F. Fletcher.

Did I understand you to say it had never been cleaned out?

Mr. H. L. Stillson.

It has not. The benefit of such a basin is that the noxious part does not get into the earth and pollute the supplies below.

W. L. Havens, M. D.

You trap into it?

Mr. H. L. Stillson.

Just as you would into a sewer. The size of the "settling basin" depends upon the amount of sewage you have to run into it. This was for a hotel. The "settling basin" is under the band stand. It went in nine years ago and it has worked very satisfactorily ever since. The outlet is nearly under one of the parlor windows of one of the best houses in the village and there never has been a word said against it. My advice is, avoid litigation.

G. B. Hatch.

There is a mill pond where the ice is removed for refrigerator purposes for meat markets, etc. Several private sewers run into this pond. Is it proper to allow the cutting of that ice?

Dr. C. S. Caverly.

Has that ice been analyzed?

G. B. Hatch.

Once.

Dr. C. S. Caverly.

it.

Have the ice analyzed and if it is not safe for drinking purposes, condemn

Dr. C. S. Caverly.

Some of the older members of this school will remember an address given by Colonel Baker of Rutland that covered the question of how nuisances should be abated more thoroughly than any which I recall since that time. He told you that the local boards of health had as much authority, almost, as the Czar. I think you gentlemen, in getting at the subject of the ways and means of abating a nuisance and interpreting what they are, should study the law itself. Mr. Butterfield has asked the question whether a certain thing is a nuisance. That is for the local board to determine. Nobody else can decide that. You in your respective towns can decide those things with the other members of the local board of health. The law specifies that the local board of health has certain authority. For instance it may abate

all nuisances. The health officer shall make sanitary inspections whenever and wherever he has reason to suspect that anything exists which may be detrimental to the public health. The local health officer alone has no authority except as to the investigation. The full local board of health should take the initiative in the matter of abatement of nuisances. How are you going to show any court of justice that you have that authority? The only way would be to have a record of the meeting of the local board in which you were given the authority to act for them in regard to the abatement of each individual nuisance. I have noticed by the recent reports of health officers that the local boards of health are meeting oftener than they ever did before. You, as health officers, can advise and use moral suasion; you can appeal to the decency of people to abate nuisances, but you have no authority to serve a notice for the abatement of any kind of a nuisance unless you can show that you have been authorized to do this by your local board of health. The full local board has the authority and can abate a nuisance in any way it sees fit. After a particular condition has been deemed a nuisance by the full local board of health and the notice of abatement has been served, if the nuisance is not then taken care of, as secretary of the local board you can order it done and collect the expense of such work of the person or corporation liable therefor. You, as health officers, have only the power to investigate or inspect. The abatement must be the action of the full local board.

Dr. H. A. Elliott.

are.

We always get such a diversity of opinion that I hardly know where we Last year we had a nuisance. The selectmen consulted a lawyer and the lawyer said that it was a private affair and the board had no right whatever to interfere with that partly burned-down building. I wrote to our secretary, Dr. Holton, and he said it was not only unsightly, but those burned walls might fall upon some one passing and should be considered a public nuisance. There is a little friction between our state's attorneys and the State Board of Health. Some one needs instruction, either the state's attorney or the State Board of Health.

Dr. C. S. Caverly.

Please make a minute of your questions and present them to the legal adviser who will be here to-morrow.

Dr. H. D. Holton.

I want to say a word on this subject as to what a nuisance is. Dr. Darling has defined it very well. A nuisance is anything that interferes with the use of a man's property or his rights, not only dangerous to public health, but offensive to the senses and annoying to the rights which each one has. Keep it in mind that a nuisance has not got to be detrimental to public health. The doctor spoke of the cans being emptied into the ravine. They probably gave some odor, but the sight being unpleasant warrants the right of

abatement. You get your fees for inspecting a supposed nuisance and you have got to get the facts yourself; you have got to collect the evidence. If the party does not abate the nuisance after notice from you to do so, you must call the attention of your state's attorney to the matter and if he does nothing with it, then just write to the attorney general. You must personally examine every complaint that is made to you. It is not sufficient that you are sure there has been a quarrel which calls for this complaint, but you must go after the complaint has been made to you and you must investigate it. I have traveled many extra miles and found it a neighborhood quarrel and there was nothing to the matter, but the health officer is obliged to examine every complaint made to him. He is not to blame for the complaint and this should be plainly stated to the party when you go to make your examination. Just tell them you have got to make this examination or you will be subject to a severe penalty. You have got to perform the duties presented to you just as the sheriff has to do his duty.

PRACTICAL PHASES OF LABORATORY WORK.

BY B. H. STONE, DIRECTOR OF THE LABORATORY OF HYGIENE, BURLINGTON.

The sphere of the hygienic laboratory in the sanitary system of the state is so well known that it hardly seems worth while to discuss it in this meeting. Starting from a very humble and uncertain beginning ten years ago, our institution, like the Health Officers' conference, has come to be recognized as indispensable to the best interests of the state. It is one of those innovations made necessary by the increasing age of the country and consequent pollution of the soil, the growth of population and its segregation in the cities, the greater facilities for and consequent increase in travel, and lastly the development in the knowledge of the etiology of disease and methods of prevention. Laboratories are as much a necessity to the sanitary improvement of the country as factories and railways are to its commercial development.

The human mind is always groping for definite results and any method or system which holds forth a promise of such fulfilment in any line is always eagerly accepted, oftentimes by enthusiasts, before the methods have had the benefits of thorough proof. Particularly is this true of medicine. New medical, surgical and diagnostic measures have always been hailed with great avidity, by the laity particularly, but also by a large proportion of the medical profession. Too many times, alas, the utter fallacy of these methods has later been made plain. Thus laboratory methods were eagerly accepted as giving a ready and exact solution of many problems which had always been puzzling. Such institutions have been in operation now such a length of time that a better estimation of their accomplishments can be made than was possible ten years ago. Now we are in a position to weigh carefully the evidence for and against laboratory methods and see wherein, if at all, they have been found wanting.

In the diagnosis of diphtheria, we find that the clinical and bacterial results are at variance almost as often as they agree. In 2560 specimens diagnosed as diphtheria by laboratory examination, 248 were not so diagnosed by clinical examinations. Who was right in these 248 cases of discrepancy? Investigations have shown that many times infection caused by the diphtheria bacillus may be very slight in the individual owing to some personal peculiarity of immunity, and even farther, diphtheria bacilli are found in a certain proportion (about 1 per cent) of apparently healthy throats. Clinically these individuals do not have diphtheria, yet from a sanitary standpoint they are as truly infected as the most severe case. The fact that they are not susceptible, interferes in no way with the virulence of the germs for others. Indeed, these cases, owing to the fact that their wanderings are not

interfered with by illness, are more apt to disseminate the disease than is an individual who is really sick. Furthermore, these individuals are a menace to themselves as some temporary exposure or loss of tone may interfere with this immunity which protects them from the severe manifestations of the disease. Many of these cases will, of course, go undetected, as ordinarily only those with suspicious throats are subjected to bacteriological examination. The problem of the complete eradication of diphtheria is largely the problem of these ambulatory cases. Whether or no it is morally justifiable or legally possible to quarantine a perfectly healthy individual who chances to be carrying diphtheria bacilli in his or her throat, is not a question which I care to discuss. It would raise a similar but more difficult question with regard to those infected with the germ of lobar pneumonia (20 per cent of all healthy individuals). Thus we see that both clinician and laboratory may be correct in these apparently discordant cases, depending entirely upon the view point. Disease has long been diagnosed by clinical symptoms (results) rather than etiology (cause). The latter is unquestionably the most scientific way, but will probably never entirely replace the old system. From the point of view of the health officer, diphtheria should certainly mean infection with diphtheria bacilli, be the clinical symptoms more or less, and recovery should mean a complete disappearance of the infecting organism from the throat. The best method we have at present of determining the latter fact is to secure two consecutive negative cultures taken from nose and throat. That the second negative is a precautionary measure of value is evident from the fact that in many cases, a positive result may follow a negative. Even with two negative cultures, unless taken with great care, it is probable that many cases are released while a few organisms are still lurking in the throat.

Thus in the examination of specimens of sputum for tubercle bacilli results are often obtained which surprise or disappoint the sender. This surprise is more often at negative than positive results. A little consideration of the pathology of tuberculosis, ought, however, to make one anticipate just this result. Tubercle bacilli infecting the lungs whether by way of respiratory or digestive tract finally reach their resting place and lead to proliferation, nodule formation, and ultimate necrosis in the framework of the lung and not on the epithelial surfaces. In the tubercle thus formed, the bacilli lie firmly embedded and it is only when such a growth has invaded an air vesicle and become broken down, usually as a result of secondary infection, with the beginning of cavity formation, that tubercle bacilli are found in the sputum. Provided the infection is a fairly general one, the patient may present many of the clinical signs characteristic of the disease before bacilli are found and on the other hand, one small tubercle may go on to ulceration and tubercle bacilli be found in the sputum at times, long before physical signs are definite. When we consider the great expanse of mucous surface in the lungs and bronchii and realize that there is some normal desquamation and secretion from this surface all of the time and then in comparison with this, consider the relatively small amount of lung structure usually in process of ulceration,