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Table 41 shows the mortality from cholera infantum in the cities of the State. Of the 399 deaths from this disease in the year 1890, 235 occurred in the cities, 146 being recorded in Manchester; 56 in Nashua; 12 in Dover; 8 in each of the cities of Portsmouth and Concord, and 5 in Keene.

REMARKS ON CONTAGIOUS AND INFECTIOUS DISEASES.

A glance at the mortality records of the so called contagious and infectious diseases for the past few years, coupled with a knowledge of the prevalence of these diseases throughout the State for a period longer than that covered by an accurate registration, leads us to believe that the efforts of the local boards of health throughout the State, to restrict and prevent this class of diseases, have been productive of good results. It is observed by physicians that these diseases, especially typhoid fever and scarlet fever, are not so prevalent in this State as formerly. The reduction in the amount of typhoid fever is doubtless due directly to sanitary work, more

especially in the introduction of better water supplies for the general public, together with improved facilities for drainage. It is a matter of history that the introduction of a public water supply into some of the towns of this State has been followed by an almost entire disappearance of typhoid fever. In nearly every village where polluted or contaminated wells have been abandoned, typhoid fever has been reduced in a corresponding ratio. Glancing at the records of this disease we see that the largest number of deaths returned from this cause in a single year was in 1886, 194; in 1889 there were 161 deaths; in 1888, 150; in 1884, 137; in 1885, 136; in 1887, 134; and in 1890, 143. Observing physicians who have been in practice in the State for from 40 to 50 years, assert that in their judgment the prevalence of typhoid fever is not half so great as formerly, and that in some localities where it used to be very common, scarcely a case is now known. We believe that if sanitary regulations were thoroughly and intelligently enforced throughout the State, and if the people could be forced to abandon the use of polluted wells, typhoid fever could be practically banished from every community.

Scarlet fever is another disease that may be controlled by intelligent action. The mortality from this disease has been reduced to quite small proportions. In 1884 there were 52 deaths from scarlet fever in New Hampshire; in 1885, 53; in 1886, 21; in 1887, 26; in 1888, 34; in 1889, 18; and in 1890, 16. This result has been brought about wholly through the work of local health authorities, in causing the immediate isolation of every case, and the better understanding of the nature of the disease by the people themselves. This is a disease that may be effectually controlled by isolation and disinfection, and so promptly has this work been carried out in some localities that it has been restricted to a single case. Formerly scarlet fever raged through town after town in epidemic form, and no thought was given to its restriction, and its spread was frequently furthered by the very general, but erroneous idea that every child must have the disease at some time; hence parents would purposely expose their chil

dren to a mild case of the disease, thinking it a favorable opportunity, and not realizing that a malignant case was liable to be the result of such exposure. While this low rate of mortality is very gratifying and might be reduced still lower, it is almost too much to expect that these figures can be maintained each and every year. There are periods during which the disease appears to have a thoroughly epidemic tendency, at which times it is more than ordinarily difficult to control; but the fact should not be lost sight of, that it is strictly a preventable disease, and every means known to health authorities and to families should be adopted to prevent its obtaining a foothold and to prevent its spread.

Diphtheria, a contagious and infectious disease, as well as belonging to the preventable class, shows a mortality for 1890 less than that of former years, and is more effectually under the control of health authorities than heretofore. There were 164 deaths from this cause in 1890, as against 210 in 1889. However, the mortality is still very much larger than it should be, and there is no good reason why it cannot be very materially reduced, if every health officer in the State would promptly isolate every case as soon as it appears, and thoroughly disinfect the premises afterward. this statement has been exemplified in a most convincing manner in many of our towns.

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The mortality from measles for the year 1890 was 9, as against 16 the previous year, while in 1888 there were 55 deaths from this disease. The remarks made concerning scarlet fever are substantially applicable to measles. In some States it is classed as one of the dangerous diseases coming within the jurisdiction of the health authorities, and against which stringent restrictive and preventive measures are applied.

The diseases above mentioned are those which have received the especial attention of sanitarians during recent years, and the result is manifest in their lessened prevalence and mortality. This by no means implies that sanitary work has had no effect in other directions. It is well known that

anything that improves the sanitary condition of a locality, increases its healthfulness and renders it less liable to the invasion of disease. The work of the health officer is by no means restricted to the few so called contagious and infectious diseases indeed, this is but a minor labor in the great field of sanitation. As a result of the investigations and progress in medical science during the past decade, that chief of all diseases, consumption, is transferred to the list of preventable causes of death. Against this terrible malady the united efforts of all the health officers in the civilized world should be directed, and the prospects are, that with determined and united work its terrible ravages may be very materially lessened.

Cholera infantum, which causes so many deaths, especially in the cities of Manchester and Nashua, is believed to be produced by conditions largely within the control of a health department.

The value of sanitary work has been demonstrated beyond any question of doubt, and it only remains to push on the work until there is no longer need of it; until filth and degradation, disease and premature death are supplanted by cleanliness, purity, good health, and happiness.

DUTIES OF BOARDS OF HEALTH.

By virtue of the law of the State every town has a board of health. If no action is taken regarding health officers, the selectmen, ex officio, constitute the board of health. A town may, and frequently does, elect a board of health or health officer; but if no action is taken by the town and the selectmen desire to appoint a board of health, they can legally do so, failing to do this they themselves must act as a board of health.

The duties of a board of health are many, exacting, important, and attended with many moral and legal responsibilities. The man who is unprepared to assume all these or who

does not recognize their full import is not fitted to be a health officer. To administer the office as though there were nothing to do but to act reluctantly upon complaints and to draw the usually meagre salary, is to confess an unfitness for the place at the outset. A board of health has duties to perform second in importance to no office within the gift of the town. There is no town, however small, that may not be benefited by an active board of health.

1. A local board of health should inform themselves fully as to the advantages, benefits, and possibilities that sanitary science has in store for all communities; the grand results for the public good that may be and frequently have been accomplished by its teachings, not only in large cities, but also in small towns, hamlets, and even isolated homes. The information may be gathered in a large degree from the reports of boards of health, which may usually be had upon application. After the appointment or election of a board of health, it should organize by choosing one of its members chairman, and another secretary, the latter of whom should keep a careful record of all the doings of the board.

2. The board should establish and promulgate rules and regulations as it may deem necessary for the better preservation of the public health. The regulations must be approved by the selectmen, recorded by the town clerk, and either printed in some newspaper published in the town or posted in two or more public places. The rules and regulations should be carefully and considerately drawn, to the end that the community for which they are intended may be benefited to the greatest possible extent. These rules have the force of law, and for the wilful violation of the same the offender may be punished by fine of $10 for each offense. A sample set of rules and regulations are herewith appended for the guidance of such health officers as may desire to avail themselves of the suggestions contained therein:

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