by the same health officials who send 
 the patients to the hospitals. In private hospitals there is of course no 
 such control. Second, if regular board is paid for each patient, there 
 is a tendency for health officials to economize by not sending as many 
 patients to the hospitals as they might otherwise do. Lastly, the 
 facilities for the care of the patients especially as regards isolation are 
 not usually as good in private hospitals, or in fact in any general hos- 
 pital as they are in hospitals designed especially for that purpose. The 
 following shows some of the cities which have only the facilities above 
 referred to. the amount paid for the service and the hospital to which 
 the patients are sent : 
 
 Buffalo Buffalo < teneral Hospital $4 per \* eek 
 
 Cambridge Cambridge Hospital 20 per week 
 
 Chicago Cook County Hospital (paupers only) ... no charge 
 
 Hartford • :; pej week 
 
 Hoboken, \. J St. .Mary's (under twelve years) 3 per week 
 
 (over twelve years) 5 per week 
 
 Newport, R, I Newport Hospital 14 per \\ eek 
 
 Newt mi. Mas^ Newton Hospital I4.ii7 per week 
 
 Pittsburgh Mercy 1 [ospital 14 per week 
 
 Providence Rhode Island Hospital 1 15 per week 
 
 Rochester 12 per week 
 
 Wilmington County Hospital (paupers only) no cha rge 
 
 Bloonitield, \. .J Mountainside Hospital '.» per week 
 
 Mont chtir. N. .1 Mountainside Hospital to 
 
 Verona, S.J Mountainside Hospital 18 per week 
 
 Of the above hospitals those in Cambridge, Newton and Providence 
 have small hut fairly well arranged isolated buildings for the care of 
 their communicable disease cases, and in Wilmington, Del., the county 
 
 hospital is said to afford good facilities. Init iii most of the cities the 
 
 arrangements made arc entirely inadequate andc paratively few cases 
 
 are senl to the hospital. Iii some instances the wards are in the same 
 
 building with the genera] wards. The health department in almost 
 
 even, instance is \er\ desirous for the establishment of an independent 
 hospital. 
 
 A lew cities which have no real provision for such cases yel occa- 
 sionally send a patient with scarlet fever or diphtheria to their general 
 
 1 In this citj tin- building was constructed bj Hie Rhode Island Hospital with 
 monej appropi iated h\ t he i 
 
516 COMMUNICABLE DISEASES. 
 
 hospitals when it happens that the removal of such a patient from the 
 street or railroad car is absolutely necessary. The patient will then be 
 cared for in a small ward or room set apart temporarily or permanently 
 for that purpose. That is almost all that is done in Cincinnati and 
 Louisville and indeed in some of the cities mentioned on the preceed- 
 ing page. In other cases separate wards are built in connection with 
 the general hospitals to which the city patients are sent. Such sepa- 
 rate wards are found in Hartford, Minneapolis, St. Paul and Provi- 
 dence. 
 
 Undoubtedly the best arrangement is for the city to build and 
 maintain a separate hospital for the care of communicable disease as 
 this is the surest way to secure complete isolation. There may be no 
 objection to having the building on the grounds of a general hospital,, 
 and heat and light may be advantageously furnished from the general 
 plant. The writer however believes that it is unwise to have any other 
 connection if it can be avoided. This is the result of his experience in 
 Providence where the medical attendance and some other service, and 
 the kitchen, are in common for the contagious wards and the general 
 hospital. This opinion is concurred in by the officers of the hospital 
 who only entered into this arrangement as offering the best means 
 available at the time for the care of such cases. 
 
 The following places have what are practically independent munici- 
 pal hospitals for the care of communicable disease other than smallpox 
 (chiefly diphtheria and scarlet fever) : Alleghany, Atlantic City, Asbury 
 Park, in conjunction with the adjoining township of Neptune ; Bridge- 
 port, Boston, Brooklyn, Brookline, Denver, District of Columbia, Eliza- 
 beth, N. J., Grand Rapids, Mich., Jersey City, Lynn, Memphis, Mil- 
 waukee, Morristown, N. J., New York, Paterson, Pittsfield, Mass., 
 Philadelphia, Portland, Me., Spokane, Springfield, Mass., Syracuse, 
 Trenton, N. J., Utica, Waltham and Worcester. Denver and Memphis 
 have a series of cottages or small houses for an isolation hospital : in 
 the latter city there are eight of these cottages and in the former seven. 
 The total capacity of the Denver cottages is forty-six. 
 
 Rules for the administration of communicable disease hospitals may 
 be found in the report of the commissioner of health of Milwaukee for 
 the year ending April, 1894, and in the report of the Worcester board 
 of health for 1896. The cost of maintaining communicable disease 
 hospitals varies as the size of the hospital and the number of patients 
 vary. In Denver in 1898 there were treated seventy-nine cases of 
 diphtheria, twenty-seven of scarlet fever and fifty-four of other dis- 
 eases, mostly measles, at a cost of $5,800. In Lynn in 1899, fifty-three 
 cases of diphtheria and seventeen of scarlet fever were treated at an ex- 
 
C OMMUNIL \ J BLE 1)1 SEA SMS. 6 1 7 
 
 pense of 84,878.01. In Paterson in 180s. 102 patients and eighteen 
 well mothers who went with their children cost $5,097.93, including 
 repairs and the payment of $300 to the attending physician, in Brook- 
 line, .Mass.. in 1899, sixty-eight cases of diphtheria and twenty-one of 
 
 scarlet fever cost #4,113.39. The cost of running' the dwelling which 
 was seized for a hospital in Cambridge in 1899 was $265.60 per week, 
 and during December twenty-eight patients were treated there. In 
 Boston in 1898, 1,517 patients were treated at the Boston City Hospi- 
 tal, contagious division, at a cost of $71,687.34. In Springfield, Mass., 
 in 1900, thirty-seven patients were cared for at an expense of $2,500. 
 In Worcester in 1899 203 patients cost about 87,000. 
 
 Municipal hospitals for communicable disease are designed primarily 
 for the use of the poor or persons of moderate means, whose homes are 
 not ample enough for the proper isolation of the sick. It is true that pri- 
 vate rooms arc usually added to the hospital which may be hired by persons 
 of more means, but who, for one reason or another, desire to make use 
 of the facilities tor isolation afforded by a hospital. Municipal hospitals 
 do not ordinarily need to offer all the luxuries which the rich would 
 have in their own homes, and it has been deemed advisable, at least in 
 New York City, to establish a hospital which would more nearly fulfill 
 the demands of wealthy people. The Minturn Hospital for scarlet fever 
 and diphtheria was built in 1896, 1))' private subscription, though upon 
 land owned by the city and near to the municipal hospital used for the 
 Bame diseases. A similar hospital is proposed for Philadelphia. 
 
 One serious difficulty which is usually encountered in providing hos- 
 pitals for the care of communicable diseases is the securing of the uec- 
 essar} site. The public is much more apt to be frightened by imaginary 
 than by the real dangers of communicable diseases. There is no reason 
 why a contagious disease hospital should not be so conducted that there 
 would be no danger in ha\ ing it in the midst of a built up block : indeed 
 it oii'jht always to he conducted in just that manner: but the public are 
 afraid <>l it. and want it in the middle of a ten acre lot. and that far aw ay 
 from all habitations. There is of course great difficulty in securing such 
 a location, and it is unfortunate to place a hospital so far out in the 
 suburbs that ever} patient has to have a long ambulance ride. Some- 
 times the opposition to the location of the hospital takes the form of an 
 appeal to the council by which the appropriation is defeated, and some- 
 times 1>\ an appeal to the courts resulting in an injunction. In the Dis- 
 fcricl of < 'olumbia such object ion was made iii I 895 to the local ion of a con- 
 tag OUS hospital that ( 'oligress was induced to enact that lio BUCh hospital 
 
 should be built within 300 feet of any building ow ned 1>\ a private indi- 
 vidual or any other party than t he one erecting the building. As the health 
 
618 
 
 COMMUNICABLE DISEA SES. 
 
 officer of the district has shown, this would require a fifteen acre lot for the 
 hospital, which would make it far too expensive. Finally Congress 
 forced the building- of the new contagious wards on the grounds of two 
 private hospitals, threatening to refuse further' appropriation for their 
 support unless this was done. This is often the best solution of the 
 site problem, for, provided the contagious ward is separate and has an 
 entirely independent service, there can be no possible danger to the gen- 
 eral wards. Often the contagious hospital can be so placed without 
 exciting any opposition, and again it can be so placed notwithstanding 
 opposition. A number of illustrations are given of communicable 
 disease hospitals with plans and cost of construction. 
 
 Some of the large cities have good hospital facilities for the care of 
 communicable diseases, notable among which are New York, Brooklyn, 
 Philadelphia, Boston and the District of Columbia, In New York, 
 Boston and the District of Columbia brick buildings of considerable 
 size are provided while in Brooklyn and Philadelphia one story wooden 
 pavilions are made use of. In Boston nearly $300,000 was expended 
 on the buildings for communicable diseases which are under the man- 
 agement of the city hospital. A plan of these buildings is shown in 
 Fig. 55. In the District of Columbia less extensive buildings but yet 
 structures built of brick and well planned are worthy of study of all 
 who contemplate building hospitals of that character. 
 
 £>JT PAf/l/ON CeMTHAl BU/IDINC 
 
 Fig. 54. 
 
 Isolation Hospital, Portland, Me. Cost, »2,150. A nmeli more commodious hospital is now 
 
 under construction. 
 
( 'OMMUNIi '. 1 B L K DISEA SES. 
 
 619 
 
.620 
 
 ( ' OMM ( Wit A B L E BISEA sEs. 
 
 ' = x 
 
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l'lan of the Worcester Hospital for Communicable Diseases. From electrotype loaned by the Worcester Busi 
 
 ltd ..i Health. 
 
( ■ <>MM I r Nl t \ 1 B L E DIS E. 1 S ES. 
 
 621 
 
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 COMMUNICABLE DISEA SES. 
 
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 COMMUNICABLE DISEA SES. 
 
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 C OMMUNKJA BLE DISEA SES. 
 
 Fig. 6b'. 
 
 Communicable Disease Hospital, Trenton. Cost of building, $2,449.51 ; furnishings, .¥400.31. 
 From Report of State Board of Health of New Jersey. 1896. 
 
 ^=0 
 
 \ 
 
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 CELLAR 
 
 £*TAA#C£ 
 
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 Fig. 64. 
 Plan of Communicable Disease Hospital, Trenton. 
 
COJIJirXIf ABLE 2)1 SEA SES. 
 
 627 
 
 Fig. o.">. 
 
 Hospital for Communicable Diseases, Syracuse. House purchased and remodeled and ward added. 
 Changes cost 111,146.57. From Report of Health Officer, 1S96. 
 
 scAut. .rfrccr. n R5 T FLOOR PLAN. 
 
 Pig. 86. 
 
 Plan of the Communicable Disease w ards at the Cambridge Hospital. From Report ol the 
 State Board ol Health ol Massachusetts, 188 , 
 
628 
 
 V OMMUNICABLE DISEA SES. 
 
 Fig. GT. 
 Hospital for Communicable Diseases, Lynn. Cost, $5,500. 
 
 Ambulances. 
 
 If a hospital is provided for the care of communicable diseases it is 
 very necessary that some suitable vehicle should be provided to trans- 
 port patients to it. Patients with scarlet fever and diphtheria should 
 not be carried in hacks or any other public conveyance ; neither is it 
 proper to carry such cases in an ambulance used for general purposes. 
 A city or town which maintains a "pest house," and there are still 
 many such, probably has no ambulance, but trusts to luck in hiring 
 some old express wagon whenever smallpox chances to appear. If a 
 city has sufficient intelligence to provide a decent hospital for the com- 
 moner communicable diseases, some sort of ambulance is usually pro- 
 vided to be used exclusively for such cases. Yet the writer knows of 
 a city of 100,000 inhabitants which built a contagious hospital at a 
 cost of •$ 25,000 and then hired by the hour an undertaker's wagon to 
 remove patients to it. Another city of even larger size carries its com- 
 municable disease patients in its general ambulance. 
 
 The following account of the ambulance service for the smallpox 
 hospital in St. Louis is by the superintendent i 1 
 
 " I have seen no later than a year ago, a patient brought to this institution in 
 what was at one time an ambulance; but from the appearance it presented at the 
 time referred to, it had evidently been used as a chicken roost, so full of chicken 
 dirt was it. In this so-called ambulance there was not even a pillow, not a blanket, 
 in fact nothing, not even a seat, unless the patient chose the floor; fortunately the 
 patient was not very sick at the time, so he managed to balance himself on the end 
 gate of the wagon for fifteen miles." 
 
 1 St. Louis, Report of Health Commissioner (1896-7), p. 179. 
 
COMMUNICABLE DISEASES. 
 
 629 
 
 In providing an ambulance for communicable diseases three things 
 should be borne in mind. First, the ambulance should be so constructed 
 that it may be easily disinfected, and second, it should, if possible, be so 
 arranged that patients may sit up in it, as many persons a"re perfectly 
 able, and prefer to ride in that way ; third, it should not be forbidding 
 in appearance. 
 
 Doubtless other cities have a special ambulance for communicable 
 disease, but the following is a list of some which are shown by their 
 health reports to be so provided. Brookline, Mass., District of Colum- 
 bia, Cambridge, Trenton, Grand Rapids, Milwaukee, Minneapolis, Xew 
 Haven, Charleston, Xew York City, Utica, Philadelphia, Boston, Brook- 
 lyn. Providence, Buffalo, Taunton, Trenton, Newton, Mass., Paterson, 
 Lynn, Chicago and Pittsburgh. 
 
 In Xew York City, Chicago and Utica cabs are used for conveying 
 many contagious cases. In Xewton a rockaway lined with rubber is 
 employed. 
 
 Fig. 68. 
 Ambulance for Communicable Diseases, Providenci . Cost, $500. 
 
 Ambulances should be disinfected after each use, but this is in many 
 cities not done. The ambulance is simpi} kepi clean and washed oul 
 occasionally with corrosive sublimate or Bprayed with formalin, as in 
 Minneapolis, St. Paul and Providence, or, in one city at Least, fumigated 
 
630 COMMUNICABLE DISEASES. 
 
 with sulphur. All cities, however, change the blankets and movable 
 bedding after each trip and wash it or steam it. In Boston and Cam- 
 bridge a rubber covered mattress is used which is washed with bichloride 
 after each trip. 
 
 An ambulance should be in readiness to respond promptly to all 
 calls, but in small cities where the calls are infrequent it is not feasible 
 to do this in all cases. Thus in Paterson, although the city has a hos- 
 pital and an ambulance it owns no horse, and one has to be hired for 
 each occasion. In large cities like Xew York and Boston of course the 
 ambulance is kept ready to respond at a moment's notice. There ap- 
 pears to be no rale in regard to the attendance of a physician on the 
 ambulance. One goes with every trip in Xew York but not in Boston. 
 In Boston a ward attendant in a white duck suit accompanies the 
 driver. In Providence a physician goes only in severe cases. The 
 driver wears a long linen duster over his ordinary suit. 
 
 Quarantine. 
 
 The word quarantine is used with varying significance in sanitary 
 literature. The term was originally applied to the detention of a 
 vessel having on board communicable disease; but it has come to be 
 applied to any restriction placed upon the communication of infected 
 with uninfected persons or things. In the opinion of the writer it 
 would be well to restrict this use of the word to the interference with 
 communication between infected and uninfected localities, countries, 
 states, towns, villages, etc. The detention of an individual in a house 
 or hospital is a matter requiring such totally different procedure that 
 it is well to designate it by another term, such as isolation. 
 
 Quarantine also lias two natural divisions, maritime and inland. 
 The conditions of trans-oceanic and coastwise commerce are so different 
 from those of communication on land, or even on inland waters, that it 
 is well to make these divisions of the subject. 
 
 Maritime Quarantine. 
 
 The first colonial quarantine law was passed in Massachusetts in 1699, 
 and during the next century every colony had laws of this kind on its 
 statute books. Up to the time of the establishment of the national 
 board of health in 1879, maritime quarantine was entirely in the hands 
 of the states which, however, frequently delegated it to the seaports 
 within their borders. The federal government doubtless has authority 
 to maintain quarantine, and it then for the first time attempted to do so. 
 After this board was abolished, quarantine powers were conferred upon 
 
( OMMUNIt \ 1 BLE DI8EA SES. 
 
 631 
 
 I - 
 
632 COMMUNICABLE DISEASES. 
 
 the marine hospital service. At present there is very little direct fed- 
 eral legislation in regard to quarantine, but rules have been formulated 
 by the secretary of the treasury which must be obeyed before vessels 
 can enter at the custom house. Local quarantines very generally enforce 
 these rules and also act under state laws and rules of their own. The 
 federal government through the medium of the marine hospital service 
 has established the following quarantine stations : Reedy Island, 
 Delaware Breakwater, Cape Charles, Cape Fear, South Atlantic, 
 Brunswick, Tortugas, Gulf Island, San Diego, San Francisco, and Port 
 Townsend. The rules are promulgated and the stations' established 
 in accordance with the Act of Congress approved 15 February, 1893. 
 This act also gives the secretary of the treasury authority to make 
 rules in regard to the procedure of masters and owners at foreign ports 
 and enlists the consular service in the aid of the marine hospital service. 
 Medical officers of this service are also detailed from time to time to in- 
 fected foreign ports to assist in seeing that infected vessels are not 
 allowed to sail for United States ports. 
 
 It is the belief of many and shared by the writer, that maritime 
 quarantine should be exclusively in the hands of the federal government, 
 but at present it is not, and it is existing conditions that are here con- 
 sidered. Most of the quarantines are maintained by local governments 
 while some of the most important are exclusively state organizations. 
 The federal government cannot supersede any of these except on their 
 volition, but it can and does insist on minimum requirements which 
 must be uniform at all ports of entry. 
 
 All of the seaboard states have laws in regard to maritime quaran- 
 tine, but their treatment of the subject varies considerably. In the New 
 England states and Delaware, Georgia, Maryland, New Jersey, and 
 Wasliington, the administration of quarantine is practically left to local 
 officers, that is, to officers appointed by seaport cities. In all these 
 states except Georgia the board of health or health officer is given quar- 
 antine power, but in Georgia this is conferred upon the municipal 
 governments. In the other states the state exercises more or less execu- 
 tive power. In New York the health officer of the port of New York, 
 in most respects the most important quarantine officer in the country, is 
 appointed by the governor. He must be a physician of ten years' 
 experience, skilled in quarantinable diseases, and his term of office is 
 four years. In Pennsylvania the control of quarantine is vested in a 
 state board consisting of a member appointed by the College of Physi- 
 cians and Surgeons, one by the Maritime Exchange, of the secretary of 
 the state board of health, of the health officer of Philadelphia, of the 
 quarantine physician appointed by the mayor of Philadelphia, and a 
 
COMMUNICABLE DISEASES. 633 
 
 member appointed by the governor of Pennsylvania. In Virginia the 
 governor appoints the quarantine officer at Newport News and his term 
 of office is two years ; but for the protection of Norfolk and Portsmouth 
 the state has established a board of quarantine commissioners for Eliza- 
 beth River, three of whom are appointed by the city council of Nor- 
 folk, three by the city council of Portsmouth, and one by the judge of the 
 "county court of Norfolk County. In South Carolina the state board of 
 health controls quarantine and the quarantine officers are appointed by 
 the governor. The quarantine officer at Charleston, the chief port, has 
 a salary of *1,800 and is nominiated by the state board of health. In 
 Florida, also, the state board of health has full control of quarantine and 
 the local officers are its agents. When this law went into effect the two 
 counties of Escambia and Franklin were allowed to maintain a separate 
 health and quarantine organization, but this arrangement has recently 
 been abandoned. In Alabama the quarantine of Mobile is administered 
 by a board established by special act and known as the quarantine board 
 of Mobile Bay. It consists of the president of the board of revenue and 
 road commissioners of Mobile County, the mayor and health officer of 
 Mobile, the president of the Chamber of Commerce and the president of 
 the Medical Association of Mobile, and the probate judge and the health 
 officer of Baldwin County. In Mississippi and Louisiana the state 
 board of health has charge of quarantine, and in Texas the state health 
 officer. In Oregon the governor appoints local quarantine officers of 
 whom there are four. In North Carolina the entire quarantine has been 
 transferred to the marine hospital service. 
 
 It is thus seen that in New York, South ( larolina, Florida, Mississippi, 
 Louisiana, Texas, and < )regon maritime quarantine is directly admin- 
 istered by state officials, while in the other states administration is in 
 the hands of local officials, though sometimes, as at Philadelphia, Eliza- 
 abeth River, Va., and Mobile Bay, Ala., a special hoard is created to be 
 made up of certain of the neighboring officials. 
 
 Besides the above evidences of state control, in Maine. New 
 Hampshire, and Alabama the state hoard of health is authorized to 
 establish quarantine, and if its arrangements are in conflicl with Local 
 regulations, the latter musl give way. In Alabama, Georgia, Louisiana, 
 
 Maryland, Rhode Island, and Texas the governor also has authority to 
 
 proclaim quarantine. It is thus seen thai while in a considerable num- 
 ber of seaports, including such important ones as Boston, Baltimore, and 
 San Francisco, quarantine is a local affair, yel in the main there is a 
 disposition to consider it a function of the state rather than of the Local 
 government. 
 
634 COMMUNICABLE DISEASES. 
 
 There is a very considerable amount of statutory legislation in regard 
 to quarantine and also not a few ordinances made by the seaport cities 
 themselves. 1 There are also a good many rules, orders, and proclama- 
 tions issued under authority by various quarantine officials, all of which 
 go to make up the volume of quarantine legislation. Much of the statu- 
 tory legislation is very old, dating back to the eighteenth century. Its 
 phraseology is apt to be peculiar and many of its provisions are obso- 
 lete. It often, too, deals with details which might well be left to the 
 quarantine officer. Many of these acts sadly need revision. 
 
 Several of the states in the interior lying upon navigable lakes or 
 rivers, have copied some of the quarantine provisions of the seaboard 
 states in regard to the detention of vessels. Among such are Kentucky? 
 Ohio, West Virginia, Michigan, and also the cities of Chicago and 
 St. Louis, but the conditions are so different from what prevails on the 
 sea coast that these regulations rather belong to the subject of inland 
 quarantine. Among the subjects covered by quarantine legislation are 
 the following : 
 
 Authority t<> declare quarantine. The authority to decide what 
 vessels shall be detained and to order them into quarantine is some- 
 times conferred upon the governor, as in Alabama, Georgia, Maryland, 
 Rhode Island, Texas and Louisiana, and more often upon the state 
 board of health as in Florida, Louisiana, Maine, Massachusetts, New 
 Hampshire, South Carolina, and Texas ; but it is usually given to the 
 local authority. This authority is granted in all states except Penn- 
 sylvania, Florida, Mississippi, Louisiana and Texas. More rarely the 
 statute attempts to specify the vessels that shall be subject to quaran- 
 tine. This is more often found in the older laws, as those of Connecti- 
 cut, Delaware, Maine, New Hampshire, New Jersey, New York, North 
 Carolina and South Carolina, though it is sometimes found in some of 
 the newer laws. Thus in Connecticut it is every vessel having sick- 
 ness on board ; in Delaware any " vessel having on board more than 
 forty persons, or any one sick with any infectious disease, or coming 
 from any sickly port." Infected vessels or those suspected to be, or 
 vessels from any infected port, are common expressions in statutes and 
 local regulations. In San Francisco in addition to the above, " vessels 
 with decaying cargoes or which have unusually foul or offensive holds " 
 are subject to quarantine. The section given below is an example of a 
 
 1 Among the latter which the writer has examined are those of Bath, Boston, 
 Baltimore, Bangor, Fall River, Gloucester, Jersey City, New York City, Mobile, 
 New Bedford, New Haven, Newport, Philadelphia, Providence, Provincetown, San 
 Francisco, and Wilmington, Del. 
 
COMMUXICABLE DISEASES. 635 
 
 modern and specific statutory declaration of quarantine. 1 An example 
 of a governor's proclamation of quarantine, that of the governor of 
 Texas may be found on page 847, PuUic Health Reports, United States 
 marine hospital service 1900. Many, if not most of the definitions as 
 to what vessels are subject to quarantine are found in local regula- 
 tions, and this subject will be further considered in connection with 
 quarantine administration. 
 
 Authority to make rules in regard to quarantine is conferred upon 
 the state sanitary officials in South Carolina, Florida, Alabama. Mis- 
 sissippi, Louisiana, and upon the governor in Texas ; but in most of the 
 states the seaport towns, or the local boards of health, or the quaran- 
 tine boards have such authority and have very generally taken advan- 
 tage of it. 
 
 The board of health in Charleston can make quarantine rules but 
 only under the direction of the state board of health. In New York 
 the health officer of the port of Xew York in addition to his other 
 duties and his ''control" of quarantine "shall in the presence of im- 
 minent danger of winch lie shall be the judge, take the responsibility of 
 applying such additional measures as may be deemed indispensable for 
 the protection of the public he'alth." 2 
 
 Provisions are sometimes made for the publication of these regu- 
 lations. In Rhode Island they must "be published in one or more 
 newspapers, published in the state within or nearest the town w herein " 
 they w»-re adopted. In Alabama the quarantine board of Mobile Bay 
 is to provide the towboat captains and pilots with rules printed in 
 English, Spanish, German and French, and these officers are to furnish 
 them to the masters of incoming vessels. A similar requirement is 
 made of pilots in Louisiana, Maine New Hampshire, South Carolina 
 and Washington, and in New Hampshire the town authorities arc to 
 notify the commanders of neighboring forts and ask their assistance in 
 notifying \<ssels to anchor at quarantine. 
 
 Duties of Masters. Most of the statutes and nearly all of the 
 local regulations require that vessels subject to quarantine, or infected 
 
 I N.-w F/ork, Revised Statutes i 1896), p. 24 L6 | Public Health Law, Sec I L0): 
 
 II Every vessel arriving al tin- port of New Fork from an; place where a quaran- 
 tinable disease existed at the time of departure, or which shall have arrived at any 
 such place ami proceeded therefrom to New Sfork, or on board of which during the 
 voyage any case of any such disease sliall have occurred, shall remain ;n quarantine 
 until tli< health officer grants a permit tor the discharge of such vessel or cargo or both. 
 Everj vessel arriving at the port of New Fori from any foreign port, and everj 
 
 vessel from ;i domestic port (in the ordinary passage from which they pass south of 
 
 Gape Henlopen, arriving between the first day of May and the firsl day of Novem 
 hen. shall . . . be subject to visitation. 11 
 
 \eu Fork, Revised statutes (1896), Public Health Law, Sec. 101. 
 
<336 COMMUNICABLE DISEASES. 
 
 vessels, or vessels from infected ports, or other specified classes of 
 vessels, shall come to anchor at the quarantine grounds, or as close to 
 the quarantine grounds as possible, or as soon as a safe berth can be 
 reached. In Rhode Island where provision is made for the appoint- 
 ment of a sentinel, the master is liable only when he refuses to anchor 
 after being hailed. 
 
 Some of the states, as New Hampshire, North Carolina, and Wash- 
 ington, require the master to report to the quarantine officer or other 
 local authorities if his vessel is infected. In New Hampshire he is to 
 report if any person on board is or has been sick with any infectious 
 disease, or if there are any goods on board which may be infected. 
 Most of the state laws require the master to give to the quarantine 
 officer information desired bj the officer. Sometimes the law requires 
 him to make a truthful statement, and in other cases he may be put 
 under oath by the quarantine officials. Sometimes, as in the Massa- 
 chusetts law which was passed in 1797, seamen and passengers may 
 also be put under oath. 1 In Georgia the master is required to deliver 
 up all his books and papers, and in New York, Florida and Virginia to 
 show his bill of health. Often a general provision is introduced that 
 the master shall conform to all the provisions of the law, and that fail- 
 ure to obey any of them shall subject him to the prescribed penalty. 
 
 Duties of Pilots and Toivboat Captains. Pilots and the masters of 
 tow boats may be responsible for the failure of a vessel to come to 
 anchor at quarantine, and as these persons are in a position to be well 
 informed as to quarantine rules, and are more easily controlled by the 
 quarantine officers, it often happens that they are by law made respon- 
 sible for its enforcement. The duties of pilots in notifying masters of 
 vessels of the quarantine regulations has already been alluded to. 
 Their other duties and responsibilities are explicitly set forth in the 
 South Carolina law given below. 2 
 
 1 Massachusetts, Revised Statutes (1882), Chapter 80: 
 
 " Sec. 63. A master, seaman, or passenger, belonging to a vessel on board of 
 which any infection then is or has lately been, or is suspected to have been, or 
 which has been at or has come from a port where an infectious distemper prevails 
 that may endanger the public health, who refuses to make answer on oath to such 
 questions as may be asked him relating to such infection or distemper by the board 
 of health of the town to which such vessel may come (which oath any member of 
 the board may administer), shall forfeit a sum not exceeding two hundred dollars; 
 and if not able to pay said sum, he shall suffer six months 1 imprisonment. 11 
 
 2 South Carolina, Revised Statutes (1893) : 
 
 " Sec. 1005. It shall be the duty of each pilot belonging to either of the said 
 ports to use his utmost endeavors to hail every vessel he shall discover entering the 
 port, and to interrogate the master of such vessel in reference to all matters nec- 
 essary to enable such pilot to determine whether, according to the provisions of the 
 
COMMUNICABLE DISEASES. 637 
 
 The regulations of Mobile Bay require that pilots and officers and 
 crews of towboats shall not board infected vessels, but shall direct thern 
 to the quarantine station, and the pilot on boarding all other vessels 
 must hoist a flag at half mast at the fore until visited by the quarantine 
 officer. In Georgia and South Carolina the pilot must not board an in- 
 fected vessel. In Louisiana the rules of the state board of health require 
 that pilots are, on boarding, to hand the master a printed form, and 
 the latter shall fill out in writing the names of the crew and passengers, 
 and answer truthfully the questions therein, and return the same with 
 the bill of health to the quarantine officer. Several of the laws stipu- 
 late that pilots who have boarded a vessel shall not leave it until a per- 
 mit is granted. The rules of Providence, Newport, and Louisiana make 
 similar provisions in regard to customs officials, and the San Francisco 
 rules require them to lie disinfected and vaccinated as are others. The 
 Louisiana statute specifically forbids the masters of towboats to receive 
 passengers or freight. 
 
 Communication with Vessels hi Quarantine. The object of placing 
 vessels in quarantine is to prevent disease passing from them to the 
 shore. Hence, prohibition of intercourse between infected vessels and 
 the shore is the most important part of quarantine legislation. Most of 
 the laws provide that no person shall go ashore from a vessel in quaran- 
 tine without a permit from the quarantine officer; and in Alabama, 
 Georgia, North Carolina, Rhode Island, and Virginia such person may 
 be arrested and returned to the vessel or confined on shore. When the 
 
 preceding sections, such vessel is subject to quarantine or examination by the 
 quarantine officer. 
 
 "Sec. 1006. If, from the answers obtained to such inquiries, it shall appear 
 that such vessel is subject to quarantine or examination by the health officer, 
 according to the preceding sections, the pilot shall immediately give notice to the 
 master of the vessel that he, his vessel, his cargo, crew, and passengers are subject 
 to such examination, and that he must proceed and anchor said vessel at the quar- 
 antine anchorage, there to await the further directions of the quarantine officer. 
 
 11 Sec. 1007. It shall be the duty of every pilot who shall conduct into port a 
 vessel subject to quarantine or examination by the health officer — 
 
 "1. To bring such vessel to anchor within the buoys marking the quarantine 
 anchorage. 
 
 "2. To prevent any vessel or boat from coming alongside oi the vessel under 
 
 his charge, and to prevent anything on hoard from being transferred to or thrown 
 i n t < » any oi her \ BSSel or In, at. 
 
 •■ ::. To present to the master of the vessel a printed copy of this chapter when 
 
 sin h copy shall have been delivered to him for that purpose. 
 
 " 4. To take care that 00 violation's of this chapter be committed by any person, 
 and to report such as shall be committed, as soon as maj be, to the health officer. 
 
 " r>. To subject himself to such detention and delay and cleansing and purifica- 
 tion as to his person and clothing as shall he prescribed by the health officer after 
 having boarded or brought to the quarantine ground anj vessel subject to quaran- 
 tine. 
 
638 COMMUNICABLE DISEASES. 
 
 ship's company is thus confined on board, the master or owners are by 
 the laws of South Carolina and Baltimore, made responsible for their 
 maintenance. It is forbidden in many states to carry goods on shore 
 and very stringent regulations are found in New York, 1 and in New- 
 Hampshire and South Carolina such goods may be seized by the quar- 
 antine officers. In New Jersey and in Boston there is a provision 
 against throwing any bedding or clothing from a vessel in quarantine. 2 
 In New Jersey, and in New York City, rags and hides may not be 
 landed without a special permit. 
 
 It is also forbidden persons to go on board vessels in quarantine and in 
 Louisiana, butchers, bakers, stevedores, and runners are named as possi- 
 ble offenders. In North Carolina the master is liable unless he informs 
 the offender that he cannot board. Such persons are also liable to 
 detention on board as long as the quarantine officer deems necessary-. 
 In New York any one who has any communication or intercourse with 
 any vessel at quarantine, or with any of the crew or passengers of such 
 vessel, or who enters the quarantine ground or anchorage is liable to the 
 penalty. In South Carolina, Providence, and Newport, boats are not 
 allowed alongside or to pass among vessels at quarantine. 
 
 New Hampshire, New Jersey, the City of New York, Rhode Island, 
 and Washington provide that if a vessel leaves quarantine without permit 
 she may be forcibly returned at the owner's expense, the costs to be a 
 lien upon her. 
 
 Inspection. Nearly all the statutes and regulations provide for the 
 inspection of vessels at quarantine for the purpose of determining the 
 question of their infection and their subsequent treatment. These 
 laws impose duties both on the masters of vessels and on the quarantine 
 officers. The former are required to submit their vessels to inspection, 
 and as has been shown, are to furnish all needed information and show 
 their books and papers and present their bill of health. The quarantine 
 officer in turn is required to inspect vessels " immediately " or " as soon 
 as possible ; " but as a proper inspection cannot be made at night, it is 
 usually directed that it shall be made between sunrise and sunset- 
 Some of the statutes, as those of New York, South Carolina, and Flor- 
 ida go into some detail as to the duties of the quarantine officer in 
 inspection, but usually these matters are left to be incorporated in the 
 local rules governing quarantine. 
 
 Care of the Sick. Quarantine officers are generally authorized to 
 remove the sick from the vessel to the shore, in order that they may be 
 the better cared for, and this is usually done, but they also have the 
 
 1 New York, Revised Statutes (1896), p. 2418, (Public Health Law, Sec. 131c.) 
 New Jersey, Rule 9, State Board of Health, 29 June, 1897. 
 
COMMUNICABLE DISEASES. 639 
 
 option of confining them on the vessel. In Louisiana the state board of 
 health is required to have nurses and physicians on call at all times, and 
 in Texas the state quarantine officers are to provide for all persons held 
 in quarantine. Usually, however, the laws, especially the older ones, 
 require that the cost of caring for the sick shall be a charge upon tl it- 
 vessel. 
 
 Disinfection. Quarantine officers are usually authorized to disinfect 
 or order the disinfection of infected vessels and their cargoes, and also 
 the ship's company. The New York statute is very explicit as to what 
 may be done. Usually, however, the details of disinfection are left to 
 the local officer, it is usually provided that the cost of disinfection 
 shall be paid by the vessel; and sometimes as in Xew York, the 
 fee to be charged for this service is fixed by statute. 
 
 Vaccination. Several of the states as New York, Xew Jersey, and 
 South Carolina provide for the vaccination of all persons on board who 
 have not been previously protected against smallpox. In Xew York if 
 they refuse to submit to examination or vaccination, they are to be 
 detained at the expense of the ship for the period of incubation of 
 smallpox. 
 
 Expenses of Quarantine. Most of the older laws provide that all the 
 expenses of quarantine such as moving vessels, furnishing the crew with 
 subsistence, caring for the sick, etc., shall be paid by the vessel, and 
 shall be a lien upon it or upon the cargo. 
 
 F>e8. It is usually provided by law that fees shall be charged for 
 the inspection of vessels at quarantine and the issuing of permits and 
 other services, and these fees are generally fixed by statute. In some 
 ports, however, no tecs are charged as will be noted in the following 
 pages. 
 
 Penalties. The penalties provided for the violation of quarantine 
 laws are more severe than arc found in other sanitary laws, those for 
 the adulteration of food only approaching them. A common maximum 
 is $500. In Louisiana, South Carolina, and New York the maximum 
 i- $2,000 or twelve months imprisonment for any violation of quarantine 
 regulations by masters, or for unloading g Is. In Georgia the penalty 
 
 for an infected person entering the slate is $500 and imprisonment. 
 
 Quarantine . 1 dministration. 
 
 Vessels subject to Inspection and Quarantine. The determination of 
 liability to quarantine rests on federal regulations, state laws, and local 
 rules. The older state laws, many of which are still in Force, required 
 the quarantine of all vessels from infected ports and all infected vessels, 
 
 and all suspected to be such. Similar provisions are found al80 in the 
 
640 COMMUNICABLE DISEASES. 
 
 older local rules. Something more specific is, however, necessary, and is 
 furnished by the treasury regulations, the later statutes, governors' 
 proclamations, and rules of the more important state and local quaran- 
 tines. The United States treasury regulations given below may be con- 
 sidered the basis for procedure at most quarantines. 1 
 
 These regulations are a minimum and their enforcement is secured 
 through the assistance of the customs officers. They are very generally 
 followed except perhaps at some of the smaller ports where there are 
 only a few entries during the course of the year. 
 
 These are the rules followed throughout New England and on the 
 Pacific coast, except that at Boston all vessels from ports south of 
 Virginia are inspected from 1 June to 31 October, and also all vessels 
 which within six months have been in an infected port. In Province- 
 town, vessels from the British Provinces are inspected from 1 May to 
 1 November, and in New Haven all the year round, and in the latter 
 port southern vessels are inspected. Passing from New England 
 towards the south, more attention is paid to the danger of yellow fever 
 infection. In New York, New Jersey, Baltimore, and Virginia vessels 
 from southern points are inspected during the summer. In New York 
 and New Jersey this applies to vessels from below Cape Henlopen, in Bal- 
 timore, Cape Henry, and at Newport News and Norfolk, Cape Lookout, 
 but in the latter ports any vessels which at any time within thirty days 
 have been south of the limit are inspected. These inspections are made 
 only between 1 May and 1 November, though in Baltimore the time 
 limits are somewhat elastic according to the season. In the southern 
 states where the greatest dread of yellow fever is felt and where this 
 is the chief disease to be quarantined, the number of vessels subject to 
 
 1 "1. Vessels arriving at ports of the United States under the following conditions 
 shall be inspected by a quarantine officer prior to entry : 
 
 "A. Any vessel with sickness on board. 
 
 "B. All vessels from foreign ports. 
 
 "C. Vessels from domestic ports where cholera or yellow fever prevails or where 
 smallpox or typhus fever prevails in an epidemic form. 
 
 "Exceptions. — Vessels not carrying passengers on inland waters of the United 
 States. Vessels from the Pacific and Atlantic coast of British America, provided 
 they do not carry persons, or effects of persons, non-resident in America for the 
 sixty days next preceding arrival, and provided always that the port of departure be 
 free from quarantinable disease. Vessels from other foreign ports via the excepted 
 ports shall be inspected. 
 
 "D. Vessels from foreign ports carrying passengers having entered a port of 
 the United States without complete discharge of passengers and cargo. Such ves- 
 sels shall be subject to a second inspection before entering any other port. Vessels 
 from ports suspected of infection with yellow fever, having entered a port north of 
 the southern boundary of Maryland without disinfection, shall be subjected to a 
 second inspection before entering any "port south of said latitude during the quaran- 
 tine season of such port." 
 
COMMUNIS A 13 LE DISK. [ sKs. (j^l 
 
 the rules is usually larger than at the north, and the rules are more 
 stringent. In South Carolina the statute requires that all vessels from 
 "infected or suspected latitudes or ports "* shall he detained five days. 
 hi these states suspected ports are those not known to he free from infec- 
 tion in the West Indies, Mexico. Central and South America north of 
 Rio de la Plata, and the west coast of Africa. Unlike many other quar- 
 antines, that of Charleston does not inspect vessels from the United States 
 unless such ports are known to he infected, or unless they come via 
 these [torts from a foreign country. Such vessels are known as " via 
 vessels." In Savannah " via vessels " and all coastwise vessels which 
 during their last voyage were in a foreign port are inspected. In Flor- 
 ida all foreign and "via vessels" are inspected, and also all domestic 
 vessels between 1 May and 1 November, unless special license is given. 
 Thus at Key West the regular Havana steamers are given certain 
 exemptions, and at Punta Rassa the regular steamer from Myers to 
 Punta Gorda is not inspected. At Pensacola all domestic vessels are 
 inspected during the summer season. Inspection of the sponge licet is 
 generally required, owing to the frequent off shore communication 
 between the spongers and the Cuban fishermen. At Mobile all vessels 
 are inspected the year around, hut a few locally owned coasters and 
 fishermen are exempted by special permit. All vessels arriving at the 
 Louisiana and Texas quarantine stations arc inspected. 
 
 It is of course the duty of masters to make themselves acquainted 
 with quarantine as with all other laws, and the greater number of cap- 
 tains sailing to the larger and more frequented ports are doubtless well 
 aware of the regulations. If not previously informed they are in- 
 structed by the pilots. Tow boat captains also are instructed as to the 
 rides, and would rarely violate them by bringing a vessel beyond the 
 quarantine grounds. At some ports in addition to this, a signal officer 
 is appointed to hail all vessels and order to the proper anchorage all 
 those requiring inspection. Such a signal officer is employed at Provi- 
 dence. Sometimes the quarantine officer is dependent on outside in- 
 formation, thus at Norfolk he is telephoned by the consignees or the 
 pilots' association. At the more important ports the quarantine station 
 Hated near by and Commanding a good view of the entrance, and 
 
 the quarantine officers are supplied with boats, or steamers are con- 
 stant^ on hand, so thai no vessel can enter without being seen. 
 
 It is of course t he dut \ of all \essels subjeel to inspection to an- 
 chor at the quarantine grounds. These grounds are frequently marked 
 hv yellow buoys or 03 buoys with yellov flags, or a quarantine flag, 
 
 Usually yellow, is set in a prominent place on the shore nearest the an- 
 chorage. When the vessel coiiies to anchor i he quarantine signal is to 
 
 I! 
 
G42 COMMUNICABLE DISEASES. 
 
 be set. The old laws of Rhode Island and South Carolina required the 
 colors to be set in the shrouds, but this signal is now used for another 
 purpose, though the Rhode Island law remains unaltered. A red flag- 
 is the quarantine signal in Maine, New Hampshire, Oregon and Wash- 
 ington. In Connecticut the statute prescribes white, but yellow is 
 the color used. At Mobile Bay the ensign is to be set at half mast on 
 the fore ; but most quarantine statutes and the federal laws prescribe 
 yellow. The quarantine signal for steamers in Louisiana is four long 
 and one short blast of the whistle. At some of the smaller ports 
 vessels are allowed to come to the wharf for inspection. This is the 
 custom in the District of Columbia and Punta Rassa, Fla., and is occa- 
 sionally permitted in Providence, New Haven, Norfolk, and San Fran- 
 cisco. 
 
 Inspections. It is assumed that a medical man will make inspec- 
 tions of vessels, and this is usually done, but it is not always, except in 
 cases of sickness, in Gloucester, Cedar Keys, Perth Amboy, the At- 
 chafalaya station of the Louisiana state board of health and at some of 
 the Florida stations. The laws generally require that inspections shall 
 be made by daylight, but sometimes at New York and in Louisiana they 
 are made at night. At New York this is done by means of an electric 
 light ; those undergoing the ordeal are required to pass directly toward 
 a powerful electric light which shines upon their faces and brings the 
 entire person under the eye of the inspector whose back is towards the 
 light. Only " liners " are thus inspected, and in case of suspicion they 
 are detained until morning. 
 
 Means must be provided for taking the inspector to the vessel, and 
 at the great ports steam vessels are used for this. The Boston, New 
 York, Pennsylvania, Baltimore, Savannah, Louisiana, and Galveston 
 quarantines have towboats for this purpose. Some of these are large 
 and powerful vessels which run up alongside steamers, which slow down 
 for the purpose, and set the inspector on board. The towboat then 
 cuts loose and the two vessels steam alongside at a good rate of speed 
 so that commerce is interfered with as little as possible and the incom- 
 ing vessel frequently is not obliged to anchor at all. At some of the 
 smaller cities, as New Haven, Newport News, and sometimes at Provi- 
 dence, the quarantine officer makes use of the regular towboats of the 
 port. Launches are used at Charleston, Pensacola and some of the 
 larger ports. At the smaller ports rowboats or occasionally sailboats 
 are maintained at quarantine, but at some ports, as Providence, New 
 Haven and the other New England ports, no boat of any kind is owned 
 by the quarantine department, and the inspector has to hire a boat for 
 the occasion or trust to a chance ride on a towboat. 
 
( ■ OMM I Wit '. \BIE 1)1 SEA SES. 043 
 
 When the inspector has boarded the vessel he immediately makes 
 
 his inspection. The treasury rule requires that 
 
 '• the bill of health and clinical record of all cases treated during the voyage, 
 crew and passengers 1 lists and manifests, and, when necessary, the ship's log shall 
 be examined. The crew and passengers shall be mustered and examined and com- 
 pared with the lists and manifests, and any discrepancies investigated." 
 
 This is the usual procedure, and in southern ports when the previous 
 voyage is to he considered, the log is generally examined. Besides 
 these details the master is usually required to sign a statement as to 
 the condition of the vessel and the health of the company, and at some 
 ports this must he a sworn statement. 
 
 The interrogatory used in Florida is shown below. 1 
 
 1 Inspection of vessels arriving nt tin- , 18 — . 
 
 •1. Name and class of vessel ? . 
 
 "2. Name of captain or master ? . 
 
 "3. Tonnage of vessel"? -. 
 
 •■4. From what port is the vessel you command? . 
 
 •••">. How mafty days have you been on the passage '.' . 
 
 "G. Where bound to ? . 
 
 " 7. At what port or ports have you touched within the last ninety days '.' . 
 
 "8. Were any contagious or infectious diseases prevailing at those ports - .' If 
 so. name the ports and diseases. . 
 
 "9. Was any freight, passengers, or ballast received at the ports at which your 
 
 vessel touched '.' . 
 
 •• 10. Had you any communication with another vessel on your passage - .' . 
 
 "11. Have you received any passengers, freight, or ballast from any other 
 vessel ? . 
 
 ■• 1"_'. If so. give particulars. . 
 
 "13. Have you a bill of health ? . 
 
 '■14. During the course of your cruise or passage, what cases of disease have 
 occurred on board, and at what date? . 
 
 "15. Have anj deaths taken place on board of your vessel since you left the 
 last port ? It' so, what dates and from what causes - .' . 
 
 "16. Are there any sick on your vessel at this time - .' . 
 
 "17. Has yellow fever, smallpox, cholera, plague, leprosy, or other contagious 
 or infectious diseases ever existed on this ship ? . 
 
 "18. If so, when ? . 
 
 •• 19. What is t he number of officers and crew ? . 
 
 "20. What is the number of passengers? 
 
 :i. What is your cargo, and to whom consigned ? . 
 
 •• 2 - .'. If in ballast, what is the character of the ballast, where was it taken 
 
 from, and how many tons have you on board? . 
 
 Wh;it is the present sanitary condition of the vessel, cargo, crew, and 
 
 passengers? . 
 
 , \IasU r. 
 
 8n ii. of Florida, ( 'ounty of : 
 
 Before me, , a notary public in and for said count] and State, per- 
 sonally came , master of the , tome well Known as the person 
 
 named, who, after being duly sworn, deposes and says thai the statements made 
 i>\ him i'i answer to the foregoing interrogatories arc true. 
 
 ■ ■ Sworn to and subscribed he tore me this daj of , A. I •. 189 — . 
 
044 COMMUNIt \ 1 11 LE DlsEA SMS. 
 
 It is customary for the inspector, especially in the south, to examine 
 all parts of the vessel. In San Francisco a very stringent regulation 
 was adopted, aimed at the Chinese immigants. 1 
 
 Masters of vessels from foreign ports are now obliged to obtain two 
 bills of health, one of which is given to the quarantine officer and the 
 other filed at the custom house. 
 
 The treasury regulations and also those of several states and cities 
 require the inspection and vaccination of all steerage passengers, and in 
 case there is smallpox on a vessel, all persons must be vaccinated unless 
 they present evidences of recent vaccination or smallpox, or else they 
 must be detained for fourteen days. 
 
 In Texas in addition to the master's affidavit the passengers are 
 obliged individually to make affidavit as follows : 
 
 State Quarantine Station - , , 189 — . 
 
 I, — -, do hereby solemnly swear that neither I nor my baggage have 
 
 been in any place infected with yellow fever, cholera, or smallpox within the last 
 twenty clays. 
 
 Sworn to before me. 
 
 Where from ? ■ . . 
 
 AVh ere to ? . 
 
 A record should be kept of all inspections, as indeed of all other 
 quarantine work, and this is properly done in all the larger stations, but 
 it is frequently neglected in the smaller ones. 
 
 After the inspection has been completed the vessel is either sent to 
 the infected anchorage, which should be out of the line of traffic, or else 
 is given pratique. As no vessel can be entered at the custom house 
 unless it has complied with the United States quarantine regulations, a 
 certificate to that effect is usually appended to the permit given by the 
 quarantine officer. The form used in Florida is shown on the next page. 
 
 J San Francisco, Regulations of Board of Health, 2u July, 1884: 
 " The Quarantine Officer and his assistants shall make an examination of every 
 part of the vessel into which they can enter. Those places which can only be 
 entered through manholes, or very narrow places, shall be fumigated with sulphur 
 or chlorine, so as to make it impossible that any person can remain therein. The 
 fumigation shall be so conducted as not to injure perishable articles of cargo. Two 
 or more inspectors shall, after all the Chinese steerage passengers have been brought 
 on the upper deck, commence at the extreme rear portion of each deck, including the 
 lower floor of the engine room and shaft alley, and proceeding forward examine 
 every compartment, stateroom, storeroom, partly-empty coal bunkers, excepting 
 specie, mail, and wine rooms, driving all Chinese steerage passengers they may lind 
 <m to the upper deck; and all passengers from the inspected portions of the vessel 
 shall be kept secure until the muster is over. When the inspection of the vessel is 
 completed, the Quarantine Officer shall come on deck, and, with the aid of his assis- 
 tants, shall count the Chinese passengers, men, women, and children, separately. 
 The white passengers and crew must be mustered and counted first." 
 
C OMMl WI( \ I BLE 1> ISE. 1 SES. | ; 4 .3 
 
 Port of , Fla., , ISO — . 
 
 I certify that , of , from , has in all respects complied with the 
 
 quarantine regulations prescribed by the Secretary of the Treasury, and that in 
 my opinion she will not convey quarantinable disease. Said vessel is this day 
 granted free pratique. 
 
 Hi, ill/, [Quarantine) Officer, Port of , Fla. 
 
 Treatment of P> t*">i.« on Infected Vessels. Formerly if there was a 
 case of contagious disease on board a vessel arriving at quarantine, the 
 vessel with all on hoard was kept in quarantine until every one had 
 recovered or died. Now, owing to the erection of hospitals and build* 
 bags for suspects at the more important quarantines, such barbarous 
 treatment is rarely necessary. It is only at the most important stations 
 that proper facilities are found for such work, though even at such ports 
 as Portland, Providence, and New Haven, smallpox infected vessels that 
 are likely to arrive could he and have heen properly handled. Boston, 
 New York. Baltimore, .Mullet Key, Fla., and the Louisiana station and 
 also the Reedy Island, Delaware Breakwater, South Atlantic. Tortugas, 
 Gulf, San Francisco, and Port Towns. -nd stations of the marine hospi- 
 tal service are equipped for the care of the personnel of the vessel on 
 shore. It is required by the treasury rules that if a vessel has on hoard 
 a case of cholera, yellow fever, typhus or smallpox, all of the passengers 
 and crew shall be removed to the shore, the sick put in the hospital and 
 the well kept under observation. The latter should he segregated into 
 small groups between which there shall he no communication. In 
 smallpox this isolation of the exposed is not necessary, provided they 
 have heen recently and successfully vaccinated before exposure, as is 
 usually the ease with most of the passengers and crew of the regular 
 liners. The duration of detention in yellow fever is ten days, and 
 cholera five days (though in Boston twenty-one days is required for 
 cholera), typhus fever twenty days, smallpox fourteen days, and plague 
 Bfteen day8. The larger stations are well supplied with hospital build- 
 ings, hut the arrangements for detention of suspects are not often suffi- 
 cient and sometimes it is necessary in keep them aboard the vessel. 
 
 Special measures are taken in regard to passenger t ral'lie between the 
 yellow fever ports of the Wesl Indies and the southern states. Accord- 
 ing to the treasury regulations this is permitted under the following 
 rules ( Treasury Rules, p. -i 11 » : 
 
 •• 1 a 1 Vessels t" !»<■ ni iron and clean immediately prioi to taking on passengers. 
 
 •• (b) The vessel mast lie at moorings in the open harbor and o< .1 approach the 
 wharves, nor niusl the crew be allowed ashore a1 the porl of departure. 
 
 "(c) 111 passengers and crew must lie immune to yellow fever and so certified 
 bj t he United States medical offlcei , 
 
 "(«/) All baggage which lias no! been disinfected at the port of departure bj 
 
 • rhe evidence ol Lmmunit) which may be accepted bj the sanitary inapectoi la 
 
 1 lint. Proof ol continued residence in an endemic focus "t yellow feyei i"i ten years, 
 
 Second. Prooi "i prei lous attack of yellow ferei 
 
646 COMMUNICABLE DISEASES. 
 
 the United States medical officer, or which is not in bond for points north of the 
 southern boundary of Maryland, shall be disinfected at the quarantine at the port of 
 arrival; no bedding or household effects to be allowed to enter. 1 ' 
 
 The extensive passenger traffic of the gulf ports is usually carried 
 on in this manner. 
 
 Treatment of Goods. Certain goods under certain conditions are 
 not admitted at all into the United States. According to the treasury 
 rules, all rags and old textiles, old gunny bags and jute, etc., collected, 
 packed, or handled in any port where there is cholera or yellow fever 
 or has been within thirty days, or from any ports where- smallpox or 
 typhus are epidemic, are not admitted. Similar articles from other 
 places are only admitted after disinfection in accordance with the 
 treasury rules at the port of departure. Jn addition to this, the rules of 
 the New Jersey board of health and the local health regulations of 
 New York and other large ports require that no rags or hides shall be 
 landed without permit from the local health officer. In New Jersey 
 where considerable trouble has arisen from the careless landing of bed- 
 ding from the Atlantic liners, this must be disinfected with steam. 1 
 
 If smallpox, cholera, or typhus occurs on a vessel, all the personal 
 baggage or other personal effects are disinfected, and at northern ports 
 such materials are not generally so treated for any other diseases. At 
 the south all the baggage accompanying the passenger traffic is regularly 
 disinfected unless in bond for northern points and all infected baggage 
 is labeled. 
 
 Except for certain kinds of goods from cholera and plague districts 
 and in the case of vessels from yellow fever districts, disinfection of 
 the cargo is not usually considered necessary. In southern ports, how- 
 ever,' vessels from yellow fever ports are detained for the disinfection of 
 their holds and cargoes. There is one class of goods, however, for which 
 detention and disinfection would prove ruinous, viz., fruits of all kinds. 
 As it is not believed that these are carriers of yellow fever, the fruit 
 trade is generally carried on at southern ports in accordance with the 
 regulations given below which were adopted by the Louisiana board of 
 health in 1896. 2 
 
 1 New Jersey, Rule 4 of State Board of Health, 27 June, 1897: 
 
 tL No straw or bedding shall be landed from any vessel from any foreign port or 
 from any infected place until said straw and bedding shall have been disinfected 
 under the supervision of the health officer of the port, if there be such an officer, 
 and if there be no such officer then by the officer designated by the local board of 
 health ; said disinfection shall consist in exposure, in a closed chamber, to steam at 
 a temperature not less than 240 degrees Fahrenheit for a period not less than thirty 
 minutes." 
 
 2 Lousinana, Board of Health Rules, adopted 23 April, 1896: 
 
 "All vessels engaged in the tropical fruit trade between Central American, South 
 American, and West Indian ports and Xew Orleans, will be allowed to pass the 
 
< 'OMMUWIt ABLE BISEA s ES. 64 7 
 
 It is believed that ballast which consists of rock, sand, earth, and 
 sometimes even garbage, is not rarely the means of the introduction of 
 yellow fever, so that in southern ports the disposition of ballast is a 
 matter of considerable importance. The treasury regulations require 
 that the ballast of an infected yellow fever vessel must be removed, ex- 
 cept hard rock which maybe disinfected in place. The South Carolina 
 law. as indeed that of most southern ports, requires ballast to be dis- 
 charged at quarantine if it comes from an infected or suspected port: 
 or at least this is the requirement in the summer time. At some 
 stations, as New York, Mobile and Louisiana, the ballast is used for till- 
 ing to make new land around the quarantine grounds. At Fernandina 
 all ballast must be discharged under water and the Texas ports require 
 that it shall be discharged outside the bars. If water ballast is used. 
 
 Mississippi River Quarantine Station without detention longer than is necessary for 
 a thorough inspection (either by day or night) by the quarantine officers, so Ions as 
 a properly accredited medical agent of this board certifies that such ports and places 
 are free from contagious or infectious disease, and provided said vessels shall 
 strictly conform bo the following conditions: 
 
 "First. They shall not be allowed tobring to this port bedding or household 
 effects of any kind. 
 
 "Second, After leaving New Orleans said vessels shall not take on hoard pas- 
 sengers during any part of their trip, nor shall they bring passengers to this port, 
 except as herein provided. Cabin passengers only will be allowed at the discretion 
 of the medical officers, provided the applicant lias been a resident of the place for 
 ten days preceding and is known to the medical officer. This officer must satisfy 
 himself that the applicant lias not been in any infected locality in the past thirty 
 days and that none of his effects have been exposed to infect ion. 
 
 14 Third. They shall carry an acclimated crew, unless impracticable. 
 
 "They shall not touch at any infected or suspected port, and have no communi- 
 cation with any vessel during their voyage, except in case of distress. 
 
 ■• Fifth. They shall only touch at such ports or stations as are mentioned in their 
 schedule, which latter shall be communicated to the board of health. 
 
 "Sixth. They shall be required to make a full disclosure when arriving at a 
 
 quarantine station of all the ports and places they have visited on their voyage. 
 
 ■• seventh. They may take on board a crew of laborers known to be acclimated 
 and from some healthy point where they permanently reside ami remain, the crew 
 being as nearly as possible always composed of the same men. The captain or 
 other officer may go ashore for the purpose of entering or clearing vessels only, 
 Any further communication with shore or natives will be considered a violation >■{ 
 regulations, and vessels in default will be treated accordingly. 
 
 "Eighth, 'l'h.se vessels shall he cleansed and. when necessary, disinfected in 
 the cit \ of New Orleans, after discharge of cargo. 
 
 ■ Ninth. Vessels receiving nighl inspection at quaranl ine will not be allowed to 
 discharge cargo on arrival at New Orleans until after a daylight inspection by the 
 
 shipping inspector of this hoard, and t he captains, owners, or agents shall nol allow 
 
 anyone to go ashore or to come on board until after such daylight inspection. 
 
 "Should for any reason a fruit port become infected or even suspicious, vessels 
 
 from that port will he liable to sink additional regulations as the board of health 
 may adopt." 
 
648 COMMUNICABLE DISEASES. 
 
 it must be discharged at sea or disinfected. Rock ballast is disinfected 
 on board or on shore by immersion in a solution of corrosive sublimate, 
 1 to 1,000, or by the use of gaseous disinfectants, or by both. The re- 
 moval of ballast is done by quarantine employees who should be yellow 
 fever immunes. A charge of twenty-five cents per ton is made in 
 Florida ports and in some others, but in Mobile the cost is somewhat 
 less. At Savannah it is twenty cents a ton. 
 
 Disinfection. In the north as a rule only infected vessels are disin- 
 fected, though if they come from infected ports or ports suspected to be 
 such, they may be disinfected even if no infection is known. Thus at 
 New York vessels from yellow fever infected ports or from ports where 
 smallpox, plague, or cholera are epidemic are disinfected. Sometimes, 
 however, the disinfection is limited to the steerage and forecastle. 
 More rarely is the hold disinfected. At the south it is the routine in 
 summer season to disinfect all vessels arriving from ports below north 
 latitude 25°; but, as has been said, exceptions are made for fruiters and 
 regular liners. For disinfection, steam, sulphur, corrosive sublimate 
 and formaldehyde are all used. The requisites for efficient disinfection 
 are laid down in rules issued by the secretary of the treasury. Of 
 course only the larger ports have arrangements for thoroughly disin- 
 fecting a large vessel, though any well equipped municipal health de- 
 partment might disinfect a small vessel as well as it can a house. For 
 sulphur disinfection a sulphur furnace with a fan is used. By this means 
 as much as eighteen per cent, sulphur dioxide ma}* be forced into the 
 hold. Such furnaces are found at Portland, New York, Charleston, 
 Fernandina, Mobile, Mullet Key, Louisiana, and Sabine Pass, and at 
 most of the federal stations. The health officer at New York, however, 
 prefers ordinary sulphur pots to the furnace. The formaldehyde 
 apparatus is that designed by Kinyoun, and has only recently come 
 into use. 
 
 Steam disinfecting chambers are found at most of the federal 
 stations and at Boston, Portland, New York, Baltimore, Charleston, 
 Fernandina, Mullet Key, Pensacola, Mobile, Louisiana, Sabine Pass, and 
 Galveston. Some of the chambers are very large, that at Louisiana 
 being 50 by 8 feet and that at Galveston <!0 by 8. Corrosive subli- 
 mate solution discharged from a tank through a hose is used for flush- 
 ing the interior of vessels at all the more important stations. At the 
 state quarantine stations of New York and Louisiana a steamer is fitted 
 up with a disinfecting plant and several of the federal stations, as Cape 
 Charles, Ship Island, San Francisco and Tortugas, have such vessels. 
 
 Fees. The fees collected from vessels inspected and undergoing 
 quarantine have been a source of much trouble. At some ports the 
 amount is very great, and if the fees belong to the officers in charge the 
 
COMMUNIt A BLE DlsEA sEs. g « 9 
 
 latter are unlikely to permit any change which would lessen their in- 
 come. In other cases, the fees may go to the city with the same 
 results. The fee system is bad and has done much to prevent im- 
 provement in quarantine administration. Federal quarantine is free as 
 is that of the state of Texas, and the Tacoma and Charleston quaran- 
 tines have recently been made free : but at most ports fees are still 
 collected. The following are some examples of these fees : 
 
 In Gloucester, Mass.. $2 for inspection and $3 if a physician makes 
 it. In Providence and South Carolina it is $3 : in New Bedford, New 
 London. New Haven. Port Angeles, $5 : Newport News and Norfolk. 
 $5. In many ports the fee is graded according to the size of the vessel. 
 In Boston it is $8 for vessels of over 500 tons and $5 for vessels under 
 that. In New York it is $5 for foreign vessels and $] to $3 for coast- 
 ers and $5 extra for night inspections. In Baltimore the fee for in- 
 spection is one cent per ton with a minimum of $2. In New Jersey 
 foreign vessels are $5, domestic S3, and domestic sailing vessels $1. 
 The inspection fees in Savannah are $15 for steamers. $10 for ships or 
 barks. $7.50 for brigs or schooners. In Florida steamers are $10, three 
 and four masted vessels $7.50, two masters $5, sloops, $3. In Louisi- 
 ana ships are $20; barks, $17 ; brigs, $10; schooners, $7.50. Disin- 
 fection fees also vary according to the size of the vessel. In New York 
 1 1 it- \ are from $5 to $50 ; in South Carolina, $10 to $68 ; in Florida. 
 $20 to $60; in Louisiana. $17.50 to $130. At Key West the fee for 
 disinfecting a trunk is fifty cents, a valise, twenty-five cents. In Boston 
 when passengers are bathed $] is charged for each bath. Twenty-live 
 cents is charged for vaccinations in Boston, and in Portland, Ore. also, 
 t Ins is the fee. 
 
 Inland Quarantine. 
 
 The quarantine of one place against another by land as well as b\ 
 sea was practiced in early colonial times and was authorized by the 
 statutes of Massachusetts and Rhode Island in the first part of the 
 eighteenth century. Shotgun quarantines were nol unknown and men 
 with Loaded flint-locks were stationed outside of villages to intercept 
 cases of smallpox that might travel that way. Towns might quaran- 
 tine against tow 1 is either in the same or neighboring states, and front ier 
 towns sometimes had special privileges and duties in regard to this. 
 
 At present many laws seem to recognize a distinction between inter- 
 state quarantine and Local quarantine between towns within the state. 
 Interstate Quarantine. In IT'. 1 " the act given belov was passed in 
 Massachusetts, 1 and. Like so man} Massachusetts laws, has been copied 
 
 1 Massachusetts, Pubic Statutes (1882), Chapter 80, Sec. 12: 
 14 The board of health of a town near to or bordering upon either of the neighbor- 
 ing states maj appoint, bj writing, suitable persons to attend at places by which 
 
050 COMMUNICABLE DISEASES. 
 
 by other states, as Colorado, Maine, Michigan and North Carolina, and 
 a somewhat similar law is found in Kentucky. In this act the burden 
 of interstate quarantine is thrown upon the frontier towns of the state. 
 In Washington also the towns alone are charged with the duties of in- 
 terstate quarantine ; but in all the states mentioned, except Massachu- 
 setts and Washington, the state board of health also has authority to 
 establish quarantine against the introduction of communicable disease. 
 Of course before the organization of state boards of health it was 
 natural that whatever interstate quarantine there was should be ad- 
 ministered by local boards of health on the frontier, just as maritime 
 quarantine was, and is in many cases now, administered by the seaport 
 towns ; but with the organization of state boards of health it was seen 
 that much more uniform and efficient action might be secured by this 
 central authority. 1 
 
 Very many of the states named below allow the local governments 
 within their borders to establish local quarantine, and it can be readily 
 seen that such may conflict with the state operations, hence most of the 
 laws provide that the state authority shall be supreme. The best of 
 these interstate quarantine laws provide that the state board of health 
 shall establish quarantine, may make rules and regulations, establish 
 stations, appoint inspectors, provide for the sick, and disinfect, and 
 also provide that all common carriers shall obey the rules so made. A 
 good example of these laws is that of New Hampshire given below. 2 
 
 Some of the state laws also deal directly with the details of inland 
 quarantine, and as maritime laws require masters of vessels to report 
 
 travellers may pass from infected places in other states; who may examine such 
 travellers as it suspects of bringing any infection dangerous to the public health, 
 and if need be may restrain them from travelling until licensed thereto by the board 
 of health of the town to which they may come. A traveller coming from such in- 
 fected place, who without such license travels within this state (except to return by 
 the most direct way to the state whence he came), after he has been cautioned to 
 depart by the persons so appointed, shall forfeit a sum not exceeding one hundred 
 dollars.'" 
 
 1 At the present time the state sanitary authority is authorized to enforce quaran- 
 tine measures against the introduction of communicable disease into the state in 
 Alabama, Colorado, California, Iowa, Illinois, Indiana, Florida, Kansas, Kentucky, 
 Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Mississippi, New 
 Hampshire, New Jersey, North Dakota, Ohio, Rhode Island, South Dakota, Ten- 
 nessee, Texas, Virginia, Vermont and West Virginia. 11 
 
 2 New Hampshire, Act of 22 March, 1893: 
 
 " Section 1. The power to establish quarantine in this state shall be vested in 
 the state board of health, and said board, whenever it is regarded necessary to pre- 
 vent the introduction of cholera, smallpox, or other epidemic diseases from another 
 state, or from another country, and to restrict said diseases if introduced, shall 
 have the power to establish quarantine stations at such places as may be deemed 
 necessary, and the said board shall make and enforce such quarantine rules and 
 
COMMUNICABLE DISEASES. 651 
 
 cases of communicable disease, so the Colorado statute requires train 
 conductors to do the same, and to hold their trains subject to the state 
 hoard of health. A similar law in regard to holding trains is found in 
 Maine. In Alabama and some other states it is forbidden to bring 1 in 
 communicable disease, and in North Carolina common carriers which 
 bring in such cases must take them out. Under these laws many state 
 authorities have made sets of rules. Among such, New Hampshire, 
 Michigan, Florida and Mississippi furnish good examples. Florida and 
 Mississippi have a very elaborate set of rules including those approved 
 by a conference of health authorities held in Atlanta, 12 April. 1898. 
 
 Many states have still further provided against the introduction of 
 communicable disease by maintaining an emergency fund which in the 
 case of threatened invasion of epidemic diseases .may be drawn upon by 
 the state hoard of health with the approval of the governor. This 
 fund ranges from $3,000 in Tennessee to $50,000 in Pennsylvania, 
 though in the latter state the hoard of health does not appear to have 
 been given such explicit [towers in regard to quarantine as in some 
 other states. In Michigan no limit appeal's to he set upon the amount 
 to be spent. 
 
 The towns were the first administrators of interstate quarantine, 
 and then with the organization of the state boards of health the latter 
 took on these powers; but with the development of the idea of federal 
 control of interstate commerce, and the conferring of quarantine powers 
 upon the marine hospital service, a new factor appeared. By the act 
 
 regulations as it may deem best Cor the public good, said rules and regulations to be 
 in font' when approved by the governor of the state. 
 
 "Sec. 2. 1 1 shall he the duty of local health nflicers, in their respectii e towns, to 
 enforce all rules and regulations issued by the state board of health; but should it 
 become necessary to establish quarantine stations, for the purpose of detention, 
 isolation, disinfection, etc., the expense of the same, and its maintenance, shall he 
 
 [»id from the epidemic fund of the state. Local boards of health may establish 
 quarantine in their respective towns, hut shall report immediately such action to the 
 state board of health; ami ii shall lie the duty of said board, as early as practicable, 
 to ascertain the necessity of such quarantine, and shall either approve and enforce 
 
 the said quarantine, or declare it raised. 
 
 "Sec. ■'•■ Whenever quarantine is declared, all railroad and steamboat corpora- 
 tions, and tin' owners, consignees, or assignees of any railroad, steamboat, stag 
 other vehicle used for the transportation of passengers, baggage, or freight, shall 
 suiiinit to the quarantine rules and regulations established by tin- state board of 
 health; they shall submit to anj examination required by the health authorities. 
 respecting any circumstances or event touching the health of the crew or passen- 
 gers, and the sanitary condition of vehicles, baggage, or freight; and any person 
 Who makes a false declaration respecting the points under examination, or who 
 
 violates the quarantine rules ami regulations, shall, upon conviction thereof, he 
 
 lined not i e than two hundred dollars, or he Imprisoned not more than six 
 
 nt hs. or both." 
 
652 COMMUNICABLE DISEASES. 
 
 of Congress of 15 February, 1893, the secretary of the treasury was 
 authorized to make rules for preventing the spread of communicable 
 disease from state to state, and on 27 September, 1894, such rules were 
 promulgated, and are to be enforced by the marine hospital service. 
 These rules relate to cholera, yellow fever, typhus fever, leprosy, and 
 plague. All outbreaks of these diseases are to be reported to super- 
 vising surgeon-general, marine hospital service. The rules are mostly 
 ordinary rules in regard to isolation and disinfection ; but a few have 
 to do more directly with commerce : 
 
 "No common carrier shall accept for transportation any person suffering with a 
 quarantinable disease, nor any infected article of clothing, bedding or personal 
 property. 
 
 "The body of a person who has died of a quarantinable disease shall not be 
 transported save in hermetically sealed coffins, and by the order of the state or local 
 health officer. . . . 
 
 " Localities infected with yellow fever, and localities contiguous thereto, should 
 be depopulated as rapidly and as completely as possible, so far as the same can be 
 safely done; persons from non-infected localities and who have not been exposed to 
 infection being allowed to leave without detention. Those who have been exposed, 
 or who come from infected localities, shall be required to undergo a period of deten- 
 tion and observation of ten days from the date of last exposure in a camp of pro- 
 bation or other designated place. 
 
 " Clothing and other articles capable of conveying infection shall not be trans- 
 ported to non-infected localities without disinfection. 
 
 " Persons who have been exposed may be permitted to proceed without deten- 
 tion to localities incapable of becoming infected and whose authorities are willing 
 to receive them, and after arrangements have been perfected to the satisfaction of 
 the proper health officer, for their detention in said localities for a period of ten 
 days. 
 
 "As soon as the disease becomes ejudemic the railroad trains carrying persons 
 allowed to depart from a city or place infected with yellow fever shall be under 
 medical supervision. 
 
 " Common carriers from an infected district, or believed to be carrying persons 
 and effects capable of conveying infection, shall be subject to a sanitary inspection, 
 and such persons and effects shall not be allowed to proceed, except as provided for 
 by paragraph 2." 
 
 Local Quarantine. In a large number of states 1 the local board of 
 health of the town or county is authorized to establish quarantine and 
 often to make rules and regulations regarding it. Similar provisions 
 are found in numerous charters, as those of Kansas, Nebraska cities, and 
 Pennsylvania, and in Baltimore, Chicago, and St. Louis. Outside of 
 these states probably most towns and cities would be authorized under 
 their general grant of sanitary powers to maintain quarantine, so that 
 
 1 Maine, New Hampshire, Vermont, Rhode Island, Connecticut, Colorado, New 
 Jersey, Delaware, (Jeorgia, Idaho, Louisiana, Michigan, New York, South Carolina, 
 Texas, Utah, Washington, Alabama, North Dakota, .South Dakota, Ohio, and West 
 Virginia. 
 
C ■ 031 Ml XI C A BLE DI8EA S EJS. 6-33 
 
 probably every city is able to do this, unless there is some adverse 
 
 provision in the statutes. In Florida and Mississippi the state hoard of 
 health only may establish quarantine, and in a considerable number of 
 other states local quarantine can only be maintained with the approval 
 of the state hoard, as in Alabama, Kentucky, Louisiana. Maine, New 
 Hampshire. South Carolina, and Texas. 
 
 Very many cities, both within and without the states above men- 
 tioned, have forbidden by their rules the introduction of communicable 
 disease. -Most of these rules are very general, and simply require that 
 no infected person or thing shall come or he brought into the city. The 
 ordinances of Denver and < Mnaha require that conductors shall report 
 cases of communicable disease, and in Denver they must hold the train 
 five miles from the city and telegraph. In Atlanta and Macon. Ga., and 
 Spokane, conductors must not bring in trains when ordered not to or 
 when they are infected. The ordinances of Chicago and St. Louis 
 confer quarantine powers upon the health commissioner and authorize 
 him to establish inspection after giving notice, and to stop trains and 
 boats and detain persons. A number of southern cities have adopted 
 the regulations of the Atlanta conference referred to on page 651. 
 
 In the northern states there is rarely felt to he any need of inland 
 quarantine, hut occasionally such quarantines are maintained. Thus in 
 L885, during the smallpox outbreak in Montreal, several states, includ- 
 ing Michigan and New Hampshire, and a number of cities, quarantined 
 passenger traffic from Canada. The United States marine hospital ser- 
 vice also cooperated. The nearest and closest connection between 
 Montreal and the United States is with New England. As soon as tin- 
 states became alarmed at the amounl of smallpox in Montreal a con- 
 ference was held with the Canadian authorities and with the railroads, 
 and it was decided that all trains to the States should he stopped at the 
 border and passengers and haggage transferred. The marine hospital 
 service established an inspection at this point and also a disinfecting 
 plant. The state board of health of New Hampshire, no1 being satisfied 
 with the federal sei \ ice, put on inspectors of its own, who hoarded every 
 train entering the state from Canada. The rules given helow were for 
 the government of these inspectors. 1 
 
 1 ■• l. \!l persons coming fr Canada and destined t" anj point in New Hamp- 
 shire, must be examined with reference to vaccination, and :tll such found unpro- 
 tected, it from ;i locality infected with smallpox, must !><■ vaccinated bj the inspec- 
 tor or detained for quarantine at such place as the inspector may designate. 
 
 •••_'. The inspector must issue to nil pi rsons coming from Canada, whether des- 
 tined t<> |xuuts in \cw Hampshire or elsewhere, tin' railwaj inspection ticket, issued 
 by this board, so punched as to indicate to the health officer a1 destination oi nip. 
 as per arranged understanding of punch marks, all the knowledge obtained of said 
 
654 
 
 C OMMUNKJABLE DISK. I 8 E8. 
 
 " The inspector, in making bis regular train inspection, ascertained 
 from what place the passenger came, and if from Montreal, as will be 
 seen by the key, the letter A was punched out of the ticket; if he had 
 checked baggage, the letter F was also punched ; if recently vaccinated, 
 the letter D was punched out. The ticket was then signed by the 
 inspector and given to the person inspected, who, not knowing the 
 significance of the punched letters, regarded the same as a clean bill of 
 
 person as to whether said person came from an infected locality or not, when vacci- 
 nated, whether with checked baggage, etc. 
 
 "3. For the information of local health authorities, the inspection ticket may be 
 issued to persons coming from localities in the state, when, in the judgment of the 
 inspector, such persons would be liable to suspicion by the local health authorities 
 at the point of destination. 
 
 " 4. The inspector will notify by telegram all towns and cities requesting it, 
 when any suspicious persons are found destined for such towns and cities. 
 
 " 5. The inspector will keep a record of all persons coming from Canada and 
 destined to points in New Hampshire, with the place of destination, date, and other 
 facts required by the inspector's record check, and of the number of inspection 
 tickets daily issued to such persons going to other states, with the name of the 
 state. 
 
 "6. Inspectors will render a weekly report to this board of the number of trains 
 inspected, and return with such report the inspector's record checks for the same 
 week.' 1 
 
 Month. 
 
 Railway Inspection Service, State Board of Health, 
 New Hampshire. 
 
 Oct. 
 Nov. 
 
 Dec. 
 Jan. 
 Feb. 
 
 Mar. 
 
 To be retained by the person to whom given, unless 
 taken up by a health officer at destination of trip. This 
 ticket will save the bearer the trouble of unnecessary 
 inspections. 
 
 P 
 O 
 pq 
 
 < 
 
 Ce billet doit etre retenu par la personne qu'il est 
 donne, a moins qu'un officier de sante vous le prenne h 
 destination du voyage. Ce billet exemptera au porteur 
 deplaisir d'une inspection non necessaire. 
 
 Inspector. 
 
 Irving A. Watson, Secretary. 
 
 Day. 
 
 1 2 :s 4 5 6 7 8 9 10 11 12 13 14 15 1G 17 IS 19 20 21 22 2:5 24 2.-. 26 27 28 20 30 31 
 
 KEY TO LETTERS ON INSPECTION TICKET. 
 
 A. From Montreal or other infected locality. 
 
 B. Cannot learn from what locality the person came. 
 
 C. Came from an uninfected locality. 
 
 D. Recently vaccinated. 
 
 E. Has vaccination scar on arm. 
 
 F. Has checked baggage. 
 
 Read only the letters tltat have been punched. 
 
 IRVING A. WATSON, 
 
 Secretary. 
 
( ■ OMM ( Wit '. t B L E D TSU. 1 S A 8. 6 5 5 
 
 health. The health officers on the lookout for such persons demanded 
 the inspection ticket at their point of destination, and one punched as 
 indicated above would inform the health officer that the person holding 
 the same had come from Montreal with checked baggage, and had 
 recently been vaccinated." 
 
 The work of the state board was supplemented by that of the local 
 boards especially in disinfection. The following is an account of what 
 was done in Manchester : J 
 
 "The Manchester Hoard of Health established fumigating rooms in the railroad 
 station at that place, and maintained a very thorough system of fumigation of per- 
 sons and baggage from October 3 to December 25. The board was no respecter of 
 persons or conditions, inasmuch as all persons who had come from the province of 
 Quebec were regarded as suspicious, and were required to register and be inspected 
 at this station. During the period named the board fumigated one thousand, two 
 hundred and sixty persons: of this number four hundred and twenty-one were 
 known to have conic from infected districts, and it was conclusively proven that 
 some of them had come from houses where the disease existed, and had served as 
 nurses for those ill with it. The number of trunks fumigated was four hundred and 
 thirty-one: handbags, valises, etc., two hundred and sixty-live: boxes containing 
 household goods, provisions, etc., two hundred and two, many of them weighing 
 from six hundred to eight hundred pounds each, constituting, in all. many tons of 
 this class of goods." 1 
 
 During the presence of cholera in Europe in 1892-3 great alarm 
 was fell in this country, and maritime quarantine was made more strin- 
 gent in nearly all ports, and most cities passed through a general 
 cleansing. Some of the states, especially the central states, placed little 
 confidence in maritime quarantine, as then administered, particularly in 
 that of Canada. In September, isi'i', a conference of the state boards 
 of health of the central stales and many railroad officials was held in 
 Chicago, and regulations were adopted in regard to immigrants which 
 were subsequently adopted officially by the various boards attending 
 the conference. 2 These rules required thai all immigrants should 
 obtain from the quarantine officers at their port of debarkation a certifi- 
 cate, Stating their history in relation to cholera and that they were qo1 
 infected, and thai their baggage had been disinfected. All other immi- 
 grants should be held at state boundaries for inspection and disinfec- 
 tion. Transportation companies should notify inspectors in advance of 
 the arrival of immigrants. The state board of health of Michigan'' also 
 adopted other rules requiring thai no carrier should bring into the stale 
 an\ immigrant or baggage until inspected b\ an inspector appointed 01 
 
 accredited by the state board. No baggage was to be admitted unless 
 
 'New Hampshire, State Board of Health Report (1886), p. 186. 
 - Michigan, State Board of II. alth Report , L898), p. XXVIII. 
 » Michigan, State Board of Health Report (1898), p. IAWIII. 
 
656 COMMUNICABLE DISEASES. 
 
 disinfected by a Michigan inspector: but baggage was excepted winch 
 bore a certificate of disinfection from an accredited inspector, or from 
 a Canadian official, or which was known to have come from a non- 
 infected ship, or which was in a sealed car for transport through the 
 state. The state board of health appointed inspectors to carry out 
 these regulations at all ports of entry. The following is a description 
 of their work by the inspector at Port Huron •} 
 
 " Steerage passengers destined to stop in Michigan, are all detained, and their 
 baggage is disinfected by us. There are two kinds of steerage passengers, those 
 who cuiiie by way of American ports, and those by way of Canadian' ports. Those 
 who come by way of Suspension Bridge having entered the United States at either 
 New York or Boston, and are destined not to stop in Michigan, their baggage is 
 sealed in a car, and passes right through the State; if destined to stop in Michigan, 
 the baggage is all disinfected on the American side at Port Huron. The baggage of 
 immigrants by way of ports, other than American ports, is all disinfected by us at 
 Sarnia, in Canada. On both sides of the line our steam disinfection is done in a box 
 car which has been especially fitted for our use. It is made of matched lumber and 
 then lined thoroughly inside, so that when closed it is practically air-tight. An 
 engine is run up by the side of the car, and the steam is first run into the iron coils 
 around the car, which raises the temperature to about 120° F., and it is held there 
 for about twenty minutes; then live steam is turned into the car, and the tempera- 
 ture is run up to about 220° F., and held there for an hour. At the expiration of 
 this time the ventilator at the top of the car is opened to let the live steam out of the 
 car gradually, at the same time the steam in the coils is kept up, and by the time 
 the things are ready to come out of the car they are all dried by the heat from the 
 coils. All the baggage except the leather and furs is disinfected in this way; the 
 rest is disinfected by the fumes of burning sulphur, for which purpose a regular box 
 car is used; it is not lined, but it is a comparatively tight car. Tilings to be disin- 
 fected are all spread out in the car, and then sulphur is burned for about three 
 hours, at the rate of three pounds per one thousand cubic feet of space, which is the 
 amount recommended by your board. It is almost impossible to go into the car for 
 a half hour after the car has been opened. The immigrants assist the inspectors in 
 this disinfection, by opening up their trunks and other containers, and placing the 
 articles of clothing, etc., on wires strung in the car, or laying them out on the 
 shelves. The containers are all disinfected by sulphur fumes. I generally find that 
 the immigrants by way of Boston are without certificates. We have issued a small 
 card signed by the inspector, which states that the immigrant has passed the inspec- 
 tion at Port Huron. The baggage has attached to it a '■ sticker " which states that 
 it has been through our disinfection. The train books which I have made have 
 been of material aid to our inspectors, and are constantly used. All the facts rela- 
 tive to the immigrant, which we can obtain, are noted in the train book, copied into 
 a book and reparted to the State Board of Health. Immigrants are released to pass 
 on after receipt of telegram to that effect from the office of the State Board. 1 ' 
 
 Some of the railroads, as the Grand Trunk, co-operated with the 
 state board and arranged for disinfection as above, but the "Soo" road 
 brought suit for interference with its business at Sault Ste. Marie and 
 lost its cause in the United States Circuit Court. 2 
 
 1 Michigan. State Board of Health Report (1893), p. XL1II. 
 
 - Minneapolis, St. Paul and Sault Ste. Marie R. R. vs. Board of Health of Michigan, 
 I'. S. Circuit Court; Western District of Michigan. Northern Division, 29 July, 1893. 
 
OMMl WIC \ 1 BLE UISL\ i SES. 657 
 
 A number of cities, among which were Chicago, Milwaukee, and 
 Minneapolis, established additional inspections of their own. In 
 Chicago, 1 "the railroads entering the city placed at the disposal of the 
 health department their resources — the department was notified of the 
 approach of trains conveying immigrants by telegraph, and in time that 
 the medical and sanitary inspectors could board trains from fifty to one 
 hundred miles outside the city, and thoroughly perform their inspection 
 of immigrants and their baggage before the city was readied. 
 
 " From September 8, 1892, when this quarantine inspection went 
 into effect, until December 31, 18$2, over 20,000 immigrants and their 
 personal belongings passed through the hands of the department of 
 health; of this number 2,916 remained in Chicago. The department 
 lias a complete record of the name, nationality, port of embarking and 
 date, name of steamer, port of entry and date of arrival, number of 
 days detained in quarantine, railroads traveled on from seaport to 
 Chicago, date of arrival in Chicago, name of inspector who examined, 
 address, street and number destined to in Chicago : all this information 
 lias been compiled for future reference. Immigrants were allowed to 
 proceed to points beyond Chicago who held a quarantine certificate for 
 person and baggage signed by a surgeon of the 1'. S. Marine Hospital 
 service or the health officer of the port of entry. The baggage of 
 immigrants destined to Chicago was most thoroughly examined, and 
 often fumigated even if it had been at the port of entry : the officers of 
 this department were determined to take no chances."' 
 
 During the outbreak of smallpox in AInncie, Ind., in L893, the state 
 board of health felt it necessary to quarantine against that city, as 
 shown in the following order: 2 
 
 •• • 'Jin- Indiana State Board of Health hereby orders that no passengers, or their 
 ge, be received on railroad trains passing through Muncie, this State, unless 
 they have a certificate from the local health authorities that their baggage has been 
 properlj disinfected, and that they have been successfully vaccinated. ' 
 
 " Near the Big Four depot a box car was provided as a fumigating station, and 
 here the contents of trunks, valises and bundles passed through a process of fumi- 
 gation or disinfection before leaving the city. 
 
 ••At the city postoffice a large si t-iron box four feci square ami .six feci high 
 
 was used to fumigate all mail leaving the city. The process of fumigation lasted 
 about "iic hour. 11 
 
 The railroads required a certificate that the holder had been vac- 
 cinated, and was free from infection. It was said that man} were 
 
 fraudulently obtained and fraudulently used. While railroad passenger 
 traffic was almost cniiivh stopped, it was possible to Leave the cit) in 
 
 1 Chicago, Report of Department of Health (1893), p. 86. 
 
 - Indiana, Report •■! Mate I;,, aid of Health 1 1893), !•• 1 1 I. 
 
G 5 8 GOMMUNIi A B L E DISE, i SE8. 
 
 other ways, and it was estimated by the health officer of Muncie that 
 probably 1,500 persons left the city in one way or another. 
 
 Even at the present writing absolute quarantine is declared at 
 several places in West Virginia on account of the presence of smallpox 
 in adjoining regions. The proclamation of the board of health of 
 Elkins, West Virginia, 1 is shown below. 
 
 At the south, where the danger of yellow fever is a real one, the 
 necessity for inland as well as for maritime- quarantine is felt to be a 
 necessity. Wheneyer an outbreak of yellow fever occurs, at any point 
 in the southern states many localities are certain to quarantine every 
 line of approach against the infection. Non-infected cities and counties 
 consider it their first duty to keep out the disease and are the authors 
 of shotgun quarantine. It is not for them to consider the welfare of 
 people in the infected districts. It is the common practice for such 
 communities to forbid all communication with the infected locality. 
 No persons or goods can come in without the permission of the health 
 officer. But something must be done besides proclaim quarantine. Often 
 notice is sent to the infected community warning travellers. The 
 transportation companies are notified and placards posted. The quaran- 
 tine is advertised in every way. To enforce the quarantine inspectors 
 are appointed who travel on all trains approaching the city, or meet 
 boats at the wharf, or are stationed at other approaches. In Augusta, 
 Ga., in 1897, persons from infected places were forbidden to come 
 
 I Public Health Reports (1900), p. 516: 
 
 " February 9, 1900. 
 
 II Whereas, the board of health of the city of Elkins is advised that smallpox 
 prevails in many communities in dangerous proximity to this city, and deems it 
 highly important that the disease be prevented from reaching this city. 
 
 " Therefore it is ordered by said board of health that from and after this date 
 until the further order of this board, no person from the counties of Gilmer, Lewis, 
 Harrison, Calhoun, or Fayette, in this State, or from the town of Buckhannon, in 
 the county of Upshur, or the town of Camden-on-the-Gauley, in Webster County, in 
 this State, shall come into or pass through the city of Elkins; 
 
 " That no goods or merchandise, by any conveyance whatever, shall be brought 
 into or taken through said city of Elkins from any place or territory above men- 
 tioned ; 
 
 " That no person now within the corporate limits of said city of Elkins shall visit 
 any of the places or counties above mentioned and thereafter return to said city of 
 Elkins; 
 
 "That all communication, except by telephone or telegraph, is prohibited by 
 persons now in the city of Elkins with persons in the counties or places aforesaid, or 
 any other place known to be infected with smallpox. 
 
 " That all railroads or other common carriers are forbidden to convey passen- 
 gers, letters, or packages from any of the counties or places herein mentioned, into 
 or through said city of Elkins. 
 
 A. S. Bos worth, M. D., 
 President Board of Health for city 0/ Elkins.' 1 ' 
 
C ■ 031 Ml WI( \ tJBZJH 1>1 SEA SES. 659 
 
 within forty miles of the cit}', and if found on the train they and their 
 baggage were put off at the nearest station. One lot of freight that 
 had been smuggled in was burned in the freight yard. Another lot 
 which had been sent from New Orleans by way of Xew York to avoid 
 suspicion, and was discovered before it was unpacked, was promptly 
 shipped back again. 1 In Charleston in 1888 several persons from 
 Florida who were caught trying to enter the city were sent to the laz- 
 zaretto and detained there ten days. 2 In Atlanta in 181»7 and 189* 
 the quarantine was less strict. Train inspection was maintained as in 
 other cities, but only persons who were suspiciously sick were detained, 
 and others, after giving their city addresses, were allowed to enter the 
 city. If the incomers can show certificates that they are from an unin- 
 fected locality they are usually freely admitted. The form of certificate 
 given in Atlanta is shown in Appendix 113. 
 
 The state authorities and the federal officers have, during these yel- 
 low fever outbreaks, a greater responsibility and a more difficult problem 
 than do the local officers of either infected or uninfected cities. Local 
 health officers are interested chiefly in their own communities and it 
 matters little to them what becomes of infected refugees. It is only 
 state and federal officers that can be expected to look after the interests 
 of the infected and uninfected alike and to see that traffic is as little 
 interfered with as possible. .Many local quarantines of varying strict- 
 
 . some weak and poorly managed, and others of the harshest non- 
 intercourse variety, present a condition that is almost unendurable, ami 
 
 also one that is tar from accomplishing the end sought for. Attempts 
 
 have been made to secure greater uniformity in inland quarantine regu- 
 lations, and conventions were held in Atlanta in 1898 and in New 
 Orleans in 1899 which were attended by local, slate, and federal health 
 officers ami representatives of the railroads, and regulations were form- 
 ulated which were very generally adopted by state and local officials, 
 
 and are in the main like those enforced by the marine hospital service. 
 Of course, many of the state and local boards have additional rules. 
 Tims the Mississippi state board of health after adopting the rule- of 
 
 the Atlanta convention added others specifying more fully the con- 
 ditions for railroad traffic. 
 
 [t is undoubtedly safer and more economical to control the spread 
 of communicable disease a1 a single point of origin, than it is to guard 
 against its introduction into a thousand uninfected localities. This con- 
 trol of the outgo can, however, only be accomplished through the 
 
 1 Augusta. Report of Board "f Health (1897), p. _l ti seq. 
 'Charleston, Report ol Department <>f Health (1888), p. '• 
 
(]60 COMMUNICABLE DISEASES. 
 
 agency of the state or federal authorities. One way to secure uniform 
 action throughout the state is for the state to assume entire control as 
 in Florida and Mississippi ; another is to strictly co-ordinate the state 
 and local boards as was done in Alabama by the act of 23 February, 1899. 
 Undoubtedly the best results can be obtained only when all three sets 
 of officials act together. In preventing the outward movement of infec- 
 tion both persons and goods must be considered. 
 
 It is in general the policy of the marine hospital service when placed 
 in charge to immediately quarantine a town in which yellow fever is 
 reported. This is at first temporary pending an investigation as to the 
 fact of the presence of the disease and its prevalence. This temporary 
 quarantine is not to be established : first, if the case is an imported 
 one ; second, when the town is a large one. This apparently illogical 
 exception of large towns is made because (a) there is less chance here 
 of general infection, (b) there is less chance of a general exodus, and 
 (c) the loss to the large city is so great as to render it impracticable. 
 The next step is a thorough investigation of the case or cases, and of 
 all who have been exposed. The mortuary records are studied and 
 cases investigated which are likely to have been yellow fever reported 
 under another name. If the infection is slight and the foci of the dis- 
 ease well under control the general quarantine may be raised. Or if 
 the disease is confined to a particular section of the city that section 
 alone may be quarantined as in Biloxi in 1897. This is ordinarily done 
 in the larger cities, as in New Orleans, Mobile, and Memphis, in 1897. 
 If, however, infection is general, absolute quarantine of the infected 
 town is established, as in Brunswick, Ga., in 1893, and it was done in 
 quite a number of smaller places. In Brunswick twenty-eight land 
 guards were employed and thirty-four water guards ■} 
 
 11 The land-guard posts consisted of three men each, all of whom were required 
 to he on duty at night. One was permitted to be absent during a part of the day. 
 They were paid $2 per day, subsisting themselves. 
 
 " The posts were four miles or more from Brunswick, including a sufficient area 
 to keep me from the charge of cooping up people. The posts were supplied with 
 tents by me. The water-guard stations, except No. 9 at Jekyl Pass, which had seven 
 men, consisted of three men each, who furnished their own boats, arms, and pro- 
 visions, and received $2.50 per day. The water duty was vexing, difficult, and at 
 times dangerous; but the duties were always done on honor in spite of weather." 
 
 It is considered better to take guards from the region to be protected 
 rather than from the infected region. Absolute quarantine did not, 
 however, mean that no persons should go in or out ; but only that they 
 
 1 These quotations are from the Report of Supervising Surgeon-General of the 
 Marine Hospital Service (1893), p. 26. 
 
( OMMl XI< AJJ LE DISK. I SES. 661 
 
 should not do so except with the consent of the surgeon in charge. 
 Surgeon Murray thus describes the issuing of passes in Brunswick: 1 
 
 '• Gentlemanly, orderly, and business communication was freely permitted. Per- 
 seus were allowed to come into Brunswick after 9 a. si., and required to leave before 
 3 P. m., for transaction of actual and necessary business. No person dare say the 
 principles of visitation were not well known to him. In no instance did disaster 
 follow tbe simple adherence to my wishes, and were I to conduct a cordon every 
 year I would ever permit just what I did permit this season. The land and water 
 guards kept records of all persons passing in and refused to permit them to return 
 any day after without a pass from me. All guards permitted people to pass out on 
 business errands who held passes written by me. Every pass was taken up on first 
 presentation and subsequently returned to my office. Thus country produce could 
 come, fish, beef, horses, milk, hay, and feed could be procured, and articles abso- 
 lutely needed on islands and in the country were obtained with scarcely an idea in 
 the minds of the people that all were under surveillance. No favors were shown to 
 anyone. No passes were given for fun or comfort. Business or distress were the 
 tin- only pleas that obtained the coveted slips." 
 
 No harm was reported as resulting from these passes and the sur- 
 geons of the marine hospital service feel that such communication open 
 and above board, though perhaps somewhat dangerous, is far less dan- 
 gerous than the illicit communication which would otherwise be sure to 
 occur. 
 
 It is desirable it' possible to permit the removal of till well persons 
 from the infected town. This is partly for their own safety and partly 
 for the community which they leave. The fewer people in the infected 
 town if it is quarantined, the easier it is to care tor them. Then too it 
 greatly hinders the service to have constantly to deal with persons chaf- 
 ing under restraint. Such well persons are allowed freely to depart it 
 the\ are to go to regions where yellow fever can not prevail, but if for 
 yellow fever regions they must pass through a detention camp. 
 
 Detention CampH are located as near to the infected district as a 
 healthful location can be obtained. The location should be dry and 
 there should be a good supply of water. Tents are \ei\ generally used 
 lor yellow fever camps and t he\ have board floors raised from the ground. 
 The following advice is from the .Marine Hospital Reporl tor L898: 
 
 ■The camp consists of a hollow square, of which the buildings form one side 
 and tents t luce. A. double camp, its two parts independent, excepl for a common 
 executive office and kitchen (although not always feasible), presents the advantage 
 that seldom or never will there be anj suspicion attached to Camp No. 2, because, 
 as a rule, nearh all sickness has, in our experience, developed within tbe first four 
 days, and hence would he developed in Camp No. l. This plan "f a double camp 
 would naturally inspire in i he people outside more confidence in the safety of camps, 
 
 ami. although ti"t at all a sanitary necessity. may he expedient, for its al effect 
 
 alone. Such double camps should he dh ided, not only bj guards, hut bj a double 
 
 These quotations are from the Report of the Supervising Surgeon-CJeneral "f 
 
 the Marine Hospital Service i ism:: i. p. •_'»;. 
 
662 
 
 C OMMUNICABLE DISEA &ES. 
 
 fence of barbed wire as well. The whole of both camps should be surrounded by a 
 double barbed-wire fence, at least six feet in height, each fence to have wires six 
 inches apart, from top to bottom, and the two fences set eighteen inches apart, so 
 as to render egress in haste a matter of physical impossibility. All refugees in the 
 main camp should be housed in tents, in order that disinfection may be easy after any 
 suspicious case has occurred. Kitchen and dining rooms should be arranged so as 
 to involve a minimum of time and labor in serving meals, and with capacity in the 
 latter for seating the whole number of refugees at one time. For purposes of good 
 discipline, there should be provided separate tables for subaltern officers, such as 
 commissary, quartermaster, clerks, et al., in order that they may the better preserve 
 their proper authority over attendants; officers of the guard may be included in the 
 list of such officers, or the whole guard messed together, according to circumstances. 
 It is not at all advisable that the guard, however, should mess with the lower grade 
 •of attendants, as the responsible nature of guard duty is prima facie evidence of the 
 necessity for a better class of men for these important posts, and they should there- 
 fore be separated when possible. 
 
 "In addition to the privies located on the plans there may be necessity for pro- 
 viding a few, more convenient of access, for delicate women, and these should by 
 all means be dry earth closets located in a tent, and daily emptied. The locations 
 indicated in the plan should not be considered as essential, but should be varied to 
 avoid contamination of the water supply or for other sanitary reasons. 
 
 
 ik=- 
 
 Hoa&oo = - ~il 
 
 Fig. 70. 
 
 Plan of Detention Camp established by the Marine Hospital Service at Brunswick, Ga. 
 From Report of Supervising Surgeon-General, 1893. 
 
COMMUNICABLE Diseases. qq» 
 
 •If not already existent, a sufficient amount of railroad siding should be pro- 
 vided to hold the necessary cars for disinfection and commissary purposes. At a 
 point most convenient for this purpose on this siding there should be built a waiting 
 and dressing pavilion containing from four to six rooms, to be used for the purpose 
 hereinbefore mentioned, and from four to six tents, end to end, for examination, 
 reception, and registration of applicants for admission. 
 
 "In addition to the commanding officer, the medical staff, and the hospital 
 steward, the necessary personnel of a detention camp should be: 
 
 ••(A) Guards, who should be placed at intervals, long or short, according to the 
 topography of the site, and be under officers to be named hereafter. 
 
 "•(B) Disinfecting force. 
 
 "(C) Quartermaster, commissary, clerks, bugler, telegraph operator. 
 
 "(D) Cooks, waiters, laundresses, scavengers, teamsters. 
 
 •All persons seeking admission to a camp should be given a permit by some 
 responsible agent in the infected centre, and such permits in any one day should in 
 no case equal more than one-eighth of the total capacity of the camp. Upon the 
 arrival of a refugee at camp he should be at once examined as to his health by one 
 of the inspecting officers detailed for that purpose, and if found not to be suffer- 
 ing from any suspicious disease he may be registered. He should then turn in 
 his effects for disinfection and await in a building provided for this purpose the 
 return of his disinfected belongings. He should then change his clothing and sub- 
 mit for disinfection the suit worn upon arrival. This being completed, he may 
 finally be admitted to the main camp, and no further disinfection required, unless 
 he subsequently develop disease in his own person. It is advisable that invari- 
 able rules should obtain in all camps, and, as nearly as may be, all persons treated 
 exactly alike and concessions made to none."' 
 
 The plan of the camp at Brunswick is shown in Fig. 70. 
 
 When a place is infected it has of late years been the custom of the 
 marine hospital service to maintain a train inspection on the roads 
 Leading out. The following- is from a report by Surgeon Glennon: 1 
 
 "The object to be attained is to ascertain that no person ill or suspected danger- 
 ous is allowed to depart from an infected city or town, and also that passengers are 
 under surveillance w hile en route to destination. 
 
 11 1 attained the first object this year at Mobile by stationing a competent physi- 
 cian at the union depot in that city, w ho personally examined all would-be departing 
 passengers and obtained a signed declaration of their residence, non-exposure to 
 infection, and number of pieces of baggage. To this declaration was attached the 
 inspector's certificate of examination of the bearer and disinfection of baggage. By 
 an arrangement with the railroad companies bos ears were located near by, for dis- 
 infection of baggage, railway mail, express packages, anil other matter, ordinary 
 shipping tags were attached marked " Disinfected," signed, and stamped with the 
 seal ol t lie marine hospital service. This baggage went through to all points with- 
 out trouble, though I learned that baggage from other point-, was overhauled along 
 
 the line. 
 
 "The second object was attained by placing a competent physician upon each 
 departing train, to examine the passengers en route, who were persons from New 
 oilcans and the infected Gulf coast towns as well; memorandum slips were taken 
 up. completed, certificates checked up and passed on at the aext relay, the inspector 
 
 taking the return train at the most convenient point. I n I h is w ay a douhle-elie, k 
 
 sen ice was inst it uted. 
 
 1 Report oi Supervising Surgeon General, Marine Hospital Service (1898), p. 362. 
 
(3 4 C OMMTTNICABLE VI SEA SES. 
 
 ■ Pullman sleeping and xipholstered cars should be discontinued, except possibly 
 upon through trains for the north. These, together with ordinary cars, should be 
 treated with the steam air blast, disinfected at some central point, and a dated certi- 
 ficate of the fact attached to each car before it is allowed to return. 
 
 " Relays of train crews should be made at not less than five miles from an infected 
 city or town, and another preferably at the state line. It is not necessary to transfer 
 the passengers into new coaches, the experience of this year showing that they are 
 best detained for observation near their point of destination. 11 
 
 The form of declaration for travellers used by the state board of 
 health of Alabama is shown in Appendix 114. 
 
 As has been stated in the preceding pages, local and state quaran- 
 tines throughout the south have frequently forbidden the importation 
 of any freight from an infected locality. The convention rules of 
 Atlanta and New Orleans and the rules of the marine hospital service 
 permit the free transportation of certain classes of freight, allow other 
 freight to be removed after disinfection, and only absolutely forbid the 
 carriage of a few things, such as household furniture and bedding. 
 Personal baggage must always be disinfected. In 1897 and 1898 the 
 marine hospital service established an inspection at many important 
 shipping points that were infected and passed a great deal of freight 
 that was very generally accepted by non-infected cities. In 1897 at 
 New Orleans, 4,6 26 cars were disinfected Iry drenching with corrosive 
 sublimate solution. 
 
 There has been much discussion as to the damage to be apprehended 
 from the mails. In New Orleans, although it was hardly believed to 
 be necessary, the marine hospital service disinfected the letters and 
 newspapers and excluded all package mail. Letters were perforated 
 and all mail exposed to steam for forty minutes and to six per cent, 
 formaldehyde in a vaccuum apparatus. 1 
 
 1 Report of Supervising Surgeon-General, Marine Hospital Service (1887), p. 628. 
 
CHAPTER XIII. 
 
 REFUSE DISPOSAL. 
 GrAKBAGE. 
 
 MUCH of the material contained in the following pages is taken 
 from reports made in 1896 and 1897 to the American Public 
 Health Association by one of its committees. Mr. Rudolf Hering, 
 chairman of the committee, collected a large amount of material cover- 
 ing nearly one thousand pages of legal cap. Unfortunately only a brief 
 summary was published in the transactions, but owing to the kindness 
 of Mr. Hering the writer was allowed to make use of the full report in 
 the preparation of this volume. The attempt has been made to note 
 the changes that have occurred since 189b", and doubtless in so doing 
 errors have crept in. Such should be attributed to the writer and not 
 to Mr. Hering. who took unusual pains to verify all the data be ob- 
 tained. * 
 
 The term garbage as used in this chapter means animal and vege- 
 table waste matter, subject to rapid decay, from dwellings, hotels, mar- 
 kets, etc. It does imt include slaughter-house refuse, dead animals. 
 night soil, street sweepings, or anything else. This appears to be the 
 most common meaning of the word throughout the United States. It 
 is true that in some lucidities other words have this meaning, and in 
 some localities garbage includes far more than the above. Thus in 
 Connecticul and Rhode Island and to some extern 1 in Massachusetts 
 and other parts of New England, and also in Jacksonville and Tacoma, 
 "swill" is used with the same meaning as garbage, and often to the 
 exclusion of the Latter term, while in the middle and western states 
 
 swill, unless limited, indicates distillery refuse. In Massachusetts offal 
 
 L8 the term U8Ually applied t<> garbage. Il is also employed iii St. Paul. 
 
 In southern cities, and popularly, thougl t officially, in Philadelphia, 
 
 garbage is called -slops. '" a word which in New England means chamber 
 refuse or an\ kind of filthy liquid from the house. In Atlanta, Charles- 
 ton, Galveston, Mac Ga., and in southern cities generally, garbage 
 
 includes not only kitchen refuse bu1 also papers and rubbish of all 
 kinds. In New York (it\ and the aeighboiing cities in thai state and 
 
(366 REFUSE DISPOSAL. 
 
 New Jersey, garbage includes ashes as well as dry refuse and kitchen 
 refuse ; but since New York has attempted to separate the kitchen 
 wastes from ashes, etc., the attempt is made, at least officially, to apply 
 the term garbage to putrescible waste only. 
 
 When garbage is treated separately from ashes and other refuse it 
 is necessary to define by rule or ordinance what is meant by garbage. 
 It is difficult to enforce the separation of garbage from other waste ma- 
 terial, and as the first step, it is necessary to inform the public what 
 will be considered garbage. So too in making contracts, it must clearly 
 be understood by both the city and the contractor exactly what is to be 
 removed or destroyed. Garbage is variously defined ; sometimes merely 
 as " animal and vegetable waste." Usually garbage is considered to 
 consist of waste from food material. In the District of Columbia gar- 
 bage is defined as " the refuse of animal or vegetable matter which has 
 been used or intended for food." Definitions of garbage from Pitts- 
 burgh 1 and Xew Orleans 2 are given below. 
 
 Most of these regulations are more concerned with specifying what 
 shall not be considered garbage and what must not be mingled with it. 
 than they are with making a positive definition. Very many of these 
 rules specifically mention a great number of substances which must not 
 be allowed to go into a garbage receptacle. Rain water is one of the 
 things that must be kept out, and often covers are required for this 
 purpose. Liquids, disli water and slops of all kinds are forMdden. In 
 Fort Wayne garbage "must be drained before being put into the ves- 
 sel." Ashes are the commonest form of household refuse and are there- 
 fore usually specifically excluded. Among other materials sometimes 
 mentioned are glass, crockery, sweepings, oyster and clam shells, saw- 
 dust, cork dust, old boots or shoes, dead animals, lawn clippings, bot- 
 tles, earthen, tin or iron ware, rubbish, dirt, tin cans, poisonous matter, 
 excrement, urine, coal, and dirt. 
 
 What is excluded from garbage yaries some in accordance with its 
 final disposition. If it is to be used as a fertilizer, slaughter-house 
 
 1 Pittsburgh, Garbage Ordinance, >Sec. 2 (15 January, 1895): 
 
 " Tbe words ' garbage and offal, 1 as used in this ordinance, shall be held to include 
 every refuse, accumulation of animal, fruit or vegetable matter, liquid or otherwise, 
 that attends the preparation, use, cooking, dealing in or storage of meats, fish, 
 fowls, fruits or vegetables." 
 
 2 New Orleans, Ordinances No. I860, Council Series : 
 
 "That the word 'garbage' as used in this ordinance shall be construed to 
 mean house and kitchen offal, and all refuse matter not excremental, whether solid 
 or liquid, and composed of animal and vegetable substances, including dead animals 
 coming from public or private premises of the city and not destined for consump- 
 tion as food. 1 ' 
 
REFUSE DISPOSAL. 667 
 
 refuse and dead animals are an advantage, the more of them the better. 
 In some cities where the garbage is reduced, and in some even where it 
 is cremated, tin cans are made to yield a profit and are not objected to. 
 In other places where garbage is fed to swine, cans are an incumbrance, 
 and when garbage is plowed in, they are a positive disadvantage. 
 Toledo and Fitchburg are examples of cities where garbage is fed to 
 hogs and where it is forbidden to place empty tins in the garbage. 
 The difficulty of enforcing such a rule, is probably the reason why it is 
 not more often found. In Boston, although garbage is to some extent 
 used for feeding, it is required that cans and bottles which have con- 
 tained food shall be put with the garbage. This rule came about from 
 the triple separation which is made in that city, the contractors declin- 
 ing to have cans with the dry refuse which they sort over for salable 
 material. In Fort Wayne, though the garbage is cremated, it is forbid- 
 den to place cans in it. When garbage is cremated it is an advantage 
 to have as much combustible material as possible mixed with it. Hence 
 in Lowell 1 it is provided that "in the garbage vessels shall be placed all 
 kitchen refuse, apple and potato parings, corn husks, cabbage leaves, 
 shoes, rubbers, old bedding, soiled linen or cotton and all refuse that 
 can be burned." and similar provisions are found in other cities. In 
 Atlanta and other southern cities a similar practice is in vogue, ami 
 garbage is held to mean kitchen waste plus all rubbish of a combustible 
 nature, but docs not include ashes. True garbage is in these cities 
 called slops. 
 
 In Columbus, ( )., Elizabeth, X. J., Rochester and St. Louis the 
 scavengers or the contractor remove and dispose of slaughter-house 
 refuse. 
 
 In Asbury Park, N. J., Augusta, Ga., Cleveland, the District of Col- 
 umbia. Detroit, Houston, Tex., Minneapolis, New Orleans, Philadelphia, 
 St. Louis, and St. Paul the garbage collectors remove dead animals. 
 
 The following is the weight of a cubic yard of garbage as reported by 
 various cities : 
 
 WEIGHT OF GARBAGE. 
 
 Asbury Park- one cubic yard, weighl 1,472 pounds. 
 
 Boston ..." " " 1,100 
 
 Brockton '• 1,500 
 
 Buffalo 1,260 
 
 Cambridge l - l 1,688 
 
 i leveland " ' 1,600 
 
 District of Columbia. . " " •■ " 1,512 
 
 Evansville ' 1,000 
 
 Lowell 1,241 
 
 Lynn •■ 1,500 
 
 ' Lowell, Rules and Regulations of Board of Bealth | L897), p. ::•"•. Sec. L. 
 
668 REFUSE DISPOSAL. 
 
 Newton one cubit- yard, weight 1,500 pounds. 
 
 Paterson " " " " 1,800 
 
 Pittsburgh " Ll lt " 1,500 
 
 Providence " " " " 1,234 " 
 
 St. Louis •• " lt ll 1,080 " 
 
 Yonkers k " " " lt 1,500 " 
 
 Average - .... 1 ,405 LL 
 
 The weight of garbage of course varies according to its character 
 and the amount of other refuse and the amount of water contained in 
 it, but the average weight given above is probably not far from correct. 
 
 In some cities garbage is collected only from private residences, and 
 not from hotels, restaurants, stores and markets. Many other cities, 
 while ready and willing to remove garbage from hotels, do not do so, 
 but permit its removal by private parties. Hotel garbage is more desir- 
 able for feeding to swine than is garbage from private houses, and 
 perhaps in the majority of cities a considerable part of the hotel garbage 
 is removed by private parties to be used for that purpose. Such gar- 
 bage usually has a small market value. The farmer may pay a small 
 amount of cash for it or in many instances he furnishes to the hotel the 
 products of the farm at a reduced price. In Providence the garbage 
 from the principal hotel is sold for about $200. A few years ago a 
 single hotel in New York City received #1200 a year from the sale of 
 its garbage, but now has to give it away. It is sometimes claimed that 
 the city has no right to prevent such a sale of garbage to private par- 
 ties, but the writer has heard of no decision on this point; but such 
 sale sometimes results in nuisance, owing to the carelessness of the pri- 
 vate contractor, and occasionally, as in Lynn, the disposal of any garbage 
 to private parties is forbidden. There are not many such cities, how- 
 ever, as the municipality is usually glad to be rid of a part of the ex- 
 pense of garbage removal. 
 
 It more often happens that a city refuses to remove the garbage from 
 hotels and markets. There is, of course, no just reason for such refusal 
 and it is only refused on grounds of economy. The removal of garbage 
 from stores, markets, produce commission houses, and the like is usually 
 considerable of a burden and some cities are glad to escape it. It is 
 argued that the waste accumulated in such places is the result of busi- 
 ness venture and the cost of removal should be a burden on the busi- 
 ness, and provided for as any other business outlay. Such a reason is 
 no reason at all, for the paramount argument for the municipal removal 
 of garbage is the prevention of nuisance, municipal removal being the 
 only means by which nuisance can be avoided. This the writer well 
 knows, for in his own city the market men and produce dealers are 
 
REFUSE DISPOSAL. 669 
 
 obliged to get rid of the refuse themselves, and they promptly deposit 
 decaying fish and vegetables on the nearest dump, evading the police 
 and other inspectors with great ingenuity. There is another reason 
 than that of economy in collection, which leads cities to decline the 
 refuse of markets, and that is the difficulty of disposal. Market refuse 
 rarely consists of pure garbage, i. e., putrescible materials, but is mixed 
 with sawdust, paper, etc. It will not do to place it on a dump, and it 
 is not desirable to put it in garbage that is to be fed to swine. In 
 Chicago the contractor is not required to remove garbage from hotels 
 containing over twenty persons. In Cincinnati, Dayton. Davenport, la., 
 Fort Wayne. Muncie, Ind., Rockford, 111., Springfield, Mass.. and Min- 
 neapolis, the public garbage service is not extended to hotels. In 
 Evansville, Fort Wayne, Pawtucket, Providence, and Wheeling markets 
 and produce dealers are obliged to dispose of refuse at their own ex- 
 pense and in their own way. In Philadelphia decayed fruits and vege- 
 tables are not collected by the contractor, but must be disposed of when 
 delivered at reduction works. In Rochester all such refuse is removed 
 by the health department, but markets and produce dealers pay to the 
 city a nominal sum for the service. In Boston produce dealers are 
 required to remove their garbage to the scows at their own expense 
 and are charged for the privilege of depositing it. In 1898 11,314.55 
 was recen <•<! from this source. 
 
 It has usually been considered best by municipal authorities, and 
 indeed !y sanitary officers, to collect ami dispose of garbage separately 
 from other forms <>f refuse. There are several reasons tor this. Gar- 
 bage is the most offensive form of a city's wastes and the necessity for 
 its removal is the most pressing. It' it is kept separate' from ashes 
 there is a less bulk to lie moved, and the expense is therefore less. For 
 most cities it is easier to dispose of pure than mixed garbage, for the 
 former may be led to hogs, while the latter is usually placed on a dump 
 to the annoyance of many. Lastly, it is only when garbage is kept 
 separate that it can be utilized. Feeding lo hogS has long been the 
 
 moving cause for separate garbage collection, and of late years the 
 promise of the recoverj of a part of the value of garbage b\ reduction 
 
 processes induced so able a sanilai\ officer as the late (ieoige F. War- 
 ring, Jr., to advocate separation of the different varieties of ; i city's 
 
 wastes. The cities named below 1 require the separation by the house- 
 holder of garbage from other forms of refuse. 
 
 1 Adrian, Mich.. Ubany, Allegheny, Asbnrj Park, Atlanta,* Atlantic city, 
 Augusta, Ga.,* Auburn, V ^ ., Baltimore, Boston, Bridgeport, Brockton, Brooklyn, 
 Buffalo, Cambridge, Camden, Chelsea, Cincinnati, Cleveland, Columbus, O., Daven- 
 port, la., Dayton, Denver, Detroit, Dubuque, Erie, Evansville, Everett, Mass., Fall 
 
670 REFUSE DISPOSAL. 
 
 The rules requiring the separation of garbage from other refuse are 
 enforced by fines, as are other similar regulations, and obedience is also 
 secured by relieving the contractor or city employee from the duty of 
 removing the garbage when it has improper substances in it, or when in 
 any other manner it is offered for collection in violation of the rules 
 prescribed. This is quite a common provision, but in some cities, as 
 Asbury Park and Buffalo, it is required that the contractor shall at 
 once report the fact to the health department. In Asbury Park a 
 separate slip is sent to the health department for each case, on which is 
 stated the reason why the garbage was not removed. 
 
 Garbage Receptacles. 
 
 The garbage receptacle, especially when separation of true garbage 
 is made, is usually one of the commonest forms of nuisance to be found. 
 Every garbage can, unless it is emptied daily and thoroughly washed 
 after emptying (which is practically never done) is in hot weather sure 
 to be offensive. The annoyance from it can probably never be entirely 
 done away with, and it is only with great care, and at some expense, 
 that it can be reduced to a minimum. 
 
 Nearly every city requires that the householder shall provide a water- 
 tight covered receptacle to hold garbage. The rule from New York 
 City, shown below, 1 has served as a model for many others. In Min- 
 
 River, Findlay, O., Fitchburg, Galveston,* Hartford, Haverhill, Holyoke, Indian- 
 apolis, Jackson, Mich., Jacksonville,* Jersey City, Kansas City, Kingston, N. Y., 
 Lawrence, Lowell, Lynn, Macon,* Maiden, Manchester, Melrose, Mass., Memphis,* 
 Meriden, Milwaukee, Minneapolis, Montclair, N. J., Muncie, Nashville, New Bed- 
 ford, New Brighton, Newbnrgli, New Haven, New London, Newport, Newton, New 
 York, Oakland, Cal., Omaha, Paterson, Pawtucket, Philadelphia, Pittsburgh, Port- 
 land, Me., Portland, Ore., Poughkeepsie, Providence, Pueblo, Colo., Quincy, 111., 
 Richmond, Va.,* Rochester, St. Louis, St. Paul, Salem, Salt Lake City, San Jose, 
 Savannah,* Sioux City, Somerville, Mass., Springfield, Mass., Springfield, O., The 
 District of Columbia, Toledo, Trenton, Utica, "Wheeling, Wilkesbarre, Wilmington, 
 Del., Worcester, Yonkers. 
 
 * In most southern cities combustible refuse and garbage are collected together, 
 but separate from ashes. 
 
 J New York, Sanitary Code (1899), Sec. 11G: 
 
 "That it shall be the duty of every owner, tenant, lessee, and occupant of any 
 and every building, or place of business in the generally built-up portions of the 
 City of New York, forthwith to provide or cause to be provided, and at all times 
 thereafter to keep and cause to be kept and provided within such building, or place 
 of business, suitable and sufficient boxes, barrels or tubs for receiving and holding 
 without leakage, and without being filled to within four inches of the top thereof, 
 all the ashes, rubbish, garbage, and liquid substances, of whatever kind, that may 
 accumulate during thirty-six hours, from said building or place of business, or the 
 portion thereof of which such person may be the owner, tenant, lessee, or occu- 
 pant." 
 
REFUSE DISPOSAL. 671 
 
 neapolis the manager, proprietor and agent are made responsible. In 
 
 Chicago and Cincinnati the ordinance requires that the owner shall pro- 
 vide the receptacle when a house contains more than two tenements. 
 Tn St. Louis where private scavengers collect from hotels, they must 
 furnish two sets of receptacles to avoid transferring the garbage in the 
 street. In Grand Rapids where the garbage is collected by private 
 scavengers at the owner's expense, the contractor or licensee is obliged 
 to furnish the receptacles. 1 The rule shown below' 2 is found in the act 
 establishing a bureau of health in Pennsylvania cities of the second 
 class. 
 
 Of about LOO cities from which reports have been received on this 
 subject, the following have no regulations in regard to the garbage re- 
 ceptacles: Galveston. Macon, .Maiden, Mass., Manchester, X. II., Xew 
 Brighton, X. Y.. Newburgh, Newton, Pawtucket, Portland, Ore., 
 Poughkeepsie, Springfield, O., and Toledo. .Ml the others require 
 water-tight receptacles for garbage, and nearly all require that they shall 
 l»e kept covered. In Pennsylvania cities of the second class garbage 
 receptacles must -'be perfectly water-tight and so kept" and be "pro- 
 vided with a tight fitting cover, which cover shall not be removed ex- 
 cept when absolutely necessary.'" It is a difficult matter to enforce the 
 rule about covering garbage receptacles, and according to the observa- 
 tions of the writer in his own and other cities, it is much more often 
 violated than obeyed. It is perhaps for this reason that a few cities, 
 although requiring tight garbage receptacles, do not reqire that they 
 shall be covered, as Atlantic City, Brooklyn, and Davenport, la. In 
 Detroit the covers must be hinged. In the District of Columbia the 
 Cover must be provided with a handle. Receptacles must be provided 
 with handles in Asbury Park, Buffalo, Chicago, the District of Col- 
 umbia, Kansas City, Pennsylvania cities of the second class, and Sail 
 Lake City, and usually it is specified that there shall be two handles, 
 one at each side. 
 
 The size of the receptacle is not usually regulated. In Brooklyn, 
 
 New York. Jersey City, and Memphis, it must be large enough to con- 
 tain the garbage made during thirty-six hours. In Cleveland it nui-i 
 be large enough to contain forty-eight hours' garbage, and in Yonkers it 
 
 Miraiid I!;t]ii<ls. Ordinance of 18 July, L898, Sec. 5. 
 
 'Pennsylvania, Chapter 258 of L895, Sec •-'": 
 The bureau of health shall cause :> printed notice t" '"■ lefl at each and everj 
 hotel, tavern, eating house ami dwelling he use in tin- city, Btal ing thai a scavenger 
 will call for offal, garbage and swill at certain times mentioned in the notice, and 
 requiring thai such offal, garbage and swill be ready in prescribed and suitable yes 
 vi is for the scavenger when h<' '-alls for the same, and a copj of tins section shall be 
 appended to such not ice." 
 
672 KEF CSV DISPOSAL. 
 
 must hold the garbage for three days. Most of the above cities and 
 also some others provide that the receptacles shall be sufficient for hold- 
 ing the garbage " without being filled to within four inches of the top." 
 A minimum size is prescribed, of two gallons in Muncie, Inch, three gal- 
 lons in the District of Columbia and St. Louis, four gallons in Cleve- 
 land, five gallons in Asbury Park and Kansas City, and six gallons in 
 Paterson, and one bushel in Wilmington, Del., and a maximum of ten 
 gallons in the District of Columbia, Paterson, and Muncie, fifteen gal- 
 lons in Kansas City and St. Louis, twenty gallons in Asbury Park and 
 Fort Wayne, and one-half barrel in Bridgeport, and two bushels in 
 Erie, Pittsburgh, and Allegheny. In Rockford, 111., garbage receptacles 
 must be fifteen inches in diameter, and twenty inches deep. In the 
 District of Columbia not more than one receptacle under ten gallons is 
 allowed. In Philadelphia the garbage receptacle must be " easily and 
 quickly handled by one man." Several cities which do not prescribe 
 the size of garbage receptacles report the size in common use as follows : 
 Sioux City, thirty gallons; Denver, twenty-four to thirty inches deep 
 and fifteen to twenty-four inches in diameter; Evansville, from four 
 gallons to a barrel ; Indianapolis, about ten gallons. In Rochester the 
 garbage receptacles must have a capacity of one gallon for each member 
 of the family. 
 
 The materials of which garbage receptacles shall be made are some- 
 times specified. Thus in Cleveland they may be either metal or earthen. 
 In the District of Columbia, Pueblo, Denver. Kansas City, and Buffalo 
 they must be of metal, and in Rockford, 111., Milwaukee, New London, 
 Newport, R. I., Holyoke, and Asbury Park they must be of galvanized 
 iron. It is recommended, though not required, that they be of gal- 
 vanized iron in Allegheny, Atlantic City, Erie, Newton, Mass., New 
 Haven. Nashville, Pittsburgh, Worcester, and Yonkers. Lowell and 
 Providence recommend that they be not made of metal as the garbage 
 freezes to them in the winter, and it is impossible to pick it out with a 
 bar without speedily destroying the can. In Providence, the advice is 
 to use galvanized iron in summer, but wooden vessels in the winter. 
 Printed slips advising this are given the drivers of the wagons to be left 
 at the houses where galvanized cans are found on the advent of cold 
 weather. 
 
 It has been the observation of the writer that regulations in regard 
 to garbage receptacles are very pooly enforced, and that in most of the 
 cities of the United States wooden barrels, firkins, tubs, pails, and 
 boxes are generally used as suits the convenience of the householder, 
 ('overs as a rule are not provided, or if they are, speedily become lost. 
 Almost any wooden receptacle is water-tight, as it is kept swollen by 
 
REFUSE DISPOSAL. 673 
 
 the moist garbage, but very serious nuisance results from the absence of 
 covers. The uncovered garbage barrel is not only offensive, but eats 
 and dogs scatter its contents about the yard, and it receives large 
 amounts of rain and snow which very much increase the cost of either 
 cremation or reduction. Theoretically, wooden receptacles are not so 
 good as metal, but unless the latter are emptied daily and washed out, 
 conditions never fulfilled, the metallic ones soon become nearly as offen- 
 sive as those made of wood. A common form used in Providence is a 
 beer keg. It is durable, tight, and will not be destroyed in winter, it is 
 not readily tipped over by dogs, and if it has an iron cover is secure 
 from all animals. The scavengers, however, object to it on account of 
 its weight. Sometimes the garbage pail is kept in a small house or box 
 built for that purpose, but the experience of the writer is that this also 
 soon becomes filthy and offensive. 
 
 It is, of course, clear that if garbage pails could be emptied and 
 washed daily they could be really kept clean. Otherwise to talk about 
 a clean garbage receptacle is absurd. For this reason, there are few 
 regulations as to how garbage receptacles shall be kept, but in Asbury 
 Park the owners of garbage receptacles "shall cause the same to be kept 
 (dean," and in "good repair,*" and in Minneapolis they shall be "emptied 
 and cleansed as often as may be necessary to prevent such receptacles 
 or the contents thereof from becoming a nuisance:"" but the same ordi- 
 nance, perhaps because it was realized that the foregoing was impracti- 
 cable, requires that the receptacle shall be placed in a position " as 
 remote as possible from any surrounding dwellings and not less than 
 twenty-five feet from any adjacent street." In Buffalo it is required of 
 the contractor that " From May 1st until October 31st, all garbage recep- 
 tacles, when emptied of contents, shall be thoroughly disinfected before 
 they are returned to the premises, and such disinfecting shall be done 
 as directed by and to the satisfaction of the commissioner of health.'" 
 A similar requirement is found in Erie. 
 
 There is no use in providing garbage cans unless all garbage is kept 
 in them and not thrown into the yard or around the can. Hence the 
 I >i>t rid of < 'olunibia 1 rule requires that 
 
 " occupants of anj dwelling house, apartment 01 tenement bouse, and each pro- 
 prietor of anj boarding bouse, commission warehouse, botel, restaurant, and other 
 place where garbage is accumulated, shall cause all garbage from bis or her prem- 
 ises i" '"• inn in the receptacle provided for thai purpose, 11 
 
 and in Providence 2 no 
 
 u swill, garbage or offal shall be placed in any receptacles for ashes or rnbbisb, 
 or deposited in anj yard or \auli other tlian its proper receptacle." 
 
 1 District of Columbia, Police Regulations, \rt. \l\'.. Sec. S. 
 ^Providence, Rules of the Board of Udermen (1899), Chapter 1, Sec. 16. 
 
 a 
 
674 REFUSE DISPOSAL. 
 
 In that city whenever improper substances are put in the garbage, 
 a printed copy of the rule is given to the householder. 
 
 Trouble sometimes results from persons overhauling garbage after 
 it has been placed in the alleys or other accessible places, looking for 
 junk, or perhaps for the best of the garbage itself to take away for 
 their own use. Hence the following rule in the District of Columbia: 1 
 
 " No person other than the owner or authorized collector shall interfere with or 
 disturb any garbage after it shall have been piit in a garbage receptacle and placed 
 in an accessible place for collection; nor shall any unauthorized person molest, hin- 
 der, delay, or in any other manner interfere with any garbage collector in the dis- 
 charge of his duty.' 1 
 
 A similar regulation forbidding molestation of the garbage or upset- 
 ting it or scattering it upon the street is found in Atlanta, Charleston, 
 Chicago, Cincinnati, Grand Rapids, Memphis, and Pennsylvania cities 
 of the second class. 
 
 Location of Garbage Receptacles. 
 
 The fact that a garbage pail ie a nuisance and that therefore its 
 location should be as far from dwellings as possible, has only been 
 recognized so far as the writer is aware in Minneapolis, as shown on 
 page 678 ; but in Bridgeport, Camden, District of Columbia, New 
 Haven, Providence, Rochester, and Yonkers they must be placed where 
 the board of health or its inspectors direct, though in Rochester 2 the 
 position is not to be fixed by the board of health if " they are kept 
 within or upon the private grounds of residences and sufficiently removed 
 from adjoining premises to prevent any offense thereto." In those 
 cities in which it is required that the garbage pails be placed outside of 
 the premises it is intended and often specified that they shall be so 
 placed only on the days for collection, and in Buffalo they must be taken 
 in from the curb line within one-half hour of the time they are emptied- 
 
 The most important practical consideration in regard to the location 
 of garbage receptacles is whether they shall be kept on the premises or 
 placed on the sidewalk. In a general way it may be said to cost more 
 to remove garbage from the yard than from the curb, but the conditions 
 may sometimes be such that one is as cheap as the other. The length 
 of haul may for instance prevent the collection of more than two loads 
 in working hours, even if the collection is made from the curb, and yet 
 the margin of time may be sufficient to permit of the collection of the 
 two loads from the premises. In Chelsea, Mass., it costs twenty-five 
 per cent, more to collect from the rear of the house than from the side- 
 
 1 District of Columbia, Police Regulations, Art. XIV., Sec. 8. 
 
 2 Rochester, Ordinances of Board of Health (1895), No. 23. 
 
REFUSE DISPOSAL. 675 
 
 walk, but the citizens insist upon the former. In Boston this practice 
 is followed, but is considered too expensive. In Cincinnati on the other 
 hand, where the practice is to place them on the sidewalks, it is not con- 
 sidered satisfactory. 
 
 The cities named below 1 provide that the receptacles for garbage 
 shall be placed on the sidewalk for the convenience of the scavengers. 
 
 In Colorado Springs, Kansas City, Toledo, and Chicago, the garbage 
 is to be placed in the alley in the rear, if there is one. In Cambridge 
 it is to be placed outside the premises in the summer but not in the 
 winter. In Detroit, while outside the lot line, the receptacles must not 
 be over two feet from it, and in Allentown, Pa., and in Paterson they 
 must be set at the curl). 
 
 In most cities the garbage pail must be kept on the premises. 2 In 
 Boston, Milwaukee, New Haven, the District of Columbia, and St. Paul 
 it is provided that the receptacle must be kept in an accessible loca- 
 tion. Scavengers are not expected to go up stairs or down cellar for it. 
 
 In Denver, Fort Wayne, Omaha, Pueblo, and St. Louis it may be 
 placed either just within or just without the street line ; but in Atlanta. 
 Cleveland, Erie, New Brighton, and Pennsylvania cities of the second 
 class it must he kept in rear of the house, or, in the latter cities, in 
 areas in- passageways. In Macon it must be set on the premises near 
 the gate. 
 
 It is more economical tor the scavengers to carry a pail to the recep- 
 tacle when the latter is on the premises and to empty the receptacle 
 into the pail than it is to carry the private receptacle to the wagon and 
 return it. By the use of a carrying pail one trip is saved at each house, 
 and this is the more common method of collection, hut it is sometimes 
 forbidden, as in Asbury Park. In such cases it is supposed that the 
 Scavengers will return the receptacle to the place where found, and this 
 is specified in sonic of the rules, as in the one given below. 3 
 
 1 Camden, Colorado Springs, Cambridge, * " 1 1 i < ; i l^ • • - Cincinnati, Detroit, Fitcbburg, 
 Galveston, Holyoke, K;uis;in City, Nevi London, New Fork, Paterson, (leading, 
 Sioux City, Springfield, <>.. Toledo, and LTtica. 
 
 2 Allegheny, Asbury Park, Atlanta, Atlantic City, Auburn, Battle Creek, Boston, 
 Bridgeport, Buffalo, Chelsea, Columbus, Dayton, District of Columbia, Erie, Fall 
 River, Grand Rapids, Hartford, [ndianapolis, . lacks.. n, .Mich., Lowell, Lynn, Mil- 
 waukee, Minneapolis, New Bedford, Nevi Brighton, Newport, Newton, Pawtucket, 
 Providence, Philadelphia, Pittsburgh, Richmond, Quincy, 111.. Rochester, Salem, 
 Savannah, Somerville, Springfield, Muss.. Syracuse, Wheeling, Wilmington, Del.. 
 and Worcester. 
 
 : Buffalo, Contractors 1 Specifications for Removal "f Ashes and Garbage: 
 "Receptacles containing material shall be removed from premises, placed at 
 curl) line by contractor, and contents unloaded into wagons within a reasonable 
 length of time, which shall no1 exceed one (1) hour after receptacles are placed at 
 i-urb in ticni of premises, and the receptacles Bhall be returned to the place on prem- 
 ises from which they were re red within one-half (i) hour after they are emptied." 
 
676 REFUSE DISPOSAL. 
 
 frequency of Removal. 
 
 The frequency of removal of garbage varies in different cities, 
 though it is rarely moved less often than once in a week. 
 
 The only city in which garbage is collected seven times in a week 
 is Washington. In other parts of the District of Columbia it is col- 
 lected less often. 
 
 It is collected six times a week during the entire year in Adrian, 
 Mich., and Allegheny, Macon, Ga., New York City, Philadelphia, and 
 Savannah ; from 15 May to 15 October in Brookline ; from 15 June 
 to 15 September in Asbury Park, N. J. ; from 1 April to 20 November 
 in the centre of city in Dubuque, la. ; in the summer time in Atlantic 
 City, Davenport, la., Denver (in centre), Colorado Springs (in centre, 
 May-October 1 ), Norfolk, and Richmond, and in the central districts of 
 Buffalo and Chicago, Columbus, Cincinnati, Detroit, Manchester, N. H., 
 Milwaukee, New Brighton, Pittsburgh, St. Paul, Salt Lake City, and 
 Quincy, 111. 
 
 Garbage is collected four times a week in Newport, R. I., from May 
 to September. 
 
 The most common method is to collect the garbage three times each 
 week. This is followed in Newburgh, New London, Ct., and in San 
 Jose, Cal., all the year round and in all parts of the" city. It is collected 
 in certain districts three times a week in Detroit, Hartford, Chicago, 
 Cincinnati, Columbus, Quincy, 111., Pittsburgh, Manchester, New 
 Brighton, St. Paul, and Toledo. The garbage is collected three times 
 a week in the winter in Atlantic City, Norfolk, and Richmond ; three 
 times a week in the summer in Brockton, Mass., Cambridge, Colorado 
 Springs, Galveston, Holyoke, Kansas City, Lynn, Maiden, Paterson, 
 Sioux City, Somerville, Mass., Utica, Worcester, and Wilmington, Del. ; 
 from 15 November to 15 June in Asbury Park, N. J. ; from 21 Novem- 
 ber to 30 March in the suburbs of Dubuque, la. : from November to 
 April in Newport, R. I.; from June to September in Bridgeport; from 
 May to October in Brooklyn and New Bedford; from 16 July to 15 
 October in Camden ; from April to November in Cleveland and Chel- 
 sea, Mass. ; from 15 April to 15 November in suburbs of the District 
 of Columbia ; from May to September in Haverhill ; from April to 
 October in Providence, Fall River, and Pawtucket; from April to Sep- 
 tember in Newton, Mass., and St. Louis ; from May to November in 
 New Haven; from April to November in Evansville. 
 
 Garbage is collected twice a week all the year around in all parts of 
 the city in Allentown, Pa., Fitchburg, Lowell, Portland, Ore., Salem, 
 
 1 In all these periorls both months aiv included. 
 
REFUSE DISPOSAL. 677 
 
 Springfield, Mass., .Springfield, ()., Tacoma, and Wilkesbarre. It is 
 collected twice a week in certain parts of Chicago, Cincinnati, Colum- 
 bus, Quincy, 111., Pittsburgh, Hartford, and Toledo. Garbage is col- 
 lected twice each week in the summer in Boston, Dayton, Erie, Pa., 
 Muncie, Ind., Rochester, CJtioa : New York City from May to October, 
 in Bridgeport, Brockton, Buffalo (except in centre), and Cleveland: in 
 the winter in Cambridge, Holyoke, Maiden, Mass.. Paterson, Sioux 
 City, Somerville, Mass., Dtica, Wilmington, Worcester ; from November 
 to April in Brooklyn, New Bedford : from :2i! October to 15 July in 
 Camden, from December to March in Chelsea; from 16 November to 20 
 March in the suburbs of the District of Columbia; from October to 
 April in Haverhill: from December to April in Xew Haven; from 
 October to March in Newton, Mass.. and St. Louis; from November to 
 March in Providence, Pawtneket, Fall River, and in the spring and 
 autumn in Kansas City: in June, July and August in LambertviUe, 
 X. .1. : from December to March in Evansville. 
 
 '•arbage is collected once a week at all seasons and in all parts of 
 Battle Creek. Mich. It is collected once a week in certain parts of 
 Denver and Colorado Springs, and from residences in Salt Lake City 
 all the year. It is collected once a week in the winter from all parts of 
 Boston, Muncie. Ind., Kansas City, Dayton. Rochester, and Davenport, 
 la. It is collected once a week from December to March in Auburn, 
 X. Y.: from November to March in Erie; from November to April in 
 Bridgeport, Buffalo, and Cleveland. It is collected once a week in the 
 snmmer from Rockford, 111. In Rockford, 111., in winter not over a 
 load is allowed to accumulate. In Dubuque, la., municipal collection 
 ceases entirely in tin- winter. 
 
 From the foregoing it will be noticed that very few cities collect 
 garbage every day, and of these several are southern cities. A number 
 of cities make a distinction as to frequency of collection in different 
 sections, collecting \\ oftener in the central portions. Such are Buffalo, 
 Chicago, Cincinnati, Columbus, Denver, Detroit, District of Columbia, 
 Dubuque, la.. Hartford, Milwaukee. New Brighton, Pittsburgh, St. 
 Paul, and Salt Lake City. A majority of the cities collect the garbage 
 more frequently in the summer than in the winter, and it is usually 
 done three times a week in the slimmer ami twice in the winter. 
 
 Unless garbage is collected daily, il is necessarj to divide the city 
 
 into districts, certain scavengers collecting in certain districts on certain 
 
 days. A practical difficulty is thereby developed, which in Providence, 
 
 at least, is the cause of much complaint. Ii is evidenl that with tri- 
 weekly collections, certain houses musl each week he neglected from 
 
 Friday until Monday. As this in the long inn would happen to a given 
 
678 REFUSE DISPOSAL. 
 
 individual not more than once in three weeks, it would appear not to 
 work a great hardship; but from the fact that the seeming neglect is 
 apparently sporadic, it causes just so much the more friction. 
 
 Only a few cities make no distinction in frequency of collection in 
 different seasons. 1 
 
 In a number of cities garbage is collected more frequently from 
 hotels and restaurants than it is from private houses. Usually it is col- 
 lected daily from all such. 2 Garbage is collected daily from markets in 
 Auburn, Buffalo, Chelsea, Somerville, and Tacoma. 
 
 Hours for Removal. 
 
 In most cities the garbage, when collected separately, is collected 
 during the day time, the period extending over the whole working day. 
 In a few cities collections are made at night. In Buffalo it is collected 
 from the business district between (3.30 p. m. and 5 A. m. ; Portland, Ore., 
 between 9 P. M., and 8 A. M. ; in St. Paul, between 12 p. M. and ( .» A. M. : 
 in Elmira, during June, July, August, and September, between 6 p. M. 
 and 9 A. M. In Spokane, it is collected from 10 P. M. to 10 A. M. from 
 1 April to 1 October, and from 10 p. M. to 11 A. M. during the rest of 
 the year. In Ridgewood, N. J., garbage is collected at night. 
 
 In other cities it is collected early in the morning. In Asbury Park 
 it is collected from the business section before 9 A. M., also in Norfolk ; 
 in Salt Lake City, before 8 A. M. In Milwaukee it is collected between 
 4 A. M. and 2 P. M. In Asbury Park, Boston, and Buffalo it is collected 
 from hotels early in the morning. 
 
 In New Orleans and Wilmington, Del., the scavengers must ring a 
 bell at each corner loud enough to be heard the length of the block, 
 and in Erie they must give notice of their approach. In Philadelphia 
 the contractor is to frequently call out " slop." In Pennsylvania cities 
 of the second class, " warning of their approach shall be given by the 
 sounding of a horn at each street corner and at the middle of each 
 block." 3 
 
 Vehicles for Garbage Removal. 
 
 All the cities reporting except Cincinnati, Savannah, and Springfield, 
 O., have some regulations in regard to garbage wagons. If there are 
 any regulations at all, they invariably require that the wagons shall be 
 
 Adrian, Mich., Allegheny, Allentown, Pa., Battle Creek, Fitchburg, Lowell. 
 Macon. Newburgh, New London, New York City, Philadelphia, Portland, Ore., 
 Salem, San Jose, Cal., Savannah, Springfield, Mass., Springfield, O., Tacoma, Wilkes- 
 barre, and Wilmington, Del. 
 
 2 Battle Creek, Boston, Bridgeport, Brooklyn, Buffalo, Chelsea, Detroit, Denver, 
 Evansville, Haverhill, (if they have five guests), Kansas City, (in summer), Lynn, 
 Nashville, Portland, Ore., St. Louis, Somerville, Tacoma, and Utica. 
 
 3 Pittsburgh, Garbage Ordinance (1895), Sec. 4. 
 
REFUSE DISPOSAL. 679 
 
 tight or water-tight. They also require that the wagons shall be 
 covered. The only cities where this is not the practice are Lambert" 
 ville, N. J., Portland, < )re., Springfield, 0., and Savannah. Usually it 
 is specified that the cover shall be wood or metal to correspond with the 
 cart, but canvas covers are permitted in Atlanta, Asbury Park. Bridge- 
 port, Buffalo, Cincinnati, Richmond, San Francisco. Scranton, and 
 Springfield. Mass. It is sometimes specified that the covers must be 
 kept on except during the actual loading of the garbage, as in the Dis- 
 trict of Columbia and St. Louis. 
 
 In some cities wooden wagons or carts are used for the collection of 
 garbage. The only regulation for their construction beyond those above 
 given, and that the writer has seen, is in Omaha where the garbage 
 wagons, if of wood, must be one and one-half inch tongued and grooved 
 pine stock. Metal carts are either required or are used in the cities 
 named below. 1 They are invariably preferred to wooden carts as it is 
 easier to keep them tight, and in the end they are more economical. 
 The only objection to metal carts was made in Lowell where a certain 
 style of cart, the Flanagan, was considered too heavy and clumsy. In 
 Atlanta the wooden garbage carts are made by the city at a cost of 840. 
 In Providence the contractor builds his own wagons which have metal 
 bodies- They hold from two to three tons and cost about $300. 
 
 No facts were obtained to show whether dump carts and wagons are 
 chiefly used, or these from which the contents have to be shoveled. It 
 is the impression of the writer that dump carts and wagons are preferred. 
 They render the handling easier, but in many cases this may not decrease 
 the number of employees or the cost. The objection to dumping carts 
 is that if properly constructed they cost rather more than those that do 
 not dump. It is bad to have any sort of opening or movable tail-board 
 in a garbage cart, as it is almost impossible to keep it water-tight 
 
 The number of horses used with a garbage wagon is usualh either 
 
 one or two, though sometimes, as in Brooklyn ami Providence, three 
 
 horses are used with some of the wagons. As regards the use of single 
 or double tennis, the cities are about evenly divided. 
 
 In most cities either one or two men go with each wagon, and here 
 again the cities are about evenly divided as to practice. In Brooklyn 
 
 lour men go with each wagon, in Cincinnati and Chelsea three, ami in 
 
 Providence sometimes three. The writer has not learned that any 
 
 Allegheny, Aabury Park, Atlantic City, Boston, Buffalo, Camden, Cleveland, 
 Columbus, Davenport, Denver, Detroit, District <<( Columbia, Erie, Evansville, 
 
 Fall River, Fori Wayne, Lynn, Milwaukee, New I- Ion, New Orleans, New i'ork, 
 
 Norfolk, Pawtucket, Philadelphia, Pittsburgh, Providence, Trenton, Wilmington, 
 Del., Xonkers. 
 
680 
 
 REE USE DIHP 8 A L. 
 
 scavengers are uniformed except in Asbury Park where they are required 
 to wear duck suits. 
 
 A few cities make use of barrels for the collection of garbage. In 
 Lowell they are used by private scavengers, and in St. Louis, Bridge- 
 port, Rochester, and the District of Columbia they are employed in 
 municipal work, but not exclusively. In Haverhill, New Bedford, New 
 Haven, Muncie, Ind., and Syracuse they are used exclusively for muni- 
 cipal collection. In the District of Columbia and Muncie, metal barrels 
 are used of thirty gallons capacity in the District of Columbia, and 
 forty-three gallons in Muncie. In the latter city eight barrels are used 
 on each wagon. In New Bedford each two-horse wagon carries eight 
 to thirteen kerosene barrels ; these are provided with galvanized iron 
 covers which come down eight inches over the barrel. The barrels last 
 about one season. 
 
 Fig 71. 
 Garbage Wagon, New Bedford. 
 
 In Syracuse barrels and covers like those in New Bedford are used. 
 They have an iron handle on each side. Ten of these are carried on a 
 two-horse wagon with two men. They hold 350 pounds of garbage 
 each. When seen by the writer, they appeared to be satisfactory ; all 
 the covers were on and very little garbage was dropped between them, 
 but they are to be given up for metal wagons. In Haverhill and Bridge- 
 port the wooden barrels have wooden covers which are provided Avith 
 gaskets and fastenings, though plain kerosene barrels costing ninety 
 
TtEF I r SE DISP & 1 L . 
 
 681 
 
 Fig. 72. 
 Garbage Cart, Richmond. Cost, $75. Capacity, one cubic yard. 
 
 cents with covers not fastened have been used in the latter city, but 
 box wagons are preferred. In New Brighton and Haverhill sonic 
 trouble is experienced from the dropping of garbage between the barrels, 
 and in Haverhill in keeping the covers on. In that city, in order to 
 secure better results, it is proposed to put one man only on each 
 wagon in order to fix responsibility for its condition. Collection in 
 barrels in Haverhill is found to he more expensive than collection in 
 box wagons. 
 
 In Lowell many private scavengers use barrels. Some arc like those 
 used in New Bedford with deep galvanized iron covers and others have 
 
 Covers which are screwed down like those of niedit soil tubs. Screw 
 
 covers are also used iii St. Paul. Yonkers lias abandoned this method 
 in favor of metal carts. 
 
 The ideal way to collect garbage Would he to remove the receptacle 
 with its contents, replacing it with a (dean and empty one. This is. ot 
 
 course, too expensive to he practical, hut ii is sometimes required Eor 
 
 fish market or other especially offensive offal. 1 A similar rule is in 
 
 force in Fort Wayne in regard to hotels. 
 
 lAsbury Park, Sanitary Code (1897), Sec. 84: 
 
 ■• In tlic case ef lisli markets, oo tisli refuse or other offal shall be emptied from 
 the receptacle in which ii is stored, bul both offal and receptacle shall be removed 
 from the premises and transported together outside "f the city, and the sai<l recep- 
 tacle shall no! !"• broughl bach into ill-' i Itj until ii has been made clean and odor- 
 less. 
 
682 
 
 A* El ' USE J J ISP O SA A. 
 
 Fig. 7;]. 
 New Style Metal Garbage Wagon, Providence. Cost, $300. 
 
 Fig. 74. 
 Old Style Wooden Garbage Wagon, Providenc e. 
 
REE USE DISP SAL. 
 
 683 
 
 There is nothing to be gleaned from a study of the data given, to show 
 the most economical number of men and animals, or size of vehicle to 
 be used in collecting garbage. The number of horses and also the num- 
 ber of men to a certain extent, depend upon the size of the wagons. 
 The following shows the size of vehicles used in a number of cities : 
 
 Asbury Park 48 cubic feet. 
 
 Atlantic City 51 cubic feet. 
 
 Boston 57 cubic feet. 
 
 Brockton 32 cubic feet. 
 
 Buffalo 4 cubic yards. 
 
 Denver 3 cubic yards. 
 
 Detroit 52 cubic feet. 
 
 District of Columbia 37 cubic feet. 
 
 Li iwell 75 cubic feet. 
 
 Newton 60 cubic feet. 
 
 Pittsburgh 54 cubic feet. 
 
 Providence 74 to 96 cubic feet. 
 
 Rochester 128 cubic feet. 
 
 Salem 42 cubic feet. 
 
 In Buffalo it is required that the garbage and other refuse wagons 
 be of a uniform size and multiples of one cubic yard. 
 
 The cost of garbage carts and wagons varies from ¥40 in Atlanta to 
 $350 in Paterson. As a rule the cheapest carts are used in the south 
 and the most expensive wooden wagons in New England. Metal 
 wagons and carts are, as a rule, more expensive than those of corre- 
 sponding dimensions made of wood. 
 
 Fig. 75. 
 Hill Dump Cart. 
 
 Fi<;. 76. 
 ii ill i mi ii 1 1 • ( .hi upset . 
 
684 REFUSE DISPOSAL. 
 
 A cart used in the city of New York and neighboring cities for 
 separate and mixed wastes and other purposes is shown in Figs. 75- 
 76. It is made in various sizes by Thomas Hill, 48 Railroad Ave- 
 nue, Jersey City. A cart holding thirty-five cubic feet costs about 
 $115, with covers $10 more. A wagon somewhat similar to this cart 
 is quite popular, and the style used in Boston is shown in Fig. 82. 
 
 The cart used in the District of Columbia, Wilmington, Del., Port- 
 land, Me., and other cities is shown in Fig. 77. It is made by the 
 United States Sanitary Co., Washington. A cart holding thirty-seven 
 cubic feet weighs 1,300 pounds and costs $175. A fifty-four-foot cart 
 weighs 1,500 pounds and is sold at the same price. 
 
 The wagon body shown in Figs. 78 and 79 is used in Detroit and 
 Cleveland. In the former city they are made by the Detroit Safe Com- 
 pany and cost $50. They are said to be durable. They are lifted off of 
 the wagons and put in tiers on freight cars to be removed from the city. 
 
 The wooden tip-carts used in some parts of the south, where much 
 dry refuse is mixed with the garbage, may be seen in the illustration of 
 the interior of the Jacksonville crematory. 
 
 The following, prescribing the care to be taken of garbage wagons, 
 is from the District of Columbia 1 garbage rules : 
 
 " No driver, owner, or superintendent having charge or control of any cart or 
 other vehicle for carrying garbage shall allow such cart or vehicle to needlessly re- 
 main, nor allow a needless number of such carts or vehicles to gather before any 
 residence, building, or place of business within the city of Washington or the more 
 densely populated suburbs thereof; nor allow any such cart or vehicle, or anything 
 thereto appertaining, to be in a condition needlessly filthy or offensive; nor allow 
 any such cart or vehicle, or implement used in connection therewith, to be stored or 
 kept in any place where needless offense is given to any person or persons. No 
 driver of any such cart or vehicle shall occupy an unreasonable length of time in 
 loading or unloading such cart or vehicle or in passing along any alley, street, ave- 
 nue, or public road; nor allow the lid or cover of such cart or vehicle to be other- 
 wise than securely closed except as may be necessary for the loading or unloading 
 and cleaning of such cart or vehicle." 
 
 Overloading of garbage wagons is a cause of offence and renders 
 covers useless, and is often forbidden. 2 In New York 3 " no part of such 
 contents or load shall fall, leak or spill therefrom." In Yonkers a gar- 
 bage wagon is not to be kept within fifty feet of a dwelling. In 
 Asbury Park two garbage wagons must not be within 600 feet of each 
 other on the street. 
 
 1 District of Columbia, Police Regulations, Art. XIV., Sec. 1. 
 
 2 St. Louis, Ordinance 17216, Sec. 9: 
 
 " Said carts or wagons shall not be filled to overflowing, and the covers of said 
 carts or wagons shall be kept closed except when the garbage is being placed in 
 them." 
 
 * Sanitary Code (1899), Sec. 125. 
 
REFUSE DISPOSAL. 
 
 685 
 
 Fig. i r. 
 United States Sanitary Company's Cart. 
 
 side: view 
 
 Fig. Ts. 
 Working Drawing of Movable Bodj for Garbage Wagon, Detroit. 
 
 Fig. 79. 
 Working Drawing ol Movable Bodj i"i Garbage Wagon, Detroit. 
 
686 REFUSE DISPOSAL. 
 
 It is often one of the regulations that the wagons shall be marked 
 "garbage cart," "garbage wagon," "licensed garbage," or "garbage," 
 and sometimes the number and owner's name is added. The letters are 
 usually to be four inches high, and are to be black upon a white ground. 
 In Cambridge private garbage wagons are to have the owners' initials 
 two inches high. In Colorado Springs the words on the cart must be 
 legible at eighty feet. Often, as in Brooklyn, the District of Columbia, 
 and Providence, the wagons must be inspected and approved by the 
 health officer. Usually garbage wagons are required to be painted 
 uniformly and of a distinctive color. 
 
 In Asbury Park the garbage wagons are owned by the city and the 
 contractor pays a rental of fifteen per cent, per annum on their cost, 
 and is obliged to keep them painted and in repair. 1 In Atlantic City 
 and Fort Wayne the wagons are owned by the city ; the work is let out 
 by contract. 
 
 Garbage wagons, in order to be kept clean, must be frequently 
 washed, and this is required to be done daily by many rules, and some- 
 times, as in Asbury Park, it is specified that they be washed inside and 
 out. Mr. Hering's report showed that in nearly all cities it is required 
 by rule, or is the custom to wash the garbage wagons daily, and in some 
 cases after each load. The latter is the rule in Boston, Brockton, Cam- 
 bridge, Dayton, Erie, Fall River, Grand Rapids, Lynn, Pawtucket, 
 Pittsburgh, Providence, St. Louis, and St. Paul. In Kansas City and 
 St. Louis it is said that they are washed with hot water. In Detroit 
 they are steamed. 
 
 In a number of cities it is required that the garbage, or the wagons, 
 or the receptacles be disinfected, but usually only in the summer time. 
 In Buffalo the dates are from 1 May to 31 October. According to 
 Mr. Hering's report, in Kansas City and Salem the wagons after washing 
 are disinfected with carbolic acid, and in Tampa this, is used for the 
 scows. In Newark " Egyptian Powder" and lime are used, in Pitts- 
 burgh phenyl, and in Chicago the garbage which is collected together 
 with ashes is said to be disinfected twice daily at the dumps with 
 potassic permangate in solution, at a cost of thirty-three cents a ton. 
 In Detroit the bodies of the wagons are disinfected with copperas. Lime 
 is used for disinfection in Macon, Rochester, Ltica, and Wilmington, 
 Del., and in Newport, R. I., on the scow. In Buffalo there is attached 
 to each garbage wagon a tank containing a solution of " dead oil " and 
 compressed air, by means of which the driver sprays the wagon and the 
 receptacles. 2 In Atlantic City, Boston, Cleveland, Erie, Galveston, 
 
 1 Asbury Park, Report of Board of Health (1897), p. 24. 
 
 2 Municipality and County, Vol. 3, p. 159. 
 
REFCSE DISPOSAL. 
 
 68; 
 
 Tex.. Grand Rapids, and Lynn it was simply stated that the garbage 
 wagons were disinfected, but no particulars were given. 
 
 It sometimes becomes necessary to transport garbage a considerable 
 distance from the city where it is collected in order to provide for its 
 proper disposal. ( Occasionally it is found most economical to do this in 
 wagons, either those in which it is collected or in larger ones to which 
 it is transferred. Where garbage is fed to swine or plowed in, and the 
 distance is only a few miles, this is the usual practice. In Providence 
 farmers find it profitable to draw it from seven to twelve miles. If the 
 distance is great, other means have to be provided. In Providence at 
 one time all the garbage was taken out on cars, small dump cars being 
 used for the purpose. At present some of it in that city is carried out 
 on flat cars. Such cars are, of course, uncovered, and the method 
 creates considerable nuisance. In Pittsburgh the half dried garbage is 
 removed in box cars. The best method of railroad transportation is 
 that employed in Cleveland and Detroit. In those cities the wagon 
 bodies in which the garbage is collected, shown on page 685, are 
 hoisted on to flat cars, twenty-four bodies being placed on one car. 
 
 Sometimes garbage is transported by water, as in Baltimore, Boston. 
 Cincinnati, the District of Columbia, Lynn. Newport, R. I., Tacoma, 
 and Tampa. In Boston and Lynn such of it as is towed to sea is taken 
 
 I'h.. SI I. 
 
 Cai used ;i i Cleveland for Transporting Wagon Bodies loaded with Garbage 
 
G88 
 
 REFUSE DISPOSA L. 
 
 out together with the other refuse in Barney dumping scows. In New- 
 port the scow is arranged with a slanting deck so that the load may 
 slide off into the water. But in the other cities ordinary deck scows 
 are used. 
 
 Fig. 81. 
 Scow for Transporting Garbage to Sea, Newport. 
 
 Collection of Garbage. 
 
 There are few general laws which authorize municipalities to col- 
 lect and dispose of garbage. Power to do this is usually conferred by 
 charters or general incorporation laws. The laws of Massachusetts. 1 
 Xew York, 2 and Xew Jersey, 3 do, however, provide that cities and 
 towns may contract for the disposal of garbage, and in New York they 
 may also collect garbage. In New Jersey 4 garbage crematories may not 
 be built without the consent of the township in which they are to be 
 located. 
 Methods of Collection. 
 
 .Most cities provide for the collection of garbage at public expense. 
 There are two ways of doing this, by contract and by the employees of 
 
 1 Massachusetts, Chapter 377 of 1889. 
 - New York, Chapter 066 of 1894. 
 
 3 Xew Jersey, Fublic Laws (1896), p. 50. 
 
 4 Xew Jersey, Public Laws (1885), p. 822. 
 
REF I r S£! 1> isp SA I . 
 
 689 
 
 Fig. 82. 
 
 Method of Dumping Garbage onto scows in Boston, also showing Metal Garbage Wagons. 
 From Report of the Street Department, 1898. 
 
 some municipal department. Below is given a list of cities which pro- 
 vide for the collection of garbage by contract and also the department 
 which has charge of the work. 1 
 
 Cities which provide for the removal of garbage, ashes, and rubbish 
 by contract usually let the contract only after advertising for bids. In 
 
 1 Health Department Asbury Park,* Atlantic City,* Auburn, N. Y., Augusta, 
 Ga., Bridgeport, Brookline, .Mass., Chelsea, Cleveland, Columbus, Davenport, 
 Denver, Detroit, District of Columbia, Dubuque, Everett, Fall River, Fitchburg, 
 Haverhill, Holyoke, Milwaukee, Minneapolis, Montclair, New Bedford, New Haven, 
 Newport, Newton, Paterson, Paw tucket,] Portland, Me.,1 Providence,] Quincy, 
 Rockford, 111., St. Louis. St Paul, San Antonio, Utica, Wheeling, Wilkesbarre, 
 ;ind Wilmington, Del. 
 
 The director of public safety makes the contract in Allegheny, Columbus, and 
 Pittsburgh. 
 
 The department of public works has charge in Buffalo, Evansville, Fori Wayne, 
 Philadelphia, and Terre Haute. 
 
 The street department has charge in Boston (in certain districts, in others the 
 work is done by citj employees), Brooklyn, Hartford, Indianapolis, Manchester and 
 New London. 
 
 In Newburghi Rochester, and Toledo, the city council makes the contract 
 
 * The city ow us t he wagons. 
 Sanitary committee. 
 Board of Aldermen, ex officio Board of Health. 
 
690 REFUSE DISPOSAL. 
 
 order to secure uniform conditions for the bids, specifications are usually 
 furnished which describe at some length the character of the work to be 
 done. Such specifications are issued by all the larger cities. On page 
 4 ( .» of the Report of the State Board of Health of New Jersey for 1897, 
 may be found model specifications for the removal of garbage and rub- 
 bish. Good specifications may also be obtained from Buffalo and Phila- 
 delphia. Contractors are, of course, to give bonds and obey the regula- 
 tions of the health department. Contractors are generally required to 
 call daily, or oftener for complaints, and sometimes, as Augusta, Ga., and 
 Pittsburgh, and doubtless other cities, they are required to have a tele- 
 phone. The contractor frequently has a special man to attend to these 
 complaints. In all cities which have sanitary inspectors these officers 
 on their rounds look after the garbage collection ; but some cities, as 
 Pittsburgh, have a special inspector for this, and in Detroit there are 
 two such inspectors. 
 
 The list below 1 gives the cities in which the garbage is collected by 
 employees of the city and also the departments which have charge of the 
 work. 
 
 In quite a number of cities there is no municipal collection of 
 garbage. 2 
 
 There appears to be a well nigh unanimous demand on the part of 
 health officers and oftentimes of the public generally, for the municipal 
 collection of garbage. This may be inferred from the small number 
 and generally small size of the cities which do not thus provide for gar- 
 bage collection, and also from the expressed desire of the sanitary au- 
 thority of several of these cities for municipal collection. There are 
 several stages in the development of the methods of garbage collection 
 
 iHealth Department. Atlanta, Dallas, Galveston, Houston, Joliet, 111. , Kansas 
 City, Mo., Lafayette, Ind., Lawrence, Lowell, Lynn, Macon, Memphis, Milwaukee, 
 Richmond, Salem, Salt Lake City, Sioux City, Somerville, and Tampa. 
 
 Street Department. Boston (in part), Camden, and Manchester. 
 
 Street Cleaning Department. Baltimore, Cincinnati, and New York. 
 
 Overseers of Poor. Brockton, Cambridge, Taunton, and Worcester. 
 
 Board of Public Works. Evansville, Louisville (1901), New Orleans, Norfolk, 
 Terre Haute, and Yonkers. 
 
 Superintendent of Streets. Kingston, N. Y. 
 
 Scavenger Department. Savannah. 
 
 Board of City Affairs. Dayton. 
 
 Board of Public Affairs. Springfield, O. 
 
 City Commissioner. Muncie. 
 
 -Albany, Altoona, Akron, Battle Creek, Bay City, Mich., Binghamtnn, Canton, 
 Concord, Council Bluffs, Des Moines, Duluth, Erie, Elmira, Findlay, Fort Worth, 
 Gloucester, Mass., Grand Rapids, Harrisburgh, Jackson, Mich., Lancaster, Pa., 
 Meadville, Pa., Oakland, Cal., Omaha, Peoria, Plainfield, N. J., Portland, Ore., 
 Pnughkeepsie, Pueblo, Scranton, Seattle, South Bend, Inch, Sacramento, San Fran- 
 cisco, Tacoma, Troy, and Woonsocket. 
 
REFUSE DISPOSAL. 691 
 
 and disposal. In small cities, villages, and in the country, garbage is 
 often fed to swine, composted or buried on the premises, or mixed with 
 ashes and other refuse and carted off at intervals at the owner's expense- 
 The next step is for the neighboring farmers who wish to use garbage 
 to feed to swine to call along certain routes with more or less regularity 
 to remove the garbage which is kept separate for them by the house- 
 holder. Such methods are now rarely if ever employed in cities of 
 25,000, though they are in Peoria and Poughkeepsie, and very many 
 cities much smaller have better and more systematic methods. The 
 next step is for the city, usually through the agency of the board of 
 health, to attempt to control the collection of garbage by licensing and 
 regulating the scavengers. Indeed a survival of this method is found 
 in nearly all cities, for almost every municipality finds it necessary to 
 permit private scavengers to collect garbage from hotels and restaurants, 
 and often from private houses, and sometimes, as has been shown, this 
 method of disposal is forced on the hotels and markets by the muni- 
 cipality. In most of the cities named on page »'»!»<), note 2, the garbage is 
 collected in this way. Other cities which maintain a good municipal col- 
 lection yet collect a considerable quantity in this way. Thus in Lowell 
 and Fort Wayne about half the garbage is so collected. In Denver 
 from thirty to sixty scavengers collect without charge nearly all the 
 garbage except the poorest, but this city in 1899 was put to the ex- 
 pense of 11,600 in looking after their omissions. 
 
 Nearly all these cities forbid the removal of garbage, except by 
 licensed scavengers. The licenses are usually granted by the health 
 department, but sometimes when the municipal collection is made by 
 another department, that depart nienl may also control the licensing. 
 This is the case in Hartford where the street depart incut collects the 
 garbage and the ashes. In Grand Rapids, Mich., and Erie, Pa., the 
 License is issued by the mayor. The regulations governing the garbage 
 wagons usually apply to both municipal and private wagons, and have 
 been fully considered. Usually a written application has to be made 
 
 stating the name of the owner, the kind and size of vehicle, the places 
 from which the garbage is taken, and its disposal. The form of appli- 
 cation used in Philadelphia requires the applicant to state that the gar- 
 bage will be ved in accordance to the rules of the board of health, 
 
 ami he must also stale where the garbage is to be taken and tor what 
 
 it i- to be used. 1 In that city no licensee are granted if the garbage i^ 
 to l.e fed to hogs, ami this requiremenl is practically prohibitive. In 
 Salt Lake City persons who remove the garbage from their own prem- 
 - me nol required t<> take oul a license. 
 
 1 Philadelphia, Reporl ot Board ol Health (1895), p. 115. 
 
592 REFUSE DISPOSAL. 
 
 Another step is to require the licensed scavengers to collect all the- 
 garbage in their districts or in the city, and to require the householder 
 to deliver the garbage in suitable receptacles to the licensee, the house- 
 holder paying for the collection. This is the plan followed in Cleve- 
 land (until 1898), Erie, Grand Rapids, 1 Oakland, Cal., and Portland, 
 Ore. ; in such cases the charge to be made is usually fixed by the 
 ordinance. 
 
 In Chicago in 1899 a new ordinance was adopted governing private 
 collectors of garbage, manure, ashes and all other kinds of wastes. 2 All 
 wagons must be inspected monthly by the health officials, and on each 
 inspection they are furnished with a tin sign, the signs being of different 
 colors on alternate months. 
 
 I The Grand Rapids ordinance has been tested in the Supreme Court and its 
 validity affirmed. Report of Board of Health (1899-1900). 
 
 2 Rules and Regulations Governing the Gathering, Removal, and Dis- 
 posal of Garbage, Manure, and other Refuse by 
 Private Scavengers. 
 " Rule 1. (a) The box or body of every wagon or other conveyance used for the 
 private scavenging of offal, table refuse and other matter usually known as garbage r 
 or swill and other animal and vegetable refuse and wastes, including decaying 
 animal matter and fish, shall be absolutely water-tight and provided with close-fit- 
 ting covers, which shall be kept closed except when loading, unloading or cleansing.. 
 The outside of the box or body is to be painted white, and on each side shall appear 
 in black letters, not less than four (4) inches high, the name of the Licensee and the 
 
 number of the wagon, thus : 
 
 JOHN SMITH 
 
 Licensed 
 
 No. 1. 
 
 "If more than one wagon is employed by a Lincesee, his wagons shall be num- 
 bered consecutively No. 1, No. 2, etc. 
 
 " Rule 2. (a) Drivers and collectors must perform their work expeditiously, with- 
 out loitering or delay, and shall not allow any garbage (solid or liquid), or other 
 refuse to fall upon the sidewalk, gutter, street or other surface without at once re- 
 moving and cleaning up the same. Under no circumstances shall they empty tlie 
 contents of garbage cans or other receptacles on the ground, or elsewhere than into 
 the wagon box direct. 
 
 " (b) No driver shall allow his wagon to be so fully loaded, or to be in such bad 
 condition or repair, or of such faulty construction, or to be so improperly driven or 
 managed that any portion of its offensive contents, solid or liquid, shall fall upon or 
 in any place, street or premises; and it shall be his duty, in such event, to replace 
 at once on his wagon and to remove what has so fallen. 
 
 II (c) Garbage wagons must be cleansed and disinfected at the place of disposal 
 and before being returned to service. They must at all times, when not in use, be 
 kept in a cleanly, inoffensive condition; repainted from time to time, and the owner's 
 name and the wagon number be always legible and distinct. 
 
 " (d) The boxes or bodies of wagons for hauling manure or dry wastes and refuse 
 must be sufficiently tight to prevent any leakage or filtering of dust, etc., and their 
 loads must be securely covered with canvas sheets or tarpaulins. No portion of the 
 contents of such wagons must be allowed to escape into the air or to litter the street- 
 
REFUSE DISPOSAL. 693 
 
 Often no fee is charged for a garbage license, and in other cases it 
 is nominal, as twenty-five or fifty cents. In Spokane it is $2. But in 
 those cities where the licensee has an exclusive privilege and makes an 
 authorized charge upon the householder for collection a larger fee is 
 sometimes imposed. 'Jims in Elmira, X. Y., it is $40 annually, in Erie, 
 Pa., $100; and in Portland, Ore., $12. Most licenses are granted for 
 one year, but in Spokane the time is three months. 
 
 In cities where collection is by private scavengers, it is made com- 
 pulsory upon the householder, not only to provide a receptacle and place 
 the garbage in it, but to deliver it to the scavenger. In Cleveland 1 the 
 householder was (before municipal collection was adopted) fined $5 for 
 every day during which garbage was allowed to remain on the premises 
 after the scavenger had called. In Erie the householder is fined if gar- 
 bage remains on the premises more than four days in the summer and 
 one week in the winter, but the scavenger is not required to move it if 
 the householder is more than one month in arrears in his payment. 
 These regulations have not as yet (1899) been thoroughly enforced in 
 either Erie or Grand Rapids. In fact one reason why the collection is 
 unsatisfactory, when conducted in this manner, is that it almost impos- 
 sible to overcome the ingenuity and persistence of the householder in 
 avoiding the payment of the necessary fees. Thus in Montclair, X. J., 
 where greal effort was made to secure the thorough removal of garbage 
 in this manner, it was reported that only thirty-five per cent, was regu- 
 larly collected. 2 
 
 The maximum [nice fixed for the removal of garbage by private 
 scavengers is in : 
 
 Grand Rapids: 1<» <<-nt >. per week for private families and f] for hotels, res- 
 taurants, aii'l boarding houses. 
 
 Tin- name <>f the Licensee and the number of the wagon must be displayed as in the 
 
 t garbage wagons. 
 
 Rule ■'>. As soon as a wagon is leaded it must be driven at once to the specified 
 place "i disposal and on no account be allowed to stand in the vicinity of human 
 
 habitations, sele.nl houses, etc. All collections must he disposed of within twelve 
 
 (12) hours after being collected. 
 
 "Rule 1. Collections of garbage, manure and other refuse must be disposed of 
 
 onlj at the place or places specified in the application for license. This specification 
 
 is a prime condition of the approval of the license, and disposal elsewhere, without 
 
 -, authority of the Commissioner of Health, will result in prompl revocation 
 
 of i he license. 
 
 '• Rule •">. All private scavenging of garbage and ot her material defined in Rule 1 
 must be done between seven (7) o'clock p! m. and seven (7) o'clock \. u. during the 
 months of Slay, June, July, August, September, and October, and between six (6) 
 o'clock p. m. and eighl (8) o'clock v. m. during the remaining months of the year. 
 
 'Cleveland, Ordinances (1892), Chapter 80, Sec. 196. 
 New Jersey, Report of State Board of Health (1896), p. 84 
 
694 REFUSE DISPOSAL. 
 
 Erie: Hotels or restaurants, daily or bi-weekly, $1.50 per month. 
 Families, 3 collections a week, 75 cents per month. 
 2 lt " 50 " " " 
 
 2 " " April-October and 1 collection per week No- 
 
 vember-March, 25 cents per month. 
 Elmira: 10 cents per cubic foot for first 100 feet and 8 cents afterwards. 
 Omaha: Each barrel of 30 gallons or over, 20 cents. 
 
 Receptacles of less than 30 gallons, for each 10 gallons 10 cents. 
 Oakland, Cal. : Private families, 25 cents per month. 
 Portland, Ore. : Private families, 25 to 50 cents per week. 
 Montclair, N. J. : 15 cents a can, or $ 12 per annum per house. 
 Superior, Wis. : 50 cents per house per month. 
 
 It can be readily seen that if garbage is removed from every house 
 at the above prices, and even at the lowest price given, it would amount 
 to several times more than the most expensive municipal collection. 
 Even if the garbage is half collected, private scavengers furnish the 
 most expensive means of getting rid of garbage. It would seem that 
 this alone ought to compel every city to provide for municipal removal ; 
 but it must be remembered that payments for garbage removal must be 
 made from the tax levy, and a councilman who votes to raise the tax 
 rate, meets with no favor at the hands of constituents, even if by so 
 doing he has diminished their living expenses ; but outside of any 
 pecuniary advantage in municipal collection, its sanitary value requires 
 its adoption. Health officers are agreed that it is only by municipal 
 collection, that a good service from a sanitary standpoint can be secured. 
 
 As regards the choice between collection by contract and by city 
 employees the correct decision is not so evident. There are general 
 economic and social considerations in regard to the letting out of muni- 
 cipal work which it is not intended to discuss here, but which are of 
 great importance and which should have perhaps the greatest weight in 
 deciding the question. As a matter of fact, good results are obtained 
 by both contract and municipal collection. 
 
 Contract work is sometimes not as satisfactory as that done by city 
 employees, for many health officers have expressed a wish that their 
 cities would employ municipal labor instead of contract, but the writer 
 knows of no instance in which a contrary preference has been expressed. 
 
 The writer has attempted to collect data in regard to the amount and 
 cost of collecting garbage, ashes, and rubbish, but it has been found a 
 very difficult task. In most cities these waste materials are not weighed 
 and the amount in tons or cubic yards must be estimated from the num- 
 ber of loads, and as these are not always of the same size the estimate 
 may not be a very close one. In many cities no account is kept of even 
 the number of loads, so that in such cases the estimate is still more 
 unreliable. It is important to know the cost of disposal as distinguished 
 
REFUSE I) isp os A L. 
 
 695 
 
 from the cost of collection but often they can not be separated. Again, 
 the cost of collecting garbage and ashes is lumped with street cleaning 
 or other sanitary work. A few of the figures in the tables here given 
 are taken from the September Bulletin (1900) of the U. S. Commis- 
 sioner of Labor, but most of the data have been obtained by corre- 
 spondence or from official reports. 
 
 Table Showing the Amount of Garbage Collected anh Cost of Collec- 
 tion in a Numbeb of American Cities. 
 
 City. 
 
 Allegheny 
 
 Asbury Park 
 
 Atlanta 
 
 Augusta, Ga ........ 
 
 Atlantic City 
 
 Baltimore 
 
 Birmingham, Ala . . . 
 
 Boston 
 
 Bridgeport 
 
 Brockton 
 
 Brookline 
 
 Borough of Brooklyn 
 
 Buffalo 
 
 Cambridge 
 
 Camden 
 
 ( Ihelsea 
 
 Cincinnati 
 
 < lleveland 
 
 Columbus 
 
 Dayton 
 
 Dallas 
 
 Denver 
 
 Del roit 
 
 I )isi i iii of < lolumbia 
 
 Evansville 
 
 Kail River 
 
 Fitchburg .... .. 
 
 Port Wayne 
 
 ( rah eston 
 
 Hartford 
 
 Haverhill 
 
 Holyoke 
 
 Houston 
 
 Indianapolis. 
 
 Joliet, 111 
 
 Kansas City, Mo 
 
 Law rence 
 
 Lowell 
 
 Los \ ngeles. 
 Lynn 
 
 Macon 
 
 Maiden, Mass 
 
 Manchestei 
 
 M ilwaukee 
 
 M inneapolis 
 
 Population, 
 
 < ensus of 
 
 1900. 
 
 129.NJMJ 
 4,148 s 
 
 S'.t.STL' 
 
 39,441 
 27,838 9 
 
 r.ns.'.cT 
 :;s.4ir» 
 
 560,892 
 
 70,990 
 
 40,063 
 
 19,935 
 
 ,166,582 
 
 352,219 
 
 91.ssr, 
 
 75,935 
 
 34,072 
 
 325,902 
 
 381,768 
 
 UJ5,560 
 
 85,333 
 
 12,638 
 
 133,859 
 
 285,704 
 
 278,718 
 
 59,007 
 
 104,863 
 
 31,531 
 
 15,1 !■"■ 
 
 37,789 
 
 79,850 
 
 37,175 
 
 15,712 
 
 14,633 
 
 169,164 
 
 29,353 
 
 62 559 
 94,969 
 L02, IT'.' 
 68,513 
 23,272 
 
 285,315 
 202,718 
 
 fear to 
 which 
 
 da ta 
 refer. 
 
 1900 
 1900 
 1899 
 1899 
 1900 
 1! 
 
 1899 
 1899 
 1899 
 1899 
 1899 
 is;is 
 1900 
 1899 
 1900 
 1899 
 1899 
 1899 
 1899 
 1899 
 1900 
 1899 
 lsi.s 
 1899 
 1899 
 1900 
 1899 
 L898 
 1899 
 1899 
 1899 
 L899 
 1899 
 L899 
 1899 
 1899 
 L899 
 1899 
 1899 
 L899 
 L899 
 
 1899 
 1899 
 1899 
 
 Amount Collected. 
 
 3,772 cu. yds. 
 31,200 tons 10 
 15,003 loads 10 
 1 1,463 tons 
 49,000 tons 
 
 60,000 tons 
 0,000 tons 
 4,500 tons 
 
 lll-J.OIMI 
 
 22.SS1 
 
 6,794 
 2,000 
 
 l.S.II) 
 
 11,752 
 
 22,375 
 
 7,794 
 
 7,133 
 
 9,000 
 
 12,000 
 
 14,732 
 
 20,946 
 
 5,000 
 
 tons 
 
 tons 
 
 tons 
 tons 
 
 tons 
 
 tons 
 
 tons 
 tons 
 tons 
 cu. yd 
 
 cu. yils. 
 tons 
 
 tons 
 t^ns 
 
 ( ..~t ol Collection. 
 
 528,000 00 
 2,600 00 » 
 
 4,500 00 
 9,900 00 7 
 
 65,504 44 
 9,600 00 
 
 112,641 09 
 
 per ton 
 
 5,421 tons 
 l 1,887 tons 10 
 13,500 tons 
 
 3, tons 
 
 27,000 tons 10 
 
 IT. 15 I ions 
 3,500 ions 
 
 15, Ions 
 
 1. 163 ions 
 1,035 ions 
 
 I tons 
 T.ooo cu. yds. 1 
 7,695 cu. yds. 
 
 28,716 o.iis 
 
 6,958 41 » 
 
 1,800 00i 
 
 120,000 00' 
 
 33,1 0' 
 
 25,952 65* 
 1,200 00 
 3,800 00 ] 
 24,583 00 
 • ■■'.MOO 00 i 
 15,800 00 1 
 16,674 00 
 
 1,60 
 
 50,1 00" 
 
 57,000 00 
 
 1. •_".!."> 00 
 
 11.1 Ml' 
 
 2,600 oo' 
 
 3,349 60 
 
 18,933 "in 
 
 9,850 00' 
 
 2,725 00 1 
 
 1,0515 00' 
 16,691 
 
 30,000 00 1 
 
 3,222 00 
 
 17,798 00 
 
 6,500 00* 
 
 7,191 
 
 12,767 00 1 
 
 12,836 :>' 
 
 5,00 
 
 1(1 50* 
 
 •j.:,( mi i mi' 
 
 01,883 21 
 
 IT.im, 
 
696 
 
 REFUSE UISPOKA L. 
 
 City. 
 
 Montelair, N. J 
 
 Muncie, Ind 
 
 New Bedford 
 
 New Haven 
 
 Newport 
 
 New Orleans 
 
 Newton 
 
 New York / 
 
 Borough of Manhattan ) 
 
 Norfolk 
 
 Paterson 
 
 Pawtncket 
 
 Philadelphia 
 
 Pittsburgh 
 
 Providence 
 
 Portland, Me 
 
 Reading 
 
 Richmond 
 
 Richmond, Ind 
 
 St. Louis 
 
 St. Paul 
 
 Salem 
 
 Salt Lake City 
 
 San Antonio 
 
 Somerville 
 
 Springfield, Mass 
 
 Syracuse 
 
 Taunton 
 
 Terre Haute 
 
 Toledo.. 
 
 Trenton 
 
 Utica 
 
 Wheeling 
 
 Wilmington 
 
 Worcester 
 
 Yonkers 
 
 
 Year to 
 
 Census of 
 
 which 
 
 1900. 
 
 data 
 
 
 refer. 
 
 13,962 
 
 1899 
 
 20,942 
 
 1899 
 
 62,442 
 
 1899 
 
 108,027 
 
 1899 
 
 22,034 
 
 1900 
 
 287,104 
 
 1900 
 
 33,587 
 
 1899 
 
 1,850,093 
 
 1898 
 
 42,624 
 
 1899 
 
 105,171 
 
 1899 
 
 39,231 
 
 1899 
 
 1,293,697 
 
 1899 
 
 321,616 
 
 1899 
 
 175,597 
 
 1899 
 
 50,145 
 
 1899 
 
 78,961 
 
 1899 
 
 85,050 
 
 1899 
 
 18,226 
 
 1899 
 
 575,238 
 
 1899 
 
 163,632 
 
 1899 
 
 35,956 
 
 1899 
 
 53,531 
 
 1900 
 
 53,321 
 
 1899 
 
 61,643 
 
 1899 
 
 62,059 
 
 1899 
 
 108,374 
 
 1899 
 
 31,036 
 
 1899 
 
 36,673 
 
 1899 
 
 131,822 
 
 1899 
 
 73,307 
 
 1899 
 
 56,383 
 
 1899 
 
 38,878 
 
 1899 
 
 76,508 
 
 1899 
 
 118,421 
 
 1899 
 
 47,931 
 
 1899 
 
 Amount Collected. 
 
 1,573 cu. yds. 
 3,705 tons 
 
 17,000 cu. yds. 
 07,500 tons 10 
 
 152,000 tons 10 
 
 5,719 tons 10 
 4,443 tons 
 
 199,357 tons 
 25,000 tons 
 16,000 tons 
 
 4,146 tons 
 4,810 tons 10 
 3,935 tons 
 69,634 tons 
 
 3,651 tons 
 11,546 cu. yds 10 
 
 8,000 load's 10 
 11,274 tons 
 
 4,858 tons 
 8,187 loads" 
 
 4,000 tons 
 7,204 cu. yds. 
 
 7,450 tons 
 9,390 tons 
 9,360 tons 
 6,260 tons 
 
 Cost of Collection. 
 
 per tan 
 
 $4,000 00 > 
 1,754 10 
 
 15,000 00 1 
 5,500 00 i 
 4,980 00 
 
 97,200 00 i 
 5,700 00 1 
 
 67 
 
 per ton 
 
 4,000 00 1 
 398,000 00 1 
 92,000 00 1 
 25,200 00 1 
 4,500 00 J 
 1 35 
 10,460 00 
 2,340 00 
 99,673 00 
 15,533 00 1 
 8,000 00 4 
 8,755 75 
 10,000 00 
 11,456 00 4 
 12.000 00 1 
 20,401 75 
 1,484 87 4 
 2,800 00 
 12,000 00 1 
 6,000 00 1 
 5,700 00 1 
 5,500 00 
 12,000 00 
 17,109 00 4 
 
 1 Cost of collection and disposal. 
 
 2 Cost of collection and disposal of ashes and garbage, $27,500. 
 
 3 Cost of collection of ashes and garbage, $22,500. 
 
 4 Cost is lessened by sale of garbage or garbage fed pork. 
 
 5 Only a part is collected by the city. The rest is collected by ranchmen at no 
 cost to the city. 
 
 6 A load consists of ten barrels. 
 
 7 The city owns the wagons. 
 
 8 Resident population. The summer population is probably over 30,000. 
 
 9 Resident population. In summer the population is said to exceed 200,000 at 
 times. 
 
 10 The garbage has a considerable amount of dry refuse mingled with it. 
 
 11 Approximately. 
 
REFUSE I) isp & 1 1 . 
 
 69" 
 
 Disposal of Garbage. 
 
 The problem of garbage disposal has not yet been solved. Although 
 the theoretical value of the garbage is considerable, in practice it has 
 never been found possible to get rid of it without some expense and 
 usually not without some nuisance. Probably every form of garbage 
 disposal has been tried in the United States, and has found its advo- 
 cates, but the variance in method is in itself a demonstration that none 
 of the methods are entirely successful. 
 
 It is possible in the country to dispose of garbage on the. premises 
 where it is made either by burying it, feeding it to animals, or burning- 
 it in a stove. In cities the latter is the only possible method of private 
 disposal. It is sometimes adopted by neat people who do not wish to 
 have a garbage pail about : but such people forget that to put garbage 
 on a kitchen lire, however carefully, usually gives rise to some disagree- 
 able odor which may he perceived by the neighbors. A device was 
 put upon the market a few years ago which overcomes this difficulty by 
 drying the garbage before it is put on the tire. The following is a 
 description and cut of this "carbonizer" : 
 
 Kk;. 88. 
 Qarbage < arlxmizei closed ;i~ in use). 
 
 Fig. si. 
 i .:n bage < larbonizer open. 
 
 •• Between the Btove, or range, and the flue of the chimney is placed ;i horizontal 
 
 cylinder about one-third larger in diameter than the stovepipe, and in length :ii i 
 
 twice the diameter of tin' pipe. One end of this cylindei is removable, and attached 
 
 i" ill'' ins i< !<■ "f this end is a basket, ors p, n i:i< !•• with perforated sides ami a tight 
 
 bottom and somewhat smaller in dia ter than tin' cylinder, giving a free passage 
 
 for the smoke and heat, from the Btove, around ii ami through the perforations. 
 When it is to be used the haskct or scoop is withdrawn bj means of a handle on the 
 outside of tin- cylinder head, tilled with garbage and replaced in the cylinder. The 
 
098 REFUSE DISPOSAL. 
 
 heat from the fire drives off the water and transforms the residuum into charcoal 
 and this is put into the Are, burning witli a clear name, or after being left over night 
 may be used to kindle the morning fire, since, with a piece of paper or a stick of 
 kindling to start it, this carbonized garbage will ignite coal." 
 
 This apparatus is made by the Sanitary Construction Company, 30 
 State Street, New York. It sells for $5. It has given satisfaction in 
 many families, as reported by the boards of health of Boston and Brook- 
 line, Mass., but has never come into very general use. 
 
 Dumping. The simplest and most primitive method of disposal is 
 to deposit the garbage on some dump, using it to fill up low lands. 
 This is only slightly better than allowing it to remain and decay in the 
 back yard. This method of disposal is more common when garbage is 
 collected together with ashes than when it is collected separately, which 
 alone is now under consideration. This method of disposal is less 
 offensive when the garbage is mixed than when it is separate, but none 
 of the cities which adopt it are satisfied with it, and the writer never 
 knew or heard of such a dump which was not bitterly complained of 
 by all who dwelt or worked in its vicinity. It is forbidden by the rules 
 of the state board of health of Florida. 
 
 According to Mr. Herings report, the cities named below collect 
 their garbage separately and dispose of it by dumping in waste places. 1 
 Sometimes an appreciable expense attaches to this method, for an avail- 
 able dumping ground may only be secured after a very long haul and 
 sometimes it is necessary to hire land for the purpose, and usually it is 
 necessary to station men on the dumps to level off and cover material 
 deposited. In Baltimore in 1897 the expenses were -$2,370.81. It is 
 seen that the cities employing this method of disposal are few in num- 
 ber and mostly of small size, and the report from nearly every one indi- 
 cates that the method is far from satisfactory. In most of them the gar- 
 bage is supposed to be buried in pits, or covered with a thick layer of 
 earth or ashes, but judging from the complaints made, this is frequently 
 neglected. The dump question will be further considered in connection 
 with the disposal of mixed refuse. 
 
 Plowing In. A much more scientific treatment of garbage is by 
 plowing it into the soil and making use of its fertilizing qualities for 
 the growth of crops. 2 Garbage was formerly used as a fertilizer by 
 
 1 Adrian, Mich., Auburn. X. Y., Battle Creek, Mich., Bay City, Mich., Elmira, 
 Hartford. Muncie, Meadville, Pa., Xew Brunswick, X. J., Xewburgh, Oshkosh (in 
 part), Poughkeepsie (in part), Pueblo (in part), Williamsport, Pa., Albany (in part), 
 Baltimore (in part), Holyoke (in part), Wheeling (in part). 
 
 -This is done in Manchester, X. II., Baltimore (in part), Minneapolis (in part), 
 Xew London (in part), Auburn (in part), Battle Creek (in part), Omaha (in part), 
 Pawtucket (in part), Providence (in part), Fall River (in part), Springfield, Mass. 
 
REFUSE DISPOSAL. 609 
 
 plowing in at Asbury Park, New Bedford, Newport, and doubtless many 
 other places, but the plan was abandoned on account of the nuisance 
 produced. In Baltimore, in l!»00, it cost $9,950 to tow the garbage 
 in scows to points where it could be used as a fertilizer. 
 
 Thumping in Water. The dumping of garbage in streams, lakes, 
 or the ocean is in some respects even worse than its deposit on land. 
 A city which deposits its garbage on land usually annoys its own citi- 
 zens merely, but a city which deposits it in a river often injures other 
 communities as well as itself. It rarely, if ever, fails to create some 
 nuisance, and is without exception unsatisfactory to others, if not to the 
 city committing the offence. 1 
 
 With the exception of Newport, New Orleans, Boston, and Lynn, 
 where it is towed out to sea, the cost of disposal by this method adds 
 nothing to the cost of collection. In Boston and Lynn the amount so 
 disposed of is mixed with other refuse. In Cleveland the garbage was 
 taken ten miles out into Lake Erie, and some of it floated back to shore. 
 The annual cost was $1,600. The cost of towing to sea in Boston is 
 fifteen cents per load. In Newport the cost of disposal is $2,534 per 
 annum. 
 
 Feeding to Animals. Another ancient method of garbage disposal 
 is b\ feeding to animals, chiefly swine. Formerly it is said that con- 
 siderable garbage was fed to cows, but at present it is rarely attempted. 
 Colorado, Massachusetts, and New Jersey have statutes forbidding the 
 feeding of garbage to milch cows, and so do a considerable number of 
 cities, as the City of New York, Rochester, the District "of Columbia, 
 and many other states and cities practically forbid it by forbidding the 
 Bale of milk from garbage-fed cows, see p. :>7<». That garbage-fed cows 
 give poor milk, often offensive to the taste, and that they are poorly 
 nourished is generally admitted, and the practice was condemned in 
 nearly every answer to the committee's inquiry; but in Peoria, Lynn, 
 
 and Salem the health officials reported that no evil effects could be seen 
 
 from such use of garbage. A former contractor in Providence was 
 
 accustomed to \'n't\ garbage to rattle, sheep, and swine, and claimed 
 that that was the most economical method, as the different kinds of 
 animals ate different portions of the garbage most suitable for them, 
 
 lin part), Toledo, [Jtica, St. Paul (in part), Ne\i Haven (in part), Montclair, V J., 
 Rochester (largely). In Milwaukee ii was formerly plowed in, l>ut is now buried in 
 i reaches t \n o feel \\ ide. 
 
 'The following cities dispose of ii in this manner: < leveland until 1898 (Lake 
 
 Davenport (Mississippi River), Dubuque, Kansas Citj (Missouri River), Nash- 
 
 villi- (Cumberland River), New Orleans (Mississippi River), Newport (Atlantic 
 
 Ocean), Quincj (in part), Boston (in pari into ocean), Lynn (in part into ocean). 
 
 In Dubuque it is dumped fr a platform into the Mississippi River. 
 
700 REFUSE DISPOSAL. 
 
 and therefore thrived better and consumed the garbage more completely ; 
 but he admitted that garbage was not a wholesome food for cattle. 
 
 In a few cities, as Cambridge and Denver, and probably to a slight 
 extent in many other cities, garbage is used as a food for poultry ; but 
 it is for feeding swine that garbage is chiefly employed. There can be 
 little question that this is the most economical method of utilizing gar- 
 bage yet devised, and is the cheapest way in which it can be disposed 
 of. The larger the city the more difficult it is to make use of it, but 
 that it is a very popular method of disposal is shown by the fact that 
 it is employed in the cities named below. 1 
 
 It is generally stated that the feeding of swine upon garbage exclu- 
 sively produces an inferior quality of pork, but the managers of the poor 
 farm at Worcester where all the city garbage is fed to swine and is their 
 exclusive food, state that they receive more for their pork than western 
 pork brings in the same market. It is also said that it induces hog 
 cholera, but there does not seem to be any evidence that this is so. 
 The longer the garbage is kept before it is fed the further it has under- 
 gone putrefaction and the worse it is said to be for the swine ; but if 
 the animals are fed on garbage which is reasonably fresh, and especially 
 if garbage is not the sole food, and corn is used for the final fattening, 
 very good pork can be obtained. Another objection to the feeding of 
 garbage to swine is that garbage-fed swine are more liable to trichinosis 
 than are swine fed on other food. According to the investigations of 
 the Massachusetts state board of health garbage-fed hogs are afflicted 
 with trichinosis to the extent of thirteen per cent., which is a very much 
 larger percentage than is found in western hogs. 2 This is not, how- 
 ever, so serious a matter as would at first appear, for this disease is 
 transmitted to man almost exclusively through eating raw ham, and as 
 a matter of fact it is rare as a human disease. If the small minority 
 who indulge in raw pork would give up the practice there would be no 
 cases in the human subject. By thus attempting to minimize the evil 
 of the disposal of garbage by feeding to swine the writer does not intend 
 to maintain that it is a desirable method, but would simply venture the 
 opinion that under certain conditions it is not a very bad method ; and 
 unfortunately, no method as yet devised is entirely satisfactory. The 
 
 1 Adrian (in part), Albany, Asbnry Park, Battle Creek, Bay City, Boston (in part), 
 Brockton, Cambridge, Cbelsea, Denver, Erie (in part), Fall River, Fitchburg, Haver- 
 hill, Holyoke (in part), Jackson, Mich., Lawrence, Lowell, Lynn, Maiden, Minne- 
 apolis (in part), Newburgh (in part), New Haven, New London, Newton, Omaha, 
 Pawtucket, Portland, Me., Poughkeepsie, Providence (mostly), Pueblo (in part), 
 Quincy (in part), Rochester (in part), Rockford, Salem, San Jose, Sioux City, Somer- 
 ville, Springfield, Mass.. Springfield, O., St. Paul (in part), Taunton, and Worcester. 
 
 - Massachusetts, State Board of Health Report (1889), p. 113. 
 
REFUSE DISPOSAL. 701 
 
 feeding of garbage to swine is the only method as yet by which a city 
 can receive some return for the outlay for collection and disposal. 
 Sometimes the garbage is sold to farmers, thus bringing a direct money 
 return, as is shown below. 1 
 
 In Rochester, Taunton, and Worcester the garbage is not sold, but 
 is fed to swine on the poor farm. In Brockton in 1899 the collection 
 of garbage cost $6,779.43, and the amount received from the sale of 
 swine was $4,258.41. In Worcester in the same year the cost of col- 
 lection was *17,109 and the amount received for pork was $10,641.52. 
 In the cities just mentioned a direct income is received from the dis- 
 posal of garbage, but there are a number of other cities in which the 
 cost of collection and disposal is materially lessened by feeding it to 
 swine. The contractor is enabled to name a low figure because he 
 derives some return from his swine. In Boston the cost of collection is 
 $0.20 per capita, in Cambridge *<l2~, in Brockton $0.17, in Lynn 
 $0.18, in Lawrence $0.10, in Somerville, $0.17, in Worcester, $0.14* 
 In all of them the collection is made by the city. In the following 
 cities contracts are let at lower prices because the contractor makes 
 profit from his swine : In Fitchburg the contract is $2,600, or $0.08 
 per capita. In Haverhill it is about $0.07, in Portland. .Mi-.. $0.09, in 
 Holyoke $0.02. These are very low figures for New England. In 
 New Haven the contract for 1899 was $5,500, or $0.05 per capita, 
 while in Hartford, where most of the garbage is worse than wasted on 
 dumps, the cost of collection in 1896, the last year for which figures 
 were obtained, was about $0.11. In Denver there are six contractors 
 who collect each in his own district. They do the work for nothing. 
 getting their compensation from the swine which they feed. Certain 
 portions of the city could not be let out in this way. and the cost of 
 collection in these districts was $1,600 in 1899. 
 
 Reduction Processes. The value of the materials contained in gar- 
 bage is so considerable that during the pasl ten years an Immense 
 amount of labor and large sums of money have been spent to find some 
 way to utilize it other than by feeding to swine. The valuable ingre- 
 dients which can be obtained from garbage, besides such extraneous and 
 
 Boston received for the sale of garbage in 1898, $10,982.25. 
 » ambridge received for the sale of garbage in 1899, $6,997.40. 
 Lawrence received for the sale of garbage in i v, .'T. $796.23. 
 Lowell received tor the sale "t garbage in 1899, $8,547. 
 Lynn received for the sale of garbage in 1899, $2,714.60. 
 Maiden received for the sale of garbage in ' - 
 Salem received for the sale "i garbage in 1899, $900. 
 Somerville received for the sale "i garbage in L899, $800. 
 Springfield, Mass, received for tin- sale of garbage in 1900, $1,244.05. 
 
7()2 REFUSE DISPOSAL. 
 
 accidental materials as junk, rags, lost articles, etc., are the grease and 
 the fertilizing ingredients, nitrogen, phosphoric acid and potash. The 
 value of the garbage, as it depends upon these substances, varies in 
 different seasons, and in different cities and in different sections of the 
 same city. The poorer the people, the poorer the garbage, for the 
 grease and nitrogenous matters are more completely used as food. 
 Summer garbage is not as valuable as that gathered at other seasons, 
 chiefly on account of the waste vegetable matter as corn husks and 
 melon rinds, and partly also doubtless because less meat is consumed 
 at that season. In northern cities winter garbage is less valuable than 
 that of the autumn and spring, because it usually is mixed with more 
 or less ice and snow. The variation in garbage analyses, and also in 
 garbage statistics, is due many times to the varying amounts of water 
 contained in it. If water-tight receptacles are insisted on, garbage will 
 contain more water than when it is kept in leaky boxes. If the recepta- 
 cles are kept covered there will be less water than otherwise, on ac- 
 count of the exclusion of rain and snow. If garbage is weighed as col- 
 lected in the cart it will contain a higher proportion of water than if 
 allowed to drain after dumping on to a floor or railway car. Also the 
 weight and value of garbage will vary according to the strictness of 
 separation from other wastes. The average composition of 3,000 tons 
 of summer garbage from Buffalo, St. Louis, Philadelphia, and Brook- 
 lyn, N. Y., treated under the direction of George E. Waring, Jr., 1 was 
 as follows: 
 
 Average Composition of One Ton of Garbage: 
 
 Rubbish, 140 lbs 7 Per Cent. 
 
 Water, 1420 lbs 71 
 
 Grease, 40 lbs 2 " 
 
 Tankage, 400 lbs. (Containing Ammonia, 13 lbs., Phosphoric Acid, 13 
 
 lbs., Potash 3 lbs.) 20 
 
 It is not clear from the report whether the garbage was allowed to 
 drain before the analysis, but probably it was. Garbage in most of the 
 New England cities is rather more valuable than that treated by Mr. 
 Waring. It also has rather less rubbish and more water. 
 
 In Providence the composition of the garbage treated by the Sim- 
 onin process was : 
 
 Tankage 20 per cent. 
 
 Grease 4-5 l L 
 
 Ammonia 3.5 "■ 
 
 Bone phosphate 12 " 
 
 Potash 1 
 
 1 Report on the Final Disposition of the Waste of New York, George E. Waring, 
 Commissioner of Street Cleaning, New York, 1890. 
 
REFUSE DISPOSAL. 
 
 703 
 
 The analysis of the Merz output in Buffalo for several months was : 
 
 Grease 3.59 per cent. 
 
 Ammonia 3.70 " 
 
 Phosphoric Acid :].9o " 
 
 An analysis of the Philadelphia tankage as made from garhage by 
 the Arnold process is given by Mr. Hering as: 
 
 Moisture 4.80 per cent. 
 
 Phosphoric Acid 2.69 " 
 
 Ammonia 0.06 " 
 
 Potash GO " 
 
 The analysis in Pittsburgh was : 
 
 Ammonia 3 per cent. 
 
 Phosphoric Acid 3 " 
 
 Potasli 1.5 '• 
 
 According to Waring's estimates, which are not high, garbage would 
 be worth, if its ingredients could be utilized, -S2.4T a ton. 
 
 The amount of garbage collected per day varies very greatly accord- 
 ing to the care with which it is separated by the householder and gath- 
 ered by the city. The following are the estimates of the amount of 
 garbage collected per capita annually: 
 
 City. 
 
 Boston 
 
 Buffalo 
 
 Cambridge. . 
 
 Detroit 
 
 Indianapolis. 
 Lowell 
 
 Lynn 
 
 Milwaukee. 
 
 Pounds of Garbage 
 
 Collected per capita 
 per annum. 
 
 :>47 
 137 
 150 
 84 
 174 
 100 
 16G 
 205 
 
 City. 
 
 New York . . . 
 
 Paterson 
 
 Philadelphia. 
 
 Salem 
 
 Somerville. . . 
 
 St. Louis .... 
 
 Worcester. . . 
 
 Average . . . 
 
 Pounds of Garbage 
 
 < lollected per capita 
 
 per annum. 
 
 147 
 80 
 321 
 21 '■-' 
 :'.7."> 
 223 
 178 
 L99 
 
 If the above average be correct, millions of tons must be collected 
 annually from our large cities worth double that Dumber <>t' millions of 
 dollars. It is not to be wondered that energetic efforts have been made 
 
 to save this waste. 
 Merz Proc< 88. 
 
 This was the first successful led net ion process tor the treatment of 
 garbage, that is. it was the first that was applied for an\ length of time 
 to the treatment of all the garbage of a eit\ of considerable size. .Manx 
 attempts at reduction had previously been made, sometimes on a con- 
 siderable scale, as those of the Whites at Barren Island at about 1870; 
 
 but none of these attempts were entirely successful even from a mechan- 
 ical standpoint. The Merz process was introduced into Buffalo in 
 
704 REFUSE DISPOSAL. 
 
 1888, and is still in operation there. It is also employed in St. Louis, 
 and a modification of it in Pittsburgh. The garbage, when received at 
 the works, is dumped into a large steel hopper grated below, from which 
 the superfluous water can drain off into the sewer. From the receiving 
 tanks the garbage is drawn up as wanted onto the second floor, and as 
 much of the foreign matter as possible, such as rags, bones, iron, cans, 
 bottles, etc., is culled from it. The materials culled out are sold. The 
 garbage is then dumped into the driers. The driers are jacketed cylin- 
 ders with revolving shafts, with arms to stir the garbage during the 
 process of drying. Each drier holds about three tons and the operation 
 of drying consumes about six hours. When the material leaves the 
 dryer it is pretty well triturated, is of a dark brown color, is quite greasy 
 and has very little odor. It is then carried to the extractors, winch are 
 closed tanks with false bottoms. Here naphtha is allowed to percolate 
 through it to extract the grease. The solution of grease is drawn off, 
 the naphtha driven off, and the grease barreled for sale. Garbage 
 grease, however obtained, always has a garbage odor and is not suited 
 for soap making. Much of it is shipped abroad, and the market here 
 is limited to a few customers, as it can be put to little use unless sub- 
 jected to destructive distillation. Grease obtained by the Merz process 
 is of a dark brownish or greenish color, as is indeed the grease obtained 
 by all the reduction processes. The dry residue after the separation of 
 the grease in the extractors is ground and sifted and sold to fertilizer 
 manufacturers. The writer twice visited the works in Buffalo and 
 found them quite offensive. The process may, however, be carried on 
 in a much more sanitary manner, and is so in St. Louis. The following 
 conditions were found in that city by Dr. William C. Woodward •} 
 
 " Gases arising in the course of this process are passed through condensers, and 
 the non-condensible portions passed through the furnace. 
 
 "Throughout the entire establishment, wherever garbage or its products are 
 exposed to the atmosphere, are large ventilating lines, into which all foul gases are 
 drawn by means of fans. These gases are carried through the fires under the boilers 
 and are there decomposed. A separate sewer has been laid directly into the river, 
 it having been found impossible to use the public sewer without creating a nuisance. 
 This, it is claimed, is not due to odors from the reduction plant, but to the hot 
 water from that plant setting free foul gases from materials deposited in the sewers 
 elsewhere. 
 
 "At the time of making inspection the factory was engaged in ordinary daily 
 work. Outside of the building no odor could be detected. Inside, in places, it was 
 quite foul. The sanitary condition, so far as the public is concerned, depends on 
 the system of ventilation, and not on anything peculiar to the Merz process. All 
 windows and doors, except a few on the side from which the wind blows, are kept 
 closed. 11 
 
 1 District of Columbia, Report of Health Officer (1896), p. 240. 
 
REE USE DISP SAL. 
 
 05 
 
 ^ 
 
 Extractor. 
 
 Discharging 
 Quor. 
 
 Sepo. 
 
 
 Grease 
 Pipe 
 
 Merz Process. 
 St LouJs.Mo. 
 
 Vapvr/zer. 
 
 ExfracTion Apparatus. 
 
 O 
 
 rr% 
 
 5 
 
 \McltirPife tyray 
 
 Vdpcr Pipe 
 
 1 
 
 Condenser 
 
 ■Wlter Column 
 
 '■.. 
 
 Section of Dryer. 
 
 Trap. 
 
 &■ 
 
 n 
 
 \\ySltornty-- I I 
 
 Dryer and Condenser 
 
 Km. 85. 
 
 Diagram Illustrating the construction »f;i Merz Reduction Planl . From the Reporl ol the 
 ii. ..mi Department ol Brooklyn 
 
706 REFUSE DISPOSAL. 
 
 The plant in St. Louis is said to have cost $280,000. The amount 
 of garbage treated there in the year ending 31 March, 1897, was 66,341 
 tons. The contract price paid by the city for the reduction was $1.80 
 per ton up to 100 tons per day or $65,689.48 for that year. The per 
 capita cost of disposal in St. Louis for that year was perhaps $0.12. In 
 Buffalo the contract price for disposal is $15,840 per year. In 1900 
 22,881 tons of garbage were reduced, making the cost per ton $0.69 
 a] id per capita $0,045. Works were at one time in operation in Detroit 
 and Milwaukee, but they have been abandoned. 
 
 In Pittsburgh the garbage is collected and disposed of by contract. 
 The garbage is carried to works situated in the thickly built portion of 
 the city. It is here partially dried in Hogel dryers and it is then 
 loaded in box cars and carried out into the country where the grease is 
 extracted by naphtha, somewhat on the plan of the Merz process. The 
 works in Pittsburgh when visited by the writer were causing a good 
 deal of offence, though the vapors from the dryers were burned under 
 boiler fires : but little attention was paid to details and it is only by 
 such attention that real cleanliness can be secured. The Pittsburgh 
 contract for collection and disposal is for $92,000, or about $0.29 per 
 capita. The amount collected could not be determined, so that the 
 cost per ton could not be determined, nor could the cost of disposal be 
 separated from the cost of collection. 
 
 Simouin Process. 
 
 The Simonin process, like the Merz process, extracts the grease from 
 the garbage by the use of naphtha. It has this advantage over the Merz 
 process, in that the garbage can be at once placed in the extractors 
 without previous drying. This process was introduced in Providence 
 in 1890 and was abandoned as it was not profitable, the owners receiv- 
 ing no bonus from the city. It was afterwards operated for a short 
 time in New Orleans, but there was trouble between the contractors and 
 the city in regard to the collection of garbage, so that after a short 
 time the plant was abandoned. A plant was also started in Cincinnati 
 sih m after the one in Providence and has been in operation ever since. 
 In 1898 the amount paid for garbage disposal by the Simonin process 
 in that city was $25,000, and the amount of garbage about 15,000 
 tons, or $1.62 per ton. The reduction company, however, claims not to 
 have found the business very profitable since the advance in the price 
 of naphtha. The following- cut and description of the process were pre- 
 pared by the writer for a meeting of the American Public Health Asso- 
 ciation held in Mexico in 1892. 1 
 
 1 American Public Health Association, Reports and Papers, Vol. XVIII., p. 259, 
 
 189:;. 
 
REFUSE DISPOSA L. 
 
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708 REFUSE DISPOSAL. 
 
 The garbage is dumped on the floor and loaded onto perforated pans 
 which are run into the extractors on cars. The extractor is closed and 
 filled with naphtha which is rapidly evaporated by steam coils in the 
 bottom. The hot naphtha vapor carries off the water and both water 
 and naphtha are condensed and separated, the former flowing into the 
 river and the latter being used again. The naphtha dissolves the grease, 
 and as the evaporation is stopped before all the naphtha is driven off, a 
 solution of grease in naphtha is left in the bottom of the extractor and is 
 drawn off for complete separation in another still. This process is 
 repeated several times till all the water is removed when the naphtha 
 remaining in the garbage is driven off by live steam. The extractor is 
 then opened and the dry garbage removed and ground and sifted. The 
 extractors hold about eight tons and the process takes about forty-eight 
 hours. 
 
 The writer, from considerable personal experience, believes that this 
 process can be conducted with very little nuisance and with a moderate 
 degree of profit, even without the payment of a bonus ; but this can 
 only be done in a city where the garbage is very carefully separated. 
 
 Arnold Process. 
 
 There are several processes in use for the disposal of garbage which 
 consist in rendering it to recover the grease which it contains and (Irv- 
 ing the residue to be used as a fertilizer. One of these is known as 
 the Arnold Process, operated by various local companies in which the 
 same persons are interested. 
 
 This concern has contracts for the disposal of the garbage of Boston, 
 New York (Manhattan and Brooklyn), and Philadelphia. The works 
 are different in the different cities, for experiments are constantly being 
 tried and improvements introduced. At the works in Boston, when 
 visited by the writer, the garbage was brought from the dumping dock, 
 a distance of about six miles by water, on a large deck scow. From 
 this it was shovelled by six men into an elevator and conveyor which 
 carried it to the upper floor of the building and discharged it into the 
 digesters. These are upright cylinders, capable of holding eight tons. 
 They are arranged in groups of four over a press. After they are filled 
 with garbage they are closed, and the garbage treated with live steam. 
 After the garbage is cooked a sufficient length of time the contents of 
 the digesters are allowed to fall through a valve in the bottom into the 
 press. This press is of novel design, and the pressing is a continuous 
 operation, the tankage being passed between powerful rollers. These 
 presses seemed to work well when seen, though they sometimes get out 
 of order when heavy foreign substances get into them. From a sanitary 
 standpoint they are far better than screw presses, for the hot material 
 
REFUSE DISPOSAL. 70<) 
 
 need not be at all exposed to the air. If they can be kept in repair it 
 would seem that they ought to be economical as they do not require as 
 much labor as ordinary presses. From the presses which are arranged 
 in a series beneath the digesters the tankage is carried by a common 
 conveyor to the dryers, which in Boston are of the Anderson type. In 
 Boston when the works were started the nitrogen was extracted from 
 the tankage and sold in the form of ammonia, but at the time of the 
 writer's visit the works had suffered from fire and the tankage without 
 being dried was carried to sea. It is said that in other works operated 
 under this company the tankage after drying is ground, screened and 
 bagged and sold to fertilizer manufacturers. The grease and water 
 which runs from the presses is pumped into a tank where the grease 
 floats and is drawn off into barrels, and the water allowed to run into 
 the bay. At Boston, and it is said in other cities, little attempt is made 
 to prevent odors arising from the process. It would be possible to keep 
 the entire process enclosed so as to keep in and condense and burn 
 all gases, but it is evidently considered by the operators to be cheaper 
 not to try to prevent nuisance, but to seek a location where the nuisance 
 will affect very few persons; but certainly in New York, Brooklyn, and 
 Boston the\ spend a considerable sum in transporting the garbage to 
 their works. In Boston they own six scows costing $3,500 each, besides 
 a towboat. 
 
 In Boston the contract is for ten years from L898. The amount 
 named is $47,500 per year and the contractors are to take care of all 
 garbage delivered to them. At present (1899) from three-fourths to 
 four-fifths of the total garbage is disposed of in this way and the 
 remainder is sold to farmers. The amount of garbage collected in Bos- 
 ton in 1899 was about 60,000 tons, and of this about 45,000 tons were 
 treated by the reduction company. The cost to the city for disposal 
 must therefore have been about $1.00 a ton. In the borough of Man- 
 hattan a five year contract for the disposal of garbage expires I August, 
 L901. The amount received l>\ the New York Sanitary Utilization 
 Company under the contract is $89,990. As the amount disposed of 
 in l s '.»'.» was L51,100 tons, the cost per ton was not quite $0.60. The 
 garbage is delivered on board the company's scows at the city docks 
 ami the company tows them to the works at Barren Island iii Jamaica 
 Bay at its own expense. The borough of Brooklyn had a contracl for 
 the collection and disposol ,,f garbage for $120,000 per annum. As 
 onl\ the contractors" estimates are given for the amount ot garbage col- 
 lected, it is impossible to determine how much it costs per ton, and 
 likewise it is impossible to separate the cost of collection from that id 
 disposal. It is said by the contractor that 102,000 tons were collected 
 
710 REFUSE DISPOSAL. 
 
 in 1898. The per capita cost of collection and disposal in both Man- 
 hattan and Brooklyn is not far from $0.10. In Philadelphia also the 
 contract is for collection and disposal so that it is not possible to 
 separate the cost of the two. The contract is for #398,000. Accord- 
 ing- to the statement of the director of the department of public works 
 the amount collected in 1899 was 199,357 tons. According to this, 
 the cost of collection and disposal was about -12.00 per ton. The per 
 capita cost of collection and disposal was aboat $0.30, or three times 
 what it is in Manhattan and Brooklyn, but not very much more than 
 the cost for the same service in Boston. 
 
 Chamberlain Process. 
 
 The Merz process was at one time operated in Detroit, but does not 
 appear to have been successful. Some of the persons interested in that 
 undertaking afterwards adopted a rendering process which has since 
 been employed in that city and has also been operated at Indianapolis 
 and Cleveland. The writer has understood that the contractor who 
 collects the garbage at Columbus, O., employs this process for its dis- 
 posal, but has never been able to obtain definite information whether 
 this is so or not, though a recent letter from the city clerk states that 
 it is rendered in some way. Neither has the writer been able to obtain 
 any description of the process, as he was not permitted to inspect the 
 works which he visited at Cleveland. It is said that the garbage is 
 rendered as in the Arnold process and the resulting tankage dried in 
 rotary driers and made into a fertilizer, or sold to fertilizer manufac- 
 turers. At Cleveland apparently little attempt was made to prevent 
 nuisance. The works were perhaps three miles out in the open country 
 and the garbage was carried out on cars as explained on page 087. In 
 Detroit also the works are twenty-five miles from the city, but in In- 
 dianapolis they are not far away, so that the garbage is drawn out in 
 the wagons in which it is collected. In Indianapolis the disposal is 
 contracted for separately from collection and the amount paid in 1899 
 according to the superintendent of the street department was $12,000. 
 The amount collected according to the same authority was 17,454 tons, 
 which would make the cost of disposal about $0.69 per ton. The 
 amount paid for collection and disposal is $42,000, which would make 
 the cost per ton about *2.40 and per capita $0.24. In Cleveland, 
 Detroit and Columbus the contracts are for collection and disposal, so 
 that it is impossible to separate the cost of the two. In Detroit, 
 according to the engineer of the board of health, 14,732 tons were col- 
 lected and disposed of at a cost of $50,000 or $3.40 per ton. This 
 amount of garbage is small for a city the size of Detroit. The per 
 capita cost of collection and disposal in 1899 when the contract price 
 
REFUSE I'isposAL. 
 
 '11 
 
712 REFUSE DISPOSAL. 
 
 was $60,000 was #0.21. In Cleveland the contract for collection and 
 disposal is for $69,400. It is stated that 22,375 tons were collected in 
 1899 which would make the cost per ton $3.10. The per capita cost 
 of collection and disposal is $0.18. In Columbus the contract for col- 
 lection and disposal is for $15,800 or nearly $0.12 per capita. In 
 l<s ( .>!) the amount collected was 7,794 tons, making the cost $2.03 per ton. 
 Holthaus System. 
 
 This system was first used for the treatment of municipal garbage 
 at Bridgeport, Conn. The works were well constructed and from a 
 .sanitary standpoint the results were excellent. The project was how- 
 ever soon abandoned, apparently because it was a financial failure. 
 The amount paid in that city was $0.34 a ton. The only plant now in 
 operation is at Syracuse. The garbage in that city is collected in 
 barrels and is dumped from them into a car standing on an elevator, 
 which carries it to the top of the building. The car is rolled to the 
 digester and its contents discharged into the latter. This digester 
 when full is closed, and about twenty per cent, of water added, and the 
 whole is digested with steam. The digesters are arranged in groups 
 of four connecting by valves with a press below. When the digestion 
 is complete the mass is allowed to fall into the press where the water 
 and grease is pressed out and allowed to run into the separating tank 
 from which the grease is drawn off into the grease tank and then into 
 barrels. The tankage falls into a dryer and from this it is carried by a 
 conveyor to a room where it is ground and screened. The whole pro- 
 cess, from the time the garbage is put in the digesters till the dry tank- 
 age and the grease appear, is conducted in apparatus which is securely 
 closed. Pipes lead from the different portions of the apparatus to a 
 vacuum pump which draws all gases through a condenser and then 
 passes them through the fire. All water vapor from the drying and 
 rendering processes is condensed and all water is evaporated and then 
 condensed so that all the liquid wastes from the works are free from 
 offence. When visited by the writer the works and their vicinity were 
 almost entirely free from odor. There is no reason why the works can- 
 not be operated in this manner, for the apparatus is intelligently 
 designed to keep all gases from escaping. The contract price for dis- 
 posal in Syracuse is $26,000 per annum. It is said that about thirty- 
 five or forty tons are collected daily. If the yearly total is 12,000 tons, 
 which is perhaps not improbable for a city of 108,000, the cost for dis- 
 posal would be |2.16 per ton. The per capita cost of disposal alone is 
 •S<».24. Baltimore has recently contracted to dispose of its garbage by 
 this system but the matter has been taken to the courts. The contract 
 is to collect and dispose of garbage and ashes for ten years at $148,000 
 per year, which is more than $20,000 less than the city now expends. 
 
REFUSE DISPOSAL. 713 
 
 American Reduction Company's Process. 
 
 This process does not differ in principle from that of the Arnold 
 and Holthaus systems being one of rendering and drying. An experi- 
 mental plant of large capacity was some years ago constructed in Brook- 
 lyn and was seen in operation by the writer. The construction of this 
 plant was far from satisfactory, but it is understood that subsequent 
 plants were better built. One was in operation for a year or two in 
 Philadelphia, and the following description is from a report by the board 
 of health which was furnished the writer by the company and is doubt- 
 less correct : 
 
 "The garbage is brought there daily to the amount of, say about forty-five loads. 
 It is immediately damped on a space adjacent to the lift consisting of an endless 
 chain supplied with buckets. The garbage is thrown upon these buckets and car- 
 ried to an upper floor and fed to the digesters, of which there are six. These diges- 
 ters are large steel cylinders supplied with steam-pipe and lids fitted with clamps, 
 so as to make them steam-tight. When filled with garbage a certain proportion of 
 sulphuric acid is added for the purpose of disintegrating the mass and fixing the 
 volatile constituents, such as ammonia and the like, for the value in fertilizer. Live 
 steam is admitted to these cylinders for about three hours. There is about three 
 per cent, of oil secured, and this, at present, is skimmed from the surface and 
 placed in i. pen tanks until cooled, when it is barreled and shipped abroad. 
 
 • At the completion of the digesting process the material is transferred to dryers, 
 three in number, located on a lower floor. These dryers are cylindrical, steel- 
 jacketed tanks in which there are revolving arms for the purpose of agitating the mass 
 and preventing charring. The steam is admitted into the jacket and the process 
 occupies about ten hours, when the contents, deprived largely of its moisture, is 
 sifted, ground and bagged for transportation. 
 
 l> This product is a dark brown granulated substance, having t he so-called caramel 
 smell or smell characteristic of roasted vegetable fibre, and is not putrid, nor foetid, 
 nor pungent, nor markedly offensive. 
 
 "From the digesters, pipes are carried to condensers into which they are admitted 
 near the bottom, so that the vapors and gases can he thoroughly washed by innumer- 
 able jfts ,,f water before the} escape al the top. From the dryers pipes are also 
 
 led to condensers for the same purpose. The exhaust pipes from the condensers 
 
 carrying gases which have escaped condensation to a large iron retort. r> x L3, where 
 they are mixed with gases generated from burning gas coal. 
 
 "The gases from the condensers are combustible and when mixed in the retort 
 tin- chemical combustion produces a colorific and combustible gas. which is fed to 
 the furnaces and t lien- burned, forming the sole source of heal for generating steam 
 
 for t he works. Tin; live pits of the furnace-, are SO arranged thai the gases must 
 
 necessarily impinge upon a thoroughly heated and somewhat obstructing surface of 
 
 brick, thus ensuring a more complete combustion. What escapes into the smoke 
 
 stacks must necessarily he deprived of any deleterious or odorous quality. The 
 water of condensation passes into the sewer. Tins water upon examination does 
 not appear to be markedly offensive, li has been tested in the laboratory without 
 producing any verj significant results. 
 
 '•An apparatus has heen designed and constructed l'.\ which the slumming of oil 
 
 can be dispensed with. This apparatus is a centrifugal machine, ingenious in design 
 and satisfactory in its results. It consists of a bi-conical chamber, with outlets al 
 the central plain by which tl ii is whirled out into a covered circular trough. 
 
 After the oil is extracted ih.> remainder of the material is gotten nd of by the same 
 
714 REFUSE DISPOSAL. 
 
 process, by simply raising the dome and collecting it. as expelled, into a proper 
 receptacle. Were this centrifugal apparatus in nse it would lessen greatly the 
 manipulation and exposure of the material to the air during the process of manu- 
 facture." 1 
 
 The only city where this company is at present operating works is 
 Reading. The contract price for disposal in that city is sixty-five cents 
 per ton. 
 
 In Paterson the contractor disposes of the garbage which he collects 
 by drying it in sonic sort of drying apparatus and disposing of the dry 
 material to farmers, either giving it away or selling it for a nominal 
 sum, as ten cents a ton. It is impossible to learn the cost of this treat- 
 ment, as the contract in Paterson is for the collection and disposal of 
 garbage and ashes, which are, however, collected separately. The 
 amount of the contract is $27,500, and in 1898 4,443 tons were 
 treated. 
 
 hi New Bedford the contractor delivers the garbage to a company 
 which renders it for the grease. The company receives no return except 
 what it is able to obtain from the garbage. The works have not been 
 long in operation. 
 
 In Ttica the garbage is collected and disposed of by contract. The 
 contractor is said to make a fertilizer of it, but the writer has not been 
 able to learn anything of the process. He receives $5,700 for collection 
 and disposal. 
 
 ( Vernation. 
 
 ( remation is exclusively employed for getting rid of garbage in 
 England and on the continent of Europe, and is rapidly coming into 
 use in the United States. The destruction by fire is theoretically an 
 ideal way from a sanitary standpoint for the disposal of garbage. The 
 products of combustion are inoffensive and sometimes have a slight 
 value. The process ought to be so conducted as to create no nuisance, 
 a condition, however, which cannot be obtained without great care. 
 The chief drawback is the expense. There is little or no return and 
 the outlay for repairs, labor and fuel is considerable. 
 
 Burning in the Open Air. 
 
 This is the most primitive method of cremation and is almost as 
 unsanitary in its operation as dumping, but better in its results. This 
 method is employed in Augusta, Galveston, and Macon, ami a number 
 of small cities in the South 1 and to some extent in Minneapolis and 
 Youngstown, < ). 
 
 Augusta ami Macon are the only cities which claim that this method 
 is satisfactory. In the former city it has been in use for sixty years. In 
 
 1 North Carolina, Report of State Board of Health (1893-4), p. 132. 
 
REFUSE DISPOSAL. 715 
 
 both cities there are few persons dwelling near the (lumps. In Augusta 
 the garbage and dry refuse are simply burned where dumped on the 
 surface of the ground. One man tends the dumps and the tires. The 
 ashes in Augusta are carted away to farms for a fertilizer. In Macon 
 the garbage is burned in open pits on ordinary grate bars. Cotton waste 
 and rosin dross are used for fuel. Six men are employed at $1.25 a 
 day. The cost of disposal in Macon is $3,200 for about 7,<>0() cubic 
 yards. 
 
 Engle Furnace. 
 
 One of the earliest and most popular furnaces in this country was 
 the Engle : and it was brought to the attention of the public by its use 
 to cremate the garbage of the World's Fair at Chicago. The following 
 is from a paper by Col. .Morse : ] 
 
 " The Engle garbage cremator may be briefly described as a rectangular brick 
 structure, forty feet long, ten feet wide, and twelve feet high. At one end a stack 
 of iron or a brick chimney seventy-five feet high, over the furnace an iron covering 
 house with sliding doors, and at the sides, a little above the top of the furnace, 
 wide platforms with ample driveways and approaches. From the platforms iron 
 slopes lead down to the feed-holes in the top of the furnace. These are five in num- 
 ber, one being large enough to receive the carcass of a horse, the collection carts 
 dump their loads directly upon the slopes, no further handling being needed. The 
 garbage, as it falls through the Eeed-holes, is caught by grate bars, extending across 
 the interior half way from top to bottom. The liquid passes through these bars and 
 is retained in a shallow concave pan or hearth below the bars. 
 
 '• The furnace being charged, the fires are lighted first at the front and afterward 
 at the rear end. the flames from this tire passing over and through the mass of gar- 
 bage piled on the grates, driving the smoke and gases into and across the second 01 
 front lite, where they are consumed. The tlanics front the second tire are. by the 
 action of the strong draught, brought back underneath the garbage grates, intensely 
 
 heating the garbage from the under side. When liquids are to be destroyed, a part 
 of this heat and flame is directed under the hearth or pan, and all the contents 
 quickly evaporated and burned. All the odors, gases, and product of combustion 
 are passed through one or tin- other of the fires, there being no escape except across 
 
 these fire boxes. The ashes, ;is they fall through tin- grates, are raked out of a 
 lower range of doors on the side, and from time to time, as required, the garbage is 
 stirred up and distributed over the grates by bars thrust through an upper range ..f 
 stoke di tors." 
 
 This furnace, like other garbage works. lias been built in a number of 
 citiefi where it has been afterwards abandoned, bul al present it is in 
 operation in Des Moines, Evansville, hid., Grand Rapids, Lowell, 
 
 Norfolk, Portland, Ore., bid »nd, In<L. Richmond, Va., Savannah 
 
 and Sail Luke ( ity. 
 
 Probably the most accurate data concerning the cost of cremation 
 may be found in the reports of the board of health of Lowell. A ere- 
 
 1 The methods of collection and the disposal "f garbage by Cremation, read at 
 the sanitary convention of boards of health at Erie, Pa., 28 April. 1892, by W. F. 
 
 Moi se. 
 
716 REFUSE DISPOSAL. 
 
 matory Avas built in that city in 1892 at a cost of $7,615.90; the next 
 year 3,500 tons of garbage were consumed at a cost of $7,670.77, 
 or 82.19 per ton. The second year, 1894, when everything was in 
 better running order, the amount burned was 3,486 tons at a cost of 
 $5,742.59, or «$1.64 per ton. In the largest week of that year 93 tons 
 were burned at a cost of $1.05 per ton. The chief value of the Lowell 
 data is that they are given in such detail week by week for several 
 years. The items for fuel, labor, and repairs are clearly shown. Thus 
 of the total expenses in 1894. viz., 85,742.59, $3,000.15 was for coal; 
 $1,553.90 for labor ; $158.05 for the lease, and the remainder for repairs. 
 Coal cost $4.70 per ton. In 1895 2,750 tons were burned at a cost of 
 $3,662.53, or $1.33 per ton. Apparently the reduction in cost of crema- 
 tion was due largely to the increased disposal to farmers of a part of 
 the garbage containing the most water and the least combustible material, 
 and also to the fact that householders were encouraged to put paper and 
 other combustible material in the garbage. Lowell has to pa}* more for 
 fuel than the great majority of cities, and as the fuel item is consider- 
 ably over half the total expenses, it can be seen that a reduction of one- 
 half in that item, which many cities can easily make, would rnaterialhy 
 diminish the cost. The lack of funds to operate the crematory at the 
 rate of expense above given, lias resulted in shutting it down in the 
 winter and selling more and more garbage to farmers, till in 1899 only 
 105 tons of swill (from hospitals) and 485 tons of market refuse and 
 many mattresses and some dead animals were cremated. The cost that 
 year was $1,397.86, of which $177.54 was for coal and $690 for labor. 
 The cost of cremation seems to be high in Lowell, but if the figures 
 were as carefully presented, and if the character of the material was as 
 well known, the apparently much lower cost in other cities might 
 possibly be readily accounted for. An attempt was made at Lowell to 
 sell the resulting ashes, but with little success. An analysis showed 
 them to contain 10.21 per cent, phosphoric acid, and potassum oxide 
 6.01 per cent. 1 Portland, Ore., for some }*ears bad a crematory twelve 
 miles down the river and towed the garbage down on scows ; but 
 recently a new crematoiy has been built, about thirty minutes drive 
 from the centre of the city, at a cost of $16,000. The health com- 
 missioner states that in 1899 12,520 cubic yards were cremated at a 
 cost of $5,400, or $0.06 per capita. If the garbage was of average 
 weight the cost per ton is about $0.60. In Grand Rapids a crematory 
 was built at a cost of $14,780. The health officer cannot give the cost 
 of operating, but states that a single test gave a cost of $0.21 a ton. 
 His report for 1899-1900, however, states that the expense account 
 
 1 Lowell. Report of Board of Health (1897), p. 10. 
 
REE USE I) isp o SA L . 
 
 717 
 
718 REFUSE DISPOSAL. 
 
 for the year was $3,962.11. In Richmond, hid., 1 from 1 May, 1897, to 
 1 May, 1898, 8,031 cubic yards of garbage were burned with natural 
 gas as a fuel, for $1,639.05. Such an amount of true garbage could 
 not be collected in a city of 25,000 inhabitants, and indeed the report 
 states that 4,964 cubic yards were "dry garbage" which leaves 3,067 
 yards " wet " or true garbage, or about 2,200 tons, which might he ex- 
 pected in a city of that size. As the 4, ( .h;4 tons of dry garbage would 
 help the fuel account, nothing definite can be inferred from these 
 figures. A crematory was built in Salt Lake City in 1897 at a cost of 
 #1:2,000. In 1898 11,059 cubic yards of garbage including many 
 dead animals were cremated at a cost of $4,418.21, or #0.39 per cubic 
 yard. But it must be remembered that much of this " garbage " is 
 combustible material. Three men are employed at the crematory who 
 work in shifts of eight hours. 
 
 In Richmond. \'a., about 7,500 cubic yards of garbage were cre- 
 mated in 1899 besides many dead animals, at a cost of$3,960.08. Most 
 of the time only one man is employed and $2.75 a ton is paid for coal. 
 Not much over half of this garbage is true house garbage, a very small 
 amount for a city of 105,000, so that the apparently small cost of dis- 
 posal per capita, $0,037 is misleading. It is probable that the cost per 
 ton is over #0.00, although 1,227 cubic yards of waste paper, etc., were 
 burned, thus helping out the fuel account. Mr. Hering's report states 
 that the crematory at Savannah cost $12,000, and that 120 yards are 
 burned daily at a cost of from $20 to $25. 
 
 Dixon Furnace. 
 
 This furnace is at present in use at Bridgeport, Conn., Camden, 
 Dayton, Fort Wayne, Joliet, Lafayette, Ind., Louisville, McKeesport, 
 Penn., Memphis, Trenton, Wilmington, Del., York, Pa., and until 1899 
 was in use in Atlanta. One is soon to be built in Spokane. 
 
 In operating the Dixon furnace three fires are required. Two of 
 these are at the end of the furnace farthest from the stack, and they are 
 so arranged that one of them sends its flames over the garbage and the 
 other under the grate bars on which the garbage rests. These fires are 
 made with coal, wood, or gas, and are started in the morning about one 
 hour before the garbage begins to arrive. Another fire, usually of coke, 
 is kept burning at the foot of the stack to consume the half burned 
 gases from the garbage. The garbage is dumped directly from the 
 carts into the furnace where it rests upon the grate bars. The ashes 
 fall through the grate bars and are removed through openings at the 
 sides of the furnace. 
 
 1 Proceedings, Second Annual Convention of League of American Municipalities 
 1 898, p. 35. 
 
REFUSE DISPOSAL. 
 
 10 
 
 — ^___ — __ - 
 
 13 
 
720 REFUSE DISPOSAL. 
 
 The Atlanta crematory cost $12,190 in 1895. About forty-eight 
 tons per day were cremated that year, at a cost of $0.34 per ton. Accord- 
 ing to the board of health report about one-third of this weight was 
 night soil, and it must be remembered that garbage in Atlanta includes 
 all dry refuse which assists the combustion. In Atlanta it is said that 
 the crematory burning garbage alone without night soil requires no ad- 
 ditional fuel. Such an operation with garbage, as the term is under- 
 stood at the north, is, of course, utterly impossible. According to the 
 health department report of 1897, 110,204 loads of garbage were col- 
 lected in that year, and such an amount could only be collected by in- 
 cluding a large amount of dry refuse. The furnace in Camden cost 
 $9,990. It is only operated a part of the time, and the expense is said 
 to be about $1 per ton. At Bridgeport a crematory was erected under 
 contract to cremate garbage at a cost not to exceed $0.35 per ton, but 
 at the present writing it is stated by the city clerk that it costs about 
 $0.45 a ton. The crematory at Dayton cost about $33,000. In 1899 
 it cost for operation $8,074.06, of which $4,278.66 was for fuel, which 
 is natural gas, $1,719.75 for labor, and $2,076.25 for repairs. According 
 to the report of the superintendent, 73,519 barrels were consumed in 
 1899, of which 6,754 were night soil. As the superintendent of the 
 crematory states in a letter published by the Dixon Company that the 
 garbage weighs about 250 pounds to the barrel (1,000 pounds to the 
 cubic yard) the cost per ton for cremating must be $0.80. It is likely that 
 there is considerable combustible material with the garbage, otherwise 
 the great bulk of 14,191 cubic yards could hardly be collected in a city 
 of 85,000 inhabitants. Furthermore true garbage would weigh over 
 250 pounds to the barrel. This would tend to lower the price, but the 
 night soil would increase it. In Fort Wayne in 1898 5,235 tons of 
 garbage were cremated at an expense of $2,686.43, of which $1,409.64 
 was for fuel. The cost per ton for cremation was about $0.50. Mem- 
 phis has recently constructed two crematories of thirty tons capacity for 
 $7,000 each, and two crematories of twelve tons capacity for $2,700 
 each. The cost of operating the crematories is not separated from 
 the other expenses of the health department in that city. Trenton 
 lias a small crematory which has been advertised as cremating garbage 
 at *0.30 per ton. 1 When the writer visited the crematory in Septem- 
 ber, 1899, it was not in use, and is not used by the contractor when he 
 can dispose of garbage in any other way. Nothing reliable can be 
 learned from that crematory. In Jacksonville a crematory was built in 
 1897 at a cost of $15,000. In 1899 3,673 tons were cremated at a 
 cost of $4,000, or $1.08 per ton. As may be inferred from the wagons 
 
 1 Proceedings, League of American Municipalities, Detroit (1808), p. 30. 
 
REFUSE I) ISP SA L. 
 
 721 
 
 2 n 
 
722 REFUSE DISPOSAL. 
 
 shown in the illustration, the garbage contains considerable combustible 
 material. When the writer visited the Wilmington crematory in Sep- 
 tember, 1899 (the visit was not expected), he found it being operated 
 without any offence whatever. The only objectionable feature was the 
 draining of garbage carts before they entered the building. This was 
 done on a platform from which the water drained to a sewer. The in- 
 terior of the crematory presented as neat an appearance as that of 
 Jacksonville shown in the illustration. At Wilmington the ashes are 
 sold for from $6 to $8 per ton. The}'' are said to form from five per 
 cent, to ten per cent, of the amount of garbage burned. No data could 
 be obtained from the city officials in regard to the amount of garbage 
 consumed or the cost of cremation. But at the time of the writer's 
 visit four men were employed and a foreman who stated that in August 
 942 tons of garbage were cremated and 133 tons of coal at $2 per ton 
 were required. This would probably make the cost about $0.60 per 
 ton exclusive of repairs. The crematory cost $16,000 in 1897. 
 
 In Camden in 1900, 2,000 tons of garbage were disposed of at a 
 cost of $1,453.50 or $0.73 per ton. In Louisville a 50-ton crematory 
 has been built at a cost of $22,000, and is guaranteed by the Dixon 
 company to cremate for thirty cents per ton, but it has not yet (Feb- 
 ruary, 1901), been accepted by the city, though it is said to give satis- 
 faction. According to the statement of the health commissioner of 
 Joliet, garbage is cremated in that city for $0.20 per ton. 
 
 The Dixon company has recently designed another style of furnace 
 in which the garbage is first partially dried in a chamber over the cre- 
 matory proper. See Figs. 91 and 92. 
 
 M. V. Smith Cremator)'. 
 
 This crematory is built by M. V. Smith of the American Stoker 
 Company, Washington Life Building, New York. Crematories of this 
 type have been built at Atlantic City, the District of Columbia, Muncie, 
 Ind., Philadelphia, and Wheeling. The furnaces at the District of Col- 
 umbia and Philadelphia are no longer used. The following description 
 is by William C. Woodward, health officer of the District of Columbia i 1 
 
 Ll The crematory may consist of any number of furnaces arranged in pairs around 
 an apparatus for the generation of the gas used as fuel. Each furnace is an upright 
 iron tank, lined on the inside with fire brick, and is connected, on one side by under- 
 ground flues, one leading from the gas generator and the other to a chimney com- 
 mon to both furnaces of the pair, and on the other side by a short flue, with the 
 other furnace of the pair. The opening for the reception of garbage is in the top of 
 the furnaces. The ashes are raked out from an opening low down in the side. 
 There is no grate, the garbage resting on the bottom of the furnace and burning 
 only on top. In the flue leading to the chimney is a mass of checkerwork of fire 
 
 1 District of Columbia, Report of Health Officer (1896), p. 230. 
 
REF USE J) ISP SA L. 
 
 723 
 
 _ b v - a ft" 
 
 -*. - -z ~ —--■■- - 
 
 -. - ■ -~ i - — — ■- z. 
 
 ~- - " J - - £ - - - : _ - f& 
 
 i- •- i- y r. r — n 
 
724 
 
 REFUSE DISPOSAL. 
 
 Fig. 93. 
 
 Diagram illustrating the Gas Producer of the Smith Crematory and its connection with the Checkerwork 
 
 Chamber. 
 
 brick, to insure the complete destruction of offensive gas. Valves to control the flow 
 of gas are set in the flues. 
 
 " The crematory is built so as to allow the carts to drive to the top and dump 
 their contents directly into the furnace, and is not inclosed in a building. Each pair 
 of furnaces is independent of all others. All are dependent, however, on the proper 
 operation of the gas generator. 
 
 " The operation of any pair of furnaces is as follows: Carts drive to the top of 
 the crematory, depositing all garbage into one furnace, filling it to the proper height. 
 The gas is then made to pass directly from the generator through the flue, where it 
 is mixed with air to support combustion, to the charged (proximal) furnace. The 
 flame attacks the mass of garbage in it, and then passes through the communicating 
 flue into the empty (distal) furnace, and thence to the flue leading into the chimney. 
 The brick checkerwork in this flue is so intensely heated by the flame, and secures 
 by its arrangement such thorough contact with the gases from the garbage, that they 
 are completely decomposed and free from objectionable odor, and so find their way 
 out of the chimney. 
 
 " While the contents of the proximal furnace are being burned the garbage is 
 emptied into the distal furnace, where it is warmed and partially dried by the flame, 
 which, as has been previously described, passes through this furnace during this 
 time. As combustion progresses in the proximal furnace the ashes are raked off the 
 top of the mass ^through the door in the side. When the entire charge has been 
 burned, the direction of the flame is reversed by means of valves, so that it passes 
 into the furnace which has just been filled. This now becomes the proximal fur- 
 nace, and the place of combustion. The other becomes the distal furnace, into 
 which the garbage is dumped, warmed, and partly dried. The direction of the 
 flame may be reversed as often as desired. The operation of the furnace is, there- 
 fore, continuous. 
 
 ''The operation of the Smith crematory was witnessed in September, 1894, in 
 Atlantic City, N. J. The plant is owned and operated by the city, and has fully 
 
REFUSE DISP SAL. 
 
 725 
 
 : - 
 
 3 % 
 
 — a 
 :r -: 
 
 s - 
 --■ 
 
 - _- 
 
 d B 
 
 B E 
 
 x -_ 
 
 ~ 3 
 
726 REFUSE DISPOSAL. 
 
 demonstrated its ability to burn pure garbage in large quantities and without nui- 
 sance. The only objectionable feature at the time of inspection was the leaking of 
 water from the garbage around the lower doors of the furnace, even when closed. 
 This water saturated the soil near by, giving to the place a faint sour smell, charac- 
 teristic of garbage. The crematory is located in the immediate vicinity of a poor 
 class of dwellings. 11 
 
 The crematory at Muncie cost $5,000, and according to a letter 
 received from the chairman of the garbage committee, 3,705 tons were 
 cremated in 1899 at a cost of $3,532.49, or $0.90 per ton. The cost of 
 repairs included in the above was $488.39, which is about, the annual 
 average. 
 
 The crematory at Atlantic City cost $65,000 and has eight cells with 
 a capacity of twenty-five tons in twelve hours. In August, 1900, 3,700 
 tons were consumed. The operating expenses in 1900 were $11,280, 
 of which $6,214 was for coal (steam coal being $3.25 per ton), $4,166 
 for labor, and about $900 for repairs. The amount of garbage cremated 
 Avas 11,463 tons. This furnace is exceptionally large for the annual 
 consumption of garbage, for during a few weeks of the summer it must 
 receive the garbage of over 200,000 people. 
 
 Brown Crematory. 
 
 This crematory is built by McBarron & Co., 39 to 45 Oliver Street, 
 Boston. One was built in the District of Columbia but has now been 
 abandoned. Another is used by the contractor in Troy to cremate 
 such of the garbage and refuse as he cannot use for rilling. The 
 crematory in Troy cost $10,000. In the Brown furnace the flames are 
 driven over the top of the garbage to the end of the furnace and then 
 back again underneath. The furnace is surrounded by a water jacket. 
 Dr. Woodward stated that its operation in the District of Columbia 
 was satisfactory from a sanitary standpoint. No figures could be 
 obtained of the cost of operating. 
 
 Rider Crematory. 
 
 The builder of this furnace is W. W. Patrick of Pittsburgh. The 
 only furnace in operation is at Allegheny, and no data could be obtained 
 by the writer, but according to Hering's report the crematory cost 
 $5,300 and the cost of cremating was about $0.25 per ton. 
 
 Brownlee Crematory. 
 
 Crematories of this type have been built at New Brighton, Staten 
 Island, Sail Antonio, Gainesville, Tex., and Terre Haute. The cost of 
 the crematory in the latter city was $7,000. During the last six 
 months of 1899 2,000 tons of garbage were cremated at a cost of 
 $1,035.35, or about $0.50 per ton. 
 
REFUSE DISPOSAL. 707 
 
 Vivartos Crematory. 
 
 This is said to be in use at Scranton. 
 
 Ideal Cremator)-. 
 
 A crematory known as the Ideal is in use at Findlay, O. About 
 200 cubic yards per month are burned by contract at a cost of $117. 
 
 McKay Crematory. 
 
 One of these was built at honkers at a cost of $5,000. Hering 
 states that from twenty to twenty-five tons per day in summer and ten 
 to fifteen in winter are cremated, at a cost of about $3,000 per annum. 
 According to a letter from the- eommissioner of public works the cost 
 of operation in 1900 was $3,526. The United States commissioner of 
 labor states that <>,200 tons were cremated which is a large amount for 
 a city of that size. These figures would make the cost per ton 80.56. 
 
 Lester Furnace. 
 
 The only furnace of this kind is at Atlanta. It was built in 1899 
 by the Dennis Cremation Co., of Atlanta. The city does not own t lie 
 crematory but contracts for the cremation of garbage at v l 2,000 per 
 annum, or about $0.12 per capita. 
 
 Risley Furnace. 
 
 There is a furnace of this type at Houston. Tex., built at a cost of 
 $8,000. In 1900 there were consumed 19,348 cubic yards at a cost of 
 $3,362.62. Of course a large pari of this was combustible refuse as is 
 common in southern cities. 
 
 Dry Refuse. 
 
 While almost all cities are convinced of the importance of the 
 municipal collection of garbage, they arc by no means all convinced of 
 the advantage of the systematic removal of other forms of waste, par- 
 ticularly ;ishcs and general rubbish. When such material is collected 
 by the city and separately from garbage it is usually called dry refuse, 
 but in the south it is more commonly known as trash. Sometimes this 
 material is -till further separated into ashes and dry refuse or rubbish, 
 
 the latter term including all kinds of rubbish except ashes. 
 
 [f all decomposable refuse was ad ually put into the garbage pail there 
 
 would not be so much need of the municipal collection of dry refuse; 
 but such is never the case even in those cities where separation is 
 carried <>ut in the best manner. Some offensive matter is sure to gel 
 
 into tlie ash bill or ash pile and create more or less of a nuisance. 
 
 Moreover, the very existence of an ash pile is a temptation to throw all 
 kinds of refuse, slops or garbage upon it. Unless there is municipal 
 collection, the landlord or householder is prettj certain to remove the 
 
728 REFUSE DISPOSAL. 
 
 dry refuse only once or twice a year except in the better class of 
 houses. There thus remains almost all the time in each yard or cellar, 
 a pile or bin of ashes and rubbish which hi three cases out of four is 
 more or less offensive. If municipal collection cost more than private 
 collection, there would be some reason for hesitancy in adopting it, but 
 it is really cheaper. The refuse has to be carted away in any event and 
 the systematic removal at short intervals is not only far more satisfac- 
 tory, but appears to be more economical than the slovenly method of 
 private removal. 
 
 Dry refuse in many cities includes ashes and all the rubbish which 
 accumulates in private houses and also in stores, markets, and the like. 
 It does not include the wastes from building operations which are of ten 
 expressly excluded from the collection by ordinance. Usually the ashes 
 from steam boilers used for power are removed by the producers at 
 their own expense, but in Boston the}' are collected by the city, but the 
 cost of collection is charged to the owner. In Chicago ashes are not 
 removed from boilers used for heating purposes. In Salt Lake City on 
 the contrary, ashes are removed from the business section, and in 
 Elizabeth, N.. J., they are removed from factories. Manufacturing 
 wastes of all kinds are usually not removed by municipal collection. 
 Garden rakings, primings of trees and shrubs are not generally collected, 
 though they are in some southern cities. In Charleston and Florence, 
 S. C, they are collected if put on the street after 6 o'clock P. M. in 
 the summer, and 5 p. m. in the winter. Cut grass and sweepings are 
 removed in Philadelphia. In Lynn all kinds of rubbish are removed if 
 placed in receptacles. In Buffalo 1 the contractor removes 
 
 "everything in the nature of dirt, refuse, ashes, garbage, grass, manure from 
 lawns, leaves from trees, branches of trees, etc., which maybe found upon premises, 
 as provided in city ordinances, or piled on street under permit from the superintend- 
 ent ofstreets. 1 ' 
 
 The general spring house cleaning gives rise to much extra domestic 
 refuse, and this may in Boston be put on the street outside of recep- 
 tacles on certain days as shown in the circular given below. 2 A similar 
 collection is made twice each year in Fitchburg. 
 
 1 Buffalo, Specifications for Contractor, Sec 7. 
 
 2 City of Boston. 
 Notice in Housekeepers urnl Tenants. 
 " Housekeepers and other occupants of dwellings are requested to place their 
 bouse and cellar dirt and sweepings in the streets opposite their premises between 
 the hours of sunrise and two o'clock p. m. of the following days: Monday, May 3; 
 Tuesday, May 4; Wednesday, May 5; Thursday, May 6; Friday, May 7, when they 
 will be removed by the city carts. After which times no person will be allowed to 
 
REFUSE DISPOSAL. 799 
 
 In Asbury Park, Boston, Brockton, Brookline, Lawrence, Lowell, 
 New York, Richmond, Utica, Yonkers, and perhaps some other cities, 
 dry refuse at least in certain sections of the city is collected separately 
 from ashes. In Augusta, Ga., in 1809, an ordinance was passed to re- 
 quire persons who had much of this refuse to tie it in bundles or park 
 it in hags. But it was found to be entirely impracticable to enforce it. 1 
 In Ism; Mr. Waring in Xew'York instituted a change in the collection 
 by which the wastes of the city were to be collected in three separate 
 divisions, garbage, ashes, and dry refuse or general refuse. The sep- 
 aration of other dry refuse from ashes is not complete as yet, but never- 
 theless large quantities are collected in that manner, and at least two 
 furnaces have been built for its disposal. In Boston in *1S!>7 the 
 separation of dry refuse from ashes was begun. The rules of the street 
 elcamug department in regard to such separation are given below. 2 
 
 The card shown in Appendix 115 is also very generally distributed 
 about the city, especially among school children. 
 
 In Asbury Park only the dry refuse exclusive of ashes is removed 
 by the city. 
 
 The average weight of a cubic yard of dry refuse including ashes 
 is given as 1,000 pounds in Cincinnati, 800 pounds in Evansville, 750 
 pounds in Boston, and in Buffalo 500 pounds. 
 
 place any dirt, ashes, filth or rubbish of any kind whatever in any of tbe ways, 
 streets or places of the city, without a permil from the superintendent <>f streets. 
 
 "Dirt of any kind not to be placed in the streets mi Saturday. 11 
 
 in n.i amis W. Wells, 
 
 City Ham.. Boston, 1897. Superintendent of Streets. 
 
 Note, This circular, printed in English, Hebrew and Italian, was posted in prominent places 
 bj tbe regular lull posting companies, and for a week was also carried on the Bides of nil the wagons 
 and cai 1- owned by this division. 
 
 1 Augusta, Report of Board of Health (1899), p. 59. 
 
 '"On and after Monday, October 11, 1897, nothing but garbage, f I cans, and 
 
 fddd bottles must be put into the garbage receptacles, and nothing but dust and 
 ashes must !><■ put into the receptacles for ashes. 
 
 ■•All papers, light waste, and other general refuse must be placed in a third 
 receptacle, or, if too bulky, must be tied in bundles to prevent their being scattered 
 in handling, and must be protected fr the weather until collected by the proper 
 
 BUthorit ies. 
 
 "Revised Ordinances of 1892, Chapteb 18, Sectios it. No person shall 
 place or keep in or near any building, ashes or cinders in such a manner ;is to be 
 liable t" cause lire, nor mix them with other substances, nor place or keep them ex- 
 cept in metallic vessels, so placed :is to be < ■ : 1 -s i 1 > removed, 
 
 "The superintendent <>f streets, therefore, calls attention to the necessity of 
 keeping ashes and other refuse matter as required by law, and gives notice that no 
 refuse will be removed unless protected from the weather, and placed so as to ho 
 easily removed, and kept as follows: — 
 
 \shis must he kepi free from all other refuse matter and in metallic vessels." 
 
730 REFUSE DISPOSAL. 
 
 The weight of dry refuse exclusive of ashes is 165 pounds per cubic 
 yard in Lowell, 300 pounds in Asbury Park, and 205 pounds in Boston. 
 
 Receptacles. 
 
 There are comparatively few regulations in regard to the receptacles 
 to be used for dry refuse. Galvanized iron cans are very generally 
 recommended and are in common use. For this use they are not open 
 to the same objections which attaches to their employment for garbage 
 cans and they are reasonably durable. All sorts of barrels and boxes 
 are used to some extent in almost all cities ; but as a large part of dry 
 refuse is combustible, and as hot ashes are liable to be placed in the 
 receptacles, or ashes accidentally dropped into them, it is much safer to 
 have them of metal or otherwise made fire proof, and this is required 
 in Boston, Brooklyn, Buffalo, Chelsea, Chicago, Denver, Jackson, 
 Jersey City, and New York. The Boston rule is shown on page 729. 
 
 The New York City ordinance and those copied after it require the 
 receptacles to " be made or lined with some suitable metal." In 
 Chicago they are only required to be of iron in the central districts of 
 the city, and they are also required to have iron covers. In Denver 
 brick bins are permitted for ashes, otherwise they must be kept in metal 
 receptacles. Brick bins shaped like a bee-hive and holding about a 
 load are found in nearly every yard in that city, but there is no muni- 
 cipal collection. Doubtless similar rules are found among the fire regu- 
 lations of other cities. It is not usually required that refuse receptacles 
 shall be covered. 
 
 The size of the receptacle is not generally specified, but in Phila- 
 delphia it must not weigh over one hundred pounds. In Chicago if of 
 a greater capacity than two bushels, it must be provided with handles 
 at the sides midway between the top and the bottom. 
 
 Local 'm a. 
 
 Receptacles for dry refuse are less objectionable on the sidewalk 
 than are garbage receptacles. Little mention was made of their loca- 
 tion in the reports made to Mr. Hering's committee, and it was not 
 thought worth while to make a special enquiry. Probably those cities 
 which require that garbage receptacles be placed outside the premises 
 require that refuse receptacles shall be placed there also. Besides these 
 the following, which require that garbage shall be kept on the premises, 
 direct that ashes shall be kept on the sidewalk : Cambridge, Lowell, 
 Philadelphia, Somerville, Syracuse, and Salem. The Cambridge rule is 
 given below. 1 
 
 1 Cambridge, Ordinances, Chapter 24: 
 
 " Sec. 28. Whoever desires the removal of ashes accumulated from the burning 
 of materials for heating or domestic purposes only, and other house dirt, not includ- 
 
REFUSE DISPOSAL. 731 
 
 In Syracuse it is required that the empty barrels shall not remain on 
 the sidewalk over an hour. The barrels must also never be more than 
 half rilled. In Springfield, Mass., the ash receptacles are kept in the 
 cellar, from which they are removed by the contractor. 
 
 Frequency of Removal. 
 
 Dry refuse is not usually collected as frequently as garbage. The 
 
 data obtained were not as complete as for garbage, but for the cities 
 reporting they were as follows : Refuse is collected at irregular inter- 
 vals in Allegheny, Columbus, Nashville, and Omaha ; " when necessary "' 
 in Davenport: when "set out" in Milwaukee. It is collected six times 
 a week in Brooklyn. Holyoke, Mass., and New York, and in the central 
 district of Buffalo: from the hotels, stores, and tenements of Boston 
 Haverhill, and Macon: and in summer time in Adrian, Mich. It is 
 collected four times a week in the business parts of Boston. It is col- 
 lected three times a week in Newburgh, Norfolk, San Jose, and certain 
 parts of Manchester, and in New Brighton. It is collected twice each 
 week in Richmond, the greater part of Buffalo, Boston, Brockton, 
 Adrian in the winter, and Paterson in the summer. The most common 
 interval between refuse collections is one week. Weekly collections are 
 the rule in Boston, Cambridge, Haverhill, Macon. New London, Newport, 
 Newton, Philadelphia, Rochester, Sioux City, Somerville, Springfield, 
 O., Utica, Wilmington, Buffalo, and Paterson in the winter. 
 
 Hours for Removal. 
 
 The hours for the removal of ashes are usually the working hours 
 of the day, but often it is the custom to colled ashes in the early morn- 
 inn- hours, especially in the business districts of the great cities. 
 
 Vehicles for Dry Refuse. 
 
 In almost all cities dump carts are used for collecting the dry refuse, 
 especially when it includes ashes. Usually these carts are made of 
 wood, though in Wilmington, Del., Flanagan metal carts are employed, 
 
 ing offal, shall cause the same i" be pul in suitable boxes or barrels, and sel upon 
 the sidewalk adjoining his premises, and the superintendent of streets shall cause 
 such removal to be made at least once In each week, on -^i a i ••<! days for different 
 portions <>f the city; but such l><>\i-s or barrels shall ool be placed upon anj side- 
 walk so as unnecessarily to prevent the convenient use thereof bj travellers. Wher- 
 ever there is a convenient driveway into a yard connected with any dwelling-house, 
 the superintendent "f stivHs may. at Ms convenience and upon reasonable notice, 
 cause ili" city teams t" be driven into such yard, ami t.> remove therefrom the ashes 
 ami rubbish before mentioned thai may be accumulated therein, at the times herein- 
 specified. 
 •\n\ person having or leaving after dark any ashes, rubbish, or other refuse on 
 :m\ street shall causes lighted lantern to !><■ kept thereon during the night 
 
 ■ I n < iommon < louncil, A pril i v . 1 899." 
 
732 REFUSE DISPOSAL. 
 
 and occasionally metal carts like those shown on page 683, are used. 
 It is probable that in a large proportion of cities, perhaps a majority, 
 covers are required for refuse wagons, though it was not definitely 
 stated in Mr. Hering's report. The following cities at least require 
 covers, and in all of them canvas covers are permitted and used : Asbuiy 
 Park, Boston, Brockton, Buffalo, Lowell, Lynn, New Brighton, Newport, 
 Newton, Paterson, Philadelphia, Richmond, and Somerville. 
 
 In the following covers are not required : Chelsea, Dayton, Fitch- 
 burg, Manchester, Nashville, and Utica. 
 
 In most cities one Horse and one man go with each cart, but when 
 larger wagons are used there may be two horses and two men. In a 
 few cities, as Boston, Cambridge, and Chelsea, when single carts are 
 employed with one driver, other helpers accompany the cart along the 
 street. 
 
 In Omaha it is reported that the refuse wagons carry five cubic 
 yards ; in Philadelphia, three cubic yards. In Boston the refuse carts 
 have a capacity of 54 cubic feet; in Lynn, 50 cubic feet; in Cambridge, 
 48 cubic feet; in Paterson, 40 cubic feet; in Richmond, 27 cubic feet. 
 
 In Asbury Park where ashes are excluded from dry refuse, iron 
 carts are used which are described below. 1 They are made by Thomas 
 II ill of Jersey City. Similar carts are used in Boston and New York. 
 In Boston wooden paper wagons are used, made by the street depart- 
 ment, which cost about -1140. 
 
 1 Asbury Park, Report of Board of Health (1898), p. 23: 
 
 " The vehicles which have been especially designed for use in the collection and 
 removal of rubbish in Asbury Park, have two wheels and large bodies set near to the 
 ground by means of bent axles. 
 
 " They have 54-inch wheels with 4-inch tread and the top of the body stands 61 
 inches from the ground, while the rear of the bottom of the body is 15 inches from 
 the ground. 
 
 "Rubbish is thrown into the carts over the top of the sides of the body, and 
 when loaded a canvas cover is spread over the load and snugly tied down to prevent 
 the light material from blowing off. 
 
 "The cart is provided at the rear with two hinged doors which, when open, per- 
 mit the quick discharge of the load from the rear. 
 
 "These carts weigh 960 pounds, 40 pounds of the weight being supported from 
 the saddle on the horse's back. Frequent trials, have shown that, when judgment is 
 used by the driver of the cart in loading, the cart is so evenly balanced that when 
 loaded not more than four or five pounds of the gross weight rests on the horse's 
 back. 
 
 " The additional weight which is placed on the back of the horse by a driver 
 weighing 128 pounds occupying the seat at front of the cart is found to be 30 pounds. 
 
 " The inside dimensions of the body are as follows: Length, 91| inches; width, 
 50| inches; depth, 40 inches; giving a capacity of 107.78 cubic feet, or 3.99 cubic 
 yards." 
 
RE1 'USE DISP SA L . 
 
 733 
 
 Fig. 95. 
 
 Paper Cart, As bury ['ark, X. J. From plate loaned by the maker of the cart, Thomas Hill. Jersey City. 
 
 Below 1 is a list of the cities in which there is a municipal collection 
 of dry refuse, and it is also shown whether the work is done by con- 
 tract, and what department lias it in charge. 
 
 Disposal of Dry Refus< . 
 
 When dry refuse is collected separately from garbage the must of it. 
 except from markets, produce dealers, etc., where a perfect separationis 
 almost impossible, is comparatively (dean and may very properly be 
 um-(\ for filling low land, and some of it even utilized in laying side- 
 walks and cellar floors. Ashes are also employed in the floors and par- 
 
 health Department A.sbury i';u-k. • Atlanta. 1 Chelsea, 1 * Florence, S. C.,1 Gal- 
 restonj Lawrence, Lowell,1 Lynn,1 Macon, Ga.,1 Maiden, 1 Newport,* Newton,* 
 Paterson,* Richmond,! Salem, 1 SaH Lake City, 1 Somerville,1 Syracuse.1 
 
 Street Department Boston, 1 Brockton, 1 Brookline,1 Buffalo, 4 Cambri< 
 Camden, 1 Cincinnati, 1 Dayton, 1 Fall River, 1 Fitchburg, Hartford, 11 Manchester, 1 
 New London,* Qtica,* Wilmington, Del.* 
 
 Street Cleaning Department: Baltimore, 1 \<\\ Fork.1 
 
 Department of Public Works : Davenport, 4 Detroit,* Milwaukee, Ne^ Bedford, 
 Norfolk : Philadelphia.* 
 
 Fire Department Battle Creek, Mich.t 
 
 Poor Depart ment Haverhill. t 
 
 Execul i\ •■ Board. Rochestei , 
 
 Ash Committee of the Council Springfield, Ma 
 
 * By contract 
 
 t By city employees. 
 
734 
 
 REFUSE DISPOSAL. 
 
 titions of fire-proof buildings. 1 The ultimate disposal of most dry refuse 
 collected by municipalities consists in dumping on low land. Usually 
 such land is conveniently situated in the city or its immediate suburbs, 
 so that a long haul is not required. Usually the owners of such land 
 are only too glad to have it brought to grade in this way and readily 
 donate it for this purpose. Sometimes, however, the city is required to 
 pay something for the privilege. This is true of Fitchburg, and in 
 Portland, Ore., the city has to pay •$ 15 per month for a dump, and in 
 Utica $60 per month. 
 
 It is often necessary to keep a man stationed upon a public dump to 
 prevent illegal dumping of filth, to keep the dump level, to burn the 
 paper and prevent the intrusion of scavengers. This usually consti- 
 tutes the only cost of this method of disposal. 
 
 As might be expected, it is sometimes possible for a city to sell some 
 of its ashes. The following are the prices asked and the amount 
 realized in certain cities : 
 
 City. 
 
 Year. 
 
 Price Per Load. 
 
 Amount Received. 
 
 Brockton 1896 10c . 
 
 Cambridge 1896 15c . 
 
 Chelsea 1896 12c . 
 
 Lynn 1895 
 
 Somerville 1896 
 
 .$ 802 25 
 
 1,278 81 
 49 10 
 
 Table Showing the Amount of Dry Refuse Collected and the Cost of 
 Collection in a Number of American Cities. 
 
 City. 
 
 Population, 
 
 Census of 
 
 1900. 
 
 Year to 
 which 
 data 
 refer 
 
 Amount Collected. 
 
 Cost of Collection. 
 
 Asbury Park 
 
 4,148 2 
 
 560,892 
 
 508.'. t57 
 
 40,063 
 
 19,935 
 
 1,166,582 
 
 352,219 
 
 91,886 
 
 325,902 
 
 85,333 
 
 285,704 
 
 104,863 
 
 79,850 
 
 37,175 
 
 45,712 
 
 62,559 
 
 1899 
 1899 
 1900 
 1899 
 1900 
 1898 
 1900 
 1898 
 1899 
 1899 
 1898 
 1899 
 1900 
 1899 
 1899 
 1899 
 
 7,402 cu. yds. 
 329,096 loads 3 
 218,507 cu. yds. 
 
 9,568 loads 
 29,561 cu. yds. 
 1,488,600 cu. yds 
 307,341 cu. yds. 
 39,045 loads 
 258,648 tons 
 17,528 tons 
 80,000 loads 
 
 4,532 tons 
 54,000 cu. yds. 
 
 $1,800 00 
 
 208,350 47 
 
 98,256 67 
 
 Huston 
 
 Baltimore 
 
 
 Brookline 
 
 11,202 60 
 
 237,000 00 
 
 50,000 00 
 
 21,198 55 
 
 Brooklyn 
 
 Buffalo 
 
 Cambridge 
 
 
 Dayton 
 
 10,162 00 
 
 Detroit 
 
 Fall River 
 
 
 Hartford 
 
 Haverhill 
 
 15,000 00 
 
 4,500 00 
 
 19,000 00 
 
 14,300 00 
 
 Holyoke 
 
 9,600 tons 
 12,000 tons 
 
 1 Report on the Final Disposition of the Wastes of New York, George E. 
 Waring, Jr., 1800, p. 132. 
 
 2 Resident population. The summer population is probably over 30,000. 
 
 3 A load equals about 54 cu. ft. 
 
REFUSE DISP OS A L. 
 
 ,.,.» 
 
 City. 
 
 Population, 
 
 Census of 
 
 1900. 
 
 Lowell 
 
 Lynn 
 
 Maiden 
 
 Manchester, X. II 
 
 Newton / 
 
 Newport 
 
 New York (Manhattan) 
 
 Paterson 
 
 Philadelphia 
 
 Rochester 
 
 Salem. Mass 
 
 Somerville 
 
 Springfield, Mass 
 
 Syracuse 
 
 Utica 
 
 Wilmington, Del 
 
 York. I'enn 
 
 Year to 
 
 which 
 
 data 
 
 refer. 
 
 94,969 
 68,513 
 33,664 
 56,981 
 
 33,587 
 
 22,034 
 
 1,850,093 
 
 105,171 
 1,293,575 
 
 162,435 
 35,956 
 61,643 
 62,050 
 
 10S.:;74 
 56,383 
 76,508 
 33, 70S 
 
 1899 
 
 1890 
 1900 
 1899 
 1899 
 1900 
 1.898 
 L899 
 1899 
 1899 
 1S99 
 L899 
 1900 
 1899 
 1899 
 1899 
 1899 
 
 Amount Collected. 
 
 26,572 loads 
 :j:;.207 loads 
 13,961 loads 1 
 18,000 cu. yds. 
 
 20,000 cu. yds. 
 876,400 tons 
 
 625,459 cu. yds. 
 206,272 cu. yds. 
 
 10,582 cu. yds. 
 
 29,093 loads 
 
 24,353 loads 3 
 
 5,726 
 
 Cost "f Collection. 
 
 110,903 30 
 
 12,476 85 
 
 4..Y77 7."i 
 
 17,500 00 
 
 4,900 00 
 
 2,988 00 
 
 592,500 00 
 
 
 67,285 71 
 
 2, HI 2 00 
 
 7,840 83 
 
 11,000 00 
 
 18,508 25 
 
 4. M 10 00 
 
 7,500 00 
 
 1,880 39 
 
 Ashes contain a considerable amount of unconsumed coal. Experi- 
 ments in New York City have shown that the average ash in that city 
 contains twenty per cent, of unburned coal, but probably much of this 
 is very finely divided. Little soft coal is burned in that city. The 
 attempt is made to utilize this coal in the ashes in those crematories 
 where mixed wastes are burned as in the Thackery crematory. Other- 
 wise ii" attempt has been made to save this waste. 
 
 In a few instances dry refuse is dumped into the ocean or a large 
 river. In Sioux City it was reported in 1896 that it was dumped into 
 tin- .Missouri river, but the method was not approved of. In Boston 
 and in Lynn where the best of the garbage is sold to farmers and where 
 the best of the dry refuse is used tor filling, the rest of the garbage and 
 dry refuse is deposited together on scows and towed to sea. In Boston 
 in 1898 112,528 loads of refuse or twenty-eight per cent of the whole 
 39 1,937 Loads collected, was towed to sea. Sometimes the federal gov- 
 ernment steps iii and forbids the dumping of refuse into navigable 
 waters as has been done in New York i>\ the supervisor of the har- 
 bor under acts of Congress of 28 June, 1888, and L8 August, 1894. 
 
 Dumping in the Ohio and .Mississippi ri\ers, lias it is stated, been for- 
 bidden, but the writer has not been able to find the acts. The details 
 
 of this method of disposal will be further considered in the discussion 
 
 of the disposal of mixed refuse. 
 
 \ load equals 27 barrels. 
 - i ,,>i ,,t colled ion and disposal "f msIi.'n and garbage, 127,500. 
 a load equals '■'• cu. yds. 
 
736 
 
 REFUSE DISPOSAL. 
 
 Fig. 96. 
 Barney Dumping Boat, loaded. 
 
 Fig. 97. . 
 
 Barney Dumping Boat, loaded, 
 sectional view. 
 
 Fig. 98. 
 Barney Dumping Boat, after discharge at sea. 
 
 Refuse may be carried to sea in various ways. The simplest is to 
 use ordinary deck scows which are towed to the dumping ground by a 
 tow boat. Such scows must be unloaded by hand labor which often 
 makes their use expensive. If the deposit is made in the open ocean 
 the danger is greatly increased from the number of men carried, the un- 
 seaworthy character of the vessels and the time taken to unload. The 
 City of New York owns two self propelling steam dumping 1 touts, but 
 they have not proved entirely satisfactory. Probably the best and 
 cheapest method of getting refuse to sea is in the Barney scows made 
 by the Barney Dumping Boat Co. of New York. In that city the 
 street cleaning department charters thirteen of these scows at $35 per 
 day. The city also pays $46 for towing two scows to sea and back 
 making the total cost of disposal #0.12 per cubic yard. These scows 
 are also used in Boston where two are owned by the city. In Boston 
 in 1898, 373 trips were made at a cost of #71.02 per trip or 15 cents 
 per cart load of refuse carried to sea. 
 
 A considerable amount of dry refuse is combustible and burning is 
 the most effectual way to get rid of it. When refuse is used for filling 
 low land a man is often stationed on the dump to burn paper brought 
 
REFUSE DISPOSAL. 737 
 
 there in order to prevent its blowing away, and also to improve the 
 character of the filling. In Asbury Park all dry refuse which is col- 
 lected separate from ashes and garbage is burned in this way in the 
 open air on the ground. In Evansville, Lowell, Muncie, Yonkers, and 
 many southern cities, the combustible part of the dry refuse is burned 
 in the garbage crematory together with the garbage, thus lessening the 
 cost for fuel. In Pittsburgh some of the combustible dry refuse is 
 burned in the old garbage furnace. 
 
 The valuable junk material found in dry refuse is usually re- 
 covered to a considerable extent by rag pickers who swarm over the 
 dumps and who usually make themselves a nuisance by interfering with 
 the leveling of the dumping, and by setting fire to rubbish. In Troy 
 the contractor sorts out the junk from the refuse. Chicago and the city 
 of New York are the only cities reporting which receive an} T income from 
 this source. Chicago received in 1896 the sum of $100 a month for 
 the privilege of picking over the dumps. In New York in 1H98, 
 
 Lt the money paid by the contractor for the privilege of picking over the rubbish 
 dumped with the ashes and street sweepings at the various dumps, after furnishing 
 the department with sufficient labor for trimming all the scows and dumpers tarry- 
 ing ashes, street sweepings and rubbish, for operating the chute dump at Seven- 
 teenth street. East river, and for unloading, at night, the temporary storage bin for 
 garbage received during the day at Lincoln avenue, amounts t<> $53,691.62. This 
 gives for 90,000 tons an average payment of $0.56 per ton." 
 
 In Boston and New York alone is the attempt made to utilize the 
 junk found in dry refuse. In both these cities the utilization is joined 
 with cremation as a method of ultimate disposal of the lighter portions 
 of dry refuse (excluding ashes), particularly that collected from busi- 
 ness sections. In Boston the contract went into effect in January, 
 1899, and is for ten years, but the city has the privilege of buying on 
 appraisal at the end of live years. The land was given rent free by the 
 city, but the buildings and machinery were erected by the contractors. 
 The plant is situated in the business portion of the city near one of the 
 refuse wharves. 
 
 The com raetor receh es $5,500 per annum for destroy ing or dispos- 
 ing of all dry or combustible refuse which is delivered b\ the city 
 wagons. Recently the same parties have made a contract with the ad- 
 joining town of Brookline t<» dispose of the combustible refuse oi that 
 town for $1,875 per annum, the town agreeing to deliver twenty-five 
 loads - day. It is proposed t<> build a new destructor in Brighton (a 
 pari of Boston), to receive the wastes of Brookline and that pari of 
 Boston. The plant consists of a Large room into which the wagons drive 
 and deposit their Loads. A Long travelling apron runs from the Eronl of 
 this room back through it into the furnace room where it discharges 
 
 47 
 
738 REFUSE DISPOSAL. 
 
 into the furnace. This apron is about four feet wide. The power for 
 moving the apron, for baling, and for furnishing light is obtained from 
 the furnace, and it appeared to the writer that a large amount of heat was 
 going to waste. It was said that a sixty-horse power boiler was kept 
 continually at eighty pounds pressure. Cheap labor is employed to 
 stand along the moving apron to cull out paper, rags, rubber, metal, 
 glass, etc., and sort it and prepare it for sale. There appeared at the 
 time the works were visited to be no nuisance arising from them out- 
 side the building. The dust in the building is quite annoying. The 
 city employs twenty-two wagons or carts to collect this refuse and the 
 amount, which was about seventy -five loads a day, has greatly increased 
 since that time. It is said that about eighty per cent, of the refuse is 
 marketable and that the value of the daily collection is not far from $6.0. 
 In New York (Manhattan) in 1898 there were collected 94,000 
 tons of rubbish at a cost of -$63,500. It is disposed of in a manner 
 similar to that of Boston. 
 
 Mixed Refuse. 
 
 It is difficult, if not impossible, to determine why some cities have 
 elected to collect and dispose of all their house refuse together, and why 
 others separate their garbage from dry refuse. It is a fact, however, 
 that for a long time even before municipal sanitation received much at- 
 tention, both methods have been in vogue. The largest city in the 
 country for many years pursued this method and it has also been 
 adopted by many quite small cities. 
 
 When mixed refuse is collected, garbage, ashes, and dry refuse of 
 all kinds are mixed together in the receptacles. Some restrictions are, 
 however, made, and probably in most cities builders' wastes and garden 
 waste are not removed together with the garbage. 
 
 The weight of mixed garbage cannot vary much from ordinary dry 
 refuse, although in the long run it must be somewhat heavier. The 
 only weights given in Mr. Hering's report were in Jacksonville, where 
 one cubic yard is 500 pounds ; in Seattle it is 1,222 pounds in winter, 
 and 781 in summer; in New Brighton and San Francisco, 666 pounds; 
 in Salt Lake City, 650 pounds. 
 
 "Receptacles for Mixed Refuse. 
 
 In Petersburgh, Seattle, Tampa, Trenton, and probably in several 
 other places there are no regulations in regard to receptacles. In 
 Chicago, Jersey City, and Memphis the regulations are modeled after 
 those of New York before separation of garbage and other wastes was 
 made in that city. The receptacles are to be of sufficient size to con- 
 tain the refuse without being filled, to have covers and to be of metal 
 
REFUSE DISPOSAL. 739 
 
 or metal lined, but in Memphis it is stated that the rule is not enforced, 
 and in Chicago ordinary wooden boxes are in common use. In Eliza- 
 beth, Meriden, and Tacoma galvanized iron cans are reccommended, but 
 they are not in general use. In fact the regulations and the reports of 
 the different cities would indicate that little is accomplished in the way 
 of controlling the receptacles for mixed refuse, and that ordinary bar- 
 rels and boxes are generally used for this purpose. 
 
 Location of Receptacle. 
 
 The receptacle must be placed on the sidewalk in almost all cities, 
 usually on the curb line. It must be set out in time for the collection. 
 In Chicago it must be promptly returned to the premises when emptied. 
 Tin' only cities in which the receptacle is required to be kept on the 
 premises for the collection are Chicago, Jacksonville, and Memphis, and 
 in the two latter cities the rule is more often violated than observed. 
 
 Hours for Collection. 
 
 Usually collection of mixed garbage takes place during the day, but 
 in Mobile it is between ."> and 8 a. .m., and in the central portion of Chicago 
 before 7 a. m. ; and in the central portions of Meriden, Conn., before 
 9 a. M. : in Charleston before 10 A. m. in summer and A'2 >r. in winter; 
 in Louisville before 10 A. m. 
 
 I'r, quency of < Collection. 
 
 .Mixed garbage is collected daily in Charleston, Long Island City, 
 Mobile, and formerly in New York, and in the central portions of 
 Chicago, Raleigh, Elizabeth, Newark. Meriden. Sacramento, Seattle; 
 and in tiie summer time in Petersburg!}. It is collected three times a 
 week in certain parts of Chicago, Jersey City, Louisville, Newark, and 
 Orange, h is collected twice a week in certain parts of Chicago, in the 
 side streets <>l' Elizabeth, Raleigh, and Meriden. in Memphis in the sum- 
 mer, and in Petersburg!] in the winter. It is collected once a week in 
 Troy, from the residences of Seattle and in the winter in Memphis. 
 
 Vehicles for Mixed Refuse. 
 
 The regulations in regard t<> the vehicles required for mixed refuse 
 are doI much more strict than for dry refuse wagons. In eight cities 
 covers are required, canvas in all cases excepl in Troy where wooden 
 covers are used. In Newark, Jersey City, Meriden, Tacoma, Troy, 
 San Francisco, and formerly in New York Cityii was stated thai covers 
 were not required. 
 
 I 9ually dump carts are employed with one horse and one man. In 
 Jersey <it\ and New York the Mill cart shown on page 683 is used. 
 
740 
 
 REFUSE DISPOSAL. 
 
 •Below 1 are given a number of cities in which garbage and ashes are 
 collected together, and also the department which has charge of the 
 work. 
 
 Table Showing the Amount of Mixed Refuse Collected and Cost 
 Collection in a Number of American Cities. 
 
 of 
 
 City. 
 
 Population, 
 Census of 
 
 1900. 
 
 Charleston 55,807 
 
 Chicago 1,698,575 
 
 Elizabeth 52,130 
 
 Hoboken 59,364 
 
 Jersey City 206,433 
 
 Knoxville. 
 
 Louisville 
 
 Newark 
 
 Orange 
 
 Passaic 
 
 Perth Amboy . 
 Troy 
 
 32,637 
 
 204,731 
 
 246,070 
 
 24,141 
 
 27,777 
 17,699 
 
 Year to 
 which 
 data 
 refer. 
 
 1898 
 1899 
 1899 
 1900 
 1900 
 1900 
 1899 
 1898 
 1899 
 1899 
 1899 
 1899 
 
 Amount Collected. 
 
 17,428 
 
 .,189,970 
 
 25,000 
 
 tons 
 en. yds. 
 en. yds. 
 
 17,000 
 
 86,380 
 
 325,000 
 
 3,000 
 
 18,750 
 
 en. yds. 
 tons 
 en. yds. 
 tons 
 cu. yds. 
 
 32,850 tons 
 
 Cost of Collection. 
 
 $5,152 00 
 
 399,637 91 
 
 6,000 00 
 
 4,090 00 
 
 20,000 00 
 4,000 00 
 
 40,086 00 
 
 61,000 00 
 3,500 00 
 3,400 00 
 2,300 00 
 
 28,000 00 
 
 Disposal of Mixed Refuse. 
 
 Dumping. By far the commonest method of disposing of mixed 
 wastes is by dumping on low lands. That such a method of disposal 
 creates a nuisance goes without saying. It usually gives rise to many 
 complaints and is rarely satisfactory, but is merely tolerated because of 
 its economy. If land which needs filling is to be found within easy 
 hauling distance it is by far the cheapest method of disposal. The cost 
 of hauling is the only cost, and this would not usually be greater than 
 for some other method. Generally nothing is paid for the privilege and 
 no income is derived from it though occasionally, especially in some of the 
 larger cities, some of the cleanest ashes are sold for filling. Sometimes 
 one or more men are kept on the dump to superintend it. The follow- 
 ing cities dispose of their mixed refuse in this way : Augusta, Ga., 
 Bayonne, X. J., Charleston, Chicago, Duluth, Elizabeth, Jersey City, 
 
 1 Charleston. Street Department, city employees. 
 Chicago. Street Cleaning Department, city employees. 
 Elizabeth. Health Department, contract. 
 Hoboken. City Council, contract. 
 Jersey City. Street Commissioners, contract. 
 
 Louisville (previous to 1901). Department of Public Works, city employees. 
 Newark. Department of Public Works, contract. 
 Passaic City. Health Department, contract. 
 Perth Amboy. Health Department, contract. 
 Troy. Contracting Board, contract. 
 
REFUSE DISPOSAL. 741 
 
 Long Island City, Louisville, Meriden, Conn., Mobile. Newark, Passaic 
 City, X. J., Perth Amboy, X. J., Orange. N. J., Raleigh, Tacoma (in 
 part), Williamsport, Pa., and Wilmington, X. C. 
 
 In Providence a large public dump is cared fur and kept level by ;i 
 contractor, who as compensation has the refuse he can recover from it- 
 
 Dumping in Water. In Memphis until 1898 the mixed garbage 
 was dumped in the Mississippi river about one mile below the city. In 
 Xew Orleans it was formerly dumped into the Mississippi and caused 
 no trouble or offence, but it was forbidden by the Federal government 
 as it was considered likely to injure navigation. In Tampa the mixed 
 garbage is dumped into the bay about two miles from land and the 
 method was reported satisfactory in 1896. In Tacoma a part of the 
 refuse- is deposited in Puget Sound and in Xew York, Boston and Lynn 
 a part is towed out and dumped into the ocean. 
 
 Cremation. In Augusta, (in., Oalveston and Macon, parts of the 
 garbage and dry refuse are separated from the ashes on the dumps and 
 are burned together in the open air. In the first two cities the method 
 is said to lie satisfactory, but in Galveston not. 
 
 In Troy a part of the mixed wastes, the most offensive part, i> 
 cremated ill a Brown crematory. In this city the contractor uso ;i^ 
 much of the refuse as be can for filling an island in the river, and the 
 most offensive he dumps into the crematory and burns it twice each 
 week. 
 
 In S;m Francisco all the mixed refuse is treated in a Thackery 
 crematory. This crematory was built by a private corporation which 
 has a fifty years' franchise. In San Francisco the refuse is collected by 
 private scavengers who are obliged to deliver it to the crematory and 
 pay twenty cents per ton for its destruction. They in turn collect tins 
 from the householder. The manager of the works states that aboul 
 '.to. oihi loads of one ton or three cubic yards each are collected annually. 
 
 The crematory consists of a series of cells or furnaces just alike, 
 into which the refuse is discharged through a hopper. All these cells 
 communicate with a very high chimney. After the lire is once started 
 no fuel ia used as there is enough combustible material in the refuse to 
 consume the garbage. The only expense is labor and repairs. A large 
 amount ol ash results, from eighty-five to ninety per cent., and the 
 
 works mUBl be located where that Can be easih disposed of for filling. 
 The works in San Francisco arc said to have C08< $200,000, and on ;i 
 six day8' test the cost is said to have been L5| cents per ton. The 
 
 crematory was built by the Thackery Incinerating and Fertilizing Corn- 
 pan} of San Francisco. 
 
742 REFUSE DISPOSAL. 
 
 Night Soil. 
 
 Night soil is usually understood to mean the human excrement con- 
 tained in privy vaults and also the liquid house wastes received in cess- 
 pools, whether such wastes come from water-closets or kitchen sinks. 
 Sometimes, however, the contents of cesspools is spoken of as " cess- 
 pool matter " or " cesspool water." It is not nearly so offensive as true 
 night soil from privy vaults, and its value as a fertilizer is far less. 
 
 The only true solution of the night-soil problem is to do away with 
 vaults and cesspools, by utilizing city sewers to carry off all such wastes ; 
 but in all cities there will be unsewered areas in the suburbs where 
 vaults or at least cesspools are a necessity, and many cities are as }"et 
 imperfectly sewered, even in their thickly settled portions, and others 
 still, while endeavoring to abolish vaults have made only little progress, 
 so that the question of how best to remove and dispose, of night soil is 
 still an important one. 
 
 Licenses. 
 
 The persons who engage in the business of collecting refuse of all 
 kinds are called scavengers, though this name is perhaps most closely 
 associated with the business of removing night soil. The work of 
 scavengers is regulated in most cities by ordinances, and the first step 
 in such regulations is the licensing of the persons who engage in the 
 business. The power to license scavengers and otherwise to regulate 
 the cleaning of vaults is undoubtedly contained in any broad grant of 
 sanitary power as was shown by a decision in Maryland, 1 and it is usually 
 exercised by virtue of such. Nevertheless, special legislation is some- 
 times found on this, as on almost all other sanitary subjects. Thus in 
 New Jersey 2 the board of health in incorporated municipalities is 
 empowered to make rules " for the purpose of regulating the business 
 of emptying privy vaults, sinks, and cesspools in any municipality." 
 Similar provisions are found in Colorado, 3 Ohio, 4 and Rhode Island. 5 
 
 There are very few cities which do not require a license for a person 
 to engage in the business of removing night soil, and they of course, 
 usually forbid the cleansing of any vault or cesspool except by a licensed 
 scavenger. 6 As shown in this rule, the owners of property may be per- 
 
 1 Boehm vs. Baltimore, 61 Md., 259. 
 
 2 New Jersey, Chapter 102 of 1898, Sec. 1. 
 
 3 Colorado, Act of 13 April, 1893, Sec. 7. 
 
 4 Ohio, Annotated Statutes (1900), Sec. 2G16. 
 
 5 Rhode Island, General Laws (1896), Chapter 92, Sec 21. 
 
 6 Providence, Rules of Board of Aldermen (1899), Chapter 1, Sec. 45: 
 
 ' No person shall engage in the business of removing the contents of privy 
 vaults and cesspools, or shall remove the contents of privy vaults or cesspools, with- 
 
REFUSE DISPOSAL. 743 
 
 mitted to remove the contents of the vaults and cesspools owned by 
 them. In some cities, as in Hartford, the owner of a vault is never 
 allowed to empty it. 
 
 In a number of cities, as Denver, Jersey City, Rochester, Pennsyl- 
 vania cities of the first and second class, the person who desires a 
 license must make a written application. See Appendix llti. In 
 Rochester the licensee must be a resident of the county. In Philadel 
 phia he must be of good character and must not only have suitable 
 apparatus, bur must keep it under cover and out of view when not in 
 use. The license must be duly recorded, and as is the case with all 
 other licenses and permits, it is best recorded on a stub. 
 
 In most cities the license is issued by the board of health, though 
 sometimes by the clerk or health officer, but in Chicago and Denver it 
 is issued by the mayor. Sometimes no charge is made for a license, as 
 in Detroit. Usually there is a fee for the license, in many cases, how- 
 ever, a nominal one, as* fifty cents in Meadville, Pa., or $1 in Providence. 
 In Charleston, Baltimore, and Hartford it is $2; in Chicago, $5 : in 
 .Milwaukee, Mobile, and Xew Haven, $10; in Paterson, $15 for each 
 wagon; in Jersey City, $20; in Minneapolis, Reading, and Scranton, 
 $25; in Buffalo, Denver, Philadelphia, and Ottumwa, la., $50 for each 
 wagon. 
 
 The licensee is often required to give bond for faithful compliance 
 with the rules. In Mobile it is $100, in Chicago and Denver $500. 
 In almost every city the license must be renewed annually, but in Boston 
 and Haverhill it is given for three years. Often the privilege of revok- 
 ing the license for cause is reserved by the licensing power, and this us 
 especially authorized by the act establishing the bureau of health in 
 Pennsylvania cities of the second class. 1 In Denver the scavengers are 
 required to wear badges which are furnished by the health commissioner 
 and paid for by the scavenger and the money refunded when the badge 
 is returned. 
 
 Apparatus. 
 
 'riic mosl primitive method of removing ami disposing of aighl soil, 
 is for the owner of the vault or the occupant of the premises to dip out 
 
 ontents and spade il into the soil of the yard or garden. This is 
 not ;i bad method in the country or for the more isolated dwellings "i 
 villages, or tin- suburbs of cities, and is occasionally and under proper 
 
 out first obtaining a license of the board 01 alder n; but nothing in this section 
 
 shall be construed as forbidding any person the owner of a privj vault or of a cess- 
 pool from removing the contents therefrom, provided ;t permit be flrsl obtained from 
 t be su perintendenl of lieall b.' 1 
 
 1 Pennsylvania, Chapter 268 of 1896. 
 
744 
 
 REF USE DI8P OSA L. 
 
 restrictions permitted even in cities of a considerable size. In most 
 cases such a simple procedure is not desirable, and as has been stated 
 in most cities, there are persons who make a business of removing night 
 soil, and such persons are licensed and their method of doing the work 
 regulated. 
 
 Almost without exception the regulations prescribe that the receptacle 
 to be used for conveying night soil shall be tight or air-tight, usually 
 the latter. This was in former times about the only regulation, and 
 under it it was permissible to use large box wagons for this business. 
 The night soil was baled out of the vault in a long-handled dipper, and 
 the more solid portions shoveled out and carried in a large tub and 
 poured into an opening in the top of the box which remained standing 
 in the wagon in the street. The use of boxes is considered very un- 
 satisfactory and is now permitted in only a very few cities, as Bridge- 
 port, Chicago, Minneapolis, New Haven, ( Htumwa, la., Salem, and 
 St. Paul. 
 
 The next improvement was the introduction of tubs or barrels which 
 could be carried or rolled to the vault or cesspool and into which the 
 night soil could be directly dipped with a bucket. Such are used ex- 
 clusively in Atlanta, Cleveland, Hartford, New Bedford, Newport, R. I., 
 Portland, Providence, and Syracuse, and in almost all cities there are 
 some vaults in which the contents are too solid to be pumped, and in 
 such cases barrels or tubs must necessarily be used. 
 
 Fig. 99. 
 
 Night-soil Tub used in Providence. Costs $3.50, and holds 3J cubic feet. 
 
REFUSE It isp os. | L. 
 
 74-1 
 
 Fig. 100. 
 Night-soil Barrel made by Odorless Excavating Co., <H Federal Street, Boston 
 
 Fio. 101. 
 
 *i 1 1 1 1 1 > and Tank Wagon made hj the Odorless Excavating < ■ > . G4 Federal Street, Boston ["his 
 apparatus is used In Boston, Cambridge, Brookline, Newton, Somerville, QHlncy, and other 
 Massachusetts cities and towns. 
 
746 REFUSE DISPOSAL. 
 
 In Atlanta two sets of barrels are used. The full set is left at the 
 dump and a clean set put on the wagon. In Syracuse the barrels must 
 be carried in a covered box wagon. 
 
 Nearly all cities now require the use of the so-called odorless or 
 pneumatic apparatus, though sometimes, as in Camden, it is only 
 required during the summer. The odorless method consists in the use 
 of a pump and a hose and tank wagon. The suction from the pump is 
 placed in the vault or cesspool and the outlet is attached to the tank and 
 and the night soil is pumped into the tank without being exposed to the 
 air. As the night soil is forced into the tank, the air of the tank which 
 is of course offensive, is forced out, and sometimes is made to pass 
 through a small charcoal fire or through some deodorizer. 
 
 Sometimes instead of the tank wagon barrels are used to which the 
 hose can be screwed. Their use is very common in the District of 
 Columbia, Fall River, Baltimore, Asbury Park, and Camden. 
 
 With cesspools of course the contents can be readily and completely 
 removed by means of the pump, but in the case of vaults there is almost 
 always some solid refuse or some extraneous substances, as tin cans and 
 the like, which cannot be pumped. As has been shown in a previous 
 chapter, it is often made an offence to put such substances in a privy 
 vault, and in Fall River the following effectual method is taken to 
 secure the enforcement of the law : ] 
 
 " When a vault, privy or cesspool, shall be found to contain an excessive amount 
 of tins, crockery or other rubbish, the health agent or inspector shall report the 
 same to the board, and a tine of two dollars may thereupon be imposed at the dis- 
 cretion of the board upon the owner of said property, and the proceeds thereof shall 
 be equally divided between the board and the scavenger cleaning said receptacle. 11 
 
 Even when all such matter is excluded from vaults, a considerable 
 part of the contents and perhaps the whole contents may be solid unless 
 the vault is absolutely water-tight. Many vaults intended to be water- 
 tight are not so, and very many are built so as to permit the fluid con- 
 tents to leach away, so that it is often impossible to remove the 
 entire contents with a pump. Sometimes, as in Woonsocket, R. I., 
 water is pumped into the " dry vaults " beforehand to facilitate the 
 pumping the next da}- ; but in any event it happens that something is 
 left behind by the pump which has to be removed with a shovel. To 
 render such removal as inoffensive as possible, the pitting outfit was 
 devised. 
 
 This consists of a sort of tent set up over the opening into the vault 
 and provided with a ventilator leading to a deodorizer. The use of this 
 is required by rule in Baltimore, Newark, New Orleans, Haverhill, and 
 
 1 Fall River, Regulation of Board of Health (1804), Sec. 58. 
 
REFUSE DISPOSAL. 747 
 
 Philadelphia, but as a matter of fact it is seldom used in any of these 
 
 cities. 
 
 In Portland, Me., night soil is removed by the old fashioned dipping 
 process and screens are required around the vault. 
 
 Among the most complete rules for apparatus for removing night soil 
 are those found in Philadelphia. See Appendix 117. It is almost always 
 required that the apparatus shall be kept well painted, sometimes of a 
 distinctive color, and shall have upon it the name of the licensee and 
 the number of the license, and the height of the letters or figures is 
 often specified, and varies from two to six inches. In Providence - all 
 apparatus must have the name of the licensee upon it in plain letters."* ' 
 which is interpreted as requiring the name upon every tub, barrel, and 
 wagon. The capacity of the wagon in cubic feet must also be marked 
 upon it in many cities. In a number of cities where night soil is re- 
 moved at night, as Chicago, Jersey City, Milwaukee, Mobile, and 
 Rochester, it is required that the scavenger's wagon shall In- provided 
 with lamps. The Chicago rule is given below. 2 
 
 Wagons "ml Apparatus Must be Krj>t Clean. 
 
 '•The entire apparatus and appliances shall at all times present a clean appear- 
 ance, be free from obnoxious odors, and always in good and efficient working order. 
 Tin workmen shall be well instructed in their duties, and orderly while in the per- 
 formance of their work." 3 
 
 In Jersey City, Minneapolis, Cincinnati, and some other cities it 
 is required that the wagons must be washed. In Cincinnati "all carts, 
 tanks, and vessels used lor the purpose must be water-tight and the 
 same must be thoroughly washed and disinfected immediately after 
 being emptied." 4 
 
 The rule given below, originally enacted in the sanitary nu\i- of 
 New York, has been quite generally copied by other cities.' In Wil- 
 
 1 Providence, Rules of Hoard of Aldermen (1890), Chapter l. See. 48. 
 I uicago, < >rdinances (1881 1, Sec. 1870: 
 
 • Scavengers \\ ho engage in the business of remoi ing the contents of privy vaults 
 at night, shall cause to be painted upon the wagon box of their wagons, in letters 
 and figures, their names and the number of their licenses, together with a lighted 
 la m [i with plain glass fronts and sides, with the number of the license of such wagon 
 painted with black paint on the sides and front of each of said lamps, in distinct and 
 legible figures at least two inches in size, and so placed that said lamps maj be dis- 
 tinctly seen, and said Dumber easily re;id." 
 
 • Philadelphia, bales of Health Department (1895), see. 224. 
 1 Cincinnati, Manual of Health Departmeni (1898), p. LI. 
 
 New Fork City, Sanitary (•■d-- (1899), Sec. 124: 
 •• That do carl or other vehicle for carrying anj offal, swill, garbage, or rubbish, 
 or the contents of any privy, vault, cess] I, or sink, or having upon it or in any- 
 thing "ii such cart, an] manure, oi other nauseous or offensive substance, shall, 
 
748 
 
 REFUSE DISPOSAL. 
 
 mington, Del., the carts " when not in use must be kept under cover 
 and from public view." In Milwaukee scavengers' wagons must be 
 kept outside the city unless they are " rendered inodorous by the use of 
 carbolic acid or some other equally efficient deodorizer, and kept in a 
 tight barn or building." In Lowell scavengers must " avoid as far as 
 possible travelling in the principal streets when crowded." 
 
 In very many cities it is required that the apparatus be inspected 
 by the proper officers before the license is granted. Besides the prelim- 
 inary inspection and approval, it is necessary for the apparatus to be 
 inspected every three months in New Bedford, and every month in 
 Cincinnati, Jersey City, Minneapolis, and Wilmington, Del. 
 
 Methods of Removal. 
 
 In most cities the removal of night soil is left to private enterprise. 
 All the city attempts to do is to control the work by license and in- 
 spection, and perhaps by fixing a maximum price for which the work 
 shall be done. The following are some of the prices fixed by ordinance 
 or board of health regulations : 
 
 If over 75 cubic feet the charge is $4. 
 Fixed by agreement of scavengers. 
 $3 for subsequent loads. 
 
 Price per 
 
 Cubic Yard. 
 
 
 $5.40 
 
 Newburgh. 
 
 4.00 
 
 Milwaukee. 
 
 
 Minneapolis. 
 
 
 Denver. 
 
 
 District of Columbia. 
 
 3.24 
 
 New York City. 
 
 
 Yonkers. 
 
 
 Philadelphia. 
 
 
 Spokane. 
 
 8.00 
 
 Buffalo. 
 
 
 Chicago. 
 
 
 Mobile. 
 
 2.70 
 
 Elmira, X. Y. 
 
 
 Fitchburg. 
 
 
 < Htumwa, la. 
 
 
 St. Paul. 
 
 
 Wilmington, Del. 
 
 2.4:; 
 
 AVarren, (). 
 
 If over 100 cubic feet, $2.16; over 150 cubic 
 
 feet, $1.35. 
 If less than 20 cubic feet the minimum is $2. 
 If work is done by day, $2.16. 
 The minimum is $2. 
 
 without necessity therefor, stand or remain, nor shall a needless number gather 
 before or near any building, place of business, or other premises where any person 
 may be; nor shall any such cart or vehicle occupy an unreasonable length of time in 
 loading or unloading, or in passing along any street or through any inhabited place 
 or ground; nor shall any such cart or vehicle, or the driver thereof, or anything 
 thereto appertaining be (or by any person having a right to control the same, be 
 allowed to be), in a condition needlessly filthy or offensive; and when not in use, all 
 such carts, vehicles, and all implements used in connection therewith, shall be stored 
 and kept in some place where no needless offense shall be given to any of the people 
 of said city. 1 ' 
 
l'rice per 
 Cubic Yard. 
 
 
 »2.00 
 
 Boston. 
 
 
 Holyoke. 
 
 1.90 
 
 Cleveland. 
 
 1.65 
 
 Grand Kapids. 
 
 1.45 
 
 Manchester. 
 
 1.35 
 
 Lowell. 
 
 
 Providence. 
 
 
 Somerville. 
 
 REFUSE DISPOSAL. 749 
 
 Over 240 cubic feet, $1.55. 
 
 If over 80 cubic feet, SI. 65; over 120 cubic 
 feet, §1.50. 
 
 Barrels with solid matter are 20 cents each, and 
 the minimum charge for all work is 83. 
 
 Iii New Bedford the price is $2 for a load of twelve tubs, and in 
 Hartford #2 for ten tubs ; in Newton, Mass., $3 per load, but the size 
 of the tubs and loads is not given; in Manchester $3.50 per load of 
 twelve barrels. In Florence, N. C, fifteen cents per month is charged 
 for every privy and the work is done by the city. 
 
 It is possible to exercise a better control over the business if a license 
 is issued to only one party, and that is the method pursued in Boston, 
 Cleveland, District of Columbia, Hartford, Haverhill, Newton, Mass., 
 Portland, Me., Richmond, Ya., Somerville, Mass., Springfield, Mass., 
 and Warren, O. In Pittsburgh there are two licensees. This license, 
 or contract as it is often called, is usually for one }*ear, but in some of 
 the Massachusetts cities it is for three years. The form of the hist 
 contract in Boston may be found on page 93 of the report of the board 
 of health for 1898. 
 
 Whether or not there is one licensee or many, the city often assists 
 and controls the work through its own employees. Thus orders for 
 work are frequently received by the city at police stations, as in Cam- 
 bridge; or at the board of health, as in Boston and Cincinnati, and 
 either sent to the contractor or called for by him. This is to facilitate 
 work and assist the citizens rather than the licensee. A different plan 
 is pursued in Warren, ( >. i 1 
 
 "The owner of a closet desiring the same cleaned, applies to the sanitary office, 
 where, in a book for that purpose, is kepi a record "f the drawers and dimensions 
 of all vaults in the city. The sanitary policeman gives the owner a check "r slip 
 from a stuiehrmk of hkinks. wIico-mm is stated the name, street and number, the 
 
 amount in vault or drawer, as the rase may be, and the amount of money to l>e paid. 
 
 The holder takes this check or slip to the hank, pays the amounl required, the hank 
 stamps the slip •• paid," and drops it in a hoard of health metallic safety-box, with 
 Vai<- loch similar to government Letter-box, onlj smaller fastened in the bank 
 or some convenient place. The contractor, who has a kej to this box, goes to it 
 and gets the slip. This slip indicates to him bis order for work, and place where, 
 
 and also the important fact that the cost of said work is deposited in the bank. \i 
 the end ol « - : i . h month the president of the hoard of health ^i\es the contractor, in 
 exchange for the month's slips, a check on said hank for the amount." 
 
 Paper read bj William T. Fee of Warren at a meeting of Local Hoards of Health 
 of ohio. Columbus, 1895. 
 
750 REFUSE DISPOSAL. 
 
 In Cleveland the owner calls at the health department and makes 
 his payment in advance, which can well be done, for all vaults in that 
 city are of standard size, and the health officer sends the contractor to 
 do the work, and an inspector to see that it is done. One clerk is 
 detailed to look after this part of the office work. 
 
 The nature of this business is such that employers do not care to 
 give the work much attention, and hence are liable to be imposed on in 
 some instances, and in others to imagine that they are imposed upon. 
 The city occasionally steps in to help settle the dispute. In Cambridge : 1 
 
 "For the purpose of allowing the property owners an opportunity of ascertain- 
 ing the quantity taken from any privy vault or cesspool any police officer is author- 
 ized to detain for not more than thirty minutes any wagon or tank used for removing 
 the contents of privy vaults or cesspools. 11 
 
 In Yonkers, N. Y., " No scavenger shall be entitled to receive com- 
 pensation for such services until his verified account therefor has been 
 approved and certified to by the health officer." 2 See Appendix 118. 
 In Boston : 
 
 "Said board of health on complaint of a person charged for such work, may 
 cause the work to be measured, and if it measures less than reported by said com- 
 pany, said company shall pay the cost of measurement, and the charge shall be 
 abated accordingly. 113 
 
 In Philadelphia where a large number of orders (2,095 in 1896), 
 are issued by the board of health to remove the contents of privy vaults 
 the rules sriven below are in force. 4 
 
 Cambridge, Rules of Board of Health (1897), Sec. 27. 
 
 2 Yonkers, Sanitary Code (1897), Sec. 30. 
 
 3 Contract with Odorless Excavating Company, Boston, Board of Health Report 
 (1896), p. 94. 
 
 4 Philadelphia, Rules of Board of Health (1895), Sec. 137: 
 
 " The measurers shall, under the direction of the health officer, measure all wells 
 cleaned by order of the board, and shall furnish said officer with a duplicate copy of 
 an account of the measurement. If the cost of cleaning said wells exceeds the sum 
 of twenty dollars, they shall receive as compensation therefor a sum equal to six 
 per cent, of the amount of the bills. In all other cases the sum of one dollar only 
 shall be paid equally by the cleaners and the owners of the property froin whence 
 the nuisances are removed. They shall not grant a certificate of measurement until 
 the rule of the board " requiring the entire contents of the well to be removed, 11 
 has been complied with, unless otherwise ordered by the board. 
 
 "They shall refuse a certificate of measurement, unless furnished with the 
 original order and permit to £lean said well. 
 
 "They shall present the health officer with the certificate of measurement, 
 accompanied by the original order and permit for cleaning said well, within forty- 
 eight hours after the receipt of the order from the cleaner. 11 
 
UK FVsK DISPOSAL. 751 
 
 Two measurers are appointed by the board of health for this pur- 
 pose. They are also obliged to report all violations of rules. Of 2.207 
 inspections in 1895 they reported only three violations. In Denver the 
 scavenger is required to give a receipt to the owner of the vault. 
 
 A few cities proceed one step further and provide for the municipal 
 removal of night soil, though this has never been as popular as the 
 municipal collection of garbage and dry refuse. It is the plan pursued 
 in Atlanta, Brockton, Florence, X. C, Lawrence, Lynn, Macon, Mans- 
 field, O., Rochester, Salem, Mass., and Youngstown, ( ). ] 
 
 Frequency of ('/cm In;/. 
 
 ( Mi page 186 were given regulations in regard to the minimum distance 
 from the top of the privy vault which the contents might be permitted 
 to reach. As regards the time limit, quite a number of cities require 
 that privy vaults shall be cleaned annually. In Asbury Park, which is 
 chiefly a summer city, they must be cleaned between 1 November and 
 1 -lime. In Florence, N. C, where dry closets are in use they are 
 cleaned by the city each month. In Atlanta the health department 
 cleans the privy vaults once each week. 
 
 There arc very few regulations as to the frequency of cesspool 
 cleaning. 
 
 Hours for Cleaning Vaults and Cesspools. 
 
 As its name implies, night soil was at one time usually removed at 
 night because it was thought that if the owner of the premises was 
 asleep the offensive odors created by the crude apparatus formerly 
 employed would not be noticed. As a matter of fact the owner was 
 usually awakened by the noise if not by the odor, and the nuisance was 
 then felt to be more intolerable than in the day time. Moreover, it is 
 not as easy to do the work well at night, or as economical, nor is it as 
 easy to supervise it. So the work of removing night soil has in many 
 cities gradually been transferred to the day time. Nevertheless, the 
 regulations in a considerable number of cities still require that night 
 
 1 List of cities showing amount of night snil removed by municipal collection: 
 
 Amount. 
 
 9,949 loads or 7,986 tons of nighl soil. 
 2,699 loads of nighl soil. 
 4,7:;" loads <a cesspool matter. 
 615 loads of night soil. 
 
 i . 7 _m loads "f cess] I mat ter. 
 
 i ,8 16 loads of aighl soil. 
 966 loads <>f night soil. 
 *In Lynn the health department also cleanses catch basins with its nighl Boil 
 apparatus and charges it t<i the commissioners of drains. 
 
 \ « -: 1 1 . 
 
 City. 
 
 
 At lanta, 
 
 
 Brockton, 
 
 1899. 
 
 Law rence, 
 
 
 l,\ mi,* 
 
 
 Sal<- in. 
 
Bangor, Me 
 
 . . 10 P. m. to 4 A. M. 
 
 Biddeford, Me.. 
 
 . . 10 P. m. to 4 A. M. 
 
 Chicago 
 
 . . 10 P. M. tO 6 A. M. 
 
 Cincinnati 
 
 . .10 P. M. to 5 A. M. 1 
 
 Cleveland 
 
 . . 10 P. M. to 5 A. M. 
 
 Denver 
 
 . .10 P. M. to 5 A. M. 
 
 Hartford 
 
 . .11 P. M. tO 5 A. M. 
 
 Jersey City 
 
 . . 11 P. M. to 4 A. M. 
 
 
 June to September, 
 
 
 10 P. m. to 6 A. M. 
 
 
 < >etober to May. 
 
 752 REFUSE DISPOSAL. 
 
 soil shall be removed at night. The following are some of the cities 
 and the hours specified : 
 
 Asbury Park 11 p. m. to 4 a. m. May Kingston, N. Y. . . .10 p. m. to 6 a. m. 
 
 to October only. Melrose 9 p. m. to 6 a. m. 1 
 
 Augusta, Ga 9 p. m. to 6 a. m. Milwaukee 6 p. m. to 4 a.m. 1 
 
 Newburgh 10 p. m. to 5 a. m. 
 
 Niles, < > After midnight. 
 
 Omaha 10 p. m. to 5 a. m. 
 
 Ottumwa, la 10 p. m. to 5 a. m. 
 
 Rochester, N. II.. 10 p. m. to 6 a. m. 
 1 May to 1 Novem- 
 ber. 
 
 Spokane 10 p. m. to 4 a. m. 
 
 St. Louis 9 p. m. to 4 a. m. 
 
 Westbrook, Me . . .Sunset to sunrise. 
 
 In Buffalo, Providence and Philadelphia night soil must be removed 
 between sunrise and sunset, though permits are given to open grease 
 traps in the business district after sunset. In Fall River the time is 
 from sunrise to 6 P. M., in Manchester 6 to 11 A. m. and 1.30 to 6 p. M., 
 in Lowell from 7 A. M. to 10 A. M. and 1.30 p. m. to 6 p. M. In San 
 Francisco and New Orleans the work must be done in the day time. 
 
 Permits for Emptying Vaults. 
 
 A large number of cities in order to control and inspect the work of 
 scavengers require not only that the scavenger shall be licensed but 
 that a permit shall be required for the emptying of every vault or cess- 
 pool. 2 Some of the forms of permits in use are shown in Appendices 
 119-120. In Baltimore the permit is stamped by the keeper of the 
 dock where the night soil has to be delivered, and is then returned to 
 the health department and kept on file under the scavenger's name. 
 
 In most cities the scavengers are required to take out these permits 
 and are liable to be fined if they do not do so ; but sometimes, as in 
 Albany and Syracuse, the owner of the property is made responsible for 
 the permit. In Milwaukee the owner applies to the health department 
 and then the health department " orders " the scavenger named in the 
 application, to clean the vault. In San Francisco the driver of the 
 night soil wagon is required to have a copy of the permit. In many 
 cities no charge is made for such permits. In Scranton, Philadelphia 
 
 1 Unless odorless apparatus is used. 
 
 2 Among some of the important cities which have this requirement are Boston, 
 Baltimore, Buffalo, Chicago, Jersey City, Newark, New Orleans, Pennsylvania 
 cities of second class, Philadelphia, Reading. Rochester, San Francisco, Milwaukee, 
 Minneapolis, and St. Paul. 
 
REFUSE DISPOSAL. 753 
 
 and Reading the fee is fifty cents, but in the latter city it is one dollar 
 when the vault has been ordered cleaned by the board of health. In 
 New Orleans the fee is twenty-five cents, in Newark and Paterson, 
 ten cents. 
 
 Disinfection of Night Soil. 
 
 A very considerable number of cities require that the contents of 
 privy vaults and cesspools shall be disinfected before or at the time of 
 removal. The writer has often seen such disinfection attempted, but it 
 has never seemed that the deodorants every really accomplished the 
 desired purpose of destroying to any marked degree the objectionable 
 odors. As for real disinfection of the contents of a privy vault, that is 
 probably never in actual practice accomplished. The Lowell rule 
 given below is a typical one. 1 In Xew Orleans and Shreveport, La., 
 the disinfection must be done twenty-four hours before the removal of 
 the contents of the vault ; and carbolic acid or copperas must be used 
 i'oi that purpose. After the vault is emptied, it is to be disinfected 
 with lime. In Newburgh the disinfection is to be six hours before re- 
 moval and with carbolic acid or copperas. 
 
 Thoroughness and Promptness of Work. 
 
 It is often prescribed in the permits to empty vaults that the work 
 must be done within a given time, usually forty-eight hours. 2 Another 
 rule given below is found in a number of cities. 3 
 
 1 Lowell, Rules and Regulations of Board of Health (1894), p. 31, Rule 6: 
 
 "In no case shall the contents of any privy vault be removed unless the same is 
 properly disinfected before the work is commenced, and also during the progress of 
 the cleaning and after the completion of the cleaning, by such disinfectants as shall 
 be approved by the board of health." 
 
 8 Philadelphia, Rules of Board of Health (1895), Sec. 216: 
 
 l 'A permit for emptying or cleaning a privy well, vault, sink, or cesspool shall 
 he issued in the name of the licensed party applying for the same, stating therein 
 the location of the premises and the name of the owner, agent, or occupant thereof 
 go employing him. It must be obtained before said cleaning, and shall specify the 
 ila\ for the removing of the contents, bul maybe extended for two days longer, if, 
 in the jndgmenl of the clerk, the work waa deferred or postponed in consequence of 
 some unavoidable circumstances. Permits -.hull only be good ^f or forty-eight (48) 
 hours from date of issue (nol including Sunday or any legal holiday thai maj in- 
 tervene), and parties cleaning a well <>n a permit upon which the time or extension 
 herein specified has expired, will be considered as cleaning said well witl t a per- 
 mit, and wil BUbjed thelusehes tO the penalty of $25, :is provided hy the A < t Of 
 
 Assembly, forever] violation thereof." 
 ( hicago, I Irdinances 1 1881 I, Sec. 1867: 
 " The cleaning, emptying and removing of the contents of privy vaults, shall be 
 done in an inoffensive manner, and anj scavenger having begun any such scavenger 
 work, shall, withoul any interruption or delay, Finish the same, and shall in everj 
 instance leave the privj in as good condition upon the \ault as when the work was 
 undertaken. 11 
 
 18 
 
754 REFUSE DISPOSAL. 
 
 Many cities also require that the vault in all cases shall be cleaned 
 to the bottom, but in Cincinnati, Fall River, Jersey City, and Omaha 
 this only applies to vaults that have been ordered cleaned by the 
 health department. 
 
 Returns. 
 
 In a number of cities scavengers are obliged to make return to the 
 
 health department of all work done by them : 
 
 " Each scavenger shall make return to the commissioner of health of every per- 
 mit issued to him, within five days after the work shall have been performed, certi- 
 fying to the number of yards or loads removed from the vault or vaults therein 
 described, and the place where the same was deposited, under the penalty of not 
 less than ten dollars for each offense. 1 ' 1 
 
 Similar rules are found in other cities. In Cleveland and Spokane 
 the returns must be made in five days as in Chicago. In Cincinnati, 
 Omaha, Newbiirgh, and Yonkers they are to be made daily, in Milwaukee 
 within two days, in Denver weekly, in Warren, O., monthly, in Fall 
 River, annually. The form of return used in Milwaukee is shown in 
 Appendix 121. 
 
 Disposal of Ni<jlit S>>iJ. 
 
 The oldest and principal method for the disposal of night soil is to 
 deposit it on land and use it as a fertilizer. Such a method, unless 
 regulated, is liable to cause nuisance. There is, too, a temptation for 
 scavengers to deposit the contents of their wagons in the most conveni- 
 ent spot, whether on the surface of the land, into a convenient sewer 
 opening, or on the bank of some stream or lake. Hence cities have gen- 
 erally made it a rule that night soil shall not be deposited anywhere 
 within the city limits without a permit, or except in some place desig- 
 nated by the health department. 2 In Omaha night soil must not be 
 deposited within three miles of the city and in Wilmington, Del., within 
 one mile. Other cities as Lowell, and Mobile simply require its removal 
 beyond the city limits. When it is permitted to deposit night soil within 
 the limits of a city, it is invariably required, if it is deposited on land, 
 that it shall be immediately buried or covered with earth. Sometimes 
 more explicit directions are given, as in Rochester. 3 
 
 1 Chicago, Ordinances (1881), Sec. 1867. 
 
 2 Denver, Ordinance No. 44 of 1893, Sec. 51: 
 
 " The health commissioner shall designate the dumping grounds upon which may 
 be dumped the contents of vaults, privies and cesspools, and all garbage and refuse 
 of any kind whatsoever, and it shall be unlawful for any person engaged in cleaning 
 vaults, privies, or cesspools, or in hauling garbage or other refuse of any kind, to 
 dump such material on any other place or places in the city of Denver.' 1 
 
 3 Rochester, Ordinances of Board of Health, No. 29, Sec. 10: 
 
 "Until further directions of this board, the contents of privy vaults shall be re- 
 moved in the manner aforesaid, to a place or places designated by this board, and 
 
REFUSE DISPOSAL. 755 
 
 In Atlanta a part of the night soil is cremated, but the rest is 
 deposited in pits 8 by 10 feet by 5 feet deep. It is. then thoroughly 
 mixed with dry ashes from the crematory and afterwards covered with 
 earth and sown over either with grain or grass as rapidly as practicable. 1 
 In Salt Lake City it is disposed of in much the same way but causes 
 complaint from those who live near by. In Woonsocket it is deposited 
 in similar pits. 
 
 In the District of Columbia the night soil is collected in barrels and 
 tli*- barrels are carried down the river in scows. It is supposed to be 
 landed on the shores and used as a fertilizer but is said to be sometimes 
 dumped in the river. In Indianapolis it is composted with marl and 
 sawdust and after some months is used as a fertilizer. 
 
 Night soil contains a considerable amount of nitrogen in forms 
 readily available for use in fertilizer. The amount of course varies very 
 gnarly, depending upon whether the material is true night soil, or the 
 contents of cesspools, whether the vaults which contained it were tight 
 or leaching vaults, and whether much or little extraneous matter as 
 rain-water, ashes, garbage, rubbish and the like are mingled with it. 
 
 In order to make use of night soil in commercial fertilizers, it is 
 necessary to get rid of the large amount of water by evaporation, and this 
 is rendered difficult by the offensive character of the material, and also 
 by its chemical and physical properties. Attempts have been made to 
 use night soil in this way and processes are at present in operation in a 
 few cities. 
 
 In Baltimore the city has what is practically a perpetual contract 
 with a firm to remove the night soil from the city. The concern owns 
 four scows and one towboat. They have a dock not far from the 
 centre of the city, but in an isolated position, and it is required that all 
 the night soil be deposited at this dock on the scows. The contractors 
 (for the disposal) pay nothing for the franchise and receive nothing 
 Erom the city, but the scavengers pay the contractor twenty-five cents 
 for each _<") gallons of night soil. The contractor is secured by the 
 fact thai tbe scavenger has to present his permit at the dock, where it 
 is after payment of the U-v, endorsed by the contractor's agent and 
 
 shall be deposited <>n land in one of two ways. vi/.. ; In trenches aol less than three 
 feel in depth, in which the contents of the privy vaults shall not exceed three inches 
 
 in depth. Said contents shall !><■ covered with dry earth in a manner so thai aoi ( 
 
 tin- saiil contents shall be (risible or in anj manner offensive; or thej maj be 
 deposited into pits made for thai purpose, according to the directions "i this board, 
 and after each and everj <!••[>' >^ i t said contents shall be covered with a layer of dry 
 earth, which shall be al hast (oar inches in thickness or bj one fool in thickn* 
 drj manure." 
 
 1 Atlanta, Report of Board of Bealtfa 1 L805), p. 1. 
 
756 
 
 REE USE I) ISP O SA L. 
 
 returned to the health department. The method of loading is shown in 
 the accompanying cut. 
 
 Fig. 102. 
 Method of loading Night Soil on Scows in Baltimore. 
 
 The scow is towed to an isolated spot seven miles down the river 
 and the night soil is pumped out, steam from the towboat being used 
 for the purpose. Two large depressions in the ground are used to 
 receive the night soil, one being left to dry, while the other is being 
 filled. When dry enough to handle, it is shoveled out onto a protected 
 platform where it is further dried and finally sifted and sold as a fertil- 
 izer at about twenty dollars per ton. 
 
 Besides the making of night soil into a fertilizer, and its deposit on 
 land where it mostly ultimately becomes plant-food, night soil is some- 
 times gotten rid of without any attempt at utilization. This is the case 
 when night soil is deposited in rivers, lakes, or the ocean. The deposit 
 of night soil in lakes or rivers which are used as a source of municipal 
 supply is a most dangerous practice, and even if the waters are not put 
 to such use, nuisance and offence are likely to be created. Among the 
 cities which dispose of night soil in this way are Brooklyn, Cincinnati, 
 Cleveland, Davenport, Dubuque, Lynn, Minneapolis, New Orleans, 
 Pittsburgh, and St. Paul. 
 
 In Cleveland a large scow is kept moored at the lake front. It is 
 built somewhat like a catamaran with a space for the night soil between 
 
REFUSE DISPOSAL. 757 
 
 the two hulls. This is from time to time towed out into the lake and 
 there deposited. It is supposed to be taken ten miles from the city but 
 in had weather in winter may not be towed so far. The city pays forty 
 dollars per week for this disposal. 
 
 In Minneapolis and St. Paul the night soil wagons drive down to 
 the bank of the Mississippi and discharge their contents into the river. 
 In St. Paul it is discharged on to a shute which is kept clean with 
 water from an eight-inch flowing well. In Cincinnati it was formerly 
 deposited on a scow which was towed out into the river and there dis- 
 charged its contents: but the federal government ordered this discon- 
 tinued, so that it is now emptied into a sewer on the bank just before 
 the sewer empties into the river. At Pittsburgh one of the scavengers 
 has a float on the river onto which the teams can be driven and the 
 contents of the wagons be dumped in the water. The owner of the 
 float charges the others a small fee. Another scavenger has a tank 
 scow which is towed down the river a short distance and there dis- 
 charged. 
 
 Night soil contains so much water that it is rarely disposed of by 
 cremation, though in several cities a portion at least is carried to the 
 crematory. This is true of Atlanta, Camden, Dayton, Evansville, Find- 
 lay. <).. Jacksonville, McKeesport, Pa., Muncie, and New Brighton. 
 In Atlanta in 1898 there were cremated '2,'-\t\'2 loads of night soil. 
 In Dayton during thirty days there were cremated 1,900 barrels con- 
 taining 300 pounds to the barrel. During the year 1899 there were 
 cremated in that city ''>.7o4 barrels of night soil for which service the 
 scavengers paid the city $1,350.80. 
 
 Grease, Bones, etc. 
 
 Waste grease "I domestic production, commonly known as soap 
 
 grease, is usually an offensive material as it accumulates slowly and is 
 
 allowed to remain on the premises some time before sold to the " soap 
 grease man.'" This soap grease is usuallj collected by itinerant dealers, 
 who trade for it, using snap in exchange, or else pay cash, and who 
 make their collections in hand carts or modesl wagons. This business 
 tends to give considerable offence from the slow transportation of the 
 decomposing grease through the streets. Many cities attempl to regu- 
 late it by specific rules, ami others control it through general rules, such 
 as are referred t" on page 1 5 I. 
 
 These regulations require thai the collector shall be Licensed and 
 that the material shall hi' removed in tighl covered receptacles. In 
 
 man\ cities it is Bpecified that the wagons shall not stand on the street 
 
758 REFUSE DISPOSAL. 
 
 in one place any longer than necessary. 1 In Pennsylvania cities of the 
 second class such wagons are allowed to stand in one place not longer 
 than fifteen minutes, and in Cincinnati the time is five minutes. In the 
 latter city closed vessels are required between 1 October and 1 May. 
 In Denver grease can be collected only after sunset. In St. Louis soap 
 grease may be stored only beyond one mile from the city. 
 
 Besides domestic grease, there is in all cities a large amount of mar- 
 ket refuse consisting of tallow and bones, the latter having adherent a 
 large amount of fat and some flesh. These materials are usually col- 
 lected by parties who render them, and a considerable sum is paid the 
 market men for them. They are often quite offensive, particularly if 
 they are not collected daily in the summer time. Among the most ex- 
 plicit regulations of this business whieh the writer has seen are those of 
 Lynn 2 and Camden. 3 In Lynn the wagons must be brought to the 
 health department on the first of each month for inspection. The 
 license fee is one dollar per month. In Camden the fee is $75 per year 
 for each wagon. 
 
 A firm engaged in this business in several cities makes use of the 
 form of wagon shown in the accompanying illustration and in the city 
 of the writer it gave excellent satisfaction. This firm believes that it 
 is for their interest to collect market refuse daily as it is then in better 
 condition and the products obtained from it bring a better price. 
 
 !Fall River, Regulations of the Board of Health (1894), Sec. 13: 
 " No person shall allow any vehicle under his control, containing fat, bones, soap 
 grease or any bad smelling substance to stand in any street, alley, lane or on any 
 public grounds of the city, longer than is absolutely necessary for the purposes of 
 loading and unloading." 
 
 2 Lynn, Rules of the Board of Health: 
 
 " First. A license fee of one dollar per month for each and every wagon licensed 
 shall be paid. 
 
 Lk Second. Vehicles and vessels used exclusively for the transportation of bones 
 and tallow shall have a covering of canvas which shall completely cover the con- 
 tents of the vehicles and vessels so used. 
 
 tl Third. Vehicles used for the transportation of grease and other refuse matter 
 shall have a covered top to the same, with nap on front and rear, which shall be 
 kept down and fastened except when in actual use. 
 
 lt Fourth. All vehicles and vessels used in the transportation of either bones, tal- 
 low, grease, or refuse matter, shall be kept in such condition as will prevent the 
 escape of any of their contents, or the odor thereof, and entirely conceal the same 
 from view. 
 
 '• Fifth. Every vehicle so used shall have the name of the owner and number of 
 the wagon in letters and figures of two inches in size painted thereon in some con- 
 spicuous position. 
 
 -'■sixth. When the holder of this license discontinues the business for which it 
 is granted lie shall return it to this office. 
 
 " Seventh. Any violation of the above rules will cause a revocation of this license 
 and subject the offender to prosecution. 11 
 
 :i Camden, Ordinances, 28 July, 1890, and 26 June, 1893. 
 
REFUSE Ulsp s. 1 L. 
 
 759 
 
 Fig 103. 
 Fat Wagon used liy Schwarzschild & Sulzberger, of New Sqrk. 
 
 Old Junk, Rags, and Bones. 
 
 Among the various kinds of refuse or junk that are collected by 
 peddlers, those most liable to cause offence are hours and rags. Junk 
 bones differ from market bones, as the former are of domestic origin 
 and have usually been cooked and freed from most of the adherent fat 
 and meat. Midi rags and bono arc not usually offensive enough to 
 lied covering during transportation through the streets, and though the 
 collectors are usually licensed, it is by the police rather than by the 
 sanitary department. The storage of this form of junk may, however, 
 give rise to nuisance, and regulations in regard to it are Found in many 
 cities. Sometimes a permit for storage is required. It is sometimes 
 forbidden to store such jnnk in dwelling houses. ;is in Cambridge, 
 Lowell, and Lynn, [n Jersey City rags and bones must not he kept 
 
 within twenty feci of ;i dwelling. A more stringenl rule is found in 
 • ; i I district of ( lolumbia. 1 
 
 iict of ( !olumbia, Webb's Di| 
 ii Ski e II'. It shall be unlawful for any person to store, put, or place 
 
 bones which shall have been purchased <>v bartered in anj bouse, storeroom, stable, 
 
 bnilding, or place, within two I dred feet "t anj dwelling bouse, other than the 
 
 dwelling house of the person storing Buch bones, under a penalty of t i x . - dollars for 
 each and every day thai the same shall he stored, put, "i placed as aforesaid; and it 
 shall be unlawful for any person or persons to Btore old rags which shall have been 
 
760 REFUSE DISPOSAL. 
 
 Dead Animals. 
 
 Dead animals are of two classes, the smaller animals, as dogs, cats, 
 rats, hens, etc., which are altogether worthless, and the larger animals, 
 as horses, cattle, and swine, which are of value for their grease, hides, 
 and for fertilizer. 
 
 In regard to the smaller animals there is oftentimes no very efficient 
 means of getting rid of them, and it is no uncommon thing in many 
 cities to see them lying for days in yards and vacant lots, in ponds and 
 streams, and in the streets. In some cities, as Atlanta, Buffalo, Cleve- 
 land, Detroit, Houston, Tex., Lawrence, St. Louis, and St. Paul, the 
 garbage men are required to remove small dead animals if placed with 
 the garbage. In cities like Omaha, where the licensed garbage collector 
 receives his pay from the householder, the price for such removal is 
 fixed by ordinance. In Omaha it is seventy-five cents for each dog, and 
 twenty-five cents for each cat. If small animals are found on the street 
 it is usually the duty of the street cleaning department to remove them, 
 but in Philadelphia the garbage contractor performs this duty, and in 
 the City of New York the health department. In Denver a special 
 contractor collects and disposes of all dead animals for $1,500 per 
 annum. In Nashville they are collected by the board of public works. 
 In Mobile there is a special contractor who is paid by the city, but the 
 owner of the animal must pay if he can be found. In Richmond also 
 there is a special contractor. In a number of cities it is customary for 
 citizens to report dead animals to the police, and for the scavenger to 
 call at the station for orders. 
 
 If such dead animals are on private property the health department 
 may properly order the owner to dispose of them. In Providence this 
 is usually done if the private property is enclosed like a yard or area ; 
 but in the case of open lots, private alleys, and streams and ponds the 
 carcass is removed at the expense of the city. A considerable nuisance 
 is thus promptly abated at a small expense. 
 
 The larger animals usually have a considerable value. In most 
 cities one or more parties are found who remove such when notified by 
 citizens, police, or sanitary officers. Usually this is done without cost, 
 but sometimes a small charge is made, and in other cases a small sum, 
 
 purchased or bartered in any house, storeroom, stable, building, or place, within 
 fifty feet of any dwelling house, other than the dwelling house of the person storing 
 such rags, and the entire stock of old rags, so collected and stored, shall be removed 
 from the premises or shipped at least once in every fifteen days; and any person or 
 persons storing old rags, or refusing or neglecting to remove the same in accordance 
 with these provisions, shall be liable to a line of five dollars for every day that they 
 shall so offend." 
 
REFUSE DISPOSAL. 761 
 
 as one or two dollars, is paid. In St. Louis they must be delivered to 
 the garbage contractor. 
 
 Lest dead animals should be allowed to remain in the streets, it is 
 sometimes required that the fact of the body so lying shall be at once 
 reported to the city officer. 1 In Cleveland the report must be made 
 within eight hours. 
 
 While provision is thus made by private or public effort for the 
 proper disposition of dead animals, the improper disposition is usually 
 forbidden. The disposal of dead animals by throwing into public waters 
 is most objectionable, and this is often prohibited by laws designed to 
 prevent the pollution of rivers or to protect public water supplies. 
 Most of the legislation specifically relating to the disposal of dead ani- 
 mals is local, but some of it is statutory, as in Georgia, Maine, 2 Mis- 
 souri, and Vermont. The Georgia Law 3 applies only to counties con- 
 taining cities of 60,000 inhabitants, and requires that dead animals shall 
 be buried or made into a fertilizer within three hours. 
 
 Most of the local regulations forbid the improper disposition of dead 
 animals, and many of them follow the type of that of the City of New 
 York. 4 The rules also go further and prescribe what shall be done 
 with the carcass. 5 
 
 I New York, Sanitary Code (1899), Sec. 140: 
 
 II That it shall be the duty of tin- owner, and of the person that last had or then 
 having charge of any animal, so dead or injured oi diseased, and being in any street 
 or public place, to at once give notice thereof, and of the nearest street and avenue 
 where it may be, to sonic inspector or officer of this department, or of the sanitary 
 bureau, unless such animal is at once removed by some proper person." 
 
 Maine, Chapter 39 of 1899: 
 
 " Whoever personally or through the agency of another leaves or deposits the 
 
 carcass of a dead horse, row, sheep, hog or any other of t he larger domestic animals 
 
 in any place where it may cause a nuisance shall, upon receiving a notice to that 
 
 effect from the local board of health, promptly remove, bury, or otherwise dispose 
 
 of the remains, and if lie fails to do so within such time as may be prescribed by the 
 
 local hoard of health, and in such manner as may be satisfactory to such hoard of 
 
 health, shall he guiltj of a misdemeanor, and shall be punished by a tine of not less 
 than live nor more than twenty-live dollars, or by imprisonment not exceeding one 
 nioiit h.*" 
 
 ' I reorgia, ' lhapter 143 of L895. 
 
 New York. Sanitary Code (1899), Sec 187: 
 
 I 'hat no person shall leave in or thrown into any place or si reet, or public water, 
 nor offensively expose or bury, the body (or any part thereof) of any dead or fatally 
 si.k or injured animal; nor shall anj person keep anj dead animal or any offensive 
 meat, bird, fowl, or fish in a place where the same nun he dangi rous to the life or 
 detrimental to the healtb of any person/ 1 
 
 ' \ew Fork, Sanitarj I ode 1899 Sec. 139: 
 1 hat : 1 1 1 > person having a dead animal or an animal past recovery, and not 
 killed for and proper for use as meat or fish, or in anj offensive condition, or sick 
 with aii infectious 01 contagious disease on his premises in said city, and everj 
 
762 REFUSE DISPOSAL. 
 
 In smaller cities or cities where open land is accessible, it is some- 
 times required that dead animals shall be buried, as in Hartford, Jersey 
 City, Newport, R. I., and Newton, Mass. In Hartford they must be 
 buried within twelve hours ; in Jersey City six hours, and in Denver 
 three hours. In other cases they must be removed at the expense of 
 the city, as in Bradford, Penn., and Ottumwa, la. In Fitchburg they 
 are to be carried to the fertilizer factory, and in Bridgeport they may 
 be disposed of by burial, cremation, or rendering in a proper manner. 
 
 In a number of cities dead animals are consumed in the crematory. 
 This is reported to be the case in Atlantic City, Columbus Dayton, 
 Evansville, Jacksonville, Lowell (formerly), Macon, Muncie, Inch, New 
 Brighton, Portland, Ore., Richmond, Salt Lake City, Savannah, Scran- 
 ton, Yonkers, and Wilmington, Del. It is, however, likely that in 
 most of these cities the larger and more valuable animals are not so 
 treated, but are utilized. Indeed it would not be easy to get a whole 
 horse into the opening of an ordinary crematory. In Atlanta it is ex- 
 pressly stated 1 that few large animals are so disposed of, but in 1898 
 there were cremated 2,992 dogs. In Columbus in 1899 there were 
 cremated 2,366 dead animals. 
 
 When there are reduction works for the disposal of garbage dead 
 animals are usually taken to them as they furnish good fertilizer 
 material. 
 
 The most common method of disposing of the larger dead animals 
 is by skinning in order to save the hide, and rendering the rest of the 
 body. In nearly all the larger cities there are parties engaged in this 
 business, but in smaller places where there are not enough animals to 
 warrant the establishment of such a business, the animals have to be 
 buried. The regulations governing rendering have been considered in 
 another place. 
 
 It is sometimes prescribed, and even when it is not the law, it is 
 often the custom to remove dead animals in covered vehicles. 2 
 
 person whose animal or any animal in his charge or under his control in any street 
 or place, may die or become or be in a condition past recovery, shall at once remove 
 or cause the removal of such animal, dead or alive, to some proper place, and when 
 such place may be designated by the sanitary superintendent of this department, to 
 the place so designated.'" 
 
 1 Atlanta, Board of Health Report (1898), p. 29. 
 
 2 District of Columbia, Police Regulations (1896), Art. 8, Sec. 24: 
 
 " No dead animal of the horse, mule or jack kind, and no dead cow, goat, calf, 
 sheep, dog or swine, or any part of the aforesaid dead animals, shall be transported 
 thi( nigh any street, avenue, alley, or public space within the City of Washington, or 
 the more densely populated suburbs of said city, unless the same shall be conveyed 
 in vehicles substantially air tight, constructed either of wood or metal, or both; 
 nor shall any such dead animal or part thereof be deposited or left upon any wharf, 
 
RE F L sA' UISP SAL. 
 
 '63 
 
 Fig. ln4. 
 Wagon used in the District of Columbia for Dead Horses. 
 
 Fig. 105. 
 Deadhorse Wagon used in Providence 
 
764 REFUSE DISPOSAL. 
 
 In Pennsylvania cities of the second class steel boxes must be used 
 which must be water tight and be washed and disinfected after each 
 
 trip. 
 
 Other Offensive Substances. 
 
 Besides regulations specifically prescribing the manner of removal 
 of garbage, ashes, night soil, soap grease, etc., a number of cities have 
 other regulations applying to offensive matters in general or else in- 
 clude in night soil and garbage regulations general phrases intended to 
 include all kinds of offensive substances. Such general regulations 
 almost always require that offensive substances must be removed 
 in tisfht covered vehicles or vessels, that the work must be done in a 
 cleanly manner, and that a license or permit be required therefor. The 
 rules from Cleveland are a good example of such regulations. 1 
 
 A type of regulation governing the manner of collection and re- 
 moval, taken from the sanitary code of the City of New York, is given 
 on page 747. See also the Chicago rules on page 692. 
 
 Street Cleaning. 
 The cleaning of the city streets is usually in charge of the board of 
 public works, the street commissioners, or a special department. Some- 
 times, however, it is made a part of the duties of the health depart- 
 ment. This is true of Atlanta, Augusta, Ga., Memphis, Raleigh, and 
 Richmond. In Denver the health department removes refuse from 
 alle} T s while the street department cleanses the streets. 
 
 street, avenue, alley or public place within said city; and in all cases where such 
 animal or part thereof is transported upon the Potomac river or the Eastern branch, 
 it shall be unloaded from the aforesaid vehicle directly into a scow provided for the 
 purpose, covered and closed therein, and thereupon immediately conveyed beyond 
 the District of Columbia, or to such place within the said district as may be 
 designated by the health officer, and there so disposed of as, in the judgment of the 
 health officer, not to be injurious to health, nor offensive to sight or smell. Pro- 
 vided, That this section shall not apply to the transportation of animals intended 
 to be used for food." 
 
 1 Cleveland, Revised Ordinances (1892), Chapter 80: 
 
 "Sec. 493. No person shall transport night soil, swill, garbage, fat, bones, 
 offal, or any decayed or putrid or stinking animal or vegetable matter through any 
 of the streets, lanes, alleys, avenues or other public grounds of the city, except by 
 written permit of the director of police or health officer, and the same shall be 
 transported in vehicles or barrels that shall be effectually covered and water-tight, 
 so that no odors or liquids shall escape. 
 
 "Sec. 532. No person shall sell, barter, or give away, or cause to be sold, bar- 
 tered, or given away, by agent or otherwise, any house offal, slaughterhouse offal, or 
 any tilth, or any refuse substances from any slaughter house, dwelling house or other 
 place in the city, or the carcass of any dead animal, or part thereof, not killed for 
 human food, unless the person or persons so buying or receiving the same shall 
 have a written permit from the director of police or health officer to remove or 
 carry the same in or through the streets, avenues, squares, courts, lanes, alleys, or 
 places of the city." 
 
CHAPTER XIV. 
 
 MISCELLANEOUS SANITARY WORK. 
 Communicable Diseases of Animals. 
 
 THIS is a subject that receives far more attention from the stock 
 raiser, the business man, and the economist, than it does from the 
 sanitarian. Vast numbers of animals die every year from diseases 
 which are not communicable to man, and the death of these animals 
 entails pecuniary losses which mount into the millions. Diseases such 
 as pleuro-pneumonia, Texas fever, hog cholera, and sheep scab are not 
 directly dangerous to man, and it is to the prevention or eradication of 
 such diseases that the attention of law makers has been chiefly directed. 
 The subject matter of the great body of laws relating to the diseases of 
 animals, and most of the executive work of boards of cattle commis- 
 sioners concerns diseases which can only indirectly affect human health, 
 and hence are of no special interest to sanitary officials. Other dis- 
 eases which fortunately are much rarer among animals are sometimes 
 transmitted to man, and hence their control both in animals and man 
 properly comes under our consideration. Such diseases are glanders, 
 rabies, anthrax, actinimycosis and tuberculosis. How often the latter 
 is transmitted from animals to man is still a disputed question, but all 
 must admit that the probability of its being so transmitted is sufficient 
 to warrant health officers in taking the liveliest interest in the methods 
 which arc taken for the eradication of the disease in animals. It is 
 these diseases which are common to men and animals which il is pro- 
 posed to consider, and the laws and administrative methods which can 
 be made to apply to them. The federal, slate, and local governments 
 
 have all made efforts to control communicable animal disease. The 
 bureau of animal industry in the depart incut of agriculture has power to 
 make regulations to prevent the spread of these diseases and it has made 
 such rules and also enforced them, 8 •limes with great BUCCeSS, as in 
 
 the case of pleuro-pneumonia and Texas cattle fever; but this depart- 
 ment, engaged as it ostensibly is in the interests of foreign and inter- 
 state commerce, has given comparativel) little attention to the diseases 
 that are here under consideration. The state governments have \<\\ 
 generally interested themselves in the checking of glanders, rabies, and 
 
766 MISCELLANEOUS SANITARY WORK. 
 
 particularly tuberculosis, and have done much work in the attempt to 
 control them, and some of our cities have done still more. 
 
 Legislation concerning communicable disease of animals may be 
 found in almost every state and territory and in not a few cities. The 
 regulations of the latter are usually adopted by local boards of health 
 under their general grant of power, but sometimes as in Massachusetts, 1 
 " the board of health of cities and towns may take all measures neces- 
 sary or expedient to suppress or prevent the spread or introduction of 
 communicable disease among animals . . . and may make regula- 
 tions in writing for the purpose named." Similar powers are specifically 
 granted to town councils in Rhode Island and local boards of health in 
 Minnesota. Statute law relating to this subject may be found in the 
 annual reports of the bureau of animal industry. The items included 
 in such legislation so far as it concerns our subject are not very 
 numerous. 
 
 Importation of Disease. It is of course of the utmost importance to 
 prevent the introduction of a communicable disease into a country, a 
 state, or any smaller sub-division which is free from it. So far as the 
 whole country is concerned the secretary of agriculture is authorized to 
 make quarantine regulations for the control of foreign importations, and 
 he has done so, and they are enforced by the bureau of animal industry 
 as is shown in its reports. A large number of states also forbid the im- 
 portation of animals sick with communicable disease or which have been 
 exposed to such disease, and some cities do the same. Most of these 
 laws and regulations forbid the importation of communicable disease 
 without further specification, but glanders is mentioned in Arkansas, 
 California, Florida, Iowa, Maryland, South Carolina, Tennessee, and in 
 New Orleans. Rabies may not be imported into Florida and eighteen 
 states have laws against the introduction of tuberculosis. 
 
 Many of the state laws provide that the cattle commissioners, or in 
 some cases the governor, shall proclaim quarantine either at the state 
 boundary or against an}' infected locality ; but such power is rarely ex- 
 ercised against any of the diseases that are here considered. In Texas, 
 however, on 28 December, 1899, the governor issued a proclamation 
 against the importation of tuberculosis. 
 
 Notification. If a communicable disease once breaks out in a com- 
 munity, it is impossible for the authorities to take any action unless 
 they are made aware of the facts. As in human so in animal diseases, 
 it is required that persons having a knowledge of the existence of such 
 disease or suspecting it, shall notify the board of health or the cattle 
 
 Massachusetts, Chapter 491 of 1894, Sees. 24-5. 
 
MISCELLANEOUS SANITARY WORK. 707 
 
 commissioners as the case may be. Thus the owner is required to re- 
 port in Arizona. Illinois, Louisiana. Maine, Mississippi, Ohio, Rhode 
 Island, Tennessee, and Virginia, any person who knows of the case in 
 Colorado, Michigan, and Wisconsin, and veterinarians in Connectciut. 
 I usallv such reports are to be to the cattle commissioners or similar 
 officials, but in Colorado, Maine, and Tennessee the reports are to be 
 made to the board of health, and in Mississippi to the county super- 
 visors. In Massachusetts, Maine, New Jersey, and Wisconsin the local 
 board of health, and in ( onnecticut the selectmen are to notify the state 
 officials of any cases which come to their knowledge. In a number of 
 Massachusetts cities and in Charleston. Jersey City, and New York 
 City the owners or persons having knowledge are to report to the board 
 of health, and in Minneapolis, New Orleans, Xew York City, and Yon- 
 kers, veterinarians are to report. 
 
 It has been found in practice with human diseases, impossible to rely 
 upon reports from the friends or relatives of patients. If it were not 
 for physicians, a very much larger number of cases would go unreported 
 than does now. In animal diseases there is usually no physician to 
 rely upon. The owner looks after his animals himself and usually is 
 unable to make a correct diagnosis. It is generally for his interest if 
 lie does know of a case to conceal it. and concealment of animal dis- 
 eases is comparatively easy. Hence if state and city officials relied 
 upon reports from owners very few cases of animal disease would come 
 to their notice. It is through the operation of special inspectors that 
 most cases of animal disease are brought to light. The appointment 
 and duties of such inspectors will be referred to later. In some of the 
 western states, ;is Missouri, the law provides for the investigation of 
 rumors, for the statute provides that on the request of six citizens, who 
 state their belief that communicable disease exists, the state veterinary 
 surgeon shall be sent to investigate. 
 
 Investigation <m<l Diagnosis. Most of the laws which provide for 
 any executive action in cases of communicable disease of animals pro- 
 vide thai the officials shall investigate cases of suspected disease and 
 determine its nature and that they shall for this purpose have free access 
 to all animals, and that the owners shall give all required information, 
 ami shall do nothing to obstrucl the action of the officers. In M 
 chusetts the officials are authorized to put the witnesses under oath. 
 In some states, a- Colorado, Iowa, and .Maryland, the state officer is a 
 veterinarian, and in must states the cattle commissioners are authorized 
 t<> employ skilled persons to determine the nature of the disease. Such 
 cities ;i^ Boston, Lynn. Minneapolis, New York, St. Paul, and San 
 Francisco, thai have attempted to- deal energeticallj with these dis< 
 eniplo\ a veterinarian. 
 
768 MISCELLANEOUS SANITARY WORK. 
 
 Isolation. Probably the isolation of domestic animals can never be 
 maintained as successfully as that of human beings, and the latter all 
 health officers know, is difficult enough. Nevertheless, most laws require 
 the isolation of animals affected with communicable disease. Nearly 
 all the executive officers are authorized or directed to quarantine (with 
 the meaning of isolate) cases of communicable disease. Moreover, 
 the laws of a number of states 1 lay upon the owner the duty of isolation. 
 Sometimes the owner is simply required to isolate, at other times he is 
 forbidden to allow the animal to come in contact with others, to sell, 
 barter or give away, to slaughter for food, to allow upon the high- 
 way, to move or transport in any way, or it may be, as in Maine or 
 Illinois, the transportation companies are forbidden to carry infected 
 animals. In Illinois the penalt} 7 for violating this law is to be not less 
 than $1,000 nor more than <f 10,000. 2 Glandered animals must not be 
 driven or used. It is sometimes required that animals that have been 
 exposed to contagion shall be isolated. In Alabama dogs that have 
 been bitten by an animal suj)posedly rabid must be isolated for six 
 months. Among the more explicit isolation regulations may be men- 
 tioned those of California, 3 Maine, 4 Massachusetts, 5 and New Hamp- 
 shire.*' The expense of isolation is usually to be borne by the owner. 
 In Utah if an owner fails to isolate an animal as required by law he is 
 not only liable to a fine, but also for such damages as may accrue to 
 others through his negligence. 
 
 Killing of Diseased Animal*. Fortunately the state can largely 
 overcome the difficulties of isolation by an alternative which is not 
 admissible in the case of human diseases. In the case of animals suf- 
 fering from contagious disease it is allowable to effectually prevent the 
 spread of the disease by destroying the animal. The only troublesome 
 question that can arise is that of compensation to the owner. In Iowa, 
 Washington, and Wisconsin the law requires the killing of infected 
 animals, and the same is true of Massachusetts with the exception of 
 tuberculosis, and of the ordinances of Denver and Minneapolis. In 
 California, Connecticut, Louisiana, Utah, Mississippi, New York City, 
 New ( )rleans, and Omaha all glandered animals are to be killed. In 
 
 1 Arkansas, California, Colorado, Georgia, Illinois, Maryland, Maine, New Hamp- 
 shire, Massachusetts, North Dakota, Ohio, Oregon, Rhode Island, Tennessee, Utah, 
 and Vermont. 
 
 - Illinois, Annotated Statutes (189G), Chapters, Sec. 22. 
 
 3 California, Chapter 219 of 1893. 
 
 4 Maine, Statutes, Supplement (1885-95), Chapter 14(7)7. 
 
 5 Massachusetts, Chapter 491 of 1894. 
 
 "New Hampshire, Public Statutes (1891), Chapter 113. 
 
MISCELLANEOUS SANITARY WORK. 769 
 
 most states, however, the question of killing is optional with the execu- 
 tive officers of the state. Almost all such officers are authorized to 
 kill if they deem it necessary. Most of these states also provide for 
 compensation to the owner. 1 Almost every one of them (excepting 
 Minnesota, Michigan, and Illinois) provide that the value of the animal 
 shall be before killing determined by the state officers and owner, or in 
 case of their failure, by appraisal. Usually, however, a limit is set to 
 the compensation to be made. In Connecticut, Michigan, and Oregon, 
 it is the value at the time of killing, in Massachusetts the value at the 
 time of killing with a maximum of $40; in Xew Jersey for tuberculosis 
 three-fourths of the value at time of killing with a maximum of §100 
 for registered animals, and 840 for non-registered ; in Maine one-half 
 value in health, with a maximum of 8100 for pedigree animals and $50 
 for others: in New Hampshire one-half value in health up to 8100 ; 
 in New York one-half value in health up to 800 for registered cattle, 
 and $50 tor horses, but for tuberculosis the limit is 825 for non-registered 
 cattle: in Pennsylvania the limit is $50 for pedigree animals, and *-~> 
 for others, and for horses 840 and one-half value in pedigree horses ; 
 in Rhode Island the amount is one-half value when well, and in Ver- 
 mont the same with a maximum of 840. In Iowa the limit is $25, and 
 in Kentucky $50 in cases of tuberculosis. Several states attach other 
 conditions to the payment. In Maine the animal killed must have been 
 in the state three years, in Connecticut six months, and in Rhode Island 
 three months: in Michigan and New Mexico it must not have been 
 imported, and in Massachusetts it must (in tuberculosis) have been 
 kept in a sanitary manner. In Maine and Xew Hampshire if the owner 
 declines to accept the appraised valve, the animal is "quarantined" at 
 his expense and he is liable to a heavy penalty for breaking the quaran- 
 tine. 
 
 Disposal and Disinfection. Several of the states have laws in regard 
 to the disposal of bodies of animals dead with communicable disease. 
 In Arizona they must be burned, in Louisiana, Maryland, and Ohio 
 burned or buried, and in Delaware the owner musl cremate cases of 
 
 anthrax for which he is paid by the state $8 for large annuals, and $2 
 
 for swine, and $1 for sheep. In Maine and North Dakota the^ must 
 
 be buried within twenty-four hours, and in North Dakota they must be 
 
 buried six feel below the 'surface of the ground. In Maine, however, 
 
 'hey i r i ; i \ be rendered within forty-eighl hours after death, but in all 
 
 Imong such are Connecticut, Iowa, Illinois, Kentucky, Maine, Massachusetts, 
 Michigan, Minnesota, Missouri, \<-w Hampshire, New Jersey, Sen Mexico, New 
 Fork, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode island, Tennessee, 
 Texas, Vermont, Wes( Virginia, and Wisconsin. 
 
 4'.i 
 
770 MISCELLANEOUS SANITARY WORK. 
 
 cases in that state the cattle commissioners must promptly inject the 
 carotid artery with kerosene. In New York the flesh of slaughtered 
 animals is sprinkled with kerosene. 
 
 Connecticut by statute requires the disinfection by the owner of 
 premises occupied by glanders, but most of the states leave disinfection 
 to the executive officers. 
 
 Various methods have been adopted in the different states for 
 executing the laws relating to animal diseases. In some a single officer 
 is to inspect animals, isolate or destroy those infected and otherwise 
 enforce the laws. Such an officer may have assistant -inspectors, and 
 must do so if his work is to be efficient. States which have a state 
 veterinarian are Arkansas, California, Colorado, Idaho, Iowa, Louisiana, 
 Maryland, Missouri, Montana, North Dakota, Oregon, South Carolina, 
 South Dakota, Virginia, Wisconsin, and Wyoming. 
 
 In other states the executive is a board or commission, and in some 
 of those above named there is nominally such a board. In Delaware, 
 Florida, Kentucky, Minnesota, Mississippi, Nebraska, Utah, Washington, 
 West Virginia, and New York the state board of health is charged with 
 these duties, but in Minnesota and Washington the veterinarian of the 
 experiment station, and in the others the veterinarian of the agri- 
 cultural college is to have charge of the work. In New York the 
 execution of the animal laws relating to glanders and tuberculosis is 
 entrusted to the state board of health, the tuberculosis committee of 
 which looks after that disease. In Georgia, North Carolina, Rhode 
 Island, and Vermont the state board of agriculture is to look after dis- 
 eases of animals. In New York the commissioner of agriculture attends 
 to all diseases except tuberculosis and glanders. In Arizona, Colorado, 
 Connecticut, Illinois, Indiana, Kansas, Maine, Maryland, Massachusetts, 
 Michigan, Nevada, New Hampshire, New Jersey, New Mexico, Ohio, 
 Oklahoma, Pennsylvania, Tennessee, and Texas a special commission is 
 created. In New Hampshire the cattle commissioners consist of the 
 secretary of the board of health, the secretary of the state board of 
 agriculture and the master of the state grange. In New Jersey the 
 tuberculosis commission consists of the president and secretary of the 
 state board of agriculture, and three persons appointed by the presi- 
 dent. 
 
 Most of the cattle commissioners are appointed by the governor and 
 serve for a term of years. Many of them receive a compensation of $3 
 t ( > $5 per day of actual service. In New York the members of the tuber- 
 culosis committee of the state board of health receive $800 per annum. 
 When a veterinarian is the executive he usually receives a reasonable 
 salary. The commissioners are usually authorized to employ inspectors 
 
MIS < EL LA NEO Us s. YXU\ iRY WO UK. 771 
 
 and veterinarians, and it is through these that the actual work is chiefly 
 done. In Colorado there were, in 1898, seven inspectors : in Illinois, 
 fifty-eight ; in Iowa, twenty-three : in Maryland, fourteen ; in Minnesota, 
 six: in North Dakota, nine : in Washington, four: in Wyoming, six. 
 In Massachusetts at one time 465 inspectors were employed. 
 
 Not only have state officials done something towards the suppression 
 of communicable disease among animals, but in some instances the 
 municipalities have aided in this work and occasionally gone further 
 than the state officials. In Massachusetts. Mulligan, and Minnesota 
 the local boards of health conjointly with state boards, are charged with 
 the duty of enforcing the laws in regard to the communicable diseases 
 of animals. In Massachusetts also the local boards of health are 
 required to appoint inspectors of animals and provisions. In Boston, 
 Lynn, and Brookline, and some other towns these inspectors are vet- 
 erinarians. Veterinary physicians are also employed by the board of 
 health of some other cities to look after the contagious diseases of ani- 
 mals. Among such are the District of Columbia, Denver. New York 
 City. Minneapolis, St. Paul, Omaha, and San Francisco. In almost all 
 of these the attention of the officers is chiefly devoted to tuberculosis, 
 and employment of the officer was necessitated by the attempt to con- 
 trol the health of the animals furnishing the milk supply to the city. In 
 other cities veterinarians may he occasionally employed to investigate 
 special outbreaks as of glanders, or to make an experimental inspection 
 of dairy cows. 
 
 Tuberculosis. 
 
 The importation of tuberculous cattle into the Tinted States is 
 guarded against by the inspectors of the bureau of animal industry. 
 While this bureau might under the laws attempt to prevent the passage 
 of tuberculosis from one state to another, it has not as yet had the 
 means tor doing so. This is at present controlled by the states and 
 
 eighteen of them have Laws respecting it. ai ig which are low a. Maine, 
 
 Massachusetts, Montana, New Hampshire, New Jersey, Pennsylvania, 
 Rhode Island. Texas, and Vermont A common form of the law is that 
 requiring that no animal shall be imported without a certificate that it has 
 been inspected and tested with tuberculin with negative results. 1 In 
 
 1 Rhode tsland, A.i of 15 May, 1896: 
 
 14 Sec. 2. \ll persons, corporations, or companies intending n> ship, transport, 
 or i" drive cattle into the state must produce a certificate to the effect that the 
 cattle i" be shipped, transported, or driven are free from tuberculosis a-, far as maj 
 be determined bj physical examination and the tuberculin test The certificate 
 shall give a description of each animal brought into the state sufficiently accurate 
 for identification, and shall give also the date and place of examination of each 
 animal, the preparation of tuberculin used, the quantity injected, 1 1 * « - temj erature 
 
772 MISCELLANEOUS SANITARY WORK. 
 
 Texas cattle must not be imported for breeding or dairy purposes, but an 
 exception is made in favor of animals certified to as natives of Colorado 
 or Nebraska. In New Hampshire animals may be brought in for pas- 
 turage only, without the tuberculin test, provided they are sound on 
 physician's examination. In Connecticut, when any one imports cattle 
 from an adjoining state he must within six days notify the commissioner 
 on domestic animals. 
 
 Very little work has been done in eradicating bovine tuberculosis 
 by municipal health officers except in connection with the protection of 
 the milk supply, as was noticed in the chapter on dairy products. 
 Nearly all the active work except in a few cities, as Indianapolis, New 
 York, Minneapolis, St. Paul, Rochester, and Lynn, has been done by 
 state boards of health, and hence does not properly belong to our sub- 
 ject ; but the matter is one of such moment, and is one which so many 
 local boards of health are considering, that it is worth while to note 
 what the states are doing. Much of what follows is taken from the 
 seventh report of the state veterinarian of Maryland. 
 
 Illinois. 
 
 " The live stock commission has been conducting tests on herds where the own- 
 ers apply for it. All animals reacting are slaughtered without compensation, the 
 owners having whatever proceeds there may be from the sale of the hide and car- 
 cass; where the disease is slight, the beef may be sold, if fit, for food. During the 
 year 1897, thirty-six herds were tested, including 851 animals; of these seventy-seven 
 were found diseased, or about nine per cent. (This percentage includes a herd of 
 251 that had previously been tested.) Of the seventy-seven diseased animals, forty- 
 one carcasses were condemned and thirty-six passed as fit for food." 
 
 Massachusetts. 
 
 " Under Chapter 491, acts of 1894, some four hundred and sixty-five inspectors 
 were appointed, whose duty it was to inspect cattle and stables and report the 
 occurrence of any contagious disease. All cattle visibly affected witli tuberculosis 
 were killed and paid for, while many were tested at the state's expense at a cost of 
 $240,737.84. This does not include the cost of testing many more cattle, which was 
 made at the expense of individual owners. 
 
 " Condemned cattle were paid for upon written application for the test to be 
 applied, and upon the promise to thoroughly disinfect their premises, and to in- 
 troduce none but cattle tested (at owner's expense) in the future. This led to an 
 order that cattle to'be paid for must be tested by the cattle commissioners or their 
 authorized agent. The large amount of money spent and the number of animals 
 
 immediately before inoculation, the temperature at the eleventh hour, and every 
 two hours subsequent thereto for at least ten hours or until the reaction is com- 
 pleted. The certificate shall be signed by a veterinarian who is a graduate of a 
 recognized veterinary college, and shall be sent immediately to the secretary of the 
 state board of agriculture, who shall immediately notify a commissioner of the 
 county into which the cattle are to be shipped, transported, or driven, and said 
 commissioner shall examine the cattle to identify them. Failure to comply with 
 the law shall be considered a misdemeanor, punishable by a fine not to exceed one 
 hundred dollars." 
 
 The above law was recently weakened by amendment. 
 
MISCELLANEOUS SANITARY WORK. 773 
 
 destroyed caused great opposition and resulted in a change of policy. It is now re- 
 quired by law that each town and city shall appoint an inspector who will act in 
 conjunction with state hoards. 
 
 "This work may he considered under three heads : — 
 
 " 1. The supervision of the traffic in live cattle brought into the state. 
 
 '■ 2. A general inspection, the examination of cattle quarantined as diseased by 
 the local inspectors in the various cities and towns, and the payment for those found 
 to be infected with tuberculosis. 
 
 •■ 3. Testing entire herds for the purpose of permanently eradicating tubercu- 
 losis from the premises. 1 ' 
 
 In 1899 175,000 was appropriated and only 150,000 was to be 
 asked for the next year. Seven hundred and eighty-five tuberculous 
 animals were killed for which $17,277.69 was paid. Five hundred and 
 sixty-five animals were tested for owners who were trying to free their 
 herds, and of these sixty-three were condemned. 
 
 Maim . 
 ■ Maine was the first of the New England States to adopt the system of placing 
 quarantines on the admission of out-of-state cattle. The law was first enforced in 
 1892 against Massachusetts, because of the large per cent, of Massachusetts cattle 
 that were found-diseased. Later it was placed on all out-of-state territory, except 
 to such as were provided witli certificates of tuberculin test. The authorities in 
 Maim- test herds only on the voluntary application of the owner. The owner to 
 receive one-half the value, as determined on the basis of health before infection, t he 
 limit of compensation being one hundred dollars for pedigreed animals and fifty 
 dollars for others. The commission have power to investigate as to the existence 
 of disease and to condemn and destroy such as show physical evidence of disease. 
 During the year 1898 11") head of cattle were destroyed at an appraisal of $ 18, 122." 
 
 Michigan. 
 
 u Cattle found to be tuberculous are quarantined and killed. The law does not 
 provide compensation, however, and, as a result, the commission has met with a 
 good deal of opposition. The commission lias followed tin- plan of testing with 
 tuberculin such herds as have been brought to their attention as suspicious, killing 
 such ;is react, with compensation. 
 
 " During ls'.iT and ls'.is the commission has applied the tuberculin lest to nearly 
 1,000 head of cattle, a goodly proportion being milch cows. In fact, a larger mini- 
 1m i of cattle have been tested for tuberculosis during the last two years than had 
 previously been tested since the tuberculin test was adopted by the commission. 
 
 " The tuberculin test is applied only when suspicion is directed toward, or com- 
 plaint made of, either a single animal or an entire herd. The records of tests made 
 show but a small percent of infected animals, and when we consider the tact thai 
 onlj suspicious herds are tested, we feel safe in estimating that less than two per 
 cent, of the cattle in Michigan are affected with tuberculosis/ 1 
 
 Minrti %ota. 
 
 11 All cattle which show symptoms of tuberculosis must be quarantined at once 
 and the entile herd tested with t ubeivulin. When cattle have ome reacted the 
 owner has his option . ,t having them killed or continued in quarantine for a period 
 n..i to exceed three mouths, when they are again tested, ir thej read on the 
 second test, they must be killed within one month. The owner has no compensa- 
 tion for cattle killed, bul he is allowed to have them killed under inspection, and. if 
 they pass, he oan dispose of it like any other beef, tn 1898,2,975 cows mostly fur- 
 nishing milk to St. Paul were tested and 6.81 per cent were condemned.'" 
 
774 MISCELLANEOUS SANITARY WORK. 
 
 New Hampshire. Diseased animals are reported to the commission 
 through the selectmen, and are released or condemned on physical 
 examination. When the owner applies for inspection of his herd, and 
 where there is reason to believe the disease exists, the board may treat 
 the entire herd, the owner receiving half compensation. In 1898 225 
 herds were tested and 148 animals killed, for which $2,894 was paid. 
 
 New Jersey. 
 
 "Sew Jersey has a commission of seven members. The commission, on appli- 
 cation from the owner, the state board of health, or the state dairy commission, will 
 make an examination of suspected herds, the reacting animals to be condemned and 
 killed. They are appraised at their market value, not exceeding forty dollars, the 
 owner receiving compensation at the rate of three-fourths of their valuation.'" 
 
 In 1898 there were tested 1,438 cows, of which 245 were con- 
 demned. The cost of inspection was $1,179, and the amount paid for 
 the cows was $5,098.20. 
 
 New York. In New York State tuberculosis in cattle is handled by 
 a tuberculosis committee of the state board of health. No appropria- 
 tion has been made by the legislature for the use of this committee, 
 and no cattle have been ordered killed, except where the owners have 
 waived all right to compensation. The committee, however, have 
 received many requests from owners asking to have their herds tested, 
 and also to test the animals belonging to public institutions. 
 
 Pennsylvania. It has been the practice in Pennsylvania to test 
 herds only on the application of the owner, and then only where the 
 disease was suspected to exist. The application is made on a printed 
 form, and in making the application the owner promises to observe every 
 direction recommended that tends to the purification of his premises, 
 If he has to tear down half his barn, or cut windows through his stables, 
 or put in new floors, he agrees to do that before the examination is 
 made, and he agrees also to procure his animals for restocking from as 
 healthy a source as possible. It has been impossible, however, to 
 comply with all the requests sent in, and, as far as possible, the worst 
 herds have been picked out for testing. Reacting animals are all con- 
 demned and compensation given the owner. 
 
 "At the time of publication of the last annual report the average appraisement 
 for cattle condemned was twenty-four dollars and lifty cents. Since the beginning 
 of the last fiscal year the appraisement has been twenty dollars and forty-five cents. 
 The total payments for tuberculous cattle to date (January 1, 1898,) amount to 
 $57,191.16 for 2,510 animals, an average of $22.78 per head. 
 
 " In Pennsylvania the number of cattle tested up to the first of June, 1897, was 
 9,108; the number condemned as tuberculous was 1,839, a percentage of 20.39. 
 Since the first of June 4,887 cattle have been tested; of these 671 were found to be 
 tuberculous and were killed, a percentage of 13.73. All parts of the state are repre- 
 sented among these herds, as only herds suspected as diseased are tested. It would 
 
MISCELLANEOUS SANITARY WORK. 775 
 
 seem to be fair to assume that many of the worst herds have been discovered, and 
 that the percentage of tuberculosis among cattle at large is being steadily and 
 rapidly reduced.'" 
 
 Rhode Island. Rhode Island has a commissioner in each county, 
 appointed by the board of agriculture, whose duty it shall be to inquire 
 into the condition of any animal in their county whenever there is any 
 reason to suspect tuberculosis. When any animal is thought to be 
 tuberculous by a commissioner, he shall immediately quarantine and 
 examine. In 1898 496 animals were killed, for which $9,014.50 was 
 paid. 
 
 I r ermont. 
 
 " Vermont, with itssmall percentageof diseased animals, lias probably been more 
 successful than any other slate in its attempts to control tuberculosis. Since Feb- 
 ruary the 1st, 1897, tin. 0110 have been tested and 2,360 have been found diseased and 
 killed, a percentage of disease of nearly four per cent. In Vermont no animals are 
 tested unless the owners allow the entire held to be tested, and thereafter every 
 animal admitted to the herd must he tested and the stables thoroughly disinfected. 
 The commission test only where application is made by the owner. In their annual 
 report a list of seventy-eight retested herds is given in which tuberculous animals 
 were found. Twenty-three herds were found free on the second test, and twenty- 
 three hail only die case each on the second test. Bight of the remaining herds that 
 were found diseased <m the second test were free on the third test. The report 
 states that l the proper disinfection is a more difficult matter than is the discovery 
 of the diseased animal." 
 
 "The commissioners "have found that cattle buyers from slates where no quar- 
 antine was enforced have purchased many suspected animals at a juice a little less 
 than would have been paid if not suspected." 1 
 
 Wisconsin. The state hoard of health are applying the tuberculin 
 te8l to infected herds reported, as far as their means will allow, and 
 Condemning the animals that react 10 the test, the state paying two- 
 thirds of the appraised value 
 
 It is thus seen that a few cities haw attempted probably with a very 
 fair degree of success to stamp out tuberculosis among the cows within 
 their limits or among those furnishing the milk supply to the city. In 
 Massachusetts and Vermonl the state authorities have made very 
 Btrenuous efforts to eradicate the disease. In this, the former state at 
 leasl has not been very successful, and by the efforts made createdgreal 
 opposition which verj decidedly crippled the work by cutting down the 
 appropriation. All of the states named attempt at present to destiny 
 the herds most affected, and to help those who really desire it, to tree 
 
 their farms from tuberculous animals. How much they bave really 
 accomplished in this direction is not entirely clear, bul some, as 
 Dr. Pearson, state veterinarian of Pennsylvania, and the state officials in 
 Vermont, are optimistic enough to believe thai the course pursued in 
 those states will in the not distant future, reduce the number of tuber- 
 culous animals, to a very small percentage. 
 
776 MISCELLANEOUS SANITARY WORK. 
 
 Glanders. 
 
 As in tuberculosis so in glanders a number of states specifically for- 
 bid the importation of the disease, and in others the general laws against 
 the importation of any communicable disease would of course include 
 this. Alabama, Arkansas, California, Iowa, Louisiana, Massachusetts, 
 Michigan, Mississippi, Missouri, New York, Oklahoma, Tennessee, 
 Washington, and Wisconsin, provide that all glandered animals shall 
 be isolated or killed, and usually impose upon the owner a penalty 
 for failure to do this. It is also often forbidden to drive upon the 
 highway, or to expose in public, or to sell a glandered animal. The 
 authorities having charge of such matters are usually empowered to kill 
 glandered animals, and sometimes, as has been noted, compensation is 
 allowed. It is often required that owners shall report glandered 
 animals. Besides the states referred to many cities have regulations in 
 regard to this disease among which may be mentioned Atlanta, Charles- 
 ton, Chicago, Cleveland, Denver, the District of Columbia, and Omaha. 
 
 These laws are sometimes enforced by state boards and sometimes 
 by city officials, and in some states, as Massach.usetts.and Minnesota, the 
 state and local officers co-operate. In Michigan the live stock sanitary 
 commission in its report for 1898-9 states that pursuing a policy of 
 exterminating the disease has nearly eradicated it from that state. The 
 Illinois state board killed 90 horses in 1898 and tested many more, 
 using mallein. Pennsylvania reports very little glanders, only 13 cases 
 having been discovered in 1898. In Minnesota on the other hand in 1898 
 507 suspected cases were reported of which 317 were killed without 
 compensation. In Massachusetts also the disease is on the increase and 
 there were killed 543 animals, much more than ever before. In Boston 
 and Lynn the control of glanders and rabies is vested in the board of 
 health. Bacteriological examinations are made in cases of suspected 
 glanders in Boston, a serum tube and swab being used, very much like 
 a diphtheria outfit. In 1899 193 animals were examined and killed. 
 In Lynn 14 horses were examined and 8 killed. The New York City 
 board of health does a little in the way of examining horses and also 
 prepares mallein for the purpose. In Minneapolis and St. Paul glanders 
 receives considerable attention from the health department, and in the 
 former city, in 1899, a large number of horses were examined, of which 
 129 were killed, and it was stated that the disease was increasing. 
 
 Rabies. 
 
 This disease is not very common, being unknown in some parts of 
 the country but sometimes occurring with considerable frequency in 
 others ; but it is one which appeals strongly to the fears of many, 
 
MISCELLANEOUS SANITARY WORK. 777 
 
 although its existence is denied by some. There is not much statutory 
 legislation in regard to it. In Florida it is forbidden to import it, and 
 in that state and in Alabama, Massachusetts, and Michigan cases must 
 be killed or isolated (in Alabama for six months). New York City, 
 Minneapolis, and the District of Columbia have similar regulations. In 
 Boston the owners of rabid animals must report them to the board of 
 health and the latter has authority to investigate and condemn. In 
 most states the same action could be taken under the general laws 
 relating to the communicable diseases of animals. In Massachusetts 
 every dog license must have printed upon it a description of the 
 disease. Aldermen and selectmen are empowered to order that all dogs 
 shall be muzzled and the health officer of the District of Columbia has 
 similar authority. 
 
 In Pennsylvania in 1898 1 there were fifty-five authenticated cases 
 of rabies in dogs, three in horses, six in cattle, four in pigs, one in a 
 goat, ten iii sheep, and four in human beings. Most of these cases were 
 in Allegheny and Beaver counties, and the live stock sanitary board 
 issued an order for the muzzling of all dogs in those counties for sixty 
 days. In Minnesota from 1896 to 1900 at least eighty-four cases of 
 rabies came to the knowledge of the state laboratory, in thirty-one of 
 which the diagnosis was proved. Four of these were in human beings. 2 
 If it is possible to secure with certainty all animals bitten by a rabid 
 one they may be killed or quarantined, but if it is suspected that in- 
 fected animals are at large all dogs should be muzzled, as it is by dogs 
 almost entirely that the disease is spread. The adoption of these 
 methods is said to have almost exterminated the disease in England. 
 In muzzling a considerable area should be included, and for this reason 
 the Massachusetts law which leaves it to the towns is bad. There lias 
 been considerable rallies in eastern .Massachusetts, and the towns and 
 cities have from time to time enforced a muzzling ordinance. In Lynn, 
 Boston, Minneapolis, St. Paul, ami Denver, in 1898, numerous animals 
 
 were killed and examined for rallies by laboratory methods, but diffi- 
 cult} was experienced in the latter city owing to trouble iii getting the 
 
 necessary rabbits on which to tesl the virus. In Massachusetts of 
 thirt\ cases tested iVoin March, L897, to December, L898, by the 
 pathologist of the state board of cattle commissioners, twenty proved 
 to be rab 
 
 In the District of Columbia 4 the number of cases of rabies in dogs, 
 
 1 Pennsylvania, Report of State Veterinarian 1898, p. 12. 
 
 i.i. Wesbrook, St Paul Medical Journal, October, 1900. 
 
 Journal ■•! Boston v "< ietj •■! Medical s ' iences, Vol. ••. p. B3. 
 1 Bureau of Animal Industry, Department "f Agriculture, Circular No. 30, 1900. 
 
778 MISCELLANEOUS SANITARY WORK. 
 
 as demonstrated in the laboratory, was in 1898, seven ; in 1899, nine- 
 teen ; in 1900 (to March 31), fifteen. From October, 1899, to 30 
 April, 1900, twenty-four human beings in the District were bitten by 
 rabid animals. A six months muzzling order is now in force, but was 
 met with much popular opposition. It is the opinion of the health 
 officer that the muzzling should continue for a year. At the present 
 writing (January, 1901,) the mayor of Rochester has just issued an 
 order that all dogs shall be muzzled for six months. 
 
 In some cities, as Jersey City and Hoboken, the licensing of dogs is 
 in the hands of the local board of health. 
 
 School Hygiene. 
 
 The sanitary construction of schoolhouses and management of 
 schools is a matter of vast importance. Yet there is a great amount of 
 ignorance displayed in both the construction and management. Defects 
 are of course often seen by school boards when the} T cannot remedy 
 them, simply because they have no money ; but oftentimes the reason 
 why the defects exist is because they are not seen. The primary object 
 of our school system is of course the mental training of the young, and 
 those who are most fitted to provide this are not always the best fitted 
 to provide for the physical welfare of the pupils. Health officials who 
 are devoted to their work always take an active interest in the schools 
 of their district, but there are decided limitations to the good which 
 they can accomplish. The management of the schools is hi another 
 department, and one noted defect in our methods of municipal govern- 
 ment is lack of co-ordination between its different departments. The 
 health department rarely has any control over the school department, 
 and advice is usually not heeded. Even if the health department can 
 issue orders to the school board it would rarel} T be wise to do so, for 
 the result would be likely to be a quarrel which would do no good to 
 either. For these reasons it has come about that health officials have 
 done far less for the advancement of school hygiene than might have 
 been expected. There has also been comparatively little legislation 
 concerning hygiene of schools. A compilation of the laws on this sub- 
 ject was made by the United States commissioner of education in 1894 1 
 and is not very voluminous. Laws and ordinances in regard to vaccin- 
 ation and communicable diseases have already been considered. Many 
 states also have laws prescribing the strength of school buildings and 
 how they shall be constructed so as to be as secure as possible against 
 fire. Many states also require that schools shall be provided with fire 
 
 1 Report of Commissioner of Education (1893-4), p. 1301. 
 
MISCELLANEOUS SANITARY WORK. 779 
 
 escapes, and that doors shall open outwards. 1 Such regulations hardly 
 come within the scope of this work. 
 
 One of the most important means of improving the construction of 
 schoolhouses would he to have the plans of all buildings about to he 
 constructed submitted to some competent authority which could com- 
 pel such plans to he made in accord with recognized sanitary prin- 
 ciples. Such control lias not generally been very successful in the 
 United States, because it is not easy to find a central authority which 
 is really competent to pass niton schoolhouse plans, and because such 
 an interference by the state in local affairs, or such control of one 
 municipal department by another is not acceptable. In a lew states as 
 Colorado, Denver. Kansas, Tennessee and Wisconsin the state board of 
 health is authorized to advise with the school authorities in the con- 
 struction of schoolhouses. and in other states the state board under its 
 general grant of power does so advise, but Vermont is the only state 
 where it does exert any direct control. In California, Kentucky, 
 Virginia and West Virginia the county superintendent of schools, and 
 in New York the state commissioner, is to approve all schoolhouses, 
 and in Pennsylvania the state superintendent of schools is to prepare 
 plans and estimates of different types of buildings for the use of local 
 school boards. Jt is only in .Massachusetts, Connecticut, and Vermont 
 that any efficient control of school construction is exercised by officers 
 outside the school department, and even then the supervision only 
 covers construction, lire, and ventilation. In Massachusetts the factory 
 inspectors who are state officers are to approve all schoolhouse plans, 
 alter which no change can lie made in them.'-' h is further provided 
 in Massachusetts- that the factory inspectors may compel changes 
 in the ventilation of school buildings, and any school or other official 
 who fails to obey an order of a factory inspector within four weeks is 
 to be lined not to exceed $100. The act establishing a board of health 
 
 in Detroit gh es that board similar power. In < Oklahoma the rules of the 
 
 Liuong states which have such laws are < lolorado, Connecticut, Illinois, Indiana, 
 Massachusetts, .Maine, Michigan, Missouri, Nebraska, Nevada, New Hampshire, 
 Niw Jersey, Ohio, Pennsylvania and Wisconsin. 
 - Massachusetts, Chapter 388 <.r 1894. 
 
 Massachusetts, Chapter 508 of 1894, Sec. 12: 
 •• Whenever it shall appear to an inspector of factories ami public buildings that 
 furl lire or differenl sanitary provisions or means of ventilation are required in any 
 public building or Bchoolhouse in order to conform to the requirements of this act, 
 and thai the same can be provided withoul incurring unreasonable expense, such 
 inspector maj issue a written order e* the proper person or authority directing such 
 sanitary provisions or means of ventilation i" be provided, and they shall thereupon 
 
 he provided in accordance with Buch order bj the public authority, corporati r 
 
 m having charge of, owning "i [easing such public building or Bchoolhouse." 
 
780 MISCELLANEOUS SANITARY WORK. 
 
 state board of health give this right to local boards, and in Connecti- 
 cut the state board of education has similar powers. The insertion of 
 the terms " without unreasonable expense " in the Massachusetts law it 
 is to be feared, makes it difficult to improve those houses that most 
 need it. In Vermont 1 the state board of health is directed to issue a 
 circular of information on schoolhouse construction and the statute 
 provides that: 
 
 "All school houses hereafter built shall be constructed in respect to lighting, 
 heating, ventilation and other sanitary arrangements according to regulations fur- 
 nished by the state board of health." 
 
 In New York cities of the second class the health officer can stop 
 the erection of any public building which is not satisfactory. 
 
 Nine states, Connecticut, Iowa, Kansas, Massachusetts, Maryland, 
 Nebraska, Nevada, New York, and Pennsylvania require that school- 
 houses shall be provided with a suitable number of privies, water-closets 
 or earth-closets. A number of the states require that privies for the 
 two sexes shall be provided and that they shall be separated, and in 
 Pennsylvania 2 unless they are at remote distances the approaches and 
 walks shall be separated by a substantial close fence not less than seven 
 feet high. The Massachusetts law 3 requires that " every schoolhouse 
 shall be kept in a cleanly state and free from effluvia arising from any 
 drain, privy, or other nuisance." Pennsylvania 4 goes further and pre- 
 scribes how the schoolhouses shall be kept clean. 
 
 Most of the labor of keeping the schoolrooms clean seems to be lost 
 if the children are allowed to remain filthy. In the country the prob- 
 lem of keeping the children clean is not so serious a one, but in city 
 
 1 Vermont, Chapter 102 of 1896. 
 
 2 Pennsylvania, Chapter 279 of 1893. 
 
 3 Massachusetts, Chapter 508 of 1894, Sec. 4. 
 
 4 Pennsylvania, Chapter 165 of 1895 : 
 
 " Section 1. Be it enacted, etc., That the boards of school directors and con- 
 trollers of each school district of this commonwealth, be and they are hereby re- 
 cpiired at least once during each school term, and prior to the first of January of each 
 year, and within thirty days after the close of each annual school term, to have 
 taken out, removed and hauled away all excrement and waste matter from every 
 out-house or water-closet connected with or standing upon the premises of every 
 public schoolhouse in the commonwealth, or have the same properly disinfected; 
 and they are required to have every out-house or water-closet properly scrubbed, 
 washed out and cleaned, the inside walls whitewashed, and the vaults or receptacles 
 covered with a layer of fresh dirt or dry slacked lime within ten days of the opening 
 of each annual school term. 
 
 " Sec. 2. That the president of each board of school directors or controllers is 
 required each year to certify in the regular form provided for that purpose, that the 
 requirements of this act have been fully carried out before the district can draw its 
 annual appropriation from the state." 
 
MIS C ELLA NEO Us & i NIT A BY II r ORK. 781 
 
 schools in the poorer sections of the city it is more difficult Many of 
 the city school boards have rules fori lidding children to he in school 
 who are unclean in person or dress. Such a rule is, however, not easy 
 to enforce, and children are rarely sent home for failure to comply with 
 its requirements. Boston, in one school, the Paul Revere School, seems 
 to have solved the problem, at least. so far as cleanliness of person is 
 concerned. Shower baths have been constructed in the basement of the 
 school for the use of the pupils. On the boys' side the baths are all in 
 one room around the sides of which are arranged benches on which the 
 boys may sit while undressing, and above are hooks on which they may 
 hang their clothes. On the girls' side separate dressing rooms and sep- 
 arate bathrooms are provided, making the girls' outfit much more expen- 
 sive than the boys'. Soap and towels are free. Bathing is not com- 
 pulsory, but practically all the children use the bath. For this purpose 
 each room is given one hour a week of the regular school time. Similar 
 baths have recently been put in a public school in New York City. 
 
 The heating and ventilation of schoolrooms is of the utmost import- 
 ance, but there is practically no statutory legislation in regard to it, ex- 
 cept that of Massachusetts and Connecticut above referred to. New 
 York City, 1 Chicago, and some others following them, have a general 
 rule which requires that the ventilation and heating as well as every- 
 thing else about schoolhouses shall be managed as well as possible, — a 
 rule so genera] in its provisions that it is probably of little use. In the 
 school board rules of several cities regulations are found concerning 
 ventilation, heating, temperature of the rooms, form and size of scats. 
 methods and manner of cleaning, etc., but rarely or never are these 
 matters regulated by the department of health. None of these matters 
 appear to be touched by statute law except in Kentucky. 2 
 
 The thorough inspection of schoolhouses is desirable to discover 
 what detects ought to be remedied and what can be remedied at a rea- 
 
 1 city of New Fork, Sanitary Code (1899), Sec. 190. 
 Kentucky, Statutes 1 1894) ; 
 
 "Sec. 1440. . . . Each schoolhouse hereafter erected shall have a rl 'space 
 
 of not less than ten square feel to each pupil in the district; shall be at least tea 
 feet between floor and ceiling; shall have at hast four windows, one or more fire- 
 places, with chimneys made entirely "i brick or stone, or a sufficient aumbei of 
 stoves or other beating apparatus, with safe thus, to warm the room in the coldest 
 weather. . . . The trustees shall furnish cadi schoolhouse with at least the fol- 
 lowing articles .,i furniture and apparatus, ... a seat, patent '>■■ otherwise, 
 with back, for each child, the height of the Beat and its hack to suit the age "t the 
 
 child. . . . 
 
 14 Sec. W47. . . . They shall see that a sufficient supply of g I water is fur- 
 nished within easy access of the Bchoolhouse foi the benefit "f the school during the 
 term of school. . . . -1 
 
782 MISCELLANEOUS SANITARY WORK. 
 
 sonable expense. Massachusetts has provided for such inspection by 
 its state factory inspectors and in Ohio 1 local boards of health are " re- 
 quired to inspect semi-annually and oftener if in the judgment of the 
 board it shall be deemed necessary, the sanitary condition of all schools 
 and school buildings within its jurisdiction/' Other boards of health, 
 both local and state, have considered such inspection to be within their 
 field of work, even if not expressly so stated by statute. Sometimes 
 school inspection is undertaken by special committees appointed for 
 that purpose as in Boston in 1896 by a committee appointed by the 
 mayor, or in Philadelphia by an expert, Prof. S. H. Woodbridge, ap- 
 pointed by the Woman's Health Protective Association. Sometimes 
 such inspections are made by the state board of health, as in South 
 Carolina 2 and Wisconsin. 3 
 
 More often, however, the inspection of schoolhouses is undertaken 
 b}" the local board of health. Such an inspection may or may not be of 
 much value. To be of value it should be thorough and the inspector 
 should be sure of his conclusions and wise in his advice. Furthermore, 
 such inspection is of much greater usefulness when conducted with the 
 hearty co-operation of the school board. If there is any antagonism be- 
 tween the health officers and the school officers, or if the criticisms of the 
 health officers are directed as much at the school board as at the school- 
 houses, little good is likely to come of the exposure of defects. In a 
 word, little good can be accomplished unless the two departments act 
 in harmony. Usually it may be assumed that school boards desire to 
 have the houses in the best possible sanitary condition. What they 
 need is money to put them in this condition, and the health officer if 
 lie acts with tact can do much to help them to get the money. Among 
 local boards of health which have made such inspections, may be 
 mentioned Alameda, Cal., in 1888, District of Columbia in 1807, Law- 
 rence in 1888, Lowell in 1888, Lynn in 1888, Manchester, N. H. in 1897, 
 Mansfield, O. in 1891, Minneapolis in 1890, Reading in 1801, Provi- 
 dence in 1886 and 1896, Rochester in 1897, Sacramento in 1897, 
 St. Louis in 1896-7, L T tica in 1807. Among the most complete of these 
 inspections are those of the District of Columbia, Providence, Rochester, 
 and Reading. School inspections should in order to increase knowledge 
 of schoolhouse sanitation, and to carry more weight to the councils to 
 whom they are addressed, be quantitative as well as qualitative. The 
 measuring tape and the anemometer, but particularly the former, 
 
 ioliio, Annotated Statutes (1900), Sec. 2135. 
 
 2 South Carolina, Report of State Board of Health (1895), pp. 01-89. 
 
 ; Wisconsin, State Board of Health Report (1889), p. 53, of seq. 
 
MIS C EL L . J NEO I r S & t XI T. IMY W OllK. 783 
 
 should be always in the hands of the inspector. The report of the in- 
 spection in Reading is an excellent example of what can be done in 
 this direction, and the tabular statement of results is the most complete 
 that the writer has met with in any health report. In Providence the 
 anemometer was used in every school, and in some tests a recording 
 anemometer was used tor a number of days. Special attention in that 
 city was given to the alleged •• back draughts " of the •• Smead System'' 
 and to investigate this a recording instrument was used to indicate any 
 reversal of the air current. Various schedules have been devised to be 
 used in the inspection of schools. 1 The following was the schedule used 
 in Providence : 
 
 SCHOOLHOUSE T N ^ PECTION. 
 
 Name. Location. Character of site. 
 
 Dale. Temperature outside. Direction of Wind. Force of Wind. 
 
 Number of Room. Size. Number of pupils. 
 
 Recitation Rooms, size. Number of Pupils. Heating. Ventilation. Lighting. 
 
 Cloak Rooms. Ventilation. 
 
 Stairs. Position. Width. Tread. Rise. 
 
 Fire Escapes. 
 
 Doors inside, open in or out. < hit side, open in or out. 
 
 Ventilation and Heating System. 
 
 Position of Inlets, size. Kate of Flow. Open or closed (how regulated). 
 
 Posil ion of < >ui lets. Size. Rate of Flow. < >pen or closed (how regulated). 
 
 Size of Fresh Air Inlet. Size Of Outlet Shaft. 
 
 Temperature. .Method of Regulating. 
 
 Windows. Number, size. Height from Floor. 
 
 •■shutters. Blinds. Curtains. 
 
 Storm Windows. Weatherstrips. Window Ventilation. 
 
 Plumbing. Set Bowls. Waste Pipes. Soil Pipes. Traps. 
 
 Water Closets. Latrines. Sewer Connection. 
 
 Water for Drinking. Filters. Cups. 
 
 Excreta Disposal. Method. 
 
 1 >esks. 
 
 In Rochester the amount of carbon dioxide determined by the 
 Wmckler apparatus, and the humidity by wel and dry bulb were aoted 
 for curb room. 
 
 In Philadelphia and Milwaukee the regular medical inspectors have 
 been required to make inspections of the public schools. These routine 
 inspections are of course qoI us thorough us those jusl referred to, but 
 are carried <>n in order to correct minor delects in management and to 
 discover the smaller structural defects, though of course the larger 
 defects it' not corrected are noted again and again. It had been hoped 
 by the writer thai the dail} medical inspection of bc! Is would furnish 
 
 1 I. v poii of 1 . s . Commissioner of Educal ion (1898-4), p. 1348. 
 
784 MISCELLANEOUS SANITARY WORK. 
 
 a means of doing much to assistant! correct janitors and teachers in their 
 care of the schoolhouse, but it does not appear from reports that much 
 has vet been done in this line. 
 
 Medical Inspection of Schools. 
 
 To Dr. Samuel H. Durgin of the Boston board of health is due the 
 credit of inaugurating this method of improving the sanitary condition 
 of school children. The principal aim in undertaking this inspection was 
 to bring to light unrecognized cases of communicable disease, and it 
 was hoped thus to do much to check the spread of these diseases among 
 school children ; but it has been shown that much good is accomplished 
 in other directions, and it is not unlikely that the control of communi- 
 cable diseases will come to be considered as a very minor part of school 
 inspection. Such an inspection was urged by the Boston board of 
 health as early as 1890, but was not set in operation until 1 Novem- 
 ber, 1894. 1 Parochial as well as public schools are included in the 
 scheme. The city is divided into fifty districts and an inspector is ap- 
 pointed for each district. There does not seem to be any difficulty in 
 securing enough competent physicians, and vacancies are easily filled. 
 The salary is $200 per annum, but the inspector is required to visit at 
 their homes, at least twice, all cases of diphtheria and scarlet fever re- 
 ported in his district. Each inspector has four or five schools and about 
 2,000 children. The inspector visits each school soon after the opening 
 of the morning session. The teacher has already noted whether any 
 child appears to be ill or in airy way to need the advice of the inspector. 
 Sometimes the teachers agree to put a card in the window when the 
 inspector is needed so that he may not have the trouble of entering the 
 building unless it is necessary. The principal receives early in the 
 session, from each of the teachers, a notice of any child which may re- 
 quire attention. 
 
 It will be seen that after all the teacher has the most responsibility 
 in these inspections. If the teacher is intelligent and observing, the 
 work will be successful, otherwise not. In Boston it is found that the 
 teachers with a little instruction become very adept in recognizing cases 
 that need attention ; and the teachers appear to greatly appreciate the 
 aid which is given by this inspection. While it has given them a new 
 duty to perform each morning, it has relieved them of the burden of 
 deciding what to do with the doubtful cases. 
 
 In Boston at first a book was kept in which were entered the cases 
 
 1 Paper read by Samuel II. Durgin, M. D., before the Massachusetts Medical 
 
 Society, 9 June, 1897. 
 
MISCELLANEOUS SANITARY WORK. >:, 
 
 to be sent to the inspector, but slips like that shown below 1 have been 
 substituted for it. 
 
 In New York it is required by a rule of the board of education that 
 if the teacher suspects that a child may have a communicable disease, 
 it is to be isolated in a separate room until the inspector arrives. 
 Doubtless the same plan is followed in other cities. Unless the case is 
 suspected to be a communicable disease or unless the teacher feels that 
 it is too sick to remain even a short time, the pupil goes on with its 
 tasks as usual. In Boston the inspectors see the majority of the sus- 
 - in the hallway, but if small rooms are available they may he 
 need. If the inspector finds the child too ill from any cause to remain 
 at school he advises the teacher to send the child home for the observa- 
 tion and care of its parents and family physician. In New York when 
 a child is sent home a card is sent with it. stating the reason for ex- 
 clusion. If the illness is a dangerous communicable disease, the child 
 is at once ordered home. In Philadelphia where the inspection is not 
 under the health department, a special form of report card is used for 
 communicable disease. Of course many cases of sore throat are seen, 
 and in these it is the routine practice to take a culture before sending 
 the child home. In Boston the inspectors frequently do not carry cul- 
 ture outfits, but take the suspects to the nearest culture box station. 
 
 Of course, often, perhaps USUally, the inspector desires to see the 
 teacher and give some explanation of the case, but in any event lie tills 
 out the slip relating to the case and returns it to the teacher. The in- 
 spectors are not allowed to have any of the pupils sent to their own 
 offices for consultation, but they must be examined in the schools or 
 sent to their own physician or to the hospitals. 
 
 " The school inspectors do net give professional treatment in any case. They 
 merely point out the need of professional treatment where the need <\isis. The 
 
 19 
 
 Keep on I'ii.i:. 
 
 Ti \' in B's Si \ i i \h \ i 
 
 School. 
 
 Advia 
 
 I'm »n i \ \- s i \ ii .mi si. 
 
786 MISCELLANEOUS SANITARY WORK. 
 
 treatment itself must be received from the family physician, or in the hospitals, or 
 in the dispensaries, and great care is necessary to avoid giving offence to physicians 
 and their families. 11 
 
 The inspectors vaccinate some in Boston but not very much and 
 only the poor; only 260 vaccinations were performed in 1898, but 
 many arms were examined and 1,142 certificates of vaccination filled 
 out. The inspector carries with him a report sheet on which he tallies 
 the cases that he meets with and at the end of the month he writes out 
 this report on a new sheet and sends it to the board of health. See 
 Appendix 122. On the back of this is printed a classification of dis- 
 eases. A similar but simpler form is used in New York, but a separate 
 report must be made out each day for each school. 
 
 In Boston, as indeed in other cities, much trouble has been caused 
 by pediculosis, and in these cases it is not considered necessary to send 
 to the family physician for treatment. The following card is sent to 
 the parent in each case : 
 
 " School. 
 
 "Boston, 189 
 
 has been reported 
 by the Medical Inspector of Schools as showing evidence of parasites in the hair, 
 and I am therefore obliged to request that the child be kept out of school for a few 
 days until the disease is cured. 
 
 " Master. 
 
 "The following method of treatment for killing parasites and nits is recom- 
 mended by the Board of Health : — 
 
 "Wet the hair thoroughly with crude petroleum, of which half a pint may be 
 obtained at a drug store. (Set accompanying prescription.) Keep it wet for three 
 hours. Then wash the whole head with warm water and soap. Repeat this process 
 on three successive days. The nits may then be removed by combing the hair very 
 carefully with a fine toothed comb wet witli vinegar. Repeat the combing for 
 several days until no more nits can be found. To make the treatment easier and 
 more thorough, the hair may be cut short if there is no objection. 
 
 "All the children in a family are likely to be affected, and should also be treated 
 as above. 
 
 " Brushes and combs should be cleansed by putting them in boiling water for a 
 few minutes. 11 
 
 A more simple form, printed in three languages is used in New 
 Bedford. 
 
 The child is then not admitted to school until he brings the follow- 
 ing slip signed by the parent : 
 
 '•I hereby declare that on three different days during the past week I have 
 applied crude petroleum to my child's hair, as directed on the card received. 11 
 
 To be signed by Parent or Guardian. 
 
MISCELLANEOUS SANITARY WORK. 787 
 
 While the more important communicable diseases are not discovered 
 perhaps as often as was expected, outbreaks are sometimes checked as 
 shown by the report of one of Boston's inspectors. 1 
 
 In 1n ( .»7 the board of health of New York City inaugurated an 
 inspection similar to that in Boston, to include both the public and 
 parochial schools. At present (1899) there are 205 inspectors of which 
 14" are in Manhattan and 38 in Brooklyn, at a salary of $36< '. with a chief 
 at a salary of $2,500. The appointment of a chief inspector seems to be 
 almost a necessity in large cities. The work of inspection requires a 
 good deal of special knowledge and much can be done to increase the 
 efficiency of the inspectors by a capable chief. Moreover with a large 
 corps of inspectors there are sure to be some that are negligent or ineffi- 
 cienl and these need to be disciplined or discharged, [n a small city the 
 executive officer of the health department may well supervise this work 
 of school inspection, but in large cities a special supervision is necessary 
 and lias been supplied in New York. In Boston the need of it is felt. 
 In that city the inspectors have attempted to improve their service by 
 having meetings every two months for the discussion of matters con- 
 nected with their work. 
 
 Temporary inspection of schools on the foregoing plan was carried on 
 during outbreaks of communicable diseases in Brookline, Mass., in 1894 
 and in 1895. 2 
 
 A similar inspection was begunin Hartford in 1899, during an out- 
 break of diphtheria and the two inspectors have continued their work 
 ever since. In 1899 21,973 children were examined. 
 
 In Philadelphia, 8 in 1898 the board of health directed its fifteen 
 
 .nil medical inspectors to inspect one school each day in accordance 
 
 with the system employed in Boston. This was done in order to show 
 
 the benefits of the scheme and secure its final application to all scl Is. 
 
 The cit\ has not yei established a paid service, bu1 recently the board of 
 public education has instituted a daily inspection by the voluntary ser- 
 vices of physicians, though not enough have offered for all the schools. 
 In that city a circular was sent to each principal explaining the 
 system. 
 
 In St. Louis 3 some of the public spirited physicians undertook tin 1 
 same work tor a lew schools and with the same end in view, but no 
 
 public inspection has yet been inaugurated. 
 
 Article bj II. I». Arnold, M. D., Annals of Gyna logy and Pediatrics, January, 
 
 'Brookline, deports of Board of Health for years ending 31 January, 1895 and 
 1896. 
 
 Report "i I . N . < "i issioner of Education (1897-8), i>. 1492 
 
788 MISCELLANEOUS SANITARY WORK. 
 
 In Chicago, 1 owing to lack of funds, the health department was not 
 at first able to establish a daily examination of each school, but in 
 September, 1896, the city was divided into eight districts, each covering 
 an area of about twenty-two square miles, with an inspector for each. 
 These inspectors were to devote their entire attention to the schools and 
 were to look after the vaccinal condition of the children and to super- 
 vise all cases of communicable disease reported among the school 
 children, visiting the schools which the children attended and inspecting 
 the pupils when necessary. But hi January, 1000, a daily inspection 
 was begun. This work is under the technical direction of the board of 
 health, but it is attached to the compulsory education department of 
 the public school system, and is thus operated under the joint jurisdic- 
 tion of the department of health and the board of education. There are 
 fifty inspectors who receive $50 a month. They work from nine in the 
 morning until twelve noon. School districts are sub-divided so that 
 each inspector has a certain number of schools to visit each day. 
 Children are excluded who are found to be suffering from contagious 
 diseases, and all children who have been absent for four days or more 
 are required to submit to an examination of their throats before they 
 can return to their class rooms. 
 
 An inspection similar to that formerly practiced in Chicago 1 was 
 inaugurated in Milwaukee in 1898, the city being divided into five dis- 
 tricts and an inspector appointed for each district. 2 The next year the 
 number of districts was increased to twelve, with five schools in each 
 district, and twelve inspectors were appointed. In each school a 
 "quarantine room" is provided, to which all suspected children are sent 
 and which is used for nothing else. All children who have been out of 
 school two days or are sick must be seen by the inspectors before they 
 are readmitted. 
 
 In Newton, Mass., 3 seven school inspectors are appointed at a salary 
 of 850 per annum, who visit the schools at the beginning of each term 
 and inspect the children, giving especial attention to vaccination and the 
 existence of communicable disease. During the term time suspicious 
 cases if noticed by the teacher are reported to the health department, 
 and so far as possible, examined. This is doubtless done in other cities, 
 but probably only in the more important diseases, as scarlet fever and 
 diphtheria. 
 
 1 Chicago, Report of Department of Health (1895-6), p. 75. 
 
 -Milwaukee, Report of Health Commissioner, year ending April, 1899, p. 32, and 
 Report for the year ending April. 1900, p. 30. 
 
 Newton, Mass.. Report of Hoard of Health (1898), p. 16. 
 
MIS CEL LA XEO I ~s sA NIT. VR Y WORK. 
 
 789 
 
 The results of school inspections are fairly shown by the following 
 table taken from the Boston board of health report : ' 
 
 Number of pupils examined in the schools 17.440 
 
 Number recommended to be sent home 2,583 
 
 Number consultations with teachers (about pupils returning to school, etc.). 3,089 
 Note.— In further diagnosis the nomenclature of Osier's Practice of Medicine is recommended. 
 
 I. — Specific Infectious Diseases. 
 
 Diphtheria 
 
 Scarlet fever 
 
 Measles 
 
 Whooping cough . 
 
 Mumps 
 
 Smallpox 
 
 Chicken-pox 
 
 [nfluenza 
 
 Erysipelas 
 
 Syphilis 
 
 Tuberculosis 
 
 Malaria 
 
 II. — DlSE VSES OF 1111. OBAX 
 
 Respibatobi Tbact. 
 
 /. Mouth. 
 Stomatitis: 
 
 a Simple (eryl bematous) .... 
 
 Aphthous (herpetic) 
 
 I riceratn e 
 
 d) Parasitic (1 brush, etc i . . . . 
 Alveolar abscess 
 
 13 
 
 •"> 
 
 So 
 
 134 
 
 7, 
 
 82 
 61 
 
 1 
 
 468 
 
 AND 
 
 Pharynx. 
 
 Acute pharyngitis 
 
 Hypertrophic pharyngitis (acute 
 
 ami rlir. .nil) 
 
 Tonsils. 
 
 Ann.- follicular tonsillitis 
 
 Hypertrophic tonsillitis 
 
 Abscess 
 
 -_'*; 
 
 :;:; 
 
 1,285 
 
 55< i 
 
 Utnh 
 
 Elongal ion. 
 
 
 Acute ihinit is 
 
 ( Ihronic rhinitis 
 
 Purulent rliinit is. . 
 
 < tzaena 
 
 I u-\ i;ii inns oi sepl urn, 
 
 I'. 1 1 i s t a x i s 
 
 :;i 
 
 13 
 
 <;. Naso-Pharynx. 
 
 Naso-pharyngitis (Post-nasal ca- 
 tarrh) 
 
 Adenoid disease 
 
 Larynx. 
 
 Acute laryngitis 
 
 < hronie laryngitis 
 
 x. Bronchi. 
 
 Acute bronchitis 
 
 ( 'hronie bronchitis 
 
 '.elite pleurisy 
 
 25 
 
 ■'7 
 
 :;;• 
 
 141 
 
 III. 1)1-1. V.SES OF rm.; ]■; \k. 
 
 Foreign bodies (cerumen, etc. i . . 
 
 ''tin's media, catarrhal, acute... 
 
 < 'tit i ss media, chronic 
 
 Otitis, media, suppurative, acute 
 
 < Hit is media, suppurative, chronic 
 
 Mastoiditis 
 
 Imperfect hearing (without visi- 
 ble cause) 
 
 IV.— DlSE \-i s OF l ill El l.. 
 
 /. Foreign Bodies. 
 
 ign bodies 
 
 Eyelids. 
 Illepbaritis 
 
 Stye 
 
 1 'tnsi.s 
 
 Trichiasis 
 
 Lachrymal Organs. 
 
 ' >>st ruction of duct 
 
 A bscess 
 
 121 
 
 11 
 144 
 
 13 
 
 1 
 
 1 
 
 ' onjunctica. 
 
 < on juiiei i\ itis : 
 
 \cutc catarrhal 
 Puruleni 
 
 ■ i Phlj ctenular 
 
 • / < . ranular , 
 
 I is 
 
 1 Boston, Report of Hoard of Health, (1890), p. 51. 
 
790 
 
 MISCELLANEOUS SANITARY WORK. 
 
 5. Cornea. 
 
 Interstitial keratitis 5 
 
 Ulcer 16 
 
 Opacity 6 
 
 6. Iris. 
 
 Iritis 1 
 
 Synechia 
 
 7. Muscles. 
 
 Strabismus 10 
 
 Nystagmus 2 
 
 Paralysis of extra-ocular muscles 
 Imperfect sight (without visible 
 
 cause) ITS 
 
 Unclassified i; 
 
 4:51 
 V. — Diseases of the Skin. 
 
 Acne 28 
 
 Alopecia areata 10 
 
 Dermatitis 55 
 
 Eczema 288 
 
 Erythema multiforme 2 
 
 Erythema simplex 18 
 
 Furunculus 20 
 
 Herpes { simplex 7 " 
 
 ( zoster 4 
 
 Impetigo contagiosa 199 
 
 Pediculosis 2,292 
 
 Pemphigus 4 
 
 Pityriasis maculata et circinata . . 
 
 Pruritus 2 
 
 Psoriasis :, 
 
 Purpura — 
 
 Scabies 39 
 
 Seborrhoea 32 
 
 f favosa 13 
 
 Tinea -<J tricophytina 104 
 
 (_ versicolor 
 
 Urticaria 31 
 
 Verruca 6 
 
 Unclassified 10 
 
 3,252 
 VI. — Miscellaneous Diseases. 
 
 Anaemia 86 
 
 Debility 94 
 
 Headache (habitual) 170 
 
 Cervical adenitis -. 78 
 
 Chorea 17 
 
 Ulcer 25 
 
 Deformities '.' ' ' 
 
 ( extremities 
 
 Dislocations 2 
 
 Sprains 47 
 
 Fractures 2 
 
 Contusions 49 
 
 Wounds 68 
 
 Abscess 33 
 
 Dental caries (painful) 27 
 
 Neuralgia 37 
 
 Epilepsy 8 
 
 Rheumatism 21 
 
 Cardiac diseases 8 
 
 Gastric diseases 97 
 
 Intestinal diseases 25 
 
 Urinary diseases 8 
 
 Vaccinations (performed) 1,016 
 
 Certificates of vaccination 1.896 
 
 "No disease," (no pediculi, no 
 
 vaccination marks, etc.) 6,510 
 
 Unclassified 85 
 
 10,413 
 
 In New York in 1898 1 139,965 children were examined and 7,606 
 were excluded. Of these 118 had diphtheria, 25 croup, 328 scarlet 
 fever, 253 measles, 380 chicken pox, 517 mumps, 1,627 contagious dis- 
 eases of the eyes, 703 contagious diseases of the skin, 3,502 parasites of 
 the head, and 152 parasites of the body. The average daily attendance 
 was 456,394. 
 
 In Cambridge in 1899 there were excluded 372 children, of whom 
 4 had diphtheria, 5 scarlet fever, 24 measles, 18 mumps, 18 chicken pox, 
 and 57 pediculosis. 
 
 I Medical News, 21 October, 1899, p. 535. 
 
MISCELLANEOUS SANITARY WO EX. 791 
 
 In Chicago during the first four months of 1900, 16,805 children 
 were examined of which 4,539 were excluded. Of these 170 had diph- 
 theria, 401 scarlet fever, 648 measles, ob whooping cough, 670 chicken 
 pox. and 1,160 purulent eyes. 
 
 Public Baths. 
 
 Public baths belong properly to the department of public works, but 
 they are here considered because a number of public baths in American 
 cities are in charge of the health department, and because the health 
 officers are usually greatly interested in this public improvement and 
 are often instrumental in securing it. It is doubtless because of this 
 active interest of health officials that the construction and maintenance 
 of baths is placed in their hands. While municipal baths are common 
 in Europe they are not in this country. Public baths constructed by 
 private effort are found in several cities. Some of these are intended 
 as public charities, the fee charged not being sufficient to pay the run- 
 ning expenses. Examples of such baths are the People's Baths, 9 
 Centre Market Place, New York, the Baron de Hirsch Bath, corner 
 Henry and Market streets. New York, and the Riverside Baths, 259 West 
 Sixty-ninth street, New York. It lias been felt by many that public 
 baths should not be left to private initiative but that the best and surest 
 way to secure this civilizing agent is through municipal action. 1 
 
 Summer It'ttJis. In a number of cities which are so fortunately 
 situated as to permit it. floating baths have been in use for many years. 1 
 These are moored in rivers or harbors and of course can be used only 
 during a few months in the summer. 2 
 
 In Lowell and Brookline they had to be abandoned on account of 
 the contamination of the water. In New York the first floating baths 
 were constructed in 1*70. In L897 there woe fifteen such baths 
 maintained by the department of public works. They are usually kept 
 open from the middle of June to the first of October. The hours are 
 
 5 A. M. to 9 P. M.. except Sundays, when they (dose at noon. Mon- 
 days, Wednesdays, and Fridays are set apart for women and children. 
 
 •• All bathers excepting children are required to Eurnish themselves with bathing 
 
 s, and, to avoid infection, no towels or « >i h«r toilel articles can be hired ;tt the 
 
 baths. Two male attendants are in charge of each batb on the days set aparl for 
 
 males, and two female attendants on the other Ways. A male guard at each bath on 
 
 women's days, a policeman to keep order, and a keeper at each bath at night are 
 
 'See Report on Public Baths and Comfort Stations, Mayor's Committee, New 
 Fork 1 1897). Most of the facts here given ami the quotations are from this report. 
 
 - ich baths have been maintained in Boston, Brookline, Mass., Brooklyn, < 
 bridge, Charleston, Cleveland, Hartford, Lowell, Milwaukee, Newton, Mass.. New 
 Fork, Portland, Providence, Taunton, Watertown, Mass., and Worcester. 
 
792 
 
 MISCELLANEOUS SANITARY WORK. 
 
 employed. Each bath lias an average of sixty-three dressing rooms, a reception, 
 toilet and retiring room, and is lighted by gas. The baths have a supply of ice 
 water and are thoroughly swept, scoured and washed down nightly. . . . The 
 average cost of construction and equipment of each bath is .$13,000 and the annual 
 cost of maintenance and repairs for the fifteen baths is $48,000, including $30,000 for 
 the salaries of attendants. In 1896 there were 3,895,755 male bathers and 1,658,143 
 female; total 5,553,898." 
 
 Fig. 106. 
 
 A Floating Bath, West Boston Bridge, Boston. From a plate loaned by 
 the Commissioners of Baths. 
 
 
 
 
 
 
 IT 
 
 1 1 ,~.^T.-i ., „ 
 
 nTH 
 
 
 >1M 
 
 <■ 
 
 
 Fig. 107. 
 
 New type of Floating Hath. Harvard Bridge, Boston. From a plate 
 loaned by the Commissioners of Baths. 
 
 The first floating bath house in Boston was built in 1866. In 
 1898 there were eighteen houses which until that year were maintained 
 by the board of health, but at that time were transferred to a special 
 
JUS f ELLA XA'O US & J XI TA 11 Y 11 r 0R K. 
 
 93 
 
 i »e 
 
 
 
 Fig. 108. 
 
 Swimming Pool, Orchard Park, Roxbury, Boston. From a plate loaned bj the Com- 
 missionei s of Baths. 
 
 l-'i... 109. 
 A River Bath, Boston. From a plate loi d bj the Commissioners oi Bath* 
 
794 MISCELLANEOUS SANITARY WORK. 
 
 commission. During 1897 there were 657,275 bathers of whom 120,- 
 915 were women and girls. The total expense for maintenance for 
 that year was $23,768.31. In that year there were thirteen floating 
 houses. The old style floating houses are about sixty by thirty feet 
 with twelve feet posts. They are four feet six inches under water and 
 are supported by tanks holding 8,000 gallons. Sometimes casks are 
 used to float the house. They last several years but are recoopered 
 annually. The baths accommodate about seventy-five bathers at a 
 time. 1 
 
 The new style of floating bath is open to the sky, thus ensuring 
 better ventilation. There are also in Boston six beach baths and two 
 swimming pools and two river baths. 
 
 " The swimming pools were established to supply summer baths to the sections 
 of the city without water frontage. One of the pools is at Orchard Park, a small 
 open space with grass and trees in the midst of the tenement districts of Roxbury. 
 It consists of a tank made of concrete, eighty feet in length by thirty feet in width 
 and four feet in depth; to which fresh water is supplied from the city pipes. This 
 tank is enclosed merely by a high board fence. Two or three polling booths tem- 
 porarily fitted up for the purpose afford the necessary dressing accommodations. 
 Great care is taken to keep the water clean. The surface is drawn off several times 
 daily, and once each day the tank is completely emptied and washed out. Every 
 bather before entering the pool must use the shower bath. Between eighty and 
 ninety thousand gallons of water are used daily." 
 
 The number of bathers accommodated at all the Boston baths in 1899 
 was 1,920,368. 
 
 In-door Baths. While the summer or out-door baths are excellent, 
 they can only be used about one-third of the year and even then are not 
 so desirable for cleansing as are shower baths. It is very generally 
 agreed that the rain bath is the best form for general public use, though 
 tub baths and plunge baths have their place in public plants. As was 
 above stated, public baths of this kind were first established by private 
 philanthropic enterprise, but there are now municipal works in a number 
 of cities. Massachusetts 2 has permitted her towns to construct such 
 baths, and New York 3 has required cities of the first and second class 
 to establish baths of hot and cold water which shall be open fourteen 
 hours each day. These baths are to be constructed as the board of 
 health may require. Baths have been built under this law in Buffalo, 
 Rochester, New York, and Utica. The first municipal bath of this 
 character was the Carter H. Harrison Bath in Chicago, which was 
 opened in March, 1893. 
 
 1 Boston, Report of Department of Baths (1899). 
 
 - Massachusetts, Chapter 125 of 1898. 
 
 3 New York, Revised Statutes (1896), p. 433. 
 
MISCELLANEOUS SANITARY WO UK. 795 
 
 "It is a handsome structure of pressed brick and brown stone, twenty-five feet 
 wide by one hundred and ten feet deep. In the basement are the laundry and two 
 furnaces, one for heating the building, the other for heating the water for the baths. 
 In the front of the main floor is a waiting room sixteen feet square, seating forty 
 people. Beyond this are the bath rooms, with necessary toilet accommodations. 
 There are sixteen shower and two tub baths, and a plunge twenty by thirty feet. 
 This last has not been a success, owing to its small size and to the aversion of peo- 
 ple to sharing so small a body of water. Allowing twenty-five minutes to each 
 bather, the capacity of the bath is 2,000 persons a week. Two minutes are allowed 
 for undressing after entering the bathroom, when the water is turned on for eight 
 minutes. One minute's notice is given before the water is turned off, to allow time 
 for a rinse off. Fifteen minutes are allowed for dressing. Women are allowed to 
 use the baths two days a week, men using them the remainder of the time. For 
 women the temperature is 105 degrees, and on days for men, 100 degrees. Many 
 people resort to this bath, not o.ily for the purpose of cleanliness, but for relief for 
 rheumatism and other diseases, with, as they claim, good results." 
 
 The bath cost $10,856, and the operating expenses in 1898 were 
 $4,434.72, the total expense for each bath averaging four and one-tenth 
 cents. During ls'.ts. 1 (h;.l'.;: , ) baths were given. 25,608 to women and 
 girls. In July. 18 ( ,Mi, the remarkable number of 11,250 baths were 
 recorded. 
 
 The following account of the .Madden bath is from the report of the 
 Chicago Health Department for 1897-8, p. ( .»i > : 
 
 "The Martin B. Madden bath, at 39th street and Went worth avenue, was opened 
 to the public, April 17, 1897. The dimensions of this building are as follows: 
 
 ■• The I' in. lit part of the building, which ((insists of waiting rooms and office, is 30 
 feci by 19 feet 6 inches; winy part, which is the bath proper, is 26 by To feet, and 
 contains 31 separate dressing rooms and shower baths, one tub hath, and all nec- 
 essary toilet arrangements annexed. The basement is divided into a boiler r o, 
 
 laundry and soup kitchens. 
 
 •• Baths given in 1898 (288 days, closed 67 days, including holidays. Sundays and 
 for repairs) : 
 
 To males, 96,461; females L2,461 : total 108,922 
 
 Cost of maintenance, (including wages) 14,040 31 
 
 Average cost per hath given o:!, 7 ,, 
 
 Daily average of baths given 374 1 
 
 Two more baths, one with two Bwimming i ls,have since been 
 
 built. 
 
 The bath built by the town of Brookline, Mass.. is a mosl remark- 
 able example of public spirit. This town with a population of less than 
 20,000, built a public bath at a coat of about 143,000, exclusive of 
 land, h was opened in January, b s '. , 7. 
 
 • The main part of the building contains the natatorium, spectators 1 gallery, run- 
 ning I ra.k and dressing rooms, and is well lighted, well ventilated, and en in Ik. us. 
 
 The mam tank is 80 feel long and 26 feet wide, and has an average of i 1 - feet of 
 water. The bottom of the tank slopes gradually, and isfourfeet deep at one end 
 and seven feet at the other. Ground the Bwimming ball are forty-two dressing 
 
796 
 
 J//.v ( EL L . I NE 1 r S S. I XJ TARY WORK. 
 
 Fig. 110. 
 
 Brookline Public Bath. From a plate loaned by the Committee mi tin- Public Bath. 
 
 rooms, with a passageway 1 cm either side. At one end of the swimming hall are 
 three rain baths, at the other, two: these are for the preliminary cleansing hath re- 
 quired of all before entering the swimming tank. On the right of the entrance is the 
 instruction room, containing a small tank 22 by 10 feet, with water of an average 
 depth of :; 1-2 feet; six large (double) dressing rooms and a rain bath (s). On the 
 left of the entrance is a large room (c) containing six rain and foot baths, and three 
 bath tubs with an overhead rain-bath attachment, and nine dressing rooms. The 
 rain baths are of the " Gegenstrom" pattern, and there are lifteen of them in all. in 
 various parts of the building, with space for three more when needed." 
 
 Rules for the conduct of the bath are given in the 1st Report of the 
 Bath Committee. 1896. The fee for a hath is ten cents which includes 
 towels and soap, hut on two days in the week the bath is free. In 1899 
 there were 49,391 bathers. The running expenses were $7,600 and 
 the receipts were $5,230 making the net cost $2,370. 
 
 Buffalo lias a brick hath house which cost $14,800. It has twenty 
 
 shower baths. Powdered soap is used, and only enough for one bath is 
 
 issued to each person. The hath is entirely free. The following data 
 
 were kindly furnished by the health commissioner: 
 
 Statistics Pebtaining to Free Pcblic Bath House. No. 1, 
 liriT.u.o, X. Y. 
 
 Cost of land -$0,500 00 
 
 Cost of building 8,000 00 
 
 Cost of equipment 300 00 
 
 814,800 00 
 
 of those using the bath during 1800, 00,029 were men, 2,588 women, and 10,170 
 children. 
 
 3,166 persons took advantage of the laundry privileges. 
 
 1 The stone floors of the passageway and dressing rooms are kept warm by spec- 
 ial steam pipes underneath. 
 
MISCELLANEOUS SANITARY WORK. 
 
 797 
 
798 
 
 MISCELLANEOUS SANLTARY WORK. 
 
 A. Swimming Bath. B, Plunge Bath. C, Private Baths. 
 
 E, Swimming School. D, Dressing Rooms. s, Rain Baths. 
 
 Fig. 112. 
 
 Ground Plan of Bath-house, Brookline. From a plate loaned by the Committee 
 on the Public Bath. 
 
 A second free public bath house to cost $15,000 is now under 
 construction in the Polish tenement district, on land which cost 
 $2,600. 
 
 Yonkers built a bath in 1897, at a cost of #9,400, exclusive of land. 
 There are twenty shower baths and two tub baths. The building is of 
 brick, 25 by 53 feet. Five cents is charged for towel and soap. Another 
 bath has since been constructed. In 1899 there were 22,989 bathers, 
 
MISCELLANEOUS SAJSTITAR Y WORK. 
 
 799 
 
 16,648 male, 6.541 female. The operating expenses were about 
 00. 
 
 The bath in Rochester was open 27 July, 1899. It cost $15,028 
 including land. When purchased it was a dwelling house and $4,700 
 of the above was used in altering it and fitting it up. There are seven- 
 teen baths, and a place where bathers can wash their shirts and have 
 them dry while bathing. No fee is charged and soap and towels are 
 furnished. The operating expenses are about $3,500 per year. 
 
 Fig. II::. 
 i: ,i i o '"ii. From a plate loaned bj the Commissioners ol Baths 
 
 The Dover Streel bath in Boston, waa opened II < >ctober, L899. 
 It cosl $86,000, of which $1 1,15 1.25 waa for land. 
 
8(10 MISCELLANEOUS SANITARY WORK. 
 
 " The building is a simple but imposing structure 43 feet wide by 110 feet 
 deep. . . . On the first floor are separate waiting rooms for men and women with 
 the laundry and engine room in the rear. On the second floor are separate bath 
 rooms for men and women. The third floor in the front part of the building con- 
 tains an apartment for the manager of the baths and his family. . . . There are 
 thirty sprays and three tubs for men, and eleven sprays and six tubs for women. 
 All the baths are enclosed. Each shower cabin contains a dressing alcove, with 
 seat. A Gegenstrom apparatus is used. 1 ' 
 
 A charge of one cent is made for towels and soap, but the bathers 
 may bring them if they prefer. 
 
 There are two public baths in Milwaukee with large swimming 
 pools. The one on the south side cost 124,363.36. In 1899 the 
 operating expenses were |4,270.49, and 172,061 bathers were accom- 
 modated. The west side bath cost -123,135.89. In 1899 the operating 
 expenses were $4,755.66 and the number of bathers was 191,245. 
 
 Newark has two public baths which cost together about $15,000, 
 and proposes to build another at a cost of 87,200. 
 
 "The pools are about IS by 60 in size; the baths are heated by steam from 
 boilers to a certain temperature both in summer and winter; only one of these bath 
 houses is used in winter, and is heated by steam; in one house there are eight 
 shower baths. Outlet and inlet pipes for the pools are running continually, thereby 
 allowing all scum and filth that might collect on the top of the water to run off; a 
 pi n't inn of the water is run off every day and the baths are emptied and thoroughly 
 cleansed twice a week; the use of snap is not allowed in the pools; there are sixty 
 small lockers for the use of those persons wishing a private place to disrobe, five 
 cents being charged for the use of them, including towels and tights; the baths are 
 open two days in the week for women and the remainder for men." 1 
 
 It cost in 1899 to operate the two baths for salaries 85,085.25, for 
 coal $776.50, for incidentals $284.64. A superintendent and assistant, 
 a fireman and a matron are required for each bath. The receipts for 
 the use of rooms and suits which are hired at the option of the bather 
 was $300. The attendance in 1S99 was 100,039 males and 15,086 
 females. 
 
 Control of Barbers. 
 
 Five states, Michigan, 2 Minnesota, 3 Missouri, 4 Nebraska, 5 and Ore- 
 gun.' 1 have recently attempted to regulate the barber's trade lyy statutes 
 enacted ostensibly for the protection of the public health, but it is to be 
 feared intended rather to strengthen the trade. All of these acts pro- 
 vide for a state licensing board to examine candidates and issue licenses. 
 
 1 Letter from the Health Officer of Newark. 24 February, 1900. 
 - Michigan, Chapter 212 of 1899. 
 3 Minnesota, Chapter 186 of 1897. 
 
 4 Missouri, Act of 5 May, 1899. 
 
 5 Nebraska, Chapter 53 of 1899. 
 
 ,; < >regon, Act of 23 February, 1899. 
 
MISCELLANEOUS SANITARY WORK, 801 
 
 These boards are to be appointed by the governor, except in Nebraska, 
 where the board consists of the governor, attorney general, and auditor, 
 and in Missouri the appointees must be examined b}* the state board of 
 health and approved by it. In Nebraska the board appoints two barbers 
 ■retaries who do the examining. In Missouri the law only applies 
 to cities of over 50,000 inhabitants. The members of the board receive 
 three dollars per day for actual services and their expenses. In Nebraska 
 each applicant is to pay the secretaries live dollars. All persons acting 
 as barbers at the time of the passage of the act can receive a license on 
 payment of one dollar, and all others must pass an examination and 
 must be free from contagious or infectious disease. In Missouri and 
 Nebraska the barbers must conduct their business in accordance with 
 rules to be made by the stale hoard of examiners for barbers, which rules 
 must be approved b\ the state board of health. In Oregon 1 barbers are 
 required to disinfect their tools. 
 
 The Michigan law has been sustained by the supreme court. 2 
 At a meeting of the board of health of Boston, 4 May, 1900, the 
 regulation respecting barber shops shown below was adopted under the 
 general sanitary authority granted the board. 3 
 
 (i.\s Fitting. 
 
 The Boston board of health found that leaky gas pipes in dwellings 
 
 are very coi in, occurring in as many as eighty-nine per cent, of the 
 
 dwellings in that city. 4 Rightly believing that such leaks are more 
 
 Oregon, A< t of 23 February, L899, Sec 12: 
 
 ••Any person who slums another person afflicted with syphilis, eczema, blood 
 poison or any skin disease, who does nol before he again uses his tools, towels, or v» ater, 
 subject them to such disinfection as may remove any virus, scale, or filth that may 
 be "ii such tools, towels, or instruments, shall be guilty of a misdemeanor, and upon 
 conviction thereof be punished by a fine of not less than ($20) twenty dollars nor 
 more than ($50 I fifty dollar-, or by imprisonment in the county jail not less than ten 
 days nor more than twenty-five days, oi by both tine and imprisonment." 
 
 - N. W. Reporter 82*, p. 234, Wass d«. Michigan Hoard of Examiners for Barbers. 
 •Tin- place of business, together with all the furniture, shall be kept, at all 
 ti mes, in a cleanly condition. 
 
 " Mugs, shaving brushes, and razors shall be sterilized l>y immersion in boiling 
 waor alter e\ cry separate use thereof. 
 
 A separate, clean towel shall be used for each person. 
 
 •■Alum, or other material, used to stop the How of blood shall be so used only in 
 powdered form, and applied on a towel. 
 •• The use of powder puffs is prohibited. 
 
 The U-. ..i sponges is prohibited. 
 "Everj barber shop shall be provided with running hoi and cold water. 
 \.i person shall he allowed to use any barber shop as a dormitory. 
 
 Everj barber shall cleanse his hands thoroughly imi liately after serving each 
 
 customer. 11 
 
 1 Host, ,n. Report of Board of Health 1 1897), p. 50. 
 
 51 
 
802 MISCELLANEOUS SANITARY WORK. 
 
 liable to do harm than is leaky plumbing, application was made to the 
 legislature and an act secured which authorized the examination and 
 licensing of gas fitters in Boston. 1 This act is patterned after the 
 plumbing act, and provides for the appointment of a board of examiners to 
 consist of the building commissioner, the chairman of the board of health, 
 and a gas fitter of five years' experience to be appointed by the board of 
 health. The last named member is to receive five dollars per day for 
 his services. Both master and journeymen gas litters must be examined 
 and licensed, the former paying two dollars, and the latter fifty cents. 
 The licenses are good until revoked. New work must be done under 
 the supervision and with the approval of the building commissioner. 
 The law contains certain requirements as to the cutting of timbers and 
 the location of brackets, but other rules governing the work are to be 
 made by the board of health and building commissioner. The board of 
 health is to inspect and order changes in old gas-fittings. In 1898 of 
 400 applicants for gas fitters' licenses, 258 were rejected for failure 
 to pass the examination. 
 
 Lying-in Hospitals. 
 Both Massachusetts 2 and Pennsylvania 3 have enacted laws for the 
 regulation of lying-in hospitals under the direction of the health 
 officials. In Massachusetts the licenses are issued by the selectmen on 
 the approval of the board of health, but in Pennsylvania the license is 
 issued by the board of health, and the application must be endorsed by 
 six citizens. The license is for two years. In Philadelphia the board 
 of health have made rules for these hospitals. 4 They must be in- 
 spected every month and must keep a record in the form prescribed by 
 the board of health, of all cases, and must within five days report each 
 birth to the board of health, and must also report when the child is re- 
 moved from the hospital. In Boston in 1898 sixteen lying-in hospi- 
 tals were licensed, and in them there were 376 confinements. 
 
 Baby Farms. 
 
 Massachusetts, 5 Rhode Island, 6 Connecticut, 7 and New York, 8 have 
 enacted laws " for the protection of infants " who are placed out to 
 board. In Rhode Island and New York the persons who are to receive 
 
 1 Massachusetts, Chapter 265 of 1897. 
 
 2 Massachusetts, Public Statutes (1882), Chapter 80, Sees. 56-69. 
 
 3 Pennsylvania, Act of 26 April, 1893. 
 
 4 Philadelphia, Rules of the Board of Ilealth (1S95), Sees. 112-115. 
 
 5 Massachusetts, Public Statutes (1882), Chapter 80, Sees. 60-1. 
 
 6 Rhode Island, Chapter 464 of the Public Laws (20 May, 1897.) 
 
 7 Connecticut, General Statutes (1888), Sees. 2610-11. 
 
 w Xew York, Revised Statutes (1SU6), Public Health Laws, Sec. 206. 
 
MISCELLANEOUS SANITARY WORK. 803 
 
 infants to board must first be licensed. In New York the license is to 
 be issued by the board of health or the mayor, and in Rhode Island by 
 the state board of charities, but it must first be approved by the board 
 of health of the town or city in which the applicant resides. In Rhode 
 Island the application must also be approved by two citizens. In 
 Connecticut and Massachusetts the law does not require a license, but 
 the person who receives the infants to board must make report to the 
 selectmen in Connecticut, and to the board of health in Massachusetts. 
 In Rhode Island the law is applicable to every one who takes a single 
 child under two years of age, but in the other states it is only applicable 
 to cases where two or more are taken, and the maximum limit of age is 
 three years in Massachusetts and New York and ten years in Con- 
 necticut. The premises must be open to inspection by the board of 
 health in Massachusetts, the society for the prevention of cruelty to 
 children in New York, the town officers, state board of charities or 
 Connecticut Humane Society in Connecticut, and in Rhode Island the 
 health officer is required to inspect annually. In Rhode Island in 
 1899 thirty such licenses for children were issued of which thirteen 
 were in Providence. Irresponsible baby tanners have by this law been 
 pretty thoroughly suppressed in that city. 
 
 Pbeventhxn of Bijndness. 
 
 Ophthalmologists have shown that a large proportion of blindness 
 is due to the purulent infection of the eyes of infants at or soon after 
 birth. Owing to the exertions of physicians interested in diseases of 
 the ityc->, laws intended to prevent this injury have been adopted in 
 Connecticut, .Michigan. New Jersey, Ohio, Pennsylvania, and Rhode 
 Island. 
 
 The laws do imt differ very much and arc fairly represented by the 
 one given below ; ' but in some of the law s as in New Jersey, the health 
 officer is nol to treat the child as in Pennsylvania, but has it placed in 
 charge of a physician or the cifrj physician. In New Jersey copies of 
 the law are to be sent to physicians as well as nurses. In Rhode Island 
 the nurse is to reporl to a physician. 
 
 1 Pennsylvania, Chapter 263 of 1895: 
 -i i i [o» i. Be il ena< ted, &c, Thai sli"ulil one or both eyes of an infant be- 
 come inflamed or swollen or reddened at anj time within t\\" weeks after birth, it 
 shall be the duty of the midwife or aurse, or other person having the care of such 
 infant, to reporl in writing, within six hours after the discovery thereof, to the 
 health officer or legally qualified practitioner of the city, town or district in which 
 the mother "f 1 1 1 * - child resides, the faci thai such inflammation or swelling i 
 aess exists. 
 
 "Sectios ■-. Thai it shall be the duty <>f Baid health officer, immediately upon 
 receipt of said written report, to notify the parents or the person liaving chai 
 
804 MISCELLANEOUS SANITARY WORK. 
 
 Nursing Bottles. 
 
 The rubber tubes of long tube nursing bottles are difficult to clean 
 
 and sterilize, and health officers and physicians have long opposed their 
 
 use ; but they are more convenient than the short nipple and hence are 
 
 demanded by many mothers. Buffalo is the only city which has 
 
 attempted to prevent their use. 1 Dr. Wende, the energetic health 
 
 officer of that city, has pretty thoroughly succeeded in enforcing the 
 
 ordinance, though he met with strong opposition from some of the 
 
 dealers. 
 
 Excursions for Sick Children. 
 
 No board of health has, so far as the writer knows, provided such 
 excursions out of its own funds, but some have assisted private philan- 
 thropists in this work. In New York City the " summer corps " of 
 physicians to the tenement poor, distribute tickets to the excursions on 
 the harbor of the St. John's Guild. In 1806 15,887 of these tickets 
 were thus distributed. In Lowell in 1897 2 the board of health through 
 private subscriptions was enabled to provide eight such excursions on 
 the river, furnishing not only transportation but milk, ice, nursing 
 bottles, and medical and other attendants. The amount expended was 
 $138.48 and 500 children were taken on the excursions. 
 
 Protection of Working Children. 
 
 The state of New York, like many others, has laws for the pro- 
 tection of children who are put to work at too early an age. Unlike 
 most of the laws, that of New York puts upon the health department a 
 large part of the administrative work connected with the enforcement 
 of the act. According to Chapter 415 of 1897, Sees. 102-163 : 
 
 said infant of the danger to the eye or eyes of said infant by reason of said condition 
 from neglect of proper treatment of the same, and he shall also enclose to them 
 directions for the proper treatment thereof. 
 
 " Section 3. Every health officer shall furnish a copy of this act to each person 
 who is known to him to act as midwife or nurse in the city or town for which such 
 health officer is appointed, and the Secretary of State shall cause a sufficient num- 
 ber of copies of this act to be printed and supply the same to such health officers 
 on application. 
 
 " Section 4. Any failure to comply with the provisions of this act shall be 
 punishable by fine not to exceed two hundred dollars, or imprisonment not to ex- 
 ceed thirty clays, or both." 
 
 1 Buffalo, Ordinances, Chapter 25, Sec. 81: 
 
 "And it shall be unlawful for any person or persons to use or to engage in the 
 sale of any bottle, mechanism or other device for the artificial feeding or nursing of 
 infants or children under three years of age, that has connected therewith a rubber 
 tube, hose or similar contrivance.' 1 
 
 2 Lowell, Report of Board of Health (1897), pp. 30 and 33. 
 
MISCELLANEOUS SANITARY WORK. 805 
 
 "A child under the age of fourteen years shall not be employed in any mercantile 
 establishment, except that a child upwards of twelve years of age may be employed 
 therein during- the vacation of the public schools of the city or district where such 
 establishment is situated. No child under the age of sixteen years shall be em- 
 ployed in any mercantile establishment, unless such child shall produce a certificate 
 issued as provided in this article, to be tiled in the office <>f such establishment. 
 
 "Certificate for employment; how issued. — Such certificate shall be issued 
 by the executive (.hirer of the hoard, department or commissioner of health 
 of the city, town or village, where such child resides or is to be employed, or by 
 such other officer thereof as may he designated, by resolution for that purpose, upon 
 the application <>f the child desiring such employment." 
 
 At the time of making the application the child's parents must rile 
 an affidavit as to its age, and the certificate is not to he issued by the 
 health officer unless he is satisfied that the child is of the age stated 
 and is physically able to do the work. A certificate of school attend- 
 ance must be furnished by the school which the child has attended. 
 The forms used for this work in the City of New York are shown in 
 Appendices 1 25-6. 
 
 Certain exemptions are made for work during the Christmas holi- 
 days and for this " vacation certificates " are granted. This same act 
 provides for water-closets and wash rooms for women and children. 
 Seals must he provided for female employees and women and children 
 shall not ho employed in a basement except with the permission id' the 
 health department. All these provisions arc to he enforced by this 
 department. 
 
 Institutions foe Children. 
 
 In Now York in 1886 1 an act was passed which was amended in 
 - ! and which was intended to provide lor the better cmv of all in- 
 stitutions, receiving dependent children. This law- provides tor monthly 
 reports to the hoard of health, and also provides that when the hoard 
 of health finds ••anything therein dangerous to life or health" it 
 
 shall " cause the evil to be remedied without delay." The hods must 
 
 be two loot apart and there must lie 600 cubic loot of air space lor each 
 bed. In New York City 8 this law has not been a dead letter hut the 
 institutions have been under ;i constant supervision, a medical inspector 
 being detailed to inspect them. In tins waj great improvements have 
 been made in plumbing, ventilation, heating, bathing, dietaries, etc., 
 ami in every way the condition id' the children is far better than before. 
 
 As unlimited visiting bj parents and friends was found to he a fertile 
 source of communicable disease ; this has been limited to monthly visit- 
 
 1 \.-\n Y.ok. Chapter >;.::: oi lg 
 
 ' n.-u n ork, Rei ised Statutes ( 1896), p. --ns , Public Health Law, Se< s. 208 6). 
 \.u \ or* < ity, Report ol Department of Health i L896), p. 868 
 
806 MISCELLANEOUS SANITARY WORK. 
 
 ing days in most asylums. Much attention has been given to the pre- 
 vention of contagious ophthalmia and there has been a marked diminu- 
 tion in this disease. In order to prevent the introduction of communi- 
 cable disease, every institution must appoint a physician who must ex- 
 amine all children before the}' are admitted and certify that they are 
 free from communicable disease. 1 The physician must also make a 
 monthly report to the board of health on the sanitary condition of the 
 institution. In Denver 2 no child is admitted to an institution until the 
 throat has been examined and pronounced free from diphtheria bacilli. 
 In Michigan 3 the law requires that every child shall be examined for 
 contagious disease before entering a public institution. 
 
 Public Institutions. 
 (Other than those previously mentioned. ) 
 
 Public markets are under the exclusive control of the health 
 department in Cincinnati. This department has charge of the leasing 
 of the stalls and appoints the market masters, market police, and all 
 other employees. In this way a very firm control can be maintained 
 over the goods sold. 
 
 In San Francisco and St. Louis the poor house is administered by 
 the health department and in the latter city the public hospitals also are 
 in charge of this department. 
 
 Cigar Factory Supervision. 
 
 Most of the supervision of manufacturing whether it be in factories 
 or in dwellings (sweat-shops), is done for the protection of the opera- 
 tives and is under the direction of factory inspectors, usually appointed 
 
 1 New York, Revised Statutes (1896) p. 2418 (Public Health Law, Sec. 203): 
 "... The officer of every such institution, upon receiving a child therein, 
 by commitment or otherwise, shall, before admitting it to contact with the other 
 inmates, cause it to be examined by such physician, and a written certificate to be 
 given by him, stating whether the child has diphtheria, scarlet fever, measles, 
 whooping cough, or any other contagious or infectious disease, especially of the 
 eyes and skin, which might be communicated to other inmates, and specifying the 
 physical and mental condition of the child, the presence of any indication of heredi- 
 tary or other constitutional disease, any deformity or abnormal condition found 
 upon the examination to exist. No child shall be so admitted until such certificate 
 shall have been furnished, which shall be filed with the commitment or other papers 
 on record in the case, by the officers of the institution, who shall, on receiving such 
 child, place it in strict quarantine thereafter from the other inmates, until dis- 
 charged from such quarantine by such physician, who shall thereupon indorse upon 
 the certificate the length of quarantine and the date of discharge therefrom." 
 
 - Denver, Report of Bureau of Health (1897-8), p. 68. 
 ; Michigan, Compiled Laws (1807), Sec. 2027. 
 
MISCELLANEOUS SANITARY WORK. 807 
 
 by the state. Sometimes, however, inspection is intended to protect the 
 product as well, as in the bakery laws, and such laws are often en- 
 forced by local sanitary officials. In San Francisco 1 an ordinance was 
 adopted for the supervision of cigar making which was intended to pro- 
 tect the cigars rather than the Chinese who make them. The ordinance 
 provides that each maker must obtain a certificate from the health 
 officer, that no person with communicable disease shall be allowed to 
 work in the shop, no opium shall be smoked in it, no person shall sleep 
 in it. no cigar shall be touched to the lips or tongue, tobacco is not to 
 In- sprayed with the mouth, expectoration on the floor is forbidden, and 
 it is forbidden to dry tobacco on the floor. A special inspector was 
 appointed for this work and he reported that conditions found in the 
 Chinese shops were very bad. 
 
 Laundry Inspection. 
 
 In 1897 the board of supervisors of San Francisco- adopted an 
 ordinance forbidding the moistening of clothes in laundries by spraying 
 water from the mouth. A special inspector of laundries was appointed 
 who was to see to the enforcement of this ordinance, and also to see 
 that the laundry-men did not sleep under the ironing tables and to 
 sccniv the proper cleansing of the premises. Cement floors were re- 
 quired in all wash rooms. In 1898 the inspector made 1,750 inspections 
 of forty-two laundries. In New Orleans in 1899 s a similar ordinance was 
 adopted and a fee of twenty-five cents is charged for each inspection. 
 
 Kerosene. 
 
 The control <»t' the sale of kerosene or similar illuminating oils is usu- 
 ally given to special inspectors independent of the health department ; 
 but in New Jersey 4 the Law concerning kerosene authorizes both the state 
 
 board of health and local boards of health to enforce it. In New York 
 City the Hash test for oil is fixed by the sanitary code."' 
 
 Public Urinals. 
 The maintenance of public urinals it might be supposed, would be 
 
 in charge of the department of public works and it is so rn many cities. 
 
 As these fixtures are. unless properly constructed and cared for. certain 
 
 San Francisco, Report of Health Department (1807-8), p. 259 (Ordinance of IT 
 
 .tunc-. I>''- 
 
 San Francisco, Report of Health Department (1896-7), p. 6. 
 
 \.w Orleans, Ordinance No. 15709, Council Series, 15 November, 1899. 
 
 \.-\ !■ neral Statutes (1896), pp. 2454-5. 
 
 \«w Fork, Sanitarj Code (1899), Sec. 105. 
 
808 MISCELLANEOUS SANITARY WORK. 
 
 to become nuisances, it is in some cities thought best to place the health 
 department in charge of them. This is clone in Cambridge, Lawrence, 
 Providence, and in Boston until 1898. In most instances these urinals 
 are simply iron affairs which are supposed to be kept clean by running 
 water, but unless very carefully looked after, they are more or less 
 offensive and filth}^. 
 
 Decent urinals and decent water-closets are rarely provided at public 
 expense in American cities and the public are forced to rel}~ upon the 
 facilities furnished by hotels, restaurants, railroad stations, and public 
 institutions. Boston and New York are notable exceptions, for these 
 cities have built and maintained in good condition, first-class toilet 
 rooms for both men and women. 
 
 Sick Poor. 
 
 The care of the sick poor is in a number of cities wholly or partially 
 in the charge of the health department. In most cases it is the care of 
 the out poor or dispensary work which is given to the health department. 
 In rarer instances this department manages the public general hospitals. 
 
 There are excellent reasons why the care of the sick poor at their 
 homes or in dispensaries should be a part of health department work. 
 Almost invariably medical men are in control of this department and 
 are thus better fitted to select physicians to the poor, and to supervise 
 their work than are laymen. Then, too, the work of poor physicians is 
 such that the}' can do much to assist the health department in regard 
 to vaccinations, communicable diseases, investigation of causes of death 
 and nuisances. Whatever may be said in favor of such an arrangement, 
 it has not been adopted in most cities. 1 But in Ohio 2 the board of health 
 is authorized by statute to " appoint as many ward or district physicians 
 as it may be deemed necessary for the care of the sick poor." 
 
 In most of the cities named below there are several district physi- 
 cians appointed to care for the sick poor in their districts. These 
 physicians are usually required to live in their districts and to have cer- 
 tain office hours. They are often required to keep records of their cases 
 and to make monthly or weekly reports. Specific rules for their guid- 
 ance are to be found in Cleveland 3 and Cincinnati, 4 and the District of 
 
 111 It has, however, been in Buffalo, Colorado Springs, Cleveland, Cincinnati. 
 Charleston, District of Columbia, Denver, the larger Indiana cities, Kansas City, 
 Jersey City, Knoxville, Memphis, Xewark, Richmond, San Francisco, St. Louis, and 
 Savannah." 
 
 2 Ohio, Annotated Statutes (1900), Sees. 2115 and 2135. 
 
 s Cleveland, Rules of the Health Division, Department of Police, Rule 6. 
 
 * Cincinnati, Manual of Department of Health (1898), Sec. 281. 
 
MISCELLANEOUS SANITARY WORE, 809 
 
 Columbia lias excellent printed instructions. In a number of cities, as 
 Colorado Springs, Cleveland, and Memphis, the district physicians are 
 required to give medical attendance in police stations or jails. In Col- 
 in-ado Springs, Cleveland, Cincinnati, and Kansas City, they are to per- 
 form the public vaccinations. In Cincinnati the district physicians 
 perform certain sanitary work in regard to the control of communicable 
 disease and the report of nuisances. In that city the health officer lias 
 monthly conferences of these physicians at which the details of their 
 work and public health matters are discussed. The following shows 
 the number of physicians employed in several cities: 
 
 Vein. city. Number of Physicians. 
 
 1897 Buffalo 8 
 
 1898 Cleveland 12 
 
 1898 Cincinnati 21 
 
 1899 Charleston 6 
 
 1898 District of Columbia 22 
 
 L898 Jersey City S 
 
 1898 Kansas City 2 
 
 1897 Newark 11 
 
 1898 Richmond 4 
 
 1890 Savannah 4 
 
 189G Toledo 5 
 
 1899 Troy ."> 
 
 Ill Colorado Springs, Kno\ ville, and Memphis there is only one 
 physician to look after the out patient poor. In Memphis this is the 
 secretary of the hoard of health. In Spokane the health officer is to 
 visit the sick poor. The salary of the physicians to the poor varies 
 from $29.16 per annum in Toledo, to $850 in Charleston. It is $300 
 in Cleveland and Cincinnati, $360 in the District of Columbia, and $400 
 in Newark. The number of visits made by the city physicians upon 
 
 the poor in their h \s semis to vary greatly in different cities. This 
 
 doubtless depends upon the character of the population, the care with 
 which patients able to pay are sifted out, and the amount of aid 
 furnished by private charities : 
 
 Year. « Ity. Bultations. Patients. 
 
 L899. Charleston 32,087 
 
 L898. Cincinnati is. 212 5,314 
 
 1899. District of Columbia 20,025 7,583 
 
 1899. [ndianapolis 21,61 1 
 
 L898. J( rsej Citj 3,118 1,641 
 
 1898. Kansas Citj 28,065 
 
 L898. Memphis i,949 
 
 L899. Newark 30,160 
 
 i-'.''.'. Richmond, Va 21,896 1,700 
 
 Some cities, instead of requiring the district physicians to receive 
 
 patients at their offices, estahlish, under control of the health depart- 
 
810 MISCELLANEOUS SANITARY WORK. 
 
 ment, public dispensaries to which all patients who are able, shall go for 
 medical advice. In Indianapolis, Memphis, Mobile, Newark, St. Louis, 
 and San Francisco this is done. In the latter cit} r there are two branch 
 dispensaries as well as a central one, and apparently from the reports, 
 very few patients are treated at their homes. In Indianapolis only 3,242 
 patients were visited at their homes, and in Newark, 8,700 persons, 
 while in District of Columbia, 13,905 persons were treated at home. 
 There are various ways in which the medicines may be furnished. 
 Probably the most unsatisfactory and expensive, way is to have the pre- 
 scriptions filled at contract druggists as is done in Buffalo, Charleston, 
 and Savannah. Another way is for the physicians to furnish as much 
 of the medicines as possible and this can be largely done with tali- 
 lets. In this way the expense of medicines has in Cincinnati been re- 
 duced from 13,818.70 per annum (1880-1893) to 1221.03 (1891-1898). 
 Where dispensaries are established, the medicines are usually furnished 
 there by an apothecary employed for the purpose. In Nashville there 
 is a " city prescriptionist " in the health department who puts up med- 
 icines for out patients treated free at the city and other hospitals, but 
 it does not appear from the reports that the health department controls 
 the medical attendance of the sick poor. 
 
 In Mobile the health officer is police and jail surgeon and also 
 admits patients to the city hospital. In Boston, Lynn, and Omaha the 
 " city physician " is a member of the health department. In Omaha he 
 looks after accident cases chiefly, in Boston and Lynn he is a police 
 surgeon and in the latter city attends to vital statistics. 
 
 In accordance with the provisions of Chapter 501, Section 1, of the 
 Laws of New York(1879), the sum of $10,000 must annually be expended 
 in New York City for the medical inspection of tenements during the 
 summer. In July and August fifty physicians are employed to visit 
 every tenement, especially in the poorer quarters, to prescribe for the 
 helpless sick, give needful advice, and distribute circulars for the care of 
 infants. In 189(3 there were treated 37,160 persons and 271,712 visits 
 were made. A similar plan has been followed in Hartford where two 
 physicians are employed. 
 
 So far as the writer knows general hospitals are controlled by the 
 health department only in Indianapolis, Kansas City, Memphis, San 
 Antonio, San Francisco and St. Louis. Accounts of the administration 
 of these institutions may be found in the reports of those cities. 
 
 Office Librae y. 
 Every health officer has, or certainly every health officer should 
 have, a library of works relating to sanitation. If a health officer could 
 feel that he would remain in office as long as he proved faithful and 
 
MISCELLANEOUS SANITARY WORK. 811 
 
 efficient, he would probably at his own expense and by bis own efforts, 
 collect such a library ; but with the uncertain tenure of office which 
 prevails, it is rare that the health officer deems it worth while by study 
 to make himself better fitted for his office. Not only are standard works 
 and text books useful in such a library, but reports of work done in 
 other cities and states should form an important part of it. Much can 
 be learned from both successes and failures of others. Here again the 
 constant changes in health officials makes it difficult to keep up files of 
 reports. Nevertheless, some cities do attempt to maintain a library and 
 accounts of such may be found in the reports of St. Louis, 1 District of 
 Columbia, and Minneapolis. In St. Louis an index has been kept of 
 the contents of various reports received and placed in the library. 
 This index is not as full as it might be, but is a move in the right 
 direction, and it would be well if organized effort could be made to 
 index all sanitan reports. 
 
 Advancement of Knowledge. 
 
 It is the duty of every physician and of every health officer to take 
 advantage of each opportunity that may offer to add his mite to the 
 sum of human knowledge. Such duty is not confined to men of 
 scientific pursuits, but is incumbent upon every one; but the scientific 
 man is daily making use of the cumulative studies of thousands of his 
 predecessors without which his own work would be impossible, he well 
 knows how inestimable may be the value of a single new fact dis- 
 covered, and he is constantly seeing new lines of investigation invite his 
 labors. He must indeed be a selfish man who would freely receive 
 from others the priceless legacy of modern science and make no effort 
 to show his gratitude in the only way he can show it, by striving to 
 increase the sum of human knowledge for the benefil of those who are 
 to come after. 
 
 In one sense this effort to advance the science of sanitation is by 
 far the mosl important w oik that the health officer can do. It was a 
 
 far more useful thing for the members of the New York health depart- 
 ment to show how to make a concentrated antitoxin than it would be 
 
 to tear down a hundred tenements or to disinfect a thousand houses; 
 
 and loi the Massachusetts board of health to show the world how to 
 filter water and sewage is ten fold more important than all the routine 
 
 work ever done l>\ that board, useful enough though the latter has 
 been. 
 
 With some truth it may be said that the municipal health officer 
 does not have the opportunity or the time for investigation, and that 
 
 St Louis, Report of Health Depar mi (1895-6), p. 281. 
 
812 MISCELLANEOUS SANITARY WORK. 
 
 such work had best be done by the federal or state governments or by 
 the universities. Original research certainly would be a leading function 
 of a national board of health if we had one, and is made an important 
 part of the work of many state boards. It is also true that certain 
 lines of investigation which are of a general character do not belong to 
 the work of the local health officer. The study of filtration as pursued 
 in Massachusetts, properly belongs to a state board. Yet sometimes 
 even cities may be forced to undertake work of this nature. Because a 
 certain method of filtration had not been studied at Lawrence (chiefly 
 from lack of opportunity), municipal investigation became necessary at 
 Providence, Louisville, Cinncinnati, and Pittsburgh. So the work of 
 the New York board of health on vaccine virus and antitoxin might 
 have been expected of a state board of health or a university, but was 
 undertaken by a local board because no one else would do it; but there 
 are certain lines of investigation which can be best followed by local 
 health officers. Problems connected with the mechanism of the spread 
 of communicable disease can be best studied by those who can per- 
 sonally follow the history of many cases. The relation between de- 
 fective plumbing and sickness, or between privy vaults and the spread 
 of typhoid fever is to be learned best Ivy the man who has charge of the 
 inspections. The local health officer can alone determine the necessity 
 for disinfection and the value of methods proposed. He can best de- 
 termine the degree and duration of the immunity conferred by vaccine 
 or antitoxin. 
 
 Every one cannot expect to make a great discovery, and to solve 
 completely an important problem need not be one's aim. Facts care- 
 fully recorded and carefully published are always useful and may be- 
 come invaluable. Much of the routine work of the municipal health 
 department may be done in such a way as to give it a permanent use- 
 fulness, or it may be done in such away that its momentary value is its 
 only value. Care and thought applied to the recording of all work 
 done should be a health officer's first duty. Reliable data in regard to 
 garbage cremation are hard to find in this country, but if every city 
 which operates a crematory had kept and published the work of the 
 crematory as carefully as was done in Lowell for several years, a very 
 correct estimate of the cost of construction and operation might by this 
 time have been available. 
 
 Many health officials have done work for the advancement of 
 knowledge. The recording of vital statistics and cases of sickness is 
 such work. Most local officers do not do much in this direction be- 
 sides record the bare number of cases and deaths from different 
 diseases. Tabulation is left for those who handle larger masses of 
 
MISCELLANEOUS SANITARY WORK. 813 
 
 figures, as the state registrars. In some local reports, especially in 
 those cities where registration was established before it was required 
 by statute, the causes of death are subjected to a more or less exten- 
 sive analysis as in Baltimore, Boston, Charleston, District of Columbia, 
 New York, Philadelphia, Providence, St. Louis, and San Francisco. 
 The most elaborate tables are those of Providence which were begun in 
 1855 by Dr. E. M. Snow who was the first health officer and registrar. 
 
 A good many cities have carefully inspected the sanitary condition 
 of all houses where communicable disease is reported. Some few 
 health officers have analyzed the results of these inspections. Among 
 cities where this has been done is Boston. Investigations in Boston 
 have shown that scarlet fever and diphtheria are as likely to occur in 
 clean houses and houses free from defective plumbing and sewer gas as 
 they are in bouses where these conditions are found. Furthermore, 
 such unsanitary conditions are shown by house to house inspection to be 
 as common in those houses where the diseases in question are not, as 
 they arc in houses where these diseases exist. In a word, it is shown 
 by most excellent statistical evidence that there is no causative relation 
 between unsanitary conditions and scarlet fever and diphtheria. Un- 
 fortunately, the Boston board of health has not seen fit to publish the 
 details of its investigations, but merely its conclusions. 
 
 The record of communicable diseases and as many tacts concerning 
 location, exposure, duration, number in family and house, extension of 
 infection to others, etc., is of great scientific importance; but it is 
 equally important that the results of such investigations should be pub- 
 lished. It is an excellent thing to plat each ease of communicable 
 disease on a map. but it is more important to study the map when 
 made and during its making. Thus only could the board of health of 
 New York City determine the important tact that phthisis is more 
 prevalent in some houses than in others, and that some houses seem to 
 
 be thoroughl} infected. In Providence b\ a careful study of the eases 
 
 occurring in tenement houses it was learned that scarlet fever and diph- 
 theria do not spread in such houses more than in neighboring houses, 
 
 and thai children, except in the infected family, may safely be allowed 
 in school, [f everj health officer would record and publish everj case 
 where a well person apparently carried a communicable disease to 
 another, every instance where there was a recurrence alter disinfection, 
 and every instance where the patient remained infectious for a long 
 
 period, as BllOWE by his infecting others, much light would soon be 
 shed on the \erv BeriouS problems which are troubling the health 
 
 officer. 
 
 The value of methods of disinfection can best be tested in routine 
 
814 MISCELLANEOUS SANITARY WORK. 
 
 work. It may be clone by exposing bacteria in the rooms or in the 
 goods to be disinfected. Such work has been done in a number of 
 cities, as Asbury Park, Boston, Chicago, Concord, Fitchburg, New- 
 ton, Pittsburgh, and Providence. Some of the most valuable of 
 these experiments have been carried on at Boston in connection with 
 formaldehyde disinfection. The methods employed are shown in the 
 report for 1898, page ninety-one, and 1899, page eighty-three. In 
 Pittsburgh a test culture is put in every room disinfected and the 
 results are published, but unfortunately the methods employed are not 
 fully given. 
 
 The investigation of local outbreaks of communicable disease is a 
 duty which should be faithfully performed by every health officer. He 
 must keep careful watch of his returns and when any unusual increase 
 occurs he should seek out its cause and if necessary should call in ex- 
 pert assistance. Many examples of such investigations may be found 
 in municipal reports, as for example, New Haven, 1896; Boston, 1892 ; 
 Providence, 1888; New Bedford, 1893; Springfield, Mass., 1892; 
 Manchester, N. H., 1894 ; Syracuse, 1892; Burlington, Vt., 1895; Dis- 
 trict of Columbia, 1895; Worcester, 1894; Montclair, N. J., 1897; 
 Paterson, 1892-1893 ; Minneapolis, 1893. The above are, of course, 
 only a few of the cases where the origin of an outbreak has been studied 
 by local health officers. 
 
 The establishment and maintenance of laboratories gives a fine op- 
 portunity for scientific work under the direction of the health officer. 
 The chemist is employed to test water, milk, and other foods and to 
 detect impurities and adulterations, but he ought to do more than mere 
 routine work. If his analyses are carefully recorded, summarized, and 
 published he cannot help doing something for the advancement of 
 science, even if he makes no brilliant discovery. But the bacteriologist 
 has the widest range of problems clearly mapped out for him. Only 
 the larger laboratories like those of Boston, Chicago, and Philadelphia, 
 and especially New York, can be expected to take up systematically 
 the newer problems of pathology. The New York laboratory with its 
 exceptional facilities has been able to accomplish much, both of prac- 
 tical and theoretical importance : but certain problems can be and should 
 be attacked in every laboratory. Tests of disinfection, investigations of 
 the distribution among the well, and outside of the body, of the specific 
 organisms of typhoid, diphtheria, and tuberculosis, their persistence in 
 each individual, and their virulence under varying conditions, give 
 promise of furnishing the greatest aid in developing a scheme for the 
 management of these diseases. Unfortunately, very little has yet been 
 done along these lines. The investigation of the connection between 
 malaria and the mosquito can well be taken up by health officials. 
 
MISCELLANEOUS SANITARY WORK. 815 
 
 The thorough and systematic inspection of schoolhouses before re- 
 ferred to, is an example of good scientific work. So is the examination 
 of springs, ice, and water supplies. In this connection may be men- 
 tioned the fifteen wells in Asbury Park in which for many years the 
 height of the ground water has been noted at stated intervals. It is a 
 good thing to distribute pasteurized milk, but it is a better thing to fol- 
 low the lives of the children to whom it is given and show that the 
 practice saves lives. 
 
 A leading educator has been quoted as saying that the first duty of 
 a school superintendent is to secure the aid of the local press. There 
 is no doubt that the health officer can do much to secure the advance- 
 ment of sanitation if he can gain the hearty cooperation of the news- 
 papers. Judgment and tact here count for much and the health officer 
 should always advertise his department, not himself. 
 
 Another method of teaching the public is by means of circulars of 
 information. Many of these circulars have been referred to and ex- 
 amples given. Circulars in regard to the various communicable dis- 
 eases, in regard to disinfection and vaccination and the care of infants, 
 are distributed in nearly every city. Before plumbing laws were SO 
 generally enacted, circulars in regard to good plumbing were often sent 
 out. The establishment of bacteriological laboratories necessitates the 
 issusingof explanations of the purposes of the laboratory and directions 
 h<>\\ to make use of its facilities. The passage of new laws, or the 
 adoption of new methods along any line of sanitary work, render it 
 advisable to issue an explanatory notice which may be sent to the par- 
 ties must interested, or in some cases to the general public. It is often 
 unwise to rely upon the educational effect of a single issue, but it 
 should he repeated from time to time. It is often necessary to print 
 circulars of information in several Languages. State boards of health as 
 a rule, provide more thoroughly for this educational work than do local 
 boards. They have to instruct local boards as well as the public and 
 their circulars of information cover a wider range of subjects. Ex- 
 amples of circulars lor the care of infants are shown in Appendices 
 I 23 4. 
 
 Man) cities issue weekly or month reports bj their health officials. 
 Among those which issue the former maj he mentioned: Baltimore, 
 Charleston, Philadelphia, Pittsburgh, and New York City. Monthly 
 reports are issued in Brockton, Buffalo, Chatanooga, Chicago, Cleve- 
 land, Detroit, Evansville, Fitchburg, Hartford, Houston, Knoxville, 
 Lawrence, Lincoln, Los Angeles, Cal., Lynn. Macon, Ga., Manchester, 
 N. II.. Milwaukee. New lla\cii. New Orleans, Oakland, Cal., Omaha, 
 Paterson, Portland, Ore., Rochester, Sacramento. San Diego, Scranton, 
 
816 MISCELLANEOUS SANITARY WORK. 
 
 Seattle, and Yonkers. These reports are of every conceivable form and 
 size from a postal card to the monthly report of the San Francisco 
 board of health which is 9 \ by 11 \ inches and contains twenty-seven 
 pages. These sheets would be exceedingly annoying to file if any one 
 thought it worth while to attempt it. Most of these weekly and 
 monthly reports contain merely vital statistics. Scarcely any two are 
 arranged alike, and they are useless for purposes of comparison. The 
 writer believes they are useless for any purpose. As was stated else- 
 where, the monthly report issued in Providence was discontinued by the 
 writer and its value was indicated by the fact that only one person after- 
 wards wrote to inquire about it. It was a report above the average in 
 quality as the writer is free to say, as it was entirely the work of his prede- 
 cessor. Some of the monthly reports include other items beside those 
 of vital statistics, such as reports of communicable disease, nuisances, 
 plumbing, market and milk inspections, disinfections, garbage collec- 
 tions, scavenger work, meteorological reports, and sick poor reports, re- 
 ports of chemical and bacteriological work, lists of sanitary officials, and 
 in some cities general municipal statistics are included. In fact every- 
 thing that should properly be included in a complete report of health 
 department work may sometimes be found on these ephemeral reports. 
 Even the results of original scientific investigations are sometimes in- 
 cluded as in Buffalo and Chicago. Usually only the mere statement of 
 work done is made without any explanation. It is difficult to find two 
 reports that are alike either in form, subject matter, or arrangement. 
 Some cities, as Chicago, Buffalo, and Omaha, have published no 
 other reports for several years. The writer looks upon these reports as 
 an insufferable nuisance. They are extremely unsatisfactory. If a 
 person desires to know what is done in his own or another city he will 
 never learn from a monthly health report. The proper time division 
 for the consideration of all sanitary matters is a year, not a month or a 
 week. It matters little how the deaths from influenza this week com- 
 pare with the week before last, or how many loads of garbage were col- 
 lected in August as compared with January. Annual compilations 
 only are useful, and furthermore, a mere numerical statement of facts 
 without any text is of little use to any one. Even if a person should 
 take any interest in the monthly reports, as the writer has done in those 
 of Chicago and Buffalo (simply because annual reports were not avail- 
 able) he would find difficulty in keeping files of them as they are mailed 
 as second class matter, and a considerable number are sure to be cast 
 into the waste basket together with the advertisements of patent disin- 
 fectants, etc., which they are made to resemble by the one-cent postage 
 stamp which is affixed to them. If the money that is spent in printing 
 
MISCELLANEOUS SANITARY WORK. SI 7 
 
 and mailing these ephemeral sheets were spent in publishing or strength- 
 ening an animal report, it would be a distinct advantage. 
 
 Annual reports should present a summary of the work done by the 
 health department during the year, with the necessary explanation and 
 discussion of the same, and also suggestions for desired improvements. 
 These reports are issued first to serve as an official record of work done, 
 second to give information concerning this work to all members of the 
 city government and to the citizens, and third to furnish information to 
 tin- officials and citizens of other cities. The last is a function which is 
 not recognized as legitimate by the average councilman. He calls it a 
 waste of money to print a report which may be useful to others. He 
 sees nothing dishonest in taking all the information he can get from 
 others and giving nothing in return ; but whether a report is intended 
 for use in the city of its publication or in other cities, its form and con- 
 tents should be the same. 
 
 All municipal documents should be of uniform size, and all cities 
 should adopt the same size. Most cities have adopted the octavo, but 
 there are a few exceptions. Reports sent by mail should never be rolled. 
 An envelope costs no more than a wrapper, and takes less time. Reports 
 should have the different subjects arranged in the same way year by 
 year. Jt is then much easier to find what is wanted. All publications 
 of fifty pages and over should have an index, or at least a table of 
 contents. Some quite bulky reports, as those of Baltimore, Milwaukee. 
 and Philadelphia, are without this. 
 
 Certain municipal statistics should lie included, as the population, 
 area, parks, streets, sewer connections, vaults, wells, houses, tenements, 
 etc. A large number of health departments include registration among 
 their duties, and such departments usually include vital statistics in 
 their reports, though sometimes, as in Providence, a separate registra- 
 tion report is issued. If a full report of births, marriages, and deaths 
 is not included in an annual report, at least the total number of deaths 
 should lie given and the death rate and the deaths from tin' more im- 
 portant diseases, particularly the communicable diseases. These details 
 should be lovcii tor a number of years. In fact. nearl\ all the facts 
 given in numerical form in the report should lie in tables including a 
 series of years. This iseo;uall\ i mporlant and valuable for the health 
 
 officer who makes the report, tin' members of the council or the mayor 
 
 to whom it is made, the citizen who pays for it. and the worker in the 
 other cities. |f ii is objected that it makes t he report too lai^eaiid 
 
 expensive, it maj be remarked that i ley may be saved b) discontinu- 
 ing the monthly sheet. \ perusal of many reports will show padding 
 
 in the form of general remarks (often quoted) on sanitary subjects, 
 
818 MISCELLANEOUS SANITARY WORK. 
 
 which might well be omitted in favor of the summaries. It is a good 
 plan to give in the first part of the report a list of the officers of the 
 department. Whoever opens the report at all will probably be interested 
 in this. % It is found in most reports, but not in those of Boston, the 
 District of Columbia, Denver, Philadelphia, and a number of smaller 
 cities. A statement of the expenses of the health department should 
 be made. This should be given in some detail showing the amounts 
 expended for salaries, for hospital expenses, ambulances, vaccination, 
 disinfection, carriage hire, office expenses, removal of ashes, garbage or 
 night soil, registration and laboratory expenses. If any of these mat- 
 ters, which are usually in the health department, happen to be in 
 another department, it would be well to note this and also the amount 
 expended by that department. It is sometimes deemed inadvisable to 
 publish salaries, but it is usually best to do so, and a good way to give 
 the expense items of the health department is to state that so much was 
 spent for such and such a department, as plumbing inspection, and then 
 under that specify the salaries of the inspectors. 
 
 Two faults are frequently found in financial statements. One is 
 that little or no detail is given, the other is that too much is given. It 
 is important to know just how much it cost to remove so many tons of 
 garbage, but not that John Smith was paid #75 for a horse, and John 
 Doe ninety-seven cents for a whip. 
 
 In reporting the working of the department each year it is not 
 practicable to go into details in regard to everything which is done 
 where the same methods are followed year by year, but it is a good plan 
 to have such a complete account in at least one report, and refer to it 
 by year and page in those subsequently issued. New methods and new 
 investigations should always be explained in the clearest possible man- 
 ner. 
 
 Statistics of communicable disease should be made as full as possible 
 and should cover a number of years. It is of advantage to give them 
 by months but it should not be forgotten that the totals should be given 
 also. In some reports the only way the reader can get totals is to add 
 the columns. The annual rate per 10,000 of the population is also 
 desirable. It should be made clear whether croup is included with 
 diphtheria or not. Nearly every health officer is in a position to secure 
 antitoxin statistics, and they should be published as carefully as 
 possible. Immunization statistics are particularly desirable. Special 
 cases throwing light on disputed points concerning the period of in- 
 cubation or infection, or concerning the manner of infection should be 
 reported in full. At the present time accurate accounts of disinfection 
 are very desirable. The collection and disposal of garbage and other 
 
MISCELLANEOUS SANITARY WORK. 819 
 
 refuse should receive careful attention. The manner in which the 
 work is done, the amounts handled and the cost should be clearly in- 
 dicated. It is very unsatisfactory to read of loads of garbage without 
 knowing how large the loads are. and the cost of collection should, if 
 possible, always be separated from that of disposal. Laboratory work 
 should be reported in detail, and methods, particularly if they are new 
 ones, fully described. 
 
 It may be objected that this plea for comprehensive reports made by 
 the wiitei- is due simply to his own personal need for such reports while 
 preparing the foregoing pages ; but it is not alone the student of 
 municipal affairs that desires good reports. The average citizen who 
 desires to look into the workings of a department, the councilman or 
 mayor to whom the reports are technically made, or the health officer 
 in another city, all desire that a report which they take up shall tell 
 them what is done, and how it is done, and shall convey this knowledge 
 clearly and fully, taking nothing for granted. 
 
 Finances. 
 
 The appropriation available for most health departments is entirely 
 dependent upon the will of tin- council or other appropriating body. 
 Much or little may be given as seems fit. Sometimes the amount is 
 specifically divided by the act of appropriation, so much being set aside 
 for salaries, so much for hospital expenses, so much lor the disposal of 
 garbage, etc. In other cases the particular use which is to be made of 
 the appropriation is left entirely to the board of health, but of course. 
 subject to the ordinances. The latter plan is followed in the city of 
 the writer and he sees no reason to desire a change, but members of 
 health boards in other cities have spoken to him of the disadvantage of 
 having the appropriation divided by outside officials who cannot possibly 
 foresee all the exigencies that may arise. 
 
 I sualTj ;i council may witliold all appropriation if it chooses, but 
 some states have provided thai the local sanitary administration shall 
 
 each year have a • available funds. In Iowa. 1 Ohio, 2 Wisconsin.'' and 
 
 .Minnesota 1 it is provided that the expenses incurred under the pro- 
 visions of the act providing for the establishment and operations of 
 boards of health must be met. No attempt is made ill the above slates 
 
 except iii Minnesota to !i\ the amount available. In other states the 
 
 Iowa, Code L807 , Sec. 2571. 
 
 I >hio, Annotated Statutes (It , Sec. 21 U). 
 
 Wisconsin, Statutes (1808), s «'--. 1 121. 
 i Minnesota, Statutes 1 1894), Se< , 7078. 
 
XJIi MISCELLANEOUS SANITARY WORK. 
 
 amount is fixed, or at least the minimum. This is the case in Florida 1 
 and New Jersey. 2 In Florida where local health administration is in 
 the hands of the state board of health that board may expend for sani- 
 tary purposes other than quarantine one-half mill on each dollar of the 
 assessed valuation. In Minnesota the amount is one mill on each dol- 
 lar. The New Jersey law allows the expenditure of -ftlOO per annum 
 for 2,000 inhabitants and an increase according to population. The 
 law is given below. 3 
 
 Several laws in these and other states make provisions for expendi- 
 tures for specific purposes, as the care of communicable .disease, main- 
 tenance of quarantine, building of hospitals, establishment of baths, 
 licensing of plumbers, destruction of diseased animals, inspection of 
 milk, etc. 
 
 It is extremely difficult if not impossible to prepare a comparative 
 statement of the amounts expended for sanitary purposes in different 
 cities. The following table is taken from the September Bulletin of the 
 Department of Labor (1900). It is not definitely stated in this report, 
 but it so appears from a study of the items, that expenditures for gar- 
 bage and other refuse disposal and for hospitals for communicable 
 diseases are not included, except where it is so specified. Other items 
 such as expenditures for plumbing inspection, food inspection, for 
 the care of the sick poor, for maritime quarantine, and for the recording 
 of births, marriages, and deaths, are in some cities included and in others 
 not. It was found impossible owing to lack of printed reports from 
 many cities and to the unsatisfactory character of the reports of others 
 to make the desired corrections. The table then must be considered as 
 only a rough indication of the sanitary expenditures of the different 
 cities. 
 
 1 Florida, Chapter :J2 of 1809. 
 
 - New Jersey, Revised Statutes (1805). p. 1650, See. 80. 
 
 ; New Jersey, Act of 31 March, 1887, Sees. 34-35: 
 
 "That the local board of health of each township in this state may expend 
 annually the sum of one hundred dollars in the care of the public health, and in 
 addition thereto fifty dollars for each one thousand of the inhabitants thereof over 
 two thousand, as returned by the last preceding census, if in its judgment such ex- 
 penditure shall be required for the purpose, and itemized bills for such expenditure, 
 having been approved by the president and secretary of such board, shall be paid 
 by the usual disbursing officer of the township, and if in case of any emergency or 
 of any special need for the protection of the public health such board shall consider 
 the expenditure of a greater sum necessary, the board shall so certify to the town- 
 ship committee, and with their consent and approval may incur such further ex- 
 pense as said committee may authorize, and if the funds at the disposal of the 
 township committee are not sufficient to cover such expenditure, said committee is 
 hereby authorized to borrow money for the purpose on the credit of the township, 
 and is directed to place the amount in the next annual tax levy, and with the 
 money so raised to pay the debts so incurred. 1 ' 
 
MISCELLANEOUS SANITAR V WORK. 
 
 821 
 
 Table Showing the Expenditures for the Health Department in Cities 
 of Over 30,000 Inhabitants. 
 
 Bulletin of the Department of Labor, .September, 1000. 
 
 New York. N. Y $1,070,546 
 
 Chicago, 111 190,844' 
 
 Philadelphia. Pa 240,928 
 
 St. Louis, Mo 134,201 
 
 Boston, Mass 145,021 
 
 Baltimore, Md 91,641 
 
 Cleveland, Ohio 35,532 
 
 Buffalo, X. Y 4:;.TT1 
 
 San Francisco, Cal 111,137 
 
 Cincinnati, <> 40,446 
 
 Pittsburgh Pa 81,507 
 
 New < Cleans, La 20,250 
 
 Detroit, Mich 38,079 
 
 Milwaukee, Wis 34,193 
 
 Washington, D. C 44.u:,4 
 
 Newark, X. J 56,615 
 
 Jersey ( !ity, X. .1 7,766 
 
 Louisville, Ky 9,638 
 
 Minneapolis, Minn 23,340 
 
 Providence, R. I 20,270 
 
 Indianapolis, Ind 10,000 
 
 Kansas City, Mo 36,198 2 
 
 St Paul, Minn 9,011 
 
 Rochester, \. V 28,359 
 
 I)<'ii\ .i. ( !olo 41,530 
 
 Toledo, Ohio 14,895 
 
 Allegheny, Pa 15,337 
 
 ( iolumbus, O 55,340 
 
 Worcester, Mas-, 11,502 
 
 S3 racuse, \. V ~r,.-j>-j 
 
 X.w Haven, Conn B,023 
 
 Paterson, N. .1 7,112 
 
 Fall River, Mass 23,619 
 
 St Joseph, Mo 6,478 
 
 Omaha. Neb 10, 195 
 
 Los Angeles, Cal 36, 156 
 
 Memphis, Tenn 60,664 ' 
 
 Bcranton, Pa ".Too 
 
 Lowell, Mass 40,820 
 
 Albany, X. Y $9,539 
 
 Cambridge, Mass 22,048 
 
 Portland, < >re 4.121 
 
 Atlanta, Ga 103,779" 
 
 Grand Rapids, Mich 4,639 
 
 Dayton. <> T.'.Mi:; 
 
 Richmond, Ya 67,469 s ,* 
 
 Nashville, Tenn 7,322 
 
 Seattle, Wash 8,798 
 
 Hartford, Conn 10,476 
 
 Reading, Pa 2,965 
 
 Wilmington, Del 7. To] 
 
 Camden, X'. J 3,500 
 
 Trenton, N. J 4,500 
 
 Bridgeport, Conn 4,000 
 
 Lynn, Mass 4..~>2s 
 
 Oakland. Cal 10,446 
 
 Lawrence, Mass 28,184 
 
 New Bedford, .Mass 5,513 
 
 Des Moines, la 6,360 
 
 Springfield, Mass 6,801 
 
 Somerville, Mass 8,079 
 
 Troy, V Y 7,610 
 
 Hoboken, N. J 2,332 
 
 Evansville, Ind 2,123 
 
 Manchester, X. II 1,594 
 
 Utica, V. Y L3,334 
 
 Peoria, 111 6,253 
 
 Charleston, S. C 13,500 
 
 Savannah. La 29,409 
 
 Salt Lake City. I'tah 12,202 
 
 San Antoni,.. Tex 12,347 
 
 Duluth, Minn 6,419 
 
 Erie, Pa 5,657 
 
 Elizabeth, N. J 1,560 
 
 Wilkesbarre, Pa 2,67 I 
 
 Harrisburg, Pa 1,126 
 
 Portland, Me 3,125 
 
 Yonkers, ff. T " 10,178 
 
 Nol including data relating to sanitary district of Chit 
 
 including expenditures for hospitals. 
 
 Including expenditures for hospitals, asylums, almshouses, and other charities. 
 1 including expenditures for garbage removal. 
 
 Including expenditures forstreel cleaning and sprinkling and garbage removal. 
 '• Including expenditures for cleaning Bewers. 
 
 I lata for lo months. 
 
822 
 
 MISCELLANEOUS SANITARY WORK. 
 
 Norfolk. Va $32,822 J 
 
 Waterbury, Conn 2,998 
 
 Holyoke, Mass 3,245 
 
 Fort Wayne. Ind 3,562 
 
 Youngstown, O 6,695 
 
 Houston, Tex 24,899 
 
 Covington, Ky 2,128 
 
 Akron, () 2.242 
 
 Dallas, Tex 9,371 
 
 Lancaster, Pa 2,206 
 
 Lincoln, Neb 1,275 
 
 Brockton, Mass 4,988 
 
 Binghaniton, X. Y 4.026 
 
 Augusta, Ga 11,286 
 
 Altoona, Pa 1,786 
 
 Wheeling, W. Va 2,629 
 
 Mobile. Ala 1,939 
 
 Birmingham, Ala 3,487 
 
 Little Rock, Ark o.SO.j 
 
 Springfield, O l'.."i22 
 
 Galveston, Tex 4,626 
 
 Tacoma, Wash 1.777 
 
 Haverhill, Mass :i.277 
 
 Spokane, Wash 8,634 
 
 Terre Haute, Ind S2,.">!»4 ; 
 
 Dubuque, Iowa 1,521 
 
 Quincy, 111 2,069 
 
 South Bend, Ind 42.") 
 
 Salem, Mass 14,640 
 
 Johnstown, Pa 1,013 
 
 Allentown, Pa 3,299 
 
 Davenport, la 6,654 
 
 McKeesport, Pa 1,933 
 
 Springfield, 111 1,517 
 
 Chelsea, Mass 17,321 
 
 Maiden, Mass 2,041 
 
 Topeka, Kans ' 8,476 
 
 Sioux City, la 3,865 
 
 Knoxville, Tenn 1.00s 
 
 Chattanooga, Tenn 2,159 
 
 Superior, Wis 4,657 
 
 Rockford, 111 1,868 
 
 Taunton, Mass 2,956 
 
 Joliet, 111 4,500 
 
 Canton, Ohio 2,012 
 
 Butte, Mont 9.153 
 
 Auburn, X. Y 3,650 
 
 As illustrating sanitary expenditures in smaller communities refer- 
 ence may be had to the report of the state board of health of ( )hio for 
 1896. The figures refer to incorporated villages mostly of 1,000 to 
 2,000 inhabitants. In two of these the sanitary expenditures were oyer 
 81,000 ; in one between 8500 and 81,000 ; in seven between 8250 and 
 8500; in twenty-one between *100 and 8250, and in 159 under 8100. 
 In most of them the chief item of expense was the salary of the health 
 officer. 
 
 Tenement Hotsks. 
 
 The housing of the poor is one of the most serious problems con- 
 fronting large cities. The tenement house question is a pressing one 
 with sanitarians as the death rate in tenement house districts is usually 
 much higher than in other parts of the same city. It is believed that 
 by improving the tenements, the conditions of life are improved and 
 that the better environment conduces to the physical and moral well being 
 of the occupants, and increases the amount of happiness and extends the 
 duration of life. Tenement houses may be defined, and are so defined 
 in laws dealing with the subject, as dwellings designed for a certain 
 number of families. The popular notion of a tenement is a dwelling 
 
 1 Expenditures for Brambleton and Atlantic City wards included in other expend- 
 itures for maintenance and operation. 
 
 2 Including expenditures for street cleaning and sprinkling and garbage removal. 
 
MIS < EL /, AXEO I r S s. 1 XT T. IRY II r ORK. 8 2 3 
 
 hived by the poor and usually cramped and dirty. To improve the con- 
 dition of the tenement, both the popular and the legal tenement, has 
 been one of the chief aims of sanitary officers. 
 
 All the. laws against nuisances and the methods devised for their 
 abatement, are largely put in operation for the benefit of dwellers in 
 tenements, and the general building and plumbing laws, the operation 
 of medical relief, and the care of contagious disease, have all done much 
 to better the condition of the inhabitants of tenement houses. 
 
 Besides these general efforts, special attempts have been made directed 
 specifically to the improvement of tenements. The necessity for such 
 efforts varies greatly in different cities. It is greatest in the cities 
 of the old world: that is in the older portions laid out irregularly with 
 narrow streets and alleys. The regular plan and generous thorough- 
 fares of most American cities have been of enormous advantage. The 
 tenement question is as a rule the more important the larger the city. 
 The smaller the city the less valuable the land, and the smaller the 
 houses and the greater the space around them. Rapid growth some- 
 times, as in Chicago, has almost necessitated the occupation of many 
 unsuitable buildings as dwellings. Lack of freedom to expand in all 
 directions, as in Boston and New York, will also foster the tenement 
 evil. In fine, crowding is what makes the houses of the poor a problem. 
 In the country there is light and air for all. no matter how poor the 
 dwelling. In the city, darkness and suffocation come, unless care is 
 taken. The greater the demand for space the greater the crowding and 
 resulting harm. 
 
 All the conditions of the tenement house evil were more actively in 
 Operation in New York than in any other city, and in New York the 
 evil has in the past reached greater proportions than in any other city. 
 
 has received more attention, and has hail more done to eliminate it. 
 
 The labor of improving tenement houses is so vast that it could hardly 
 
 lie expected that a board of health could accomplish much without out- 
 side assistance. As a matter of tact public opinion has been formed 
 and Legislation adopted Largely by other agencies. Thus in New York 
 City there have been four independent commissions appointed to con- 
 sider this tenement problem, and to their reports and the public senti- 
 ment created by them has been due much of the improvement ill the 
 dwellings of the pom- in that city. A tilth commission is at present 
 < 1900), considering the subject. The secretary of this commission, Mr. 
 Lawrence Veiller, has recently (October, 1900,) issued a report on 
 Housing Conditions and Tenement Laws in Leading American Cities, 
 and to this reporl the writer is greatl) indebted. The enforcement of 
 tenement house laws when the\ are once enacted is usually leii to the 
 
824 MISCELLANEOUS SANITARY WORK. 
 
 department of health and can only be secured by it when backed by 
 strong public opinion. The most important tenement house legislation 
 is embodied in special acts passed to affect certain large cities as Bos- 
 ton, 1 Chicago, Cincinnati, Cleveland, New York, 2 and Philadelphia. 3 
 There have also been a few acts conferring upon local government the 
 power to regulate the construction of tenement houses. Thus in New 
 Hampshire 4 towns and villages, and in New Jersey local boards of 
 health are authorized to do this, and a similar authority was given to 
 Baltimore 5 though few ordinances have been adopted under its pro- 
 visions. The ordinances governing the construction of tenements in 
 Buffalo are adopted under the provisions of the charter which gives the 
 [lower to regulate the construction of buildings.' 1 
 
 The earliest tenement house laws were enacted for New York City 
 in 1867 and these serve as the basis of the present statutes. Various 
 modifications of these laws have been made from time to time. The 
 latest form is that found in the charter for the greater city." The fol- 
 lowing is a brief synopsis of the sections with the exception of those 
 relating to the vacation and destruction of houses unsuitable for occu- 
 pancy which have been considered on page 110 : 
 
 Sec. 1304. Tenements must be ventilated as required by the board of health. 
 
 1305. A tenement is defined as a dwelling leased to three or more families or 
 more than two families on a floor; a lodging house is where persons for hire sleep 
 for less than one week. 
 
 1306. Roofs must not leak and stairs and banisters must be kept in repair and 
 means of escape from fire provided. 
 
 1307. Sleeping rooms if without a window must have a transom (of three 
 square feet area), opening into a room with a window, and also a transom into a 
 hall or room opening into a hall. There must be a ventilator over the stairway. 
 
 1308. Sewer connection must be made when there is a sewer, and vault or 
 water closet provided. The owner must see that all plumbing is kept in good order 
 and no tilth must be put in an improper place. When there is no sewer there are 
 strict rules about vaults, and yards must be drained into the gutter. 
 
 1309. Cellars in buildings hereafter erected are not to be used wholly or in 
 part as a dwelling, and in old buildings they are not to be used as a dwelling with- 
 out a permit. Cellars so used must be seven feet high, two feet above street, sur- 
 rounded by two and one-half feet open space and drained, and have one foot of 
 space below the floor. There must also be a window of nine square feet. If there 
 is a rear room in the cellar, it must have a door and transom into the front room. 
 Light must not be obstructed by steps or otherwise, and a water closet must be 
 provided. 
 
 1 Massachusetts, Chapters 419 of 1892, 97 of 1895, and 161 of 1899. 
 
 - New York, Chapter 378 of 1897, Sees. 1304-25. 
 
 3 Pennsylvania, Act of 7 June, 18'.)."). 
 
 1 New Hampshire, Public Statutes (1891), Chapter 116. 
 
 5 Maryland, Public Local Laws (1888), Vol I, p. 415, Sees. 400-1. 
 
 6 New York, Chapter 105 of 1891, Title II., Chapter I, Sec. 17(5). 
 
 7 New York, Chapter 378 of 1897, Title 7. 
 
MISCELLANMO Us SANITA A* Y WORK. 825 
 
 1310. No cellar can be used for sleeping without a permit. Wall paper must 
 be taken oft' before new is put on. Owner, keeper or lessee must cleanse house 
 whenever board of health requires. 
 
 1811. When part of a tenement is used for a bakery or bar room, transoms 
 must be tight to keep out odors, and doors must be tire proof. 
 
 1312. There must be proper garbage and ash receptacles, no combustibles or 
 hay or grain may be stored, and no animals kept. There must be no bakery unless 
 the building is fire proof. 
 
 1313. Owners and persons having control must file name and address and 
 description of property with hoard of health. In ease of change, new owner must 
 register in thirty days. Notices of the health department must be posted five days 
 and mailed. 
 
 1314. Tenements are to be inspected twice a year. Contagious diseases must 
 be reported by owner or occupant. 
 
 1315. Prescribes method of vacating tenements unfit for habitation. 
 
 1316. Provides for the condemnation and destruction of all such. 11 
 The following provisions are for new buildings: 
 
 1318. Two tenements cannol be erected on one lot without a permit from the 
 department of buildings. If the buildings are one story high there must be a ten 
 foot space between them; if two stories, fifteen feet; if three stories, twenty feet, 
 if more than three stories, twenty-live feet: hut if there is through ventilation, the 
 space may, bj permission, be less. The building is not to occupy more than 62 per 
 cent, of the lot. except on corners, when 92 per cent, is allowed. Such building 
 shall not come within five feet of the rear of the lot. and the interior shaft shall not 
 lie less than two feel four inches wide. Xo shaft over ten feet square shall be 
 ■ ■ rered with a skylight. The cellar stairs must be fireproof. There must he an 
 area in front from level of cellar. All elevator shafts must have automatic doors 
 unless there is an attendant. The elevator well in cellar must be fireproof. In 
 buildings of over five stories, the stairs must he lire], roof, and of over three stories 
 of slow burning construction with no wood wainscot. < >ne flight niusi extend to 
 roof. Every room must have a window into the open air. The water closet must 
 open outside, or if it has its own vent shaft, may open into shaft if twenty-fiv< feel 
 square. The floor of water closet must Jbe asphalted or otherwise water proofed, 
 
 and it must be water proofed sixteen inches up thesides. The depart meiit of build- 
 ings may make further explanatory regulations. Tenements ma> noi be used for a 
 private school, stable, or for storing rags, bul underwritten regulations, the hoard 
 of health may give permit for a scl I. In cases of violation, any court of record 
 
 may alter notice, enjoin further use of building. 
 
 1319. In all new houses r is must be eighi feet high, except in attic where 
 
 they must be eight feel for one-half t hen- ana. livers room shall have a window or 
 a ventilator over door into a hall with window. Windows musl ha\ le-tentli ana 
 
 ot room, and extend to seven and one half feet above ll ', and the upper half must 
 
 open full width. Habitable rooms of less than 100 feet floor space, if not provided 
 with window or fireplace, shall have separate air shafi as prescribed by the board 
 
 of health. 
 
 1320. There must be a chimney opening for stove for each room and recep- 
 tacles for rubbish and water on each floor. Cellars (of all houses) shall be made 
 
 water tiglli and ceilings plastered, and in made hind in wel pl.i< es musl he moisture 
 
 proof. The hoard of health is to compel these changes to be made. Halls to have 
 
 windows, unless \eiitilated otherwise to I he satisfaction of the board of health. 
 
 Hall lights musl be kepi fr sunset to ten p. m.. and in halls without windows 
 
 from eight \. m to ten p. m. 
 
 1821. Everj aduli occupant shall have 100 cubi< feel of space and children 
 
 Under twelve, 300 feet In a house lor more than eight families, there shall he a 
 resident janitor. 
 
826 MISCELLANEOUS SANITARY WORK. 
 
 lo22. The penalty for violations of the tenement house law is from $10 to §100 
 and 310 for each day of violation, and ten days imprisonment for each day of viola- 
 tion. The owner and lessee are responsible. 
 
 1323. Provides that the department of buildings may make other regulations 
 as to light and ventilation of all new tenement or lodging houses consistent with the 
 foregoing, when it shall be satisfied that such regulations will secure equally well 
 the health and safety of the occupants; likewise the board of health shall have 
 authority to make other regulations as to cellars and as to ventilation in completed 
 buildings, consistent with the foregoing, when it shall be satisfied that such regu- 
 lations will secure equally well the health of the occupants. 
 
 i:»24. Provides for inspection by sanitary police. 
 
 The New York law has served as the basis of tenement house legis- 
 lation throughout the country. Several cities have incorporated more 
 or less of it into their sanitary codes and it has been copied quite closely 
 in several acts of special legislation for individual cities. It was em- 
 bodied with few changes in the act for Boston and for Philadelphia, and 
 for cities of the first class in Ohio, and the most important features 
 enter into the sanitary codes of Brooklyn, Buffalo, Chicago, Paterson, 
 and the ordinances of St. Louis. A lesser number of its items can be 
 traced in the act for buildings in Providence, and in the sanitary regula- 
 tions of Lowell. 
 
 Some minor differences may be noticed in these cities. 
 
 In Milwaukee, Paterson, and Toledo a tenement house is one oc- 
 cupied by two families, in Denver and San Francisco it is a tenement if 
 occupied by two families above the first floor, in Chicago if there are 
 more than three families or more than two on one floor, and a similar 
 definition is found in St. Louis, Boston, Baltimore, Providence, Kansas 
 City, and Syracuse. In Buffalo four families, or three above the second 
 floor are necessary to constitute a tenement. In Lowell and Bridge- 
 port, tenement house plans must be approved by the board of health, 
 but only when the buildings are over two stories. In New Haven, a 
 rear tenement cannot be built without the permission of the board of 
 health. 
 
 The difficulty of fixing the responsibility for the care of tenements 
 is overcome in Buffalo by the following : 
 
 " Every owner or lessee of a tenement or lodging-house, and every person hav- 
 ing control of a tenement or lodging-house, shall, on or before May 15, 1893, and in 
 the month of May in each year thereafter, tile in the office of the department of 
 health a certificate stating his name and address, and also, if he shall not be a per- 
 manent resident of the city, the name and address of his resident agent for the man- 
 agement of said tenement or lodging house; and also containing a description of the 
 property by street number or otherwise, as the case may be, in such manner as will 
 enable the department to easily find the same, and also the number of apartments 
 in each house, the number of rooms in each apartment, the number of persons oc- 
 cupying each apartment and the trades and occupations carried on therein, and said 
 facts shall be recorded in the office of the department of health. He shall also file 
 
MISCELLANEOUS SANITARY WORK. 827 
 
 with the said certificate a plan ot diagram of the lot, and each floor in the building, 
 showing all dimensions, and also showing all doors, windows, closets, water-closets, 
 privies, staircases, and means of exit, and shall Hie such a plan or diagram annually, 
 unless his annual certificate shall state that no changes have been made affecting 
 
 the previous plan or diagram."" l 
 
 The form of owner's certificate used in Buffalo is shown in Appen- 
 dix 127. 
 
 In Boston tlic cellar ceiling must be one foot above the ground, in 
 Baltimore three feet, in Cleveland, Milwaukee, Jersey City, Toledo, and 
 Columbus lour feet, and the rooms must be eight feet high, and in Cin- 
 cinnati three and one-half feet above the ground and seven and one-half 
 feet high. A concrete floor three inches thick is allowed in Phila- 
 delphia ami Pittsburgh, and two inches in the District of Columbia and 
 Buffalo. 
 
 The Buffalo rules are very strict in regard to cellars. Nfo one is 
 allowed to sleep, lodge, or dwell in a cellar. 
 
 •'The cellar of every tenement or lodging-house shall be protected by a two- 
 inch bed of concrete (cement and gravel or tar and grave] I or asphalt, or hard bricks 
 
 laid in cement with concrete: asphalt or brick shall be laid on four inches of broken 
 • s, Mich stones not being greater than two inches in size."' 
 
 In Philadelphia on corner lots uinety per cent, may be covered by 
 the tenement and on the other lots eighty percent., in Boston sixty-five 
 per cent, al second story level measured to the middle line of the street 
 on which it abuts, in Buffalo on corner lots ninety per cent., on others 
 Beventy-five per cent., in Cincinnati interior lots ninety per cent, above 
 the first story, and for each additional story two and one-half percent. 
 less. In Chicago and the District of Columbia a ten-foot space must be 
 left in the rear. In Philadelphia Bpace between a trout and rear ten- 
 ement musl not In- less than twelve feet, in Baltimore thirt\ feet. 
 Iii Cleveland and Columbus the length of the space must lie three- 
 fourths of the width of the buildings, and in Cleveland lor two-storj 
 buildings the space must he twenty feet. 
 
 In Chicago if rooms open into a shafl the latter must have at leasl 
 thirty-six square feet of area, in Denver forty square feet. In Phila- 
 delphia such air shaft musl he eight feet wide and every window must 
 be eight feel from the opposite wall or lot line. In Baltimore, Kansas 
 City, Cleveland, Milwaukee, Districl of Columbia, and Providence the 
 law permits rooms i" open into a room with windows but it musl also 
 open into the hall. Air -hilts in Chicago must for three-stor} build- 
 ings l»e thirty-six feet square, for four stories forty-six feci, and for five 
 stories fifty-six feet, and soon increasing ten feet for each Btory. In 
 
 Buffalo, < Ordinances. < lhapter 25, v >-. . r_\; 
 
828 MISCEL L. 1 NEO Us SAN11AE Y WORK. 
 
 ( Ileveland and Columbus the areas are for three stories twelve square 
 feet, for four stories sixteen square feet, and for five stories twenty 
 square feet. In Denver, Toledo, and Milwaukee for three stories the 
 area is forty square feet, and for four stories fifty square feet, increas- 
 ing ten feet for each story, and the air space is not to be roofed over. 
 In Boston two open spaces must be left on the lot, ten feet wide and of 
 an aggregate length of one twenty-fifth of area of building, also a clear 
 open space at rear in depth one-half the width of the street in front of 
 the building. In Buffalo there must be a "court" ten feet wide and of 
 250 square feet of area. The width of shafts must not be less than two 
 feet in Chicago and three feet in Cleveland. In Philadelphia the open 
 space at side or rear must cover twenty per cent, of the lot and the 
 minimum width of all spaces is eight feet, or if between tenements 
 twelve feet. 
 
 In Buffalo every room must have a window opening into a street, 
 yard or court, which window must equal in area one-tenth of the area 
 of the room, and must extend seven and one-half feet above the floor 
 and both sashes must be movable. In Lowell every room must have a 
 window of twelve square feet area, and the sash must be hung with 
 weights, and there must be a window in every hall except with the per- 
 mission of the board of health. In Philadelphia there must be a win- 
 dow of twelve square feet in every room, and there must be eight feet 
 between the window and every dead wall, and the window must extend 
 eight feet above the floor. Rooms may be seven feet high in Columbus 
 and Cleveland, seven and one-half in Cincinnati, and must be eight and 
 one-half in Jersey City. 
 
 In Boston and St. Louis tenements must not be over two and one- 
 half times the width of the street in height, in Milwaukee and Toledo 
 the height must not be over two and two-thirds the distance from the 
 face of the building to the middle of the street. In the District of 
 Columbia no building is to exceed in height the width of the street and 
 there is a maximum of ninety feet. In Buffalo on streets less than twenty 
 feet wide no tenement may be more than thirty feet high, and in Provi- 
 dence not over thirty-five feet. 
 
 In New York City there must be one water-closet on each floor for 
 every two families and none are allowed in the yard. In Chicago none 
 are allowed in cellars. In Philadelphia there must be one for every 
 suite of rooms and none are allowed in sleeping rooms. In Boston, 
 Baltimore, and Denver there must be one water-closet for every twenty 
 persons. In Buffalo there must be one for every three families or every 
 fifteen persons, in Detroit one for every two families, in Rochester one 
 for every ten persons. In Buffalo, Hartford, Pittsburgh, and Rochester 
 
MI& t EL LANJSO US & i XI TAB J * WORK. % 2 9 
 
 no water-closet may be in a cellar. In Chicago and Denver a water- 
 closet must not lie ventilated by the same shaft that ventilates a habit- 
 able room. 
 
 In Chicago tenements must have the wall and ceilings whitewashed 
 in April and < October each year, and in Boston in April or Maw and in 
 Buffalo twice a year. 
 
 In Philadelphia there must be 700 cubic feet of space in every habit- 
 able loom. In Denver there must be 700 feet for each occupant, in 
 Buffalo or Nashville 600 feet, and in the Districl of Columbia 400 
 cubic feet. In the latter city the health officer may affix a notice to any 
 room stating the number of occupants that may he allowed and must 
 serve a similar notice on the owner. In Rochester there must he 500 
 cubic feet tor each occupant with a floor space one-twelfth as great. 
 
 In Philadelphia tenement houses of over four stories must he lire- 
 proof. There must lie tower lire escapes, and the stairs must extend to 
 the ground floor. Stair- must he three feet wide in a fifteen room 
 building, three and one-half feet in a tenement house of from fifteen to 
 twenty rooms, and four feet wide in tenements of over twenty rooms. 
 Stairs shall have an eight inch riser and nine inch tread without the 
 nosing. In Buffalo no winders shall he less than twelve inches wide at 
 tin- middle point of the stair. There shall he a staircase leading to the 
 roof with an opening three feet by two feet. In Buffalo: 
 
 ■• Every tenement or lodging-house hereafter erected more than two stories bigh 
 shall bave at least two independent means "f egress, each accessible from each 
 nt'iit. either directly "i bj means "i common halls, ami shall conform to exist- 
 ing building laws, ordinances, rules and regulations relating to tire escapes. 
 
 ■• In every tenement-house containing eight families or more, ami of the height 
 of three stories or more, ami in every lodging-house at least one red light shall be 
 kept burning at night on every flight of stairs, ami one or more u'Ui^s shall he 
 placed ami he <it' such size ami number as could give an alarm through the house in 
 i tire. All doors of exit or entrance shall open outward. The superintendent 
 may make such other <>r further requirements for prevention or escape from fires as 
 may he reasonably necessary under the conditions of each cast 
 
 In Buffalo, as in New York, there must be water on each floor, ami 
 tor ead, family, and in Philadelphia there is, the same requirement, and 
 there must he a sink for each tenement and there musl he no hydrant 
 
 in the yard. 
 
 Buffalo has the following : 
 
 Ml receptacles for ashes, waste ami other substances 
 
 liable by spun tan s combustion or otherwise to cause inc. shall he made of inc - 
 
 bustible material, satisfactory to the superintendent. Everj building used as a 
 tenement or lodging-house shall have outside ami appurtenant to said building, on 
 land "i the owner, a suitable space, satisfactory to the health commissioner, ami 
 
 Buffalo, « Ordinances, Chaptei 25 
 
830 
 
 MISCELLANEOUS SANITARY WORK. 
 
 approved by him in writing, for the temporary deposit of garbage and other refuse 
 matter. The requirement that such deposit shall be made upon the land of the 
 owner shall not apply to any building already erected where it covers the whole lot, 
 or where there is no direct exit from the court of such building." 1 
 
 In Illinois, in cities of over 50,000 inhabitants, the plans of all ten- 
 ement houses must be approved by the board of health. 
 
 The various building and plumbing laws which are enforced in all 
 the larger cities have done much to improve the character of tenement 
 houses though they may have no special provisions relating to that class 
 of buildings. 
 
 Boston, Buffalo, Chicago, New York, and St. Louis all have syste- 
 matic inspection of their tenement houses, and in New York in 1896, 
 fifty sanitary police were detailed for this service, and in Chicago, ten. 
 
 In New York City and Boston the law requires the tenement house 
 inspection to be made twice a year. In the latter city this is perfunc- 
 torily made for the apartment houses, but in the tenements of the poor 
 monthly, weekly, and even daily inspections are made. In New York 
 the inspectors are simply required to look after nuisances and the viola- 
 tions of the law in tenements. They are not required to make a full 
 report of the conditions of each house for filing in the office. This is 
 required in St. Louis and Buffalo and in the latter city a form is used 
 which is shown in Appendix 49. 
 
 In New York night inspections are made to determine over-crowding 
 and for this work the following; blank is used : 
 
 HEALTH DEPARTMENT. 
 Sanitary Bureau. 
 
 Report of Night Inspection made at o'clock P. M., 
 
 of premises situated 
 
 by Sanitary Officers 
 
 ISO 
 
 NAME OF TENANT 
 
 Family 
 
 Adults Child 
 
 Lodgers 
 
 Adults Child 
 
 Size of Rooms 
 
 Length Width Height 
 
 Total 
 Cubic 
 
 Feet 
 
 Cubic 
 Feet for 
 Adults 
 
 Cubic 
 Feet for 
 Children 
 
 Simitar// Officers, 
 
 1 Buffalo, Ordinances. Chapter 25, Sec. 139. 
 
MISCELLANEOUS SANITARY WORK. 83] 
 
 In New York in 1896 there were made 190,134 inspections which 
 resulted in 38,858 complaints of nuisances. There were 40,461 front 
 tenements and i\448 rear tenements. These houses were occupied by 
 339,237 families with 1,487,392 persons, of whom 180,359 were under 
 live years of age. 
 
 In order to enforce the law requiring lights in tenements from sun- 
 set till 10 P. M., night inspections were made. One hundred and fifty 
 inspectors visited 40,000 houses between 26 and 30 March, 1896; 14,- 
 000 violations of the law were found and orders issued. At a sul.- 
 sequent inspection 5,630 violations were found and notices of suit were 
 served. Another inspection in April showed that in all cases the law 
 had been complied with. 
 
 Night inspections are also made in Newton. .Mass.. and in one in- 
 stance thirteen persons were found in a room of 1,700 cubic feet. 1 
 
 In St. Louis in 1896 there were in 1,851 tenemenl houses 59,621 
 persons. Of the occupied rooms there was an average of 1.4 persons 
 to a room. The average cubic capacity of rooms was Loot; feet and 
 the ana unt of -pace per person was 1,111 euhic feet. 
 
 Lodging Houses. 
 
 The laws governing the construction of tenements are usually made 
 applicable to lodging houses as well, hut there are in some cities other 
 regulations prescribed, either by statute or ordinance. The Boston act 
 ami the Pennsylvania law have the following requirements tor the 
 licensing of lodging bouses : 
 
 v. such license shall be granted until the inspector of buildings of said city 
 has certified that the said building is provided with sufflcienl means to escape in 
 
 t tire ami that suitable appliances are provided for extinguishing fires and for 
 
 giving alarm to the inmates in case "t fire; and said inspoctor may Er time t" 
 
 time require such alterations to be made or suoh additional appliances t" !»<■ pro- 
 vided as may in his judgmenl he necessary for the protection of lite and property in 
 
 i ,i-i' of lire. 
 
 • \o su« h license shall he granted until the board of health has certified thai the 
 building is provided with a sufflcienl number of water-< L.seis and urinals, ami with 
 good and sufficient means of ventilation; and said board may from time t<. time re- 
 quire the licensee t" thoroughly cleanse and disinfect all parts of said building and 
 the furniture therein, to the satisfaction of said board. 11 
 
 In pursuance of the above statute, the board of health of Boston 
 has adopted the following regulations: 
 
 • i. Tin' means for lighi ami \ em i lat inn must he satisfactory t" the board of 
 health and beyond the control of lodgers. 
 
 ••■_'. All floors and stairways must he si.und. smootll and either painted or 
 
 shellacked. 
 
 \eu ton, Report oi Board '•) Health 1 1897), p. 
 Massachusetts, Chapter n t • •! 1894, Sees. I 
 
832 MISCELLANEOUS SANITARY WORK. 
 
 " 3. There shall be allowed not less than 300 cubic feet of space to each lodger 
 in sleeping rooms. 
 
 " 4. Open and spacious dormitories will be preferred. 
 
 "5. Single or small rooms will be allowed only in exceptional cases, and then 
 only with fireproof partitions. 
 
 "6. No carpeting will be allowed on floors or stairways. 
 
 " 7. There shall not be less than two horizontal feet between the sides of any 
 two beds. 
 
 "8. All bedsteads must be single and of iron. 
 
 " 9. Blankets will be required and " comforters " will be prohibited. 
 " 10. Mattresses must be covered with a waterproof covering. 
 " 11. No person will be allowed to retire or sleep in his day clothing. 
 " 12. No person who is not clean will be allowed to retire without a bath. 
 "13. Water closets (one to every twenty lodgers), lavatories and shower bath, 
 with hot and cold water, all with open plumbing, must be furnished on each floor, 
 and the floors to same shall be of marble, slate or concrete. 
 "14. All movable receptacles for excretions are prohibited. 
 " 15. Smoking in sleeping rooms is prohibited. 
 
 " 16. All stairways, fire escapes and other means of exit in case of fire must be 
 in accordance with the statutes and ordinances on that subject and to the satisfac- 
 tion of the Building Commissioner. 
 
 " 17. Stoves for heating will be allowed only tinder the most favorable con- 
 ditions for safety. 
 
 " 18. The use of portable kerosene lamps is prohibited. 
 
 "19. A reliable person or persons must be in attendance at all hours of the 
 night." 1 
 
 The following is from the Sanitary Code of the City of New York : 
 
 "... The beds in all [lodging-houses and in every room in which beds are 
 let for lodgers shall be separated by a passageway of not less than two feet, horizon- 
 tally, and all the beds shall be so arranged that under each of them the air shall 
 freely circulate, and there be adequate ventilation. Four hundred cubic feet of air 
 space shall be provided and allowed for each bed or lodger, and no more beds shall 
 be permitted than those provided in this way, unless free and adequate means of 
 ventilation exist, approved by the board of health, and a special permit in writing 
 be granted therefor, specifying the number of beds or the cubic air space which 
 shall under special circumstances be allowed." 2 
 
 Iii Fitchburg 500 cubic feet of space are required for each lodger, 
 and a similar requirement is found in the California law. 3 In Illinois 4 
 400 cubic feet are required and no more than six persons may sleep in 
 one room. 
 
 In order to secure the enforcement of these sanitary regulations, 
 the licensing and inspection of lodging houses are necessary. Lodging- 
 houses are licensed in Boston, Jersey City, New York City, and Phila- 
 delphia. In Boston and Pennsylvania cities it is provided for by 
 
 1 Boston, Rules of Board of Health, 22 March. 1898. 
 
 2 New York, Sanitary Code (1899), Sec. 26. 
 
 3 California, Act of 3 April, 1876. 
 
 4 Illinois, Act of 21 April, 1899. 
 
Vise ELL. I XKors SA XITAE Y WO UK. s: 1 ,: 1 , 
 
 statute. In Boston 1 every building not licensed as an inn, in which ten 
 or more persons are lodged for a single night for a price of twenty-five 
 cents or less, is a lodging house. All such must take out an annual 
 license from the board of police. No fee is charged for the license. In 
 Pennsylvania 2 the law is applicable to all cities and the mayor issues 
 the license: in other respects it is like the Boston act. In New York 
 City licenses are required for lodging houses containing more than four 
 beds. 3 
 
 Both the New York and Boston acts and the Illinois law require the 
 proprietors of lodging houses to keep a register of all lodgers which shall 
 at all times he open to inspection. In New York 4 the register is only to he 
 kept hetween the 1st of September and the 15th of Xovemher, hut in 
 Boston it is to he permanent. In New York the hoard of health 
 furnishes the record hook, and the proprietor every fortnight must make 
 a sworn return of the particulars in regard to each lodger for the pre- 
 ceding twenty-four hours. The following is the heading of the return 
 made in pursuance of this law: 
 
 Xanie. 
 
 Birthplace. 
 
 Residence. 
 
 lor. 
 Approximate age, height, and weight. 
 Peculiarities of form. 
 Visible marks on face. 
 Whether monthly, weekly or daily lodger. 
 Whether or not he occupies a hed. 
 
 In Illinois the keeper of the lodging house must file annually with 
 the county clerk such statements as the state hoard of health may 
 direct. 
 
 In New York nightly inspections are made of each house. This not 
 
 only results in a strid enforcement of the laws against overcrowding and 
 
 lilthiness, but is the means of getting control of walking cases of coiita- 
 
 Blassachusetts, < Chapter nt of 1804. 
 Pennsylvania, Chapter 806 "f 1895. 
 New Fork, Sanitary Code (1899), Sec. 201: 
 "Thai for all lodging-houses in which i»eils are let for lodgers containing four 
 or more heds in any apartment therein for the use ..f lodgers, a permit in writing 
 from this department siiail !><• required, and no person in the City of New Fori 
 
 shall have, lease, lei or keep any Buch lodging-hous • the lodgings therein, or 
 
 assist in the keeping, hire, or assisi in hiring, or conduct the business of any such 
 lodging-house, or the lodgings therein, except pursuant t" the terms and con- 
 ditions of a permit in writing previously obtained therefor from this department, 
 an application t"i which shall !>•• made In accordance with the rules and regulations 
 
 of the board of health by the pers r persona who propose to use the same. 
 
 1 New Fork, Chapter 758 of 1895. 
 
834 
 
 MISCELLANEOUS SANITARY WORK. 
 
 gious disease. Many a mild or incipient case of small-pox has thus 
 been discovered, which probably would otherwise have become the 
 starting point of an outbreak. The accompanying blank form of report 
 shows the items to be noted by the night inspectors in New York. 
 
 MEMORANDA. 
 
 Sanitary Bureau. 
 Report of Class Lodging Houses, Inspected 189 
 
 Report of the Sanitary Condition. 
 
 Street 
 
 Privies 
 
 Urinals 
 
 Cha niber 
 Utensils 
 
 Sinks 
 
 Bedding 
 
 
 
 
 
 
 
 Walls and 
 Ceilings 
 
 Floors 
 
 Beds in Excess 
 
 Respectfully submitted, 
 
 Sanitary Officer. 
 
 Of the difficulties of maintaining a high standard in lodging-houses 
 the Boston board of health speaks as follows : l 
 
 " One drawback to the proper sanitation of these houses is the disinclination of 
 the patrons to avail themselves of such ventilation as is provided, as they much pre- 
 fer a heated atmosphere, however foul, to fresh air of a lower temperature. 
 
 "A proprietor of one of these lodging-houses has instituted a reform, which al- 
 though very unpopular among his customers could be imitated by others in the 
 business with beneficial results, viz. : that of requiring every lodger to take a bath 
 or going elsewhere for accommodations. " 
 
 In this connection there may be profitably read an article in the 
 Forum of November, 1894, presenting the view taken of lodging house 
 restrictions by the average lodger. 
 
 Besides the cities above mentioned, others, as Chicago and St. Louis, 
 make more or less frequent inspections of their lodging houses. In 
 Illinois inspection of lodging-houses in cities of 100,000 inhabitants and 
 over has by a recent act been placed in the hands of the state board of 
 health. 
 
 In New York City in 1896 there were nine lodging houses with 
 300 lodgers or over, thirteen with from 200 to 300, fifty-six with from 
 100 to 200, twenty with from 50 to 100, and twelve with less than 
 fifty lodgers; in all 110 lodging houses in the city. 
 
 1 Boston, Report of Board of Health (1895), p. 95. 
 
MIS < EL L . 1 XEO US & 1 NI TARY II r ORK. 835 
 
 In Chicago in 1898 there were 128 lodging houses which provided 
 on the average for 6,737 lodgers per night. Thirty-nine of these houses 
 were provided only with bunks, 2,703 hunks in all, while in the other 
 houses there were 6,350 rooms with partitions running part way up 
 and 533 entirely separate rooms. 
 
 In Philadelphia in 1896 the number of lodging houses was eighty- 
 three, and of beds 3,037, and in 1899 there were 119 houses, but the 
 number of beds was not given. 
 
 Sweat Shops. 
 
 The sweating system is associated with, if it be not, the direct cause 
 of the most terrible phase of human life that is found in the United 
 States. A sweat shop is a manufactory in the dwellings of the very 
 poor. Very excellent accounts of the sweating system may be found 
 in a report on that subject by the House Committee on Manufactures, 
 52 Congress, Report No. 2309, and also in Bulletin No. 4 of the 
 department of labor for May, 1896. The writer of the latter article, 
 IIeiii\ White, general secretary of the United Garment Workers of 
 America, sums up the conditions that produce the sweating system ; 
 first, crowded population: second, high rent: third, contract work. 
 Home labor if the home be healthful, the labor reasonable, and the 
 wages fair, is by no means to he discouraged: but the gradations are 
 
 gradual from tins ideal conditi if labor to the destruction of home 
 
 l>\ the overcrowding and intense application and competition, and 
 starvation wages of the sweat shop. As it is a product of high rent 
 and competition, it bee es acryingevil in great cities. 
 
 The efforts that have been made to secure remedies hy legislation- 
 have been both h\ the wage earners themselves and by others interested 
 
 in promoting the welfare of the | '. In this movement the danger to 
 
 the public from the t ransmissioii in the goods made, of contagious 
 
 diseases from the makers to the buyers has figured largely. Health 
 
 inspectors and visitors of the pOOT bave too often seen the infection 
 
 of garments in process of making, to doubt thai this danger is a real 
 one; hut it has doubtless been much exaggerated. The dut\ of the 
 state to help the helpless, and make life more bearable for the most 
 wretched of mankind, is reason enough for an\ action which will 
 abolish or mitigate the sweat shop, without conjuring up an exaggerated 
 danger of sickness to the well-to-do. 
 
 The following states have legislation concerning sweat shops: 
 
 Illinois. Indiana. Maryland, Massachusetts, New Jersey, New York, 
 Ohio, Pennsylvania, and Wisconsin. Thefirsl law was passed by New 
 
836 MISCELLANEOUS SAKITABY WORK. 
 
 York in 1892, 1 the others have largely followed it. This law was re- 
 vised in 1899. 2 It is by this law forbidden to manufacture articles of 
 clothing, cigarettes, etc., in a tenement house without a license, but 
 white goods can be so made. License is granted by the factory in- 
 spectors after inspection. There must be 250 cubic feet of air space 
 for each worker between 6 A. M. and 6 P. M. and 400 cubic feet 
 between 6 p. M. and 6 A. M., but the rooms must in all cases be lighted 
 by electricity. Licenses must specify conditions and must be posted 
 on the premises. Employers must keep a register of all persons work- 
 ing for them in sweat shops. The factory inspector is to tag as " tene- 
 ment made " any articles which he rinds made contrary to the pro- 
 visions of the law. Sweat shop goods brought from another state are 
 to be inspected and tagged. Owners of buildings are responsible for 
 their illegal use for sweat shop purposes. The factory inspectors en- 
 force the law but the following are the duties of the board of health : 
 
 "If the factory inspector finds evidence of disease present in a workshop or in a 
 room or apartment in a tenement or dwelling house or in any room or apartment of 
 a building in the rear of a tenement or dwelling house, in which any of the articles 
 named in section one hundred of this chapter are manufactured, altered, repaired 
 or finished or in process thereof )\e shall affix to such articles the label prescribed 
 in the preceding section, and immediately report to the local board of health, who 
 shall disinfect such articles, if necessary, and thereupon remove such label. If the 
 factory inspector finds that infectious or contagious diseases exist in a workshop, 
 room or apartment of a tenement or dwelling house or of a building in the rear 
 thereof, in which any of the articles specified in section one hundred of this 
 chapter, are being manufactured, altered, repaired or finished, or that articles 
 manufactured or in process of manufacture therein are infected, or that goods used 
 therein are unfit for use, he shall report to the local board of health, and such 
 board shall issue such order as the public health may require. Such board may 
 condemn and destroy all such infected articles or articles manufactured or in the 
 process of manufacture under unclean or unhealthful conditions. 1 '' 
 
 The Massachusetts law has recently been amended as follows : 
 
 " No room or apartment in any tenement or dwelling house shall be used for the 
 purpose of making, altering, repairing or finishing therein any coats, vests, trousers 
 or wearing apparel of any description whatsoever, except by the members of the 
 family dwelling therein, and any family desiring to do the work of making, altering, 
 repairing or finishing any coats, vests, trousers or wearing apparel of any descrip- 
 tion whatsoever in any room or apartment in any tenement or dwelling house shall 
 first procure a license, approved by the chief of the district police, to do such work 
 as aforesaid. A license may be applied for by and issued to any one member of 
 any family desiring to do such work. No person, partnership or corporation 
 shall hire, employ or contract with any member of a family not holding a license 
 therefor, to make, alter, repair or finish any garments or articles of wearing apparel 
 as aforesaid in any room or apartment in any tenement or dwelling house as 
 aforesaid. Every room or apartment in which any garments or articles of wear- 
 
 1 New York, Chapter 655 of 1892. 
 
 2 New York, Chapter 191 of 1899. 
 
MISCELLANEOUS SANITARY WORK. 837 
 
 injj apparel are made, altered, repaired or finished, shall be kept in a cleanly condi- 
 tion and shall be subject to the inspection and examination of the inspectors of the 
 district police, for the purpose of ascertaining whether said garments or articles of 
 wcaiing apparel or any part or parts thereof are clean and free from vermin and 
 every matter of an infectious or contagious nature. A room or apartment in any 
 tenement or dwelling house which is not used for living or sleeping purposes, and 
 which is not connected with any room or apartment used for living or sleeping pur- 
 5, and which has a separate and distinct entrance from the outside, shall not be 
 subject to the provisions of this act. Nor shall anything in this act lie so construed 
 as to prevent the employment of a tailor or seamstress by any person or family for 
 the making of wearing apparel for such person's or family's use." 1 
 
 The Pennsylvania law lias an additional provision : 
 
 '• Not less than two hundred and fifty puhic feet of air space shall be allowed for 
 each and every person in any workroom where persons are employed at such labor 
 as i> hereinbefore described. There shall be sufficient means of ventilation pro- 
 vided in each workroom of every such establishment, and said workroom <>r rooms 
 in said establishment shall be kept thoroughly clean, sanitary and fit for occupancy 
 for such work or business. The factory inspector and deputy factory inspector, 
 under the direction of the factory inspector, shall notify the owner, agent or lessee 
 in writing to provide, or cause to he provided, ample and proper means for ventilat- 
 ing such workroom or rooms, and to put said workroom or rooms in a thoroughly 
 clean, sanitary and tit condition for occupancy for such work or business, and shall 
 prosecute such owner, agent or lessee if such notilication he not complied with 
 within ten days of the service of such notice; and any factory or shop under this 
 act requiring exits or other safeguards provided tor in the fire escape law. the same 
 shall be erected and located by order of the factory inspector regardless of the 
 exemption granted by any hoard or [of] county commissioners. lire marshals or 
 other authorities, and if such alterations and additions are not made within sixty 
 days from the date of sucb notice, or within such time as said alterations can be 
 mule witli proper diligence upon the part of such proprietors, said proprietors or 
 agents shall be deemed guilty of violating the provisions of this act" 2 
 
 The Ohio law forbids cooking in a sweat shop and also provides that 
 there shall In- do bed in it. There must be a stairway Leading in the 
 outside of tin- house. There must be separate water-closets for 
 thf two sexes and the Dumber «>t' closets is prescribed. There must be 
 250 cubic feet of air space for each person by day and 4<mi feel at aight. 
 In Maryland there must ]»• tOOcubic feel «»t' air space per person if the 
 temperature rises above eighty degrees hot worn < October first and .May first 
 or if artificial lighl is required between s \. \i. and 1 v. m. In Indiana 
 100 cubic lo.t «.f space are required unless the room is t>» ho Lighted by 
 electricity and a permit must be obtained from the factor] inspector. 
 
 As will ho soon from the above, the pari played l>\ the board oi 
 
 health in these nlninis, i^ iml UAUallj \ei\ great. The w mk nut itially 
 
 comes within the jurisdiction of the factor] inspector and the results "i 
 the efforts made may lie studied in their reports. A review of this 
 work may ho found in the article by Mr. Whiteabove referred t". 
 
 Massachusetts, < ihaptei 160 of I : 
 Pennsylvania, Chapter 87 ol 1897, Sec 2. 
 
APPENDICES. 
 
APPENDICES. 
 
 NO. 1. 
 
 ANNUAL REPORT 
 
 OF TIIK 
 
 Health Officeb-ob Secbetaby of the Board ok Bubeau of Health 
 
 (>ni " of County, 
 
 madetotkt Stati Board of Health of Pennsylvania, for the year, beginning January 
 J. 189 . and ending December SI, 189 . 
 
 ^£r"( Include nothing outside of these dates.) 
 I^-The annual report of the local board of health should be made as early in 
 January as possible.— Write in the blank space after each question, or, if more room 
 is ii' eded, write on the accompanying blank sheet placing the appropriate li^ure be- 
 fore each answer. 
 
 1. Give the name and address of each member of your board. 
 
 Name. 
 
 Post Office Address. 
 
 , President. 
 
 
 . Member. 
 
 
 
 it 
 
 
 It 
 
 
 . Secretary. 
 
 
 . Health Officer. 
 
 
 
 
 2. How many meetings have been held by the board during the year".' 
 :!. Have any improvements or changes been made as regards water supply, drain- 
 age and sewerage, <>r in the methods employed in disposing of excreta? 
 i. Nuisances. How many have been reported to your board? 
 How many have been removed? 
 
 Please report the tacts in regard to any nuisances of unusual char- 
 acter, or which have given unusual trouble in respect to deci 
 sions regarding them, or in which there has been unusual diffi- 
 culty in securing abatement. 
 ."). Mortality. What is your population ? 
 Total cumber of births '.' 
 Total number of deal lis ? 
 Deatb rate per thousand of persons living? 
 8. Communicable diseases. Please give the facts called for in the Following table: 
 
 Nil I Dii 
 
 No of 
 
 No.ol 
 Deaths 
 
 Nil. • 1 1 
 
 Outbreaks. 
 
 No nt Houses 
 Inspected. 
 
 No. nt i Outbreaks Confined 
 
 i" in -t Kouse. 
 
 Smallpox. 
 
 
 
 
 
 
 Diphtheria (in- 
 cluding Croup). 
 
 
 
 
 
 
 Measles. 
 
 
 
 
 
 
 Scarlel Fever. 
 
 
 
 
 
 
 ( lonsumpi ion. 
 
 
 
 
 
 
 Typhoid Fever. 
 
 
 
 
 
 
842 APPENDICES. 
 
 7. Are these diseases reported to your board by the physicians in attendance in 
 
 accordance with the law, ordinance or regulation requiring such reports? 
 
 8. What action has been taken by your board when cases of the communicable 
 
 diseases have been reported to it '? 
 
 9. Were houses in which cases of smallpox, diphtheria or scarlet fever occurred 
 
 placarded '? 
 
 10. What other epidemic diseases were more than usually prevalent during the 
 
 year? (Influenza, whooping cough, German measles, pneumonia, cerebro- 
 spinal meningitis, dysentery, diarrheal diseases of children, etc.) 
 
 11. Please communicate the facts regarding any cases of disease which were inter- 
 
 esting from a sanitary point of view. (Unusual course of epidemic pre- 
 valence, unusual symptoms or want of certain symptoms, observations as 
 regards period of incubation, communication of diseases by contagion, spread 
 of contagious diseases by public funerals, long periods of vitality of infec- 
 tion, concurrent or consecutive prevalence of diseases, etc.) 
 
 12. .Schools. Have any special cases come under your observation in which un- 
 
 healthy conditions existed ? Have contagious diseases entered any of the 
 schools ? If so, what action was taken ? 
 
 13. Have you any particularly unhealthy localities ? If so, what appears to be the 
 
 cause of such unhealthfulness ? 
 
 14. What methods can you suggest for improving your sanitary conditions ? 
 
 15. Accidents. Has sickness or death resulted from accidental causes; drowning, 
 
 fires, and kerosene accidents ? If accidents have occurred from the last 
 cause, please report in full to this Board. 
 
 16. Please communicate the facts regarding any cases of disease which appeared to 
 
 have been caused by polluted water, cess-pool or sewer gas, defective venti- 
 lation, lead, arsenical, or other forms of poisoning. 
 IT. Have any instances of food adulteration, or injurious effects from it, come to 
 your knowledge ? 
 
 18. Diseases of animals. Please report any cases of diseases of animals which have 
 
 occurred, and any cases of relation or apparent relation between such dis- 
 eases and human diseases. 
 
 19. Were any by-laws adopted by your board during the year ? If so, please for- 
 
 ward copies of all such to the office of the State Board. 
 
 20. Please give an account of any other work of interest which has been done by 
 
 your board during the year. 
 
 21. Has the experience of your board suggested any changes which ought to be 
 
 made in the health laws of the State ? If so, please report them. 
 
 22. Registration. Do you enforce registration of births? 
 
 Do you enforce registration of still-births ? 
 Do you enforce registration of marriages ? 
 Do you enforce registration of plumbers ? 
 Do you enforce registration of undertakers ? 
 Do you enforce registration of nurses and midwives ? 
 Do you enforce registration of vaccination of school children ? 
 2:;. What compensation has been received by the secretary and health officer of 
 your board ? If payment has not been received, for what reason ? 
 
 Signed 
 
 Dai'- , 189 . 
 
APPENDICES. 843 
 
 NO. 2. 
 
 WMTAIiV REGULATIONS. 
 
 Recommended by the State Boabd of Health of New Yobb for Adoption 
 1sy loc \ i bo lrd8 of ii i. \ i. 111. 
 
 Nuisances Section 1. Whatever is dangerous to human lift- or health; 
 
 defined. whatever building, or part or cellar thereof, is overcrowded or nut 
 
 provided with adequate means of ingress and egress, or is not suffi- 
 ciently supported, ventilated, sewered, drained, lighted or cleaned: and whatever 
 renders soil, air, water or food impure <>r anwbolesonie, are declared to be nuisances 
 and to be illegal; and every person having aided in creating or contributing to the 
 same, or who may support, continue or retain any <>f them, shall be deemed guilty 
 of a violation of this ordinance, and shall also be liable for the expense of the abate- 
 ment or remedy required. 
 
 S 2. No privy-pit, cess-pool or reservoir into which any privy, 
 /'/'Vox. watcr-dosct. stable, sink or other receptacle of refuse or sewage is 
 
 cess-pools, drained, shall be constructed or maintained in any situation or in any 
 
 etc. manner whereby, through leakage or overflow 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 receptacle 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 Hoard 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. 
 
 § :!. All house-sewers or drains for the conveyance of deleterious 
 
 Sewers, or offensive matters shall be water-tight, and the plans and methods 
 
 drains, ■ tc. of their consl ruction shall be subject to the approval of the Board of 
 
 Health. In streets or avenues where public sewers are or shall be 
 
 constructed, the Board of Health may order house-connections to be made there- 
 with. 
 
 S 4. No house-refuse, offal, garbage, dead animals, decaying 
 Houst refuse, vegetable matter, or organic waste substance of any kind, shall be 
 garbayi , etc. thrown upon any street, road or public place, and no putrid or decay- 
 ing animal or vegetable matter shall be kept in anj house, cellar or 
 adjoining outbuilding for more than twenty-four hours. Violation of any of the 
 provisions of this ordinance shall subject the offending party to a penalty of 
 
 Filled-in 
 
 § :>. No sunken places shall be filled, nor made land constructed, 
 
 with any materials containing an admixture of putrescible animal or 
 
 mad( land. vegetable matter, under penalty of for each cartload, 
 
 pari thereof, of such materials deposited. 
 
 !j 6. No person or company shall erect or maintain any manufac- 
 Voxlous tory or place of business dangerous to life or detrimental to health. 
 
 trades. or where unwholesome, offensive or deleterious odors, gas, smoke, 
 
 deposit or exhalations are generated, without the permit of the Board 
 of Health, and all such establishments shall !>•■ kept dean and wholesome so as not 
 to be offensive or prejudicial to public health; nor shall anj offensive or deleterious 
 waste-substance, gas-tar, sludge, refuse or injurious matter be allowed to accumu- 
 late upon the premises oi be thrown or allowed to run into anj public waters, 
 stream watei course, street or public place. \ n< I everj person or company con 
 ducting such manufacture or business shall use the best approved ami all reasonable 
 means to prevent the escape of smoke, gases and odors, and tt the health 
 
 and ill operatives employed therein. A.nj violation of any of th< 
 
 visions of this ordinance shall subject tl Sending partj to a penaltj of not less 
 
 t hau nor more t ban foi each offense. 
 
844 APPENDICES. 
 
 § 7. Xo meat, fish, bird, fruit, or vegetables, milk, or anything 
 Unwholesome for human food or drink, not being then fresh or properly preserved, 
 food. 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 not 
 less than and by the seizure and destruction of such unsound, un- 
 wholesome, immature food substances. 
 
 § 8. Xo person or persons, without the consent of the Board of 
 Slaughter- Health, shall build or use any slaughter-house within the limits of 
 houses, this municipality and the keeping and slaughtering of all cattle, 
 markets, etc. sheep and swine, and the preparation and keeping 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 per- 
 son 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 after the use thereof for 
 any of the purposes herein referred to, and shall also at all times keep all wood- 
 work, save floors and counters, in any building, place or premises 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 washings from 
 settling in the earth beneath. Any violation of any of the provisions of this ordi- 
 nance shall subject the offending party to a penalty of for each day's 
 
 continuance or repetition of the offense. 
 
 § 9. Every householder or head of family in a house wherein any 
 Notification case of infectious disease may occur shall report the same to the 
 of infectious Board of Health or to the Health Officer within twelve hours from the 
 disease. time of his or her first knowledge of the nature of such disease; and, 
 
 until instructions 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, diphtheria and membranous croup. Any violation of any 
 of the provisions of this ordinance shall subject the offending party to a penalty 
 
 of 
 
 § 10. Xo person or article liable to propagate a dangerous disease 
 Importation shall be brought within the limits of this municipality unless by the 
 of infect cil special permit and direction of the Board of Health; and any one 
 persons or having knowledge that such person or article has been brought 
 things. 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 not less than nor more than 
 
 § 11. Xo person shall, within the limits of this municipality, 
 ^Exposure of unless by permit of the Board of Health, carry or remove from one 
 infected per- building to another any patient affected with any contagious or 
 • s "" s ' or infectious disease. Xor shall any person, by any exposure of any 
 
 things. individual so affected, or of the body of such individual, or of any 
 
 article capable of conveying contagion or infection, or by any negli- 
 gent act connected with the care or custody thereof, or by a needless exposure of 
 
APPENDICES. 845 
 
 himself or herself, cause or contribute to the spread of disease from any such indi- 
 vidual or dead body. Any violation of any of the provisions of this ordinance shall 
 subject tin- i .ft'ending party to a penalty of Dot less than 
 
 § 12. There shall not be a public or church funeral of any person 
 Funerals who lias died of Asiatic cholera, small pox. typhus fever, diphtheria. 
 after infec- membranous croup, scarlet fever or measles, without the permit of 
 /inns r/;.s- the Hoard of Health therefor; and the family of the deceased shall in 
 eases. all such cases limit the attendance to as few as possible, and take all 
 precautions possible t.. prevent the exposure ..f other persons to con- 
 tagion or infection. Any violation of any of the provisions of this ordinance shall 
 subject the offending party to a penalty of not less than 
 
 § 13. No animal affected with an infectious or contagious disease 
 Infectious shall be brought or kept within the limits of this municipality, except 
 diseases of by the permission of the Board of Health; and the bodies of animals 
 animals. dead of such disease or killed on account thereof, shall not be buried 
 within five hundred feet of any residence, nor disposed of otherwise 
 than as the said hoard 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 not 
 less than 
 
 >j 14. It shall be the duty of the groom in every marriage, or the 
 
 Reports of clergyman «.r magistrate performing the ceremony, and of the parents 
 
 marriages or custodian of every child born, and the physician or midwife who 
 
 and births. attended at the birth of such child to make sure that the prescribed 
 
 report of such marriage or birth is presented to the Hoard of Health 
 
 or its registering 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 
 expiration of the first thirty days, an additional penalty of shall be incurred. 
 
 S 15. 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 Mate Hoard of Health. 
 the certificate of such birth, and make sure that said certificate is returned to the 
 local hoard of health, or person designated by it to receive it, within thirty days of 
 such birth. Any violation of the provisions of this ordinance shall subject the 
 offending party to a penalty of 
 
 s' 16. Every undertaker or other person who may have charge of 
 Certificates the funeral of any dead person, shall procure a properly filled-oul cer- 
 of death tiflcate of the death and its probable cause, in accordance with the 
 
 andburial form prescribed by the state Hoard of Health, and shall present the 
 permits. same to the designated officer or member of the Hoard 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 oi the provisions of this ordinance shall subject the offending party to a penalty 
 
 Of not less than 
 
 S 17. It shall he t he duty of the physician last in attendance upon any person 
 
 who may die within t he limits of the jurisdiction of this Hoard 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 familj of 
 the deceased, or hand or -end it to the undertaker in charge of the remains. Incase 
 an inquest has been required by law, the coroner shall till out the said certificate, 
 
 and if no inquest has been required by law and DO physician has been in attendance. 
 
 the certificate shall be filled out, setting forth the probable or believed cause of 
 death, l>y some reputable person known to the officer issuing the burial or transit 
 
 burial permit, and the said person shall also make atlida\it to the facts sel forth in 
 
 the certificate, which affidavit must be attached to said certificate.' Any violation 
 of the provisions of this ordinance shall subject tl Sending party to a penaltj 
 
 of 
 
 S 18. Everj person who acts as a Bexton, or undertaker, or cemeterj 
 ,.>•. keeper, within the limits of this municipality, or has the charge oi 
 
 cemetery careofanj tomb, vault, burying ground or other place for the recep 
 
 keepers, etc. tionof the dead, or where the bodies of anj human beings are deposited, 
 shall so conduct his business and so care for any such place above 
 named, as to avoid detriment or daoger to public health; and every person under- 
 taking pre | .a rat ions for the burial of a bodj dead from contagious or infectious dis- 
 ease as hereinbefore enumerated shall adopt such precautions as the Board of Health 
 
846 
 
 APPENDICES. 
 
 may prescribe to prevent the spread of such disease. Any violation of any of the 
 provisions of this ordinance shall subject the offending party to a penalty of not less 
 
 than 
 
 § 19. The Health Officer is directed and empowered to execute and 
 Duties and enforce all sanitary regulations of general obligation now or hereafter to 
 powers of be published by this board; also to enter upon or within any premises 
 health offi- where conditions dangerous to the public health are known or believed 
 cer. 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 accurate records of his official actions and report the same to the 
 Hoard of Health at its next meeting. And whenever in his judgment danger to pub- 
 lic health shall arise requiring special regulation not of general application, 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. Every person who willfully violates pr refuses to comply 
 
 Penalties. with, or who resists any ordinance, 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 mtist be taken. 
 
 NO. 3. 
 
 Size 84 in. x 11 in. 
 
 REPORT 
 
 Of Undertaker in the City of Milwaukee, for the month of 189 
 
 to the Commissioner of Health, in pursuance of Chapter 4, of City Ordinances. 
 Reports are to be made on the first of every month. 
 
 Section 85 of Chapter IV, of General Ordinances of the City of Milwaukee, relat- 
 ing to Burials, reads as follows: Upon the death of any person within the corporate 
 limits of the City of Milwaukee, it shall be the duty of every undertaker or other 
 person, who inters such deceased person, and before the removal of such deceased 
 person for interment, and within thirty-six hours after the death. of such person, to 
 apply to the Health Office for a permit for interment from said Commissioner of 
 Health or Secretary; (Permits will only be issued upon Certificates of Physician, of 
 Commissioner of Health or one of his Medical Assistants.) 
 
 When 
 Interred 
 
 NAME OF 
 DECEASED. 
 
 WHERE 
 INTERRED, 
 
 Date of 
 Burial Permit. 
 
 No. 
 
 Name of 
 Person who 
 
 signed 
 Certificate. 
 
 Date 
 of Death 
 
 on 
 Certificate. 
 
 STATE OF WISCONSIN, J 
 
 County of Milwaukee. > I, Undertaker, residing at 
 
 Street Ward, City of Milwaukee, do solemnly swear 
 
 that the above report for the month of 189 , is correct in all respects.— 
 
 .So Help Me God. 
 
 Subscribed and sworn to before me, this day of 189 
 
 Votary Public, Milwaukee Co., Wis. 
 
APPENDIt ES. 
 NO. 4. 
 
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848 
 
 APPENDICES. 
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APPENDICES. 
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850 
 
 APPENDICES. 
 
 NO. 7. 
 
 Size \\ is. x 13 i\. 
 These permits are bound in books with stubs for record. 
 
 When a body from another State or 
 city is in transit for burial, besidt tin 
 transport coupon some eities. like New 
 York, require that the ferry or transport 
 agent should tear off and' return a cou- 
 pon to their health department, in order 
 that it may have 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 1 and 2, this special No. 3, for 
 such use when required. When nor 
 needed, this coupon should not lie given 
 out or should not be signed by the officer 
 issuing the permit. 
 
 (See back of this Coupon. | 
 
 SPECIAL COUPON FOR CITY TRANSIT WHEN REQUIRED. 
 
 Special Coupon A7». Thm to Transit Permit 2V».. 
 
 of tin in, ii 1/ of 
 
 who died at'. N.J., and is to be 
 
 bur led at 
 
 Perm it issnrit Is!) 
 
 i Kate.) 
 
 nt .-. 
 
 for transit lliiiimili tin vittiof..'. 
 
 Sii/iiiil '...' 
 
 Official Title.. 
 
 Before this body leaves the city of through 
 
 which it is in transit, the ferry or bridge master or 
 transport agent will tear oif this coupon and send it 
 to the Heatlh Department of the citv, as its regula- 
 tions may require. 
 
 TRANSIT PERMIT. 
 
 '■ 7= 
 
 
 |" 5 1 
 I I - 
 
 
 Second ( Taken at, 
 ( lotipon I By 
 
 First f Taken at 
 
 ( 011)1011 / ]{y 
 
 This Permit must in all eases accompany the 
 body to its destination and be retained by the 
 Superintendent of the Cemetery. 
 
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 Coupon No. Two to 'transit Permit No of 
 
 who died at 
 
 This Coupon will be detached by Train Baggage- 
 man of terminal line and sent to General Baggage 
 Agent. SEE BACK. 
 
 ( loupon No. ( ine to Transit Permit No of 
 
 who died at 
 
 This Coupon will be detached by Train Baggage- 
 man at starting point and sent to General Agent. 
 
 SEE HACK. 
 
APPENDICES. 85] 
 
 NO. 8. 
 
 Size ::} in. >; 5± in. 
 STAT] OF \I.\V HAMPSHIRE. CERTIFICATE OF DEATH. 
 
 ■ . . 
 
 Place and date of Death . 
 
 Single, 
 Marriei 
 I Hvorced, or 
 
 1 I \'< .ii -. 
 
 ., , Married. 
 
 1 " 1 " 1 " .... .. , Age, ' Months, 
 
 Widowed. I " a > 
 
 pation Place of Birtli 
 
 Disease or Cause of Death, 
 
 Name of Fal liei . 
 
 Maiden Same of Mother 
 
 Birthplace of Fal her,.. Mother 
 
 ■'•.it ion ••! Fal lier, . . 
 
 \l. I». 
 
 of Burial. I-'.' . 
 
 Place "i' Burial. < lemetery, . Undertaker. 
 
S52 APPENDICES. 
 
 NO. 9. 
 
 Size 8 in. x 10 IN. 
 
 The following form of return is suggested for general adoption by the Director of 
 
 the 12th Census. 
 
 RETURN OF A DEATH. 
 
 County.. 
 Town. . . 
 Village,. 
 
 City 
 
 NO 
 
 . OF RECORD. 
 
 
 No. OF 
 
 K I' RIAL PERMIT. 
 
 
 NO INCOMPLETE RETURN WILL BE ACCEPTED. 
 
 1. Name, in full, 
 
 ■i. Color: 3. Sex: 4. Conjugal Condition: 
 
 White. Malt-. Single. 
 
 Black (Negro or mixed). Female. Married. 
 
 Indian. Widowed. 
 
 Chinese. Divorced. 
 
 Japanese. 
 
 vote.— Vox questions '-'. :'•. and 4. strike <>ut words not applicable. 
 
 T , ( Year ( Year ( Years, . . 
 
 • ,; J,) ■ Month. '>• OfBirth.J Month 7. Age.- Months,. 
 
 ( Day. ( Day, ( Days... . 
 
 Death 
 i. Occupation, 
 
 Return occupation lor all persons 10 years of age and over.) 
 
 9. Place of Birth, ) 
 
 10. Birthplace of Father, state or Country. 
 
 11. Birthplace of Mother ) 
 
 ,_ , T , Id UATION. 
 
 12. Disease or Cause of Death: 
 
 Chief Cause __ 
 
 Contributing Cause 
 
 Place where Disease was Contracted, if other than place of death, 
 
 13. Place of Death, Xo Street, Ward. 
 
 If death occurred in an institution, give the name of same 
 
 Length of time deceased was an inmate and 
 
 previous residence 
 
 14. Late residence,. .' 
 
 Length of residence (in city or town), 
 
 Undertaker 
 
 Place of Intern icnt 
 
 Signature 
 
 Of physician or informant.) 
 Date of Certificate , 19 
 
APPENDICES. 
 
 NO. lO. 
 
 Size TA in. x 12 in. 
 
 853 
 
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8 54 APPENDIt 'E& 
 
 NO. 11. 
 
 Size H in. x 10$ in. 
 
 RETURN OF A DEATH. 
 City of Providence. 
 
 1. Date of Death 
 
 2. Name in Full 
 
 3. Date of Birth Age? yrs ....... mos dys. 
 
 4. Place of Death, Street 
 
 and Number 
 
 5. Usual Residence 
 
 *'». Sex T. Color 
 
 S. Single, Married, Wid. | 
 owed, or Divorced S 
 
 '.». Name of Husband or Wife 
 
 10. < >ccupation of Decedent 
 
 11. Birthplace, State or Country City . 
 
 12. Father's Name 
 
 13. Mother's Name 
 
 14. Parents 1 Birthplaces Fa Mo 
 
 15. Where to be Buried 
 
 Name of Informant and Relationship to Deceased. 
 
 PHYSICIAN'S CERTIFICATE. 
 
 Please state different causes of death in order of occurrence. as FULLY as possible, particularly 
 
 in DOIBTFUL cases. 
 
 Date of Death Hour M. 
 
 Name 
 
 Causes of Deatli 
 
 I Miration of Diseases 
 
 Physician. 
 
 / certify that the above is a true reurn to thebest of my knowledge and belief. 
 
 Undertaker. 
 
 TO THE PHYSICIAN. If more than one cause of death is given, please under- 
 line that which you consider the most important. 
 
A PPENDIl 'JS& 
 
 855 
 
 NO. 12. 
 
 Size 7.1 ix x 8 in. 
 
 MICHIGAN 
 
 DEPARTS! KM' I >1 SI \ I i: 
 
 Lansing 
 
 1 "'ii'i'.i' Vital Statistics Division 
 
 ' ''" Certificate and Record of Death 
 
 ^ ,- i outuy... 
 a 1 Townsh i/i 
 
 The Registrar should 
 Dumber each certificate 
 received at ona . in 
 space below, beginning 
 with •■ No. l " for each 
 year. 
 
 REGISTER] D SO. 
 
 i Location i 
 
 i in City I Ward: No St. 
 
 /■-„// DaU of 
 Vanu Death 
 
 Month. 
 
 Day. 
 
 \ ear. 
 
 
 190 
 
 y. :l 
 
 s g 
 
 Arjt 
 
 Single, married, widowed or divorced Sex 
 
 ^ If married, age at first' marriage years. 
 
 ' Parent of children, of whom- -are living. 
 
 Occupation 
 
 f Note — Th scupationshould.be stated /.,,,, ,,,■ 
 
 for all persons aged i<> years and over. 
 Be precise and definite, and whenever 
 necessary give the kind of industry, trade 
 or employment, as well as the special oc- 
 cupation. 
 
 i Birthplace of ) 
 lather (State' 
 
 (or country i ) . . 
 
 i Birthplace ol \ 
 ] mother (State 
 /mother 1 (or country) ) 
 
 Color- 
 
 Years. Months. 
 
 Hays. 
 
 
 
 birth 
 
 Year of 
 Birth 
 
 Month. 
 
 Hay. 
 
 l 
 
 
 
 i Name of l 
 i Father i 
 
 i Maiden 
 
 ; name of 
 
 \ Date of burial i 
 
 I or removal ( 
 
 j Signature of i 
 
 i Place of burial i 
 i or removal i 
 i Address of I 
 
 i undertaker \ (undertaker! 
 
 i Birthplace i 
 
 State or 
 
 ' country) ) 
 
 Certificate of Reporter. 
 The personal and family partic- 
 ulars herein given relative to de- 
 ceased are true to the best Of my 
 knowledge and belief 
 
 i Signed) 
 
 (Address) 
 
 MEDICAL CERTIFICATE OF ( A.USE OF DEATH. 
 
 I berebj cerl ify thai [attended deceased from 190. ...to L90 
 
 that l las t saw h alive on 190 that died <>n 190 
 
 about o'clock M., and that to the best ol my knowledge and 
 
 belief the ('a usi of Death was as hereunder written : 
 
 Disease causing death* 
 
 Immediate cause of death* 
 
 Contributor) causes or complications, it any* 
 
 i Place where Disease Causing Death was I 
 Post-mortem . ...' contracted, if other than place of death '■ 
 
 I Mi rat ion of each Cause. 
 
 z - 
 
 — v 
 7 / 
 
 Witness my h I this .daj ol 190. 
 
 • /■// j/« Iciitns are requested to 
 note the " Suggest Ions to Phj bJ 
 clans Relative to Statemenl ol 
 i ;ui-i'- of i >eath " on the back of 
 t hi> cert iflcate. 
 
 In Vlolenl Deaths, a different 
 form of statement i- necessary, > Signature ol physician / 
 a- follows i health offloei "i coroner i . 
 
 1 Mi, ih hi injury and w let In i 
 iiiiiilinhrl, -11 iriilnl or limn i 
 
 I Ida I 
 
 Vature of Injury ii ullate \ > !■ 1 1 < — 
 
 ■ i deal h . 
 < < . 1 1 1 1 1 1 ■ 1 1 1 . . i •. cause* 
 
856 
 
 APPENDICES. 
 
 NO. 13. 
 
 Size 4| in. x 7| in. 
 RETURN OF A BIRTH. 
 
 City of Providence. 
 
 1. Date «.f Birth? 189. 
 
 'J. Full name of Child? 
 
 t'». 
 
 7. 
 
 8. 
 
 !). 
 10. 
 11. 
 12. 
 13. 
 14. 
 1.-.. 
 Hi. 
 17. 
 
 Sex ° 
 
 S No. of Child of 
 
 / Mother ? 
 
 Plate of Birth '.' 
 
 Present Residence '.' .... 
 
 Father's Name '.' 
 
 Father's Age '.' 
 
 Father's Occupation ?. . 
 Father's Birthplace ?. . . 
 
 Mother's Name'? 
 
 Mother's Maiden Name ' 
 
 Mother's Age ? 
 
 Mother's Birthplace '.'... 
 Color of Parents ? Fa . . 
 *Remarks ? 
 
 Color 
 
 Mi 
 
 Physici \ \. 
 
 \. 1>. — At No. 2, give the full name of the child, and be particular to get the mid- 
 dle name in full. At No. 4, state whether the child is white, black or mulatto. At 
 No. 5, state whether it is the 1st, 2d, 3d, etc., child of the mother. At No. 0. give 
 the street and number if in a city, the name of the town and village if in a village, 
 and State if elsewhere in this country. At No. 7, give the present home of Mother, 
 Street and No. At Nos. 9 and 14, give the age at last birthday. At Nos. 11 and 15, 
 give the town and State, if in this country, if not, then the name of the foreign 
 country. 
 
 *If the child was still-born, or has died since its birth, or tens illegitimate, state 
 the facts a( No. 17, with any other facts of interest. 
 
 In case of twins or triplets, a separate blank is to be filled for each child. 
 
 The above blanks bound in book form with stubs are furnished to the physicians 
 and midwives. In Massachusetts the physicians report all their births monthly on 
 one sheet. 
 
 NO. 14. 
 
 Size 4 in. n 14 in. 
 
 COMMONWEALTH OF MASSACHUSETTS. 
 
 Lisl of Births occurring in the practice of the undersigned during the month of. 
 
 Date of s 
 Birth. * <x - 
 
 Color, if 
 
 other than 
 
 white. 
 
 Name 
 i it named. 
 
 Place of 
 Birth. 
 
 Names of Parents. 
 
 (Maiden name of 
 
 mother.} 
 
 Resi- 
 dence of 
 
 Parents. 
 
 Occupa- Birth- 
 tion of place of 
 Father. Father. 
 
 Birth- 
 place of 
 Mother. 
 
 • 
 
 
 
 
 
 
 Signed, 
 
 Postals arc used for reports in Florida and in Denver, Omaha, Chicago and other cities. 
 
APPENDICES. 
 
 v -">, 
 
 >0. 15. 
 
 Size 34 vs. x T : in. 
 
 189 
 
 To Mr 
 
 I'. <>. Address 
 
 'I'm enable me to complete the record <>f the birth of your child which occurred 
 
 189 . please enter it^ name in the first line 
 
 in the blank on the other side of this >Iij>. together with the facts called for in any 
 other lines indicated l>y a cross (X) made with pen or pencil. 
 
 The law requires, under penalty for neglect, parents to report the births of their 
 children; but, irrespective of this, a permanent and accurate record <>f all births is 
 a matter of great importance to parents, to children, and to society. 
 
 Respectfully, 
 
 Clerk of. 
 
 I Kl.\ ERSE. | 
 
 s - 
 
 _= '/ '— i -' 
 
 X X > - - 
 
 - - 
 
 r 
 
 - 
 
 - - 
 
 | § 
 
 In Providence the items required are left blank, the others being tilled in as 
 they appear "ii the records. Opportunity i^ thus given for corrections. 
 
858 
 
 APPENDICES. 
 
 NO. 16. 
 
 Size ~i in. x 8-J in. 
 
 STATE OF NEW JERSEY 
 
 S I' ATI: OF XEW JERSEY". 
 
 RETURN OF STILL-BIRTH. 
 
 RETURN OF STILL-BIRTH. 
 
 SEE PENALTY FOB SON-REPORT. 
 
 Place of Birth 
 
 (If in city, give name, street and number; if not, 
 give township and county.) 
 
 Date 18!) 
 
 Sex Color 
 
 Name of Father 
 
 Name of Mather 
 
 SEE PENALTY FOB NON-REPORT. 
 
 Place of Birth 
 
 (If in city, give name, street and number: if not, 
 give township and county.) 
 
 Datt 
 
 Sex 
 
 Namt of Fathe 
 Xante of Mothe 
 
 •r. 
 
 Residence of Mother Residence of Mothi 
 
 I If in f city, give name, street and number; if not, 
 give township and county. i 
 
 (If in city, give name, street and number; if not.. 
 give township and county.) 
 
 Agi 
 
 Age 
 
 Period of Utero- Gestation ■ Period of Ultero Gestatioi 
 
 How many previous children.... No. Living. 
 
 Country of Motht r's Birth 
 
 Country of Father's 
 
 Cause of Dead-Birth i if known) 
 
 How many previous children. . . No. Living. 
 
 i 'ountry or Mother's Birth 
 
 < 'ountry of Father's 
 
 const of Dead-Birth i if known.) 
 
 I, as Ho attendant in eharge. certify Uiat the I, as the attendant in charge, certify that the 
 
 Child was dead befori birth. 
 
 child was dead before birth 
 
 Mtt ndant. 
 P. o. Address. 
 Undertaker. 
 Plate of Burial. 
 
 Attendant, 
 P. O. Address. 
 Undertaker. 
 p/oee of Burial. 
 
APPENDICES. 859 
 
 >0. 17. 
 
 Sl/.K 11 IN. X .V. IN. 
 
 MARRIAGE LICENSE. 
 
 DECLARATION OF [NTENTION OF MARRIAGE. 
 
 State of Rhode Island. 
 
 ( Expectant. > 
 i . Pi i.i. name of G room '.' 
 
 •_'. Place of Residence ? 
 
 8. Age in years? Color? 
 
 4. < Occupation? 
 
 ■">. 1 'lace of birtli ? 
 
 6. Father's Name '.' 
 
 7. Mother's Maiden Name ? 
 
 Parents' Birthplace? Father Mother 
 
 l'a rents' Occupat ion? Father Mother 
 
 8. No. oi Marriage '.' Divorced ? 
 
 18 
 
 /. ih< expectant yroom named in the foregoing declaration, hereby certify that the 
 information given is correct to the best of my knowledge and belief. 
 Signed in the presence of 
 
 Expectant Groom.) 
 
 ■ ctunt.) 
 1. Fc i.i. name of Bride ? 
 
 (Maiden Name if a Widow.) 
 
 i. Place of Residence ? 
 
 :). Age in years ? Color ? 
 
 4. Place of Birtli ? 
 
 .">. l'a i her's Name? 
 
 6. Mother's Maiden Name? 
 
 Parents' Birthplace ? Father Mother 
 
 Parents' Occupation '.' Fathei Mother 
 
 7. No. of the Marriage? Divorced ? 
 
 is 
 
 /. /A- expectant bridi named in tin foregoing declaration, hereby certify that the 
 
 information yiren is correct to the best m' my knowledge and belief. 
 
 ined in tin nrescner of 
 
 pertant RrUl> . > 
 
 N.B. State whether the marriage is the 1st, 2d, kl, &c, marriage ol each. State whether white 
 black, or mulatto, Olve Idle names In full. 
 
 Re ei Be on succeeding pa 
 
860 
 
 APPENDICES. 
 
 ( REVERSE.) 
 
 OFFICE OF CITY REGISTRAR. 
 Proyi dence, K. I. 
 
 No. 
 
 ,189. 
 
 I hereby certify that the within license and declaration of intention of marriage, 
 is duly recorded in this office. 
 
 City Ueyixtrar 
 
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APPENDICES. 861 
 
 NO. 18. 
 
 Size 8^ in. x 81 in. 
 
 These lilank-; siv furnished in books with stul»s containing the same items. 
 State of New Jersey. 
 
 MARRIAGE RETURN. 
 
 Set- Penalty for Non-Report Within :'.(> Days. 
 I "he ink and write plainly, especially names. 
 
 1 . F r i.i. Name ok Hush and 
 
 i r colored, so state. 
 
 Place of ll< suit no 
 
 It in city, give name, street and number: it not, give township and county.) 
 
 ■_'. .1'/' years months. Number of his marriage 
 
 :; Occupation ■ ( 'ountry of Birth 
 
 4. Name of Father < 'ountry of Hirth 
 
 5. Maiden Name of Mother Country of Birth 
 
 1. I'i i.i. Maiden N ami: ok Wife, 
 
 t 'ountry of Hirth 
 
 1 1 colored, so state. 
 
 2. Plact of llesidenct 
 
 'It in city, (rive name, 81 reel and number; it not, give township and county.) 
 
 8 l./r nean */ birthdau ! " '" :| "- V tradeor • 
 
 ... .1./' . neai si nu inaay j business, so Mate j 
 
 4. Last name, if << widow Viimher of Bride's Mai riage 
 
 .*). Name -;/' i'ntlii )• < 'ountry of Hirth 
 
 6. Maiden Nairn •■( Motht r ' ountry of Birth 
 
 1. Dati {in full) 18 Plaei 
 
 Citj <>!■ t"« nship and count] . 
 
 2, //' nresenct oj Be sure to have witness 
 
 :;. Signature of Minister i 
 
 i what ( liurch Pastor of) 
 
 '//• person officiating. > 
 
 \o 1 1 . \ II the facts called for in this blank are important and should be accur- 
 ately given. 
 
 \ir\ erse on succeeding pa g 
 
862 
 
 APPENDK Es. 
 
 (reverse. ) 
 
 Above space to be left blank. 
 
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 ! 53 £ SS 
 
 RETURN OF MARRIAGE. 
 
 r,7,/„/- ToivnsMp, 
 
 < 'ml III I/. 
 
 Parties Married. 
 
 hull .... 
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 Note.— Blanks for the Return of Marriages 
 ■are to be obtained from the local Registrarof Vital 
 Statistics, or in some Cities from the Citj Clerk. 
 In Townships such Blanks are to be obtained 
 from Assessors. When Blanks have been tilled 
 out they are to be returned to the local Registrar, 
 City Clerk or Assessor, as the case may require. 
 
 *• = '- " h ™ 
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 r^= es - i) = *" 
 g +» S "^ 43 « 
 
 
APPENDICES. 
 NO. 19. 
 
 863 
 
 ■^ 
 
 r. 
 
 fe ■_ 
 
 
 
 z - 
 — „ 
 
 
 
 7 ^ 
 
 
 
 Place id Death. 
 
 Ward No. 
 
 St. 
 
 
 6 
 
 it 
 
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 - - Ed 
 
 
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S64 
 
 APPENDICES. 
 
 NO. 20. 
 
 NO. 21, 
 
 ■A -> 
 
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 s = 
 
 
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 ce 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDICES. 
 NO. 2>. 
 
 SlZK 8J IN. X 121 IN. 
 
 si;:, 
 
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 — - - 
 
 
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866 
 
 APPENDICES. 
 NO. 23. 
 
 Size 4 in. x in. 
 
 State of Connecticut, Town op 
 
 189 
 
 Marriage License 
 
 I , one «>f the persons named in the 
 
 Marriage License to which this is attached, do solemnly swear thaf the statements 
 therein made are true. 
 
 Signed 
 
 Sworn to before me 
 
 this day of p 189 Attest 
 
 lieyistrar. 
 
 T Hereby Certify That Mr and 
 
 M the above-named parties, were legally 
 
 joined in marriage by me at this 
 
 day of L89 (Signed) 
 
 < official Capacity 
 
 Received for record on the day of 
 
 
 189 
 
 
 This copy of Marriage License is correct. 
 
 Attest : 
 
 
 
 Write Legibly (~) 
 
 
 
 R 
 
 Registrar 
 
 (reverse.) 
 
 This Certifies, that the within named parties have declared their intention of 
 marriage, and have complied with the provisions of the laws of the State of Con- 
 necticut, relating to the issuing of a marriage license as indicated by attached 
 affidavit. 
 
 Attest: , Registrar. 
 
 Groom 
 
 Residence 
 of < > room 
 
 Bride 
 
 .Maiden name 
 if widow 
 
 Age ('(dor 
 
 
 Residence 
 of Bride 
 
 < Occupation 
 
 
 Age Color 
 
 Birt liplace 
 of Groom 
 
 
 Birthplace 
 of Bride 
 
 1st, 2d, 3d marriage Widowed 
 Name of Father 
 Maiden name of Mother 
 
 >r Divorced 
 
 1st, 2d, 3d marriage Widow or Divorced 
 
 
 Name of Father 
 
 
 Maiden name of Mother 
 
 Nationality of Father 
 
 
 Nationality of Father 
 
 Nationality of Mother 
 
 O 
 
 Nationality of Mother 
 
 . 
 
 
 
APPENDICES. 
 
 NO. >4. 
 
 Width of Sheet 14 in. 
 
 Return of I>i-atli~ Registered in the Town of during the Month of. 
 
 86' 
 
 Causes of Death 
 
 Sex 
 
 I'aicnt- 
 
 Ages <>f Decedents. 
 
 Primary Secondary •£ 
 
 Under 
 
 s. v . ■- 
 
 2 3 
 to to 
 
 3 5 
 
 5 10 
 to to 
 10 15 
 
 1.-. 20 
 to to 
 •JO .'30 
 
 30 40 50 
 to tn tn 
 4i) 50 60 
 
 so 90 \_' 
 
 tn and not Total. 
 
 '.•ii over, stated. 
 
 NO. 25 (a). 
 
 Size 7 \ in. n > s in. 
 
 State of Iowa — Ueaeth Department. 
 
 APPLICATION FOR DISINTERMENT PERMIT. 
 
 TO THE STATE IK > All I > OF HEALTH: 
 
 Application is lierebj made for a per mil for the disinterment of the bodj of 
 
 Give full hi i in' here, whether it be two or three; use no initials. 
 
 now lying in < lemetery in the 
 
 State whether city, town or township, 
 
 of Count) of State of Iowa, 
 
 and wIki died mi the day of 18 aged years 
 
 tin mt lis days, the cause of death being 
 
 and n< 1 1 directly or indirectly by Diphtheria, 
 
 Membranous Croup, Scarlel Fever, (Scarlatina, Scarlet Rash), Small Pox, Leprosy, 
 
 Asiatic Cholera, Typhus Fever, or Yellow Fever or other contagious disease, as 
 
 shown by the certificate oi attending physician. 
 
 Give lull name of ph> ulcl m liei e 
 
 The bodj is to be removed bj 
 
 State whether 1>) railroad or hj private conveyance. 
 
 Cometerj in the 
 
 state whether oity, town or towntdiip. 
 
 ,,i County of State of 
 
 f for interment. 
 
 A pplicaut. 
 
 This . < 1 : i > ..I I 
 
 Postottlce Address County ol Iowa. 
 
 Send [.limit bo P< »stoffl< e 
 
 c, units ..I Iowa. 
 
868 APPENDIt b S. 
 
 NO. 25 (b). 
 
 Size 8 in. x 14 in. 
 
 State of Iowa. 
 
 embaemer's department. 
 
 DISINTERMENT PERMIT. 
 
 Application having been made for the disinterment of the body of. 
 now lying buried in - 
 
 Cemetery, in the of County of 
 
 (City, Town or Township) 
 
 State of Iowa, who died on the day < >f 
 
 1 aged years months days, the cause <>f 
 
 death being 
 
 and not directly or indirectly by diphtheria; (membraneous croup;) scarlet fever: 
 
 smallpox; leprosy; Asiatic cholera; typhus fever; or yellow fever; as shown by 
 
 the certificate of death of said deceased, given by attending physician, 
 
 this is to certify that permission is hereby given for such disinterment and removal 
 
 by to 
 
 Cemetery, in the of 
 
 (I ity. Town or Township) 
 
 County of State of to take 
 
 effect upon approval by the local board of health of the 
 
 of it being understood and provided that nothing herein shall be 
 
 deemed as contravening or in anywise modifying or releasing the Regulations of the 
 State Board of Health governing the Transportation of Corpses or the requirements 
 for a Transportation Permit, and all Transportation Companies and Common Car- 
 riers will be governed accordingly ; and provided further, that where the disinter- 
 ment is for the purpose of reinterment in another part of the same cemetery, or in a 
 contiguous cemetery, the removal shall not be made by any public conveyance. 
 Given under my hand and seal of the State Board of Health at 
 
 Des Moines, this day of 
 
 A. D. 1 
 
 Secretary. 
 By 
 
 The foregoing application for disinterment and removal is hereby approved by the 
 
 local board of Health of the of 
 
 (City, Town or Township) 
 
 Mate of Iowa, this day of 1 r. 
 
 President Lorn] Board of Health. 
 
 r If a City or Town "I 
 
 [_affix corporate seal. J Attest 
 
 Clerk Loral Board of Health. 
 
APPENDICES. 869 
 
 NO. 26. 
 
 OHIO ANNOTATED STATUTES, 1900. 
 
 Se< . 6921. Whoever erects, continues, uses, or maintains, any building, structure 
 or place for the exercise <>f any trade, employment, or business, or for the keeping 
 or feeding- of any animal, which by occasioning noxious exhalations, or noisome or 
 offensive smells, becomes injurious to the health, comfort or property of individuals. 
 or the public, or causes or suffers any offal, filth, or noisome substance to be col- 
 lected, or to remain, in any place, to the damage or prejudice of others, or the pub- 
 lic, or obstructs or impedes, without legal authority, the passage of any navigable 
 river, harbor, or collection of water, or corrupts, or renders unwholesome or im- 
 pure, any water-course, stream, or water, or unlawfully diverts any such water- 
 course from its natural course or state, to the injury or prejudice of others, or 
 obstructs or incumbers, by femes, buildings, structures, or otherwise, any public 
 ground or highway, or any street or alley of any municipal corporation, shall be lined 
 noi more than live hundred dollars. 
 
 Si ' • 6922. Whoever builds, erects, continues, or keeps up, any dam or other 
 obstruction, in any river or stream of water, and thereby raises an artificial pond, 
 or produces stagnant water, which is manifestly injurious to the public health and 
 safety, shall he lined not more than live hundred dollars. 
 
 SEC. <;'.»•_'•'!. Whosoever puts the carcass of any dead animal, or the offal from any 
 slaughter-house, or butcher's establishment, packing-house, or fish-house, or any 
 Spoiled meat, or spoiled fish, or any putrid substance, or the contents of any privy 
 vaults, upon or into any lake, river, bay, creek, pond, canal, road, street, alley, lot, 
 field, meadow, public ground, market space or common, and whoever being the 
 owner or occupant of any such place, knowingly permits any such thing to remain 
 therein, to the annoyance of any of the citizens of this state, neglects or refuses to 
 remove or abate t he nuisance occasioned thereby, within twenty-four hours after 
 knowledge of the existence of such nuisance upon any of the above described 
 premises, owned or occupied by him, or after notice thereof in writing, from any 
 supervisor, constable, trustee, or health officer of any municipal corporation or 
 township in which such nuisance exists, or from a county commissioner of such 
 county, shall lie lined not more than fifty dollars nor less than ten dollars, and pa\ 
 the cost of prosecution, and in default of the payment of said tine and costs, be im- 
 prisoned not more than thirty da\ s. 
 
 Sec. 6925. Whoever intentionally throws or deposits or permits to be thrown or 
 deposited, anj coal dirt, coal slack, coal screenings, or coal refuse from coal mines, 
 
 or any refuse or filth from any coal oil refinery or gas works, or any w hey or filthy 
 
 drainage from a cheese factory, upon or into any of the rivers, lakes, ponds, or 
 
 streams of this state, or upon or into any place from which the same will wash into 
 
 any such river, lake, pond, or stream; or \\ I vex shall, by himself, agent or em- 
 ploye, cause, suffer or permit anj petroleum or crude oil, or refined oil or refuse 
 
 mailer or filth from an\ oil well, or .,il tank, or oil vat. or place of deposit of crude, 
 or refined oil. to run into, or he poured, or emptied, or thrown into any ri\cr. or 
 
 ditch, or drain, or water-course, or into anj place from which said petroleum, or 
 
 crude oil. or refuse matter, or filth or refined oil may run or wash, or does run or 
 
 wash into any such river, or ditch, or drain, or watercourse shall be lined in anj 
 
 sum not more than one thousand dollars nor less llian fiftj dollars. 
 
 ^1 < . 6927. Wl \er maliciously puts an\ dead animal, carcass, or pari thereof. 
 
 or anj other putrid, nauseous, noisome, bl offensive substance, into, or in any man 
 
 ner befouls, any well, spring, brook, or branch "i running water, or any reservoir 
 of water- works, of which use i^ or may in' made for domestic purposes, shall be 
 lined not more than fifty nor less than five dollars, or imprisoned not more than 
 
 Sixtj days, or hot h. 
 
S 7 1 ) A P FEND ICES. 
 
 NO. 27. 
 
 ATLANTA SANITARY EULES. 
 
 Rules for the District Inspectors. 
 
 7th. The Inspectors shall devote their whole time and attention to the business 
 of the .Sanitary Department, and to the performance of the duties already prescribed, 
 or that may be hereafter prescribed, by the Board of Health; and although certai.i 
 hours are allotted to the performance of ordinary duties, each Inspector must, at all 
 times, be prepared to act immediately on notice that his services are required. 
 
 8th. The Inspectors shall be quiet, orderly and civil in their conduct and de- 
 portment. They shall at all times refrain from boisterous manner and from violent 
 or profane language, and in the performance of duty they shall maintain full com- 
 mand <>f their temper. 
 
 Oth. The Inspectors are strictly forbidden to drink intoxicating liquors while on 
 duty, or to enter any bar-room or drinking saloon, or house of ill-fame in their uni- 
 forms, except upon official business. No gaming, playing of cards or games of 
 chance will be allowed. Smoking while on duty is prohibited. 
 
 10th. The Inspectors shall not leave the city without the consent of the Board 
 of Health. Applications for leave of absence, when desired by the District Inspec- 
 tors, shall be made to the Board through the Chief Inspector. 
 
 11th. The Inspectors shall not wilfully maltreat or use unnecessary violence to 
 a prisoner or to a citizen. They shall not use their canes or pistols except in urgent 
 cases and in self-defense. 
 
 12th. The Inspectors shall be punctual and prompt in reporting for duty. They 
 shall be neat in person, with clothes and shoes clean and brushed. Their uniforms, 
 including overcoats, shall be worn buttoned. An umbrella may be carried during 
 rain only. 
 
 13th. The Inspectors shall carefully inspect every part of their respective dis- 
 tricts. They shall keep so informed that they can give particular information, when 
 requested, respecting the state of the district, including the condition of the streets, 
 alleys, lots, cellars, areas, privies, etc. They shall report in writing to the Chief 
 Inspector, at the time fixed, before every regular meeting of the Board of Health. 
 They shall make out a weekly pay-roll, showing the amount due each laboror under 
 their control, and submit the same at the approved time to the Chief Inspector. 
 
 14th. The Inspectors shall promptly pay over to the Chief Inspector any money 
 that may come into their hands on account of the city, and he shall immediately 
 deposit the same with the City Treasurer. Each Inspector shall make an acceptable 
 bond, to insure the faithful performance of duty, in the sum of five hundred dollars. 
 All purchases made by Inspectors on account of the city shall be made by orders of 
 prescribed and printed form, which shall be returned with the bills as vouchers. 
 Any abuse of this privilege on the part of the Inspectors shall subject the offender 
 to dismissal from service. 
 
 15th. The Inspectors shall not leave their respective districts while on duty 
 without the permission of the Chief Inspector, except upon strictly official business, 
 or in going to dinner, for which one hour daily will be allowed. 
 
 10th. The Inspectors shall walk their districts while on duty. No lounging or 
 loitering on street corners or at any other places will be tolerated. Conversation 
 with each other or with any other person, except on official business, is prohibited. 
 
 17th. Failure of the Inspectors to be present at roll-call for two consecutive 
 occasions, without a good and valid excuse, shall subject the offender to trial and 
 dismissal. 
 
 lstli. The Inspectors shall strictly and promptly obey all orders issued by or 
 through the Chief Inspector, or, officially, by the Board of Health. If any order 
 issued by the Chief Inspector should appear to the District Inspectors unlawful and 
 improper, formal complaint in writing maybe made directly to the Board of Health. 
 But no refusal to obey an order will be tolerated, nor will unnecessary delay or any 
 inattention be permitted. 
 
 10th. The Inspectors shall not use their office with malice, to oppress, persecute 
 or annoy any person. Any Inspector violating this rule shall be dismissed from 
 service. 
 
 20th. Neither the Chief Inspector nor any of the District Inspectors shall ad- 
 vocate the claims of any candidate for municipal office. The Inspectors are the 
 servants of all the people, and any partizanship manifested in any political contest, 
 or in any election held within the city, whether for State, county or municipal 
 officers, will not be tolerated. 
 
APPENDICES. 
 NO. £8. 
 
 Sl/.K 7 IN. X 8 IN. 
 
 DEPARTMENT OF HEALTH. 
 
 Office Health Commissioner. 
 
 i:i RE M SAXIT VTIOX. 
 
 {'i-i'iiiixi s No 
 
 Tenant ■ 
 Otcner, A<jt nl 
 
 Buffalo, .V. T. 
 
 No. 
 No. 
 
 871 
 
 189 
 
 >/,■■ i / . 
 
 COMPLAINT. 
 
 (I iMl'l. AIN \ N I 
 
 NO. >». 
 
 Size 3^ IN. n B in. 
 
 BOARD OF HEALTH, CITY OF 
 
 SEW HAVEN SANITARY [NSPECTION. 
 
 Mo Street. 
 
 . The Premises No Street of which 
 
 [nspected 189 . yon are owner, agent, tenant, is in an unsanitary 
 
 Notice I s '- 1 . condition "ii account of. 
 
 ( 'ondit ion . 
 
 Unless i In nuisance is abated in days, '•> 
 
 .\il\ ised 
 
 Time 
 
 ii will be reported i" the Board "i Health i"i in 
 diate acl ion. 
 
 To 
 Days, 
 .Inspector. 1 >ate 
 
 1 80 - 'tary lnnpt ctor. 
 
( S7:> APPENDICES. 
 
 NO. 30. 
 
 The following blank is in use in Asbury Park, N. J. These blanks are bound into 
 books, one book for each street and one blank for each lot or separate premises. 
 Each blank has four pages and the books measure seven inches by eight and one- 
 half inches. The printing and binding (twenty-seven books) of these blanks cost 
 880 per 1,000: 
 
 RECORD OF SANITARY INSPECTION. 
 
 No Street, Avenue. 
 
 Owner Address '. 
 
 Agent 
 
 SITE OF HOUSE. 
 
 1. .Size of lot feet x feet. Area of lot square feet. 
 
 Area covered by buildings square feet. 
 
 •J. Has lot been tilled in ? 
 
 3. Elevation of house sill above curb feet. 
 
 4. Ground-water level below curb feet. 
 
 5. Height of buildings on adjoining lots ' 
 
 6. Yard 
 
 T. Privy-vault: size x ; distance from privy-vault to dwelling 
 
 feet; distance from privy-vault to w T ell feet; construction of privy- 
 vault 
 
 8. Catch-basin: size x x ; size of grating x 
 
 how covered ; is ventilation adequate ? 
 
 9. Cesspool : size, constuction, location and ventilation 
 
 10. Water supply : analysis of well-water 
 
 1 1 . Stable : ; number of stalls ; how floored 
 
 disposal of fluid excrement 
 
 storage of solid excrement 
 
 manure receptacle ; size . . . 
 
 cover 
 
 12. Chickens kept on premises? 
 
 13. Oarbage : how stored? 
 
 HOUSE. 
 
 14. House erected 
 
 15. House used for boarders? ; for other business? 
 
 1G. House faces ; sun exposure 
 
 IT. Number of sleeping-rooms 
 
 18. Rooms without windows 
 
 19. Heating ; has furnace an air-tight fresh air box?. 
 
 20. Lighting 
 
 21. Number of stories high 
 
 ~1'1. Material of construction 
 
 sheathed and covered with building paper?. 
 '!'■'>. Eire escape 
 
APPENDICES. 
 
 24. Roof. 
 
 26. 
 
 34. 
 
 Hack dwelling on lot 
 
 Ki mndation : thickness ; damp ? ; cause 
 
 Cellar: how floored : under all of house? : outside entrance .' 
 
 : number and size of windows ; is cellar dry <>r 
 
 damp? : is ground-water level below cellar bottom ? 
 
 •liar well ventilated '.' 
 
 PLUMBING. 
 
 Water-.!, isets: number ; located 
 
 style : condition 
 
 windows in water-closel apartment : is apartment used for 
 
 sleeping-room ? 
 
 House drain : material 
 
 size : fall 
 
 Trap on main drain 
 
 1 nlei for fresh air 
 
 An- all fixtures trapped ? ; t raj >s vented '.' 
 
 Premises connected with street sewer.' 
 
 VITAL STATISTICS. 
 
 1'ojiulat ion of house 
 
 N Limber of families 
 
 Diseases reported during |>ast year 
 
 Diseases reported during pasl ten years 
 
 :;s. Deaths during past year 
 
 39. Deaths during pasl ten years. 
 
 PLAN <>F PREMISES. 
 
 1,1 S I II ill 
 
 Scale. < >ue inch, 25 feet; one-fifth inch. ~> feet. Each square represents 5 
 square feet. 
 
 I.I Mil:- INDICATE IS FOLLOWS: W, well; ('.cistern; I". privy-vault; D. drain 
 
 (dotted line shows course of drain); L, leaching cesspool; I!, brick cesspool; 
 ( li. catch-basin. 
 
 _|_ |__ 
 
 . : ' L 
 
 , : !_ 
 
 ' I 
 
 J i L. 
 
 i I 
 
 _i_ 
 
 : I 
 
 _' l_ 
 
 ! i i 
 
S7-L 
 
 APPENDICES. 
 
 NO. 31. 
 
 Form proposed by the Minnesota State Board of Health. 
 
 The following model plat for recording facts of inspection can be drawn with 
 pencil on a half sheet of letter paper making a convenient record which can be 
 changed as occasion requires. 
 
 To be used in making and recording a sanitary survey of a farm, lot or block (as 
 the case may be), as parts of a township, village or city survey. (The signs illus- 
 trated and described below enable the record to be made with the minimum of 
 notes.) 
 
 No. of Plat 
 
 1. House: Roman numeral (e.g., 
 II) indicates adult population. Arabic 
 (c g., 4), child population. Number in 
 parenthesis (e. </., 1), reference number 
 of house. 
 
 2. Well; if used for drinking pur- 
 poses, mark u. f. d. 
 
 3. Water or earth closet. 
 
 4. Privy, with ordinary vault; see 
 23 helow. 
 
 5. Cistern; if used for drinking pur- 
 poses, mark u. f. d. 
 
 6. Cesspool and drain from house. 
 T. Garbage heap. 
 
 8. Barn; marks on diagonal indicate 
 horses and number of same. 
 
 9. Shed; marks indicate cattle and 
 number of same. 
 
 10. Manure heap. 
 
 11. Pig pen; numeral {<■. ;/., 9) indi- 
 cates number of occupants. 
 
 12. Plank sidewalk. 
 
 13. Stone, brick or concrete sidewalk. 
 
 14. Water main and connection with 
 house; arrow indicates direction of how. 
 
 15. Sewer and connection with house; 
 arrow indicates direction of flow. 
 
 16. Swamps or wet ground. 
 
 17. Flowing stream. 
 IS. Stagnant pool. 
 
 19. Trees. 
 
 20. Arrow indicates direction of sur- 
 face drainage. 
 
 21. U. F. D., used for drinking pur- 
 poses. 
 
 22. Ft. D., followed by numeral, indi- 
 cates number of feet deep. 
 
 23. W. T., means water tight. 
 
 1- cc r. - 
 
 
APPENDICES. 
 
 •>i •» 
 
 NO. 32. 
 
 This form is used in North Carolina ami also in Brunswick, <.a. 
 SAMPLE PAGE OF INSPECTION BOOK. 
 
 1893-'n4. 
 
 1 .2 3 
 
 April 
 
 1 
 
 124 Wolf Street, 
 
 b 
 
 a 
 
 a 
 
 May 
 
 .-; 
 
 
 a 
 
 a a 
 
 .1 line 
 
 2 
 
 
 a 
 
 a 
 
 a 
 
 July 
 
 - 
 
 
 I. 
 
 a 
 
 a 
 
 Aug. 
 
 1 
 
 
 a 
 
 a 
 
 a 
 
 Sept. 
 
 2 
 
 b 
 
 a 
 
 a 
 
 Oct. 
 
 1 
 
 a 
 
 a 
 
 a 
 
 Jan. 
 
 
 ... 
 
 a 
 
 a 
 
 a 
 
 April 
 
 1 
 
 T. II. Jones, 
 
 <• 
 
 
 c 
 
 May 
 
 ■> 
 
 
 b 
 
 
 b 
 
 .1 une 
 
 2 
 
 Ami so on down. 
 
 a 
 
 
 a 
 
 4 :> 
 
 1, c 
 
 a 
 
 a 
 
 a a 
 
 a a 
 
 x 
 
 a a 
 a a 
 a a 
 
 KKMARKj 
 
 1. Too mucli litter ami trash. 
 
 5. Very foul. 
 .">. Improved hut not clean yet. 
 
 l. Rank weeds, •">. Not enough 
 dry earth used. 
 
 Land 3. Dim pig-pen too near well. 
 
 5. Very foul, never cleaned. 
 1. Pig-pen improved, door raised. 
 N., thai ean lie raked under. 
 
 NOTE. - Bj allowing nine lines to each lot there will be a line for each one of the 
 inspections required bj the ordinance — monthly from April to October, inclusive. 
 •■ 124 Wolf Streel " represents a complete establishment, " T. II. .lones"' an humbler 
 one with no stable or other out-building and no sink. 
 
 The inspector should carry this hook with him when making his rounds and make 
 his notes on I he spot. 
 I' IB.M No. 2. 
 
 I he printed or written on tirst fly-leaf of Inspection Book). 
 
 Column No. i indicates condition of Premises other than below]. 
 
 .. . z .. .. stable. 
 
 :; » •■ Well or Pump. 
 
 •• 4 ■• •• ^ink. 
 
 ■• :, ■■ Privy. 
 
 ■ 6 •• Out-building. 
 
 •- T •• •• Residence. 
 
 A indicates Good. B indicates Fair. C indicates Bad. X indicates a serious 
 menace to heall h. 
 
 no. :;:;. 
 
 Size s in. t 10 in. 
 
 Boakd of Mi \i in. l_' Beacon Sthei i 
 
 Boston 189 
 
 T 
 
 of Boston, in the Countj of Suffolk, ami C monwealth of Massachusetts: 
 
 The Board ol Health ol said city of Boston hereby order you to remove, at your 
 
 Own expense, within days from service Of this notice. ;i 
 
 nuisance, source of tilth and cause of sickness, found on certain private property, 
 of which you are the owner and occupant, to wit : 
 
 situated on and appurtenant to the premises numbered. 
 
 in s;iiil Boston : and which sai'l 
 
 sanl Board of Health have adjudged to be a nuisance. 
 
 Bj ordei of the Board ■■< Heath 
 
 I Reverse has blanks for record oi service. ] 
 
 "•• i rptan ■ 
 
876 
 
 APPENDICES. 
 NO. 34. 
 
 Size 84 in. x 14 in. 
 The following is the form used in Providence under the Rhode Island law 
 
 [FORM A.] 
 
 THE CITY OF PROVIDENCE. 
 
 No. 
 
 In Hoard ok Aldermen 
 
 189 
 
 ordered, that. 
 
 being the owner or occupant of premises situated. 
 
 in tlie City of Providence, Rhode Island, remove at own expense a 
 
 certain nuisance, source of filth, filth, or cause of sickness, to wit : 
 
 found on said premises, within twenty-four hours. 
 after service of this notice of said order. 
 
 Clerk of the Board of Aldermen. 
 
 [reverse.] 
 State of Rhode Island. 
 
 Providence, sc, 
 City of Providence. 
 
 I have made service of the within notice and order 
 
 by leaving a copy thereof personally with the said 
 
 at the last and usual place of abode of said 
 
 within this state, by reading the same in the presence and hearing' of said 
 
 of 
 
 the authorized agent of said 
 
 on the day of A. D. ISO at 
 
 <>"clock, M. 
 
 Constable. 
 
 < 9 
 
 H — 
 
APPENDICES. 
 
 877 
 
 NO. 35. 
 
 The Ohio nuisance law appears to be a very effectual one and the state board of 
 health has prepared a blank form of order for the use of local boards in that state 
 
 in abating nuisances. 
 
 Size 4 in. x 91 in. 
 
 2 
 
 £ « 
 
 — 
 r. 
 
 ?. 
 
 /. 
 
878 
 
 APPENDICES. 
 NO. 36. 
 
 Size T in. x 84 in. 
 
 t— i 43 O 
 
 5fe 
 
 No 
 Nuisance 
 
 Ward. 
 
 S; 
 
 
 
 
 
 M 
 
 
 •fc3 
 
 
 •y. 
 
 
 
 g 
 
 ~ 
 
 ;_; 
 
 G 
 
 
 05 
 
 ** 
 
 — 
 
 0) 
 
 CS 
 
 >= 
 
 
 
 
 
 
 
 
 
 
 
 
 s* ® ° — 
 
 
 c 
 
 p 
 
 tf3 
 
 
 
 
 
 ® 
 
 £ 
 
 - 
 
 O 
 
 Inspector — District N< 
 
 18 
 
 By order of the Board of 
 
 Health, the Health Officer 
 is directed to have the 
 within-described nuisance 
 abated or removed. 
 
 Chief Clerk. 
 
 ( REVERSE. 
 
 Ward, 
 
 A LIST OF LICENSED CLEANERS CAN BE SEEN ON APPLICATION AT THE HEALTH OFFICE. 
 
 HEALTH OFFICE. Philadelphia, 
 
 To 
 
 owner, agent, or occupier of premises situated.. 
 
 is 
 
 You are hereby notified and required to have removed within days 
 
 from the date of the service hereof, a certain Nuisance on the above-described prop- 
 erty, arising from 
 
 which Nuisance has been declared to have a tendency to endanger and be prejudicial 
 to the public health. On failure to do and perform which, the said Nuisance will 
 be removed at your expense, and a lien entered agreeably to the provisions of the 
 Act of Assembly. 
 
 By order of the Board of Health. 
 
 Attest: Chief Clerk. 
 
 Clerk. 
 
 Extract from Act of Assembly. 
 
APPENDICES. 879 
 
 NO. 37. 
 
 Size 8 in. x 10.1 in. 
 
 I x Board of Health, 
 
 Boston 189 
 
 Whereas, upon due examination ii is adjudged by this Board that a nuisance 
 exists on premises 
 
 consisting of 
 
 rendering the same unlit for occupation as a dwelling place therefore 
 
 hat the tenants of sa 
 days from service 
 
 A true copy. Attest. 
 
 Ordered, That the tenants of said premises lie notified to vacate the same 
 within days from service of not ice lierei >f. 
 
 Secretary. 
 
 tenants of premises No 
 
 In compliance with the above adjudication and order you are hereby ordered to 
 vacate said premises within days from service hereof. 
 
 A true copy. Attest . 
 
 Secretary. 
 
 Constable. 
 
 NO. 38. 
 
 Size 8 i\. \ 1 1 i\. 
 
 Cm of Camhridg k. 
 
 OFFICE OK 
 
 L. S. I BOARD OF H E A I. Til. 
 
 I'm II \ i i . 
 
 ISO 
 
 M 
 
 Sib : 
 
 In the oj.iii ,f this Hoard the privy vault maintained upon your premises 
 
 situated on in said Cambridge, and 
 
 numbered t hereon, said street being 
 
 a public street wherein t here is a public sewer opposite your said premises 
 
 is injurious to t he public health. 
 
 In accordance with the provisions of Chapter 74 of the Legislative Acts of the 
 year 1890, said privj vaull is hereby declared to be a nuisance, and the further con 
 
 tiliualice thereof is f >>l I » i( h len. Veil ale then >foP 
 
 Ordf.ued, 
 
 To remove the aforesaid nuisance al your own expense within 
 
 afiei sen ice oi nol ice of this ordi i , 
 
 Bj order of the Board of Health. 
 
 Clerk. 
 
 Middlesex, --. Cambridge, . L89 
 
 I have this daj served the foregoing notice bj delivering in hand to the said ... . 
 bj leaving al the l:t -. t and usual place of abode in said 
 ( laiubridge, oi i lie said 
 
 a i rue and attested copj oi tin same 
 
880 
 
 APPEXDK 'JUS. 
 
 NO. 3<>. 
 
 SlZF. 8 IX. X 1(1 IX. 
 
 APPLICATION FOR DRAINAGE PLUMBING PERMIT. 
 
 No. 
 
 No. of Building Permit Denver, Colo., 180 
 
 Application* is hereby made for Permit fob Drainage Plumbing: 
 
 Class of Buildings, stores, 
 
 No. Street, Avenue, 
 
 Lot. Block. Addition, 
 
 owner, Address, 
 
 Plumber. Address, 
 
 Number. 
 
 Ilaseluent. 
 
 Yard 
 
 1st floor.. . 
 •.'.1 floor.... 
 3d floor.... 
 4th floor.. 
 5th floor.. . 
 0th floor.. . 
 7th flour.. . 
 Stli floor... 
 
 Wash j Bath 
 Howls. Talis. 
 
 Sinks. 
 
 Wash 
 Tubs. 
 
 Urinals. 
 
 Stop 
 Hoppers. 
 
 Grease < 'ess- 
 Traps, pools. 
 
 Sewer. 
 
 All work, mat rials, and construction to lie strictly in accordance with the Rules, Regulations, 
 ami city ordinances pertaining to Plumbing and House Drainage of the City of Denver, 
 
APPENDICES. 
 No. 40. 
 
 Si/.k si in. x 14 In. (Four pag< s. 
 PLAN No 
 
 881 
 
 Street No 
 
 CITY OF PROVIDENCE. 
 
 I'd tin Inspector <>( Plumbing : 
 
 As required by Chapter 061 of the Ordinances, the following Plan is this day, 
 
 189. . .submitted for approval; and we, the undersigned, do hereby 
 
 agree to do all drainage and plumbing in the building specified herein according to 
 this PLAN and iii accordance with the ordinance in relation to plumbing. 
 
 Location Street. 
 
 Owner Address Street. 
 
 Master Plumber , Address Street. 
 
 Architect , Address Street. 
 
 Estimated Cost "t Plumbing 
 
 Class of Building Old or New, Number of Stories 
 
 How is building t.i be occupied '.' 
 
 Where does the I >rain Pipe Discharge? 
 
 Js the Drain Pipe above or below the basement floor? 
 
 Size "i' Drain Pipe in cellar, inches; size of Snii <.r Waste Pipe inches. 
 
 Where dues t lie Air Inlet Pi] pen? Iii Court-Yard or at Sidewalk ? 
 
 Is there Underdrainage ? I low dues it connect with Sewer ? 
 
 u \ 1 i.i: I LOS1 rs 
 
 \ LRD. 
 
 B 181 
 
 Ml\ 1 '. 
 
 lsl 
 
 1 LOOR. 
 
 2d 
 Floor. 
 
 3d 
 Floor. 
 
 ■nil 5th 
 
 R. Ii. :. 
 
 6th 
 1 LOOR. 
 
 Pal tei Name of 
 
 
 
 
 
 
 
 
 l|.iu Supplied with 
 w atei . 
 
 
 
 
 
 
 
 
 
 [a tpai tnnni Venti- 
 lated '.' n bo, state 
 
 it ii is i.\ \n Shaft 
 
 . r \\ niilow. 
 
 
 
 
 
 
 
 
 lli.u i.o are I rapi 
 from \ ertical Pipe? 
 
 
 
 
 
 
 
 How are Tank « »\ er- 
 Howe Trapped 1 
 
 
 
 
 
 
 
882 
 
 APPENDICES, 
 
 \ 
 
 < 
 
 ■f. 
 
 1 '- 
 
 - 
 
 .- ~ '- 
 
 £ 5 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 • 
 
 
 
 
 el 
 
 *5 
 
 
 
 
 
 
 
 
 < 
 
 
 
 
 - 
 
 a) 
 
 
 
 :. 
 X 
 
 
 
 
 [s there 
 
 a 
 separate 
 
 one '.' 
 
 
 
 • 
 
 e 
 
 K 
 O 
 
 M 
 
 o 
 
 CO 
 
 Connected 
 
 with 
 Sewer or 
 
 Cesspool. 
 
 
 
 G3 
 
 i - — 
 
 
 
 
 &c<h £, 
 
 'S = r 
 
 
 
 i 
 
 Size of 
 Soil in- 
 Waste 
 Pipe. 
 
 
 
 KIND OF TRAP. 
 
 
 
 
 
 
 
 
 
 4- 
 
 
 Q 
 
 — 
 
 c 
 c 
 
 c 
 
 c 
 c 
 
 c 
 c 
 
 -r 
 
 c 
 
 c 
 
 '- 
 
 
 s 
 
 a 
 ■/ 
 
 e 
 X 
 
 | 
 
 3 
 
 c 
 c 
 
 c 5 
 
 4- 
 
 [* 
 
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 -t 
 
 -_ 
 
 
 
 SX5 
 
 so r 
 
 10 
 
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 \ . 
 
 A 
 
 
 "Sh 
 
 IS> 
 
 a 
 
 HS1 
 
 AV 
 
 
 
 •s 
 
 an 
 
 L i 
 
 i i \ 
 
 a 
 
 
APPENDICES. 
 
 883 
 
 
 
 
 
 
 
 ti 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 j 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 — 
 
 
 
 
 
 
 
 
 
 
 
 
 z 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ■~ 
 
 
 
 
 
 
 93 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 s. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 -r 
 Z 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 > 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 — 
 
 0) 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 - \ \ 
 
 3 r S l - z 
 
 ■_ - - - — 
 
 ■ — — j- ~ 
 
 '- z : - : : 
 
 1 I ~ ~ a 1 
 
 ■- i I | n~\ \\ 
 
 I" - I IV 
 
 1 
 
 - 
 
 - 
 
 1 
 
 — 
 
 - 
 
 — 
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 1 1 
 
 \ 
 
 
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 g I s i § l 
 
 _ • r E fc 
 
 
 
 - — — — 
 
 - 
 
 •»:i I.I.IOH ■!< 
 
 — - — 
 - a - 
 
 — i ■ • i uo)onp 
 
 ri.nil|..:| <!• . ( Ml 1JI 
 
884 
 
 APPENDICES. 
 
 INSPECTOR OF PLUMBING 
 
 City of Providence. 
 
 Plan of Plumbing and Drainage. 
 
 Plan No 
 
 No Street. 
 
 Filed 
 
 Inspected 189 
 
 .189.. 
 
 Final Inspection shows that all work 
 lias been done in accordance with this 
 Plan and the Rules and Regulations. 
 
 Inspector of Plumbing. 
 
APPENDICES. 
 
 885 
 
 Bureau of Health. 
 
 No. 41. 
 
 Size 4 VS.. x 5$ in. 
 
 ORIGIN AX. 
 PLUMBING CERTIFICATE. 
 
 No. 
 
 D< river, < 'olo 189. . . . 
 
 I hereby certify that lhave on this day examined the plumbing of house oioned 
 
 by Lot 
 
 Block Add Street 
 
 b( '"■' en 
 
 and find that the work has been dont according to requirements of tin City Ordinance in 
 relation to plumbing. 
 
 Health ( omnusstom i 
 
 Plumbing Lisj» ctor, 
 
 [JJ8P K "I l'K"\ ISIONS. 
 
 So 
 Proridt nee, 18U 
 
 Quant it a. 
 
 Kind 
 
 i Qutu i . 
 [Address, 
 i i 'onsiffiu ■ .. 
 I Addn is,. 
 Privatt mark . 
 
 hull o) mrii "/. 
 
 NO. 42. 
 
 Size \\ in. \ 8 in. 
 city of providence health departmen1 
 
 [NBPEI riOK 01 l"l:n\ ISIONS. 
 
 No. 
 
 18 
 
 l i, r eby i - rtl/y thai mi Via day 
 
 ,.188 , I seized and coiulemnril at 
 
 i hi jn ii/n 1 1 a "i 
 
 ,i ,,,i cotislf/neil in 
 U ,■■• . R. I 
 
 aropi 1 1 ii '" \ng 
 
 ,n„l hi, III fo 
 
 I ,,*i„ , tor ni l'i ■■• i *ian». 
 
886 
 
 APPENDICES. 
 
 NO. 43. 
 
 Size 7 in. x 8 in. 
 
 APPLICATION FOE LICENSE TO SELL MILK. 
 
 City of Minneapolis, Minnesota. 
 
 Application of to the City Council of the City of 
 
 Minneapolis, for a License to sell milk in said city. 
 1st. Name of Applicant and residence 
 
 2d. Location of dairy from which applicant obtains his milk 
 
 3d. Name of owner of such dairy 
 
 4th. Number of cows in dairy from which applicant obtains his milk. 
 
 5th. Manner of disposing of milk 
 
 Date 
 
 No. of Application. 
 
 (OVER. ■ 
 
 189.. Signed 
 
 (BEVEBSE.) 
 
 O 
 
 1 '-= - z 
 
 .2 ►. =3 £ 
 
 -t-= cs = — 
 
 £ 2 
 
 c3 <s 
 
 o 
 
 CD r- 
 
 •fl 
 
 r/i 
 
 £ 
 
 ? 
 
 o 
 
 O 
 
 o 
 
 y 
 
 
 «*-( 
 
 o 
 
 ° 
 
 o 
 
 o 
 
 fc 
 
 K 
 
 X X 00 
 
 U ~ s 
 
 i. CD cS 
 
 9h 3h — 
 
APPENDICES. 887 
 
 NO. 44. 
 
 Size T in. x 14 ix. 
 
 APPLICATION FOR LICENSE TO SELL MILK IX THE CITY OF BOSTON 
 DURING THE YEAR ENDING MAY :ilst, 1900. 
 
 Xanie of applicant 
 
 Residein-e (street and number, town) 
 
 Place of business 
 
 Number of wagons used in delivery of milk. 
 Number of drivers employed 
 
 NAMES OK DKIVEBS. 
 
 RESIDENCES. 
 
 ' If any. lill out Form 3. 
 
 1'. M. 
 
 Section supplied 
 
 Amount of Milk raised, (quarts) 
 
 Number of cows kept 
 
 Amount of milk bought (quarts) 
 
 of whom bought 
 
 Where delivered by him 
 
 Sour delivered A. M 
 
 Where stored and handled after delivery 
 
 Whether mixed, handled, or stored where cows, horses, or other animals are kept, 
 
 or where manure is stored 
 
 Whether mixed, handled, or stored iu rooms used for domesl ie purposes or sleeping 
 
 rooms 
 
 Location of milk room 
 
 How drained 
 
 Whether walls are tight and easily cleaned 
 
 Whether floor is tight and easily cleaned 
 
 Whether appliances are at band for washing or sterilizing all utensils 
 
 Whether any water-closet, urinal 01 privj is located in the room. 
 Whether ice-box or refrigerator drained, and how 
 
 The above is a c< irrect statement. 
 
 Signal ure. 
 
 Witness. 
 
 Host, ,11 
 
 License Issued. 
 Number of License. 
 
888 A PPEXU1 C 'JUS. 
 
 NO. 45. 
 
 Size T in. x 10} in. 
 
 APPLICATION FOE REGISTRATION AS A DEALER IN MILK AND FOR 
 LICENSE TO SELL MILK IN A STORE IN THE CITY OF BOSTON. 
 
 Name of applicant (if a partnership, the name and address of each member must be 
 given). 
 
 Residence 
 
 Residence : 
 
 Kind of store (bakery, provisions, groceries, etc.) 
 
 Place of business, N< Street. 
 
 District Amount sold per day (quarts) 
 
 From whom purchased 
 
 Time received 
 
 Whether kept in a separate covered cooler or refrigerator 
 
 Whether cooler or refrigerator is drained and how 
 
 Where and how the measures are washed. 
 
 Whether there is a urinal or water-closet in the store 
 
 Whether any part of the store is used for domestic purposes or as a sleeping- 
 room 
 
 The above is a correct statement. 
 Signature 
 
 Witness 
 
 Boston 
 
 License issued 
 
 Number of License. 
 
 NO. 46. 
 
 Health Department of the City of New York, \ 
 
 Criminal Court Building, v 
 
 New York, 189.. ) 
 
 Permit No 
 
 is hereby authorized to sell Milk, Fresh and Condensed, 
 
 at No under the laws, rules and regulations of the Board 
 
 of Health of the Health Department of the City and County of New York. 
 
 This permit is not transferable to any person or location other than above, and 
 must be kept posted at all times in a conspicuous place in this store, and is revoc- 
 able at the pleasure of the Board. 
 
 By order of the Board of Health, 
 
 CHARLES (i. WILSON. 
 
 President. 
 Emmons Clark, 
 
 Secretary. 
 
 Countersigned. EDWARD W. MARTIN, 
 
 Chief Inspector, Fooil Division, etc. 
 
APPENDICES. 
 
 for Wagons: 
 
 Health Department of the City of New York, ) 
 Criminal Court Building, 
 
 New York 189.. ) 
 
 Permit No 
 
 resid i ng a i 
 
 is hereby authorized to sell Fresh and Condensed Milk 
 
 from Wagon No , in the City and County of New York, under the laws, rules 
 
 ami regulations of the Board of Health of the Health Department of said City and 
 County. This permit is revocable at the pleasure of the Board. 
 By order of the Hoard of Health, 
 Emmons Clark, CHARLES G. WILSON, 
 
 Si cretary. President. 
 
 Countersigned, Edward W. Martin, 
 
 Chief Inspector, Food Division, etc. 
 This permit is void if used for any cart except the One designated on the face. 
 
 Driver" s name 
 
 Residence 
 
 Not transfi ruble. 
 
 NO. 47. 
 
 Size 4 in. \ Q{ in. 
 Ins. Date Time Lab. X". 
 
 Name 
 Address 
 Attendant 
 
 Marks on Can Size of Can Approx. Ami. in Can 
 
 Tag.' Yes No. Duplicate Given ? Yes No. Milk Cream 
 
 No. of Wagon License No. Ward 
 
 Where Taken 
 
 Remarks 
 
 Specific Gravity Butter Fal Total Solids 
 
 ( Kl.\ RBSE. I 
 
 The Milk Ordinance requires Milk to contain at hast three per cent, of 
 
 butter fat : this means three pounds of butter fat in one hundred pounds <'!' milk. 
 
 "Skim 1 ' milk may lie sold if 1 lie can. jar. ^lass or ressel in which the milk is 
 kepi is marked with a • skim " milk tag in plain sighl where customers may see it. 
 
 mi must contain at least twelve per cent, of butter fat ; this means twelve 
 pounds of butter fal in ever] one hundred pounds of cream. 
 
 v • whole milk, 11 -skim milk 11 or cream may he sold which coin a ins water, 
 color, preservative, soda, salt or any other adulteration. 
 
 This blip is \ beceip' t tour saupu and you cannot gel youi t< -: 
 
 without it. unless it has been destroyed or lost, when satisfactory evidence of tin- 
 fact must be given. No results of tests will he given by telephone ; either presenl 
 this slip for your test or mail with it a two cent stamp enclosed, to Room 111, Cit} 
 
 Hall, and result of test will he sent you. 
 
 Samples of milk "i cream will he received for i> sting between nine o'clock in 
 the morning and four o'clock in the afternoon. A half pint of milk or cream is re- 
 quired for a test. Ml testing is done free of , harge. 
 
 For furt her informal ion. ado ■ 
 
 E. B. ST1 \KT. 
 
 Slipt ri ill' /ill' ill Mill, I iisjii , I 
 
 Room II I. City Hall 
 
890 
 
 APPENDICES. 
 NO. 48, 
 
 Size 3i in. x 10 in. 
 
 Warning Notice to Sellers of 
 Illegal Milk 
 
 No. 
 
 DEPARTMENT OF HEALTH. 
 City of Minneapolis. 
 
 Minneapolis, Minn.,. 
 
 . . . 189 . 
 
 You are hereby notified that <i sample of m ilk recently 
 obtained, from you has been found mi analysis to be of a 
 
 Address ■ character declared bylawto beillegaT. )'<>" are respect- 
 fully notified that the sale of such m ilk, «</• the offering or 
 
 ( "haracter of m ilk sold exposing <>r delivering of such m ilkfor sale or consumption 
 
 renders you liable to the penalties provided /></ the Ordi- 
 nances of the City of Minneapolis. 
 
 Further information will be furnished you <m personal 
 Date 180. . application to I his office. 
 
 Respectfully, 
 No. of Notice 
 
 To 
 
 Commission* r of Health. 
 
 NO. 49. 
 
 SANITARY INSPECTION OF TENEMENT OR LODGING HOUSE. 
 
 Date of inspection 189 .... 
 
 1. Street No 
 
 •_'. Owner, Agent Address 
 
 3. Condition of Street. Paved or Unpaved. 
 
 4. Condition of yards and courts: Clean, Unclean; rubbish, ashes, garbage, wet, 
 
 damp, dry. 
 
 5. Barn: Clean, unclean, wet, damp, dry, sewered. Manure Box: Clean, unclean, 
 
 covered, or uncovered. 
 
 6. Outhouses: Clean, unclean, whitewashed, not whitewashed. 
 
 7. Animals : No Nature 
 
 8. Basement or Cellar: Cemented, uncemented, wet, damp, dry, clean, rubbish, 
 
 ashes, filth, lighted, ventilated. 
 
 '.'. Apartment No. 1. Living rooms ; Sleeping rooms ; Ventilated ; 
 
 No. of occupants ; Color . . ; Nationality 
 
 Air space 
 
 29. Apartment No. 21. Living rooms ; Sleeping rooms ; Ven- 
 
 tilated; No. of occupants ; Color ; Nationality ; 
 
 Air space 
 
 30. Sickness in house ; what diseases 
 
 31. Sickness during 12 months; what diseases 
 
 32. Deaths during past 12 months ; what diseases 
 
 33. Water supply ; Source of contamination 
 
 34. Janitor. Night lights. Gong. Metal receptacles for refuse, etc. 
 
 35. Plumbing : Yard 
 
 Basement 
 
 1st floor 
 
 2d floor 
 
 3d floor 
 
 4th floor 
 
 5th floor 
 
 Conductors discharge 
 
 36. Sanitary needs ; observations 
 
APPENDICES. 891 
 
 NO. 50. 
 
 Size 8-J in. x 14 in. 
 
 REPORT OF INSPECTION OF DAIRY FARM. 
 
 Health Department, Distbict <>f Columbia. 
 
 Washington, 
 
 To thi Health Officer: 
 Sib:— 
 
 1 respectfully submit the following report upon an inspection of the dairy 
 
 farm of , located 
 
 BUILDING. 
 
 Brick Frame Stories high. 
 
 Condition 
 
 Is any part of it used for any other than dairy purposes ".' 
 
 If so. specify, in the space for remarks, what parts of it are so used, and the pur- 
 poses for which used. 
 Room for < 'attle. 
 
 Mz.- long wide high 
 
 Floor. Kind 
 
 Condition 
 
 Is it properly sloped and guttered ? '. 
 
 What disposition is made of the drainage .' 
 
 Ventilation and lighting. How accomplished?. 
 
 Windows. 1 low man] ? 
 
 Location 
 
 Size. 
 
 Are window s glazed '.' 
 
 Ventilators. How many .' 
 
 Kind 
 
 I., ical ion . 
 
 Size 
 
 I toors. How many ? 
 Local ion 
 
 Mall>. Where located ? 
 
 How man] ? 
 
 Size of each ? wide long . 
 
 wide long 
 
 Lre animals of any kind other than cattle kepi in i Ins room? 
 
 [f so, specif] ho\\ many, and what kind 
 
 /•"< ediny trouyhs or boxen. I low many ? 
 
 Kind 
 
 Local ion 
 
 ( ondit ion 
 
 Water trouy ha. ll"W many? 
 
 K ind 
 
 Local ion 
 
 ( '• 'iid ition 
 
 it water troughs are nol used, how are cattle watered 
 
892 APPENDICES. 
 
 Source of water supply. 
 
 If from well, state location 
 
 Approximate depth feet, and construction . 
 
 Location of well with reference to nearest privy. State distance and slope 
 of ground 
 
 Location of well with reference to place where dung is deposited. State 
 distance and slope of ground 
 
 lias water any perceptible odor, color or taste ? 
 
 If so, describe 
 
 Receptacles for dung and other refuse. How many? 
 
 Kind 
 
 Location 
 
 Condition 
 
 Receptacles for milk. How many ? „ 
 
 Kind 
 
 Condition 
 
 What provision is made for cleaning ? 
 
 Is milk cooled immediately after milking ? 
 
 If so, how ? 
 
 BARN-YARD. 
 
 .Size long wide 
 
 Is it properly graded ? and drained ? 
 
 Is it paved 
 
 What disposition is made of the drainage ? 
 
 What is its condition as to cleanliness, at time of inspection? 
 
 PASTURE. 
 
 Size of 
 
 Location of . . 
 Condition of . 
 
 Is it supplied with drinking water for cattle '.' . 
 If so, from what source ? 
 
 CATTLE. 
 
 How many milk cows are usually kept ? 
 
 How many other cattle, if any, are kept in the same stable ?. 
 
 Kind of milch cows used 
 
 Condition of cows at time of inspection. General condition. 
 
 Cleanliness, etc 
 
 Character of feed 
 
 PRIVY ACCOMMODATIONS. 
 How is human excreta from the premises disposed of ?. . . 
 
 Location of privy, if any. 
 Construction of privy. . . 
 
 SEWER AND WATER. 
 
 Is a public sewer available for premises ? 
 
 If so, have sewer connections been made ? 
 
 Is a public water main available for premises ? 
 
 If so, are the premises connected therewith? 
 
 1! KM ARKS. 
 
 Inspector, 
 
APPENDICES. 
 
 89a 
 
 NO. 51. 
 
 Size \\ in. x 11 ix. 
 
 
 
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894 
 
 APPEXDK 7-:s. 
 
 NO. 52. 
 
 Postal Card. 
 
 Diseases to be Reported :; ip ? er ^ Me h as H es c Mernb w r h anous c i oup ; Puerpera 
 
 wiwuuvuw iu m« nufjunuu ■ Smallpox . Typhoid Fever, Whooping Cough 
 
 Fever, Scarlet Fever, 
 Optional — Tuberculosis. 
 
 NOTE. — Where the Attending Physician will undertake to enforce necessary measures 
 against the spread of contagion in a case of any of the above-named diseases, tlie intention 
 should be indicated by writing in the word assume in Entry No. 8. If this be done the De- 
 paetmest will not placard the premises — except in Smallpox. If it is proven that efficient 
 precautions are not being enforced, the premises will be taken in charge of, placarded and 
 quarantined by the Department — Tuberculosis excepted. 
 
 If the Physician does not see fit to assume this responsibility, the word decline should be 
 written in the blank space, when the Department will placard and quarantine as may be 
 necessary fur the protection of the neighborhood. Absence of any indication will be construed 
 as declining' the responsibility and the DEPARTMENT will take action accordingly. 
 
 Where the responsibility is assumed, the Physician must cause neighboring families to be 
 fully warned against the disease and must prohibit members of the infected family from ex- 
 posing others to the risk of infection. 
 
 1 Chicago 1 Case of 
 
 •1 Xo Ward 
 
 Avenue, Boulevard, Court. Place, Street. 
 
 3 Case connected with Milk .Shop or Depot, Laundry, Shop, other business 
 
 place. If n " r so connected write in blank space the word not. 
 
 4 Name of patient 
 
 5 Age years months. Color Sex 
 
 (If the Patient had lived outside Chicago within the last .30 days, state below where 
 and date of return.) 
 
 Returned from on the 
 
 Name of place and State. Date of return. 
 
 7 
 
 In Puerperal Eever — where Midwife had been in attendance, give her name and address on 
 
 above line. 
 
 8 See note above. — I the responsibility of preventing spread of contagion 
 
 from this case. 
 
 M. I). 
 
 Address 
 
 NO. 53. 
 
 Postal Card. 
 
 Physicians are required by Utn- to report within twenty-four hours all cases of 
 contagious or pestilential diseases,namely: Smallpox, Epidemic Cholera, Epidemic 
 Dysentery, Scarlet Fever, Diphtheria, Typhoid Fever, Puerperal Fever, Measles, 
 Erysipelas, AVhooping Cough, Hydrophobia, giving name, age and residence. 
 
 See Revised Ordinances, Sec. 69. 
 
 To Health 
 Division. Age. 
 Name. 
 
 Kesidence 
 
 Street and 
 
 Number. 
 
 3 
 
 -f.— 
 
 73 . 
 
 2 S 
 
 ■s > 
 
 ft o 
 
 02 
 QD 
 
 o 
 
 00 
 
 S3 
 
 QD 
 
 6J3 
 
 £ 3 
 
 Miscellaneous 
 Diseases. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Cleveland, Ohio, 
 
 18QZ. \ ^r it 
 
 
 
 
 
 
 
 
 
 
APPENDICES. 895 
 
 NO. 54. 
 
 Postal Card. 
 
 San Francisco, 1893. 
 
 Tht Board of Health is hereby notified thai 
 
 agt . . . .//' ars, living 
 
 ill No. . . . 
 is ill with 
 
 . M. It. 
 
 Order No. 2313 — Sec. 6. It shall Bs the duty of each physician in this city and 
 county to report to the Eealth Office in writing, every patient heshall have laboring 
 under Small Pox, Asiatic Cholera, Diphtheria, Scarlet Fever, or other contagious 
 disease, immediately after he shall be satisfied of the nature of the disease. lie 
 shall also reporl to the .^ame officer every ease of death from such disease. 
 
 Any person who shall violate any of the provisions of this < )rder shall be deemed 
 guilty of a misdemeanor, and upon conviction thereof shall he punished by a line of 
 not more than five hundred dollars, or by imprisonment in the County Jail for not 
 more than six months, or by both such tine and imprisonment. 
 
 This law will be strictly enforced. 
 
 Health Officer. 
 
 NO. 55. 
 
 Size :,\ IN. X 8 IN. 
 
 Fob Typhoid Feveb.] 
 
 Evebett, M .\>>. 189 
 
 TO THE BOABD 01 III \ I ill : 
 
 In the case of 
 
 Disease 
 
 I >;ile of first s\ mptoms : 
 
 lias the person been oul of town within three weeks.' (Visit or at work.) 
 
 Has the person drunk anj w eii or spring water within three weeks! 
 
 I" i . . 1 1 • w bom is milt bought " 
 
 Is t his 1 1 ii I > milk used? 
 
 It ;it work out oi town where are dinners obtained 
 Has the person risited any one sick with fevei 
 
896 APPENDICES. 
 
 NO. 56. 
 
 SlZE 8 IX. X 11 IX. 
 
 Mobile, Ala., 187 
 
 Dr. T. S. Scales, Health Officer. 
 
 Dear Sir : I most respectfully report a case of Yellow Fever in the person of 
 
 Sex. ; Color, ; Age, ; 
 
 Street 
 
 Contracted when. 
 
 Contracted where 
 
 remarks. 
 
 Very Respectfully, 
 
 M. D., 
 
 Attending Physician. 
 
 Office of the Board of Health, 
 
 Mobile, Ala., Sept. 20th, 1878. 
 Dear Doctor: Please All out a blank similiar to the above for each case that 
 you may meet with, and return them to this office by 12 m. of each day. Please 
 give all the history known to you of each case under the head of Remarks. 
 
 Yours Very Respectfully, 
 
 T. S. SCALES, M. D., Health Officer. 
 
 NO. 57. 
 
 Size 5 ix. x 8 in. 
 REPORT OF OUTBREAK OF A COMMUNICABLE DISEASE. 
 
 To be mailed to the Secretary of the State Board of Health, Concord, N". H., 
 immediately on the occurrence of a first case of cholera, smallpox, typhus fever, 
 yellow fever, diphtheria, membranous croup, scarlet fever, typhoid fever, and 
 measles. 
 To the Secretary of the State Board of Health : 
 
 Sir : — There has come to my knowledge a case of 
 
 (Name of disease.) 
 
 (Town, city or village.) 
 
 The hrst person sick is 
 
 a , about old, who was taken sick with 
 
 (Male or female.) (Age.) 
 
 this disease on the day of ,189 . The 
 
 (Month.) 
 
 number of cases which have already occurred is 
 
 The danger of the spreading of the disease is 
 
 (Great, not great, etc.) 
 for the reason that 
 
 Precautionary measures 
 
 (Will be taken, have been taken, or are suggested to the 
 
 as follows, 
 
 state Board of Health, as the case may be.) 
 
 Signature, 
 
 (Whether Health Officer, or Secretary of Local Board ofHealth.) 
 
 189 .. 
 
 (Postoffice Address.) (Date.) 
 
 Please fill the blank spaces in this notice if possible, but having learned the 
 name of the disease, do not delay sending the report in order to learn other facts 
 provided for in this blank. — Sec. State Board of Health. 
 
APPENDICES. 
 
 897 
 
 NO. 58. 
 
 Size :>', in. x 8i in. 
 THE STATE OF NEW HAMPSHIRE, 
 
 Weekly Report During the Prevalence of a Communicable Disease.* 
 
 '/'.« the Secretary of the State Board of Health, Concord, N. II.: 
 
 Sir:- The following is a report of all known cases of the diseases named below, 
 
 in , X. II., during and at the 
 
 if the week ending Saturday 189 
 
 , (Date.) 
 
 X mkes of Diseases. 1 
 
 Number In ring ihi: Week, Ni mbek. 
 of sick 
 
 Number sick 
 
 at Close lit' 
 week. 
 
 Number 
 of 
 
 at last 
 
 Report. Taken sick Recovered. Died. 
 
 infected 
 bouses. 
 
 DIPHTHERIA 
 
 
 
 MEMBR VXni s croup.. .. 
 
 
 
 
 BC LRLET FEVER 
 
 . 
 
 
 
 
 TYPHOID FEVER 
 
 
 
 
 
 
 Mi: \^i i ■•> 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 What action lias your Hoard taken'.' 
 
 - Signature, 
 
 (Health officer or secretary Local Board of Health. 
 
 PobI office \ ■ i • 1 1 ■ — . 
 
 1 1. ite of making this Report.) 
 
 ■ The i lea i iii officer or secretary "i each local board ol health in New Hampshire is respectfullj 
 requested i" forward a report on this blank in the State Board "i Health, Concord, V n.. promptlv 
 alter the close ol each week, during any portion "t which a caseol the diseases named in thft 
 
 report has been present within the jurisdici "i In- board. 
 
 \,iii to iiii- n-i the names "i such diseases a- smallpox, cholera, yellow fever, typhus fi 
 etc.. » benevei it sure. 
 
 ii this i- tin- lasl blank (F 3 that you have, make a cross against this sentence and more 
 
 U ill lie -enl Mill. 
 
898 
 
 APPENDICES. 
 
 NO. 59. 
 
 Size 9 in. x 18 in. 
 
 SMALLPOX. 
 
 A Contagious and Infectious Disease. 
 
 All persons are forbidden to go into or out of these premises, or to carry into 
 or out of them any material whereby Small-Pox may be conveyed except by 
 permission of the Board of Health, under penalty of not less than rive dollars 
 ($5.00) nor more than twenty-five dollars ($25.00) for any violation of this order. 
 
 The Burgess or Health Officer will give to all who ask printed instructions 
 how to prevent Small-Pox and all infectious diseases. 
 
 Clerk of Council. 
 
 Chairman Board of Health or Sanitary Com. 
 
 Date 18.... 
 
 Benjamin Lee, M. D., Secretary State Board of Health. 
 
 NO. 6(). 
 
 Size 61 in. x 9 in. 
 
 Health Department, City ok New York. 
 
 DIPHTHERIA. 
 
 All persons not occupants of this apartment are advised of the 
 presence of Diphtheria in it, and are warned not to enter. 
 
 The person having Diphtheria must not leave the apartment 
 until the removal of this notice by the Health Department. 
 
 By order of the Board of Health, 
 
 CHARLES G. WILSON, President. 
 
 Emmons Clark, Secretary. 
 
 Date 
 
 Chief Inspector. 
 
APPENDICES. 899 
 
 NO. 61. 
 
 Size si in. x 11 in. 
 
 City of Seattle — Department of Sanitation. 
 KEEP OUT. 
 
 Whereas^ There is a person affected with an infections disease in this house, 
 it is hereby ordered that no person enter or leave this house without the written 
 permission of the Health officer of the City of Seattle. 
 
 Any person violating this order will he subject to prosecution, and liable 
 upon conviction to a penalty of line and imprisonment as provided by Ordinance 
 No. 2406 as amended. 
 
 F. S. PALMER, M. I)., Health Officer. 
 
 NO. <>2. 
 
 l'-K!> IN XEWAliK. 
 
 Size :'>'. in. x .V, in. 
 
 
 
 
 Notice. 
 
 
 
 
 
 
 
 This house contains a case i 
 
 f 
 
 
 
 
 
 
 SCARLET FEVER. 
 
 
 
 
 When 
 
 the 
 
 danger 
 
 rom contagion has passed, this 
 Per 
 
 card will he 
 irder, 
 BOARD OF 
 
 removed. 
 HEALTH. 
 
 
 Any person removing, defacing or obscuring this 
 Liable to a tine of Fifty I dollars. 
 
 card withou 
 
 L authority, 
 
 is 
 
 NO. 63. 
 
 Postal C led. 
 
 HEALTH DEPARTMENT. 
 
 l'i:o\ inisci ... 
 
 on account of contagious disease in the In. use. the following named, said to 
 be employed by you, should not be permitted i" return i" work without a permit 
 from t he Medical I nspector: 
 
 i i .. i m P. K is... M< dical Inapt ctor. 
 
900 A PP END ICES. 
 
 NO. 64. 
 
 Size 3 in. x 5| in.} 
 
 BOARD OF HEALTH. 
 
 Ref. No. 
 PASS 
 To Quarantine Inspector, and others whom it may concern: 
 
 This is to Certify, That 
 
 has permission to leave and enter the premises No 
 
 now under quarantine for 
 
 The isolation of the patient in a remote part of the house, and the non-inter- 
 course of the person to whom this pass is granted witli the patient, or those in 
 attendance upon the same, is the basis upon which this privilege is granted. 
 
 Any violation of the above conditions will operate as a forfeiture of this Pass. 
 
 M. D. , 
 
 Health Officer. 
 
 Detroit, 189 • • 
 
 Incase of any difficulty show this pass to the Quarantine Inspector. 
 
 NO. 65. 
 
 Size 3-i- in. x 5 -J- in. 
 BUSINESS PERMIT. 
 
 Health Department, City Hall, 
 Providence. 
 
 residence 
 
 is hereby given permission to attend business. 
 
 Medical Inspector, 
 
 NO. 66. 
 
 Size Si in. x 51 in. (Yellow Paper.) 
 BUSINESS PERMIT. 
 
 Health Department, City Hall, 
 Providence. 
 
 residence 
 
 is hereby given permission to attend business while he lives away from home. 
 
 Medical Inspector, 
 
 NO. 67. 
 
 Size 5+ in. x 8 in. 
 
 Pro 
 BOARD OF HEALTH. 
 
 Detroit, Mich., 189 
 
 Reference No 
 
 Permission is herewith given ■■ 
 
 to continue work, provided that remains perfectly isolated 
 
 from the patient 
 
 at 
 
 and lias no contact with any one attendant upon the same, until the above house 
 has been disinfected and placard removed by an officer of this department. 
 
 Per 
 
 Any violation of the terms of the above agreement, will result in a forfeiture 
 of the privilege granted. 
 
APPENDICES. 901 
 
 NO.* 08. 
 
 Size :ii ix. x .VI ix. (Yellow Papeb.) 
 SCHOOL PERMIT. 
 
 HEALTH DEPABTMENT, CITY HALL, 
 
 Providence. 
 
 residence 
 
 is hereby given permission to attend school while he lives away from home. 
 
 M. dical Inspector. 
 NO. (>9. 
 
 S I /. I 4 l .V . X I i '. IN. 
 
 Office of the IJoAlU) <)F HEALTH. 
 
 Minneapolis, Minn., 189 
 
 This is to Certify, That the children of- 
 
 living at No St. A.ve. X. E. 
 
 an- hereby permitted to return to school, all the rules and regulations of the said 
 board pertaining to the public health in which the above family was interested, 
 having heen complied with. 
 
 Commissioner of Health. 
 
 Per Clerk. 
 
 NO. 70. 
 
 Size B{ in. \ 5 \ in. 
 scilool. PERMIT. 
 
 UK a I ill DEP \ RTMENT, city II \ I.I.. 
 
 Providence. 
 
 residence 
 
 is hereby given permission to attend scl 1. 
 
 Mi dical Tnspi <\,,,-. 
 
 NO. 71. 
 
 Si xi •". in. \ 8 IN. 
 OFFICE <>K THE 
 
 HEALTH DEP \ i;tm i-.vi . 
 \... 19 Oily Hall. 
 
 Rochester, V Y.. L89 
 
 To the Principal of Scl I No. 
 
 I do herebj < lerl if) thai the Children of 
 
 M 
 
 ,,, \,, Street, ill whose familj eases 
 
 j have recentlj existed, are 
 
 in a safe condition to attend school, there being no further danger of contagion or 
 
 infection. i Signed) 
 
 M. I>. 
 
 \ pproi eii i.\ i he Boabd oi Health. 
 
 //.„///, < >tlir,r. 
 
902 APPENDICES. 
 
 NO. 12. 
 
 Pennsylvania Laws, Chapteb 124 of 1895. 
 
 Section 4. In the care and burial of the bodies of persons who have died of 
 cholera, small-pox, yellow fever, typhus fever, scarlet fever, relapsing fever, diph- 
 theria, diphtheritic croup, membranous croup, or leprosy, in any of the municipal- 
 ities of this commonwealth, it shall be the duty of the undertaker or other person 
 or persons having the body in charge, to thoroughly disinfect and place every such 
 body within the coffin or casket in which it is to be buried within six hours after 
 first being called upon to take charge of the same : Provided, Said call is made 
 between the hours of five ante meridiem and eleven 'post meridiem ; otherwise such 
 body shall be placed in such coffin or casket within twelve hours, the coffin or 
 casket then to be closed tightly, and not again opened, unless permission be granted 
 by the health authorities for special and satisfactory cause shown : Provided, That 
 the health authorities in any municipality may adopt more stringent rules and regu- 
 lations than are herein provided for the disinfection, preparation, and burial of the 
 bodies of persons who have died of any of the diseases named in this section, which 
 rules and regulations they may from time to time alter or amend. 
 
 Section 5. The body of a person who has died of any of the diseases mentioned 
 in section four of this act, shall not remain unburied for a longer period of time 
 than thirty-six hours after death, unless special permission be granted by the health 
 authorities extending the time during which said body may remain unburied for 
 special and satisfactory cause shown. The head of the family and the person or 
 persons having charge of the funeral of such body shall be responsible for any vio- 
 lation of the provisions of this section. 
 
 Section 6. All services held in connection with the funeral of the body of a 
 person who has died of any of the diseases mentioned in section four of this act 
 must be private, and the attendance thereat shall include only the immediate adult 
 relatives of the deceased and the necessary number of adult pall-bearers, and any 
 advertisement of such funeral shall state the cause of death. The head of the 
 family and the person or persons having charge of said funeral services shall be 
 responsible for any violation of the provisions of this section. 
 
 Section 7. The body of a person who has died of any of the diseases mentioned 
 in section four of this act, shall in no instance be taken into any church, chapel, 
 public hall or public building for the holding of funeral services. The head of the 
 family, and the person or persons having charge of said funeral services, and the 
 sexton, janitor, or other person or persons having charge or control of such church, 
 chapel, public hall or public building, shall be responsible for any violation of the 
 provisions of this section. 
 
 Section 8. No undertaker, or other person or persons having charge of the 
 funeral or burial of the body of a person who has died of any of the diseases men- 
 tioned in section four of this act, shall in any case furnish or provide for such 
 funeral more than the necessary number of conveyances for said adult relatives and 
 pall-bearers, and all such conveyances which may have been used or occupied by 
 any person or persons who have been residing in the same family or house with the 
 deceased, shall be fumigated and disinfected at such time and in such manner as 
 may be directed and required by the health authorities. 
 
 Section 9. The body of a person who has died of any of the diseases mentioned 
 in section four of this act, shall not be conveyed to or from any dwelling, or other 
 building or place, to any cemetery or other point except in a hearse or other vehicle 
 used for the purpose of conveying corpses only, or in such vehicle as shall be satis- 
 factory to the health authorities, and under such regulations as they may in any 
 case adopt. The undertaker and the person or persons having charge of the funeral 
 or transportation of such body, shall be responsible for any violation of the pro- 
 visions of this section. 
 
APPENDICES. 003 
 
 NO. 7.J. 
 
 Kile 1. The transportation of bodies dead of Small-pox, Asiatic Cholera, 
 Yellow Fever. Typhus Fever or Bubonic Plague is absolutely forbidden. 
 
 RvLE 2. The bodies of those who have died of Diphtheria (Membranous 
 Croup), Scarlet Fever (Scarlatina, Scarlet Rash), Glanders, Anthrax or Leprosy, 
 shall not be accepted for transportation unless prepared for shipment by being 
 thoroughly disinfected by arterial and cavity injection with a proved disinfectant 
 fluid (b) disinfecting and stopping of all oriftcies with absorbent cotton, and (c) wash- 
 ing the body with disinfectant, all of which must be done by anembalnier holding a 
 certificate as such approved by the State Board of Health. After being disinfected 
 as above, such body shall be enveloped in a layer of cotton not less than one inch 
 thick, completely wrapped in a sheet and bandaged, and encased in an air-tight 
 zinc, tin, copper, or lead lined coffin, of iron casket, all joints and seams hermeti- 
 cally soldered, and all enclosed in a strong, tight wooden box. Or, the body being 
 prepared for shipment by disinfecting and wrapping as above, may be placed in a 
 stron»' coffin or casket, and said coffin or casket encased in an air-tight zinc, copper. 
 or tin case, all joints and seams hermetically soldered, and all enclosed in a strong 
 outside wooden box. 
 
 Ki ii 3. The bodies of those dead from Typhoid Fever, Puerperal Fever, Ery- 
 sipelas, Tuberculosis, Measles, or other dangerous communicable diseases, other 
 than those specified in rules l and 2, may be received for transportation when pre- 
 pared for shipment by filling cavities with an improved disinfectant, washing the 
 exterior of the body with the same, stopping all orifices with absorbent cotton and 
 enveloping the entire body with a layer of cotton not less than one inch thick, and 
 all wrapped in a sheet and bandaged and encased in an air-tight coffin or casket. 
 provided that this shall apply only to bodies that can reach their destination within 
 forty-eight hours from time of death. In all other cases such bodies shall be pre- 
 pared for transportation in conformity with rule 2. But when the body has been 
 prepared for shipment by being thoroughly disinfected by an embalmer holding a 
 certificate as in rule 2, issued by the State health authorities, the air-tight sealing 
 may be dispensed with. 
 
 Rule 4. The bodies of those dead from diseases that are not contagious, infec- 
 tious or communicable max he received for transportation when encased in a sound 
 coffin or casket and enclosed in a strong outside wooden box, provided they reach 
 
 their destination within thirty hours from time of death. If the body cannot 
 reacb its destination within thirty hours from time of death it must lie prepared for 
 shipment by filling the cavities witli an approved disinfectant, washing i he exterior 
 of i lie body with tlie same, stopping all orifices with absorbent cotton and enveloping 
 the entire body with a layer of cotton not less than one inch i hick, and all wrapped 
 in a bandage and encased in an air-tight coffin or casket. But when the body has 
 been prepared for shipment by being thoroughly disinfected by an embalmer hold- 
 ing a Certificate :ts in rule J. issued bj the Mate health authorities, the airtight 
 
 Bealing may he dispensed w it b. 
 
 Ri i i; :,. [n case of contagious, infectious or communicable diseases the body 
 must not be accompanied by persons or articles which have been exposed to the 
 infection of the deceased, unless certified by the health officer as having been 
 properly disinfected; and before Belling passage tickets agents shall carefully 
 examine the transit permit and note the name of the passenger in charge, and of 
 anj others proposing to accompany the' body, and see that all necessary precautions 
 have been taken to prevent the .spread of the disease. The transit permit in such 
 
 cases shall Specifically slate who is authorized by the health authorities to 
 
 accompany the remains. In all cases where bodies are forwarded under rule •! 
 notice must he sent bj telegraph to the health officer at destination, advising the 
 date and train on which the bodj maj be expected. This notice must be sent by 
 
904 APPENDICES. 
 
 or in the name of the officer at the initial point, and to enable the health officer at 
 destination to take all necessary precautions at that point. 
 
 Kile 6. Every dead body must be accompanied by a person in charge, who 
 must be provided with a passage ticket and also present a full first-class ticket 
 marked "corpse 11 for the transportation of the body, and a transit permit showing 
 the physician's or coroner's certificate, name of deceased, date and hour of death, 
 age, place of death, cause of death, and, if of a contagious, infectious or communi- 
 cable nature, the point to which the body is to be shipped, and when death is caused 
 by any of the diseases specified in rule No. 2, the name of those authorized by the 
 health authorities to accompany the body. The transit permit must be made in 
 duplicate, and the signatures of the physician or coroner, health officer and under- 
 taker must be on the original and duplicate copies. The undertaker's certificate 
 and paster of the original shall be detached from the transit permit and pasted on 
 the coffin box. The physician's certificate and transit permit shall be handed to 
 the passenger. The whole duplicate copy shall be sent to the official in charge of 
 the baggage department of the initial line, and by him to the Secretary of the State, or 
 Provincial Board of Health of the State or Province from which said shipment was 
 made. 
 
 Rule 7. When the dead bodies are shipped by express the whole original tran- 
 sit permit shall be placed upon the outside of the box and the duplicate forwarded 
 by the express agent to the express agent and secretary of the State or Provincial 
 Board of Health of the State or Province from which said shipment was made. 
 
 Rule 8. Every disinterred body dead from any disease or cause shall be treated 
 as infectious or dangerous to the public health, and must not be accepted for trans- 
 portation unless said removal has been approved by the State or Provincial Health. 
 Authorities having jurisdiction where such body is to be disinterred, and the consent 
 of the health authorities of the locality to which the body is consigned has first 
 been obtained; and all such disinterred remains must be enclosed in a hermetically 
 sealed (soldered), zinc, tin or copper lined coffin or box. 
 
 NO. 74. 
 
 FOR THE 
 
 Notification of Persons Haying Charge 
 
 of 
 
 CONTAGIOUS DISEASE. 
 
 1. The patient must be kept in a room by himself. 
 
 2. All children in the house must be kept from school. 
 
 3. No visitors should be admitted. 
 
 4. Other members of the family must be kept away from the patient. 
 
 5. The one who nurses the patient must keep away from other people. 
 
 6. It is best to have some disinfectant always in the vessel in which discharges 
 are received. In case of diphtheria or scarlet fever, all discharges from mouth and 
 nose should be received in old cloths which can be burned. If received into a mug 
 or dish, these.should be thoroughly scalded. 
 
 7. In the room where patient is, the carpets should be taken up, all stuff, 
 hangings, rugs, mats and chairs having stuff covers taken out, and the attendant 
 should wear calico dresses. 
 
 8. Upon recovery of the patient, notice should be sent to the Office of the Health 
 Board, City Building. 
 
 9. In case of death, the body should be immediately coffined, the coffin not 
 again opened, the funeral must be within twenty^four hours after death. The 
 funeral must be strictly " private, 11 the body being carried in a hearse and not in a 
 carriage. No wake can be allowed. All bed clothes, clothes of patient, and articles 
 in the room, must remain in room until fumigated. 
 
 By order of the Board. 
 
 Health Officer. 
 
APPENDICES. 905 
 
 NO. 75. 
 
 Health Department Cieci lab 
 
 concerning 
 
 SCARLET FEVER 
 
 - cagion. Scarlet Fever is a contagious disease. It spreads from one person 
 
 to another. The contagion is probably present front the lirst days of the disease . 
 until about live wirk.v from that time. Person-, exposed to the disease do not 
 always catch it. but we do not know any way of telling whether a person is sus- 
 ceptible or not. Therefore the patient should he isolated; that is. separated as 
 much as possible from all well people. 
 
 ISOLATION. When a room is < hosen for isolation, lirst. all useless articles should 
 he removed, since everything in the room is liable to become infected with the 
 disease. Then keep the patient in the one room until complete recovery. Nio one 
 
 but the physician, nurse or mother should be allowed in the 1 i. No articles 
 
 should be taken from tin- room until they have been disinfected. 
 
 No visitors, especially children, should be allowed in the house. 
 
 Soiled linen, sheets, underwear, towels, and similar articles, should beat once 
 placed in a tub or pail standing in the room and containing a disinfecting solution, 
 and after standing awhile should be thoroughly boiled and washed apart from the 
 rest of the washing. The Circular on Disinfection shows what to use as a disin- 
 fectant. It is best not to use handkerchiefs at all. but pieces of old. soft cloth 
 which should be burned at once. 
 
 All dishes used by the patient should be put in a disinfecting solution in the 
 To.. m. and scalded and washed by themselves. 
 
 I)n ,,,,/ lit the child wear school clothes while sick, for they should not be worn to 
 school until they have been disinfected. All school and library books must be given 
 to the Superintendent of Health for disinfection. 
 
 When possible it is a good plan to send away from the house any children that 
 may not have been exposed to the fever. Such children should of course be care- 
 fully watched for any symptoms of the disease, and if m» such symtoms appear the 
 
 children should remain away until after the removal of the placards. As soon as it 
 seems certain that such children thus living away are not likely to have the disease, 
 this Department will issue to them a permit to attend scl 1. if desired. 
 
 The law requires that under no circumstances shall the sick person leavi H" housi 
 without " permit from the Superintendent "I Health. 
 
 It is also againsl the law lor other children in the family of the sick one to 
 attend school. Sunday school, of t<. visit the public library or any other public 
 place, or to tide in the cars, and they should not play in the street with other 
 children. 
 
 About two or three weeks aftei the beginning oi the sickness some of the 
 patient's skin usually becomes tike "dead skin," and rubs off or peels off. This 
 peeling usually continues longest on the hands and feet. Sometimes it is so slight 
 that it is not noticed. When five weeks have passed since the beginning of the 
 disease, and when the patient is through u peeling," it is proper to disinfect the 
 
 patient and the rooms in which he has been si.k. \ticr satisfactory disinfection 
 
 the cards will be removed from the house, and school and work permits will be 
 given when required. 
 
 ./'// this Department when ready/or disinfection. 
 Please read the Rules of the board of Aldermen in regard to Contagious 
 I diseases. 
 
 All these precautions must be taken in the mildest as well as in the most sev< re 
 cases. 
 pi:o\ i in \. i . Februarj . i B99. 
 
 An excellent and much more- extended cin ular was issued by the New Hampshire 
 
 board of health in It 
 
906 APPENDICES. 
 
 ISO. 76. 
 
 What You Ought to Know About 
 DIPHTHERIA. 
 
 Diphtheria, one of the gravest of infectious diseases, is due to a bacillus which' 
 invades, by preference, the mouth, nose and throat. Of the many persons whose 
 throats and noses harbor these little organisms only some develop diphtheria, and 
 they are the ones whose mucous surface the bacillus is able to penetrate. Neither age 
 nor robust health exempts any one from infection, but children, whose tissues are 
 less resistant, suffer far more from diphtheria than do adults. Any person, therefore, 
 who has been in intimate contact with a case of diphtheria may curry the infect ion 
 about with him and yet remain well. In the presence of an epidemic of diphtheria 
 every sore throat, however mild, every running at the nose, in child or adidt, should 
 be treated with the respect due to a formidable enemy. Every individual who has 
 been in personal contact with a case of diphtheria should be regarded as infected 
 until the contrary is proved. 
 
 But a man whose nose is infested with these malignant organisms, carries in his 
 pocket a thing more deadly. His handkerchief contains the dried virus in a condition 
 to be preserved indelinitely. It may go with his own or other people's clothing to 
 the unsuspecting laundress, or it may remain for 7nonths in the pocket of an unused 
 coat, to be fished out at last as virulent as ever. 
 
 Bearing in mind these observations in the outskirts of an epidemic, if one reflects 
 upon the focus of germs in the bed chamber of diphtheria, the view will be as alarm- 
 ing as the truth will bear. 
 
 It remains to say much that is of better cheer. It is quite possible to confine the 
 evil influence of a case of diphtheria to a radius of six feet or so, and to make a 
 nurse within such narrow bounds reasonably secure against infection. The poison 
 of diphtheria is not easily diffusible. The patient's breath, though often offensive,, 
 is not noxious. No particle of active virus can escape from his body except in the 
 form of discharge from his mouth or nose, nor can any attendant become infected 
 unless 
 
 Some Ponderable Portion of this Discharge is Conveyed into Nose, Month or Eyes. 
 Surely then the attendant commands all. the avenues. Knowing this much she will 
 easily avoid direct transfer of the infection from the patient to herself. To guard 
 against indirect transfer by means of handkerchief, towel, cup, spoon, or worst of all, 
 fingers, is not so easy. Only unrelaxed vigilance, and a devout observance of details 
 will serve this end. 
 
 If then a case of diphtheria occurs in your house, do these things religiously. 
 Strip the sunniest room, at the top of the house, of its carpets, curtains, upholstery, 
 chairs, pictures, ornaments, trunks. Empty closets and drawers. As far as possible 
 send out everything and bring in nothing which cannot be baked, boiled or burned* 
 If you have a cheap cot which can be made comfortable with a quilt or two, you 
 have the best possible bed. In addition to the necessary queensware, you want a 
 pail or two to hold antiseptic solutions. You must have a little pile of towels for 
 your own exclusive use, and a large assortment of cloths, mostly small ones, to 
 serve the patient in place of towels, napkins and handkerchiefs. Now bring your 
 patient in and from this moment you must not permit either yourself or anything in 
 the room to pass the door without first going through the most rigid antisepticuritual 
 that you can conveniently practice. The little cloths which the patient uses must 
 do but one single service, and then either be burned or dropped into a pail of 
 bichloride solution. 
 
 Every sjioon, cup, thermometer or other article must, after use, be immediately 
 immersed in an antiseptic solution, and left there until needed again, when it must 
 be rinsed in clear water. 
 
APPENDICES. 907 
 
 The expectorated or vomited matters and the discharges from the bowels and 
 bladder must be treated with antiseptic solution at once, and before being carried 
 from the room the utensil should be wrapped in a cloth wet with bichloridi solution. 
 
 four own hands and tliose of your patient are to be objects of momentary solic- 
 itude. Keep a bowl of bichloride solution always ready, and wash your hands every 
 time you touch your patient or Ins bed. Never touch your own face, nor that of 
 your patient, nor move a chair, nor fetch a utensil, nor turn the door knob, 
 
 Except with Hands Fresh from the Bichloride Solution. 
 
 Prevent, if possible, your patient from touching his own fare, and if lie does so. 
 clean his hands instantly with a bichloride cloth. You will certainly not permit the 
 patient to touch your face. When you must leave the room do not touch any person 
 or thing that can be passed without contact. 
 
 II7;<,, tin doctor comes, take away from the bed the chair which you have used, 
 ami place for him the only other one, which you have not used, and must not use. 
 Give him a bichloride towel if he wants one, and hold a bowl of bichloride solution 
 for him to drop instruments into. Let him have bichloride for his hands, a nail 
 brush and a fresh towel. When he is ready to leave, open the door for him, and let 
 him <j" away as clean as In- came. 
 
 I,, your ""■/' person and dress be as clean as circumstances will permit. However 
 careful you habitually are. 
 
 Double Your Customary Care of Teeth, Throat, Month and Nose. 
 If after two weeks another case of diphtheria appears in your household, it may he 
 impossible to say who or what furnished the infection, but if you have faithfully 
 followed these rules yon will have the comfortabli belief that none of the poison 
 which you carried into the room ever leaked out. On the other hand if you slurred 
 the details, and took avoidable chances, you will not be able to meet a fresh case 
 without some guilty fear that you have let the enemy through. 
 
 John s. Fulton, 
 Secretary <;/' //" State />'<<<o</ <>f Health <>/ Maryland. 
 
 Tablets of Bichloride of Mercury can be bought at any drug store in bottles of 
 100 with printed directions for making solutions. 
 
 NO. 77. 
 
 MEASLES. 
 
 BOABD ok 111: A 1 mi. 
 
 :;•_' Pkmhkkton SQl \kk, 
 
 Boston, June L, 1888. 
 
 The Heard of Health issues the following circular of recommendations, witli the 
 hope 'hat those who are not familiar with the proper means to lie used in cases oi" 
 Measles to present the spread of the disease. nun he benefited thereby. 
 
 This disease is like Small-poi and Scarlet Fejer in its power to spread from per- 
 son to person by contagion or infection. 
 
 it may be contracted directly fr the person who is ill with the disease, or i< 
 
 may be taken from the room, olothing or anything that ha, been used l»y or aboul 
 
 the si.k person, and which has not been thoroughly disinfei ted. 
 
 It attacks persons o! all Bgflfl ami at all seasons of the year. 
 
 It manifests itself in aboul a week after exposure to the disease, and, as a ml.', 
 
 occurs hut once ill t he same person. 
 
 When a case oi Measles occurs, put the patienl in a room apaii from the other 
 
 inmates of the house and allow no person to enter such room, excepi the nurse and 
 
908 APPENDICES. 
 
 physician. Have the sick chamber properly warmed, exposed to the sunlight, well 
 aired and relieved of all unnecessary furniture and other articles which cannot be 
 cleansed without injury. 
 
 All clothing removed from the patient, or the bed, should be at once placed in 
 boiling water, or in a tub of disinfecting fluid, — 3 pounds of sulphate of zinc and 
 1| pounds of common salt to each 10 gallons of water. Water-closets and privies in 
 the house should be disinfected frequently with a solution of copperas, — two pounds 
 to a gallon of water. Every kind of filth in or about the house should be removed 
 and disinfectants freely used. 
 
 Children in the family should not attend school, or mingle with other children, 
 until the patient has wholly recovered, and all infected articles have been disinfected. 
 
 On the recovery or death of the patient, the most thorough disinfection should 
 follow. ■ The room and all articles in it should be at once subjected to the fumes of 
 burning sulphur as follows: Close the room tightly, and burn two pounds of sul- 
 phur to each thousand cubic feet of space. 
 
 After four or six hours open the room and expose it to free currents of air. 
 
 Anything that can be boiled without injury may be so treated. The walls and 
 ceilings should be dry rubbed or lime washed, and the floors washed with some 
 disinfecting liquid. When death occurs the body should be immediately placed in 
 a tight coffin, with disinfectants, and the coffin tightly and finally closed. 
 
 Xo public funeral should ever take place at the house where the patient died, 
 untir the coffin has been tightly sealed, and the most thorough disinfection has 
 taken place. 
 
 Nurses ought to be particularly careful to remove all infection from themselves 
 and their clothing before leaving the house. 
 
 Note. — The fumigation by sulphur will be done by the Board of Health, if 
 desired, free of expense. 
 
 By order of the Board of Health, 
 
 SAMUEL II. DURGIX, M. U., 
 
 Chairman. 
 
 NO. 78. 
 
 Restriction and Prevention 
 
 OF 
 
 WHOOPING-COUGH. 
 
 Document Issued by the Michigan State Board of Health. 
 
 May, 1899. 
 
 1. Whooping-Cough is a Dangerous, Contagious Disease, hence it is a "disease 
 dangerous to the public health" under the laws in Michigan, and the observance of 
 the following precautions is of importance. 
 
 2. Inasmuch as whooping-cough is one of the most contagious diseases and 
 when uninfluenced by treatment runs a course of from two to three months, an 
 average of ten weeks, and is spread by those sick with it before the "whoop? 1 
 appears, therefore, in order that its restriction shall be most complete, it is import- 
 ant that the early symptoms be generally known. The first or catarrhal stage 
 resembles an ordinary cold. The symptoms are a cough, usually rather severe with 
 a tendency to become paroxysmal, sneezing, sometimes watering of the eyes, and 
 often a slight fever. Restlessness, with a loss of appetite, and increased thirst, 
 usually accompany these symptoms. It is often necessary to wait for the second 
 
APPENDICES. 909 
 
 stage, which is characterized by the "whoop' 1 before the disease can be distin- 
 guished. When a child or young person lias symptoms of whooping-cough, or a 
 cold or cough unusually severe with a tendency to become paroxysmal.it should 
 immediately be kept separated from all other persons, except necessary attendants 
 until it is ascertained whether or not it has whooping-cough, or some other coin 
 municable disease. 
 
 3. Period of Incubation. — The interval between the date of infection and that 
 of the outbreak of symptoms of whooping-cough usually varies between four and 
 twenty-one days. 
 
 4. Every person known to be sick with whooping-cough should be promptly and 
 thoroughly isolated from the public; uo more persons than are actually necessary 
 should have charge of or visit the patient, and they should be restricted in their 
 intercourse with other persons. 
 
 •">. Plain and distinct notices should be placed upon the premises or housi in which 
 tht re is a person sick with whooping-cough. 
 
 6. Householders and Physicians must immediately give notice of the first case 
 and of every cass of whooping-cough to the local health officer. This is required 
 by law. 
 
 DUTIES OF THE LOCAL BOARD OF HEALTH. 
 
 7. Upon the receipt of notice of the occurrence of whooping-cough, the health 
 
 officers and the Hoard of Health have duties to perform in taking measures to 
 restrict the spread of the disease, which it is a violation of public trust for such 
 officers to neglect or postpone. That no time may lie lost, it is the duty of every 
 hoard of health to make provisions for prompt action by its health officer, author- 
 izing and directing him to he prepared at all times, as executive officer of the hoard, 
 to take action without waiting for a meeting of the hoard, whenever a case of diph- 
 theria, scarlel fever, measles, whooping-cough, small-pox, <//• other disease dangt rous 
 to the public health occurs within its jurisdiction. The duties of the local hoard of 
 health relative to the restriction and prevention of diseases are treated of in a cir- 
 cular No. [120] issued by the Male Hoard of Health. 
 
 Li TIE8 OF THE Hi: A I. ill l IF] tCI B. 
 
 Some of the duties of the health officer generally required by law, may be briefly 
 
 suggested as follows: Whenever he has reason to believe that there is in his juris- 
 diction a case of whooping-cough, he should, — 
 
 a. I'd »ni pt Is investigate the subject. 
 
 ii. Order the prompt and thorough isolation of those sick or infected with 
 whooping-cough. 
 
 c. See that no person suffers foi lack of nurses or supplies. 
 
 ./. Give public notice of infected places bj placard on the premises, and other- 
 wise it necessary. 
 
 Notify teachers or superintendents ol schools concerning families in which 
 
 there are cases of whOoping-COUgh. 
 
 /'. Supervise funerals of persons dead from whooping cough. 
 
 !/. Disinfect i s. clothing and premises, and all articles likelj to be infected, 
 
 before allowing them to he used by other persons than those m isolation. 
 
 A. Keep the |, resident ,,i' this hoard ..i' health and the secretary oi the State 
 Board of Health constantlj informed respecting everj outbreak "i \\ I ping cough. 
 
 In the absence of regulations made bj the local hoard of health, conflicting there- 
 with, orders by the health officer in the lawful performance of these duties have the 
 force of regulations by the hoard of health. 
 
 1'nless otherwise ordered bj the local hoard of health, these duties are required 
 
 of the health officer i>y Act 187, laws of i vv -. Section _ of this act, as amended by 
 \. i No. 34, approved March 28, L889, provides thai 
 
910 APPENDICES. 
 
 ''Whoever shall knowingly violate the provisions of section one of this act, or 
 the orders of the health officer made in accordance therewith, shall be deemed 
 guilty of a misdemeanor, and upon conviction thereof he shall be punished by a fine 
 not exceeding one hundred dollars, and the costs of prosecution, or in default of 
 payment thereof, by imprisonment not exceeding ninety days in the county jail, in 
 the discretion of the court." 
 
 This penalty seems to apply to the health officer, or to whoever violates his 
 orders. The health officer should also, in due time, give certificates of recovery and 
 of freedom from liability to give whooping-cough, but not until after thorough dis- 
 infection following complete recovery. 
 
 THE RESTRICTION OF WHOOPING-COUGH. 
 
 8. The room in which one sick with whooping-cough is to be placed should 
 previously be cleared of all needless clothing, carpets, drapery, and other materials 
 likely to harbor the poison of the disease. This room should constantly receive a 
 liberal supply of fresh air, without currents or drafts directly upon the patient. 
 
 9. The discharges from the throat, nose, and mouth are liable to communicate 
 the disease, and should be received in vessels containing a strong disinfectant, or on 
 soft rags or pieces of cloth which should immediately be burned. 
 
 10. Nurses 1 and attendants' hands should be washed and disinfected by chlo- 
 rinated soda, their hair, (and beard if any), should receive attention, and their cloth- 
 ing should be disinfected, before they go in public. 
 
 11. Every person recovering from whooping-cough should be considered danger- 
 ous. The duration of infectiousness may be three weeks before the " whoop" and 
 four or six weeks after apparent recovery; therefore such a person should not be 
 permitted to associate with others, or to attend school, church, or any public 
 assembly until in the judgment of a careful and intelligent health officer he can do 
 so without endangering others; nor until after all his clothing has been thoroughly 
 disinfected. Nor should a person from premises in which there is or lias been a case 
 of whooping-cough, attend any school, Sunday-school, church, or public assembly, 
 or be permitted by the health authorities or by the school board to do so, until after 
 disinfection of such premises and of the clothing worn by such person, if it shall 
 have been exposed to the contagion of the disease. 
 
 12. No public funeral should be held at a house in which there is a case of 
 whooping-cough, nor in which a death from whooping-cough has recently occurred. 
 No child should attend, and it would be better in most cases that few adults attend 
 a funeral of a person dead of whooping-cough. 
 
 HOW TO AVOID AND PREVENT AVHOOPING-COUGII. 
 
 15. Avoid the special contagium of the disease. Do not let a child go near a 
 «ase of whooping-cough; this is especially important to be observed by guardians 
 of children between one and two years of age. Do not permit any person or thing, 
 or a dog, cat, or other animal to come direct from a case of whooping-cough to a 
 child. Unless your services are needed, keep away from the disease yourself. If 
 you do visit a case, bathe yourself, and change and disinfect your clothing before 
 you go where there is a child. 
 
 16. Do not permit a child to ride in a hack or other closed carriage in which has 
 been a person sick with whooping-cough, except the carriage has since been thor- 
 oughly disinfected with fumes of burning sulphur, as specified in paragraph 15. 
 
 IT. Do not permit a child to wear or handle clothing worn by a person during 
 sickness or convalescence from whooping-cough. 
 
 18. Beware of any person who has a cough with a tendency to become paroxys- 
 mal; do not permit a child to kiss, or take the breath of such a person, nor to drink 
 from the same cup, blow the same whistle, or put his pencil or pen in its mouth. 
 
APPENDICES. 9 1 1 
 
 IMPORTANT K OF BE8TBICTING WHOOPING-COUGH. 
 
 In Glasgow the annual mortality from whooping-cough for forty years. 1855-94, 
 was nearly fourteen (13.5) per ten thousand inhabitants, and exceeded those from 
 any other dangerous communicable disease. 
 
 In all England and Wales in 1891, the deaths from whooping-cough (13,612), 
 were nearly five (4.68) per ten thousand inhabitants, and exceeded those from 
 measles (12,673), diphtheria (5,036), scarlet fever (4,959) or typhoid feveT (4,875). 
 
 In Michigan, the reported deaths from whooping-cough are several times as 
 many as from small-pox; for the twenty-four years. 1870-1893, they averaged 1 4-~> 
 per year. If we assume that only three-fourths of the deaths were reported, the 
 deaths in Michigan from whooping-cough have been about 193 per year. If the in- 
 habitants of Michigan now number two and a quarter millions, and the mortality 
 from whooping-cough were to equal that in England and Wales in 1891, the deaths 
 from that disease in Michigan would equal a little over one thousand per year. 
 
 It is claimed that the high mortality in whooping-cough is due to the complica- 
 tions and sequelae which are said to occur probably in one-third or one-fourth of all 
 cases. If that is true, it would be no extravagance to presume that the mortality 
 from whooping-cough would be still higher if all the deaths directly or indirectly 
 due to it were completely reported, as it is a fact that when a secondary affoction 
 attacks, the primary disease is sometimes lost sight of entirely. 
 
 According to Dr. Farr's law — of increase of contagious diseases as density of 
 population increases — the deatli rate from whooping-cough, unless restrictive 
 measures are taken, will undoubtedly rapidly increase in Michigan with the rapidly 
 increasing population, and especially with the rapidly increasing lines of railroads 
 and other facilities for easy, frequent, and rapid movements of the people. The 
 present vei\ considerable mortality from whooping-cough, and also the much 
 greater mortality which may be expected, supply urgent reasons why the measures 
 herein recommended should be generally and thoroughly adopted and enforced. 
 
 This document is published by the State Board of Health, for gratuitous distribution through- 
 out the State. A copj may be obtained by applying to the Secretary of rHE State Board of 
 
 ii i: w i ii. La sst so, Michigan. 
 
 NO. 7i>. 
 TYPHOID FEVER 
 
 II i \ i in DKPAB imi;\ i . 
 
 ( >ld Court House, 
 
 B( tston. 
 
 This circular is issued for the purpose of inducing greater care in preventing the 
 spread of typhoid fever, which may be contracted by infection, directly from the 
 patient, or indirectly from anything which h:is been infected by the patient. 
 
 'I he discharges from the bowels and bladder of i lie typhoid patient are the princi- 
 pal if not the 6nly sources of dangerand they maj infeel the sick chamber, drain, 
 cesspool, vault, or by percolation, may infeel the well, cistern or other source of 
 drinking water, and so foods, especially milk, fruit, greens, etc, and produce the 
 
 disease ill o| her pel's.. lis. 
 
 Win M a case of typhoid fever occurs in any family, the sick person should be 
 
 placed in a loom apart Ii<>im the other inmates of the house and should be nursed as 
 
 possible bj one person only. The sick chamber should be well ventilated, 
 
 warmed and exposed to sunlight ; its furniture should be such as w ill permit cleans- 
 ing without Injury, and all extra articles should be removed from the r i. All 
 
 doubtful cases should be referred foi diagnosis t" the laboratory of the Health 
 
 I lepart nt. 
 
912 APPENDICES. 
 
 No person who is in any way connected with a case of typhoid fever as nurse or 
 attendant, or who handles anything which may have been soiled by the discharges 
 of a person while suffering from typhoid fever, should touch any kind of food or 
 water or receptacles for such food or water, which may be used by other people. 
 
 Keep on hand a solution of the best fresh chloride of lime (one-half pound to a 
 gallon of water) in a jug well corked, and put one-half pint or more of this solution 
 into the vessel immediately before it is used to receive the discharges of the patient. 
 The discharges should always be well mixed and covered with the disinfecting solu- 
 tion, anfl remain for thirty minutes before being removed. 
 
 The same disinfectant should be freely used in all wash-bowls, sinks, water- 
 closets and slop-hoppers. Vaults and cesspools, if used, should receive large 
 quantities of dry chloride of lime. 
 
 All clothing, bed-linen, etc., which comes in contact with the patients should be 
 put into a disinfecting solution of corrosive sublimate (one drachm of corrosive sub- 
 limate and eight drachms of common salt to each gallon of water (1 in 1000), in a 
 wooden vessel marked poison) and then boiled for one-half hour. 
 
 This disinfecting solution may be used on all hard surfaces not metallic. For 
 metallic surfaces use 5 per cent, formalin. Every kind and source of filth in and 
 around the house should be removed, disinfectants freely used and drains put in 
 good condition. 
 
 On the termination of the disease, the room, bedding and clothing should be 
 thoroughly disinfected, as recommended in this circular. 
 
 Typhoid patients may be a source of danger to the community until their urine 
 is free from typhoid bacilli. This dangerous condition of the urine may last several 
 weeks after recovery, and during this time the urine should be disinfected. The 
 presence of the bacilli in the urine and their disappearance later will be tested, on 
 request, at the laboratory of the Health Department. 
 
 By order of the Board of Health, 
 
 SAMUEL II. DURGIN, M. D., 
 Revised October, 1899. Chairman. 
 
 NO. 80. 
 
 .Size 5i ix. x 9 ix. 
 
 O 
 
 ang this Card hi ///<• sick room. 
 
 IX CASES OF 
 
 INFECTIOUS OR CONTAGIOUS DISEASES. 
 
 Don't allow carpets or draperies in the sick room. 
 
 Don't send the bed or body linen to the wash without disinfection. 
 
 Don't use dishes again which have been in the sick room without boiling 
 them 15 minutes in Sal-Soda water. 
 
 Don't throw the discharges into the water closet or privy. 
 
 Don't bury them until they have been thoroughly disinfected. 
 
 Don't leave the room or eat, without first washing your hands in a good 
 disinfecting solution of Bichloride of Mercury or of chlorinated Soda. 
 (For further particulars see Infectious Disease Circulars.) 
 
 Circulars of information in regard to smallpox are not very necessary, as such 
 patients are usually removed to the hospital. Circulars urging vaccination are 
 more useful. Excellent vaccination circulars have been issued by the state boards 
 of health of Alabama, Maine, and Connecticut. 
 
APPENDICES. 913 
 
 NO. 81. 
 
 FULL QUARANTINE NOTICE. 
 
 Fob Use in Casks of Smallpox, Typhus Feveb, Choleba, Diphthebia, 
 
 and Sc lblet Feveb. 
 To 
 
 having been reported to me as 
 
 being- in your family, you will see that all persons and things now on the premises 
 or in the house occupied by you are at once isolated from all other persons and 
 things: you will allow no communication between any person now on the premises 
 or in the house occupied by you, and any other person whatever, except that articles 
 of food and drink and such fuel and clothing as are necessary for the comfort and 
 health of those persons under quarantine, papers and letters, may be received, and 
 such pails, cans, bottles or boxes of metal as are necessary for the conveyance of 
 the above may be given out, all in the manner and under the conditions prescribed 
 by the Health I (fficer. 
 
 And further exception is berebj made, so that all drugs, food and oilier articles 
 sary to the proper treatment of the sick maybe received by you, and the 
 attending physician may enter and leave your premises at pleasure, provided such 
 measures are used as to prevent carrying the infection outside. 
 
 No other person whatever shall enter or leave your premises during the existence 
 of this quarantine, except as permitted, in writing, by the Health Officer. 
 
 You will carefully observe the above quarantine, under penalty of the law. as 
 prescribed in No. 103, Laws of 189G, until such time as the quarantine shall be 
 terminated by a written notice signed by the Health < officer. 
 
 Health Officer for 
 
 Town (or ( ity) of 
 
 MODIFIED QUARANTINE NOTICE. 
 
 Fob Use in Cases of Measles wi> Whooping-Cough. 
 
 To 
 
 ...having been reported as being 
 in your family, you will see that no person now in your family, who has not had 
 this disease, is allowed t" leave the house or premises occupied by you. and that no 
 person who has nol had this disease is allowed to enter your house or premises until 
 
 further notice, under penalty of the law. as prescribed in No. !"•"'. Laws of 1896. 
 
 Health i >fficer for 
 
 Town for < ity I "I 
 
 . 189 
 
 NO. S>. 
 
 Size •">, in. s 8 in. 
 OFFICE OF THE BOARD OF II E \ I. Til. 
 
 Hi \ ni no. p \ 1895. 
 
 Information lias been received at this office thai a contagious disease < 
 
 i exists in your house, No Street. 
 
 You are hereby notified uot toallov. any child or inmate of your house to attend 
 an> school until the attending physician has given a certificate to the Health Office 
 that all danger from contagion bj reason ol such disease lias passe. I away. 
 ■ 
 
914 APPENDICES. 
 
 Extract from the Rules. 
 Sec. 14. No principal, teacher, or superintendent of any school, and no parent 
 or guardian of any child attending urn/ school, shall knowingly permit any child sick 
 with any contagious or infectious disease, or any child residing in any house in which 
 such disease shall exist, to attend any school until this Board shall have given its 
 permit therefor. 
 
 Penalty for refusing or neglecting to comply witli the Rules of the Board as pre- 
 scribed by Act of Assembly, from $10 to $100. 
 
 By order of the Board of Health, 
 
 Iliiillh' ( ommissioner. 
 
 NO. 83. 
 
 Size 7 in. x 9 in. 
 City of Indianapolis. 
 
 DEPARTMENT OF PUBLIC HEALTH AND CHARITIES. 
 
 Sanitary Survey. 
 
 No Date 189 . . 
 
 Disease Name of Patient 
 
 Street and No Sex Age 
 
 Name of tenant Number of people 
 
 Name of owner Agent 
 
 Frame. Brick. Kind of foundation 
 
 Old. New. State of repair 
 
 Number of rooms Any well ? Dug. Driven. Public supply. 
 
 Surroundings of well 
 
 Filled ground 
 
 Any cellar ? Yes. No. Extent and condition 
 
 Name of dairyman ? Iceman 
 
 Sinks. Number and condition 
 
 Cesspools. Number and condition 
 
 Vaults. Number and condition 
 
 Distance of vault and cesspool from well On premises or adjacent 
 
 Direction of ground trend 
 
 Sewer connection ? Yes. No Properly trapped ? Yes. No 
 
 Name of physician 
 
 Diphtheria, measles, scarlet fever, or typhoid within a year 
 
 Any deaths '? Yes. No. Cause of death 
 
 Where has patient been in last 30 days ? 
 
 School attended by patient 
 
 School attended by any of family Teacher. 
 
 Condition of adjacent premises 
 
 Place of business of patient 
 
 Remarks 
 
 Officer. 
 
APPENDICES 915 
 
 >0. S4. 
 
 Size 8j i\. x 14 in. 
 HEALTH DEPARTMENT. 
 
 COT OF ROCHESTER. 
 
 Inspector Date 189 
 
 Streel No Size (if Lot Per cent, covered 
 
 Buildings 
 
 Owner Address 
 
 I Private I Rooms, 
 House- JSSSLt , *"■ of Stories 
 
 pan 
 tenement. | Occupants, 
 
 Condition 
 
 l 
 Rooms without windows, 
 
 Vent ilal i<>n 
 
 Halls 
 
 Light-shaft, sky-light, or ventilating shafts, transoms: 
 
 Heating Has furnace an air box '.'... 
 
 Where does it open Condition 
 
 Cellar Depth. 
 
 How floored No., size and condition of windows. . 
 
 Drainage 
 
 Plumbing Is house connected with sewer or cess-pool 
 
 Is sewer in streel Is Hemlock water used 
 
 Number of fixtures Fixtures withoui t raps 
 
 Main waste pipe : Iron. lead. Joints 
 
 Water Closets Number Kind 
 
 Sufficient water flushing Condition 
 
 Is the room ventilated 
 
 llniisc drain tiling , underground or exposed. . .. 
 
 I wood \ 
 
 •loints, etc 
 
 Mam oi running i rap Fresh air inlet 
 
 Sard 
 
 • ,;n bage, li"v. kept? 
 
 Ashes, how kepi .' 
 
 When removed '.' 
 
 Privy < "list ruction 
 
 \ ent dated Is il full 
 
 When was it last cleaned 
 
 ited ft. from bousi .ft. from nearest adjoining house 
 
 ft. from \. lii I' lot. ft. from S. line .ft. from E. line 
 
 ft. from W. line. 
 
916 
 
 APPENDICES. 
 
 Disease Age Sex School and Grade 
 
 School and Grade attended by other children 
 
 Occupation and Place Milk Ice ... . 
 
 Occupation and place of employment of every member (if the family. 
 
 Have there been any cases of contagious diseases where the patient lives or 
 where he has lived '? 
 
 Are the members of the family subject to sore throat or catarrh ? 
 
 Has any one with sore throat recently visited the patient '? 
 
 What, if any, means are provided for isolating the patient? 
 
 How are the discharges from the mouth and nose received ?. 
 
 Well ? Disinfection and Disposition of Stools ? 
 
 Probable Source of Disease ? 
 
 Health Officer's Notice to Abate Nuisance 
 
 Nuisance Abated 
 
 Referred to Medical Officer 
 
 Citation. . . . 
 
 Order 
 
 Referred to . 
 
 NO. So. 
 
 Postal Card. 
 
 
 c 
 
 
 a 
 
 S3 'S £ C 
 
 11 " b ,. S : 
 
 
 
 X 
 
 
 0) 
 
 £ = * « P fe 
 
 aj a ea sh i_J © 
 
 
 H 
 
 
 
 x> 
 
 
 
 
 *4 
 
 
 rt 
 
 •t; _2 ~ <K 35 «J 
 
 a t2 M < =; 
 
 
 3 
 
 3 
 
 
 
 3ii a 
 
 itce 
 may 
 
 ODW 
 
 
 < 
 
 M 
 
 
 &JD 
 
 5 -= 3 ^ P 
 
 
 Ch 
 
 u 
 
 
 > 
 
 "3 to ** ,3 
 
 
 W 
 
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 a 
 
 -T Q> -, 4J Q 
 
 
 
 O 
 
 
 
 cJD c « 2 S 
 
 
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 fi C3^3 > 
 
 
 H 
 
 jj3 
 
 
 
 ^ ^ — CX 
 
 
 »J 
 
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 c "-3 = 
 
 
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 DO 
 
 
 
 s« gs 
 
 
 W 
 
 P 
 
 
 
 <£ « - * 
 
 
 1—1 
 
 
 
 
 "■^ yi 
 
 
 
 
 
 a 
 c 
 
 C 
 
 5 
 
 2' £ 2 g 
 
 *i 
 
 
 
 
 " 2 1 £ a 
 
 - 
 
 
 
 < 
 
 c 
 
 stree 
 
 any, 
 
 from 
 
 this 
 
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 rt 
 
 
 
 
 !* 
 
 # 
 
APPENDICES. 917 
 
 XO. 86. 
 
 Kkim.y PoSTAr Card. 
 
 Chicago 189. 
 
 Tiik Principal 
 
 Si 1 1 1 n.l.: 
 
 Tin: Health Department has just learned of the existence of a ease of 
 Diphtheria, Measles, Scarlet Fever, Whooping Cough. 
 
 in the family of 
 
 I i vino; at 
 
 in the vicinity of your school. 
 
 For the protection of your pupils you are hereby authorized to exclude from 
 school attendance, and from the buildings and grounds under your charge, all 
 persons of said family, especially school children,it there be any such in the 
 family. 
 
 This exclusion must be maintained until you are notified by the DEPARTMENT 
 that the disease has terminated and that the premises have been disinfected. 
 
 Yon are also requested to warn the pupils of your School against any com- 
 munication or contact with the members of the afflicted family during the period 
 nf exclusion. 
 
 Respectfully M. !>.. 
 
 Medical Inspector. 
 
 School, 
 
 Chicago 189. . 
 
 Received from Dr notification 
 
 of a case i »f 
 
 Diphthi 8carlel Fever, Measles, H hooping Cough, 
 
 ;i No in 
 
 family named 
 
 Principal. 
 
018 
 
 APPENDICES. 
 
 NO. 87. 
 
 Size 3 in. x ."> in. 
 
 Feb. Diph. 
 
 No St. or Ave Ward 
 
 Date 189 Name 
 
 Age M. F M. S No. Case Date first Case Kind of House.. . 
 
 No. Fams No. Adults .... No. Children No. Sell. Children 
 
 Reported by M. D 
 
 Isolation — Home. . . Hospital Result 
 
 Bac. Exam True Pseudo Final Bac. Exam. No 189. 
 
 Disinfected 189 Milk Supply 
 
 Treatment — Anti-Tox City. .Other. . . .Not used. . . .Water supply 
 
 Remarks O Quarantine raised 
 
 Indcrtaker Date of Funeral 
 
 Mule bv Library Bureau. Chicago. 
 
 NO. SS. 
 
 Size 5* in. x 10 in. 
 
 Residence. 
 
 DIPHTHERIA, 
 
 
 04 
 
 Occupation. 
 
 Members of Family. 
 
 X 
 
 > r. 
 
 Age. 
 
 Date of ~ 
 Attack. 1 iJ 
 
 1 i 
 
 Results of Cultures. 
 
 til 
 
 -r 
 W 
 to 
 
 
 
 
 
 
 
 
 
 Residence 
 Physician 
 
 Water, Pawt.uxet 
 
 Iceman 
 
 Milkman 
 
 Grocer 
 
 Marketman 
 
 (REVERSE.) 
 
 Inspector 
 
 Visits 
 
 Laundry 
 Paper Boy 
 
 Disinfection 
 Permits 
 
APPENDICES. 919 
 
 NO. 89. 
 
 Size 4 in. x '■> in. 
 
 CITY OF CLEVELAND, 
 
 Dep't of Police. Public Hkai.tii Division, 189 
 
 No. 102 City Hall. 
 
 Mr... 
 
 No s t. 
 
 You are hereby notified to have the Physician in charge of persons sick with 
 Contagious disease sign this notice, when they have fully recovered, otherwise the 
 
 children cannot attend school at School. 
 
 By order of the Public Health Division. 
 
 Health Officer. 
 
 By 
 
 Sanitary Patrolman. 
 
 I Hebeby Cebtift, That 
 
 of Street, has fully recovered from 
 
 Physician. 
 
 Address 
 
 Date convalescence commenced 189. . 
 
 Brim; this ticket to 102 < its Hall, as tin- children will not be allowed to return to school, ami con- 
 tagion disease caul will not I'm- taken down from your home by this Division until days after 
 
 convalescence and disinfection of the premises. 
 
 NO. 90. 
 
 Reply Postal Card. 
 DEPARTMENT OF II KALTH:— CITY OF CHICAGO. 
 
 Do< roB: — 
 
 Your report of Contagions Disease at address named on accompanying Reply 
 Postal Card, is received. 
 
 As the Principal of the Scl 1 attended by the patient or children .4' the 
 
 family will not admit to School any one from the house until permission is given 
 by this DEPABTMENT, you will kindly mail the Reply Postal Card when all 
 danger is passed. 
 
 The placard — if any — will then be removed from the house, and the premises 
 disinfected by the Department, \fyou so request. 
 
 D. however, you ;issume responsibility tor the disinfection, at the termination 
 of the case, the word not should be written in last line of Reply Postal < aid. 
 
 AKTliri; K. REYNOLDS, M. D. 
 
 ' 'omtnlssiom r <<f Health. 
 S. i;. Formaldehyd has supplanted sulphur in all Depabtmi nt disinfection. 
 
 To BE SIGNED B1 rHE ATTENDING PHYSICIAN, D \ii:t> 
 L SD i: l it BNED OS i i RMIM \ MOH 01 i HE \-i . 
 
 Chicago, 1899. 
 
 The case of Contagious Disease In the family of 
 
 living al 
 
 lias terminated. 
 
 .Members of the familj including school children, if any should be relieved 
 
 from an> further restriction. 
 
 Disinfection by the Dkpabtmeni is requested. 
 
 . M. I). 
 
 • ii the attending Physician assume* responslbtlitj of disinfection the word not should be 
 written in this space. 
 
920 APPENDICES. 
 
 NO. 91. 
 
 State Board of Health of Massachusetts. 
 
 TYPHOID FEVER. 
 
 Date 
 
 C Of taking to bed 
 
 ' Of physician's first visit. 
 
 Name, ., \-< 
 
 Street and No. (when taken ill) : 
 
 Present address 
 
 Place of work, business or school 
 
 Physician while ill 
 
 Health before attack 
 
 < Hit of town. 
 
 Length of illness 
 
 Chills Nosebleed 
 
 Vomiting Diarrhoea 
 
 Headache Tongue 
 
 Fever Delirium 
 
 Pain in bowels Eruption 
 
 City Filter 
 
 Drinking 
 
 <j Canal 
 
 Water. 
 
 [ Spring Well 
 
 Milk Milkman. 
 
 Previous cases in house 
 
 ( >ther cases near by 
 
 Privy or W. C Plumbing 
 
 Remarks 
 
 The fixing of the precise time of infection is of supreme importance for the inves- 
 tigator, and this may often be obtained with considerable accuracy by the date of 
 the physician's first visit or the time of the patient's taking to bed. The former can 
 usually be got from the attending physician; the latter, in a surprising number of 
 cases with tolerable accuracy, from the patient or his friends. The location of the 
 patient when attacked is also highly important, as possibly indicating the place of 
 infection, the place of work, business or school giving alternative information of the 
 same nature. The symptoms are asked for partly as a matter of routine, partly to 
 get the patient or his friends to talk and so disarm suspicion, and partly for use 
 when it is denied that the epidemic is real. 
 
APPENDICES. 92] 
 
 NO. 92. 
 
 PRACTICAL FACTS ABOUT CHOLERA. 
 
 [SSUED HV THE STATE BOABD OF HEALTH OK MAINE. 
 
 (BE VISED EDITION. I 
 
 Cholera, as it appears in America, is an exotic disease: that is, it never arises 
 spontaneously on our soil. When it lias appeared here, it has always been possible 
 to trace it back to European ports 330$ towns where cholera prevailed, and from 
 there to India, where it always has its origin. Whenever it has left its Asiatic home 
 ami overrun Europe, it has invariably, sooner or later, found its way to our own 
 country. In view of the possibility of having to deal with Asiatic cholera in our 
 own Commonwealth, the State Hoard of Health thinks it prudent to issue this 
 circular. 
 
 Nature of the Mala dt. 
 
 It is a specific disease caused by a specific organic poison, or disease germ. 
 derived directly or indirectly from pre-existing cases of the same disease. 
 
 Symptoms. 
 
 Cholera almost always begins with a premonitory diarrhoea. Later come vomit- 
 ing, cramps, exhaustion, and collapse. In some cases the advent of the disease is 
 sudden and its course and termination rapid; in other cases the disease advances no 
 farther than the stage of simple diarrhoea, cases that are fraught with grave danger 
 to the public, as their true character is often overlooked. 
 
 How it i- Spread. 
 
 Cholera is an infectious disease, but it is infectious only in certain ways. It is 
 not "catching," as smallpox and scarlet feverare understood to be. In Calcutta, 
 where cholera is always present, hundreds of cases have been treated in the general 
 
 hospital, and oft< n in the same rooms wit li pal i en is sick with other diseases, with- 
 out ever being asourceof infection to them. Physicians and nurses who care for 
 
 the sick are little, if any. i e liable to take the disease than others. And yet. "ti 
 
 the Other hand, a single case may poison many other individuals, and give rise to a 
 
 wide-spread and very fatal explosion of the disease. How can we account for this 
 paradoxical behavior of cholera? In this way: The cholera poison exists princi- 
 pally in the discharges from the bowels and in t he vomited matter. It t his poison is 
 
 completely destroyed as s i as it leaves the alimentarj canal, there is no danger of 
 
 the patient's being a source • •> infei tion t" other persons. But if the dejections ate 
 thrown, for instance, into the privj vault, the cholera germs find all the favoring 
 conditions for their development and increase. Prom the privj vault, or from the 
 Burface of tin- ground, the poison may percolate through the soil, many feet it maj 
 i>e. and gain access to our wells or other water supply. 
 
 I.ri a i,i distinctly bornt in mind that, /<< take tin cholera, you n utt <<ii it <>,- drink 
 ;/. This is in,t an esthetic statement of a general recognized tact, but it is impel 
 
 to make ii emphat ic. 
 
 Further tacts in relation to the extension of cholera, are these: Privj vaults, 
 cess-poois. sink drains, heaps "t manure. Blth-sodden earth, and other unclean 
 plac.s. once contaminated with the cholera-germ, may serve as culture grounds for 
 them and for their multiplication, and maj remain tources "i danger for some time. 
 
922 APPENDICES, 
 
 giving off their infection, which, by being breathed in, may be mixed with the 
 saliva and be swallowed. The infection multiplies rapidly in clothing or bedding 
 that has been soiled by the cholera patient, and, without disinfection, remains 
 damp. Hands soiled never so little with the infection, may, at a touch, infect 
 articles of food and thus spread the disease. 
 
 Articles of clothing from cholera regions, especially if soiled with the cholera 
 excreta, may carry the disease long distances. During the epidemic of 1873, clothing 
 packed up in Holland, Sweden and Russia, made the ocean voyage and the railway 
 journey with no harm to persons on the way, but started cholera epidemics in the 
 far West when the articles were opened. 
 
 Be reassured by the fact that cholera comes not from a mysterious epidemic con- 
 stitution of the atmopshere, but that it comes, as explained above, in accordance with 
 certain laws which are now well understood. Remembering this, all unnecessary 
 alarm maybe avoided — only that salutary fear is desirable which shall lead each 
 invididual to avoid and remove those conditions which favor not only cholera but 
 typhoid fever and other diseases. 
 
 How Prevented. 
 
 When the importation of cholera is threatened, a grave responsibility rests upon 
 State and local authorities. Especially at ports engaged in foreign commerce, 
 vigilance should be constant and action prompt, when required. If cholera should 
 be allowed to effect a landing, the soil and the water may be contaminated and the 
 " stamping out" of the disease made impossible. 
 
 Special, Rules. 
 
 1. Experience has abundantly proved that a town or district with a clean soil, 
 pure air, and pure water, may bid defiance to cholera. The rule is therefore imper- 
 ative to search for and abate all filth nuisances. Remove all decomposing animal 
 and vegetable substances. Empty all privy vaults; drench them with Solution A. 
 Abolish privy vaults as far as possible, substituting better methods of disposal of 
 excreta. Treat all cess-pools in the same way. Ventilate rooms and keep the cellar 
 dry and well ventilated. Of the greatest importance is an assurance that the water 
 supply is not polluted, — by filthy soakage through the soil in case of wells; by 
 human excreta from sewers or otherwise in the case of public water supplies. 
 
 2. Never neglect the preliminary diarrhoea. During this first stage the disease 
 is usually curable. 
 
 3. If possible, burn all discharges coming from the patient, as well as all soiled 
 cloths or other articles that are not too valuable. 
 
 4. If the discharges cannot be burned, do not, upon any consideration, throw 
 them upon the ground or into the privy vault. Have them passed into a vessel con- 
 taining several times their bulk of Solution A or Solution E, and then poured into 
 a deep, narrow hole in the ground remote from all buildings or water supply. 
 
 5. All soiled clothes from the cholera patient, before or after death or recovery, 
 should be, as soon as possible, enveloped in a sheet wet with Solution C (1 : 1000) or 
 Solution E, carried to the laundry or an outdoor boiler, and boiled immediately. 
 
 6. Upon the death of a cholera patient, the body should be enveloped immed- 
 iately in a sheet wet with Solution C (1 : 1000) or Solution E, on no account to be 
 afterward opened, and buried privately as soon as possible. 
 
 After death or recovery, the room should be fumigated thoroughly by burning 
 sulphur. After remaining closed twenty-four hours, open doors and windows and 
 ventilate thoroughly. Burn all mattresses and other bedding or furniture that has 
 been soiled with excreta or vomited matter, and that cannot be disinfected with 
 boiling water or with steam. Wash doors and walls thoroughly with Solution C (1 : 
 1000) or Solution E. Repaper if need be. 
 
APPENDICES. 923 
 
 NO. !>3. 
 
 Information fob Consumptives am> Those Living with Them. 
 
 HEALTH DEPARTMENT. 
 No. SOI Mott Street. 
 
 New Yokk. February 13th, 1894. 
 
 Consumption is a disease which can be taken from others and is not simply caused 
 by ("ids. A cold may make it easier to take the disease. It is usually caused by 
 germs which enter the body with the air breathed. The matter which consumptives 
 cough or spit up contains these germs in great numbers — frequently millions are 
 discharged in a single day. This matter, spit upon the floor, wall or elsewhere, is 
 apt to dry, become pulverized and float in the air as dust. The dust contains the 
 germs, and thus they enter the body with the air breathed. The breath of a con- 
 sumptive does not contain the germs and will not produce the disease. A well 
 person catches the disease from a consumptive only by in some way taking in the 
 matter coughed up by the consumptive. 
 
 Consumption can often be cured if its nature is recognized early and proper 
 means are taken for its treatment. /// a majority of cases it Is not a fatal disease. 
 
 It is not dangerous for other persons to live with a consumptive, if the matter 
 coughed up by the consumptive is at once destroyed. This matter should not be 
 spit upon the floor, carpet, stove, wall, or street, or anywhere except into a cup kept 
 for that purpose. The cup should contain water, so that the matter may not dry, 
 and should be emptied into the closet at least twice a day and carefully washed with 
 hot water. Great care should be taken by a consumptive that his hands, face and 
 
 clothing d i become soiled with the matter coughed up. If they do become 
 
 soiled they should be at once washed with hot soapand water. When consumptives 
 are away from home, the matter coughed up may be received on clot lis. which should 
 
 be at once burned on returning home. If handkerchiefs are used (worthless cloths 
 
 which can be binned are far better) they should be boiled in water i>> themselves 
 before being washed. 
 
 It is better for a consumptive to sleep alone, and his bed-clot hing and personal 
 
 clothing should be boded and washed separately from the clothing belonging to 
 other people. 
 
 Whenever a person is thought to be suffering from consumption, the name and 
 address should be sent at once to the Health Department, on a postal card, with a 
 
 statement of this fact. A medical inspe< tor from the Health Department will then 
 call ami examine the person to see if he has consumption, providing be has no 
 physician, and if necessary, will give proper directions to prevent others from catch- 
 ing t he disease. 
 
 quentlj a person Buffering from consumption may not only do bis usual work 
 without giving the disease to others, but may als.. get well, if the matter coughed 
 
 Up is properly desl loyed. 
 
 Booms that nave been occupied by consumptives should be thoroughly cleaned. 
 
 scrubbed, whitewashed, painted or papered before thej are again occupied, Car 
 
 pets. rugs, bedding, etc, from rooms which have been occupied bj consumptives, 
 
 should be disinfected. The Health Department should be notified, when thej will 
 
 be sent for, disinfected and returned to the owner free of charge, or, if he so desires 
 
 they will be dest roj ed. 
 
 By order of the Board of Health, 
 
 in \ki.i-s ... \\ 1 1 son, President. 
 i-.m uons Ci ibk, -' ■ ■/■> tary. 
 
924 APPENDICES. 
 
 NO. 94. 
 
 State Board of Health of Maine. 
 
 THE PREVENTION OF CONSUMPTION. 
 
 [Revised Edition of 1900.] 
 
 That insidious disease which we call consumption, phthisis, or tuberculosis of 
 the lungs, is the most terrible destroyer of lives with which civilization has to con- 
 tend. 
 
 At the present time the fact of the infectiousness of consumption is firmly estab- 
 lished in a scientific way, and enough is known of the natural history of the infective 
 agent, the bacillus of tuberculosis, and of the ways in which it is communicated to 
 man, to enable us to lay down rules for the prevention of the disease with more 
 positiveness than was formerly possible. 
 
 The source of infection is two-fold, from one human being to another, and from 
 tuberculous animals to man. The tuberculosis of animals and human consumption 
 are of the same nature. 
 
 From domestic animals there is danger of contracting the disease by the use of 
 the flesh, and especially by the use of the milk from those which are tuberculous. 
 Many children die in their earlier years from various tubercular diseases, tubercular 
 inflammation of the brain, " consumption of the bowels, 1 ' etc. Many of these deaths 
 are due to living amid infectious surroundings and breathing infected air, but a 
 considerable proportion die from infection received in the milk of tuberculous cows, 
 or in that from mothers suffering from tuberculosis in some form. 
 
 By far the greatest source of infection, however, are consumptive human beings, 
 but fortunately the ways in which the contagion is disseminated are but few, and 
 by intelligent care they may be effectually controlled. 
 
 From the human source, we may consider the expectoration (the sputum) as 
 practically the one great danger. The consumptive sputum usually contains an 
 abundance of the infection, the bacilli, and these microscopic organisms are found 
 to be capable of retaining their vitality and their infectious qualities for a long 
 while, even after the sputum has been thoroughly dried. 
 
 As a general proposition the statement is true that the breath of the patient is 
 not infectious, and that the same may be said of the sputum so long as it remains 
 moist. Later experimental work, however, indicates a possibility of infection in the 
 immediate vicinity of hard, open-mouthed coughing. 
 
 Another line of investigation has proved that the careless consumptive patient is 
 a focus of infection, and a danger to all persons who come much in proximity t<> him, 
 especially to those who dwell in the same rooms with him. 
 
 The reason of this is that the expectoration of the patient, spit upon floors, 
 carpets, pocket handkerchiefs, or clothing, becomes dried and pulverized, and, 
 floated in the air, still contains the infectious germs, and cannot be inhaled without 
 great danger. 
 
 Though infection maybe regarded as the principal, the essential, cause of con- 
 sumption, there are nevertheless various untoward influences which have much to 
 do with increasing the death-rate from this disease, and they should never be disre- 
 garded. The most important of these are the breathing of impure air, — that of 
 unventilated sleeping rooms, living rooms, schoolrooms, and offices, — the use of 
 food not sufficiently nutritious, and dwelling upon a damp soil. 
 
 Heredity, formerly thought to be a potent cause of pulmonary consumption and 
 other forms of tuberculosis, is now know to have but little part in the causation of 
 the disease. Since the infectiousness of the disease has been shown, family groups 
 of consumption, " house epidemics," are now referred to infection rather than to 
 hereditary influence. Though heredity is possible, the best authorities, the world 
 over, now teach that cases of hereditary transmission of tuberculosis are very rare. 
 
APPENDICES. 925 
 
 Prevention. 
 jQp^ Rules for the patient. 
 
 Two farts should encourage the patient: One is that there is always an intrinsic 
 tendency to recovery in the earlier stages of the disease, and that, under modern 
 treatment, a large percentage of cases do recover; the other is that there is no 
 reason for any person to think that he is doomed by heredity, no matter what his 
 family history may he. 
 
 It should be impressed upon consumptive patients and other persons living with 
 them that the sputum (what they cough up) is dangerous and must be properly dis- 
 posed of. It must not become dry. There are several ways* in which the sputum 
 may safely be eared for: 
 
 A. Pressed paper spit-cups, costing but little, are on the market. One or sev- 
 eral can be used daily and, after it has been used, each cup with cover and contents 
 can be burned. 
 
 B. Paper cups held in a metal frame may be used. After use the cup and con- 
 tents are burned. 
 
 C. Metal or porcelain spit-cups or spittoons, each containing a small quantity 
 of disinfecting solution 1, 2. or:!, maybe used. The, final disposal of the sputum 
 may he 
 
 1. By pouring it down the water-closet. 
 
 2. By cremation when practicable, (a) In a small fire outdoors, (b) In the 
 house heater, using a stout sheet iron box with a handle three feet long. Partly 
 
 till the box witli sawdust, or fold a paper inside it ; pour in the contents of the spit- 
 cup or cuspidor; with the direct draft of the heater open, invert the box over the 
 litejiot. holding the box in place a moment until the flame or the heat sterilizes it. 
 When tlie sputum is to he cremated, hut a small quantity of the disinfecting solution 
 should he used in the spittoon. 
 
 :;. By setting the vessel aside, preferably in a warm place, so that the disin- 
 fectant maj act eight or twelve hours longer. The quantity of disinfecting solution 
 should be in excess ot that of the sputum. Then bury or otherwise dispose of it so 
 that flies and the domestic animals cannot reach it. 
 
 The patient should have two spit-cups or spittoons for alternate use. A cover 
 should exclude flies. Cleansing can be done with washing soda and boiling water, 
 
 or soap and hot water. 
 
 I). Knopf's aluminum pocket spit-flask is very convenient, especially when the 
 
 patient is away from home, is traveling, or is confined to his bed. 
 
 E. When away from his room the patient may spit into Japanese paper napkins 
 
 to he put immediately into a rubber tobacco pouch until they >an be burned. 
 
 F. Spitting into handkerchiefs should be avoided. If occasionally forced to do 
 
 this, the handkerchief should be boiled before the sputum dries. Handkerchiefs 
 
 upon which the sputum is allowed to dry, surround the user with a balo of infec- 
 tion, infect the pocket and everything else they touch, and lessen the patient's 
 chances of recovery. After coughing, the lips should not he wiped with the hand- 
 kerchief used for the nose. Tin' lips ma\ he wiped with paper napkins to lie 
 burned later. 
 
 Repress cough as much as possible. Cough gentlj with the mouth closed as 
 much as possible. Sever swallow the sputum. By so doing you favor the extension 
 
 of t lie disease tot lie inte-.t inal t lad. 
 
 Dm not soil personal or hid clothing with the sputum nor the hands when avoid 
 a hie. Wash I he ha nils often. Male |,at ients. win. w 8*1 a mustache <.r beard, should 
 
 keep it ch.seiy clipped. 
 
 Do not infect the im diate surroundings of the home, • spit upon the grass or 
 
 hay or any where else where the sputum mas be eaten bj cattle, chickens, or other 
 
 animals. 
 
926 APPENDICES. 
 
 $^~Rulesfor attendants. 
 
 The floors, woodwork, and furniture of rooms in which consumptive patients 
 stay should be wiped with a damp cloth, not dusted nor swept i.i the dry way. 
 
 Clothing may be disinfected by boiling, as in ordinary laundry processes. Rooms 
 may be disinfected with formaldehyde fumigation — large doses — supplemented 
 with the washing of the floor with solution 7. This should be done every few weeks 
 when practicable, while the rooms are occupied by the patient. If the floor or other 
 surfaces are accidently soiled with sputum, the spots should be wet and rubbed 
 thoroughly with solution T, 1,2, or 3. 
 
 Rooms for consumptives should have no fixed carpets. A few rugs may replace 
 them. They should frequently be carried into the open air and exposed to the 
 action of direct sunshine several hours at a time. For the thorough disinfection of 
 them steam is the best. The tableware of the patient, the knife, fork, cup, and 
 spoons particularly, should be kept separate and washed by themselves in scalding 
 water. 
 
 In addition to the danger from infectious dust, if it is allowed to be diffused 
 through the air, there are other possible ways of communicating the infection. It 
 may be carried directly to the mouth by the fingers, or indirectly by handling 
 articles of food. After soiling the hands, cleanse them carefully. Guard against 
 inoculating cuts or abrasions of the hands'with the sputum. 
 
 ft^^Rulesfor everybody. 
 
 A. Anything tending to lower the tone of the general health may act as a pre- 
 disposing cause, — insufficient nutriment, overwork, loss of sleep, worry, close and 
 dusty air. Avoid these. Give sleeping rooms a prolonged airing and sunning by 
 clay, and as much night ventilation as is practicable. The dwelling place should be 
 dry naturally or made so artificially. If it is thought that there is a family predis- 
 position to consumption, an outdoor occupation should be chosen. Live in the 
 open air and sunshine as much as possible. 
 
 B. Every new case of tuberculosis comes from some earlier case. The germs of 
 this disease retain their vitality and their infectivity a long time under favoring con- 
 ditions. Therefore do not bring into your house clothing formerly used by con- 
 sumptives unless it has been thoroughly disinfected; do not move into an infected 
 house or rooms, until the thoroughness of the disinfection is unquestionable; do not 
 put to your lips or mouth, pipes, wind instruments, money or anything else that has 
 been used or handled by consumptives: do not buy bread, milk, or other articles of 
 food, not to be cooked, from consumptives; kissing, particularly lip- to-lip, is unsafe 
 if one party to the act is tuberculous; thorough cooking for meat, or a temperature 
 somewhat below the boiling point (176 F. for 10 minutes) for milk, will render these 
 safe articles of food. 
 
 By observing the rules which are expressed and suggested in the foregoing, the 
 principal, if not all danger of infection may be avoided. 
 
 The open air treatment of consumptives and those who are threatened with 
 tuberculous disease, has given much better results than any other. Particularly in 
 Germany, and to some extent in this country, such treatment has been systematized 
 in "sanitaria" for consumptives. Here the patients have the advantage of a life 
 under medical regulation, nutritious food, and such exercise or rest as each case re- 
 quires; but the chief curative agent is an abundance of fresh air. Even in cold 
 winter weather, patients, after a period of gradual habituation, and always guided 
 by the judgment of the physician, pass almost the whole day in the open air, walk- 
 ing or sitting, or lying on resting places comfortably wrapped in blankets and furs. 
 The results obtained in these institutions have been very successful even in those 
 with climatic conditions less favorable than those of many parts of Maine. An 
 abundance of pure air is the all important thing. 
 
APPENDICES. 927 
 
 DISINFECTING SOLUTK >NS. 
 
 Solution i. 
 Carbolic Acid (pure liquified), 7 ounces. 
 
 Water. 1 gallon. 
 
 -Mix. This is approximately a 5 percent, solution. For the disinfection of cloth- 
 ing this solution mixed half and half with water will do. 
 
 Solution 2. 
 
 I.ysol, .". ounces. 
 
 Water. 1 gallon. 
 
 Mix. This may be used as a substitute for solution 1. one-half the strength 
 sufficing for uncolored clothing. Many colors are changed by it. 
 
 v oi n ;;. 
 
 Solutol (crude or p I pint. 
 
 Water, 2 or 3 gallons. 
 
 Mix. This is a very efficient disinfectant for excreta, tuberculous sputum, and 
 gross disinfection generally. If to be used in dwelling houses, or wherever the 
 odor of the crude produci would be offensive, pure solutol should be used. 
 
 Soi i HON T. 
 Solution of Formaldehyde (Formalin), 6 ounces. 
 
 Water. 1 gallon. 
 
 Mix. This mixture contains a little less than '_' per cent, of formaldehyde. 
 It is a good plan to dissolve 4 or "> tablespoonf uls of common salt in each quart of 
 solution l. tii- solution •_'. thereby increasing considerably the disinfecting power of 
 
 the solution. 
 
 NO. «.>."">. 
 
 THE PREVENTION OF CONSUMPTION. 
 
 Instructions to Consumptives and their Friends. 
 
 Consumption is the most destructive disease, the number of persons dying an- 
 nually from this cause in Michigan amounting to about three thousand. 
 
 Consumption is a dangerous communicable disease, the most dangerous one in 
 Michigan. One consumptive may spread the disease to very many healthy persons. 
 The chief danger exists in the expectoration of the consumptive person, and if this 
 expectoration is carefully destroyed before il is dried, Little danger need he feared. 
 
 Consumptives should be instructed not to spit upon the sidewalks, the doors ol 
 rooms, public balls, Btreel and railway cars, and other vehicles, nor where fowls or 
 
 dairy COWS may take in the sputum, or the dust of it with their food. They should 
 
 spit into pieces of cloth, or receptacles made for the purpose, containing a saturated 
 solution of carbolic acid (one part of carbolic acid crystals to aln. ut fifteen parts of 
 water). Such pieces of cloth should be destroyed by fire, before the sputa become 
 dry, and other receptacles should he cleansed with scalding water, their contents 
 baving been destroyed or otherwise carefullj disposed of. Handkerchiefs which 
 maj have been used from necessity should he boiled half an hour before washing. 
 
 li is hest that all persons who bave a cough should uarrj --mall pieces "i doth 
 leach jusl large enough to properhj one sputum) and paraffined paper envel- 
 op! ^ or wrappers in which the .loth, as - as once used, maj he put and securelj 
 
 enclosed, and with Its envelope, burned on the first opportunity. 
 
 Remember that sputa must never !>•■ allowed t" become dry. 
 Office oi rin Secret aby oi rm State Boabp oi Health, 
 ,i'i. Wirhigan, August, t8SH. 
 
928 APPENDICES. 
 
 NO. 9<>. 
 
 Size 3i in. x 5-i in. 
 
 No Street 
 
 Record No 
 
 Name 
 
 Age Sex Occupation . 
 
 Reported : Date by 
 
 Assigned : Date to . 
 
 Order No Date 
 
 (reverse.) 
 
 Returned : Date by . . . 
 
 i ( >wner \ 
 C. ] or [ Address . 
 
 ( Agent ) 
 
 N. C. C. Reason 
 
 ^ ( Patient 
 
 Recom. 
 
 ' Disinfection 
 
 Premises: San. Cond Previous Instructions. 
 
 Instructions by Inspector 
 
 ~ , . r , i Living 
 
 Otlier Cases , n 
 
 ' Dead 
 
 Remarks 
 
 NO. 97. 
 
 Size hi in. x in. 
 HEALTH DEPARTMENT. 
 
 City of Chicago, Bureau of Contagious Diseases. 
 
 DISINFECTOR'S DAILY REPORT. 
 
 C. W. BEIIM, M. D., 
 
 Medical Officer in Charge of Disinfection. 
 
 Sir: — I hereby report that I have this day of 
 
 1 , disinfected for 
 
 The premises at 
 
 Miles from office 
 
 Number rooms disinfected 
 
 Area of rooms cubic feet. 
 
 Formaldehyd used C. C. 
 
 Disinfection began at M. 
 
 Rooms opened up at M. 
 
 Other disinfections performed 
 
 Signature 
 
APPENDICES. 929 
 
 NO. 98. 
 
 CIRCULAR CONCERNING DISINFECTION. 
 
 Before leaving the room the patient should have a bath and a shampoo and be 
 dressed in fresh clothes that have nut been exposed to the infection. The clothes 
 worn during the sickness must he either burned or disinfected. 
 
 Clothing that can be boiled is most easily disinfected by boiling it for half an 
 hour. Clothing that cannot be boiled will be disinfected by the Health Department 
 men. 
 
 sheets and pillowcases are disinfected by boiling. Blankets, feather beds, pil- 
 lows, mattresses, and comforters will be disinfected by the Department. 
 
 Furniture, floors, and woodwork should be washed in a disinfecting solution of 
 corrosive sublimate. The corrosive sublimate will be furnished by this Department. 
 It should be used carefully, according to directions, as it is very poisonous. A 
 corrosive sublimate solution cannot be used with soap, therefore it is better to do 
 any necessary scrubbing first and then wash over with the disinfecting solution. 
 The wall pajk'r may be removed and burned, or the walls may he wiped oil" witli a 
 cloth placed on a broom and the cloth may then be burned. The ceiling is not very 
 likely to be infected. It may be whitened. Small articles should be wiped with a 
 doth wrung out in a disinfecting solution. 
 
 Upholstered furniture should not be kept in the room. If such by chance should 
 
 lie infected, it should be thoroughly sprayed or dampened with a disinfectant. 
 
 Formalin is the best for this. 
 
 Lastly the room should be thoroughly aired. 
 The following are good disinfecting solutions: 
 
 I. Carbolic acid ; a half cupful of the strong acid to a pail of water. 
 II. Corrosive sublimate; three drachms to a pail of water. 
 
 The box furnished by the Health Department contains enough for one 
 pail of water. 
 IIJ. Formalin, one ounce to three pints of water. 
 
 The buttle furnished by the Health Department contains enough for 
 three pints of water. 
 
 Corrosive sublimate and formalin will be furnished by the Health Department 
 when requested. 
 
 Usually the Department men can do their part of the disinfecting the next daj 
 after they receive orders from the Superintendent. Sometimes a longer delay is 
 necessary. The Department does its part of the work free of charg 
 
 PROVIDENCE, November. 1890. 
 
 NO. 99. 
 
 Size 6 in. \ ''■ in. 
 Hetttrn Swab and both Tuben. 
 
 DIPHTHERIA. 
 
 Name of Pal iciil ^ge. 
 
 Address. , 
 
 Attending Phj sician \dd ress 
 
 \'a f Maker of Culture 
 
 I late Time Mo. Of Culture. 
 
 1 )urat ion of Disease 
 
 I low ( .ml railed " 
 
 Ib.u Man> in Famib ? Idults Children 
 
 ( 'an < lase be Isolated ' 
 
 Does Patient attend School ' Where 
 
 Local ion of Membrane. 
 
 ill ure [noculat ion Katisfactorj ? 
 ( 'linical Diagnosis 
 
 If made hei I.xaniiiiat ion 
 
 //. ' urn Hwab and both I uht >. 
 
930 
 
 APPENDICES. 
 
 NO. lOO. 
 
 Size 3 in. x 5 in. 
 
 DIPHTHERIA. 
 
 Date 
 
 Name 
 
 Laboratory No 
 
 Male White 
 
 Female Colored 
 
 Address 
 
 
 
 Age 
 
 
 How long Sick? 
 
 Location of Membrane: 
 
 Where contracted: 
 
 Clinical Diagnosis. 
 
 How much Antitoxine 
 used ? 
 
 How long since an antiseptic 1 Number of children 
 was used in throat? immunized: 
 
 Doctor's Name: 
 
 Address : 
 
 Report by mail or telephone: 
 
 Telephone number: 
 
 Please state number of culture, whether 1st, 2d, 3d, etc., in this space: 
 
 What school has the child been attending? I Remarks: 
 
 ThefoUowing blank spaces are t<> be filled out by tln j Health Department: 
 
 Bacteriological, Examination: Date, 1st 2d. . . .3d 4th 5th. . . 
 
 6th... .7th. ..8th 9th. ..10th... 
 
 Disinfected — Date. By whom/""^ 
 
 Please read Notice on other side. 
 
 x Positive Culture, 
 o Negative " 
 
 NO. lOl. 
 
 Size 51 in. x 84 in. 
 DEPARTMENT OF HEALTH. 
 
 Municipal Laboratoby, Room 317, City IIai.l. 
 
 Chicago, 180. 
 
 Dk. 
 
 , City. 
 
 Dear Sir: — The examination of the culture in the case of. 
 
 has given the following result: 
 
 Bacillus diphtheria' Staphylococcus 
 
 Pseudo-diphtheria bacillus Contamination 
 Streptococcus No growth 
 
 The case is therefore one of true diphtheria. 
 
 M. D., 
 
 Bacteriologist and Director, Municipal Laboratory. 
 
 PLEASE NOTE. — Diphtheria bacilli may be found in the throats of healthy 
 persons. 
 
 In a small number of cases the bacillus is not found in the first culture when it 
 may be found in later ones. . 
 
 The bacillus sometimes disappears before the membrane does. 
 
 Accuracy of results depends primarily upon careful inoculation of the culture 
 tube. 
 
 Where the pseudo-bacillus cannot be positively distinguished, the case will be 
 regarded as true diphtheria until second cultures are examined. 
 
APPENDICES. 931 
 
 NO. 102. 
 
 Sl/.K Sj IN. X 8 IN. 
 
 Laboratory No 
 
 HEALTH DEPARTMENT. 
 
 Division of Pathology, Bactebiologt and Disinfection. 
 
 New Yoi:k 180. . . . 
 
 Dr 
 
 Dear Sir: 
 
 The examination of the culture made by inoculating the tube 
 
 with the exudation from the throat of 
 
 on dors not admit of an exact bacteriological diagnosis, 
 
 foj- the following reasons: 
 
 A. The inoculation was made at so late a period in the disease that it is possible 
 1 lie diphtheria bacilli, though now absent, were at an earlier time present. 
 
 /;. The growth on the culture medium was so scanty that it is possible the 
 i noc ulation was not properly made, or that some antiseptic had been applied to the 
 throat shortly before the tube was inoculated. 
 
 < . The culture was in some way contaminated by saprophytic bacteria, covering 
 the medium, and obliterating the growth of throat bacteria. 
 
 I). The culture medium was dry. 
 
 /;. The bacilli present, though resembling diphtheria bacilli, were not sufficiently 
 characteristic for positive identification. 
 
 /•". No diphtheria bacilli were found; but the location of the lesion (laryngeal) 
 precludes the certainty that they may not be present. 
 
 1. A prompt confirmatory culture is requested. 
 j. The case will be treated as one of diphtheria. 
 
 .".. The case will be treated as one of false diphtheria, unless the physician in 
 charge of the case requests otherwise. 
 
 Examined by 
 
 Hi km w\ m. Biggs, m. I».. 
 Pathologist and Director of the Bacteriological Laboratory. 
 
 NO. 103. 
 
 Size 5 1 1 \ . t 8 in. 
 HEALTH DEPARTMENT. 
 
 Di\ i-io\ ,,1 Pathology, Bacterio -> in» Disinfection. 
 
 SPUT1 M FROM \ CASE OF SUSPECTED TUBERCULOSIS. 
 
 Name of pal lent 
 
 Sej 
 
 Address 
 
 < >ccii pation 
 \ Mending Physician 
 
 Address 
 
 clinical Diagnosis 
 
 Duration of Di 
 
 Have there been cases of consumption in the familj " 
 
 II..U man] ? 
 
 Relation to pal lent 
 
 I >ate "I last case 
 
932 APPENDICES. 
 
 NO. 104. 
 
 Size 5 in. x 5 in. 
 Bacteriological Laboratory, Beffalo, N. Y. 
 
 Directions for Collection of Sputum for Bacteriological Examination in Pulmonary 
 
 Tuberculosis. 
 
 Sputum should be collected only in clean, wide-mouthed, well-stoppered bottles, 
 with a capacity of at least four ounces. 
 
 Care should be taken that bronchial and not pharyngeal secretion is collected, 
 and the expectoration discharged early in the morning is to be preferred. If the 
 expectoration is scanty, the entire amount discharged in twenty-four hours should 
 be collected. 
 
 NO. 105. 
 
 Size 5| in. x 8 in. 
 
 Laboratory Xo. 
 
 Health Department, Baltimore. 
 
 TYPHOID FEVER. 
 Physician Date . 
 
 No. of .Specimen. 
 
 Address Agglutination 
 
 to be tilled out \ 
 at department J 
 
 Patient 
 
 Address 
 
 Motility 
 
 Age 
 
 Day if Disease Diagnosis. 
 
 History of previous attacks 
 
 Clinical Diagnosis 
 
 Quinine or Blood test for exclusion of malaria (if made) 
 ( >ther symptoms ( in brief) 
 
 NO. 10(>. 
 
 Size 3 in. x 5| in. 
 
 illinois state hoard of health. 
 PERSONAL CERTIFICATE OF VACCINATION. 
 
 (1) , HI. 
 
 I hereby Certify that I have, this (2) day of 180. . . . 
 
 examined (3) and pronounce 
 
 (4) . ' in my judgment, properly protected against Small-Pox or Varioloid by 
 
 reason of (5) 
 (A) Successful recent primary vaccination. (C) ..unsuccessful recent attempts 
 
 at vaccination. 
 ( B) Successful recent re- vaccination. (D) Previous attack of small-pox 
 
 or varioloid. 
 
 (0) M. D. 
 
 Explanation of figures: 1 — Write in the name of city, town or village. 2 — 
 Date. 3 — Give name in full. 4 — Strike out supertluous pronoun. 5 — Check the 
 initial "A, 11 " B," "C" or "D" which indicates the " reason." If it be " C," 
 insert number of attempts. 6 — Signature of certifying physician, who should in all 
 c tses in' a legally-qualified practitioner. 
 
APPENDICES. 
 
 933 
 
 NO. lOT. 
 
 Size •*>,. in. x 8 in. 
 ILLUSTRATIONS OF MODES <>F USING THE VACCINATION RECORDS. 
 
 Note. — It will be understood that t lie figures and words or phrases printed 
 in italic, in these illustrations; are hypothetical — the reporting physician will, of 
 course, insert his own figures; give his own reasons for preferring bovine to human- 
 ized virus (or vice xersaj) and furnish the proper address of the propagator whose 
 bovine virus he has found most trustworthy. 
 
 Where the physician has met with noteworthy vaccinal complications, sequela or 
 results, it is especially desired that these be reported separately, with as much fullness 
 "f detail as may he deemed necessary. Facts concerning reported fatal results, am- 
 putated anus, communicated disease. </ ccet., should, in all cases, he furnished. 
 •• Facts 1 "iily can set the public mind at rest on these points. 
 
 of more purely professional interest would he data concerning unusual latency of 
 virus (as manifested by prolonged delay in manifestation of activity;) final success 
 after repeated failures; successful vaccination after an attack of variola; frequent suc- 
 cessful vaccinations of the same individual; success of bovine, after failure of human- 
 ized virus (or the reverse;) modes of performing tin operation. 
 
 Proper credit will be given, in the published report, for all information. To this 
 end records and statements should be dated, post-office address given, and name of 
 reporting physician signed in full. 
 
 s J 
 
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 1 
 
 
 
 
 
 
 
 
 
 
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 - 
 
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 9 
 
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 - - ■"- « <5 ** 
 
 = ill - 
 
934 APPENDICES. 
 
 NO. 108. 
 
 .Size 3-A- in. x 8 in. 
 BOARD OF HEALTH BLANK. 
 
 Physician's Certificate. 
 
 Philadelphia 189 
 
 I hereby certify, from personal examination, that. 
 
 Age Residence 
 
 is successfully vaccinated, or has had Smallpox. 
 
 .M. D. 
 
 . . . . Residence. 
 
 NO. 109. 
 
 Size ."> in. x 8 in. 
 
 The Principal will please destroy this Permit upon admitting pupil. 
 HEALTH DEPARTMENT. 
 
 Sanitahy ■ Bureau. 
 
 DIVISION OF CONTAGIOUS DISEASES. 
 
 Criminal Court Building, 
 Centre, White, Elm. and Franklin Streets. 
 
 New York 189 
 
 The bearer lias been vaccinated ( ) 
 
 and may attend school. 
 
 This is not a certificate of successful vaccination, but is only a permit to attend 
 until examined by an officer of this Department. 
 
 Chas. S. Benedict, M. D., 
 
 < 'hii'f Inspector. 
 
APPENDICES. 
 
 935 
 
 no. no. 
 
 Sl/.K 6 IN. X 11 IN. 
 
 Stub to be retained at 
 
 Stat inn. 
 
 FOE GRATIS USE. 
 
 Furnished ..vial. . No. 
 
 To Dr 
 
 Dale lN'.C 
 
 II' Mil' M. 
 
 Culture tube received. 
 
 Date 189? 
 
 Hour. m. 
 
 To lie forwarded to the Health Department with Culture- 
 Outfit. Diagnosis and Report not Required for Anti- 
 toxin \ii. i, which is used only for Prophylaxis. 
 
 Received from the Chicago Health Department, 
 through Diphtheria Antitoxin Station No. ........ 10 c. c. 
 
 vial . . .Diphtheria Antitoxin No. . . .for gratis use in the 
 
 ease of 1 ) 
 
 2) 
 
 payment for which remedy / hereby Certify, upon infor- 
 mation and belief, would he a hardship to the patient or 
 fa mily. 
 
 It is understood that the conditions — hereby accepted 
 by i ne — upon which the Department furnishes this Anti- 
 toxin without charge are — 
 
 First, that the diagnosis of the case shall be sub- 
 
 mitted to bacteriologic investigation, for which purpose 
 
 I undertake to return to this Station within twelve 
 
 hours after receipt of the serum a culture tube properly 
 
 charged with exudate from the throat of the patient. 
 
 Second, that 1 will make a clinical report of the case 
 promptly upon its termination, to the Bureau of Con- 
 tagious Diseases on the blank form furnished by the 
 I department for that purpose. 
 
 S) SID. 
 
 4) 
 
 Dai.': :>) 1895. 
 
 Hour: til in. 
 
 Culture tube returned 1895, hour m. 
 
 Note. Spaces nuiiii.cn'. i l name >.i patient), S address ..( 
 |. client ,3 and i signature and address ol physician), 5 and 6 will 
 !>.• fllled in bj the physician who receives the Antitoxin. All other 
 spaces will i.e Ailed in by the druggist . who will send this Receipt 
 i.. I Mr Department, with the Culture Outfit. 
 
936 
 
 APPENDKKs. 
 
 NO. 111. 
 
 Size 5i in. x 5^ in. 
 
 CLINICAL BLANK. 
 
 Date . 
 
 Add 
 
 N 
 
 Pliys. : Name. 
 
 Patient : Name Age Add 
 
 Antitoxine make Units injected . 
 
 Duration of Disease at time of injection 
 
 Location and Extent of Exudate or Pseudo-Membrane 
 
 189 
 
 Result of Culture 
 
 Case Intubated ? Tracheotomized ? . 
 
 Case Recovered ? Died ? (Day of Decease) 
 
 Complications (Skin, Heart, Kidneys, Nervous System, &c 
 
 Remarks. 
 
 Cases Immunized: No Result, (after weeks) 
 
 Signed 
 
 Please return this blank as soon as the above information can be furnished. 
 
 Cn/riRE 
 
 NO. 118. 
 
 Size 4 in. x 6 in. 
 Diphtheria 189 . 
 
 Antitoxin. 
 
 No. Name 
 
 No St. Ave. A'y Ward 
 
 Yrs. Sex Color 
 Clin. Diagnosis 
 Mild Severe Site Exudate 
 
 Dr. No. 
 St, Ave. 
 
 Date culture 111 days Loc. Membrane 
 
 Clin. Diagnosis 
 
 Date Exam. Bact. Diagnosis 
 
 Injected M. C. C. 
 
 Croup began before after first injection 
 Recovery Urticaria Joint pains 
 
 Convalescent Exx. 
 
 Contagious days 
 
 Death hours after first injection 
 M. the day of 189 . 
 from 
 
 Tracheotomy Dr. 
 Intubation 189 . 
 
 Reported Antitoxin 
 
 As Returned \~) 
 
 
 
APPENDICES. 93' 
 
 NO. 113. 
 
 .Sl/.K 8 IX. X 11 IX. 
 
 A I 1 \NT \. GrA 
 
 T<> WHOM IT MAY CONCERN: 
 
 Tut- i- to Certify, That Mr 
 
 on oath says tliat lie lias been in Atlanta, »'\. 
 
 Date 
 
 from 
 
 Issued to j or days, ami tliat he has aot been 
 
 who has been in Atlanta. Ga., exposed to the infection of Yellow Fever, or 
 
 ' ,( "" Smallpox, and has not been in any infected or 
 
 suspected locality for days. 
 
 for days, and has 
 
 not been in an infected or sus- 
 
 pected locality of Smallpox or Description: Age years. Weight 
 
 Fellow Fever for days. I """" 1 " Hei S h< Complexion 
 
 < ertificate issued by lla "' Eyes 
 
 Secretary Hoard of Health. 
 Sworn and subscribed this day of 
 
 Notary Public, Fulton County. Ga. 
 
 NO. 114. 
 
 Size 7 in. x 7, in. 
 SI \TK QUARANTINE. 
 
 1. At what Station did you, or anj irresponsible person traveling in your charge, 
 
 gel on i his Train '.' 
 Answer Destination? 
 
 2. Where have you. or lias any irresponsible person, traveling in your charge, been 
 
 for the pas! ten days? 
 
 Answer 
 
 s ' ■ far as you know, bave you. or has any irresponsible person t ra\ eling in your 
 charge, been exposed to yellow fever within the past ten days? 
 
 . I nsiri /• 
 
 i. Have you. or lias any irresponsible person traveling in your charge, been within 
 
 the pasl ten days, in 
 
 or any other place infected with yellow fever, and, if so, In w hat place? 
 
 . ! nsxoer 
 
 5. When were you, oi was any irresponsible person traveling in your charg* 
 
 in either of the ai«o\e named places, and it there, for bow long? 
 
 . I iisin r 
 
 1 do solemnly swear thai the answers to 
 
 the foregoing questions are true, So Help Mi God! 
 
 Sworn to and subscribed before me this daj "t .1890. 
 
 I ,» i \ l : \ s i ! n i i > i i 1 1 i i ; . 
 
 Note. Untrue answers to anj of the above questions will expose the affiant to 
 
 ■m-\ ere penalties. 
 
938 
 
 APPENDICES. 
 
 NO. 115. 
 
 Size 3i IK. x 5 ix. 
 
 GARBAGE. 
 
 ASHES. 
 
 PAPER. 
 
 All Vegetable Matter. 
 
 t Sauce Bottles. 
 
 t Only catsup and other 
 sail re bottles should be 
 put into the garbage can; 
 all other bottles into the 
 paper barrel. 
 t Tin Cans. 
 
 X Fruit, vegetable and 
 meat cans should be put 
 into the garbage can; other 
 cans into the paper bar- 
 rel. 
 
 * Where there is a large quantity, as at a res 
 taurant, they must be hauled by the owners. 
 
 (OVER.) 
 
 Sawdust, 
 
 Broken Bottles, 
 
 Broken Glass, 
 
 Broken Crockery, 
 
 Floor and Street Sweep- 
 ings, 
 
 *Oyster and Clam Shells, 
 
 Tobacco Stems. 
 
 Bottles, 
 Rags, 
 Tin Cans, 
 Excelsior,' 
 Straw, 
 Mattresses, 
 Old Ch.thes, 
 Pasteboard Boxes, 
 < )ld Shoes, 
 
 Leather and Rubber 
 Scrap, 
 
 Carpets, 
 
 Combustible Refuse gen- 
 erally. 
 
 [reverse.] 
 
 
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APPENDICES. 939 
 
 NO. 116. 
 
 Size s , in. x 11 in. 
 
 Philadelphia 189 
 
 To th< Board of ll<;Uh : 
 
 The undersigned respectfully app for a License to clean privy wells and 
 
 sinks, and to remove the ((intents thereof, under the provisions of the Laws of the 
 State, and in conformity to the rules and regulations of the Hoard. 
 
 bona fide the owner of horses pumps tanks, 
 
 trucks barrels feet of rubber hose hoods 
 
 feet air hose furnaces, etc. which number intend to employ in the 
 
 business. Said apparatus are all in good working order, and the accommodations 
 
 for keeping them are under cover and out of public view also state that 
 
 not in collusion or combination with any person or persons to deceive or 
 
 defraud the Hoard, and further that the representations herein contained are all 
 
 true. 
 
 propose 
 
 Residence 
 
 And 
 
 Residence 
 
 as sureties upon bond. 
 
 Very respectfully, your obedient servant. 
 
 Residence 
 
 I'lace of business. : 
 
 I Cebtift, That the above applicant is the owner of the number of horses, 
 
 vehicles, and apparatus named in the application, and that they are all in g 1 
 
 working order, and that the law has in every respect been fully complied with. 
 
 //.,-///, Officer. 
 Philadt Iphia 189 
 
 | ki.\ EB8E.) 
 
 l'llll M.l.l.lMIlA 189 
 
 being duly sworn or affirmed according to law, doth 
 
 depose and say, that the allegations made in Petition for License to than 
 
 Privy Wells, are i me, ; 11 "' that i ne is interested or c serned in the said Li. ense, 
 
 except those named in the said Petition, and that will do no work 
 
 for Parties not owners or Agents of Properties, except by order of Hoard of Health. 
 . or affirmed, <in<l Hubncribed be/ore m- thin \ 
 
 day of , 
 
 .1. h. 189 \ 
 
 //.-////, OfflCCT. 
 
 no. in. 
 
 «/. The apparatus for the removal of the contents oi privj wells, vaults, sinks, 
 etc., Bhall consist of pumps, tanks, nose, deodorizing furnaces, ther efficienl de- 
 odorizing apparatus, tents or hoods, dunnigans or barrels, and trucks u hereinafter 
 
 lied. 
 
 /,. The pumps shall be suitable for the purpose required, and shall have valves 
 
 not less than four inches internal diameter, whlchwill allow obstructive rubbish and 
 
 • mentitious matter to pass freely through the pump, and he I 
 through tin- hose to the tank. 
 
940 APPENDICES. 
 
 c. The hose shall be of rubber, or some other material impervious to water, 
 and shall have an inside diameter of not less than four inches, and shall be well 
 secured at the joints by efficient couplings. No strainer or other device to prevent 
 the free ingress of material shall be used while the induction end of the hose is in 
 the well or vault. 
 
 ij. Each tank shall have its capacity measured and the number of cubic feet it 
 contains stamped or branded on the rear end by a sworn measurer of the Board of 
 Health. Each tank shall have an indicator conspicuously placed on the rear end. 
 which shall correctly indicate the quantity in the tank. 
 
 e. The gases escaping from the tank while being tilled shall be thoroughly de- 
 odorized. If by fire, a suitable furnace protected by the intervention of a screen or 
 other suitable device between the tire and the ignitable gases in the tank, to prevent 
 explosion, shall be used. 
 
 /. The tent or hood shall be made of canvas, and so constructed as to give space 
 for one or more barrels, and so erected as to form a close joint with the walls of the 
 privy building and the pavement or ground, completely enclosing the door, and so 
 secured that no odor can escape except through the air hose. 
 
 ij. The air hose shall be made of some air-tight material, expanded by a spiral 
 wire, or other suitable device, and shall have an inside diameter of not less than five 
 inches, and shall be at least ten feet in length. When in service the air hose shall 
 be attached with a tight joint to the tent, at a point not less than four feet from the 
 ground, by one end, and the other connected by a practical air-tight joint with the 
 deodorizing apparatus or furnace when vised, so that no air can enter below the grate 
 of the latter except through the air hose from inside of the tent. 
 
 h. The pitting furnace shall be so constructed that the air-hose connection shall 
 give its only supply of air below the grate, and shall always be full of burning 
 material, while in operation, to ensure a strong draft from the inside of the tent. 
 
 i. The dunnigans or barrels shall be water-tight, and have their capacity 
 measured and branded or stamped thereon by a sworn measurer of the Board of 
 Health. The lid shall be of iron, secured to the barrel by clamps or cams, and made 
 tight by means of a rubber gasket between the lid and the chime. 
 
 NO. 118. 
 
 Size 5 ix. x Ti ix. 
 
 Xo. of Permit 
 
 City of Yoxkkks, X. Y 18 
 
 The Beaker, City Scavenger, is hereby authorized to 
 
 DISINFECT AXD EMPTY TO THE BOTTOM, the 
 
 on the premises Xo , the said work to be com- 
 pleted within 48 hours from date of permit. 
 
 M. I). Health Officer. 
 
 City of Yoskkhs, X. Y 18 
 
 The undersigned Scavenger deposes and says: that on the day of 
 
 18 he did empty to the bottom, the 
 
 on premises Xo containing cubic feet: 
 
 that he did thoroughly remove the entire contents of the said , 
 
 and that he did dump the same on the premises designated by the Health Officer. 
 
 Scavenger. 
 
 City of Yonkeks, N. Y 18 
 
 I have this day examined the Xo 
 
 and found the same thoroughly emptied and disinfected. 
 
 Sanitary Inspector. 
 
APPENDICES. 
 
 NO. 119. 
 
 Size 4 in. x H3 in. 
 
 941 
 
 > V- 
 
 z. s 
 
 — r. 
 
 •:- "E ■& 3 
 
 -. - 
 
 
 
 — — " - 
 
 ■z - 
 
 - — 
 
 's. -r 93 
 
 r bf -E - 
 
 >. r ~ 
 
 - = 
 
 ■=■ 7. 
 
942 
 
 APPENDK ES. 
 
 NO, 120. 
 
 The following form is issued in Baltimore. The stub is filed under the scaven- 
 ger's name and the permit is endorsed at the night-soil dock where a fee has to be 
 paid for each load put on the scow, and is then returned, and riled with the stub. 
 
 Size 4 in. x 9 in. 
 
 Not Good Unless Signed by Commissioner 
 of Health. 
 
 Application for permission to open 
 
 and clean privy on premises No St. 
 
 ( )wner or Agent Mr 
 
 loads. Work to be done by 
 
 Address. 
 
 DUPLICATE. 
 
 Application for permission to open 
 
 and clean privy on premises No 
 
 St. 
 
 Owner or Agent Mr 
 
 Permission is given to do this work in 
 
 loads. Work to be done bv .. ■., ,, , .. t ,i 
 
 ■' compliance with the regulations of the 
 
 Health Department; and this permit, en- 
 dorsed by the Superintendent of the Dump. 
 
 Address shall be returned to this office within 48 
 
 hours from this date. 
 
 NO. 131. 
 
 Size .">i in. x 8 in. 
 NIGHT SCAVENGER PERMIT. 
 
 No 
 
 Mr whose registered license is No 
 
 is hereby ordered to remove contents of and clean Privy Vault at No 
 
 Street Ward, which is owned by 
 
 and remove the same to beyond city limits 
 
 within five days from date, and make report to this office, according to Sec. 212 of 
 the General Ordinances of the City of Milwaukee, passed Nov. 10, 1800, and amend- 
 ment passed Nov. 14, 1892. 
 
 Milwaukee, 180 
 
 Gominifosionev <>f Health. 
 
 No OF RETURN. 
 
 I hereby certify that I have cleaned. Privy Vault at. 
 
 Street, Ward, by order of 
 
 and removed yards from said premises to 
 
 on the day of 
 
 according to permit issued by the Health Commissioner, on 
 
 189 , and charged for said wcrk the sum of $ 
 
 Scavenger License Nt 
 
 Milwaukee, 189 
 
 189. 
 
APPENDICES. 943 
 
 NO. 122. 
 
 Size %\ in. x 11 in. 
 
 REPORT OF MEDICAL INSPECTOR <>k SCHOOLS AND AGENT OF 
 THE BOARD OF HEALTH. »>F BOSTON. 
 
 For the Month of 189 . 
 
 List of Diseases Foi n d 
 
 IN SCHpOIiS. 
 
 Schools. 
 
 Totals. 
 
 Number of pupils examined in the schools 
 
 Number recommended to be seni home 
 
 Number consultations with teachers (about pupils returning to 
 school, etc.) '• 
 
 Medical Inspector of School* 
 and Agent Board of Health. 
 
 \o. 12:;. 
 
 I,'i r.E9 I'M; 
 
 CARE OF INFANTS. 
 
 Departmeni <m iii \i in. Cm iii Mi u York, > 
 t Irlminal Cour! Building, 
 Centre, White, Elm and Franklin Streets. \ 
 
 June, 1808 
 
 The following series of rules (approved bj rnanj physicians) for the management 
 of children during the liot season, witli :i view i" prevent the large annual ruortalitj 
 of this class, submitted bj the Santtarj Committee, is approved and published bj 
 the Board: 
 
944 APPENDICES. 
 
 I. Nursing of Infants. 
 
 Over-feeding does more harm than anything else; nurse an infant a month or 
 two old, every two or three hours. 
 
 Nurse an infant of six months and over, live times in twenty-four hours, and no 
 more. 
 
 If an infant is thirsty, give it pure water, or barley-water, no sugar. 
 
 II. Feeding of Infants. 
 
 Boil a teaspoonful of powdered barley (ground in coffee-grinder) and i pint of 
 water, with a little salt, for fifteen minutes, strain, then mix it with half as much 
 boiled milk, add a lump of white sugar, size of a walnut, and give it lukewarm from 
 a nursing-bottle. Keep bottle and mouth-piece in a bowl of water, when not in use, 
 to which a little soda may be added. 
 
 For infants live or six months old, give half barley-water and half boiled milk, 
 with salt and a lump of sugar. 
 
 For older infants, give more milk than barley-water. 
 
 For infants very costive, give oatmeal instead of barley. Cook and strain as 
 before. 
 
 When your breast-milk is only half enough, change off between breast milk and 
 this prepared food. 
 
 In hot weather, if blue litmus-paper, applied to the food, turns red, the food is 
 too acid, and you must make a fresh mess, or add a small pinch of baking-soda. 
 
 Infants of six months may have beef-tea, or beef-soup once a day, by itself, or 
 mixed with other food; and when ten or twelve months old, a crust of bread and a 
 piece of rare beef to suck. 
 
 No child under two years ought to eat at your table. 
 
 Give no candies, in fact, nothing that is not contained in these rules, without a 
 doctor's orders. 
 
 III. Summek Complaint. 
 
 It comes from over-feeding, and hot and foul air. Keep doors and windows 
 open. 
 
 Wash your well children with cool water twice a day, or oftener in the hot 
 season. 
 
 Never neglect looseness of the bowels in an infant; consult the family or dispen- 
 sary physician at once, and he will give you rules about what it should take and 
 how it should be nursed. Keep your rooms as cool as possible, have them well 
 ventilated, and do not allow any bad smell to come from sinks, privies, garbage* 
 boxes, or gutters about the house where you live. See that your own apartments 
 are right, and complain to the Board of Health, Centre, White, Elm and Franklin 
 Streets, if the neighborhood is offensive. Where an infant is cross and irritable in 
 the hot weather, a trip on the water will do it a great deal of good (ferryboat or 
 steamboat), and may prevent cholera infantum. 
 
 By order of the Board, 
 
 Michael C. Murpht, 
 Emmons Ci-ahk, President. 
 
 Secretary. 
 
APPENDICES. 945 
 
 NO. 1^4. 
 
 HEALTH DEPARTMENT. 
 
 S estions fob the Care of Infants. 
 
 The proper food for an infant is its mother's milk. 
 
 If the mother's milk fails use cow's milk. 
 
 Milk must befresh, sweet and pure. Adulterated milk makes sickly children. 
 
 Except in cold weather, /ml the milk as soon as rec< i»< d in a prest rvejar and scald 
 it : s. rew on the cover tight, and keep it on ice if possible. 
 
 For an infant under four months, the milk should be diluted with one-third to 
 one-half water. After that time it may gradually be made stronger. It is a good 
 plan to add sugar of milk (never ordinary sugar) and sweet cream to the milk. A 
 teaspoonful of sugar of milk, and four tablespoonfuls of cream to a pint of milk 
 is a good proportion. The milk should be diluted, and the cream should lie added 
 before the milk is sterilized, and the sugar of milk afterwards. 
 
 Never givt condensed milk, or any other food, •>*■ any molasses candy, sugar, or 
 anything else whatever, without the advice of a physician. 
 
 Nursing bottles should have a rubber nipple attached directly to the neck of the 
 bottle. Never use " nursing bottlt with a /"».'/ tube. The "Graduated Nursing 
 Bottle," with the tablespoonfuls marked in glass, is the best ami cheapest. When 
 not in use the bottles should be filled with saleratus water, ami the nipples should 
 also be kepi in such water. Scald immediately after using, and keep bottles and 
 nipples perfectly clean. Rinse again before using. 
 
 Infants are frequently fed too much and too often. They are more apt to cry 
 from stomach-ache after over-feeding than thej are to fret because they are hungry. 
 The time of feeding and amount of food vary with the age. 
 
 The quantities given below are not for the undiluted milk, but for the milk properly 
 diluted. Dilute the milk first, then measure out the proper amounts. If the milk 
 is to he sterilized, dilute ami measure before sterilizing. fever feed oftener than 
 once !u two hours. 
 
 For the 1 i i-. t week . . not over '■) tablespoonfuls every _' hours. 
 
 From the first week to the sixth " " 4 " " •_' 
 
 " six weeks to four months, " " B " " 3 
 
 " four months to ten months, " " 12 •■ '* '■'< 
 
 At ten months - - - " lt Hi " " :'. " 
 
 At three months an infant can readily go six hours i at trig lit I without f I, and 
 
 at six months it can go from 10 o'clock P. \i. until B \. \i. 
 
 ing infants take the breast at the same hours that bottle babies are ted. 
 
 Peed //" baby at regular hours, even if it has to '».• waked. This is trerj import 
 
 ant . hot h for t lie mol her and t he baby. 
 
 The baby should also sleep, have its bath and go out at as near the same time as 
 possible every day. 
 
 Do not have the food too hot or too Cold; always aboul Id 1 warm. 
 
 l)o not wean a babj or change its food duringthe summer months, (between 
 June 1st and October i>t i. without the advice of a physician. 
 
 gleet vomiting or looseness of th( bowels. Consult a doctoral once; bj so 
 
 doing J on w ill save him many \ isits. 
 
 no paregoric, laudanum, soothing syrup m- other medicine without •< doctt/r's 
 advia . 
 
 When an infant purges or \ its give it nothing to eat for four or si\ hoars. 
 
 \u infant should have from one t" three movements everj twenty-four hours. 
 Thej should be soft and yellow. If they are nol right consult the doctor. Don't 
 attempt to dose t be child > ourself. 
 bo 
 
946 APPENDICES. 
 
 Give the baby a batli every day. The water should be about blood warm, the 
 room should be warm, and there should be no draughts. Do not keep the baby in 
 too long. Five minutes is long enough. Use Ivory or Castile soap. 
 
 Always have woolen next to the baby's stomach. A knitted band, not too tight, 
 with shoulder straps, is the best, but a flannel one will do. 
 
 Take the baby out in the fresh air, morning and afternoon. Do not let the sun 
 shine in its eyes. 
 
 Remember that must stomach and bowel troubles are caused by improper food. 
 Follow the directions given above for infants, and be careful in the diet of older 
 children. Never let them have unripe or decayed fruit. 
 
 Every child should be vaccinated before it is a year old. It is best to do it in 
 cold weather. Free vaccination at the Fourth Ward-room every Friday afternoon 
 between 2 and 3 o'clock. 
 
 Additional copies of this circular, either in English, French or Italian, may be 
 obtained at this office. 
 
 OFFICE OF THE SUPERINTENDENT OF HEALTH. 
 Providence, Dec. 18, 1893. 
 
 NO. 125. 
 
 Size 81 in. x T in. 
 
 Forms very similar to the following are used for children who work in manufac- 
 turing establishments: 
 
 DEPARTMENT OF HEALTH, CITY OF NEW YORK, 
 
 Criminal Court Building, Borough of Manhattan. 
 
 Certificate of Employment, Mercantile Establishments. 
 
 No New York 189 ... . 
 
 The Department of Health of the City of New York Hereby Certifies, 
 
 That has complied with all the 
 
 provisions of Chapter 384, Laws of 1896, and is qualified for employment in any 
 Mercantile establishment in this city, in the position herein designated; and 
 further certifies that he is physically able to perform the work which he intends 
 to do, as* 
 
 JUNIOR HELPER. 
 
 and further certifies that the date of birth 
 
 in this certificate is correctly stated, or cannot be ascertained, and that, after 
 careful examination, it is satisfied that said child is fourteen years of age or 
 upward. * 
 
 Name Date of Birth 
 
 Residence Place of Birth 
 
 Color of Hair Color of Eyes 
 
 Height feet inches. Weight pounds. 
 
 Facial Marks 
 
 By order of the Board of Health, 
 
 President. 
 
 EMMONS CLARK, Secretary. 
 
 Countersigned Inspector. 
 
 *The designation "Junior Helper " includes 
 the positions (male and female) known as 
 " Minor Sales," "Cash," "Messenger." "Small 
 
 Parcel Wrapper." " Errand," " Stock," the '''.,'.'''. '.- 
 
 duties under the above designations being those Signature of person named in above 
 usually performed by such employees in Mer- ( 'ertifirate. 
 
 cantile establishments. 
 
APPENDICES. 947 
 
 NO. Vli\. 
 
 Size v in. x 14 in. 
 
 DEPARTMENT OF HEALTH OF THE CITY OF NEW YORE". 
 
 Borough df 
 
 (Mercantile Establishments, r 
 
 New York 
 
 To //" Boai d of Eft tilth, < Hty of X< to York : 
 
 Gentlemen: — Application is hereby made for a Certificate of Employment by 
 
 the undersigned he being physically able to perform the duties of Juniob 
 
 Helper. 
 
 Signature of Applicant) 
 
 (Address) 
 
 Affidavit of Parent, Guardian or Persons Standing in Parentai 
 Relation to the Applicant. 
 
 Extract from Section 168, Chapter 415, Laws of 1897. 
 
 Certificate tor Employment, How Issued. Such certificate shall be issued 
 by the executive officer oi the board, department or commissioner "f health, <>f the 
 city, town <ir village where such child resides or is to be employed, or by such other 
 officer thereof as maj be designated by resolution for that purpose, upon the appli- 
 cation of the child desiring such employment At the time of making such appli- 
 cation there shall be filed with such board, department, commissioner <>r officer the 
 •atiidu\it of the parent or guardian of such child or the person standing in parental 
 relation thereto, showing the date and place of birth of Buch child. Such certificate 
 shall not be issued unless the officer issuing the same is satisfied that such child is 
 
 fourteen years of ag ■ upward, and is physically aide to perform the work which 
 
 he intends tn do. 
 
 No fee shall be demanded or received for administering an oath as required by 
 t Ins sect ion. 
 
 Stati "i \ i \\ York, ) 
 City of New York, [ 
 
 residing at in i he State of 
 
 being dulj sworn, say that .he is (father, mother, guardian, or stands In parental 
 relation t" the above-named applicant); that said applicant was born at 
 in on t In- day of in the yeai I 
 
 i Signal ure) 
 
 sw mil tn before me this daj » 
 
 Votary Public. 
 
948 APPENDICES. 
 
 Certificate of School Attendance. 
 
 To the Board of Health, City of New York: 
 
 Gentlemen : — I Hereby Certify that 
 
 residing at in the of attended school 
 
 situated at in the uf 
 
 State of for a period equal in length to one school year, during 
 
 the year previous to h arriving at the age of fourteen years, or during the year 
 previous to date; that reading, writing, spelling, arithmetic, English grammar and 
 geography were regularly taught in said school. 
 
 (Signature) 
 
 Dated 189 . 
 
 (Official Designation) ". 
 
 (REVERSE.) 
 
 Certificate of Special Instruction. 
 
 To the Board of Health, City of Nero York: 
 
 Gentlemen : — I Hereby Certify that 
 
 residing at in the of State of 
 
 has received the benefit of instruction in reading, writing, 
 
 spelling, arithmetic, English grammar and geography, or equivalent instruction, by 
 a competent teacher, elsewhere than at a school, for a period equal in length to one 
 school year, during the year previous to his arriving at the age of fourteen years, or 
 during the year previous to date. 
 
 (Signature) 
 
 Dated 189 . 
 
 (Official Designation) 
 
 Certificate of Inspector. 
 
 I Hereby Certify That I have examined 
 
 the above-named applicant, and I am satisfied that he is fourteen years of age or 
 upward, and is physically able to perform the duties of Junior Helper. 
 
 M. D., 
 
 Inspector. 
 Dated 189 . 
 
 Information as to Applicant. 
 
 Name Date of Birth 
 
 Residence * . Place of Birth 
 
 Color of Hair Color of Eyes 
 
 Height feet indies. Weight pounds. 
 
 Facial Marks. 
 
 Remarks. 
 
 Application No Filed, 189 
 
 Certificate dated 189 Certificate No 
 
APPENDICES. 949 
 
 NO. 127. 
 
 Size s j i \ . \ 1 1 i \ . 
 
 TENEMENT <>i: LODGING BOUSE CERTIFICATE, 
 
 I »l IP IRTMEKT OF IIkai.i II. 
 
 Office of Ilealtli Commissioner. 
 
 ERNEST WENDEM D. BUFFALO, X. Y 189 . 
 
 Health < Commissioner. 
 
 Tin- i> to Certify, Tliat I , residing- at No 
 
 Street, in the city of State 
 
 of am the owner of the house at No 
 
 street, in the city of Buffalo, X. V., That 
 
 "f Xo Street, is 
 
 the resident agent for the management of said house. That said 
 
 house is situated at No Street, in said city of Buffalo, 
 
 and contains sets of apartments, with rooms to each set of apartments. 
 
 The ii i milier of persons occupying each apartment is as follows: 
 
 That the following trades and occupations are carried on in said bouse : 
 
 That I filed on the day of 18. . .in the office of the 
 
 Department of Health, in said city, a plan or diagram of the lot on which said 
 
 1 louse is situated, and of each tloor of said house, 
 
 in accordance with the provisions of Sec. 123 of Ordinances of the city of Buffalo, 
 regulating tenement and Lodging houses, and thai no changes have been made affect- 
 ing said plan or diagram previously hied with said Department of Health, except 
 
 . Oipmi r. 
 
INDEX. 
 
 Abatement of nuisances. See Nui- 
 sances. 
 
 Abattoir : public, 2<>o. 
 
 Abbott. I>r. S. \V. : paper on adultera- 
 tion, 341. 
 
 Adulteration of food: 324 <t x< -/. : ges* 
 eral laws. 324-327 : execution of laws. 
 337 et aeq. See Food. 
 
 Advisory board of health, 25, 26. 
 
 Ailantus trees. 156. 
 
 Air pressure test, linn. 
 
 Air space: for dwellings, 139, 154, 155; 
 for tenements. 825, 829; for lodging 
 houses. 832. 
 
 Albany filter, 280. 
 
 Aldermen: appoint board of health. '11 : 
 as board of health, 14-16; on board <>i 
 health, :.•:;. 
 
 Alleys: car '. 147-1 18. 
 
 Aluminum boxes for diphtheria cultures 
 561. 
 
 Ambulance: 628-631; undertaker's wagon 
 used as. 628; St Louis ambulance a 
 disgrace, 628; communicable disease 
 in general ambulance, 628; construc- 
 tion of. 629; cities which have 629; 
 disinfect ion of. 629; horse for. <'.::<>: 
 physician for. 630: at Providence, 
 629 : ai Brookline, .Mass.. 631. 
 
 American Reduction Company's process 
 rbage disposal, 71-"-. 
 
 Ammonia: from garbage, 709; t<> neu- 
 tralize formaldehyde, 540. 
 
 Analysis: of food. 340; of garbage, 702; 
 of milk. 385 : of water, 273. 
 
 Anatomical material, 104. 
 
 Animals: carriers of communicable 'lis 
 
 162 : c nunicable diseases of. 
 
 765 »/ aeq. See Communicable 'lis 
 
 driving through Btreets 207; 
 federal inspection of. 338; state in 
 spectrin. 339; diseased food from, 309, 
 310, 326; food from over heated ami 
 
 feverish, .ll"; w ided, 310: 
 
 nam. :;i 1 ; emaciated, .".l i ; Immature, 
 
 313; unclean do) '" i Bed for food. 
 
 :vi ] . used for f I must be bled, 
 
 .leaned and cooled, -".II ' diseased, milk 
 from. •".'•'' I. 699 ' I H ■/■ ; 
 
 keeping of, 169; yarding of, I7'»: in 
 dwellings, 170; noisy animals. 170; 
 breeding of. 171 
 
 Antitoxin: free distribution. 598, 599, 
 601; application for, 935; circular, 
 599; amount furnished, 599; report of 
 
 u se. ( '>( « >. ! i.' II i : record of ca se, '• ••' '>• ! : 
 production of. 600; regulation of pro- 
 dint ion. tHU : control of by state. 581 ; 
 study of in New York. Nil'. 
 
 Appointment of board of health. 26. 
 
 Arnold process of garbage disposal: 708. 
 
 Asbetos formaldehyde generator, 537. 
 
 Asbury Park smallpox hospital, 603. 
 
 Ashes: see Dry refuse; for ashes and 
 garbage, aee Mixed refuse: excluded 
 from garbage, 666; notice in regard 
 to. 938; sale of. 734 : value of as fuel. 
 735. 
 
 Assistance for the poor in communicable 
 
 disease. 487, 4!H">. 
 
 Attorney: on board of health. 29; as 
 health officer, 4. S: for health depart- 
 ment. 38; city, on board of health. 23. 
 
 Autoclave: Trillat's. 536. 
 
 BABY farms, sir.'. 
 
 Bacillus of diphtheria. See Diphtheria 
 
 bacillus. 
 Bach air pipes, 242. 
 
 Back pressure valve. 239. 
 
 Bacteria : in vaccine virus. 582. 
 
 Bacteriological laboratories: 553 et seq.; 
 first established. 556; state, 556 : mu- 
 nicipal, 556; cost of, 557; uses of. 
 
 557; material for by mail. 556; cities 
 Which have. 559; for diagnosis ,,f diph- 
 theria. 559 < ' aeq.; record of diphthe- 
 ria work. 567 : reporl of results to 
 physicians, •"•'•7. 568, 930, • ■•■i: for 
 diagnosis of tuberculosis. 569; for 
 miosis of typhoid, 569; for the diag- 
 nosis of malaria. .">7 1 ; of cerebro- 
 spinal ningitis, 571 : of influenza, 
 
 .-.7"_' : of glanders, ~>~- ; of rabies, .~i7'_' ; 
 precautions tO be taken in. ."i7'J. 
 
 Bacteriologists, and their salaries, 558. 
 disinfection of. 663 : of rail- 
 road passengers, disinfection of. 655, 
 056 657. 
 
 Baker: not i" sell forbidden food. 350, 
 
 Bakeries: 318-320; consumption in. 522. 
 
 Baki is' .aris. 320. 
 rder, '■'•'■'•'■'<■ 
 
 Ballasl : 1 reatmenl of, G 17. 
 
952 
 
 INDEX. 
 
 Barbers : control of, 800. 
 
 Barney clumping scow, 736. 
 
 Barns. See Stables. 
 
 Barrels for removal of ni°-ht soil : 744. 
 
 Barren Island: garbage disposal at, 703. 
 
 Bathing : in public water supplies, 207. 
 
 Baths: in schools, 781; public, 791 et 
 seq.j summer baths. 701 ct seq.; 
 floating baths. 701, 792 ; swimming 
 pools, 793; in-door baths, 794-800; 
 cost, maintenance, number of bathers, 
 795-800. 
 
 Bath tubs required, 249. 
 
 Bedding in ambulance disinfected, 630. 
 
 Beer : adulteration of, 327. 328. 
 
 Bi-chloride of mercury : spraying with. 
 507, 509, 539, 540: tanks for, 540, 
 546 ; washing with, 507. 509, 513, 548, 
 553 ; washing with at quarantine, 648. 
 
 Bill of health : to be shown at quaran- 
 tine. 636, 643, 644. 
 
 Bi-partisan boards of health, 29. 
 
 Births : enumeration of, 71 ; returns, 71- 
 77. 845, 856 ; time for, 73 : items on, 
 75-77 ; return for completing record, 
 857. 
 
 Births, marriages and deaths : recording 
 officers, 87; records, 89, 863-865; in 
 public institutions, 90 : index, 91 ; cor- 
 rection of records, 92 ; original re- 
 turns, disposition of, 80 : copies of 
 record, 93 : returns to state registrar, 
 866-867 ; returns of non-residents, 63, 
 73, 84. 
 
 Bissell, Dr. Wm. G. : tubercle bacilli in 
 second-hand clothing, 210. 
 
 Blanks. See Forms. 
 
 Blindness ; prevention of, 803. 
 
 Blown veal and mutton, 312. 
 
 Board of administration the board of 
 health, 23. 
 
 Board of communicable diseases at pri- 
 vate hospitals, 615. 
 
 Board of health : advisory, '-o, 26 ; ear- 
 liest, 22 ; organization, 29 ; size of, 
 28 : appointment of, 26 ; executive 
 functions, 32 ; legislative, 43 ; judi- 
 cial, 47. 
 
 Boarding vessels at quarantine, 642. 
 
 Bodies dead of communicable disease : 
 470; disinfection of, 470, 902, 903; 
 to be in air tight coffin, 472, 902, 903 ; 
 time of burial. 473. 902 : funeral, 473, 
 902; transportation of, 100, 476, 902, 
 903; disposal of, 476, 902, 903. 
 
 Boilers. 249. 
 
 Bonds : for officials, 29, 39 ; for night 
 soil scavengers, 743; plumbers, 256. 
 
 Bones. See Grease, bones, etc.. also 
 Junk. 
 
 Books and communicable disease: 4(12 ; 
 disinfection of, 554. 
 
 Boroughs : sanitary organization, 13-16. 
 
 Boston : communicable disease hospital, 
 619 : smallpox in 1678, 1, 425 ; yellow 
 fever, 2, 19. 
 
 Bottles for milk. 416, 417. 
 
 Bovine virus. See Vaccine virus. 
 
 Boxes for diphtheria culture outfits, 561- 
 564. 
 
 Branding of food. See Marking. 
 
 Bread. Mill). 322. 331. 
 
 Brewers' grains for cows, 370. 
 
 Brighton abattoir, 205. 
 
 Broad irrigation for sewage, 300. 
 
 Brookline, Mass. : ambulance, 631 ; hos- 
 pital. 621; bath, 796-?. 18. 
 
 Brooklyn : preparations for cholera in, 
 517. ' 
 
 Brown garbage crematory, 726. 
 
 Brownlee garbage crematory, 726. 
 
 Buckwheat, 332. 
 
 Buildings must be sanitary, 155. 
 
 Bureau of animal industry. 338, 765. 
 
 Bureau of health, 24. 26. 
 
 Burial: time of 100; in cemetery only, 
 101 : only a single body in a grave, 
 102; permits, 58-63, 847-849: who is- 
 sues, 59 ; forms, 60, 847-850 ; return 
 of, 61 ; for out-of-town deaths. 62 ; of 
 communicable disease, time of, 473 ; 
 of dead animals, 762. 
 
 Butchers' frocks, 317. 
 
 Butter: 361-365; defined, 364; process, 
 or renovated butter, 365 ; Quinness 
 patent, 365. 
 
 Butterine: 361-365: federal law, 361; 
 marking of, 362 ; sale of, 363, 365 ; 
 coloring of, 364, 365. 
 
 By-laws. 29, 30. 
 
 Cabbage stalks. 156. 
 
 Calf: flesh of immature, 313. 844. 
 
 Camps, detention: in inland quarantine, 
 661, 
 
 Candles: paraform, 539: sulphur, 530. 
 
 Candy. 334, 335. 
 
 ( 'anned goods, 322. 
 
 Canvas bags and sheets for removal of 
 goods for disinfection, 552. 
 
 Capillary tubes: (vaccine), 592. 
 
 Captains of vessels. See Masters. 
 
 Carbolate of lime : for disinfection. .">.">4. 
 
 Carbolic acid : for washing. 548, 519, 
 553. 
 
 Carbon izer : for garbage. 097. 
 
 ( 'aid index : vital records, 91. 
 
 Carriages: at funerals in communicable 
 disease, 474. 902. See also Communi- 
 cable disease, removal of. 
 
 Cars: for transportation of garbage, 
 687; railroad, disinfection of, 664. 
 
 Cat: not for food, 321. 323. 
 
 Cats : in communicable disease. 462. 
 
IXDEX. 
 
 953 
 
 Catsup, 336. 
 
 Cattle. See Dairy, farms; Animals; 
 Cows; keeping of in cities, 171. 
 
 Cattle Commissioners: appointment and 
 duties. 77" >. 
 
 Cause of death: how reported. 65-69; 
 investigation of, 66, 67, 68. 
 
 Causes of sanitary organization: 19; 
 
 Cellars: for sleeping, 152; must be san- 
 itary. lo.'J: in tenements, 824, 825, 
 827. 
 
 Cemeteries: '■>'■>: and water supplies, 100, 
 267-268. 
 
 Cemetery committee: chairman of, on 
 hoard of health, •_'.".. 
 
 Cerebro-spinal meningitis: to be 
 ported. 139; to be placarded, 444: pri- 
 vate funeral in, 177: laboratory diag- 
 nosis of, 571. 
 
 Certificate. See Marriage; Vaccination ; 
 Plumbing: of disinfection, ~>~>'2; of 
 freedom from sickness. 937; of owner- 
 ship of tenement or lodging house, 
 949. 
 
 Cess Is: 184-186. 843. 
 
 Chamberlain process of garbage dis- 
 posal. 7U». 
 
 Chapin, \V. II.. Dr.: investigation of 
 typhoid in Springfield, 531. 
 
 ( iharters for cities, it. 
 
 chc.se. 358-361. 
 
 Chicago: method of formaldehyde disin- 
 fection, .">.*:'.•: Chicago small pox hos- 
 pital, 609-611. 
 
 Chicken Pox: to be reported, 439; t<> l>e 
 placarded, 111 : and small pox, •~><>1. 
 
 Children in infected house: isolation "t". 
 152, I 55 : institutions fur. 805; pro- 
 tection of weikin-. 804, 946, !I47. 
 
 Chloride of lime: disinfection with. 555. 
 
 Cholera: to be reported, l-">7. 844; t" l>" 
 placarded. 143; isolation of persons 
 exposed to. 456; private funeral in, 
 ITT: outbreaks of, 516; sanitary prep 
 arations for, 516; preparations in 
 Brooklyn, ."»17: preparations in New 
 York, r>17: rags from dumps nol t'> be 
 sold, 518; circulars. 518, 921; quaran 
 tine, stringency of, 518; hospitals 
 for. ~>|N: management <d'. 518; quar- 
 antine for at Canadian border, 655. 
 
 t 'hurch funeral forbidden, IT-". 
 
 ( icatris of vaccination its significance, 
 586. 
 
 Cider vinegar, 328, 329. 
 
 Cigar factories) supervision, 806. 
 
 Circulars: of information, 815; concern- 
 ing >'. lunicable disci • 186 004 ei 
 
 V- ./. ; care of infants, '■' 13, II b~> : 
 cholera, 921; consumption, 923, 924, 
 '. r_'T : disinfection, 550, 553, 554, 927, 
 929 : diphtheria, 906 ; measles, 907 
 
 scarlet fever, 905: typhoid, 911, 912; 
 vaccination, 598; whooping cough, 908. 
 
 Cities. See Munici] ia!i ties : sanitary or- 
 ganization. C>. 12-16; under general 
 laws. 20; charters for, 1~ : to establish 
 quarantine, 650, 652; quarantine es- 
 tablished by. 657. 
 
 Citizens to report communicable d 
 431. 
 
 City Councils: as boards of health, 14-HJ: 
 to appoint board of health. 14-16. 
 
 Civil service regulations, 41. 
 
 Cleanliness: prescribed, 144: of markets. 
 ::i4. 
 
 Clean outs, 236. 
 
 Cleansing: premises, 122; power of local 
 
 board. 427 ; arm for vaccination. 593. 
 
 Clergyman: license. 96; responsible for 
 violation of funeral rules. 4TT : to re- 
 port deaths. 55; to report births. 73; 
 and marriages, 81-85. 
 
 Clerk: city, on board id" health, -•"> : of 
 council, on board of health. 23. 
 
 Closure of schools for communicable dis- 
 ease. 469. 
 
 Clothes: disinfection of. 506, 509, 519, 
 55cs, 554. 
 
 Clothing: disinfection of. .">.". 1. 
 
 Codes: sanitary, IN: model. 843. 
 
 Coffee, ::::.".. 
 
 Coffin: air tighl for communicable dis- 
 eases. 472, '•>":.'. 903. 
 
 Collectors of milk samples: outfit Ol 
 
 Coloring food. 326, ."..■'«•".. 
 ( loloring matter in milk. 368. 
 Combustible materials: deposit of. 195. 
 Commissioner of health. 25; appoint- 
 ment of. 27. 
 ( ommissioners of cattle, 7T<». 
 Commissioners of quarantine, 632, 633. 
 
 Con in carrier: anil communicable dis- 
 eases. 100, ITT. 
 
 Communicable disease: case of defined, 
 135: in iiciial institutions, 606; in bak- 
 eries 319; and the milk supply, 119; 
 
 relation l<» milk business. Hi_; not to 
 
 lie imported, Ml; infected goods, 161, 
 '.in".- animals in. 162: public libraries. 
 
 162; animals in. 162; public libraries. 
 
 162 : importance of i ecording, s I". ; 
 record of cases, 190, 191, 918; card rec- 
 ord, 191; man record, 191; prevention 
 oukIiI io be taught in s.hnoi. 169; dis- 
 
 I of bodies dead ol. 170, 903 \ I'll 
 
 ii. r.ds in. it::. 194, 845, 902 : investi- 
 • iii ..f outbreaks 81 I ; form for. 920. 
 
 Communicable diseases of animals. 765 I I 
 
 845; con! rid of, 765, 77 1 : impor 
 
 tation of. 766, TTI : reports of. 766; 
 
 ins| tors io search for. T<'.T : diagnosis 
 
 of, 767; isolation of, 768; slaughter of 
 clise:is«cl animals. 768, TT'J TT.'i : com 
 
954 
 
 INDEX. 
 
 pensation for slaughtered animals, 769, 
 772-775 ; disposal of slaughtered ani- 
 mals, 769 : disinfection of premises, 
 7i"0; executive officials, 770; inspectors, 
 appointment of, 770: duties of, 7G7. 
 
 Communicable disease, control of : earliest 
 425 : statute law. 428 : local rules, 428 : 
 rules of state board of health, 428 ; 
 state control of. 425-428; local boards 
 of health to control. 427 : have quaran- 
 tine power, 427 ; may care for sick, 427 : 
 may disinfect, 427 : to report communi- 
 cable disease to state board, 427, S41. 
 897 ; extraordinary powers, 427 ; diag- 
 nosis of communicable disease, 483 ; in- 
 vestigation of, 484, 920 ; circulars con- 
 cerning, 480, 904 et seq.; police assist- 
 ance in, 480 : sanitary survey in. 487, 
 014, 915; unsanitary conditions. 487: 
 order for isolation, 913 : daily inspec- 
 tion in, 493 ; guards for, 493 : nurse as 
 guard. 493 : report of recovery, 494, 
 919 ; assistance for poor in, 487, 496 ; 
 duties of state board of health. 499; 
 duties of marine hospital service. 499. 
 See also Medical inspectors. 
 
 Communicable disease, exposure to : iso- 
 lation after, 452 et seq., 456, 493, (545 ; 
 isolation after in smallpox, 503 : exclu- 
 sion from school after, 466, 467. 
 
 Communicable disease funerals, 473, 
 404, 9(12: carriages at, 474, 902: place 
 of, 475, 902 : funeral notice. 475 : in 
 what diseases to be private, 477, '.102; 
 disinterment of bodies, 104 ; inspectors, 
 494 : disinfection of draperies. 476. 
 
 < 'onununic able disease hospitals : author- 
 ity to construct, 602 ; required, 604 ; 
 location for, 605, 608, 617 : forcible 
 removal to, 605 ; removal of infected 
 persons, 606: removal of patient to, 
 precautions, 519 ; removal of smallpox 
 to. 502 ; removal of yellow fever to, 
 508: diseases which require, 607; cities 
 without, 007, 612 ; cities with. 608, 616, 
 618 ; for scarlet fever and diphtheria, 
 612, 615; board of patients at private 
 hospitals, 615 ; private hospitals. 615. 
 til7: rules for, 010; cost of mainte- 
 nance, 616 ; for smallpox, 504 : for tu- 
 berculosis, 522-525; at Boston, 619; 
 Brookline, Mass.. 021; Cambridge, 
 Mass.. 627: Lynn, Mass., c>28; Pater- 
 son, 624, 625; Portland, Me.. 618; 
 Providence, 022. 023 ; Syracuse. 627 ; 
 Trenton. 626; Worcester, 020; commu- 
 nicable disease in general hospital, 615. 
 
 Commuuicable disease, isolation of: state 
 laws, 448; duty of local board. 427- 
 429; responsibility for, 4 IS. 450, 454; 
 guarding premises. 44S. 606; no dis- 
 ease in public place or conveyance, 448,. 
 
 454 ; local regulations, 449, 450 ; ab- 
 solute isolation, 449, 450, 452 ; in one 
 room, 450, 451 ; in a house, 451 ; on 
 premises, 452 ; of family, 452 et seq, : 
 wage earners, 452, 453, 899, 900; 
 teachers, 453 ; visits to infected house 
 forbidden. 454; nurse, 454, 455; physi- 
 cian, 454 ; other families in the house, 
 455 ; persons exposed to disease, 456, 
 645; duration of, 456 et seq.; decided 
 by health officer, 456 ; by physician, 
 457 ; fixed by law, 456 ; enforcement of 
 rules, 492 : after death of patient, 459 ; 
 during incubation, 456 ; „of smallpox at 
 home, 501, 503; yellow fever at home, 
 508 ; orders for to be left at house, 486, 
 913 ; duration of determined by medical 
 inspector, 492 ; placards, 427, 442 et 
 svq. See Placards. 
 
 Communicable disease, removal of, 448, 
 459, 477 : responsibility for, 448. 460 ; 
 to hospital, 502, 508, 519, 605, 606 ; in 
 public conveyance, 448, 454, 461, 477, 
 844 ; removal of bodies dead of, 903 ; 
 removal of well persons from infected 
 house. 4<'p.">; carried in general ambu- 
 lance, 628 ; removal of infected goods, 
 461. 903. 
 
 Communicable disease, reports of: earliest 
 laws. 429; state laws, 430; persons re- 
 quired to report, 430-433. 844 ; to whom 
 made, 433 ; how made 434 ; time for 
 making, 434 ; suspected cases to be re- 
 ported, 435 : exposed persons to be re- 
 ported, 435 ; subsequent cases reported, 
 435 ; diseases to be reported, 436 et 
 seq. : to be in writing, 440 ; forms, 440, 
 893-896; payment for reports, 440; 
 false reports, 441 ; reports to state 
 board of health, 441, 896; penalty for 
 not reporting, 442. 
 
 Communicable disease and school attend- 
 ance, 463 et seq. ; rules for, 463 ; per- 
 sons excluded, 464 ; permits for attend- 
 ance, 465, 901. 919 ; schools included, 
 467 ; duration of exclusion, 467 : teach- 
 ers to exclude communicable disease, 
 466, 467; rules to be posted in schools, 
 469; closure of schools, 469; exclusion 
 of teachers, parents and janitors, 404 ; 
 responsibility for exclusion, 466; of ex- 
 posed persons, 466, 467 ; notices to be 
 sent, 488, 489, 913, 916, 917: orders 
 for exclusion, 486; permits for return, 
 468. 001. 019. See also Bodies dead 
 of : Animals ; Disinfection ; Hospitals ; 
 Placards: Quarantine. 
 
 Complaints of food by citizens, 324. 
 
 Composition of garbage, 702. 
 
 Compound cheese, 358; flour, 331; lard, 
 336. 
 
 Compulsory vaccination. 579. 
 
INDEX. 
 
 955 
 
 Condemnation of food, o47. 
 
 Condensed milk. .".".">. 
 
 Conductors: duties at quarantine, 651, 
 653; to report communicable disease, 
 432. 
 
 Confectioners: National Association of. 
 334. 
 
 Connection with the sewer required, 189- 
 192, 843. 
 
 Consumption: in bakeries, 319; in mar- 
 kets ami bakeries, 522 : to be excluded 
 from school. 4<*>4 : circular concerning, 
 923, '• | -4. uiiT: report of examination 
 of sputum, 931, 932; record of cases 
 and deaths. 928. See also Tuberoulo- 
 sis. 
 
 Contract : for garbage collection, 688; for 
 sale of forbidden foods, 354. 
 
 Conveyance, public: communicable dis- 
 ease in, 44s. 460, 477: disinfection of. 
 460. 
 
 Copies of records of births, marriages 
 
 and deaths, 93. 
 
 Copperas t"<>r disinfection, 554. 
 
 Correction <>t' records of births, marriages 
 and deaths. 92. 
 
 Cosr of garbage disposal. See Garbage 
 disposal. 
 
 ( lottage hospitals, 616. 
 
 Council of cities: appoints hoard of 
 health. .17. 
 
 Council of towns and cities and nui- 
 sances, 110, 111. 
 
 Council: president of, on hoard of health. 
 
 < 'olllisel. See Attorney. 
 
 County and township: relative import- 
 ance, 'i, 10. 
 
 County hoards under general laws. 20. 
 
 County commissioners: as boards of 
 health. 7. 
 
 Countj sanitary organization, 6 l". 
 
 Cows. See Dairy farms; Cattle; garbage 
 
 for, 699: distillery slop for, .:7i>: 
 
 stables, 115; stabling of, L71, 369; 
 
 feeding of, 369; inspection of, l"i ei 
 
 : tagging of, 104 ; t aberculim 
 
 of, in 1 ■ l"7 : i ber oermil ted in cit ies, 
 
 HO; space prescribed for, 1 !»'. : gr n 
 
 niir of, 1 16 : water for, I L6 ; udders, 
 washing of, H6 ; milk from diseased, 
 369. 
 
 Crabs ".17. 
 im, •■'•7.">. 
 
 ( 'r.-ini of tartar. .;."..".. 
 
 < 'reameries : law to protect, 860. 
 
 Cremation: of dead animals. 762 : of an 
 male killed for communicable di 
 769; of night toil, 755, 7.">7 : of the 
 d< ad, 63, 104 ; ol 3ee G 
 
 bj cremation. 
 
 Cremators : for mixed refuse, 711. 
 
 Crew of vessels at quarantine : treat- 
 ment of, 645. 
 
 Crop: removal from poultry. 312. 
 
 Croup: to be reported, 437, S44 : to be 
 placarded, 443, 446; private funeral in, 
 477. 
 
 < Juban fishermen, i*>41. 
 
 Culture method of diagnosis, 559-568. 
 See Diphtheria; outfits for diphtheria. 
 559; directions for use 565; form for 
 physician's report of case. 564, 565, 
 929; outtits how distributed. ."<;.">: 
 method of collecting, 566, 567; report 
 of examination, 930, 93] : culture re- 
 quired after recovery, 458; from all 
 members of the family. 159; for re- 
 moval of well children from infected 
 house, 465 : for school attendance, 465; 
 in suspected diphtheria, interpretation 
 of, 483; to be taken by medical inspec- 
 tor, 188; for termination of isolation. 
 495; taken by school inspectors, 785. 
 
 Custody of records of births, marriages 
 
 and deaths, '.i^. 
 Customs officials at quarantine. ti.",7. 
 
 D.uuv commission, 383, 400. 
 
 Dairy farms: control of, 384, 400 ei seq.; 
 
 inspection and license of, 379, I'M. 102, 
 103, 11": inspected by veterinarian. 
 103; tuberculin test. 104-407; volun- 
 tary tuberculin test, 107.; frequency of 
 inspection, 408; results of inspection, 
 109, 110; cities which practice, 411; 
 
 reports of inspection. 891, *'■>'+: list of 
 farms to be kepi by dealers. 382. 
 Dairy rules: of department of agricul- 
 ture, 412; in certain cities. 414; of the 
 
 Illinois stati' board of health. 111. Il">; 
 
 of Massachusetts Association of Boards 
 of Health. U7, 119. 
 Day nurseries: notified of communicable 
 
 disease. 190. 
 
 Dead animals. T« "■< ► >i acq.; to be reported, 
 761; rules for disposal of, 761, 762; 
 disposal of small animals. 7i><>: burial 
 required, 762; cremation of, 7'Vj : ren- 
 dering of, 762; iu garbage, 667; cost of 
 removal, 760; vehicles for, 763; food 
 
 from. 311. 
 
 I »• ad borse wagons, 763. 
 
 Death: cause of, how reported, 65-69; in- 
 \ esl igal Ion of, 66, ,- '7. i 
 
 Deaths: enumeration of, 5 I ; returns of, 
 how obtained, 54-63; bj physicians 55, 
 .".7: by clergj n, 55; by head of fam 
 
 lly, 55; b.V pole., 68; bj undertaker. 
 
 50; register of bj physicians, 57; of 
 noil ' ime limit, 57 ; 
 
 items required, 68-71; forms for re- 
 turns, 845, 846, v -"'i 
 
 on of court : in regard to abatement 
 
956 
 
 INDEX. 
 
 of nuisance, 122 ; on payments for re- 
 ports of communicable diseases, 440 ; 
 on payment for damage by disinfection, 
 r>28 ; in regard to filling low land, 196, 
 107 : in regard to use of lactometer, 
 389 : in regard to the inspection of 
 milch cows, 401 ; in regard to removing 
 privy vaults, 190, 191 ; concerning 
 quarantine of railroad trains, 656; in 
 regard to separator milk, 374 ; in re- 
 gard to smoke laws. 213-218; invali- 
 dating rule prescribing stable floors. 
 163 : power of state board of health to 
 make rules, 43, 428 ; concerning vac- 
 cination, 575, 57*;. 
 
 Delegation of powers, 47. 
 
 bensity of population and sanitation, 1. 
 
 Department of agriculture, 338. 
 
 Desquamation, isolation during, in small- 
 pox and scarlet fever. 457. 
 
 Destruction : of goods in disinfection, 
 528; of unsanitary buildings, 140. 
 
 Detention camps in inland quarantine, 
 061. 
 
 Diagnosis of communicable disease. 483 ; 
 in animals. 757. 
 
 Diagnosticians : official, 481, 485. 
 
 Diphtheria: to be reported. 437, 844; to 
 oe placarded, 443, 446 ; isolation of 
 family in, 4.">2. 453 ; isolation of per- 
 sons exposed to, 456 ; duration of isola- 
 tion. 457 : private funeral in, 477 ; to 
 be excluded from school. 404. 465; dis- 
 putes concerning diagnosis. 483 ; circu- 
 lar, 906 ; culture method of diagnosis, 
 559; outfits for culture. 559 et seq.; 
 directions with outfit, 565 : smear ex- 
 aminations. 507 : records of bacterio- 
 logical examinations. 567. 
 
 Diphtheria bacilli: meaning of. 483; iso- 
 lation while present. 457. 
 
 Diphtheria hospitals. 612. 615. 
 
 Diphtheria outbreaks : 514 ; results of, 
 514 ; closure of schools, 515 ; inspection 
 of schools, 515 ; culture, systematic use 
 of, 515: diphtheria in institutions, ."(15. 
 
 Directions for the care of vaccination, 
 
 ..JO. 
 
 Disinfectants : given to the householder, 
 549. 
 
 disinfection: 52S et seq. ; authority for, 
 427 ; power to make rules for. 429 ; dur- 
 ing the disease. 527 : compulsory, 526, 
 550; by householder, 528; charge for, 
 528; payment for injuries in, 528: de- 
 struction of goods in, 528 ; methods of 
 disinfection, 528 et seq.; sealing of 
 openings. 530, ~>.'!1 : circulars concern- 
 ing, 550, 553, 554, 1)27. 929; apparatus 
 loaned. 550; tests of, 546, 813; report 
 of. 928 : records of. 551 : family during 
 disinfection, .V>:t: by burning, 506, 509, 
 
 529 ; with electrozone. 554 : with carbo- 
 late of lime. 554 ; with copperas, 554 ; 
 with bichloride of mercury. 507, 509, 
 513, 539, 540, 546, 548. 553; by wash- 
 ing woodwork, etc., 513, 519, 548 ; in 
 smallpox, 506 ; in tuberculosis, 522 ; in 
 yellow fever, 509, 555 ; by asphalt fur- 
 nace. 509, 555; by chloride of lime. 
 555 ; of ambulance. 629 ; of funeral 
 draperies, 476 : of bodies dead of 
 communicable disease, 470 ; of room 
 after death. 471 ; of undertaker, 471 ; 
 of coffin, 471 ; of carriages after funer- 
 als. 475 : of public conveyance, 460, 
 461 ; infected goods, 461 ; animals, 462 ; 
 books, 463 ; vehicles. 461, 544, 552 ; of 
 premises occupied by diseased animals, 
 770. 
 
 Disinfection at detention camp. 663 ; of 
 baggage, 663 ; of cars. 064 : of mail, 
 664. 
 
 Disinfection of vessels, 639. 648 : of oal- 
 last. 648: of baggage. 645. 646, 655. 
 657. 
 
 Disinfection with formaldehyde, ."nil. 529, 
 530 : by wood alcohol, 533 ; by genera- 
 tion of gas from formalin. 534-537 ; 
 with paraform. 538 : by spraying for- 
 malin, 539; paraform candles. 539. 
 
 Disinfection with steam. 513. 529, 540; 
 first municipal plant. 542: cities which 
 employ, 542 : apparatus described. 542- 
 548 : cost of apparatus. 546 ; portable 
 apparatus. 548: removal of goods for, 
 519. 552 ; at quarantine, 648, 656. 
 
 Disinfection with sulphur, 506, 509, 513, 
 519, 528, 529; sulphur candles. 530; 
 chamber for in the District of Colum- 
 bia, 544 ; at quarantine, 648, 656. 
 
 J Hsinfection of vaults, 509, 554 ; yards. 
 509, 554; gutters, 554; streets, 554; of 
 garbage vehicles. 686 : of night soil, 
 753. 
 
 1 >isinfectors : number and salary. 550 : 
 duties, 551-553; precautions taken, 
 553; report by, 928; to remove pla- 
 card, 496. 
 
 Disinterment, ll >4. 130; permit for, 868; 
 application for permit. 867. 
 
 Disposal of garbage. See Garbage. 
 
 Disposal of the dead, 99-104. 
 
 Distillery slop for cows, 370. 
 
 1 >ixon garbage crematory, 718-723. 
 
 Documents, municipal: size of, 817. 
 
 Dogs : not for food, 321 : in communicable 
 disease. 4H2 ; rabies in. 770: muzzling 
 of. 777. 
 
 Drain: house drain, 149. 150, 222. 226- 
 229, 843: surface drain. 240: subsoil 
 drain. 250. 
 
 Drugs: adulteration of, 3ns. 325, 327. 
 
 Drug stores: culture outfits kept at, 565. 
 
IXUEX. 
 
 '.'•-.7 
 
 Dry refuse, ~'1~ el seq.; definition, 727- 
 7:J'.>: from building operations, 7l"*> : 
 from steam boilers, 728; from manu- 
 factories, 728; ira rcl.-ii refuse, 7"Js ; to 
 he put on streets, T'js : weight of. 7'_".>: 
 collected separately from ashes, 729; 
 receptacles for. 7:'.i»: locution of. 730; 
 hours for removal. T."!1 : frequencj ■• 
 removal, 7:'.l : collection of. 728, 7-"..'; : 
 department whicu collects. 733; amount 
 collected in various cities. ~'.'A : ... 
 collection in various cities. 7.'!4 : ve- 
 hicles for collection, 731, 732; disposal 
 of. 733-738; l>.\ deposit in water, 7 ■".."> ; 
 for filling low land. 7:!7 : by cremation 
 of. 737 : transportation by scows, 736. 
 
 Dumping: of garbage, 698, 699; ashes 
 ami dry refuse, 7:'.-".: mixed refuse. 7 In ; 
 night soil. 755, 7.~»i'>. 
 
 Dumping grounds, 193; at Borne, 193; 
 utilization of junk on. 7">7. 741. 
 
 lunation of isolation. 452, 156, I'-'::. 503, 
 645 : of exclusion from school. 4<17. 
 
 Durgin, Dr. 8. II.: and medical inspec- 
 tion <d" schools, 784 : long service of. 31. 
 
 Dust: trades which produce, 211. 
 
 Dusty materials: to In- covered when car- 
 ried in the Street. [46. 
 
 Duties of officials. See Health Officer; 
 Inst tors. .•!■•. 
 
 Dyer, Dr. Isadore: on venereal diseases, 
 526. 
 
 Dysenterj in "epidemic" form to he re- 
 ported. 139. 
 
 Earliest: hoard of health. 22; control of 
 communicable disease. 125; food law. 
 308; quarantine, 630, 649; registra 
 tii.n. 52. 
 
 Early sanitation, 1. 
 
 Earth closets, 182 1. 
 
 Eas1 I'to\ idence Biter, 'JV>. 
 
 Education of sanitary officials, II. 
 
 ! J. st i:uics. 334, 336. 
 
 Election of hoard of health. 16, 26. 
 
 Klect in/one lor disinfect inn. 554. 
 
 Einbalmer's license, 90. 
 
 Embalming, I'M. 
 
 Engineer on hoard of health. 15, 23, 29. 
 
 Engh ■ rematorj . 715-718. 
 
 Entrance of premises: power of food in- 
 
 '■'. to : health officials, 12 : medi 
 
 cal ins|i. . !•.: 185 : milk inspe< 
 S 3 : nuisance inspectors, I 12. 
 
 Enu ration of deaths. 54; births, 71: 
 
 marriages, 84. 
 
 198 : e\i raordinary nowers in. 
 duties of itate board of health. 
 i: ''. i ; duties of federal government 199 
 
 llpox, '•'"> . yellow fever, 501 
 phoid (<■■>> ■"■I" typhus fever, 512; 
 let !'• ver and diphtheria, oil. 
 
 cholera. 516; the cause of sanitary or- 
 ganization, 19. 
 
 Erysipelas: to he reported, 439. 
 
 Examination of plumbers, 253-256 : rules 
 for. 255 : gas titters. Mil. 
 
 Exclusion from school in communicable 
 disease. See Communicable disease 
 and school attendance. 
 
 Excursions for sick children. 804. 
 
 Executive functions of the health depart- 
 ment, J I. 32. 
 
 Ex-oflicio hoards of health. ^:! : county. 
 7 : township, 1 1 : cities. 14- Hi. 
 
 Expenses of the health department. See 
 Finances. 
 
 Extraordinary powers of health officials 
 in epidemics, 4'J7. 198 
 
 False representation in regard to food. 
 323, 326. 
 
 false returns of births, marriages and 
 deaths. 85. 
 
 Family : isolation of, 152. 
 
 Federal quarantine established, 630. 
 
 Fee for garbage license. 693; for milk 
 license. 380, 381 : for night soil license. 
 743; quarantine, 639, 648; for plumb- 
 er's license. 256; for reports of com- 
 municable disease. -I l'i: for vaccina- 
 tion. 591 : for registrati >f vital rec- 
 ords. 97-99. 
 
 Fertilizer made from night soil, 755. 
 
 Fert ilizers : sale of, 209. 
 
 rrertilizing ingredients in garbage, 702. 
 
 Filth and disease. 108. 
 
 Filth: removal of, 122: prohibitions in 
 regard to, 1(1 >' seq.; on private prem- 
 ises, 144, 1 to : not to be placed in 
 streets. 1 to. 1 16; filthy water in streets. 
 145-147; filth in water, 265 267, 843, 
 869; in rivers. 298-300, 869. 
 
 Filthy shores. 192. 
 
 Filtration investigation in Massachusetts 
 and in certain cities, 812. 
 
 Fill rat ion of water: natural or sand. '_'7<'> : 
 at Poughkeepsie, Lawrence, Albany, 
 280 : mechanical, 282. 
 
 Finance committee: chairroi n hoard 
 
 of health. •_•::. 
 
 Finances of health depart in. 818-822. 
 
 Fire department: chief of, on hoard of 
 health, 23. 
 
 Firemen: rules for. See Smoke. 
 
 Fish: cleaning in ttreets forbidden, 146; 
 markets for. 315; peddlers of, 317; 
 
 ■ale of, •"• 17 : -plead on land. 209. 
 
 Fish r -.ewers. :v2'2. 
 
 Fit less of officials, 1 1. 
 Flies ; to he kept from food. 318. 
 Flour. 309, -17. 322, 331. 
 
 Flush vaults. ITs 
 
958 
 
 INDEX. 
 
 Food. See Communicable diseases of 
 animals ; defined, 327 ; adulteration of 
 an economic question, 307 ; laws. 80S. 
 324 et seq.; adulteration in Massachu- 
 setts. 341 : coloring of food. 326, 333 ; 
 poison in. 32G, 333 ; mixtures and com- 
 pound. 326 ; mis-branding. 323, 326. 
 
 Food commissioners,".:^). 
 
 Food : diseased, 309 ; control of by health 
 department. 307 ; danger in impure, 
 306; animals used for must be bled, 
 cleaned and cooled. 311 ; exposure to 
 dust. 317: from dead animals, 311; 
 from emaciated animals, 311 ; from im- 
 mature animals, 313, 844 : from over 
 heated and feverish animals, 310 : from 
 pregnant animals. 811: from wounded 
 animals. 810; packages for to be 
 clean, 81S: protection from flies. 318; 
 sale of impure and adulterated. 341) : as 
 a gift. 840: possession of, 350; taking- 
 orders for. 350 : unwholesome, impure, 
 tainted, unhealthy, 808 ct seq., 844. 
 
 Food inspection: federal, 338; state, 339; 
 local. 341. 
 
 Food, inspectors : duties of, 340 : as milk 
 inspectors, 342 ; other officials acting 
 as. 842 : market inspectors. 842 : live 
 stock, grocery, provision inspectors, 
 343 : number and salary of, 344 : power 
 lo enter premises, 345; at the railroads, 
 347 : records and reports. 348 ; analyses 
 of food, 340 ; seizure of food. 314, 316, 
 847. 351-353 ; of milk. 377 : samples of 
 food, 340; power to take, 845, .".40 : 
 seizure of food, 314. 316, 347, 351-353. 
 885. 
 
 Food laws: liability in, 84S et seq.; pen- 
 alties for, 351. 
 
 Formaldehyde: disinfection with. 529, 
 558; at quarantine, 648. See also Dis- 
 infection. 
 
 Formalin : strength of. 534 : for generat- 
 ing gas for disinfection, 534 : amount 
 required. 537 ; for spraying, 539. 
 
 Forms : undertaker's report of deaths, 
 846; burial permit. 847-849: transit 
 permit. 850; certificate of death, 851- 
 855; birth return. 856; completing re- 
 turn of birth, 857; return of still birth. 
 858; marriage license and return. 859- 
 862; records of births, marriages and 
 deaths, 863-865 : returns of births, mar- 
 riages and deaths to state registrar, 
 866-867; disinterment permit, S69 ; ap- 
 plication for, 867 ; complaint of nui- 
 sance, 871 : report of nuisance. 871 ; 
 report of sanitary inspection. 872-875 ; 
 order to abate nuisance 875-878; or- 
 der for vacation of premises, 879 ; or- 
 der for connection with sewer, S79 ; ap- 
 plication for plumbing permit, 8S0 ; for 
 
 plans of plumbing, 881-884 ; certificate of 
 plumbing, 885 ; certificate of condemna- 
 tion of provisions, 885 ; certificate of 
 analysis of food, 341 ; food inspec- 
 tor's report, 348 : milk inspector's rec- 
 ord books, 391 : index cards for same, 
 394, 395 ; inspector's reports, 396 : no- 
 tice to dealer having poor milk, 398 ; 
 index card milk producers. 402 ; appli- 
 cation for milk license, S80. S87, 888; 
 milk license, 88S-S89 : for record of 
 milk inspection, 889 ; warning to milk 
 dealers, 890 : report of inspection of 
 dairy farm, 891, 892: index card for 
 dairy farm inspection, 403: index cards 
 for inspection of cows, 404, 405 : for 
 reports of communicable disease, 440, 
 893-896 ; to state board of health. 896. 
 897 ; recovery from, 919 : records of 
 communicable disease, 918, 920, 928, 
 930; placards. 898, 899; order forbid- 
 ding school attendance. 913. 916. 917: 
 permits for attendance, 901, 919; or- 
 der for isolation, 913 : exclusion of 
 wage earner from work. 899; permits 
 for work, 900; report of inspection in 
 communicable disease, nil. 915; report 
 of disinfector, 928 : directions for diph- 
 theria cultures, 564 : physicians' re- 
 ports of cases, 564, 565, 929; reports 
 of examination of cultures, 568, 930, 
 931 : used in connection with the exami- 
 nation of sputum. 569 : used in connec- 
 tion with Widal test, 569, 571, 931* 
 932; report of sputum examination, 
 
 931, 932: vaccination certificate, 586, 
 
 932, 934; reports of vaccinations, 933; 
 application for antitoxin, 599, 935; re- 
 port of use of, 600. 936 ; record of, 936 ; 
 of master's statement at quarantine, 
 643: certificate of pratique, 645; state- 
 ment of passenger at quarantine, 644 ; 
 land traveller's statement, 987 ; certifi- 
 cate. 937; train inspection card. 654; 
 application for night soil license. 939 : 
 permits for cleaning vaults. 940-1)42; 
 school house inspection, 7S3 ; report of 
 medical inspector of schools, 785, 943 : 
 directions for treatment of pediculosis 
 7S0 ; permit for child to work, 946; ap- 
 plication for, 941; tenement inspection, 
 830, 890 ; registration of lodgers, 833 ; 
 inspection of lodging house. 834 ; re- 
 port of local board of health to state 
 board of health, 841 ; certificate of 
 ownership of tenement or lodging 
 house, 949. 
 
 Forum: article on lodging hous?s, 834. 
 Fowls. 171. 
 
 Freight : quarantine of, 658. 
 Fresh air inlet : for furnaces, 153 ; for 
 plumbing, 241. 
 
INDEX. 
 
 959 
 
 Fresh air societies notified of communi- 
 cable disease, 490. 
 
 Fries Bros. : formaldehyde generator, 536, 
 
 Fruit. 321. 
 
 Fruit jellv, 335. 
 
 Fruit trade: control of, 646. 
 
 Fuller: report on mechanical filter, 285. 
 
 Funerals. See Communicable disease fu- 
 nerals. 
 
 Furnace: disinfection by asphalt furnace, 
 509, 555; fresh air inlets for, 1.53. 
 
 Game, 309. 
 
 Garbage: definition of, 665, 666; what is 
 included in, 666 et seq.j data concern- 
 ing, should l»' carefully prepared, 812; 
 Eleriug's report on, 665; in markets. 
 315; composition of, 7< »i! : junk con- 
 tained in. Tn2 : value of, 101 ei seq.j 
 fertilizing ingredients, T< »'J : water in, 
 702; weight of cubic yard, 667, 702. 
 
 Garbage, collection of, 688 ci seq.j sepa- 
 rate collection, 669; notice concerning, 
 938; collection by contract, 688; by 
 municipal employes, 689; department 
 ecting, 74ii: license for, 692; rules 
 for, 692; Fee for license, 693; cost of 
 collection in various cities, 695;,cos1 of 
 private collection, 694; amount col- 
 lected in various cities. 695; per capita. 
 7<i.", ; buildings from which it is col- 
 lected, 668; hotel collection, 668; mar- 
 kets, collection, 668; frequency <>J' re- 
 moval, 676-678; hums for removal, 
 678. 
 
 Garbage, disposal of, 697 et seq.j on the 
 premises, 691, 6U7; by feeding to ani- 
 mals. 699; i" cows, :'.7n : by feeding to 
 e, 701 : profit in, 7<H ; by dumping 
 mi land, 698; dumping in water. 699; 
 i fertilizer, 698; by ploughing in, 
 l..\ sale of, T» » 1 ; 1>.\ cr< mat ion, 71 I 
 n seq.; [deal furnace, 7'_'7 : 1. ester fur- 
 • 7'J7 : McKay furnace, 7l'7 : Rider 
 furnace, 726; Risley furnace, 7"_'7 . 
 Brown furnace, 726; Brownlee fur- 
 nace, 726; burning In open air, 714; 
 ■ .a furnace, 7l v 7i'.':: Engle fur- 
 7 1"' 718; Smith furnace, 7*_"J 7 '_'."> : 
 Vivartos furnace, i27; bj reduction 
 processes, 7ni ci seq.j American lie 
 duction Company's process, 7K'. : Ar- 
 nold process, 708; Chamberlain pro- 
 7 1" Holt haua process, 711, 712; 
 Merz process. 703, 7i»."> : at Paterson, 
 714; at New Bedford, 714; Bimonin 
 700, 707; at Utica, Til. 
 Garbage disposal, cost of: I" dumping, 
 (KMJ; b} ploughing in, 699; i>> dumping 
 
 in 899; bj f linu to swine, 
 
 7"l : l>.\ Merz process, 706; bj Bimonin 
 i.i ... rCt bj Arnold process, 7i»'.' . 
 
 by Chamberlain process, 7M: by Holt- 
 haus process, 7VJ: by American Re- 
 duction Company's process, 714: by 
 burning in open air, 715; by cremation 
 in Bngle furnace. 71<'>. 718; in Dixon 
 furnace. 720, ~i-2 : in Smith furnace. 
 726; in Rider furnace. 7"_'f> : in Brown- 
 lee furnace 726; in Meal furnace. 7U7 : 
 in McKay furnace, 7"J7 : in Lester fur- 
 nace, 7l'7 : in Risley furnace, TUT. 
 
 Garbage, receptacles: 670; covers, * "> T 1 : 
 handles. 671; size. 671; material. t>7"-! : 
 enforcement of rules. 672 : wooden re- 
 ceptacles. 672; care of, 673; garbage to 
 be kept in, »;7.". : location of, <*>74 ; in 
 tish markets, 681. 
 
 Garbage, vehicles for removal : use of bar- 
 rels. 680; size of, 683; care of on 
 streets. 684; movable bodies, 684; 
 marks upon. 686; owned by the city, 
 686; regulations, 678; to be water 
 tight, 679; covers. 679; cost of, *>7'.». 
 681, 682, 683, 684; number of horses. 
 <i7'.»: number of men. 679; cleansing of, 
 686; disinfection of, 686; garbage not 
 to be carried in milk wagon, 416; 
 transportation by ear. 687; transporta- 
 t ion by scows. 687. 
 
 Garbage urease. See Grease. 
 
 Garbage and ashes. See Mixed refuse. 
 
 Gas : not to be turned off, 153. 
 
 < las fitting : regulal ion of, 801. 
 Gas works. Jim. 
 
 General hospitals: communicable disease 
 
 in. 615. 
 General laws for sanitary organization, 
 
 19. 
 Generators for formaldehyde, 532. 
 Geneste Herscher i\- Co.'s formaldehyde 
 
 gi aerator, 539. 
 German measles: to be reported, 1 •">'•' ; t<> 
 
 lie excluded from school. 16 I. 
 
 Getty, Dr. S. E. : milk distribution at 
 
 Vollkers. 122. 
 
 < llanders : com rol 
 
 diagnosis of, ~'7l! 
 Glycerinized virus. 
 Goats, 17'_'. 
 Governor: appointment of board of health 
 
 by, I. 5, 26; maj declare Quarantine, 
 
 634 
 Grain 332 
 
 ( I rave, regulat i<m of, 102. 
 i Iraj . Mr. : long Ben ice of, '■'< 1. 
 Grease, bones, etc.; rules for removal. 
 
 757 759 
 Urease from garbage, 702, 7".".. 7m. 709 
 
 712, 713. 
 
 < ; mini: of cow s. 1 III. 
 
 kI water: record of height, Aslmrv 
 
 Park, 815. 
 
 of, 776; laboratory 
 io lie reported, i W. 
 
 S. .• Vaccine virus. 
 
960 
 
 INDEX. 
 
 Guards for communicable disease, 493, 
 
 606; for inland quarantine, 660. 
 Gutters. See Streets. 
 
 Halibut, 323. 
 
 Harrisburg smallpox hospital, 014. 
 
 Health commissioner. 14-10. 25; on board 
 of health, 23. See also Health Officer. 
 
 Health department : expenses of. See 
 Finances. 
 
 Health inspector on board of health, 23. 
 
 Health officer : appointment of, 4, 5, 34 : 
 in counties. 4, 8, 9 ; in cities, 14-16 ; in 
 townships, 11; required, 34: compensa- 
 tion, 35 ; duties of, 33, 37, 846 ; educa- 
 tion of, 41 ; fitness of. 35, 41 ; fine for 
 failures, 40 ; legislative power, 43 ; ob- 
 struction of. 41 ; other titles, 34 ; term 
 of office. 35 ; and communicable dis- 
 eases, 481 : to post placards. 445 : to 
 fix duration of isolation. 4.17. 459 ; to 
 remove persons to hospital. 606; and 
 nuisances. 111, 112. 
 
 Health officer of port on board of health, 
 2::. 
 
 Heating and ventilation of schoolhouses, 
 
 781. 
 Herds. See Dairy farms. 
 Ilering, Rudolph: report on garbage, 065. 
 Ilolthau's process of garbage disposal, 
 
 711. 712. 
 Honey. 330, 331. 
 Horlbeck, Dr. : long service, 31. 
 Horse for ambulance, 030. 
 Horse meat, 323. 
 tiospital : general, managed by board of 
 
 health, sue,. 810; communicable disease 
 
 in. 615. 
 Hotel garbage: collection of, 668. 
 Hotels : sale of food in, 320, 350. 
 Hours of service for health officials. 39. 
 House : isolation of inmates, 455. 
 House to house inspection. 132 : in small- 
 pox, 501 ; house to house vaccination, 
 
 590. 
 Householder: to disinfect. 528; to report 
 
 communicable disease. 431. 432 : deaths. 
 
 50 ; births. 72. 
 Humanized virus. See Vaccine virus. 
 Hides: dealing in. 208-9. 
 Hydrants, 151. 
 Hydrophobia: to be reported. 439. See 
 
 also Rabies. 
 
 Ice: examination of, 296; how cut from 
 public water supply, 207 : no driving on 
 ice on water supply. 207 ; pollution of. 
 292; laws regulating the sale of. 293- 
 295; license of dealers. 294; in milk 
 wagons, 418; undertakers not to place 
 in street. 104. 
 
 [ce l.oxes, 318. 
 
 Ideal garbage crematory, 727. 
 
 Immature animals food from, 313, 844. 
 
 Immigrants: vaccination of, 573. 639, 
 044. 
 
 Incubation of communicable disease. 450 ; 
 isolation during, 450. 
 
 Independent boards of health, 23 ; in 
 counties, 8 : in townships, cities. 14-16. 
 
 Index for vital records, 91. 
 
 Infants : boarding houses for, 802 ; cir- 
 cular on care of, 943, 945. 
 
 Infected goods, 401, 902. 
 
 Infected milk, 399. 
 
 Infected persons, removal to- hospital. 006. 
 
 Influenza : laboratory diagnosis of, 572. 
 
 Ink for records, 90. 
 
 Inspection. See Milk ; Plumbing ; Medi- 
 cal inspectors ; Communicable diseases ; 
 Nuisances. 
 
 Inspection : authority to enter premises, 
 42. 112. 345, 385. 485; obstruction of 
 officers, 42, 113 ; house to house inspec- 
 tion, 132 : reports of, 872-875 ; of cigar 
 factories, 800; of dairies, 379; of i<-e, 
 200; of kerosene, 807; of laundries. 
 807; of lodging houses, 831-834; of 
 schoolhouses. 7S1 et seq. ; of sponge 
 fleet, 041 ; of slaughtering, 346, 347 ; of 
 tenement houses. 825, 826, 830, 831; 
 of trains, 051. 653, 05'.). 663; of vessels 
 at quarantine, 038, 641, 042; of water 
 shed. 271. 
 
 Inspectors: impersonation of. 113: ob- 
 struction of. 113; authority to enter 
 premises. 42. 112. 345, 385. 485; of fu- 
 nerals. 494; live stock inspectors. .".4.'!; 
 medical. See Medical insnectors. 481 ; 
 of milk, 383 : of night soil scavenging, 
 750; of nuisances. See Sanitary in- 
 spectors, 126-130 ; of plumbing. 2.">T : 
 of schools. 784 ; duties of, 784, 785. 
 
 Institutions for children, 805. 
 
 Instruction in hygiene, 41. 
 
 Intermittent filtration for sewage, 301. 
 
 Investigation of communicable disease: 
 authority for, 484. 
 
 Itch : to be excluded from school, 404. 
 
 Ivory points for vaccine, 592. 
 
 Ivy: poisonous, 150. 
 
 Jail. See Penal institution. 
 
 Janitors excluded from school, 464. 
 
 Jelly, 335. 
 
 Jimson weed, 150. 
 
 Joints : in drains, soil, and waste pipes, 
 
 223 229 232. 
 .Indue: appointment of board of health 
 
 by. 10. 27. 
 Judicial functions of board of health, 47- 
 
 40. 
 Junk in garbage, 7<>2 ; in dry refuse. 737; 
 
 utilization of on dumps. 741. 
 
INDEX. 
 
 961 
 
 Junk, rags and bones: collection of, 759. 
 
 Jurisdiction of board of health: county, 
 
 8, '». 10; township, 1 12 : municipal, 18. 
 
 Kerosene: control of sale of, 807; in- 
 jection of animals killed for dis. ase 
 with. Tin; on condemned fond. :;.".:;. 
 
 Klebs-Lceffler bacillus. See Diphtheria 
 bacillus. 
 
 Knopf, Dr. S. A.: writings on tubercu- 
 losis, 520 - 1 xi </. 
 
 Knowledge: advancement of. Ml. 
 
 Kny's formaldehyde generator, 534. 
 
 Kny-Sheerer's formaldehyde generator. 
 536. 
 
 Kuhn's formaldehyde generator, 533. 
 
 Laboratories. See Bacteriological lab- 
 oratories. 
 
 Lactometer, 389; use of. 392 ; by milk 
 dealers, 399. 
 
 Lactosc-ope, 389. 
 
 Lamb: flesh or immature, 313, Ml. 
 
 Lance for vaccination, 593. 
 
 Lanciani : accounl of dumping grounds al 
 Rome, 193. 
 
 Laid. 330. 
 
 Laundrj : clothes disinfected before sent 
 to. 553 : iuspecl ion of, 807. 
 
 Lawrence filter, 280. 
 
 Lawyer on hoard of health, '_"••: as health 
 officer, I. 8. 
 
 Layman on board of health, lis. 
 
 Legislative functions of the board <>\ 
 health, 42-47: in single headed deparl 
 mcni. -1~>. 
 
 Lentz's formaldehyde generator, 530. 
 
 Leprosv : management of. 525; to be re- 
 ported, 139. 
 
 Lester garbage crematory, 7:27. 
 
 Liability of oiii.ials in discharge of duty, 
 40. 
 
 Libraries. See Public libraries; Office 
 library. 
 
 Library books. See Hooks. 
 
 Library of the health deoartment. 810. 
 
 I See Pediculosis. 
 
 License. See Marriage: for garbage col 
 lection, 092; for ice dealers, 294; for 
 milk producers, HO; for milk dealers, 
 ::7^ 382 : io !.<• posted, 382 : for night 
 soil scavengers, 7 12 : offensive trades, 
 203 204 : lor plumbers, 252 : physi 
 ciann, midwives, clergymen, under tak 
 ers. 90 : gas fitters, 801. 
 
 Lily's formaldehyde generator, 534. 
 
 Lincoln: smallpox hospital at, 008. 
 
 Liquor: in candy 334; adulteration of. 
 324, 327, 328. 
 
 Live stock inspectors, 3 13. 
 
 Lobsters, .".•J'-'. 
 
 (51 
 
 Location for communicable disease hos- 
 pital, 605, »'><>s. 617. 
 
 Lodgers : register of. 883. 
 
 Lodging houses: licenses for. 831, 832; 
 rules for. 831 : air space required, 832; 
 inspection of. 831, 834; registration of 
 lodgers, 833; in New York. Chicago 
 and Philadelphia, 834; report of in- 
 spection, 83 1. 
 
 Low land : filling of. 190, 843. 
 
 Lozenges, •"••■'>.">. 
 
 Lying-in hospitals. 802. 
 
 Lyle, Dr.: consumption hospital ai Cin- 
 cinnati. r>°.4. 
 
 MAGRl mi:. Surg. : report of smallpox in 
 
 Birmingham, 506. 
 .Mail: disinfection of. 664; bacteriological 
 
 material sent by, 556. 
 Malaria: laboratory diagnosis of, ">71 : to 
 
 he reported, 1 10. 
 
 Malt liquors, 327, 328. 
 
 Map for communicable diseases. 491, 492 ; 
 
 for tuberculosis cases. 521; locating 
 
 dairy farms, 402. 
 Maple sugar, 331. 
 Marine hospital service in epidemics, 199; 
 
 quarantine powers, <'>'■'<-. 652; yellow 
 
 (f\<-v outbreaks, control of. 660. 
 
 Ma rl.et : inspect ion of food in. 342 : 
 cleanliness id'. .".11 : control of. 316, 
 • 117. consumption in, ~>'2'2 : control of 
 food in. 353; garbage, collection of. 
 608; managed l>.\ hoard of health. 806! 
 
 Marking cheese, 360; butterine, 362; 
 ski led milk. :;7 1 : milk dealers' 
 
 wagons, 381, 382. 
 Marriages: registration by health depart 
 incut. 77: forbidden in cases of venereal 
 disease. 526; legal restrictions, minors' 
 permits. 82; certificates, 81; licenses, 
 78-81, 859-862; where required, 78; 
 
 fees for. 78; bj whom issued. . s: ; 
 
 items, 80; register of. 83; returns of, 
 77 85, 845, 859 802 ; time for 84. 
 Master of vessel: duties in quarantine, 
 035, 636, 641 : Btatemenl of. 643 : to 
 
 report ion Uicable disease. 132. 
 
 .Mayor mi hoard of health, 1 I 16, 23 : to 
 appoint board of health. U7. 
 
 McKaj garbage crematory, 7:27. 
 
 McLellan vent, 243. 
 
 Meal, 309. 
 
 Measles: to he reported, 138, 844; to he 
 placarded, I !•">. 117: duration of isola- 
 lion 159.; private funeral in. 177: cir- 
 cular. !>o7. 
 
 Mea mi ers of nighl soil, 750. 
 
 Meal cased, blown, plaited, i a ised, 
 stuffed, impure, etc., 309; meat to he 
 tagged, -'117. 
 
 Mechanical stokers, jis. 
 
962 
 
 INDEX. 
 
 Medical inspection of schools. 7*4 et seq.j 
 schools inspected. 784; salary of in- 
 spectors. 784, 787, 788 ; teachers' du- 
 ties. 784 ; by board of health, 784, 787. 
 788 : by board of education, 788 ; re- 
 sults of, 787-89. 
 
 Medical inspectors : list of, salaries, 481 : 
 duties. 482 : authority to enter prem- 
 ises. 485; no one to obstruct or assault. 
 485 : investigation of cases, 485 ; to 
 give directions, 4SG ; to put up placards, 
 488; to take cultures, 488; to vacci- 
 nate, 488; to send out notices, 488: 
 frequency of visits, 492, 493; to' ex- 
 amine patient at termination of ease 
 493; reports of. 4*7, 943. 
 
 Medical soeie.ty as board of health, 7 : 
 nominates board of health, 8, 10. 
 
 Medicine. See Drugs. 
 
 Mercury. See Bichloride of. 
 
 Merz process of garbage disposal, 703, 
 7( to. 
 
 Meters for water. 202. 
 
 Midwife's license, 96. 
 
 Milk adulteration: importance of. 366; 
 legislation, 807 et seq., 376-378 : de- 
 lined. 367-368; liability for violation 
 of law. 870 ; penalty for. 870 : seizure 
 of milk. .".77: prosecution for. 8!>7: col- 
 oring matter in. 80*: preservatives in. 
 369 : standards. .".71 ; average quality 
 of. .".71: samples, collectors of. 386; 
 outfit of. 389; samples, how taken. ."!*2. 
 393 : furnished by dealers, ."'.lit ; taken 
 by citizens. 398 : analyses of. 385 : by 
 two chemists. 398; instruments to be 
 tested. 398. 
 
 Milk : condensed. .",7.">. 
 
 Milk: inspection of. 382-397; by state 
 officials, 383; laws concerning, 8*8; 
 where made. 387, 388; record of. 889; 
 in New York City, 390-397. See Milk 
 adulteration. 
 
 Milk inspectors, 383 et seq.; appointment 
 of, 384; power to enter premises, 385; 
 duties. 385; as chemists, ."*.">: collec- 
 tors of samples for. 386; officials 
 charged with the duty. 386; number 
 and salary. 386; buggy for. 388; outfit 
 Eor samples, 389-92. See Milk adul- 
 teration. 
 
 Milk dealers' licenses. 378-382, 888, 889; 
 application for. 380, 886-888; revoca- 
 tion of. .".77: required. 378; issued by 
 state. 379; by local officials. 379; re- 
 quirements for. 379, 380; fees for. 380, 
 381; license for -producers. 410; deal- 
 ers' reports, 380; to furnish names of 
 producers, 402 : wagons, marking of. 
 .".si. 382; not to carry water. 370. 
 
 Milk, skimmed: 372; standards. 373: 
 marking. ."74. 
 
 Milk, unclean and impure. 800 et seq. ; 
 danger in, 399 : disease produced by, 
 .".'.t'.), 4(M): from diseased animal. 326, 
 369 : infected milk. 399 : cause of ty- 
 phoid in Springfield, 512. 
 
 Milk supply and communicable diseases, 
 419 : dealers' duties in, 462 ; dealers 
 notified of, 490; milk bottles and tick- 
 ets not to be left at infected house. 
 462; care of milk, 412, 417. See also 
 Dairy rules - care and use of bottles. 
 416, 417: sterilized milk vessels, 417. 
 
 Milk wagons: protection of milk in. 418; 
 ice in. 418; garbage in, 49'.. 
 
 Mills. Hiram : designer of Lawrence 
 filter. 278. 
 
 Minturn hospital. New York. 017. 
 
 Mis-branding of foods, 323, 326. 
 
 Mixed refuse. 738 et seq.; amount col- 
 lected in various cities. 740; cost of 
 collection in various cities. 740; depart- 
 ments which collect. 74o : weight of, 
 738; receptacles for, 7:!*: location of, 
 780 : frequency of collection. 739; hours 
 for collection. 789: vehicles for. 7."'.» : 
 disposal of by cremation, 741: cost of, 
 741: by dumping on land, 740; by 
 dumping in water. 741. 
 
 Model code of sanitary regulations, 4*. 
 843. 
 
 Molasses, 330. 
 
 Morrison-Jewell filter. 2*2. 
 
 Mulford's formaldehyde generator, 536. 
 
 Mumps: to bo reported, 439; to be pla- 
 carded, 444; to be excluded from 
 school. 404. 
 
 Muncie : smallpox hospital. 612-613. 
 
 Municipal boards under general laws. 2<>. 
 
 Municipal officers, appoint board of 
 health. 27. 
 
 Municipal sanitary organization, 12-17. 
 
 Municipalities. See Cities. 
 
 Mutton : blown. 812. 
 
 Muzzling dogs. 777. 
 
 NAPHTHA: garbage reduction. 708-70*. 
 Xeedles for vaccination, 593. 
 
 New Bedford: garbage disposal at. 714. 
 
 Xew York: preparations for cholera. 517; 
 typhus fever in. 1*02. 512; milk inspec- 
 tion in, 390-397; sanitary organization, 
 .",'.). 
 
 Night schools and communicable disease, 
 407. 
 
 Night soil, 742 et seq.; amount collected 
 in certain cities. 7ol : license for re- 
 moval of. 742: application for, 939; 
 by whom issued, 743 : fee for, 748 ; 
 fond for, 748: exclusive license. 740; 
 removal of. thoroughness and prompt- 
 
INDEX. 
 
 963 
 
 - required, 753; returns of work 
 done, 7.~>4. 755; rules for removal. 747: 
 price of removal tixeil by ordinance. 
 7 is : control of, 748 et s< q. : by the mu- 
 nicipality, 753 : permits for cleaning 
 vaults. 752, 7.":'.. 940-942; disinfection 
 of night soil, 7.".*!: apparatus for re- 
 moval of, 74:i : barrels. 7 H. 745; box 
 gons, 74 1 : odorless or pneumatic ap- 
 paratus, 746; pumps. 7 Hi: pitting ap- 
 paratus, 746; <are of, 717: in be ba- 
 ted, 748; transported by scow, 755; 
 disposal of, 751 : by cremation. 1T,7>. 
 7.">7 : by burial, 755; by drying, 755; 
 as a fertilizer. 755, 7.">f>. 7.">7 : deposit 
 in water, 756. 
 
 forbidden, 158; noisy animals. 
 170. 
 
 Notice "I" funerals, 47-">. 
 
 Nuisance: definition of, 108, 123, 843, 
 8G9; early control of. Ins. ion ; rela- 
 tion to public health, 108, 109; preven- 
 tion <>f. 109; complain! of, 130, 871 : 
 prohibition of, legislation, 123 </ seq.j 
 local authority concerning, 124, 125, 
 143 el scq. 
 
 Nuisances, abatement of: legislation, 109- 
 11.".: officials charged with the. duty of, 
 110, 111 : orders for, 113, 133, 875- 
 orders for preliminary bearing, 
 L15 ; service ut orders, 11*'>. 136; time 
 allowed, 115, 11'"': work of abatement, 
 lis. 137, 138; injunction not allowed. 
 119; officers required to abate, 119; 
 costs of abating, paymenl fur. 119-121; 
 bj injunction. 121; abatemenl of, by 
 state board of health, 1 1 1. r_"J. 
 
 Nuisances <>n water shed, 270. 
 
 Nuisances: inspectors of. See Sanitary 
 inspectors. 
 
 as guard for communicable dis- 
 193 : e ccepted from isolal ion 
 rules. 150; duties of. iu communicable 
 154, I"'"'. 
 
 Nursing l. ..til.-. 80J 
 
 Oaths: administering, 29, 17; power of 
 
 registrar to administer, s '.>' oath of 
 
 office, ■_".'. 
 
 noting officers, 12, I 1 '.. 
 Odorless apparatus for re v;*l of night 
 
 snil 7 W. 
 
 i\ •■ mat ten rules for i e \ al and 
 
 transportation, 717. 704 
 Offensive trades, 199; location of bj the 
 
 .iu! horit ies, umi 202 : rules for in 
 
 men I of, 202 21 I, 843 ; licenses, 203 
 
 204 forbidden, 212 _'l 1 
 Officials: subordinate, -".7: appointmcnl 
 
 ut. '■'■'■'.. '■'•'■> : c'liu .it i I. I I : tun. 
 
 1 1 protect ion of, I" 
 < »tli. • library, 81(1 
 
 Oleomargarine. Sec Butterine. 
 
 Olive oil. 336. 
 
 ophthalmia, contagious: control of. 803; 
 
 tu he excluded from school, 464. 
 Organization of board of health. :J!>. 
 < Iver-erowding. 154. 
 
 Overseer of poor on heard of health. 23. 
 
 Owatonna : diphtheria in school at, 516. 
 
 I'a< cages for food to be dean. :'.17: for 
 fruit. 321. 
 
 Paper: for records, 90; waste collection 
 of, 7"_ > :i : waste in dry refuse, utiliza- 
 tion of. 7-".7. 
 
 Paper carts, 7:'."J. 7:'..".. 
 
 Paper mills: vaccination in. 579. 
 
 Parent-: excluded from scln.nl. 404 : tu 
 control children with communicable 
 disease, 1 18, 450. 
 
 Parish hoard of health. 8. 
 
 Parke, Davis & Co.'s formaldehyde gen- 
 erator, 539. 
 
 Parochial schools and communicable dis- 
 ease. 4< >T : vaccination in. 578, 590. 
 
 Passengers: duties at quarantine, 637; 
 statement of. 64 I : treatmenl of. 6 15. 
 
 Pasteurized milk: municipal distribution, 
 420. 
 
 Paterson : garbage disposal at, 714. 
 
 Pathogenic organisms in water. I'd.;. 
 
 Pat ienl : isolal ion of. 150. 
 
 Pawtucket smallpox hospital. 603. 
 
 Paymenl for -nods destroyed in disinfec- 
 tion. 528. 
 
 Peddlers of food. 316, :;17. 320. 
 
 Pediculosis in schools: treatment of. 786. 
 
 Penal institutions-, communicable disease 
 in. 606. 
 
 Penall ies : 17 ; lor not report ing commu- 
 nicable disease. I 12 : for food laws, 
 351 ; I'm- violation of funeral rules. 
 
 177: for milk laws, 376, 377 ; for plumb- 
 ing laws. 261 : for violating quarantine, 
 639; for leaving quarantine ground, 
 638; for registration laws. 99; for dis- 
 regarding nuisance orders, 117. 137; 
 
 for nuisance laws. 1'_'.".. 
 
 Pensions, 1 1. 
 Peppermint test, 260. 
 
 I'est hollies. 007. 
 
 Philadelphia : smallpox in. 19 
 
 Phthisis. See < lonsumpt ion. 
 
 Physicians : on board of health, ll. II 16, 
 L'.' - .. 28, '-"•': license foi-. 96; physician 
 I'm- si, u poor, mis: for ambulance, 630; 
 i,, report communicable disease, 130, 
 
 t ■".'_' : excepted from isolation rule-. 150; 
 
 dui.\ of in communicable disease, 154; 
 to h\ duration of Isolation, 157, 158; 
 in e\i hide children from scl I in com- 
 municable disease, I'm to not if) health 
 department of recoverj of natient, 190, 
 
964 
 
 IXDEX. 
 
 . 494; precautions to be taken by, 519; 
 in smallpox. 503; to certify to disinfec- 
 tion, 552 : may exempt from vaccina- 
 tion, 577. 
 
 Pig : flesh of immature. 313, 844. 
 
 Pigeons. 172. 
 
 Pilots: duties of, 636, 641. 
 
 Pioscope, 389. 
 
 Pitch of drains and pipes, 22:;. 233. 
 
 Placards for communicable disease re- 
 quired, 441': in certain diseases. 443; 
 in suspected contagion. -144; responsi- 
 bility for removal. 444: where placed, 
 44."). 4.~»0 ; health officer to placard, 445 ■ 
 officers who put up, 488" how removed, 
 405; to be kept up after death. 450 ; 
 form, size and color, 44<'>. 447. 8it&, 899 : 
 how fastened. 447. 
 
 Plague: to be reported, 4::o ; placard for, 
 443. 
 
 Plan: of privy vault in Cleveland. 170; in 
 District of Columbia. 183; of valve for 
 flush vault. ISO; of plumbing to be 
 Bled, 224. 
 
 Planing mill smoke. 219. 
 
 Plumbers : license for. 252 : examination 
 of. 253-256; fee, 256; registration. 255, 
 256; publishing license, 256: bonds, 
 256. 
 
 Plumbing : not to be used until approved, 
 260; defective work, penalty. 201; cer- 
 tificate of work. 260; in old houses, 
 150-152. 251. 
 
 Plumbing inspection : department in 
 charge of. 252: application for permit. 
 880 : notification that work is ready,259 : 
 inspection to be made promptly, 259; 
 tests for plumbing. 259; certificate of 
 inspection. SS5 ; inspectors, authority 
 to appoint. 257: duties. 257; salary. 
 258; inspector on board of health, 23. 
 
 Plumbing rules: first adopted, 220; stat- 
 utes authorizing, 220-222: model codes 
 of. 222, 22.'! : applied to old plumbing, 
 251 : back aii' pipes required, 242: size 
 and direction, 24.'!; material, 244; back 
 pressure valve. 2.">0 ; bath tubs required, 
 240; boilers, 240: clean outs, 236; 
 drain, size of. 227 : material of, 222, 
 228 : joints of. 228 : surface drains, 
 240: sub-soil. 250; changes in direction. 
 Si'-',. 234 : deviation from rules permit- 
 ted. 220: exposure of plumbing. 235 ; 
 fresh air inlet. 241 ; joints, how made, 
 XVI : materials and workmanship, 220; 
 McLellan vent, 2-1.'! ; openings for pipes. 
 2o4 : overllow pipes, 245; pitch of 
 drains and pipes. 22.'!. 2.'!.'!; plans 
 to be tiled. 222-220; form for, 881- 
 884; approval of plans. 225: rain 
 water leaders. 238 ; refrigerator wastes, 
 245: safe wastes. 245; sewer connec- 
 
 tions, 222 and 226; sinks, wooden not 
 allowed. 240; soil pipe. 220 et seq.; 
 size of, 220; material. 230-232; ter- 
 mination at roof. 237; specifications 
 for plumbing, 22."> : steam not allowed 
 in sewer. 250; strainers. 240; supports 
 for pioes. 2:!4 : termination of pipes at 
 roof. 237 : trap, main, 230 ; for fixtures. 
 240: grease trap. 241; non-syphoning. 
 242. 24.'! : sanitas trap. 243 : tubs, 
 wooden not allowed. 240; urinals, 250; 
 water closets required, 240; certain 
 closets forbidden, 240: floor flanges, 
 246: ventilation of, 247:- seat ventila- 
 tion. 240 ; water closets, location of.247 ; 
 water supply for. 248; water pipe, 250; 
 waste pipe. 220 et xcq.; size of. 229; 
 material. 230-232; termination at roof, 
 237. 
 
 Pneumatic wagon for removal of night 
 soil. 74."i. 740. 
 
 Pneumonia : to be reported, 440. 
 
 Poisonous plants, 150. 
 
 Police: assistance in communicable dis- 
 ease. 486, 404; to collect culture outfits 
 for diphtheria. 565, 500. 
 
 Police commissioner on board of health. 
 
 15, 2:!. 25. 
 
 Police power. 2. 
 
 Pollution of rivers. See Rivers; Water. 
 
 Ponds: filling and draining to prevent 
 cholera. 517. 
 
 Poor: care of sick. See Sick poor. 
 
 Poor: assistance of in communicable dis- 
 ease. 4S7. 400. 
 
 Poor : overseer of on board of health. 2-".. 
 
 Poor house : managed by board of health, 
 806. 
 
 Port : health officer of. on board of health. 
 23. 
 
 Portable apparatus for steam disinfec- 
 tion. 548. 
 
 Port la ml. Me. : communicable disease hos- 
 pital, ois. 
 
 Post office: notified of communicable dis- 
 ease. 490. 
 
 Poughkeepsie filter. 280. 
 
 Poultry. 309; undrawn. 312: slaughter 
 of. 315, 316; garbage for. 700. 
 
 Pratique: when given. 044. 
 
 Pregnant animals: food from. 311. 
 
 Prescriptions for the poor. 810. 
 
 Preservatives in milk. 300. 
 
 President of board of health. 37. 
 
 President of council on board of health, 
 2.'!. 
 
 Press: the. and the health department, 
 sir,. 
 
 Presses for garbage. 70S. 
 
 Prison. See Penal institution. 
 
 Private premises: authority to enter, 42. 
 112, 345. 385, 485. 
 
INDEX. 
 
 965 
 
 Privies: for schoolhouses, 780. 
 
 Privy vaults, 17U: permits for, 174: in- 
 spection of, 174: location of, 175; size, 
 176; depth, 177: materials for con- 
 struction, 177. 843 : bottom construc- 
 tion, 177-8; openings and ventilation, 
 17i>: sewer and Hush vaults, 178; 
 school sinks. 181 : wells not to 1"' used 
 as, 179; sluice vaults. 181; connection 
 with sewer, 180; overflow from, 182; 
 box privies, 182-4; ran- of, improper 
 materials in, ool to overflow, distance 
 of contents from top. 186; obstruction 
 152: unused, to be filled, 192; re- 
 moval <>i' on sewered streets, 187-192; 
 cleaning of, 187, 843; permits tor clean- 
 ing, 752, 753; frequency of cleaning, 
 7"i1 : hours for cleaning, 751. See also 
 -In soil. 
 -- bul t> r, 365. 
 
 Prosecution for milk adulteration, 397, 
 398. 
 
 Protection : for officials, 40; by vaccina- 
 tion, 595; of working children, 804, 
 946, '.'17. 
 
 Providence ambulance, 629. 
 
 Provisions. See Pood. 
 
 I'ul»li<; conveyances. See Carriages : Com- 
 municable disease, removal of. 
 
 Public libraries and communicable dis- 
 ease, 1'''i! : not ices sen! to, 189. 
 
 Public places: no communicable disease 
 in 4 is 154. 
 
 Public safety: department of and health 
 department, 16, l' 1. 26. 
 
 Public works: president of board on 
 board of health, 23. 
 
 - 1 1 i n ir : aames of violators of food 
 laws 354; of violators of milk laws. 
 • 177: quarantine regulations, 635. 
 
 Puerperal fever: to be reix>rted, [■'•'■>. 
 
 Puncl ure : \ accinat ion l>.\ . 59 1 
 
 Putificatiou of water -71 < i s< </. 
 
 'ji «i iik moNH for members of board 
 of health, 28. 
 
 in tine. Bee Isolation. 
 
 - 630 i / m 7 : definit ion of, 
 630; most important sanitarj work. 
 \S> authority of local board, Il'7. 
 Quarantine: power of state hoard of 
 health, 126. 
 
 nl mi- inland : earliest, II 19 ; inter 
 • quaranl ine, I) H) : authority to es 
 tahlish. 650; state rules for, 651; of 
 i rains. 651, 653. 658, 659, 663; emer 
 ind, 651 : federal conl rol of, 
 652: local control of, 652; state eon 
 trol of, 651; where required, 653; in 
 \i-i\ Knglnnd, • '•■"•■': . disinfection, 055 
 >'•'<! baggage disinfect Ion, 
 657 « ravel rertifii 116 1. 
 
 '.»:;7: absolute in West Virginia. 658; 
 freight quarantine of, 658: in yellow 
 fever, 659 </ seq.j control of yellow 
 fever by, <'><'><' et seq.; guards for, 660; 
 passes given, 661; detention camps, 
 661. 
 Quarantine: maritime, 630 et •*<</..■ 
 earliest, 630; national established, 630; 
 maintained by Marine Hospital Ser- 
 vice, 632; secretarj of tin' treasury to 
 make rules. 632; state control of, *'>'■'<-: 
 quarantine board, •;.",:;: state hoard of 
 
 health to coin rol. »'.:;:;: on lakes and 
 rivers, 634; authority to declare. 631 : 
 
 -is subject to, U34, 636, 639; 
 uvtions in cities, 634; publishing 
 regulations, 635 : season for, <'>."!•". 640; 
 pilot and tow hoar captains' duties, •■>.*!•>. 
 641; passengers' duties, 637, 644; com- 
 munication with vessels, 637; inspec- 
 tion of vessels. i;.,.>. r,4l. (',40 : Blasters, 
 duties of. 635, 636, 641; quarantine 
 grounds, 641; signals, 641; statement 
 of master, 643; treatment of passen- 
 gers, 645; treatment of crew, 645; 
 fruit trade, control of. 646; bag 
 treatment of, 645, 646; bedding and 
 clothing, treatment of, 646; cargo, 
 treatment of, «'>4i' f : ballast, treatment 
 of, 647; sick, care of at, 638; vaccina- 
 tion of immigrants, 639, c>\l; expenses 
 to be borne by vessel, 639; fees, i'^' 1 . 
 tits: penalties. 639; treasury rules, 
 640; disinfection, 639, 648; of ballast, 
 648. 
 
 Quarantine of communicable diseases of 
 animals. 766, 771. 
 
 Quinness butter, 365. 
 
 LtABIES : control of, 77''.: laboratory diag 
 
 iiosis of, ~>7l'. 
 
 collection of, 759; from dumps not 
 
 to be sold during cholera outbreaks. 
 
 518 : storage of, 21 1. 
 Railroad: coaches, closets of, 157; truin* 
 
 and cars. See Trains and cars. 
 Ilain water leaders. '_'•".*. 
 Raymond, Dr. J. II.: preparations for 
 
 cholera, 516; on disinfection, 529. 
 Receptacles for garbage, ' ■ T • * : for mixed 
 
 refuse, 738; for drj refuse, 7-".<». 
 Recording officers: viial records, 87. 
 
 da ol births, marriages and deaths, 
 
 8'.'. H 1 ndmenl of, 02 ; copies 
 
 of, '•'•'■•. care of, '.»'_': paper for, 90; ink 
 
 fo . 00; index, '.'i ; of communicable 
 
 diseases 190, '.Ms. 020; of tuberculosis. 
 
 52 1 
 Reduction process for garbage, 701 <t teq, 
 ■ •1 a 1 or w aates, "_' 15 
 s.c 1 > r t refuse. 
 
966 
 
 IXJJEX. 
 
 Registration : a sanitary function, 53 ; 
 earliest, 52 : reports long published by 
 certain cities. 813 
 
 Registration : of physicians, undertakers, 
 etc.. 96; of plumbers, 255. 
 
 Relapsing fever: to be reported, 439. 
 
 Removal of bodies dead of communicable 
 disease. 47li. 477. '.n>3 : of cases of com- 
 municable disease. 449 : to hospital, 
 148, 450, 451, 605. 
 
 Rendering, 207-S. 
 
 Rendering processes for garbage disposal. 
 708-714. 
 
 Renovated butter. 365. 
 
 Reports of health officials. 42: weekly 
 and monthly. SIC; annual. 817-819; 
 to state board of health. 841; of regis- 
 trars, 95. 
 
 Restaurant: sale of food in. 320, 350. 
 
 Reynolds, Dr. A. K. : method of collect- 
 ing records of births. 74. 
 
 Rider garbage crematory. 727. 
 
 Ring-worm : to be excluded from school, 
 4(J4. 
 
 Riseley garbage crematory, 7li7. 
 
 River pollution: nuisance caused by. i".)7 ; 
 laws concerning. 298-300, 843. 869; 
 power of state board of health, 299. 
 
 Roofs : must not leak. 153. 
 
 Rules: how enacted and promulgated, 46. 
 
 Rural sanitation, 12. 
 
 Safe wastes. 24.". 
 
 Safety: director of public, on board of 
 health. 23. 
 
 Salary: of, boards of health. 31; health 
 officers, 35; bacteriologists, 558 : food 
 inspectors, .".44: of medical inspectors 
 of schools. 7X4. 7S7. 788 : of milk in- 
 spectors, 386; of plumbing inspectors, 
 258; of physicians to the poor. 809; 
 <>f sanitary inspectors. 12S; of vaccina- 
 tors, 591. 
 
 Salem : smallpox. 1678, 2. 42."). 
 
 Saleratus, :::;::. 
 
 Salt in streets, 157. 
 
 Samples. See Food. 340, :',4. - ;. and Milk 
 386, 389. 
 
 Sanitary codes. 48, 843. 
 
 Sanitary committee: chairman on board 
 of health, 23. 
 
 Sanitary Construction Company's formal- 
 dehyde generator, .">:'»<'>: carbonizer, 697. 
 
 Sanitary inspectors, 126-130; number and 
 salary. 128; reports of. 131. 871; rec- 
 ords. 131, 133, 136; rules for, 870 ; du- 
 ties in communicable diseases. 4S7. 
 
 Sanitary organization : first independ- 
 ent. -2. 
 
 Sanitary survey in communicable disease, 
 4S7. 
 
 Sanitas trap. 243. 
 
 Sanitation : earliest, 1 : and density of 
 population. 1. 
 
 Scarification for vaccination, 594. 
 
 Scarlet fever: to be reported. 437. S44 : 
 to be placarded, 443, 44G : isolation of 
 family in. 453 ; isolation of persons ex- 
 posed to. 456 : duration of isolation, 
 457: private funeral in. 477; to be ex- 
 cluded from school. 464 ; outbreaks of. 
 514; results of. 514; closure of schools, 
 515; inspection of schools. 515: hos- 
 pitals, 612, 615; circular, '.hi.'). 
 
 Scavengers: night soil licenses for, 742; 
 return of work done. 754. 7.">.~>. 
 
 Schering & Glatz : formaldehyde genera- 
 tor. 538. 
 
 School attendance. See Communicable 
 disease and school attendance. 
 
 School authorities to enforce vaccination 
 laws. 585, 587 : to offer vaccination. 
 587. 
 
 School baths, 781. 
 
 School books. See Books. 
 
 School children. See Vaccination : Com- 
 municable disease and school attend- 
 ance. 
 
 Schoolhouse construction : supervision of. 
 771); heating and ventilation, 781; 
 privies, 780 ■ inspection of. 781 et seq. 
 
 School hygiene. 77N et seq. : laws concern- 
 ing, 778. 
 
 School inspectors: to inspect school- 
 houses. 783. 
 
 School sinks, 181. 
 
 Schools: medical inspection of. 784 et seq. 
 See Medical inspection of schools. 
 
 Schools : rules for communicable disease 
 to be posted in. 469 : closure of, 469. 
 
 Scientific investigation by sanitary offi- 
 cials. 811. 
 
 Scows: for garbage, 687; night soil. 75t'>: 
 refuse, 7-"><i. 
 
 Seal for registrars, 89. 
 
 Sealing of openings for disinfection#530, 
 531. 
 
 Season for cpiarantiue, 635, 640. 
 
 Second-hand clothing. 209. 
 
 Secretary of board of health. 29. 37. 
 
 Secretary of the treasury to make quar- 
 antine rules, 632, 652; rules, t!4i», 652. 
 
 Sedgwick : investigation of typhoid in 
 Springfield. 511. 
 
 Selectmen : as board of health, 11 ; ap- 
 point board of health, 27. 
 
 Separator: milk, 373. 
 
 Septic tank. 301. 
 
 Sewage disposal, 300 ; by broad irriga- 
 tion, :!(!(); intermittent filtration, 301; 
 septic tank. 301 : disposal on private 
 premises, 192. 
 
INDEX. 
 
 96' 
 
 Sewer connection required, 189-192, 843; 
 order for, 879; how made 226; steam 
 not allowed in sewer, "-'."it. 
 
 Sever gas and disease: studied in. Bos- 
 ton, 813. 
 
 vaults. 178. 
 - : chairman of committee, on hoard 
 of health. 23. 
 
 -: construction of. 296; !>y health 
 department, i B 
 
 Sexton's return deaths, til. 
 
 Shark. .•'.•_'::. 
 
 Sheep : gai bage for. 699. 
 
 Shields: for vaccination, 596. 
 
 Shores : tilth upon, 192. 
 
 Shrimp, .'117. 
 
 Sick at quarantine: care of, 6, 8 
 
 Siek children: excursions for. 804. 
 
 Sick person : removal to hospital, 605. 
 
 Sick poor, 38; care of by health depart- 
 ment, 808; rules for physicians to. 808; 
 Dumber of physicians in certain cities. 
 809; salaries and work done. 809; pre- 
 scriptions for. Mn: ••summer corps" in 
 New York and Hartford. 810. 
 
 Sidewalks. See Streets. 
 
 Simonin process of garbage disposal, 706, 
 7" '7. 
 
 Single headed department ol health. 25, 
 26. 
 
 Sinks. 249. 
 
 Skimmed milk. 372-374. 
 
 Slaughter houses. 2<>r,-7. M I. 
 
 Slaughtering: manner of. 310, .".11. 315; 
 inspection of. 346, 347. 
 
 Slopv : definil ion of. 665. 
 
 Smallpox: quarantine in New England, 
 1885, 653: state quarantine at Muncie, 
 657; in Boston, 1678 1. 125; in 
 Philadelphia, 19; in Salem. 1678, 1. 
 
 125 I to III' repented. 136 ; to lie phi 
 
 carded, II".. 146; isolation of family in. 
 153; isolation of persons exposed to, 
 156; duration of isolation, ).">7 : private 
 fiHicr.il in. 177: !•> be excluded from 
 
 school, 164; exempts from vaccination, 
 ."77: management of outbreaks, 500; 
 discovery of cases, 500; failure of diag 
 ■ ■ • l : isolal ion at home ~»« » 1 ; re- 
 moval to the hospital, difficulty 
 
 502 : iSOlal i( f those exposed 
 
 precaution by physician in. .Mi:;; hos 
 
 pital for. ."hi : vaccinati luring, 501 . 
 
 t of outbreaks, 
 507. 
 Smallpox hospitals, 607: location of, 608; 
 cities without 607, 012 I cities with. 
 
 tiOH . at Asbury Park, 603 : < !h 
 
 611 ; I larrisburg, ''.1 I : Lincoln, 
 
 r.n*- : Muncie, 612 613 . Pawtuckt 
 Sun :nl system of ventilation, 783, 
 Smear examinations in diphtheria, ">''>7. 
 
 Smith garbage crematory. 722-72o. 
 Smoke nuisance: where forbidden, 214: 
 
 ordinances, 214-17: inspectors and 
 
 their work. 217-18; firemen, rules for. 
 
 218; smoke consuming devices. 218-19; 
 
 bituminous coal forbidden, 219. 
 Smoke test. 260. 
 Soda fountains. .", 1! 1 . 
 Soil : disturbance of. 155. 
 Soil pipe. 229 ' / seq. 
 
 Solicitor: city, on hoard of health. 2.'!. 
 Attorney. 
 throat: to he reported, 4-".7 : to be 
 
 excluded from school. 467. 
 
 Spatula;: for throat examinations, ."ill. 
 
 Special laws for sanitary organization, 
 18. 
 
 Spitting forbidden, 158-161. 
 
 Sponge Meet: inspection of. 641. 
 
 Spray: formaldehyde for disinfection. 
 539, 553; bi-chloride of mercury, 539, 
 ."!»7. 509; for disinfecting vehicles, 544. 
 
 Springfield: typhoid fever in. 511. 
 
 Springs, 291. 
 
 Sputum: examination of for tuberculosis, 
 569; samples, care of. .".72. 
 
 Stable for cows. 1 1.".. 
 
 Stable manure. 164 : removal of, 165, 
 166 : disposal of. 166. 
 
 Stables: state legislation, 161; location 
 of. 161; permits and application for. 
 161, 162; cleanliness prescribed, 162; 
 must not he noisy. 162; Moor imper- 
 vious, 162-161 : bedding, ic>7. 
 
 Stagnant water, 196: penalty for caus- 
 ing, 869. 
 
 Standards of purity for milk. 371. 
 
 State hoard of agriculture controls dis- 
 eases of animals. 77i». 
 
 State hoard of health: appointment of 
 
 local by, 27: controls diseases of ani- 
 mals, 770; and communicable disease, 
 125 128; legislative power, 12: control 
 
 of water supplies. 261 ct *<</■.' rules of. 
 
 268; abatement of nuisances on water 
 shed. 27'»: power in regard to river pol- 
 lution. 299; to control quarantine, 633; 
 maj declare quarantine, 634; to esttfb 
 lish quarantine, 650; report of local 
 board to. 8 1 1 . 
 
 control in local sanitary affairs, 
 in communicable diseases, 125 
 128. 
 St.iti registration of vital sintisiii ... pi 
 
 Steam. Se< I 'i -inl'eci inn with. 
 Steam not allowed in sewer. 250. 
 Steamers: regular, quaranti f, •'•II. 
 
 645. 
 Sterilizing iuatruments for vaccination, 
 
 593. 
 Sternberg : pi i • ■■:! disinfection, 
 
 529. 
 
968 
 
 IXIJEX. 
 
 Still births, 77 : return of, 85S. 
 
 Sr. Louis ambulance a disgrace, «'.2S. 
 
 Strainer for drain, 150. 
 
 Strangers : registration of births, mar- 
 riages and deaths at place of residence. 
 63, 73, 84. 
 
 Strauss. Nathan: distribution of pasteur- 
 ized milk. 421. 
 
 Street cars : no cushions in. cleansing of. 
 transportation of clothing, ventilation 
 of. open cars, 1.T7. 
 
 Street cleaning, 704. 
 
 Streets and alleys : chairman of, on board 
 of health, 23. 
 
 Streets : filth in, l4.>. 84."'. : washing ve- 
 hicles in. 146; gutters, obstruction of, 
 14C>: fish cleaning forbidden. 14tj : 
 cleaning of by abutters, 147: removal 
 of filth before washing, 140. 
 
 Streets : roping off in sickness, l.'iS. 
 
 Subordinate officers, •'!•">. 37, 39. 
 
 Subpoenas, 47. 
 
 Substitution in foods. .' , >24 et seq. 
 
 Sugar. 330. 
 
 Sulphur. See Disinfection with. 
 
 "Summer corps" of physicians to the 
 poor. 810. 
 
 Sunday schools and communicable dis- 
 ease. 4<i7. 
 
 Supervisors: appointment of board of 
 health by, 27: as board of health. 11. 
 
 Supreme court: appointment of health 
 officers by, 27. 
 
 Swabs : for diphtheria cultures. 561 ; 
 wires for, 559. 
 
 Swamps: draining and filling, 107. 
 
 Sweat shops. 835. 
 
 Swift. Dr. W. X. : on vaccination. . r i ( .i2. 
 
 Swill : definition of, 665. 
 
 Swill milk. 369. 
 
 Swimming pools. 793. 
 
 Swine: keeping forbidden. 1»'>7: seizure 
 of, K',7; permits for, !<'>'.): pens for. 
 168; yarding, 169; garbage for, 7<m. 
 
 Syrup, 330. 
 
 Tagging of meat, 847. 
 
 Tankage from garbage, 7<>2. 7<i."!. 7<>4. 7ns. 
 
 Tanneries. 209. 
 
 Taylor's paraform candles. .j.'J'J. 
 
 Teachers: excluded from school, 4f>4. 400; 
 to exclude communicable disease, 4<'i0. 
 4<;7; to teach the prevention of com- 
 municable disease, 469; isolation of in 
 communicable disease, 153 : to report 
 communicable disease. 4.'!2 : vaccination 
 of, 576. 
 
 Telephone: reports of communicable dis- 
 ease by. 4.".4. 
 
 Tenement houses. 822 et seq.j statement 
 of problem. 822; laws concerning, 824 
 et seq.; defined, ^24. 826; ventilation 
 
 of, 824. 825. 827: roofs, stairs and fire 
 escapes. 824, 829, 828; sleeping rooms. 
 824 : sewer connections. 824 : cellars, 
 824, N2.~>. 827 : bakery and bar-room in, 
 825; receptacles for refuse. 825, 820; 
 registration of owner. 825, 826, 040: 
 inspection of, 825, 826, 830, 831, 890; 
 amount of lot to be covered. 825, 827 ; 
 elevator well, 825; water closet room. 
 825 : not to be used for other purposes. 
 825 : size of rooms. 825, 828 : chimney 
 openings, 825 : windows, size of. 825, 
 828: halls, ventilation of, 825; night 
 lights. 825; janitor required, 825: air 
 space required. 825,-829; duties of 
 board of health. 826; penalty. 826; 
 height of, 828 : water closets required. 
 828; whitewashing, 829; fire protec- 
 tion, 825, 829; water supply. 829; in 
 Xew York and St. Louis, 831. 
 
 Terms of office. 30. 
 
 Terre Haute : abattoir. 205. 
 
 Test for plumbing, 260. 
 
 Test tubes for diphtheria cultures, 560. 
 
 Thackeray crematory. 741. 
 
 Tin cans in garbage. f><'>7. 
 
 Tomb: communicable disease not to be 
 put in, 470. 
 
 Tow boat captains: duties of, 636, 641. 
 
 Town council , board, or trustees: as board 
 of health, 11: to appoint board of 
 health. 27. 
 
 Townships and counties : relative import- 
 ance, <>. 10; township sanitary organi- 
 zation. 11 - 1 < i ; under general laws. 20; 
 to establish quarantine, 650, »'>">2. 
 
 Train inspection. 651, •'>■">•">. 659, ''>t;:;. 
 
 Transit permits, 61, <i2. 850. 
 
 Trait. 223, 239; grease trap, 241; non- 
 syphoning. 242-4.'!: required in drain. 
 l.~><>: in soil and waste pipe, 151. 
 
 Travellers: statement of, '.».'!7: certificate. 
 C.-.7. 659, 664. 
 
 Treasury. See Secretary of. 
 
 Trichinosis: to be reported, 439 : in gar- 
 bage feil swine. 700. 
 
 Trillat's autoclave. 536. 
 
 Trustees : township as board of health, 
 11. 
 
 Tubercle bacilli in vaccine virus. 582. 
 
 Tuberculin test for milch cows. 404-407 : 
 how applied, 4n7: in various states. 
 
 Tuberculosis (animal), 771 et seq.; im- 
 portation forbidden, 771: eradication 
 of in various states. 772-774: milk from 
 tuberculous cows. 408; tuberculin test. 
 4< >4-4l)7. 772-77.".. 
 
 Tuberculosis : laboratory diagnosis of. 
 569; to be repotted. 438, 139, 521; pri- 
 vate funeral in. 477: municipal control 
 of. 520; circulars. 520, 509, '.12.'!. 924, 
 927 : reports of cases and deaths. ."121 : 
 
IXDEX. 
 
 969 
 
 management of in New York. r>21 ; rec- 
 ord of cases, map for, 521 ; inspection 
 of premises, 521 : disinfection, '>-'- : in 
 bakeries and markets, 522 : hospitals, 
 522-525. See also Consumption. 
 
 Tubs. 249. 
 
 Typhoid fever: to l"' reported, 138 844; 
 circular. '.HI. '.UU: outbreaks, discovery 
 of origin, 510, 920: investigation of 
 outbreak in Springfield, 1892, 511 <t 
 seq.; laboratory diagnosis of, 569, '•»•'>'_'. 
 
 Typhus fever: to be reported, 438 844; 
 isolation during exposure to, 456; pri- 
 vate funeral in, 477: outbreak in New- 
 York. 1892, 512. 
 
 Udders : washing of, 416. 
 
 Unclean milk. 399 et seq. 
 
 Undertaker: license of, •"'• : to report 
 deaths from communicable disease, 
 I7<>: disinfection of, 471: responsible 
 for funeral notice, 475; responsible for 
 violation of rules. 477. 
 
 Undertaker's wagon used as ambulance. 
 1128. 
 
 Unsanitary conditions and communicable 
 
 disease. 4^7. 
 
 I n-\ aceinaied children: number in 
 
 school, 587. 
 Unwholesome food, 308 et seq. 
 Upholstered furniture: disinfection of, 
 
 553. 
 Up-turning of soil. 155. 
 Urban population, 12. 
 Urinals, 250; .are of, 152; public, • V|, 7. 
 Utica : disposal <>f garbage in, 714. 
 
 \ \< wi lots: cleansing of t<> prevent 
 cholera, .">17: not to l>< tilled with tilth. 
 194 : care of, fencing of, combustible 
 material on, 195; stagnanl water on, 
 196. 
 Vacation of premises, 138; order for, s ~'.i 
 Vaccination, -"»7.". </ seq.; legislation, 573; 
 of immigrants, "»7.'! : local regulations, 
 authority for, 574: smallpox outbreaks, 
 vaccination during, 505, 574; enforce- 
 ment of laws by school authorities, ~' s ~'. 
 587; of Bchool children, 575; where re- 
 quired, 576, 577 : exceptions, 575; fail- 
 ure to enforce.578 ; in parochial schools, 
 578, 590; of employes required, 578; in 
 paper mills. 578; of fruit growers and 
 packers, 579; compulsory, 579; \irus 
 used 580 ci neq.; public nl vaccinator's 
 office, 589; public in schools, 589; by 
 school inspectors, 786; house to house 
 vaccination, 590; decisions in regard 
 To ."i7.">. o7'i. 590; payment for, 591; 
 
 may be marie compulsory by cities and 
 
 tow ns. 585; to I Bfered by board of 
 
 health. 587; school authorities to offer 
 vaccination. 587: of the poor. 588; 
 methods of, 592 ■ ( seq. : implements for 
 inoculation, 593; cleansing the arm. 
 593; methods of inoculation. .">'.i4 : place 
 for insertion. .V.i4 : number of points of 
 insertion. 595; protection of, 595; 
 shields for. 596; directions for care of, 
 596; contra indications. 597; success 
 in vaccinating, 597 : circulars concern- 
 ing, 598; of immigrants, 639, «'>44 : tees 
 for, 649. 
 
 Vaccination certificate: required, 585; 
 form of, 586, '.'.'"_'. '•••"-4: cicatrix value 
 as evidence, 586; returns to be made to 
 state board of health. 586, 933; to be 
 recorded, 586. 
 
 Vaccinators: public. 588, 591 : reports of, 
 590, 591. 
 
 Vaccine virus. 580 et seq.; humanized 
 virus. 580, 592, .">!>:',: bovine virus. 580, 
 592; control of by state. 581; tests of, 
 582; furnished by city or state. 582; 
 preparation of in New York. ,~>N.", : 
 glycerinized, preparation of, 584; forms 
 in which sold. 592; <>n ivory points. 
 7,'.\-J.: in capillary tubes. ."V.r_>: in vials. 
 593; humanized crusts. 593; study of 
 in New York. 586. 
 
 Vacuum as an aid to steam disinfection. 
 542. 
 
 Vans. See Disinfecting, vans for. 
 
 Vaults : for the dead. lnj. L03. 
 
 Veal: blown. 312; immature. 313, 844. 
 
 Vegetables, 309, 321 
 
 Vehicles: for disinfectors, 519-552; for 
 
 dead animals. 7»'.:', : for mixed refuse. 
 739; for removal <>( night soil, 744: 
 for the collection of dry refuse, 731, 
 7:;:;. 
 
 Veiller, Lawrence: report on tenement 
 houses, 823. 
 
 Venerea] diseases: in bakeries, 319; lack 
 of control of in United States. 525; 
 attempts al control. 526; in public in- 
 stitutions. 526; a legal bar to marriage, 
 526. 
 
 Ventilation: of plumbing. See Back air; 
 
 Of BOll and waste pipes. 1 .". 1 ; of school- 
 llOlls.s. 7M . 
 
 j: subject to quarantine, 634, 636, 
 630; inspection of, 638, 641, 642; i" 
 bear quarantine expenses, 639; "via 
 
 • Is." till ; disinfection of, 639, 648, 
 
 Veterinarian! 343; to ins] t dairy 
 
 farms. 103, 111: to investigate diseases 
 of animals. 7<>7, 771. 
 
 "Via \ ess, is." 641. 
 
 Villages: sanitarj organization, 13 17. 
 
 Vinegar, 328, 329. 
 
 Virus, See Vaccine \ irus. 
 
 Visits: to infected house forbidden, 154, 
 
970 
 
 INDEX. 
 
 Vital statistics. See Registration ; 
 
 Births: Marriages; Deaths; Births. 
 
 Marriages and Deaths. 
 Vivartos garbage crematory, 727. 
 
 Wage earners : isolation of, 452, 453, 
 899; permits for work (minors), 945. 
 
 Ward : member of board of health from 
 each, 8. 28. 
 
 Ward's formaldehyde generator, 533. 
 
 Waring: on garbage utilization, 702, 703. 
 
 Warning to milk dealers. 890. 
 
 Warning sign for communicable disease. 
 See Placard. 
 
 Washing soda: a disinfectant in tubercu- 
 losis. 522, 550. 
 
 Washing vehicles. 140. 167. 
 
 Waste pipe, 229 et seq. 
 
 Water: analysis of chemical. 273 : bacte- 
 riological. 273: microscopical, 273; 
 chemical composition. 203 : suspended 
 matter in. 203 : color. 263; taste, 263; 
 odor. 203; pathogenic organisms in, 
 263; control of by state board of 
 health. 264 et seq.; control of by local 
 health officers. 264, 265; pollution of. 
 statutes concerning, 265-270, 869; 
 cemeteries. 207-08: local rules concern- 
 ing, 271. 843; state board of health 
 rules, 268; inspection of water shed. 
 271: purification of, 274 et seq.; by 
 aeration. 275; by sedimentation. 27."> : 
 by nitration. 27."> et seq. 
 
 Water required for tenements. 829. 
 
 Water for cows. 41<i. 
 
 Water closets, 246; certain closets for- 
 bidden. 246; door flanges. 246; seat 
 ventilation, 246; ventilation of. 247: 
 location of. 247: water supply for. 248: 
 water required, 151. 828. 832; obstruc- 
 tion of. 151, l.~>2: construction of. 152. 
 
 Water pipes, 250. 
 
 Water supplies in the United States. 262. 
 
 Water test for plumbing. 250. 
 
 Weeds, 156. 
 
 Weight of cubic yard: of garbage. 007: 
 of dry refuse. 72!) : of mixed refuse. 
 738. 
 
 Wells : danger in contamination of. 2S7 : 
 examination of, 288. 291 : laws relat- 
 ing to. 289; closure of. 289. 290: to 
 prevent cholera. .">17 : not to be used as 
 vaults. 179. 
 
 Wesbrook. Dr. F. F. : diphtheria at Owa- 
 tonna. 516. 
 
 Whipple, Geo. F. : microscopical exami- 
 nation of water. 274. 
 
 AVhite, Henry: report on sweat shops, 
 835. 
 
 Whooping cough : duration of isolation. 
 459; private funeral in. 477: circular. 
 908. 
 
 Widal test for typhoid. 569 : report of, 
 932. 
 
 on state registration 
 
 1)4. 
 
 diphtheria at < >wa- 
 
 Wilbur, Dr. Cressy : 
 
 of vital statistics. 
 Wilson. Dr. L. B. : 
 
 tonna. 516. 
 Wine. 327, 328. 
 Witnesses. 47. 
 
 Wood alcohol : for disinfection. .">.",:;. 
 Working children : protection of. 804. 
 Wounded animals : food from, 310. 
 Wright, Carroll D. : report on marriage 
 
 and divorce, 78. 
 
 Yellow fever : at Boston. 2. 10 : to be re- 
 ported. 43S, S44 : isolation during ex- 
 posure to. 456; private funeral in. 477: 
 disinfection in. 555; inland quarantine 
 in 659 et sc<j.: outbreaks of, 507; dis- 
 covery of cases. 508; hospital removal 
 to. 508; isolation at home, guards. 508; 
 care of the sick. 509; disinfection, 509; 
 airing of houses after. 510. 
 
 Young animals : food from. 313. S44. 
 
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