Sec. 3. Whenever any person shall die within the limits of the city it shall be the duty of the physician attending such person during his or her last sickness to fill out and deliver to the undertaker, or other person superintending the burial oi said deceased person, a certificate, duly signed, setting forth, as far as the same may be accertained, the name, age, color, sex, nativity, occupation, whether married or single, duration of residence in the city, cause, date, and place of death of such deceased person; and it shall be the duty of the undertaker, or other person in charge of the burial of such deceased person, to add to said certificate the date and place of burial, and, having duly signed the same, to forward it to the registrar aforesaid and obtain a permit for burial; and in case of death from any contagious or infectious disease suid certificate shall be so made and forwarded immediately.

SEC. 4. No interment or disinterment of the dead body of any human being, or disposition thereof in any tomh, vault, or cemetery, shall be made within the city without a permit therefor, granted as provided by the laws of the State, nor otherwise than in accordance with such permit: Provided, That in case hurials are to be made in other cemeteries than those under the control of the commissioners for Blossom Hill and Old North cemeteries such permits may be issued by the clerks of the several committees whenever, in their opinion, the circumstances of the case demand their action. No undertaker or other person shall assist in, assent to, or allow any such interment or disinterment to be made until such permit has been given as aforesaid; and it shall be the duty of every undertaker or other person having charge of any burial place as aforesaid, who shall receive such permit, to preserve and return the same to the registrar, or to the clerk of the town from which it was issued, within six days following the day of burial. No undertaker or other person shall bury, or cause to be buried, the body of any deceased person within the limits of the city, except in such grounds as are now known to be used as burial grounds or such as shall be hereafter by law designated and authorized to be used as such, unless by a permit of the board of health.

SEC. 5. No dead body or part of the dead body of any human being from without the limits of the city shall be received into or allowed to be buried in any cemetery or other place of interment in said city, unless the person in charge, or undertaker, shall have first obtained a permit, as provided by the laws of the State of New Hampshire.

Sec. 6. Whenever a permit for burial is applied for, in the case of death without the attendance of a physician, or it is impossible to obtain a physician's certificate, it shall be the duty of the city physician to investigate the case, and make and sigh a certificate of the probable cause of death.

Sec. 7. The registrar shall receive, in addition to the fees allowed by law, such sum for his service as the board of aldermen may from time to time determine.

Sec. 8. There shall be appointed by the mayor a suitable number of funeral under. takers, who shall be responsible for the faithful and orderly management of all funerals undertaken by them. They may appoint or recommend assistants (for whose conduct they shall be responsible). Funeral undertakers appointed in January, 1911, shall hold office during the terms for which they were appointed, unless sooner removed by the mayor

Sec. 9. Any person violating any of the provisions of this chapter shall be fined not less than $1 nor more than $10.

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By JOSEPH W. SCHERESCHEWSKY, Surgeon, United States Public Health Service.

The extent to which trachoma is present among school children is a fair index of the incidence of the disease in the general population, and doubtless some valuable indications of probable results of a house-to-house inspection might have been obtained by an examination of the pupils in the public schools. The public schools not being in session at the time the examination was made, the investigation had to be limited to such institutions in and around Knoxville as contain inmates the entire year.

Institutions examined.-- Three such institutions were available for examination, viz, the Knox County Poor Farm, the Knox County Industrial School, and the Episcopal Orphanage.

Knor County Poor Farm.-- This institution is situated about 10 miles outside of Knoxville. Through the courtesy of Mr. Ogden, of that city, the writer was enabled to visit the farm and examine 60 of the inmates, of whom 17, or about 28 per cent, were found to be suffering from trachoma. In many instances the disease was severe in type and somegave histories of having been affected from childhood.

It is interesting to note that one inmate, presenting the disease in such severe form as to render the supposition likely that his presence on the poor farm was due to loss of efficiency through the disease, stated that he had suffered from “sore eyes” all his life and came from Lee County, Va. The remainder of the trachomatous inmates stated, with one or two exceptions, that they came from Knox


Knor County Industrial School. This institution was also visited. It is pleasantly and healthfully situated upon a hili about 14 miles out of Knoxville. The prevalence of trachoma on the Knox County Poor Farm rendered it likely that the disease would be found among



the pupils at the industrial school, but hardly to the extent which the following figures indicate.

Out of 139 white pupils examined 66, or about 47.5 per cent, were found infected with trachoma--a serious condition of affairs. Of 3 these 66 cases, 31 were severe and 35 were mild. One boy had already become practically blind as a result of the disease. Twentynine colored pupils were examined, of whom 3, or 10 per cent, were suffering from trachoma. This is interesting, in view of the impression which has erroneously prevailed that the negro race is immune to trachoma. It should be stated that the cases of trachoma found among the colored students were in full-blood negroes. The writer's personal opinion is that the negro is probably less susceptible than the white man to trachoma, but that, when once the disease is contracted, its course is practically the same in both races.

Episcopal Orphanage. This institution was examined at the request of one of the directors. Thirty-five children were examined, and only one case of trachoma was found. This was of a mild type. The sanitary conditions at this institution were good and the medical supervision was competent.

The incidence of trachoma at this institution--namely, about 3 per cent-is probably nearer the actual rate of prevalence among

the general population of Knox County than the very high percentages found at the Knox County Industrial School and at the poor farm.

In justice to the authorities of these institutions it should be stated that they were unaware of the conditions shown by the investigation. The matter was brought immediately to the attention of the board of directors, and it is thought that prompt steps will be taken to combat the disease.

The following recommendations were made:
1. Screening of all doors and windows.
2. Separate beds for each individual.
3. Individual towels.
4. Segregation of trachomatous pupils.

5. The use of only shower baths for bathing purposes and of only running water for hand and face washing.

6. Competent medical treatment for the trachomatous.
7. Medical examination of future pupils upori admission.



BF VICTOR G. HEISER, Surgeon, United States Public Health Service, Chief Quarantine Officer and

Director of Health for the Philippine Islands.

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Two patients who had been confined to the San Lazaro Leper Hospital on account of leprosy have been pronounced apparently cured and discharged from that institution on probation.

The first case was that of a male Filipino, aged 27, who was admitted to the San Lazaro Leper Hospital, Manila, May 29, 1909. On admission the case clinically showed thickened reddish spots on the nose and thickening and discoloration of the lobe of the right ear. Scrapings made from the lesions showed lepra bacilli. He received vaccine treatment at intervals, beginning August, 1909, but at the expiration of one year no change was noted in his condition. From September, 1910, to November, 1910, crude chaulmugra oil was given by mouth in increasing doses. On account of nausea the administration of the oil by mouth had to be discontinued.

The case showed evidences of improvement. On November 10, 1910, chaulmugra oil combined with oil of camphor and resorcin was giren hypodermically. By May 6, 1911, the lesions above described had disappeared and leprosy bacilli were not found in repeated microscopical examinations. The hypodermic treatment was continued and microscopical examinations were made at frequent intervals, but these were always negative. On June 11, 1913, a most careful clinical and microscopical examination was made of the patient, which resulted negatively for leprosy, and as the patient had now been apparently cured for a period of over two years he was discharged on probation.

The other case was that of a Filipino woman, aged 22, who was admitted to San Lazaro Leper Hospital, Manila, January 7, 1910. Clinically this patient presented a suffused countenance due to generalized infiltration. There were red macules over the cheeks, forehead, and chin. Scrapings made from the lesions and examined microscopically were positive for leprosy bacilli.

['pon admission this patient was placed upon the vaccine treatment for a period of five months, but at the end of the first month after her admission crude chaulmugra oil by mouth was given in addition to the vaccine.

After the second month the patient began to improve rapidly, and on May 6, 1911, leprosy bacilli could not be found on microscopical etamination. During May, 1911, on account of the nausea caused by the oil its use by mouth had to be discontinued. Hypodermic injection of chaulmugra oil combined with camphor and resorcin was then begun. This treatment was continued, and frequent microscopical examinations were made from time to time, all of which resulted negatively. The last examination, both clinical and micro scopical, was made on June 11, 1913, when no further evidences of leprosy could be found. The patient was therefore discharged from the hospital on probation.

It is not known whether the vaccine treatment had any influence in the cures. There are at the present time.& number of other cases at the San Lazaro Leper Hospital that have been negative for a period of 22 months, which, upon admission, presented more marked evidences of leprosy than the cases mentioned above, yet they received only chaulmugra oil either by mouth or hypodermically, i or in both ways.



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