"State and local boards which have not adopted the recommendations of the National Board are requested to do so as soon as convenient, in order to secure uniformity of action. "It should be observed that these recommendations are for a minimum amount of precaution, and therefore that additional precautions may be taken by State or local boards if deemed necessary, it being borne in mind all the while that the end in view is to secure or restore the public health by measures which interfere with travel or traffic as little as possible; in other words, to render commerce secure; and (with rare exceptions) not to put an end to or eren suspend it. In this connection it is proper to add that non-intercourse quarantines, especially by local authorities, are not approved by this board. "2. Applications to the National Board of Health for aid should be made by or through the State board; or in case there is no State board, then by or through the governor of the State. 3. Applications for aid should give details of what is required, and the estimated cost for each item. Amongst other things should be specified the duties and powers of the officers whose appointment or payment is requested. 4. The application should be accompanied by an official certificate from the governor of the State or the mayor or other chief officer of the municipality, respectively, to the effect that there are no State or municipal funds available to carry out the particular sanitary measures because of which the application is made. Official information should be given therein of the adoption by such State or local board of any rules and regulations that have been recommended in such case by this board, and of any other State or local rules and regulations that appear to be necessary for the purpose in question. "5. Of the supplies required for the sick, those furnished by this board to local authorities shall, as a general rule, be applied to other objects than those of shelter and furniture, which should be furnished by such authorities. Where, however, it shall be otherwise ordered the local authorities will be expected to account to this board from time to time for the safe-keeping and proper use of the furniture, provisions, medicines, &c., so furnished. persons to understand the requirements of the Treasury Department as to the form of vouchers, receipts, &c., but all these gradually disappeared. All disbursements being made by the disbursing clerk of the board stationed at the central office in Washington, it became sometimes necessary for the local authorities to advance. money to laborers employed by the day or for brief periods of time, and this was also the occasion of some delay and dissatisfaction. Should a similar emergency again occur, it will probably be found expedient to send a disbursing clerk of the board to pay this class of employés promptly upon some form of roll or voucher to be approved by the auditing officers of the Treasury Department. It is a matter of regret that isolation of the first cases could not have had a fair trial in Memphis. The disease, however, had become fairly established in several different localities before its existence was publicly known, and a number of cases of a mild type had occurred among the negroes, who had not called in any physician and among whom the existence of the fever was not known until some time afterwards; and it is owing to this difficulty of securing prompt information as to the existence of the earlier cases that is due one of the great obstacles in the way of securing the proper amount of isolation. A large amount of work was done during the summer in the city of Memphis by the State board of health of Tennessee, assisted by the National Board of Health, in destroying infected material and in disinfecting infected premises, all of which was valuable, not only for its immediate effects, but for the prevention of the reappearance of the disease in that city during the coming summer. In concluding this portion of the report the board takes great pleas ure in stating that the operations of the State and local boards aided by it were harmonions and satisfactory, and that all the officers of these boards showed great interest in the work, furnishing information and rendering services of great value to this board, irrespective of the immediate results which all parties were trying to reach. The same may be said of the inspectors employed by this board in, or in the immediate vicinity of, infected points, many of whom labored with an energy and constancy worthy of the highest praise. In this connection the board desires to call special attention to the services rendered in Memphis by Dr. J. W. Ross, passed assistant surgeon United States Navy. This officer, having volunteered for servon the 22d of August, and on the 26th of August was placed in charge there as the inspector representing the National Board of Health to co-operate with the State and local health authorities to prevent the spread of the disease. Dr. Ross remained on this duty until the close of the epidemic, when he was relieved and returned to his proper station on the school-ship Saint Mary's at New York. The position filled by Dr. Ross was one which required great energy and administrative ability, and the board takes great pleasure in stating that his duties were in every respect satisfactorily performed. "6. Whenever this board shall order the erection of temporary buildings, or provide any buildings for the purpose of quarantine, the necessary contracts therefor shall be made by one of its own officersice in connection with yellow fever, was assigned to duty in Memphis or agents, subject to the approval of the board or of its executive committee. "7. Care should be taken that the officers to be paid from funds furnished by the National Board are employed only in such number and for such time as there is actual need of their services. The National Board of Health reserves the right of judging from time to time, by means of reports received from its own agents, whether such need exists. "8. Funds are not furnished by the Treasury to State or local boards. They are placed in the hands of the disbursing clerk of the National Board of Health, by whom bills, properly certified and approved, will be paid by check on Washington or New York. All bills must be in accordance with the estimates as approved by the Secretary of the Treasury, must be made out in duplicate on forms furnished by the National Board, and be certified as to their correctness by some authorized officer of the State board or by the governor of the State, and must be approved by some member or special inspector of the National Board duly authorized. All bills for services rendered or for articles furnished local or State boards must be sworn to by the person rendering the service or furnishing the articles. "The names of all persons whose services as inspectors, &c., are to be paid for out of its funds must, previously to their appointment, be submitted to and approved by the National Board. "It is expected that at the close of the season a full report will be made by State boards of health to the National Board as to their operations in carrying out those rules and regulations for the prevention of the spread of yellow fever in which the National Board has rendered aid and co-operation, and it is desired that copies of all orders issued from time to time to inspectors shall be promptly furnished to this board. "It is to be remembered that a full account of its expenditures must be made by the National Board of Health to Congress, and that such account ought to set forth these expenditures in detail, and exhibit their propriety and necessity. "It is therefore essential that State and municipal boards shall cooperate with the National Board in supplying material for such an account, and it is earnestly desired that they will preserve and furnish due evidence of the propriety of each item of their expenditure for both persons employed and articles purchased with the funds in question; particularly as the future aid of both State and National Boards must depend largely upon the record for efficiency and economy made during the year now current. "9. State and municipal boards of health which receive aid from this board are requested to furnish weekly reports to this office of their operations, including copies of orders issued by them and of reports made to them by their quarantine and sanitary inspectors with reference to the occurrence of cases of yellow fever and to measures adopted for isolating such cases; such reports to be presented in a form suitable for publication in the BULLETIN." The operation of these regulations was upon the whole satisfactory. Some confusion and delay occurred because of the failure of some After the passage of the joint resolution authorizing the Secretary of the Navy, at the request of the National Board of Health, to place, gratuitously, at the disposal of the commissioners of quarantine, or the proper authorities at any of the ports of the United States to be used by them temporarily for quarantine purpose, such vessels or hulks belonging to the United States as are not required for other uses of the National Government, approved June 14, 1879, an application was made to the Secretary of the Navy on the 7th day of July for such hulks for use at the ports of Wax Bayou and Atchafalaya. It was found, however, that the Secretary of the Navy did not construe this resolution as authorizing him to have said vessels or hulks delivered at the places at which they were to be used, and for this reason, as well as on account of the lateness of the season when this decision was reached, no action has been taken under the resolution. The use of hulks, especially if old and containing much decayed wood for hospital purposes in connection with yellow fever, or the placing such hulks in positions where they are liable to become in. fected with yellow fever, is only justifiable in cases of special emergency, or in places where it is impossible to secure the space necessary for the pitching of tents or erection of cheap temporary wooden structures. Under the provisions of section 2 of the act approved June 2, which provides, "That upon the request of the National Board of Health the President is authorized to detail a medical officer to serve in the office of the consul at any foreign port for the purpose of making the inspection and giving the certificates herein before mentioned: Provided, That the number of officers so detailed shall not exceed at any one time six," a request was made for the detail of two medical officers, skilled in naval hygiene, to serve at the ports of Havana and Matanzas respectively. It was found, however, extremely difficult to obtain the detail requested, for the reason that no officers were available for such service who had had yellow fever, and the board was unwilling to send to these infected ports and charge with the special duty of examining infected vessels and localities gentlemen who were not thus protected by an attack of the disease. The result was that but one officer was found to be available. This gentleman, Dr. Somerset Robinson, medical inspector, United States Navy, was detailed for duty at the port of Matanzas, and set sail for that port on the 14th day of August, 1879. His relief from duty was approved on the 18th day of October, there being no further necessity for inspections at that port; and the board desires to return thanks for the services thus rendered. By the terms of the act "to authorize the Secretary of the Treasury to contract for the purchase or construction of a refrigerating ship for the disinfection of vessels and cargoes, and for other purposes," approved April 18, 1879, it was made the duty of the National Board of Health to recommend with regard to the form of steamvessel and refrigerating machinery to be used for this purpose. This was done by a letter to Hon. John Sherman, Secretary of the Treasury, under date June 17, 1879, after having obtained the aid and counsel of a board of experts in naval engineering and ship construction, convened at the request of this board by the courtesy of the Secretary of the Navy. All the documents and correspondence in connection with this subject have been presented to Congress in a letter from the Secretary of the Treasury in reply to a Senate resolution of June 23, 1879, and published as Executive Document No. 33, Senate, Forty-sixth Congress, first session, to which reference is made for further information on this point; and to Executive Document No. 30, Forty-sixth Congress, first session, being a letter from the Secretary of the Navy in reply to Senate resolution, June 17, 1879, and transmitting a copy of the report of the naval engineer officers ap; pointed to examine plans and specifications of refrigerating ship and machinery, reference is made for further information. It is understood by the board from the annual report of the honorable Secretary of the Treasury that no action has been taken in this matter, and that the whole subject has been referred for additional action by Congress, if such should be deemed expedient. In this connection the board would respectfully observe that, in its opinion, it is not expedient that the construction of such disinfecting ship should be carried out by contract given to the lowest bidder. If such ship is to be constructed at all, it should be for disinfecting purposes, including not merely apparatus for refrigeration, but also for disinfection by dry heat, by superheated steam, by disinfecting gases or vapors, &c.; it should also have means for disinfecting clothing and bedding. Such a ship must necessarily contain a large amount of machinery entirely new in design and pattern, and of which it is extremely difficult to make any accurate estimate of cost; this is especially the case with regard to the machinery proposed for the ship recommended by the board of naval engineers, which contains much machinery of a kind never before constructed, and which will require special skill and, in all probability, repeated trials for its satisfactory adjustment. It is the opinion of the board that it would be wiser, if the construction of such a ship should be carried on, that it should be done at one of the navy-yards, under the direction of the Secretary of the Navy, and that the gentleman who furnishes the designs and specifications for such ship should be paid a fair amount for such designs and specifications, and also for his supervision of the construction of the vessel. When such vessel is completed, the operation of her machinery should be fairly tested at some northern port, as, for instance, in the harbor of New York, before being sent to any of the South Atlantic or Gulf ports. But one case has occurred in which, in the opinion of the board, it was desirable to take action under the provisions of the latter clause of section 3 of the act approved June 2. This case arose from the complaints made by the health authorities of Philadelphia that vessels coming from infected ports were boarded by boarding-house runners from that city, at points outside of the jurisdiction of its quarantine authorities. The board having ascertained by a special inquiry that neither the State of Delaware nor New Jersey could execute and enforce regulations adequate to meet the emergency, reported the facts to the President of the United States, and were authorized by him to carry out the provisions of the law as set forth in said section. Under this order the board framed certain additional rules and regulations, a copy of which is given in No. 10 of the Bulletin, page 84, which were approved by the President August 22, 1879. To carry out these rules, Surgeon J. W. Coles, United States Navy, was detailed by direction of the President. That officer proceeded to Philadelphia to confer with the health authorities of the city, and after consultation reported that in view of the lateness of the season it was not considered desirable to establish this quarantine station or to attempt to carry out the proposed rules and regulations during the present year, which recommendation was approved by the executive committee. The matter has since been investigated by an officer of the board, who, after conference with the board of health of Philadelphia, and with some of the leading merchants and ship-owners of that city, reported that the danger of the introduction of contagious or infectious diseases at this port by evasion of its quarantine is not at present sufficiently great to warrant the expense to the United States or the hinderance to commerce with such an inspecting station as was proposed by the board would entail, if the quarantine station of Philadelphia is to be continued as at present. The board have therefore advised the President that in its judgment it is expedient to cancel the rules made by it and approved by him relative to this station. It is believed that hereafter it may be desirable that the United States should establish a complete quarantine station at some point below Newcastle, on the Delaware, which station would remove the necessity for any State or local quarantine higher up the river. The requirements of the 4th and 5th sections of the act approved June 2, 1879, have been met by the weekly publication of the National Board of Health Bulletin, a complete file of which, to date, accompanies this report. The total number of copies of the Bulletin regularly issued is 4,500. The duty imposed on the board by section 3 of the act approved July 1, 1879, has not yet been performed, for the reason that Drs. Bemiss and Cochran have been occupied throughout the summer for the board in sanitary and professional work connected with the epidemic, and Colonel Hardee has been employed on the Havana commission; hence these gentlemen have been unable to complete their reports. They will be placed in the hands of the board during the first week in January. In connection with this report, to present it in proper form, it will be necessary to reproduce about a hundred maps of cities and towns, prepared by Colonel Hardee, and also a number of diagrams of the record of temperatures, prepared by Dr. Bemiss. The total cost of the work is estimated as follows at the Government Printing Office: Miscellaneous expenses Pay and expenses of board... Printing Bulletin.. Quarantine expenses, pay and expenses of inspectors........... Services of T. S. Taylor (act June 2, 1879)... $1,824 08 11,216 48 1,319 09 875.00 187 80 1,141 75 7,371 91 1,439 85 1,389 71 481 36 2,095 77 1,700 96 11,797 29 1,772 40 178 25 12, 314 34 540 00 13,628 30 3,006 28 47,742 03 903 75 13, 180 24 3,849 77 520 00 7,539 51 115 00 150 00 3,915 15 1,806 35 154,002 42 Total expenditures .... Appended to this is given an estimate of expenditures from January 1 to June 30, 1880, and of expenditures from July 1, 1880, to June 30, 1881. It will be perceived that to meet these estimates the sum of $90,392.42 should be appropriated for the use of the board in addition to the balance of funds which it has on hand. In addition to this estimate it is advised that an appropriation of about $100,000 be made, to be held in reserve for the emergency of the occurrence of such an epidemic as that of 1879, and to be used solely for purposes of inland quarantine in case of such an outbreak. From January 1 to June 30, 1880. For establishment of quarantine stations at mouth of $100,000 SUPPLEMENT No. 3, National Board of Health Bulletin. WASHINGTON, D. C., March 1, 1880. At the meeting of the National Board of Health October 13, 1879, it was decided that a sanitary survey of the city of Memphis should be made, and a special committee of the Board, consisting of Drs. J. S. Billings, H. A. Johnson, and R. W. Mitchell, was appointed to take charge of the matter. This committee was authorized to have made a house-to-house inspection, provided this was agreed to by the authorities of the city, and to employ two experts. It was also directed to visit Memphis at the close of the November meeting of the Board. On the 21st of October the following resolution was received from the State Board of Health of Tennessee: "Whereas proper sanitation, having for its object the promotion of the public health as applied to cities, can only be accomplished through the means of a thoroughly systematized and comprehensive plan, and the city of Memphis is now in such a condition as to demand the early adoption of a plan for future operations relating to its permanent sanitation; and "Whereas the geographical position of Memphis and her relations by commercial intercourse place that city in a situation to imperil, in times of pestilence, the health of the whole Mississippi Valley; and "Whereas neither the authorities of Memphis nor the board have the means at hand necessary to the accomplishment of this work: Therefore, "Be it resolved, That the co-operation of the National Board of Health be requested for the purpose of making a thorough and complete sanitary survey of the city of Memphis at as early a date as possible, after the close of the present epidemic of yellow fever, with the view of indicating what conditions exist favorable to the production and spread of disease, and what measures should be adopted for their removal, with the methods of their accomplishment and the estimated cost of the same. "Adopted at the quarterly meeting of the Tennessee State board of health, held October 7 and 8, 1879." In accordance with a request made by the National Board, Hon. John Johnson, of Memphis, member of the State Board of Health of Tennessee, was designated to represent that body, and to aid and counsel with the committee having charge of the survey. On the 30th of October a telegram was received from Hon. D. T. Porter, president of the taxing district of Shelby County, asking the National Board to make a complete sanitary survey of the city as soon as practicable, in reply to which he was informed of the action of the Board, and was requested to give such assistance toward making the examination complete and accurate as might be in his power. At this time yellow fever was still prevailing in the city, and it was useless to undertake any house-to-house inspection or survey at that time, since the great majority of the inhabitants were absent and their houses were closed. The necessary blanks for the house-tohouse inspection were, however, prepared after an examination of a number of blank forms of a similar character. The form decided on measures 7 by 9 inches, and is as follows: No.-. 3. Area of lot, 4. Age of house, NATIONAL BOARD OF HEALTH. 1. Ward 2. Owner or owners, ; of house, 5. Cellars and basement, 6. Rooms and passages, 7. Sinks, drains, and cess-pools, 8. Privies or water-closets, location and condition, 9. Yards, 10. Hogs or other animals, 1879. Fifty such sheets were put together, forming a memorandum block, on the back of which was printed the following "DIRECTIONS. "The figures below refer to the corresponding numbers on the other side. (See above.) "1 and 2. Give the exact and full name of the owner or owners of the estate. Give the street and number, and describe the location so that it cannot be mistaken. "3. Give dimensions of sheds, privies, stables, &c., with their relations to living-rooms. "5. Examine cellars VERY CAREFULLY, and describe their condition, particularly with regard to dampness, amount and kind of filth, ventilation, &c. "7. Is there any offensive smell from the sinks? Are the pipes or spouts water-tight? Are there any traps to prevent foul air from coming into the rooms? Are the spouts broken, leaky, and filthy? Are the sink-drains clogged or uncovered? Are the cess-pools tightly covered and clean? Do the cess-pools leak into the cellar or into the well? "8. Privies and vaults: Describe their condition particularly. Are they full or running over? Are they filthy? Is the vault tightly covered? Do they smell badly? Do the vaults need emptying? "9. Describe particularly the kind and amount of all heaps of filth about the premises, and the general condition of the yards. "11. Public nuisances, as sewers, stables, offensive manufactories, &c. "12. Note overcrowding. "13, 14, 15. Inquire particularly. "16. State whether, in addition to the supply from water mains, water is used from a well or cistern; whether it is called good or bad; whether any filth probably drains into the well, &c. "17. Note bedding, wearing apparel, and upholstered furniture, and whether disinfection has been performed in the house. "Give any other information and make such suggestions as may occur to you on the back of the form, referring, when necessary, to the numbers. Give all descriptions in as few words as possible, but be clear and definite." It is considered that this form is more convenient for the purposes of such an inspection as the committee desired to make than any form of memorandum-book to be carried in the pocket. It was found that a very excellent contour map for the greater portion of the city had been prepared by Mr. Charles Hermany, the engineer in charge of the water-works at Louisville, Ky., in connection with a report made by him to the city proposing a system ef sewerage and water supply in the year 1868, and after examination of this map it was not considered necessary to have any further work done in this direction for the purposes of the survey. As soon as the epidemic had ceased and a majority of the citizens had returned to their homes, the house-to-house inspection was commenced under the immediate direction of Dr. R. W. Mitchell, the resident member of the Board. At the close of the meeting of the National Board of Health at Nashville, Tenn., November 22, the committee met in Memphis, having associated with it Maj. W. H. H. Benyaurd, United States Engineers, detailed by the War Department as consulting engineer in accordance with the request of the Board; Dr. C. F. Folsom, secretary of the State Board of Health of Massachusetts; George E. Waring, jr., and Dr. Charles Smart, United States Army, who had been specially detailed for the purpose of making analyses of the water supply. After a general survey of the city and obtaining information and suggestions from the authorities and principal citizens of the place, and after an examination of the results of so much of the house-tohouse inspection as was then completed, the committee prepared a preliminary report, and in view of the urgency of the case and the importance of prompt action, furnished a copy of the same, with their recommendations, to Governor Porter, authority to furnish such re-; No. of per- | port having been granted by the board at the Nashville meeting. A copy of this preliminary report is given in No. 24 of the BULLETIN. The recommendations of the committee were as follows: First. That measures be at once taken to secure proper superintendence and subsequent care of the sanitary work to be undertaken by the city. This will involve, among other things, the employment of a trained and thoroughly competent sanitary officer, and it is absolutely necessary that such intelligent superintendence and care shall be provided and continued, if good results are to be obtained from any comprehensive system of municipal sanitation. There is a large ; where kept, 11. Public nuisances on or near premises, 12. No. of families in house, ; names of heads of families, |