for preventing unnecessary communication with such premises, as you may think proper. It is also your duty to enforce all regulations and ordinances of your State Board. You should be particularly vigilant in seeing that quarantine and all rules and regulations are observed.

These laws, which give you such powers and impose such responsibilities, have been enacted for the benefit of the whole people. The powers are greater than are conferred upon any one except it be the Czar of all the Russias. In order that these duties and responsibilities shall be carefully and properly performed, certain qualities and attainments should be possessed by the individual who is to execute them. He should be a man with cultivated powers of observation; should be, or should make himself, familiar with the natural conditions of his town; should know the soil, the water courses, the direction in which surface water usually finds its way into the streams; the sources of water supply, how they are cared for; should be alert to discover anything that arises, or is created by any person, that is likely to affect unfavorably the public health. He should be familiar with the principles of public and practical hygiene; should have a fair knowledge of bacteriology although not necessarily a laboratory man; should be a student of wide reading in all subjects which may in any way aid him in his work, especially such as relate to the causes of infectious diseases, their natural history, the best means of disinfection, and just how and when it is to be done. He should be prepared to give practical advice regarding the best means of sanitary construction of buildings, warming, ventilating, and sewage; should be able to advise as to sewage disposal, purification of water and sanitary plumbing, and should, in fact, not only possess knowledge upon all sanitary subjects, but should embrace every opportunity to inform the people upon all subjects pertaining to sanitary matters. He should be a practical man, possessed of good common sense and great tact. He may have the largest fund of scientific knowledge, but unless he is endowed with the last two natural gifts he is likely to prove a failure as a health officer.

Some men are so constituted that when they are invested with certain powers they cannot fail to show to all that they are conscious of their power, and in every action and word, those with whom they come in contact are made to feel that the slightest supposed infringement of any regulation will be met with the full penalty of the law. These are the persons who go round with a metaphoric chip on their shoulder looking for some one to knock it off. They are always looking for trouble and usually are accommodated with all they want. Under the circumstances they become overbearing and disagreeable when they should be courteous and kind. These latter qualities should always be combined, when he knows he is right, with firmness and a polite insistence that his requirements be complied with. While he has a right to hold his own personal opinion of men and things, officially he has not the right to publicly express it. If in some instance it is an open question whether or not he possesses this right, discretion would indicate that he should be silent. The public will soon come to recognize

that he is wise, discreet, just, careful of the feelings of others, tactful, fearless, yet firm for the right. Then they will confide in him, will always give him cordial support in his work. It would be well if the health officer should from time to time, either by public lecture or through the newspaper of his locality, instruct the public in the necessity and legality of sanitary measures, the importance of and relation of his work to vital statistics, the means necessary to be adopted to prevent the spread of communicable diseases, the quarantine required for this purpose, the methods of disinfecting, the necessity of pure air, water and food, the influence of heredity, environment, climate, exercise, sunlight and clothing upon individual health, the wisdom of a temperate and contented life, the duties, personal and social, to be observed by every person who desires to make a good, happy citizen.

One of the most important duties imposed upon the local health officer is the quarantine of communicable diseases. Every practicing physician is required to report to the local board any such disease coming under his observation. Many times the practitioner neglects for a time to give notification, and in this interval many persons may be exposed to the disease. Hence the health officer, while not always giving ear to town gossip, should take early measures to satisfy himself as to the fact of there being present in his community a communicable disease dangerous to the public health. If the attending physician has failed of his duty it will be your duty to see that he is subjected to the penalty of the law. However, your first duty will be to the public, in establishing a quarantine or isolation, not only of the patient, but of the family who have been exposed, the premises and all things by which the disease may be conveyed to others. Your quarantine should be a full one and you should see to it that it is strictly observed. By full quarantine I mean that no communication be allowed between persons within the quarantined premises and any other person whatever, except that articles of food and drink and such fuel and clothing be supplied as are necessary for the comfort and health of those persons under quarantine. Papers and letters they may be allowed to receive, all in such manner and under such regulations as the health officer may prescribe. No person shall leave the premises without a written order from the health officer. Many cases will occur when at first it seems a great hardship to enforce a strict or full quarantine. You must keep in mind that the citizen must conform to what is for the greatest good of the greatest number. If it is scarlet fever, and the bread winner has had the disease, he may be quarantined out, living for a period elsewhere, and thus be enabled to continue his daily vocation and to provide support for the family. The same may be true of other members of the household, who may, at some previous time, have had the disease. These could be disinfected and allowed to attend to their business, living, of course, at some other place. You will see that the quarantined family do not suffer for the want of the necessities of life, always with the understanding that they shall pay if of sufficient financial ability so to do; otherwise the town must assume this

expense. You should also see that the attending physician takes such precaution in entering and leaving the premises as will ensure his not being a source of infection by carrying the contagion. Dogs and cats must be as carefully prevented from going abroad and as thoroughly disinfected as any member of the family, before quarantine is raised.

Regarding persons who have been exposed to the disease, but who are not included in the quarantine of the premises, they should be subjected to such surveillance as the health officer may, under all the circumstances, think wise. In any event, they should be so guarded that in case they develop the disease they shall not communicate it to others. Never omit to notify in writing the librarian of your public library, or the teacher of the school which the pupil usually attends, when a case of communicable disease attacks a pupil; in the first instance, so that books shall not be received from the family until they have been disinfected, and second, that the teacher may be especially attentive to any indisposition of other pupils. All this matter of quarantine is probably not new to you; however, as a duty pertaining to your office it is of great importance. It is one of those duties that affects so intimately the families that have to submit to it that it is essential that you should exercise this function of your office with all possible urbanity, never for a moment, however, letting your sympathy for those thus affected cause you to relax in the least the strictness of your work or forget the community that are depending upon you to protect them from the contagion, which by this act of quarantine you are attempting to do. The result of your quarantine, if it is properly instituted and rigidly enforced, will result in the protection which the public have a right to demand. Whether you make it a success or not, it will have its effect upon the social and commercial life of the community. Some one has said that "To enforce strict and impartial quarantine, without unduly antagonizing physicians or patient, calls for honesty of purpose, pluck and tact." Here is the test of an efficient health officer. Having instituted and maintained a quarantine in any case, the question arises, When shall it terminate? The answer to this important question will vary with the disease for which it was instituted. In my state we say in scarlatina, when desquamation is complete; in diphtheria when two cultures, taken twenty-four hours apart, show the absence of the Klibes-Loffler bacillus; in smallpox when full desquamation has taken place and the skin beneath the pustule has completely healed. The point having been reached when the case has terminated, by recovery or death, a new condition confronts the health officer, that of disinfecting the house, its contents and the people. How shall this be done so as to render all free from any of the contagium that may give rise to other cases? This is a duty that the health officer should never delegate to any one except in very exceptional cases, unless in cities large enough to employ a corps of fumigators. He should make himself familiar with the methods used and should attend to all the details to the end that the work shall be so thorough that it will be impossible that a focus of contagion shall be left. Whatever method is adopted, two or more rooms that have not

been occupied by the patient should be first disinfected; then the person to be disinfected should pass into one of these aseptic rooms, divest himself of his infected clothing, passing to the next room, where after a thorough bath and the use of the disinfectants, he can put on fresh, clean, aseptic clothing and pass to another room or to another house. Other rooms of the house should be prepared for the disinfection by closing all cracks, loose joints, about windows and doors, hanging the bed clothes and garments upon chairs, and everything so arranged that the gas to be generated may find as free access as possible to everything. It will be often found best to burn many things that cannot be fumigated.

What agent is best to use to accomplish the desired results? The fumes of burning sulphur (sulphurous acid gas) is efficacious, three pounds to 1,000 cubic feet of space, if mixed with a sufficient amount of moisture. This, however, destroys many things, or injures them to such an extent that other agents have been sought, which, while as effective as germicides, cause less damage to the furnishings of the room. Hydrocyanic acid is undoubtedly most efficient as a disinfectant; however, an agent so destructive to animal life that but to inhale its fumes means almost instant death, cannot be recommended for general use. At the present time formaldehyde gas is the most satisfactory and practical substance we have for this purpose, as with its efficiency as a germicide it is not injurious to any materials subjected to its influence. A great variety of apparatus has been devised to produce it; many are expensive, others unsatisfactory. Candles and various patented preparations are offered on the market, each claiming to be the cheapest and most efficient. However, in a series of experiments made at the Laboratory of Hygiene in Vermont it was found that, in almost every case, a very much larger quantity of these preparations was required to produce the desired effect than was advertised upon the packages. For a safe disinfection there should be used twenty-three and one half ounces of the forty per cent solution of formaldehyde, with one part of glycerine and forty parts of water to ten parts of the formaldehyde solution; this, disregarding the cost of the apparatus, will be about eighty-three cents per 1,000 cubic feet of space. The Chicago method of using this solution, in spraying sheets hung across the room, has proved efficacious, but is very trying to the eyes and air passages of the person doing the spraying; hence is not likely to be as thoroughly done. The more simple way used in St. Louis has much to recommend it. There is no complicated apparatus to get out of order, it is simple and comparatively cheap. A copper kettle resting on legs six inches long, of sufficient capacity to hold two or three gallons of hot water, with a lamp filled with steel wool, which will hold a quart of wood alcohol, is lighted and placed under the kettle on a tin plate; into the kettle of water is placed another small copper kettle, resting on legs, into which is placed for each 1,000 cubic feet of space, a pint of forty per cent solution of formalin, the doors are closed and not opened for six or eight hours.

The State Board of Health for Maine have, after considerable experimentation, devised apparently a reliable and cheap method of using for

maldehyde as a disinfectant. Any tin vessel can be used. They have found that a tin dish, ten inches in diameter, eight inches high, wrapped with asbestos paper so as to retain the heat, with a funnel fitted to it which flares at an angle of fifty degrees and rises nine inches, is best. Six and one half ounces of potassium permanganate is put in this generator and a pint of formalin is poured upon it, and a hasty exit is made from the room. This is sufficient for disinfecting 1,000 cubic feet of space, and will cost only about forty or fifty cents. There is no apparatus to get out of order; there is no danger from fire. Personally, I have not tested this method, but shall do so and if it proves satisfactory, as seems probable, shall recommend it to our health officers.

In presenting to you some of the duties devolving upon the health officer, I trust that in all your official acts you will be actuated by the high and holy purposes that are the foundation of all sanitary work.

"As Life's unending column pours,
Two marshalled hosts are seen-
Two armies on the trampled shores
That Death flows black between.

"One marches to the drum-beat's roll,
The wide-mouthed clarion's bray,
And bears upon a crimson scroll,
'Our glory is to slay.'

"One moves in silence by the stream,
With sad, yet watchful eyes,
Calm as the patient planet's gleam
That walks the clouded skies.

"Along its front no sabres shine,
No blood-red pennons wave;
Its banners bear the single line,
'Our duty is to save.'

The President, Dr. Caverly.

QUESTION BOX.

I think all of you have learned from the sessions we have been holding the last three or four days, that the health officer, the health official of any kind, cannot keep too close to the law, cannot be too familiar with the law, and with the practical interpretation of the law. The legal phases, the legal questions that are continually arising in connection with the administration of public health laws, are frequently very embarrassing to the health officer, and I know from past experience that, with these questions coming up, you come here, very largely, to get enlightenment on the subject of the laws. If this school is at all like its predecessors there are a great many of