What action has your board taken?. (Signature.) (Health Officer or Secretary of Local Board of Health.) (Post-office Address.) (Date of making this report.) If this is the last blank (Form 3.) that you have, make a cross against this sentence and more will be sent you. It is believed that this system of notification is as nearly perfect as can be devised, and if carried out to the letter would give the health authorities, state and local, a full and complete knowledge of the prevalence of these diseases, and thereby lead to their prompt isolation, control, and suppression. As a matter of fact, there is one obstacle in the way of a complete enforcement of this plan of sanitary work, and that consists in an occasional passive, inefficient, incompetent local board of health. We see no way under the present law to remedy this serious organic defect. a rule, however, the regulations have been complied with, and most excellent work has been done by many local boards in restricting the spread of these preventable diseases, to the undoubted saving of many lives, especially among children, from diphtheria and scarlet-fever. The prompt and efficient work that has been done by some of our local boards abundantly demonstrates the character of the work that might be done by every board in New Hampshire. DIPHTHERIA. During the year ending Oct. 31, 1893, diphtheria was reported to this board from thirty-two towns, with a total of one hundred and eighty-six cases. By comparing the returns thus made by local boards of health with the mortality rates from this disease for several years past, it is evident either that diphtheria has prevailed to a much less extent than heretofore, or else notification has been very incomplete. We feel certain that all cases have not been reported. The law which requires weekly returns did not in fact become operative until about the first of June, while the old regulation requiring monthly returns was not heeded by all towns. At this point, we wish to call the attention of health officers, physicians, and others to whom the law of notification refers, that we shall demand the prosecution of any and all wilful violations of this law. Human life must not with impunity be trifled with through a neglect to do what the law requires in an endeavor to prevent and restrict the spread of dangerous communicable diseases. No law is of use unless it is enforced. The object of notification is to reveal to the health authorities, local and state, the location of every case, as early as possible, that the necessary restrictive measures may be taken to prevent a further extension of the disease. The actual sanitary management of the diseases specified in the regula tions devolves upon the local boards under the public statutes and the regulations of the state board of health. The law requires that the attending physician shall report immediately every case of diphtheria (and membranous croup) to the local board of health. The local board of health upon receipt of such information, should act at once by making a determined effort to restrict the disease. 1. Promptly investigate the matter in person and put the following placard (furnished by the State Board of Health) upon the infected premises in a conspicuous position, so as to warn the public against entering: DIPHTHERIA. All persons are strictly forbidden to enter or leave these premises without special permit from the Board of Health. All persons are strictly forbidden to remove this card without orders from the Board of Health. Any violation of these regulations will be punished to the fullest extent of the law. BOARD OF HEALTH. 2. Order prompt and thorough isolation of those sick or infected with diphtheria, and see that this order is enforced. 3. See that no person suffers for want of attendants or supplies. 4. Notify the people in the vicinity by printed notice or otherwise, so that the infected place may be avoided. 5. Notify teachers and superintendents of schools concerning families in which there are cases of diphtheria. 6. Prohibit public funerals of persons dead from diphtheria. 7. See that rooms, clothing, premises, and all articles likely to be infected, are disinfected before allowing them to be used by persons other than those in isolation. 8. Report to the State Board of Health every case, upon blanks furnished all local boards for that purpose. Also send for as many copies of "Diphtheria: its Restriction and Prevention " as can be profitably distributed in the community where the case or cases exist. This pamphlet also contains explicit directions and instructions to local boards of health, regarding the management of the disease, disinfection, etc. The communicable nature of this disease is often very marked, although there are still some people who ignorantly or erroneously believe to the contrary. One of the many instances of this kind may be cited. A young man in Bow came home ill with diphtheria; result: Seven cases developed in his family, three of which were fatal. A woman living in Canterbury visited the afflicted family, and conveyed the disease to her home, with the terrible consequence of destroying the lives of her three children. A further spread of the disease in both of the instances mentioned, was doubtless prevented only by the prompt and efficient action of the health authorities. Many instances of this kind could be given, but it seems hardly necessary to further emphasize a fact that is not even open to controversy among those who have studied the nature and history of this terrible disease. The methods by which the germs of diphtheria are distributed are as numerous and varied as those of scarlet fever, although the former disease is not so actively communicable as the latter, as a rule. At the late International Medical Congress the question was asked: "How long can a diphtheritic patient furnish infectious excretions?" In reply to this, it was stated that excretions were found infectious three weeks after apparent recovery, and pieces of membrane yielded cultures fourteen weeks after discharge from the throat. Children having had the disease should therefore be kept from school for at least four weeks after recovery, and every article of apparel worn by them should be thoroughly disinfected. All doubtful cases of throat disease should be treated as diphtheritic until the contrary is clearly shown. By this means a danger would be averted that under any other course might be imminent. DIPHTHERIA SPREAD BY INFECTED MILK. Early in June last, diphtheria made its appearance in Portsmouth, and the mayor requested the State Board of Health to investigate the matter. Dr. Berry, a member of the board, conducted a careful investigation, and reported as follows: Dr. I. A. Watson, PORTSMOUTH, N. H., June 16, 1893. DEAR BROTHER: In regard to the threatened epidemic of diphtheria in Portsmouth which the board have been requested to investigate, I would make the following report: The fact that the disease, which first appeared about ten days ago, appeared suddenly and was distributed quite evenly over the city, and was confined to the patrons of Mr. Leavitt, a milk-dealer of Newington, at whose house a case of diphtheria existed, rendered the theory of propagation by infected milk a very plausible one. The man Richardson was reported sick June 6, and died, I understand, June 12th, of a very severe type of the disease. The fact was not brought to the notice of the board until June 12th, the day of his death, when the selectmen of his town were directed to quarantine the premises, pending further investigations. A personal examination was yesterday made of the farm and stock. The latter, consisting of twentythree cows, was examined by Dr. I. R. Kimball, V. S., and found to be in a healthy condition. There was no apparent contamination of the water-supply. This latter is obtained from a spring forty rods or more from the buildings, and sent into the latter by a hydraulic ram. There are no wells on the farm. The drainage is fairly good. Sink waste is carried by lead pipes (untrapped) into wooden drain leading into an open cesspool one hundred feet or so below the house. Overflow pipes of two small storage tanks of drinking-water in house lead into these waste pipes. The drain, however, is thoroughly flushed each day, and its lower section, leading into cesspool, is uncovered. This did not appear to me to be exerting any harmful influence. Fumigation of the premises had already been completed. The history of the case, as gathered from the inmates. and others, showed that Richardson had undoubtedly been sick for a day or two prior to taking his bed. This man had sole charge of the milk, and was in the habit of |