Natural-gas poisoning.

Phosphorus poisoning.

Wood-alcohol poisoning.

Naphtha poisoning.

Bisulphide of carbon poisoning.

Dinitrobenzine poisoning.

Caisson disease (compressed-air illness).

Any other disease or disability contracted as a result of the nature of the person's employment.

Gonoccoccus infection.

Syphilis.

Pellagra.

Cancer.

GROUP III. Venereal diseases.

GROUP IV. Diseases of unknown origin.

Provided, That the State department of health (or board of health) may from time to time, in its discretion, declare additional diseases notifiable and subject to the provisions of this act.

SEC. 3. Each and every physician practicing in the State of

who treats or

examines any person suffering from or afflicted with, or suspected to be suffering from or afflicted with, any one of the notifiable diseases shall immediately report such case of notifiable disease in writing to the local health authority having jurisdiction. Said report shall be forwarded either by mail or by special messenger and shall give the following information:

1. The date when the report is made.

2. The name of the disease or suspected disease.

3. The name, age, sex, color, occupation, address, and school attended or place of employment of patient.

4. Number of adults and of children in the household.

5. Source or probable source of infection or the origin or probable origin of the disease.

6. Name and address of the reporting physician.

Provided, That if the disease is, or is suspected to be, smallpox, the report shall, in addition, show whether the disease is of the mild or virulent type and whether the patient has ever been successfully vaccinated, and, if the patient has been successfully vaccinated, the number of times and dates or approximate dates of such vaccination; and if the disease is, or is suspected to be, cholera, diphtheria, plague, scarlet fever, smallpox, or yellow fever, the physician shall, in addition to the written report, give immediate notice of the case to the local health authority in the most expeditious manner available; and if the disease is, or is suspected to be, typhoid fever, scarlet fever, diphtheria, or septic sore throat, the report shall also show whether the patient has been, or any member of the household in which the patient resides, is engaged or employed in the handling of milk for sale or preliminary to sale: And provided further, That in the reports of cases of the venereal diseases the name and address of the patient need not be given.

SEC. 4. The requirements of the preceding section shall be applicable to physicians attending patients ill with any of the notifiable diseases in hospitals, asylums, or other institutions, public or private: Provided, That the superintendent or other person in charge of any such hospital, asylum, or other institution in which the sick are cared for may, with the written consent of the local health officer (or board of health) having jurisdiction, report in the place of the attending physician or physicians the cases of notifiable diseases and disabilities occurring in or admitted to said hospital, asylum, or other institution in the same manner as that prescribed for physicians.

SEC. 5. Whenever a person is known, or is suspected, to be afflicted with a notifiable disease, or whenever the eyes of an infant under two weeks of age become reddened, inflamed, or swollen, or contain an unnatural discharge, and no physician is in attendance, an immediate report of the existence of the case shall be made to the local health officer by the midwife, nurse, attendant, or other person in charge of the patient.

SEC. 6. Teachers or other persons employed in, or in charge of, public or private schools, including Sunday schools, shall report immediately to the local health officer each and every known or suspected case of a notifiable disease in persons attending or employed in their respective schools.

SEC. 7. The written reports of cases of the notifiable disease required by this act of physicians shall be made upon blanks supplied for the purpose, through the local health authorities, by the State department of health. These blanks shall conform

to that adopted and approved by the State and Territorial health authorities in conference with the United States Public Health Service.

SEC. 8. Local health officers or boards of health shall within seven days after the receipt by them of reports of cases of the notifiable diseases forward by mail to the State department of health the original written reports made by physicians, after first having transcribed the information given in the respective reports in a book or other form of record for the permanent files of the local health office. On each report thus forwarded the local health officer shall state whether the case to which the report pertains was visited or otherwise investigated by a representative of the local health office and whether measures were taken to prevent the spread of the disease or the occurrence of additional cases.

SEC. 9. Local health officers or boards of health shall, in addition to the provisions of section 8, report to the State department of health in such manner and at such times as the State department of health may require by regulation the number of new cases of each of the notifiable diseases reported to said local health officers or boards of health.

SEC. 10. Whenever there occurs within the jurisdiction of a local health officer or board of health an epidemic of a notifiable disease, the local health officer or board of health shall, within 30 days after the epidemic shall have subsided, make a report to the State department of health of the number of cases occurring in the epidemic, the number of cases terminating fatally, the origin of the epidemic, and the means by which the disease was spread: Provided, That whenever the State department of health has taken charge of the control and suppression or undertaken the investigation of the epidemic, the local health authority having jurisdiction need not make the report otherwise required.

SEC. 11. No person shall be appointed to the position of local health officer in any city, town, or county until after the qualifications of said person have been approved by the State department of health.

SEC. 12. In localities in which there are no local health officers or boards of health and in localities in which, although there are health officers or boards of health, adequate provision has not, in the opinion of the State department of health, been made for the proper notification, investigation, and control of notifiable disease, and in localities in which the local health authorities fail to carry out the provisions of this act, the State department of health shall appoint properly qualified sanitary officers to act as local health officers and to prevent the spread of disease in and from such localities and to enforce the provisions of this act: Provided, That salaries and other expenses incurred under the provisions of this section shall be paid by the local authorities.

not less than

SEC. 13. Any physician or other person or persons who shall fail, neglect, or refuse to comply with, or who shall violate any of the provisions of this act, shall be guilty of a misdemeanor, and upon conviction thereof shall be sentenced to pay a fine of dollars nor more than dollars or to imprisonment for not days nor more than days for each offense: Provided, That in the case of a physician his license to practice medicine within the State may be revoked in accordance with existing statutory provisions.

less than

SEC. 14. No license to practice medicine shall be issued to any person until after the applicant shall have filed with the State licensing board a statement, signed and sworn to before a notary or other officer qualified to administer oaths, that said applicant has familiarized himself with the requirements of this act, a copy of which sworn statement shall be forwarded to the State department of health.

SEC. 15. Each and every person engaged in the practice of medicine shall display in a prominent place in his or her office a card upon which sections 2, 3, 4, 7, 13, 14, and 15 of this act have been printed with type not smaller than 10-point. A similar card shall be displayed in a prominent place in the office of each and every hospital, asylum, or other public or private institution for the treatment of the sick. These cards shall each be not less than 1 square foot in size and shall be furnished to institutions and licensed physicians without cost by the State department of health. SEC. 16. The sum of dollars is hereby appropriated from any money in the State treasury not otherwise appropriated for carrying out the provisions of this act. SEC. 17. This act shall take effect immediately and all acts or parts of acts inconsistent with the provisions of this act are hereby repealed.

The following model notification blank for cases of sickness was also adopted by the conference and is the one referred to in section 7 of preceding model law. This blank is intended to be printed on a post card.

If typhoid fever, scarlet fever, diphtheria, or septic sore throat, was patient, or is any member of household engaged in the production or handling of milk.. Address of reporting physician..

Signature of physician.

The significance of the resolution and of the model State law for morbidity reports adopted by the official conference of United States health authorities is readily appreciated when it is understood that the accomplishment of effective public-health work depends largely upon the use of information obtained from the notification of cases of the preventable diseases; that adequate notification shows the occurrence, prevalence, and geographic distribution of these diseases; and that without this knowledge attempts at their control are to varying degrees ineffective and the proper protection of the health of the community is impossible.

Originally the duties of the health officer were very simple, and related only to the control of certain diseases associated with popular dread. As knowledge, however, of the causes of diseases and their means of spread has been acquired, the responsibilities of the health

department have rapidly increased, so that at the present time the health department is properly the guardian of the community's health in so far as health can be conserved by the prevention or control of disease.

Only those diseases may be properly classed as preventable or controllable of which something is known of the cause or means of spread. Given this knowledge, the first and essential step in their prevention or control is the securing of information of the occurrence and location of the factors that produce disease and of the foci from which disease may spread. Of the communicable diseases a knowledge of the existence and location of cases is necessary, as each such case constitutes a focus from which the disease may spread. Of the diseases that are preventable but not communicable a knowledge of the occurrence of cases and of the conditions under which they are occurring is necessary, as it shows the existence of the conditions which produce these diseases. This knowledge can be obtained only when the occurrence of cases is made known to some authority that is, when cases are reported. Any attempt at the prevention of disease will be at best incomplete and in large measure a makeshift unless it is based upon a knowledge of the occurrence and prevalence of disease.

The health department in a community is able to control disease in proportion to the completeness and exactness of its knowledge of the occurrence of cases. With full information of existing cases it can work effectively; it can direct its efforts at prophylaxis against the disease itself; it can work in the light of knowledge of the situation. Without such information its attempts at control must be of a general nature, sometimes effective, more often not, for it is working in the darkness of ignorance of the location and prevalence of that which it is attempting to control. If cases are not reported there may be hundreds of cases of typhoid fever, or infantile paralysis, or scarlet fever, or smallpox in a locality, and the health officer not be aware that there are any present.

Tuberculosis is a communicable disease. With the exception of the relatively small proportion of cases contracted through milk from diseased cows each case is contracted directly or indirectly from some preexisting human case. To control this disease effectively, it is necessary that each case be known to the health department, so that it may ascertain that the patient is not unnecessarily exposing others to infection. Tuberculosis is usually chronic in nature, and those affected frequently remain, for months and sometimes years, foci from which the infection may spread to others. To control this disease the health department should make sure that the patients understand how to so conduct themselves that others may not be infected, and that those associated with the sick know the manner in which the disease is spread and how to protect themselves from it. Then, too, the health department should know of those suffering from tuberculosis, as those so affected, for the protection of the community, should not engage in certain occupations in which they would be especially apt to spread the disease.

Typhoid fever is another disease in which the health department should be informed of the occurrence of each case. Every case of typhoid fever has potential possibilities for harm to the community through the contamination of water, milk, or other food supply.

knowledge of all cases is necessary for the protection of others, for each case is a focus from which, under suitable conditions, an outbreak may arise. When there are a number of cases of this disease, there are usually some one or more sources from which it is being spread, and it is only when cases are reported that the health department can ascertain their relationship to each other or their common source of infection when such exists. It is only through the notification of cases that outbreaks due to infected milk or the infection of a common water supply can be recognized and proper remedies applied or that typhoid-bacillus carriers can be traced and controlled.

Scarlet fever is another common disease in which the need for the notification of cases is universally understood. Every case of this disease comes from some preexisting case. No community would expect and no health department would attempt to control this disease in the absence of the notification of the cases that were occurring. The same is true of plague, yellow fever, and cholera. There are many other diseases, however, in which the importance of the reporting of cases has not been generally appreciated, but in which the necessity is just as great if they are to be prevented. The necessity for notification exists in all preventable diseases. Their causes or methods of spread may be different and the measures necessary to prevent them may vary, but the notification of the occurrence of cases is essential in all for their successful control. The health department can not prevent the spread of disease of the existence of which in the community it is unaware.

For purposes of public-health administration cases of the communicable diseases may be divided into four groups, namely: First, the well-marked cases; second, the mild, concealed cases; third, the mild, unrecognized cases; and, fourth, the well, or apparently well, carriers. To prevent the spread of these diseases control of all four groups is necessary. The control of only the first group by quarantine or other means, a practice by no means uncommon, is of little value in preventing the spread of these diseases, as the well-marked cases usually come less in contact with others than do the cases of the other groups, and are likely, therefore, to be less potent factors in spreading infection. The well-marked cases are presumably usually reported. The mild cases should also be reported. The notification of the cases in the first two groups should enable a well organized health department to discover most of those in the other two by a careful study of the conditions under which the reported cases occur. To find the unrecognized cases and carriers is a prime duty of the health officer. The accomplishment of this requires intelligence and watchfulness and will be possible in proportion to the completeness with which the recognized cases are reported.

But the health department of a city, township, or county needs to know not only of the occurrence and prevalence of disease in its own jurisdiction, but also of the prevalence of disease in neighboring cities, towns, and counties, so that it may be informed of the possibility of the introduction of disease from other communities. The prevalence of infectious diseases in every city and county has an important bearing on the welfare of every other city and county in a State. a well-organized State, therefore, the local health authorities keep the State health department currently informed of the prevalence of

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