OFFICIAL ORDER

CONCERNING THE PREVENTION OF SMALL-POX.

THE following is the revised text of the Official Order of the ILLINOIS STATE BOARD OF HEALTH, Concerning the Prevention of Small-Pox, re-enacted January 1, 1882. The fifth edition, published in May, 1882, was thus prefaced:

ILLINOIS STATE BOARD OF HEALTH,

OFFICE OF THE SECRETARY, SPRINGFIELD, ILL., May, 1882.

WHILE small-pox is diminishing in the State at large, there still occur outbreaks of the disease wherever the infection finds a community, or family, or individuals, not protected by recent vaccination.

Such persons are generally (but not entirely) found now only in the country or small settlements, where it has been difficult, during the past winter, to procure virus, or the services of a vaccinating physician; or where there has been a prejudice against vaccinating until warmer weather.

These difficulties and objections no longer exist. Virus is plentiful; the great demand upon physicians has largely subsided; the weather is mild and favorable, so that there is little or no danger of complications from rigorous or changeable temperature; and there is now no reasonable excuse for neglecting this simple and only efficient safeguard.

Notwithstanding the proposed sanitary inspection of immigrantsby which it is hoped to check the further importation of the diseasethere is no certainty that any given group of these people, now arriving in thousands every day, may not carry the infection into any township or locality, no matter how remote or secluded, and there cause an outbreak which will be limited only by the number of unprotected subjects who may be exposed.

I. In view of these facts it is the duty of those charged by law with the care of the public health-

First, and most importantly, to secure at once such a condition of every individual, child and adult, as will make him or her safe, even if exposed to the contagion. This can be certainly, readily and inexpensively done by enforcing proper vaccination or revaccination, as the case may be.

Secondly, to be vigilant against the introduction of the disease from without-as for example, by a watchful supervision of hotels, lodging-houses and other resorts of travelers, and especial scrutiny

of immigrants and new settlers. Although this is of incidental importance if the first injunction be obeyed, cases may occur where a non-intercourse quarantine might be justifiably enforced-as where a notoriously infected locality is lax in its protective measures, or allows its small-pox patients to wander off to other places.

Finally, it is the duty of all health authorities to be prompt and vigorous in enforcing such well-advised measures in the care of those who may, unfortunately, become afflicted (and of their families and households) as will prevent any spread of the disease. Under no circumstances must such cases be allowed to go at large, or be sent away to escape the cost and care of their proper treatment. They must at once be rigidly isolated, if necessary at the expense of the town, city or county; or, if transferred by arrangement to a neighboring small-pox hospital, the transfer must be effected in such a manner as to avoid the risk of spreading the contagion in transit.

II. In furtherance of these ends the appended Rules and Regulations of this BOARD-orginally promulgated in March, 1881,-are again published, with the knowledge that wherever they have been thoroughly carried out, small-pox has either been averted where it threatened, or readily controlled where it had already appeared. A sanitary necessity still exists, and the BOARD is compelled, in the interest of the public health, to use the power conferred upon it by law to meet such necessity.

This order is issued in conformity with the statute, which charges the STATE BOARD with authority in all matters pertaining to quarantine, and with the duty of making all necessary rules and regulations for the preservation or improvement of the public health; and such rules and regulations have, therefore, the weight and authority of law. By the same statute their enforcement is made binding upon all health authorities in the State. Such authorities embrace1. Regularly constituted Boards of Health of incorporated cities, towns and villages.

2. Supervisors, assessors and town clerks of townships; and

3. County commissioners of counties in which there are no township organizations.

The officers designated in the second and third classes 'constitute, ex-officio, the Boards of Health, for their respective territories, in the absence of any other provision therefor.*

*In this connection attention is again called to the following Order of the STATE BOARD, made at its regular meeting, September 30, 1881.

Under the authority conferred upon the STATE BOARD OF HEALT by section 2 of the State Board of Health Act, it is ordered that, on and after January 1. 1882, the first cases of small-pox occuring in any county, township, town or city in this State, as also the prevalence and progress of any epidemic, shall be promptly reported to the BOARD by the local health authorities; it being borne in mind that in counties where township organization exists, the township board is the Board of Health, and in counties not under township organization, the county commissioners act in like capacity.

Reports of first cases must be made immediately upon discovery; and of the progress of the disease from time to time, at least weekly. Forward all reports to the Secretary. State Board of Health, Springfield, Illinois.

All and singular of these are hereby charged with the enforcement of the ORDER and its appended rules. Small-pox can be either totally excluded from any given community, or confined to the first cases by so doing. If it spread beyond the first cases, it is because of criminal neglect of these precautious, for which neglect those who are responsible should be held accountable by their constituents.

This assertion may be qualified in its application to large cities or other distributing points for newly-arriving immigrants. But even in such, with a proper system of rail and river inspection and vaccination of the unprotected, small-pox may always be held in control, as has been signally demonstrated in the city of Chicago, where, since the inauguration of the Immigrant-Inspection Service, the disease has practically disappeared, nothwithstanding the enormous influx of immigrants and great number of the transient population. The sanitary administration of the city in this respect bas been most efficient and successful.]

All needed power and authority for the enforcement of these rules are provided by the law, and should be unhesitatingly em- . ployed whenever, necessary. Police officers, sheriffs, constables, and all other officers and employés of the State are specifically enjoined. by the statute to aid in the enforcement of such rules and regulations.

III. In this enforcement, if a question should arise as between private rights or interests and the interests of the health of the community, the public interest must be held paramount. Therefore, to the question, which is often asked of this BOARD, as to the right of recompense for losses incurred by the destruction of infected clothing or other effects, a negative answer must be returned. No. individual has the right to preserve contagion or infection about his premises, whereby the public health may be endangered. If the destruction of the infected material be necessary in order to destroy the contagion or infection, the loss must be borne by the owner; it cannot be recovered from the community.

As to the policy and expediency of reimbursing such losses, that is a question for the consideration of the proper authorities-town, city or county; and cases might arise in which relief would properly be afforded-as, for example, where such destruction would entail great hardship upon an indigent person.

Should the property of an innocent owner become infected through the preservation of known infected material which it was the duty of the health authorities to cause to be destroyed-the value of such property, if destroyed, to protect the public health, may be recovered under the constitutional provision that private property shall not be taken for public use or benefit without just compensation. This, however, applies only to the property of persons who are not in any wise responsible for the contagion, and who have taken reasonable. precautions to prevent or avoid it.

IV. It is competent for local boards of health, as above defined, to incur expense for the vaccination of those who are unable to pay for the same; and they may, also, make such other expenditures, as, in the exercise of a sound discretion, may seem prudent and necessary either to effect a cure or to prevent the spread of any

epidemic, contagious or infectious disease-as, for example, by establishing a small-pox hospital, employing a small-pox physician, etc. Expenses so incurred should be paid out of the general fund of the body (town, city or county,) incurring the same.

Concert of action between neighboring towns or communities, whose sanitary interests are often identical, is strongly enjoined upon the health authorities. Friction, clashing of authority and unnecessary expense may thus be avoided. Where there is no medical man upon a board of health, the advice and coöperation of the county medical officer should be secured; or, if this be impracticable, a competent and legally-qualified physician should be employed. If a district or locality become seriously infected, better work will be secured, with less danger of the contagion being spread, if such district or locality be put in charge of one medical officer, instead of allowing several physicians to visit individual patients or families. Such officer should be selected with an eye not only to his medical skill and experience, but also to his knowledge and ability as a sanitary executive.

Local boards and authorities are strongly advised against the policy of concealment. Small-pox cannot be suppressed by denying its existence. It will out, more certainly than murder. Official reticence in this is not only useless to protect commercial interests and reputation, but is in the highest degree mischievous, in that it begets false confidence, which may lead the innocent and unwary into such danger as an honest announcement of the facts would have warned them to avoid. Insist upon prompt publicity in every instance.

The following rules are believed to cover every important detail, and are part and parcel of this ORDER, to be strictly enforced in appropriate cases. A copy should be left in every house where there is a case of small-pox, and their republication in the local papers, or otherwise, is recommended. By this means a more ready obedience and intelligent coöperation will be secured, of the first importance in the present emergency.

No disease can be so surely prevented or controlled as small-pox. Its existence in a community argues unjustifiable prejudice, carelessness or ignorance, for neither of which is there any excuse. By order of the BOARD:

JOHN H. RAUCH, M. D., Secretary.