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the duplicate copy will be retained by the agent at the initial point and sent to the General Baggage Agent.
7. It is intended that no dead body shall be moved which may be the means of spreading disease; therefore, all disinterred bodies, dead from any disease or cause, will be treated as infectious and dangerous to public health, and will not be accepted for transportation unless enclosed in a new wooden box, made air tight if possible, and said removal has been approved by the State Board of Health, or the consent of the health officer or other legal authority of the locality to which the corpse is consigned, has first been obtained.
In submitting these rules for consideration, it is not assumed that they are perfect, but are recommendations which, in our opinion, will be in the interests of the public health, and at the same time not unnecessarily burdensome and expensive to the public.
It has previously been suggested that it was obvious, that infectious or communicable diseases follow more quickly the lines of communication, being spread by the movements of the people ; and as the railroads are the principal medium of communication among the people, the trunk lines spanning the continent, bringing to our doors inhabitants from all parts of the county, it is patent to all that local rules, be they ever so rigid, can afford but partial protection, and as the bodies of the dead are transported in the same cars and among the baggage containing the wearing apparel of the passengers, the necessity for some effective rules, which will apply the same in all the States, is the more apparent. It seems that this can be accomplished, and our coöperation to that end will be cordially given.
We believe it is a good policy to have a list of specified dangerous diseases that should not be carried, as in rule 1.
In preparing bodies for shipment, it is not necessary that the cavities be injected if prepared otherwise as in rule 2, although such preparation skilfully accomplished would be of some advantage. Embalming as usually performed, is of doubtful value. And when well performed the expense need not necessarily be above ter dollars.
The expense of so-called air tight zinc, copper, lead lined or iron coffins or caskets would be entirely prohibitory on the part of many people, and at times because of distance from procurement, very difficult if not entirely impossible to obtain at any expense, and very seldom, if of any additional safely to rule 2.
There is no standard by which undertakers in Rhode Island are graded to ascertain whether competent or not before being allowed to practice the art of embalming. We think each State should require every undertaker to take out a license and pass examination before a competent board of examiners before be is allowed to prepare a dead body for shipment.
There is no penalty in this state for making false affidavit or issuing false certificate, either as to cause of death or as to the preparation of a body for transportation, except as for a misdemeanor at common law. Legislation should give the necessary protection.
It is desirable tbat all permits for the removal of dead bodies be issued by Boards of Health, health officers or other competent legal authority, and this can be done in all cases even in small towns or country districts.
It is also desirable that a nearly uniform style of removal permits be used, to insure definite and necessary information, to enable persons to transport dead bodies through several States without danger of being stopped at some intermediate poin Sa of permits used in this state included.
By order of the Board,
CHAS. H. FISHER, Secretary.
An account of the current office work in detail would obviously, because of its varied character, extend a report to an unwonted length. Allusion has already been made as to the enormous amount of work required in the preparation of the reports on the vital statistics.
Briefly, all changes in the laws having relation to the duties of physicians, town clerks and undertakers, which occur nearly every year, are written out and explained, as they may have application to either of the occupations—600 persons or more in all, with blanks for each, changed to meet the requirements of law; the prompt and continued forwarding of a supply of other blanks as needed to town and city clerks for monthly and annual returns of deaths, and of births and marriages ; blanks for an account of improvements of a sanitary character in the towns and of new sanitary ordinances ; also, to physicians for monthly report of prevalent diseases, distributed monthly, and for physicians returns of cause of death to town and city clerks, and for annual general returns; also to clergymen the blank certificates of marriage ; and to undertakers the blanks for returns of death to town and city clerks, and blanks for undertaker's notice to physicians; also, to health officers for annual returns of duties attended to and work accomplished.
Other circulars are written and distributed to various town officials and other parties, having duties under the laws in relation to public health and the vital statistics of the State, reminding them of those duties, suggesting methods of performance and urging their prompt discharge.
Distribution is made, when occasion requires, of the tracts for the “Prevention of Typhoid Fever” and “ Prevention of Scarlet Fever," the “Manual” prepared for the use of health officers, the “Nomenclature” of diseases for the use of physicians, and the posters, “Treatment of the Drowned,” when called for. In some of the pub
and ages ;
lic schools the rules of the latter are committed to memory by the senior class and recitations thereof given every week.
A record of the investigations of cases of contagious diseases of domestic animals, the date, the name of the owner, the location, the characteristics of the disease and other notes. (See Report of the Cattle Commission department.)
The publication of the Monthly BULLETIN has been continued through the year, for which the secretary has written 94 articles, long and short; has prepared 12 summaries of deaths, with sex, parentage
24 pages of causes of deaths and number, with comments and percentages ; and 24 pages of meteorological observations and summaries. Supervision is also given to printing, correcting proofs, addressing, wrapping, mailing and other methods of distribution of copies. The MONTHLY now reaches over 1,000 of the teachers in the public schools of the State.
There were 1,268 letters written by the secretary during the year, about 150 of which were to parties in different States and countries, in reply to inquiries for various kinds of information.
The number of blanks necessarily sent out for returns and reports from different officials and professions, and at different times during the year, for purposes within the province and duties of the Board, exceeded 20,000.
The report upon “Tuberculosis among the neat-cattle in the State,” and the preparation of the Eleventh Report of the Board, comprising 177 pages, including Tuberculosis, were among the duties and work of the secretary during the year, in addition to the preparation of the Report on vital statistics comprising 220 pages, or about 400 pages of printed reports in all, and about 130 pages of original matter for the MONTHLY BULLETIN.
Differing from other States, the Cattle Commission of Rhode Island is vested in the State Board of Health. The duties in this department consume a large amount of time. For the purpose of securing an economical administration of the duties incumbent in this department, the secretary has personally performed a considerable part of the veterinary work.
Some part of 168 days was occupied by him during 1889, in the investigation and examination of cases of domestic animals, having or suspected of having contagious or infectious diseases.
The cases included glanders and farcy, tuberculosis, cow pox, swine plague and various other diseases, having some symptoms in common with contagious diseases.
Of 114 cases of suspected glanders or farcy, 78 were confirmed and destroyed. Some of the cases were visited two, three or more times. 156 different animals, equine, bovine and porcine came under investigation during the year.
1,424 horses were inspected by the secretary during the year, comprising team, market, railway, hack, express, carriage and other horses in the city, the country and at the State Fair.
The large prevalence of tuberculosis among the bovine animals of the State makes the subject a question of very grave importance, inasmuch as the consensus of medical opinion is to the effect that the disease is identical in its specific cause with phthisis pulmonalis, or tubercular consumption in mankind, and that the disease may be communicated from bovine animals to mankind by reason of the specific virus—the tubercle bacillus—transmitted by ingestion of the meat or milk.
The following in respect to such transmission, from Dr. Robert Koch, a privy councillor in the German empire, the first to demonstrate, eight years ago, the exact relation of tuberculosis to a specific bacillus as its cause, and who is by universal acknowledgment one of the foremost biologists in the world, will be of interest in this connection :
The second principal sourse for the tuberculous bacilli, namely, tuberculosis of the domestic animals, appears not to have anything like the importance of the phthisic sputum'. The animals, as is well known, produce no sputum, so that during their life no tuberculous bacilli get from them into the outer world by means of the respiratory passages.
Also in the excrement of tuberculous animals tuberculous bacilli appear to be only exceptionally present. On the contrary, it is a fact that the milk of tuberculous animals can cause infection. With the exception of this one way, therefore, the tuberculous virus can only have effect after the death of the animal, and can only cause infection by the eating of the meat. Aside from the probably only rarely occurring cases of direct infection, wbich can follow from coming in contact with tuberculous parts of i he flesh of little wounds and exoriations of the skin, the reception of
the infeotious material will result in this case only by means of the organs of digestion, and in accordance with this the first appearances of the disease must first show themselves here. But now primary tuberculosis of the intestines is not at all frequent in proportion to primary lung tuberculosis-indeed, a decidedly rare affection. From this it is to be concluded, that the infection in question does not often occur from eating the flesh of tuberculous animals. Probably it would occur frequently if the visibly diseased parts of the flesh were not put aside, as is usually the case, and if as is almost invariably the case, the meat were not eaten cooked. Also especially it must be considered that the tuberculosis eatable animals, especially the perlsucht? of cattle, remains more or less localized, so that after all only the use of the tuberculously altered lungs, glands, etc., would be dangerous. That, nevertheless, the infection from the intestinal canal is indeed possible, is proved by the frequent cases of secondary intestinal tuberculosis of consumptives, which must be attributed to the swallowing of their own sputa. It is, to be sure, strange that, although it is to be supposed, that every consumptive swallows more or less of the tuberculous bacilli-bearing secretion from his lungs, nevertheless intestinal abscesses are not to be found in all. I explain this in the following manner: In the first place, the intestines appear to offer a still more unfavorable point of attack for the slowly growing tuberculous bacilli than the lungs. But further, the feedingattempts with anthrax bacilli and their spores, have taught that anthrax bacilli, which contain no spores, are destroyed in the stomach, while the spores of these bacilli are able to pass through the stomach unharmed. On that account only spore-bearing substances can cause infection from the intestinal canal. The tuberculous bacilli will conduct themselves most probably in this regard, like the anthrax-bacilli, and only in case they are provided with spores will cause tuberculosis of the intestines, provided they do not go through the intestinal canal too quickly to render their germinating and establishing themselves at any point of the mucous membrane of the intestines possible. Just the same holds, of course, for the danger of an infection from tuberculous meat, and this circumstance may explain the relatively rare infection from the use of such meat.
The same conditions hold for infection from the milk of cows suffering from perlsucht'. Before all ogs, if infection is to take place it is necessary that the milk contain tuberculous bacilli. But this appears only to be the case when the milk-glands themselves are tuberculously diseased. But since perlsucht-knots do not often occur in the udder, the milk of perlsucht cows will often possess no infectious properties. This explains immediately the contradictions in the statements of the various authors, who have made feeding attempts with milk from cows suffering from perlsucht. The one set maintain that they have gained positive results, and their statements are of such a sort that it is impossible to doubt the correctness of their observations. The others, on the contrary, could obtain no infection in the animals experimented with. This result is also correct. The positive results were then obtained from milk which accidentally contained tuberculous bacilli, the negative with milk which was free from bacilli.
1 Bovine tuberculosis.