English observations and calculations-no notice is taken of sickness for less than a week -- that for every death there are two persons constantly sick; and that means 730 days sickness and disability for every death.

In 1870 in Massachusetts, amongst the people of the working age, there were 24,554 years and eight months sickness, or disability; or just so much loss of labor.

In contrast to this sad record, let me say that upon the whole the health service of the country, and of the world, is certainly improving; but while this is true, it is necessary to add that, as an entire people, we are only in the beginning of the required work of real civilization. The death rate in the United States army from all causes is but nine per thousand of white men and twenty per thousand of colored troops.

The last annual report of Surgeon General Barnes shows that among the white troops the total number of cases of all kinds reported on the sick list was 37,408, being at the rate of 1,768 per thousand of mean strength. Among the colored troops the total number reported was 4,600, or 1,984 per thousand of mean strength. The total number of deaths from all causes among the white troops was 197, or a deathrate of nine in 1,000 of mean strength; and the total deaths of colored soldiers from all causes was forty-eight, or twenty in 1,000.

In my own State I record with satisfaction that since the establishment of the State Board of Health, as many as fifty, and at one time sixty, local Boards have been organized in a single month. They now exist in the twenty-four cities, three hundred villages, and in nearly all of the towns of the State. The cause of this improvement is due to the fact that physicians in many of the counties of the State, supported by boards of supervisors, village trustees, county, town and district clerks, and, indeed, by nearly all county officers, have been requested to co-operate with the State Board of Health in calling attention to, and in maintaining, public health at home, and to this end they were asked to respond to any and every call looking to private work, and to public meetings for the con sideration and discussion of measures relating to drainage, sewerage and general cleanliness; to the ventilation of schools and public institutions; to the supplies of pure water; to the proximity of wells to cesspools and water-closets; to the adulteration of food and drugs, as affecting health, and to all general work which seeks to secure the health of the people. Work at home, as the best missionary field of labor, is the first improvement needed. The best work always begins there.

When, many years ago, Lord Palmerston met his Scotch petitioners, asking for a day of fasting and prayer, he gave them the wise but rather startling answer: "Go home, and see that your towns and cities are freed from those causes and sources of contagion which, if allowed to remain, will breed pestilence and be fruitful in death, in spite of all prayers of a united but inactive people!" And Ruskin, at a later day, declared that "any interference which tends to reform and protect the health of the masses is viewed by them as unwarranted interference with their vested right to inevitable disease and death." Yet this amiable cynic induced Octavia Hill to invest ten thousand pounds sterling of his money in the lowest quarter of the city, where she might witness the transforming power of its worth in sanitary reform. And so this noble woman, aided by Ruskin's magnificent donation of money proved that wealth is health and that health means the happiness of the people.

In this spirit, Ralph Waldo Emerson, many years ago, in his words on "One in Robust Health," said, in a spirit which I have endeavored to inculcate. "The first wealth is health. Sickness is poor-spirited; it must husband its resources to live. But health answers its own ends, and has to spare; runs over and inundates the creeks and neighborhoods of other men's necessity."

Let me prescribe one other rule of business, and for domestic and public duty; banish from your dwellings all possibilities of contamination from effete matter, all noxious and miasmatic gases from fecal decompositions resulting from soil and sewer pipes. Obstructed pipes send back into your closets, sinks and basins the foulest odors, and only the freest flow of water can keep them clear and clean.

If the sources are all pure and the road straight aud clear, there is a way of escape. The head of every house and building should be prac tically a health inspector. Open the doors and windows of your dormitories and school-rooms, that the air of heaven may enter therein. A little care will shut out filth and darkness, and make room for the light of heaven and the vigor of health. One marked feature of our American life is the disease known as fret and worry.

The haste and zeal of the times causes what is called "American nervousness," which means mental and physical derangement, and which, in turn, again means what has been characterized as hypotism, hysteria, catalepsy, somnambulism, and other preternatural and abnormal manifestations and hallucinations, as seen, in part, in Guiteau's villainous purpose, whatever the measure of his alleged insanity, for killing President Garfield. Some of these evils are born of deceit, passion, vanity and imposture. Others are born of intemperate lives and habits and education, and produce insomnia, dyspepsia, irritability, and a long train of nervous diseases, or disorders, characteristic of the times and the people. These are the diseases which lead the way to asylums for the idiotic and the insane, where it is so hard to

"Minister to the mind diseased,

Pluck from the memory a rooted sorrow;
'Rase out the written troubles of the brain;
And, with some sweet, oblivious antidote,

Cleanse the stuff'd bosom of that perilous stuff
Which weighs upon the heart."

The only offset to this amount of fret and worry is a corresponding reduction of inflammatory diseases; and this, it is said, is almost, if not quite in proportion to the growth of nervous irritability, and also a corresponding increase of longevity where, as one reads, diseases of the many have been most apparent.

But leaving all these specific references to life and death, disease and cure, let me return and close with a single reference as to the duty of the citizen and the obligations of the State, condensing both in the words of another: "Duty is a moral obligation imposed from within; obligation is a duty imposed from without. Duty implies a previous obligation; and an obligation involves a duty. My obligation is to give another man his right; my duty is to do what is right. Hence duty is a wider term than obligation. Duty and right are relative terms. If it be the duty of one party to do something, it is the right of some other party to expect or exact the doing of it."

* * *

MODES AND EXAMPLES ON SANITARY PROCEDURE, ETC.

At the annual meeting in May, 1881, and subsequently, the Secretary was directed to prepare a circular of information upon the best methods of procedure by local sanitary authorities, under the amended laws, against nuisances and other sources of damages to public health. The Board having directed that suitable and most economical plans for contagious disease refuges should be prepared as an appendix to such circular, and that the whole be issued to all local Boards of Health and also be printed in the Second Annual Report, that document is here presented. E. H., Secretary.

[No. 27.]

STATE BOARD OF HEALTH OF NEW YORK.

DUTIES AND PROCEDURES OF LOCAL BOARDS OF HEALTH AND THEIR OFFICERS.— EXAMPLES, METHODS AND SUGGESTIONS.

The laws require the Health Boards to" have cognizance of the causes of injury or danger to the public health." Full power is given every Board to make and enforce regulations and orders of general obligation, which shall be published and obeyed as laws; also to make special orders, without publication, to be immediately enforced for the suppression of nuisances and of sources of contagious diseases or other great dangers to life and health. In this circular the State Board of Health presents a practical view of sanitary procedures, as they relate to nuisances, the protection of health in schools, the removal of causes of malaria, and the control of contagious diseases. In this service, every local Board of Health is required

To be organized according to the statutes.

To have a competent physician as Health Officer."

To adopt and publish regulations and orders of general obligation. To prescribe "the duties and powers of the local Health Officer." To give information to all inhabitants concerning their duties in regard to the registry of deaths, births and marriages, the burial of the dead, and the sanitary care of contagious diseases, and to designate the persons who shall grant permits for the burial of the dead.

To notify all physicians, clergymen and magistrates of their duty relating to certified records for registration.

To make and preserve accurate records of all official proceedings, and to require the Health Officer to do so in his service.

To cause every case of small-pox to be reported immediately to the local Health Officer, and to require him to report to the State Board of Health the fresh outbreaks of that contagion the day he verifies the cases; also to report to the State Board monthly.

All citizens should be free to enter complaints, and the Board should supply a form and a book for recording such complaints.

PROCEDURES AGAINST NUISANCES.

Under the Board's instructions its Health Officer, or other qualified person, must inspect, examine evidence, and make his report to the Board, as the preliminary step to his formal complaint or an official order. Notification, official advice, and a summary or informal order may be usefully given without delay. The formal complaint and order must state that the offense is in violation of a regulation or order of the Board, or that it is "dangerous to life and detrimental to health;" or, being on or near a route of public travel, is noisome or detrimental to public health." Such specific complaints and orders will chiefly relate to scavenging and removal of filth-nuisances, disinfecting, etc., draining, and removal and prevention of obstructions; also cleansing and filling, grading, ventilating, lighting or regulating tenements and places of assemblage, the prevention of noxious emanations, etc.; the isolation and control of dangerous contagions, and the necessary interference with any other causes of imminent peril to life and health.

ILLUSTRATIVE CASES IN PRACTICE.*

The Board of Health in the town of V, at its stated meeting June 25, having already adopted and published the first eleven sanitary Regulations as advised by the State Board of Health [Paper No. 261,

took action as follows:

For the removal of marshy and malarial borders of a mill-pond, seven acres in extent, in the village of M—. Upon complaint of the Health Officer and on personal inspection by the Board,

"Resolved,―That the Secretary serve the following notice upon Messrs. B. and A, as part owners, and on Messrs. A. B. and E. B. as part owners and lessees :- That they are hereby ordered to remove and drain the marshy borders of the mill-pond hereby declared to be a nuisance,situated on their respective lands and under their control, on or before the 20th day of July, 1881."

For the Abatement of an Old Slaughter-House Nuisance, and for the Cleansing and Disinfection of the Building. Upon complaint of the Health Officer, and after inspection by the Board on the 19th of June, "Resolved, That the Secretary of this Board serve the following notice upon H. S--, the owner :—

"That she is hereby ordered to remove and burn all boards, timbers and other things which are saturated with animal matter in and about the building known and used as a slaughter-house on the western border of the mill-pond marsh, on C-street, and that the building be thoroughly fumigated, cleansed and disinfected, on or before the 20th of July, 1881."

*The examples here given have occurred during the past twelve months. The forms of procedure are such as will be found most convenient and effectual in daily sanitary service.

To Remove a Cause of Pollution of a Running Stream used for Domestic Purposes.

66

Resolved, That the following notice be served by the Secretary on CS: That he is hereby ordered forthwith to remove or burn the dead horse which he has buried near a running stream at

Complaint by Citizens, and summary Orders from the Board of Health, served by Health Officer, under the published regulations. Report of service and compliance:

COMPLAINT

"To the Board of Health, village (or town) of

"Take notice that there is, upon the premises owned by J- Kand occupied by Mrs. ——, at No. street, an overflowing privy

vault; and that I hereby complain of the same as a nuisance."

CONCERNING NUISANCE AT

"To the Board of Health of....

"I certify that on the 7th day of May, 1882, I re-
ceived the within complaint, and that on the 7th of
May I examined the premises and requested the owner
to remove the contents of privy-vault. This he did par
tially; the nuisance remaining. June 7th he was
served with notice to abate within 3 days. June 10th
it was found abated.

"You are hereby required within 3 days to abate a
nuisance upon your premises on ———, in — village,
viz., an overflowing privy-vault and a cesspool in
front of said premises, or the same will be done, and
the expense thereof collected from you, together with
the penalty of neglect in relation thereto.
"By order of the Board of Health.

Health Officer."

NOTE. This order was served on owner and the tenants at the same time. It was fully complied with by J. K., the owner.

Summary Order for Abatement of Nuisance of Stagnant Water, and an old Cistern, by the Board of Health of the town of

"To

and W

:

owner and occupant of premises on

streets :

the corner of I"You are hereby notified that the stagnant water upon your premises and bordering upon the public streets here mentioned, and an old cistern there situated, have been declared a nuisance by this Board, dangerous to life and detrimental to health. You are hereby required to abate said nuisance, within three days from the date hereof, by filling up said cistern, removing all rubbish and obstructions to drainage, and by keeping the said premises so drained, as to be free from all surface-water."