hod after emptying. No other cleansing is required. It is better not to use an earth-closet as a urinal, but so much of such use as is incidental to its employment as a stool in no respect interferes with its satisfactory workings. Slops should on no account be poured into it. "The best of materials which can be had without expense or trouble, is the fine siftings of anthracite coal ashes. Ashes from bituminous coal are not adapted to the purpose. Dry loamy earth, or leaf-mold, will answer very well, but it is troublesome to dry and store it. It cannot be had dry enough out of doors, even in mid summer. Sand is useless. Discreetly and decently used, an earth-closet gives very little trouble. If ashes are thrown in after each use, it will not require any attention until the receiving vessel is full. The object of leaving the larger compartment bottomless, is to facilitate cleaning. More or less ashes will be spilled around the hod, and this should be swept out frequently. By raising one end of the box, the floor under it can be swept much cleaner than the bottom of a box could be without turning it over. Such an earth-closet can be placed and used anywhere indoors. No doubt it could be made a nuisance, especially if boys were permitted to saturate the wood with urine, if a person using it should forget to use ashes, or if the hod were left to become overful and matter intended to be held in it should roll off on the floor. It needs attention like every other good thing, but, given as much care as would be bestowed upon any other article of furniture, it meets all the requirements of a safe and convenient indoor commode." 26 BOARD OF HEALTH. 402 APPENDIX F, CIRCULARS, FORMS AND MANUALS. 1. Circular letter to physicians during epidemics. For the medical profession. 3. Model ordinance for the better preservation of the public health in cities and 4. Return of a birth. 5. Return of a death. For boards of health. For boards of health. 6. Return of a still-birth. For boards of health. 7. Return of a communicable disease. For boards of health. 8. Disinterment permit. For boards of health. 9. Transit permit for dead bodies. For boards of health. 10. Notification of contagious diseases. For secretaries of boards of health. 11. Supplement to the model ordinance for mayors and boards of health. 12. Circular on the prevention of scarlet fever. and families. Second edition. For physician 13. Circular on the prevention of diphtheria. Second edition. For physicians and families. 14. Circular on the prevention of typhoid fever. Second edition. For physicians and families. 15. Circular on the prevention of contagious diseases. Second edition. For physicians and families. 16. Circular on quarantine and disinfection. For physicians. 17. Manual of camp hygiene. For medical officers of the National Guard. 18. Manual of school hygiene. For teachers. 19. Questions for the sanitary inspection of schools. For inspectors. 20. Notice of adulteration of food. 21. Notice of adulteration of drugs. 22. Notice of adulteration of candy. I. CIRCULAR LETTER TO PHYSICIANS DURING EPIDEMICS. FOR Dr.. THE MEDICAL PROFESSION. STATE BOARD OF HEALTH, EXECUTIVE OFFICE, Philadelphia, . 188. DEAR DOCTOR: The State Board of Health requests that you will keep a record of all cases under your care in connection with the and report to this office at the end of present epidemic at.. each week, giving name of patient, sex, age, when taken sick, water used, character of illness, result, and any other points that you may Whether all the cases are typhoid fever or not, the deem of interest. interests of the public health demand that their excreta should be treated as though they were. You will therefore give positive instructions to have all discharges disinfected on passing, and then buried. The sick must not be allowed to use the same outhouses as the well even during convalescence. All the privy vaults and cesspools in the neighborhood should be disinfected, emptied, and then disinfected again. The enclosed circular contains instructions for disinfection.I have the honor to be, Yours respectfully, Secretary and Executive Officer. II. TO THE MEDICAL PROFESSION. The Importance of Caution and Precision in the Diagnosis of Typhoid Fever. At the conclusion of a recent report of an inspection in a rural dis trict. of the prevalence of typhoid fever in which exaggerated rumors had been spread, causing much uneasiness, Prof. Wm. B. Atkinson, Medical Inspector of the Delaware District, makes some observations on the unfortunate results of hasty diagnosis in fever cases, which the Board considers of sufficient importance to warrant their distribution in connection with the circular on "Precautions Against Typhoid Fever," earnestly hoping that their perusal may lead to greater caution and precision in the use of this always alarming designation. They are substantially as follows: "In this connection, I would remark upon the ease with which a sensation is created from slight foundation. Unfortunately, members of our profession are not always as exact as they might be in their diagnosis or their nomenclature, and so every fever may be carelessly called typhoid, every sore throat diphtheria, and thus alarm is caused and an epidemic is created on paper. "Perhaps one difficulty is the apparent confusion as to the diagnosis of enteric (typhoid) fever. In many instances, at the outset of an illness, there may be a continuation of febrile symptoms for a few days, with looseness of the bowels; the name of this disease is suggested and the attendant carelessly allows himself to accept it, and when a little later the case rapidly convalesces, he is loath to be regarded as having made a wrong diagnosis. Thus another case of aborted typhoid is added to the list. Absence of epistaxis, of iliac tenderness, of tympanitis, of continued high temperature, of emaciation, of the peculiar eruption, all should cause the physician to hesitate as to pronouncing the case one of typhoid fever. Among the laity the use of the word typhoid indicating a low condition, as typhoid pneumonia for example, is regarded as meaning a kind of typhoid fever. I have not seldom found this error to prevail in the profession as well, and thus is propagated an additional means by which the public is falsely led to believe that typhoid fever is epidemic in certain localities. Recently I have encountered a number of such instances, and more than once, through the medium of the press, it has been heralded to the public that an epidemic of this fever is prevailing, thus causing a feeling of alarm which is extremely liable to work injury to business, and also to the health of people of a nervous temperament. I would, for these reasons, most earnestly urge that your Board should take some steps to bring this matter to the notice of the profession, in order that its members may no longer act as alarmists, and at the same time bring discredit upon our general knowledge. (As long as the diagnosis is in suspense, however, all the precautions suggested by the Board as essential in the care of typhoid cases should be observed) "We may view this matter as even of greater importance when we reflect upon the fact that another and still more alarming disease is at our doors. Should it gain an entrance, with similar want of diagnostic skill or care, every case of cholera morbus would then be termed cholera and the direst results would be sure to follow." In connection with the subject of typhoid fever, the attention of both physicians and the public in rural districts is solicited to the following description of a Cheap and Convenient Earth Closet, principally copied from the Chicago Sanitary News, and from the pen of Mr. J. C. Bayles, a well-known sanitarian: When water-closets cannot be made available, the earth-closet will be found of the greatest convenience and benefit. In addition to the well known dangers attending the neglected accumulations in privy vaults, few things are more destructive to health and comfort. than dependence upon one of these dreadful out-buildings. A visit to one of them involves an amount of exposure in cold weather which even strong men have reason to dread. In the case of women, children and invalids, what can be worse than a plunge out of doors in cold or stormy weather, usually without the precaution of extra clothing or overshoes, for a visit to the foul shrine of Cloacina? The neglect of regular attention to the calls of nature which the dread of this exposure induces, tends to encourge women and children in disregarding them as long as possible, until the evils inevitably attendant upon the habit of constipation, much too prevalent in this country, are induced and confirmed. The head of a family who makes no better provision than an out door privy for the needs of his household neglects the most obvious as well as the most selfish of his sanitary duties. The accompanying sketch requires but brief explanation: "The body is a plain pine box. Its sides are not over 14 inches high; its depth is 18 inches (measuring from front to back), and its length about 30 inches. It is divided into two compartments, one 18x18 inches, and the other 18x12 inches. The larger of these com partments has no bottom; the smaller has a tight bottom. On top are two covers. The lower cover, hinged to the upper edge of the back, extends all the way across both compartments. In this is cut the seat, over the center of the larger compartment. The upper cover is hinged to the lower one, and may be raised independently. * *NOTE.-The hole in the seat should be long from front to back, but narrow from side to side, never made circular with a pair of dividers, as a country carpenter will invariably make it, unless otherinstructed. The proper dimensions are 11x4 inches. The edges should be moderately beveled. This shape will make the act of relief much easier and tend greatly to prevent that painful disease hemorrhoids. |